Urban African American Cohort Research Articles

The Baltimore Partnership to Educate and Achieve Control of Hypertension (The BPTEACH Trial): A Randomized Trial of the Effect of Education on Improving Blood Pressure Control in a Largely African American Population

Hypertension is a major risk factor for developing cardiovascular disease and is more prevalent in African Americans compared with Caucasians. African Americans are often underrepresented in clinical trials. This study was composed of a largely urban African American cohort of hypertensive patients. This was a prospective, 4-arm, randomized controlled trial designed to evaluate the comparative effectiveness of both physician and patient education (PPE), patient education only (PAE), and physician education only (PHE) vs usual care (UC). Hypertension specialists gave a series of didactic lectures to the physicians, while a nurse educator performed the patient education. The mean adjusted difference in systolic blood pressure (SBP) from baseline in the PPE group was an average reduction of 12 mm Hg (95% confidence interval [CI], -4.5 to -19.4) at 6-months, followed by average reductions of 4.6 mm Hg (6.9 to -16.12) in the PAE group, 4.1 mm Hg (3.4 to -11.7) in the PHE group, and 2.6 mm Hg (3 to -8.2) in the UC group. The PPE group achieved a significantly better reduction in SBP compared with the UC group. Additional research should be conducted to evaluate whether the use of certified hypertension educators in collaboration with physicians will result in a similar blood pressure reduction.

Antecedents and consequences of marijuana use trajectories over the life course in an African American population

BackgroundWe examined developmental trajectories of marijuana use among a cohort of urban African Americans followed from first grade to mid adulthood. We compared risk factors in childhood and adolescence and consequences in mid adulthood across trajectory groups. MethodsUsing semiparametric group-based mixture modeling, five marijuana trajectories for men (n=455) and four trajectories for women (n=495) were identified extending from adolescence to young adulthood (age 32). We labeled the four trajectory groups similar for men and women “abstainers,” “adolescent only users,” “early adulthood decliners,” and “persistent users.” We named the unique fifth group for men “late starters.” ResultsMultivariate multinomial logistic regressions show that childhood problem behaviors, adolescent family involvement, and dropping out of high school differentiated trajectory membership. Analyses comparing the trajectory groups on behavioral, social, and health outcomes at age 42 revealed that for both men and women, those in the persistent trajectory had the most problems, and those in the early adult decliner group also had specific problems. Male late starters also had poor outcomes. ConclusionsThe findings point to the value of identifying specific patterns of substance use over the life course and understanding the differences in their correlates and consequences. The implications of these findings are discussed.

Does heavy adolescent marijuana use lead to criminal involvement in adulthood? Evidence from a multiwave longitudinal study of urban African Americans

While marijuana use is common during adolescence, it can have adverse long-term consequences, with serious criminal involvement being one of them. In this study, we utilize longitudinal data from the Woodlawn Study of a community cohort of urban African Americans ( N = 702) to examine the effects of heavy adolescent marijuana use (20 or more times) on adult criminal involvement, including perpetration of drug, property and violent crime, as well as being arrested and incarcerated. Utilizing propensity score matching to take into account the shared risk factors between drug use and crime, regression analyses on the matched samples show that heavy adolescent marijuana use may lead to drug and property crime and criminal justice system interactions, but not violent crime. The significant associations of early heavy marijuana use with school dropout and the progression to cocaine and/or heroin use only partially account for these findings. Results suggest that the prevention of heavy marijuana use among adolescents could potentially reduce the perpetration of drug and property crime in adulthood, as well as the burden on the criminal justice system, but would have little effect on violent crime.

Computerized cognitive assessment of mild cognitive impairment in urban African Americans.

Few objective cognitive assessment tools have been validated for mild cognitive impairment (MCI) in African Americans despite higher prevalence of disease. This preliminary study evaluated discriminant validity of a computerized cognitive assessment battery for MCI in an urban African American cohort. Twenty-seven participants with MCI and 22 cognitively healthy individuals completed a multidomain battery (Mindstreams, NeuroTrax Corp, New Jersey). Mild cognitive impairment participants performed more poorly than cognitively healthy participants in all domains, with significant differences in memory (P = .003; d = 0.96), executive function (P = .046; d = 0.64), and overall battery performance (P = .041; d = 0.63). Adjustment for intelligence quotient (IQ) yielded significant differences in memory (P < .001; d = 1.34), executive function (P = .007; d = 0.86), attention (P = .014; d = .80), and overall performance (P = .001; d = 1.09). Such a validated battery may help to address an important clinical need in this population.

Long-Term Patterns of Drug Use Among an Urban African-American Cohort: The Role of Gender and Family

Cross-sectional analyses and the little existing longitudinal analyses on substance use over the life course have been integral in providing information about the epidemiology of substance use in the United States. However, it is unclear whether these estimates provide an accurate portrayal of long-term substance use patterns among African-American men and women who have grown up in an inner city environment. The current study uses longitudinal data from a community cohort of African-American inner-city males and females followed from first grade through mid-adulthood. It identifies the substance use patterns through mid-adulthood, including lifetime prevalence, age of onset and termination, and sequencing of substance classes, as well as the risk of initiation of substance use changes over the life course using survival analysis. It also investigates whether early family structure and process play a role in drug use initiation throughout the life course, and whether the relationship between family factors and drug initiation differs by gender. Overall, among the general trends of use, we find a considerable amount of abstention with over 40% of the participants never using illegal drugs by mid-adulthood, over 70% never using cocaine, and over 90% never using heroin. With respect to onset, we find a long-term influence of early family factors on substance use, particularly for females. Family discipline in childhood and family cohesion and parental rule setting during adolescence seem to be key factors in predicting later substance use for females. The implications of these findings for future research and policy are discussed.

Childhood adversity and later mortality in an urban African American cohort.

The Woodlawn Project is a longitudinal study of the development of psychological well-being and social adaptation in an epidemiologically defined cohort of African American first graders interviewed as adolescents and again as adults. The identification of childhood factors predictive of mortality has clear public health importance. Family and childhood adversity and psychosocial factors have been shown to have long-term effects on later mental health and school achievement in adolescence and young adulthood. However, possible effects of such factors on longevity have been “mostly unstudied.” In this article, we examine family and childhood factors in relation to the risk of later mortality.

Life Stage, Substance Use and Health Decline in a Community Cohort of Urban African Americans

This longitudinal study analyzed chronic health effects, predominantly somatic, resulting from substance use in a homogeneously urban African American community cohort (n = 411). Individual and collective effects of eight licit and illicit substances on change in perceived health (index of reported health conditions formulated as regressed change scores) were tested as the cohort matured into young adulthood. Ten additional measures of health behavior, social attainment and social networks were introduced to control against spurious causal attribution. Gender differences in direct and intercorrelated drug effects and their timing processes were observed. Substance use explained a larger share of the variance in men's health than in women's. In absolute numbers of health problems, however, substance use had a greater effect on women's health.