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1.  Racial and ethnic differences in willingness to participate in psychiatric genetic research 
Psychiatric genetics  2009;19(4):186-194.
Objective
The National Institute of Mental Health’s effort to rectify the underrepresentation of American Blacks in the genetic studies of psychiatric disorders has met with mixed success. This study was designed to understand some of the barriers to recruitment.
Methods
Men and women, who were of Black, White or Hispanic race/ethnicity, aged 18–79 years (Nλ=λ353), were recruited from clinical and community settings in New York City Participants responded to a survey that was designed to measure willingness to participate and attitudes toward genetic research. Principal components analyses generated eight factors including perceived benefits, concerns about, and drawbacks of genetic research, and beliefs about genetic or environmental contributions to psychopathology. Analysis of variance assessed within-ethnic group differences on factor scores, as they related to willingness to participate in genetic research.
Results
Ethnic groups did not differ significantly in stated willingness to participate in genetic research; more than 70% in each group were willing to participate. Among Blacks and Hispanics, mistrust and wariness, and stigma were significantly increased in those unwilling to participate; for Whites, perceived benefit to society and perceived importance for knowledge/education were associated with willingness to participate. For Blacks and Hispanics, youth (aged 18–29 years) and college education reduced, but did not eliminate the association between wariness and mistrust and willingness to participate.
Conclusion
Findings suggest that recruitment efforts aimed at increasing the representation of Blacks should be aware of the barriers among those who are less educated, and involve interactive community collaborations, to fully address the mistrust in this population.
doi:10.1097/YPG.0b013e32832cec89
PMCID: PMC2742945  PMID: 19593860
attitudes; Blacks; depression; genomic; recruitment; mental illness
2.  Religious Coping Among African Americans, Caribbean Blacks and Non-Hispanic Whites 
Journal of community psychology  2008;36(3):371-386.
This study examined demographic predictors of attitudes regarding religious coping (i.e., prayer during stressful times and look to God for support, strength and guidance) within a national sample of African American, Caribbean Blacks and non-Hispanic Whites (National Survey of American Life). The findings demonstrate significant Black-White differences in attitudes regarding religious coping with higher endorsements of religious coping among African Americans and Black Caribbeans (Caribbean Blacks). Comparisons of African Americans and Black Caribbeans revealed both similar and divergent patterns of demographic effects. For both African Americans and Black Caribbeans, women were more likely to utilize religious coping than men and married respondents were more likely than never married respondents to report utilizing prayer when dealing with a stressful situation. Further, for both groups, higher levels of education were associated with lower endorsements of the importance of prayer in dealing with stressful situations. Among African Americans only, Southerners were more likely than respondents who resided in other regions to endorse religious coping. Among Black Caribbeans, those who emigrated from Haiti were more likely than Jamaicans to utilize religious coping when dealing with a stressful episode.
doi:10.1002/jcop.20202
PMCID: PMC2967036  PMID: 21048887
Prayer; coping; religion; African Americans; Caribbean Blacks
3.  A Moderator-Mediator Analysis of Coronary Heart Disease Mortality 
Journal of psychosomatic research  2010;69(6):549-554.
Objective
To better understand how risk factors for Coronary Heart Disease (CHD) mortality may interact.
Methods
We conducted a moderator-mediator analysis of a representative national sample of 5,027 and 2,902 community-dwelling women and men in the first National Health and Nutrition Examination Survey free of CHD in 1982. The outcome was 10-year CHD mortality.
Results
267 subjects experienced CHD mortality. In the complete sample, gender moderated the effect of depressive symptoms, and among women race-ethnicity moderated the effect of nonleisure activity on CHD mortality, defining 3 subgroups for further analysis: men, white women, and black/ other women. Among men, baseline differences from median age (55 to 64 years), systolic blood pressure (129 to 158 mmHg), or self-rated general health (“good” to “poor”) were associated with equivalent increases in 10-year CHD mortality from 2.3% to 5.3% (Area-under-the-curve effect size (ES)=.53). These factors appeared to mediate the effect of education on CHD mortality. Severe depression in men was associated with higher 10-year CHD mortality than less or no depression, 10.0% versus 2.5% (ES =.55). Among white women, increasing baseline age (from median 51 to 65 years) was also associated with 10-year mortality (1.2% to 13.4%, ES =.56), as was higher blood pressure (from median 125 to 151 mm Hg) or worse self-rated health (from median “very good” to “fair”) to a lesser extent (1.2% to 3.5%, ES =.51).
Conclusion
Moderators (gender, race-ethnicity) defined possible pathways to CHD mortality characterized by varying factors and interactions between factors, highlighting potential utility for targeted interventions among community-dwelling persons.
doi:10.1016/j.jpsychores.2010.04.018
PMCID: PMC2993016  PMID: 21109042
CHD-related mortality; depression; moderator-mediator analysis
4.  Using Visual Displays to Communicate Risk of Cancer to Women From Diverse Race/Ethnic Backgrounds 
Patient Education and Counseling  2012;87(3):327-335.
Objective
This study evaluated how well women from diverse race/ethnic groups were able to take a quantitative cancer risk statistic verbally provided to them and report it in a visual format.
Methods
Cross-sectional survey was administered in English, Spanish or Chinese, to women aged 50 to 80 (n=1,160), recruited from primary care practices. The survey contained breast, colorectal or cervical cancer questions regarding screening and prevention. Women were told cancer-specific lifetime risk then shown a visual display of risk and asked to indicate the specific lifetime risk. Correct indication of risk was the main outcome.
Results
Correct responses on icon arrays were 46% for breast, 55% for colon, and 44% for cervical; only 25% correctly responded to a magnifying glass graphic. Compared to Whites, African American and Latina women were significantly less likely to use the icon arrays correctly. Higher education and higher numeracy were associated with correct responses. Lower education was associated with lower numeracy.
Conclusions
Race/Ethnic differences were associated with women’s ability to take a quantitative cancer risk statistic verbally provided to them and report it in a visual format.
Practice Implications
Systematically considering the complexity of intersecting factors such as race/ethnicity, educational level, poverty, and numeracy in most health communications is needed. (200)
doi:10.1016/j.pec.2011.11.014
PMCID: PMC3359420  PMID: 22244322
risk communication; cancer screening; cancer prevention; ethnic disparities; numeracy; decision making
5.  Racial and Ethnic Differences in All-Cause Mortality Risk According to Alcohol Consumption Patterns in the National Alcohol Surveys 
American Journal of Epidemiology  2011;174(7):769-778.
Previous studies have found J-shaped relations between volume of alcohol consumed and mortality risk in white Americans but not in African Americans, suggesting the need for studies in which race/ethnicity-defined subgroups are analyzed in separate comparable models. In the present study, the authors utilized mortality follow-up data (through 2006) on respondents from the 1984 and 1995 National Alcohol Surveys, including similar numbers of black, white, and Hispanic respondents by oversampling the minority groups. Cox proportional hazards models controlling for demographic, socioeconomic, mental health, and drug- and tobacco-use measures were used to estimate mortality risk from all causes. Findings indicated a protective effect of moderate alcohol drinking (2–30 drinks/month for women and 2–60 drinks/month for men) with no monthly ≥5-drink days) relative to lifetime abstention for whites only. Elevated mortality risk relative to moderate drinking was found in former drinkers with lifetime alcohol problems. Moderate drinkers who consumed ≥5 drinks in 1 day at least monthly were also found to have increased risk, suggesting the importance of identifying heavy-occasion drinking for mortality analyses. These differential results regarding lifetime abstainers may suggest bias from differential unmeasured confounding or unmeasured aspects of alcohol consumption pattern or may be due to genetic differences in the health impact of alcohol metabolism.
doi:10.1093/aje/kwr147
PMCID: PMC3203376  PMID: 21856649
alcohol drinking; continental population groups; ethnic groups; mortality
6.  Race and trust in the health care system. 
Public Health Reports  2003;118(4):358-365.
OBJECTIVE: A legacy of racial discrimination in medical research and the health care system has been linked to a low level of trust in medical research and medical care among African Americans. While racial differences in trust in physicians have been demonstrated, little is known about racial variation in trust of health insurance plans and hospitals. For the present study, the authors analyzed responses to a cross-sectional telephone survey to assess the independent relationship of self-reported race (non-Hispanic black or non-Hispanic white) with trust in physicians, hospitals, and health insurance plans. METHODS: Respondents ages 18-75 years were asked to rate their level of trust in physicians, health insurance plans, and hospitals. Items from the Medical Mistrust Index were used to assess fear and suspicion of hospitals. RESULTS: Responses were analyzed for 49 (42%) non-Hispanic black and 69 (58%) non-Hispanic white respondents (N=118; 94% of total survey population). A majority of respondents trusted physicians (71%) and hospitals (70%), but fewer trusted their health insurance plans (28%). After adjustment for potential confounders, non-Hispanic black respondents were less likely to trust their physicians than non-Hispanic white respondents (adjusted absolute difference 37%; p=0.01) and more likely to trust their health insurance plans (adjusted absolute difference 28%; p=0.04). The difference in trust of hospitals (adjusted absolute difference 13%) was not statistically significant. Non-Hispanic black respondents were more likely than non-Hispanic white respondents to be concerned about personal privacy and the potential for harmful experimentation in hospitals. CONCLUSIONS: Patterns of trust in components of our health care system differ by race. Differences in trust may reflect divergent cultural experiences of blacks and whites as well as differences in expectations for care. Improved understanding of these factors is needed if efforts to enhance patient access to and satisfaction with care are to be effective.
PMCID: PMC1497554  PMID: 12815085
7.  HIV Knowledge and Beliefs among men who have sex with men (MSM) in Buenos Aires, Argentina 
AIDS and behavior  2013;17(4):1305-1312.
Five hundred men who have sex with men (MSM), recruited through Respondent Driven Sampling in Buenos Aires, Argentina, were interviewed in order to assess knowledge and beliefs about HIV infection. The mean proportion of HIV correct knowledge answers was 62%; however participants whose sexual partners in the prior year included women (MSM&W) had lower frequencies of correct answers than participants with no women partners. Men with previous HIV testing experience and those who were HIV positive had higher HIV knowledge. In relation to HIV beliefs, less than half of participants responded correctly to each of the scenarios presented. Accurate answers for all items were more likely among those who only have sex with men. Men have basic HIV knowledge but also many misconceptions about transmission and prevention. Furthermore, MSM&W have less information than those who are exclusively MSM, probably related to the fact that information campaigns specifically targeted gay identified men.
doi:10.1007/s10461-012-0404-x
PMCID: PMC3891816  PMID: 23297085
men who have sex with men; Respondent Driven Sampling; HIV Knowledge Questionnaire
8.  Misinformation and misbeliefs in the Tuskegee Study of Untreated Syphilis fuel mistrust in the healthcare system. 
The Tuskegee Study of Untreated Syphilis (TSUS) is an important issue in research, healthcare, ethics and race relations. The assumed consequences of knowledge of this study on the African-American community include mistrust of the healthcare system. In the July 2005 issue of the Journal of the National Medical Association, Brandon, Isaac and LaVeist (the authors), who were at the Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, reported the results of black-white differences in awareness of and knowledge about the TSUS and the effect of that awareness and knowledge on medical mistrust. The study surveyed blacks, whites and others in the Baltimore, MD community about their knowledge of and attitudes about the TSUS. The respondents who were aware of the TSUS were asked survey items to assess specific factual information about the TSUS. The respondents who were not aware of the TSUS were read a brief description of the TSUS taken from the CDC website. Both groups were asked if a similar study was possible today. The authors performed a regression analysis of mistrust of medical care based on race, knowledge of the TSUS and demographic variables. The editorial identified and explained challenges in the article, i.e., challenges in calculations, demographic analysis by race, knowledge of TSUS, cultural sensitivity and methodology. The authors miscalculated the "similar proportions" of blacks and whites who were aware of the TSUS; the recalculated proportions, favoring whites, were different than reported by others. There was no demographic analysis by race in their article--also different than other published reports. Most respondents--blacks and whites--who were aware of the TSUS at baseline answered incorrectly the author-selected questions about the TSUS, particularly the fact-based question of whether the TSUS researchers gave syphilis to the men-not dissimilar to one other report. The source for TSUS information (the CDC website) that was used to educate respondents who were not aware of the TSUS at baseline had contradictions, errors and challenges in black history, medical and public health history, and women's studies. The content of what was actually read to respondents was unknown. Proportionally more whites who were not aware of the TSUS but who were read author-selected information about the TSUS believed that a similar study could happen today-a belief and possibly mistrust of medical care that appeared to be induced-compared to whites with prestudy awareness of the TSUS but not read information from the CDC website. Both black groups were not dissimilar from each other. The authors used a survey that measured a race difference in response to a medical event (TSUS) specific to only one racial group (blacks) when there were inclusive examples specific to other groups available. The authors used "Tuskegee" as a single-word sound bite for the TSUS--a misuse that was inappropriate in scientific and research discourse and that may fuel mistrust of medical care. Whether knowledge of the TSUS was a predictor of mistrust of the healthcare system was inconclusive based on the results in the authors' article. The core findings of the article made believing their case difficult. The editorial suggested that bias and misinformation in undertaking, analysis and reporting the study may in itself fuel mistrust in medical care in the community. Because of these challenges, the editorial urged caution with regard to any change in research direction or policy debate based on the results reported in the article.
PMCID: PMC2594917  PMID: 16334509
9.  The Effects of Race, Ethnicity, and Mood/Anxiety Disorders on the Chronic Physical Health Conditions of Men From a National Sample 
American journal of men's health  2013;7(4 0):58S-67S.
Racial/ethnic differences in health are evident among men. Previous work suggests associations between mental and physical health but few studies have examined how mood/anxiety disorders and chronic physical health conditions covary by age, race, and ethnicity among men. Using data from 1,277 African American, 629 Caribbean Black, and 371 non-Hispanic White men from the National Survey of American Life, we examined associations between race/ethnicity and experiencing one or more chronic physical health conditions in logistic regression models stratified by age and 12-month mood/anxiety disorder status. Among men <45 years without mood/anxiety disorders, Caribbean Blacks had lower odds of chronic physical health conditions than Whites. Among men aged 45+ years with mood/anxiety disorders, African Americans had greater odds of chronic physical health conditions than Whites. Future studies should explore the underlying causes of such variation and how studying mental and chronic physical health problems together may help identify mechanisms that underlie racial disparities in life expectancy among men.
doi:10.1177/1557988313484960
PMCID: PMC3895415  PMID: 23609347
race; ethnicity; comorbidities; mental health; chronic physical health conditions
10.  Excess type 2 diabetes in African-American women and men aged 40-74 and socioeconomic status: evidence from the Third National Health and Nutrition Examination Survey 
OBJECTIVE—To examine whether socioeconomic status (SES) explains differences in the prevalence of type 2 diabetes between African-American and non-Hispanic white women and men.
DESIGN—Cross sectional study of diabetes prevalence, SES, and other risk factors ascertained by physical examination and interview.
SETTING—Interviews were conducted in subjects' homes; physical examinations were conducted in mobile examination centres.
PARTICIPANTS—961 African-American women, 1641 non-Hispanic white women, 839 African-American men and 1537 non-Hispanic white men, aged 40 to 74 years, examined in the Third National Health and Nutrition Examination Survey (NHANES III), a representative sample of the non-institutionalised civilian population of the United States, 1988-1994.
MAIN RESULTS—Among women, African-American race/ethnicity was associated with an age adjusted odds ratio of 1.76 (95% confidence intervals 1.21, 2.57), which was reduced to 1.42 (95% confidence intervals 0.95, 2.13) when poverty income ratio was controlled. Controlling for education or occupational status had minimal effects on this association. When other risk factors were controlled, race/ethnicity was not significantly associated with type 2 diabetes prevalence. Among men, the age adjusted odds ratio associated with African-American race/ethnicity was 1.43 (95% confidence intervals 1.03, 1.99). Controlling for SES variables only modestly affected the odds ratio for African/American race/ethnicity among men, while adjusting for other risk factors increased the racial/ethnic differences.
CONCLUSIONS—Economic disadvantage may explain much of the excess prevalence of type 2 diabetes among African-American women, but not among men.


Keywords: diabetes mellitus; ethnic groups; socioeconomic factors
doi:10.1136/jech.54.11.839
PMCID: PMC1731578  PMID: 11027198
11.  Social context explains race disparities in obesity among women 
Background
National data do not account for race differences in health risks resulting from racial segregation or the correlation between race and socioeconomic status. Therefore, these data may inaccurately attribute differences in obesity to race rather than differing social context. The goal of this study was to investigate whether race disparities in obesity among women persist in a community of black people and white people living in the same social context with similar income.
Methods
Race disparities in obesity were examined among black women and white women living in the same social context with similar income, using the data from the Exploring Health Disparities in Integrated Communities-SWB (EHDIC-SWB) study, and these estimates were compared to national data (National Health Interview Survey) to determine if race disparities in obesity were attenuated among women in EHDIC-SWB. Obesity was based on participants’ self-reported height and weight. Logistic regression was used to examine the association between race and obesity.
Results
In the national sample, black women exhibited greater odds of being obese (OR 1.99, 95% CI 1.71 to 2.32) than white women after controlling for covariates. In the EHDIC-SWB sample, black women had similar odds of being obese (OR 1.25, 95% CI 0.90 to 1.75) as compared to white women, after adjusting for covariates.
Conclusions
There are no race disparities in obesity among poor, urban women sharing the same social context. Developing policies that focus on modifying social aspects of the environment may reduce disparities in obesity among low-income women living in urban communities.
doi:10.1136/jech.2009.096297
PMCID: PMC3099623  PMID: 20445215
12.  The publics' understanding of daily caloric recommendations and their perceptions of calorie posting in chain restaurants 
BMC Public Health  2010;10:121.
Background
Calorie posting in chain restaurants has received increasing attention as a policy lever to reduce energy intake. Little research has assessed consumer understanding of overall daily energy requirements or perceived effectiveness of calorie posting.
Methods
A phone survey was conducted from May 1 through 17, 2009 with 663 randomly selected, nationally-representative adults aged 18 and older, including an oversample of Blacks and Hispanics in the United States. To examine differences in responses by race and ethnicity (White, Black, and Hispanic) and gender, we compared responses by conducting chi-squared tests for differences in proportions.
Results
We found that most Americans were knowledgeable about energy requirements for moderately active men (78%) and women (69%), but underestimated energy requirements for inactive adults (60%). Whites had significantly higher caloric literacy and confidence about their caloric knowledge than Blacks and Hispanics (p < 0.05). As compared to their counterparts, Blacks, Hispanics and women reported a significantly higher likelihood of eating at a chain restaurant and of selecting lower calorie foods where caloric information was posted. Most Americans favored the government requiring chain restaurants to post calorie information on menus at the point of purchase (68%). Support for government mandated calorie posting in chain restaurants was significantly higher among Blacks, Hispanics and women as compared to their counterparts. The public was divided about the mode of caloric information that would best help them make a lower calorie decision; a third favored number of calories (35%) which is the current standard mode of presenting caloric information in chain restaurants, a third favored a physical activity equivalent (26%), and a third favored percentage of total energy intake (39%).
Conclusion
Mandating calorie posting in chain restaurants may be a useful policy tool for promoting energy balance, particularly among Blacks, Hispanics and women who have higher obesity risk.
doi:10.1186/1471-2458-10-121
PMCID: PMC2847976  PMID: 20214811
13.  Linking sleep duration and obesity among black and white US adults 
Clinical practice (London, England)  2013;10(5):10.2217/cpr.13.47.
SUMMARY
Aims
The effect of race/ethnicity on the risk of obesity associated with short or long sleep durations is largely unknown. This study assessed whether the sleep–obesity link differentially affects black and whites.
Methods
Analysis was based on data obtained from 29,818 adult American respondents from the 2005 National Health Interview Survey, a cross-sectional household interview survey.
Results
Multivariate-adjusted odds ratios for obesity associated with short sleep (≤6 h) among blacks and whites were 1.98 (95% CI: 1.69–2.30) and 1.20 (95% CI: 1.10–1.31), respectively, and with long sleep (≥9 h) for blacks and whites were 1.48 (95% CI: 1.14–1.93) and 0.77 (95% CI: 0.67–0.89), respectively (all p < 0.001).
Conclusion
Race/ethnicity may have significantly influenced the likelihood of reporting obesity associated with short and long sleep durations. Relative to white respondents, an excess of 78% of black respondents showed increased obesity odds associated with short sleep. Black long sleepers also showed increased odds for obesity, but white long sleepers may be at a reduced obesity risk.
doi:10.2217/cpr.13.47
PMCID: PMC3855998  PMID: 24340171
14.  The Social Patterns of a Biological Risk Factor for Disease: Race, Gender, Socioeconomic Position, and C-reactive Protein 
Objective.
Understand the links between race and C-reactive protein (CRP), with special attention to gender differences and the role of class and behavioral risk factors as mediators.
Method.
This study utilizes the National Social Life, Health, and Aging Project data, a nationally representative study of older Americans aged 57–85 to explore two research questions. First, what is the relative strength of socioeconomic versus behavioral risk factors in explaining race differences in CRP levels? Second, what role does gender play in understanding race differences? Does the relative role of socioeconomic and behavioral risk factors in explaining race differences vary when examining men and women separately?
Results.
When examining men and women separately, socioeconomic and behavioral risk factor mediators vary in their importance. Indeed, racial differences in CRP among men aged 57–74 are little changed after adjusting for both socioeconomic and behavioral risk factors with levels 35% higher for black men as compared to white men. For women aged 57–74, however, behavioral risk factors explain 30% of the relationship between race and CRP.
Discussion.
The limited explanatory power of socioeconomic position and, particularly, behavioral risk factors, in elucidating the relationship between race and CRP among men, signals the need for research to examine additional mediators, including more direct measures of stress and discrimination.
doi:10.1093/geronb/gbs048
PMCID: PMC3695599  PMID: 22588996
Behavioral risk factors; Gender; Inflammation; Race
15.  PAP SMEAR RECEIPT AMONG VIETNAMESE IMMIGRANTS: THE IMPORTANCE OF HEALTH CARE FACTORS 
Ethnicity & health  2009;14(6):575-589.
Objective
Recent US data indicate that women of Vietnamese descent have higher cervical cancer incidence rates than women of any other race/ethnicity, and lower levels of Pap testing than white, black, and Latina women. Our objective was to provide information about Pap testing barriers and facilitators that could be used to develop cervical cancer control intervention programs for Vietnamese American women.
Design
We conducted a cross-sectional, community-based survey of Vietnamese immigrants. Our study was conducted in metropolitan Seattle, Washington. A total of 1,532 Vietnamese American women participated in the study. Demographic, health care, and knowledge/belief items associated with previous cervical cancer screening participation (ever screened and screened according to interval screening guidelines) were examined.
Results
Eighty-one percent of the respondents had been screened for cervical cancer in the previous three years. Recent Pap testing was strongly associated (p<0.001) with having a regular doctor, having a physical in the last year, previous physician recommendation for testing, and having asked a physician for testing. Women whose regular doctor was a Vietnamese man were no more likely to have received a recent Pap smear than those with no regular doctor.
Conclusion
Our findings indicate that cervical cancer screening disparities between Vietnamese and other racial/ethnic groups are decreasing. Efforts to further increase Pap smear receipt in Vietnamese American communities should enable women without a source of health care to find a regular provider. Additionally, intervention programs should improve patient-provider communication by encouraging health care providers (especially male Vietnamese physicians serving women living in ethnic enclaves) to recommend Pap testing, as well as by empowering Vietnamese women to specifically ask their physicians for Pap testing.
doi:10.1080/13557850903111589
PMCID: PMC2788032  PMID: 19626504
Cervical cancer; Immigrants; Pap testing; Vietnamese
16.  Race/Ethnicity, Psychological Distress, and Fruit/Vegetable Consumption: The Nature of the Distress-Behavior Relation Differs by Race/Ethnicity 
Appetite  2011;56(3):737-740.
Objective
We explored how the relation between psychological distress and fruit/vegetable consumption differed as a function of race/ethnicity.
Method
Data from the 2007 Health Information National Trends Survey was analyzed. Participants reported current psychological distress, race/ethnicity, and current fruit and vegetable consumption. Linear regression analyses were used to examine the association between race/ethnicity, distress, and their interaction and fruit and vegetable consumption.
Results
There was a significant interaction between race/ethnicity and psychological distress in predicting fruit and vegetable consumption. Follow-up analyses indicated that distress was related to fruit and vegetable consumption for White and Hispanic but not for African American respondents.
Conclusion
The association between psychological distress and fruit/vegetable consumption differs as a function of race/ethnicity. The findings have implications for understanding the role of distress in eating behavior regulation and for developing interventions to address fruit/vegetable consumption targeted to members of different race/ethnic groups.
doi:10.1016/j.appet.2011.02.012
PMCID: PMC3100390  PMID: 21349306
17.  Racial Differences in Self-Reported Healthcare Seeking and Treatment for Urinary Incontinence in Community-Dwelling Women from the EPI Study 
Neurourology and urodynamics  2011;30(8):1442-1447.
Aims
Objectives of this study are: 1) To examine the prevalence of healthcare seeking among black and white women with self-reported urinary incontinence (UI), 2) To investigate barriers to treatment for incontinence, and 3) To investigate commonly used therapeutic modalities for UI.
Methods
This is a planned secondary analysis of responses from 2812 black and white community-dwelling women living in southeastern Michigan, aged 35-64 years, who completed a telephone interview concerning UI, healthcare-seeking behaviors and management strategies. The study population was 571 subjects (278 black, 293 white) who self-identified as having urinary incontinence.
Results
Of these women with UI, 51% sought healthcare with no statistically significant difference between the two races (53% black, 50.6% white, p 0.64). In multivariate logistic regression analysis, a higher likelihood of seeking healthcare was associated with increased age, body mass index lower than 30 kg/m2, prior surgery for UI, having regular pelvic exams, having a doctor, and worsening severity of UI. There was no significant association between hypothesized barriers to care seeking and race. Almost 95% of the subjects identified lack of knowledge of available treatments as one barrier. Black and white women were similar in percentage use of medications and some self-care strategies, e.g., pad wearing and bathroom mapping, but black women were significantly more likely to restrict fluid intake than white women and marginally less likely to perform Kegels.
Conclusions
Black and white women seek healthcare for UI at similar, low rates. Improved patient-doctor relationships and public education may foster healthcare seeking behavior.
doi:10.1002/nau.21145
PMCID: PMC3184333  PMID: 21717504
Coping strategies; Population study; Kegel exercises; Fluid intake; Treatment barriers; Bladder control; Treatment seeking; Health knowledge; Healthcare treatment; Obesity
18.  Race/Ethnicity and Self-Reported Diabetes Among Adults in the National Health Interview Survey: 2000–2003 
Public Health Reports  2007;122(5):616-625.
SYNOPSIS
Objectives.
We investigated the effect of race among Hispanic and non-Hispanic people on self-reported diabetes after adjusting for selected individual characteristics and known risk factors.
Methods.
Using the National Health Interview Survey 2000–2003, these analyses were limited to Hispanic and non-Hispanic people who self-identified as white or black/African American for a final sample of 117,825 adults, including 17,327 Hispanic people (with 356 black and 16,971 white respondents).
Results.
The overall prevalence of diabetes was 7.2%. After adjusting for selected covariates, Hispanic white and black respondents were 1.56 (95% confidence interval [CI] 1.32, 1.83) and 2.64 (95% CI 1.10, 6.35) times more likely to report having diabetes than non-Hispanic white respondents. The estimate for non-Hispanic black respondents was 1.45 (95% CI 1.29, 1.64). When compared to low-income non-Hispanic white respondents, low-income Hispanic white respondents (odds ratio [OR] 1.64; 95% CI 1.26, 2.19) and non-Hispanic black respondents (OR 1.71; 95% CI 1.38, 2.11) were more likely to report having diabetes. Hispanic black people born in the U.S. were 3.54 (95% CI 1.27, 9.82) times more likely to report having diabetes when compared to Hispanic white people born in the U.S. In comparison to non-Hispanic white respondents, the odds of reporting diabetes decreased for non-Hispanic black respondents, while the odds remained constant for Hispanic white respondents (p-value for interaction between survey year and race/ethnicity = 0.03).
Conclusions.
This study suggests that race may be a proxy for unmeasured exposures among non-Hispanic and Hispanic people. Thus, given the importance of race on health and the racial heterogeneity among Hispanic people, race among Hispanic people should be investigated whenever the data allow it.
PMCID: PMC1936960  PMID: 17877309
19.  Perceptions of Informed Decision Making About Cancer Screening in a Diverse Primary Care Population 
Family medicine  2010;42(6):421-427.
Objective
Our objective was to describe primary care patients’ perceptions of informed and shared decision making about cancer screening tests in a diverse sample.
Methods
We administered a 33-item survey to 467 women and 257 men aged 50 years and older from seven practices in a family medicine practice-based research network. We used ordered logistic regression to assess the relationship between gender, race, education, marital status, and self-rated health with measures of patient-centered care relating to cancer screening tests, controlling for practice site.
Results
Men had greater odds than women of reporting they did not know the benefits of cancer screening (1.46, 95% CI=1.08, 1.99). Compared to white respondents, black respondents reported greater odds of not knowing the benefits (1.70, 95% CI=1.23, 2.36) and risks (1.38, 95% CI=1.00, 1.90) of cancer screening, of not making informed choices (1.50, 95% CI=1.09, 2.07), and that their doctor did not give them some control over their cancer screening tests (1.57, 95% CI=1.12, 2.20). Low education level was also associated with lower perceptions of informed decision making.
Conclusions
Patients with male sex, non-white race, and low education level reported more uncertainty about cancer screening tests and less patient-centered care.
PMCID: PMC3192531  PMID: 20526910
20.  Virginity Lost, Satisfaction Gained? 
Journal of sex research  2010;47(4):384-394.
Despite the literature's focus on (hetero)sexual initiation, we know little about the degree to which young people are satisfied by their first vaginal intercourse experience, let alone the factors that predict satisfaction. We analyzed data from a cross-sectional survey of 1986 non-Hispanic White and Black 18-25 year old respondents from four university campuses. Respondents were asked to rate the degree to which their first vaginal intercourse was physiologically and psychologically satisfying. Both Black and White women were significantly less likely than Black and White men to experience considerable or extreme satisfaction at first vaginal intercourse, particularly physiological satisfaction. Among all four gender-race groups, being in a committed relationship with one's sexual partner greatly increased psychological satisfaction, particularly among women. Experiencing less guilt at first sexual intercourse was also strongly associated with psychological satisfaction for women. Developing sexual relationships with partners they care for and trust will foster satisfaction among young people at first vaginal intercourse. Our findings highlight strong gender asymmetry in affective sexual experience.
doi:10.1080/00224491003774792
PMCID: PMC3572537  PMID: 20401787
sexual debut; sexual initiation; first heterosexual intercourse; sexual satisfaction (physical, psychological); gender differences
21.  Racial and Ethnic Disparities in Cancer Screening 
Journal of General Internal Medicine  2003;18(12):1028-1035.
CONTEXT
Racial/ethnic groups comprised largely of foreign-born individuals have lower rates of cancer screening than white Americans. Little is known about whether these disparities are related primarily to their race/ethnicity or birthplace.
OBJECTIVE
To determine whether foreign birthplace explains some racial/ethnic disparities in cancer screening.
DESIGN, SETTING, AND SUBJECTS
Cross-sectional study using 1998 data from the National Health Interview Survey.
MAIN OUTCOME MEASURES
Completion of cervical, breast, or colorectal cancer screening.
RESULTS
Of respondents, 15% were foreign born. In analyses adjusted for sociodemographic characteristics and illness burden, black respondents were as or more likely to report cancer screening than white respondents; however, Hispanic and Asian-American and Pacific Islander (AAPI) respondents were significantly less likely to report screening for most cancers. When race/ethnicity and birthplace were considered together, U.S.-born Hispanic and AAPI respondents were as likely to report cancer screening as U.S.-born whites; however, foreign-born white (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.41 to 0.82), Hispanic (AOR, 0.65; 95% CI, 0.53 to 0.79), and AAPI respondents (AOR, 0.28; 95% CI, 0.19 to 0.39) were less likely than U.S.-born whites to report Pap smears. Foreign-born Hispanic and AAPI respondents were also less likely to report fecal occult blood testing (FOBT); AORs, 0.72; 95% CI, 0.53 to 0.98; and 0.61; 95% CI, 0.39 to 0.96, respectively); and sigmoidoscopy (AORs, 0.70; 95% CI, 0.51 to 0.97; and 0.63; 95% CI, 0.40 to 0.99, respectively). Furthermore, foreign-born AAPI respondents were less likely to report mammography (AOR, 0.49; 95% CI, 0.28 to 0.86). Adjusting for access to care partially attenuated disparities among foreign-born respondents.
CONCLUSION
Foreign birthplace may explain some disparities previously attributed to race or ethnicity, and is an important barrier to cancer screening, even after adjustment for other factors. Increasing access to health care may improve disparities among foreign-born persons to some degree, but further study is needed to understand other barriers to screening among the foreign-born.
doi:10.1111/j.1525-1497.2003.20807.x
PMCID: PMC1494963  PMID: 14687262
cervical cancer; breast cancer; colorectal cancer; cancer screening; race/ethnicity; immigrant status; health disparities
22.  Physician race and ethnicity, professional satisfaction, and work-related stress: results from the Physician Worklife Study. 
There are limited data about minority physicians' professional satisfaction and job stress. In this study, we describe by race and ethnicity, satisfaction, and job stress among a national sample of physician. We analyzed data from 2,217 respondents to the Physicians' Worklife Survey (PWS), a career satisfaction survey of physicians drawn from the AMA Physician Masterfile. Scales measuring overall job and career satisfaction and work-related stress were constructed from Likert-response items. We examined the association between physician ethnicity and each of these scales. Respondents included 57 black, 134 Hispanic, 400 Asian or Pacific Islander, and 1,626 white physicians. In general, minority physicians appeared to serve a more demanding patient base than did white physicians. Hispanic physicians reported significantly higher job (p=0.05) and career (p=0.03) satisfaction compared to white physicians but no significant difference in stress. Asian or Pacific Islander physicians averaged lower job satisfaction (p=001) and higher stress (p<0.01) compared to white physicians. Black physicians did not differ significantly from white physicians on any of the three measures. Significant racial and ethnic variations were found with respect to several specific satisfaction domains: autonomy, patient care issues, relations with staff, relations with the community, pay, and resources.
Images
PMCID: PMC2568518  PMID: 15540879
23.  Black–White Disparities in Disability Among Older Americans: Further Untangling the Role of Race and Socioeconomic Status 
Journal of aging and health  2009;21(5):677-698.
Objectives
To explore the impact of adjusting for income and education on disparities in functional limitations and limitations in activities of daily living (ADLs) between Black and White older Americans.
Method
Data from the 2003 American Community Survey were used to examine the associations of education and income, stratified by race and gender, with functional limitations and ADLs, in a sample of 16,870 non-Hispanic Blacks and 186,086 non-Hispanic Whites aged 55 to 74. Sequential logistic regressions were used to examine the relative contribution of income and education to racial disparities.
Results
Ninety percent of the Black–White difference in disability rates for men and 75% of the difference for women aged 55 to 64 were explained by income and education.
Discussion
The greatly elevated risk of disability among Blacks aged 55 to 74 is largely explained by differences in socioeconomic status. Reductions in Black–White health disparities require a better understanding of the mechanisms whereby lower income and education are associated with functional outcomes in older persons.
doi:10.1177/0898264309338296
PMCID: PMC2907066  PMID: 19584411
African Americans; ethnicity; health inequalities; activities of daily living; functional limitations
24.  Differences in the measured alcohol content of drinks between black, white and Hispanic men and women in a US national sample 
Addiction (Abingdon, England)  2009;104(9):1503-1511.
Aims
To measure and describe drink alcohol content differences between Hispanic, non-Hispanic white and non-Hispanic black men and women in the US.
Design
A telephone survey re-interview of 397 respondents who originally participated in the 2005 National Alcohol Survey of whom 306 provided complete information on home drinks.
Setting
United States
Participants
Adults 18 and older from across the US.
Measurements
Direct measurement by respondents of simulated drink pours in respondents’ own glassware using a provided beaker and reported beverage brands were used to calculate drink alcohol content.
Findings
Black men were found to have the largest overall mean drink alcohol content at 0.79oz (23ml) of alcohol. This was significantly larger than the mean for white men or for black women and added 30% to black men’s monthly alcohol intake when applied to their reported number of drinks. Spirits drinks were found to be particularly large for men. Multivariate models indicated that drink alcohol content differences are attributable more to income and family structure differences than to unmeasured cultural factors tied to race or ethnicity per se. Models predicting alcohol-related consequences and dependence indicate that adjusting drink alcohol content improves model fit and reduces differences between race/ethnicity defined groups.
Conclusions
Differences in drink alcohol content by gender, race/ethnicity and beverage type choice should be considered in comparisons of drinking patterns and alcohol-related outcomes. Observed differences can be partially explained by measured characteristics regarding family structure and income.
doi:10.1111/j.1360-0443.2009.02579.x
PMCID: PMC2747628  PMID: 19438419
alcohol content; ethnic differences; race; ethnicity; gender; beverage type
25.  The Language of Love?—Verbal versus Implied Consent at First Heterosexual Intercourse: Implications for Contraceptive Use 
Background
Little is known about how young people communicate about initiating intercourse.
Purpose
This study was designed to gauge the prevalence of implied versus verbal consent at first intercourse in a U.S. college population, assess effects of consent type on contraceptive use, and explore the influences of gender, race and other factors.
Methods
We conducted and analyzed a cross-sectional survey of non-Hispanic white and black students from four universities, exploring associations between verbal and nonverbal consent, contraceptive use and covariates.
Results
Among those with consensual first intercourse experiences (N=1883), half (49%) provided nonverbal consent. Black men were the most likely to provide nonverbal consent (61%), followed by white men (55%), black women (51%), and white women (43%). Respondents who used condoms at first intercourse were more likely to provide verbal consent, suggesting that condoms may prompt sexual discussions (or vice versa). In contrast, even when controlling for covariates, those who provided nonverbal consent were less likely to have used contraception (significantly so for women).
Discussion
These findings confirm the hypothesis that young people who do not discuss whether to engage in vaginal intercourse for the first time are less likely to use contraception. These results add an important layer to our current conceptual model of sexual development, in particular, how young people adopt, or fail to adopt, behaviors that will keep them healthy once they decide to become sexually active.
Translation to Health Education Practice
Enhanced sexual communication skills are greatly needed. Public health practitioners should investigate type of consent in future research and programming, with sensitivity to gender and racial influences.
doi:10.1080/19325037.2010.10599148
PMCID: PMC3586313  PMID: 23460940

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