The Effects of Selective Survival on Black Adults' Cognitive Development.

OBJECTIVES: The theory of selective survival suggests that possibly around 70-75 years of age, Blacks may display substantive changes in their pattern of cognitive decline. This study examined the age-graded pattern of cognitive decline within older Blacks by describing a trend that characterizes differences in the change of cognitive decline from ages 51.5 to 95.5, and hypothesized that this age-graded pattern is nonlinear. METHOD: Utilizing 2 waves of longitudinal data from the Baltimore Study of Black Aging, this study used multilevel modeling to test whether the interaction between age and the 3-year study period (time between waves) had a positive effect on changes in inductive reasoning, declarative memory, working memory, and perceptual speed. RESULTS: A significant positive interaction between age and wave was found for inductive reasoning, demonstrating an age-grade pattern of change/decline in cognitive pattern for Blacks aged 51.5-95.4. Simple slope probing via the Johnson-Neyman Technique suggested that Black adults ~64 years and younger experienced significant decline in inductive reasoning across study time, whereas for those older than 63.71, the decline was nonsignificant. No significant age-wave interactions were found for declarative memory, working memory, or perceptual speed. DISCUSSION: Findings suggest a selective survival effect for inductive reasoning ability among Blacks. With decline evident so early, common cognitive intervention programs targeting adults 65+ may come too late for Blacks, signifying the importance and urgency for early health interventions and public policy designed to promote cognitive reserve.

Greater Disease Burden, Greater Risk? Exploring Cognitive Change and Health Status Among Older Blacks.

Objective: The objective of study is to examine the relationships between health status and changes in cognition over time among middle to older aged Blacks. Method: Data come from the Baltimore Study of Black Aging-Patterns of Cognitive Aging. At baseline, 602 Black participants, ranging from ages 48 to 95 years, were enrolled. At follow-up, approximately 3 years later, 450 participants were re-interviewed. Results: After accounting for baseline cognition, age, sex, and education, a greater number of health conditions was associated with slower perceptual speed (b = -5.099, p = .022). Average peak expiratory flow was also associated with improvements in working memory (b = 0.029, p = .019) and perceptual speed (b = 0.026, p = .026), controlling for model covariates. Discussion: Study findings demonstrate that greater disease burden is associated with declines in specific fluid cognitive abilities in middle to later life among Blacks. This finding highlights the importance of reducing health disparities that disproportionately affect Blacks.

Racial/Ethnic Disparities in Police Reporting for Partner Violence in the National Crime Victimization Survey and Survivor-Led Interpretation.

Despite compromising women's health and safety, intimate partner violence (IPV) is among the most underreported crimes, and our understanding of factors that drive police reporting by race/ethnicity is underdeveloped. The purpose of this study is to examine racial/ethnic differences in self-reporting IPV to police. Race/ethnicity-stratified models identified predictors of reporting IPV to police among recent, female survivors (n = 898) in the National Crime Victimization Survey (NCVS; 2011-15). Focus groups (n = 3) with recent survivors (n = 19) in Baltimore, MD (2018), contextualized results. Black women in the NCVS were twice as likely to report IPV to police relative to White women (AOR = 2.05, 95% CI: 1.01-4.15). In race/ethnicity-stratified models, police reporting significantly increased with increasing age between 18 and < 35 years (AOR = 1.18, 95% CI: 1.05-1.33) for Black women, and with IPV-related injury for Black (AOR = 2.51, 95% CI: 1.10-5.71) and Hispanic women (AOR = 2.87, 95% CI: 1.22-6.71); Hispanics with less than a high school education were least likely to report (AOR = 0.24, 95% CI: 0.07-0.91). Focus groups explained racial/ethnic influences on reporting including a culture of silence and discrimination, socioeconomic status, and social desirability. We identified influences on reporting IPV to police that vary by race/ethnicity using national data in context to an urban environment. Results demonstrate the need to enhance equity in survivors' health and public safety through training and organizational change.

An examination of grit in black men who have sex with men and associations with health and social outcomes.

AIMS: This study sought to examine the prevalence and correlates of grit in a sample of Black men who have sex with men (BMSM) in Baltimore, Maryland. METHODS: A trained research assistant administered the Short-Grit and Center for Epidemiological Studies Depression (CES-D) scales and surveyed participants of a community-based behavioral health intervention for demographic, health, and sexual behaviors. RESULTS: Of 239 participants, two-thirds scored in the high grit category. A greater proportion of men with high grit demonstrated higher educational attainment, were employed in the prior 6 months, reported very good/excellent health, were human immunodeficiency virus-positive, scored < 16 on the CES-D, and had more friends who were gay. After controlling for other variables, high grit was associated with higher odds of having more friends who are gay and lower odds of alcohol use, unemployment, and a high CES-D score. CONCLUSIONS: These findings demonstrate that grit could be an important mechanism upon which to focus health and behavioral interventions for BMSM.

Racial discrimination, John Henryism coping, and behavioral health conditions among predominantly poor, urban African Americans: Implications for community-level opioid problems and mental health services.

The current study examined the relationship between John Henryism Active Coping (JHAC), experiences of racial discrimination, and behavioral health outcomes in a community sample of 319 Black adults. Assessments included primary health care screenings as well as self-reported survey questions to assess JHAC, experiences of discrimination, and self-reported behavioral health. Logistic regression models, adjusted for control variables, found a significant relationship between JHAC and having an opioid problem (odds ratio [OR] = 0.95, p = 0.003) and needing mental health services (OR = 0.95, p < 0.001), such that higher levels of coping were associated with lower odds of reporting an opioid problem and needing mental health services. Notably, racial discrimination was not significantly independently associated with behavioral health. Implications for interventions and community programming are discussed.

Centro SOL: A Community-Academic Partnership to Care for Undocumented Immigrants in an Emerging Latino Area.

PROBLEM: From 2000 to 2014, the Latino population in Baltimore city, an emerging Latino settlement area, experienced rapid growth. Many of these individuals are undocumented and not eligible for coverage. Academic medical centers often lead the way in addressing the health needs of undocumented immigrants; however, examples from emerging immigrant areas are limited. APPROACH: In October 2013, Johns Hopkins Medicine clinicians established the Center for Salud/Health and Opportunities for Latinos (Centro SOL) to better address the health needs of Baltimore's growing Latino community. Centro SOL's mission focuses on four core activities: clinical services; advocacy and community engagement efforts; pipeline/education opportunities; and research consultations. Progress is measured through a scorecard reviewed annually by Centro SOL leadership. OUTCOMES: Centro SOL's program has expanded health care access for undocumented immigrants, patient safety and quality of service/care programs for patients with limited English proficiency, and pipeline opportunities for Latino youth. In 2017, 2,763 uninsured patients received primary or specialty care and 290 people received group therapy to address stress-related conditions. In addition, 49 Latino students (ranging from high school to postgraduate students) received mentorship at Centro SOL. NEXT STEPS: In the next five years, Centro SOL plans to expand the pipeline for Latinos interested in health professions fields and to further improve access to health services for Latino families through both advocacy efforts and enhanced clinical services.

The Costly Consequences of not Being Socially and Behaviorally Ready to Learn by Kindergarten in Baltimore City.

Social, emotional, and behavioral skills are foundational to learning and long-term success. However, poverty and exposure to adverse childhood experiences reduce the chances of children entering kindergarten socially-behaviorally ready to learn. This study examined the unique impact of 5-year-old children (N = 11,412) entering kindergarten not socially-behaviorally ready on three costly school outcomes by fourth grade in Baltimore City Public Schools: being retained in grade, receiving services and supports through an IEP or 504 plan, and being suspended/expelled. Controlling for all other types of school readiness, students not identified as socially-behaviorally ready for kindergarten were more likely to experience all three school outcomes. Findings underscore the importance of early prevention and intervention strategies targeting parents and social-behavioral readiness skills during the first 5 years of life.

Differential Associations of Socioeconomic Status With Global Brain Volumes and White Matter Lesions in African American and White Adults: the HANDLS SCAN Study.

OBJECTIVE: The aim of the study was to examine interactive relations of race and socioeconomic status (SES) to magnetic resonance imaging (MRI)-assessed global brain outcomes with previously demonstrated prognostic significance for stroke, dementia, and mortality. METHODS: Participants were 147 African Americans (AAs) and whites (ages 33-71 years; 43% AA; 56% female; 26% below poverty) in the Healthy Aging in Neighborhoods of Diversity across the Life Span SCAN substudy. Cranial MRI was conducted using a 3.0 T unit. White matter (WM) lesion volumes and total brain, gray matter, and WM volumes were computed. An SES composite was derived from education and poverty status. RESULTS: Significant interactions of race and SES were observed for WM lesion volume (b = 1.38; η = 0.036; p = .028), total brain (b = 86.72; η = 0.042; p < .001), gray matter (b = 40.16; η = 0.032; p = .003), and WM (b = 46.56; η = 0.050; p < .001). AA participants with low SES exhibited significantly greater WM lesion volumes than white participants with low SES. White participants with higher SES had greater brain volumes than all other groups (albeit within normal range). CONCLUSIONS: Low SES was associated with greater WM pathology-a marker for increased stroke risk-in AAs. Higher SES was associated with greater total brain volume-a putative global indicator of brain health and predictor of mortality-in whites. Findings may reflect environmental and interpersonal stressors encountered by AAs and those of lower SES and could relate to disproportionate rates of stroke, dementia, and mortality.

Adding to the Education Debt: Depressive Symptoms Mediate the Association between Racial Discrimination and Academic Performance in African Americans.

Although the United States faces a seemingly intractable divide between white and African American academic performance, there remains a dearth of longitudinal research investigating factors that work to maintain this gap. The present study examined whether racial discrimination predicted the academic performance of African American students through its effect on depressive symptoms. Participants were a community sample of African American adolescents (N=495) attending urban public schools from grade 7 to grade 9 (Mage=12.5). Structural equation modeling revealed that experienced racial discrimination predicted increases in depressive symptoms 1year later, which, in turn, predicted decreases in academic performance the following year. These results suggest that racial discrimination continues to play a critical role in the academic performance of African American students and, as such, contributes to the maintenance of the race-based academic achievement gap in the United States.

Posttraumatic stress symptoms in context: Examining trauma responses to violent exposures and homicide death among Black males in urban neighborhoods.

Concentrated disadvantage in urban communities places young Black men at disproportionate risk for exposure to violence and trauma. Homicide, a health disparity, positions Black males vulnerable to premature violent death and traumatic loss, particularly when peers are murdered. Posttraumatic stress disorder (PTSD) has been demonstrated as a health consequence for middle-income and White homicide survivors; however, understandings of traumatic stress among young Black men situated in contexts of chronic violence exposure remains limited. Guided by phenomenological variant of ecological systems theory (PVEST), the current study used in-depth qualitative interviews (average length: 90 min) to examine the presence and expression of traumatic stress symptoms among 37 young Black men (18-24) in Baltimore who experienced the homicide death of a loved one. Participants were recruited over 18 months through fieldwork at a large organization that serves Baltimore youth and young adults. Confidential participant interviews were audio recorded, transcribed verbatim, coded, and analyzed in ATLAS.ti. Pseudonyms were assigned to all participants. More than 70% of participants reported experiencing 2 or more Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V)-defined posttraumatic stress symptoms. Hypervigilance was most frequently experienced and expressed as being on point. Findings identify the prevalence of traumatic stress symptoms among young Black men in urban contexts; identify contextually specific expressions of traumatic stress; and, present implications for the mental health and clinical treatment of Black males living in environments where no "post" exists. (PsycINFO Database Record

Ethnic differences in ischemic stroke subtypes in young-onset stroke: the Stroke Prevention in Young Adults Study.

BACKGROUND: Prior studies indicate that young African-Americans (AA) have a greater frequency of ischemic stroke than similarly aged European-Americans (EA). We hypothesized that differences in stroke subtype frequency mediated through sex and differing risk factor profiles may play a role in ethnicity-specific stroke. Utilizing our biracial young-onset stroke population, we explored these relationships. METHODS: Fifty nine hospitals in the Baltimore-Washington area participated in a population-based study of young-onset stroke in men (218-AA, 291-EA) and women (219-AA, 222-EA) aged 16-49. Data on age, sex, ethnicity and stroke risk factors (hypertension (HTN) and smoking) were gathered through standardized interview. A pair of vascular neurologists adjudicated each case to determine TOAST subtype. Logistic regression analyses evaluating for differences in stroke risk factors by TOAST subtype were performed. RESULTS: Analyses controlling for age and sex demonstrated that AA were more likely to have a lacunar stroke than EA (OR = 1.61; 95% CI = 1.12-2.32; p = 0.011) when utilizing the other TOAST subtypes as the reference group. This effect was mediated by HTN, which increases the risk of lacunar stroke (OR = 2.03; 95% CI = 1.38-2.98; p = 0.0003) and large artery stroke (OR = 1.70; 95% CI = 1.01-2.88; p = 0.048) when controlling for sex, ethnicity, and age. Cases below age 40 were more likely to have a cardioembolic stroke than those above age 40 (OR = 1.62; 95% CI = 1.15-2.27; p = 0.006), controlling for sex and ethnicity. Lastly, current smokers were more likely to have a large artery stroke than non-smokers (OR = 1.79; 95% CI = 1.08-2.98; p = 0.024). CONCLUSIONS: Our population-based data demonstrate ethnic differences in ischemic stroke subtypes. These findings may help clarify mechanisms of stroke in young adults which may in part be driven by ethnic-specific differences in early-onset traditional risk factors, thereby indicating differing emphasis on workup and prevention.

Associations Between Diabetes and Cognitive Function in Socioeconomically Diverse African American and White Men and Women.

OBJECTIVES: To examine whether race and poverty (income <125% of the federal poverty limit), modifies associations between diabetes and cognition in a biracial, urban-dwelling sample. METHODS: Cross-sectional data for 2066 participants (mean age = 47.6 years, 56.8% women, 56.2% African American, 38.6% below poverty) from the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span study were used for analyses. Eleven tests measured cognitive function. Interactions among diabetes, race, and poverty status with cognition were assessed in multiple regression analyses. RESULTS: Significant interactions among diabetes, race, and poverty status were observed. Among African Americans below poverty, diabetic individuals performed lower than nondiabetic individuals on California Verbal Learning Test Free Recall Short Delay (z = -0.444 [0.123] versus z = -0.137 [0.045]) and Long Delay (z = -0.299 [0.123] versus z = -0.130 [0.045]), Digit Span Backward (z = -0.347 [0.109] versus z = -0.072 [0.041]), and the Brief Test of Attention (z = -0.452 [-0.099] versus z = -0.099 [0.047]), and higher on Category Fluency (z = 0.114 [0.117] versus z = -0.118 [0.044]). No consistent differences between diabetic and nondiabetic individuals were found for African American and white participants above poverty. CONCLUSIONS: Diabetes was associated with poorer verbal memory, working memory, and attention among African Americans living in poverty. Diabetic African Americans below poverty may have increased risk of cognitive deficit at a younger age. Improving health literacy, doctor-patient communication, and multidisciplinary medical care for impoverished individuals may reduce differences. Additional research is needed to clarify mechanisms underlying these associations.

Racial differences in self-reports of short sleep duration in an urban-dwelling environment.

OBJECTIVES: To explore whether there are differences in sleep duration between blacks and whites residing in similar urban neighborhoods and examine whether the relationship between sleep durations and sociodemographic and/or health indices are consistent for blacks and whites. METHODS: A total of 1,207 participants from the Healthy Aging in Neighborhoods of Disparities across the Life Span study (age: mean = 47, standard deviation = 8.74). Sleep duration was assessed by a self-report of hours of nightly sleep in the past month. Sociodemographic measures included age, sex, education, poverty status, and perceived neighborhood disorder. Health status was assessed using measures of vigilance, depression, perceived stress, coronary artery disease, diabetes, blood pressure, and inflammation. RESULTS: There were no significant racial group differences in sleep duration. Whites, however, were more likely than blacks to report sleep durations of <6/6-7 hr compared with >7 hr with increasing stress and education levels. Blacks were more likely than whites to report short sleep durations (i.e., 6-7 hr vs. >7 hr of sleep) with increasing inflammation levels. DISCUSSION: Although racial disparities in sleep duration are minimized when the environment is equivalent between blacks and whites, the underlying demographic and health explanations for short sleep durations may vary between whites and blacks.

Gambling and sexual behaviors in African-American adolescents.

OBJECTIVES: Late adolescence represents a developmental risk period when many youth become involved in multiple forms of high-risk behaviors with adverse consequences. This study assessed the degree to which two such behaviors, adolescent sexual behaviors and gambling, were associated in a community-based sample with a large African-American presence. STUDY DESIGN: Data are derived from a cohort study. This study focuses on 427 African-American participants with complete information on gambling and sexual behaviors by age 18 (72% of original cohort). Gambling involvement and related problems were based on responses to the South Oaks Gambling Screen - Revised for Adolescents. Several questions assessed sexual behaviors, including age of initiation. Multivariable logistic regression models adjusted for demographics, intervention status, impulsivity, depressive and anxiety symptoms, and alcohol and illegal drug use. RESULTS: Almost half of the sample (49%, n=211) had gambled at least once before age 18. More gamblers than non-gamblers had initiated sexual intercourse by age 18 (aOR: 2.29 [1.16, 4.52]). Among those who had initiated sexual activity, more gamblers than non-gamblers with high impulsivity levels at age 13 (vs. low impulsivity levels) had become pregnant or had impregnated someone. Among those who had initiated sexual activity by age 18, more male gamblers had impregnated someone by age 18 as compared to female gamblers becoming pregnant. CONCLUSIONS: Gambling and sexual behaviors often co-occur among adolescents. Such findings prompt the need for the inclusion of gambling, an often overlooked risky behavior, in behavioral prevention/intervention programs targeting adolescents.

Growing up as "man of the house": adultification and transition into adulthood for young men in economically disadvantaged families.

Many children in economically disadvantaged communities assume adult roles in their families. Negotiating the responsibilities and expectations associated with becoming what some young men describe as "man of the house" has important implications for how adolescent boys move into adulthood. In this study, we share insights from field work and life-history interviews with low-income, young African American men and Salvadoran men in the Washington, DC/Baltimore region to illustrate how adultification may deliver contradictory expectations for adolescents. The findings also show how the accelerated responsibilities that accompany the experience of adultification create difficulties in the young men's transition into adulthood. These findings indicate that the age period of emerging adulthood may begin earlier for economically disadvantaged young men.

Objective and perceived neighborhood characteristics and tobacco use among young adults.

BACKGROUND: In the US, past month tobacco use is higher among young adults aged 18-25 years than among any other age group. Neighborhood disorder may be a malleable environmental determinant of tobacco use among young adults; its correlation with tobacco use is understudied. The purpose of this study is to examine whether perceived and objectively measured neighborhood factors are associated with tobacco use among young adults in Baltimore City. METHODS: This cross-sectional study of predominately African American young adults (n=359) used logistic regression models via generalized estimating equations (GEE) to estimate the association of perceived and objective neighborhood disorder with past month tobacco use, adjusting for race, age, sex, income, and other substance use. Two measures of perceived neighborhood environment - neighborhood drug involvement, and neighborhood social cohesion - were derived from the Neighborhood Environment Scale (NES). Objective neighborhood disorder was measured via trained field raters using the Neighborhood Inventory for Environmental Typology (NIfETy) instrument. RESULTS: Sex modified the relationship between perceived neighborhood drug involvement and past month tobacco use, and the association was significant among women only (aOR=1.49; 95% CI=1.19-1.88). Perceptions of neighborhood social cohesion (aOR=0.97; 95% CI=0.83-1.13), and objective neighborhood disorder (aOR=1.17; 95% CI=0.98-1.38) were not significantly associated with past month tobacco use. CONCLUSION: Understanding the correlation between perceived and objective neighborhood disorder, and their independent association with tobacco use can potentially lead to environmentally based interventions aimed at reducing tobacco use among young adults who live in urban environments.

Left ventricular mass and hypertrophy by echocardiography and cardiac magnetic resonance: the multi-ethnic study of atherosclerosis.

BACKGROUND: Left ventricular mass (LVM) and hypertrophy (LVH) are important parameters, but their use is surrounded by controversies. We compare LVM by echocardiography and cardiac magnetic resonance (CMR), investigating reproducibility aspects and the effect of echocardiography image quality. We also compare indexing methods within and between imaging modalities for classification of LVH and cardiovascular risk. METHODS: Multi-Ethnic Study of Atherosclerosis enrolled 880 participants in Baltimore city, 146 had echocardiograms and CMR on the same day. LVM was then assessed using standard techniques. Echocardiography image quality was rated (good/limited) according to the parasternal view. LVH was defined after indexing LVM to body surface area, height(1.7) , height(2.7) , or by the predicted LVM from a reference group. Participants were classified for cardiovascular risk according to Framingham score. Pearson's correlation, Bland-Altman plots, percent agreement, and kappa coefficient assessed agreement within and between modalities. RESULTS: Left ventricular mass by echocardiography (140 ± 40 g) and by CMR were correlated (r = 0.8, P < 0.001) regardless of the echocardiography image quality. The reproducibility profile had strong correlations and agreement for both modalities. Image quality groups had similar characteristics; those with good images compared to CMR slightly superiorly. The prevalence of LVH tended to be higher with higher cardiovascular risk. The agreement for LVH between imaging modalities ranged from 77% to 98% and the kappa coefficient from 0.10 to 0.76. CONCLUSIONS: Echocardiography has a reliable performance for LVM assessment and classification of LVH, with limited influence of image quality. Echocardiography and CMR differ in the assessment of LVH, and additional differences rise from the indexing methods.

The prevalence and correlates of single cigarette selling among urban disadvantaged drug users in Baltimore, Maryland.

BACKGROUND: Selling of single cigarettes, also known as loosies, is a public health concern. Loosies allow for those with fewer resources to buy cigarettes without having to purchase a pack. Selling of loosies may cue smoking behaviors. In the US, socioeconomically disadvantaged populations have high rates of smoking and illicit drug use and the selling of loosies appears to be linked to the urban informal economy. We examined the proportion and frequency of cigarette selling and roles in the informal economy associated with selling loosies among a sample of urban drug users. METHODS: There were 801 participants, recruited by community outreach, assessed at baseline, who were enrolled in an HIV prevention intervention for drug users. RESULTS: Most (89%) smoked cigarettes in the prior 30 days, of whom 92% smoked daily. Self-reported selling of cigarettes was common with 58% reporting that they had sold cigarettes within the last six months; 20.4% reported selling cigarettes a few times a week and 7.4% reported daily selling of cigarettes. In a stepwise regression model, four sources of income were associated with frequent cigarette selling: providing street security (OR=2.214, 95% CI 1.177-4.164), selling food stamps (OR=1.461, 95% CI 1.003-2.126), pawning items (OR=2.15, 95% CI 1.475-3.135), and selling drugs (OR=1.634, 95% CI 1.008-2.648). CONCLUSION: There is a high rate of selling loosies among urban substance users. The wide availability of loosies may promote smoking. Smoking cessation programs with drug treatment and economic development programs may help to reduce economic pressures to sell loosies.