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This article compared and contrasted the Telephone Interview of Cognitive Status (TICS) to the racially-sensitive Short Portable Mental Status Questionnaire (SPMSQ). The empirical questions addressed was whether the TICS over-represented African American (AA) cognitive impairment (CI) relative to the SPMSQ, if there were age differences in CI prevalence between younger subjects (ages 50-64) and older ones (>64 years) and on accuracy to detect CI in individuals with higher levels of educations (> or =13 years) versus those with lower education levels (<13 years). A secondary data analysis was performed on 396 AA participants from the Carolina African American Twin Study on Aging (CAATSA). The SPMSQ measured CI prevalence at 10.3% and the TICS at 45.0%. Within the younger group, TICS and CI prevalence was 49.3 and 80% among the older group. Within the younger group SPMSQ and CI prevalence was 14.5 and 53.8% among the older group. Within the higher educated group, TICS and CI prevalence was 36.7 and 51.4% among the lower educated. Within the higher educated group, SPMSQ and CI prevalence was 7.7 and 14.5% among the lower educated. Findings are consistent with our hypotheses that the TICS would be a less accurate assessor of CI among AAs.

Depression is typically considered relative to individuals and thought to originate from both biological and environmental factors. However, the environmental constraints and insults that African Americans experience likely influence the concordance by age and gender for depression scores among adult African American twins. Monozygotic (MZ) (n = 102) and Dizygotic (DZ) (n = 110) twins, age 25-88 years in the Carolina African American Twin Study of Aging were examined using an 11-item version of the CES-D measure of depressive symptomatology. Those participants with scores above nine were considered depressed. Overall, the MZ pairs had a higher concordance than the DZ pairs implying genetic influence. Both MZ and DZ males had higher concordances than either female zygosity groups. The difference between the concordance rates for MZ and DZ twin pairs was greater in males than females. By age group, the difference between the concordance rates for younger MZ and DZ twin pairs was much larger than for older pairs. The results suggest that, even though African Americans may be at risk for depression due to contextual/environmental factors, genetic influences remain important.

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.

The rates of high blood pressure among African Americans, as a group, are the highest in the world. The implications for higher average blood pressure include complications for many major chronic conditions, such as cardiovascular disease and diabetes. Less well studied is the effect of blood pressure on the cognitive functioning of African Americans. The purpose of this study was to examine the effect of blood pressure on memory measures in a sample of adult African Americans. Analyses were conducted on a sample of 361 African American adults (mean age 61.50 years, standard deviation 9.39 years). We found significant correlations between systolic blood pressure and most cognitive measures but only for one of the measures and diastolic blood pressure. Regressions revealed significant effects for systolic blood pressure on Digit Symbol, Telephone Interview of Cognitive Status, and Immediate Recall on the Wechsler Logical Memory test. These findings suggest that blood pressure is a source of individual variability in cognitive aging among African Americans.

The present study examined differences in cognitive performance of African American and European American older adults on cognitive and intellectual measures, and the extent to which literacy status or reading level was useful in explaining these group differences. African American elders performed more poorly than European American elders on 12 of 13 cognitive tests administered, p < .05. After controlling for reading level achievement, differences in performance became nonsignificant for 5 of these 12 tests. Nonetheless, some differences persisted, suggesting that other potential mediators of race differences remain to be explored in future research.

Traditionally, neuropsychological deficits due to Sickle Cell Disease (SCD) have been understudied in adults. We have begun to suspect, however, that symptomatic and asymptomatic Cerebrovascular Events (CVE) may account for an alarming number of deficits in this population. In the current brief review, we critically evaluated the pediatric and adult literatures on the neurocognitive effects of SCD. We highlighted the studies that have been published on this topic and posit that early detection of CVE via neurocognitive testing, neuropsychiatric evaluations, and neuroimaging may significantly reduce adult cognitive and functional morbidities.

Objectives: Fear of movement (ie, kinesiophobia) has emerged as a significant predictor of pain-related outcomes including disability and psychologic distress across various types of pain (eg, back pain, headache, fibromyalgia, complex regional pain syndrome). However, no research has examined the prevalence of kinesiophobia in adults with sickle cell disease (SCD). The purpose of this study was to assess the degree of kinesiophobia reported by African American men and women with SCD and to determine whether kinesiophobia is related to pain and psychologic distress in this population., Methods: Sixty-seven men and women with SCD recruited from a comprehensive sickle cell treatment program in a large academic medical center completed questionnaires that assess fear of movement, pain and pain interference, and psychologic distress., Results: Participants reported levels of kinesiophobia (M=30.48, SD=7.55) that were comparable to those obtained for patients with low back pain and fibromyalgia. Although pain levels did not differ by sex, men reported greater kinesiophobia than women (P=0.02). As hypothesized, higher levels of kinesiophobia were associated with greater psychologic distress, particularly Phobic Anxiety (r=0.35), Psychoticism (r=0.29), Somatization (r=0.45), Anxiety (r=0.35), Obsessive-compulsive (r=0.34), Interpersonal Sensitivity (r=0.25), Depression (r=0.29), and all 3 summary indices of the SCL-90-R (all Ps<0.05)., Discussion: Although and historically, pain associated with SCD has not been considered in the context of fear of movement, findings suggest that both kinesiophobia and sex are relevant constructs for consideration in understanding pain-related outcomes in SCD. Though our results require replication, this study suggests that greater kinesiophobia is associated with greater pain and psychologic distress.

Mnemonic strategy use in older adults has been measured a number of ways, and although strategy measurement has received considerable attention, little work has been done to compare various types of subjective strategy reporting. The authors compared self-generated and endorsed strategies for memory tasks in a sample of 85 African-American and Caucasian older adults and investigated demographic characteristics related to each strategy measurement and the relationship between strategy use and memory performance. Across memory measures, significantly more strategies were endorsed than self-generated. Race, favoring Caucasians, was the most salient demographic predictor of mnemonic strategy usage. Although strategic behavior was associated with ability performance on most memory measures, specific strategies for optimal performance were identified for number and story recall only. Findings highlight the importance of measuring both self-generated and endorsed strategies and confirm previous work on the relationship between strategy use and memory performance.

Normative neuropsychological data for U.S. racial/ethnic minorities are limited. Extant norms are based on small, regional groups that may not be nationally representative. The objectives of this study were to (1) provide norms for a modified Symbol Digit Modalities Test (M-SDMT) based on a nationally representative sample of African Americans, Caribbean Blacks, and non-Latino Whites (NLW) living in areas with large populations of Blacks; and (2) determine significant correlates of M-SDMT performance. The M-SDMT was administered to a subset of respondents from the National Survey of American Life in standard face-to-face interviews. M-SDMT performance was influenced by race/ethnicity, age, education, and gender. African Americans and NLW groups had similar M-SDMT performances, which differed from Caribbean Blacks. The Black ethnic differences in M-SDMT were not explained by the sociodemographic factors considered in this study. Unlike previous work, this study supports the consideration of Black ethnicity when evaluating Black neuropsychological test performance.

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.

Unlabelled: The current study examined the extent to which pulmonary functioning, as measured by average peak expiratory flow, was related to performance on seven cognitive measures. Analyses were conducted on a sample of 396 African American adults ranging in age from 22 to 89 years., Results: Lung functioning was not uniquely associated with cognitive performance in the younger adults, though it emerged as a significant predictor of individual differences in performance on the Telephone Interview of Cognitive Status even after controlling for age, education, and smoking history. Biobehavioral assessments such as the one presented here appear to provide important new insights into the sources of individual differences in cognition observed in this understudied population.

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.

Current projections suggest that by 2050, the total number of non-Hispanic Whites aged 65 and over will double, the number of Blacks aged 65 and over will more than triple, and the number of Hispanics will increase 11-fold. These significant increases in older minority adults in the United States are in direct contrast to the current limited knowledge about health behaviors like smoking, drinking, and drug use among older Americans. This represents a major area of opportunity for researchers to advance science on the long-term effects of substance abuse and HIV/AIDS. The provision of appropriate public health information for these populations depends, in part, on increased basic and social/behavioral research and particularly on integrative biobehavioral approaches in these understudied older groups. This article provides a brief overview of some of the challenges faced in studying older ethnic minority adults. These include issues such as recruitment, conceptualization, and methodology. Some potential areas for future research are offered.

Understanding the origins of racial health disparities is currently a central focus of health-oriented funding agencies and the health policy community. In particular, the role of genetics in the origin of racial health disparities is receiving growing attention and has been susceptible to considerable misinterpretation. In this article, the authors provide a basic discussion about the concept of genes and race, an introduction to quantitative genetics, and some examples of quantitative genetic analyses of health conditions in an underserved population. The intent is to outline the conceptual limitations of exclusivist views of either environmental or genetic determination and to emphasize the coaction and interaction of genes and environments in health., ((c) 2005 APA)

This study examined whether measures of health status enhance the prediction of performance on everyday problem solving in adult African Americans. The sample consisted of 209 community-dwelling African American adults with a mean age of 66.82 years (SD=7.95). The following variables were included in the analysis: Everyday Problems Test (EPT), summary index of chronic illnesses (cardiovascular disease, hypertension, arthritis, stroke, and diabetes), self-rated health (current health, health in the past month, health compared with others, health compared with 5 years ago), and demographic information. Using hierarchical regression and follow-up communality analysis, the authors found that the number of chronic illnesses and self-rated health as compared with 5 years prior were significant and unique predictors of performance on the EPT but did not account for all of the demographic-related variance. The results indicate that health indices contribute to the variability in everyday cognition in this understudied population., (((c) 2004 APA, all rights reserved).)

Objectives: Previous research found measures of pulmonary functioning to be strong predictors of cognitive functioning and mortality; however, there is considerable individual variability in performance on these measures. In the present analyses, the relative contribution of genetic and environmental influences to variability in average peak expiratory flow rate (APEFR) are examined 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, which 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 with 39% of the sample being men., Results: Phenotypic correlations between APEFR, age, gender, height, and cigarette consumption (measured in pack years), were all significant, ranging from -.63 to .43. After the affects of age, gender, height, and pack years were partialled out of APEFR, quantitative genetic analyses were conducted on the residuals. Model fitting demonstrated that variance in APEFR was accounted for by shared environmental effects (30%), genetic effects (14%), and non-shared environmental effects (56%)., Conclusion: These results are discussed in relation to previous research conducted in other countries, and the importance of a complex systems approach to explanations of the impact of genes on central indices of health, such as APEFR.

In twin research, typically both members of a pair must participate. Survivorship of members of intact pairs compared to surviving members of nonintact twin pairs may reflect differences in psychosocial and health factors, and represent a potential selection bias relative to the general population. The purpose of the present study is to examine health, cognition, and well-being among members of African American intact twin pairs compared to individuals from nonintact twin pairs. Data from the Carolina African American Twin Study of Aging (CAATSA) were used for analyses. Subjects ranged in age from 25 to 89 years of age (mean = 59.78 years, SD = 12.84 years). CAATSA implements a 3-h protocol to collect data on demographics, health, cognition, and well-being. Data from one randomly selected member of each twin pair (N = 78) was compared to data from surviving members of nonintact twin pairs (N = 52). The results indicated significant differences on 11 of the 39 measures (i.e., age, education, forced expiratory volume, mean standing and sitting systolic and diastolic blood pressures, cognitive impairment score, alpha span, digit symbol, and logical memory). In each case, members of intact twin pairs performed better than surviving members of nonintact twin pairs. After controlling demographic variables, only blood pressures differed between the groups. It appears that using only pairs in research on older African American twins may represent a selection bias in estimating origins of individual variability in cognitive functioning and health but not psychological well-being.

Participation in genetic studies is often limited by a volunteer's reluctance to donate blood samples. We wished to determine if alternate, less painful, methods to venipuncture could be used to collect cells to provide DNA for genotyping, and whether the cells could be grown in culture for extraction of DNA. Volunteers in the study were comprised of two groups. Nine individuals from a university campus were recruited to provide samples for initial experiments. A second group of 710 twins and singletons from North Carolina and of African-American descent were a part of an ongoing study of age-related traits and participated in collection of buccal swabs via the mail. A protocol was generated that maximizes the recovery of DNA from buccal swabs, which are easier to handle than saline rinses. The DNA recovered is stable over several years, allowing genotype tests at a future date. Attempts to encourage growth of buccal epithelial cells recovered from swabs in tissue culture proved unsuccessful. Buccal swabs work well for the collection of DNA, especially from nonclinic-based volunteers, and can be sent via the mail to the laboratory for DNA extraction. Thus, an inexpensive and efficient method exists for genetic studies of population-based samples., (Copyright 2003 Wiley-Liss, Inc.)

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.

Objective: The purpose of the present study was to identify sources of variability for systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) in a sample of adult African-American twins., Design: The classic twin design was employed to examine genetic and environmental sources of variance in the outcome measures of interest., Participants: Participants were 143 (71 MZ and 72 DZ) same-sex, intact twin pairs (mean age = 49.87 years; SD 13.62), who took part in the Carolina African-American Twin Study of Aging (CAATSA)., Main Outcome Measures: Outcome measures of interest included SBP and DBP, and PP., Results: For older twins, heritabilities were .52 for SBP, .36 for DBP, and .14 for PP. However, for younger twins, heritabilities were .44 for SBP, .27 for DBP, but no genetic influence on PP was observed., Conclusion: The results indicate that genetic factors are a significant source of variance in hemodynamic indices, and also suggest that, with advancing age, genetic factors play an increasing role in determining blood pressure and PP in this population.

The purpose of this study was to examine the relationship between social support, health status, and everyday problem solving in African Americans. The sample included subjects recruited from Baltimore, Maryland. The sample consisted of 249 community-dwelling African American adults, 32% of whom were male, with a sample mean age of 67.8 years (SD = 8.47 years). Variables included: Everyday Problem Solving Test (EPT), social support given and received, physical limitations, counts of chronic illness, smoking, and demographic information. Using stepwise regression, age, education, physical limitations, and social support given were found to be significant predictors of performance on the EPT. Further analysis found support for a partial mediating effect of physical limitations on the relationship between social support and everyday problem solving. The results indicate that there may be differences in the cognitive abilities of those actively involved in social activities.

As the aging population continues to become more diverse, there is growing interest in understanding the similar and unique aspects of aging within and across people of different ethnic groups. The impact of culture on the sources of variation identified in quantitative genetic approaches has not been well discussed in the literature. The purpose of this paper is to review previous research pertinent to the cultural aspects of quantitative genetic approaches and methodologies, and provide conceptual and statistical approaches for advancing the science. To meet this objective, results from previously published studies as well as preliminary data analyses from the Carolina African American Twin Study of Aging will be presented. There are three themes to draw from the issues discussed in this paper: (1) avoiding genetic reductionism, (2) interpreting differential heritabilities, and (3) modeling cultural influences.

Objective: To investigate the genetic and environmental influences on body-fat measures including waist circumference (WC), waist-to-hip ratio (WHR), and body mass index (BMI) among African-American men and women., Research Methods and Procedures: Measurements were taken as part of the Carolina African American Twin Study of Aging. This sample currently comprises 146 same-sex African-American twins with an average age of 50 years (range, 22 to 88 years). This analysis included 26 monozygotic and 29 dizygotic men and 45 monozygotic and 46 dizygotic women. Maximum likelihood quantitative genetic analysis was used., Results: In men, additive genetic effects accounted for 77% of the variance in WC, 59% in WHR, and 89% in BMI. In women, additive genetic effects accounted for 76% of the variance in WC, 56% in WHR, and 73% in BMI. The remaining variance in both men and women was attributed to unique environmental effects (WC, 21%; WHR, 36%; BMI, 11% in men and WC, 22%; WHR, 38%; BMI, 27% in women) and age (WC, 2%; WHR, 5% in men and WC, 2%; WHR, 6% in women). When BMI was controlled in the analysis of WC and WHR, it accounted for a portion of the genetic and environmental variance in WHR and over one-half of the genetic and environmental variance in WC., Discussion: There are both genetic and environmental influences on WC, WHR, and BMI, and independent of BMI, there are genetic and environmental effects on WC and WHR among both genders. The results from this African-American twin sample are similar to findings among white twin samples.

The broad array of economic and cultural diversity in the U.S. population correlates with and impacts on the study of behavioral aspects of health. The purpose of this article was to provide a selective overview of behavioral medicine research on sociodemographically diverse populations, with a focus on ethnicity, gender, and socioeconomic status. Suggestions are provided with regard to methodological refinement of research and insights into possible future directions in behavioral medicine research on ethnically and economically diverse populations.