US Ethnic Groups Research Articles

Chapter 37 - Epidemiology of drinking, alcohol use disorders, and related problems in US ethnic minority groups

This chapter reviews selected epidemiologic studies on drinking and associated problems among US ethnic minorities. Ethnic minorities and the White majority group exhibit important differences in alcohol use and related problems, including alcohol use disorders. Studies show a higher rate of binge drinking, drinking above guidelines, alcohol abuse, and dependence for major ethnic and racial groups, notably, Blacks, Hispanics, and American Indians/Alaskan Natives. Other problems with a higher prevalence in certain minority groups are, for example, cancer (Blacks), cirrhosis (Hispanics), fetal alcohol syndrome (Blacks and American Indians/Alaskan Natives), drinking and driving (Hispanics, American Indians/Alaskan Natives). There are also considerable differences in rates of drinking and problems within certain ethnic groups such as Hispanics, Asian Americans, and American Indians/Alaskan Natives. For instance, among Hispanics, Puerto Ricans and Mexican Americans drink more and have higher rates of disorders such as alcohol abuse and dependence than Cuban Americans. Disparities also affect the trajectory of heavy drinking and the course of alcohol dependence among minorities. Theoretic accounts of these disparities generally attribute them to the historic experience of discrimination and to minority socioeconomic disadvantages at individual and environmental levels.

Abstract MP62: The Role of Primary Care Physician Visits in Promoting Medication Adherence as Part of a Randomized Controlled Diabetes Management Intervention in American Samoa

Background: The Native Hawaiian/Pacific Islander group is one of the fastest growing US ethnic groups, and Samoans make up the second largest Pacific Islander group in the US. Samoans are at a disproportionately high risk of type 2 diabetes mellitus (T2DM) and other cardiovascular disease risk factors, with prevalence rates of T2DM in adults in the US Territory of American Samoa around 20%, nearly double that of US Hispanics. A randomized, controlled trial of a community health worker (CHW)-facilitated diabetes management intervention in American Samoans with T2DM showed improved HbA1c levels in part through promoting health behaviors associated with diabetes management, including diet, physical activity, and most strongly, medication adherence. The current study sought to examine a potential intermediate variable through which the CHW intervention influenced health behaviors, in particular, whether the CHW intervention resulted in more frequent primary care physician (PCP) visits, which in turn, were associated with increased engagement in health behaviors. We also examined if relationships differed by baseline PCP utilization. Methods: Participants were 266 Samoan adults diagnosed with T2DM, randomized to the CHW intervention or wait-list control condition. Participants were additionally classified as meeting American Diabetes Association guidelines for PCP utilization at baseline (i.e., ≥4 PCP visits in the year prior to the intervention, “high utilizers”) or not (“low utilizers”). Regression models were used to examine the association between treatment assigned and frequency of PCP utilization, and whether PCP utilization was associated with the probability of engaging in diabetes management health behaviors (at least moderate intensity physical activity, healthy diet, medication adherence). Results: After adjustment for covariates including age, gender, and comorbidities, results indicate that CHW participants had greater rates of PCP visits over the intervention period, but only amongst low utilizers (RR = 1.94, 95% CI= 1.27, 2.97). A greater number of PCP visits, in turn, was associated with a higher odds of medication adherence (but not diet or physical activity), only amongst low utilizers (OR = 1.40, 95% CI= 1.12, 1.74). Conclusions: Results suggest that a CHW-facilitated diabetes intervention in the Samoan population may have promoted diabetes medication adherence (which has previously been associated with lower HbA1c in this cohort) by increasing the frequency with which participants encountered and interacted with their PCPs, specifically those participants in greatest need (i.e., those who had fewer PCP visits than recommended at baseline). Future research should further examine how increasing engagement with PCPs can serve as a mechanism through which to elicit behavior change in diabetic minority populations at high risk for cardiovascular disease.

Survival Disparities in Bladder, Kidney, and Prostate Cancer in Asian-Indian & Pakistani Immigrants to the United States as Compared to Other US Ethnic Groups: A Surveillance, Epidemiology and End Result (SEER) 2011 Public Use Database Study

Objective: To compare the SEER 2011 public use data prognostic variables and survival of US Asian-Indians and Pakistanis (US-AIP) diagnosed with bladder, kidney, or prostate cancers, to patients in three comparable US ethnic groups (African-Americans, Hispanics, and Caucasians) diagnosed with the same cancers. Patients and Methods: SEER 1988-to-2008 data (released in 2011) was analyzed using SEER*Stat Software V7.0.5 and SAS version 9.3. Results: From 1988-to-2008, SEER documented 14,006 cancers in US-AIP (7,118 male, 6,888 female), with 2,867 (20%) being bladder, kidney, or prostate. Compared to the three other US ethnic groups examined, US-AIP genitourinary (GU) cancers occurred at significantly younger ages (p <0.01-to-<0.001). US-AIP had significantly more grade 3-4 (p <0.01-to-<0.001) and stage 3-4 (p<0.001) cancers than the other three groups. Paradoxically, despite having worse prognostic factors, five year age-adjusted survival for the bladder, kidney, and prostate cancers in US-AIP were significantly better than in the other three US ethnic groups (p <0.01-to-<0.001). Conclusions: SEER 1988-to-2008 data contained a “survival disconnect” for genitourinary cancers in US-AIP. All three US-AIP GU cancers had worse prognostic features but better age-adjusted survival when compared to three other US ethnic groups, even though US-AIP appeared to have had similar treatment. US-AIP cultural and biologic factors, which might modify the clinical behavior of their GU cancers, are discussed. Of note, SEER 2000-to-2008 data showed a significant decline in bladder, kidney, and prostate cancer relative risk of death for all four ethnic groups studied versus earlier era SEER 1994-to-2000 data.

Epidemiological and Survival Disparities of Multiple Myeloma in Different Ethnicities in the USA: A SEER Database Based Analysis From 1973 to 2009

AbstractAbstract 4967 Background:Multiple myeloma (MM) is a common hematological malignancy affecting all races and the incidence is increasing. The rise in incidence is partly due to an increase in average life span in the patient population above the age of 65. It is estimated that 21, 700 individuals will be diagnosed with and 10, 710 patients will die of myeloma in 2012. The comparative epidemiological and survival data on different ethnic groups has not been analyzed on a large population scale. The aim of this study is to analyze and compare the epidemiologic and survival parameters of MM in major US ethnic groups which may provide new insights into disease pathophysiology. Methods:The SEER (Surveillance Epidemiology and End Results) database has been reporting cancer incidence since 1973. Using SEER 18 registries database 1973–2009, appropriate frequency and survival analyses (Kaplan-Meier survival method age adjusted) were performed and compared. Results:US whites (USW) accounted for the highest reported cases (77%) while the next highest reported cases were AA population (17%) (Table 1). On the contrary, the incidence of MM was highest in AA (11. 7%) and lowest in the US-Hispanic group (3. 4%). Male to female distribution was similar among groups. The median age at diagnosis was 63yrs in AA and 62yrs in US-Asians compared to ∼70yrs in the other ethnic groups. The cancer at presentation was more advanced in the AA and US-Asian groups. However, as shown in both Tables 1 &2, the mortality rates were significantly lower in the US-Asian population when compared to other ethnic groups (2. 4%).Table 1:Comparison of selected variables of MM among major US ethnic groupsVariablesAllUSWAAHispanicUS-AsianReported cases (%)79,186 (100%)61,083 (77%)13,611 (17%)2,393 (3%)1,872 (3%)Incidence rate5.85.311.7*3.44.1Male7.46.914.36.34.7Female4.74.110.14.73.9M% - F%53%–47%54%–46%49%–51%53%–47%49%–51%Median age of diagnosis697163*7062*Age <50 at diagnosis23%21%28%*19%*31%*Advance stages83%79%89%*81%92%*Mortality rate3.73.46.6*2.82.4*Male4.44.183.32.8Female2.72.55.42.31.9*P<0. 01 compared to all reported cases of MM.Table 2:Comparison of survival among major US ethnic groups with MMSurvivalAllUSWAAHispanicUS-Asian1 – year71%70%72%71%76%*2 – year56%55%57%54%59%*3 – year45%44%46%45%51%*4 – year36%35%37%34%42%*5 – year29%28%30%28%34%**P<0. 01 compared to all reported cases of MM. Conclusions:Our analysis shows that the incidence of MM is highest in AA population, with more males affected than females, and least common in US-Asian population, more specifically US-Asian women. Interestingly, we observed that not only the average age of diagnosis is significantly less in both groups, but those presenting with an advanced stage are also significantly increased in number. However, the improved mortality rates and survival in US-Asians may be attributed to differences in tumor biology, cytogenetics, emigrational factors, higher socioeconomic status, better health care, higher educational background with awareness, lifestyle and environmental factors such as dietary habits and obesity. Large scale epidemiological studies performed by Alexander et al in 2007 demonstrated an association between obesity and an increased risk of MM whereas dietary factors such as increased consumption of green vegetables and fish was linked to a decrease in risk. Molecular and cytogenetic studies are warranted to examine the behavior and biology of MM in these AA and US-Asian ethnicities, directly comparing the treatment and management of this particular disease, which may translate into better understanding of pathogenesis and identification of prognostic factors leading to improvements in treatment. Disclosures:No relevant conflicts of interest to declare.

Interethnic variation in lipid profiles: implications for underidentification of African–Americans at risk for metabolic disorders

Interethnic differences exist in the distribution of serum lipids, with African–Americans (AAs) generally having a healthier lipid profile than other US ethnic groups. Similar lipid distributions are observed among other African-ancestry groups with distinct lifestyle characteristics, suggesting the importance of inherited factors. Despite healthier serum lipids, AAs experience a disproportionate burden of Type 2 diabetes and cardiovascular disease. As evidence of a different relationship between serum lipids and disease exists, the characterization of metabolic risk using lipid concentration (as in metabolic syndrome criteria) may lead to the underidentification of AAs at risk. Given the disproportionately high rate of metabolic disorders in AAs, understanding interethnic differences in the association between serum lipids and disease should be a research priority, as better appreciation of these differences will enhance knowledge of disease etiology, improve intervention targeting and may lead to mechanisms to ameliorate debilitating health disparities in the USA and globally.

Barriers to Cancer Clinical Trial Participation Among American Indian and Alaska Native Tribal College Students

American Indians and Alaska Natives (AIs/ANs) have some of the highest cancer-related mortality rates of all US racial and ethnic groups, but they are underrepresented in clinical trials. We sought to identify factors that influence willingness to participate in cancer clinical trials among AI/AN tribal college students, and to compare attitudes toward clinical trial participation among these students with attitudes among older AI/AN adults. Questionnaire data from 489 AI/AN tribal college students were collected and analyzed along with previously collected data from 112 older AI/AN adults. We examined 10 factors that influenced participation in the tribal college sample, and using chi-square analysis and these 10 factors, we compared attitudes toward research participation among 3 groups defined by age: students younger than 40, students 40 and older, and nonstudent adults 40 and older. About 80% of students were willing to participate if the study would lead to new treatments or help others with cancer in their community, the study doctor had experience treating AI/AN patients, and they received payment. Older nonstudent adults were less likely to participate on the basis of the doctor's expertise than were students (73% vs 84%, P = .007), or if the study was conducted 50 miles away (24% vs 41%, P= .001). Finding high rates of willingness to participate is an important first step in increasing participation of AIs/ANs in clinical trials. More information is needed on whether these attitudes influence actual behavior when opportunities to participate become available.

Hyperinsulinemia, Insulin Resistance, Vitamin D, and Colorectal Cancer Among Whites and African Americans

African Americans have the highest incidence and mortality rates of colorectal cancer among all US racial and ethnic groups. Dietary factors, lifestyle factors, obesity, variability in screening rates, socioeconomic differences, barriers to screening, and differences in access to health care may be contributory factors to racial and ethnic disparities. African Americans are more likely to demonstrate microsatellite instability in their colorectal tumors leading to malignancy. However, these differences do not completely explain all the variances. Ample evidence implicates insulin resistance and its associated conditions, including elevated insulin and insulin-like growth factor-1 (IGF-1), in colorectal carcinogenesis. African Americans have a high risk for and a high prevalence of insulin resistance and subsequent overt type 2 diabetes. Recent clinical studies revealed that ethnic differences between whites and African Americans in early diabetes-related conditions including hyperinsulinemia already exist during childhood. African Americans have a much higher prevalence of vitamin D deficiency than whites throughout their life spans. Vitamin D deficiency has been associated with higher rates of diabetes and colorectal cancer, particularly in individuals with high serum insulin and IGF-1 levels. Moreover, African Americans have lower insulin sensitivity in tissues, independent of obesity, fat distribution, and inflammation. Further development of measures of biomarkers of tumor biology and host susceptibility may provide further insight on risk stratification in African Americans.

Testing for variants in CYP2C19: population frequencies and testing experience in a clinical laboratory

PurposeWe sought to determine the genotype frequencies for cytochrome p450 enzyme 2C19 variant alleles both in the US pan–ethnic population and various US ethnic groups and to establish the frequency of clinically actionable genotypes. MethodsAnalytical results were obtained from 1,396 consecutive samples submitted for cytochrome p450 enzyme 2C19 genotyping tests and stored in a proprietary database. This database was queried and genotypes and predicted phenotypes established. Anonymized samples were obtained from specimens submitted for cystic fibrosis genotyping that contained ethnicity information. Samples from 357, 149, and 346 individuals self–identified as white, African American, and Hispanic, respectively, were analyzed. In addition, 342 anonymized samples submitted for Ashkenazi Jewish panel testing were analyzed. ResultsSignificant ethnic differences were observed in the frequencies of the *17 ultrarapid allele among the various groups studied. In the pan–ethnic population, 3.8% of tested patients were classified as ultrarapid metabolizers, 24% as extensive metabolizers heterozygous for a *17 ultrarapid allele, 27% as intermediate metabolizers, and 3.5% as poor metabolizers. Using stringent criteria, 7.3% of individuals would have clinically actionable genotypes. In addition, we detected two individuals with a haplotype of *2/*17 and a single individual with a haplotype of *4/*17 indicating that the *17 hypermetabolic allele can occur on a *1, *2, or *4 background.Genet Med 2012:14(1):95–100.

Abstract P351: Ethnic Differences in the Risk Estimates of Novel Biomarkers for Future Cardiovascular Outcomes

Background: Elevated inflammatory markers, haemostatic factors as well as homocysteine predict cardiovascular disease (CVD) events and mortality. Although racial/ethnic disparities in CVD risk factors and outcomes exist, comparative data on the predictive utility of novel biomarkers for future CVD events in US ethnic groups is limited. Methods: The study comprised 6814 asymptomatic men and women (52.85%), aged 45-84 yrs without prior cardiovascular disease, enrolled in the Multi-Ethnic Study of Atherosclerosis [MESA] obtained from NHLBI Data repository. 6270 asymptomatic men and women [1384 Hispanics, 2409 Caucasians, 753 Chinese and 1724 African Americans] with a host of novel biomarkers drawn were considered for this analysis. The CVD events were defined as ALL CVD events and HARD CVD events per MESA protocol (see Table). Results: A total of 302 all CVD events and 203 hard CVD events were identified during a mean follow up of 4.6 years. We observed significant ethnic differences in the prognostic utility of novel biomarkers for cardiovascular risk assessment, in a large multi-ethnic population of US adults free of clinical cardiovascular disease. While homocysteine emerged as a robust biomarker across racial cohorts, most other biomarkers analyzed predominantly predicted events in Caucasians (see Table). Conclusion: These findings raise serious concern about the prognostic potential or generalizability of risk stratification tools across racial subsets and underscore the need for further ethnicity-specific research in this area.

The association between depression and parental ethnic affiliation and socioeconomic status: a 27-year longitudinal US community study

This study examined the extent to which parental SES and ethnic affiliation during adolescence are associated with Center for Epidemiologic Studies Depression Scale (CES-D) scores compatible with depression during adulthood. The data were extracted from the US National Longitudinal Survey of Youth (NLSY79) conducted in 1979 on several ethnic groups (African-Americans, Hispanics and Others). These data included paternal socio-economic status (SES) when respondents (N = 8,331) were on average aged 18. The CES-D was re-administered 27 years later to assess the presence of depression. Adjusted for age, binary logistic regression modeling showed that parental low SES increased the risk of CES-D of scores compatible with depression across ethnic groups for both genders. A gradient was observed of an increased likelihood of depression scores with lower parental SES levels: among African-American respondents, depression scores were highest at the lowest parental SES levels (OR = 3.25, 95% CI 2.19-4.84) and the risk dropped at medium (OR = 3.00, 95% CI 1.96-4.59), and highest SES levels (OR = 1.85, 95% CI 1.12-3.07). An analogous pattern was generally found for each ethnic group. Low parental SES during adolescence significantly increases the likelihood of CES-D scores compatible with depression during adulthood across US ethnic groups and in both genders.

Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders.

The study compared the prevalence, correlates of functional impairment, and service utilization for eating disorders across Latinos, Asians, and African Americans living in the United States to non-Latino Whites. Pooled data from the NIMH Collaborative Psychiatric Epidemiological Studies (CPES;NIMH, 2007) were used. The prevalence of anorexia nervosa (AN) and binge-eating disorder (BED) were similar across all groups examined, but bulimia nervosa (BN) was more prevalent among Latinos and African Americans than non-Latino Whites. Despite similar prevalence of BED among ethnic groups examined, lifetime prevalence of any binge eating (ABE) was greater among each of the ethnic minority groups in comparison to non-Latino Whites. Lifetime prevalence of mental health service utilization was lower among ethnic minority groups studied than for non-Latino Whites for respondents with a lifetime history of any eating disorder. These findings suggest the need for clinician training and health policy interventions to achieve optimal and equitable care for eating disorders across all ethnic groups in the United States.

Reflux episodes are similar in healthy African Americans and non-Hispanic whites

Ambulatory esophageal pH monitoring is the current gold standard diagnostic exam for gastroesphageal reflux disease. Presently, no data are available for normal 24-hour esophageal pH monitoring among any US ethnic group. The aim of the present study was to obtain normal values of 24-hour esophageal pH monitoring in healthy adult African American (AA) volunteers and compare these with values obtained in healthy non-Hispanic white (nHw) volunteers to determine if ethnic variation exists in 24-hour esophageal pH testing. Twenty-four-hour dual esophageal pH monitoring was performed in healthy AA and nHw. Values for total number of reflux episodes, episodes longer than 5 min, total reflux time in minutes, and longest reflux episode in the proximal and distal esophagus were obtained for both ethnic groups. Differences between groups were considered significant if P < 0.05. Eighty subjects volunteered for the study and completed 24-hour pH testing. Forty-one were AAs and 39 were nHws, with males making up 49% of each group. The AAs were older and had higher body mass index than the nHws. No difference was observed between the AA and the nHw subjects for any measured pH parameter in either the proximal or distal esophagus. There is no difference in values obtained during esophageal pH monitoring in healthy African Americans and non-Hispanic whites. This indicates that the currently accepted normal values of ambulatory esophageal pH monitoring are readily applicable to African Americans and can be used without compromising diagnostic accuracy in this ethnic group.

A simple method for establishing concordance between short‐tandem‐repeat allele frequency databases

Current paternity and forensic accreditation standards do not require concordance to be established between short-tandem-repeat allele frequency databases representing the same population. The current statistical methods for evaluating databases do not establish concordance. Although acceptable under current forensic statistical methods, databases representing the same population may have sufficient variation to influence the outcome of a nondirect relationship testing result (i.e., siblingship). Hence there is a need for a quantitative method to determine concordance between databases. Local allele frequency databases were generated for major US ethnic groups. Statistical analysis was performed as recommended by international forensic standards. A new method was developed and used for evaluating concordance between the locally developed and published databases. Smaller deviation values signify greater concordance between compared databases. The results were quantitatively confirmed against data obtained from a multidimensional scaling analysis system (SPSS, SPSS, Inc.). The locally developed database deviated from the mean of the published data by approximately 0.1073 for Caucasians, 0.1341 for US Hispanics, and 0.1287 for African Americans. Upon pairwise comparison, the published databases deviated from one another by 0.1210 in US Caucasians, 0.1457 in US Hispanics, and 0.1228 in African Americans. The local database was observed to be more concordant to published databases than some of the published data to themselves. The developed database was shown to be concordant with four previously published databases using the new method. The results were confirmed by comparison to qualitative data obtained from the multidimensional scaling analysis system.

Extent of Control of Cardiovascular Risk Factors and Adherence to Recommended Therapies in US Multiethnic Adults with Coronary Heart Disease

Guidelines for cardiovascular risk factor control in people with coronary heart disease (CHD) focus on compliance with beta-adrenoceptor antagonists (beta-blockers), angiotensin receptor blockade (ACE inhibitors/angiotensin II receptor antagonists [angiotensin receptor blockers; ARBs]) [ACE/ARBs], and lipid-lowering agents, with goals for BP of <140/90 mmHg and low-density lipoprotein cholesterol (LDL-C) levels of <2.6 mmol/L (100 mg/dL). Most data derive from registries of hospitalized patients or are from clinical trials. Little data exist on goal attainment and adherence with therapy among CHD survivors of major US ethnic groups in the real-world setting. We assessed levels of cardiovascular risk factor control and adherence with recommended therapies among US CHD survivors. We identified 364 US adults (representing 12.8 million in the US with CHD) aged 18 years and over in the National Health and Nutrition Examination Survey 2005-6 with known CHD. We calculated proportions of patients who were receiving recommended treatments, and who achieved goal targets for BP, LDL-C levels, glycosylated hemoglobin (HbA(1c)), and nonsmoking status, and differences between actual and goal levels ('distance to goal'), stratified by sex and ethnicity. Overall, 58%, 38%, and 60% of CHD survivors were receiving beta-adrenoceptor antagonists, ACE/ARBs, and lipid-lowering medications, respectively (22% received all three). However, treatment rates for beta-adrenoceptor antagonists and lipid-lowering agents were lower (p < 0.05 to p < 0.01) in Hispanics (36% and 27%, respectively) and non-Hispanic Blacks (47% and 42%, respectively) than in non-Hispanic Whites. Moreover, lipid-lowering treatment rates were lower in females (50%) than in males (67%) [p < 0.01]. Overall, 78% were nonsmokers while 68% achieved goal levels for BP, 57% for LDL-C levels, and, if diabetic, 67% for HbA(1c). Only 12% met all four goals. Non-Hispanic Whites had the lowest SBP and DBP as well as HbA(1c) (p < 0.05 to p < 0.01 across ethnicity). In those who did not achieve goal levels, distance to goal averaged 1.0 mmol/L (37.0 mg/dL) for LDL-C levels, 15.6 mmHg for SBP, and 1.3% for HbA(1c). Despite clear treatment guidelines, we show that many US adults with CHD, especially Hispanics and non-Hispanic Blacks, are neither receiving recommended treatments nor adequately treated in terms of BP, LDL-C levels, and HbA(1c). Greater efforts by healthcare systems to disseminate and implement guidelines are needed.

Harris Infant Neuromotor Test: Comparison of US and Canadian Normative Data and Examination of Concurrent Validity With the Ages and Stages Questionnaire

The Harris Infant Neuromotor Test (HINT) was developed as a screening tool for potential motor and cognitive developmental disorders in infants. Scoring on the HINT has been shown to be reliable, and several studies have supported the validity of the HINT. Normative values for the tool have been developed using Canadian infants. The aims of this study were (1) to further evaluate the validity of the HINT by comparing data obtained on US infants who were developing typically with data previously acquired on Canadian infants and (2) to determine the concurrent validity of the HINT with the Ages and Stages Questionnaire (ASQ). Secondary analyses of HINT scores for US white and nonwhite infants and for US infants who had parents with lower levels of education and US infants who had parents with higher levels of education (as a proxy for socioeconomic status [SES]) were conducted. Cross-sectional exploratory and quasi-experimental comparative research designs were used to evaluate the validity of the HINT. Sixty-seven infants from the United States who were developing typically and who were aged 2.5 to 12.5 months were recruited via convenience sampling. Sixty-four of these infants were compared with Canadian infants matched for age, sex, ethnicity or race, and parental education. The HINT was administered by raters who had been trained to attain acceptable levels of interrater reliability, and parents completed the ASQ. The HINT scores for US white versus nonwhite infants (n=46) and infants who had parents with lower SES versus a higher SES (n=52) were compared. There were no significant differences between HINT total scores for US and Canadian infants or for US racial or ethnic groups and SES groups. There were high correlations (r=-.82 to -.84) between HINT and ASQ scores. The study used a small US sample with limited geographical diversity. Small sample numbers also did not allow for comparisons of specific racial or ethnic groups. The SES groups were created primarily using parental education as a proxy for SES. The results suggest that HINT screening in the United States is supported on the basis of Canadian norms and the validity of the HINT in screening for motor and cognitive delays. Although there is preliminary support for the HINT as an appropriate screening tool for US infants who are nonwhite or who have parents with a lower SES, more research is warranted.

The prevalence of erectile dysfunction in heart failure patients by race and ethnicity

Erectile dysfunction (ED) is a common problem in male patients with heart failure (HF). However, no study was found that estimates the prevalence of ED by US ethnic groups with HF. We conducted an observational, cross-sectional study of patients enrolled in a HF disease management program in two sites Louisiana (N=329; 178 white, 99 black) and Florida (N=52; Hispanic). All male patients with an ejection fraction <or=40% were included. The Sexual Health Inventory for Men was used to estimate the prevalence of ED. Overall prevalence of ED was 89% and ED severity did not vary by race/ethnic group. Race/ethnic group differences were found for age, New York Heart Association functional classification, and blood pressure. Hispanic patients had the lowest unadjusted and adjusted prevalence rate of ED (81, 85%) compared to Black (90, 95%) and White (91, 92%) patients. There is a high prevalence of ED in Hispanic, Black and White ethnic groups with HF.

Parental beliefs about young children’s socialization across US ethnic groups: coexistence of independence and interdependence

This study compared dimensions of independence and interdependence in parents’ beliefs about daily child‐rearing practices across four ethnic groups. Two questionnaires were completed by 310 parents of preschool‐age children, and three belief constructs were identified. Conformity was least valued by European Americans. Autonomy was equally valued by European Americans and African Americans, and less by Asian Americans. There were no group differences in the importance of prosocial. Parental education was negatively associated with conformity except among Asian Americans, for whom education and conformity were positively associated. This study provides further evidence that differentiating the broad cultural orientations of independence and interdependence provides more accurate and sensitive cultural models of parenting. This study’s findings may enhance the cultural competence of educators and community workers who interact with children and parents of diverse ethnic groups.

158-P: HLA frequency analysis of Brazilian ethnic groups & comparison to US ethnic groups

158-P: HLA frequency analysis of Brazilian ethnic groups & comparison to US ethnic groups

6-OR: Deducing source population HLA composition in US ethnic groups

6-OR: Deducing source population HLA composition in US ethnic groups

Waist circumference, BMI and the prevalence of self-reported diabetes among the elderly of the United States and six cities of Latin America and the Caribbean

Using data from the Salud Bienestar y Envejecimiento (SABE) project and the U.S. National Health and Nutrition Examination Survey (NHANES 1999–2004), we examined the prevalence of obesity and diagnosed diabetes among older adults in the Americas; we also examined the association of age, sex, level of education, weight status, waist circumference, smoking, and race/ethnicity with diabetes among older adults.The prevalence of diagnosed diabetes was highest in the US Blacks and Mexican Americans, followed by Bridgetown and Mexico City (22% for each) and lowest in Santiago, Montevideo, Havana, and US Whites (13–15%). Diagnosed diabetes was significantly associated with BMI among participants from Bridgetown, Sao Paulo, and the three US ethnic groups, while it was associated with waist circumference in all sites except Mexico City.Our findings suggest major geographical and ethnic variation in the prevalence of diagnosed diabetes among older adults. Waist circumference was more consistently associated with the prevalence of diagnosed diabetes than BMI. Higher prevalences of diabetes are found among the elderly of African or Mexican descent in the United States and in other countries of the Americas when compared to the prevalence among whites in the United States and in other Latin American countries with populations of predominant Western European descent.