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issn:1049-510
1.  Community Screening for Pre-Diabetes and Diabetes Using HbA1c Levels in High Risk African Americans and Latinos 
Ethnicity & disease  2014;24(2):195-199.
Objective
To evaluate community screening using HbA1c levels in high risk African Americans and Latinos in those not known to have diabetes.
Design
HbA1c levels were measured in 1542 African Americans and Latinos aged ≥40 years with one or more of the following risk factors: family history in first degree relatives, waist circumference ≥40 inches in males or ≥35 inches in females, and hypertension, either treatment for or a measured BP of ≥140/90 mm Hg. Oral glucose tolerance tests (OGTT) were offered to those meeting the HbA1c criterion for pre-diabetes.
Setting
Churches, community health fares, senior citizen sites.
Participants
People without known diabetes.
Main Outcome Measures
Proportion of people meeting the HbA1c criteria for pre-diabetes (5.8-6.4%) and diabetes (≥6.5%).
Results
32% had one, 50% had two and 18% had three risk factors. By HbA1c criteria, 40% had pre-diabetes and 25% had diabetes. Increased waist circumference was the most common risk factor followed by a positive family history, and lastly, hypertension. Each individual risk factor was significantly (P<.001) and progressively more common as glycemia increased. Each additional risk factor increased the odds of pre-diabetes or diabetes by 2- to 4- fold. In individuals with pre-diabetes who underwent an OGTT, 59% were normal, 35% had pre-diabetes and only 6% had diabetes.
Conclusions
Community screening of high risk African Americans and Latinos with HbA1c levels identifies a large proportion of people with pre-diabetes and diabetes. Those identified with pre-diabetes are unlikely to meet the OGTT criteria for diabetes.
PMCID: PMC4287403  PMID: 24804366
Screening; Risk Score; Pre-diabetes; HbA1c Levels
2.  Association of American Indian cultural identity with physical activity 
Ethnicity & disease  2014;24(1):1-7.
Objective
Cultural factors are associated with health behaviors among American Indians. Accordingly, the objective of this study was to investigate whether cultural identity, defined as the primary language spoken at home, is associated with (1) higher total physical activity levels and (2) levels of leisure-time physical activity recommended for health benefits in a diverse sample of American Indians.
Design
Cross-sectional analysis of 5,207 American Indian adults 18 to 82 years. Participants resided on the Oglala Sioux (n = 2,025) and Cheyenne River Sioux (n = 1,528) reservations in South Dakota, and the Gila River Indian Community (n = 1,654) in Arizona.
Results
Bicultural participants in South Dakota, but not Arizona, reported significantly higher total physical activity compared to the English-only group (p < 0.05). About 35% of English only speakers, 39% of American Indian/Alaska Native only speakers, and 39% of participants speaking both languages met the 150 minutes/week activity threshold. Odds of being sufficiently active were higher among bicultural respondents in both regions when compared to respondents endorsing only English, controlling for socio-demographic and health-related covariates (p < 0.05).
Conclusion
Bicultural respondents among tribal members in South Dakota had significantly higher total physical activity, and higher levels of sufficient leisure-time activity in both South Dakota and Arizona, compared to those who spoke either language exclusively. Interventions that encourage American Indians to develop their bicultural efficacy and to draw on resources for healthy living that may be available in all the cultures with which they identify are recommended.
PMCID: PMC3970840  PMID: 24620441
American Indian; Culture; Language; Physical Activity
3.  The Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study: Sample, Design, and Procedures 
Ethnicity & disease  2014;24(1):77-83.
Objectives
The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study aims to examine associations between sociocultural and psychosocial factors and cardiovascular disease (CVD) and metabolic syndrome prevalence in Hispanics/Latinos. The conceptual framework is based on the Reserve Capacity and Lifespan Biopsychosocial Models, which emphasize multiple risk and protective pathways underlying socioeconomic and ethnic influences in health. This study describes the rationale, participants, and procedures for the HCHS/SOL Sociocultural Ancillary Study.
Design and Setting
The Sociocultural Ancillary Study to the HCHS/SOL is a cross-sectional cohort study with future opportunities for prospective investigation.
Participants
Participants were 5,313 adults, aged 18-74 years, of self-identified Hispanic/Latino descent and representing multiple Hispanic/Latino background groups, recruited from the Bronx, NY, Chicago, IL, Miami, FL, and San Diego, CA.
Intervention
Participants completed an interview-administered sociocultural assessment battery within 9 months of their HCHS/SOL clinical baseline exam.
Outcome Measures
The primary outcomes are CVD and the metabolic syndrome and its component risk factors.
Results
The Sociocultural Ancillary Study sample is broadly representative of the HCHS/SOL cohort. Weighted demographics are: 55% male, 56% 18-44 years, 44% 45 years and older, and 37% Mexican, 20% Cuban, 16% Puerto Rican, 12% Dominican, 8% Central American, and 5% South American descent.
Conclusions
By testing theoretically driven hypotheses concerning sociocultural and psychosocial factors in CVD, the Sociocultural Ancillary Study seeks to inform future prevention and intervention efforts for U.S. Hispanic/Latinos.
PMCID: PMC3986116  PMID: 24620452
Cardiovascular Disease; Culture; Hispanic; Latino; Metabolic Syndrome; Psychosocial Factors; Social Factors
4.  Health Characteristics and Health Behaviors of African American Adults According to Self-rated Health Status 
Ethnicity & disease  2014;24(1):97-103.
Objectives
Although African Americans report poorer self-rated health (SRH) than Whites, few studies have explored what factors are associated with SRH in this population. Our study described the health characteristics and health behaviors of a sample of adult church members according to SRH status.
Design
Cross-sectional.
Setting
74 African Methodist Episcopal churches in South Carolina.
Participants
1077 church members (99% African American).
Main Outcome Measures
Self-reported physical activity, fruit and vegetable consumption, fat- and fiber-behaviors, perceived stress, and presence of chronic health conditions, objectively measured body mass index (BMI), waist circumference, and blood pressure. Health-related characteristics and health behaviors across SRH categories were calculated. Analysis of covariance examined relationships between SRH and the presence of chronic diseases, the total number of chronic diseases, health-related variables, and health behaviors.
Results
The health characteristics and health behaviors of participants worsened with declining SRH. The percentage of participants with each individual chronic health condition increased, as did the total number of chronic health conditions, as SRH declined. A higher BMI, a greater waist circumference, and higher perceived stress were associated with poorer SRH. Participants with lower physical activity and poorer fat- and fiber-behaviors also had poorer SRH. Fruit and vegetable consumption was not associated with SRH.
Conclusions
A better understanding of what health-related variables and health behaviors contribute to SRH may inform future interventions, as researchers and practitioners can target and effectively change the most salient factors. Fortunately, a majority of the factors are modifiable and can be prevented or reversed with changes in lifestyle.
PMCID: PMC4230694  PMID: 24620455
Self-rated Health; Health Behaviors; Chronic Health Conditions; African Americans
5.  Effect of Race and Socioeconomic Status on Cardiovascular Risk Factor Burden: The Cooper Center Longitudinal Study 
Ethnicity & disease  2013;23(1):35-42.
Objectives
This study examines the prevalence of cardiovascular risk factors and chronic disease burden among African Americans compared to Caucasians in a population of higher socioeconomic status.
Design
The current study is a cross-sectional, secondary data analysis of the Cooper Center Longitudinal Study.
Setting
Patients with a medical examination from 1970-2010 at the Cooper Clinic.
Participants
762 African Americans and 40,051 Caucasians who met the criteria.
Outcome Measures
Racial differences in cardiovascular risk factors/burden of disease between African Americans and Caucasians.
Results
African Americans had higher prevalence of evaluated cardiovascular risk factors than did Caucasians after controlling for obesity, tobacco use, and physical fitness. Caucasians had greater likelihood of no risk factors while African Americans were more likely to have all three risk factors. Race was typically predictive of cardiovascular risk factors in African Americans compared to Caucasians.
Conclusions
Findings suggest that health differences persist despite greater socioeconomic status, and further investigations of biopsychosocial causes are warranted. (Ethn Dis. 2013;23[1]:35-42)
PMCID: PMC4266688  PMID: 23495620
Socioeconomic Status; Racial/ethnic Minorities; Preventive Medicine; Cardiovascular Risk Factors
6.  Older depressed Latinos’ experiences with primary care visits for personal, emotional and/or mental health problems: a qualitative analysis 
Ethnicity & disease  2014;24(1):84-91.
Objective
To describe salient experiences with a primary care visit (e.g., the context leading up to the visit, the experience and/or outcomes of that visit) for emotional, personal and/or mental health problems older Latinos with a history of depression and recent depressive symptoms and/or antidepressant medication use reported 10 years after enrollment into a randomized controlled trial of quality-improvement for depression in primary care.
Design
Secondary analysis of existing qualitative data from the second stage of the continuation study of Partners in Care (PIC).
Participants
Latino ethnicity, age ≥ 50 years, recent depressive symptoms and/or antidepressant medication use, and a recent primary care visit for mental health problems. Of 280 second-stage participants, 47 were eligible. Both stages of the continuation study included participants from the PIC parent study control and 2 intervention groups, and all had a history of depression.
Methods
Data analyzed by a multidisciplinary team using grounded theory methodology.
Results
Five themes were identified: beliefs about the nature of depression; prior experiences with mental health disorders/treatments; sociocultural context (e.g., social relationships, caregiving, the media); clinic-related features (e.g., accessibility of providers, staff continuity, amount of visit time); provider attributes (e.g., interpersonal skills, holistic care approach).
Conclusions
Findings emphasize the importance of key features for shaping the context leading up to primary care visits for help-seeking for mental health problems, and the experience and/or outcomes of those visits, among older depressed Latinos at long-term follow-up, and may help tailor chronic depression care for the clinical management of this vulnerable population.
PMCID: PMC4244226  PMID: 24620453
depression; aging; Latino; primary care
7.  Health promotion in barbershops: Balancing outreach and research in African American communities 
Ethnicity & disease  2010;20(2):185-188.
Promoting health and preventing illness among African American men, who die disproportionately from preventable diseases, is a challenging health disparity that has seen limited progress. However, focusing our efforts in places outside of traditional clinical and community settings such as the barbershop has shown promise for ameliorating these disparities. In particular, barbershop-based health promotion as conducted by the Black Barbershop Health Outreach Program has successfully reached nearly 10,000 men nationwide through a grassroots, volunteer-driven effort. At the same time, researchers have begun to conduct formal clinical trials in barbershops in order to explore interventions targeting this at-risk population. Herein, we describe, in brief a review of barbershop-based health promotion and the experience of this novel community-based organization. We argue for continuing to integrate evaluation and research using community-partnered principles into successful grassroots initiatives without dulling the practical impact of these programs is a crucial next step as we move beyond simply acknowledging health disparities and seek to find solutions.
PMCID: PMC4244298  PMID: 20503901
community organizing; health promotion; barbershops; African-American men
8.  The Relation of Acculturation to Overweight, Obesity, Pre-Diabetes and Diabetes Among US Mexican-American Women and Men 
Ethnicity & disease  2012;22(1):58-64.
Objective
To estimate and compare the prevalences of overweight, obesity, pre-diabetes and diabetes among a nationally representative sample of Mexican-American, non-Latino White and Black adults, and by acculturation for Mexican-Americans.
Design, settings and participants
The NHANES 1999–2008 data sets were used. Binomial regression models were used to compute prevalence ratios and their respective 95% confidence intervals to assess the relationships of race/ethnicity and acculturation with obesity, overweight, pre-diabetes and diabetes.
Main outcome measures
overweight, obesity, pre-diabetes, and diabetes.
Results
Mexican Americans had a higher prevalence of overweight than White non-Latinos and Black non-Latinos. Obesity was significantly more prevalent among the most acculturated Mexican Americans but not the least acculturated. In contrast, the least acculturated Mexican Americans had the highest prevalence of overweight. The prevalence of pre-diabetes was higher among Mexican Americans than White non-Latinos and Black non-Latinos. The most acculturated Mexican Americans had a higher prevalence of diabetes and the prevalence of pre-diabetes was elevated in less acculturated Mexican Americans. In both unadjusted and adjusted models, the less acculturated were significantly more likely to be overweight and significantly less likely to be obese, compared to more acculturated Mexican Americans, and acculturation was not associated with diabetes or pre-diabetes in adjusted models.
Conclusion
Our results suggest that obesity was less prevalent among the least acculturated Mexican-Americans but, overweight was more prevalent.
PMCID: PMC4203316  PMID: 22774310
acculturation; Mexican Americans; diabetes status; body mass index status
9.  Restaurant foods, sugar-sweetened soft drinks, and obesity risk among young African American women 
Ethnicity & disease  2013;23(4):445-451.
Background
The prevalence of obesity is disproportionately high in African American women, and consumption of fast foods and sugar-sweetened soft drinks is also especially high among African Americans.
Objective
We investigated the relation of intakes of sugar-sweetened soft drinks and specific types of restaurant foods to obesity in the Black Women's Health Study.
Design
In this prospective cohort study, 19,479 non-obese women aged 21–39 years at baseline were followed for 14 years (1995–2009). Dietary intake was assessed by validated food frequency questionnaire in 1995 and 2001.
Main outcome measures
Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of intakes of restaurant foods and sugar-sweetened soft drinks with incident obesity.
Results
Higher intakes of burgers from restaurants and sugar-sweetened soft drinks were associated with greater risk of becoming obese. The associations were present in models that included both factors and adjusted for overall dietary pattern. The HR of obesity in relation to restaurant burger consumption of ≥2 times/week compared with <5 times/year was 1.26 (95% CI: 1.14–1.40; P-trend<0.001). For sugar-sweetened soft drink intake, the HR was 1.10 (95% CI: 0.99–1.23; P-trend=0.14) for ≥2 drinks/day compared with <1 drink/month. The associations were stronger among women younger than age 30 with normal weight at baseline.
Conclusions
Frequent consumption of burgers from restaurants and sugar-sweetened soft drinks contribute to obesity among young African American women.
PMCID: PMC3884219  PMID: 24392607
fast food; sugar-sweetened beverages; obesity; African American women
10.  Racial and socioeconomic disparities in sleep and chronic disease: results of a longitudinal investigation 
Ethnicity & disease  2013;23(4):499-507.
Objectives
Sleep problems appear to differentially affect racial minorities and people of lower socioeconomic status (SES). These population subgroups also have higher rates of many debilitating diseases such as obesity, type 2 diabetes mellitus (T2DM), hypertension, coronary heart disease, stroke, and mortality. Considering the presence of social disparities in sleep and chronic disease, this research aims to assess the role of sleep disparities in the incidence of obesity, T2DM, hypertension, and/or cardiovascular disease (CVD).
Design
The Boston Area Community Health (BACH) Survey is a population-based random-sample cohort of 5502 participants aged 30-79. Sleep restriction (≤5 hours/night) and restless sleep were assessed at baseline. Health status was ascertained at baseline and approximately 5 years later among 1610 men and 2535 women who completed follow-up.
Setting
Subjects completed an in-person, home visit, interview at baseline (2002- 2005) and follow-up (2006-2010).
Participants
Boston, Massachusetts residents (2301 men, 3201 women) aged 30-79 years from three racial groups (1767 Black, 1876 Hispanic, 1859 White) participated in the BACH Survey.
Interventions
N/A
Results
There were significant differences in the prevalence of sleep-related problems at baseline by both race and SES as well as significant disparities in the incidence of T2DM, high blood pressure and cardiovascular disease at follow-up. Restless sleep was associated with an increased risk of obesity, T2DM, and CVD. However, we found that sleep does not mediate social disparities in health outcomes.
Conclusions
Results from the BACH Survey confirm large social disparities in health outcomes as well as large social disparities in short sleep duration and restless sleep. However, sleep did not appear to mediate the relationship between race, SES, and health disparities.
PMCID: PMC3884220  PMID: 24392615
disparities; sleep quality; chronic disease
11.  THE ASSOCIATION BETWEEN RENAL FUNCTION BIOMARKERS AND SUBCLINICAL CARDIOVASCULAR MEASURES IN AFRICAN CARIBBEAN FAMILIES 
Ethnicity & disease  2013;23(4):492-498.
Background
Risk of cardiovascular disease (CVD) and mortality are increased in people with subclinical CVD. The impact of ethnicity and race on subclinical CVD is substantial. Previous studies assessed the heritability of several renal function biomarkers and their relationship with subclinical CVD among populations of European ancestries, but no such data is available in African ancestry populations.
Objective
Our aim was to investigate the relationships between renal function biomarkers and subclinical CVD among Afro-Caribbeans residing on the island of Tobago.
Design and Methods
402 participants aged 18 to 103 years from 7 large, multi-generation pedigrees (average family size: 50; range: 19 to 96; ~3500 relative pairs) were included in this study. Subclinical cardiovascular disease (SCVD) was assessed by brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT). Serum cystatin C, creatinine, and eGFR based on the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation were used to assess kidney function. The variance component approach, implemented in Sequential Oligogenic Linkage Analysis Routines (SOLAR), was used to assess heritability of these traits, and association with SCVD.
Results
Heritability of renal function biomarkers ranged from .19–.32 (all P< .001), and was highest for cystatin C (h2=.32, p<.0001). Serum cystatin C was independently associated with arterial stiffness (P=.04). This association was not found with other renal function biomarkers. No significant association between renal function and IMT was found.
Conclusion
Our data suggest that cystatin C is significantly heritable and associated with arterial stiffness among Afro-Caribbeans.
PMCID: PMC4059560  PMID: 24392614
12.  Racial and Ethnic Disparities in Lifetime Risk of Corpus Uterine Cancer: A Comparative Study of Puerto Rico and the United States SEER Population 
Ethnicity & disease  2012;22(1):90-95.
Background
Corpus uterine cancer is the most common gynecologic malignancy in Puerto Rico and the United States.
Methods
We assessed the lifetime risk of developing and dying of corpus uterine cancer in women living in Puerto Rico (PR) and among Hispanics, non-Hispanic Whites (NHW), and non-Hispanic Blacks (NHB) in the United States. Data from the PR Central Cancer Registry and the Surveillance, Epidemiology, and End Results program were analyzed from 1993–2004.
Results
In PR, the probability of developing corpus uterine cancer increased from 1.21% in 1993–1995 to 1.69% in 2002–2004. The probability of developing this malignancy from 2002–2004 was 1.59% for NHB, 1.80% for Hispanics and 2.54% for NHW. The ratio of estimated probabilities only showed significant lower risk in PR as compared to NHW (.67, 95% CI=.59–.74). The probability of dying from corpus uterine cancer during 2002–2004 was .47% for Hispanics, .49% for NHW, .53% for PR and .76% for NHB. The ratio of estimated probabilities only showed significant lower risk of death in PR as compared to NHB (.70, 95% CI=.54–.85).
Conclusions
The lifetime risk of developing corpus uterine cancer has increased in PR, suggesting higher exposure to risk factors in this population. Despite the lower lifetime risk of this malignancy in PR as compared to NHW, the similar lifetime risk of death in these groups suggests a disparity that may be influenced by differences in disease etiology and/or access or response to treatment. Assessment of risk factors, in addition to access to health services, is required to further understand these patterns.
PMCID: PMC4170919  PMID: 22774315
Endometrial Cancer; Hispanics; Minority Health; Health Status Disparities; Risk
13.  Socioeconomic Factors and Women's Use of Complementary and Alternative Medicine in Four Racial/Ethnic Groups 
Ethnicity & disease  2008;18(1):65-71.
Objective
Higher socioeconomic status (SES) is associated with using complementary and alternative medicine (CAM) in national surveys. Less is known about how socioeconomic factors affect CAM use in US subpopulations. We examined whether the relationship between SES and CAM use differs by racial/ethnic groups.
Methods
Using national survey data, we assessed education and income effects on women's CAM use in four racial/ethnic groups (Whites, Blacks, Mexican Americans, and Chinese Americans), controlling for age, health status, and geographic region. CAM use was defined as using any of 11 domains in the prior year.
Results
Adjusted effects of SES on CAM use were similar among Mexican American and non-Hispanic White women—education had a distinct gradient effect, with each increasing level of education significantly more likely to use CAM; household income ≥$60,000 was associated with CAM use compared to income <$20,000. For Chinese American women, socioeconomic factors were not associated with CAM use when controlling for confounders. Although income was not associated with CAM use among African American women, college graduates were three times more likely to use CAM than those with less than a high school education, adjusting for confounders.
Conclusion
SES effects on CAM use are not uniform across racial/ethnic populations. Other factors, such as culture and social networks, may interact with SES to influence CAM use in minority populations.
PMCID: PMC4160874  PMID: 18447102
Alternative Medicines; Complementary Medicine; Race; Ethnicity; Socioeconomic Status
14.  Acute Myocardial Infarction Quality of Care: The Strong Heart Study 
Ethnicity & disease  2011;21(3):294-300.
Objectives
Evaluate the quality of care provided patients with acute myocardial infarction and compare with similar national and regional data.
Design
Case series.
Setting
The Strong Heart Study has extensive population-based data related to cardiovascular events among American Indians living in three rural regions of the United States.
Participants
Acute myocardial infarction cases (72) occurring between 1/1/2001 and 12/31/2006 were identified from a cohort of 4549 participants.
Outcome measures
The proportion of cases that were provided standard quality of care therapy, as defined by the Healthcare Financing Administration and other national organizations.
Results
The provision of quality services, such as administration of aspirin on admission and at discharge, reperfusion therapy within 24 hours, prescription of beta blocker medication at discharge, and smoking cessation counseling were found to be 94%, 91%, 92%, 86% and 71%, respectively. The unadjusted, 30 day mortality rate was 17%.
Conclusion
Despite considerable challenges posed by geographic isolation and small facilities, process measures of the quality of acute myocardial infarction care for participants in this American Indian cohort were comparable to that reported for Medicare beneficiaries nationally and within the resident states of this cohort.
PMCID: PMC4151497  PMID: 21942161
Acute Myocardial Infarction; Ethnicity; Guideline Adherence; Outcome and Process Assessment; Quality Indicators
15.  Relationship of Body Size and Mortality among US Asians and Pacific Islanders on Dialysis 
Ethnicity & disease  2011;21(1):40-46.
Objectives
The influence of body size on dialysis-related mortality among Asians and Pacific Islanders - heterogeneous ethnic groups with dissimilar body compositions - is poorly understood. Our study objective was to compare the relations of body size and mortality among patients with end-stage renal disease of different ethnicities.
Design, setting, and participants
We examined data from a cohort of 21,492 adult Asians, Pacific Islanders and non-Hispanic Whites who initiated dialysis during 1995–2003 within California, Hawaii and the US Pacific Islands.
Main outcome measure
Time to death through September 22, 2008.
Results
Among both men and women, Pacific Islanders were the heaviest and Whites the tallest of the ethnic groups examined. Annual mortality rates were highest among Whites (29.6%), intermediate among Pacific Islanders (18.8%) and lowest among Asians (17.3%). Larger body size was associated with lower mortality among Pacific Islanders, Whites and most Asians on dialysis after adjustment for patient-level sociodemographic and clinical factors, area-based socioeconomic status and geographic clustering. Filipinos were the exception to this rule and showed a trend towards higher mortality with increasing body size. These findings were consistent irrespective of how body size was measured.
Conclusions
Larger body size is associated with lower mortality among Pacific Islanders, Whites and most Asians on dialysis. Use of disaggregated ethnicity data may enhance our understanding of how ethnicity- or community-specific factors influence body size, body composition and dialysis-related outcomes in these diverse populations.
PMCID: PMC4115365  PMID: 21462728
ESRD; Body Size; Obesity; Mortality; Ethnicity; Asian; Pacific Islander
16.  Need for Effective HPV Vaccine Promotional Messaging Before Sexual Activity Begins 
Ethnicity & disease  2012;22(3):266.
PMCID: PMC4113661  PMID: 22870567
Human Papillomavirus; HPV
17.  Differences in Diabetes Mellitus Onset for Older Black, White, and Mexican-Americans 
Ethnicity & disease  2013;23(3):310-315.
Objectives
This research examines the differences in estimated odds of developing diabetes mellitus for white, black, and Mexican-Americans age 51 and over for a period of 11 years.
Design, Setting, and Participants
Longitudinal data came from 14,783 respondents of the Health and Retirement Study (1995–2006) who report being diabetes-free at the first time period. Discrete-time survival models were used to analyze ethnic variations in the probability of developing diabetes.
Main Outcome Measure
Estimated odds of developing diabetes mellitus.
Results
The odds of newly diagnosed diabetes increased between 1995 and 2006, with 11% cumulative incidence for all study participants. The probability of incident diabetes among black Americans was 0.01 during the period of 1995/96–1998, which increased to 0.03 during 1998–2000 and remained at 0.03 throughout subsequent periods, with cumulative incidence over the 11 years at 12%. In contrast, for Mexican-Americans the probability more than doubled from 0.02 in 1995/96–1998 to 0.05 in 2004–2006, with cumulative incidence at 19%. White Americans had 11% cumulative incidence during the 11 year period.
Conclusions
Relative to white Americans, Mexican-Americans had significantly elevated odds of developing diabetes throughout the 11-year period of observation even after controlling for differences in demographic, socioeconomic, and time-varying health characteristics.
PMCID: PMC4106363  PMID: 23914416
Ethnic differences; diabetes mellitus incidence; discrete-time survival analysis
18.  Ethnicity and Sex Modify the Association of Serum C-Reactive Protein with Microalbuminuria 
Ethnicity & disease  2008;18(3):324-329.
Objectives
To study the association between serum C-reactive protein (CRP) and urinary albumin excretion in the Multi-Ethnic Study of Atherosclerosis and to assess whether the association is modified by ethnicity, sex, or systolic blood pressure.
Methods
This was a cross-sectional study of 6675 participants who were free from macro albuminuria and clinical cardiovascular disease (mean age 62.1 years, 53% female; 39% White, 27% African American, 22% Hispanic, and 12% Chinese). Urinary albumin excretion was measured by spot urine albumin-to-creatinine ratio (ACR). Effect modifications were tested after adjusting for age, diabetes, body mass index, smoking, use of angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker, other antihypertensive drugs, estrogens, statins, and high-density lipoprotein cholesterol and triglyceride levels.
Results
The association between CRP and ACR was modified by ethnicity (P=.01) and sex (P<.001), but not by systolic blood pressure. After multivariate adjustment, the association remained in Chinese, African American, and Hispanic men and African American women (P<.02 for African American men, and P<.04 for the other subgroups).
Conclusions
The association between CRP and ACR was modified by ethnicity and sex; it was stronger in non-White men and African American women. These interactions have not been reported before, and future studies should consider them.
PMCID: PMC4089959  PMID: 18785447
Albuminuria; C-Reactive Protein; Ethnicity; Gender
19.  Racial and Ethnic Differences in Hypertension Risk: New Diagnoses After Age 50 
Ethnicity & disease  2012;22(2):175-180.
Objectives
This research examines the differences in estimated risk of developing hypertension in whites, blacks, and Mexican-Americans age 50 and over for a period of 11 years.
Design, Setting, and Participants
Data came from 9,259 respondents who reported being hypertension-free at the baseline in the Health and Retirement Study with up to five time intervals (1998-2006). Discrete-time survival models were used to analyze ethnic variations in the probability of developing hypertension.
Main Outcome Measure
Estimated odds of developing hypertension.
Results
The risk of newly diagnosed hypertension increased between 1995 and 2006 for HRS participants over age 50 years. After adjusting for demographic and health status, the probability of incident hypertension among black Americans was 0.10 during the period of 1995/96-1998, which increased steadily to 0.17 in 2004-2006, and cumulative incidence over the 11-year period at 51%. In contrast, among white Americans the risk was 0.07 during 1995/96-1998 and 0.13 in 2004-2006, with cumulative incidence at 43%. For Mexican-Americans, the probability also increased from 0.08 during 1995/96-1998 to 0.14 during 2004-2006, and cumulative incidence at 42%.
Conclusions
Relative to white and Mexican-Americans, black Americans had an elevated risk of incident hypertension throughout the 11-year period of observation. These variations persisted even when differences in health behaviors, socioeconomic status, demographic, and time-varying health characteristics are accounted for.
PMCID: PMC4084710  PMID: 22764639
Ethnic differences; hypertension incidence; discrete-time survival analysis
20.  Optical Recording of Intracellular pH in Respiratory Chemoreceptors 
Ethnicity & disease  2010;20(1 0 1):S1-33-8.
We studied the spontaneously active in vitro tadpole brainstem and recorded whole nerve respiratory activity while simultaneously visualizing intracellular pH (pHi) dynamics using the pH-sensitive dye, 2′,7′-bis-(2-carboxy-ethyl)-5-(and-6)-carboxyfluorescein, acetoxymethyl ester (BCECF, AM). The isolated, superfused tadpole brainstem is well oxygenated and retains synaptic connectivity among respiratory central pattern generators, central respiratory chemoreceptors, and respiratory motor neurons. We generated a calibration curve to correlate the emitted fluorescence of BCECF to pHi. In addition, we demonstrated that the dye loading protocol that we established labeled an adequate number of cells and did not disrupt spontaneous respiratory rhythmogenesis or the respiratory response to central chemoreceptor stimulation. Validation of the use of the pH sensitive dye BCECF in this preparation will permit further characterization of the pH regulatory responses of central respiratory chemoreceptors and allow correlation between the changes in pHi in central chemoreceptors and respiratory motor output recorded from cranial nerves.
PMCID: PMC4068026  PMID: 20521382
pH; Respiration; Carbon Dioxide; Chemoreceptors
21.  The Viability Of Outercourse For HIV Prevention Within The Puerto Rican Context 
Ethnicity & disease  2010;20(1 0 1):S1-178-84.
Background
As the number of HIV/AIDS cases continues to increase in Puerto Rico, outercourse, or non-penetrative sexual activities, may be one alternative for healthy sexual living for persons living with or at risk for HIV/AIDS.
Methods
Between April and August 2006, we surveyed 1138 women living in low-income housing in Ponce, PR on their attitudes toward and participation in outercourse activities.
Results
The majority of the sample were aged >25 years (80.2%), with a mean sample age of 36.77 (SD=12.31). Approximately one half (49.8%) of the women in the sample were legally married or involved in a common-law relationship. Mutual masturbation and the use of sex toys were viewed as “real sex” by only 33% and 16%, respectively, of the women surveyed. A slight majority had at least a high school education (57.5%). Of those with a steady sex partner in the previous 12 months, 47% engaged in mutual masturbation, and 17% used sex toys. Of those with a non-steady sex partner in the previous 12 months, 41% engaged in mutual masturbation, and 14% used sex toys. Logistic regressions indicated that persons who perceived mutual masturbation and the use of sex toys as real sex were more likely than those who did not perceive them to be so to engage in either or both behaviors with their most recent steady sex partner (OR54.5, CI53.3–6.2 and OR518.11, CI511.5–28.6, respectively); the same relationship emerged with their most recent non-steady sex partner (OR5 4.0, CI51.9–8.3 and OR515.9, CI55.3–47.4).
Conclusions
The levels of participation in outercourse were low across the sample; also low was the perception of outercourse as being real sex. Outercourse appears to be, primarily, a precursor to penetrative sex, especially with steady sex partners. If culturally sensitive prevention messages were to promote outercourse as real sex and as an ultimate sexual goal, couples might be able to maintain an intimate, yet safe, sexual relationship. Outercourse should not be promoted as the only option for safer sex relationships but instead in the context of a comprehensive prevention message, which would also include protected sexual intercourse for those who choose to engage in penetrative activities.
PMCID: PMC4064672  PMID: 20521411
Culture; Outercourse; Puerto Rico; Latina; HIV prevention
22.  Glutamate Transporters are Differentially Expressed in the Hippocampus During the Early Stages of One-day Spatial Learning Task 
Ethnicity & disease  2010;20(1 0 1):S1-28-32.
Introduction
Uptake of glutamate in the hippocampus by specialized transporters appears to be important for the prevention of glutamate-induced neurotoxicity. However, the role of these transporters in synaptic plasticity and learning is still unclear. We examined the expression pattern of glutamate transporters at different stages of spatial learning using a one-day (three blocks) version of the Morris Water Maze.
Methods
Male rats (Sprague Dawley, 3 months old) were divided into three groups (learner, swim control, or naïve control) and animals were sacrificed after the first, second, or third block of training. The hippocampi were immediately extracted and flash frozen for RNA analysis. Real time polymerase chain reaction was employed to examine the expression of glutamate transporter 1 (Glt-1), Glt1b, glutamate-aspartate transporter (GLAST) and excitatory amino acid carrier-1 (EAAC1) in whole hippocampi.
Results
EAAC1 and GLAST RNA were down-regulated in the learner and swimmer groups (compared to naïve) after the first two blocks of training during the one-day protocol but EAAC1 returned to control levels by the end of the third block. GLAST levels were upregulated by the third block of training. Glt-1b expression was downregulated during the second block of training but returned to control by the third block.
Conclusions
The observed decreases in glutamate transporter expression may be important during the early stages of spatial learning as a possible mechanism to enhance glutamatergic availability during critical stages of learning. However, similar decreases in glutamate transporter expression in both the learner and swimmer groups indicate that the observed differences may be task-induced. Additional experiments are currently underway to examine this possibility.
PMCID: PMC4064826  PMID: 20521381
Hippocampus; Glutamate Transporters; GLAST; EAAC1; Glt-1
23.  Dental Caries in American Indian Toddlers after a Community-Based Beverage Intervention 
Ethnicity & disease  2010;20(4):444-450.
Objective/Setting
The Toddler Overweight and Tooth decay prevention Study (TOTS) was an overweight and early childhood caries (ECC) project in the Pacific Northwest USA. It targeted American Indian (AI) toddlers from birth, to effect changes in breastfeeding and sweetened beverage consumption.
Design/Intervention/Participants
The intervention cohort was children born in three communities during 12 months; expectant mothers were identified through prenatal visits, and recruited by tribal coordinators. The local comparison cohorts were children in those communities who were 18–30 months at study start. A control longitudinal cohort consisted of annual samples of children aged 18–30 months in a fourth community, supplying secular trends.
Outcome measures
d1–2mfs was used to identify incident caries in intervention, comparison, and control cohorts after 18-to-30 months of follow-up in 2006.
Results
No missing or filled teeth were found. For d1t, all three intervention cohorts showed statistically significant downward intervention effects, decreases of between 0.300 and 0.631 in terms of the fraction of affected mouths. The results for d2t were similar but of smaller magnitudes, decreases of between 0.342 and 0.449; these results met the 0.05 level for significance in two of three cases. In light of an estimated secular increase in dental caries in the control site, all three intervention cohorts showed improvements in both d1t and d2t.
Conclusions
Simple interventions targeting sweetened beverage availability (in combination with related measures) reduced high tooth decay trends, and were both feasible and acceptable to the AI communities we studied.
PMCID: PMC4058337  PMID: 21305835
Caries; American Indian; child; community intervention; soft drinks; sugared beverages
24.  Social Determinants of Cardiovascular Health among Black and White Women Residing in Stroke Belt and Buckle Regions of the South 
Ethnicity & disease  2014;24(2):133-143.
Objective
To assess the associations of social determinants on cardiovascular health among White and Black residing in Stroke Belt (urban) and Stroke Buckle (rural) regions of the South.
Design
A cross-sectional observational analysis based on a random digit-dial telephone survey of a representative sample of White and Black adults residing in urban and rural Georgia conducted from 2004–2005. Separate logistic regression analyses examined the effects of social determinants on cardiovascular health within and between White and Black women and within and between urban and rural residential location. The main outcome measure was poor cardiovascular health defined as ≥2 self-reported clinical cardiovascular disease risk factors (hypertension, diabetes, elevated cholesterol, overweight or obese). Social determinants were defined as socioeconomic status (SES), general daily stress, racial discrimination, and stress due to exposure to racial discrimination. Significance was established as a two-tailed P,.05.
Results
A total of 674 White and Black women aged 18–90 years were included in the sample. Results showed Black women with lower SES had worse cardiovascular health than White women in both rural and urban areas (rural odds ratio [OR] 2.68; confidence interval [CI] 1.44, 4.90; P=.001; urban OR=2.92; CI=1.62, 5.23; P=.0003). White women reporting high or very high exposure to general daily stress where more likely to have worse cardiovascular health than White women reporting very little to no daily stress (OR =2.85; CI=1.49, P5.44; P5.001).
Conclusion
Our findings demonstrate the importance of social determinants associated with cardiovascular health. Tailored cardiovascular risk reduction intervention is needed among lower SES Black women in Stroke Belt and Buckle regions of the South, as well as stress-reduction intervention among White women in the South. (Ethn Dis. 2014;24[2]:133–143)
PMCID: PMC4051397  PMID: 24804357
Black; White; Women; Cardiovascular Risk Factor; Social Determinants; Stroke; South
25.  Food Insecurity is Related to Increased Risk of Type 2 Diabetes Among Latinas 
Ethnicity & disease  2011;21(3):328-334.
Objectives
To examine the independent association of food insecurity with type 2 diabetes (T2D), and to identify the T2D risk factors related to food insecurity among Latinas.
Methods
Case-control study in a convenience sample of 201 Latinas (100 cases with T2D, 101 controls) aged 35–60 years and living in an urban setting. Self-reported data, including food insecurity, T2D status, depression symptoms, and socioeconomic, demographic, and lifestyle characteristics (food and alcohol intake, cigarette smoking, physical activity) were collected, and height, weight and waist circumference were measured. Separate multivariate logistic regression models were specified for T2D and food insecurity.
Results
Participants with very low food security were 3.3 times more likely to have T2D (OR 3.33, 95% CI 1.34-8.23) independently of employment status, acculturation, waist circumference, and lifestyle characteristics. High waist circumference (>88cm) (OR 2.46, 95% CI 1.13-5.38) and being in the lowest quartile of physical activity level (OR 3.75, 95% CI 1.21-11.62) were also risk factors for T2D. Elevated depression symptoms and participation in the Supplemental Nutrition Assistance Program (SNAP) were positively related to low and very low food security after adjusting for waist circumference (P<.01); cigarette smoking was positively associated with very low food security, and nutrition knowledge was negatively related to low food security (P<.01).
Conclusions
These results highlight the need for interventions focusing on prevention of depression and food insecurity among Latinas with T2D.
PMCID: PMC4048712  PMID: 21942166
Food Security; Hispanic or Latino; Diabetes; Obesity; Depression; Nutrition; Physical Activity; Acculturation

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