Racial and sex differences of fruit and vegetable self-efficacy and intake among college students in a rural, southern location

Objective: To examine fruit and vegetable intake and self-efficacy among U.S. college students in a rural, Southern location. Participants: Undergraduate students (n = 1503) enrolled in a university-wide health class at one large public institution during the spring 2017 semester. Methods: Cross-sectional survey data were collected online and analyzed using independent samples t test, one-way ANOVA, and regression. Results: On average, participants did not meet fruit or vegetable intake recommendations. Mean self-efficacy scores were 17.2 (SD = 3.4) and 16.42 (SD = 3.7) for fruit and vegetables, respectively, with statistically significant differences observed by sex and race (p < 0.05). Hierarchical multiple regression results indicated self-efficacy explained 20.9% (fruit) and 29.3% (vegetables) of the variance in consumption. Similar patterns were found for meeting daily fruit and vegetable intake recommendations. Conclusions: Health campaigns are needed to address sex and racial disparities in college student fruit and vegetable intake and self-efficacy.

Racial differences in dermatologic conditions associated with HIV: A cross-sectional study of 4679 patients in an urban tertiary care center

BACKGROUND

Because of reduced mortality, patients with HIV are living longer and presenting with chronic diseases. Little is known about racial differences in dermatologic conditions associated with HIV infection.

OBJECTIVE

This study examines associated dermatologic conditions in a large population of patients with HIV at a tertiary care center with a diverse patient population.

METHODS

Cross-sectional study of patients with HIV seen between July 14, 2013, and July 14, 2018, in a tertiary health care system. The burden of HIV-related dermatologic conditions was collected by using medical records. Patients with HIV were compared with control individuals of the same race, and significance was assessed using the chi-square test. A Bonferroni correction was performed to control for multiple hypothesis testing.

RESULTS

The study population (N = 4679) was 64.7% male and 69% African American, with 88.7% of patients receiving antiretroviral therapy. African American patients with HIV had a greater risk of oral hairy leukoplakia (odds ratio [OR], 64.49), herpes zoster (OR, 9.27), prurigo nodularis (OR, 8.80), and squamous cell carcinoma (OR, 5.72).

LIMITATIONS

Our data describe patients seen by 1 health care system.

CONCLUSIONS

African American patients with HIV may be at increased risk for pruritic disorders compared with race-matched control individuals and white patients with HIV.

Examining the Association Between Personal Victimization in Adolescence and Intimate Partner Victimization in Adulthood

A large body of research has examined various issues related to repeat victimization, including potential risk factors and theoretical explanations. Despite the amount of studies dedicated to focusing on repeat victimization, there are some notable gaps in the literature. One particularly noteworthy omission in this research is whether there is a link between personal victimization in adolescence and intimate partner violence (IPV) victimization in adulthood. The current study sought to address this gap. To do so, data drawn from the National Longitudinal Study of Adolescent to Adult Health were analyzed. The results revealed a statistically significant and relatively consistent association between personal victimization in adolescence and IPV victimization in adulthood. This association was detected for both males and females, and it was detected even after controlling for low self-control (males and females) and being the perpetrator of IPV (males). We conclude by noting some of the implications of these findings, as well as limitations to the study that need to be addressed in the future.

Ethnic Disparities in Adiposity: Focus on Non-alcoholic Fatty Liver Disease, Visceral, and Generalized Obesity

PURPOSE OF REVIEW

Excessive adiposity has become a public health problem worldwide, contributing to the rise in obesity-related diseases and associated morbidity and mortality. This review details the relative significance of race/ethnicity as it pertains to adiposity and non-alcoholic fatty liver disease (NAFLD).

RECENT FINDINGS

Fat distribution remains a more reliable measure of adiposity than anthropometric measures, with visceral adipose tissue (VAT) associated with increased risk of cardiometabolic disease. While obesity is the most common risk factor for NAFLD, the racial/ethnic prevalence of obesity does not completely parallel NAFLD risk. Combating racial/ethnic disparities in obesity requires understanding differential risk among various groups. Hispanics are disproportionally impacted by NAFLD and have high rates of obesity, VAT, and insulin resistance (IR). This contrasts with Blacks, who have high prevalence of obesity and IR, accompanied by a paradoxically favorable lipid profile and low prevalence of VAT and NAFLD. Many features of adiposity and NAFLD are mediated by genetic and environmental factors, the latter being modifiable and the focus of interventions.

The effect of exercise training on blood pressure in African and Asian populations: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Exercise is key in the primary prevention and management of hypertension. Yet, current exercise recommendations are predominantly based on meta-analyses involving populations of European descent. Since blood pressure (BP) responses to pharmaceutical interventions are known to differ among ethnic groups, we aimed to investigate the BP responses to exercise training in non-European descendants.

PURPOSE

The aim of this study was to systematically summarize the available literature on the efficacy of exercise on BP in healthy adults (age ≥18 years) of African or Asian origin.

METHODS

We searched the MEDLINE database for randomized controlled trials that evaluated the effect of exercise training on BP in healthy African and Asian adults with optimal BP, elevated BP or hypertension and published in a peer-reviewed journal up to May 2019. Random effect models were fitted to estimate the effect sizes.

RESULTS

We identified 22 trials involving individuals of Asian origin (n = 931; mean age: 44 years; 41% male) and four trials involving individuals of African origin (n = 510; mean age: 56.7 years; 80% male). Aerobic exercise training significantly (p < 0.001) reduced systolic and diastolic BP in each ethnic group. Resistance training did not affect the BP of Asian participants with optimal BP. The effect of resistance training in Asians with elevated BP or hypertension and Africans could not be determined due to lack of data. Sub-analyses suggested somewhat larger reductions in systolic BP following aerobic training in hypertensive Africans compared with hypertensive Asians.

CONCLUSIONS

We found favorable effects of aerobic exercise training on BP in the African and the Asian populations. However, the overall low number of studies and especially the lack of data on resistance training and combined training in African and Asian populations warrant more research to improve the quality of evidence.

Prevalence of twenty-four hour urine testing in Veterans with urinary stone disease

OBJECTIVE

The American Urological Association guidelines recommend 24-hour urine testing in patients with urinary stone disease to decrease the risk of stone recurrence; however, national practice patterns for 24-hour urine testing are not well characterized. Our objective is to determine the prevalence of 24-hour urine testing in patients with urinary stone disease in the Veterans Health Administration and examine patient-specific and facility-level factors associated with 24-hour urine testing. Identifying variations in clinical practice can inform future quality improvement efforts in the management of urinary stone disease in integrated healthcare systems.

MATERIALS AND METHODS

We accessed national Veterans Health Administration data through the Corporate Data Warehouse (CDW), hosted by the Veterans Affairs Informatics and Computing Infrastructure (VINCI), to identify patients with urinary stone disease. We defined stone formers as Veterans with one inpatient ICD-9 code for kidney or ureteral stones, two or more outpatient ICD-9 codes for kidney or ureteral stones, or one or more CPT codes for kidney or ureteral stone procedures from 2007 through 2013. We defined a 24-hour urine test as a 24-hour collection for calcium, oxalate, citrate or sulfate. We used multivariable regression to assess demographic, geographic, and selected clinical factors associated with 24-hour urine testing.

RESULTS

We identified 130,489 Veterans with urinary stone disease; 19,288 (14.8%) underwent 24-hour urine testing. Patients who completed 24-hour urine testing were younger, had fewer comorbidities, and were more likely to be White. Utilization of 24-hour urine testing varied widely by geography and facility, the latter ranging from 1 to 40%.

CONCLUSIONS

Fewer than one in six patients with urinary stone disease complete 24-hour urine testing in the Veterans Health Administration. In addition, utilization of 24-hour urine testing varies widely by facility identifying a target area for improvement in the care of patients with urinary stone disease. Future efforts to increase utilization of 24-hour urine testing and improve clinician awareness of targeted approaches to stone prevention may be warranted to reduce the morbidity and cost of urinary stone disease.

It's Not the CSI Effect: Criminal Justice Students' Choice of Major and Career Goals

The media tends to influence public perceptions of the criminal justice system. The media's impact, known as the CSI Effect, is not well documented in criminal justice majors. The present study adds to a small body of literature regarding the impact of media on criminal justice students' decisions, and seeks to identify the factors that influence students' choices, regarding their major/career goals. Based on the results from surveys administered at an urban university in the United States, most criminal justice students reported that they were not influenced by the media, yet the vast majority believed this to be true of their fellow majors. These students chose criminal justice because they found the subject matter interesting and relevant to the real world, and they wanted to work in a field in which they could be a problem solver. Upon graduation, these students overwhelmingly reported an interest in pursuing a career in federal law enforcement. Unfortunately, corrections, a field dedicated to working with offenders, was the lowest preferred profession among criminal justice students.

Determinants of per- and polyfluoroalkyl substances (PFAS) in midlife women: Evidence of racial/ethnic and geographic differences in PFAS exposure

BACKGROUND

Per- and poly-fluoroalkyl substances (PFAS) are public health concerns because of widespread exposure through contaminated foods/drinking water. Although some determinants of PFAS exposure have been suggested, the role of geographic location and race/ethnicity in PFAS exposure has not been well characterized.

OBJECTIVES

We examined potential determinants of PFAS from the Study of Women's Health Across the Nation (SWAN).

METHODS

This study includes 1302 women aged 45-56 years from 5 SWAN sites where white women and women from one minority group were recruited (black from Southeast Michigan, Pittsburgh, Boston; Chinese from Oakland; Japanese from Los Angeles). We determined concentrations of 11 PFAS in serum samples collected in 1999-2000 and examined 7 PFAS detected in most women (>97%). Linear regression with backward elimination was used to identify important determinants of PFAS serum concentrations among a set of pre-specified variables (age, body mass index, site, race/ethnicity, education, financial hardship, occupation, born outside the United States (US), parity, menstrual bleeding within the past year, smoking status, alcohol consumption, and consumption of fish, dairy, pizza, salty snack, and French fries).

RESULTS

Site and race/ethnicity were two major determinants of PFAS. White women had higher concentrations of linear perfluorooctanoic acid (PFOA) compared with the Chinese in Oakland (p < 0.0001) and blacks in Pittsburgh (p = 0.048). Black women in Southeast Michigan and Boston (vs. white women) had higher concentrations of linear (p < 0.001 for Southeast Michigan; p < 0.0001 for Boston) and total perfluorooctane sulfonic acid (PFOS) (p < 0.001 for both Southeast Michigan and Boston) and 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (p = 0.02 for Southeast Michigan; p < 0.001 for Boston). Chinese (Oakland) and Japanese (Los Angeles) women had higher concentrations of perfluorononanoic acid (PFNA) compared with white women in each site (p < 0.01 for both). Within white women, those in Pittsburgh had relatively higher concentrations of PFAS. Within Chinese and Japanese women, those who were born outside the US had significantly lower concentrations of most PFAS but significantly higher PFNA concentrations. Menstrual bleeding and parity were significantly associated with lower PFAS concentrations. Higher intake of salty snacks including popcorn was significantly associated with higher concentrations of linear PFOA, PFOS and 2-(N-ethyl-perfluorooctane sulfonamido) acetic acid.

DISCUSSION

Geographic locations and race/ethnicity play an important role in differential exposure to PFAS, with racial/ethnic burdens differing between PFOS, PFOA and PFNA. Menstruation and parity were also determinants of PFAS concentrations possibly as an elimination route.

Elevated Depressive Symptoms Are a Stronger Predictor of Executive Dysfunction in HIV-Infected Women Than in Men

BACKGROUND

HIV-infected (HIV+) women seem to be more vulnerable to neurocognitive impairment (NCI) than HIV+ men, perhaps in part due to mental health factors. We assessed the association between elevated depressive symptoms and NCI among HIV+ and HIV-uninfected (HIV-) women and men.

SETTING

Women's Interagency HIV Study and Multicenter AIDS Cohort Study.

METHODS

Eight hundred fifty-eight HIV+ (429 women; 429 men) and 562 HIV- (281 women; 281 men) completed the Center for Epidemiologic Studies Depression (16 cutoff) Scale and measures of psychomotor speed/attention, executive, and motor function over multiple visits (or time points). Women's Interagency HIV Study and Multicenter AIDS Cohort Study participants were matched according to HIV status, age, race/ethnicity, and education. Generalized linear mixed models were used to examine interactions between biological sex, HIV serostatus, and depression on impairment (T-scores <40) after covariate adjustment.

RESULTS

Despite a higher frequency of depression among men, the association between depression and executive function differed by sex and HIV serostatus. HIV+ women with depression had 5 times the odds of impairment on a measure of executive control and inhibition versus HIV- depressed women and 3 times the odds of impairment on that measure versus HIV+ depressed men. Regardless of group status, depression was associated with greater impairment on processing speed, executive (mental flexibility), and motor function (P's < 0.05).

CONCLUSIONS

Depression contributes to NCI across a broad range of cognitive domains in HIV+ and HIV- individuals, but HIV+ depressed women show greater vulnerabilities in executive function. Treating depression may help to improve cognition in patients with HIV infection.

Emerging Public Health Law and Policy Issues Concerning State Medical Cannabis Programs

Thirty-four states, the District of Columbia, and Puerto Rico have legalized medical cannabis. While no two state medical cannabis programs are alike, public health concerns related to advertising, packaging and labeling, pesticide use, scientific research, and the role of medical cannabis in the opioid crisis are emerging across the country. This article examines these issues, the policy approaches states are adopting to protect patients and the public, and an assessment of the underlying federal legal landscape.

Jurors' cognitive depletion and performance during jury deliberation as a function of jury diversity and defendant race

Racial diversity in juries, meant to ensure representation of minority voices, can also reduce racial bias in verdicts and improve group performance during deliberation (Sommers, 2006). Although jury diversity might increase cognitive depletion because it involves interracial interactions (Richeson & Shelton, 2003), it might also reduce racial disparity in verdicts and deliberation quality by improving the quality of deliberation for Black defendants. In 6-person juries that included 2 White or 2 Black confederates, White jurors viewed trial evidence including a defendant race manipulation (White, Black) and completed measures of cognitive depletion and case facts recall. Deliberation transcripts were coded for the number of total, correct, and new case facts mentioned by jurors. As predicted, jurors in diverse versus all-White juries were more depleted after deliberation, but depletion was not related to deliberation performance. For the Black defendant, jurors on diverse (vs. homogeneous) juries discussed more case facts; for the White defendant, the effect was not significant. Jurors on all-White juries discussed more case facts when they judged a White (vs. Black) defendant, but this difference was not significant for jurors on diverse juries. Thus, jury diversity reduced racial disparity in the quality of deliberation. Before and after deliberation, jurors were less likely to convict the Black (vs. White) defendant regardless of jury composition. These findings reinforce the importance of constructing racially diverse juries, given that they may be better equipped to evaluate trial evidence for both Black and White defendants despite the cognitive demand of deliberating within a diverse group. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neighborhood Racial Diversity, Socioeconomic Status, and Perceptions of HIV-Related Discrimination and Internalized HIV Stigma Among Women Living with HIV in the United States

Relationships that traverse sociodemographic categories may improve community attitudes toward marginalized groups and potentially protect members of those groups from stigma and discrimination. The present study evaluated whether internalized HIV stigma and perceived HIV-related discrimination in health care settings differ based on individual- and neighborhood-level characteristics of women living with HIV (WLHIV). We also sought to extend previous conceptual and empirical work to explore whether perceived HIV-related discrimination mediated the association between neighborhood racial diversity and internalized HIV stigma. A total of 1256 WLHIV in the Women's Interagency HIV Study (WIHS) attending 10 sites in metropolitan areas across the United States completed measures of internalized HIV stigma and perceived HIV-related discrimination in health care settings. Participants also provided residential information that was geocoded into Federal Information Processing Standard (FIPS) codes and linked with census-tract level indicators. In cross-sectional analyses, greater neighborhood racial diversity was associated with less internalized HIV stigma and less perceived HIV-related discrimination regardless of individual race. Neighborhood median income was positively associated with internalized HIV stigma and perceived discrimination, while individual income was negatively associated with perceptions of stigma and discrimination. In an exploratory mediation analysis, neighborhood racial diversity had a significant indirect effect on internalized HIV stigma through perceived HIV-related discrimination. An indirect effect between neighborhood income and internalized stigma was not supported. These findings suggest that greater neighborhood racial diversity may lessen HIV stigma processes at the individual level and that HIV stigma-reduction interventions may be most needed in communities that lack racial diversity.

Racial factors and inpatient outcomes among patients with diabetes hospitalized with foot ulcers and foot infections, 2003-2014

Background

In patients with diabetes, foot amputations among Black patients have been historically higher compared with White patients. Using the National Inpatient Sample database, we sought to determine if disparities in foot amputations and resource utilization have improved over time. We hypothesized there would be improvements and reduced differences in foot amputations between the two races as quality of care and access to healthcare has improved.

Methods and findings

Patients over 18 years old with a principal diagnosis of diabetic foot complications and secondary diagnosis of Diabetes Mellitus were selected. We compared the primary outcome of foot amputations between Black and White patients. Adjusted rates, odds ratios (aOR) and trends of foot amputations among Black and White patients were studied. Healthcare utilization was measured via length of hospital stay (LOS). Of 262,924 patients, 18% were Black. Following adjustment for confounders, major foot amputations decreased among Whites (1.5% in 2003 to 1.1% in 2014) and Blacks (2.1% in 2003 to 0.9% in 2014). On pooled analysis, Black patients had higher adjusted odds of major foot amputations in 2003–2004 [aOR 1.7; (1.16–2.57), p<0.01]. Disparities in major foot amputations disappeared in 2013–2014 [aOR: 0.92 (0.58–1.44), p = 0.70]. Black patients had declining but persistently longer LOS (adjusted mean difference (aMD): 1.1 days (0.52–1.6) p<0.01 in 2003–2004 and 0.46 days (0.18–0.73) p<0.01 in 2013–2014). The main limitation of the study was that the NIS uses ICD-9 and ICD-10 CM codes, and hence prone to incorrect or missing codes.

Conclusions

Major foot amputations declined among Black and White patients hospitalized with Diabetic foot complications between 2003 and 2014. The observed difference for amputations in 2003–2004 was absent by 2013–2014. Future research to determine specific contributors for this reduction in health disparities is needed for ongoing improvements and sustainability.

Ethyl glucuronide hair testing: A review

Ethyl glucuronide (EtG) is a minor, non-oxidative ethanol metabolite that can be detected in several matrices (e.g. blood, urine, hair, meconium) for variable periods of time. Quantification of EtG in hair (hEtG) has established itself, over recent years, as one of the most reliable biomarkers of long-term alcohol consumption habits, with the Society of Hair Testing (SoHT) offering cut-off values for assessment of both abstinence and heavy drinking (>60 g/day). Despite its high diagnostic performance, however, issues concerning inter- and intra-laboratory variability as well as data interpretation are still being investigated and represent the ultimate barrier to widespread acceptance of hEtG in the forensic context. The aim of this review is to summarize currently available analytical methods of hEtG testing, provide a framework to understand current hEtG cut-offs and their possible upcoming changes (in particular, a lower abstinence cut-off has been proposed for the 2019 revision of the SoHT consensus), and offer a schematic but exhaustive overview of the pitfalls in result reproducibility and interpretation that may limit applications of hEtG testing in the forensic context. Ultimately, the purpose of the authors is not to undermine the reliability of hEtG as an alcohol use marker, but rather to enhance it by promoting familiarization with all aspects related to it, from ethanol pharmacokinetics and EtG incorporation into hair, to sample preparation and analytical methods, to specific cases warranting close attention and additional tests for correct interpretation of hEtG results.

Demographic differences in response rates for PHQ9 in a university student population

OBJECTIVE

To examine differences in complete response rates for depression screening questions based on demographic characteristics.

METHODS

Cross-sectional study examining associations between demographic characteristics and completely responding depression-screening questions.

PARTICIPANTS

"Healthy Minds Study" data, collected in a public University in February 2016, where 7,326 students participated.

RESULTS

women (AOR: 0.69; 95% CI =0.57-0.83) and gay/lesbian students (AOR: 0.24; 95% CI =0.10-0.60) had better complete response rates. Non-US (AOR: 1.46; 95% CI =1.03-2.07), black (AOR: 3.32; 95% CI =1.92-5.77), and Middle-Eastern students (AOR: 3.73; 95% CI =1.73-8.02) had lower complete response rates.

CONCLUSIONS

Our study shows sex, gender, citizenship, and race categories have significant differences in complete response rates for the outcome. Our findings have several implications; including recognizing interventions for depression based on responders may not target those that tend to be "partial-responders". Efforts in survey design, recruiting and completion of surveys should be maximized.

Distinguishing between-individual from within-individual predictors of gun carrying among Black and White males across adolescence

Longitudinal studies have found that male adolescents who deal drugs, associate with delinquent peers, and engage in aggressive behavior are at increased risk for carrying a gun (between-individual risks). However, it is unclear whether changes in these risk factors help to explain fluctuations in youth gun carrying across adolescence (within-individual risks). The current study examined this issue using a community sample of 970 adolescent males (58% Black, 42% White) assessed annually from ages 14 to 18. Multilevel models examined the extent to which between-individual differences and within-individual changes in drug dealing, peer delinquency, aggressive behavior, and neighborhood disadvantage were associated with gun carrying across adolescence. Each of these predictors, except for disadvantage, exerted a between-individual and within-individual influence for Black youth. For White youth, drug dealing was significant on both levels, peer delinquency was a significant between-individual predictor, and aggression was a significant within-individual predictor. Neighborhood disadvantage did not significantly predict gun carrying in the model, on either the between- or within-individual level, for Black or White youth. These results stress the importance of examining race-specific predictors of gun carrying among Black and White adolescents and point to drug dealing as a robust predictor of gun carrying, at both the between-individual and within-individual levels for youth of either race. Efforts to prevent drug market involvement and reduce aggressive behaviors in adolescence may in turn prove useful for preventing firearm violence. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

High Birth Weight, Early UV Exposure, and Melanoma Risk in Children, Adolescents, and Young Adults

BACKGROUND

Melanoma, the deadliest form of skin cancer, is the second most common cancer diagnosed before age 30. Little is known about potentially modifiable or intervenable risk factors specific to developing melanoma at a young age. The objective was to determine if high birth weight or higher early-life ultraviolet (UV) radiation exposure would be associated with increased risk of melanoma in young patients.

METHODS

Population-based, case-control study of 1,396 cases of melanoma diagnosed before age 30 in 1988-2013 and 27,920 controls, obtained by linking cancer registry data to birth records in California.

RESULTS

High birth weight (>4,000 g) was associated with 19% higher risk of melanoma (OR = 1.19; 95% CI = 1.02, 1.39), while low birth weight (<2,500 g) was associated with 41% lower risk (OR = 0.59; 95% CI = 0.43, 0.82), compared with normal birth weight (2,500-4,000 g); dose-response per 1,000 g increase was also evident (OR = 1.24; 95% CI = 1.13, 1.36). All quartiles of birthplace UV greater than the lowest quartile were associated with increased melanoma risk. The strongest relation between birthplace UV and melanoma was for 15-19 years of age at diagnosis.

CONCLUSIONS

High birth weight and high early-life UV exposure may be important independent risk factors for melanoma diagnosis before age 30. The implication is that adopting skin-protective behaviors as early as infancy could be important for primary prevention of melanoma in younger people. However, research that accounts for early-life behavioral patterns of skin protection during infancy is needed to advance our understanding of how birth weight and early-life UV may influence the development of early-onset melanoma.

Incidence Trends of Esophageal and Gastric Cancer Subtypes by Race, Ethnicity, and Age in the United States, 1997-2014

BACKGROUND & AIMS

There is limited information on contemporary incidence rates and trends, by race, ethnicity, and age, for major subtypes of esophageal and gastric cancer in the United States. We examined the most recent nationwide incidence data for esophageal squamous cell carcinoma, esophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA), and gastric non-cardia adenocarcinoma (GNCA) by race, ethnicity, and age in the United States.

METHODS

Average contemporary incidence rates (2010-2014) and annual percent changes in rates (from 1997 through 2014) by race, ethnicity, and age were calculated for each cancer subtype using nationwide data compiled by the North American Association of Central Cancer Registries.

RESULTS

From 1997 through 2014, overall esophageal squamous cell carcinoma incidence rates continuously decreased in both sexes and all racial and ethnic groups, although rates remained stable among younger non-Hispanic white women. Overall, EAC incidence rates decreased or stabilized during the most recent time period (2006-2007 through 2014) in men and women, after increasing from 1997 through 2006 and 2007. However, EAC incidence rates continued to increase from 1997 through 2014 in several subpopulations, including non-Hispanic white men younger than 50 years, non-Hispanic white women younger than 70 years, and Asian/Pacific Islander men (all ages combined). Overall GCA incidence rates increased among non-Hispanic whites, but decreased among Hispanics (men only) and Asian/Pacific Islanders. Although overall GNCA rates decreased in both sexes and all racial and ethnic groups, rates increased in younger age groups among men (all races and ethnicities combined) and non-Hispanic white, non-Hispanic black, and Hispanic women.

CONCLUSIONS

Using high-quality nationwide population-based data, we found increasing incidence trends for EAC, GCA, and GNCA in several subpopulations in the United States.

Pacing of Women and Men in Half-Marathon and Marathon Races

Background and objective: Half-marathon is the most popular endurance running race in terms of number of races and runners competing annually; however, no study has compared pacing strategies for this race distance with marathon. The aim of the present study was to profile pacing in half-marathon, compare half-marathon and marathon for pacing, and estimate sex differences in pacing. Materials and methods: A total of 9137 finishers in the half-marathon (n = 7258) and marathon race (n = 1853) in Ljubljana 2017 were considered for their pacing in five race segments (0–23.7%, 23.7–47.4%, 47.4–71.1%, 71.1–94.8%, and 94.8–100% of the race. Results: Half-marathon runners followed a positive pacing with every segment being slower than its previous one without the presence of an endspurt. Compared to marathon (where the average percent of change in speed (ACS) was 5.71%), a more even pacing was observed in half-marathon (ACS = 4.10%). Moreover, women (ACS = 4.11%) had similar pacing as men (ACS = 4.09%) in half-marathons. Conclusions: In summary, running a half-marathon followed a unique pattern that differentiated this race distance from marathon, with the former showing a more even pacing with an absence of endspurt, and sex difference compared to the latter. Consequently, runners should be advised to adopt a less variable pacing when competing in a half-marathon, regardless of their sex. To the best of our knowledge, the more even pacing in half-marathon, than in marathon, was a novel finding, as it was the first study to compare the two race distances for this characteristic.

Bipolar Disorder and Comorbid Borderline Personality Disorder: Patient Characteristics and Outcomes in US Hospitals

Background and objectives: The quality of life and disease outcomes in bipolar patients, including increased risk of psychiatric hospitalizations and suicide, are adversely affected by the presence of borderline personality disorder (BPD). Our study aims to determine the impact of BPD on the inpatient outcomes of bipolar disorder patients. Methods: We used Nationwide Inpatient Sample from the US hospitals and identified cases with bipolar disorder and comorbid BPD (N = 268,232) and controls with bipolar disorder only (N = 242,379), using the International Classification of Diseases, 9th Revision, and Clinical Modification codes. We used multinomial logistic regression to generate odds ratios (OR) and evaluate inpatient outcomes. Results: The majority of the bipolar patients with BPD were female (84.2%), Caucasian (83.1%) and 18–35 years age (53.9%). Significantly longer inpatient stays, higher inpatient charges, and higher prevalence of drug abuse were noted in bipolar patients with BPD. The suicide risk was higher in bipolar patients with BPD (OR = 1.418; 95% CI 1.384–1.454; p < 0.001). In addition, utilization of electroconvulsive treatment (ECT) was higher in bipolar patients with comorbid BPD (OR = 1.442; 95% CI 1.373–1.515; p < 0.001). Conclusions: The presence of comorbid BPD in bipolar disorder is associated with higher acute inpatient care due to a longer inpatient stay and higher cost during hospitalization, and higher suicide risk, and utilization of ECT. Further studies in the inpatient setting are warranted to develop effective clinical strategies for optimal outcomes and reduction of suicide risk in bipolar patients with BPD.

How do we assess a racial disparity in health? Distribution, interaction, and interpretation in epidemiological studies

Identifying the exposures or interventions that exacerbate or ameliorate racial health disparities is one of the fundamental goals of social epidemiology. Introducing an interaction term between race and an exposure into a statistical model is commonly used in the epidemiologic literature to assess racial health disparities and the potential viability of a targeted health intervention. However, researchers may attribute too much authority to the interaction term and inadvertently ignore other salient information regarding the health disparity. In this article, we highlight empirical examples from the literature demonstrating limitations of overreliance on interaction terms in health disparities research; we further suggest approaches for moving beyond interaction terms when assessing these disparities. We promote a comprehensive framework of three guiding questions for disparity investigation, suggesting examination of the group-specific differences in (1) outcome prevalence, (2) exposure prevalence, and (3) effect size. Our framework allows for better assessment of meaningful differences in population health and the resulting implications for interventions, demonstrating that interaction terms alone do not provide sufficient means for determining how disparities arise. The widespread adoption of this more comprehensive approach has the potential to dramatically enhance understanding of the patterning of health and disease and the drivers of health disparities.

Upstaging papillary lesions to carcinoma on surgical excision is not impacted by patient race

BACKGROUND

The management of papillary lesions is controversial with studies showing different rates of upstaging to malignancy. There is a paucity of research into race as an independent risk factor. The aim of this study is to identify if race is correlated with upstaging to malignancy with a secondary focus of analyzing for other personal and tumor specific risk factors for upstaging.

METHODS

We performed a retrospective review of 123 papillary lesions with univariate analysis to identify risk factors for upstaging.

RESULTS

The incidence of papillary lesions found on core needle biopsy was 6%. Atypical papillary lesions were most likely to be upstaged to malignancy at a rate of 27.7%. Papillary lesions and papillary lesions with hyperplasia were also upstaged to cancer at a lower rate of 8.3% and 12.5%, respectively. A univariate analysis of all papillary lesions and a separate analysis of atypical lesions demonstrated a higher likelihood of upstage based on BIRADS classification. Race, age, size of tumor and other radiographic features were not associated with an increased risk for upstaging to malignancy.

CONCLUSIONS

Atypia remains the most significant contributor to the risk of upstaging papillary lesions to malignancy. Our research supports the practice of excising all atypical papillary lesions with selected excision of those without atypia. In our cohort, there was no association between race and risk of upstaging to malignacy.

Racial Variation in the Complexity of Coronary Artery Disease in Patients with Acute ST-Segment Elevation Myocardial Infarction

BACKGROUND

Racial variations in presentation of patients with ST-segment elevation myocardial infarction (STEMI) have been suggested.

METHODS

This was a retrospective analysis of a tertiary center from 2012 to 2016. We included patients presenting with acute STEMI who received primary percutaneous coronary intervention (PCI). The main outcome was racial variation in the complexity of coronary artery disease assessed by SYNTAX score. We also reported predictors of higher SYNTAX scores in the study population.

RESULTS

Our final analysis included 260 patients: 201 Whites (77.3%), 24 African Americans-AA (9.2%), 19 Hispanics (7.3%) and 15 were of other ethnicities (5.8%). The mean SYNTAX score was 13.8 ± 7.7. There was no significant difference between Whites, AA, Hispanics and other races in the SYNTAX score (13.8 ± 7.7, 13.4 ± 7.9, 14.5 ± 9 and 13.5 ± 6.6, p = 0.965). Logistic regression analysis identified chronic kidney disease as the only significant predictor of higher SYNTAX score (Coefficient = 3.5, 95%CI:0.41-6.60, p = 0.026), while no significant association was identified between different races and higher SYNTAX score.

CONCLUSION

The current study did not identify racial variations in the complexity of coronary artery disease for STEMI patients. Further studies are needed at a larger scale to identify racial variations in STEMI patients.

Racial Differences in Rates of Change of Childhood Body Mass Index and Blood Pressure Percentiles

OBJECTIVE

To assess whether racial differences in rates of change in body mass index (BMI) and blood pressure (BP) percentiles emerge during distinct periods of childhood.

STUDY DESIGN

In this retrospective cohort study, we included children aged 5-20 years who received regular outpatient care at a large academic medical center between January 1996 and April 2016. BMI was expressed as age- and sex-specific percentiles and BP as age-, sex-, and height-specific percentiles. Linear mixed models incorporating linear spline functions with 2 breakpoints at 9 and 12 years of age were used to estimate the changes in BMI and BP percentiles over time during age periods: <9, 9-<12, and >12 years of age.

RESULTS

Among 5703 children (24.8% black, 10.1% Hispanic), Hispanic females had an increased rate of change in BMI percentile per year relative to white females during ages 5-9 years (+2.94%; 95% CI, 0.24-5.64; P = .033). Black and Hispanic males also had an increased rate of change in BMI percentile per year relative to white males that occurred from ages 5-9 (+2.35% [95% CI, 0.76-3.94; P = .004]; +2.63% [95% CI, 0.31-4.95; P = .026], respectively). There were no significant racial differences in the rate of change of BP percentiles, although black females had higher hypertension rates compared with white females (10.0% vs 5.7%; P < .001).

CONCLUSIONS

Childhood patterns in BMI percentiles differ by race. Racial differences in rates of change in BMI percentile emerge early in childhood. Further study of early patterns could help to identify critical periods during childhood where disparities begin to emerge.

Sleep duration and risk of incident stroke by age, sex, and race: The REGARDS study

OBJECTIVE

To investigate the association between reported sleep duration and incident stroke in a US cohort of black and white adults, and evaluate race, age, and sex as potential effect modifiers.

METHODS

From 2008 to 2010, 16,733 black and white adults, aged ≥45 years, without a history of stroke or sleep-disordered breathing from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, reported their habitual sleep duration (<6, 6.0-6.9, 7.0-8.9 [reference], ≥9 hours). Incident strokes were identified through biannual participant contact followed by physician adjudication of medical records. Cox proportional hazards analysis was conducted to calculate hazard ratios of interactions between sleep duration with race, age, sex, and 2-way combinations of these factors on incident stroke adjusting for stroke risk factors and sleep-disordered breathing risk.

RESULTS

The sample comprised 10.4% (n = 1,747) short sleepers (<6 hours) and 6.8% (n = 1,134) long sleepers (≥9 hours). Over an average 6.1 years follow-up, 460 strokes occurred. There were significant interactions between sleep duration and race (p = 0.018) and sleep duration and race-sex groups (p = 0.0023) in association with incident stroke. Short sleep duration was significantly associated with decreased risk for stroke among black participants (hazard ratio [HR] 0.49 [95% confidence interval (CI) 0.28-0.85]), particularly black men (HR 0.21 [95% CI 0.07-0.69]), whereas long sleep duration was significantly associated with increased risk for stroke among white men (HR 1.71 [95% CI 1.06-2.76]).

CONCLUSIONS

The association of sleep duration with incident stroke differs by race and sex, with short sleep duration among black men associated with decreased risk, whereas long sleep duration among white men associated with increased risk for stroke.

Anthropometric Analysis of the External Nose of the Egyptian Males

OBJECTIVE

The aim of this study was to describe average nasal anthropometric measurements for young Egyptian males by using the Rhinobase^® software.

MATERIALS AND METHODS

This was a cross-sectional study involving the evaluation of facial photographs. Frontal, right lateral and basal photographs for 300 healthy adult male Egyptian volunteers (n = 300) were taken; then, the photos were edited using Rhinobase^® Software and CorelDraw graphics (2017) software. Twenty anthropometric landmarks were determined. The calculated measurements of the soft tissue of the external nose included ten linear measurements and five angles.

RESULTS

The means of the linear measurements of the external nose in this study were as follows: nasal height (56.12 mm), nasal bridge length (47.0 mm), columella length (9.1 mm), alar length (29.3 mm), morphological nose width (41.0 mm), anatomical nose width (38.0 mm), nasal tip protrusion (21.0 mm), nasal tip projection using 'Goode's method' (29.36 mm), dorsum width (9.6 mm) and nasion height (2.04 mm). The means of the angular measurements of the nose were as follows: nasofacial angle (33.1°), nasofrontal angle (144.0°), nasolabial angle (104.5°), nasomental angle (127.6°) and mentocervical angle (104.7°).

CONCLUSIONS

Racial differences of the external nasal anthropometric values exist; hence, it is important to establish the average anthropometric measures for several races and ethnic groups. Measurements collected in this study can serve as a database for anthropometric average values of the external nose in healthy adult Egyptian males. Moreover, these measurements can aid in planning prior to nasal reconstruction and esthetic rhinoplasty by serving as a reference standard. Although the Rhinobase^® software is an easy, reliable and safe indirect method for nasal analysis, we should be cautious during interpretation of some edited landmarks on Rhinobase^® software pictures. In addition, inserting two rulers (in the horizontal and vertical dimension) allows accurate assessment of the linear anthropometric measurements.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Racial Disparities in the Incidence of Pulmonary Embolism after Colectomy

Disparities in the incidence of pulmonary embolism (PE) based on racial and socioeconomic factors remain ill-defined. The present study evaluated the impact of race and hospital characteristics on rates of PE for all adult colectomy patients in the 2005 to 2014 Nationwide Inpatient Sample. Hospitals were designated as high-burden hospitals (HBHs) or low-burden hospitals of underinsured payers. Chi-squared tests of trend and multivariable regression adjusting for patient and hospital characteristics were performed. Of the 2,737,977 adult patients who underwent colectomy in the study period, 79 per cent were White, 10 per cent Black, and 7 per cent Hispanic. The annual rate of PE increased from 0.6 per cent in 2005 to 0.95 per cent in 2014 (P < 0.0001). Black patients had significantly higher incidence of PE than Whites (1.5% vs 0.9%, P < 0.001) and Hispanics (1.5% vs 0.8%, P < 0.001). Colectomy at HBHs was also associated with significantly higher rates of PE (1% vs 0.86%, P < 0.001). After adjusting for baseline differences, colectomy at HBHs (odds ratio 1.14, 95% confidence interval 1.02-1.27, P = 0.02) and Black race (odds ratio 1.4, 95% confidence interval 1.26-1.66, P < 0.001) were independent predictors of PE. In this national study of colectomy patients, Black patients experienced a disproportionate burden of postoperative PE. Further investigation into the causes and prevention of PE in vulnerable populations may identify targets for surgical quality improvement.

Comparing initial and follow-up responders to a New Zealand patient experience survey

AIM

This study investigates non-response bias in an inpatient experience survey with a low response rate by comparing sociodemographic characteristics and response behaviours of initial responders with responders to follow-up, and further explores the factors contributing to non-response. Prior research suggests non-response may be endogenously related to patient characteristics.

METHOD

We re-contacted a convenience sample of non-responders to a nationally representative, cross-sectional inpatient survey conducted in New Zealand. Participants were given a subset of six items drawn from the initial survey and the opportunity to disclose reasons for non-response. Responders to follow-up (n=163) were subsequently compared with responders to the initial survey (n=910) using chi-squared tests of association and logistic regression to assess differences in sociodemographic variables and substantive responses.

RESULTS

We find no significant differences in the responses given by initial and follow-up responders. The most common reasons for non-response were "can't remember" (33%), not receiving the survey (25%) or being too busy at the time (25%).

CONCLUSION

Responders to follow-up have similar experiences of inpatient care in New Zealand to initial responders. Further study is needed to strengthen inferences regarding hard-to-reach patients.

An assessment of progress in cancer control

This article summarizes cancer mortality trends and disparities based on data from the National Center for Health Statistics. It is the first in a series of articles that will describe the American Cancer Society's vision for how cancer prevention, early detection, and treatment can be transformed to lower the cancer burden in the United States, and sets the stage for a national cancer control plan, or blueprint, for the American Cancer Society goals for reducing cancer mortality by the year 2035. Although steady progress in reducing cancer mortality has been made over the past few decades, it is clear that much more could, and should, be done to save lives through the comprehensive application of currently available evidence-based public health and clinical interventions to all segments of the population. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.

Mentoring Across Differences

INTRODUCTION

Effective mentoring can contribute to wellness and career growth and satisfaction. However, the same social forces and interpersonal dynamics affecting all relationships can compromise mentoring relationships. This is especially true when there are issues that are compounded by structural disadvantage due to racism, gender bias, social class, and other discriminatory factors. The Mentoring Across Differences (MAD) sessions are a workshop designed to develop and nurture skills, tools, self-awareness, and mindful practice in mentors and mentees. The workshop encourages participants to gain confidence in navigating differences across a variety of domains.

METHODS

We designed interactive sessions for faculty as part of a nine-part training series on mentoring in an academic setting. Teaching methods drew from adult learning theory. We used cases distilled from real teaching and mentoring experiences to trigger discussion and activate emotion and intrinsic motivation. Participants' prior knowledge and experience were drawn on to cocreate knowledge through small-group peer learning.

RESULTS

As part of a course, 167 participants completed the sessions; several hundred more people participated in them in faculty development venues. Participants highly rated the open discussions regarding differences and enhanced awareness of their assumptions, specifically highlighting knowledge and tools addressing bias in their roles as mentors and teachers.

DISCUSSION

The MAD sessions function both as an important module in a comprehensive mentoring curriculum and as stand-alone sessions. They fill a critical need of faculty and training institutions to explore difference in order to foster diversity and inclusion.

Urinary biomarkers of polycyclic aromatic hydrocarbons in pre- and peri-pubertal girls in Northern California: Predictors of exposure and temporal variability

BACKGROUND

Polycyclic aromatic hydrocarbons (PAHs), a class of chemicals produced as combustion by-products, have been associated with endocrine disruption. To understand exposure in children, who have been less studied than adults, we examined PAH metabolite concentrations by demographic characteristics, potential sources of exposure, and variability over time, in a cohort study of pre- and peri-pubertal girls in Northern California.

METHODS

Urinary concentrations of ten PAH metabolites and cotinine were quantified in 431 girls age 6-8 years at baseline. Characteristics obtained from parental interview, physical exam, and linked traffic data were examined as predictors of PAH metabolite concentrations using multivariable linear regression. A subset of girls (n = 100) had repeat measures of PAH metabolites in the second and fourth years of the study. We calculated the intraclass correlation coefficient (ICC), Spearman correlation coefficients, and how well the quartile ranking by a single measurement represented the four-year average PAH biomarker concentration.

RESULTS

Eight PAH metabolites were detected in ≥ 95% of the girls. The most consistent predictors of PAH biomarker concentrations were cotinine concentration, grilled food consumption, and region of residence, with some variation by demographics and season. After adjustment, select PAH metabolite concentrations were higher for Hispanic and Asian girls, and lower among black girls; 2-naphthol concentrations were higher in girls from lower income households. Other than 1-naphthol, there was modest reproducibility over time (ICCs between 0.18 and 0.49) and the concentration from a single spot sample was able to reliably rank exposure into quartiles consistent with the multi-year average.

CONCLUSIONS

These results confirm diet and environmental tobacco smoke exposure as the main sources of PAHs. Controlling for these sources, differences in concentrations still existed by race for specific PAH metabolites and by income for 2-naphthol. The modest temporal variability implies adequate exposure assignment using concentrations from a single sample to define a multi-year exposure timeframe for epidemiologic exposure-response studies.

Prevalence and Correlates of Trichomonas vaginalis Infection Among Men and Women in the United States

Background

The epidemiology of Trichomonas vaginalis (TV) infection in the United States is poorly defined.

Methods

Males and females aged 18-59 years who participated in the 2013-2014 National Health and Nutrition Examination Survey and provided a urine specimen were tested for TV infection (n = 4057). Participants were also examined for Chlamydia trachomatis (CT) infection, genital human papillomavirus (HPV) infection, and herpes simplex virus type 2 serostatus. Weighted adjusted prevalence ratios (aPRs) were estimated by multivariable Poisson regression.

Results

TV infection prevalence was 0.5% and 1.8% among males and females, respectively. TV infection prevalence was 4.2% among black males, 8.9% among black females, and 0.03% and 0.8%, respectively, among males and females of other races/ethnicities. TV infection prevalence (aPR [95% confidence interval]) was positively associated with female sex (6.1 [3.3-11.3]), black race (vs other races/ethnicities; 7.9 [3.9-16.1]), older age (vs 18-24 years; 3.0 [1.2-7.1] for 25- to 39-year-olds and 3.5 [1.3-9.4] for 40- to 59-year-olds), having less than a high school education (vs completing high school or more; 2.0 [1.0-4.1]), being below the poverty level (vs at or above the poverty level; 4.0 [2.1-7.7]), and having ≥2 sexual partners in the past year (vs 0-1 sexual partners; 3.6 [2.0-6.6]). There were no TV and CT coinfections. Genital HPV detection was not independently associated with TV infection. Among persons aged 18-39 years, there was a significant racial disparity in all sexually transmitted infections examined, and this disparity was greatest for TV infection.

Conclusions

There is a high and disproportionate burden of urinary TV infection in the adult civilian, noninstitutionalized black population in the United States that warrants intervention.

Whole-Genome Sequencing of Pharmacogenetic Drug Response in Racially Diverse Children with Asthma

RATIONALE

Albuterol, a bronchodilator medication, is the first-line therapy for asthma worldwide. There are significant racial/ethnic differences in albuterol drug response.

OBJECTIVES

To identify genetic variants important for bronchodilator drug response (BDR) in racially diverse children.

METHODS

We performed the first whole-genome sequencing pharmacogenetics study from 1,441 children with asthma from the tails of the BDR distribution to identify genetic association with BDR.

MEASUREMENTS AND MAIN RESULTS

We identified population-specific and shared genetic variants associated with BDR, including genome-wide significant (P < 3.53 × 10-7) and suggestive (P < 7.06 × 10-6) loci near genes previously associated with lung capacity (DNAH5), immunity (NFKB1 and PLCB1), and β-adrenergic signaling (ADAMTS3 and COX18). Functional analyses of the BDR-associated SNP in NFKB1 revealed potential regulatory function in bronchial smooth muscle cells. The SNP is also an expression quantitative trait locus for a neighboring gene, SLC39A8. The lack of other asthma study populations with BDR and whole-genome sequencing data on minority children makes it impossible to perform replication of our rare variant associations. Minority underrepresentation also poses significant challenges to identify age-matched and population-matched cohorts of sufficient sample size for replication of our common variant findings.

CONCLUSIONS

The lack of minority data, despite a collaboration of eight universities and 13 individual laboratories, highlights the urgent need for a dedicated national effort to prioritize diversity in research. Our study expands the understanding of pharmacogenetic analyses in racially/ethnically diverse populations and advances the foundation for precision medicine in at-risk and understudied minority populations.

Do Demographic Factors Moderate How Well Criminal Thinking Predicts Recidivism?

Is the relationship between criminal thinking and recidivism the same for criminal justice-involved individuals from varying demographic backgrounds? Relying on two independent samples of offenders and two measures of criminal thinking, the current studies examined whether four demographic factors-gender, race, age, and education-moderated the relationship between criminal thinking and recidivism. Study 1 consisted of 226 drug-involved probationers enrolled in a randomized clinical trial. Study 2 consisted of 346 jail inmates from a longitudinal study. Logistic regression models suggested that the strength of the relationship between criminal thinking and subsequent recidivism did not vary based on participant demographics, regardless of justice system setting or measure of criminal thinking. Criminal thinking predicts recidivism similarly for people who are male, female, Black, White, older, younger, and more or less educated.

Taming Asthma in School-Aged Children: A Comprehensive Review

Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity as measured by school absences, emergency department visits, and hospitalizations. Multiple factors play a role in the development, treatment and prevention of childhood asthma including racial/ethnic and socioeconomic disparities, both the home and school environments, and medication use. The goals of this review are to summarize these aspects of asthma in school-aged children and to present an updated review of medications as it relates to treatment strategies that will help in the care of these children. We conclude that phenotypic heterogeneity and appropriate environmental assessments and interventions are important considerations in the management of childhood asthma.

Recent trends in the prevalence of type 2 diabetes and the association with abdominal obesity lead to growing health disparities in the USA: An analysis of the NHANES surveys from 1999 to 2014

AIM

To assess whether the secular trends in type 2 diabetes prevalence differ between abdominally obese and non-obese individuals.

METHODS

Data from the National Health and Nutrition Examination Surveys (NHANES) were used to estimate the prevalence of type 2 diabetes and abdominal obesity among individuals aged ≥20 years in the USA from 1999/2000 to 2013/2014, after standardization to the age, sex and ethnicity population distribution estimates on January 1, 2014, as published by the US Census Bureau.

RESULTS

The prevalence of abdominal obesity in the US population increased from 47.4% (95% confidence interval [CI] 42.6-52.2) in 1999/2000 to 57.2% (95% CI 55.9-58.5) in 2013/2014. A significant increase was observed in all age groups: 20 to 44, 45 to 64, and ≥65 years. The prevalence of type 2 diabetes has also increased from 8.8% (95% CI 7.2-10.4) in 1999/2000 to 11.7% (95% CI 10.9-12.6) in 2013/2014, with no substantial change in trend over the recent years. However, the increase in the prevalence of type 2 diabetes was limited to individuals with abdominal obesity, and more specifically to individuals aged ≥45 years with abdominal obesity, with no significant change in prevalence in the non-obese group and in individuals aged <45 years.

CONCLUSION

These findings highlight the critical importance of abdominal obesity-both as a likely key contributor to the continuing epidemic of type 2 diabetes in the USA and as a priority target for public health interventions.

Influence of metabolic syndrome and race on the relationship between intensive blood pressure control and cardiovascular outcomes in the SPRINT cohort

AIMS

To determine whether baseline metabolic syndrome (MetS) modifies the effect of intensive blood pressure control on cardiovascular (CV) outcomes, and whether the effects varied by race/ethnicity.

METHODS

We performed post hoc analyses among non-Hispanic black, non-hispanic white and Hispanic participants, with and without MetS, in the Systolic Blood Pressure Intervention Trial (SPRINT), who were randomized to a systolic blood pressure (SBP) target of <120 mm Hg (intensive group, N = 4544) or an SBP target of <140 mm Hg (standard group, N = 4553). The median follow-up was 3.26 years. The primary outcome was the composite of the first occurrence of myocardial infarction, stroke, heart failure, non-myocardial infarction acute coronary syndrome or CV death.

RESULTS

Overall, 3521/9097 participants (38.7%) met the criteria for MetS at baseline. Baseline characteristics were similar in the two SBP target groups within each MetS subgroup, except body mass index was slightly higher in the standard arm of the MetS subgroup (33.3 ± 5.6 vs 33.0 ± 5.3 kg/m² ; P < .01), but were similar across treatment arms in the non-MetS subgroup. The hazard ratio for the primary outcome was similarly reduced in participants with or without baseline MetS: 0.75 (95% confidence interval [CI] 0.57, 0.96) and 0.71 (95% CI 0.57, 0.87), respectively (adjusted P value for treatment by subgroup interaction = .98). Similarly, there was no evidence of treatment × MetS subgroup interaction for all-cause mortality (adjusted interaction P value = .98). The findings were also similar across race/ethnic subgroups.

CONCLUSIONS

In this analysis the CV benefit of intensive SBP control did not differ among participants by baseline MetS status, regardless of race/ethnicity.

Race Effects of Inhaled Nitric Oxide in Preterm Infants: An Individual Participant Data Meta-Analysis

OBJECTIVE

To assess whether inhaled nitric oxide (iNO) improves survival without bronchopulmonary dysplasia (BPD) for preterm African American infants.

STUDY DESIGN

An individual participant data meta-analysis was conducted, including 3 randomized, placebo-controlled trials that enrolled infants born at  <34 weeks of gestation receiving respiratory support, had at least 15% (or a minimum of 10 infants in each trial arm) of African American race, and used a starting iNO of >5  parts per million with the intention to treat for 7 days minimum. The primary outcome was a composite of death or BPD. Secondary outcomes included death before discharge, postnatal steroid use, gross pulmonary air leak, pulmonary hemorrhage, measures of respiratory support, and duration of hospital stay.

RESULTS

Compared with other races, African American infants had a significant reduction in the composite outcome of death or BPD with iNO treatment: 49% treated vs 63% controls (relative risk, 0.77; 95% CI, 0.65-0.91; P = .003; interaction P = .016). There were no differences between racial groups for death. There was also a significant difference between races (interaction P = .023) of iNO treatment for BPD in survivors, with the greatest effect in African American infants (P = .005). There was no difference between racial groups in the use of postnatal steroids, pulmonary air leak, pulmonary hemorrhage, or other measures of respiratory support.

CONCLUSION

iNO therapy should be considered for preterm African American infants at high risk for BPD. iNO to prevent BPD in African Americans may represent an example of a racially customized therapy for infants.

Using Allostatic Load to Validate Self-rated Health for Racial/Ethnic Groups in the United States

This study evaluates the validity of subjective health measurement for racial/ethnic comparisons in the United States, by assessing whether allostatic load (AL) is equally associated with poor/fair self-rated health (SRH) for different racial/ethnic groups. This study used data from the National Health and Nutrition Survey (NHANES) for 2006-2010. Multivariable logistic regression models were fit and stratified by race/ethnicity to study the association between AL and poor/fair SRH. Higher levels of AL were associated with higher odds of reporting poor/fair SRH. However, this association differs by race/ethnicity. Analysis of interactions and racial/ethnic-stratified models suggest that AL is less associated with poor/fair SRH status for non-Hispanic Blacks and Hispanics populations. These results demonstrate that subjective health ratings potentially underestimate actual measures of biological health risk, especially for racial/ethnic minorities. As a result, population-based assessments of racial/ethnic health disparities based on SRH may be significantly understated.

The Links Between Youth Employment and Educational Attainment Across Racial Groups

Research suggests that the relations between adolescent employment and youth development vary by socioeconomic status (SES) and race/ethnicity. However, it is unclear whether the links between paid work and college outcomes vary by either SES or race/ethnicity, or both. Using data from the Educational Longitudinal Study, we find that low-intensity work during high school is associated with positive college outcomes for almost all students, whereas the associations between high-intensity work and negative postsecondary outcomes are mostly limited to White students. Our results suggest that both differential selections into youth employment and differential consequences of youth employment contribute to these varying links between paid work and educational outcomes across different racial groups.