Comparison of reflux esophagitis and its complications between African Americans and non-Hispanic whites

AIM: To determine the effect of ethnicity on the severity of reflux esophagitis (RE) and its complications. METHODS: A retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from January 1 to March 31, 2001 was performed. Inclusion criteria were endoscopic evidence of esophagitis using the LA classif ication, reflux related complications and self-reported ethnicity. The data obtained included esophagitis grade, presence of a hiatal hernia, esophageal ulcer, stricture and Barrett's esophagus, and endoscopy indication. RESULTS: The search identified 259 patients with RE or its complications, of which 171 were non-Hispanic whites and 88 were African Americans. The mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture and hiatal hernia frequency were likewise similar in the groups. Barrett's esophagus was present more often in non-Hispanic whites than in African Americans (15.8% vs 4.5%; P < 0.01). Heartburn was a more frequent indication for endoscopy in non-Hispanic whites with erosive esophagitis than in African Americans (28.1% vs 7.9%; P < 0.001). CONCLUSION: Distribution of RE grade and frequency of reflux-related esophageal ulcer, stricture andhiatal hernia are similar in non-Hispanic whites and African Americans. Heartburn was more frequently and nausea/vomiting less frequently reported as the primary endoscopic indication in non-Hispanic whites compared with African Americans with erosive esophagitis or its complications. African Americans have a decreased prevalence of Barrett's esophagus compared with non-Hispanic whites.

African Americans,hypertension and the renin angiotensin system

African Americans have exceptionally high rates of hypertension and hypertension related complications. It is commonly reported that the blood pressure lowering efficacy of renin angiotensin system(RAS) inhibitors is attenuated in African Americans due to a greater likelihood of having a low renin profile. Therefore these agents are often not recommended as initial therapy in African Americans with hypertension. However, the high prevalence of comorbid conditions, such as diabetes, cardiovascular and chronic kidney disease makes treatment with RAS inhibitors more compelling. Despite lower circulating renin levels and a less significant fall in blood pressure in response to RAS inhibitors in African Americans, numerous clinical trials support the efficacy of RAS inhibitors to improve clinical outcomes in this population, especially in those with hypertension and risk factors for cardiovascular and related diseases. Here, we discuss the rationale of RAS blockade as part of a comprehensive approach to attenuate the high rates of premature morbidity and mortality associated with hypertension among African Americans.

Qualitative Study among African American Parents to Inform an Intervention to Promote Adoption of the Dietary Guidelines for Americans Food and Physical Activity Recommendations

This qualitative study was conducted to enable the research team to culturally tailor an intervention to increase adherence to Dietary Guidelines for Americans (DGA) in African American parents and their children living in Lower Mississippi Delta (LMD) communities. Focus group results guided the planning of an obesity prevention intervention utilizing the We Can! (Ways to Enhance Children’s Activity and Nutrition) obesity prevention program. Main outcome measure was perceptions of approaches to use in culturally tailoring a nutrition and physical activity intervention. Six focus group sessions were conducted with 86 African American adults to identify cultural concerns, intervention strategies in two Louisiana parishes in the LMD. Focus groups discussions were audio recorded, transcribed, and analyzed to identify recurring trends and patterns among focus groups. Major themes that emerged included cultural influences on food habits and physical activity, challenges of meeting the DGA and the CDC physical activity guidelines, facilitators and barriers to adhering to healthy food and physical activity guidelines and program development. Wider acceptance and use of the DGA recommendations are needed by LMD populations, leading to reduced prevalence of overweight and obesity and parallel reductions in the prevalence of chronic diseases. Interventions are needed that will enhance adherence to the DGA particularly for diverse subpopulations in the U.S. This study provides important insights for culturally tailoring an intervention to promote adoption of the DGA in two low-income African American Delta communities.

Poverty Status and Clustering of Cardiometabolic Risk Factors and Metabolic Syndrome among African Americans: Results from the National Health and Nutritional Examination Survey 2001-2006

Background: African Americans (AA) are disproportionally affected by cardiovascular disease as compared to other racial-ethnic groups. Exposure to adverse socioeconomic conditions may partially explain disparities in risk factors and prevalence and cardiovascular diseases for AA. We aim to study the impact of poverty status on metabolic syndrome (MetS) and its components among African Americans. Methods: We used data from the National Health and Nutritional Examination Survey (NHANES) cycles 2001-2006. We defined MetS using the Joint Scientific Definition as the presence of any 3/5 components: elevated blood pressure (BP), elevated triglycerides (TGL), lower high-density lipoprotein cholesterol (LDL), elevated fasting plasma glucose (FPG), and elevated waist circumference (WC). Poverty to income ratio (PIR) was categorized as below poverty (<1), above poverty (1 - 3) and high income (>3) groups. We used multivariable survey-weighted logistic regression models to study the impact of poverty status of prevalence of MetS and its components among AA men and women. Results: Overall, the average aggregate prevalence of MetS among AA sample was 22% in our study with prevalence being 25% for women and 18% among men (p < 0.001). In regression models, among women, living below poverty (PIR < 1) was associated with a higher prevalence/odds of having metabolic syndrome compared to those living in the high-income group (PIR > 3) (OR = 1.57, 95%CI = 1.00 - 2.46, p = 0.05) with no association observed among men (OR (PIR < 1 vs PIR >= 1) = 0.70, 95%CI = 0.43 - 1.19, p = 0.13). Further, similar associations were observed for individual components among women including: elevated waist circumference (OR = 2.04, 95%CI = 1.37, 3.01, p < 0.001), elevated triglycerides (OR = 1.85, 95%CI = 1.02 - 3.36, p = 0.04), reduced HDL (OR = 2.04, 95%CI = 1.15, 3.60, p = 0.02) and elevated blood pressure (OR = 2.16, 95%CI = 1.34 - 3.49, p = 0.002) as compared to women in high income group (PIR > 3). No association of poverty status with MetS and its components were observed among AA men. Clustering of factors identified key groups that define MetS among women included WC. Conclusion: African American women living below poverty have a higher likelihood of having MetS and 4 of 5 individual components. Clustering of these factors differ across men and women and should be further explored as tools for clinical management. Main Points: 1) Metabolic syndrome remains an important public health burden among African Americans and shows disparities by socioeconomic status;2) Women living below poverty were more likely to have MetS and associated components as compared to women living above poverty;3) Clustering of components gave us snapshot of factors that should be considered to develop gender specific targeted health interventions for MetS among African Americans.

The association of depression and perceived stress with beta cell function between African and Haitian Americans with and without type 2 diabetes

Background: Diabetes and diabetes-related complications are major causes of morbidity and mortality in the United States. Depressive symptoms and perceived stress have been identified as possible risk factors for beta cell dysfunction and diabetes. The purpose of this study was to assess associations between depression symptoms and perceived stress with beta cell function between African and Haitian Americans with and without type 2 diabetes. Participants and Methods: Informed consent and data were available for 462 participants (231 African Americans and 231 Haitian Americans) for this cross-sectional study. A demographic questionnaire developed by the Primary Investigator was used to collect information regarding age, gender, smoking, and ethnicity. Diabetes status was determined by self-report and confirmed by fasting blood glucose. Anthropometrics (weight, and height and waist circumference) and vital signs (blood pressure) were taken. Blood samples were drawn after 8 10 hours over-night fasting to measure lipid panel, fasting plasma glucose and serum insulin concentrations. The homeostatic model assessment, version 2 (HOMA2) computer model was used to calculate beta cell function. Depression was assessed using the Beck Depression Inventory-II (BDI-II) and stress levels were assessed using the Perceived Stress Scale (PSS). Results: Moderate to severe depressive symptoms were more likely for persons with diabetes (p = 0.030). There were no differences in perceived stress between ethnicity and diabetes status (p = 0.283). General linear models for participants with and without type 2 diabetes using beta cell function as the dependent variable showed no association with depressive symptoms and perceived stress;however, Haitian Americans had significantly lower beta cell function than African Americans both with and without diabetes and adjusting for age, gender, waist circumference and smoking. Further research is needed to compare these risk factors in other race/ethnic groups.

COVID-19 among African Americans and Hispanics:Does gastrointestinal symptoms impact the outcome?

BACKGROUND The coronavirus disease 2019(COVID-19)disproportionately affected African Americans(AA)and Hispanics(HSP).AIM To analyze the significant effectors of outcome in African American patient population and make special emphasis on gastrointestinal(GI)symptoms,laboratory values and comorbidities METHODS We retrospectively evaluated the medical records of 386 COVID-19 positive patients admitted at Howard University Hospital between March and May 2020.We assessed the symptoms,including the GI manifestations,comorbidities,and mortality,using logistic regression analysis.RESULTS Of these 386 COVID-19 positive patients,257(63.7%)were AAs,102(25.3%)HSP,and 26(6.45%)Whites.There were 257(63.7%)AA,102(25.3%)HSP,26(6.45%)Whites.The mean age was 55.6 years(SD=18.5).However,the mean age of HSP was the lowest(43.7 years vs 61.2 for Whites vs 60 for AAs).The mortality rate was highest among the AAs(20.6%)and lowest among HSP(6.9%).Patients with shortness of breath(SOB)(OR2=3.64,CI=1.73-7.65)and elevated AST(OR2=8.01,CI=3.79-16.9)elevated Procalcitonin(OR2=8.27,CI=3.95-17.3),AST(OR2=8.01,CI=3.79-16.9),ferritin(OR2=2.69,CI=1.24-5.82),and Lymphopenia(OR2=2.77,CI=1.41-5.45)had a high mortality rate.Cough and fever were common but unrelated to the outcome.Hypertension and diabetes mellitus were the most common comorbidities.Glucocorticoid treatment was associated with higher mortality(OR2=5.40,CI=2.72-10.7).Diarrhea was prevalent(18.8%),and GI symptoms did not affect the outcome.CONCLUSION African Americans in our study had the highest mortality as they consisted of an older population and comorbidities.Age is the most important factor along with SOB in determining the mortality rate.Overall,elevated liver enzymes,ferritin,procalcitonin and C-reactive protein were associated with poor prognosis.GI symptoms did not affect the outcome.Glucocorticoids should be used judiciously,considering the poor outcomes associated with it.Attention should also be paid to monitor liver function during COVID-19,especially in AA and HSP patients with higher disease severity.

Elderly African Americans Insights on the COVID-19 Pandemic: An Exploratory Study of Risk Perception and Personal, Social, and Cultural Factors

This exploratory study examined elderly African Americans attitudes on the COVID-19 pandemic by identifying their perceptions of risk based personal, social, and cultural factors. It seeks to understand their insights toward public health pandemic response initiatives and other efforts to mitigate COVID-19 outbreak response measures impacting elderly African Americans, including policies, interventions, and public information/communication. The effectiveness of pandemic response measures and community caregiving support for the elderly African Americans was examined as well. Respondents in this study were a convenient sample of 60 residents predominantly in a Midwestern metropolitan area. Respondents were eligible for study participation if 1) there were 60 years and over and, 2) African American or people of African descent. A mixed research method design comprising focus groups and online survey was used to collect the data for the study. The respondents characterized the impact of the coronavirus as a personal, family, and community loss (e.g., less socially engaged and burdensome). An overwhelming majority (98.3%) expressed no worries about getting health care if they or their family members needed it. A sizable number of respondents expressed the need for all to be tested to help prevent the spread of the virus.

Gut microbiome profiling and colorectal cancer in African Americans and Caucasian Americans

AIM To determine whether and to what extent the gut microbiome is involved in regulating racial disparity in colorectal cancer(CRC). METHODS All patients were recruited and experiments were performed in accordance with the relevant guidelines and regulations by the Institutional Review Boards (IRB), committees of the John D. Dingell VAMC and Wayne State University guidelines. African American (AA) and Caucasian American (CA) patients were scheduled for an outpatient screening for colonoscopy, and no active malignancy volunteer patients were doubly consented, initially by the gastroenterologist and later by the study coordinator, for participation in the study. The gut microbial communities in colonic effluents from AAs and CAs were examined using 16 sRNA profiling, and bacterial identifications were validated by performing SYBR-based Real Time PCR. For metagenomic analysis to characterize the microbial communities, multiple software/tools were used, including Metastats and R statistical software.RESULTS It is generally accepted that the incidence and mortality of CRC is higher in AAs than in CAs. However, the reason for this disparity is not well understood. We hypothesize that the gut microbiome plays a role in regulating this disparity. Indeed, we found significant differences in species richness and diversity between AAs and CAs. Bacteroidetes was more abundant in AAs than in CAs. In particular, the pro-inflammatory bacteria Fusobacterium nucleatum and Enterobacter species were significantly higher in AAs, whereas probiotic Akkermansia muciniphila and Bifidobacterium were higher in CAs. The polyphyletic Clostridia class showed a divergent pattern, with Clostridium XI elevated in AAs, and Clostridium IV, known for its beneficial function, higher in CAs. Lastly, the AA group had decreased microbial diversity overall in comparison to the CA group. In summary, there were significant differences in pro-inflammatory bacteria and microbial diversity between AA and CA, which may help explain the CRC disparity between groups.CONCLUSION Our current investigation, for the first time, demonstrates microbial dysbiosis between AAs and CAs, which could contribute to the racial disparity of CRC.

Effect of Medical Advice for Diet on Diabetes Self-Management and Glycemic Control for Haitian and African Americans with Type 2 Diabetes

Adequate care of type 2 diabetes is reflected by the individual’s adherence to dietary guidance;yet, few patients are engaged in diabetes self-care at the recommended level, regardless of race/ethnicity. Few studies on the effect of dietary medical advice on diabetes self-management (DSM) and glycemic control have been conducted on Haitian and African American adults with type 2 diabetes. These relationships were assessed in total of 254 Blacks with type 2 diabetes (Haitian Americans = 129;African Americans = 125) recruited from Miami-Dade and Broward Counties, Florida by community outreach methods. Although dietary advice received was not significantly different between the two Black ethnicities, given advice “to follow a diet” as a predictor of “using food groups” was significant for Haitian Americans, but not for African Americans. Haitian Americans who were advised to follow a diet were approximately 3 times more likely to sometimes or often use food groups (or exchange lists) in planning meals. Less than optimal glycemic control (A1C > 7.2) was inversely related to DSM for African Americans;but the relationship was not significant for Haitian Americans. A one unit increase in DSM score decreased the odds ratio point estimate of having less than optimal glycemic control (A1C > 7.2%) by a factor of 0.94 in African Americans. These results suggest that medical advice for diet plans may not be communicated effectively for DSM for some races/ethnicities. Research aimed at uncovering the enablers and barriers of diet management specific to Black ethnicities with type 2 diabetes is recommended.

Perceptions and Receipt of Cancer Screening among African Americans: A Community Networks Program Project

Objective: Minority groups constitute one of the nation’s highest cancer risk groups. Historically, these groups have not been adequately informed about cancer, its prevention and/or treatment. The purpose of this study was to examine participants’ receipt of cancer screening and to explore perceptions of barriers to and facilitators of cancer screening. Methods: A two-part study design consisting of a survey and focus group was conducted among African Americans residents of neighborhoods geographically defined as low-income areas of Chattanooga, Memphis, and Nashville in the state of Tennessee. The survey was administered to 1071 participants, and 12 focus groups were conducted with a total of 112 participants, with both sets of participants being residents of similarly defined underserved communities served by the community health centers. Results: Overall, 51% of surveyed respondents were females;the majority (75%) had a yearly income of less than $25,000;and 67% reported 12 years of education or less. Most surveyed respondents had a family history of cancer. More than 30% and 64% of male respondents over 50 years old did not receive prostate cancer and colorectal cancer screening, respectively;58% of women 50 years and older were not screened for colorectal cancer;28% of women over 40 years old did not receive breast cancer screening. Barriers to cancer screening included: lack of information about cancer screening and treatments, cost of cancer treatment and fear. The need for more information about cancer and cancer treatment, as well as the involvement of churches to increase cancer screening awareness was identified as facilitators. Conclusion: This study provides information into the structural and psychological barriers in cancer screening. It describes the self-reported prevalence/frequency of screening among men and women in our target population, and the associated facilitators to screening.

Identification of a novel germline missense mutation of the androgen receptor in African American men with familial prostate cancer

Race, family history and age are the unequivocally accepted risk factors for prostate cancer （PCa）. Androgen receptor （AR）-dependent signaling is an important element in prostate carcinogenesis and its progression to metastatic disease. We examined the possibility of genomic changes in the AR in association with familial PCa in African Americans who have a higher incidence and mortality rate and a clinically more aggressive disease presentation than Caucasians. Genomic DNAs of 60 patients from 30 high-risk African American and Caucasian families participating in the Louisiana State University Health Sciences Center genetic linkage study of PCa were studied. Exon-specific polymerase-chain reaction, bi-directional automated sequencing and restriction enzyme genotyping were used to analyze for mutations in the coding region of the AR gene. We identified a germline AR （A1675T） （T559S） substitution mutation in the DNA-binding domain in three PCa-affected members of an African- American family with a history of early-onset disease. The present study describes the first AR germline mutation in an African-American family with a history of familial PCa. The AR （T559S） mutation may contribute to the disease by altering AR DNA-binding affinity and/or its response to androgens, non-androgenic steroids or anti-androgens. Additional studies will be required to define the frequency and contribution of the AR （A 1675T） allele to early-onset and/or familial PCa in African Americans.

Poor CD4 count is a predictor of untreated depression in human immunodeficiency virus-positive African-Americans

AIM: To determine if efforts to improve antiretroviral therapy(ART) adherence minimizes the negative impact of depression on human immunodeficiency virus(HIV) outcomes. METHODS: A cross-sectional study of a clinic-based cohort of 158 HIV seropositive(HIV+) African Americans screened for major depressive disorder(MDD) in 2012. CD4 T lymphocyte(CD4+) counts were obtained from these individuals. Self-report on adherence to ART was determined from questionnaire administered during clinic visits. The primary outcome measure was conditional odds of having a poorer CD4+ count(< 350 cells/mm3). Association between CD4+ count and antidepressant-treated or untreated MDD subjects was examined controlling for self-reported adherence and other potential confounders. RESULTS: Out of 147 individuals with available CD4+ T lymphocyte data, 31% had CD4+ count < 350 cells/mm^3 and 28% reported poor ART adherence. As expected the group with > 350 cells/mm^3 CD4+ T lymphocyte endorsed significantly greater ART adherence compared to the group with < 350 cells/mm3 CD4+ T lymphocyte count(P < 0.004). Prevalence of MDD was 39.5% and 66% of individuals with MDD took antidepressants. Poor CD4+ T lymphocyte count was associated with poor ART adherence and MDD. Adjusting for ART adherence, age, sex and education, which were potential confounders, the association between MDD and poor CD4+ T lymphocyte remained significant only in the untreated MDD group.CONCLUSION: Therefore, CD4+ count could be a clinical marker of untreated depression in HIV+. Also, mental health care may be relevant to primary care of HIV+ patients.

A comprehensive cardiovascular disease lifestyle treatment controlled trial among high-risk African Americans

Background: The purpose of this study was to assess the effects of a comprehensive lifestyle intervention on modifiable cardiovascular risk factors among high-risk African Americans. Methods: The study included a randomized treatment/controlled intervention trial among 136 African Americans residing in Atlanta, GA who were overweight and had elevated blood pressure. The treatment group was exposed to 3-months of a multi-component intervention and the control to an abbreviated 6-week intervention after the completion of the treatment group’s intervention. The main outcomes included mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), mean waist circumference, mean body mass index (BMI), mean number of times exercise per week, mean number of servings of fruits and vegetables per day, and mean level of daily stress. Data were collected at baseline and at 6-month follow-up. Separate linear regressions were used with an established significance level of P P P = 0.002). Conclusion: These results show that a comprehensive lifestyle intervention can improve cardiovascular risk factor profile among high risk African Americans. Caregivers should encourage patients to participate in such programs and public health policymakers should allocate resources to community based health oriented organizations to implement comprehensive lifestyle program.

Stress intervention and disease in African American lupus patients: The balancing lupus experiences with stress strategies (BLESS) study

Very little is known about the impact of psychosocial stress on underlying biological mechanisms in African American lupus patients, although African American women display the highest rates of lupus. Due to the exposure of African Americans to a unique trajectory of stressors throughout the life course, it may be critical to understand the relationship between psychosocial stress and underlying biological mechanisms that influence disease activity and pathology in this high risk group. To begin to fill this research void, an evidence-based self-management program was piloted among a cohort of African American lupus patients participating in a SLE database project at the Medical University of South Carolina (MUSC). To assess disease activity, during each clinic visit, a history is obtained, and physical examination, phlebotomy, and urine collection are performed. SLE Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) scores are assessed at each visit. Disease data corresponding with data collection timeframes for each participant were extracted from the MUSC SLE Database to assess the effectiveness of the program. Several differences were observed between the intervention and control groups on symptoms pertaining to lupus activity, and many of these differences had large effect sizes. Our findings can be rapidly translated into improved delivery of health care and targeted trials/interventions with relevance to health disparities, and if widely implemented, morbidities and mortality related to lupus could be drastically reduced in African-Americans.

The Benefits and Barriers Related to Regular Participation in Physical Activity by African-American Women: Implications for Intervention Development

A common strategy for improving health behaviors is to emphasize the benefits and reduce the barriers to behavior change. This study investigated potential differences in perceived benefits and barriers related to participation in physical activity (PA) between women in pre-maintenance versus the maintenance phase of PA behavior to determine if perceived benefits were greater and perceived barriers lower in women with more extensive and successful PA participation experience. Data were collected from a community-based sample (N = 113) of middle-aged African-American women. The sample was stratified into two groups according to how long they had been regularly engaging in PA (6 months or longer versus less than 6 months). Chi-square analyses were conducted to investigate possible differences between the two groups of women in regard to perceived benefits and barriers associated with PA. Descriptive data showed that nearly all of the benefits and barriers to PA were perceived as being important for a majority of the participants and chi-square and t-test results indicated few significant between-group differences (p < .05) in regard to these perceptions. Additional analyses indicated there was no significant between-group difference (p < .05) for Body Mass Index. The results suggest the benefits and barriers related to PA behavior are already valued and understood by many African-American women. Further, the results do not support the commonly held belief that effective health behavior improvement programming should emphasize the benefits and reduce the barriers related to the behavior. Practitioners should consider focusing on other evidenced based factors proven to promote PA behavior such as counseling regarding social support (e.g., buddy system) and increasing self-efficacy (e.g., goal setting) to initiate and sustain a physically active lifestyle.

Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography

BACKGROUND Left atrial(LA)enlargement is a marker of increased risk in the general population undergoing stress echocardiography.African American(AA)patients with hypertension are known to have less atrial remodeling than whites with hypertension.The prognostic impact of LA enlargement in AA with hypertension undergoing stress echocardiography is uncertain.AIM To investigate the prognostic value of LA size in hypertensive AA patients undergoing stress echocardiography.METHODS This retrospective outcomes study enrolled 583 consecutive hypertensive AA patients who underwent stress echocardiography over a 2.5-year period.Clinical characteristics including cardiovascular risk factors,stress and echocardiographic data were collected from the electronic health record of a large community hospital.Treadmill exercise and Dobutamine protocols were conducted based on standard practices.Patients were followed for all-cause mortality.The optimal cutoff value of antero-posterior LA diameter for mortality was assessed by receiver operating characteristic analysis.Cox regression was used to determine variables associated with outcome.RESULTS The mean age was 57±12 years.LA dilatation was present in 9%(54)of patients(LA anteroposterior≥2.4 cm/m^(2)).There were 85 deaths(15%)during 4.5±1.7 years of follow-up.LA diameter indexed for body surface area had an area under the curve of 0.72±0.03(optimal cut-point of 2.05 cm/m^(2)).Variables independently associated with mortality included age[P=0.004,hazard ratio(HR)1.34(1.10-1.64)],tobacco use[P=0.001,HR 2.59(1.51-4.44)],left ventricular hypertrophy[P=0.001,HR 2.14(1.35-3.39)],Dobutamine stress[P=0.003,HR 2.12(1.29-3.47)],heart failure history[P=0.031,HR 1.76(1.05-2.94)],LA diameter≥2.05 cm/m^(2)[P=0.027,HR 1.73(1.06-2.82)],and an abnormal stress echocardiogram[P=0.033,HR 1.67(1.04-2.68)].LA diameter as a continuous variable was also independently associated with mortality but LA size≥2.40 cm/m^(2) was not.CONCLUSION LA enlargement is infrequent in hypertensive AA patients when traditional reference values are used.LA enlargement is independently associated with mortality when a lower than“normal”threshold(≥2.05 cm/m^(2))is used.

Trust in the State Courts： Hispanic and African American Communities

The paper aims to compare the levels ofa＇ust Caucasians, African Americans, Hispanics, and other minority groups have in state courts. The paper presents four hypothesize which contend that African Americans, Hispanics, and other minority groups have lower levels of trust in state courts in comparison to Caucasians. Using data from a 2001 Justice at Stake Public Survey, a multivariate regression analysis was performed to assess the validity of each hypothesis. The variable for Race/Ethnicity was used as a baseline allowing for the comparison of levels of trust among each racial/ethnic group. The findings indicate that African Americans have a lower level of trust in state courts in comparison to their Caucasian and other minority counterparts and vice versa. Surprisingly, Hispanics were found to have no more or less trust in state courts when compared to Caucasians, African Americans, and other minority groups. Further research regarding trust in state courts should be carried out in both African American and Hispanic communities. Lastly, it is noteworthy to mention that the data set contained some limitations, such as its age and the exclusion of＂Asian＂ in the racial/ethnic categories.

HEALS: A Faith-Based Hypertension Control Program for African-Americans: A Feasibility Study

Objective: To determine the feasibility of a behavioral faith-based PREMIER study modified hypertension (HTN) control intervention in a semi urban African-American (AA) church. Methods: In a prospective longitudinal study design, a 12-week behavioral HEALS (Healthy Eating and Living Spiritually) intervention was tested for its feasibility and efficacy in a semi urban AA church. High-risk adult church members with HTN were recruited. Program sessions were weekly delivered by the trained church members. Data were analyzed using repeated measures ANOVA. Results: 22 of 34 subjects (65% retention) provided complete information on the outcome measures. Mean systolic blood pressure (SBP) reduction from baseline was 22 mmHg (p < 0.001) and 6.5 mmHg for diastolic BP (p = 0.0048). Mean weight reduction of 3.11 kg from the baseline (p < 0.0001) was also observed. 91% subjects attended 7 - 9 sessions. Conclusion: Promoting behavioral HTN control interventions in high risk AAs by empowering AA church communities is feasible and efficacious.

Pain, Struggle, and Hope： An African American Reading of Mildred D. Taylor＇s The Land

The Land （2001） is a powerful coming-of-age story by African-American writer Mildred D. Taylor. Through vividly depicting the mental and physical pains suffered by black people as well as the undying hope of protagonist Paul in the struggle of achieving social and economic independence by obtaining a land of his own, Mildred D. Taylor not only pungently exposes the evils of racism but also successfully builds up positive image of black character in The Land. Based on African American criticism theory and close reading of the text, the present paper aims at exploring the central themes of pain, struggle, and hope presented in the novel with the hope of interpreting the historical and realistic significance of the novel.

Correlates and Covariates of Type 2 Diabetes in an African American Population in the Washington DC Area

In the United States, type 2 diabetes mellitus (T2DM) disproportionately affects the African American (AA) community, which has not been systematically included in molecular studies of underlying mechanisms. As part of a gene expression study, we recruited cases with T2DM and matched, unaffected controls at an urban hospital in Washington, DC, with a majority AA population. Here we describe the profile of socio-demographic, behavioral, and health-related associations of the study population. Self-reported data were collected from cases with T2DM (N = 77) and age- and gender-matched controls (N = 80), ages 45 - 65 years. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). As expected, obesity, hypertension, and cardiovascular disease were more prevalent in cases than in controls. Tobacco smoking and working alongside other tobacco smokers were also associated with T2DM. After adjusting for covariates, current tobacco smoking remained statistically associated with the disease (OR per half pack of cigarettes 1.43, 95% CI 1.04 - 1.95;p-value 0.027). HbA1c levels were elevated in T2DM cases who smoked more than a pack of cigarettes daily. These associations highlight the comorbid burdens of T2DM in an AA urban community setting and identify tobacco control as an unmet need for future prevention and control efforts.