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Dementia can be overwhelming to families and their caregivers. Informal caregiving is a widespread mode of providing dementia care in African American communities, yet impact of caregiving on informal or family caregivers in African American communities is burdensome. This study aimed to describe the lived experiences of informal caregivers of African American People Living with Dementia (PLWD) to understand their perceptions of dementia and dementia care, caregiver support needs, and service needs. Interpretive phenomenological qualitative inquiry guided this study to understand caregivers' experiences and needs. Ten family caregivers of African American PLWD in the community participated in this study. Data were collected through in-depth interviews and a diary study approach to document and interpret caregivers' experiences. The data analysis was based on procedures of content analysis. Four major themes emerged from the in-depth interviews: caregiver burden, familism, lack of information and community-based resources, and desire and need for culturally appropriate community-based resources. Triangulated diary entry data complemented the in-depth interviews with similar themes. This study highlights how African American informal caregivers of PLWD face various caregiving needs and challenges in dementia care including lack of culturally appropriate community resources and information. The study illustrates that African American cultural beliefs of familism are significant aspects of their caregiving experience and their coping strategies. These study results provide a useful foundation for various stakeholders to develop culturally targeted interventions and programs to support African American informal caregivers and their family members with dementia. [ABSTRACT FROM AUTHOR]

Introduction: Recent years have witnessed an increase in highly publicized attacks targeting members of ethnoracial and religious minority groups. To date, existing research has primarily focused on the tendency for such "trigger events" to generate violent aftershocks. We argue that beyond such ripple effects, highly salient trigger events significantly increase hate-crime related stress among racial and ethnic minorities. Additionally, we explore whether these effects are limited to the group most clearly targeted, or if they "spill over" to other minoritized communities. Methods: To study reactions to hate crimes, we draw upon national survey data (N = 1,122) in combination with a natural experiment involving the Unite the Right rally and vehicle attack in Charlottesville, Virginia in August 2017. We employ an "unexpected event during survey" design to estimate the causal effect of the Charlottesville rally on stress about hate crimes. Results: We first show that there was an increase in anti-Black hate crimes in the 2 weeks following the Charlottesville incident. We also find a corresponding increase in stress due to the perception of personal vulnerability to hate crimes among African-Americans. However, we do not observe a significant increase in levels of stress following the trigger event among Hispanics and Asian Americans. Discussion: Our results suggest that highly publicized instances of intergroup violence can have significant impacts on stress about hate crime victimization within the target group. However, we find that this effect is short-lived, and that both violent aftershocks and the general climate of fear spurred by hate crimes may be racially bounded. [ABSTRACT FROM AUTHOR]

AbstractThe police-perpetrated killings of George Floyd in 2020 and Tyre Nichols in 2023, respectively, provide a unique opportunity for comparison of news content. Both incidents were recorded on video and appear to be characterized by unwarranted aggression and brutality. A key difference worth exploring is the race of the perpetrator(s). In the case of Floyd, the killer, Derek Chauvin, was white, while Nichols’ killers were black. The purpose of the present research was to comparatively examine how the Fox News website framed these two police-perpetrated killings. Quantitative content analysis was used to examine Fox News website coverage of the murders of Floyd and Nichols during the one-month periods following the publicity of both incidents. Findings were consistent with researcher expectations that Fox News would be more sympathetic to Nichols than Floyd, and more critical of the black police officers who killed Nichols than the white officer who killed Chauvin. In all, eight out of the study’s ten sub-hypotheses were supported. [ABSTRACT FROM AUTHOR]

Opioid misuse among African-Americans (AAs) has increased over the last two decades. However, there has been surprisingly little investigation into when/how AAs initiate their misuse of opioids. The purpose of this study, therefore, was to identify opioid misuse initiation patterns among AAs and assess whether these patterns differed from those of White Americans. The research goals were to identify the: (1) age at which opioid misuse initiation among AAs occurs, (2) opioids that AAs most commonly use at initiation, and (3) source of opioids used at initiation. Qualitative interview data are also presented to contextualize the circumstances surrounding initiation. Data were drawn from The Florida Minority Health Survey, a mixed-methods project that included online surveys (n = 403) and qualitative in-depth interviews (n = 30). Data collection was conducted from August 2021 to February 2022 throughout the state of Florida. The sample was approximately three-fourths male, half was age 34 or younger, and consisted of 303 AA and 100 White adults. Analyses revealed that AAs and White Americans differed somewhat in the way they begin their opioid misuse. While AAs and White Americans both tended to initiate with prescription opioids (not heroin), AAs initiated at younger ages and mostly acquired opioids through non-healthcare related sources (e.g. friends, dealer). These findings add to the limited research on opioid misuse initiation and provide important data to providers by identifying when/how AAs begin their use of opioids. [ABSTRACT FROM AUTHOR]

IntroductionRecent years have witnessed an increase in highly publicized attacks targeting members of ethnoracial and religious minority groups. To date, existing research has primarily focused on the tendency for such “trigger events” to generate violent aftershocks. We argue that beyond such ripple effects, highly salient trigger events significantly increase hate-crime related stress among racial and ethnic minorities. Additionally, we explore whether these effects are limited to the group most clearly targeted, or if they “spill over” to other minoritized communities.MethodsTo study reactions to hate crimes, we draw upon national survey data (N = 1,122) in combination with a natural experiment involving the Unite the Right rally and vehicle attack in Charlottesville, Virginia in August 2017. We employ an “unexpected event during survey” design to estimate the causal effect of the Charlottesville rally on stress about hate crimes.ResultsWe first show that there was an increase in anti-Black hate crimes in the 2 weeks following the Charlottesville incident. We also find a corresponding increase in stress due to the perception of personal vulnerability to hate crimes among African-Americans. However, we do not observe a significant increase in levels of stress following the trigger event among Hispanics and Asian Americans.DiscussionOur results suggest that highly publicized instances of intergroup violence can have significant impacts on stress about hate crime victimization within the target group. However, we find that this effect is short-lived, and that both violent aftershocks and the general climate of fear spurred by hate crimes may be racially bounded.

To identify disciplinary alternatives to replace spanking, this study investigated ethnic differences in the associations of five disciplinary techniques with subsequent externalizing behavior problems in a national sample of 7- to 11-year-olds with ANCOVAs and difference-score analyses. Most techniques led to significant reductions in externalizing problems for African-Americans or Hispanics, but only after overcoming known biases in ANCOVA and not for other European-Americans. Privilege removal had the most significantly effective results, followed by grounding. Sending children to their room and spanking significantly reduced externalizing problems only in one or two analyses for African-Americans, whereas removing children's allowance was significantly effective in one overall analysis. Parenting research needs to distinguish between more vs. less effective use of all disciplinary techniques across multiple situational and cultural contexts. [ABSTRACT FROM AUTHOR]

Since their inception, public libraries in the United States have been understood to be free for all to use. Yet throughout their history, socio-political currents and developments limited or barred access for certain segments of the population. The paper looks at the accessibility for women and Black Americans during the 1850–1950 period, taking into account the image of women in the Victorian and New South era, as well as the Jim-Crow segregation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the thickness of the macular retina and central choroid in an indigenous population from Ghana, Africa and to compare them with those measured among individuals with European or African ancestry. Design: Cross-sectional study, systematic review, and meta-analyses. Participants: Forty-two healthy Ghanaians, 37 healthy individuals with European ancestry, and an additional 1427 healthy subjects with African ancestry from previously published studies. Methods: Macular retinal thickness in the fovea, parafovea, and perifovea and central choroidal thickness were extracted from OCT volume scans. Associations with ethnicity, age, and sex were assessed using mixed-effect regression models. Monte Carlo simulations were performed to determine the sensitivity of significant associations to additional potential confounders. Pooled estimates of retinal thickness among other groups with African ancestry were generated through systematic review and meta-analyses. Main Outcome Measures: Macular retinal thickness and central choroidal thickness and their association with ethnicity, age, and sex. Results: When adjusted for age and sex, the macular retina and central choroid of Ghanaians are significantly thinner as compared with subjects with European ancestry (P < 0.001). A reduction in retinal and choroidal thickness is observed with age, although this effect is independent of ethnicity. Meta-analyses indicate that retinal thickness among Ghanaians differs markedly from that of African Americans and other previously reported indigenous African populations. Conclusions: The thickness of the retina among Ghanaians differs not only from those measured among individuals with European ancestry, but also from those obtained from African Americans. Normative retinal and choroidal parameters determined among individuals with African or European ancestry may not be sufficient to describe indigenous African populations. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

OBJECTIVE: Little is known about the scope and role of discriminatory experiences in dentistry. The purpose of this study is to document the experiences that American Indian/Alaska Native (AI/AN), Black, and Hispanic dentists have had with discrimination. METHODS: This study reports data from a 2012 nationally representative study of dentists documenting experiences with discrimination during their dental careers or during dental school by the setting of the discrimination, the providers education, and geographic location. This study does not differentiate between levels of discrimination and focuses holisticly on the experience of any discrimination. RESULTS: Seventy-two percent of surveyed dentists reported any experience with discrimination in a dental setting. The experiences varied by race/ethnicity, with 49% of AI/AN, 86% Black, and 59% of Hispanic dentists reporting any discriminatory experiences. Racial/ethnic discrimination was reported two times greater than any other type. CONCLUSIONS: Experiences with racial/ethnic discrimination are prevalent among AI/AN, Black, and Hispanic dentists, suggesting that as a profession work is needed to end discrimination and foster belonging.

Abstract Introduction Inequities in clinical care may contribute to racial disparities observed in studies of heart disease morbidity and cardiogenetic testing outcomes. There is a lack of research aimed at understanding the complexity of those inequities, but stigma likely contributes. This qualitative exploratory study helps close that gap in the literature by describing intersectional stigma manifestations perceived by the Black cardiomyopathy patient population at one academic medical center. Methods Qualitative interviews were conducted with 14 Black cardiomyopathy patients. Interviews aimed to elicit patients’ experiences with discrimination related to diagnosis, symptoms, genetic testing, knowledge of genetic results, genetic counseling, providers’ actions, and providers’ communication. The interview guide was informed by The Health Stigma and Discrimination Framework. Data were also collected about participant demographics, type of cardiomyopathy, age of diagnosis, documentation of relevant family history, and completion of genetic counseling and/or genetic testing. Results More than half of participants reported intersectional stigma manifestations related to their race, age, and/or weight while receiving care from cardiologists, nurse practitioners, genetic counselors, or clinical support staff. Stigma manifestations included physical roughness during patient care, withholding diagnostically-relevant information from the patient, impersonal care, coercion, and use of offensive stereotyped language by providers. These stigma manifestations impacted access to care, uptake of genetic testing, timeline to diagnosis, patient emotion, patient-provider trust, and adherence to medical recommendations. Conclusions This study provides nuanced qualitative descriptions of stigma manifestations that affect patient and clinical outcomes in cardiology care and genetic services in one medical center in the Southeastern United States. The results of this study suggest that provider bias and stigma manifestations have an adverse effect on cardiogenetic and clinical outcomes among Black cardiomyopathy patients. Clinical interventions are suggested to assist health professionals in providing culturally-competent and respectful care. These results help inform patient-provider communication, clinical policies, and evidence-based practice in cardiology care and genetics. Continued study of this topic across more institutions and with a larger sample size is needed to confirm the generalizability of the conclusions.

Optimism is associated with reduced mortality risk among Whites, but evidence for this relationship is limited among African-Americans, whose life expectancy is shorter than Whites. This study examined the association between optimism and mortality rate in African-Americans. Data were from African-American women (n = 2652) and men (n = 1444) in the United States from the Jackson Heart Study. Optimism was measured using the Life Orientation Test-Revised at the baseline period (2000-2004), and mortality data were obtained until 2018. Using Cox proportional hazards models, we estimated hazard ratios (HRs) of mortality by optimism level, controlling for sociodemographic factors, depressive symptoms, health conditions, and health behaviors. In secondary analyses, we evaluated potential effect modification by sex, age, income, and education. Higher optimism was related to lower mortality rates (HR = 0.85, 95% confidence interval [CI] = 0.74, 0.99), controlling for sociodemographic factors and depressive symptoms. After further adjusting for health conditions and health behaviors, associations were slightly attenuated (HR = 0.89; 95%CI = 0.77, 1.02). Stronger associations between optimism and mortality were observed in men, among those with higher income or education, and with age ≤ 55 (all ps for interaction terms

Introduction: Inequities in clinical care may contribute to racial disparities observed in studies of heart disease morbidity and cardiogenetic testing outcomes. There is a lack of research aimed at understanding the complexity of those inequities, but stigma likely contributes. This qualitative exploratory study helps close that gap in the literature by describing intersectional stigma manifestations perceived by the Black cardiomyopathy patient population at one academic medical center. Methods: Qualitative interviews were conducted with 14 Black cardiomyopathy patients. Interviews aimed to elicit patients' experiences with discrimination related to diagnosis, symptoms, genetic testing, knowledge of genetic results, genetic counseling, providers' actions, and providers' communication. The interview guide was informed by The Health Stigma and Discrimination Framework. Data were also collected about participant demographics, type of cardiomyopathy, age of diagnosis, documentation of relevant family history, and completion of genetic counseling and/or genetic testing. Results: More than half of participants reported intersectional stigma manifestations related to their race, age, and/or weight while receiving care from cardiologists, nurse practitioners, genetic counselors, or clinical support staff. Stigma manifestations included physical roughness during patient care, withholding diagnostically-relevant information from the patient, impersonal care, coercion, and use of offensive stereotyped language by providers. These stigma manifestations impacted access to care, uptake of genetic testing, timeline to diagnosis, patient emotion, patient-provider trust, and adherence to medical recommendations. Conclusions: This study provides nuanced qualitative descriptions of stigma manifestations that affect patient and clinical outcomes in cardiology care and genetic services in one medical center in the Southeastern United States. The results of this study suggest that provider bias and stigma manifestations have an adverse effect on cardiogenetic and clinical outcomes among Black cardiomyopathy patients. Clinical interventions are suggested to assist health professionals in providing culturally-competent and respectful care. These results help inform patient-provider communication, clinical policies, and evidence-based practice in cardiology care and genetics. Continued study of this topic across more institutions and with a larger sample size is needed to confirm the generalizability of the conclusions. [ABSTRACT FROM AUTHOR]

Cinemas are often used as an element of escapism and a representation of reality to the audience. Cinema also plays a crucial part in developing and sustaining racial cultural ideas and attitudes in the United States of America and globally. Since the 1830s, African Americans have appeared in film as either shown unfavorably or as small-minded people in comparison to their white peers. In a famous film in America, “Birth of Nation”, a white actor who acted as African American was portrayed as savagely violent who seized on Caucasian women. Despite the inaccurate portrayal of African Americans in the film, identical tropes have continued to emerge in the film industry since the 1920s. Therefore, this paper studies the representation of African Americans in Hollywood films using Critical Race Theory. Two Hollywood films will be used as a comparative case study namely Steve McQueen’s 12 Years A Slave (2013) and Gerard Bush and Christopher Renz’s Antebellum (2020) respectively. The result shows the importance of race and racism in society, several common types of racial prejudice have been detected in the films. Pathological stereotypes have also been presented through the films and the white characters show their power and control towards the African Americans who once had equal privilege with them.

The COVID–19 pandemic has greatly affected college students nationwide. Recent research suggests that the COVID–19 pandemic has disproportionately impacted African–American young adults. The infection case rates, hospitalizations, and death rates in African–American populations are 2–5 times higher than among White populations. The intergenerational trauma and systemic racism that African–Americans have faced in past and present times have fomented conditions that lead to vulnerability within this historically resilient community. These stresses and losses increase the risks of anxiety and substance use. This study examined the relationship between COVID‐19‐related anxiety and substance use, and how adaptive coping and optimism influence this relationship in African–Americans young adults. Results reveal that COVID‐related anxiety predicts alcohol and drug use. Optimism and adaptive coping are related to lower pandemic‐related anxiety, alcohol, and drug use among African–American young adults. [ABSTRACT FROM AUTHOR]

BackgroundFive-year survival on dialysis is only 40%, compared to 74% with a deceased donor kidney transplant (DDKT) and 87% with a living donor kidney transplant (LDKT). An American Society of Transplantation (AST) Consensus Conference recommended that patients with chronic kidney disease (CKD) Stages 3-5 have the opportunity to learn about and decide which treatment option is right for them, particularly about LDKT. However, early education about LDKT and DDKT outside of transplant centers is inconsistent and often poor, with patients in CKD 3 and 4 and ethnic/racial minorities even less likely to receive it. A new randomized control trial (RCT), in partnership with Kaiser Permanente Southern California (KPSC), will assess knowledge gaps and the effectiveness of a supplementary video-guided, print and technology-based education intervention for English- and Spanish-speaking patients in CKD Stages 3, 4, and 5 to increase LDKT knowledge and decision-making. To date, no published LDKT educational interventions have studied such a large and diverse CKD population.MethodsIn this RCT, 1200 English and Spanish-speaking CKD Stage 3-5 patients will be randomly assigned to one of two education conditions: ET@Home or KPSC standard of care education. Randomization will be stratified by CKD stage and primary language spoken. Those in the ET@Home condition will receive brochures, postcards, DVDs, and text messages delivering educational content in modules over a six-month period. Baseline data collection will measure demographics, transplant derailers, and the amount of previous CKD and transplant education they have received. Changes in CKD and transplant knowledge, ability to make an informed decision about transplant, and self-efficacy to pursue LDKT will be captured with surveys administered at baseline and at six months.DiscussionAt the conclusion of the study, investigators will understand key knowledge gaps for patients along the CKD continuum and between patients who speak different languages and have assessed the effectiveness of both English- and Spanish-language supplementary education in increasing KPSC patients' knowledge about the opportunities for and risks and benefits of LDKT. We hope this program will reduce disparities in access to transplant.Trial registrationClinicalTrials.gov Identifier: NCT03389932; date registered: 12/26/2017.

The goals of this article are to trace and analyze the complex relationship that the United States has built with the notion of genocide and to identify its political, geopolitical and memorial aspects. From the first debates on the conceptualization of the crime of genocide after the Holocaust and until the ratification of the UN Convention in 1948 (debates in which the United States was heavily involved), it was clear that the definition of the term genocide was a difficult and sensitive matter. Since 1948, even while the United States did not ratify this convention until 1988, the use of the term raised questions. These uses were often related to possible diplomatic or military interventions to prevent ongoing massacres and to commemorative activities. This article discusses the position of U.S. authorities vis-à-vis the major cases of mass violence during the 20th and 21st centuries and contrasts it with the difficulties of the United States in memorializing the dark pages of its own national history.

Students from minoritized backgrounds, who disproportionately face higher poverty rates, are more likely to encounter risk factors, which tend to undermine individuals' broader well-being by compromising self-regulatory processes. Yet, sociocultural theory highlights the presence of minoritized families' cultural wealth. Consistent with a focus on assets, it is notable that college enrollment rates have increased among Black and Latino students in the U.S. Using a mixed methods approach, the current study integrated asset and risk frameworks, in order to advance knowledge on the context of minoritized teens' college preparedness, defined here as making decisions and taking action steps toward college. Participants included low-income, predominantly Black and Latino families with adolescents (n = 344). First, drawing from the voices of families, we examined responses to open-ended questions about aspirations, supports, and challenges. Salient themes included social-emotional and social-cultural factors. Indicators of cumulative contextual risk and cumulative individual risk were based on the qualitative data. Second, we tested whether the linkage from cumulative risk indices to teens' college preparedness occurred via various dimensions of self-regulation (i.e., lower impulsivity, more cognitive control, and better organization skills), net of background characteristics. Adolescents' organization skills were a significant mediator. Possible next steps for research are discussed. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the efficacy and mediation of a culturally appropriate, theory-based HIV/STI (sexually transmitted infection) risk-reduction intervention delivered in barbershops by barbers via iPads to African-American young men in reducing sexual risk behaviors. In a cluster randomized controlled trial, 24 matched pairs of barbershops serving African-American men ages 18–24 in the 10 Philadelphia, PA zip codes with the highest HIV/AIDS prevalence were randomized to implement via iPads one of 2 interventions: "Shape Up! Barbers Building Better Brothers," an HIV/STI risk-reduction intervention based on the theory of planned behavior and formative research or an attention-matched violence-prevention control intervention. The primary outcome was self-reported consistent condom use 3, 6, and 12 months postintervention, controlling for baseline consistent condom use. Participants were 618 men, 319 in the HIV/STI intervention and 299 in the control intervention. Generalized estimating equation analysis indicated that the direct effect of the HIV/STI intervention in increasing consistent condom use postintervention was nonsignificant (odds ratio = 1.13, 95% confidence interval: 0.73–1.75), adjusting for clustering among participants in barbershops and baseline condom use. However, mediation analysis using the product-of-coefficients approach revealed indirect effects of the intervention. Consistent with the theory of planned behavior, the intervention increased behavioral beliefs and self-efficacy regarding using condoms, which raised condom use intention, which, in turn, boosted consistent condom use. Sexual risks among young African-American men can be reduced by barber-led theory-based, culturally appropriate HIV/STI risk-reduction interventions in barbershops in high HIV prevalence neighborhoods that increase behavioral beliefs and self-efficacy. [ABSTRACT FROM AUTHOR]

Expanding on previous industry guidance relative to increased clinical trial diversity, while honing more exacting treatments and better ways to fight diseases that have often disproportionately impacted people of color, is a topic being discussed by multidisciplinary public health experts across the nation. This writing draws attention to the African American demographic, which is continually subject to health care disparities. Any glimpses of knowledge or medical discovery that could potentially help to redress harm or reinforce a weakened familial-cultural infrastructure should be emphasized for sanative restoration of the impacted communities. The focus of this writing is the African American cohort and its nexus to Benign Ethnic Neutropenia as the diverse target population of discussion, hoping to convey a harmonized approach in the examination of (1) the African American Benign Ethnic Neutropenia cohort within the context of basic scientific understanding, (2) the interplay of applicable governing regulatory protections, and (3) increased clinical trial participation to enlarge the pathway for increased diversity in clinical trials. [ABSTRACT FROM AUTHOR]

This paper focuses on one of the most important screenplays, Django Unchained (2012), by the famous Hollywood auteur Quentin Tarantino. The story revolves around the life of a slave family, and Django is the central protagonist, a runaway slave, who had suffered at the hands of the slave owners. The methodology used for the investigation of the portrayal of Django is the textual analysis, given the qualitative nature of the research. The theoretical base of the investigation is the Critical Race Theory, which upholds the pervading and continuous presence of racism against African-Americans, and most specifically, in its institutionalized manifestation. The paper finds that though there are elements of melodrama and surrealism, the representation of Django takes the proto-form of the magical hero. The hero overcomes dire circumstances with the help of Dr. Schultz. The research finds that despite the apparent mainstream representation of the African-Americans, Tarantino did succeed in not only highlights but also contemporariness the racism, discrimination and marginality of the African-Americans.

The article is devoted to the military mobilization of the African-American community to the USA Army during the First World War; the expectations of African-Americans of participating in hostilities on the fronts of World War I in the U.S. Army; and the point of view of the U.S. government and military on the role of African-Americans as part of the U.S. Army. This question remains relevant today, as some aspects of the problem are still not studied enough in world historiography. The research methodology involves general scientific and special historical research methods. The integrated approach helped to combine different theoretical aspects of the issues under the study and relate them to specific historical events, based on which it was possible to trace the positions of different segments of society on both national and financial grounds regarding the role of African-American soldiers at the front. The chronological approach contributed to the study of the topic in historical retrospect, the study of the sequence of events of the mobilization activities and the arrival of African-American soldiers on the European front. The biographical approach identified certain individuals who played a key role in the mobilization of African-Americans and their further distribution in the military. A statistical approach to studying the problem made it possible to determine the number of African-Americans involved in the American armed corps in Europe and their relationship between combat and support battalions. The scientific novelty of the paper is that the study of the position of the African-American community in the mobilization of the First World War, their expectations and realities, called the racist position of the establishment and the army, are studied. The paper concludes that World War I was the first global event to give the African-American community hope for equal rights within its state. In practice, due to the predominance of racists in the command structure, the recruitment of African-Americans to the military was soon reduced, and segregation and racial discrimination remained within its borders.

[Display omitted] • Black hypertensive patients had higher copeptin levels than White hypertensives. • Copeptin levels fell in Black but not White patients after HCTZ. • Copeptin values remained higher in Black patients after HCTZ than in White patients. • There may be an ADH-related mechanism for hypertension in Black patients. • This may explain the propensity of Black patients to volume-sensitive hypertension. • We could not define a value of copeptin to identify those more responsive to HCTZ. Among hypertensive patients, plasma renin activity is lower and the response to diuretic monotherapy greater in volume responsive hypertensive patients. We hypothesized that hormones influencing extracellular volume such as vasopressin / antidiuretic hormone (ADH) might permit the development of a simple test to identify those with volume-related hypertension. Such a test might be of particular benefit to the Black population which is purported to have a higher incidence of volume-related and responsive hypertension. Thus, using copeptin, a surrogate marker for ADH, we studied if there were differences in this hormone between those with and without volume responsive hypertension. Serum copeptin was measured in biobanked blood samples from the Genetic Epidemiology of Responses to Antihypertensives (GERA) I study and analyzed with other variables from the study dataset. There was no relationship between PRA and copeptin values nor could the response in blood pressure be predicted by the copeptin values. However, baseline copeptin levels were higher in Black than in White subjects (7.5 pmol/L vs 5.4 pmol/L, P < 0.001) while plasma sodium and calculated plasma osmolality were slightly lower in keeping with the concept that Black subjects have more volume-related hypertension. In addition, after hydrochlorothiazide (HCTZ), copeptin was significantly lower in Black (6.2 pmol/L, P = 0.004) but unchanged in White subjects (5.2 pmol/L, P = 0.901) and there were also changes in sodium. The current study suggests differences in ADH physiology between hypertensive Black and White patients. However, the use of copeptin to identify volume responsive patients could not be confirmed. [ABSTRACT FROM AUTHOR]

ObjectiveDepression in late life is associated with substantial suffering, disability, suicide risk, and decreased health-related quality of life. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a depression diagnosis is derived from a constellation of symptoms that may be described differently by different people. For example, the DSM language may be inadequate in capturing these symptoms in certain populations such as African-Americans, whose rates of depression misdiagnosis is high.MethodsThis study reports the findings from a church-based, qualitative study with older African-Americans (n = 50) regarding the language they use when discussing depression and depression treatment, and how this compares to the DSM-IV depression criteria. Content analyses of the in-depth discussions with African-American male and female focus group participants resulted in a deeper understanding of the language they used to describe depression. This language was then mapped onto the DSM-IV depression criteria.ResultsWhile some words used by the focus group participants mapped well onto the DSM-IV criteria, some of the language did not map well, such as language describing irritability, negative thought processes, hopelessness, loneliness, loss of control, helplessness, and social isolation.ConclusionsThe focus group setting provided insight to the language used by older, church-going African-Americans to describe depression. Implications include the advantages of using qualitative data to help inform clinical encounters with older African-Americans.

Disparities in diet-related diseases persist among African-Americans despite advances in risk factor identification and evidence-based management strategies. Cooking is a dietary behavior linked to improved dietary quality and cardiometabolic health outcomes. However, epidemiologic studies suggest that African-American adults report a lower frequency of cooking at home when compared to other racial groups, despite reporting on average cooking time. To better understand cooking behavior among African-Americans and reported disparities in behavior, we sought to develop a survey instrument using focus group-based cognitive interviews, a pretesting method that provides insights into a survey respondent’s interpretation and mental processing of survey questions. A comprised survey instrument was developed based on input from a community advisory board, a literature review, and a content review by cooking behavior experts. The cognitive interview pretesting of the instrument involved African-American adults (n = 11) at risk for cardiovascular disease who were recruited from a community-based participatory research study in Washington, D.C., to participate in a focus group-based cognitive interview. Cognitive interview methodologies included the verbal think-aloud protocol and the use of retrospective probes. Thematic analysis and evaluation of verbalized cognitive processes were conducted using verbatim transcripts. Five thematic themes related to the survey were generated: (1) Clarity and relevancy of question items; (2) influence of participants’ perspectives and gender roles; (3) participant social desirability response to questions; (4) concern regarding question intent. Eleven survey items were determined as difficult by participants. Cooking topics for these items were: cooking practices, cooking skills, cooking perception (how one defines cooking), food shopping skills, and socialization around cooking. Question comprehension and interpreting response selections were the most common problems identified. Cognitive interviews are useful for cooking research as they can evaluate survey questions to determine if the meaning of the question as intended by the researcher is communicated to the respondents—specific implications from the results that apply to cooking research include revising questions on cooking practice and skills. Focus-group-based cognitive interviews may provide a feasible method to develop culturally grounded survey instruments to help understand disparities in behavior for culturally relevant diet behaviors such as cooking.

Background and objective: Black men have an increased risk of prostate cancer mortality compared with any racial or ethnic group. Further, research on prostate cancer prevention and control messaging focusing on Black men is limited. Community screening events are successful in attracting members from high-risk groups, like Black men, and are a valuable source to collect cancer screening and health promotion data. Therefore, the authors examined data of Black men attending a community-based PCa screening event to evaluate predictors of annual PCa screening, and identify sub-populations of Black men needing targeted cancer prevention messaging. Methods: Black men attending PCa screening events in St. Louis, MO 2007–2017 were eligible. Participants completed either a mail-in or on-site survey at the time of their screening to collect information on annual screening history. We analyzed sociodemographic factors, having a first-degree relative with a history of PCa, healthcare utilization characteristics, and predictors of annual PSA screening. Logistic regression analysis was used to assess the association between predictors and annual PSA screening. Results: Data was analyzed from 447 respondents. One-third of the residents did not know their cancer family history status. Older age and having a primary healthcare provider predicted an annual prostate cancer after attending the PCa community screening event. In the fully adjusted model, all ages older than 45 years were 2–4 times more likely to have an annual PCa screening. Having a healthcare provider also predicted an annual PCa screening (OR: 4.59, 95% CI: 2.30–9.14). Conclusion: Regardless of sociodemographic and family history factors, older Black men and those with a primary physician are more likely to have an annual PSA screening. Cancer prevention promotion efforts for Black men should target mechanisms that facilitate family cancer history conversations to engage younger Black men. Also, additional health promotions efforts are needed to educate Black men without a primary healthcare provider.

Background: There is limited information on new onset poststroke dementia (NPSD) in sub-Saharan Africa (SSA). We estimated incidence, cumulative incidence, risk factors and outcome of NPSD at 1 year in Nigerian survivors of a first-ever stroke. Methods: Hospital-based prospective observational study. Assessments for global cognition, learning, memory, executive and activities of daily life (ADL) functioning were conducted at 3 poststroke timepoints (Baseline, 3- and 12 months). NPSD was ascertained according to the "National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria." Outcomes were assessed using the modified Rankin Scale (mRS), center for epidemiologic studies depression scale (CES-D 10), health related quality of life in stroke patients (HRQOLISP-26) and caregivers strain index (CSI). Results: Among 144 stroke survivors who were free of dementia at baseline, we found a 1-year cumulative incidence of 4.52% (95% C.I = 3.20, 6.39). In multivariate Cox regression analyses, diabetes was associated with NPSD (Hazard Ratio = 2.10, 95% CI = 1.02, 4.35). NPSD at 3 months was independently associated with motor decline [Mean difference (MD) in mRS = 1.6, 95% C.I = 0.9, 2.3)], depression (MD in CES-D = 2.9, 95% C.I = 0.3, 5.4), caregivers burden (MD in CSI = 1.2, 95% C.I = 0.5, 1.8), and poor quality of life (MD in HRQOLISP-26 = −11.2, 95% C.I = −15.7, −6.8) at 1 year. Conclusion: Approximately 4.5% of stroke survivors in Nigeria had NPSD at 1 year. Diabetes, which can be prevented, represent a primary prevention target for NPSD and its consequences in SSA. [ABSTRACT FROM AUTHOR]

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We formulate a MIDUS longitudinal data-based multi-population LISREL model to gauge variation among Black and White Americans in the reciprocal relationship across time between perceived major and everyday discrimination, and psychological distress. Two hypotheses building on prior theory and empirical findings are generated: reciprocity between perceived discrimination and distress, and stronger reciprocity among Blacks. Here, "reciprocity" denotes positive effects of perceived discrimination and mental health problems such as distress on each other across time. Both hypotheses are supported for relationships between perceived everyday discrimination and distress. The model controls for several potentially relevant variables. [ABSTRACT FROM AUTHOR]

This article grapples with the unlikely combination of veganism, righteous black bodies, and servitude as expressed in the "divine holistic culture" of the African Hebrew Israelite Community (AHIC). Based on our ethnography of how the Community re-scripts strong, virile black male bodies from rough brutes to responsible and righteous patriarchs, we show how the Hebrew Israelites' vegan diet undergirds their Biblically based culture and fuels their salvation project. We propose the term "culinary redemption" to encapsulate the dramatic shift made by the AHIC from a theology based on salvation in the afterlife to a restorative cosmology in the here and now, and suggest that the food and foodways of other subaltern groups also provide powerful material for initiating social justice movements and religious change. [ABSTRACT FROM AUTHOR]

ObjectivesThe purpose of this paper is to describe the Black dentist workforce, the practice patterns of providers, and their contributions to oral health care for minority and underserved patients.MethodsA national sample survey of underrepresented minority dentists was conducted in 2012 and received a 32.6 percent response rate for self-reported Black dentists. Data were weighted for selection and response bias to be nationally representative. Descriptive and multivariable statistics were computed to provide a workforce profile of Black dentists. National comparisons are provided from published data.ResultsAmong all Black dentists (weighted n = 6,254), 76.6 percent self-identify as African-American, 13.2 percent as African, and 10.3 percent as Afro-Caribbean. The largest share of Black dentists are male, married, heterosexual, born in the United States and raised in a medium to large city. One third of Black dentists were the first in their family to graduate from college. Black dentists report higher average educational debt than all dental students, with graduates from International Dentist Programs having the greatest debt. Traditional practices (i.e., private practices) dominate, with 67.1 percent of Black dentists starting out in this setting and 73.5 percent currently in the setting. Black dentists care for a disproportionate share of Black patients, with an average patient mix that is 44.9 percent Black. Two in five Black dentists reported their patient pool is made up of more than 50 percent Black patients.ConclusionsThe underrepresentation for Black dentists is extraordinary, and the Black dentists that are in practice are shouldering a disproportionate share of dental care for minority and underserved communities.

African-Americans are diagnosed with more aggressive prostate cancers and have worse survival than Caucasians, however a comprehensive understanding of this health disparity remains unclear. To clarify the mechanisms leading to this disparity, we analyzed the potential involvement of miR-34b expression in African-Americans and Caucasians. miR-34b functions as a tumor suppressor and has a multi-functional role, through regulation of cell proliferation, cell cycle and apoptosis. We found that miR-34b expression is lower in human prostate cancer tissues from African-Americans compared to Caucasians. DNA hypermethylation of the miR-34b-3p promoter region showed significantly higher methylation in prostate cancer compared to normal samples. We then sequenced the promoter region of miR-34b-3p and found a chromosomal deletion in miR-34b in African-American prostate cancer cell line (MDA-PCA-2b) and not in Caucasian cell line (DU-145). We found that AR and ETV1 genes are differentially expressed in MDA-PCa-2b and DU-145 cells after overexpression of miR-34b. Direct interaction of miR-34b with the 3' untranslated region of AR and ETV1 was validated by luciferase reporter assay. We found that miR-34b downregulation in African-Americans is inversely correlated with high AR levels that lead to increased cell proliferation. Overexpression of miR-34b in cell lines showed higher inhibition of cell proliferation, apoptosis and G1 arrest in the African-American cells (MDA-PCa-2b) compared to Caucasian cell line (DU-145). Taken together, our results show that differential expression of miR-34b and AR are associated with prostate cancer aggressiveness in African-Americans.

Abstract Population studies point to regional and ethnicity‐specific differences in genetic predisposition for some lysosomal storage disorders (LSDs). The aim of the study was to determine the prevalence of the three treatable forms of lysosomal storage disorders (Gaucher disease [GD], Pompe disease [PD], and Fabry disease [FD]) in a cohort of mostly urban‐dwelling individuals of African ancestry, a previously unknown genetic landscape for LSDs. Large‐scale selective multistep biochemical and genetic screening was performed in patients seeking healthcare for various health concerns. Fluorimetric enzyme assays for GD, PD, and FD were performed on dried blood spots. Targeted gene sequencing was performed on samples that showed significantly lower enzyme activities ( G; p.T158A, (b) c.503G > T; p.R168L, (c) c.1985del. Regarding FD, two subjects had pathogenic GLA mutations, and four had single nucleotide polymorphisms in the 5'UTR, previously implicated in modulating gene expression. The findings highlight a higher incidence of abnormal enzyme levels and pathogenic mutations in the target population reflecting ancestry‐based specific genotype and phenotype variations.

Aim: Assess factors associated with EGFR TKI initiation among patients with metastatic non-small-cell lung cancer (mNSCLC). Patients & methods: Medicare Part D patients diagnosed with non-squamous mNSCLC and starting an EGFR TKI within 1 year of diagnosis were selected from the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Associations between patient characteristics and time from diagnosis to treatment initiation (time-to-treatment [TTT]) were analyzed. Results: Among the sample (n = 890), the patients who were younger, African–American or from rural communities had significantly longer TTT. Patients who did not receive surgery, who were Asian and those with brain metastases had significantly shorter TTT. Conclusion: Patient demographics and clinical characteristics may affect timeliness of EGFR TKI treatment for mNSCLC. Future research should examine potential barriers to treatment. This study aimed to identify factors that may affect the time to initiate treatment with a product in the EGFR TKI class of drugs for patients with metastatic non-small-cell lung cancer (mNSCLC). We used an anonymized database that combines health information on cancer patients (SEER) with insurance claims information for Medicare Part D patients. Our study included 890 patients. We found that patients who were younger, African–American or from rural communities had longer times to starting treatment. Patients who did not receive surgery, who were Asian and those with cancer that had spread to the brain had notably shorter times to starting treatment. Further research should examine potential barriers that may contribute to treatment initiation delay. #RWE study finds patients with #metastatic non-small-cell #lungcancer who were younger, African–American or from rural communities had longer time-to-treatment initiation with #EGFR TKIs. Time to initiation was shorter for patients with no surgery, who were Asian or with brain metastases. [ABSTRACT FROM AUTHOR]

Extending the rich literature about women-of-color activism, this article analyzes the ways Chicago-based Chicanas and Black women maintain, build, and expand low-income residents' access to and ownership of the city. I draw on 30 months of community-engaged, ethnographic fieldwork within high-poverty Mexican- and African-American neighborhoods and on interviews with 22 women-of-color activists across Chicago. Combining the cultural signifiers "ratchet" and "rasquache," I highlight the strategic use of discursive and aesthetic frames to disrupt negative narratives of these women's activism and their often-vilified communities. As a framework, ratchet-rasquache activism counters urban development practices that marginalize Black and Chicana/o/x communities. Emerging from African-American communities, "ratchet" connotes unruliness and low-class behavior. In Mexican communities, "rasquache" similarly connotes negative or low-class behavior but also means making the most with the tools one has. Both concepts, rooted in working-class sensibilities, can subvert narratives of racial uplift and reject normative whiteness as the standard for both activism and community development. Deploying "ratchet" and "rasquache" as positive attributes, Chicago-based women-of-color activists used nonhierarchical community-organizing tactics to operate as neighborhood strategists. Acknowledging the strength and expertise within marginalized, impoverished communities, they embraced a working-class, asset-based, ratchet and rasquache strategy, while striving to build something from something. [ABSTRACT FROM AUTHOR]

This article uses Ernst Fraenkel's concept of the "dual state" as the vehicle for examining the role of "lynch law" as a mode of governance of African Americans in the United States from 1865 to 1940 (roughly). It begins with a largely jurisprudential inquiry placing my interpretation of Ernst Fraenkel's distinction between the normative state and the prerogative state in dialogue with a version of American Legal Realism, in which law consists entirely of "moves" such as permissible distinctions and analogies that are treated (sociologically) as acceptable by relevant professional communities. Seen through that lens the distinction between the normative state and the prerogative state thins out. The arbitrariness Fraenkel associates with the prerogative state infects the normative state and the prerogative state is pervaded by norms that aren't mere simulacra of legal norms. The two kinds of state are different in degree rather than in kind—but differences in degree can matter. Part II uses the revised distinction in a preliminary examination of lynch law in the U.S. South. Lynch law was not an example of Fraenkel's prerogative state; the norms enforced through lynch law might have been popular versions of norms drawn from the prerogative state. And yet "lynch law" was different not only in content from the rules of law formally applicable to all people in the United States but also in the lived experience of those subject to lynch law. Lynch law might not have been arbitrary in the sense that it had no knowable normative content, but, perhaps because the norms were popular rather than legislated or formal, it was substantially vaguer than the formal law and significantly less able to guide the choices made by those subject to it. [ABSTRACT FROM AUTHOR]

Carolyn H Still,1 Chris Burant,1 Shirley Moore,1 Doug Einstadter,2,3 Cheryl Killion,1 Charles Modlin,4 Sophia Sundararajan,5,6 John D Thornton,3,7 Jackson T Wright Jr,5,6 Martha Sajatovic6,8 1Frances Payne Bolton, School of Nursing, Case Western Reserve University, Cleveland, OH, USA; 2Center for Health Care Research and Policy, Case Western Reserve University, Cleveland, OH, USA; 3The MetroHealth System, Cleveland, OH, USA; 4Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; 5Case Western Reserve University, School of Medicine, Cleveland, OH, USA; 6University Hospitals Cleveland Medical Center, Cleveland, OH, USA; 7Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, OH, USA; 8Department of Psychiatry and of Neurology, Case Western Reserve University, School of Medicine, Cleveland, OH, USACorrespondence: Carolyn H StillFrances Payne Bolton, School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, USATel: +1 216 368 6338Email cwh11@case.eduBackground: African American (AA) male survivors of strokes or transient ischemic attacks (TIA) have the highest risk of recurrent stroke when compared to other racial-ethnic men. However, there is a paucity of evidence-based strategies, including organizational, educational, or behavioral interventions, that targets secondary stroke risk reduction in AA men.Methods: Targeted Management for Reducing Stroke Risk (TEAM) is an ongoing, 6-month prospective, randomized controlled trial that will determine whether a curriculum-guided self-management approach, using peer dyads (men who had a stroke or TIA and their care partners) will improve post-stroke care in AA men.Results: The study sample will consist of 160 AA men who have experienced a stroke or TIA within 5 years, randomized to TEAM or Wait-list control group. The primary outcome changes in systolic blood pressure (BP) and high-density lipoprotein (HDL), while secondary outcomes include diastolic BP, total cholesterol, low-density lipoprotein, triglycerides, and glycemic control for diabetics. We hypothesize that AA men in TEAM will have significantly lower systolic BP and higher HDL when compared to AA men in the Wait-list control group at 6-month.Conclusion: Persistent disparities for stroke burden in AA men highlight the need for novel interventions to promote secondary stroke-risk reduction. Building on promising pilot data, TEAM uses a group format, with a nurse and patient co-led intervention focused on AA men and family needs, practice in problem-solving, and attention to emotional and role management. In addition, the TEAM approach may help reduce stroke risk factors and health disparities in AA men.Clinicaltrials.gov Identifier: NCT04402125.Keywords: stroke, transient ischemic attack, stroke prevention, African-Americans, health disparities

Abstract Background African-Americans/Blacks have suffered higher morbidity and mortality from COVID-19 than all other racial groups. This study aims to identify the causes of this health disparity, determine prognostic indicators, and assess efficacy of treatment interventions. Methods We performed a retrospective cohort study of clinical features and laboratory data of COVID-19 patients admitted over a 52-day period at the height of the pandemic in the United States. This study was performed at an urban academic medical center in New York City, declared a COVID-only facility, serving a majority Black population. Results Of the 1103 consecutive patients who tested positive for COVID-19, 529 required hospitalization and were included in the study. 88% of patients were Black; and a majority (52%) were 61–80 years old with a mean body mass index in the “obese” range. 98% had one or more comorbidities. Hypertension was the most common (79%) pre-existing condition followed by diabetes mellitus (56%) and chronic kidney disease (17%). Patients with chronic kidney disease who received hemodialysis were found to have lower mortality, than those who did not receive it, suggesting benefit from hemodialysis Age > 60 years and coronary artery disease were independent predictors of mortality in multivariate analysis. Cox proportional hazards modeling for time to death demonstrated a significantly high ratio for COPD/Asthma, and favorable effects on outcomes for pre-admission ACE inhibitors and ARBs. CRP (180, 283 mg/L), LDH (551, 638 U/L), glucose (182, 163 mg/dL), procalcitonin (1.03, 1.68 ng/mL), and neutrophil:lymphocyte ratio (8.3:10.0) were predictive of mortality on admission and at 48–96 h. Of the 529 inpatients 48% died, and one third of them died within the first 3 days of admission. 159/529patients received invasive mechanical ventilation, of which 86% died and of the remaining 370 patients, 30% died. Conclusions COVID-19 patients in our predominantly Black neighborhood had higher in-hospital mortality, likely due to higher prevalence of comorbidities. Early dialysis and pre-admission intake of ACE inhibitors/ARBs improved patient outcomes. Early escalation of care based on comorbidities and key laboratory indicators is critical for improving outcomes in African-American patients.