Population Of African American Women Research Articles

Obesity‐induced and LDL‐mediated NK Cell Function Loss is Accompanied by Proteasome‐dependent induction of Lysophagy in an at‐risk population of African American Women

Obesity and related chronic diseases (i.e. cardiovascular disease (CVD) and cancer) disproportionately affect African Americans (AA), shortening life expectancy and impacting quality of life. Life‐long exposure to adverse social determinants of health (SDoH) have been linked to obesity, warranting intensified research to further elucidate the ‘biology of adversity’ or the biologic consequences of adverse social conditions. Evidence suggests that exposure to chronic psychological and environmental stressors as SDoH leads to immune cell dysfunction, particularly for Natural Killer (NK) cells. Therefore, we examined changes in NK cell function in AA women, a group at high risk of Class III obesity (BMI ≥40 kg/m2). We have previously shown that NK cell degranulation is impaired in AA women with Class III obesity accompanied by a decrease in IFNg and TNFa, a loss in function driven by plasma LDL levels (b=‐0.35, p=0.03). A similar phenotype of dysfunctional NK cells could be achieved by overnight LDL treatment (50mg/dl) of healthy donor NK cells. To further determine the underlying signaling pathways, we employed proteomics of control and LDL treated NK cells. Here we identified 18 statistically significant regulated proteins (p<0.05), and 23 proteins approaching significance (p<0.07). Signaling pathway analysis revealed endolysosomal function, actin cytoskeleton regulation, and regulation of innate immune responses as significant pathways. Several proteins associated with autophagy and ubiquitination were also identified. This is of particular importance as LDL treatment of various cell types has been related to damaging lysosomes and a subsequent potential induction of lysophagy. Therefore, we investigated the impact of LDL on NK cell autophagy through western blot analysis of LC3 and p62 and found that enhanced autophagy is present in LDL treated NK cells. By employing the proteasome inhibitor MG‐132, we also found that the LDL‐induced increase in autophagy appears to be dependent on the activation of the 20S proteasome and subsequent ubiquitination of lysosomal proteins which results in depletion of functional lysosomes through lysophagy and is accompanied by NK cell function loss. In summary, we show a novel pathway potentially explaining obesity‐related NK cell function loss as a result of adverse SDoH in a population at highest risk for obesity‐related diseases like CVD and cancer. In the future, more research is needed to further understand the ‘biology of adversity’ and identifying targets for tailored interventions, ultimately reducing health inequities in chronic disease outcomes.

Adverse Perinatal Outcomes Before and After Diagnosis of Systemic Lupus Erythematosus Among African American Women.

Women with systemic lupus erythematosus (SLE) may experience adverse perinatal outcomes in the years before an SLE diagnosis. Overall, there is limited research on perinatal outcomes among African American women with SLE. We undertook this study to examine the risk of preterm and small-for-gestational age births among African American women with SLE compared to the general population of African American women in a large metropolitan area. Information about women with SLE was identified from the Georgia Lupus Registry and the Georgians Organized Against Lupus Cohort and was linked with birth certificates by the Georgia Department of Public Health. Births were categorized into occurring more than 3 years before SLE diagnosis, 0-3 years before SLE diagnosis, 0-3 years after SLE diagnosis, or more than 3 years after SLE diagnosis. Comparison birth certificates to African American women in the same geographic area were obtained from the National Center for Health Statistics. We used log-risk models to compare the risk of preterm or small-for-gestational age births among SLE births in each diagnosis timing category to the general population, adjusting for maternal age and education and parity. Births to women with SLE were more likely to occur preterm at 0-3 years before SLE diagnosis (risk ratio [RR] 1.71, 95% confidence interval [95% CI] 1.24-2.35), 0-3 years after SLE diagnosis (RR 2.29, 95% CI 1.70-3.09), and 3 or more years after SLE diagnosis (RR 2.83, 95% CI 2.36-3.38), but not 3 or more years before SLE diagnosis compared to the general population (RR 1.03, 95% CI 0.77-1.38). Similar results were observed for small-for-gestational age births. Our analysis, conducted among African American women, demonstrates an increased risk of adverse perinatal outcomes even before a clinical diagnosis of SLE.

Impulsivity Mediates the Link between Childhood Sexual Abuse and Juvenile Incarceration among Low-Income African American Women

ABSTRACT A history of childhood trauma has been found to have a robust influence on juvenile delinquency, and evidence suggests that childhood sexual abuse is particularly common among female youth involved in the juvenile justice system. The current study sought to investigate impulsivity as a potential mediator of the relationship between childhood sexual abuse (CSA) and juvenile incarceration amongst a community sample of low-income, urban, African American adult women. Although impulsivity has been studied among justice-involved youth, few studies have examined the influence of impulsivity within the relationship between CSA and juvenile incarceration and no known studies have explored their relationship in community populations of African American women with histories of juvenile incarceration. Results revealed that impulsivity mediated the relationship between CSA and previous juvenile incarceration. As an exploratory analysis, overall emotion dysregulation as well as other facets of emotion dysregulation did not serve as significant mediators in this relationship. These findings suggest that difficulties in impulse control may be one mechanism through which childhood sexual abuse increases risk for juvenile justice system involvement among African American women.

Associations of childhood trauma with food addiction and insulin resistance in African-American women with diabetes mellitus

Food addiction (FA) describes a group of disordered eating behaviors. Childhood trauma has been associated with adult FA and trauma has known effects on the endocrine system, but it is unclear whether FA is associated with insulin resistance. We hypothesized that severity of childhood trauma will be associated with FA and higher insulin resistance (HOMA-IR) in a sample of obese women with type 2 diabetes mellitus (T2DM), and that FA will mediate the association between childhood trauma and HOMA-IR. Women with a diagnosis of T2DM (N = 73; MBMI = 35.86, SDBMI = 7.72; Mage = 50.59, SDage = 9.72) were recruited from a diabetes clinic at a county hospital. Participants completed the Childhood Trauma Questionnaire and the Yale Food Addiction Scale. Fasting blood samples were obtained from 64 participants to assess plasma hemoglobin A1c (HbA1c), insulin and glucose (used to calculate HOMA-IR); Oral Glucose Tolerance Test (OGTT) was performed to measure change in glucose and insulin secretion. 48% of the sample met diagnostic criteria for FA. Women with FA reported significantly higher HOMA-IR (F = 25.692, p < 0.001, df = 1,62), HbA1c (F = 4.358, p = 0.041, df = 1,62), and OGGT glucose (F = 5.539, p = 0.022, df = 1,62) as well as severity of childhood trauma (F = 10.453, p = 0.002, df = 1,71). In a hierarchical linear regression controlling for BMI, income level, and T2DM treatment, the severity of childhood trauma did not contribute to the prediction of HOMA-IR (β = −0.011, p = 0.942) whereas FA did (β = 0.422, p = 0.007). In a bootstrapped mediation analysis, the association between childhood trauma and HOMA-IR was mediated by FA severity (b = 0.596, p = 0.020). Understanding the psychological factors that contribute to HOMA-IR in an underserved population of African American women may lead to more effective diabetes management and prevention strategies.

Abstract A09: Urban neighborhood and residential factors associated with breast cancer in African American women: A systematic review

Abstract Certain residential characteristics in urban neighborhoods have shown to have negative impacts on health, especially in the African American population. The purpose of this systematic review is to understand the relationship between urban neighborhood and residential factors and breast cancer risk, incidence, stage at diagnosis/late stage diagnosis, survival, and mortality in African Americans. Using PubMed and Web of Science, the existing literature was reviewed. Observational, cross-sectional, cohort, and prospective studies until February 2017 were examined. Studies that included populations of African American women, setting in “urban” areas, and a measure of a neighborhood or residential factor were reviewed. Three parameters related to neighborhood/residential factors were extracted, including neighborhood socioeconomic status (SES), residential segregation, and residential pollution. Eighteen studies were identified for systematic review. 10 studies showed significantly higher odds of late-stage diagnosis, higher mortality, and lower survival in African American women living in lower socioeconomic neighborhoods. One study showed slightly higher odds of upward neighborhood change and probability of distant metastasis at diagnosis of African American woman compared to White women (OR=1.24). Similarly, 5 studies showed significantly high associations between residential segregation and late-stage diagnosis, as well as high associations of residential segregation and higher mortality in African American women. Two studies assessed residential pollution on breast cancer risk. The first study showed a weak rate of breast cancer risk in African American women between differentiating levels of trihalomethane in public water (RR=1.2). The second assessed the association of magnetic field exposure and breast cancer risk and found that the odds of getting breast cancer were not significant in African American women (OR=1.02). This review provides a qualitative synthesis of major neighborhood and residential factors on breast outcomes in African American women. By enacting health policies and utilizing tools such as health informatics, steps can be taken to drive the breast cancer disparity down in this population. Citation Format: Brandi Patrice Smith, Zeynep Madak-Erdogan. Urban neighborhood and residential factors associated with breast cancer in African American women: A systematic review [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A09.

Abstract 3012: Urban neighborhood and residential factors associated with breast cancer in African American women: A systematic review

Abstract Residential characteristics in urban neighborhoods impacts health and might be an important factor contributing to health disparities, especially in the African American population. The purpose of this systematic review is to understand the relationship between urban neighborhood and residential factors and breast cancer incidence and prognosis in African American women. Using PubMed and Web of Science, the existing literature was reviewed. Observational, cross-sectional, cohort, and prospective studies until February 2017 were examined. Studies including populations of African American women, setting in “urban” areas, and a measure of a neighborhood or residential factor were reviewed. Four parameters related to neighborhood or residential factors were extracted including: neighborhood socioeconomic status (nSES), residential segregation, spatial access to mammography, and residential pollution. Our analysis showed that African American women living in low nSES have greater odds of late stage diagnosis and mortality. Furthermore, African American women living in segregated areas (higher percentage of Blacks) have higher odds of late stage diagnosis and mortality compared to White and Hispanic women living in less segregated areas (lower percentage of Blacks). Late stage diagnosis was also shown to be significantly higher in areas with poor mammography access and areas with higher Black residential segregation. Lastly, residential pollution did not affect breast cancer risk in African American women. Overall, this systematic review provides a qualitative synthesis of major neighborhood and residential factors on breast cancer outcomes in African American women. Citation Format: Brandi P. Smith, Zeynep Madak-Erdogan. Urban neighborhood and residential factors associated with breast cancer in African American women: A systematic review [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3012.

Urban Neighborhood and Residential Factors Associated with Breast Cancer in African American Women: a Systematic Review.

Residential characteristics in urban neighborhoods impact health and might be important factors contributing to health disparities, especially in the African American population. The purpose of this systematic review is to understand the relationship between urban neighborhood and residential factors and breast cancer incidence and prognosis in African American women. Using PubMed and Web of Science, the existing literature was reviewed. Observational, cross-sectional, cohort, and prospective studies until February 2017 were examined. Studies including populations of African American women, setting in "urban" areas, and a measure of a neighborhood or residential factor were reviewed. Four parameters related to neighborhood or residential factors were extracted including: neighborhood socioeconomic status (nSES), residential segregation, spatial access to mammography, and residential pollution. Our analysis showed that African American women living in low nSES have greater odds of late stage diagnosis and mortality. Furthermore, African American women living in segregated areas (higher percentage of Blacks) have higher odds of late stage diagnosis and mortality compared to White and Hispanic women living in less segregated areas (lower percentage of Blacks). Late stage diagnosis was also shown to be significantly higher in areas with poor mammography access and areas with higher Black residential segregation. Lastly, residential pollution did not affect breast cancer risk in African American women. Overall, this systematic review provides a qualitative synthesis of major neighborhood and residential factors on breast cancer outcomes in African American women.

Lifetime number of ovulatory cycles and epithelial ovarian cancer risk in African American women.

Incessant ovulation has been consistently linked to epithelial ovarian cancer (EOC). Although reproductive characteristics differ substantially by race, the association between incessant ovulation and EOC has been evaluated only in populations of predominantly white women. In the present study, we examined the association between lifetime number of ovulatory cycles (LOCs) and EOC risk among African American (AA) women. We used data from 534 cases and 722 controls enrolled in the African American Cancer Epidemiology Study. LOCs were determined using the standard method, with modifications to include episodes of irregular or missed periods. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between LOCs and EOC risk overall and by age, while adjusting for appropriate confounders. The mean number of LOCs was 378.2 ± 105.8 for cases and 346.4 ± 117.3 for controls. Women in the highest tertile of LOCs had 59% higher odds of EOC compared to women in the lowest tertile (OR = 1.59; 95% CI = 1.15-2.20). When examining this relationship by age, the positive association with EOC was stronger among women <50years of age (OR for highest vs. lowest tertile = 2.61; 95% CI = 1.15-5.94), followed by women aged 50-60years (OR = 2.27; 95% CI = 1.30-3.94). Yet, no association was present among women aged >60years (OR = 0.79; 95% CI = 0.45-1.40). In a population of AA women, we observed a positive association between LOCs and EOC risk, providing further support for the hypothesis that incessant ovulation contributes to the etiology of EOC.

Disparities in Obesity, Physical Activity Rates, and Breast Cancer Survival.

The significantly higher breast cancer (BCa) mortality rates of African-American (AA) women compared to non-Hispanic (NHW) white women constitute a major US health disparity. Investigations have primarily focused on biological differences in tumors to explain more aggressive forms of BCa in AA women. The biology of tumors cannot be modified, yet lifestyle changes can mitigate their progression and recurrence. AA communities have higher percentages of obesity than NHWs and exhibit inefficient access to care, low socioeconomic status, and reduced education levels. Such factors are associated with limited healthy food options and sedentary activity. AA women have the highest prevalence of obesity than any other racial/ethnic/gender group in the United States. The social ecological model (SEM) is a conceptual framework on which interventions could be developed to reduce obesity. The SEM includes intrapersonal factors, interpersonal factors, organizational relationships, and community/institutional policies that are more effective in behavior modification than isolation from the participants' environmental context. Implementation of SEM-based interventions in AA communities could positively modify lifestyle behaviors, which could also serve as a powerful tool in reducing risk of BCa, BCa progression, and BCa recurrence in populations of AA women.

Neighborhood and Individual Socioeconomic Status and Asthma Incidence in African American Women

Individual socioeconomic status (SES) has been associated with asthma incidence but whether neighborhood SES has an influence is unknown. We assessed the contributions of neighborhood socioeconomic status (SES), neighborhood housing density, neighborhood racial composition, and individual SES to the development of adult-onset asthma in Black women, accounting for other known or suspected risk factors. Prospective cohort study conducted among 47,779 African American women followed with biennial health questionnaires from 1995 to 2011. Incident asthma was defined as new self-report of doctor-diagnosed asthma with concurrent use of asthma medication. We assessed neighborhood SES, indicated by census variables representing income, education, and wealth, and housing density and % African American population, as well as individual SES, indicated by highest education of participant/spouse. Cox proportional hazards models were used to derive multivariable hazard ratios (HRs) and 95% CIs for the association of individual SES and neighborhood variables with asthma incidence. During a 16-year follow-up period, 1520 women reported incident asthma. Neighborhood factors were not associated with asthma incidence after control for individual SES, body mass index, and other factors. Compared with college graduates, the multivariable HR for asthma was 1.13 (95% CI 1.00-1.28) for women with some college education and 1.23 (95% CI 1.05-1.44) for women with no more than a high school education. Individual SES, but not neighborhood SES or other neighborhood factors, was associated with the incidence of adult-onset asthma in this population of African American women.

Abstract B39: Clinical characteristics of breast cancers in African American women with benign breast disease: A comparison to the Surveillance, Epidemiology and End Results Program

Abstract Although the association between benign breast disease (BBD) and risk of subsequent breast cancer is well-established, no previous studies have compared characteristics of breast cancers in women with a history of BBD to characteristics of cancers in the general population. In this study, we compared the characteristics of 109 breast cancers that developed in a population of African-American women with a history of benign breast disease (BBD population) to 10,601 breast cancers that developed in a general population of African-American women whose cancers were recorded by the Metropolitan Detroit Cancer Surveillance System (MDCSS population). The populations were compared on demographic characteristics such as age, marital status, and previous cancers, as well as clinical characteristics such as tumor hormone receptor status, grade, stage, behavior, size, and treatment. Overall and breast cancer-specific survival were also compared between populations. Women in the BBD population developed lower grade, earlier stage cancers that were more likely to be hormone receptor-positive and less likely to exhibit invasive behavior. Women in the BBD population were also significantly less likely to die from breast cancer after ten years of follow-up. These results suggest that although women with a history of BBD are at greater breast cancer risk, their breast cancers may be more likely to be detected early, leading to better breast cancer-specific survival. Citation Format: Susanna D. Mitro, Rouba Ali-Fehmi, Sudeshna Bandyopadhyay, Baraa Alosh, Bassam Albashiti, Quratulain Ahmed, Derek C. Radisky, Marlene H. Frost, Amy C. Degnim, Julie J. Ruterbusch, Michele L. Cote. Clinical characteristics of breast cancers in African American women with benign breast disease: A comparison to the Surveillance, Epidemiology and End Results Program. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B39. doi:10.1158/1538-7755.DISP13-B39

Abstract P1-09-02: GIS exploration: Might triple negative breast cancer patients face disparities in access to clinical trials due to distance?

Abstract Background The incidence of triple negative breast cancer among African-American women and Latinas with breast cancer has been estimated to be at least 25%. Black and Latina women tend to develop the disease at a younger age than white women. Preliminary research evidence suggests that there are racial differences in survival for triple negative breast cancer with African-American women more likely to experience disease progression while undergoing chemotherapy. We sought to identify and map the geographic US distribution of clinical trials enrolling patients with triple negative breast cancer and to examine the proximity of these trials to populations of Hispanic/Latina and African American women diagnosed with breast cancer. We followed this analysis with an exploratory mapping of community-based resources to reduce cancer disparities among underserved populations in two states Methods We used geographic information systems (GIS) and asset mapping tools to visually depict trials enrolling patients with triple negative breast cancer in the US, using data provided by Breastcancertrials.org. We compared the locations of the trials and breast cancer incidence among Latinas and African American women and created mortality ratios using SEER data. We also explored available patient resources in the context of geography and populations of interest for two states with significant populations of both African Americans and Hispanic/Latinas–Texas and California. We engaged breast cancer advocacy and other cancer advocacy as well as healthcare organizations in developing our resource maps. We mapped directories of patient resources in our two states, and discuss the challenges, lessons learned, and future directions for using GIS mapping of populations and resources for research and practice. Results Our maps show distinct patterns of populations of African American Women and Latinas diagnosed with breast cancer in relationship to trials enrolling TNBC patients. Our asset driven, community-based approach illustrated the distribution of locations of Latina and African American breast cancer populations and organizations that offer supportive resources. In both Texas and California, there are regions where Latina and African American women may suffer disparities both in lack of access to clinical trials and in community-based resources that could support their efforts to participate in clinical trials. Conclusion These transdisciplinary community mapping efforts of both trials and patient resources highlight the benefit of innovative community,academic, and clinical partnerships for addressing cancer health disparities in clinical trials. GiS mapping offers the potential to identify barriers to care among underserved populations and provides a useful and innovative format for discussions about community capacity-building in order to increase access to breast cancer trials among vulnerable populations. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-02.

Reliability and Validity of a Culturally Appropriate Food Frequency Questionnaire to Measure Omega-3 Fatty Acid Intakes in Midwestern African American Women of Childbearing Age

Background: Omega-3 fatty acid intakes may play an important role in maternal health outcomes and infant brain and neural development. Research has shown that pregnant African American women have intakes below recommended levels for optimal health. Objective: The aim of this pilot study was to determine the reliability and validity of a culturally specific FFQ to measure total omega-3 (n-3) fatty acid, ALA, EPA and DHA intake of Midwestern African American women (n=49) of child-bearing age and examine associations between these intakes with maternal health issues from previous pregnancies. Methods: The omega-3 FFQ questionnaire was developed by 24 hour recall interviews, analyzed for content validity and pilot tested. The final culturally appropriate 187 item FFQ was then completed by women three times, via interview by an RD, along with three non-consecutive 24 hour food recalls, during a two week period. Maternal health issues were assessed by demographic questionnaire. The reliability and validity of the FFQ was assessed by Cronbach’s coefficient alpha and Pearson correlation coefficients, respectively. Results: Mean daily consumption of total omega-3 fatty acid, ALA, EPA, DHA and DPA as estimated by the 3 administrations of the FFQ, were 2.68 + 1.37 g/day, 2.45 + 1.30 g/day, 0.07 + 0.07 g/day, 0.12 + 0.11 g/day and 0.03 + 0.02 g/day, respectively. The Cronbach’s coefficient alphas, for reliability of the FFQ, were 0.89 for total omega-3, 0.89 for ALA, 0.89 for EPA, 0.88 for DHA and 0.83 for DPA. Pearson correlation coefficients as measured for validity between the FFQ and the recalls, were 0.44, 0.44, 0.59 and 0.60 for total n-3 fatty acid, ALA, EPA and DHA (P American women with past history of low birth weight, preterm labor, premature rupture of membranes and post-partum depression had a significant difference in omega-3 fatty acid intakes when compared to those without prior history. Conclusions: In conclusion, this culturally appropriate FFQ seems to be reliable and valid in measuring omega-3 fatty acid intake in Midwestern African American women. This tool may be used to assess other populations of African American women’s intake of omega-3 fatty acids.

African American Women Aspiring to the Superintendency: Lived Experiences and Barriers

Focused on the absence of a viable population of African American women in the superintendency, this study addressed barriers described by 10 credentialed, district-level Southern women who hold advanced education degrees coupled with years of leadership experience. This phenomenological study used interview methodology to uncover the lived experiences of African American women who were positioned professionally to apply for the superintendency. A Black feminist construct was employed to interpret personal themes—early expectations, family influences, ethical beliefs, vigilant preparation—that converged with external themes—disconnection from networks, oppression, and selection processes—to reveal obstacles to applying for the superintendency. Profiles of well-credentialed African American women educators are provided.

Feasibility, acceptability, and preliminary efficacy of the unity workshop: an internalized stigma reduction intervention for African American women living with HIV.

Observational studies have examined the prevalence and impact of internalized stigma among African American women living with HIV, but there are no intervention studies investigating stigma reduction strategies in this population. Based on qualitative data previously collected, we adapted the International Center for Research on Women's HIV Stigma Toolkit for a domestic population of African American women to be consistent with Corrigan's principles of strategic stigma change. We implemented the intervention, led by an African American woman living with HIV, as a workshop across two afternoons. The participants discussed issues "triggered" by videos produced specifically for this purpose, learned coping mechanisms from each other, and practiced them in role plays with each other. We pilot tested the intervention with two groups of women (total N=24), measuring change in internalized stigma with the Stigma Scale for Chronic Illness before and after workshop participation. Sixty-two percent of the participants self-reported acquiring HIV through heterosexual sexual contact, 17% through intravenous drug use, 4% in utero, and 13% did not know the route of transmission. The intervention was feasible, enthusiastically accepted by the women, and led to decreased stigma from the start of the workshop to the end (p=0.05) and 1 week after (p=0.07) the last session of workshop. Findings suggest the intervention warrants further investigation.

Hair grooming practices and central centrifugal cicatricial alopecia

The cause of central centrifugal cicatricial alopecia (CCCA) in African American women remains to be elucidated. This study was designed to determine the hair-grooming practices in African American women with and without CCCA and to evaluate possible etiologic factors. Utilizing a novel survey instrument, the Hair Grooming Assessment Survey, we performed a retrospective comparative survey of the hair-grooming practices of two populations of African American women seen and evaluated at the Department of Dermatology, Henry Ford Hospital in Detroit, MI, between 2000 and 2007. The case group were women with clinical and histologic diagnosis of CCCA, and the control group were those without a history of alopecia. All 101 surveys that were returned were analyzed (51 from the case group and 50 from the control group). A strong association was found between the use of both sewn-in hair weaving and cornrow or braided hairstyles with artificial hair extensions and CCCA (P < .04, P < .03, respectively). Similarly, women with CCCA were more likely to report a history of "damage", typically defined as uncomfortable pulling and tenderness, from both sewn-in and glued-in weaves, and from cornrow or braided hairstyles with artificial hair extensions (P < .001, P < .02, and P < .03, respectively). In contrast to previous anecdotal beliefs, no correlation was found between the use of either hot combing or hair relaxers and the development of CCCA. Results are limited by patient recall of past hair grooming practices. Also, as hair grooming practices may vary by geographic region, these results may not be generalized to all women of African descent. There is a clear difference in both quantitative and qualitative hair grooming practices among African American women with CCCA.

Trichomonas vaginalisInfection: Can We Afford to Do Nothing?

<i>Trichomonas vaginalis</i>Infection: Can We Afford to Do Nothing?

Molecular Breast Cancer Subtypes in Premenopausal and Postmenopausal African-American Women: Age-Specific Prevalence and Survival

Breast cancer is currently regarded as a heterogeneous disease classified into various molecular subtypes using gene expression analysis. These molecular subtypes include: basal cell-like, Her-2/neu, luminal A, and luminal B. To analyze the prevalence and clinicopathologic associations for molecular breast cancer subtypes in premenopausal and postmenopausal African-American women. A retrospective analysis of all African-American women diagnosed with breast cancer from 1998 to 2005, who had assessable data for ER, PR, and Her-2/neu status. Molecular subtype classification was done based on immunohistochemical surrogates for ER, PR, and Her-2/neu status obtained from Howard University tumor registry for each patient. The molecular subtypes were defined as: luminal A (ER+ and/or PR+, HER2-), luminal B (ER+ and/or PR+, HER2+), basal-like (ER-, PR-, HER2-), and Her-2/neu (ER-, PR-, and HER2+). We analyzed the prevalence of molecular breast cancer subtypes in a population of African-American women and determined their associations with patient demographics and clinicopathologic variables: node status, tumor size, histological grade, p53 mutation status, and breast cancer-specific survival. The luminal A subtype was the most prevalent in our study sample (55.4%) compared with (11.8%) luminal B, (21.2%) basal cell-like, and (11.6%) Her-2/neu subtypes. The molecular subtypes did not differ by menopausal status. However, when stratified into age-specific groups, the basal cell-like subtype (57.1%) was the most prevalent in the age group <35 y compared with luminal A, luminal B, and Her-2/neu subtypes at 25.0%, 14.3%, and 3.6%, respectively. The basal cell-like subtype also showed an age-specific bimodal distribution with a peak in the <35 y and 51 to 65 y age groups. The basal cell-like and the Her-2/neu subtypes showed an increased association with clinicopathologic variables portending a more aggressive clinical course when compared with luminal A subtype. A paradoxical inverse relationship between the expression of p53 and Bcl-2 protooncoprotein was noted in the molecular subtypes. Breast cancer-specific survival differed significantly among the molecular subtypes (P < 0.04), with the basal cell-like and Her-2/neu subtypes having the poorest outcome. The high prevalence of the basal cell-like subtype in the young premenopausal African-American women aged <35 y could be a contributory factor to the poorer prognosis of breast cancer observed in this cohort of patients.

Family, cultural and gender role aspects in the context of HIV risk among African American women of unidentified HIV status: An exploratory qualitative study

This was an exploratory, qualitative study of contextual cultural and social realities of the sexual interactions of a representative sample of African American women of unidentified HIV status. The study expanded our understanding of family and gender role variables by exploring influences of family of origin and idealistic perceptions of roles on sexual relationships. Data was collected on 51 African American women who were recruited through probability sampling. Between 39% and 70% of study participants reported at least one of the following HIV risk factors: low condom use, substance use during sex, partner's incarceration and history of abuse. Nonetheless, all women in our study perceived their chances of HIV infection to be almost non-existent, despite a fairly good knowledge of HIV/AIDS modes of transmission including that anyone could become HIV infected, knowing somebody with HIV/AIDS and acknowledgment, among some, of their partner's infidelity and risk behaviors. Our analysis revealed that parental communications about sexuality in relationships focused largely on trust (being mistrustful of men) and women's control of their sexual impulses. Trust was also emphasized (desired) by women in the discussions of gender roles. Women reported a strong reliance on God and made frequent references to the role of the church in HIV prevention. Our findings offer suggestions for HIV prevention for the general population of African American women. HIV-prevention messages that consider their views of relationships, gender roles, sexual abuse history and the role of the church are suggested.

Culturally appropriate surrogates for vulnerable patients perspectives of participation in randomized clinical trials

869 Background: Low health literacy may preclude adequate consent for clinical trial participation in vulnerable populations. Understanding the patient perspective is essential to understand low participation rates, and the conditions under which researchers have a duty to exclude particular patients. A qualitative study was conducted to explore willingness and comprehension of randomized clinical trial participation in African American and immigrant communities. Methods: Twelve focus groups of 7–11 individuals (N=111) were recruited from African American churches (6 groups), and professional association for Medical Interpreters (MIs) (6 groups, including Asian, African, Russian/Ukranian, and Spanish languages) to serve as proxy voices for patients. Focus groups involved a 2-hour audio-taped discussion co-facilitated by two moderators, wherein a detailed breast cancer randomized clinical trial was discussed. Results: Several themes describe vulnerable patients' willingness to participate in research studies, and understanding of randomized clinical trial participation. African American church-going women were enthusiastic about breast cancer research, but were reluctant to be personally randomized, and expressed mistrust for research. MIs noted that some immigrant patients struggled to understand the indications for screening and treatment . As such MIs expressed strong concern that it is inappropriate to further burden such patients with education regarding the option to participate in clinical trials. Conclusions: Interest and enthusiasm for clinical trials is strong in a selected population of African American women, yet some immigrants may not understand the cultural context of a clinical trial, meriting possible exemption from consideration for participation. Medical clinics and researchers providing breast cancer screening and treatment options to women can benefit greatly by enhanced cultural awareness and sensitivity to the cultural context of vulnerable populations. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Avon Foundation