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Darker skin color is associated with discrimination and unfair treatment and may contribute to persisting health disparities. This study examined whether darker skin color was associated with smoking cessation and whether this association was moderated by sex and race. This study also explored whether biological and psychosocial factors, including nicotine and cotinine concentrations, discrimination, distrust, and neuroticism, mediated this association. The data for this study came from a prospective smoking cessation intervention that included 224 Black and 225 White adults from Kansas City, Missouri. Skin color was assessed using a DermaSpectrometer to measure melanin contained within the skin. Point prevalence smoking abstinence was biochemically-verified and assessed at weeks 4 and 26. Hierarchical logistic regression analyses were conducted to evaluate hypothesized relations between skin color and smoking cessation. Interactions between race and sex with skin color were also evaluated. While skin color was not associated with smoking cessation in the overall sample or among Blacks only, results indicated that sex moderated the effect of skin color on smoking cessation after adjusting for race and other covariates. Among males, darker skin color was associated with lower odds of achieving smoking abstinence at weeks 4 (OR = 0.60 [95% CI = 0.36, 0.99]) and 26 (OR = 0.52 [95% CI = 0.29, 0.91]). Skin color did not predict smoking cessation among females. Skin color was positively correlated with discrimination (r = 0.15, p = 0.02), cynicism/distrust (r = 0.14, p = 0.03) and neuroticism (r = 0.24, p < 0.01) among males only. However, these factors did not mediate the association between skin color and smoking cessation. Skin color may contribute to cessation-related health disparities among Black males, but more research is needed to understand the psychosocial and biological mechanisms through which skin color influences tobacco cessation., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: We investigated the associations of adolescent adiposity, changes in adiposity during adulthood, and attained adiposity with volumetric mammographic density measures., Methods: We recruited 383 premenopausal women who had a routine screening mammogram at the Breast Health Center, Washington University in St. Louis, MO from December 2015 to October 2016. Trained research personnel assessed current adiposity measures. Weight at ages 18 and 30 were self-reported. We evaluated mammographic density measures: volumetric percent density (VPD), dense volume (DV), and non-dense volume (NDV) using Volpara. Multivariable linear regression models were used to evaluate the associations of adiposity measures with volumetric mammographic density measures., Results: All attained adiposity measures, BMI at age 18, age 30, and weight change were significantly inversely associated with VPD, and positively associated with DV and NDV. One unit increase in body fat % was associated with a 4.9% decrease in VPD and a 6.5% increase in NDV (p-values <0.001). For each kilogram increase in weight change from age 18 to attained, VPD decreased by 16.3%, 47.1%, and 58.8% for women who gained 5.1-15, 15.1-25 and >25 kg, respectively, compared to women who gained less than 5 kg during this time period (p-values <0.001). Irrespective of BMI at age 18, VPD significantly decreased and NDV increased among women who were currently obese., Conclusions: There is a need for mechanistic studies focusing on early adulthood to provide a better understanding of how adiposity in early life relates to mammographic density, and possibly breast cancer development in premenopausal women.

Ferguson, Missouri became the center of the nation's attention when an unarmed African American teenager was killed by a Caucasian police officer. Civic unrest continued for weeks. The aim of this study was to learn how older adults experienced the social unrest. Ten focus groups were conducted with 73 participants. Eight themes were identified. Issues related to safety were most commonly discussed. Participants reported a breakdown in intergenerational communications and expressed a desire for more exchange. Findings are being discussed with relevant organizations to increase the involvement of older adults in on-going community development efforts and to provide opportunities for intergenerational dialogue.

Background: African American mothers lag behind in breastfeeding initiation. Research is needed to gain an understanding of potential reasons for breastfeeding disparities. Research aim: This study explored breastfeeding exposure, attitudes, and intentions of African American and Caucasian college students by race and gender., Methods: Women and men (696) attending college, who were younger than 45 years and without children, were included in this study. Survey data were collected using a demographic questionnaire and the Iowa Infant Feeding Attitude Scale., Results: Overall, students demonstrated favorable attitudes regarding breastfeeding but viewed formula feeding as more practical. Students who were Caucasian and female and experienced breastfeeding exposure demonstrated higher breastfeeding attitudes and intent. Breastfeeding exposure and attitudes contributed 32% of the variance in breastfeeding intentions. The odds of experiencing breastfeeding exposure and positive breastfeeding attitudes were approximately 3 times higher for Caucasian students than for African American students., Conclusion: External factors demonstrated a stronger association with breastfeeding intentions. The link with race and gender appears to operate through their effect on attitudes and exposure. More research is needed to identify strategies to improve breastfeeding exposure and attitudes among African Americans.

Purpose: To investigate whether treatment (surgery, radiation therapy, and endocrine therapy) contributes to racial disparities in outcomes of ductal carcinoma in situ (DCIS)., Patients and Methods: The analysis included 8184 non-Hispanic White and 954 non-Hispanic Black women diagnosed with DCIS between 1996 and 2011 and identified in the Missouri Cancer Registry. Logistic regression models were used to estimate odds ratios (ORs) of treatment for race. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of ipsilateral breast tumor (IBT) and contralateral breast tumor (CBT) for race., Results: There was no significant difference between Black and White women in utilization of mastectomy (OR 1.16; 95 % CI 0.99-1.35) or endocrine therapy (OR 1.19; 95 % CI 0.94-1.51). Despite no significant difference in underutilization of radiation therapy (OR 1.14; 95 % CI 0.92-1.42), Black women had higher odds of radiation delay, defined as at least 8 weeks between surgery and radiation (OR 1.92; 95 % CI 1.55-2.37). Among 9138 patients, 184 had IBTs and 326 had CBTs. Black women had a higher risk of IBTs (HR 1.69; 95 % CI 1.15-2.50) and a comparable risk of CBTs (HR 1.19; 95 % CI 0.84-1.68), which were independent of pathological features and treatment., Conclusion: Racial differences in DCIS treatment and outcomes exist in Missouri. This study could not completely explain the higher risk of IBTs in Black women. Future studies should identify differences in timely initiation and completion of treatment, which may contribute to the racial difference in IBTs after DCIS.

Introduction: Physical inactivity and childhood obesity are prevalent in American children, with increased vulnerability in minority, low-resource populations. The aim of this study was to quantify the impact of physical education (PE) on in-school physical activity quantity and intensity in urban minority children attending public elementary schools., Methods: This observational study included elementary children (N=212; mean age, 9.9 years; 81.7% black) in Grades 2-5 attending urban public schools with high eligibility for the National School Lunch Program. In-school physical activity was quantified during 4 school weeks across 4 months (January-April 2012) using Omron HJ-151 accelerometer-pedometers. Fitness was assessed with the 20-meter Progressive Aerobic Cardiovascular Endurance Run. Data were analyzed in 2013 using generalized estimating equations to determine the influence of PE and sex on total in-school steps and moderate to vigorous physical activity (MVPA) steps., Results: Based on 3,379 observation days (mean, 15.9 school days/student), students achieved higher in-school physical activity on days with PE (4,979 steps) than on days without PE (3,683 steps, p<0.0001). Likewise, MVPA steps were greater on days with PE than on days without PE (p<0.0001). Boys were more active than girls, but both accumulated more steps on days with PE. Low aerobic fitness was observed in 29.0% of students and overweight/obesity in 31.1%., Conclusions: PE significantly increases total in-school and MVPA steps in urban minority elementary children. PE as a core subject can provide opportunities for urban, minority public school children in low-resource areas to achieve age-appropriate physical activity and fitness goals., (Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Although prior studies have demonstrated that depression is associated with an overeating-binge eating dimension (OE-BE) phenotypically, little research has investigated whether familial factors contribute to the co-occurrence of these phenotypes, especially in community samples with multiple racial/ethnic groups. We examined the extent to which familial (i.e., genetic and shared environmental) influences overlapped between Major Depressive Disorder (MDD) and OE-BE in a population-based sample and whether these influences were similar across racial/ethnic groups., Method: Participants included 3,226 European American (EA) and 550 African American (AA) young adult women from the Missouri Adolescent Female Twin Study. An adaptation of the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) was administered to assess lifetime DSM-IV MDD and OE-BE. Quantitative genetic modeling was used to estimate familial influences between both phenotypes; all models controlled for age., Results: The best-fitting model, which combined racial/ethnic groups, found that additive genetic influences accounted for 44% (95% CI: 34%, 53%) of the MDD variance and 40% (25%, 54%) for OE-BE, with the remaining variances due to non-shared environmental influences. Genetic overlap was substantial (rg  = .61 [.39, .85]); non-shared environmental influences on MDD and OE-BE overlapped weakly (re  = .26 [.09, .42])., Discussion: Results suggest that common familial influences underlie MDD and OE-BE, and the magnitude of familial influences contributing to the comorbidity between MDD and OE-BE is similar between EA and AA women. If racial/ethnic differences truly exist, then larger sample sizes may be needed to fully elucidate familial risk for comorbid MDD and OE-BE across these groups., (© 2014 Wiley Periodicals, Inc.)

Background: Coronary artery disease (CAD) is a major cause of death and disability worldwide. Depression has complex bidirectional adverse associations with CAD, although the mechanisms mediating these relationships remain unclear. Compared to European Americans, African Americans (AAs) have higher rates of morbidity and mortality from CAD. Although depression is common in AAs, its role in the development and features of CAD in this group has not been well examined. This project hypothesizes that the relationships between depression and CAD can be explained by common physiological pathways and gene-environment interactions. Thus, the primary aims of this ongoing project are to: a) determine the prevalence of CAD and depression phenotypes in a population-based sample of community-dwelling older AAs; b) examine the relationships between CAD and depression phenotypes in this population; and c) evaluate genetic variants from serotoninP and inflammatory pathways to discover potential gene-depression interactions that contribute significantly to the presence of CAD in AAs., Methods/design: The St. Louis African American Health (AAH) cohort is a population-based panel study of community-dwelling AAs born in 1936-1950 (inclusive) who have been followed from 2000/2001 through 2010. The AAH-Heart study group is a subset of AAH participants recruited in 2009-11 to examine the inter-relationships between depression and CAD in this population. State-of-the-art CAD phenotyping is based on cardiovascular characterizations (coronary artery calcium, carotid intima-media thickness, cardiac structure and function, and autonomic function). Depression phenotyping is based on standardized questionnaires and detailed interviews. Single nucleotide polymorphisms of selected genes in inflammatory and serotonin-signaling pathways are being examined to provide information for investigating potential gene-depression interactions as modifiers of CAD traits. Information from the parent AAH study is being used to provide population-based prevalence estimates. Inflammatory and other biomarkers provide information about potential pathways., Discussion: This population-based investigation will provide valuable information on the prevalence of both depression and CAD phenotypes in this population. The study will examine interactions between depression and genetic variants as modulators of CAD, with the intent of detecting mechanistic pathways linking these diseases to identify potential therapeutic targets. Analytic results will be reported as they become available.

Objective: To study the association between social disorganization and youth violence rates in rural communities., Method: We employed rural Missouri counties (N = 106) as units of analysis, measured serious violent victimization data via hospital records, and the same measures of social disorganization as Osgood and Chambers (2000). Controlling for spatial autocorrelation, the negative binomial estimator was used to estimate the effects of social disorganization on youth violence rates., Results: Unlike Osgood and Chambers, we found only one of five social disorganization measures, the proportion of female-headed households, to be associated with rural youth violent victimization rates., Conclusion: Although most research on social disorganization theory has been undertaken on urban areas, a highly cited Osgood and Chambers (2000) study appeared to extend the generalize ability of social disorganization as an explanation of the distribution of youth violence to rural areas. Our results suggest otherwise. We provide several methodological and theoretical reasons why it may be too early to draw strong conclusions about the generalize ability of social disorganization to crime rates in rural communities.

Lifetime and age-conditional probabilities of human immunodeficiency virus (HIV) diagnosis risk in Missouri were assessed using cross-sectional HIV diagnosis and mortality rates. An increased lifetime risk of HIV diagnosis was associated with males, blacks, and persons residing in metropolitan areas. The estimates emphasize the disparity in risk by race/ethnicity and area of residence.

African American children with autism are seriously under-represented in existing genetic registries and biomedical research studies of autism. We estimated the number of African American children with autism in the St. Louis region using CDC surveillance data and present the outcomes of a concerted effort to enroll approximately one-third of that population into either of two large national genetic autism registries. The results revealed that even after traditional barriers to research participation were addressed and all contacted families expressed a willingness to participate, 67% of the reachable families were disqualified from participation because of family structure alone. Comprehensive efforts-including expansion of eligibility to families of diverse structure-are warranted to facilitate the inclusion of African American children in biomedical research.

Objective: The purpose of this study was to determine whether the use of race-specific definitions of short femur and humerus lengths improves Down syndrome detection., Methods: This was a retrospective cohort study over 16 years. For each self-reported maternal race (white, African American, Hispanic, and Asian), we evaluated the efficiency of Down syndrome detection using published race-specific formulas compared with a standard formula for short femur and humerus lengths (observed versus expected lengths < or =0.91 and < or =0.89, respectively). The sensitivity, specificity, and 95% confidence intervals for each parameter were compared. Screening performance was compared by areas under the receiver operating characteristic curves., Results: Of 58,710 women, 209 (0.3%) had a diagnosis of a fetus with Down syndrome. Although the race-based formula increased sensitivity in each population, the increase was statistically significant only in the white population, whereas a decrease in specificity was statistically significant in all 4 populations, as denoted by nonoverlapping confidence intervals. The area under the receiver operating characteristic curve for the model using the race-specific definition of short femur length was 0.67 versus 0.65 compared with the standard definition, and for humerus length it was 0.70 versus 0.71., Conclusions: The use of race-based formulas for the determination of short femur and humerus lengths did not significantly improve the detection rates for Down syndrome.

The move to consolidate, and eventually to close, Homer G. Phillips Hospital sparked a major uprising in St. Louis, Missouri, during the years 1976 through 1984. This article explores the struggle in St. Louis’s black community to keep open, and later to reopen, Homer G. Phillips Hospital from a vantage point that demonstrates the diversity of opinion surrounding the struggle. For many black St. Louis residents, the physical space of Homer G. Phillips Hospital was a metaphor for identity, a manifestation of citizenship rights, and a means of delineating a territory of shared histories, understandings, and values. For others, it was a relic of segregation and racism. In seeking to understand the diversity of public reaction, this article addresses class antagonism, examines the varied and divergent motivations for eliminating or maintaining services at the hospital, and reconsiders the discourse of "black politics." It is a decisive illustration of how the national twin crises of deindustrialization and privatization affected a heterogeneous black community.

When the St. Louis Exposition opened in 1904 it became host to the largest gathering of the world's Indigenous peoples to that date. However, questions about how Native peoples understood these transnational Indigenous interactions have remained largely out of the realm of academic inquiry-a fact often attributed to the "absence" of primary sources. This article counters such assertions by providing a rereading that interrogates colonial assumptions embedded in both archival materials and contemporary scholarly interpretations. By analyzing a candid photograph of two Native women-one Tzoneca, the other Ainu-taken at the fair by Jessie Tarbox Beals and utilizing Frederick Starr's journal, this article ultimately questions whether the Exposition's celebration of empire may have inadvertently served anti-colonial purposes. Namely, by presenting Indigenous participants with opportunities to forge relationships across the globe, a fact that may have served to inform the late 20th century emergence of a global Indigenous consciousness.

Study Design: Population-based telephone survey in Missouri., Objective: To examine the unique contribution of race to diagnosis and surgery rates in workers' compensation claimants., Summary of Background Data: Race differences in diagnostic specificity and rates of surgery may mediate documented differences in workers' compensation case management outcomes (treatment expenditures, disability ratings, and settlement awards) between African Americans and whites with low back injuries., Participants and Methods: African American (n = 580) and white (n = 892) workers' compensation claimants with single-incident low back injuries were interviewed regarding diagnoses and treatments received for their injury. Participants were, on average, 21 months after settlement. Analyses examined the association of race (controlling for clinical findings, legal representation, age, gender, and socioeconomic status) with diagnosis (herniated disc vs. regional backache) and surgery. Risk ratios for race were calculated., Results: Whites were 40% more likely than African Americans to receive a herniated disc diagnosis. Of claimants with the latter diagnosis, whites were 110% more likely than African Americans to undergo surgery., Conclusions: Race differences in diagnosis and surgery may help to explain why African Americans, relative to whites, receive lower workers' compensation medical expenditures, disability ratings, and settlement awards.

The objective of this study was to examine the relationship of nonmedical factors, including socioeconomic status, social class, education, race, and social support, to low birth weight. In a case-control study of all resident very-low-birth-weight births between December 1, 1989, and March 31, 1991, mothers completed an extensive survey related to their experience of pregnancy, including prenatal and postnatal care. Cases were defined as very-low-birth-weight (VLBW) infants and were matched to moderately-low-birth-weight and normal-birth-weight infants in race, age, and maternal residence. The hypothesis that social and class factors are more predictive of low birth weight than medical factors alone for women without chronic health problems was supported. Although the degree of the association varies depending on birth weight outcome, race even though addressed through matching--continued to play an important role in birth outcomes. A comparison of logistic model performance with and without the inclusion of social factors indicated the importance these variables play in prediction of birth outcomes. This is one of the few studies undertaken that explicitly investigates impact of patient factors on medical care.

A review of the literature revealed that changes in the articular eminence associated with changes in the dentition were usually overlooked in most reports. An attempt was made to determine whether changes in attrition and loss of teeth would correlate with a change (decreased angulation) in the articular eminence. The population consisted of 103 adult skulls and mandibles of both sexes and three different races. They included partial and totol edentulism, mild to severe attrition, and complete dentitions in good condition. An impression of each of the 206 articular eminences was made and the angulation established. The data were transferred to computer cards and a statistical analysis performed. The level of significance for each of the variables was established and conclusions were made.