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It is well documented that memory is heritable and that older adults tend to have poorer memory performance than younger adults. However, whether the magnitudes of genetic and environmental contributions to late-life verbal episodic memory ability differ from those at earlier ages remains unresolved. Twins from 12 studies participating in the Interplay of Genes and Environment in Multiple Studies (IGEMS) consortium constituted the analytic sample. Verbal episodic memory was assessed with immediate word list recall ( N = 35,204 individuals; 21,792 twin pairs) and prose recall ( N = 3,805 individuals; 2,028 twin pairs), with scores harmonized across studies. Average test performance was lower in successively older age groups for both measures. Twin models found significant age moderation for both measures, with total inter-individual variance increasing significantly with age, although it was not possible definitively to attribute the increase specifically to either genetic or environmental sources. Pooled results across all 12 studies were compared to results where we successively dropped each study (leave-one-out) to assure results were not due to an outlier. We conclude the models indicated an overall increase in variance for verbal episodic memory that was driven by a combination of increases in the genetic and nonshared environmental parameters that were not independently statistically significant. In contrast to reported results for other cognitive domains, differences in environmental exposures are comparatively important for verbal episodic memory, especially word list learning., Competing Interests: Declaration of Competing Interests: None

Objective To delineate the etiology, symptomatology, and treatment of sickle cell intrahepatic cholestasis (SCIC). Sickle cell disease (SCD) is the most frequently inherited hematologic disease, and SCIC is one rare and often fatal complication and comorbid disease. The literature contains only a small number of case reports involving SCIC and hence limited guidance can be obtained. Methods We reviewed the scientific literature to evaluate the science of SCIC to determine if there were consistencies in presentation, evaluation, treatment, and clinical outcomes. Results We reviewed 6 case reports and a limited number of clinical papers on SCIC. We reported consistencies in clinical presentation and treatment outcomes among cases as well as serological and hematological finding. Conclusions While there is some consistency in the symptom presentation of individuals with SCIC, reliable evaluation and clinical procedures were not demonstrated in what we reviewed. Further research is needed to delineate the attributes of this complicated disease that occurs within SCD., Competing Interests: Conflicts of Interest We have no conflicts of interests., (Copyright © 2022 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Objective: We evaluated the effects of menstrual types inclusive of PMS on reports of chronic pain intensity and psychopathology in twenty-eight women (mean age 38.93 ± 13.51) with Sickle Cell disease (SCD)., Methods: Using the Menstrual Symptoms Questionnaire, we compared women with PMS to those with less distressing spasmodic cycle types., Results: Thirty-four percent of the sample used oral contraception; there were no significant effects of birth control use on reports of pain. Women with PMS characterized the sensory (p = .04) and affective (p = .04) experiences of their SCD-related chronic pain, including their current pain intensity (p = .03), as significantly greater than women with primary spasmodic menstrual type. Further, there was a trend towards significance for women with PMS to report greater levels of overall pain intensity (p = .07) and average pain intensity over the past month (p = .08)., Conclusions: The authors interpret these results to suggest that there may be a complex interaction of neurohormonal, biological, and psychological factors associated with PMS that influence manifestation and experience of chronic pain in patients with SCD., (Copyright © 2020 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Social support (SS) is typically associated with lower emotional distress (e.g., stress and depression) in individuals. However, SS is a multifaceted construct that can vary by quality, quantity (amount), and type (i.e., it can be emotional or instrumental in nature)., Objective: The current study examined the relationships between characteristics of SS, stress, and depression in aging African Americans., Participants: Analyses focused on data from 705 participants aged 22-92 years from the Carolina African American Twin Study of Aging., Measurements: Measures included the quality and quantity of emotional and instrumental support received, as well as stress and depression., Design: A series of univariate and increasingly complex multivariate regression models were conducted in MPlus (using the cluster option to control for family structure) to examine the relationships between SS and emotional distress variables., Results: Overall, better quality of emotional SS predicted fewer depression symptoms and less perceived stress, after controlling for age, gender, socioeconomic status variables, and the other subtypes of SS. However, more instances of emotional SS were associated with higher levels of perceived stress, depression symptoms, and more stressful life events within the past year. Likewise, more instrumental SS predicted more perceived stress, while holding the other variables constant., Conclusion: African Americans who experience more emotional distress report more SS, but the quality of emotional support appears to play an important role in the association between reduced levels of stress and depression. These findings suggest that interventions should include approaches to reduce emotional distress as well as enhance the quality SS., (Copyright © 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objectives: The current study explored whether social support (SS) from family and peers, influences the relationship between depressed mood (DM) and substance use (SU). We hypothesized that SS would have a protective effect on DM, and moderate the association between DM and SU., Participants and Methods: Analyses focused on 703 individuals from the Carolina African American Twin Study on Aging (mean age = 49.78 years, STD = 14.52; 51% female). Participants reported on past year frequency of cigarettes and alcohol consumption, depressed mood, and stressful life events. Social support (SS) was assessed on two domains (i.e., emotional and instrumental), as well as for perceived quality and quantity of each type. Hypotheses were tested using ordinal logistic regression in Mplus while controlling for socioeconomic status, age, and gender., Results: Quality of emotional support was negatively associated with drinking. Smoking, but not drinking was associated with depressed mood. While individuals with high levels of depressed mood received more support, receiving better quality emotional support was associated with fewer mood and stress symptoms. Individuals who reported receiving better quality emotional support typically smoked fewer cigarettes., Conclusion: Quantity of emotional support was associated with higher levels of negative emotionality, whereas the opposite was found for quality of emotional support. Emotional support may indirectly influence smoking via depressed mood. Effecting the perceived quality of support appears to be the mechanism by which emotional support helps to reduce smoking in adult African Americans., Competing Interests: Declarations of Competing Interest The authors have no conflicts to declare., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Higher BMI, lower rates of physical activity (PA), and hormone receptor-negative breast cancer (BC) subtype are associated with poorer BC treatment outcomes. We evaluated the prevalence of high BMI, low PA level, and BC subtype among survivors with white/European American (EA) and African American (AA) ancestry, as well as a distinct subset of AAs with Sea Island/Gullah ancestry (SI). We used the South Carolina Central Cancer Registry to identify 137 (42 EAs, 66 AAs, and 29 SIs) women diagnosed with BC and who were within 6-21 months of diagnosis. We employed linear and logistic regression to investigate associations between BMI, PA, and age at diagnosis by racial/ethnic group. Most participants (82%) were overweight/obese (P=0.46). BMI was highest in younger AAs (P=0.02). CDC PA guidelines (≥150min/week) were met by only 28% of participants. The frequency of estrogen receptor (ER)-negative BC subtype was lower in EAs and SIs than in AAs (P<0.05). This is the first study to identify differences in obesity and PA rates, and BC subtype in EAs, AAs, and SIs. BMI was higher, PA rates were lower, and frequency of ER-negative BC was higher in AAs as compared to EAs and SIs. This study highlights the need to promote lifestyle interventions among BC survivors, with the goal of reducing the likelihood of a BC recurrence. Integrating dietary and PA interventions into ongoing survivorship care is essential. Future research could evaluate potential differential immune responses linked to the frequency of triple negative BC in AAs., (© 2020 Elsevier Inc. All rights reserved.)

Background: There is evidence that birth size is positively associated with height in later life, but it remains unclear whether this is explained by genetic factors or the intrauterine environment., Aim: To analyze the associations of birth weight, length and ponderal index with height from infancy through adulthood within mono- and dizygotic twin pairs, which provides insights into the role of genetic and environmental individual-specific factors., Methods: This study is based on the data from 28 twin cohorts in 17 countries. The pooled data included 41,852 complete twin pairs (55% monozygotic and 45% same-sex dizygotic) with information on birth weight and a total of 112,409 paired height measurements at ages ranging from 1 to 69 years. Birth length was available for 19,881 complete twin pairs, with a total of 72,692 paired height measurements. The association between birth size and later height was analyzed at both the individual and within-pair level by linear regression analyses., Results: Within twin pairs, regression coefficients showed that a 1-kg increase in birth weight and a 1-cm increase in birth length were associated with 1.14-4.25 cm and 0.18-0.90 cm taller height, respectively. The magnitude of the associations was generally greater within dizygotic than within monozygotic twin pairs, and this difference between zygosities was more pronounced for birth length., Conclusion: Both genetic and individual-specific environmental factors play a role in the association between birth size and later height from infancy to adulthood, with a larger role for genetics in the association with birth length than with birth weight., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Genes and the environment contribute to variation in adult body mass index [BMI (in kg/m 2 )], but factors modifying these variance components are poorly understood. Objective: We analyzed genetic and environmental variation in BMI between men and women from young adulthood to old age from the 1940s to the 2000s and between cultural-geographic regions representing high (North America and Australia), moderate (Europe), and low (East Asia) prevalence of obesity. Design: We used genetic structural equation modeling to analyze BMI in twins ≥20 y of age from 40 cohorts representing 20 countries (140,379 complete twin pairs). Results: The heritability of BMI decreased from 0.77 (95% CI: 0.77, 0.78) and 0.75 (95% CI: 0.74, 0.75) in men and women 20-29 y of age to 0.57 (95% CI: 0.54, 0.60) and 0.59 (95% CI: 0.53, 0.65) in men 70-79 y of age and women 80 y of age, respectively. The relative influence of unique environmental factors correspondingly increased. Differences in the sets of genes affecting BMI in men and women increased from 20-29 to 60-69 y of age. Mean BMI and variances in BMI increased from the 1940s to the 2000s and were greatest in North America and Australia, followed by Europe and East Asia. However, heritability estimates were largely similar over measurement years and between regions. There was no evidence of environmental factors shared by co-twins affecting BMI. Conclusions: The heritability of BMI decreased and differences in the sets of genes affecting BMI in men and women increased from young adulthood to old age. The heritability of BMI was largely similar between cultural-geographic regions and measurement years, despite large differences in mean BMI and variances in BMI. Our results show a strong influence of genetic factors on BMI, especially in early adulthood, regardless of the obesity level in the population., (© 2017 American Society for Nutrition.)

Introduction: Compared with other racial/ethnic groups, African Americans have higher rates of chronic conditions and suffer a disproportionate burden of disability. We aimed to examine the effects of social support on physical functioning among older African Americans., Methods: We analyzed a sample of 448 urban, community-dwelling, older African Americans (aged 48-98 years) from the Baltimore Study of Black Aging. Baseline physical functioning was collected between 2006 and 2008 (wave 1), and change in physical functioning was collected between 2009 and 2011 (wave 2), physical functioning was assessed by self-reported limitations in 7 activities of daily living-eating, dressing, grooming, walking, bathing, using the toilet, and transferring in and out of bed-using a binary variable to indicate whether the individual had difficulty performing each specific activity. Social support was measured by how frequently participants provided/received goods and services, financial assistance, transportation, companionship, advice, or encouragement (never [0], rarely [1], sometimes [2], frequently [3]). Negative binomial regression models were used to test the effects of social support given, received, and a ratio (support received/support given) on physical functioning for those who improved and those who declined in physical functioning., Results: Participants reported physical functioning at wave 1 (1.24, standard deviation [SD] = 1.98) and at wave 2 (0.34, SD = 0.83). Average social support given was 7.49 (SD = 3.26), and average social support received was 7.81 (SD = 3.17). Those who improved in physical function gave less social support and had lower social support ratios; social support received had no effect. Those who remained stable or declined in physical function gave more social support; neither social support received nor social ratio had an effect., Conclusion: Social support given and social support received as well as the ratio should be considered when seeking to understand how physical functioning changes over time among older African Americans., (Copyright © 2016 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Background: Race differences in chronic conditions and disability are well established; however, little is known about the association between specific chronic conditions and disability in African Americans. This is important because African Americans have higher rates and earlier onset of both chronic conditions and disability than white Americans., Methods: We examined the relationship between chronic conditions and disability in 602 African Americans aged 50 years and older in the Baltimore Study of Black Aging. Disability was measured using self-report of difficulty in activities of daily living (ADL). Medical conditions included diagnosed self-reports of asthma, depressive symptoms, arthritis, cancer, diabetes, cardiovascular disease (CVD), stroke, and hypertension., Results: After adjusting for age, high school graduation, income, and marital status, African Americans who reported arthritis (women: odds ratio (OR)=4.87; 95% confidence interval(CI): 2.92-8.12; men: OR=2.93; 95% CI: 1.36-6.30) had higher odds of disability compared to those who did not report having arthritis. Women who reported major depressive symptoms (OR=2.59; 95% CI: 1.43-4.69) or diabetes (OR=1.83; 95% CI: 1.14-2.95) had higher odds of disability than women who did not report having these conditions. Men who reported having CVD (OR=2.77; 95% CI: 1.03-7.41) had higher odds of disability than men who did not report having CVD., Conclusions: These findings demonstrate the importance of chronic conditions in understanding disability in African Americans and how it varies by gender. Also, these findings underscore the importance of developing health promoting strategies focused on chronic disease prevention and management to delay or postpone disability in African Americans., Publication Indices: Pubmed, Pubmed Central, Web of Science database., (Copyright © 2016. Published by Elsevier Inc.)

Purpose: To determine the genetic and environmental influences exerted on arthritis by measuring the distribution of self-reported arthritis diagnoses among monozygotic (MZ) and dizygotic (DZ) African American twins., Methods: A cross-sectional study was conducted on 97 MZ and 113 DZ twin pairs recruited into the Carolina African American Twin Study of Aging (CAATSA). The sample had a mean age of 47 +/- 13.9 years. A twin design was used to determine correlations in arthritis diagnosis for MZ and DZ twins and to estimate the contribution of genes and environment to the variation in an arthritis diagnosis., Results: The concordance rate for being diagnosed with arthritis was 42% for MZ twins, and 20% for DZ twins, resulting in a 2.1:1 ratio of MZ to DZ concordance. These results indicate a significant proportion of individual variability was due to genetic factors (43%) on an arthritis diagnosis as well as 57% of variance due to nonshared environmental influences., Conclusion: This research suggests that while there are genetic influences on arthritis diagnosis, environmental factors, such as infections, dietary factors, urbanization, and pollutants, also play a role in accounting for variability in the diagnosis and treatment of arthritis among diverse populations.

Purpose: African Americans are disproportionately affected by hypertension. The goal here was to better understand the relationship between well-being and environmental factors and their influence on hypertension. It was hypothesized that there would be a positive association among perceived stress, depression, and hypertension mediated by social support., Methods: Data from 2 sample populations were included: the Carolina African American Study of Aging (N = 395) and the Baltimore Study of Black Aging (N = 602) provided information on demographics, perceived stress, social support, depression, and hypertension. Regression analysis was used to examine the hypothesis., Results: Significant relationships were found between perceived stress/depression and hypertension. The relationship between depression and hypertension was partially mediated by social support (given), while the relationship between depression and hypertension was not., Conclusions: Our findings suggest that the impact of stress and hypertension is mediated by individual coping strategies. Given the excess stress and hypertension experienced by African Americans, coping may be a particularly salient factor in longevity. Future research should provide insight about specific aspects of coping and other personal characteristics that facilitate and limit the effect of coping on hypertension.

The unpredictable nature of sickle cell disease (SCD) and its social and environmental consequences can produce an unhealthy and almost exclusive focus on physical functioning. At the upper range of this focus on health concerns is somatization. In the current study, using 156 adult patients (55.13% female, 86) with SCD, mean age 35.59 +/- 12.73, we explored the relationship of somatization to pain. We found somatization to be predictive of pain severity and current pain intensity as well as a range of averaged indices of pain over time (p < .0001). We further found somatization to be predictive of a range of negative psychological experiences to include depression, anxiety, and hostility (p < .0001). We interpret these data to suggest that patients with SCD who have a propensity to focus exclusively on their health or are more sensitive to minor changes in their health status (somatization) may also be more likely to report greater concerns about their health and higher ratings of pain.

Few studies have examined traits or behaviors that may predispose some African Americans to poor cardiovascular health outcomes. While several models of personality exist, the 5-factor model (FFM) is arguably the best representation of personality and provides a useful framework for the study of personality and health. Among personality characteristics associated with health risks among African Americans, a high-effort coping style called John Henryism is among the most thoroughly examined. It is not clear if personality coping and health are connected in a meaningful way. The present study utilized data from the Baltimore Study of Black Aging (BSBA) to examine whether personality was linked to John Henryism, how personality might be linked to cardiovascular health, and how John Henryism might mediate the relationship between personality and cardiovascular health. The sample consisted of 234 older African Americans (mean age, 67 years), 28% of which were men. Regressions were used to examine the questions. The results indicated that those who are more neurotic report more cardiovascular health problems, and that openness and conscientiousness were significant predictors of active coping. The mediation analysis results suggest that coping style did not mediate the relationship between personality and reports of cardiovascular health problems. These findings highlight the importance of personality in accounting for cardiovascular health in African Americans.

There is a strong relationship between suicidal ideation, suicide attempts, and depression. Rates of successful suicides are relatively high among the chronically ill compared to other populations but are reduced with treatment. Depression and suicide rates also often differ among blacks as compared to other populations. Using survey methods, we evaluated self-reported rates of depression, suicidal ideation, and suicide attempts in 30 male and 37 female black patients with sickle cell disease (SCD). SCD is a condition characterized by chronic, unpredictable pains and psychosocial distress. Thirty-six percent of the sample self-reported depression in the past 30 days, while 22 percent of the sample exhibited scores on the Beck Depression Inventory indicative of mild or greater depression (mean BDI, 8.31 +/- 7.79). Twenty-nine percent of patients indicated an episode of suicidal ideation and 8%, a suicidal attempt in their lifetime. Thirty-three percent reported treatment by a mental health professional. We conclude that there is a continuing need for mental health services in the management of depressed affect and risk for suicide among patients with SCD. Standards of clinical care must remain flexible to accommodate the mental health needs of this population of patients.

Blacks experience disproportionately elevated rates of tobacco-related morbidity and mortality. Blacks experience delayed smoking initiation relative to other racial/ethnic groups, highlighting the importance of examining smoking correlates occurring in late adolescence/early adulthood. The current study reports data collected as part of an ongoing collaborative effort to assess alcohol and drug use on the campuses of historically black colleges and universities (HBCUs). Two-thousand, two-hundred, seventy-seven African-American subjects, aged 20.3 +/- 3.9 (range 18-53), completed the CORE Alcohol and Drug survey and a brief demographic questionnaire. Results indicated that 90% of all subjects overestimated the rate of smoking among their peers. Overestimating was associated with a > 80% increase in the risk of smoking. These data highlight the need to correct misinformation regarding smoking norms among students at some HBCUs.

Objectives: Despite greater negative environmental influences such as lower socioeconomic status, less parental education, more single-parent households and urban dwelling, African Americans are less likely to begin smoking than European Americans. The goal of the current investigation was to examine the proportion of genetic and environmental influences on smoking in a sample of adult African-American twins., Design: Birth records from North Carolina Register of Deeds Offices were used to identify participants for the Carolina African-American Twin Study of Aging (CAATSA). Participants completed an in-person interview that included measures of health status, cognition and psychosocial measures., Participants: Data for the analysis come from 200 pairs of same-sex twins (97 identical pairs and 113 fraternal), with a mean age = 46.9 years (SD = 13.9) and 38% of the sample being men., Results: Compared to previous research on smoking, our estimates are very similar with genetics, accounting for about 60% of the individual variance in current smoking. We did find that there was a significant amount of genetic variance in pack years but no shared environmental influences., Conclusion: Similarity in proportions of genetic influences lead to larger questions about the genes involved in smoking among African Americans working in the same manner as in Caucasians or other groups. Additionally, this same question holds for the environmental variance. It is perhaps most likely that while the proportions of environmental variance are similar between groups that the actual source of variance (e.g., poverty, urban rural context, socioeconomic status, attitudes of family and friends) may differ when comparing ethnic groups.

Objectives: The primary objective of this investigation was to examine the relationship between physical functioning and various clinical (pain intensity, pain locations, medications, comorbidities) and psychosocial (depression, locus of control) variables in a sample of older blacks., Methods: Data were collected from community-dwelling black adults (N=247), with a mean age of 69.4 +/- 9.4 years. Participants were recruited from several senior high-rise facilities located in an urban community in Baltimore, MD. A multivariate regression model was tested to determine the relationship between selected clinical, psychosocial and demographic characteristics, and physical functioning; and to assess the amount of unique variance in functional status accounted for by specific psychosocial, clinical and demographic indicators (independently and collectively)., Results: It was established that reporting more depressive symptoms (beta=0.18, p<0.05), multiple pain locations (beta=0.25, p<0.01) and pain intensity (beta=0.30, p<0.01) was a significant indicator of physical impairment and accounted for 36% of its variation., Conclusion: Identifying indicators of physical impairment is critical in providing baseline information on the functional well-being in older blacks. This emphasizes the need for further studies to rigorously examine the relationship between physical functioning, and clinical and psychosocial indicators within defined race and ethnic groups in order to develop data that provide meaningful comparisons between different race and ethnic groups.

Objectives: To decompose sources of individual differences in coping as measured by John Henryism among African Americans., Methods: Analyses described in this study are based on the pairwise responses from 180 pairs of same-sex, African-American twin pairs who participated in the Carolina African-American Twins Study of Aging (CAATSA). The sample consisted of 85 monozygotic (MZ) and 95 dizygotic (DZ) twin pairs., Results: Environmental factors account for most of the variance (65%) in John Henryism scores, with the remaining variance attributable to additive genetic factors (35%). The test of the genetic component suggested that the 35% represented a statistically significant proportion of variance., Conclusions: The vast majority of recent studies on African Americans and health outcomes have focused on the impact of psychosocial factors on diseases such as hypertension and diabetes, with relatively little attention to possible genetic contributors. Previous research on psychosocial indices and their relationship to cardiovascular health among African Americans has focused on assessment and epidemiological explorations rather than understanding the etiology of variability in such measures.

The development and testing of explanatory hypotheses about the underlying mechanisms that create health disparities among ethnic minorities will be crucial in identifying solutions for reducing the current differentials. This paper addresses the potential for using genetic information as a useful and necessary addition to approaches to measures of the "environment" in the study of the origins of health disparities. Approaches and theoretical perspectives on the integration of social science and genetic findings are discussed.