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1.  Diabetes and prostate cancer screening in black and white men 
Cancer causes & control : CCC  2013;24(10):1893-1899.
Prior studies conducted primarily among white men, find a reduced risk of prostate cancer associated with time since developing diabetes. While biologic explanations are plausible, the association may in part arise from more frequent prostate cancer screening among those with a diabetes diagnosis. The purpose of the present study was to investigate the association between diabetes and prostate cancer screening.
We examined differences in prostate cancer screening (prostate-specific antigen and/or digital rectal examination) testing practices after a diabetes diagnosis among lower-income persons living in the southeastern United States and enrolled in the Southern Community Cohort Study between 2002 and 2009. Baseline in-person interviews collected information on history of diabetes and prostate cancer screening from 18,809 black and 6,404 white men aged 40-79 years.
After adjustment for confounding, diabetic black (odds ratio (OR) 1.12, 95% confidence interval (CI) 1.01-1.25) and white (OR 1.25, 95% CI 1.03-1.51) men were more likely to undergo recent prostate cancer screening compared to non-diabetic men of the same race. The increased risk for prostate cancer screening, however, occurred primarily within the first 12 months after diabetes diagnosis.
Our results suggest that a diabetes diagnosis modestly increases the likelihood of having a prostate cancer screening test for both black and white men. The prevalence of screening was higher nearer to the time of diabetes diagnosis, which may contribute to an early increase in prostate cancer detection followed by lower prostate cancer detection after an extended time.
PMCID: PMC3773007  PMID: 23860952
Race; prostate cancer screening; diabetes; cohort study
2.  Factors influencing Breast Cancer Screening in Low-Income African Americans in Tennessee 
Journal of community health  2014;39(5):943-950.
This study examined demographic and lifestyle factors that influenced decisions and obstacles to being screened for breast cancer in low-income African Americans in three urban Tennessee cities. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n=334) were selected from the Meharry CNP community survey database. There were several predictors of breast cancer screening such as marital status and having health insurance (P< .05). Additionally, there were associations between obstacles to screening and geographic region such as transportation and not having enough information about screenings (P< .05). Educational interventions aimed at improving breast cancer knowledge and screening rates should incorporate information about obstacles and predictors to screening.
PMCID: PMC4165808  PMID: 24554393
3.  Religious Fatalism and its association with Health Behaviors and Outcomes 
This study examines religious fatalism as a potential barrier to good health and healthy behavior.
As part of Nashville's REACH 2010 project, residents (n=1,273) were randomly selected to participate in a telephone survey examining health variables. This survey included the Helpless Inevitability sub-scale of the Religious Health Fatalism Questionnaire.
Results indicate significant racial/ethnicity differences, however associations of fatalism with health outcomes and behaviors were only partially confirmed.
Fatalism may be primarily a coping response to illness rather than an inhibitory belief.
PMCID: PMC4144788  PMID: 17691869
Health Disparities; Fatalism; African-American Health; REACH 2010
4.  Plasma Selenium Biomarkers in Low Income Black and White Americans from the Southeastern United States 
PLoS ONE  2014;9(1):e84972.
Biomarkers of selenium are necessary for assessing selenium status in humans, since soil variation hinders estimation of selenium intake from foods. In this study, we measured the concentration of plasma selenium, selenoprotein P (SEPP1), and glutathione peroxidase (GPX3) activity and their interindividual differences in 383 low-income blacks and whites selected from a stratified random sample of adults aged 40–79 years, who were participating in a long-term cohort study in the southeastern United States (US). We assessed the utility of these biomarkers to determine differences in selenium status and their association with demographic, socio-economic, dietary, and other indicators. Dietary selenium intake was assessed using a validated food frequency questionnaire designed for the cohort, matched with region-specific food selenium content, and compared with the US Recommended Dietary Allowances (RDA) set at 55 µg/day. We found that SEPP1, a sensitive biomarker of selenium nutritional status, was significantly lower among blacks than whites (mean 4.4±1.1 vs. 4.7±1.0 mg/L, p = 0.006), with blacks less than half as likely to have highest vs. lowest quartile SEPP1 concentration (Odds Ratio (OR) 0.4, 95% Confidence Interval (CI) 0.2–0.8). The trend in a similar direction was observed for plasma selenium among blacks and whites, (mean 115±15.1 vs. 118±17.7 µg/L, p = 0.08), while GPX3 activity did not differ between blacks and whites (136±33.3 vs. 132±33.5 U/L, p = 0.320). Levels of the three biomarkers were not correlated with estimated dietary selenium intake, except for SEPP1 among 10% of participants with the lowest selenium intake (≤57 µg/day). The findings suggest that SEPP1 may be an effective biomarker of selenium status and disease risk in adults and that low selenium status may disproportionately affect black and white cohort participants.
PMCID: PMC3896351  PMID: 24465457
5.  Prevalence and Correlates of Complementary and Alternative Medicine Services Use in Low-Income African Americans and Whites: A Report from the Southern Community Cohort Study 
This study aimed to examine the prevalence, trends, and correlates of practitioner-based complementary and alternative medicine (CAM) services use according to race in a socioeconomically disadvantaged population.
Included in this cross-sectional analysis were 50,176 African Americans (AAs) and 19,038 whites enrolled into the Southern Community Cohort Study from March 2002 through September 2009. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of CAM services use associated with participant characteristics.
Outcome measures
Outcomes include the prevalence of and trends in use of CAM services during 2002–2009 and correlates of use by race.
CAM services use during 2002–2009 was greater among whites (11.7%) than among AAs (8.5%), but no significant temporal trends within the 8-year period were observed. The significant associations were observed for CAM services use with higher educational attainment (OR 1.78, 95% CI: 1.61–1.96 for college versus less than high school), household income (OR 1.61, 95% CI: 1.44–1.81 for ≥$50,000 versus <$15,000), and having a history of a chronic disease (OR 1.34, 95% CI: 1.21–1.47) among both AAs and whites. Significant differences in findings between AAs and whites were seen for age (with a sharp decline in use with older age among AAs but not whites), sex (with the excess of female users more striking among whites), employment (with the unemployed among AAs but not whites more likely to be users), alcohol consumption (with white but not AA drinkers more likely to report CAM services use), and cigarette smoking status (with negative association of use with current smokers more striking among whites).
CAM services use is associated with sociodemographic and health-related factors, and racial differences in such use exist. The descriptive findings of this study help supplement the limited information on CAM use among low-income and minority populations in the United States.
PMCID: PMC3429268  PMID: 22866972
6.  Obesity and All-Cause Mortality Among Black Adults and White Adults 
American Journal of Epidemiology  2012;176(5):431-442.
In recent pooled analyses among whites and Asians, mortality was shown to rise markedly with increasing body mass index (BMI; weight (kg)/height (m)2), but much less is known about this association among blacks. This study prospectively examined all-cause mortality in relation to BMI among 22,014 black males, 9,343 white males, 30,810 black females, and 14,447 white females, aged 40–79 years, from the Southern Community Cohort Study, an epidemiologic cohort of largely low-income participants in 12 southeastern US states. Participants enrolled in the cohort from 2002 to 2009 and were followed up to 8.9 years. Hazard ratios and 95% confidence intervals for mortality were obtained from sex- and race-stratified Cox proportional hazards models in association with BMI at cohort entry, adjusting for age, education, income, cigarette smoking, and alcohol consumption. Elevated BMI was associated with increased mortality among whites (hazard ratios for BMI >40 vs. 20–24.9 = 1.37 (95% confidence interval (CI): 1.02, 1.84) and 1.47 (95% CI: 1.15, 1.89) for white males and white females, respectively) but not significantly among blacks (hazard ratios = 1.13 (95% CI: 0.89, 1.43) and 0.87 (95% CI: 0.72, 1.04) for black males and black females, respectively). In this large cohort, obesity in mid-to-late adulthood among blacks was not associated with the same excess mortality risk seen among whites.
PMCID: PMC3499117  PMID: 22822174
African Americans; body mass index; mortality
7.  Evaluation of a Questionnaire to Assess Sedentary and Active Behaviors in the Southern Community Cohort Study 
Low physical activity (PA) is linked to cancer and other diseases prevalent in racial/ethnic minorities and low-income populations. This study evaluated the PA questionnaire (PAQ) used in the Southern Cohort Community Study, a prospective investigation of health disparities between African-American and white adults.
The PAQ was administered upon entry into the cohort (PAQ1) and after 12–15 months (PAQ2) in 118 participants (40–60 year-old, 48% male, 74% African-American). Test-retest reliability (PAQ1 versus PAQ2) was assessed using Spearman correlations and the Wilcoxon signed rank test. Criterion validity of the PAQ was assessed via comparison with a PA monitor and a last-month PA survey (LMPAS), administered up to 4 times in the study period.
The PAQ test-retest reliability ranged from 0.25–0.54 for sedentary behaviors and 0.22–0.47 for active behaviors. The criterion validity for the PAQ compared with PA monitor ranged from 0.21–0.24 for sedentary behaviors and from 0.17–0.31 for active behaviors. There was general consistency in the magnitude of correlations between the PAQ and PA-monitor between African-Americans and whites.
The SCCS-PAQ has fair to moderate test-retest reliability and demonstrated some evidence of criterion validity for ranking participants by their level of sedentary and active behaviors.
PMCID: PMC3527833  PMID: 21952413
physical activity questionnaire; low income; reliability; reproducibility
8.  Relationship Between Smoking and Obesity Among Women 
To examine the relationship between smoking and weight status in adult women and whether this association differed by race.
The study sample consisted of 22,949 African American and 7831 white women enrolled in the Southern Community Cohort Study from 2002 to 2006.
Both African American and white current smokers had decreased odds of being overweight or obese compared to normal-weight nonsmokers, and the inverse trends between current smoking and BMI held for both groups.
A strong relationship exists between smoking and weight status, with patterns nearly identical for African Americans and white women.
PMCID: PMC3717966  PMID: 22040623
BMI; smoking; race
9.  Differences in the Association between Serum Leptin Levels and Body Mass Index in Black and White Women: A Report from the Southern Community Cohort Study 
Leptin may be an important link between obesity and many high-burden diseases, including cancer and cardiovascular disease, but leptin levels and correlates in individuals of diverse racial backgrounds have not been well characterized despite racial differences in incidence and mortality patterns for many obesity-related diseases.
In a cross-sectional study of 915 white and 892 black women enrolled in the Southern Community Cohort Study (age 40–79 years, half postmenopausal), serum leptin levels were compared between the race groups and across categories of body mass index (BMI). Potential correlates of leptin were assessed via race-stratified linear regression models.
Blacks had higher unadjusted leptin levels than whites (geometric mean 22.4 vs. 19.0 ng/ml; p < 0.0001). Leptin increased with increasing BMI, and racial differences in leptin were most pronounced in women with BMI ≥25. Significant correlates of leptin included BMI, age, alcohol consumption, cigarette smoking, diabetes (both races) and fat consumption (black women only). Leptin remained higher in black women (22.7 vs. 18.8 ng/ml) after adjustment for these factors.
Persistent racial differences in leptin concentrations exist after adjustment for BMI and other factors. Leptin assessment may be informative in future studies that investigate racial differences in the development of obesity-related diseases.
PMCID: PMC3710998  PMID: 22353927
Leptin; Body mass index; Race; Adipokines
10.  Expanding the Role of Primary Care in the Prevention and Treatment of Childhood Obesity: A Review of Clinic- and Community-Based Recommendations and Interventions 
Journal of Obesity  2013;2013:172035.
Although pediatric providers have traditionally assessed and treated childhood obesity and associated health-related conditions in the clinic setting, there is a recognized need to expand the provider role. We reviewed the literature published from 2005 to 2012 to (1) provide examples of the spectrum of roles that primary care providers can play in the successful treatment and prevention of childhood obesity in both clinic and community settings and (2) synthesize the evidence of important characteristics, factors, or strategies in successful community-based models. The review identified 96 articles that provide evidence of how primary care providers can successfully prevent and treat childhood obesity by coordinating efforts within the primary care setting and through linkages to obesity prevention and treatment resources within the community. By aligning the most promising interventions with recommendations published over the past decade by the Institute of Medicine, the American Academy of Pediatrics, and other health organizations, we present nine areas in which providers can promote the prevention and treatment of childhood obesity through efforts in clinical and community settings: weight status assessment and monitoring, healthy lifestyle promotion, treatment, clinician skill development, clinic infrastructure development, community program referrals, community health education, multisector community initiatives, and policy advocacy.
PMCID: PMC3655557  PMID: 23710345
11.  Colonoscopy Screening in African-Americans and Whites with Affected First-Degree Relatives 
Archives of internal medicine  2008;168(6):625-631.
Family history is a risk factor for colon cancer and guidelines recommend initiating colonoscopy screening at age 40 in individuals with affected relatives. Racial differences exist in colon cancer incidence and mortality which could be related to variations in screening of increased risk individuals.
Baseline data from 41830 participants in the Southern Community Cohort Study were analyzed to determine the proportion of colonoscopy procedures in individuals with strong family histories of colon cancer, and whether differences existed based on race.
In participants with multiple affected first degree relatives (FDR) or relatives diagnosed before age 50, 27.3% (95% confidence interval [CI] 23.5%–31.1%) of African-Americans reported a colonoscopy within the past 5 years compared to 43.1% (37.0%–49.2%) of white participants (p-value < 0.0001). In these individuals, African-Americans had an odds ratio of 0.51 (0.38–0.68) of having undergone recommended screening procedures compared to white participants after adjusting for age, gender, education, income, insurance status, total number of FDR, and time since last medical visit. African-Americans reporting multiple affected first degree relatives or relatives diagnosed before age 50, who had ever undergone endoscopy were less likely to report a personal history of colon polyps (OR = 0.29; 0.20–0.42) when compared to whites with similar family histories.
African-Americans with first-degree relatives affected with colon cancer are less likely to undergo colonoscopy screening compared to whites with affected relatives. Increased efforts need to be directed at identifying and managing underserved populations who might be at increased risk for colon cancer based on their family history.
PMCID: PMC3557834  PMID: 18362255
12.  HTR1B, ADIPOR1, PPARGC1A, and CYP19A1 and Obesity in a Cohort of Caucasians and African Americans: An Evaluation of Gene-Environment Interactions and Candidate Genes 
American Journal of Epidemiology  2011;175(1):11-21.
The World Health Organization estimates that the number of obese and overweight adults has increased to 1.6 billion, with concomitant increases in comorbidity. While genetic factors for obesity have been extensively studied in Caucasians, fewer studies have investigated genetic determinants of body mass index (BMI; weight (kg)/height (m)2) in African Americans. A total of 38 genes and 1,086 single nucleotide polymorphisms (SNPs) in African Americans (n = 1,173) and 897 SNPs in Caucasians (n = 1,165) were examined in the Southern Community Cohort Study (2002–2009) for associations with BMI and gene × environment interactions. A statistically significant association with BMI survived correction for multiple testing at rs4140535 (β = −0.04, 95% confidence interval: −0.06, −0.02; P = 5.76 × 10−5) in African Americans but not in Caucasians. Gene-environment interactions were observed with cigarette smoking and a SNP in ADIPOR1 in African Americans, as well as between a different SNP in ADIPOR1 and physical activity in Caucasians. A SNP in PPARGC1A interacted with alcohol consumption in African Americans, and a different SNP in PPARGC1A was nominally associated in Caucasians. A SNP in CYP19A1 interacted with dietary energy intake in African Americans, and another SNP in CYP191A had an independent association with BMI in Caucasians.
PMCID: PMC3244609  PMID: 22106445
African continental ancestry group; body mass index; European continental ancestry group; genetics; molecular epidemiology; obesity
13.  Helicobacter pylori prevalence and circulating micronutrient levels in a low-income United States population 
High prevalence of Helicobacter pylori, the leading cause of gastric cancer, and low levels of micronutrients have been observed in many developing countries, and the question remains as to the whether an association between the two exists. The present study seeks to further our understanding of this potential connection in the Southern Community Cohort Study, representing a low-income population in the United States. Blood levels of antibodies to Helicobacter pylori proteins were assessed using multiplex serology for a sample of 310 African American and white participants, aged 40–79 years. Blood collected at baseline was also assayed for levels of carotenoids, tocopherols, retinol, and folate. Multivariate linear regression was used to calculate least-squares mean micronutrient levels within groups defined by Helicobacter pylori status. The mean serum levels of all micronutrients assayed were lower among Helicobacter pylori+ individuals than Helicobacter pylori- individuals, significantly for beta-carotene, folate, and retinol (decreases of 27.6%, 18.6%, and 9.7%, respectively). Individuals who were sero-positive to the virulent CagA+ Helicobacter pylori strains had even lower mean levels of micronutrients, particularly beta-carotene, folate, total carotenoids, and retinol (decreases of 38.9%, 19.1%, 17.0%, and 11.7%, respectively, compared to Helicobacter pylori- individuals). However, dietary micronutrient levels as derived from a food frequency questionnaire did not vary between groups defined by Helicobacter pylori status. These results provide support for the hypothesis that Helicobacter pylori infection impairs nutrient absorption, and suggest a need for future studies to explore the role of Helicobacter pylori infection on nutrition and gastric cancer risk in this high-risk population.
PMCID: PMC3107911  PMID: 21436385
antioxidant; micronutrient; biomarker; Helicobacter pylori; gastric cancer
14.  Operationalization of community-based participatory research principles across the National Cancer Institute’s Community Network Programs 
American Journal of Public Health  2011;102(6):1195-1203.
To examine how the National Cancer Institute-funded Community Network Program (CNP) operationalized principles of community-based participatory research (CBPR).
Based on our review of the literature and extant CBPR measurement tools, scientists from nine of 25 CNPs developed a 27-item questionnaire to self-assess CNP operationalization of nine CBPR principles.
Of 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles to recognize community as a unit of identity, build on community strengths, facilitate co-learning, embrace iterative processes in developing community capacity, and achieve a balance between data generation and intervention. CNPs varied in extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging community in research dissemination, and striving for sustainability.
Although tool development in this field is in its infancy, findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.
PMCID: PMC3292685  PMID: 22095340
Cancer disparities; community health; empowerment; health status disparities; indigenous populations; minority health; partnerships; training
15.  Lung Cancer Risk Among Smokers of Menthol Cigarettes 
Menthol cigarettes, preferred by African American smokers, have been conjectured to be harder to quit and to contribute to the excess lung cancer burden among black men in the Unites States. However, data showing an association between smoking menthol cigarettes and increased lung cancer risk compared with smoking nonmenthol cigarettes are limited. The Food and Drug Administration is currently considering whether to ban the sale of menthol cigarettes in the United States.
We conducted a prospective study among 85 806 racially diverse adults enrolled in the Southern Community Cohort Study during March 2002 to September 2009 according to cigarette smoking status, with smokers classified by preference for menthol vs nonmenthol cigarettes. Among 12 373 smokers who responded to a follow-up questionnaire, we compared rates of quitting between menthol and nonmenthol smokers. In a nested case–control analysis of 440 incident lung cancer case patients and 2213 matched control subjects, using logistic regression modeling we computed odds ratios (ORs) and accompanying 95% confidence intervals (CIs) of lung cancer incidence, and applied Cox proportional hazards modeling to estimate hazard ratios (HRs) of lung cancer mortality, according to menthol preference.
Among both blacks and whites, menthol smokers reported smoking fewer cigarettes per day; an average of 1.6 (95% CI = 1.3 to 2.0) fewer for blacks and 1.8 (95% CI = 1.3 to 2.3) fewer for whites, compared with nonmenthol smokers. During an average of 4.3 years of follow-up, 21% of participants smoking at baseline had quit, with menthol and nonmenthol smokers having equal odds of quitting (OR = 1.02, 95% CI = 0.89 to 1.16). A lower lung cancer incidence was noted in menthol vs nonmenthol smokers (for smokers of <10, 10–19, and ≥20 cigarettes per day, compared with never smokers, OR = 5.0 vs 10.3, 8.7 vs 12.9, and 12.2 vs 21.1, respectively). These trends were mirrored for lung cancer mortality. In multivariable analyses adjusted for pack-years of smoking, menthol cigarettes were associated with a lower lung cancer incidence (OR = 0.65, 95% CI = 0.47 to 0.90) and mortality (hazard ratio of mortality = 0.69, 95% CI = 0.49 to 0.95) than nonmenthol cigarettes.
The findings suggest that menthol cigarettes are no more, and perhaps less, harmful than nonmenthol cigarettes.
PMCID: PMC3096798  PMID: 21436064
16.  Serum adiponectin in relation to body mass index and other correlates in black and white women 
Annals of epidemiology  2010;21(2):86-94.
Adiponectin is a promising biomarker linking obesity and disease risk; however, limited data are available regarding adiponectin in black women among whom obesity is highly prevalent.
A cross-sectional analysis was conducted to assess racial differences and correlates of serum adiponectin measured in 996 black and 996 white women enrolled in the Southern Community Cohort Study through Community Health Centers in twelve southeastern states from 2002–2006.
Blacks had significantly lower adiponectin levels than whites (median 10.9 versus 14.9 ug/ml, Wilcoxon p<0.0001). Among blacks, adiponectin was lower among overweight and obese women compared to healthy weight women but showed no clear decreasing trend with increasing severity of obesity; adjusted geometric means (95% confidence interval) were 15.0 (13.8–16.4), 11.5 (10.6–12.5), 9.7 (9.0–10.6), 11.4 (10.3–12.6), and 10.9 (9.5–12.6) ug/ml for body mass index [BMI] categories of 18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and 40–45 (p for trend<0.0001). In contrast, among whites there was a monotonic reduction in adiponectin over increasing BMI (adjusted geometric means = 19.9 (18.3–21.7), 15.1 (13.9–16.4), 14.3 (13.2–15.5), 12.5 (11.2–13.9), and 11.0 (9.7–12.5) ug/ml, p for trend<0.0001). BMI, age, HDL-cholesterol, and hypertension were important correlates of adiponectin in both groups.
Among women, racial differences exist in both the magnitude and form of the adiponectin-BMI association.
PMCID: PMC3018848  PMID: 21109453
Adiponectin; obesity; African Americans
17.  Blood vitamin D levels in relation to genetic estimation of African ancestry 
African Americans generally have lower circulating levels of 25 hydroxyvitamin D (25(OH)D) than whites, attributed to skin pigmentation and dietary habits. Little is known about the genetic determinants of 25(OH)D levels, nor whether the degree of African ancestry associates with circulating 25(OH)D.
Using a panel of 276 ancestry informative genetic markers, we estimated African and European admixture for a sample of 758 African American and non-Hispanic white Southern Community Cohort Study participants. For African Americans, cutpoints of <85%, 85%–95%, and ≥95% defined “low”, “medium”, and “high” African ancestry. We estimated the association between African ancestry and 25(OH)D, and also explored whether vitamin D exposure (sunlight, diet) had varying effects on 25(OH)D levels dependent on ancestry level.
Mean serum 25(OH)D levels among whites and among African Americans of low, medium, and high African ancestry were 27.2, 19.5, 18.3, and 16.5ng/mL, respectively. Serum 25(OH)D was estimated to decrease by 1.0–1.1ng/mL per 10% increase in African ancestry. The effect of high vitamin D exposure from sunlight and diet was 46% lower among African Americans with high African ancestry than among those with low/medium ancestry.
We found novel evidence that the level of African ancestry may play a role in clinical vitamin D status.
This is the first study to describe how 25(OH)D levels vary in relation to genetic estimation of African ancestry. Further study is warranted to replicate these findings and uncover the potential pathways involved.
PMCID: PMC2938736  PMID: 20647395
vitamin D; African Americans; health status disparities; genetics; epidemiology
18.  Physical Activity and Obesity Gap Between Black and White Women in the Southeastern U.S. 
Differences between black and white women in the associations of sedentary and active behaviors and obesity are mostly unknown.
To examine associations of sedentary and active behaviors with BMI, a marker of overall obesity, in a large group of black and white women and to determine whether there are differences by race in these associations.
Associations between time spent in sedentary and active behaviors and BMI were examined using cross-sectional data collected from 2002 to 2006 at enrollment into the Southern Community Cohort Study (SCCS) from 22,948 black and 7,830 white women living in the southeastern U.S. These associations were examined using linear and polytomous logistic regression models controlling for age, race, income, education, occupational status, tobacco use, marital status, and comorbidities.
Time spent in sedentary behaviors was directly related to BMI while time spent in active behaviors such as moderate and vigorous physical activity was inversely related to BMI, with stronger associations for whites than blacks. White women in the highest quartile of sedentary behaviors were more likely to be moderately (BMI 30–39) or severely (BMI>40) obese than women in the lowest quartile (OR = 2.3; 95%CI 1.8–2.9 for moderate and OR = 4.0; 95%CI 3.1, 5.3 for severe obesity), while the ORs among similarly sedentary black women were modestly elevated (ORs of 1.4; 95%CI 1.2–1.6 and 1.6; 95%CI 1.4–1.8).
There are significant differences in the association of physical activity patterns and obesity between black and white women living in the southeastern U.S. While most guidelines for prevention of obesity and maintaining weight promote increased time in moderate and vigorous physical activity, these results indicate that a reduction in sedentary behavior time may represent another useful strategy in this population.
PMCID: PMC2918875  PMID: 20621261
19.  Diabetes and Co-morbid Depression among Racially Diverse, Low-income Adults 
Research suggests individuals with diabetes are twice as likely as those without diabetes to be clinically depressed. Still unknown is the relationship between diabetes and depression in socioeconomically disadvantaged populations.
We examined the relationship between diabetes and depressive symptoms in a large, racially diverse, low-income cohort in the southeastern United States.
69,068 adults were recruited from community health centers in the twelve southeastern states in the U.S. A fully adjusted polytomous logistic regression model tested the relationship between demographics, lifestyle behaviors, antidepressant use, body mass index, diabetes diagnosis, diabetes duration, diabetes medication compliance, and depressive symptoms using the Centers for Epidemiological Studies Depression scale.
Diabetes was present in 21.7% of sample. While a diabetes diagnosis was associated with having severe depressive symptoms (AOR: 1.24, 95% CI: 1.14-1.34), demographics, lifestyle behaviors, antidepressant use, body mass index were more strongly associated with severe depressive symptoms than a diabetes diagnosis.
Having diabetes was associated with the presence and severity of depressive symptoms in a large, low-income sample of racially diverse adults. However, the relationship between diabetes and depressive symptoms was weaker than other studies with higher socioeconomic groups.
PMCID: PMC3098929  PMID: 21104461
depression; diabetes; disparities; income; education
20.  Racial Disparities in the Treatment of Depression in Low-Income Persons With Diabetes 
Diabetes Care  2010;33(5):1050-1054.
Individuals with diabetes are at higher risk for depression than the general population. Although depression can be treated with antidepressant medications, patients with diabetes and comorbid depression often go untreated. The goal of this study was to examine racial disparities in the treatment of depression with antidepressant medication in the southeastern U.S.
Cross-sectional data were collected at baseline from 69,068 participants (71% African American, 60% female, and 82% with incomes <$25,000) recruited from community health centers and enrolled in the Southern Cohort Community Study (SCCS). The SCCS is a prospective epidemiological cohort study designed to explore causes of health disparities in adults aged 40–79 years. Binary logistic regression was used to identify factors associated with antidepressant use among those with diabetes (n = 14,279).
Individuals with diagnosed diabetes (14,279) were classified with no depressive symptoms (54.7%), or with mild (24.2%), moderate (12.8%), or severe depressive symptoms (8.3%). After controlling for sex, age, insurance, income, education, BMI, smoking status, alcohol consumption, and level of depression, African Americans with diabetes were much less likely to report taking antidepressant medication than whites (adjusted odds ratio 0.32 [95% CI 0.29–0.35], P < 0.0001).
Antidepressant use is much less common among African Americans than among whites with diabetes. Reasons for racial disparities in treatment of depressive symptoms are unclear but may include a combination of differential diagnosis and treatment by health professionals as well as cultural differences in seeking help for emotional distress.
PMCID: PMC2858173  PMID: 20185741
21.  Biochemical Validation of Food Frequency Questionnaire-Estimated Carotenoid, α-Tocopherol, and Folate Intakes Among African Americans and Non-Hispanic Whites in the Southern Community Cohort Study 
American Journal of Epidemiology  2010;171(4):488-497.
Few food frequency questionnaires (FFQs) have been developed specifically for use among African Americans, and reports of FFQ performance among African Americans or low-income groups assessed using biochemical indicators are scarce. The authors conducted a validation study within the Southern Community Cohort Study to evaluate FFQ-estimated intakes of α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin, lycopene, folate, and α-tocopherol in relation to blood levels of these nutrients. Included were 255 nonsmoking participants (125 African Americans, 130 non-Hispanic whites) who provided a blood sample at the time of study enrollment and FFQ administration in 2002–2004. Levels of biochemical indicators of each micronutrient (α-tocopherol among women only) significantly increased with increasing FFQ-estimated intake (adjusted correlation coefficients: α-carotene, 0.35; β-carotene, 0.28; β-cryptoxanthin, 0.35; lutein/zeaxanthin, 0.28; lycopene, 0.15; folate, 0.26; α-tocopherol, 0.26 among women; all P's < 0.05). Subjects in the top decile of FFQ intake had blood levels that were 27% (lycopene) to 178% (β-cryptoxanthin) higher than those of subjects in the lowest decile. Satisfactory FFQ performance was noted even for participants with less than a high school education. Some variation was noted in the FFQ's ability to predict blood levels for subgroups defined by race, sex, and other characteristics, but overall the Southern Community Cohort Study FFQ appears to generate useful dietary exposure rankings in the cohort.
PMCID: PMC2842194  PMID: 20061366
African Americans; biological markers; carotenoids; epidemiologic methods; folic acid; nutrition surveys; questionnaires; vitamin E
22.  Evaluation of 11 Breast Cancer Susceptibility Loci in African-American Women 
Recent genome-wide association studies (GWAS) have identified multiple common genetic risk variants for breast cancer among women of Asian and European ancestry. Investigating these genetic susceptibility loci in other populations would be helpful to evaluate the generalizability of the findings and identify causal variants for breast cancer. We evaluated 11 GWAS-identified genetic susceptibility loci for breast cancer in a study including 2,594 African-American women (810 cases and 1,784 controls). Two single-nucleotide polymorphisms (SNPs), rs13387042 (2q35) and rs1219648 (FGFR2 gene), were found to be associated with breast cancer risk. Risk increased nearly linearly with number of affected risk alleles, with a two-fold elevated risk for women homozygous for the risk alleles in both SNPs. No additional significant associations, however, were identified for the other 9 loci evaluated in the study. The results from this study extend some of the recent GWAS findings to African Americans and may guide future efforts to identify causal variants for breast cancer.
PMCID: PMC2759857  PMID: 19789366
23.  The Southern Community Cohort Study: Investigating Health Disparities 
Over 73,700 adults age 40–79, nearly 70% African American, were recruited at community health centers across 12 southeastern states; individual characteristics were recorded and biologic specimens collected at baseline for later follow-up. The Southern Community Cohort Study is a unique national resource for assessing determinants of racial/ethnic differentials in diseases.
PMCID: PMC2940058  PMID: 20173283
Cancer; cohort study; African Americans; health disparities; community health studies
24.  Parity and Breastfeeding in Relation to Obesity among Black and White Women in the Southern Community Cohort Study 
Journal of Women's Health  2009;18(9):1323-1332.
This research sought to describe associations among parity, breastfeeding, and adult obesity in black and white women in the southeastern United States.
Cross-sectional data from 7,986 white women and 23,198 black women (age 40–79 years) living in the southeastern United States and enrolled in the Southern Community Cohort Study during 2002–2006 were used to examine self-reported body mass index (BMI) and weight change since age 21 in association with parity and breastfeeding. Multiple linear regression and logistic regression with adjustment for demographic and lifestyle factors were used.
At all levels of parity and breastfeeding, black women had higher BMI and weight gain since age 21 than white women. Compared to nulliparity, five or more live births was associated with increased odds of obesity in white women (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.08–1.74) and, to a lesser extent, in black women (OR = 1.22, 95% CI = 1.07–1.38). In white women, breastfeeding for more than 12 months compared to none was associated with decreased odds of obesity (OR = 0.68, 95% CI = 0.56–0.82), whereas in black women, no association between obesity and breastfeeding was seen.
The associations between childbearing factors and measures of adult obesity appear to be larger in white women compared to black women but relatively small overall. However, when considered as part of the constellation of factors that lead to obesity, even these small associations may be important in an overall obesity prevention strategy.
PMCID: PMC2825722  PMID: 19743905
25.  Chronic illness and smoking cessation 
Nicotine & Tobacco Research  2009;11(8):933-939.
Smoking is among the leading causes of premature mortality and preventable death in the United States. Although smoking contributes to the probability of developing chronic illness, little is known about the relationship between quitting smoking and the presence of chronic illness. The present study investigated the association between diagnoses of one or more chronic diseases (diabetes, hypertension, or high cholesterol) and smoking status (former or current smoker).
The data analyzed were a subset of questions from a 155-item telephone-administered community survey that assessed smoking status, demographic characteristics, and presence of chronic disease. The study sample consisted of 3,802 randomly selected participants.
Participants with diabetes were more likely to report being former smokers, after adjusting for sociodemographic characteristics, whereas having hypertension or high cholesterol was not associated significantly with smoking status. The likelihood of being a former smoker did not increase as number of diagnosed chronic diseases increased. Participants who were women, older (aged 65+), or single were significantly less likely to be former smokers. Participants with at least a college degree, those with incomes of US$50,000+, and those who were underweight or obese were more likely to be former smokers.
These findings were inconsistent with research that has suggested that having a chronic illness or experiencing a serious medical event increases the odds of smoking cessation. Supporting prior research, we found that being male, having a higher income, and being obese were associated with greater likelihood of being a former smoker.
PMCID: PMC2734285  PMID: 19516050

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