Major depressive disorder among older African Americans, Caribbean blacks, and non-Hispanic whites: secondary analysis of the National Survey of American Life.

BACKGROUND: Previous epidemiological and clinical research on mental disorders has treated Blacks as a homogenous group and yet Blacks of Caribbean descent and African Americans differ with respect to ethnicity, national heritage, living circumstances, and immigration status. The purpose of this article is to examine the prevalence of major depressive disorder (MDD) among African Americans, Caribbean Blacks, and non-Hispanic whites aged 50 and older with data on psychiatric and physical comorbidity, mental illness severity, and service use. METHODS: Secondary analysis of data from the National Survey of American Life, a national household probability sample of African Americans, Caribbean Blacks, and non-Hispanic Whites in the United States, were used (n = 1,950). The response rate was 72.3%. RESULTS: Controlling for age, the lifetime prevalence rate of MDD was 12.1% and the 12-month rate was 5.2%. Older Whites and Caribbean Blacks had significantly higher lifetime prevalence than African Americans but 12-month rates were similar across the three groups. Rates of co-occurring psychiatric disorders and physical conditions were high and were similar for African Americans, Caribbean Blacks, and Whites. Most older adults had either moderate or severe 12-month MDD and most talked to at least one professional, most frequently a family doctor, psychiatrist, or other mental health professional. CONCLUSION: MDD among older adults is highly prevalent, often associated with other psychiatric disorders or chronic physical conditions, and is associated with high overall mental illness severity. Differences among older Blacks highlight the need for further research on this population to ensure appropriate treatment is being provided to these groups.

Blood quantum and perceptions of black-white biracial targets: the black ancestry prototype model of affirmative action.

The present study examined the causal role of amount of Black ancestry in targets' perceived fit with Black prototypes and perceivers' categorization of biracial targets. Greater Black ancestry increased the likelihood that perceivers categorized biracial targets as Black and perceived targets as fitting Black prototypes (e.g., experiencing racial discrimination, possessing stereotypic traits). These results persisted, controlling for perceptions of phenotype that stem from ancestry information. Perceivers' beliefs about how society would categorize the biracial targets predicted perceptions of discrimination, whereas perceivers' beliefs about the targets' self-categorization predicted trait perceptions. The results of this study support the Black ancestry prototype model of affirmative action, which reveals the downstream consequences of Black ancestry for the distribution of minority resources (e.g., affirmative action) to biracial targets.

Sources of self-categorization as minority for mixed-race individuals: Implications for affirmative action entitlement.

Multiracial individuals are in the unique position of being able to categorize themselves as members of multiple racial groups. Drawing on self-categorization theory, we suggest that similarity to the minority ingroup depends on self-perceptions of physical appearance and connectedness to the minority ingroup. Moreover, we argue that similarity to the ingroup determines self-categorization as minority, which predicts category-based entitlements such as perceived eligibility for minority resources (e.g., affirmative action). Using path analysis, we found support for this model on a convenience sample of 107 mixed-race minority-White participants. The results suggest that affective processes rather than observable characteristics such as prototypical physical appearance better predict self-categorization among mixed-race individuals.

A new audience segmentation tool for African Americans: the black identity classification scale.

Many health communications target African Americans in an attempt to remediate race-based health disparities. Such materials often assume that African Americans are culturally homogeneous; however, research indicates that African Americans are heterogeneous in their attitudes, behaviors, and beliefs. The Black Identity Classification Scale (BICS) was designed as a telephone-administered tool to segment African American audiences into 16 ethnic identity types. The BICS was pretested using focus groups, telephone pretests, and a pilot study (n = 306). The final scale then was administered to 625 Black adults participating in a dietary intervention study, where it generally demonstrated good internal consistency reliability. The construct validity of the BICS also was explored by comparing participants' responses to culturally associated survey items. The distribution of the 16 BICS identity types in the intervention study is presented, as well as select characteristics for participants with core identity components. Although additional research is warranted, these findings suggest that the BICS has good psychometric properties and may be an effective tool for identifying African American audience segments.

African-American rhinoplasty.

Increased width, loss of definition, and lack of projection characterize the stereotypical African-American nose. Early rhinoplasty surgeons attempted strict adherence to neoclassical aesthetic ideals. However, in reality, the anatomy and aesthetic desires of these patients are much more complex. Building dorsal height, achieving nasal tip definition amidst thick skin, and producing a more aesthetically pleasing alar base are the major challenges. Surgical planning should be sensitive to both individual and cultural differences in aesthetic perception and expectations. Here we describe the techniques used by the senior author (R.W.H.K.).

Biohistorical approaches to "race" in the United States: Biological distances among African Americans, European Americans, and their ancestors.

Folk taxonomies of race are the categorizations used by people in their everyday judgments concerning the persons around them. As cultural traditions, folk taxonomies may shape gene flow so that it is unequal among groups sharing geography. The history of the United States is one of disparate people being brought together from around the globe, and provides a natural experiment for exploring the relationship between culture and gene flow. The biohistories of African Americans and European Americans were compared to examine whether population histories are shaped by culture when geography and language are shared. Dental morphological data were used to indicate phenotypic similarity, allowing diachronic change through United States history to be considered. Samples represented contemporary and historic African Americans and European Americans and their West African and European ancestral populations (N = 1445). Modified Mahalanobis' D(2) and Mean Measure of Divergence statistics examined how biological distances change through time among the samples. Results suggest the social acceptance for mating between descendents of Western Europeans and Eastern and Southern European migrants to the United States produced relatively rapid gene flow between the groups. Although African Americans have been in the United States much longer than most Eastern and Southern Europeans, social barriers have been historically stronger between them and European Americans. These results indicate that gene flow is in part shaped by cultural factors such as folk taxonomies of race, and have implications for understanding contemporary human variation, relationships among prehistoric populations, and forensic anthropology.

HIV and sexually transmitted infection risk behaviors and beliefs among Black West Indian immigrants and US-born Blacks.

OBJECTIVES: We compared Black West Indian immigrants' and US-born Blacks' sexual and drug-use risk behaviors and their beliefs related to using condoms and informing partners of sexually transmitted infections (STIs) to identify possible differences in risk. METHODS: We drew data from the baseline assessment of a clinic-based intervention designed to increase partner STI notification. RESULTS: Black West Indian men were less likely than were US-born Black men to report nonregular partners. There were no differences in condom use. US-born Black women were more likely than were Black West Indian women to be extremely confident that they could convince their regular partners to use condoms (odds ratio [OR] = 2.40; 95% confidence interval [CI] = 1.21, 4.76), whereas there were no differences between Black West Indian and US-born Black men on this measure (interaction P = .06). US-born Black women were more likely than were Black West Indian women to be extremely confident in their ability to discuss STI screening with their regular partners (OR = 1.89; 95% CI = 1.03, 3.47). CONCLUSIONS: Black West Indian women's lower levels of confidence that they can discuss STI screening with their regular partners and convince these partners to use condoms may increase their infection risk. Gender-sensitive interventions are warranted for Black West Indian immigrants, especially women.

Using "socially assigned race" to probe white advantages in health status.

OBJECTIVES: We explore the relationships between socially assigned race ("How do other people usually classify you in this country?"), self-identified race/ethnicity, and excellent or very good general health status. We then take advantage of subgroups which are discordant on self-identified race/ethnicity and socially assigned race to examine whether being classified by others as White conveys an advantage in health status, even for those who do not self-identify as White. METHODS: Analyses were conducted using pooled data from the eight states that used the Reactions to Race module of the 2004 Behavioral Risk Factor Surveillance System. RESULTS: The agreement of socially assigned race with self-identified race/ethnicity varied across the racial/ethnic groups currently defined by the United States government. Included among those usually classified by others as White were 26.8% of those who self-identified as Hispanic, 47.6% of those who self-identified as American Indian, and 59.5% of those who self-identified with More than one race. Among those who self-identified as Hispanic, the age-, education-, and language-adjusted proportion reporting excellent or very good health was 8.7 percentage points higher for those socially assigned as White than for those socially assigned as Hispanic (P=.04); among those who self-identified as American Indian, that proportion was 15.4 percentage points higher for those socially assigned as White than for those socially assigned as American Indian (P=.05); and among those who self-identified with More than one race, that proportion was 23.6 percentage points higher for those socially assigned as White than for those socially assigned as Black (P<.01). On the other hand, no significant differences were found between those socially assigned as White who self-identified as White and those socially assigned as White who self-identified as Hispanic, as American Indian, or with More than one race. CONCLUSIONS: Being classified by others as White is associated with large and statistically significant advantages in health status, no matter how one self-identifies.

The categorization of African descent populations in Europe and the USA: should lexicons of recommended terminology be evidence-based?

This review attempts to evaluate a proposed lexicon for African-descent populations from the viewpoint of saliency amongst those described and wider official and scientific usage, focusing on Britain and the USA. It is argued that it is unsatisfactory to privilege the term 'African American' over 'Black' for African-descent populations in the USA as the evidence base shows that both labels compete as self-designations on co-equal terms, while 'Black' is the prevalent term in scientific writing. Moreover, 'African American' is not an inclusive term for the African-descent population and it is not known how prevalent and enduring the term will prove to be. With respect to Britain, the census terms of 'Black African' and 'Black Caribbean' are well established, the increasing popularity of 'Black British' also being recognized in census labels. Given the increasing interest in the relationship between ethnic identity and health, there are arguments for documenting the diversity of terminology amongst different user constituencies in country-specific settings. The approach of synthetic glossaries of consensual terms may, through the need for economy and parsimony in the use of terminology, contribute to an unsatisfactory paring of that diversity.

Differences in coronary heart disease risk markers among apparently healthy individuals of African ancestry.

OBJECTIVE: This study identified and compared coronary heart disease (CHD) risk factors among foreign-born Afro Caribbeans (FBAC), U.S.-born Afro-Caribbean Americans (USBAC) and African Americans. METHODS: Sixty-six FBAC living in the United States for <10 years, 62 USBAC and 61 African-American adults (18-40 years) were recruited. Sociodemographic, behavioral and biochemical data were collected and analyzed. RESULTS: More USBAC (26.2%) and African-American (23.7%) participants compared to the FBAC (10.8%) participants had significantly (p < 0.05) poorer diet scores and were significantly (p < 0.05) more obese (17.7% and 23.0% vs. 7.6%). These differences remained significant between the male ethnic groups but not the females. Also, more USBAC and African-American participants compared to FBAC participants watched television often/very often (54.8% and 49.2% vs. 45.5%), played less sports (56.5% and 55.7% vs. 40.9%) and smoked cigarettes (4.8% and 6.6% vs. 0.0%). In general, USBAC and African-American participants were more likely to have elevated blood glucose (BG), total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hs-CRP) levels compared to FBAC participants. More FBAC than USBAC and African-American participants had elevated blood pressure (BP) and low levels of high-density-lipoprotein cholesterol (HDL-C). However, the differences were not significant. CONCLUSION: This study demonstrated that there are differences in risk factors for CHD among ethnic groups (FBAC, USBAC and African-American participants) of persons with African ancestory.

Analyzing the use of race and ethnicity in biomedical research from a local community perspective.

Lost in the debate over the use of racial and ethnic categories in biomedical research is community-level analysis of how these categories function and influence health. Such analysis offers a powerful critique of national and transnational categories usually used in biomedical research such as "African-American" and "Native American." Ethnographic research on local African-American and Native American communities in Oklahoma shows the importance of community-level analysis. Local ("intra-community") health practices tend to be shared by members of an everyday interactional community without regard to racial or ethnic identity. Externally created ("extra-community") practices tend to be based on the existence of externally-imposed racial or ethnic identities, but African-American and Native American community members show similar patterns in their use of extra-community practices. Thus, membership in an interactional community seems more important than externally-imposed racial or ethnic identity in determining local health practices, while class may be as or more important in accounting for extra-community practices.

The use of race and ethnicity in medicine: lessons from the African-American Heart Failure Trial.

Race or ethnic identity, despite its imprecise categorization, is a useful means of identifying population differences in mechanisms of disease and treatment effects. Therefore, race and other arbitrary demographic and physiological variables have appropriately served as a helpful guide to clinical management and to clinical trial participation. The African-American Heart Failure Trial was carried out in African-Americans with heart failure because prior data had demonstrated a uniquely favorable effect in this subpopulation of the drug combination in BiDil. The remarkable effect of the drug in reducing mortality in this study has illuminated an important new mechanism of therapy for heart failure. Application of these findings need not be confined to the population studied, but the observation highlights the need for more precise ways to identify individual responsiveness to therapy.

Influence of nativity status on breast cancer risk among US black women.

Black women are at increased risk for breast cancer mortality. The black category is assumed to be homogeneous, an assumption that may be misleading. This study aims to examine the relationship between nativity and breast cancer risk factors among women identified as black. A sample of 236 black women over 18 years of age in Brooklyn, New York, was recruited. Data were collected on race/ethnicity, breast cancer risk factors, and other sociodemographic, behavioral, and early life experience factors. Logistic regression analyses were used to estimate prevalence ratios for association between nativity and breast cancer risk factors. US-born blacks were more likely to be unemployed, smoke, not breastfeed, and breastfeed for a shorter duration than foreign-born blacks (all p< or =0.01). Foreign-born blacks were more likely to have parents who achieved at least a high school education (p<0.05). After adjustment for smoking, employment, and parental education, US-born blacks were twice as likely to never breastfeed (PR 2.2, 95% CI: 1.1, 4.46) compared to foreign-born blacks. Among women who breastfed, US-born blacks were also less likely to breastfeed for 6-11 months or more than 12 months, but these associations were not statistically significant. Because lactation reduces breast cancer risk and is a leading modifiable risk factor, understanding its variation within black women will help physicians and public health practitioners to target patient counseling and education of breast cancer risk.

Residential racial concentration and birth outcomes by nativity: do neighbors matter?

OBJECTIVES: We examined the associations of residential segregation with poor birth outcomes (low birthweight, preterm) and with perinatal risk markers (maternal age, education and marital status, prenatal care and substance use, presence of paternal information on birth certificate) for foreign- and native-born black women in the Minnesota seven-county metropolitan area. METHODS: Data were from 1990-1999 Minnesota birth certificates linked to the 1990 U.S. census. We used multivariable logistic regression to examine the association of perinatal risk markers, low birthweight and preterm birth for foreign- and native-born black women by residential black concentration. RESULTS: Native-born black women had a higher prevalence of risk markers and were at almost 1.5 times the risk of foreign-born blacks for delivery of low-birthweight or preterm infants. Risk markers and poor birth outcomes were most prevalent in medium and high-black-concentration areas than low-concentration areas. Preterm birth was slightly positively associated with residential black concentration. CONCLUSIONS: Native-born black women were at higher risk than foreign-born women for delivery of preterm and low-birthweight infants. Residential black concentration was associated with risk markers and only slightly associated with preterm birth. Further study of why birth outcome differentials exist by nativity and residential black concentration may identify opportunities for community-based public health interventions.

Making a case for the examination of ethnicity of Blacks in United States Health Research.

Important differences between Blacks of different ethnicities in the U.S. in chronic disease morbidity and mortality have been reported. Blacks in the U.S. constitute a heterogeneous group, including immigrants from Africa, Caribbean nations, Central and South America, as well as people now known as African Americans. Ethnicity among Blacks is seldom examined in health research, although in-depth examination of the ethnicity and culture-related pathways through which psychosocial factors may act to influence health have the potential to improve our understanding of health disparities. This improved understanding could in turn lead to the development of new, innovative, culturally based interventions that may reduce health disparities in the U.S. We briefly review the literature that examines Black ethnicity and birthplace, health outcomes, health-related knowledge and behaviors, and health-related psychological and social factors. We present a conceptual framework to aid in understanding the links between these factors and health. Suggestions are offered for conducting research in the future.

Maternal hypertension as a risk factor for low birth weight infants: comparison of Haitian and African-American women.

BACKGROUND: The rate of low birth weight (LBW) of Black women is more than twice that of White women. This study explores if the rate of LBW differs between Haitian and African-American women with chronic hypertension. METHODS: A retrospective cohort study of all Black women self-identified as African-American (n = 12,258) or Haitian (n = 4320) delivering a singleton infant in Massachusetts between 1996 and 2000. RESULTS: Haitian women were more likely than African-American women to have chronic hypertension (2.7% vs. 2.1%, p = 0.006), but had similar rates of preeclampsia (3.1% vs. 3.3%, p = 0.27). The LBW rate was 10% among African-American women and 8.2% among Haitian women. After adjustment for sociodemographic, medical, and prenatal care characteristics, the greatest risks for delivering a LBW infant for Haitian women were chronic hypertension (OR = 6.8; 95% CI, 4.3, 10.6) and preeclampsia (OR = 3.2; 95% CI, 2.0, 5.1). For African-American women, the greatest risks for LBW infants were a history of delivering a LBW infant (OR = 3.9; 95% CI, 2.8, 5.4) and chronic hypertension (OR = 2.9; 95% CI, 2.1, 4.0). In a combined logistic regression model including interaction terms, chronic hypertension and preeclampsia continued to be associated with the greatest risk of LBW among all women. CONCLUSIONS: Differences in maternal risk factors and rates of LBW (8.2% vs. 10%) exist between Haitian and African-American women delivering infants in Massachusetts. While chronic hypertension and preeclampsia are strong risk factors for LBW for both Haitian and African-American women, unknown factors make these disorders much more potent for Haitian women.

Evaluation of African-American and white racial classification in a surveillance, epidemiology, and end results cancer registry.

OBJECTIVES: This study evaluated the validity of registry-reported race for individuals who participated in research studies conducted since 1980 through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a Surveillance, Epidemiology, and End Results (SEER) Program registry. METHODS: 5329 individuals who self-identified as African American or White and were classified in the MDCSS registry as African American or White were included. Self-identified and registry-reported race were compared, and associations between demographics and racial misclassification were examined. RESULTS: Most self-identified African Americans and Whites were correctly classified (sensitivity=98.5%, specificity=99.7%). Males were two times more likely to be misclassified than females [odds ratio (OR)=2.13, 95% confidence interval (CI): 1.06-4.29]. Individuals diagnosed with cancer after 1990 were two times more likely to be misclassified than those diagnosed before 1990 (OR= 2.17, 95% CI: 1.07-4.42). African Americans were four times more likely to be misclassified than Whites (OR=4.39, 95% CI: 2.24-8.60). CONCLUSIONS: Misclassification in the MDCSS registry of African Americans as Whites, and vice versa, is relatively low. Additional studies should evaluate misclassification of African Americans and Whites as other races and/or ethnicities in the SEER registry.

Anthropometric measurements and epithelial ovarian cancer risk in African-American and White women.

Previous studies of anthropometric factors and ovarian cancer risk have been inconsistent and none have evaluated the association among African-American women. Data from a population-based, case-control study of 593 cases and 628 controls were used to evaluate ovarian cancer risk in relation to weight, height, body mass index (BMI) and waist-to-hip ratio (WHR). Odds ratios (ORs) and 95% confidence intervals (CIs) were computed and established risk factors were adjusted for using logistic regression models, stratified by race. Among all races, weight at age 18, WHR, weight and BMI one year prior to interview were associated with elevated ovarian cancer risk. When stratified by race, the association between WHR and ovarian was similar among Whites and among African Americans. However, African-American women in the fourth quartile of height had an elevated risk of ovarian cancer (OR = 3.2; 95% CI = 1.3-7.8), but this risk was not apparent in Whites (OR = 1.0; 95% CI = 0.7-1.4). These findings support the hypothesis that obesity is an important risk factor of ovarian cancer among African-Americans and Whites and also suggest that height may be a risk factor specific to African-Americans.

Health status, health insurance, and health care utilization patterns of immigrant Black men.

OBJECTIVES: This study sought to describe the health status, health insurance, and health care utilization patterns of the growing population of immigrant Black men. METHODS: We used data from the 1997-2000 National Health Interview Survey to examine and then compare health variables of foreign-born Black men with those of US-born Black and White men. Logistic regression analyses were used to examine health outcomes. RESULTS: Foreign-born Black men were in better overall health than their US-born Black counterparts and were much less likely than either US-born Black or White men to report adverse health behaviors. Despite these health advantages, foreign-born Black men were more likely than either US-born Black or White men to be uninsured. CONCLUSIONS: In the long term, immigrant Black men who are in poor health may be adversely affected by lack of health care coverage.