Racial differences in 5-year relative survival rates of cervical cancer by stage at diagnosis, between African American (black) and white women, living in the state of Alabama, USA.

BACKGROUND: Our objective was to assess racial differences in the 5-year relative survival rates (RSRs) of Cervical Cancer (CerCancer) by stage at diagnosis, between Black and White women, living in Alabama, USA. METHODS: Data for 3484 Blacks and 21,059 Whites diagnosed with CerCancer were extracted from the 2004 to 2013 Surveillance, Epidemiology, and End Results (SEER) database. We incorporated age groups, CerCancer stages, county, and year of diagnosis to compare the RSR between Blacks and Whites, using SEER*Stat software. RESULTS: In urban, Black Belt (BB) and other rural counties, Whites diagnosed with localized stage of CerCancer always had better chances of survival because their RSRs were always more than 77%, compared to Blacks. Only exception was in Blacks living in other rural counties, who had a significantly higher RSR of 83.8% (95% Cl, 74.2-90.1). Which was the same as in Whites (83.8% (95% CI 74.5-89.9) living in BBC. Although, in other rural counties, Whites had a slightly lower RSR of 83.7% (95% CI 79.9-86.8%), their RSR was better compared to Blacks and Whites living in BB and other rural counties who had slightly higher RSRs of 83.8%. This was due to statistical precision, which depended on their larger sample size and a lower variability therefore, more reliability resulting in a tighter confidence interval with a smaller margin of error. In all the three county groups, Whites 15-44 years old diagnosed with localized stage of CerCancer had a higher RSR of 93.6% (95% CI 91.4-95.2%) for those living in urban and BB counties, and 94.6% (95% CI 93.6-95.4) for those living in other rural counties. The only exception was in Blacks 65-74 years old living in other rural counties who had the highest RSR of 96.9% (95% Cl, 82.9-99.5). However, Whites were considered to have a better RSR. This was also due to the statistical precision as mentioned above. CONCLUSION: There were significant racial differences in the RSRs of CerCancer. Overall, Black women experienced the worst RSRs compared to their White counterparts.

Associations Between Race, Perceived Psychological Stress, and the Gut Microbiota in a Sample of Generally Healthy Black and White Women: A Pilot Study on the Role of Race and Perceived Psychological Stress.

OBJECTIVE: Racial health disparities persist among black and white women for colorectal cancer. Understanding racial differences in the gut microbiota and related covariates (e.g., stress) may yield new insight into unexplained colorectal cancer disparities. METHODS: Healthy non-Hispanic black or white women (age ≥19 years) provided survey data, anthropometrics, and stool samples. Fecal DNA was collected and isolated from a wipe. Polymerase chain reaction was used to amplify the V4 region of the 16SrRNA gene and 250 bases were sequenced using the MiSeq platform. Microbiome data were analyzed using QIIME. Operational taxonomic unit data were log transformed and normalized. Analyses were conducted using linear models in R Package "limma." RESULTS: Fecal samples were analyzed for 80 women (M (SD) age = 39.9 (14.0) years, 47 black, 33 white). Blacks had greater average body mass index (33.3 versus 27.5 kg/m, p < .01) and waist circumference (98.3 versus 86.6 cm, p = .003) than whites. Whites reported more stressful life events (p = .026) and greater distress (p = .052) than blacks. Final models accounted for these differences. There were no significant differences in dietary variables. Unadjusted comparisons revealed no racial differences in alpha diversity. Racial differences were observed in beta diversity and abundance of top 10 operational taxonomic units. Blacks had higher abundances than whites of Faecalibacterium (p = .034) and Bacteroides (p = .038). Stress was associated with abundances of Bifidobacterium. The association between race and Bacteroides (logFC = 1.72, 0 = 0.020) persisted in fully adjusted models. CONCLUSIONS: Racial differences in the gut microbiota were observed including higher Bacteroides among blacks. Efforts to cultivate an "ideal" gut microbiota may help reduce colorectal cancer risk.

Sharecropper's Tuberculosis: Pathologies of Power in a Fatal Outbreak.

Tuberculosis Bacilli (TB) is a global scourge that affects poor people and regions. Drawing on Farmer's (2003) pathologies of power, and a case study approach, we examine the sociostructural landscape of a fatal outbreak of Sharecropper's TB among African Americans in rural Alabama. In a mixed-method qualitative approach involving oral history, surveys, interviews and documentary analysis, we identified three pathologies that contribute to TB susceptibility: corporate power, land wealth, and structural racism. While medicine can cure non-resistant forms of TB, control of future outbreaks will depend upon a social "cure" such as addressing structural inequality and building community trust in the health system.

Body Image Models among Low-income African American Mothers and Daughters in the Southeast United States.

Obesity among low-income African American women has been studied using the concepts of both satisfaction and acceptance. The satisfaction frame suggests greater satisfaction with their bodies than their white counterparts, irrespective of size. The acceptance frame suggests that alternative aesthetics serve as resistance against intersectional marginalization. Yet, while these women accept their body size in defiance of thinness ideals, they may not be satisfied. We describe cultural models of body image among mothers and daughters in Alabama. We found that respectability, material consumption, and parental support were important factors determining positive body image, exceeding descriptions of physical features. We further found that those expressing greater body dissatisfaction emphasized respectability, whereas those with less dissatisfaction assigned importance to consumerism and physical form. These findings suggest divergences between biomedical messaging and lived experience. They also challenge uncritical or universalist applications of these frames when interpreting African American women's perceptions of their own bodies.

Gene expression patterns in peripheral blood cells associated with radiographic severity in African Americans with early rheumatoid arthritis.

Gene expression profiling may be used to stratify patients by disease severity to test the hypothesis that variable disease outcome has a genetic component. In order to define unique expression signatures in African American rheumatoid arthritis (RA) patients with severe erosive disease, we undertook a gene expression study using samples of RNA from peripheral blood mononuclear cells (PBMCs). RNA from baseline PBMC samples of 96 African American RA patients with early RA (<2 years disease duration) was hybridized to cDNA probes of the Illumina Human HT-V3 expression array. Expression analyses were performed using the ca. 25,000 cDNA probes, and then expression levels were compared to the total number of erosions in radiographs of the hands and feet at baseline and 36 months. Using a false discovery rate cutoff of Q = 0.30, 1,138 genes at baseline and 680 genes at 36 months significantly correlated with total erosions. No evidence of a signal differentiating disease progression, or change in erosion scores between baseline and 36 months, was found. Further analyses demonstrated that the differential gene expression signature was localized to the patients with the most erosive disease (>10 erosions). Ingenuity Pathway Analysis demonstrated that genes with fold change greater than 1.5 implicated immune pathways such as CTLA signaling in cytotoxic T lymphocytes. These results demonstrate that CLEAR patients with early RA having the most severe erosive disease, as compared to more mild cases (<10 erosions), may be characterized by a set of differentially expressed genes that represent biological pathways with relevance to autoimmune disease.

Reporting on the Holocaust: the view from Jim Crow Alabama.

The press in Alabama covered major events taking place in Germany from the rise of Adolf Hitler and the Nazis in 1933 through the Nuremberg Trials in 1946. Journalists in the state provided extensive coverage, and editors did not hesitate to opine on the persecution of the Jews in Europe. Yet, Alabama's white-run press failed in the end to explain the events as a singularly Jewish tragedy. The state's black-run press, for its part, used the news of the mass killings of the Jews to warn against the dangers of conceptions of racial superiority­a primary concern for black southerners living in the Jim Crow South.

"The herald of prosperity": tracing the boll weevil myth in Alabama.

As scholars and singers have pointed out in monographs and folk songs, the cotton boll weevil was a devastating force on southern farming and rural life. No symbol is more indicative of this destruction than Enterprise, Alabama's boll weevil monument. This essay examines not how the cotton pest destroyed the region's staple crop, but how women and men across race and class lines understood the beetle's threat and used it to their advantage. The statue, like the countless blues and folk songs about the pest, was a cultural statement that shaped the understanding of the bug itself and its supposed transformation of southern agriculture. By examining the local conditions that gave rise to dramatic, albeit short-lived, crop diversification, and in turn the monument's erection, this essay uncovers the ways in which the boll weevil myth was as important a force on southern life as the long-snouted beetle itself.

The first welfare case: money, sex, marriage, and white supremacy in Selma, 1966: a reproductive justice analysis.

King v. Smith, the first welfare case heard by the U.S. Supreme Court, overturned the Alabama substitute father law. Such laws directed or allowed welfare officials to use the sexual behavior and reproductive capacity of poor African American women to alienate this population from "cash-money"; to reassert political and bureaucratic control over the intimate relationships of African Americans, demonstrating that this population was unprepared for civil rights and full citizenship; and to shore up white supremacy in the civil rights era. The context for this case which originated in Selma, Alabama in 1966 illustrates that even if poor African American women had had access to contraception and legal abortion at that time, they would still have lacked reproductive autonomy and dignity as the state surveilled their sexual behavior and enforced laws making sex, itself, as well as reproduction, and the right to define their own intimate relationships and families, a race and class privilege.

Influence of culture and discrimination on care-seeking behavior of elderly African Americans: a qualitative study.

In this study, the influence of culture and discrimination on care-seeking behavior of elderly African Americans was explored. This was a qualitative phenomenological study that involved in-depth interviews with 15 African American men and women aged 60 and older in Alabama. The sample size of 15 was adequate for the phenomenological method of this study. While this was a small exploratory study and was not intended for any generalizations, it did provide a unique opportunity to hear the voices, the concerns, and the stories of elderly African Americans, which have often been overlooked in the literature. The following themes emerged from the analysis of data: (1) perception of health as ability to be active, (2) reluctance toward prescription medicine use, (3) lack of trust in doctors, (4) avoidance of bad news, (5) race of doctors, (6) use of home remedies, and (7) importance of God and spirituality on health, illness, and healing.

Conspiracy beliefs about HIV/AIDS among HIV-positive African-American patients in rural Alabama.

This is apparently the first survey examining endorsement of HIV/ AIDS conspiracy beliefs and their relations to educational attainment among 205 HIV-positive African-American patients receiving care at an AIDS Outreach Organization in Alabama. 31% somewhat or strongly believed that, "AIDS is a form o genocide against African Americans," 29% strongly agreed that "AIDS was created by the government to control the black population," 56.1% agreed that the government is withholding a cure for AIDS, and 69.8% agreed that the government is withholding information about the disease from the public. 52% agreed that "HIV is a manmade virus," and 43.1% that "AIDS was produced in the governments laboratory." Respondents with high school or college education were less likely to endorse conspiracy liefs. Being open and sensitive to questions about conspiracy beliefs plus understanding the historical roots and social context from which such questions arise in African-American communities is needed to counter such beliefs.

Family caregiving to those with dementia in rural Alabama: racial similarities and differences.

This study explored differences and similarities in the experiences of African American and White family caregivers of dementia patients living in rural Alabama. This cross-sectional survey used a caregiving stress model to investigate the interrelationships between caregiving burden, mediators, and outcomes. Random-digit-dialing telephone interviews were used to obtain data on a probability sample of 74 non-Hispanic White and 67 African American caregivers. White caregivers were more likely to be married and older, used acceptance and humor as coping styles, and had fewer financial problems. African American caregivers gave more hours of care, used religion and denial as coping styles, and were less burdened. The authors have developed a methodology for obtaining a representative sample of African American and White rural caregivers. Further investigations are needed of the interactions between urban/rural location and ethnic/racial backgrounds of dementia caregivers for heuristic and applied reasons.

A Woman in Transition: can drama deliver a cancer awareness message?

BACKGROUND: Entertainment education is a field of health communication that utilizes a variety of entertainment to change health behaviors. METHOD: In this article, we describe a pilot project in which we measured the effectiveness of drama as a health communication tool. Attendees completed a pretest and posttest measuring knowledge, attitudes, and behavior related to breast cancer screening. RESULTS: At posttest, more women indicated breast self-exam rather than mammogram to be the "best method of early detection." CONCLUSION: Researchers who use drama as a communication tool cannot be assured of the final health message delivered. Careful evaluation to monitor the effectiveness of drama as a cancer awareness tool is vital.

Validity of plasma aldosterone-to-renin activity ratio in African American and white subjects with resistant hypertension.

BACKGROUND: Recent reports suggesting that primary aldosteronism (PA) is more common than historically thought have often relied on use of the plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio (ARR) to identify patients with PA. Prior determinations of the validity of the ARR had been generally limited to subjects that could be withdrawn from antihypertensive therapy and to non-African American subjects. METHODS AND RESULTS: The current study was designed to evaluate prospectively the diagnostic value of the ARR in treated African American and white subjects with resistant hypertension. Consecutive subjects referred to a university hypertension clinic for resistant hypertension were evaluated with an early morning ARR and a 24-h urinary aldosterone and sodium. The presence of PA was defined as a suppressed PRA (<1.0 ng/mL/h) and elevated urinary aldosterone excretion (>12 microg/24 h) during high dietary sodium ingestion (>200 mEq/24 h). In 58 subjects, PA was confirmed. The ARR was elevated (>20) in 45 of 58 subjects with PA and in 35 of the 207 patients without PA, resulting in a sensitivity of 78% and specificity of 83% with a corresponding positive predictive value of 56% and a negative predictive value of 93%. Among African American subjects, the ARR was less sensitive than in white subjects (75% v 80%), but it still had a high negative predictive value (92% v 94%). CONCLUSIONS: These data indicate that the ARR is valid as a screening test for PA in African American and white patients on stable antihypertensive treatments, but a high percentage of false-positive results precludes using it for accurate diagnosis of PA.

Racial differences in thoracic aorta atherosclerosis among ischemic stroke patients.

BACKGROUND AND PURPOSE: Atherosclerosis of the thoracic aorta is an independent risk factor for stroke. There is little information on the impact of race in the prevalence of thoracic aorta atherosclerotic plaques among ischemic stroke patients. This study was an attempt to objectively assess the prevalence, thickness, and burden of thoracic aorta atherosclerotic plaques in a large population of ischemic stroke patients and to compare the differences between American blacks and whites. METHODS: This is a retrospective study of clinical data and transesophageal echocardiography (TEE) of 1553 ischemic stroke patients (664 blacks, 889 whites) over a period of 4.5 years. Atherosclerotic plaque prevalence, thickness, morphology, and burden (sum of maximum thickness in ascending aorta [AA], aortic arch [AO], and descending aorta [DA]) were assessed with TEE. Charts were reviewed for clinical information. RESULTS: Age and sex were similar among blacks and whites. Analyses of clinical data found that blacks had significantly higher hypertension (odds ratio [OR], 2.61; P<0.0001) and diabetes mellitus (OR, 1.99; P<0.0001) and significantly lower coronary artery disease (OR, 0.75; P=0.017) and carotid artery disease (OR, 0.62; P=0.0008) compared with whites. TEE showed that whites had significantly greater plaque prevalence (AA: OR, 1.37; P=0.04; AO: OR, 1.26; P=0.03; DA: OR, 1.39; P=0.002) and plaque burden (blacks, 4.28 mm; whites, 4.97 mm; P=0.007). Whites also had a trend of increased complex plaques and plaques >4 mm thick in all regions of the thoracic aorta. CONCLUSIONS: Among ischemic stroke patients, blacks had a lower prevalence of extra cranial atherosclerotic disease even though they had significantly higher hypertension and diabetes mellitus compared with whites. This difference cannot be explained by the existing risk factors in ischemic stroke patients.

Psychosocial predictors of pregnancy among low-income African-American adolescent females: a prospective analysis.

OBJECTIVE: To prospectively identify psychosocial predictors of pregnancy among African-American adolescent females. METHODS: African-American females, 14-18 yrs old, were recruited from schools and health clinics in low-income neighborhoods. Adolescents completed an in-depth survey and provided urine specimens for pregnancy testing at baseline and 6-month intervals for 1.5 years. Selected problem behaviors, demographic, and psychosocial variables were tested for bivariate and multivariate significance relative to biologically confirmed pregnancy during the follow-up period. Only adolescents who initially tested negative for pregnancy were included (n = 241). RESULTS: About 26% (n = 63) of the adolescents became pregnant over the follow-up period. Although a broad spectrum of variables achieved bivariate significance, few retained significance in the multivariate model. Multivariate predictors of pregnancy were biologically confirmed marijuana use (adjusted odds ratios [AOR] = 12.4, P = 0.0003) and perceiving that the sex partner desired pregnancy (AOR = 1.27, P = 0.01). A protective effect was observed for adolescents who reported that a family member received welfare benefits; these adolescents were about 60% less likely to become pregnant (AOR = 0.38, P = 0.04). CONCLUSIONS: Pediatricians and other health professionals who participate in community efforts to prevent first and subsequent adolescent pregnancies may benefit from recognizing that marijuana use and pregnancy may be co-occurring problems. Adolescents' perceptions of their boyfriends' level of desire for conception may also be an important predictor of pregnancy risk. The findings also suggest a possible protective effect of receiving TANF (Temporary Assistance to Needy Families) benefits; adolescent recipients of these programs may be more vigilant in their pregnancy prevention practices than those who are not recipients.

Urinary sodium and potassium profile of blacks and whites in relation to education in two different geographic urban areas. TOMHS Research Group. Treatment of Mild Hypertension Study.

The high Na/low K environment of modern society is related to the genesis of hypertension and stroke. There is prior evidence of racial, geographical, and social class differences in Na and K intake and blood pressure. Baseline data from the Treatment of Mild Hypertension Study (TOMHS) was used to assess urinary Na and K excretion profiles by race, clinic geographic area, and education. Participants were adult black and white hypertensive patients from the Birmingham, Alabama, and Chicago, Illinois, area. Level of education was categorized as: less than college graduate and college graduate or more. Two overnight urine samples were collected and analyzed for Na and K at entry from 154 blacks and 281 whites. The urinary Na:K ratio was significantly higher in both blacks (5.1 v 3.8, P < .001) and whites (4.1 v 3.4, P < .005) in Birmingham compared with Chicago. This was primarily due to the lower excretion of urinary K in blacks (12.8 v 16.9 mmol/8 h, P < .01) and whites (14.0 v 16.5 mmol/8 h, P < .01). The highest urinary Na:K ratio was observed in blacks in Birmingham with lower education level; urinary Na excretion was high in blacks with a lower education level in both cities. No such differences were seen in whites. Although TOMHS was not population-based, these findings suggest the possibility that potassium intake among persons with stage 1 hypertension is related to geographic area in both blacks and whites, and sodium intake is inversely related to education level in blacks.