Black Americans' Diminished Return of Educational Attainment on Tobacco Use in Baltimore City.

BACKGROUND: Socioeconomic status (SES) indicators such as educational attainment are fundamental factors affecting health. One mechanism through which education affects health is by reducing the likelihood of engaging in high-risk behaviors such as smoking. However, according to the marginalization-related diminished returns (MDRs) theory, the association between education and health may be weaker for marginalized populations such as Black than White, primarily due to racism and discrimination. However, little is known about the racial variations in the differential associations between educational attainment and tobacco use in a local setting. AIM: This study aimed to investigate the differential association between educational attainment and tobacco use among racial groups in a community sample in Baltimore City. METHODS: This cross-sectional study used data from a community survey conducted in 2012-2013 in Baltimore City among adults aged 18 years or older. The participants were 3501 adults. Univariate, bivariate, and logistic regression analyses were performed using Stata to investigate the racial difference in the association between education and two outcomes: current smoking status and menthol tobacco product use. RESULTS: The study found that adults with a graduate degree were less likely to be current smokers (adjusted odds ratio [AOR]: 0.10, 95% confidence interval [CI]: 0.08-0.13) and menthol tobacco users (AOR: 0.10, 95% CI: 0.07-0.14) compared to those with less than high school diploma. The inverse associations between educational attainment and current smoking (AOR: 1.83, 95% CI: 1.05-3.21) and menthol tobacco product use (AOR: 4.73, 95% CI: 2.07-10.80) were weaker for Back individuals than those who were White. CONCLUSION: Due to MDRs of educational attainment, while highly educated White adults show a low risk of tobacco use, educated Black adults remain at a disproportionately increased risk. The study emphasizes the need for better policies and programs that address minorities' diminished return of education for tobacco use.

Association Between Socioeconomic Status and Tumor Grade Among Black Men with Prostate Cancer.

BACKGROUND: Prostate cancer affects black men disproportionately. Black men have an increased incidence of prostate cancer diagnoses at earlier ages and higher grade as indicated by Gleason score, compared to other races. This study investigates the impact of socioeconomic status (SES) on prostate cancer tumor grade among black men. METHODS: Black men with a prostate cancer diagnosis during 1973-2011 were examined using individual-level data from the SEER NLMS database. Logistic regression model estimated the likelihood of receiving a diagnosis of high versus low grade prostate cancer based on self-reported SES status at the time of diagnosis. RESULTS: Men who completed high school only were statistically significantly more likely to have a higher prostate cancer grade than those with a bachelor's degree or higher. However, there was no dose-response effect across educational strata. Retirees were 30% less likely to have higher grade tumors compared to those who were employed. CONCLUSIONS: SES differences among black men did not fully explain the high grade of prostate cancer. Further research is needed on the biology of the disease and to assess access to medical care and prostate health education, discrimination, stress exposures, and social norms that might contribute to the aggressiveness of prostate cancer among black men.

High cancer-related mortality in an urban, predominantly African-American, HIV-infected population.

OBJECTIVE: To determine mortality associated with a new cancer diagnosis in an urban, predominantly African-American, HIV-infected population. DESIGN: Retrospective cohort study. METHODS: All HIV-infected patients diagnosed with cancer between 1 January 2000 and 30 June 2010 were reviewed. Mortality was examined using Kaplan-Meier estimates and Cox proportional hazards models. RESULTS: There were 470 cases of cancer among 447 patients. Patients were predominantly African-American (85%) and male (79%). Non-AIDS-defining cancers (NADCs, 69%) were more common than AIDS-defining cancers (ADCs, 31%). Cumulative cancer incidence increased significantly over the study period. The majority (55.9%) was taking antiretroviral therapy (ART) at cancer diagnosis or started afterward (26.9%); 17.2% never received ART. Stage 3 or 4 cancer was diagnosed in 67%. There were 226 deaths during 1096 person years of follow-up, yielding an overall mortality rate of 206 per 1000 person years. The cumulative mortality rate at 30 days, 1 year, and 2 years was 6.5, 32.2, and 41.4%, respectively. Mortality was similar between patients on ART whether they started before or after the cancer diagnosis but was higher in patients who never received ART. In patients with a known cause of death, 68% were related to progression of the underlying cancer. CONCLUSION: In a large cohort of urban, predominantly African-American patients with HIV and cancer, many patients presented with late-stage cancer. There was substantial 30-day and 2-year mortality, although ART had a significant mortality benefit. Deaths were most often caused by progression of cancer and not from another HIV-related or AIDS-related event.

Weight status in US youth: the role of activity, diet, and sedentary behaviors.

OBJECTIVES: To assess associations of physical activity, diet, and sedentary behaviors with overweight and obesity. METHODS: Analyses of the NHANES 2003-06 were conducted among 2368 US adolescents, ages 12-19. Self-reported diet and sedentary behavior measures were used; physical activity was assessed using accelerometers. RESULTS: Television/video viewing (OR=1.84; CI=1.24, 2.69), physical activity (OR=0.75; CI=0.59, 0.95), and fiber intake (OR=0.96; CI=0.92, 0.99) were associated with obesity whereas television/video viewing was a risk factor for overweight (OR=1.57; CI=1.1, 2.63). CONCLUSIONS: Findings using accelerometer-measured physical activity are consistent with results from other studies using self-reported measurements. No interactions with ethnicity and gender were found.

Models for nutrition education to increase consumption of calcium and dairy products among African Americans.

Calcium and dairy consumption are documented to be low among African Americans and have demonstrated benefits to bone growth, overall nutritional status, and health throughout the life cycle. There is also an emerging relationship to the prevention of obesity. This low consumption has been attributed to both cultural and community/environmental barriers. Using a life course construct and an ecological model of health behavior, this paper will illustrate why nutrition education and food consumption behavior at one stage of the life cycle may influence health status at that stage as well as influence health and consumption of calcium and dairy products at subsequent stages. The life course construct recognizes that both past and present behavior and experiences (in this case food and nutrient intake) are shaped by the wider social, economic, and cultural context and therefore may provide clues to current patterns of health and disease. The ecological model, concerned with constructs of environmental change, behavior, and policies that may help people make choices in their daily life, complements the life course approach when examining the potential influence of nutrition education provided by federally funded food and nutrition programs on calcium and dairy consumption behavior across the life cycle. The "critical period model" within the life course construct is operative for calcium, a nutrient for which adequate intake is critically important during adolescence when peak bone density development, necessary for later protection against osteoporosis, is important.