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The article suggests that Whiteness is a critical, albeit often overlooked, component of U.S. racism and consequently a major contributor to broader U.S.-based social inequalities and health inequities. Topics discussed include unexamined phenomena associated with the relationship between Whiteness and population health, influence of the history of differential U.S. immigration policy on White racial construction, and the need to address Whiteness to disempower systemic racism.

Residents of distressed urban areas suffer early aging-related disease and excess mortality. Using a community-based participatory research approach in a collaboration between social researchers and cellular biologists, we collected a unique data set of 239 black, white, or Mexican adults from a stratified, multistage probability sample of three Detroit neighborhoods. We drew venous blood and measured telomere length (TL), an indicator of stress-mediated biological aging, linking respondents' TL to their community survey responses. We regressed TL on socioeconomic, psychosocial, neighborhood, and behavioral stressors, hypothesizing and finding an interaction between poverty and racial-ethnic group. Poor whites had shorter TL than nonpoor whites; poor and nonpoor blacks had equivalent TL; and poor Mexicans had longer TL than nonpoor Mexicans. Findings suggest unobserved heterogeneity bias is an important threat to the validity of estimates of TL differences by race-ethnicity. They point to health impacts of social identity as contingent, the products of structurally rooted biopsychosocial processes.

Studies have found both gender- and age-related differences in rates of forced expiratory volume at one second (FEV1). FEV1 decline was found to be slower in women than in men, but not at a statistically significant rate. Variability between subjects is also lower in women than in men, and rises with age.

Men with prostate-specific antigen (PSA) levels less than 2 nanograms per milliliter (ng/ml) who have no clinical signs of prostate cancer should only be screened with PSA testing every two years. Researchers associated with the Baltimore Longitudinal Study of Aging analyzed PSA levels in 40 men who developed prostate cancer and 272 without the disease. Men with PSA levels below 2 ng/ml were unlikely to experience elevated levels even after four years and 94% of the cancers found in these men were curable. On the other hand, 30% of the cancers found in men with PSA levels greater than 5 ng/ml were incurable. These men may require annual screening., Objective.--To evaluate prostate-specific antigen (PSA) testing intervals that maintain the detection of curable cancer and reduce unnecessary testing. Design and Patients.--Historical prospective study of serial PSA measurements at 2- and 4-year intervals from frozen serum samples of 40 men who eventually developed prostate cancer and 272 men without prostate cancer who were participants in a prospective aging study (Gerontology Research Center of the National Institute on Aging, the Baltimore Longitudinal Study of Aging) and the case series of 389 consecutive men treated surgically for nonpalpable prostate cancer. Main Outcome Measures.--Probability of a PSA conversion to 4.1 to 5.0 ng/mL and to greater than 5.0 ng/mL at 2 and 4 years and probability of detecting curable prostate cancer by age and PSA level. Results.--When the pretreatment PSA level was less than or equal to 4.0 ng/mL, nonpalpable prostate cancers were highly likely (34/36, 94%) to be curable (organ-confined or capsular penetration with Gleason score 5.0 ng/mL) is rare (0%) after 2 or 4 years when the initial PSA is less than 2.0 ng/mL. PSA conversion to a range at which cancers are likely to be curable and less likely to be small (4.1-5.0 ng/mL) is rare after 2 years (0%-4%) when the baseline PSA level is less than 2.0 ng/mL but common when the baseline PSA level is between 2.1 and 3.0 ng/mL (27%) or 3.1 and 4.0 ng/mL (36%). Conclusions.--These data suggest that for men with no cancer suspected on digital rectal examination, a PSA level of 4.0 to 5.0 ng/mL is an acceptable range for maintaining the detection of curable prostate cancer and a 2-year PSA testing interval is not likely to miss a curable prostate cancer when the initial PSA level is less than 2.0 ng/mL. Recognizing that 70% of a screened population between the ages of 50 years and 70 years have PSA levels less than 2.0 ng/mL, elimination of annual PSA testing for these men would result in large health care cost savings. JAMA. 1997;277:1456-1460

Background. Current knowledge of age-associated increases in blood pressure is based primarily on unscreened population studies that may not be representative of healthy men and women. We examined longitudinal patterns of change in blood pressure in healthy male and female volunteers from the Baltimore Longitudinal Study of Aging (BLSA). Methods. Longitudinal mixed-effects regression models are used to estimate the age-associated changes in blood pressure in 1307 men (age 17-97) and 333 women (age 18-93) who have been followed for up to 32 years (mean: 8.4 years for men and 3.4 years for women) and who have been screened for health problems or medications that affect blood pressure. Results. On average, systolic pressure is relatively stable in men and women until approximately age 45, increases at 5-8 mm Hg per decade in middle age, then accelerates in men and stabilizes in women. Diastolic pressure increases at 1 mm Hg per decade at all ages in men, whereas in women the rate of change in diastolic pressure increases in middle age and then plateaus and may decline after age 70. Additional findings include: (a) BLSA cross-sectional and longitudinal findings are more similar than has been observed in studies of unscreened samples; (b) there is no evidence of a gender cross-over in this group of healthy men and women; and (c) compared to previous studies of unscreened samples, healthy BLSA men and women show a weaker association between baseline blood pressure and subsequent rate of blood pressure change. Conclusions. These findings suggest that several previously described age-associated patterns of blood pressure change partially reflect the effects of hypertension and its treatment, rather than intrinsic age changes in the blood pressure of healthy individuals.

Background. Cross-sectional studies have demonstrated that olfactory function diminishes with increasing age, which may impact on the safety and quality of life of older persons. To date, however, there have been no published longitudinal studies on olfaction. The purpose of this study was to examine the influence of age and gender on smell identification over a 3-year period in a group of generally healthy men and women. Methods. Males (n = 85) and females (n = 76) between the ages of 19 and 95 years were administered the University of Pennsylvania Smell Identification Test (SIT) over a 3-year span as part of the oral physiology component of the Baltimore Longitudinal Study of Aging. A linear mixed-effects regression model was used to determine how longitudinal changes in SIT scores differ with respect to gender, history of medical problems and use of prescription medications. Results. Over the 3-year period, SIT scores diminished progressively with increased age. Women and men in the eighth decade of life experienced a decline of greater than one SIT print per year. Females consistently performed better than males in smell identification. Similar results were obtained regardless of medical problems or medication usage. Conclusions. These results extend the conclusions of previous cross-sectional olfactory studies and indicate that smell identification deteriorates progressively with greater age. Furthermore, age-related declines in olfaction occur even in the absence of overt medical problems.

Increased blood levels of prostate-specific antigen (PSA) as men age may indicate greater risk for developing prostate cancer and other prostate diseases than in men with lower blood levels of PSA. Of 54 men whose blood levels of androgen and PSA were measured over seven to 25 years, 16 did not develop prostate disease, 20 developed benign prostatic hyperplasia (enlargement) (BPH), and 18 developed prostate cancer. Men who developed prostate cancer had a more rapid increase in PSA levels with age than men who developed BPH. Men who developed BPH had a more rapid increase in PSA levels with age than men who did not develop prostate disease. Five years before diagnosis, changes in PSA levels among men who developed BPH were approximately the same as those of men who did not develop prostate disease. The PSA levels of men who developed prostate cancer increased at a much more rapid rate compared to the other two groups, however.

Urinary catecholamine excretion rates have been used as a cross-culturally valid measure of generalized stress. The purposes of this paper are to examine group differences in catecholamine excretion rates in three Samoan groups who differ in degree of modernization and to compare these findings to rates of norepinephrine and epinephrine excretion in other populations. In 1986-1987, 24-hr urine samples were collected from 18-37-year-old Samoans; 46 rural Western Samoan villagers, 53 American Samoans, and 49 Samoans residing in Honolulu. The results show that norepinephrine excretion is significantly higher in more modernized Samoan groups (P < 0.05), while epinephrine excretion is not significantly different in the three groups. The higher norepinephrine excretion rate in the more modernized Samoan groups may be related to differences in relative work load associated with changes in body weight, work capacity, and work patterns which accompany modernization. Samoan epinephrine excretion rates are relatively high compared to the results of other population studies, while norepinephrine excretion in three Samoan samples ranged from among the lowest rates observed worldwide to among the highest.

In 1981 extensive questionnaire and interview data were collected on some 100 young Samoan adults. Five years later in 1986 we determined their whereabouts and divided the data in accordance with migration status. The answers of the 35 who had migrated in the intervening period were contrasted to those 65 who remained in Samoa. The migrants differed in several distinct areas. Migrants reported a higher degree of peer-reliance as a personal adaptive strategy. Migrants also reported large numbers of individuals in social support networks, a higher quality of support and more community involvement. They also report less expressive display of anger. Those who did not migrate reported a slightly better view of life in Samoa and abroad, as well as better relations with their friends and neighbors. These findings support a hypothesis that migrants are pre-selected to fit into migrant communities and do not appear to be misfits who are unhappy with life in Samoa.