Correction to: Is racism a barrier to HIV care continuum engagement among Black People in the United States? A scoping review to assess the state of the science and inform a research agenda.

Promotion of Research on the HIV Continuum of Care in the United States: The CFAR HIV Continuum of Care/ECHPP Working Group.

Malignant transformation of the prostate and progression of carcinoma appear to be the consequence of a complex series of initiation and promotional events under genetic and environmental influences. Increased incidence of the condition may be the result of improved detection, greater awareness of the condition, and possibly an increased life expectancy accompanied by a decrease in competing causes of death rather than a true increase in the prevalence of the disease. The marked racial and geographic differences are probably multifactorial, with genetic, environmental, and possibly social influences affecting progression of the disease. Among several risk factors, evidence for the familial inheritance of some prostate cancers is compelling. Dietary influences, hormonal milieu, and the role of environmental carcinogens are currently under intense investigation. As further risk factors are identified, it will become increasingly important to identify individuals at increased risk for the disease. These men should undergo regular evaluation with state-of-the-art methods.

212 Background: In the general population, black men have higher bone mineral density (BMD) and lower fracture rates than white men. Whether race influences bone loss and fracture risk during androgen deprivation therapy (ADT) for prostate cancer is unknown. Using data from a recently completed prospective, randomized, clinical trial we compared BMD and fracture rates of black and white men receiving ADT for prostate cancer. Methods: Subjects in these analyses (n=516) were members of the placebo group of a two-year randomized controlled trial of toremifene to prevent fractures in men receiving ADT for prostate cancer. All subjects resided in United States and reported their race as either black (n=68) or white (n=448). We compared baseline characteristics, including BMD and prevalent vertebral fractures, between black (n=68) and white men (n=448). We also compared changes in BMD and rates of new vertebral fractures over the two year study period. Results: Black men had higher baseline hip BMD than white men (0.98 ± 0.15 g/m2 and 0.91 ± 0.15 g/m2, respectively; p=0.001). Black men had similar BMD of the spine (1.09 ± 0.22 g/m2 and 1.11 ± 0.22 g/m2 in black and white men, respectively; p=0.51), but fewer prevalent vertebral fractures (7.4% versus 15.0%; p=0.13). Changes in BMD from baseline to 24 months were similar between black and white men (total hip percentage change −2.54 ± 0.26 in white men and −2.09 ± 0.60 in black men; p=0.55; lumbar spine percentage change −1.30 ± 0.33 in white men and −1.67 ± 0.71 in black men; p<0.71). Rates of new vertebral fractures trended towards being lower in black men (1.15% of black men versus 4.83% of white men; relative risk 0.24; p<0.12). Conclusions: Among men receiving ADT for prostate cancer, black men had higher baseline BMD at the hip and fewer prevalent vertebral fractures. Changes in BMD during ongoing ADT were similar for black and white men. Consistent with lower baseline risk for fracture, however, black men had fewer new vertebral fractures than white men. [Table: see text]

Ethical Considerations Regarding the Use of Race in Pulmonary Function Testing

Purpose: Racism is an essential factor to understand racial health disparities in infection and mortality due to COVID-19 and must be thoroughly integrated into any successful public health response. But highlighting the effect of racism generally does not go far enough toward understanding racial/ethnic health disparities or advocating for change; we must interrogate the various forms of racism in the United States, including behaviors and practices that are not recognized by many as racism.Methods: In this article, we explore the prevalence and demographic distribution of various forms of racism in the United States and how these diverse racial ideologies are potentially associated with racialized responses to the COVID-19 crisis.Results: We find that among white Americans, more than a quarter express traditional racist attitudes, whereas more than half endorse more contemporary and implicit forms of racist ideology. Each of these types of racism helps us explain profound disparities related to COVID-19.Conclusions: Despite a robust literature documenting persistent patterns of racial disparities in the United States, a focus on the role that various forms of racism play in perpetuating these disparities is absent. These distinctions are essential to realizing health equity and countering disparities in COVID-19 and other health outcomes among people of color in the United States.

This study examines the experience of non-Hispanic Black Americans (hereinafter referred to as Black persons) and non-Hispanic White Americans (hereinafter referred to as White persons) with regard to the incidence (i.e., number of persons diagnosed with HIV), prevalence (i.e., number of persons living with HIV), and mortality rates of persons with HIV in the United States in 2019. With regard to mortality rates, this study examines the mortality rate of all Black persons and White persons with HIV in 2019 as well as the mortality rate of hospitalized Black persons and White persons with HIV in 2019. Data on the racial characteristics of all persons in the United States in 2019 were obtained from the United States Census Bureau, and data on the racial characteristics of all persons with HIV in the United States were obtained from HIV Surveillance Reports produced by the Centers for Disease Control and Prevention (CDC). In addition, data on all hospital patients in seven states (California, Florida, Michigan, New Jersey, New York, South Carolina and Wisconsin) in 2019 were obtained from the Agency for Healthcare Research and Quality (AHRQ) Hospital Cost and Utilization Project (HCUP) State Inpatient Database (SID). These seven states included 44 percent of all persons living with HIV in the United States in 2019. This study found that Black persons were more likely to be diagnosed with HIV, live with HIV, and die with HIV than White persons in the United States. This is illustrated by the fact that in 2019 Black persons comprised 13.4 percent of the population, yet they comprised 42.1 percent of persons diagnosed with HIV, 40.4 percent of persons living with HIV, and 42.9 percent of persons who died with HIV. By comparison, in 2019 White persons comprised 76.3 percent of the population, yet they comprised 24.8 percent of persons diagnosed with HIV, 29.1 percent of persons living with HIV, and 31.8 percent of persons who died with HIV. Nevertheless, this study did not find a statistically significant difference between the in-hospital mortality rates of Black and White persons in seven states in 2019. The burden of HIV was considerably greater on Black persons than White persons in the United States in 2019.

2020 Rise to the challenge

Background Disparities in chronic systemic inflammation among black and white women and men are well documented. However, while chronic stress domains such as discrimination and financial strain, as well as socioeconomic factors such as education, have all been linked to inflammation, more research is needed to clarify how these social determinants influence each other and contribute to inflammation. Guided by the Stress Process Model and Intersectionality, this present study assessed the mediating role of both discrimination and financial strain in the relationship between race-gender groups and inflammation (measured as elevated CRP levels). This research also examined if the potential indirect effects of discrimination and financial strain were contingent on the educational level of black and white men and women with the United States. Methods This secondary analysis focused on an analytic sample (ages 25–74) of black and white men and women (n=775) from the Midlife in the United States (MIDUS) Biomarkers Project (2004–2009). SPSS version 24 and PROCESS macro were used to test all mediation and moderated mediation analyses. Results Separate mediation analyses revealed that after adjusting for age and when compared to the reference category (white men), both financial strain and daily discrimination mediated the relationship between race-gender (black men, black women, and white women) and inflammation (CRP levels). That is, self-identifying as a black man, white woman, or black woman positively influenced perceptions of both everyday discrimination and financial strain, which in turn contributed to increased levels of CRP. However, when both mediators were included in the mediation model, discrimination was only significant among black men. Results of the first moderated mediation analysis indicated that the indirect effect among black men on inflammation through discrimination was significantly stronger for black men educated beyond high school. Findings from the second moderated mediation analysis findings suggested that education significantly moderated the indirect effect of race-gender on inflammation through financial strain. While this indirect effect was stronger for black men and white women with a high school degree or less; conversely, the effect was stronger for black women with educational levels that exceeded high school. Conclusion This study contributes to the literature on inflammation by further illuminating the social determinants and social patterning of inflammation among black and white women and men within the United States.

Translation Section

Excerpt of the content: Jewish activist communities have historically been allies to communities of color in the fight for racial justice and equality in our country. Jews were among those who worked to establish the NAACP in 1909. In the early 1900s, Jewish newspapers drew parallels between the Black movement out of the South and the Jews' escape from Egypt, pointing out that both Blacks and Jews lived in ghettos, and calling anti-Black riots in the South "pogroms." Historically, Jewish leaders stressed the similarities rather than the differences between the Jewish and Black experience in America, and emphasized the idea that both groups would benefit the more America moved toward a society of merit, free of religious, ethnic, and racial restrictions. In more recent history, Blacks and Jews fought side by side in the Civil Rights Movement. The kinship and relationship between the Reverend Dr. Martin Luther King and Rabbi Abraham Joshua Heschel has been regularly and continually celebrated. What has been less often discussed is the relevance of the social circumstances that created and, in some cases, still sustains a rift between Black activists and white Jewish anti-racism activists. In the late 1960s, the birth of the Black Power movement shifted the emphasis in Black activist communities toward self-determination, self-defense tactics, and racial pride. While this shift was crucial to the evolution of Black consciousness and identity in America, the expansion from the singular nonviolence and racial integration approach espoused by King left many white Jewish activists with little input in the Black community and an anti-racism movement that seemed to be moving on without them. Click for larger view "Blacks and Jews fought side by side in the Civil Rights Movement," the author writes. Here, Dr. Martin Luther King Jr. and Rev. Fred Shuttlesworth march alongside Rabbi Abraham Joshua Heschel from Selma to Montgomery, Alabama, in March 1965. Since the 1960s, efforts at coalition building and solidarity work for justice between white Jewish and Black communities have suffered and never reached the pinnacle that was reached during the early days of the Civil Rights Movement. The rapid decline of American anti-Semitism since 1945 (alongside the nation's continuing and pervasive anti-Black racism) and the increasing gap in accumulated wealth and education between Black and Jewish communities have widened the rift of perceived shared interests between Black and Jewish activists. Many of the civil rights struggles that joined Blacks and Jews in the middle of the last century--i.e., anti-lynching, desegregation, voter registration, etc.--were typically organized around divisions in society that easily identified injustices between persecutors and their victims (a division in which Jews could also identify as victims). Between the late 1960s and the present, much of the anti-racism work that has galvanized Black activists has shifted and come to be concerned more specifically with disparities in access, privilege, and power between those with and without white skin privilege in our country. Click for larger view Members of Beyt Tikkun Synagogue pray alongside Rev. Dr. J. Alfred Smith Jr. of Allen Temple Baptist Church in Oakland, California, after the acquittal of Trayvon Martin's killer. Disappointingly few synagogues nationwide engaged in similar expressions of Jewish-Black solidarity. A Weakened Coalition In 2013, the lack of deep and abiding connections between Black and Jewish communities of activists became apparent to me in the disparate responses I encountered to the events surrounding the killing of Trayvon Martin and the subsequent acquittal of George Zimmerman. Here's a quick summary for any readers who need a reminder of what happened: in July 2013, after more than sixteen hours of deliberation, a jury of five white women and one Latina woman found George Zimmerman not guilty of second-degree murder and manslaughter. Previously, on a drizzly February night, Zimmerman had shot Martin, an unarmed seventeen-year-old, in a gated community in Sanford, near Orlando. Citing Florida's stand-your-ground law, Sanford police originally did not charge Zimmerman or take him into custody. Only after social media outrage and civil rights protests alleged racial profiling and discrimination did Governor Rick Scott appoint a special prosecutor, who brought the charges against Zimmerman six weeks after... Language: en

Racial Disparity Between Whites and African Americans in Incidence and Outcome of Pancreatic Cancer: Have We Made a Difference?

BACKGROUND: Prostate cancer is the most common cancer among men in the United States. Black men represent a high-risk group that is more likely to be both diagnosed with and experience adverse prostate cancer outcomes. Both statins (to reduce cholesterol) and metformin (to treat diabetes) have been hypothesized to reduce the risk of biochemical recurrence (BCR), a clinically important outcome, among men with prostate cancer. However, few studies have examined this association specifically in Black men. Because Black men are at greater risk for adverse prostate cancer outcomes, the potential of commonly used medications, including metformin and statins, to reduce this increased risk needs to be investigated. Here, we have examined the potential of metformin and statins to reduce risk of prostate cancer recurrence in a racially-diverse cohort of men diagnosed with prostate cancer at the Veterans Health Administration (VHA). METHODS: Our cohort consisted of 20,359 Black and 52,004 White men that were diagnosed with prostate cancer between 1997-2009 at the VHA and received definitive treatment for prostate cancer (radical prostatectomy or radiation). Statin use and metformin use were defined as any statin or metformin prescription after prostate cancer diagnosis. BCR was defined using established definitions. (For men treated with radical prostatectomy, BCR was defined as a PSA of 0.2 ng/mL or higher for two consecutive assays without treatment. For men treated with radiation, BCR was defined as rise of 2 ng/ mL or more above the nadir achieved after radiation therapy.) Cox proportional hazard models adjusted for age at diagnosis, prostate cancer grade, prostate cancer stage, and locale (rural vs. urban) were used to assess the association between statin and metformin use. Statin and metformin use were analyzed in separate models, stratified by race. RESULTS: Statin use (69.9% of Black men; 75.4% of White men) and metformin use (29.4% of Black men; 24.3% of White men) were prevalent in our cohort. The mean BCR-free survival time was 5.7 years and 6.0 years in Black and White men, respectively, with 16.6% of Black men and 13.8% of White experiencing a BCR. Statin use was associated with a significantly reduced risk of BCR in the cohort as a whole (Hazard Ratio (HR): 0.87; 95% Confidence Interval (CI): 0.83, 0.91), Black men (HR: 0.84; 95% CI: 0.77, 0.90), and White men (HR:0.89; 95% CI: 0.84, 0.95). We observed no association between metformin use and risk of BCR [Overall (HR: 1.05; 95% CI: 1.00, 1.10), Black men (HR: 1.00; 95% CI: 0.93, 1.08), White men (HR: 1.05; 95% CI: 1.00. 1.11)]. CONCLUSION: Post-diagnostic statin use may reduce the risk of BCR in both Black and White men. This is one the few studies to examine statin use and metformin use specifically in Black men with prostate cancer. Importantly, because all patients treated at the VHA receive care regardless of insurance status, this study was able to control for socioeconomic status in ways other studies are unable. Citation Format: Saira Khan, Bettina Drake. Post-diagnostic statin and metformin use and risk of biochemical recurrence risk among Black and White men diagnosed with prostate cancer at the Veterans Health Administration [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C009.

POLICE REFORM IN DIVIDED TIMES

Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine.

The frequent police killings during the COVID-19 pandemic forced a reckoning among Americans from all backgrounds and propelled the Black Lives Matter movement into a global force. This manuscript addresses major issues to aid practitioners in the effective treatment of African Americans via the lens of Critical Race Theory and the Bioecological Model. We place the impacts of racism on Black families in historical context and outline the sources of Black family resilience. We critique structural racism embedded in all aspects of psychology and allied fields. We provide an overview of racial socialization and related issues affecting the parenting decisions in Black families, as well as a detailed overview of impacts of structural racism on couple dynamics. Recommendations are made for engaging racial issues in therapy, providing emotional support and validation to couples and families experiencing discrimination and racial trauma, and using Black cultural strengths as therapeutic resources.