US-born African Americans Research Articles

Abstract P115: Ethnic Differences in Cardiovascular Disease Deaths Among African American, African Immigrant and Afro-Caribbean Adults in the 1999-2018 National Health Interview Surveys

Background: Black persons are an heterogenous group in the US and bear a disparate higher burden of worse cardiovascular disease (CVD) outcomes. Our objective was to examine ethnic differences in CVD mortality among Black subgroups; African Americans(AAs); African Immigrants(AIs); and Afro Caribbeans(ACs). Methods: We analyzed the 1999-2018 National Health Interview Survey data, prospectively linked to mortality records in the National Death Index on 23,169,679 Black adults. The outcomes was CVD mortality, defined as CVD and cerebrovascular deaths, which was modelled as time till death (in years). This was calculated from each survey year till time of death or December 31, 2019 (administrative censoring) for those who survived. Using multivariable Cox proportional hazards regression analyses to model the survival function, we evaluated differences in CVD-and cerebrovascular-cause specific deaths among the three groups with progressive adjustment for age, sex, socioeconomic status and CVD risk factors. Results: With median of 10 years of mortality follow-up, there were 2.44, and 1.86 CVD deaths per 1,000 person-years among AA, and foreign born black adults (AIs and ACs combined), respectively. CVD mortality hazard was 81% lower in AIs [hazard ratio [HR], 0.19 (95% CI, 0.13–0.29], Table ) and 54% lower in ACs [HR, 0.46 (95% CI, 0.40–0.53], than among AAs. Compared to AAs, age-and sex-adjusted CVD mortality hazard was lower among AIs by 66% [HR, 0.34 (95% CI, 0.23–0.51], Table ) and ACs (HR, 0.46 [95% CI, 0.40–0.53]) by 54% (unchanged from unadjusted). In the fully adjusted model with SES and CVD risk factors adjustment, ACs had 41% lower adjusted CVD mortality hazard than AA adults (HR, 0.59 [95% CI, 0.45–0.77]). Conclusions: Cardiovascular deaths were higher among US-born AAs than foreign-born ACs. Nativity status is an important determinant of CVD mortality, and the heterogeneity of this population should be considered in health disparities research and interventions.

Clinical and Pathologic features of North American/Caribbean Adult T-cell leukemia/lymphoma (ATLL), the Brooklyn, NY experience

Adult T-cell leukemia/lymphoma (ATLL) is a rare, highly aggressive, T-cell malignancy caused by human T-cell leukemia/lymphoma virus type 1(HTLV-1) infection.1 It is estimated that there are at least 5-10 million HTLV-1 carriers worldwide. Most of the HTLV-1 infection is thought to be acquired from mother-to-child transmission through breastfeeding. Sexual transmission and blood transfusion are other means of infection. Only a small number (2-5%) of HTLV-1 infected patients develop ATLL, usually after a long latency period (30-50 years after infection), suggesting additional genetic and epigenetic events are required for HTLV-1 infected cells to transform to ATLL. 2-3ATLL is endemic in certain regions where HTLV-1 infection is prevalent, including southwestern Japan, the Caribbean basin, areas of South America and tropical Africa.4 ATLL is rare in North America and the majority of the patients are immigrants from Caribbean basin, and rarely, of US-born African Americans. Studies have shown that HTLV-1 infection is prevalent in the black, predominantly Caribbean population of central Brooklyn, NY and that ATLL is endemic in this community. 5-7 Here we review the clinical and pathologic features of Caribbean ATLL and present our findings in a cohort of ATLL from central Brooklyn, NY. Our data suggest that Caribbean ATLL is not only clinically but also molecularly distinct from Japanese ATLL. Epigenetically targeted therapy may be a potential effective adjunct therapy in treatment of ATLL.

Abstract B073: Estimating genetic ancestry of commonly used cancer cell lines

Abstract Given the scarcity of human cell lines from under-represented populations available for study, it is crucial that these cell lines be accurately characterized regarding their genetic ancestry so findings can be properly contextualized. Mischaracterization of a cell line's race/ethnicity can lead to wasted time and resources and potentially publication retractions. Here we calculated genetic ancestry proportions for 22 commercially available cell lines to test the accuracy of the “race/ethnicity” categorization assigned to these cells and to provide previously unknown genetic ancestry estimates to the scientific community. To determine cellular genetic ancestry proportions, DNA was extracted from the cell lines and genotyped for ancestry informative markers using the Agena MassARRAY platform with iPLEX chemistry. Genotypes for each cell line were analyzed with STRUCTURE software using settings of 30,000 for burn-in length, 70,000 replications, and K = 3 ancestral populations, representing West African (WA), Native American (NA), and European (EA) input genotype data. Commercially available cell lines designated as “Caucasian” in ethnicity were accurately described with mean European ancestry proportions of 97% (range 92-99%). Recently, using a much smaller panel of markers, the 22Rv1 cell line was found to have 41% WA ancestry. Our genetic ancestry analysis found the 22Rv1 cell line to have mostly EA ancestry, 91% EA, while also containing a non-negligible proportion of WA ancestry (8%). Three of the commercially available cell lines ascribed “Black” race appear to be accurate (HeLa, MDA-MB-PCa2, MDA-MB-468), although two of the three, HeLa and MDA-MBPCa2, fall far below the mean of ~80% WA ancestry for US-born African Americans with 60% and 66% WA ancestry, respectively. Interestingly, the MDA-MB-468 “Black” cell line had an appreciable amount of NA ancestry, 23% NA and 77% WA ancestry, which could suggest possible Afro-Caribbean ethnicity. Most notably, the E006 cell line, designated as “Black,” is as European as the previously mentioned cell lines ascribed Caucasian ethnicity with > 92% EA genetic ancestry. Cell lines with unassigned ethnicity varied widely in genetic ancestry with ranges of WA, NA, and EA ancestry proportions of 1%-92%, 0%-30%, and 2%-96%, respectively. Our results suggest predominantly European ancestry for the Caucasian-designated cell lines and high variance in genetic ancestry proportions for the Black-designated cell lines. However, the E006 cell line is an example of extreme misclassification, which has led to erroneous findings in the disparities literature and leave open the possibility of mischaracterization of other unanalyzed cell lines. Genetic ancestry estimates add more advanced and detailed ancestral characterization to these cell lines and allow for better contextualization of comparisons, applicability, and significant findings. We suggest robust genetic ancestry estimates as a requirement for all current and novel cell lines used in research. Citation Format: Stanley E. Hooker Jr., Madhavi Bathina, Stacy Lloyd, Priyatham Gorjala, Ranjana Mitra, Kevin S. Kimbro, Rick A. Kittles. Estimating genetic ancestry of commonly used cancer cell lines [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B073.

Surveillance for Hepatocellular Carcinoma: Current Best Practice and Future Direction.

Hepatocellular cancer (HCC) is the fourth leading cause of cancer-related deaths worldwide and the fastest growing cause of cancer deaths in the United States. The overall prognosis of HCC remains dismal, except for the subset of patients who are diagnosed at early stage and receive potentially curative therapies, such as surgical resection and liver transplantation. Given this, expert society guidelines recommend HCC surveillance every 6 months in at-risk individuals. Despite these recommendations, the effectiveness of HCC surveillance remains a subject of debate. We discuss current best practices for HCC surveillance and the evidence that support these recommendations. We also describe several initiatives that are underway to improve HCC surveillance and outline areas that may serve as high-yield targets for future research. Overall, we believe these efforts will help the field move toward precision surveillance, where surveillance tests and intervals are tailored to individual HCC risk. Doing so can maximize surveillance benefits, minimize surveillance harms, and optimize overall value for all patients.

Examining HPV- and HPV vaccine-related cognitions and acceptability among US-born and immigrant hispanics and US-born and immigrant non-Hispanic Blacks: a preliminary catchment area study.

Disparities in HPV vaccination exist. Therefore, we investigated the distinction and disparities in HPV- and HPV vaccine-related cognitions and acceptability among US-born African Americans (AA) and Black immigrants, and between US-born Latinas and Latina immigrants. Secondary data analyses were conducted with 383 female adults divided into non-Hispanic Blacks-(1) AA born in the US (n = 129) and (2) Black immigrants (n = 53), and Hispanics-(3) Latinas born in the US (n = 57) and (4) Latina immigrants (n = 144). HPV-related cognitions are assessed by measuring HPV-related knowledge and HPV vaccine-related awareness, beliefs, accessibility, and acceptability. Black and Latina immigrants were less likely to know where they can get/refer for HPV vaccine (p = .007) than their US-born counterparts. Latina immigrants were less likely to have heard of HPV vaccine (p = .033), know where they can get more information about HPV vaccine (p = .045), and know where they can get/refer for HPV vaccine (p = .001) than US-born Latinas. Both immigrant groups (Black: p = .046; Latina: p = .044) were more likely to report cost concerns than their counterparts. US-born AA were the least likely to endorse HPV vaccine safety (31.0%) and efficacy (39.7%), whereas US-born Latinas endorsed efficacy (63.2%) but less safety (44.6%). Overall, vaccine acceptability was low across all groups. Group disparities in HPV vaccine cognitions emerged, but they all had notable HPV vaccine acceptability (safety and efficacy) barriers. HPV vaccine safety and efficacy were highly unfavorable in US-born AA. The HPV vaccine safety concerns are demonstrated with only 31-54% reporting that the "HPV vaccine is safe"-potentially increasing their risk of HPV vaccine negation. With regards to HPV vaccine efficacy, only 40-63% of this study population endorsed HPV vaccine efficacy. Additionally, immigrants reported greater HPV vaccine cost barriers and healthcare access concerns-increasing their risk for HPV vaccine naiveté. Therefore, our findings on HPV vaccine cognitions and acceptability can inform targeted strategies to increase vaccination among US and immigrant Hispanics and non-Hispanic Blacks who are at elevated risk for HPV-related cancers.

Characteristics of US-Born Versus Foreign-Born Americans of African Descent With Chronic Hepatitis B.

Hepatitis B virus (HBV) infection is more common in African Americans than in white Americans. We compared the epidemiologic, clinical, and virological characteristics of US-born African Americans (USAAs) to those of foreign-born African Americans (FBAAs) with chronic hepatitis B. The adult cohort study of the Hepatitis B Research Network enrolls patients with HBV infection from 21 clinical sites in the United States and Canada. A total of 237 (15%) of the adult participants with chronic HBV infection that were enrolled from January 20, 2011, to October 2, 2013, were of African descent, including 57 USAAs and 180 FBAAs (76%). Compared with FBAAs, USAAs were older and more likely to have acquired HBV through sexual exposure, to be HBeAg-positive, to have higher HBV DNA levels, and to be infected with HBV genotype A2. FBAAs from West Africa were more likely to have elevated serum alanine aminotransferase (72% vs. 50%; P<0.01) and higher HBV DNA levels (median, 3.2 log10 IU/mL vs. 2.8 log10 IU/mL; P=0.03) compared with East African FBAAs. The predominant HBV genotype among West African FBAAs was E (67%), whereas genotypes A (78%) and D (16%) were common in East African FBAAs. Significant differences were found between USAAs and FBAAs, highlighting the need for tailored strategies for prevention and management of chronic HBV infection for African Americans.

African Ancestry Gradient Is Associated with Lower Systemic F2‐Isoprostane Levels

Context. Low levels of systemic F2-isoprostanes (F2-IsoP) increase the risk of diabetes and weight gain and were found in African Americans. Low F2-IsoPs could reflect an unfavorable metabolic characteristic, namely, slow mitochondrial metabolism in individuals with African ancestry. Objective. To examine differences in plasma F2-IsoPs in three groups with a priori different proportion of African ancestry: non-Hispanic Whites (NHWs), US-born African Americans (AAs), and West African immigrants (WAI). Design. Cross-sectional study. Setting. Georgia residents recruited from church communities. Participants. 218 males and females 25–74 years of age, who are self-identified as NHW (n = 83), AA (n = 56), or WAI (n = 79). Main Outcome Measure(s). Plasma F2-IsoPs quantified by gas chromatography-mass spectrometry. Results. After adjustment for age, gender, obesity, and other comorbidities, WAI had lower levels of plasma F2-IsoP than AA (beta-coefficient = −9.8, p < 0.001) and AA had lower levels than NHW (beta-coefficient = −30.3, p < 0.001). Similarly, among healthy nonobese participants, F2-IsoP levels were lowest among WAI, followed by AA, and the highest levels were among NHW. Conclusion. Plasma F2-IsoPs are inversely associated with African ancestry gradient. Additional studies are required to test whether optimization of systemic F2-IsoP levels can serve as means to improve race-specific lifestyle and pharmacological intervention targeted to obesity prevention and treatment.

Internalized racism and mental health among African-Americans, US-born Caribbean Blacks, and foreign-born Caribbean Blacks

ABSTRACTObjectives. The tripartite model of racism includes personally mediated racism, institutionalized racism, and the less-oft studied internalized racism. Internalized racism – or negative beliefs about one’s racial group – results from cultural racism that is endemic in American society. In this project, we studied whether these negative stereotypes are associated with mental health among African-Americans and Caribbean Blacks.Design. Using secondary data from the National Survey of American Life, we investigated the association between internalized racism and mental health (measured by depressive symptoms and serious psychological distress (SPD)) among these two groups. We also explored whether ethnicity/nativity and mastery moderate the association between internalized racism and mental health among African-Americans and Caribbean Blacks.Results. Internalized racism was positively associated with depressive symptoms and SPD among all Black subgroups. However, internalized racism was a weaker predictor of SPD among foreign-born Caribbean Blacks than US-born Caribbean Blacks and US-born African-Americans. Additionally, higher mastery was protective against distress associated with internalized racism.Conclusion. Internalized racism is an important yet understudied determinant of mental health among Blacks. Future studies should take into account additional heterogeneity within the Black population (e.g. African-born individuals) and other potential protective mechanisms in addition to mastery (e.g. self-esteem and racial identity).

Tuberculosis Knowledge, Awareness, and Stigma Among African-Americans in Three Southeastern Counties in the USA: a Qualitative Study of Community Perspectives

To inform strategies to address the tuberculosis (TB) excess among US-born African-Americans, we sought to understand the TB experience in the most highly affected southeastern communities. We conducted semi-structured interviews and focus groups in three communities with a TB excess-urban (Georgia and Tennessee) and rural (North Carolina). Participants from five groups provided diverse perspectives-African-Americans: patients with TB disease or latent TB infection (LTBI), or at high risk of contracting TB; and local community leaders and TB program staff. Few differences emerged between sites. Many participants demonstrated low levels of knowledge and awareness and held many misconceptions about TB. Patients expressed a preference for verbal communication of medical information. Patients reported fear of stigmatization and shunning, but few experienced discrimination. Patient trust for TB program staff was high, though community leaders often assumed the opposite. The findings will help guide interventions to improve knowledge and awareness regarding TB, including specific attention to the role of public and private health care providers in dispelling persistent misinformation about TB. The insight from these communities will help build the scientific foundation required to effectively eliminate health inequities.

Ethnic concentration and entrepreneurship: the case of African Americans in three US metropolitan areas

Using 2006–2010 American Community Survey data and a multilevel research design, this study examines how the spatial concentration of African Americans within local labor markets is associated with the probability of self-employment and job earnings from business ownership. We find a negative relationship between the spatial concentration of African Americans and their business ownership in Miami, but not in Atlanta. In Detroit, a higher percentage of US-born African Americans in the local labor market is actually associated with a higher probability of business ownership. The relationship between the percentage of African Americans and job earnings also differs across the three study areas. These results suggest that the relationship between racial/ethnic concentration and African American entrepreneurship is highly contingent on the economic conditions and demographic composition of local labor markets.

Beyond the black box: a systematic review of breast, prostate, colorectal, and cervical screening among native and immigrant African-descent Caribbean populations.

Cancer screening disparities between black and white groupings are well-documented. Less is known regarding African-descent subpopulations despite elevated risk, distinct cultural backgrounds, and increasing numbers of Caribbean migrants. A systematic search of Medline, Web of Science, PubMed and SCOPUS databases (1980-2012) identified 53 studies reporting rates of breast, prostate, cervical, and colorectal screening behavior among immigrant and non-immigrant Caribbean groups. Few studies were conducted within the Caribbean itself; most work is US-based, and the majority stem from Brooklyn, New York. In general, African-descent Caribbean populations screen for breast, prostate, colorectal, and cervical cancers less frequently than US-born African-Americans and at lower rates than recommendations and guidelines. Haitian immigrants, in particular, screen at very low frequencies. Both immigrant and non-immigrant African-descent Caribbean groups participate in screening less frequently than recommended. Studying screening among specific Caribbean groups of African-descent may yield data that both clarifies health disparities between US-born African-Americans and whites and illuminates the specific subpopulations at risk in these growing immigrant communities.

Heterogeneity of risk within racial groups, a challenge for public health programs

Targeting high-risk populations for public health interventions is a classic tool of public health promotion programs. This practice becomes thornier when racial groups are identified as the at-risk populations. I present the particular ethical and epistemic challenges that arise when there are low-risk subpopulations within racial groups that have been identified as high-risk for a particular health concern. I focus on two examples. The black immigrant population does not have the same hypertension risk as US-born African Americans. Similarly, Finnish descendants have a far lower rate of cystic fibrosis than other Caucasians. In both cases the exceptional nature of these subpopulations has been largely ignored by the designers of important public health efforts, including the recent US government dietary recommendations. I argue that amending the publicly-disseminated risk information to acknowledge these exceptions would be desirable for several reasons. First, recognizing low-risk subpopulations would allow more efficient use of limited resources. Communicating this valuable information to the subpopulations would also promote truth-telling. Finally, presenting a more nuanced empirically-supported representation of which groups are at known risk of diseases (not focusing on mere racial categories) would combat harmful biological race essentialist views held by the public.

The Impact of Diversity Promise Fulfillment on Professionals of Color Outcomes in the USA

This paper explores the relationship between psychological contract violations (PCVs) related to diversity climate and professional employee outcomes. We found that for our sample of US professionals of color including US-born African Americans, Hispanics, Asians, and Native Americans, employee perceptions of breach in diversity promise fulfillment (DPF), after controlling for more general organizational promise fulfillment (OPF), led to lower reported organizational commitment (OC) and higher turnover intentions (TI). Interactional justice partially mediated the relationship between DPF and outcomes. Procedural justice and DPF interacted to influence OC of employees of color. For respondents who perceived a lack of DPF, moderate racial awareness was associated with greater PCV. We discuss the implications of the findings and provide directions for future research.

Ethnic differences in patterns of social exchange among older adults: the role of resource context

ABSTRACTUsing social capital and social exchange theories, this investigation examined ethnic variation in patterns of social exchange in two heterogeneous racial groups, Blacks and Whites in the United States, and the effects of education and income on these patterns. The sample was 1,043 people aged 65–86 years from four ethnic groups (US-born European-Americans, immigrant Russians/Ukrainians, US-born African-Americans, and immigrant English-speaking Caribbeans) who had provided details of their instrumental and advice exchanges with kin and non-kin. Hierarchical multinomial logistic regressions were used to predict patterns of social exchange, variations by ethnicity, income and education, and the interactions. Ethnic differences in patterns of social exchange were found, but almost all were qualified by interactions. Those with income showed within-group heterogeneity: African-Americans and Russians/Ukrainians with higher income were more likely to engage in reciprocal instrumental kin exchange, whereas among English-speaking Caribbeans and European-Americans such exchanges were not associated with income. Unlike among European-Americans and English-speaking Caribbeans, Russians/Ukrainians with higher income and education were more likely to engage in reciprocal non-kin exchange. The findings suggest that ethnic variation in social exchange reflects both aspects of ethnic group membership and the relational context, as well as the enactment of reciprocity values in varying resource contexts.

Factors Associated with Intention to Breastfeed Among Low-Income, Inner-City Pregnant Women

To examine the relationship between sociodemographic factors, maternal characteristics, and intention to breastfeed among low-income, inner-city pregnant women. English and Spanish speaking low-income women recruited from local Philadelphia health centers were surveyed at the time of their first prenatal care visit. At the time of the visit, respondents were asked whether or not they planned to breastfeed their infant. The responses of 2,690 women were included in these analyses. Multivariate logistic regression was used to assess the independent associations of race/ethnicity, nativity status, education, and other factors on the odds of intending to breastfeed. About half (53%) of the respondents reported that they intended to breastfeed their infant. In adjusted logistic regression models, immigrant black (adjusted OR [aOR] 5.82; 95% confidence interval [CI] 3.86, 8.77), other Hispanic (who were predominantly foreign-born) (aOR 6.05; 95% CI 3.92, 9.33), and island-born Puerto Rican (aOR 3.48; 95% CI 2.04, 5.95) women were significantly more likely to report that they intended to breastfeed than non-Hispanic whites. Somewhat surprisingly, non-Hispanic, US-born African Americans in this low-income sample were more likely to report that they intended to breastfeed than non-Hispanic white respondents (aOR 1.59; 95% CI 1.20, 2.11). Lower education, not living with the baby's father, multiparous pregnancy, and smoking were negatively and independently associated with intention to breastfeed. Maternal age, household income, public housing, and depressive symptoms were not significant predictors of breastfeeding intention in adjusted multivariate models. Significant differences were documented in breastfeeding intention in our sample of low-income, inner-city women. Most notable was the higher likelihood of anticipated breastfeeding among our immigrant sub-groups when compared with non-Hispanic white women. An unexpected finding was the higher likelihood of anticipated breastfeeding among native-born, non-Hispanic African American women than among non-Hispanic white respondents. Because intentions are important predictors of future behavior, more focus needs to be directed towards breastfeeding promotion during the prenatal period and towards a better understanding of why some mothers intend to breastfeed while others do not.