African American Groups Research Articles

Analysis of Real-World Data to Investigate the Impact of Race and Ethnicity on Response to Programmed Cell Death-1 and Programmed Cell Death-Ligand 1 Inhibitors in Advanced Non-Small Cell Lung Cancers.

BackgroundRacial disparities among clinical trial participants present a challenge to assess whether trial results can be generalized into patients representing diverse races and ethnicities. The objective of this study was to evaluate the impact of race and ethnicity on treatment response in patients with advanced non‐small cell lung cancer (aNSCLC) treated with programmed cell death‐1 (PD‐1) or programmed cell death‐ligand 1 (PD‐L1) inhibitors through analysis of real‐world data (RWD).Materials and MethodsA retrospective cohort study of 11,138 patients with lung cancer treated at hospitals within the Mount Sinai Health System was performed. Patients with confirmed aNSCLC who received anti‐PD‐1/PD‐L1 treatment were analyzed for clinical outcomes. Our cohort included 249 patients with aNSCLC who began nivolumab, pembrolizumab, or atezolizumab treatment between November 2014 and December 2018. Time‐to‐treatment discontinuation (TTD) and overall survival (OS) were the analyzed clinical endpoints.ResultsAfter a median follow‐up of 14.8 months, median TTD was 7.8 months (95% confidence interval, 5.4–not estimable [NE]) in 75 African American patients versus 4.6 (2.4–7.2) in 110 White patients (hazard ratio [HR], 0.63). Median OS was not reached (18.4–NE) in African American patients versus 11.6 months (9.7–NE) in White patients (HR, 0.58). Multivariable Cox regression conducted with potential confounders confirmed longer TTD (adjusted HR, 0.65) and OS (adjusted HR, 0.60) in African American versus White patients. Similar real‐world response rate (42.6% vs. 43.5%) and disease control rate (59.6% vs. 56.5%) were observed in the African American and White patient populations. Further investigation revealed the African American patient group had lower incidence (14.7%) of putative hyperprogressive diseases (HPD) upon anti‐PD‐1/PD‐L1 treatment than the White patient group (24.5%).ConclusionAnalysis of RWD showed longer TTD and OS in African American patients with aNSCLC treated with anti‐PD‐1/PD‐L1 inhibitors. Lower incidence of putative HPD is a possible reason for the favorable outcomes in this patient population.Implications for PracticeThere is a significant underrepresentation of minority patients in randomized clinical trials, and this study demonstrates that real‐world data can be used to investigate the impact of race and ethnicity on treatment response. In retrospective analysis of patients with advanced non‐small cell lung cancer treated with programmed cell death‐1 or programmed cell death‐ligand 1 inhibitors, African American patients had significantly longer time‐to‐treatment discontinuation and longer overall survival. Analysis of real‐world data can yield clinical insights and establish a more complete picture of medical interventions in routine clinical practice.

Oppositional Identity and Back-Vowel Fronting in a Triethnic Context: The Case of Lumbee English

This study considers the dynamic trajectory of fronting of the back vowels boot and boat for 27 speakers in a unique, longstanding context of a substantive, triethnic contact situation involving American Indians, European Americans, and African Americans over three disparate generations in Robeson County, North Carolina. The results indicate that the earlier status of Lumbee English fronting united them with the African American vowel system, particularly for the boot vowel, but that more recent generations have shifted toward alignment with European American speakers. Given that the biracial Southeastern United States historically identified Lumbee Indians as “free persons of color” and the persistent skepticism about the Lumbee Indians as merely a mixed group of European Americans and African Americans, the movement away from the African American pattern toward the European American pattern was interpreted as a case of oppositional identity in which Lumbee Indians disassociate themselves from African American vowel norms in subtle but socially meaningful ways.

The Impact of Multiple Sclerosis Disease Status and Subtype on Hematological Profile.

Multiple sclerosis (MS) is an immune-mediated, demyelinating disease of the central nervous system. In this study, an MS cohort and healthy controls were stratified into Caucasian and African American groups. Patient hematological profiles—composed of complete blood count (CBC) and complete metabolic panel (CMP) test values—were analyzed to identify differences between MS cases and controls and between patients with different MS subtypes. Additionally, random forest models were used to determine the aggregate utility of common hematological tests in determining MS disease status and subtype. The most significant and relevant results were increased bilirubin and creatinine in MS cases. The random forest models achieved some success in differentiating between MS cases and controls (AUC values: 0.725 and 0.710, respectively) but were not successful in differentiating between subtypes. However, larger samples that adjust for possible confounding variables, such as treatment status, may reveal the value of these tests in differentiating between MS subtypes.

Geographic and temporal diversity in dental morphology reflects a history of admixture, isolation, and drift in African Americans

While genetic studies have documented variation in admixture proportions in contemporary African Americans across the US, relatively little is known about the socio-historical roots of this variation. Our goal in this study is to use dental morphology to explore the socio-historical correlates of admixture, localized gene flow, and drift in African Americans. Our data are ordinally-graded dental morphological traits scored in 196 Africans, 335 Europeans and European Americans, 291 pre-Spanish-contact Native Americans, and 722 African Americans. The African American data derived from contemporary and historic samples. We eliminated from analysis individuals and traits with greater than 20% missing data. We summarized the major axes of trait variation using principal component analysis (PCA), estimated biological distance, constructed multidimensional scaling (MDS) plots of the distances, and measured the correlation between geographic and biological distance. In the PCA, African American groups clustered between Africans and Europeans on PC 1, reflecting admixture between the groups. PC 2 separated African American samples, possibly reflecting movement, isolation, and drift. MDS analyses confirmed the existence of sizable biological distances between African American samples, especially between contemporary and past African American samples. We found no relationship between biological and geographic distances. We demonstrate that admixture and drift can be inferred from multi-variable analyses of patterns of dental morphology in admixed populations. Localized gene flow has not affected patterns of trait variation in African Americans, but long-range movement, isolation, and drift have. We connect patterns of dental trait variation to efforts to flee oppression during the Great Migration, and the repeal of anti-miscegenation laws.

African Americans Have Differences in CSF Soluble TREM2 and Associated Genetic Variants.

ObjectiveTo evaluate for racial differences in triggering receptor expressed on myeloid cells 2 (TREM2), a key immune mediator in Alzheimer disease, the levels of CSF soluble TREM2 (sTREM2), and the frequency of associated genetic variants were compared in groups of individuals who self-reported their race as African American (AA) or non-Hispanic White (NHW).MethodsCommunity-dwelling older research participants underwent measurement of CSF sTREM2 concentrations and genetic analyses.ResultsThe primary cohort included 91 AAs and 868 NHWs. CSF sTREM2 levels were lower in the AA compared with the NHW group (1,336 ± 470 vs 1,856 ± 624 pg/mL, p < 0.0001). AAs were more likely to carry TREM2 coding variants (15% vs 3%, p < 0.0001), which were associated with lower CSF sTREM2. AAs were less likely to carry the rs1582763 minor allele (8% vs 37%, p < 0.0001), located near MS4A4A, which was associated with higher CSF sTREM2. These findings were replicated in an independent cohort of 23 AAs and 917 NHWs: CSF sTREM2 levels were lower in the AA group (p = 0.03), AAs were more likely to carry coding TREM2 variants (22% vs 4%, p = 0.002), and AAs were less likely to carry the rs1582763 minor allele (16% vs 37%, p = 0.003).ConclusionsOn average, AAs had lower CSF sTREM2 levels compared with NHWs, potentially because AAs are more likely to carry genetic variants associated with lower CSF sTREM2 levels. Importantly, CSF sTREM2 reflects TREM2-mediated microglial activity, a critical step in the immune response to amyloid plaques. These findings suggest that race may be associated with risk for genetic variants that influence Alzheimer disease–related inflammation.

\u201cThey Made us into a Race. We Made Ourselves into a People\u201d: A Corpus Study of Contemporary Black American Group Identity in the Non-Fictional Writings of Ta-Nehisi Coates

This article examines representations of contemporary Black American identity in the non-fictional writings of Ta-Nehisi Coates. The dataset is a self-compiled specialized corpus of Coates’s non-fictional writings from 1996 until 2018 (350 texts; 468,899 words). The study utilizes an interdisciplinary approach combining corpus linguistics and corpus pragmatics. Frequencies of five identity-related terms in the corpus (African(–)Americans, blacks, black people, black America/Americans and black community/communities) are compared diachronically; then the pragmatic prosody of the terms is analyzed via the notion of control. The findings suggest that Coates’s representation of Black American group identity has shifted over time. Specifically, the terms African Americans and black America are replaced by the terms blacks and black people. The study’s empirical findings, considered through the theoretical framework on Black solidarity, suggest a shift in representation of group identity in Coates’s writings from an identity based on cultural and ethnic commonalities to an identity based on the shared experiences of anti-Black racism.

The effects of neoadjuvant chemoradiation on exosomal markers (CD63 and CD9) expression in patients with locally advanced rectal adenocarcinoma.

101 Background: Exosomes mediate intercellular communications and have pivotal roles in cancer development. CD63 and CD9 are widely accepted exosomal markers. The effect of concurrent chemoradiation on the expression of exosomal markers is unknown. Here we explored the effect of neoadjuvant concurrent chemoradiation (NCCR) on exosomal markers (CD63 and CD9) expression in patients with locally advanced rectal cancer (LARC). Methods: Between 2015 and 2018, 33 patients had LARC treated with NCCR and had pre NCCR biopsy and post NCCR resected rectum examined for exosomal markers expression using immunohistochemistry. Two pathologists independently scored CD63 and CD9 staining in the tumor. Staining intensity was graded from 1-3. Staining percentage was estimated in 10% increments. Mean quick-score (Q-score) was calculated (intensity x percentage). Un-Paired t test was used for statistical analysis. Results: In our cohort, median age was 59 years. Males represented 79% of the patients. Caucasians, African American and other ethnic groups represented 70%, 27% and 3% respectively.The mean tumor CD63 score in pre NCCR biopsy vs post NCCR resected rectum was 106 vs 165 (p = 0.0022). The mean tumor CD9 score in pre NCCR biopsy vs post NCCR resected rectum was 136 vs 215 (p &lt; 0.0001). The exosomal markers expression in the adjacent normal mucosa (ANM) from pre NCCR biopsy and post NCCR resected rectum was only performed in16 out of 33 patients (due to ANM tissue availability). The mean ANM CD63 score in pre NCCR biopsy vs post NCCR resected rectum was 166 vs 183 (p = 0.37). The mean ANM CD9 score in pre NCCR biopsy vs post NCCR resected rectum was 104 vs 145 (p = 0.0897). Conclusions: In patients with LARC, the expression of exosomal markers (CD63 and CD9) increased after treatment with NCCR. Our results show that the expression of CD63 and CD9 is relatively higher in rectal cancer specimens treated with NCCR and thus suggest a possible role of these exosomes in adaptive response to NCCR. Further follow-up and laboratory studies are required to precisely understand the underlying mechanism(s).

Inequities in Employment by Race, Ethnicity, and Sector During COVID-19.

ObjectiveTo determine whether people of Color experienced disparate levels of employment loss in frontline versus non-frontline occupations during the onset of the COVID-19 pandemic.MethodsThe Bureau of Labor Statistics Current Population Survey data was analyzed in a cross-sectional study. Percent change in number employed was tabulated quarterly for groups by race and ethnicity (Black or African American, Asian American, or Hispanic or Latinx compared to White or non-Hispanic or Latinx) and frontline occupation status between January 1 and June 30, 2020. Two-tailed two-sample tests of proportions were used to compare groups statistically.ResultsMore dramatic declines in number employed occurred in the Black or African American, Asian American, and Hispanic or Latinx groups. When stratified by sector, greater declines were noted in the Hispanic or Latinx and Asian American frontline, and Black or African American non-frontline groups when compared to the referent groups.ConclusionsStructural racism has further affected people of Color through differential employment loss during the onset of the pandemic, both overall and by sector. However, the effect of sector varies dramatically across racial and ethnic groups.Policy ImplicationsBecause employment is an important social determinant of health and a potential risk factor for contracting COVID-19, these trends may provide important context for the prioritization of PPE and immunizations, as well as the provision of stable health insurance and income support for vulnerable workers.

COVID-19 Pediatric Patients: Gastrointestinal Symptoms, Presentations, and Disparities by Race/Ethnicity in a Large, Multicenter US Study

COVID-19 Pediatric Patients: Gastrointestinal Symptoms, Presentations, and Disparities by Race/Ethnicity in a Large, Multicenter US Study

Collateral Damage: The Relationship Between High-Salience Events and Variation in Racial Discrimination

To what extent are the organizational costs of bias affected by racially salient events? We propose that acts of discrimination and the individual biases that undergird them are sensitive to high-salience events and will oscillate with the salience of the focal attribute (here, race). In short, that the propensity to discriminate reflects both individual and environmental differences, and therefore a given person may become more prone to discriminate in the aftermath of a high-salience event. We test our hypothesis in three online experiments that examine how varying the salience of race affects the evaluation of in-group or out-group founders. We find that respondents evaluate their in-group members more favorably, and outgroup members less favorably, when exposed to a high-salience event, which translates into a significant disadvantage for the minority (African American) group. We complement these studies with an assessment of how police shootings affect fundraising outcomes on Kickstarter to confirm the external validity of our findings. Together, these studies indicate that racially salient events depress the quality evaluations and success odds of African American entrepreneurs relative to others. Hence, discrimination levels can be affected by salient yet unrelated events, and such events are consequential for the economic fortunes of individuals belonging to minority and disadvantaged groups.

A Sound Archive

A Sound Archive Alex Lichtenstein (bio) Steven P. Garabedian, A Sound History: Lawrence Gellert, Black Musical Protest, and White Denial. Amherst: University of Massachusetts Press, 2020. xii + 240 pp. Figures, notes, index. $27.95. Steven P. Garabedian, A Sound History: Lawrence Gellert, Black Musical Protest, and White Denial. Amherst: University of Massachusetts Press, 2020. xii + 240 pp. Figures, notes, index. $27.95. Those of us who have done research on the history of the Communist left in the United States, on the culture of the 1930s, or on the history of southern chain gangs, have almost certainly come across a small 1936 songbook of two dozen "Negro Songs of Protest" compiled by Lawrence Gellert. Graced with a striking cover illustration by Lawrence's more famous brother, the Communist artist Hugo Gellert, Negro Songs of Protest remains a quintessential example of Popular Front culture and a radical complement to the much-better-known material collected by Alan Lomax across the South during the same period and deposited at the Library of Congress. But, as Steven Garabedian's book A Sound History proposes, the Gellert story is even far more complicated—and interesting—than it might seem at first glance. Gellert and his fieldwork, Garabedian shows, experienced a "trajectory of celebration to defamation" (p. ix). During the 1930s, the African American protest songs Gellert collected across the South made a signal contribution to what Michael Denning has called "the cultural front," exposing radicals to a taste of Black vernacular culture aligned with the politics of the moment.1 During the Cold War years, however, Gellert's association with the Communist Party (CP) and its publications—his brother Hugo was an editor at the New Masses, and some of Gellert's material initially appeared in its pages—made his work suspect. Now what had been lauded as an amazing feat of recovery of a buried folk expression was derided as "an example of white leftwing propaganda…rather than Black vernacular creativity and resistance" (p. 9). The CP, once the alleged champion of African American rights, most famously in its global campaign to free the "Scottsboro Boys," came to be regarded during the Cold War as preying on Black discontent for its own nefarious ends. Gellert's once-laudable efforts to collect and disseminate an authentic protest culture located among the most oppressed group of African Americans living under Jim Crow was now dismissed as manipulative, at best, and outright fakery at worst. [End Page 583] So, Garabedian's book asks, was the material unearthed by Gellert merely a "product of white propaganda" or rather an authentic expression of "Black vernacular creativity" (p. ix)? Astutely, Garabedian frames his discussion of the early reception of Gellert's work within the trope of "romantic racialism."2 Dating to the nineteenth century, this tradition served equally well the celebrators and the detractors of African American culture. "The romantic racialist mindset," Garabedian observes, made it possible to "favor Black music while still denying Black intellect or agency" (p. 6). As Garabedian puts it, in the romantic racialist tradition, "People of color have been expected [by whites] to sing with open hearts, but not openly speak their minds" (p. 6). Though associated primarily with nineteenth-century abolitionism, the cultural left of the 1930s was not immune to this outlook, and indeed could be said in some quarters to have revived it. Nevertheless, Garabedian resists placing Gellert himself in this camp. Instead, he regards the left-wing amateur ethnomusicologist, "audodidact[,] and self-styled bohemian radical" (p. 21) as "a sincere broker in the cause of racial justice and radical change" (p. 14). Following in the footsteps of southern white collectors of "Negro songs" like Howard Odum, Guy Johnson, and John A. Lomax, Sr. (Alan's father), Gellert's ear seemed attuned to something quite different. "Where they heard primitivism, plantation nostalgia, [or] racial nostalgia," Garabedian notes, "Gellert heard Black resistance" (p. 54). John Lomax in particular had established a template that allowed white collectors to treat Black folksong as an inexplicable expression of "Black self-pity." "Why this should be true," Lomax had written in 1917, "is difficult to say." To this astoundingly obtuse remark in the "romantic racialist" vein...

Caregiver’s Relationship Type and Race/Ethnic Group Comparisons in a Community-based Caregiver Support Program

In the past decades, a number of evidence-based interventions has been implemented to improve caregiver outcomes; however, limited attention to specific subgroups (e.g., racial/ethnic groups) still exists in dementia caregiver support interventions in community settings. The purpose of this study is to examine the effect of caregiver’s race/ethnicity and relationship type to the care-recipient on the quality of life among caregivers. This study included 354 informal caregivers enrolled in REACH-TX, a community-based caregiver program, provided by the Alzheimer’s Association North Central Texas Chapter’s from November 2011 to June 2019. Propensity score matching extracted a subset of participants who enrolled in REACH-TX to balance caregivers from three race/ethnic groups (White: 171; African American: 103; Hispanic: 80). Five dimensions of quality of life (depression, caregiving burden, social support, self-care, and problem behaviors) were assessed at baseline and 6-month follow-up among spousal and adult-child caregivers by race/ethnic group. Generalized linear models showed that significant improvement on the five domains of quality of life among White child caregivers, whereas neither spousal nor child caregivers in African American group showed improvement on any domains after adjusting covariates (age, gender, risk levels, number of therapeutic contacts), These findings indicate that the responses to intervention components vary by race/ethnic group and relationship type. Advancing tailored dementia caregiver interventions to specific subgroup needs and unique context, especially for non-White caregivers, is needed to maximize the benefit of community resources and support for diverse caregivers.

Abstract IA34: Distinct heterogeneous subtypes of Triple-Negative Breast Cancer, associated with African Ancestry

Abstract Triple negative breast cancers (TNBCs) are molecularly heterogeneous, and the link between their aggressiveness with African ancestry is not established. We investigated primary TNBCs for gene expression among self-reported race (SRR) groups of African American and European American women. RNA sequencing data was analyzed to measure changes in genome-wide expression, and we utilized logistic regressions to identify ancestry-associated gene expression signatures. Using SNVs identified from our RNA sequencing data, global ancestry was estimated. We identified 156 African ancestry-associated genes and found that, compared to SRR, quantitative genetic analysis was a more robust method to identify racial/ethnic-specific genes that were differentially expressed. A subset of African ancestry-specific genes that were upregulated in TNBCs of our AA patients were validated in TCGA data. In AA patients, there was a higher incidence of basal-like 2 tumors and altered TP53, NFB1, and AKT pathways. The distinct distribution of TNBC subtypes and altered oncologic pathways show that the ethnic variations in TNBCs are driven by shared genetic ancestry. Thus, to appreciate the molecular diversity of TNBCs, tumors from patients of various ancestral origins should be evaluated. We created a novel tool to determine the heterogenic status of TNBC, which accounts for proportional differences multiple cell 'subtypes'. Citation Format: Melissa B. Davis, Rachel Martini, Lisa A. Newman, Olivier Elemento, Jason White, Akanksha Verma, Indrani Datta, Indra Adrianto, Yalei Chen, Kevin Gardner, Hyung-Gyoon Kim, Windy D. Coleman, Isam-Eldin Eltoum, Andra Frost, William Grizzle, Andrea Sboner, Upender Manne, Clayton Yates. Distinct heterogeneous subtypes of Triple-Negative Breast Cancer, associated with African Ancestry [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA34.

Racial Disparities Among Pancreatic Adenocarcinoma Patients: A Retrospective Survival Analysis of Non-Metastatic Pancreatic Cancer Patients

It is predicted that in 2020, approximately 57,600 individuals will be diagnosed with pancreatic cancer (PaC). Based on SEER database analysis, there are conflicting opinions in literature about the overall treatment and outcomes in African-American patients with PaC. The purpose of this study was to determine if there was a racial disparity in overall survival rates between African Americans (AAs) and non-African Americans (non-AAs) diagnosed with PaC who received neoadjuvant radiation therapy (RT) in a tertiary-care cancer center with an established multi-disciplinary PaC tumor board and clinic. An IRB-approved retrospective chart analysis was completed on 100 patients who were diagnosed with pancreatic adenocarcinoma and treated with neoadjuvant RT between 2017-2019. Patients who were deemed resectable, borderline resectable (BR), or locally advanced/unresectable (LA) at initial diagnosis were included in the analysis. The following baseline characteristics were collected for each patient: staging, gender, age and ECOG score at initial diagnosis, tumor site and size, clinical T and N stage, CA19-9, and treatment variables (i.e., surgery, chemotherapy, and RT type). Overall survival was calculated from the RT start date. In order to identify any baseline differences among the AA group and the non-AA group, a two-sample t-test and Chi-square were employed. A log-rank test and Kaplan-Meier were used to determine any differences in overall survival among the two groups. Of the 100 patients included in the analysis, 25 were AA and 58 were female. There were 17 (68%) BR and 8 (32%) LA patients in the AA group. In the non-AA group, there were 2 (3%) resectable, 47 (63%) BR, and 26 (35%) LA patients. There were no statistically significant differences detected in any of the baseline characteristics except a trend for increased CA19-9 values of 399.8 U/mL for AAs and 229 U/mL for non-AAs. There was no statistically significant difference in receipt of chemotherapy and RT between the two groups. The estimated median survival rates were 11.5 months for non-AAs and 8.4 months for AAs. One-year overall survival was 45% for AAs versus 48% for non-AAs (p = 0.57). There was no difference in overall survival among AAs and non-AAs who received neoadjuvant RT+/- chemotherapy for PaC at our institution between 2017-2019. Contrary to previous publications based on large SEER database analysis, there does not appear to be any difference in overall survival based on race if patients receive treatment in a comprehensive multi-disciplinary collaborative center.

Survival Disparities of Diffuse Large B-Cell Lymphoma in a Community-Based Inner-City Cancer Center

BackgroundDiffuse large B-cell lymphoma (DLBCL) comprises approximately 30% of all non-Hodgkin lymphomas. Multiple studies have demonstrated race-based disparities in survival among patients with DLBCL across all stages of disease, in the era both before and after rituximab. The etiology for the racial disparities in survival among patients with DLBCL is still unknown. Moreover, the Revised International Prognostic Index (R-IPI), a tool that predicts the DLBCL patients’ outcome, has not yet been validated in African Americans (AA). Patients and MethodsWe conducted a cohort study of patients diagnosed with DLBCL from January 1, 2007, to December 31, 2017, from our tumor registry in a single community-based inner-city cancer center. We abstracted demographic, clinical, histopathologic, treatment, and R-IPI variables. A total of 181 patients (47.5%) with biopsy-proven DLBCL were included in the retrospective analysis. The median age was 65 years, 47% were men, 41% were AA, and 44% were white. ResultsThe AA group had a younger median age, higher lactate dehydrogenase levels, higher frequency of B symptoms, and higher HIV infection than the non-AA group. The AA group had significantly decreased median overall survival than the non-AA group (15.7 months; 95% confidence interval, 10.3 to 23.9, vs. 93.6 months; 95% confidence interval, 61.5 to 142.6, respectively; P < .001). The survival disparities persisted after excluding patients with HIV and who did not receive chemotherapy. In addition, AA race predicts a reduced survival by univariate and multivariate analysis. ConclusionAA with DLBCL may have a poorer prognosis than the non-AA population. Further studies should investigate the biology of DLBCL in the AA population.

Three-Dimensional Anthropometric Analysis of Racial and Ethnic Differences in Unilateral and Bilateral Cleft Nasal Deformity

BACKGROUND: Prior studies have demonstrated variation in nasolabial indices across racial and ethnic groups. Anthropometric data on the racial and ethnic differences in the cleft nasal deformity at the age for definitive rhinoplasty can provide a foundation for operative planning. This study used three-dimensional stereophotogrammetry measurements to provide a comprehensive nasolabial analysis of patients with unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and controls across multiple races and ethnicities. METHODS: A retrospective review of three-dimensional images of patients with UCLP and BCLP captured before orthognathic surgery or definitive cleft rhinoplasty was performed. The patients were separated by self-reported identifiers as Caucasian, Hispanic, or African American. Twelve measurements (millimeters) were collected: dorsum length, nasal protrusion, columellar height, columellar width, tip width, alar width, alar base width, nasolabial angle, upper lip length, philtrum length, nostril height, and nostril width. An equal number of age, sex, race, and ethnicity matched control patients were analyzed. Two-sample t tests were performed (P < 0.05). RESULTS: Total patients included 90 UCLP, 43 BCLP, and 90 controls. UCLP Caucasians, Hispanics, and African Americans similarly had significantly greater columellar width and tip width and lesser nasolabial angle than respective controls. Caucasian UCLP alar width (33.66 ± 3.12) and alar base width (33.66 ± 3.51) were significantly greater than matched controls (31.21 ± 2.54; 31.33 ± 2.18). Hispanic UCLP alar width (37.52 ± 3.46) and alar base width (36.77 ± 2.81) were significantly greater than matched controls (35.00 ± 3.20; 35.13 ± 3.08). African American UCLP alar width (41.63 ± 3.43) and alar base width (41.93 ± 3.78) were not significantly different from matched controls (39.17 ± 3.35; 40.56 ± 3.97). BCLP Caucasians, Hispanics, and African Americans similarly had significantly greater columellar width and tip width than respective controls. Caucasian BCLP alar width (37.66 ± 0.77), alar base width (38.06 ± 0.65), and nostril width (12.54 ± 1.68) were significantly greater than matched controls (31.21 ± 2.54, 31.33 ± 2.18, 10.34 ± 1.01). Hispanic BCLP alar width (38.75 ± 3.79), alar base width (38.73 ± 3.35), and nostril width (13.23 ± 2.13) were significantly greater than matched controls (35.00 ± 3.20; 35.13 ± 3.08; 11.92 ± 2.13). African American BCLP alar width (40.88 ± 3.92), alar base width (40.56 ± 3.97), and nostril width (13.01 ± 2.07) were not significantly different from matched controls (39.17 ± 3.35; 40.56 ± 3.97; 14.00 ± 1.45). Across UCLP groups the African American group had significantly less nasal protrusion (17.84 ± 1.38) and columellar height (8.96 ± 0.85) and significantly greater columellar width (9.56 ± 1.58) than Caucasians (20.18 ± 1.93, 10.57 ± 1.45, 8.48 ± 1.07), and Hispanics (21.14 ± 2.12, 10.83 ± 1.96, 8.26 ± 1.51). Caucasian alar width (33.66 ± 3.12), alar base width (33.66 ± 3.51), and affected nostril width (10.80 ± 1.51) were significantly lesser than Hispanics (37.52 ± 3.46, 36.77 ± 2.81, 12.04 ± 2.28) and the same measures in both Caucasians and Hispanics were significantly lesser than African Americans (41.63 ± 3.43, 41.93 ± 3.78, 13.96 ± 2.43). Across BCLP groups, there were no significant difference in measurements. CONCLUSIONS: The UCLP deformity differs between groups in alar width and alar base width. African Americans further differ in nasal protrusion, columellar height, and columellar width. The BCLP deformity does not differ between groups. The findings demonstrate that when correcting alar width, alar base width, tip refinement, and projection racially and ethnically congruent goals should be used to better approximate normal appearance.

Impacts of Layoffs and Government Assistance on Mental Health during COVID-19: An Evidence-Based Study of the United States

This study evaluates the impact of unemployment and government financial assistance during the COVID-19 pandemic on the working-age population’s mental health and further examines the differential impacts between urban and non-urban groups, as well as African American (AA) and non-African American groups. Based on the COVID-19 Household Impact Survey, four measures of mental health conditions (nervous, depressed, lonely, and hopeless) are constructed. Our empirical analysis applies the ordinal regression model (ordered logit model) that takes both the week and regional factors into consideration to control for potential time effects and time-invariant confounders varying across regions. The results show that government aid only mitigates the psychological symptoms for the group in non-urban areas, with no significant impacts on the urban group. On the other hand, the AA working-age group experiences similar or more favorable mental health than other ethnic groups, while government aid does not alleviate the mental pressure for the AA group. Therefore, government interventions should recognize the heterogeneity of impacts on socioeconomic groups within the target population.

Culture, Depression, and Coping Mechanisms among African Americans

Culture is a dynamic force that significantly affects health. It comprises beliefs, norms and values, and determines how populations view certain things. In the area of mental health, it determines whether one will seek help or not, the type of help they will seek, the type of support system they will have, and how they will cope with mental illness. There are six racial groups in the United States, each with its unique sub-culture. Belonging to the African American racial group, African Americans have their perceptions about mental illness, stigma, treatment and care, as well as preferred coping mechanisms. This paper discusses the effects culture has on depression among African Americans. It also examines the coping mechanisms this population employs to deal with depression, and proposes strategies for addressing their mental health issues.

Infant Safe Sleep Interventions in African American Communities

Background: Despite recommendations from the American Academy of Pediatrics (AAP) regarding infant safe sleep practices, 39% of sleep-related infant deaths (SRID) occur among African American (AA) families each year. Effective interventions that promote AA parents/caregivers’ safe sleep practices for infants could help reduce SRID. Objective: To identify appropriate safe sleep interventions that increased compliance of AAP recommendations to reduce the risk of SRID among AA mothers/caregivers, a literature review was conducted. Methods: PubMed, EBSCOhost, and Google Scholar search engines were utilized to identify evidence-based research studies, published in English from 2000-2019 in the U.S that demonstrated the effectiveness of safe sleep interventions for AA parents/caregivers based on the AAP recommendations. Findings: The literature review revealed that multiple-element interventions such as free cribs and related materials, and safe sleep education increased adherence to AAP recommendations as evidenced by the majority mothers using the crib and adopting safe sleep recommendations. Conclusion and Recommendations: Although multiple interventions including education are valuable, culturally appropriate research is needed to better understand what specific intervention(s) will work to increase adherence to the AAP safe sleep recommendations among the remaining 39% of AA parents/caregivers who contribute disproportionately to the SRID disparity. Behavioral and environmental barriers preventing the adoption of safe sleep interventions also need to be studied in this target group of AA parents/caregivers. It is recommended that findings from these highly targeted evidence-based culturally appropriate studies be used to focus on funding, prevention programming, and policies toward the causes of SRID to close the disparity gap.

Bone density, microarchitecture and strength estimates in white versus African American youth with obesity.

African Americans (AA) have more favorable bone density and microarchitecture compared to Whites (W), which may explain their observed lower fracture rates. Obesity has deleterious effects on bone microarchitecture and strength estimates and is associated with an increase in fracture risk. Adolescence and young adulthood are periods of active bone accrual and also periods characterized by an increasing prevalence of obesity. The effect of obesity on the relationship between race and bone parameters remains unclear, particularly in youth. To assess differences in BMD, bone microarchitecture and strength estimates in AA and W adolescents and young adults with moderate to severe obesity. We hypothesized that racial differences in bone endpoints in lean youth would also be noted in youth with moderate to severe obesity. We evaluated 24 AA and 48W adolescent and young adults with a mean age of 18.2±2.4years and a median body mass index (BMI) of 44.8 (40.5-49.4) kg/m2 who underwent dual energy X-ray absorptiometry (DXA), high resolution peripheral quantitative computed tomography (HRpQCT), extended cortical analysis (ECA) and micro-finite element analysis (FEA) to obtain measures of volumetric bone mineral density (vBMD), bone geometry, microarchitecture, and strength estimates at the distal radius and tibia. We found no differences between AA and W for total fat and lean mass, and areal BMD Z-scores (p>0.05 for all). At the distal radius, no significant differences were detected in vBMD, bone geometry or microarchitecture (p>0.05 for all); however, stiffness and failure load were higher in the AA group (p=0.031 and 0.047 respectively). At the distal tibia, cortical vBMD was higher in AA vs. W (p=0.012), while trabecular number was higher and trabecular separation lower in W vs. AA (p≤0.028). Stiffness and failure load trended higher in AA vs. W (p=0.052 and p=0.048, respectively). Groups did not differ for any other bone parameter (p>0.05). Racial differences in bone endpoints appear to be less marked in those with moderate to severe obesity, suggesting that effects of obesity may blunt the effect of race on bone endpoints.