Intergenerational effects of high socioeconomic status on low birthweight and preterm birth in African Americans

As socioeconomic status (SES) increases, the incidence of low birthweight and preterm birth decreases irrespective of social class. However, low birthweight remains twice as high for African-American women as for white women even when SES is controlled. This study examines to what extent second generation high SES African-American women experience improvement in birthweight and gestational age. One hundred eighty-nine former Meharry students were surveyed. Identified were 934 births that are the children and grandchildren of these students who matriculated at Meharry. These infants are compared with a cohort of white mothers from a study in the School of Public Health at Yale University. Low birthweight was reduced in the third generation high SES African-American children (6.9%) from the second generation (11.4%) but remained higher than white children (3.3%). Results showed that African-American third generation children remained at higher risk for low birthweight than were white children (relative risk [RR], 1.78; 95% confidence interval [CI], 1.03, 3.09). Similar results were observed for preterm delivery where the increased risk to third generation African-American children was 3.16 (1.89, 5.27). Persistent strong ethnic differences in birthweight in this high SES cohort (OR = 3.16, 95% CI, 1.89-5.27) support a conclusion that African-American women have birthweight distributions that are somewhat lighter than white women. This may explain a portion of current ethnic differences in birthweight. It is also possible that persistent psychosocial and behavioral factors continue to negatively influence birthweight, even in second generation high SES African-American mothers. This explanation will require identification of powerful risk factors, which are largely unrelated to those presently under investigation.

Parental hypertension as a predictor of hypertension in black physicians: the Meharry Cohort Study

Parental histories were obtained for a cohort of black medical students in a longitudinal study of hypertension precursors. At follow-up, 25 to 30 years later, initial and current parental histories for hypertension were compared with other precursor characteristics as well as resulting cohort hypertension. The number of participants having no positive parental history for hypertension as parents aged declined from 55% to 24%. Hypertension among black physicians varied according to parental history: 38.9% for both parents negative, 41.4% for mother only positive, 60.5% for father only positive, and 73.7% for both parents positive. Parental history of hypertension was an independent predictor of subject hypertension. Positive parental history in combination with weight gain and high normal baseline systolic and diastolic blood pressure produced a gradient of risk corresponding to the number of risk factors present. Having all four risk factors increased the hypertension risk by 15 times. Parental history together with weight gain, blood pressure, and smoking provide a strong predictor of hypertension. Weight and blood pressure control, along with cessation of smoking, should be considered important factors in the clinical management of such patients.

Cancer rate differentials between blacks and whites of three metropolitan areas

This article presents a comparison of the cancer incidence and mortality rates for the populations of the metropolitan areas of Los Angeles, Atlanta, and Nashville. The results reveal that cancer of the lung, prostate, breast, and cervix should be of major concern to all, but especially to blacks and residents of Nashville. The findings have specific implications for the prevention of cancer in the black population of the United States.

Failure of the cold pressor test to predict hypertension in black physicians: the Meharry Cohort Study

As part of a longitudinal study of precursors for hypertension and atherosclerosis in a cohort of 315 black physicians, the predictive values of cold pressor reactivity were assessed. At initial evaluation, cold pressor tests were performed on all members of the cohort. At the 23- to 30- year follow-up, the participants were again examined and tho cumulative incidence of hypertension was analyzed by the Kaplan-Meier curves in relationship to cold pressor reactivity. The relationship between follow-up hypertension status and baseline cold pressor reactivity was also examined in a logistic regression analysis in which other potential confounders were controlled.The cold pressor test had no value in predicting the occurrence of primary hypertension.

Type A behavior and black physicians: the Meharry Cohort Study

A group of 261 black, male physicians was examined for the prevalence of Type A behavior and other sociomedical correlates.Type A behavior, as measured by the Jenkins Activity Survey (JAS), was collected together with type of practice specialty, blood pressure, weight, and height. Type A behavior tended to vary by physician practice specialty. The job involvement subscale correlated significantly with blood pressure but total JAS and other JAS subscale measurements did not. The job-involvement relationship with blood pressure parallels James's finding in lower socioeconomic status blacks. Type A behavior was not found to be related to hypertension but did tend to favor leanness.

Precursors of hypertension in black compared to white medical students

Data were collected on 433 black medical students at Meharry Medical College (MMC) and 573 white medical students at The Johns Hopkins University School of Medicine (JHMS) during the period of 1958 through 1965 consisting of baseline measurement of some possible precursors of hypertension. Similar methods were employed in both cohorts. Comparison as to prevalence and significance of hypertension precursors revealed the following: Black males had significantly higher casual and resting blood pressures than whites (p less than 0.01); and higher mean changes in blood pressure following the cold pressor test. White males had a significantly higher mean change in heart rate following cold pressor test (p less than 0.01). Upon exercise black males had significantly higher mean change in blood pressure and heart rate (p less than 0.01). There appears to be more blood pressure lability in blacks as indicated by higher mean SBP + DBP changes following the cold pressor test, and by mean pulse pressure level at peak exercise. The difference in blood pressure lability observed between blacks and whites in young adulthood may be one of the earliest identifiers of later differences in the incidence of hypertension. However, of even more importance is the difference in blood pressure levels between the two groups, though both are normotensive.

Obesity and hypertension in a longitudinal study of black physicians: the Meharry Cohort Study

Obesity has been considered a risk factor among the precursors of essential hypertension for many years. Most related studies were general population surveys or predominantly white, male cohorts. This paper reports results of a longitudinal study of former black medical students, now practicing physicians for an average of 22.5 years. A remarkably high 43.8% were found to have developed hypertension. Fifty nine per cent of those who became obese during the study were hypertensive compared with 40% of the non-obese, 36% of those initially obese only, and 45% of those obese on both examinations. The risk ratio was 1.7 for the most obese (greater than or equal to 130% relative body weight) compared with 1.0 for the leanest group Dynamic weight change together with baseline diastolic blood pressure, were more prominent precursors than the other variables studied. Weight control would appear to be a potentially important nonpharmacologic hypertension risk reduction measure.

Longitudinal study of three views of mandibular third molar eruption in males

A longitudinal study, using three views simultaneously, was conducted on twenty North American black males to investigate mandibular third molar eruption. Each subject had two third molars present. Forty third molars were studied. Lateral, posteroanterior, and oblique (45 degrees left and right) cephalograms, along with plaster casts, were used. The following observations on the third molars were made; the age at which they can be identified; angulation of the occlusal surface; eruptive path, including the vertical, anteroposterior, and buccolingual positions; and the age of delineation between being unerupted or impacted, including factors related thereto. The Fisher's exact test from the SPSS package and the central tendency were the statistical instruments used to aid in interpreting the data. In some persons the crypt of the developing third molar was seen as early as 7.5 years and the occlusal surface was identified as early as age 8 years, with a mean of 9.75 years. Third molars usually form in the ramus with the distal cusp above the occlusal plane, the occlusal surface of the molar has a great cant facing anteriorly, the tooth descends below the occlusal plane, and appears to upright around 14 to 16 years of age. The impaction of the mandibular third molar is a complex multifactorial mechanism. The wide buccal location of mandibular third molars and the inadequate anteroposterior space between the distal surface of the second molar and the anterior surface of the ramus are important factors in third molar impaction. This study does not support the concept of early prediction of third molar impaction and enucleation of the asymptomatic developing third molars. If possible, the final decision for extraction of asymptomatic mandibular third molars that appear to be impacted should be delayed until after the age of 16 years.

Precursors of hypertension in black medical students: the Meharry cohort study

Data were collected on a cohort of 435 black medical students whose attendance at Meharry Medical College fell within the period 1958 to 1965, providing baseline measurements on multiple possible hypertension precursors. Relevant family history, sociodemographic, and clinical characteristics were obtained. Fifty percent of the students had at least one of the following possible precursors of hypertension: systolic blood pressure >120 mmHg; diastolic blood pressure >80 mmHg; pulse >80 beats/min; and relative body weight >120 percent of ideal body weight. Contrary to expectations, students from professional families were more likely to have higher systolic blood pressures. Students whose parents had a positive history of hypertension or stroke were likely to have higher diastolic blood pressures. Of the 24 students found to be hypertensive on survey (1981), 73 percent had a positive parental history of hypertension or stroke compared with only 40 percent of a control group matched by age and sex. A 17-year follow-up is currently underway to develop a risk profile for hypertension among black professionals.

Precursors of hypertension: a review

Recent advances in hypertension therapy have been remarkable; however, much less is known about those precursors that facilitate preventive and early intervention measures. This review of the literature indicates that relevant precursors are early elevated casual systolic blood pressures, positive family history, and obesity in females. Additional predisposing or enhancing factors point to high sodium ingestion, heavy smoking, and high socioecologic stress. Evidence for a high-risk hypertensive personality is not conclusive. There is a paucity of longitudinal data on hypertension in the black population.