Between-race Differences Research Articles

Racial Disparities in Outcomes of Delivery and Cardiac Complications Among Pregnant Women with Congenital Heart Disease.

Advances in cardiology have led to improved survival among patients with congenital heart disease (CHD). Racial disparities in cardiovascular and maternal outcomes are well known and are likely to be more profound among pregnant women with CHD. Using the 2001 to 2018 National Inpatient Sample, we identified all hospitalizations for delivery among women ≥ 18years of age with CHD. Unadjusted and adjusted between-race differences in adverse maternal cardiovascular, obstetric, and fetal events were assessed using logistic regression models. During the study period, we identified 52,711 hospitalizations for delivery among women with concomitant CHD. Of these, 66%, 11%, and 16% were White, Black, and Hispanic, respectively. Obstetric complications and fetal adverse events were higher among Blacks compared to Whites and Hispanics (44% vs. 33% vs. 37%, p < .001; 36% vs. 28% vs. 30%, p < .001), respectively. No between-race differences were observed in overall cardiovascular adverse events (27% vs. 24% vs. 23%, p < .21). However, heart failure was significantly higher among Black women (3.6% vs. 1.7% vs. 2.2%, p = 0.001). While a lower income quartile was associated with higher rates of adverse outcomes, adjustment for income did not attenuate the adverse impact of race. Black females with CHD diagnoses were more likely to experience adverse obstetric, fetal events, and heart failure compared to White and Hispanic women irrespective of their income status. Further research is needed to identify causes and devise interventions to mitigate racial disparities in the care of pregnant women with CHD.

RACE AND PLACE: PHYSICAL PERFORMANCE DECLINES IN BLACK AND WHITE OLDER ADULTS IN FOUR US COMMUNITIES

Abstract Studies suggest disparities in physical function between Black and White adults, but most lack longitudinal, objective functional measures across race and geographic regions. We examined Short Physical Performance Battery (SPPB) changes among 5,836 Black and White older adults (&amp;gt;65 years, 22% Black, 41% men) with up to three SPPB assessments. Exams were conducted in the Atherosclerosis Risk in Communities Study (Visit 5 (2011-13)-Visit 7 (2017-19), median follow-up 5.8 years (max 8.4)) in four US communities: North Carolina (n=1248; 7% Black), Mississippi (n=1179, 100% Black), Maryland (n=1618; 0.9% Black) and Minnesota (N=1791; n=0.5% Black). A difference of 0.5 SPPB points (scored 0-12) is clinically meaningful. SPPB declines were estimated using marginal standardization following GEE (with log-links, negative binomial distributions, exchangeable covariance, robust SE, adjusting for demographics, BMI, diabetes, hypertension, smoking, drinking status, heart failure, heart disease, and stroke). SPPB declines were 3.4 times greater among Black versus White participants overall; -1.99 versus -0.59 points; absolute difference=-1.41 (95% CI: -1.67,-1.14), relative difference=3.40 (2.65, 4.15). However, some within-race, between-site differences were similar; Maryland-White SPPB declines were 3.8 (2.3, 6.3) times greater than North Carolina-White SPPB declines, and Mississippi-Black declines were 2.5 (1.10, 5.90) times greater than North Carolina-Black declines. Furthermore, between-race (Black versus White) differences were less supported statistically within the same site; SPPB declines were 2.2 (0.85, 5.80) greater in Black than White participants in North Carolina. This suggests that regional variations in physical function declines may be at least as strong as differences attributed to race; both are important to consider.

Allometric analysis of sexual dimorphism and morphological variation in two chromosome races of the Sceloporus grammicus complex (Squamata: Phrynosomatidae) from Mexico

Sexual dimorphism is a widespread feature in the Animal Kingdom. In lizards of the Sceloporus grammicus complex, studies of sexual dimorphism that analyze the allometric trajectories of body traits remain unexplored. Here we investigate sexual dimorphism in key phenotypic traits, including body size (snout-vent length, SVL) as well as head length (HL), head width (HW), and forearm length (FL). We use an allometric approach to detect differences in scale relationships among body parts in the S. grammicus complex in Mexico. We focus on two chromosomal races within this complex, F5 (2n = 34) and FM2 (2n = 46). In the complex, we found that males are larger than females in all morphological variables, and this pattern was confirmed in both races. We determined negative allometric trajectories (SVLvs.HL and HW), isometry (SVLvs.FL) and intersexual differences in the slopes of the SVLvs.HL and HW; the males showed steeper slopes. Thus, the growth of the head is more pronounced in males than females. Additionally, we found between-race differences in these trajectories (SVLvs.FL) and in all morphological variables (F5 lizards are larger than those of the FM2 race), which correlate with their chromosomal divergence. We discuss biological implications of our findings in relation to sexual selection and natural selection.

Investigating racial bias within Australian rules football commentary.

International research has shown that live sports commentary exhibits racial bias. Specifically, non-White players are more likely to be praised in terms of their physicality, while White players are more likely to be praised in terms of their intellect and character. The current study, which utilised a quantitative content analysis design, examined whether the speech of AFL commentators exhibited racial bias. The study randomly selected 50 men’s AFL game quarters from the 2019 AFL season and analysed 1368 applicable statements directed at 382 unique players. Based on prior research, a coding instrument was developed that incorporated three main categories (physical, cognitive, and character attributes), and six subcategories (physical ability, appearance, cognitive ability, intelligence, general character, and hard work). In contrast to the international literature, findings revealed that there were no significant between-race differences for each main attribute category. However, non-White players received a higher proportion of statements related to their physical ability, and a lower proportion of statements related to their appearance compared to White players. Non-White players also received a higher proportion of negative statements related to their cognitive ability compared to White players. There was no evidence found to suggest that players of any race were discussed in terms of their physical ability being innate, natural, or instinctual. Given the strong, but also dated, evidence showing racial bias within both American and European sports commentary, the current study provides only weak evidence for the existence of racial bias within contemporary AFL live commentary.

Determinants of hospital outcomes for patients with COVID-19 in the University of Pennsylvania Health System.

There is growing evidence that racial and ethnic minorities bear a disproportionate burden from COVID-19. Temporal changes in the pandemic epidemiology and diversity in the clinical course require careful study to identify determinants of poor outcomes. We analyzed 6255 hospitalized individuals with PCR-confirmed SARS-CoV-2 infection from one of 5 hospitals in the University of Pennsylvania Health System between March 2020 and March 2021, using electronic health records to assess risk factors and outcomes through 8 weeks post-admission. Discharge, readmission and mortality outcomes were analyzed in a multi-state model with multivariable Cox models for each transition. Mortality varied markedly over time, with cumulative incidence (95% CI) 30 days post-admission of 19.1% (16.9, 21.3) in March-April 2020, 5.7% (4.2, 7.5) in July-October 2020 and 10.5% (9.1,12.0) in January-March 2021; 26% of deaths occurred after discharge. Average age (SD) at admission varied from 62.7 (17.6) to 54.8 (19.9) to 60.5 (18.1); mechanical ventilation use declined from 21.3% to 9–11%. Compared to Caucasian, Black race was associated with more severe disease at admission, higher rates of co-morbidities and residing in a low-income zip code. Between-race risk differences in mortality risk diminished in multivariable models; while admitting hospital, increasing age, admission early in the pandemic, and severe disease and low blood pressure at admission were associated with increased mortality hazard. Hispanic ethnicity was associated with fewer baseline co-morbidities and lower mortality hazard (0.57, 95% CI: 0.37, .087). Multi-state modeling allows for a unified framework to analyze multiple outcomes throughout the disease course. Morbidity and mortality for hospitalized COVID-19 patients varied over time but post-discharge mortality remained non-trivial. Black race was associated with more risk factors for morbidity and with treatment at hospitals with lower mortality. Multivariable models suggest there are not between-race differences in outcomes. Future work is needed to better understand the identified between-hospital differences in mortality.

Depressive and Anxiety Disorders in Alcohol Use and Related Problems among Older African Americans

Suicide is a serious public health concern, particularly for individuals in later life. Studies suggest that greater attention to suicide prevention programs for older adults is needed as well as continued research related to interventions with older adults at risk of attempting suicide. A systematic review of the literature on suicide prevention treatment and effectiveness is fundamental to assessing existing services and developing new programs and practice standards. This systematic review of the literature extends an earlier and well-cited systematic review (1966-2009) by examining articles published between 2009 and 2021 with a focus on what types of empirically evaluated suicide prevention programs effectively prevent and reduce suicidality in older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to gather the appropriate extant research and improve reporting accuracy. A three-stage review guided the selection of the articles. At stage one, titles were screened, which excluded 284 articles based on the inclusion criteria. Second, after a full review of each abstract, a final 14 articles remained for full-text review. Lastly, three independent researchers reviewed each of the full-text articles, and six articles were excluded. The final sample includes eight articles (N=8). The articles were categorized into three types of programs: 1) primary and home health care, 2) community-based outreach, and 3) counseling. Following a description of the articles, the authors assessed each study using the GRADE rating system. Findings underscore the critical need for evidence-based suicide prevention programs for older adults. Implications for future research are offered.

Abstract 16333: Racial Differences in Pressure-volume Relationships in Val122Ile Associated Cardiac Amyloidosis

Background: Transthyretin cardiac amyloidosis (ATTR-CA) is the leading cause of restrictive cardiomyopathy in older adults. The valine-to-isoleucine substitution (Val122Ile) is the most common inherited variant in the U.S., primarily affecting patients of Afro-Caribbean descent. This variant has also been identified in white individuals in Northern Italy who present with a similar disease phenotype. It is unknown whether there are between-race differences in cardiac chamber function at diagnosis of Val122Ile associated ATTR-CA. Methods: In this retrospective study of 70 patients from two amyloid centers with Val122Ile associated ATTR-CA diagnosed over two decades, clinical and echocardiographic features at diagnosis were compared between races. Cardiac chamber performance was compared using noninvasive, single beat pressure-volume analysis. Results: Average age at diagnosis was 72 years. Compared to white patients (n=17), black individuals (n=53) had lower systolic blood pressure (110 vs. 131 mmHg , p&lt;0.001), reduced pulse pressure (41 vs. 58 mmHg, p&lt;0.001), and impaired renal function (eGFR 46 vs. 67 mL/min/1.73m 2 , p&lt;0.001) at the time of diagnosis. End-systolic pressure-volume relationship (2.3 vs. 1.9 mmHg/mL, p = 0.88), and arterial elastance (3.0 vs. 3.0 mmHg/mL, p = 1.0) were similar between groups (Panel A). Black patients had an end-diastolic pressure-volume relationship shifted upward and leftward relative to white patients, indicating reduced left ventricular capacity. Accordingly, pressure-volume area at a left ventricular end-diastolic pressure of 30 mmHg was lower in black compared to white individuals (8,415 vs. 11,538 mmHg*mL, p = 0.012, Panel B). Conclusion: Despite presenting at a similar age to white patients, black individuals with Val122Ile associated ATTR-CA have a greater degree of cardiac remodeling which drives reduced overall chamber function. These findings suggest a more aggressive disease phenotype.

Abstract D123: The intersection of race and delivery of guideline-based: How treatment disparities drive racial disparities in muscle-invasive bladder cancer

Abstract Objective For patients with muscle-invasive bladder cancer, studies have shown black race is associated with 21% lower odds of guideline-based treatment (GBT) and differences in treatment explain 35% of observed black-white differences in survival. We aim to understand how the interaction between race/ethnicity and receipt of GBT drive within-race and between-race differences in survival for black, white, and latino patients with muscle-invasive bladder cancer. Methods Using the National Cancer Database, we identified individuals diagnosed with cT2-4 muscle invasive bladder cancer (MIBC) from 2004-2013. Cox regression models included random effects to accommodate intra-facility correlations of outcome response. Models were adjusted for race, age at diagnosis, gender, histology, clinical T and N stages, treatment (GBT vs nonGBT), Charslon comorbidity index, insurance, and facility type with inclusion of the GBT-by-race interaction effect. Hazard ratios (HR) and 95% confidence intervals (CI) were reported. P value of 0.05 was considered statistically significant. Results Of the 60,566 individuals identified, 90.1% were white, 6.9% black, and 3% latino. Most were 60 years or older (84.6%), had cT2 disease (76.4%), cNo/x (92.9%) and had urothelial carcinoma (88.6%). Nearly one-third were female (28.3%). Most were treated at an academic center (34.9%) or comprehensive cancer center (46.3%). Half (50.2%) received GBT. On MV models clustered by treatment facility, GBT was associated with increased survival (HR 0.76, 95% CI 0.72-0.80) compared to nonGBT when averaged across all race groups. GBT benefit was similar for black and white individuals (black, HR 0.71, 95% CI 0.65-0.77; white, HR 0.72, 95% CI 0.70-0.74) but latino individuals experienced less benefit (HR 0.85, 95% 0.74-0.97) compared to nonGBT. From the GBT-by-race interaction, the GBT effect was near equivalent for black race (HR 0.97, 95% CI 0.90-1.07) compared to white counterparts but stronger for both when compared to latino individuals (black, HR 0.83, 95% CI 0.71-0.97; white, HR 0.85, 95% CI 0.74-0.97). Black individuals who received GBT had worse survival compared to white (HR 1.12, 95% CI 1.05-1.20) and latino counterparts (HR 1.14, 95% CI 1.01-1.29). Of those with nonGBT, white (HR 1.20, 95% CI 1.09-1.32) and black individuals (HR 1.38, 95% CI 1.24-1.53) had worse survival compared to latino individuals. Lastly, mortality risk of black individuals with GBT was near equivalent to latino patients receiving nonGBT (HR 0.97, 95% CI 0.87-1.09). Conclusions The GBT effect was not uniform, with a 28-29% reduction in mortality risk experienced by white and black individuals but 15% reduction for latino counterparts. Our study illustrates how race-based treatment disparities influence survival outcomes and extend beyond black-white comparisons. Future efforts to improve the delivery of GBT, a factor directly impacted by urologic can providers, may mitigate the race-based survival differences observed in individuals with MIBC. Citation Format: Sikai Song, Maxwell V Meng, Anne M Suskind, Sima P Porten, Samuel L Washington III, Steven Gregorich. The intersection of race and delivery of guideline-based: How treatment disparities drive racial disparities in muscle-invasive bladder cancer [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 D123.

Missed opportunity: An intersectional approach to disparities in long-term survival in bladder cancer.

476 Background: For individuals with muscle-invasive bladder cancer (MIBC), studies focused on racial disparities have shown black race is associated with 21% lower odds of guideline-based treatment (GBT) and differences in treatment explain 35% of observed black-white differences in survival. To characterize how the interaction between race/ethnicity and receipt of GBT drive within- and between-race differences in survival for black, white, and Latino individuals with MIBC. Methods: We identified a cohort of individuals with cT2-4 MIBC from 2004-2013 in the National Cancer Database. GBT was defined by American Urological Association guidelines. A Cox proportional hazards model of patient mortality estimated effects of patient GBT status, race/ethnicity, and the GBT-by-race/ethnicity interaction, adjusting for covariates. Results: Of 54,910 MIBC individuals with 125,821 person-years of post-treatment observation (max=11 years), 90.1% were white, 6.9% black, and 3.0% Latino. Half (50.2%) received GBT. Averaging across GBT status, Latino individuals had lower hazard of death compared to black (HR 0.81, 95% CI 0.75-0.87) and white individuals (HR 0.92, 0.86-0.98). With GBT, Latino and white individuals had similar outcomes (HR=1.00, 0.91-1.10) and both groups fared significantly better than black individuals (HR=0.88, 0.79-0.99 and HR=0.88, 0.83-0.94, respectively). Without GBT, Latino individuals fared better than white (HR=0.85, 0.77-0.93) and black individuals (HR=0.74, 0.67-0.82) while white individuals fared better than black individuals (HR=0.87, 0.83-0.92). Latino without GBT fared better than black individuals with GBT (H=0.98, 0.88-1.09), although not statistically significant. Conclusions: Our study finds that not only are GBT levels generally low, which is concerning, but there is also an apparent 'under-allocation' of GBT to a patient group who arguably needs it the most-- black individuals. Future efforts to improve the delivery of GBT, a factor directly impacted by urologic care providers, may mitigate the race-based survival differences observed in individuals with MIBC.

Editor's Choice: Deliberative and non-deliberative effects of descriptive and injunctive norms on cancer screening behaviors among African Americans

Objective: Two longitudinal studies examined whether effects of subjective norms on secondary cancer prevention behaviors were stronger and more likely to non-deliberative (i.e., partially independent of behavioral intentions) for African Americans (AAs) compared to European Americans (EAs), and whether the effects were moderated by racial identity. Design: Study 1 examined between-race differences in predictors of physician communication following receipt of notifications about breast density. Study 2 examined predictors of prostate cancer screening among AA men who had not been previously screened.Main Outcome Measures: Participants’ injunctive and descriptive normative perceptions; racial identity (Study 2); self-reported physician communication (Study 1) and PSA testing (Study 2) behaviors at follow up. Results: In Study 1, subjective norms were significantly associated with behaviors for AAs, but not for EAs. Moreover, there were significant non-deliberative effects of norms for AAs. In Study 2, there was further evidence of non-deliberative effects of subjective norms for AAs. Non-deliberative effects of descriptive norms were stronger for AAs who more strongly identified with their racial group. Conclusion: Subjective norms, effects of which are non-deliberative and heightened by racial identity, may be a uniquely robust predictor of secondary cancer prevention behaviors for AAs. Implications for targeted screening interventions are discussed.

Between-Race Differences in Supplemental Breast Cancer Screening Before and After Breast Density Notification Law

Guidelines recommend supplemental breast cancer screening for women at increased breast cancer risk; however, the passage of breast density notification laws may lead to supplemental screening that is incongruent with women’s risk. We examined supplemental screening (ie, MRI, ultrasound, or tomosynthesis within 6 months of screening mammogram) among a sample of 2,764 African American (AA) and 691 European American (EA) women with negative or benign screening mammograms for whom we had data from both before and after implementation of breast density notification laws in the state of Michigan. Results indicated a 5-fold increase (from 0.14% to 0.7% of women) in supplemental screening among screen-negative women after passage of the law, driven in large part by an increase in supplemental screening among AA women. Breast density was more predictive of supplemental screening and had a marginally greater explanatory role in between-race differences in supplemental screening after passage of the law. Subgroup analyses (n = 250) indicated that whereas 5-year breast cancer risk was positively associated with supplemental screening before the law and negatively associated after the law for EA women, 5-year risk was not associated with supplemental screening either before or after passage of the law for AA women. Our findings suggest that whereas passage of the breast density notification laws may have motivated supplemental screening among AA women in particular, it lessened the consideration of breast cancer risk in supplemental screening decision making.

Racial differences in calculated bioavailable vitamin D with vitamin D/calcium supplementation.

Some studies suggest that bioavailable 25-dihydroxyvitamin D [25-(OH)D] is more accurate than total 25-(OH)D as an assessment of vitamin D (VitD) status in black individuals. We hypothesized that increases in bioavailable 25-(OH)D would correlate better with improvement in bone outcomes among black HIV-infected adults. This is a secondary analysis of AIDS Clinical Trials Group A5280, a randomized, double-blind study of VitD3 and calcium supplementation in HIV-infected participants initiating antiretroviral therapy. Effect of VitD/calcium on total and calculated bioavailable 25-(OH)D, parathyroid hormone, bone turnover markers, and bone mineral density in black and nonblack participants were evaluated at 48 weeks. Wilcoxon signed-rank tests and Wilcoxon rank sum tests assessed within and between-race differences. Of 165 participants enrolled, 129 (40 black and 89 nonblack) had complete data. At baseline, black participants had lower total 25-(OH)D [median (Q1,Q3) 22.6 (15.8, 26.9) vs. 31.1 (23.1, 38.8) ng/ml, P < 0.001] but higher bioavailable 25-(OH)D [2.9 (1.5, 5.2) vs. 2.0 (1.5, 3.0) ng/ml, P = 0.022] than nonblack participants. After 48 weeks of VitD/calcium supplementation, bioavailable 25-(OH)D increased more in black than nonblack participants, but there were no between-race differences change in bone turnover markers or bone mineral density. The associations between increases in 25-(OH)D levels and change in bone outcomes appeared similar for both total and bioavailable 25-(OH)D. Baseline and change in bioavailable 25-(OH)D were higher among black adults initiating antiretroviral therapy with VitD/calcium; however, associations between 25-(OH)D and bone outcomes appeared similar for total and bioavailable 25-(OH)D. The assessment of total 25-(OH)D may be sufficient for evaluation of VitD status in black HIV-infected individuals. NCT01403051.

Explaining between-race differences in African-American and European-American women's responses to breast density notification

BackgroundPrior research shows between-race differences in women's knowledge and emotions related to having dense breasts, thus suggesting that between-race differences in behavioral decision-making following receipt of breast density (BD) notifications are likely. Guided by the theory of planned behavior, this study examined differences in emotion-related responses (i.e., anxiety, worry, confusion) and behavioral cognition (e.g., intentions, behavioral attitudes) following receipt of BD notifications among African American (AA) and European American (EA) women. This study also examined whether race-related perceptions (i.e., discrimination, group-based medical mistrust), relevant knowledge and socioeconomic status (SES) explained the between race differences. MethodMichigan women (N = 457) who presented for routine screening mammogram and had dense breasts, no prior breast cancer diagnoses, and had screen-negative mammograms were recruited from July, 2015 to March 2016. MANOVA was used to examine between race differences in psychological responses (i.e., emotional responses and behavioral cognition), and a multi-group structural regression model was used to examine whether race-related constructs, knowledge and SES mediated the effect of race on emotional responses and behavioral cognition. Prior awareness of BD was accounted for in all analyses. ResultsAA women generally reported more negative psychological responses to receiving BD notifications regardless of prior BD awareness. AA women had more favorable perceptions related to talking to their physicians about the BD notifications. Generally, race-related perceptions, SES, and related knowledge partially accounted for the effect of race on psychological response. Race-related perceptions and SES partially accounted for the differences in behavioral intentions. Between-race differences in emotional responses to BD notifications did not explain differences in women's intentions to discuss BD notifications with their physicians. ConclusionsFuture examinations are warranted to examine whether there are between-race differences in actual post-BD notification behaviors and whether similar race-related variables account for differences.

Born Poor? Racial Diversity, Inequality, and the American Pipeline

The authors examine racial disparities in infants’ exposure to economic disadvantage at the family and local area levels. Using data from the 2008–2014 files of the American Community Survey, the authors provide an up-to-date empirical benchmark of newborns’ exposure to poverty. Large shares of Hispanic (36.5 percent) and black (43.2 percent) infants are born poor, though white infants are also overrepresented among the poor (17.7 percent). The authors then estimate regression models to identify risk factors and perform decompositions to identify compositional factors underlying between-race differences. Although more than half of the black-white poverty gap is explained by differences in family structure and employment, these factors account for less than one quarter of white-Hispanic differences. The results also highlight the unmet need for social protection among babies born to poor families lacking access to assistance programs and the safety net. Hispanic infants are particularly likely to be doubly disadvantaged in this manner. Moreover, large and disproportionate shares of today’s black (48.3 percent) and Hispanic (40.5 percent) babies are born into poor families and places with poverty rates above 20 percent. These results raise important questions about persistent and possibly growing racial inequality as America makes its way to a majority-minority society as early as 2043.

Influences of race and breast density on related cognitive and emotion outcomes before mandated breast density notification

RationaleMany states have adopted laws mandating breast density (BD) notification for applicable women; however, very little is known about what women knew or felt about BD and related breast cancer (BC) risk before implementation of BD notification laws. ObjectiveWe examined between-race differences in the extent to which having dense breasts was associated with women's related BD cognition and emotion, and with health care providers' communication about BD. MethodsWe received surveys between May and October of 2015 assessing health care provider (HCP) communication about BD, BD-related knowledge, BD-related anxiety and BC worry from 182 African American (AA) and 113 European American (EA) women in the state of Michigan for whom we had radiologists' assessments of BD. ResultsWhereas having dense breasts was not associated with any BD-related cognition or emotion, there were robust effects of race as follows: EA women were more likely to have been told about BD by a HCP, more likely to know their BD status, had greater knowledge of BD and of BC risk, and had greater perceptions of BC risk and worry; AA women had greater BD-related anxieties. EA women's greater knowledge of their own BD status was directly related to the increased likelihood of HCP communication about BD. However, HCP communication about BD attenuated anxiety for AA women only. ConclusionWe present the only data of which we are aware that examines between-race differences in the associations between actual BD, HCP communication and BD related cognition and emotion before the implementation of BD notification laws. Our findings suggest that the BD notification laws could yield positive benefits for disparities in BD-related knowledge and anxiety when the notifications are followed by discussions with health care providers.

Between-race differences in the effects of breast density information and information about new imaging technology on breast-health decision-making

ObjectivesSome US states have mandated that women be informed when they have dense breasts; however, little is known about how general knowledge about breast density (BD) affects related health decision-making. We examined the effects of BD information and imaging technology information on 138 African–American (AA) and European–American (EA) women’s intentions to discuss breast cancer screening with their physicians. MethodsWomen were randomly assigned to receive BD information and/or imaging technology information via 2 by 2 factorial design, and completed planned behavior measures (e.g., attitudes, intentions) related to BC screening. ResultsAttitudes mediated the effects of BD information, and the mediation was stronger for AA women compared to EA women. Effects were more robust for BD information compared to imaging technology information. Results of moderator analyses revealed suppressor effects of injunctive norms that were moderated by imaging technology information. ConclusionInformation about BD favorably influences women’s intentions to engage in relevant breast health behaviors. Stronger attitude mediated-effects for AA women suggest greater scrutiny of BD information. Practice implicationsSince BD information may influence women’s intentions to discuss BC screening, strategies to effectively present BD information to AA women should be investigated given the likelihood of their increased scrutiny of BD information.

Black Cigarette Smokers Report More Attention to Smoking Cues Than White Smokers: Implications for Smoking Cessation.

Black cigarette smokers have lower rates of smoking cessation compared with Whites. However, the mechanisms underlying these differences are not clear. Many Blacks live in communities saturated by tobacco advertisements. These cue-rich environments may undermine cessation attempts by provoking smoking. Moreover, attentional bias to smoking cues (attention capture by smoking cues) has been linked to lower cessation outcomes. Cessation attempts among Blacks may be compromised by attentional bias to smoking cues and a cue-rich environment. Attention to smoking cues in Black and White smokers was examined in 2 studies. In both studies, assessments were completed during 2 laboratory visits: a nonabstinent session and an abstinent session. In study 1, nontreatment-seeking smokers (99 Whites, 104 Blacks) completed the Subjective Attentional Bias Questionnaire (SABQ; a self-report measure of attention to cues) and the Smoking Stroop task (a reaction time measure of attentional bias to smoking cues). In study 2, 110 White and 74 Black treatment-seeking smokers completed these assessments and attempted to quit. In study 1, Blacks reported higher ratings than Whites on the SABQ (p = .005). In study 2, Blacks also reported higher ratings than Whites on the SABQ (p = .003). In study 2, Blacks had lower biochemical-verified point prevalence abstinence than Whites, and the between-race difference in outcome was partially mediated by SABQ ratings. Blacks reported greater attention to smoking cues than Whites, possibly due to between-race differences in environments. Greater attention to smoking cues may undermine cessation attempts.

Scaling of adult body weight to height across sex and race/ethnic groups: relevance to BMI

Body mass index (BMI) is formulated on the assumption that body weight (BW) scales to height with a power of 2 (BW∝height(2)), independent of sex and race-ethnicity. Powers differing from 2 are observed in studies of selected samples, thus raising the question if BMI is a generalizable metric that makes BW independent of height across populations. The objectives were to test the hypothesis that adult BW scales to height with a power of 2 independent of sex and race-ethnicity and to advance an understanding of BMI as a measure of shape by extending allometric analyses to waist circumference (WC). We conducted cross-sectional subject evaluations, including body composition, from the NHANES and the Korean NHANES (KNHANES). Variations of the allometric model (Y = αX(β)) were used to establish height scaling powers (β ± SE) across non-Hispanic white and black, Mexican American, and Korean men and women. Exploratory analyses in population samples established age and adiposity as important independent determinants of height scaling powers (i.e., β). After age and adiposity in the next series of analyses were controlled for, BW scaling powers were nonsignificantly different between race/ethnic groups within each sex group; WC findings were similar in women, whereas small but significant between-race differences were observed in the men. Sex differences in β values were nonsignificant except for BW in non-Hispanic blacks and WC in Koreans (P < 0.05). Nationally representative powers for BW were (NHANES/KNHANES) 2.12 ± 0.05/2.11 ± 0.06 for men and 2.02 ± 0.04/1.99 ± 0.06 for women and for WC were 0.66 ± 0.03/0.67 ± 0.05 for men and 0.61 ± 0.04/0.56 ± 0.05 for women. Adult BW scales to height with a power of ∼2 across the 8 sex and race/ethnic groups, an observation that makes BMI a generalizable height-independent measure of shape across most populations. WC also follows generalizable scaling rules, a finding that has implications for defining body shape in populations who differ in stature.

The acute tobacco withdrawal syndrome among black smokers.

Black smokers have greater difficulty quitting tobacco than White smokers, but the mechanisms underlying between-race differences in smoking cessation are not clear. One possibility is that Black smokers experience greater acute withdrawal than Whites. We investigated whether Black (n = 104) and White smokers (n = 99) differed in abstinence-induced changes in self-report, physiological, and cognitive performance measures. Smokers not wishing to quit completed two counterbalanced experimental sessions. Before one session, they abstained from smoking for at least 12 hr. They smoked normally before the other session. Black smokers reported smaller abstinence-induced changes on a number of subjective measures including the total score of the 10-item Questionnaire for Smoking Urges (QSU) and the total score of the Wisconsin Smoking Withdrawal Scale (WSWS). However, on most subjective measures, and on all objective measures, there were no between-race differences in abstinence-induced change scores. Moreover, Black participants did not report lower QSU and WSWS ratings at the abstinent session, but they did experience significantly higher QSU and WSWS ratings at the nonabstinent session. Abstinence-induced changes in subjective, physiological, and cognitive measures in White smokers were similar for smokers of nonflavored and menthol-flavored cigarettes. There was no evidence that Black smokers experienced greater acute tobacco withdrawal than Whites. To the contrary, Black participants experienced smaller abstinence-induced changes in self-reported craving and withdrawal on some measures. Racial differences in smoking cessation are unlikely to be explained by acute withdrawal.

Knowledge of Breast Density and Awareness of Related Breast Cancer Risk

Little is known about women's knowledge of breast density or between-race differences in this knowledge. In the current study, we examined knowledge of breast density and awareness of its role as a breast cancer risk factor among women who had previously taken part in a breast imaging study. Seventy-seven women (54.5 % Black) returned a survey assessing perceptions and accuracy of breast density knowledge, knowledge of one's own breast density, and breast cancer risk awareness. White women had greater perceived knowledge of breast density compared to Black women; however, differences in the accuracy of definitions of breast density were due to education. Black women were less likely to know how dense their own breasts were. Black and White women both lacked awareness that having dense breast increased breast cancer risk. The results highlight the need to disseminate information regarding breast density to women, while ensuring that the information is equally accessible to both Black and White women.