The “Unreliable Narrator of a Historical Manifesto”: Reimagining and Re-historicising Depictions of Sexual Violence During American Slavery in Kara Walker’s Testimony: Narrative of a Negress Burdened by Good Intentions

Disclosure: J.C. Lo: None. M. Chandra: None. W. Yang: None. U. Ozomaro: None. M.D. Sharma: None. J.A. Darbinian: None. C. Lee: None. A.L. Wheeler: None. M.M. Khan: None. Background: Prior studies using US Medicare data demonstrate that Black women have higher mortality after hip fracture than White women. However, few studies have examined findings specific to the Western US. We previously found that 1-year mortality after hip fracture (in 2000-2010) was similar among Black and White women in a Western US healthcare system. We now examine 6-month and 1-year mortality in an expanded cohort of Black and White women with hip fracture in the same healthcare system. Methods: This retrospective study includes data from non-Hispanic White and Black women aged ≥65y in a Western US healthcare system who were hospitalized with hip fracture during 2000-2019. The outcome was all-cause mortality, within 6-months and 1-year after hip fracture. Covariates included age at hip fracture, femoral neck vs pertrochanteric (hip) fracture, year of fracture, prior clinical fracture (diagnosed in the prior 5 years), Charlson-Deyo Comorbidity index (CCI based on inpatient/outpatient data in the prior year and during hip fracture hospitalization) and diabetes (diagnosed in the prior 5 years or during hip fracture hospitalization). Modified Poisson regression was used to examine mortality after hip fracture (Black vs White women), adjusting for (a) age, fracture type, year and (b) age, fracture type, year, CCI, prior fracture and diabetes. Results: The cohort included 691 Black women (age 82.9 ± 8.0y; 43.4% age ≥85y) and 20,450 White women (age 82.8 ± 7.7y; 44.2% age ≥85y) with hip fracture in 2000-2019. Black women had a similar proportion with femoral neck fracture (58.2% vs 55.2%) but were more likely to have prior fracture (23.0% vs 33.5%), diabetes (35.2% vs 18.2%), and higher CCI vs White women. For Black vs White women, respectively, group differences in 6-month (18.4% [95% confidence interval 15.7-21.4%] vs 16.4% [15.9-16.9%], p=0.12) and 1-year mortality (23.2% [20.2-26.5%] vs 22.1% [21.4-22.6%], p=0.49) were not significant. In multivariable analyses, the relative risk of death at 1-year for Black (vs White) women was 1.03 [0.90-1.19] adjusting for age, year, fracture type and 0.97 [CI 0.84-1.11] adjusting for age, year, fracture type, CCI, prior fracture, and diabetes. The relative risk of death at 6-months for Black (vs White) women was 1.05 [0.89-1.23] adjusting for covariates. Conclusions: In a Western US healthcare system, differences in 6-month and 1-year mortality post-hip fracture were small and not significant for Black and White women aged ≥65y, after accounting for age and comorbidity burden. However, the number of Black women was small, and data on social factors, frailty, post-fracture morbidity, and other health factors were not available. Nonetheless, these results suggest that racial and ethnic differences in mortality after hip fracture may vary by geographic region. Hip fracture outcomes in larger populations of Black women in the Western US should be examined. Presentation: 6/3/2024

Neo-S(k)in TradeWhite Skin, Black Bodies in Bernardine Evaristo's Blonde Roots Sika A. Dagbovie-Mullins (bio) How would they like us to make slaves of and hold them in cruel slavery, and murder them as they do us? —David Walker White myth making around the black female body is inextricably linked to the larger African diaspora, that space of rupture, dispersion, and displacement. The presence of white hegemony, the black female body as property, the pervasive phenomenon of sexual abuse, and the experience of trauma constitute significant motifs … that are indicative of the reality of black diasporic women's existential experiences. —George Yancy Responding to the question, "What sparked Blonde Roots?" Bernardine Evaristo explains, "I wracked my brains about how I could write about [the transatlantic slave trade] in a way that enabled people to see it afresh."1 The British novel combines current and historic realities; there are slave ships and minstrel shows but also subways ("Tube trains") and self-help books.2 The blending of old and new urges readers to consider how modern slavery exists and operates in a contemporary context, particularly the sociocultural hierarchies and economic infrastructures that support such oppressive systems. [End Page 1] Similar to the 1995 American film White Man's Burden, Blonde Roots interchanges the roles of blacks and whites in society, imagining a world where Europe (Europa) is the "Gray Continent" whose natives must work as slaves for the black oppressor in Aphrika, the UK of Great Ambossa, and the West Japanese Islands (i.e., Caribbean islands).3 In Evaristo's novel, the white female body occupies the position of the deviant, aberrant Other, a "role" historically held by blacks. Protagonist Doris Scagglethorpe (slave name Omorenomwara) and her fellow female slaves suffer at the hands of ruthless slave catchers, violent and abusive Ambossan slave masters, and cruel and constantly suspicious Ambossan mistresses. In Blonde Roots, everything is doubled; white is also black, the past is also the present, what is imagined is also real. The various doublings in the narrative, though primarily focused on the story of white Doris, serve to represent and underscore the complexities and contradictions of black invisibility, visibility, and hypervisibility, particularly as it relates to black women who "are likely the most socially invisible in societies where poverty, blackness, and women historically mark the depths of powerlessness." David Theo Goldberg writes, "Constitutive or reflective of strategic relations, visibility and invisibility each can serve contextually as weapons, as a defensive or offensive strategy, as a mode of self-determination or denial of it."4 Evaristo uses Doris's textual visibility or presence (in lieu of a black protagonist) as a narrative strategy to retell black women's "unspeakable" slave experiences. Her whiteness also reminds readers of the power of white oppression with regards to its strategic efforts to deny or refuse to see black subjectivity. Other doublings serve a similar purpose in the novel: they remind us of an ugly past while exposing and denouncing contemporary global problems such as sex trafficking and modern-day slavery—issues that remain concealed from or ignored by the public eye. My title signifies on Frantz Fanon's Black Skin, White Masks (1952) whose title speaks to Blonde Roots's racial inversions; Doris's supposed inferiority is due to her being a "Caucasoi," a race of people who suffer from "infantalism, aimlessness, laziness, cowardice, poor coordination, [and] moral degradation."5 In his pro-slavery pamphlet, The Flame: Reflections, Thoughts, Experiences & Sentiments Candid & Free on the True Nature of the Slave Trade Remarks on the Character & Customs of the Europanes & An Account (Modest & Truthful) of my Progression from Inauspicous Origins to the Highest Echelons of Civilized Society, Chief Kaga Konata Katamba I notes that "[b]eating the hide of a Caucasoi is more akin to beating the hide of a camel to make it go faster," a statement that equates "whyte" skin with animalistic traits historically assigned to black corporeality.6 Thus Doris's whyte skin barely masks her symbolic black body. Chela Sandoval writes that Fanon's metaphoric title "calls up, but also undoes," the very racial binary opposition that the metaphor also depends on in order...

Previous articleNext article Free“Thou maiest inforce my body but not mee”: Racializing Consent in John Marston’s The Wonder of WomenKirsten N. MendozaKirsten N. MendozaUniversity of Dayton, USA Search for more articles by this author PDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreIn Grandison, a Slave, v. The State (1841), Judge Nathan Green reversed the decision of the Tennessee circuit court of Warren County for the assault, battery, and rape of Mary Douglass. While the indictment expressed that the accused did “feloniously ravish and carnally know” the said Douglass, it had omitted the victim’s race. According to Green, “[s]uch an act committed upon a black woman would not be punished with death. It follows, therefore, most clearly, that this fact”—the victim’s White race—“gives to the offense its enormity.”1 As Green’s cold assessment makes plain, rape statutes were designed with White female victimhood in mind. In the antebellum American South, it was not just the severity of rape that was mitigated by the race of the survivor but the crime itself that could be effaced if the victim had not been White. The Mississippi Supreme Court in 1859 reversed another conviction in the lower-court ruling of George v. State, a case concerning the rape of a nine-year-old Black girl. George’s attorney argued that “the regulations of law, as to the white race, on the subject of sexual intercourse, do not and cannot, for obvious reasons, apply to slaves; their intercourse is promiscuous, and the violation of a female slave by a male slave would be a mere assault and battery.”2The debasement of the sexualities of Black people was not just a product of slavery, an institution that made their marital bonds and reproductive capacities the property of White masters, but also the consequence of pervasive stereotypes that labelled Africans as naturally libidinous and sexually insatiable. The perception of Black slaves as incapable of maintaining bonds of marriage due to a natural promiscuity maligned their pleasures and served to eradicate their legal ability to claim possession of their bodies and to defend their persons from unwanted touch and violation. The reversal of the original verdict in the Mississippi Supreme Court concerning a child under the age of consent negates the fundamental importance of will. The court’s relegation of the crime from rape to “mere assault and battery” brutally proclaims that it is the race of the victim and not a woman’s decision to withhold consent that determines whether or not rape had occurred. According to this court, the perceived whiteness of the victim makes rape happen.In both cases, the perpetrators were Black slaves. While White men could be held accountable—but rarely were—for crimes such as fornication, adultery, or miscegenation, a White man’s attempted or completed rape of a Black woman whether bonded or free was neither recognized nor punished by law.3 Slavery institutionalized the vulnerability of Black women and men by making the bodies of slaves entirely accessible to a White man’s violent touch, which criminalized their resistance and simultaneously enabled the protected status of White womanhood. “The vulnerability of all enslaved black persons to nearly every conceivable violation,” Aliyah I. Abdur-Rahman argues, “produced a collective ‘raped’ subjectivity.”4 Rape statutes make palpable how the right to property in one’s person derives from a politics of touch firmly rooted in racism and misogyny that delimit who can touch, be touched, and have their pleasure and wills matter in the court of law. The pornographic vision of a White woman’s sexual violation, according to Green, provides the emotional impetus that makes rape reprehensible. Less than twenty years later, the Mississippi Supreme Court would make race a determining factor for the crime itself on the basis of Black promiscuity. Although these cases were adjudicated in the mid-nineteenth century, the cultural biases that undergird their convictions purported as objective “fact” and “truth” had already been in circulation for hundreds of years. This article analyzes the privileged emergence of White women’s self-possession—their theoretical right to determine who can touch their bodies and in what way—at a point in history that inaugurated England’s involvement in slavery, a system that institutionalized sexual violation and denied the fundamental right of Black men and women to property in their persons.Legal tracts in England, especially after the 1530s, sought to clarify the ambiguities concerning what exactly constituted rape.5 Specifically, the statutes of 1555 and 1597 reiterated that it was a felony distinct from the abduction of a man’s goods, requiring the carnal knowledge of a woman against her will. This asserted that the woman’s lack of consent was the decisive factor for whether or not rape had occurred. Thus, in the legal transition of rape, the woman—not her father or husband—became the primary victim.6 This revision made possible the presupposition that a woman not only protected her body as a good steward would care for the belongings of her husband but as a subject who possesses ownership of her person. However, the cultural perception of women as goods, whose legal rights were subsumed by that of their owners, would not so easily be uprooted and continued to influence the adjudication of rape cases through the end of the seventeenth century.One particular legal conundrum presented at the Inner Temple and documented in Harvey 1691 exemplifies the tensions that arise at this transitory period when men’s possessions were endowed with the ability to have their wills gain legal traction. In the case presented, a woman is raped while she and her husband are separated and seeking divorce. She subsequently files an appeal under her name. As her appeal of rape is pending, the husband and wife revoke their divorce. The question posed is whether or not the husband and wife may have a new joint appeal of rape. The first unnamed lawyer who responds denies their petition for a new appeal since the crime did not occur when the woman belonged to her husband. He goes further yet, stating: “if a woman who has cause of appeal marries, the appeal is gone.”7 During her assault and when the original appeal was made, the woman was unmarried, unclaimed, and the sole owner of her body. According to this lawyer, the espousal, which made her person the possession of her husband, retroactively annuls her original appeal since a wife no longer owns her person. He perceives rape less as an assault than as an improper seizure, a distinction that diminishes the significance of the violation sustained by the survivor. The owner of the unlawfully seized body who had made the original appeal no longer exists in this lawyer’s strict interpretation of English law.Fulwood, the second to respond, counters each of the arguments posed by the unnamed lawyer. In a virtuoso conclusion, he contends: even if the woman had married another man “(which [he does] not concede in this case), she still remains the same person to whom the wrong was done.”8 For Fulwood, rape cannot be effaced because the woman’s relation to herself is immutable. It was her person that had been violated and remains her person after marriage. These starkly divergent responses reveal that the legal move toward recognizing the efficacy of women’s consent was in part hindered by a conceptual schism between proponents, like Fulwood, who held that rape is ultimately a crime against the primary owner—the woman whose body was violated without her consent—and those like the unnamed lawyer who maintained with cruel persistence that a woman could never absolutely possess her person. Fulwood’s powerful response, his call to acknowledge the woman’s right to property in her person, relied precisely on an expected visceral reaction to sexual violence. As the unnamed lawyer attended to the intricacies of coverture, theft, and rape statutes, Fulwood forces his colleagues to remember the horror of sexual crimes and the survivor of that atrocity. However, what kind of woman did the men imagine in Fulwood’s emotional appeal? What assumed class, moral status, and physical traits of the survivor made rape a monstrous act?Scholars need not look further than the early modern stage to consider the kind of woman imagined during this period of legal and cultural contestation on the efficacy of women’s consent and self-possession. John Marston’s The Wonder of Women, or The Tragedy of Sophonisba, performed by the Children of the Revels (circa 1606), turns the story of a Carthaginian princess, one that has been treated as a minor historical aside in the defeat of Carthage and rise of imperial Rome, to a drama that underscores the force of a woman’s volition and the righteous defense of her body against unwanted touch.9 Although perceived as a mere commodity, the titular heroine asserts the value of her pleasure and strives to maintain the efficacy of her consent. In Marston’s adaptation set in the Second Punic War, Sophonisba scorns Syphax the Numidian king and instead marries the Carthaginian general Massinissa.10 Rather than consummate their marriage, the princess instructs her husband to defend their kingdom against the combined forces of love-scorned Syphax and the Romans. While Massinissa fights, his prized possession is expropriated by Sophonisba’s father Asdruball and the Senate, who give Sophonisba to Syphax’s bed (2.1.10). Scenes of sexual violence dominate the third and fourth acts of the play with a barely dressed Sophonisba fleeing from Syphax who threatens to “tack [her] head / to the low earth, whilst strength of too black knaves, / [her] limbes all wide shall straine” (3.1.9–11). Although Sophonisba and her husband are reunited at the end, their happiness is short-lived; Massinissa’s alliance with Rome comes at a price. He must deliver the princess to Scipio as a prisoner of war. After being trafficked from one man to another and evading the licentious clutches of her attempted rapist, Sophonisba drinks poison to save her husband and her people.Recent critics of Marston’s The Wonder of Women, who focus on the gratuitous descriptions of sexual violence pervading this drama, have underscored the treatment of Sophonisba as one of men’s moveable goods, a possession exchanged for the benefit of male homosocial bonds. Although patriarchy requires Sophonisba to remain chaste—Sukanya Senapati argues—she is paradoxically “circulated like a common whore.”11 Unfortunately for beautiful women who rail against the inconsistencies of masculine authority, as T. F. Wharton concludes, Marston creates exemplary female figures only to kill them off at the end, a choice that retroactively undermines the agency of feminine exemplars.12 In stark comparison, critics such as Peter Ure and Reginald W. Ingram interpret the objectification of Sophonisba as trials that exemplify constancy, self-denial, and ability to control her passions, attributes that figure the princess as a Stoic model for men whose suicide is not an abnegation but a move toward a Senecan apotheosis.13 Self-possession in this play, thus, has primarily been understood as the control of one’s ignoble appetites that distract from the fulfillment of duty and honor. Instead, this article defines self-possession as having the right to property in one’s person.Rather than dramatize an utter lack of female mobility and a woman’s compromised or nonexistent will, Marston presents a compelling portrayal of a fair woman as a political subject while acknowledging the cultural biases that deny the efficacy of her consent. I argue that Marston cultivates Sophonisba’s right to self-possession and enables her ascendance as a political subject through and in relation to his dispossession of the classed and raced bodies of Zanthia, her Moorish maidservant, and Vangue, Syphax’s Ethiopian male slave. While Marston expressly highlights the whiteness of Sophonisba’s complexion, it is worth noting that the African princess could have had a range of skin complexions and mixed signifiers of both dark and fair to intimate a number of qualities of which skin tone is just one, such as morality and geographic location. Joyce Green MacDonald, in fact, reveals that Sophonisba is just one example in a long line of African princesses whitened in English drama.14 Although Marston underscores Sophonisba’s fairness, it is unclear how Syphax, the primary villain of the play, was depicted. Unlike the overabundance of signifiers attached to Sophonisba, Vangue, and Zanthia, the lack of descriptors given to Syphax makes it possible that despite the king’s reign over a territory often associated with African blackness, an early modern metaphor for skin and sin, the Numidian king could have been similarly whitened during the performance. This potential indicates another means by which the theater engaged in a politics of touch to normalize White men’s access to the bodies of all women even as they chastised such violence by making the image of a Black man on the body of a White woman the stuff of fantasy that cannot be staged.From the moment audiences are introduced to Sophonisba, blackness frames the fair princess. In the first act, her dark and bawdy maidservant undresses Sophonisba in preparation for the culmination of her long awaited nuptial rites. Later Syphax threatens to gang rape the princess by commanding Zanthia and Vangue to pinion Sophonisba’s resistant White body to the ground. And, in another scene with equally heightened erotic fervor and violence, Sophonisba orchestrates a bed trick, substituting her place with Vangue’s body. Critics have noted how the drama exploits the traditional dichotomy of Black and White to amplify the virtue of Marston’s heroine. As Ania Loomba and Jonathan Burton have argued, early modern texts reveal the development and exploitation of the “ideologically charged connections between inner essence and bodily traits,” connections that later racialized logic would most vigorously espouse.15 For example, Anthony Barthelemy highlights how Zanthia’s blackness and Sophonisba’s whiteness represent their moral states; the “vile lascivious, and faithless [Zanthia] serves the faithful, virtuous, and matchless Sophonisba.”16 As the work of Kim F. Hall reveals, fair skin marks the desirability of European women through a racialized hierarchy of beauty and virtue.17 In addition to the ways that blackness makes whiteness signify as moral, superior, and attractive, Arthur L. Little shows how the Black characters in Renaissance works were essential to representations of rape because the “black body simultaneously enables and distances (makes foreign) the pornographic story.”18Building on their crucial work, I suggest that Marston’s Black characters are more than “accessory” to the play’s investment in crafting a woman who deserves the privilege of self-possession. They are important in their own right for just as the drama thinks through the means by which fair women can claim the efficacy of their consent, The Wonder of Women also theorizes how the subjugation of Black persons can be justified through their ignoble pleasures. Marston’s drama is symptomatic of how the English Renaissance theater actively participated in the construction of modern paradigms of race. As the rape cases that began this article make clear, the translation of stereotypes to rationales that deny protections, privileges, and rights would be crucial for the later justification of the enslavement of Black men and women. “Enjoyment,” as Saidiya Hartman poignantly argues, “in turn defined the meaning of subjection [for] it appeared not only that the slave was indifferent to his wretched condition, but also that he had nonetheless achieved a measure of satisfaction with that condition.”19 The decisive work of this play, thus, is the twinned phenomena of White women’s self-possession and Black dispossession through the significations attached to their respective wills, pleasure, and consent.Throughout the play, Sophonisba maneuvers to determine to whom she submits and to what extent, adamantly confronting those who attempt to strip her of a voice with the importance of her will. Although the play safeguards the primacy of the fair Carthaginian’s consent and endows her with the ability to harness a lexis of pleasure and consensual submission reserved for male political subjects, it does so at the expense of Black characters. Audiences witness scenes in which bodies of alterity are rendered disposable and incapable of defending themselves from a totalizing dispossession that the drama unsympathetically justifies. In a play that exploits the objectification of women, servants, and slaves, The Wonder of Women distinguishes Sophonisba from other possessions through conditioning audiences to the sight of dispossessed and violated dark bodies. Ultimately, those who are marked with dark complexions are denied the fundamental right to self-possession for the whitened Sophonisba to have hers.IAt the most sexually charged moment in act 1, when Massinissa moves to embrace his wife, a wounded soldier disrupts their intimacy and calls the groom to war. and Asdruball a on the while a and dressed Sophonisba their After an of one the men the entirely her The between a wife and a of and that in that of woman’s does not matter even if it the of her her and her husband. Massinissa he is and for Sophonisba, Massinissa to his nuptial in to she his he to her my are / I must not Sophonisba his and with a to Carthage than their sexual not make to be a his every that my these Sophonisba the of an subject and a wife to a of her Sophonisba Massinissa’s her Although the princess sexual to a which who often she nonetheless their carnal in erotic Rather than her reproductive as a wife, which requires Massinissa’s physical in their she her to a woman’s traditional to in of her Sophonisba the bed and the as for men to their According to this the the choice for male than a woman’s It is not the of her body but of his that to her a her pleasure to Massinissa’s on the Sophonisba undermines the that so marks the of this her sexual and her as both and she that her consent was neither nor the consequence of Massinissa’s Sophonisba she has / of the princess the significations of her abnegation since her a of Massinissa’s a and a give her she a husband, Sophonisba proclaims that she not be wretched This to her which may a lack of just as it to her Stoic reveals how Sophonisba’s pleasure the that she Sophonisba were no that [her] / [her] to her husband, she to herself an Carthaginian through bodily the for are denied to women, she must through her husband and his body than her Sophonisba does not consent in to the in Massinissa as her husband and Instead, her and his decision are such that it to who is the head and who the whether her or his Massinissa’s choice to than consummate their Sophonisba Massinissa to her father and the Carthaginian a alliance with Syphax through her body. Sophonisba their to the of Carthage by herself Syphax’s to shall be to and of Carthage my is their what they of than that she the of the Senate, the of her father and other men who political over she her submission as an act of to the kingdom that has given her While the princess herself the possession of she also her to it and the pleasure she in the to this emotional a submission that be perceived as the product of also an act of After the had presented Sophonisba with the to her for her [her] to Sophonisba her that to be a good subject requires a consensual submission most and when one wills the of one’s body. As with the she to Sophonisba the of her that such acts of volition the distinction between and from This is all the more because feminine is to the of of requires a on feminine undermines the and that to be and too threatens to the woman’s In the of her pleasure, Sophonisba to play the part of a through which men their wills her in the of and by the princess that she has to be the subject of the but she has also herself to all have good Massinissa makes and no other man and but the consequence of this Sophonisba herself to be one of their a Carthaginian subject who has given to Massinissa and who actively the bonds that Sophonisba it was her of given this choice Syphax Sophonisba not In for her husband, and own the princess her consent. She possesses bonds to Carthage and to Rather than one to the she both that her and the efficacy of her consent. In and her duty to she maneuvers between the and on her as one of men’s and underscores her status as a political subject whose volition and pleasure have Sophonisba in her and with Syphax as he her body in in my / he that to Sophonisba exists Syphax’s he control of her In and England, on often the between a and his subject to a marriage between husband and Syphax’s of access to Sophonisba’s sexual body due to her his a of political with Sophonisba does not that her in the king access to her person. her of Sophonisba her own political that of with her body. not only acts on a subject in a the subject Sophonisba to be the primary means between people are the for to her also from recognized by the of her she ownership of her person by that she as a political subject than as Syphax Sophonisba and the that he has the ability to do as he his maiest inforce my body but not with She a to rape, that the decision to withhold consent that is not to her Sophonisba asserts that she can only be had through volition and not bodily Although Sophonisba may to the of Marston it is not her that this but Sophonisba’s that her consent has since it the between the play as a of Syphax the princess, is their force can make more than he his totalizing physical of her person with his as a than attempt to the by on the of Sophonisba that force does not with While a may to his will, Sophonisba this act Syphax to incapable of a subject to when Sophonisba that she or / she Syphax’s to his in political subjects, like Sophonisba, physical over against their “the subject forces the the of and resistance It is the who in a of the of his or her while the to a of masculine Sophonisba’s her from because it is given a value that authority, a value that Syphax and Sophonisba to her The king was right when he his to her What this from rape is the that a act his and to both Massinissa and As in the the ability for the subject to call on consent to the of the body is never Sophonisba’s to Syphax to his requires that she make acknowledge her political which distinguishes her submission from the subjugation of other English and representations of dark bodies and White feminine often enables The Wonder of exploitation of blackness for the emergence of fair women as political However, it is not just their subjugation as bodies that are and trafficked that Marston but also their distinct of erotic which as the upon which Black objectification and are justified in this Marston makes a case for Sophonisba’s right to pleasure, and the efficacy of her consent only through English audiences to the of Black characters to the value of their physical

Does Stigma Keep Poor Young Immigrant and U.S.-Born Black and Latina Women From Seeking Mental Health Care?

Background: Non-Latina Black (black) women, despite their lower BC incidence, are more likely to die from breast cancer compared to their nL White (white) counterparts. While differential access to care, comorbidities and BC aggressiveness are potential contributors to this difference, the potential impact of HMD on this disparity has rarely been explored. For example, nL black women are disproportionately diagnosed with more aggressive tumors that lack estrogen and progesterone receptors (ER and PR) and that are high grade. Therefore, if the association of HMD with breast cancer incidence varied by tumor subtype this could have implications for disparities in breast cancer aggressiveness and subsequent outcomes. Most of the conclusions establishing high mammographic breast density (HMD) as a risk factor for increased breast cancer incidence are derived from studies conducted primarily in whites, which jeopardizes generalizability. We sought to estimate the association between HMD and breast cancer incidence separately for white and black women and by tumor subtype, using data from a single, large healthcare organization. Methods: We used data from screening mammograms performed in women ages 18-100, between 2001 and 2010, probabilistically linked to incident BC cases recorded in the Illinois State Cancer Registry (ISCR) during 2001-2011. Each screening mammogram received a breast density score from the interpreting radiologist using the American College of Radiology Breast Imaging Reporting and Data System (BIRADS 1-4), defined as fatty (BIRADS 1), scattered fibroglandular (BIRADS 2), heterogeneously dense (BIRADS 3) or extremely dense (BIRADS 4). A mean BIRADS breast density score was calculated using available scores from both breasts at each exam. The mean was dichotomized as high (mean BIRADS score > 2.5) versus low (mean BIRADS score ≤2.5) and the dichotomous variable was modeled in logistic regression with generalized estimating equations (to account for multiple screens per woman) to estimate the association between breast density and the probability of a breast cancer diagnosis within 12 months of the screen. Models included age, race, family history, parity and exam year as covariates, and separate models were estimated for black and white women. Odds ratios were interpreted as rate ratios (RR) due to the rarity of the outcome (<1%). Model-based standardization (predictive margins) was use to estimate adjusted rate differences from the logistic regression models. Results: Included in this analysis were 616,466 screens on 201,348 white or black women during 2001-2010, and 4,104 BC in 3,706 women during 2001-2011 (overall rate of 6.7 per 1000 screens, 6.7 for whites and 6.5 for blacks, p=0.21). There were disparities in the distribution of tumor subtypes: breast cancers diagnosed in black women were more likely to be ER negative (23% vs. 15%, p<0.0001) and high grade (38% vs. 30%, p<0.0001) when compared to white women. Upon adjustment for age, family history, parity and exam year, HMD was associated with increased breast cancer incidence overall (RR=1.24, 95% CI: 1.16, 1.32, equivalent to an adjusted Rate Difference of 1.4 per 1000 screens). The association between HMD and breast cancer incidence was similar for whites (RR=1.26, 95% CI: 1.16, 1.36) and blacks (RR=1.19, 95% CI: 1.05, 1.34) and similar for ER positive (RR=1.23, 95% CI: 1.15, 1.31) and ER negative breast cancer (RR=1.29, 95% CI: 1.16, 1.45). HMD was modestly associated with incidence of low grade (RR=1.26, 95% CI: 1.12, 1.41), and moderate grade (RR=1.18, 95% CI: 1.08, 1.29) tumors, but more strongly associated with incidence of high grade tumors (RR=1.45, 95% CI: 1.30, 1.61). These RRs translated into adjusted Rate Differences of 0.4, 0.4 and 0.8 breast cancers per 1000 screens, respectively. Discussion: Our findings reiterate high breast density as a risk factor for breast cancer incidence. In addition, we found that the association was of roughly equal magnitude among white and black women, and of roughly equal magnitude for ER negative and ER positive tumors. The stronger association of HMD with high grade tumors, however, implies that HMD may be a more detrimental risk factor for black women who are more likely to experience higher grade tumors than white women. Citation Format: Katherine Y. Tossas-Milligan, Firas Dabbous, Garth Rauscher. Is the influence of high mammographic breast density on breast cancer incidence the same for non-Latina black and white women? [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C43.

Race, Politics, and Nation in Albion W. Tourgée's American Historical Novels Series: The Example of <i>Hot Plowshares</i>

Background: Though incidence rates for invasive breast cancer overall have been historically lower for Black than White women, recent reports show that rates have converged between the two groups. We used the age-period-cohort framework to verify the current trends and to forecast future implications. Methods: Data from Surveillance, Epidemiology, and End-Results (SEER) Program 13 registries and the age-period-cohort forecasting model were used to observe current incidence rates (1992 to 2014) and to predict future trends (2015 to 2030) of invasive breast cancer by ER status among non-Hispanic White, Hispanic, and Black women, ages 30 to 84 years. Trends in the age-standardized incidence rate (ASR) were quantitated with the estimated annual percentage change (EAPC) in the ASR. Results: Observed invasive breast cancer incidence rates from 1992 through 2014 show convergence between White and Black women but not between non-Hispanic White and Black women. Observed incidence rates for ER-positive breast cancer are rising for all races, but rising faster among Black women with an EAPC = 0.77 [0.26, 1.29] %/year. In contrast, observed incidence rates for ER-negative breast cancer are decreasing for all races, but decreasing slower among Black women with an EAPC = -2.00 [-2.55, -1.43] %/year. Forecasting for ER-positive and ER-negative breast cancers suggests a continuation of the observed trends without future convergence in overall breast cancer rates. Conclusions: Incidence rates between Black and White women did not converge when non-Hispanic White women were separated from Hispanic White women. Whenever possible, future comparative breast cancer analyses should always attempt to analyze discrete populations separately, given the complexities of differential risk factor exposures by race and/or ethnicity. A better understanding of breast cancer in general and by race may be accomplished by accurately describing the similarities and disparities among different ethnic groups. Citation Format: Brittny C. Davis Lynn, Philip S. Rosenberg, William F. Anderson. Current and future incidence rates of invasive breast cancer between Black and White women [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A28.

Breast Cancer: Breast CancerEvidence shows that breast cancer risk and outcomes vary significantly across races and ethnicity, and understanding why these disparities exist is critical for the improvement of patient care, outcomes, and quality of life. Recent research demonstrated that the microbiome and immune microenvironments of breast tumors vary significantly among women of different races, according to senior study author Dipali Sharma, PhD, Professor of Oncology in the Women's Malignancies Disease Group with the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, and a John Fetting Fund for Breast Cancer Prevention researcher. These findings, which were recently published in npj Breast Cancer, have potential clinical implications for the prediction of disease progression and/or response to treatment (2023; https://doi.org/10.1038/s41523-023-00505-6). White women have the highest lifetime risk of breast cancer incidence (13%) when compared with American Indian and Alaska Native (8%), Asian & Pacific Islander (11%), Black (12%), and Hispanic (11%) women, according to Sharma and colleagues, who noted that the risk of breast cancer among younger Black women—under the age of 45 years—is higher versus their age-matched White counterparts. While the incidence of breast cancer among Asian women has historically been lower than their Western counterparts, the research team noted an exponential increase in Asia and Southeast Asia in recent years. “Breast cancer-related mortality has been on a decline for the past several decades, but Black women are at a 40 percent higher risk of dying because of breast cancer,” emphasized Sharma, while discussing her team's research with Oncology Times. “Black women are likely to develop a more aggressive form of breast cancer—triple-negative breast cancer—at a younger age,” she said. “This disparity in breast cancer-related mortality prompted us to examine factors other than cancer cells themselves. Since the breast harbors rich microbiota, we aimed to examine the microbial population in breast tumors from women of different races.” Study Details Genomic and metagenomic data was examined from The Cancer Genome Atlas (TCGA) cohort, which included 1,018 breast cancer patients from different races—Asian (65 patients), Black (257 patients), and White (696 patients). TCGA data includes self-reported race groups in the U.S. “Self-reported race in the U.S. is largely associated with socioeconomic status, geographic location, and access to health care among other factors; and has been used by multiple studies to determine the biological differences among race groups,” Sharma and colleagues stated. Among the TCGA Asian dataset, the study authors reported that 74 percent of samples were collected in Vietnam, 9 percent in the U.S., and 3 percent in Pakistan. The remaining 15 percent were gathered from repositories around the U.S. “In the TCGA Black dataset, only two out of 257 Black breast cancer patients were Hispanic, which accounts for less than 0.8 percent of the sample population,” they noted. “Hence, we consider this dataset to be a fair representation of the non-Hispanic Black group.” Data showed unique cellular, microbial, and genomic features among the breast tumors of Asian, Black, and White women. These findings, according to the study authors, could potentially help personalize care and/or predict disease progression. Sharma and colleagues analyzed the specific 64-cell signatures of breast tumors among the patients using a web-based tool. This analysis revealed distinct, statistically significant variations among races in 11 of the cell types. The study authors observed the most distinct difference between tumors from Black and White women. Comparatively, the tumors of Asian and Black women had the least pronounced differences. “The tumors from Black women had significantly higher levels of activated dendritic cells, B cells, epithelial cells, megakaryocyte-erythroid progenitors (MEP), mesenchymal stem cells, sebocytes, and Th1 cells, and significantly lower proportions of endothelial cells, hematopoietic stem cells, and smooth muscle cells compared to the tumors from White women,” Sharma and her team reported. “The only significant difference between the tumors from Asian and Black women was the higher proportion of smooth muscle cells in the Asian group in comparison to the Black group.” Additionally, the researchers found a significantly lower proportion of hematopoietic stem cells in tumors from Asian women when compared with White women. Conversely, MEPs and Th1 cells were significantly higher in tumors from Asian women. Other observations showed that interferon gamma was higher among tumors from Asian women and CXCL9, which plays a role in immune activation, was overexpressed in tumors from Black women. Sharma and colleagues also examined the microbiota among these tumors and found that the breast tumor microbes of Asian women did not differ significantly when compared to either their Black or White counterparts. However, the data revealed significantly diverse microbe compositions among breast tumors from Black and White women. “Acinetobacter, Citrobacter, Enterobacter, Staphylococcus, Paracoccus, and Akkermansia were differentially abundant in breast tumors from Black women compared to the White group whereas Actinomyces and Veillonella were plentiful in breast tumors from White women in comparison to Black women,” the study authors stated. Among Asian women, potential race-specific microbial biomarkers of breast cancer identified by the researchers correlated with genes involved in tumor aggressiveness, blood vessel growth, tumor cell migration and metastasis, and the cancer pathways GLI1 and Notch. Pseudomonas and Methylobacter were recognized as microbial biomarkers. “The role of microbiota in breast cancer is only starting to be revealed and the racial differences have hardly been considered. The microbiome is cumulatively shaped by various environmental, lifestyle, dietary, disease, and treatment-associated factors,” Sharma and investigators explained. “It is important to note that Asian, Black, and White women face different socioenvironmental stressors (e.g., poverty, racism, discrimination, etc.) in the U.S. “It is plausible that these differences in exposures may have consequences in differences in the tumor microenvironment,” they suggested. “Microbiota is an important regulator of immunity, hormone metabolism, and energetics and a dysbiosis significantly impacts cancer risk, shapes the tumor microenvironment, and determines therapy response.” Importantly, the researchers also found that several oncogenic pathways were significantly upregulated in tumors from Black women, including phosphatidylinositol signaling, mTOR signaling, calcium signaling, and phosphotransferase system. “ABC transporters were also upregulated in tumors from Black women, which are known to be responsible for the development of chemotherapy resistance in breast cancers,” Sharma and colleagues wrote. “Surprisingly, VEGF signaling was downregulated in the same set. Two important oncogenic pathways, Notch and WNT, were also found to be upregulated in tumors from Black women (though not statistically significant).” In an analysis of gene expression profiles, the researchers identified 394 differentially expressed genes between breast tumors from Asian women versus Black women. The same examination identified 381 and 127 differentially expressed genes to be significantly different between Black women versus White women and Asian women versus White women Sharma and colleagues uncovered, respectively. When looking at the connection between genes and microbial biomarkers, the study authors found that the gene GLI1 has a positive correlation with the bacteria Terrabacter in tumors from Asian and Black women. The gene showed a negative correlation with Succinomonas in tumors from both races. “These results indicate a possible role of intratumor microbiota in tumor vasculogenesis and thus warrant further investigation,” Sharma and colleagues noted. By investigating the metabolic features of intratumoral microbes, the researchers found a “significant differential enrichment of environmental information processing pathways, oncogenic pathways, and lipid metabolism pathways.” “Concomitantly investigating tumor-centric, tumor immune microenvironment-related, and microbial alterations, our study provides a comprehensive understanding of racial disparities in breast cancer and warrants further exploration,” the investigators concluded. Sharma acknowledged that sample size is a significant limitation, and larger studies need to be conducted to identify key microbes of importance. The Johns Hopkins-led research team plans to validate their findings in a larger cohort of patients. Additional investigative aims include gaining a better understanding of the impact microbes in breast tumors have on disease progression, as well as developing microbe-based biomarkers, according to Sharma. “The study paves the path for further explorations as we try to understand this whole network more mechanistically,” she said. Clinical Significance Despite significant and ongoing therapeutic advancements in breast cancer, racial disparities in clinical outcomes remain a challenge that must be addressed. “The factors governing racial disparities in breast cancer are multifactorial and can include socioeconomic status, access to primary care, timely referrals, and health and nutrition,” Sharma said, in a statement. “However, it is important to identify additional modifiers for these differences. Our study demonstrates that the microbiome and immune microenvironments of breast tumors also vary significantly among women of different ethnicities and could potentially be used as biomarkers to predict disease progression or response to treatment.” This is the first study that shows the differential enrichment of microbes in breast tumors from women of different races, according to Sharma, who noted that “most research projects aiming to understand racial disparity in cancer have focused on tumor-related changes, but this research looks beyond the tumor cells and identifies differential enrichment of residential bacteria. “Moving forward, we can plan studies encompassing tumor-centric changes, as well as tumor microenvironment-related changes, including resident microbes, to provide a more comprehensive picture of the key processes related to tumor initiation and development in women of different races,” she told Oncology Times, while noting that the overall aim is to “develop microbe-based biomarkers for breast cancer initiation and progression and explain the higher burden of breast cancer in Black women.” Catlin Nalley is a contributing writer. Read This Article and Earn CME or NCPD! Earn continuing education credit by completing a quiz about this article. You may read the article here or on our website, then complete the quiz, answering at least 70 percent of the questions correctly to earn credit. CONTINUING MEDICAL EDUCATION INFORMATION FOR PHYSICIANS Visit http://CME.LWW.com for more information about this educational offering and to complete the CME activity. This enduring material is available to physicians in all specialties. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity expires June 19, 2025. The cost of the exam is $10. The payment covers processing and certificate fees. PROVIDER ACCREDITATION INFORMATION FOR NURSES Lippincott Professional Development (LPD) will award 1.0 contact hour for this Nursing Continuing Professional Development (NCPD) activity. LPD is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.0 contact hour. LPD is also an approved provider of continuing nursing education by the District of Columbia, Georgia, West Virginia, New Mexico, South Carolina, and Florida, CE Broker #50-1223. Your certificate is valid in all states. Visit www.nursingcenter.com for more information and to complete the NCPD activity. Fee: $12.95 Deadline: June 5, 2026 For nurses who wish to take the test for NCPD contact hours, visit www.nursingcenter.com/ce/OT. Learning Objectives for This Month's Activity: After participating in this activity, readers should be better able to 1. Synthesize the findings from the analysis of the 64-cell signatures of breast tumors among The Cancer Genome Atlas (TCGA) Asian, Black, and White patient datasets. 2. Identify a factor responsible for the development of chemotherapy resistance in breast cancers. Disclosure: All authors, faculty, staff, and planners have no relevant financial relationships with any ineligible organizations regarding this educational activity.

Differences between black and white women in the use of prenatal care technologies

Reviewed by: Intimate Justice: The Black Female Body and the Body Politic by Shatema Threadcraft Keisha Lindsay (bio) Intimate Justice: The Black Female Body and the Body Politic by Shatema Thread-craft. New York: Oxford University Press, 2016, 207 pp., $38.39 hardcover. Intimate Justice: The Black Female Body and the Body Politic is a groundbreaking text. Shatema Threadcraft demonstrates not only that black women experience intersecting race and gender-based oppression but also that how they do so is "embodied." By this, Threadcraft means that racism and patriarchy are coconstitutive in ways that severely limit black women's ability to "use the powers and capacities of the black female body freely and equally" (6). The tangible result of this disturbing reality, Threadcraft explains, is that black women experience a range of oppressions including, but not limited to, "coerced sterilizations," "racially biased child removal policies," and "systemic sexual violence as a weapon of racial terror" (8–9). Threadcraft further demonstrates that Platonic, Rawlsian, and other traditional conceptions of freedom and justice—as that which is material and is realized in the public sphere—neither recognize nor acknowledge the intersectional, intimate dimensions of black women's subordination. Intimate Justice is especially outstanding in three arenas. First, it provides a black feminist rereading of key moments in African American history. Thread-craft, in one such rereading, reveals that the race riots of the late 1890s and early 1900s were not about white hostility to black male soldiers or, more broadly, to many black males' "new status as agents of public authority" (78). The riots were also about racist whites' revolt against the many "newly liberated women [who] withdrew from the agricultural labor they had almost all performed within the plantation regime" and focused, instead, on caring for or "meeting the physical and emotional needs of the black body" (74). Threadcraft cites, as evidence, firsthand accounts of white male rioters' use of rape to coerce black women back to their "natural" role as servicers of whites' intimate desires, as well as fliers, produced by white male rioters, that demanded, "Negro women shall be employed by white persons" (72). Threadcraft reveals, second, that like "mainstream" political theorists, past and present black male scholars also ignore black women's embodied oppression at the crossroads of race and gender. The difficulty, Threadcraft [End Page 293] explains, is that these scholars' conceptualization of liberation focuses not on the intimate capacities associated with black women's subordination, but rather on "blacks' capacities for controlling their political and material environment" in the traditionally masculine public or "civic" sphere (27). One result is W. E. B. Du Bois's assumption that cultivating black people's capacity for reason—as opposed to, say, sexual autonomy—is most crucial in the struggle against racism. Another result is Tommie Shelby's failure to recognize that blacks in the "dark ghetto" are oppressed not only because of their "relegation to low-wage menial jobs within an advanced capitalist consumer society" (118), but also because many of them are victims of racist child protective services officers, sexual harassment, domestic violence, and other forms of intimate injustice. Finally, and perhaps most importantly, Threadcraft uses black male theorists' silence regarding black women's intimate, intersecting oppression as a departure point for determining what an empowering, gender-expansive understanding of black liberation looks like. The answer, Threadcraft concludes, lies in melding Afro-Modern conceptions of freedom and justice—as the ability to participate in civic life and the radical redistribution of material goods, respectively—with a more comprehensive, feminist understanding of these terms. Threadcraft draws on the work of feminists Iris Young, Martha Nussbaum, and Nancy Hirschman to make the more specific case that black freedom and justice are attainable when black women can (1) exercise intimate capabilities—such as making emotional attachments and controlling the movement of their bodies—and (2) do so in social and cultural contexts in which they, rather than men, have the "final say over the meaning of [their] sexual, reproductive, and caretaking actions" (60). Intimate Justice poses two other important questions: (1) How do we recognize a black woman when we see her? And (2) how do we recognize black women's...

Mammography utilization rates among young white and black women in the USA

Racial Differences in Stillbirth Risk Factors in Women Who Experienced Stillbirth During 2016

To compare central hemodynamics between white, black and Asian women in pregnancy. This was a prospective, longitudinal study of maternal central hemodynamics in white, black and Asian women with a singleton pregnancy, assessed using a bioreactance method at 11 + 0 to 13 + 6, 19 + 0 to 24 + 0, 30 + 0 to 34 + 0 and 35 + 0 to 37 + 0 weeks' gestation. At each visit, cardiac output (CO), stroke volume (SV), heart rate (HR), peripheral vascular resistance (PVR) and mean arterial pressure were recorded. Multilevel linear mixed-effects analysis was performed to compare the repeated measures of the cardiac variables between white, black and Asian women, controlling for maternal characteristics, medical history and medication use. The study population included 1165 white, 247 black and 116 Asian women. CO increased with gestational age to a peak at 32 weeks and then decreased; the highest CO was observed in white women and the lowest in Asian women. SV initially increased after the first visit but subsequently declined with gestational age in white women, decreased with gestational age in black women and remained static in Asian women. In all three study groups, HR increased with gestational age until 32 weeks and then remained constant; HR was highest in black women and lowest in white women. PVR showed a reversed pattern to that of CO; the highest values were in Asian women and the lowest in white women. The least favorable hemodynamic profile, which was observed in black and Asian women, was reflected in higher rates of a small-for-gestational-age infant. There are race-specific differences in maternal cardiac adaptation to pregnancy. White women have the most favorable cardiac adaptation by increasing SV and HR, achieving the highest CO and lowest PVR. In contrast, black and Asian women have lower CO and higher PVR than do white women, with CO increasing through a rise in HR due to declining or static SV. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Eliminating disparities in endometrial cancer: adherence to high-quality care is not enough

Background: Despite the prevalence of severe obesity, particularly among women and African-American women, there is little data on CV risk factor differences across the BMI spectrum including extreme obesity. Methods: Participants were 1200 black and white postmenopausal women sampled from the Women’s Health Initiative Observational Study according to BMI categories and waist circumference tertiles: 300 black and 300 white women with BMI 40-65 kg/m 2 and 75 black and 75 white women in BMI categories 8.5-&lt;25, 25-&lt;30, 30-&lt;35 and 35-&lt;40 kg/m 2 . Using stored baseline serum, total and high molecular-weight (HMW) adiponectin, leptin, ghrelin and insulin were measured by immunoassay; plasma lipoproteins and subclasses were measured by NMR spectroscopy. Race-ethnicity differences were tested in linear regression models adjusted for age, diabetes, BMI, waist, hip, hormone therapy and lipid-lowering medication. Results: Compared with white women, black women had lower levels of total and HMW adiponectin and ghrelin, and higher levels of insulin and leptin. Despite similar levels of total LDL particles (LDL-P), black women had lower levels of small LDL-P and higher levels of large LDL-P and larger mean LDL size. Levels of large HDL particles (HDL-P) and small HDL-P were also similar for black and white women, but black women had lower levels of total and medium HDL-P and larger mean HDL particle size. Black women also had lower levels of total, large, medium and small VLDL particles (VLDL-P) which increased little across BMI category, such that mean levels of total or large VLDL-P among black women with BMI≥ 40 kg/m 2 were lower than white women of normal BMI (&lt;25 kg/m 2 ) (Figure). Among white, but not black women, total LDL-P was higher and total HDL-P was lower with higher BMI category (Figure). Conclusions: Among postmenopausal women of similar BMI and waist circumference, black women have lower levels of ghrelin and total and HMW adiponectin, but better lipoprotein levels that are less related to obesity compared with white women.