Percent Of African Americans Research Articles

African American experience of FTD: A sub‐cohort assessment of the FTD Insights Survey

AbstractBackgroundWhile efforts are underway to better understand the prevalence, incidence, pathophysiology, and phenomenology of FTD, most research participation has been dominated by persons of European descent. Better understanding of early signs, the diagnostic journey, and the functional impacts in historically underrepresented groups may help shed light on healthcare inequities, support the development of more inclusive research study design, and lay the foundation for more targeted care and interventions.MethodIn preparation for an Externally Led Patient‐Focused Drug Development (PFDD) meeting, the Association for Frontotemporal Degeneration (AFTD) and the FTD Disorders Registry (FTDDR) collaborated to develop the FTD Insights Survey. The online survey queried aspects of the lived experience of FTD from the patient/family/carer perspective.ResultOf the 1,796 respondents that completed the survey, twenty‐five represented the experience of African American persons diagnosed with FTD from the perspective of those diagnosed (n = 4) and care partners (n = 21). Two additional respondents reported on their experience as African American biological family members of those with FTD. Thirty‐six percent of African Americans needed to see 4 or more doctors before receiving an FTD diagnosis, compared to 18% of total respondents, and were more likely to initially receive a different diagnosis (80% vs. 45%). While patterns of the first symptoms were reported similarly across all participants, African Americans were more likely to report having initially experienced changes in thinking, spatial reasoning, or delusions/hallucinations. African Americans were also more likely to report distress related to language, sleep, and delusions/hallucinations and less likely to report no distress or distress related to cognitive symptoms. African American participants were more likely to endorse wanting a treatment to maintain independence and hold a job than overall participants.ConclusionThe African American perspectives reported on the FTD Insights Survey represent a small sample size of individuals with greater than average levels of education (76% had an Associate’s degree or higher). The experience they report overlaps with those of other respondents, but with key differences including more difficulty in access to timely diagnosis. More information is needed on the lived experience of FTD across people of different cultural, social, economic backgrounds.

Geographic Disparities of Hematopoietic Cell Transplantation in Acute Myeloid Leukemia Patients in Virginia

Introduction: Hematopoietic cell transplantation (HCT) is a standard therapy for patients with intermediate to high-risk acute myelogenous leukemia (AML), associated with improved long-term disease-free survival. Virginia is a diverse state, with rural and urban areas, including wealthy and disadvantaged counties. In this study, we compared HCT rates among different regions in the state of Virginia, and analyzed the impact of race/ethnicity, urban vs rural location, primary insurance payor, and socioeconomic status on access to HCT. Methods: We conducted a retrospective, cohort study of patients age 18-75 diagnosed with AML in Virginia from 2013-2017 as reported to the Virginia Cancer Registry (VCR); the VCR was further linked with the Center for International Blood and Marrow Transplant Research (CIBMTR) database for identification of patients who had undergone HCT within two years of diagnosis. Socioeconomic data were generated from the VCR and the American Community Survey (ACS). Univariate and multivariable logistic regression models were used to examine several socioeconomic factors of interest, including patient-level information such as sex, age, race, marital status, primary insurance payor, and distance to closest transplant center as well as factors associated with geography, including specific regions (see Figure 1) and percentage of African Americans residing in the region (see Figure 2). Results: There were 818 patients diagnosed with AML in Virginia from 2013-2017, and of these, 168 (21%) underwent HCT within two years of diagnosis. Median age was lower in the HCT cohort vs. the non-HCT cohort, 55 vs. 64 (p=<0.0001). There was a higher proportion of married patients in the HCT cohort vs. the non-HCT cohort, 67% vs. 53% (p=0.005). The rate of HCT varied by geographic region (p=0.004; see Figure 1). The univariate and multivariate analyses (see Table 1) showed decreased likelihood of HCT with increasing age (OR: 0.96; 95% CI: 0.95-0.98). Patients from regions which had greater than 25% African American population were 42% less likely to undergo HCT (OR: 0.58; 95% CI: 0.38-0.89) (see Figure 2). Patients who were not married were less likely to undergo HCT compared to married patients (OR 0.56; 95% CI: 0.38-0.92). Patients with government insurance as primary payor were less likely to undergo HCT compared to patients with private insurance (OR 0.49; 95% CI: 0.32-0.77). Patients living in areas (by zip code) with a greater percentage of population with a college/graduate degree were more likely to undergo transplant than the patients living in areas with a lower percentage of college/graduate degree (OR: 1.02; 95% CI: 1.00-1.03). Conclusion: From 2013-2017, only 21% of patients with AML in Virginia underwent HCT within two years of diagnosis. We found that the likelihood of undergoing HCT is associated with age, percent of African Americans residing in the region, marital status, primary insurance payor, and percent of population with a bachelor or graduate degree. Our findings suggest geographic and socioeconomic factors are likely barriers to access to HCT. The decreased rate of HCT in regions with a higher percent of African-Americans may reflect structural racism, both due to factors outside and within the medical community. Resources should be devoted to specific interventions addressing disadvantaged populations, including early human leukocyte antigen (HLA) typing, caregiving resources, increased diversity of donor pool, and improved insurance coverage. Future studies will evaluate access to HCT after referral to HCT centers as well as racial disparity in access to HCT across the United States. Disclosures Balkrishnan: Merck and Co.: Consultancy. Devine:Magenta Therapeutics: Consultancy.

Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states - a statistical analysis

BackgroundRates of sepsis/septicemia hospitalization in the US have risen significantly during recent years. Antibiotic resistance and use may contribute to those rates through various mechanisms, including lack of clearance of resistant infections following antibiotic treatment, with some of those infections subsequently devolving into sepsis. At the same time, there is limited information on the effect of prescribing of certain antibiotics vs. others on the rates of septicemia and sepsis-related hospitalizations and mortality.MethodsWe used multivariable linear regression to relate state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011 and 2012 to state-specific rates of septicemia hospitalization (ICD-9 codes 038.xx present anywhere on a discharge diagnosis) in each of the following age groups of adults: (18-49y, 50-64y, 65-74y, 75-84y, 85 + y) reported to the Healthcare Cost and Utilization Project (HCUP) between 2011 and 2012, adjusting for additional covariates, and random effects associated with the ten US Health and Human Services (HHS) regions.ResultsIncrease in the rate of prescribing of oral penicillins by 1 annual dose per 1000 state residents was associated with increases in annual septicemia hospitalization rates of 0.19 (95% CI (0.02,0.37)) per 10,000 persons aged 50-64y, of 0.48(0.12,0.84) per 10,000 persons aged 65-74y, and of 0.81(0.17,1.40) per 10,000 persons aged 74-84y. Increase by 1 in the percent of African Americans among state residents in a given age group was associated with increases in annual septicemia hospitalization rates of 2.3(0.32,4.2) per 10,000 persons aged 75-84y, and of 5.3(1.1,9.5) per 10,000 persons aged over 85y. Average minimal daily temperature was positively associated with septicemia hospitalization rates in persons aged 18-49y, 50-64y, 75-84y and over 85y.ConclusionsOur results suggest positive associations between the rates of prescribing for penicillins and the rates of hospitalization with septicemia in US adults aged 50-84y. Further studies are needed to better understand the potential effect of antibiotic replacement in the treatment of various syndromes, including the potential impact of the recent US FDA guidelines on restriction of fluoroquinolone use, as well as the potential effect of changes in the practices for prescribing of penicillins on the rates of sepsis-related hospitalization and mortality.

Screening Efficiency for Hepatitis C in an Internal Medicine Practice of an Urban Medical Center (With a High Percent of African Americans)

Screening Efficiency for Hepatitis C in an Internal Medicine Practice of an Urban Medical Center (With a High Percent of African Americans)

Can Home-Based HIV Rapid Testing Reduce HIV Disparities Among African Americans in Miami?

Sixty percent of African Americans have had an HIV test, yet this population disproportionately contributes to AIDS mortality, suggesting that testing is not occurring early enough to achieve optimal outcomes. OraQuick, the first Food and Drug Administration-approved home-based HIV rapid test (HBHRT) could potentially increase testing rates. We assessed whether community health workers (CHWs) paired with HBRHT could improve HIV screening and health care access among African Americans in Miami, Florida. In October-November 2013, 60 African Americans were enrolled and randomized to the experimental condition, which received CHW assistance to complete HBHRT, or the control condition, which were instructed to complete HBHRT independently. Intervention participants were significantly (p ≤ .05) more likely than control participants to complete HBHRT and, if positive, get linked to HIV care (100% vs. 83%) χ(2) (1, N = 60) = 5.46, p ≤ .02. We concluded that CHW-assisted HBHRT may be a promising strategy to improve HIV testing and care among African Americans.

Density and Proximity of Tobacco Outlets to Homes and Schools: Relations with Youth Cigarette Smoking

This study investigated the associations of youth cigarette smoking with tobacco outlet densities and proximity of tobacco outlets to youth homes and schools across different buffers in 45 midsized California communities. The sample comprised 832 youths who were surveyed about their smoking behaviors. Inclusion criteria included both home and school addresses within city boundaries. Observations in the 45 cities were conducted to document addresses of tobacco outlets. City- and buffer-level demographics were obtained and negative binomial regression analyses with cluster robust standard errors were conducted. All models were adjusted for youth gender, age, and race. Greater densities of tobacco outlets within both a 0.75 and 1-mile buffer of youth homes were associated with higher smoking frequency. Neither tobacco outlet densities around schools nor distance to the nearest tobacco outlet from home or school were associated with youths past-30-day smoking frequency. Lower population density and percent of African Americans in areas around homes and lower percent of unemployed in areas around schools were associated with greater smoking frequency. Results of this study suggest that restricting outlet density within at least 1-mile surrounding residential areas will help to reduce youth smoking.

Racial and ethnic differences in physical activity guidelines attainment among people at high risk of or having knee osteoarthritis

This cross-sectional study examined racial/ethnic differences in meeting the 2008 United States Department of Health and Human Services Physical Activity Guidelines aerobic component (≥150 moderate-to-vigorous minutes/week in bouts of ≥10 minutes) among persons with or at risk of radiographic knee osteoarthritis (RKOA). We evaluated African American versus white differences in guideline attainment using multiple logistic regression, adjusting for sociodemographic (age, sex, site, income, and education) and health factors (comorbidity, depressive symptoms, overweight/obesity, and knee pain). Our analyses included adults ages 49-84 years who participated in accelerometer monitoring at the Osteoarthritis Initiative 48-month visit (n = 1,142 with RKOA and n = 747 at risk of RKOA). Two percent of African Americans and 13.0% of whites met the guidelines. For adults with and at risk of RKOA, significantly lower rates of guidelines attainment among African Americans compared to whites were partially attenuated by health factor differences, particularly overweight/obesity and knee pain (with RKOA: adjusted odds ratio [OR] 0.24, 95% confidence interval [95% CI] 0.08-0.72; at risk of RKOA: OR 0.28, 95% CI 0.07-1.05). Despite known benefits from physical activity, attainment of the physical activity guidelines among persons with and at risk of RKOA was low. African Americans were 72-76% less likely than whites to meet the guidelines. Culturally relevant interventions and environmental strategies in the African American community targeting overweight/obesity and knee pain may reduce future racial/ethnic differences in physical activity and improve health outcomes.

Abstract 58: Locating AEDs in an Urban City: A Geospatial View

Background: Survival from out-of-hospital cardiac arrest (OHCA) is poor and varies by geography. Variability in AED locations may be a contributing factor, but this is understudied. As publically accessible AEDs are more likely to be in commercial rather than residential areas, we sought to determine AED density in a large urban city relative to population and employment demographics. Methods: This was a retrospective analysis of MyHeartMap, a prospective cohort of AEDs in Philadelphia County. Geographic and population characteristics were obtained from US census and Local Employment Dynamics (LED) data by zipcode. Census characteristics included number of residents, percent of residents with a high school degree or above, median household income, and percent of African Americans. LED characteristics included total number of jobs reported, percent of jobs requiring a high school degree or above, percent of jobs with an annual income above $40,000, and percent of African Americans in jobs. Multivariate regression models using a Poisson distribution related the distribution of AEDs to population and employment characteristics using commercially available geographical information systems (GIS) software (ArcGIS Redlands CA) Results: AED locations (n=1295) and density per zip code (range 2-179) varied across the city. Population and employment characteristics were significantly related to the number of AEDs per zipcode (p<0.001) [R-square=0.38 and 0.74, respectively]. The incident rate ratio (IRR) for AED density was higher in zipcodes with higher-education (1.10, p<.01) and lower in zipcodes with more African American residents (0.99, p<.01). Regarding employment characteristics, the IRR for AEDs was higher in zipcodes with jobs requiring a higher education (1.03, p<.01) and jobs with higher income (1.04, p<.01) and lower in zipcodes with more African American employees (0.99, p<.01). Conclusions: Significantly fewer AEDs were located in areas with lower socioeconomic status. Employment characteristics better explained this variation across zipcodes. A more thorough study of this variability is important as optimizing the placement of AEDs in public areas may help to increase OHCA survival.

Twentieth-Century Ideology Meets Twenty-First-Century Technology: Black News Websites and Racial Uplift

While traditional Black-owned newspapers have been slow to embrace the Internet, Whiteowned media and African American entrepreneurs are taking advantage of openings in this technological space. About 35 percent of African Americans get their news from the Internet and that figure is expected to grow. Black newspapers have formed the foundation of much historical research on African American life, yet scholars have given almost no attention to the growth of Black news websites. This paper looks at three onlineonly news sites geared toward African Americans and how their editorial content compares to traditional Black-owned print publications. TheGrio.com, theRoot.com and theloop21.com launched in 2008 and 2009 with the goal of attracting a middle-class African American audience, even though White-controlled media companies own two of the three. The history of the Black press has been one of advocacy and aspiration. The first Black newspaper, Freedom’s Journal, sought to plead our own cause because too often Whites had spoken for Blacks and what they said was almost always negative. In this new digital world, Black news websites continue that tradition and more. One publisher said that the Black press used to allow only a few to speak for the many in the Black community, but digital journalism allows more African Americans to speak for themselves. The role that photography plays on these sites is critical to forming a positive racial self-identity. Besides this positive framing, the websites aim to show the heterogeneity among Blacks in the U.S. and in the Diaspora. The three sites appear to have merged old-school ideology with new-school technology.

Enrollment of women and minorities in NINDS trials

To determine policy-associated changes over time in 1) the enrollment of women and minorities in National Institute of Neurological Disorders and Stroke (NINDS)-funded clinical trials and 2) the trial publication reporting of race/ethnicity and gender. All NINDS-funded phase III trials published between 1985 and 2008 were identified. Percent of African Americans, Hispanic Americans, and women enrolled in the trials was calculated for those trials with available data. Z tests were used to compare reporting and enrollment data from before (period 1) and after (period 2) 1995 when NIH enacted their policies regarding race, ethnicity, and gender. Percent of main trial publications reporting enrollment of African Americans, Hispanic Americans, and women was also calculated. Of the 56 trials identified, 100%, 48%, and 25% reported enrollment by gender, race, and ethnicity. Women constituted 42.1% of the trial population. Enrollment of women increased over time (36.9% period 1; 49.0% period 2, p < 0.001). African Americans constituted 19.8% of the enrollees in trials with available data and enrollment increased over time (11.6% period 1; 30.7% period 2, p < 0.001). Hispanic Americans constituted 5.8% of subjects in trials with available data and enrollment decreased over time (7.4% period 1; 5.0% period 2, p < 0.001). Improvements in reporting of race/ethnicity in publications and enrollment of Hispanics in NINDS trials are needed. While African American representation is above population levels, Hispanic Americans are underrepresented in NINDS trials and representation is declining despite Hispanics' increasing representation in the US population.

Health Care Reform and Health Disparities: Implications for Social Workers

Health disparities, or preventable differences in burden of disease, injury and violence, or opportunities ... experienced by socially disadvantaged racial, ethnic, and other populations groups and communities, remain a serious problem in United States (Centers for Disease Control and Prevention, 2008). The grim figures are well known to social workers (NASW, 2009). Compared with white Americans, African Americans have shorter life expectancies and higher rates of disease and death. Although Hispanic Americans, particularly those born in other countries, are in better than nonimmigrant white Americans for at least one generation after immigrating, they lag behind in some measures (Kimbro, Bzostek, Goldman, & Rodriquez, 2008; Russell, 2009; U.S. Department of Health and Human Services [HHS], 2010). Racial and ethnic minorities, including Hispanic Americans, also generally have less access to care than white Americans, and when they get it, it is often inferior (HHS, 2010). Much less is known about disparities from Asian Americans, Arab Americans, and other racial and ethnic groups. During presidential campaign, candidates Obama and Biden pledged to tackle root causes of disparities by addressing differences in access to coverage and promoting prevention and public health (Obama Biden, n.d.). The Obama administration has also pledged to take steps to address disparities (Council on Social Work Education, 2010). Yet, what has been done to date? Thus far, one feat has been enactment of Patient Protection and Affordable Care Act (PPACA) (EL. 111-148) by Congress in March 2010. This article examines potential impact of PPACA on two kinds of disparities: racial and ethnic disparities and class (as determined or influenced by socioeconomic status) disparities. PPACA AND RACIAL AND ETHNIC DISPARITIES A central issue facing many racial and ethnic minorities is lack of access to care. In 2008, 10.8 percent of non-Hispanic white Americans lacked insurance, whereas 19.l percent of African Americans and 30.7 percent of Hispanic Americans no coverage (these figures provide a rough measure of uninsured population at a point in time, not entire year) (U.S. Census Bureau, 2009). If implemented as planned, PPACA ameliorate this problem by providing tax credits and other subsidies to individuals and families earning less than 400 percent of poverty line to assist them in buying coverage through new exchanges (Kaiser Family Foundation, 2010). Because approximately 80 percent of nonelderly blacks, Hispanics, and American Indians and Alaska Natives (compared with 57 percent of white Americans) had incomes below 400 percent of poverty, new law should help reduce disparities in access (Families USA, 2010). The legislation also extend Medicaid coverage to children and adults with incomes below 133 percent of poverty line. PPACA also should decrease group differences in by expanding funding for community centers, which have played a critical role in effort to stem the nation's growing flood of uninsured (Iglehart, 2010, p. 343). Former president George W. Bush described these centers, which grew out of antipoverty efforts of 1960s, as integral part of a care system because they provide care for low-income, for newly arrived, and they take pressure off of our hospital emergency rooms (cited in Iglehart, 2010, p. 343). In 2008, 61 percent of 20 million people served by community were African American or Hispanic American (National Association of Community Health Centers, 2009). The legislation provide $11 billion over five years, an investment that will approximately double number of people seen in centers (Wakefield, 2010). Also, plans be required to offer free preventive and wellness coverage, which many African Americans, Hispanic Americans, and others with high rates of uninsurance often go without (Health Reform for African Americans, n. …

Racial/Ethnic Differences in Blood Pressure Control and Medication Utilization in a Cohort of Older Veterans with Dementia

Hypertension and dementia are common illnesses in geriatric patients, resulting in significant morbidity and mortality. The objective of this study was to investigate racial and ethnic differences in blood pressure control and medication utilization in veterans aged 65 years or older with a diagnosis of both hypertension and dementia. We conducted a retrospective chart review for such veterans who attended the Michael E. DeBakey VA Medical Center outpatient clinics in Houston, Texas, during the period of October 1, 2003, to September 30, 2004. A total of 304 patients (190 Caucasians and 114 African-Americans) were included in the study. The mean number of concurrent antihypertensive medications for African-Americans was higher than for Caucasians (3.2 and 2.8, respectively; P = 0.02). African-American ethnicity was associated with higher use of thiazide diuretics (P = 0.02), dihydropyridine calcium channel blockers (P = 0.04), and clonidine (P = 0.01) than was Caucasian ethnicity. Forty-eight percent of African-Americans achieved adequate blood pressure control, compared with 59% of Caucasians. Mini-mental state exam scores were lower for African-Americans than for Caucasians (17.8 and 21.6, respectively; P = 0.01). The utilization of dementia medications was not found to be different between African-Americans and Caucasians. Veterans in this cohort achieved better blood pressure control than previously reported in other studies consisting of older patients. Physicians might have considered patients' race when prescribing antihypertensive medications reflected by the higher use of thiazide diuretics and calcium channel blockers for African-Americans.

The Making of a Nuclear Engineer, Inventor, and Black Film Historian: Dr. Henry Thomas Sampson, Jr.

Autobiographies and life-writings are some of the most valuable primary sources on the African American experience, and autobiography is the most important genre in the African American literary and intellectual traditions. In order to participate in these traditions. The Journal of African American History will be publishing autobiographical portraits by individuals who accept our invitation to share their life stories with our readers. I hope you agree with me that Dr. Henry T. Sampson's narrative about his life and career warrant inclusion in the documentation of the African American experience in the 20th century. [ILLUSTRATION OMITTED] On Saturday, 9 February 2008, Our Authors Study Club, Inc. of Los Angeles, California, an award-winning ASALH branch, held its annual Carter G. Woodson Scholarship and Award Luncheon honoring outstanding African Americans in various fields. At the event I received the George Washington Carver Renaissance Inventors Award. In my acceptance remarks, I attempted to answer a question that I had been asked many times over the years by friends and colleagues: How did you start out with such humble beginnings in Jackson, Mississippi, and go on to forge a successful career as an engineer and author of several books on the contributions of African Americans to American popular culture? Those questions of sincere interest prompted me to write this autobiographical portrait, with the encouragement and assistance of my wife and my daughter-in-law, describing my early life, schooling and training, and my achievements as an inventor, engineer, researcher, and black film historian. PROLOGUE On 22 April 1934 in Jackson, Mississippi, Theodore Bilbo, then regarded as the Archangel of white supremacy and subsequently dubbed America's most notorious merchant of hatred by the Saturday Evening Post, began his first term as a U.S. Senator from Mississippi. During his 1946 re-election bid, Bilbo called on every red-blooded white man to use any means to get niggers away from the polls ... if you don't understand what that means, you are just plain dumb.(1) Bilbo echoed the sentiments of the Ku Klux Klan and many other white racists all across the racially segregated state. In 1960, less than 2 percent of African Americans in the state were registered to vote. (2) Disfranchisement was not the only problem facing African Americans; Mississippi also led the nation in persecution by vigilante groups and up to 500 men, women, and children were lynched between 1882 and 1930. (3) In 1929, before the coming of the Great Depression, there were 52,000 people working in Mississippi's industrial sectors; by 1934 it had decreased to 28,000. (4) Bank deposits in Mississippi had dropped from $101 million to $9 million in that same period.(5) In the state capital of Jackson, small and large business owners experienced a measure of economic growth, stimulated by the discovery of natural gas fields near the city in the 1930s, but little of this newfound wealth managed to trickle down to African American workers and their families. Of African Americans who still had jobs outside the home, the vast majority were employed as housemaids, servants, and other service workers. Most of these positions required minimal levels of schooling and offered no opportunity for advancement. But, there were enough African Americans in the professional and working classes in Jackson to support at least one black newspaper, M. L. Rogers's Southern Register. (6) And there were numerous black churches of many denominations. This was Jackson, Mississippi's racial, social, and economic climate into which I was born at 3:00 A.M. on 22 April 1934 in the Ellis family home. FAMILY BACKGROUND AND EARLY EDUCATION As far back as I can remember, I was interested in discovering new things and I wanted to know exactly how mechanical and electrical objects worked and were put together. I created many of my own toys such as kites from homemade paste, newspapers, and tree branches; played with telephones from two empty cans connected with a wire; walked on stilts made from two empty cans with wires strung through them; shot china berries out of a pop-gun I made from a broomstick handle and an elm tree branch, an activity traced to slave boys on southern plantations; and I made slingshots. …

Cancer outcomes at end-of-life in Michigan: 2006 update

9544 Background: End-of-life care (EOLC) is an important focus of comprehensive cancer control. The Michigan Cancer Consortium has identified EOLC as one of its ten key objectives: By 2010, prevent and reduce avoidable suffering up to and during the last phase of life for persons with cancer as measured by specific data markers. 2004 data served as baseline measurements for specific strategies aimed at improving outcomes (2006 ASCO meeting - Abstact #8575). Methods: A population-based sample of caregivers, age 40 and older, including minorities, were contacted by trained, bilingual staff using computer-assisted telephone interviews in 2006. Results: 815 respondents constituted the sample size of caregivers who reported having cared for a family member with cancer in the preceding 5 years, including 199 African-Americans, 127 American Indians, 92 Arab Americans and 70 Hispanic Americans. The average level of pain in the final 3 months was reported as severe to excruciating for 40% (44.7% in 2004). Pain medications had been prescribed for 91.5% (93.5% in 2004); however, not used as directed for 11.1% (down from 30.3%). The most frequent reason given for this was side effects/fear of addiction for 87.9% & 7% respectively. The proportion who died at home was 46.7% (vs. 44.7%). A increasing trend was observed in the percent of African Americans who died at home ( from 40.8% in 2004 to 46.1% in 2006). 79.9% of cancer decedents died with the support of hospice (vs. 68.2% in 2004). The median length of stay on hospice, however, remained quite short, 16.8 days (17.5 days in 2003). The main reason hospice was not chosen was that death occured before hospice enrollment 64.6% (55.2% in 2004). 99.6% of those surveyed were aware of hospice as an available service. Only 1.1% were familiar with the term ‘palliative care.‘ Conclusions: Cancer EOLC is an important part of state-wide comprehensive cancer control. 2006 MI data reveals encouraging trends in regards to the prevelence of severe to excruciating pain in the final 3 months, proportion of those who died at home and the percent of those cancer patients who utilized hospice services. The timeliness of hospice utilization, however, continues to be problematic. Caregiver awareness of end-of-life services, such as hospice, is universal. Awareness of ‘palliative care‘, though, is almost nil. No significant financial relationships to disclose.

Beyond social dependency and political grievance

Charles Johnson argues that continued progress for African Americans depends largely on achieving cultural change among those in the African-American underclass, a prognosis so self-evident that it hardly bears mentioning. And that is itself a point that bears mentioning: thirty years ago many Americans believed that without vast new kinds of government programming and protection, racism would continue to consign African Americans to a life of muted aspirations and lost potential. This is no longer the case. Today, a majority of Americans, African American and others, believe that racism does not determine the fate of individual African Americans. A Newsweek survey from 1999, for example, showed that 70 percent of Americans think that “self-help by Black Americans themselves” did “a lot” or “some” to improve conditions for African Americans. Only 51 percent said the same for “affirmative action” programs and 46 percent for “other government programs” (Newsweek poll conducted by Princeton Survey Research Assoc. April 16-19, 1999. Found at www.pollingreport. com/race.htm) More importantly, in the same poll, 78 percent of African Americans thought “too many teenage girls having children” was a “big problem” for African Americans; 60 percent said the same for “crime in their neighborhood”; 63 percent for “people depending too much on welfare” and “people not following moral and religious values”; and 66 percent said “drugs and alcohol.” All of these percentages were higher than the percentage of whites saying the same thing. Only 56 percent of African Americans said “racism in society in general” was a “big problem” for African Americans; 46 percent said “racism in the work place” was a “big problem,” and 52 percent said “the government not spending enough on social programs” was. Apparently, even most African Americans now see the primacy of culture in determining how people fare. This does not mean that there are no reasonable debates over policy. There are some who argue that an African-American middle class could not have emerged BEYOND SOCIAL DEPENDENCY AND POLITICAL GRIEVANCE

End-of-Life Hospitalization for African American and Non-Latino White Nursing Home Residents: Variation by Race and a Facility's Racial Composition

Hospitalization of nursing home residents at the end of life is common, more so among African Americans. Whether a nursing home's racial mix is associated with hospitalization is unknown. This study examined the association between race, a nursing home's racial mix, and end-of-life hospitalization. This was a retrospective cohort study. Studied were nursing home residents in New York (n = 14,159) and Mississippi (n = 1481) who died in 1995-1996 and had a minimum data set (MDS) assessment within 120 days of death. The outcome measure was the odds of hospitalization in the last 90 days of life. A variable reflecting a nursing home's proportion of African American residents (in 1995-1996) represented a nursing home's racial mix. Forty-six percent of African Americans and 32% of whites were hospitalized in the last 90 days of life. After controlling for demographics, diagnoses, function, patient preferences (do-not-resuscitate [DNR]), and facility resources, nursing home residents in facilities having higher proportions of African American residents had greater odds of hospitalization (adjusted odds ratio [AOR] 1.14; 95% confidence interval [CI] 1.10, 1.18 in New York and AOR 1.35; 95% CI 1.24, 1.46 in Mississippi). Age and frailty interacted with race; older African Americans had a 16% greater likelihood (95% CI 1.08, 1.24) of hospitalization, and African Americans with more functional limitations had a 37% (95% CI 1.24, 1.51) greater likelihood of hospitalization than did comparable whites. It appears higher end-of-life hospitalization rates for African American residents are attributable to the facilities where most reside, and to differential hospitalization of older or more functional limited residents.

Race, Labor Markets, and Social Disorder in Twentieth-Century America

In 1900, approximately 10 percent of African Americans resided in central cities; by 1970, nearly 60 percent did, far higher than the corresponding proportion of whites. This geographic redistribution was central to the twentieth-century African American economic experience, with connections radiating in innumerable directions: to labor markets, housing markets, educational systems, the civil rights movement, and public policy responses to discrimination and poverty. Although migration patterns are not their focus, each essay in this special section is closely connected to the black population's historic redistribution.