White US Research Articles

Association of Degree of European Genetic Ancestry With Serum Vitamin D Levels in African Americans.

Circulating levels of vitamin D are generally lower in African Americans than in US whites, and 1 prior analysis carried out in a small number of African Americans suggested that, within this population, vitamin D levels may be related to the degree of genetic admixture. We assessed the association between percentage of European ancestry and serum vitamin D level (assessed in 2013-2015) among 2,183 African-American women from the Black Women's Health Study whose DNA had been genotyped for ancestry-informative markers. ADMIXMAP software was used to estimate the percentage of European ancestry versus African ancestry in each individual. In linear regression analyses with adjustment for genotype batch, age, body mass index, supplemental vitamin D use, ultraviolet B radiation flux in the participant's state of residence, and season of blood draw, each 10% increase in European ancestry was associated with a 0.67-ng/mL increase in serum vitamin D concentration (95% confidence interval: 0.17, 1.17). The association was statistically significant only among women who were not taking vitamin D supplements (for each 10% increase in European ancestry, β = 0.86, 95% confidence interval: 0.14, 1.57). Among African Americans, use of vitamin D supplements may help to reduce vitamin D deficiency associated with genetic ancestry.

The Future Burden of Colorectal Cancer Among US Blacks and Whites.

Although overall colorectal cancer (CRC) incidence rates in the United States are declining, rates among younger persons (age < 55 years) are increasing, particularly among US whites. We assessed how these trends will impact the future burden (up to 2040) of CRC among US blacks and whites using an age-period-cohort model. Over the last four decades (1973 to 2014), CRC incidence rates for all ages (both sexes) have dropped by 6.6% and 33.9% in US blacks and whites, respectively. Yet we predict an upward turn in CRC cancer incidence rates over the next quarter century, particularly among US whites. The age-standardized rates of CRC were 55.4 and 43.2 per 100 000 among US blacks and whites in 2014, respectively, and are projected to be 49.5 and 43.1 in 2040, respectively. Future interventions are needed to reduce the striking differences in CRC incidence between blacks and whites.

Disproportionately higher unintentional injury mortality among Alaska Native people, 2006–2015

ABSTRACTWe compared rates of unintentional injury (UI) deaths (total and by injury category) among Alaska Native (AN) people to rates of U.S. White (USW) and Alaska White (AKW) populations during 2006–2015. The mortality data for AN and AKW populations were obtained from Alaska Bureau of Vital Statistics and USW mortality data were obtained from WISQARS, the Center for Disease Control and Prevention online injury data program. AN and AKW rates were age-adjusted to the U.S. 2000 Standard Population and rate ratios (RR) were calculated. AN people had higher age-adjusted total UI mortality than the USW (RR = 2.6) and AKW (RR = 2.3) populations. Poisoning was the leading cause of UI death among AN people (35.9 per 100,000), more than twice that of USW (RR = 2.9) and AKW (RR = 2.5). Even greater disparities were found between AN people and USW for: natural environment (RR = 20.7), transport-other land (RR = 12.4), and drowning/submersion (RR = 9.1). Rates of AN UI were markedly higher than rates for either USW or AKW. Identifying all the ways in which alcohol/drugs contribute to UI deaths would aid in prevention efforts. All transportation deaths should be integrated into one fatality rate to provide more consistent comparisons between groups.

Observational study of the differential impact of time-varying depressive symptoms on all-cause and cause-specific mortality by health status in community-dwelling adults: the REGARDS study

ObjectiveTo assess the association between time-varying depressive symptoms with all-cause and cause-specific mortality.DesignThe REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a national, population-based longitudinal study conducted from...

Projections of primary liver cancer to 2030 in 30 countries worldwide.

Primary liver cancer (PLC) is the sixth most common cancer worldwide and the second most common cause of cancer death. Future predictions can inform health planners and raise awareness of the need for cancer control action. We predicted the future burden of PLC in 30 countries around 2030. Incident cases of PLC (International Classification of Diseases, Tenth Revision, C22) were obtained from 30 countries for 1993-2007. We projected new PLC cases to 2030 using age-period-cohort models (NORDPRED software). Age-standardized incidence rates per 100,000 person-years were calculated by country and sex. Increases in new cases and rates of PLC are projected in both sexes. The largest increases in rates are, among men, in Norway (2.9% per annum), US whites (2.6%), and Canada (2.4%) and, among women, in the United States (blacks 4.0%), Switzerland (3.4%), and Germany (3.0%). The projected declines are in China, Japan, Singapore, and parts of Europe (e.g., Estonia, Czech Republic, Slovakia). A 35% increase in the number of new cases annually is expected compared to 2005. This increasing burden reflects both increasing rates (and the underlying prevalence of risk factors) and demographic changes. Japan is the only country with a predicted decline in the net number of cases and annual rates by 2030. Conclusion: Our reporting of a projected increase in PLC incidence to 2030 in 30 countries serves as a baseline for anticipated declines in the longer term through the control of hepatitis B virus and hepatitis C virus infections by vaccination and treatment; however, the prospect that rising levels of obesity and its metabolic complications may lead to an increased risk of PLC that potentially offsets these gains is a concern. (Hepatology 2018;67:600-611).

Missives and Other Un-Notes

Beginning his series of disorienting and theatrical vignettes with an extended introduction, Gamboa describes his childhood and young adulthood coming of age in Los Angeles in the 1960s and 70s. It is through these stories of prejudice in elementary school and of mass action against police brutality and the national government’s neglect of communities of color, Gamboa implies, that readers should approach his text. Missives and other Un-notes skewers myths of US national identity, masculinity, and whiteness, placing readers in a dystopic world of violence, surveillance, and the constant threat of annihilation.

Constructing Alterity: Colonial Rhetoric in Betty Mahmoody's Not Without My Daughter

As far as literary representations of the Islamic Republic of Iran in the West are concerned, although Betty Mahmoody’s bestselling Not Without My Daughter (1987) has been called “the most popular book ever published in the US about Iran” [Milani, Farzaneh. 2008. “On Women’s Captivity in the Islamic World.” Middle East Report 38 (246): 40–46, 43], it has received scant critical attention. Hence, as the first major discursive analysis of the text, this essay illustrates how Mahmoody’s so-called memoir draws extensively on the tropes of colonial discourse to portray post-revolutionary Iran. To this end, this study employs David Spurr’s [1993. The Rhetoric of Empire: Colonial Discourse in Journalism, Travel Writing, and Imperial Administration. Durham, NC: Duke University Press] theorizations of the tropes of debasement, affirmation, negation and bestialization to analyze Mahmoody’s construction of the Iranian Other. It also investigates the cult of Iranian domesticity, the question of linguistic sovereignty, and images of Iranian “mobs” in the text. Taken together, these colonial tropes and the overall context of the narrative construct a clash-of-civilizations narrative by pitting the “civilized” white US woman against her “primitive” Iranian counterparts in whose land she is “trapped”.

A Transmedia Storytelling Intervention With Interactive Elements to Benefit Latinas' Mental Health: Feasibility, Acceptability, and Efficacy.

BackgroundLatinos report higher rates of depression and anxiety than US whites but are less likely to receive care. Transmedia storytelling interventions accessible on the Internet via smartphones, tablets, and computers hold promise for reducing reluctance to explore or get help for symptoms because they are private, convenient, and can reach large numbers of people, including Latinas with mental health needs.ObjectiveThe purpose of this study was to examine the feasibility, acceptability, and preliminary efficacy of a mental health transmedia intervention for Latinas with elevated symptoms of depression, anxiety, or both.MethodsA total of 28 symptomatic English-speaking Latina women aged 21 to 48 years participated in a 6-week study using a within-group design. All aspects of the study were completed via telephone or Internet. Participants used their personal devices to engage the Web-based transmedia intervention (in English) that included story-based videos, a data-informed psychotherapeutic video, an interactive video sequence, and a blog written from the point of view of one of the characters with links to mental health resources. Perceived confidence to get help and perceived importance for seeking immediate help were both measured using single-item questions. Participants completed surveys at baseline (via telephone) and 1 and 6 weeks after media engagement that measured various factors, including depression (Patient Health Questionnaire; PHQ-9 and PHQ-8) and anxiety (Generalized Anxiety Disorder scale; GAD-7). A telephone interview was conducted within 72 hours of media engagement. Action taken or intentions to get help (single-item question) and talking about the videos with others (single-item question) were measured 1 and 6 weeks after media engagement. Repeated measures analysis of variance was used to assess change in depression (PHQ-8) and anxiety (GAD-7) before transmedia engagement and 1 and 6 weeks after. Spearman correlations evaluated the association of confidence and importance of getting help with action taken, anxiety, and depression.ResultsAll 28 Latinas (English speakers) who engaged with the transmedia remained in the 6-week study. Within 1 week of transmedia engagement, 39% of women took action to get help, and 82% discussed the media with others. Symptoms of depression (F2,54=9.0, P<.001) and anxiety (F2,54=18.7, P<.001) significantly reduced across time. Higher levels of confidence were significantly associated with actions taken at 1 (P=.005) and 6 weeks (P=.04), and higher levels of importance were significantly associated with actions taken at 1 (P=.009) and 6 weeks (P=.003). Higher levels of confidence were associated with lower levels of depression (P=.04) and anxiety (P=.01) at 6 weeks.ConclusionsPreliminary findings indicate a culturally tailored mental health transmedia intervention is a feasible approach that holds promise for engaging large numbers of symptomatic English-speaking Latina women to begin the process of seeking help, as well as decreasing symptoms of anxiety and depression.

Cardiovascular Disease in American Indian and Alaska Native Youth: Unique Risk Factors and Areas of Scholarly Need.

In August 2016, the National Heart, Lung, and Blood Institute convened a scientific forum with 18 investigators active in the field of population health disparities. The purpose was to discuss heart, lung, and sleep disorders in children and adolescents of American Indian/Alaska Native (AI/AN)

Breast Cancer Estrogen Receptor Status According to Biological Generation: US Black and White Women Born 1915-1979.

Evidence suggests that contemporary population distributions of estrogen-receptor (ER) status among breast cancer patients may be shaped by earlier major societal events, such as the 1965 abolition of legal racial discrimination in the United States (state and local "Jim Crow" laws) and the Great Famine in China (1959-1961). We analyzed changes in ER status in relation to Jim Crow birthplace among the 46,417 black and 339,830 white US-born, non-Hispanic women in the Surveillance, Epidemiology, and End Results (SEER) 13 Registry Group who were born between 1915 and 1979 and diagnosed (ages 25-84 years, inclusive) during 1992-2012. We grouped the cases according to birth cohort and quantified the rate of change using the haldane (which scales change in relation to biological generation). The percentage of ER-positive cases rose according to birth cohort (1915-1919 to 1975-1979) only among women diagnosed before age 55. Changes according to biological generation were greater among black women than among white women, and among black women, they were greatest among those born in Jim Crow (versus non-Jim Crow) states, with this group being the only group to exhibit high haldane values (>|0.3|, indicating high rate of change). Our study's analytical approach and findings underscore the need to consider history and societal context when analyzing ER status among breast cancer patients and racial/ethnic inequities in its distribution.

Childhood socioeconomic circumstances and depressive symptom burden across 15years of follow-up during midlife: Study of Women's Health Across the Nation (SWAN).

Childhood socioeconomic disadvantage may contribute to adult depression. Understanding pathways by which early socioeconomic adversity may shape adult depression is important for identifying areas for intervention. Studies to date have focused on one potential pathway, adult socioeconomic status (SES), and assessed depression at only one or a few time points. Our aims were to examine (a) the association between childhood SES (low vs. high) and depressive symptom burden in midlife and (b) whether adult socioeconomic, psychosocial, and physical health characteristics are important pathways. Using annual data from a cohort of 1109 black and white US women recruited in 1996-1997, we evaluated the association between childhood SES and depressive symptom burden across 15years in midlife and whether adult characteristics-financial difficulty, lower education, stressful events, low social support, low role functioning, medical conditions, and bodily pain-mediated the association. Depressive symptom burden was estimated by calculating area under the curve of annual scores across 15years of the Center for Epidemiological Studies Depression (CES-D). In unadjusted models, low childhood SES was associated with greater depressive burden (P=0.0002). Each hypothesized mediator, individually, did not reduce the association. However, when five of the hypothesized mediators were included together in the same analysis, they explained more than two thirds of the association between childhood SES and depressive symptom burden reducing the P value for childhood SES to non-significance (P=0.20). These results suggest that childhood SES influences midlife depressive symptom burden through a cluster of economic stress, limited social resources, and physical symptoms in adulthood.

‘Straight with a pinch of bi’: The construction of heterosexuality as an elastic category among adult US men

The sexualities of men who have same-sex desires yet identify as straight have attracted significant attention in recent years. We present findings from interviews with 100 such men, whom we recruited while they were seeking sex with men online, and examine the logics that allow them to maintain an identity as straight. Our sample is somewhat unique in that it included men across a wide age range (from 18 to 70), and also because many of our participants are white adult US men who are married or in stable relationships with women. Based on their patterns of sexual interpretation, we discuss how these men make their same-sex desires and behaviours consistent with a primary self-identification as straight. We argue that, in the process of maintaining identities as straight men, they change the definition of heterosexuality, in effect turning it into a considerably elastic category that is perceived as fully compatible with having and enacting same-sex desires.

Expertise and Ideology in Statistical Evaluation of Circumcision for Protection against HIV Infection

Aim: To critically evaluate data and arguments by Van Howe defending his stance opposing male circumcision (MC), in particular his meta-regression analyses evaluating the ability of MC to reduce HIV infection risk in heterosexual populations within and outside Africa. Methods: We performed metaregression analysis of log odds of HIV infection between uncircumcised and circumcised men using a single covariate (MC prevalence) in the meta-regression model involving the metareg package in STATA 13 for 103 populations worldwide and for populations within Africa. The meta-regression of log odds and MC prevalence was fitted to a line, as were empirical Bayes estimates resulting from post-estimation. Results: Our critical evaluation of Van Howe’s arguments attempting to undermine the scientific evidence in support of the benefits of MC in protection of men against HIV during heterosexual intercourse, as well as other infections and conditions, together with his use of statistics to support his beliefs, revealed serious flaws, obfuscation and missing data. We therefore performed our own meta-regression analysis using a trivariate model. Doing so revealed that for MC prevalences of 50%, 75% and 100% for general populations within Africa, odds ratios for HIV risk in uncircumcised vs. circumcised men were 1.35, 1.58 and 1.85, respectively. Our meta-regression analysis of data for all countries yielded similar findings. For a general population outside Africa with 100% MC prevalence, OR was 1.5. Van Howe failed to acknowledge that since MC prevalence in US whites (91%) and blacks (76%) exceeds 75% his results support MC having a protective effect in those population groups. Conclusions: The protective effect of MC against HIV infection during heterosexual intercourse applies to populations both within and outside Africa. The debate engineered by MC opponents, and led by Van Howe, now appears to have run its course. The scientific evidence has prevailed.

Dangerous Playgrounds: Hemispheric Imaginaries and Domestic Insecurity in Contemporary US Tourism Narratives

Author(s): Rivers, Daniel Lanza | Abstract: This article explores a network of “dangerous playgrounds” narratives amid the backdrop of then President George W. Bush’s “War on Terror” and the revitalization of the “self-deportation movement” following the passage of SB1070. Tracing the journeys of young, white US American tourists traveling to Latin America to release their inhibitions, stories working in the dangerous playgrounds mode use figurations of insurrectionary violence to wed the narrative arc of the bildungsroman to the generic conventions of melodrama and horror, and so cast the Americas south of the US border as a source of danger to US American youth. By reading these narrative negotiations in relation to the legacies of US American hemispheric interventionism, post-9/11 immigration policy, and US American travel narratives, this article unpacks the ways Jessica Abel’s critically acclaimed comic La Perdida (2006) and the films Turistas (2006), Borderland (2007), The Ruins (2008), and Indigenous (2014) create slippages in meaning that project anxieties about terrorism and domestic security onto Latinx bodies and Latin American nations through figurations of imperiled white femininity. By using literary and cultural analysis to explore how popular sentiment, generic convention, and policy negotiations draw on, shape, and extend neo-Monroeist structures of feeling, this article ultimately finds that the emergence of domestic policies aimed at institutionalizing the surveillance of Latinx subjects arises in popular culture as a remarkably predictable narrative mode, which uses the conventions of adventure, melodrama, and horror to frame the nativist project of securing domestic borders and incarcerating and expelling undocumented Latinx subjects as one of the necessary compromises of a mature nation.

Predicting Breast Cancer Incidence Rates Among White and Black Women in the United States: An Application of FTS Model

Development of statistical model for cancer incidence trend predictions can provide a sound and accurate foundation for planning a comprehensive national strategy for optimal partitioning of research resources. Several studies in the past showed that that there are racial/ethnic disparities exist between breast cancer incidence rates among black and white women in the United States. Some of the studies also showed that the disparity in breast cancer incidence rates among white and black US women is widening, with relatively higher incidence rates among black women. In this paper, we apply functional time series (FTS) models on the age-specific breast cancer incidence rates for these two major groups of women in US, and forecast their age-incidence curves. The data are obtained from the Surveillance, Epidemiology and End Results (SEER) program of the United States. We use annual unadjusted breast cancer incidence rates from 1973 to 2013 in 5-year agegroups (15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84 and 85+). Age-specific cancer incidence curves are obtained using nonparametric smoothing methods. The curves are then decomposed using functional data paradigm and we fit functional time series (FTS) models for each population of women separately. The smoothed incidence curves are then forecasted and prediction intervals are calculated. Fifteen-year forecasts indicate an overall increase in future breast cancer incidence rates for both groups of women. This increase appears to be faster among black women and relatively slower among the whites. The projections suggest a need for equal delivery of quality care to eliminate breast cancer disparities among the two major groups of women in US.

Adenoma Prevalence and Distribution Among US Latino Subgroups Undergoing Screening Colonoscopy.

Colorectal cancer (CRC) is the second leading malignancy diagnosed among US Latinos. Latinos in the USA represent a heterogeneous amalgam of subgroups varying in genetic background, culture, and socioeconomic status. Little is known about the frequency of CRC precursor lesions found at screening colonoscopy among Latino subgroups. The aim was to determine the prevalence and distribution of histologically confirmed adenomas found at screening colonoscopy among average-risk, asymptomatic US Latinos according to their subgroup and socio-demographic background. Cross-sectional analysis of pathological findings resulting from screening colonoscopy among average-risk, asymptomatic US Latinos aged ≥50 in two prospective randomized controlled trials at an academic medical center. Among the 561 Latinos who completed screening colonoscopy, the two largest subgroups were Puerto Ricans and Dominicans. The findings among both subgroups were: adenomas 30.6%, proximal adenomas 23.5%, advanced adenomas 12.0%, and proximal advanced adenomas 8.9%. These rates are at least as high as those found at screening colonoscopy among US whites. While Puerto Ricans were more likely than Dominicans to be born in the USA, speak English, be acculturated, have a smoking history, and be obese, there were no significant differences in adenoma rates between these subgroups. The prevalence of adenomas, advanced adenomas, and proximal neoplasia was high among both subgroups. These findings have implications for CRC screening and surveillance among the increasingly growing Latino population in the USA.

Dietary polyunsaturated fatty acids and incidence of end-stage renal disease in the Southern Community Cohort Study.

BackgroundWhether polyunsaturated fatty acids (PUFA) are associated with end-stage renal disease (ESRD) in populations with a high burden of risk factors for kidney disease is unknown. We sought to determine whether PUFA intake is associated with ESRD.MethodsWe conducted a nested case–control study of ESRD within the Southern Community Cohort Study (SCCS), a prospective cohort of low-income blacks and whites in the southeastern US (2002–2009). Through 2012, 1,074 incident ESRD cases were identified by linkage with the United States Renal Data System and matched to 3,230 controls by age, sex and race. Dietary intake of total, n-3 or n-6 PUFA was assessed from a validated food frequency questionnaire administered at baseline. Odds ratios (ORs) and 95 % confidence intervals (CIs) were computed from logistic regression models that included matching variables, body mass index, smoking, diabetes, hypertension, education, income, total energy intake and percent energy from protein and saturated fat.ResultsThe mean (SD) age of participants was 55 (9) years. Most participants were women (55 %), black (87 %), with hypertension (67 %) and on average obtained 8 % of their energy from PUFA. Higher PUFA intake was marginally associated with a lower risk of ESRD in adjusted analyses. The adjusted odds ratios (95 % confidence intervals) for ESRD for the 5th vs. 1st quintile of PUFA were 0.79 (0.60–1.05; P trend = 0.06) for total PUFA, 0.81 (0.61–1.06; P trend = 0.04) for n-6 PUFA and 0.93 (0.71–1.21; P trend = 0.45) for n-3 PUFA.ConclusionsWe observed a marginally significant inverse trend between dietary PUFA intake and ESRD incidence, mainly driven by n-6 fatty acid intake. Our findings require replication but suggest that a diet rich in n-6 PUFA may prevent ESRD development in a population with a high burden of kidney disease risk factors.

Risk for short interpregnancy intervals among African-born black women in Washington State

Objectives: We aimed to determine risk and associated risk factors for short interpregnancy intervals among African-born Black women in Washington State. Methods: We conducted a retrospective cohort study using vital statistics from linked birth certificate and hospital discharge records for 18,984 consecutive, singleton birth pairs to African-born Black (n=3312), US-born White (n=7839) and US-born Black women (n=7833) in Washington State from 1992 to 2013. We performed logistic regression to assess the association between mother's country of birth and race with interpregnancy interval and to assess risk factors for a short interval. Results: Women with short interpregnancy intervals comprised 10% of African-born women, 4.3% of US-born White women and 6.8% of US-born Black women. African-born women had higher odds of short intervals than US-born White women (aOR, 3.44; 95% CI, 2.53–4.68) or US born Black women (aOR, 1.49; 95% CI, 1.28–1.74). Among African-born women at the time of the first birth, women from East Africa (aOR, 3.51; 95% CI, 2.20–5.63), those who had high school or less education (aOR,1.92; 95% CI, 1.41–2.61), those who were nulliparous (aOR, 1.37; 95% CI, 1.01–1.86) and those who delivered vaginally for their first live birth (aOR,1.78; 95% CI, 1.29–2.44) in the first live birth of each birth pair had higher risk for short interpregnancy intervals Conclusions: African-born Black women are at higher risk for short interpregnancy intervals than US-born White and Black women in Washington State. Efforts are needed to increase prenatal counseling and education, including contraceptive information provision, for African-born women, who may face increased risks for adverse neonatal and maternal morbidity linked to short interpregnancy intervals.

Diabetes, diabetes severity, and coronary heart disease risk equivalence: REasons for Geographic and Racial Differences in Stroke (REGARDS)

Evidence is mixed regarding whether diabetes confers equivalent risk of coronary heart disease (CHD) as prevalent CHD. We investigated whether diabetes and severe diabetes are CHD risk equivalents. At baseline, participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (black and white US adults ≥45 years old recruited in 2003-2007) were categorized as having prevalent CHD only (self-reported or electrocardiogram evidence; n = 3,043), diabetes only (self-reported or elevated glucose; n = 4,012), diabetes and prevalent CHD (n = 1,529), and neither diabetes nor prevalent CHD (n = 17,155). Participants with diabetes using insulin and/or with albuminuria (urinary albumin-to-creatinine ratio ≥30 mg/g) were categorized as having severe diabetes. Participants were followed up through 2011 for CHD events (myocardial infarction or fatal CHD). During a mean follow-up of 5 years, 1,385 CHD events occurred. The hazard ratios of CHD events comparing participants with diabetes only, diabetes, and prevalent CHD and neither diabetes nor prevalent CHD with those with prevalent CHD were 0.65 (95% CI 0.54-0.77), 1.54 (95% CI 1.30-1.83), and 0.41 (95% CI 0.35-0.47), respectively, after adjustment for demographics and risk factors. Compared with participants with prevalent CHD, the hazard ratio of CHD events for participants with severe diabetes was 0.88 (95% CI 0.72-1.09). Participants with diabetes had lower risk of CHD events than did those with prevalent CHD. However, participants with severe diabetes had similar risk to those with prevalent CHD. Diabetes severity may need consideration when deciding whether diabetes is a CHD risk equivalent.

O crime da miscigenação: a mistura de raças no Brasil escravista e a ameaça à pureza racial nos Estados Unidos pós-abolição

RESUMO Este artigo discute como o exemplo brasileiro foi debatido e apropriado por políticos, cientistas e demais membros da elite branca estadunidense, que no pós-abolição estava elaborando um projeto de nação que mantinha antigas ideologias escravistas de supremacia branca e segregação racial que perduraram no país ao longo do século XX. Na América Latina era possível avaliar os efeitos negativos da mistura racial, e o Brasil tornou-se um exemplo de atraso e degeneração, reforçando a necessidade de políticas segregacionistas urgentes a serem implementadas nos Estados Unidos. A questão da mistura racial estava atrelada à produção de uma noção de identidade nacional que se sustentava nas ideias de pureza de sangue e em oposição às sociedades latino-americanas.