African American Origin Research Articles

Consumers' intention to use generic-drug discount programmes

Abstract Objective Generic-drug discount programmes (GDDPs) offer generic drugs at subsidized costs to both insured and uninsured consumers in the USA. Understanding predictors of intention to use GDDPs could help in developing interventions to direct more consumers to take advantage of such programmes. The objective of this study was to identify predictors of intention to use GDDPs using the theory of planned behaviour (TPB). Methods A paper-based survey was self-administered to randomly selected individuals from the greater Houston area in Texas, USA. The validated questionnaire included potential predictors of intention to use GDDPs that were derived and measured using the premise of TPB and the concept of awareness. Logistic regression was performed to evaluate if awareness, attitude towards GDDPs and generic drugs, perceived behavioural control (PBC) and subjective norms predicted intention to use GDDPs after controlling for demographics, income, number of chronic conditions and number of prescription drugs taken. Key findings A response rate of 59.5% was achieved (n = 663). Approximately 62.4% (414) respondents were aware of and 80% (528) had an intention to use GDDPs. After controlling for demographics and predisposing factors (current prescription drug use, chronic conditions and insurance status), attitude towards GDDPs (odds ratio, OR = 5.08; 95% confidence interval, CI = 3.228–8.003; P < 0.0001), attitude towards generic drugs (OR = 1.733; CI = 1.231–2.441; P = 0.0016) and PBC (OR = 1.57; CI = 1.067–2.320; P = 0.0222) significantly predicted intention to use GDDPs. Individuals of Hispanic and African American origin were 3.1 times (P = 0.0016) and 2.6 times (P = 0.0173) more likely, respectively, than white people to have an intention to use GDDPs. Conclusions Attitude towards GDDPs and generic drugs, PBC, location and race/ethnicity were significantly associated with intention to use GDDPs. Interventions by stakeholders to promote positive attitudes and highlighting the ease with which GDDPs can be used would be beneficial to eventually increase consumer utilization of GDDPs.

Age at Diagnosis of Autism Spectrum Disorders

Early identification of autism has become a national priority but, despite efforts, there are children who are being identified at a later age. In this study, children of Hispanic and African American origin, foreign-born children, and children born to foreign mothers were more likely to be diagnosed later.

An elevated D-dimer value: a burden on our patients and hospitals

With 200,000 annual deaths in the United States due to pulmonary embolism (PE), efficient and accurate diagnosis is mandatory. Since negative D-dimer values are only useful in ruling out PE, elevated values alone should not result in excessive testing. This study assessed the diagnostic and financial yield of the D-dimer in diagnosing PE. This retrospective review of 220 medical records of patients at a South Chicago Community Hospital explored the extent of the work-up following an elevated D-dimer for a suspected PE. Patients were randomly selected with no exclusion criteria. Five of the 118 (4.2%) patients with elevated D-dimer values were diagnosed with a PE. Tests ordered based on elevated D-dimer values were billed for more than $200,000. The current diagnostic approach has been medically and financially inefficient. Patients should not be worked-up for a PE based primarily on an elevated D-dimer value. Two prominent factors, independent of PE, that result in elevated D-dimer values and were pertinent to the studied population, are age and African-American origin. Implementing a scoring system, like the revised-Geneva scale, will establish a better index of suspicion to improve both the physician’s diagnostic approach and the yield of the work-up.

Age‐dependent changes in eumelanin composition in hairs of various ethnic origins

Hair pigmentation is one of the most conspicuous phenotypes of humans. From a chemical point of view, however, data remain scarce regarding human hair pigmentation characteristics. To determine melanin content and composition in human eumelanic hair from individuals of different ethnic origins and at different ages, we collected hair from 56 subjects with eumelanic hair from each group of African-American, East Asian, and Caucasian origin. The 56 subjects consist of 14, seven each of males and females, each from four age classes of younger than 11, between 12 and 19, between 20 and 45, and older than 46. We analysed hair colour scale, total melanin value, and contents of pyrrole-2,3,5-tricarboxylic acid (PTCA) and pyrrole-2,3-dicarboxylic acid (PDCA). We measured age-dependent increases in the relative quantity of eumelanin in pigmented human hairs in the three ethnic groups. Regarding melanin composition, we observed an increase in the PDCA/PTCA ratio with age in African-American and Caucasian hairs until approaching the quite constant level of the ratio in East Asian hairs in the elderly individuals. Our results evidence differences in the content and composition of eumelanin in human hair among African-American, Caucasian and East Asian individuals. Furthermore, we show evidence of age-dependent changes in the quantity and quality of eumelanin in pigmented human hairs. In particular, the age-dependent modification of the PDCA/PTCA ratio, a marker for 5,6-dihydroxyindole units in eumelanin, suggests a chronological evolution of hair follicle melanocyte phenotype (e.g. decrease in dopachrome tautomerase expression).

Large-scale genome-wide association study of Asian population reveals genetic factors in FRMD4A and other loci influencing smoking initiation and nicotine dependence

Diseases related to smoking are the second leading cause of death in the world. Cigarette smoking is a risk factor for several diseases such as cancer and cardiovascular and respiratory disorders. Despite increasing evidence of genetic determination, the susceptibility genes and loci underlying various aspects of smoking behavior are largely unknown. Moreover, almost all reported genome-wide association studies (GWASs) have been performed on samples of European origin, limiting the applicability of the results to other ethnic populations. In this first GWAS on smoking behavior in an Asian population, after analyzing 8,842 DNA samples from the Korea Association Resource project with 352,228 single nucleotide polymorphisms (SNPs) genotyped for each sample, we identified 8 SNPs significantly associated with smoking initiation (SI) and 4 with nicotine dependence (ND). Because of the current unavailability of an independent Asian smoking sample, we replicated the discoveries in independent samples of European-American and African-American origin. Of the 12 SNPs examined in the replicated samples, we identified two SNPs, in the regulator of G-protein signaling 17 gene (rs7747583, p value(meta)=6.40×10(-6); rs2349433, p value(meta)=5.57×10(-6)), associated with SI. Also, we found two SNPs significantly associated with ND; one in the FERM domain containing 4A (rs4424567, p value(meta)=2.30×10(-6)) and the other at 7q31.1 (rs848353, p value(meta)=9.16×10(-8)). These SNPs represent novel targets for examination of smoking behavior and warrant further investigation using independent samples.

Physician Switching After Drug Request Refusal

Physician switching is a barometer of the quality of the relationship between a patient and a physician. Understanding the factors associated with physician switching in the context of direct-to-consumer advertising (DTCA) of prescription drugs has been largely unexamined. A total of 818 of 2,988 participants in a national telephone survey (27.4%) who had received DTCA reported asking their physician for a prescription drug, and 196 (24.0%) reported that their physician refused to prescribe the drug. Of those whose physicians refused, 13.9% (n = 27 of 194 with data) switched doctors. We found that individuals with regular medical-seeking behavior, full prescription drug coverage, with certain chronic conditions, and of African American origin were significantly more likely to switch physicians in this context.

Outcomes in children who underwent transplantation for autoimmune hepatitis

The outcomes of 113 children with autoimmune hepatitis (AIH), registered with Studies of Pediatric Liver Transplantation and who underwent transplantation between 1995 and 2006, were compared with those who underwent transplantation for other diagnoses (non-AIH). A total of 4.9% of liver transplants were for AIH; 81% of these patients had AIH type 1 and most underwent transplantation for complications of chronic disease (60%), the majority in females (72%). Transplantation for fulminant AIH was more common in males (52.5% versus 47.5% chronic; P = 0.042). Patients with AIH differed from non-AIH patients by: age (13.0 ± 0.4 versus 4.6 ± 0.1 years; P < 0.0001), sex (64.6% female versus 52.9%; P = 0.016), ethnicity (48.7% white versus 58.2%; P < 0.0001), initial immunosuppression (tacrolimus-based: 72.6% versus 62.6%; P = 0.045; mycophenolate mofetil use: 31.0% versus 21.6%; P = 0.02), and immunosuppression at 2 years after transplant (monotherapy: 51.9% versus 17.3%; P < 0.0001). Late (>3 months), but not steroid-resistant or chronic, rejection was more common in AIH (log-rank P = 0.0015). The 5-year posttransplant survival for AIH was 86% (95% confidence interval: 73-93). Patient and graft survival, infectious and metabolic complications, and retransplantation rates did not differ between AIH and non-AIH groups. In conclusion, the higher risk for late acute rejection and greater degree of immunosuppression does not compromise outcomes of liver transplantation for AIH. Children who undergo transplantation for AIH in North America are typically female adolescents with complications of chronic AIH type 1 and include more children of African American or Latino American origin compared to the overall liver transplant population. These observations may inform detection, treatment, and surveillance strategies designed to reduce the progression of autoimmune hepatitis and subsequently, the need for transplantation.

Do social networks push families toward or away from youth mental health services?: A national study of families in child welfare.

Social support networks may encourage or dissuade help-seeking for youth behavior problems in ways that contribute to racial/ethnic disparities in mental health services. We examined how parental social network characteristics were related to the use of mental health services in a diverse sample of families in contact with Child Welfare. Data from 1519 families of White (n=812), African American (n=418), and Latino (n=289) origin were drawn from the National Survey of Child and Adolescent Well-Being. Data were collected prospectively after the initiation of a Child Welfare investigation for alleged maltreatment. Results revealed that parental perceptions of support were negatively associated with service use across racial/ethnic groups, and this association was explained by better subsequent mental health status enjoyed by children of parents with stronger social support. Moderator analyses suggested that larger social networks were associated with a decreased use of services among Whites and more highly educated families.

Replication and extension of association of choline acetyltransferase with nicotine dependence in European and African American smokers

Choline acetyltransferase is critical in the synthesis of acetylcholine and regulation of cholinergic neuron functions. We recently reported association of the encoding gene ChAT with both smoking cessation and nicotine dependence (ND) in two independent European American (EA) samples; however, in the replication sample, only limited SNPs partially covering the gene were examined. In this study, we examined the association of 14 SNPs, which cover the entire gene, with ND, assessed by smoking quantity (SQ), heaviness of smoking index (HSI), and Fagerström Test for ND (FTND), in 2,037 subjects from 602 families of African American (AA) or EA origin. Individual SNP-based association analysis revealed that five SNPs showed nominal association with at least one ND measure in one of the samples (P = 0.022-0.042); none remained significant after correction for multiple testing. Haplotype-based association analysis revealed that haplotypes G-G-A-C, formed by rs1880676-rs3810950-rs10082479-rs8178990 (P = 0.005-0.0178), and G-G-T-C-G-C, formed by rs1880676-rs3810950-rs10082479-rs8178990-rs3793790-rs12266458 (P = 0.00247-0.00468), displayed significant association with all three ND measures in the AA sample, as did haplotype T-C-G-A-T, formed by rs12266458-rs11101191-rs8178991-rs4838544-rs4838547 (P = 0.00741-0.0103), in the EA sample. All these detected haplotype-based associations remained significant after correction for all major haplotypes for a given SNP combination. Together, our findings, in conjunction with the previous report of the association, warrant further investigation of ChAT in ND.

Sterilization Racism and Pan-Ethnic Disparities of the Past Decade: The Continued Encroachment on Reproductive Rights

I n the late 1960s and through the 1970s, reports of coercive, involuntary, and otherwise nonconsenting sterilizations of American Indian, African American, Mexican, and Puerto Rican origin women began surfacing in the United States.1 These revelations came at a time of intense civil rights activity and political consciousness among non-white2 groups in the United States. American Indian and African American women and girls were especially impacted by sterilization abuse. In a well-known case, recounted by Jane Lawrence, Dr. Connie PinkertonUri saw a twenty-six-year-old patient in early November 1972 who visited her clinic and requested a womb transplant.3 It turned out that the woman was given a full hysterectomy (for alcohol* ism) at age twenty after being told by an Indian Health Services (IHS) > doctor that the procedure was reversible. Other scholars have noted cases of American Indian women receiving hysterectomies as young « as age eleven.4 These cases are similar to the experiences of African 2 American women and girls, such as the Reif sisters, ages twelve and i fourteen, who were the unwilling and unknowing recipients of tubai 5 17 sterilization as well as guinea pigs for intrauterine devices and what o were then experimental DepoProvera shots (along with their older ° sister, Katie) in the early 1970s.5 African American civil rights leader £ Fannie Lou Hamer was compelled to get involved in the modern civil « rights movement, in part, after receiving a Mississippi Appendectomy

Genome size variation in Begonia

The genome sizes of a Begonia collection comprising 37 species and 23 hybrids of African, Asiatic, Middle American, and South American origin were screened using flow cytometry. Within the collection, 1C values varied between 0.23 and 1.46 pg DNA. Genome sizes were, in most cases, not positively correlated with chromosome number, but with pollen size. A 12-fold difference in mean chromosome size was found between the genotypes with the largest and smallest chromosomes. In general, chromosomes from South American genotypes were smaller than chromosomes of African, Asian, or Middle American genotypes, except for B. boliviensis and B. pearcei. Cytological chromosome studies in different genotypes showed variable chromosome numbers, length, width, and total chromosome volume, which confirmed the diversity in genome size. Large secondary constrictions were present in several investigated genotypes. These data show that chromosome number and structure exhibit a great deal of variation within the genus Begonia, and likely help to explain the large number of taxa found within the genus.

Evaluation of C1q genomic region in minority racial groups of lupus.

Complement cascade plasma proteins play a complex role in the etiopathogenesis of systemic lupus erythematosus (SLE). Hereditary C1q deficiency has been strongly related to SLE; however, there are very few published SLE studies that evaluate the polymorphisms of genes encoding for C1q (A, B and C). In this study, we evaluated 17 single nucleotide polymorphisms (SNPs) across 37 kb of C1QA, C1QB and C1QC in a lupus cohort of individuals of the African-American and Hispanic origin. In a case-only analysis, a significant association at multiple SNPs in the C1QA gene was detected in African Americans with kidney nephritis (best P=4.91 x 10(-6)). In addition, C1QA was associated with SLE in African Americans with a lack of nephritis and accompanying photosensitivity when compared with that in normal controls (P=6.80 x 10(-6)). A similar trend was observed in the Hispanic subjects (P=0.003). Quantitative analysis showed that some SNPs in C1q genes might be correlated with C3 complement levels in an additive model among African Americans (best P=0.0001). The C1QA gene is associated with subphenotypes of lupus in the African-American and Hispanic subjects. Further studies with higher SNP densities in this region and other complement components are necessary to elucidate the complex genetics and phenotypic interactions between complement components and SLE.

Technical note: Prediction of sex based on five skull traits using decision analysis (CHAID)

Osteologists commonly assess the sex of skeletal remains found in forensic and archaeological contexts based on ordinal scores of subjectively assessed sexually dimorphic traits. Using known-sex samples, logistic regression (LR) discriminant functions have been recently developed, which allow sex probabilities to be determined. A limitation of LR is that it emphasizes main effects and not interactions. Chi-square automatic interaction detection (CHAID) is an alternative classification strategy that emphasizes the information in variable interactions and uses decision trees to maximize the probability of correct sex determinations. We used CHAID to analyze the predictive value of the 31 possible combinations of five sexually dimorphic skull traits that Walker used previously to develop logistic regression sex determination equations. The samples consisted of 304 individuals of known sex of English, African American, and European American origin. Based on practical considerations, selection criteria for the best sex predictive trait combinations (SPTCs) were set at accuracies for both sexes of 75% or greater and sex biases lower than 5%. Although several of the trees meeting these criteria were produced for the English and European American samples, none met them for the African American sample. In the series of out-of-sample tests we performed, the trees from the English and combined sample of all groups predicted best.

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Detection of Genetic Association and a Functional Polymorphism of Dynamin 1 Gene with Nicotine Dependence in European and African Americans

Although it has been documented that dynamin 1 gene (DNM1) is significantly modulated by nicotine in animal models, its association with nicotine dependence (ND) in human population remained to be unexplored. To determine whether DNM1 is associated with ND, in this study, we genotyped seven single-nucleotide polymorphisms (SNPs) within this gene in 602 nuclear families of either African-American (AA) or European-American (EA) origin. Individual SNP-based association analysis revealed a significant association of SNP rs3003609 with Smoking Quantity (SQ; P = 0.0031) and Heaviness of Smoking Index (HSI; P = 0.0042) in the EA sample. Furthermore, our haplotype-based association analyses indicated that haplotypes T-G-T, formed by rs2502731-rs2229917-rs3003609 (at a frequency of 54%), G-T-A, formed by rs2229917-rs3003609-rs16930313 (at a frequency of 52%), and T-A-G, formed by rs3003609-rs16930313-rs7022174 (at a frequency of 52%) are significantly associated with SQ (Z = −2.44~−2.92; P = 0.015~0.0055) and HSI (Z = −2.52~−2.67; P = 0.012~0.0076) in the EA sample. In the AA sample, another haplotype, G-T-A, formed by rs7875406-rs2502731-rs2229917, at a frequency of 12% was significantly associated with SQ (Z = −2.58; P = 0.0098). Finally, by using in vitro gene expression assays, we demonstrated that the T allele of rs3003609 in the exon 9 of DNM1 significantly decreases the expression of dynamin 1, by 27.1% at the mRNA and 22.0% at the protein level, suggesting that rs3003609 represents a functional polymorphism affecting DNM1 expression and may partly contributed to the observed association of the gene with ND in our samples. Taken together, our findings indicate that dynamin 1 is likely involved in the etiology of ND and represents a plausible candidate for further investigation in independent samples.

Rate of arterial occlusion in patients with acute ischemic stroke

Objective: Computed tomographic angiography (CTA) was invented more than 20 years ago, but only gained acceptance recently, thanks to advancements in the computer technology. It can demonstrate areas of arterial stenosis or occlusion with accuracy nearly that of digital subtraction angiography (DSA). It is also able to clearly illustrate calcification, which is more difficult to define on magnetic resonance angiography and is not clearly depicted on DSA.Methods: Our retrospective study attempted to clarify the rate of occlusion or stenosis in the patients with acute ischemic stroke.Results: Over the period of 7 months, 93 consecutive patients were admitted with acute ischemic stroke. Fifty-six patients underwent CTA and were included in this study. Most of the patients were admitted after 6 hours following onset of symptoms. There were 28 men and 28 women, and 80.4% of the cohort was of African-American origin. The majority of strokes were attributed to small-vessel disease (25/56). The rest of the cases were deemed secondary to atheroembolism (15/56), cardioembolism (9/56) or of unclear etiology (7/56). In 24 (42.9%) patients, CTA failed to reveal any abnormalities of the cerebrovascular tree. CTA demonstrated arterial occlusion in ten (17.9%) patients and stenosis of extracranial or intracranial arteries on the symptomatic side in 22 (39.2%) patients. There was very good correlation between CTA and ultrasound techniques (carotid duplex and transcranial Doppler). CTA was superior in demonstrating distal intracranial stenosis.Conclusion: Overall, CTA is an extremely valuable and fast way to emergently evaluate the cerebrovascular anatomy, making it very useful for pre-thrombolysis evaluation of patients with ischemic stroke.

The illusion of minority status

It is common to think in terms of ‘minority’ admissions when considering displaced Natives (First Nations peoples) or populations who capture lower percentages of total physicians when compared with their percentage of the population. In America, the African American, rural, Hispanic, and lower income origin physicians are all ‘underrepresented’. Each group captures less than 10% of total physician graduates. The use of the terms ‘minority’ or ‘diverse’ should be recognized as a construct of those shaping workforce studies. It is a perception and a series of observations, typically from past tradition or based on majority status.

Association of amyloid precursor protein-binding protein, family B, member 1 with nicotine dependence in African and European American smokers

Although epidemiological studies reveal that cigarette smoking is inversely associated with Alzheimer's disease (AD) and Parkinson's disease (PD), the underlying mechanism remains largely unknown. Considering the facts that amyloid precursor protein-binding protein, family B, member 1 (APBB1) is mapped to a suggestive linkage region on chromosome 11 for nicotine dependence (ND), and has been implicated in the pathogenesis of AD and PD, it represents a plausible candidate for genetic study of ND. Five single nucleotide polymorphisms (SNPs) within APBB1 were genotyped in a sample consisting of 2,037 participants of either African-American (AA) or European-American (EA) origin, and examined their associations with ND assessed by three commonly used measures: Smoking Quantity (SQ), the Heaviness of Smoking Index (HSI), and the Fagerström Test for ND (FTND). Individual SNP-based association analysis showed that all five SNPs are associated with at least one ND measure in one of the three samples; however, only the association of SNP rs4758416 with SQ and HSI remained significant after correction for multiple testing in the pooled sample. Haplotype analysis demonstrated three major haplotypes significantly associated with ND after Bonferroni correction. Formed by rs4758416-rs10839562-rs1079199, haplotype C-C-T showed positive association with FTND in the AA and pooled samples, and conversely, haplotype G-C-T showed negative association with SQ and HSI in AA and EA samples. Another haplotype, C-T-G, formed by rs10839562-rs1079199-rs8164, was significantly associated with HSI in the EA sample. Based on these findings, we conclude that APBB1 represents an important candidate gene in the genetic study on ND and neurodegenerative diseases and warrants further investigation in future.

The Population Reference Sample, POPRES: A Resource for Population, Disease, and Pharmacological Genetics Research

Technological and scientific advances, stemming in large part from the Human Genome and HapMap projects, have made large-scale, genome-wide investigations feasible and cost effective. These advances have the potential to dramatically impact drug discovery and development by identifying genetic factors that contribute to variation in disease risk as well as drug pharmacokinetics, treatment efficacy, and adverse drug reactions. In spite of the technological advancements, successful application in biomedical research would be limited without access to suitable sample collections. To facilitate exploratory genetics research, we have assembled a DNA resource from a large number of subjects participating in multiple studies throughout the world. This growing resource was initially genotyped with a commercially available genome-wide 500,000 single-nucleotide polymorphism panel. This project includes nearly 6,000 subjects of African-American, East Asian, South Asian, Mexican, and European origin. Seven informative axes of variation identified via principal-component analysis (PCA) of these data confirm the overall integrity of the data and highlight important features of the genetic structure of diverse populations. The potential value of such extensively genotyped collections is illustrated by selection of genetically matched population controls in a genome-wide analysis of abacavir-associated hypersensitivity reaction. We find that matching based on country of origin, identity-by-state distance, and multidimensional PCA do similarly well to control the type I error rate. The genotype and demographic data from this reference sample are freely available through the NCBI database of Genotypes and Phenotypes (dbGaP).

Bitter taste receptor gene polymorphisms are an important factor in the development of nicotine dependence in African Americans

Context:Bitter sensitivity varies among individuals and ethnic groups partly due to polymorphisms in taste receptor genes (TAS2Rs). Although previous psychophysical studies suggest that taste status plays a role in nicotine...