Religious Coping Among African Americans, Caribbean Blacks and Non-Hispanic Whites

This study examined demographic predictors of attitudes regarding religious coping (i.e., prayer during stressful times and look to God for support, strength and guidance) within a national sample of African American, Caribbean Blacks and non-Hispanic Whites (National Survey of American Life). The findings demonstrate significant Black-White differences in attitudes regarding religious coping with higher endorsements of religious coping among African Americans and Black Caribbeans (Caribbean Blacks). Comparisons of African Americans and Black Caribbeans revealed both similar and divergent patterns of demographic effects. For both African Americans and Black Caribbeans, women were more likely to utilize religious coping than men and married respondents were more likely than never married respondents to report utilizing prayer when dealing with a stressful situation. Further, for both groups, higher levels of education were associated with lower endorsements of the importance of prayer in dealing with stressful situations. Among African Americans only, Southerners were more likely than respondents who resided in other regions to endorse religious coping. Among Black Caribbeans, those who emigrated from Haiti were more likely than Jamaicans to utilize religious coping when dealing with a stressful episode.     

African Americans and Caribbean Blacks: Perceived neighborhood disadvantage and depression

The purpose of this study was to advance a theoretical understanding of the effects of impoverished neighborhoods on mental health and to inform policy measures encouraging residents to leave such neighborhoods. To do this, we investigated whether individuals’ perceived neighborhood disadvantage served as a risk factor for clinical depression in a nationally representative sample of African Americans and Caribbean Blacks. We performed logistic regression analysis on stratified socioeconomic status (SES) subsamples from the National Survey of American Life sample of 5,019 African Americans and Caribbean Blacks. The association between perceived neighborhood social disorder and past‐year depression was statistically significant for low‐SES individuals (at or below the federal poverty line; odds ratio [OR] = 1.73, 95% confidence interval [CI] [1.07, 2.81], p = 0.026) and at the boundary of significance for middle‐SES individuals (between 100% and 300% of the poverty line; OR = 1.74, 95% CI [1.00, 3.02], p = 0.052), but not for high‐SES individuals (at or above 300% of the poverty line). Results suggest, at least for low‐ and middle‐income African Americans, perceived neighborhood social disorder is a risk factor for depression. U.S. housing policies aimed at neighborhood improvement and poverty de‐concentration may benefit the mental health of low‐income African Americans and Caribbean Blacks.     

Caveats in the neuropsychological assessment of African Americans

This preliminary investigation examined the predictive accuracy of six neuropsychological tests in a population of non-brain-injured African Americans. False positives were unacceptably high on five of the neuropsychological tests administered. These pilot data raise important questions about the utility of neuropsychological test norms with groups dissimilar in sociocultural background to the normative population. These findings are examined in terms of the relative merits of the race-homogenous and race-comparative paradigms and underscore the importance of conducting normative studies that involve ethnic minority populations.     

B Cell Antigens of Black Americans

Fourty-four unrelated North American Blacks and one Black family were tested for B-cell specific antigens with 7th International Workshop antisera. DR specificities were clearly defined in this group, but were generally less frequent than reported for Black Americans in the 7th Workshop report and were most similar in frequency to those reported for African Blacks. Five new B-cell specificities (DuB40-43, 45) were identified. In contradistinction to Caucasians, Black Americans type for HLA-D with homozygous typing cells failed to exhibit strong linkage disequilibrium between D and DR types.     

Parental separation, loss and psychosis in different ethnic groups: a case-control study

BACKGROUND: Numerous studies have reported high rates of psychosis in the Black Caribbean and Black African populations in the UK. However, few studies have investigated the role of specific risk factors in different ethnic groups. We sought to investigate the relationship between long-term separation from, and death of, a parent before the age of 16 and risk of adult psychosis in different ethnic groups. METHOD: All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK and a series of community controls were included in the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study. Data relating to clinical and social variables, including parental separation and loss, were collected from patients and controls. RESULTS: Separation from, and death of, a parent before the age of 16 were both strongly associated with a two- to threefold increased risk of psychosis. The strength of these associations were similar for White British and Black Caribbean (but not Black African) subjects. Separation from (but not death of) a parent was more common among Black Caribbean controls than White British controls. CONCLUSIONS: Early separation may have a greater impact in the Black Caribbean population, because it is more common, and may contribute to the excess of psychosis in this population.     

Discrimination and Depressive Symptoms Among Black American Men: Moderated-Mediation Effects of Ethnicity and Self-Esteem

Discrimination is related to depression and poor self-esteem among Black men. Poorer self-esteem is also associated with depression. However, there is limited research identifying how self-esteem may mediate the associations between discrimination and depressive symptoms for disparate ethnic groups of Black men. The purpose of this study was to examine ethnic groups as a moderator of the mediating effects of self-esteem on the relationship between discrimination and depressive symptoms among a nationally representative sample of African American (n = 1201) and Afro-Caribbean American men (n = 545) in the National Survey of American Life. Due to cultural socialization differences, we hypothesized that self-esteem would mediate the associations between discrimination and depressive symptoms only for African American men, but not Afro-Caribbean American men. Moderated-mediation regression analyses indicated that the conditional indirect effects of discrimination on depressive symptoms through self-esteem were significant for African American men, but not for Afro-Caribbean men. Our results highlight important ethnic differences among Black men.     

The help-seeking behavior of black Americans. A summary of findings from the National Survey of Black Americans

In 1977, the National Institute of Mental Health funded the National Survey of Black Americans (NSBA). The NSBA was an omnibus, nationally representative sample (N = 2,107) of adult black Americans that explored numerous issues relevant to black quality of life. One topic that has received much attention is where blacks go for help during periods of crisis. This article provides a brief summary of NSBA findings on the use of informal help, professional help, and insurance coverage. Suggestions for future research directions for those interested in the help-seeking behavior of black Americans are provided.     

Factor IX mutations in South Africans and African Americans are compatible with primarily endogenous influences upon recent germline mutations

Similar patterns of germline mutations in the factor IX gene (F9) have been observed in certain geographically and racially diverse populations. Germline mutation data have not been available from any region of Africa or from the Black race. Analysis of mutation data for Blacks is of interest, since this race has a high frequency of polymorphism compared to other races. This high frequency has been interpreted as evidence for the "out of Africa" hypothesis for the origin of humans, but it is possible that Blacks have a higher mutation rate due to genetic differences or environmental exposures. We report 26 independent mutations that were detected in patients of mixed races with hemophilia B from South Africa. The pattern of mutation in patients from this African country was similar to that of U.S. Caucasians. In addition, 22 independent mutation were detected in African American patients. The patterns of independent germline mutation in 22 African Americans (and in a combination 34 North American and African Blacks) is similar to that of U.S. Caucasians. Neither genetic differences between the Black and Caucasian races nor environmental and cultural differences between South Africa and the U.S. alter the germline pattern of mutation observed in F9. Hum Mutat 16:372, 2000.     

The Effect of Demographic Variables on Ethnic Experience

Research on ethnicity and health has increased recently, but there is still comparatively little known about the nuances of ethnicity and how they might influence health and health behaviors. Using the Scale of Ethnic Experience, this study revealed ethnic differences on perceived discrimination, ethnic identity, and mainstream comfort. Within the African American sample, socioeconomic status (SES), age, and gender influenced these factors. However, Caucasian Americans reported less perceived discrimination and ethnic identity than did African Americans regardless of age, gender, or SES. They also perceived more control over their ability to succeed in mainstream society than did African Americans. These findings suggest that ethnicity consists of multiple components, which may be influenced by demographic factors in African Americans. It is possible that each aspect of ethnicity differentially relates to health outcomes.     

Effects of ethnicity,gender, obesity,and age on central fat distribution: Comparison of dual x-ray absorptiometry measurements in white,black, and Puerto Rican adults

Population based studies relying primarily upon anthropometric surrogates of fat distribution have shown that central or upper-body adiposity is related to ethnicity, gender, age, and total body fatness. As an improvement over anthropometry, dual x-ray absorptiometry (DXA) provides more precise measurements of fat mass (FM) in the total body and trunk. DXA was performed on 510 apparently healthy White (81 females (f), 64 males (m)), Black (94 f, 79 m), and Puerto Rican (102 f, 100 m) adults aged 20–75 years in order to determine and compare the effects of race, gender, age, and total FM on trunk FM. Trunk FM was greater for Blacks and Puerto Ricans than Whites, irrespective of gender (P < 0.014). Puerto Rican males and females had a greater proportion of fat in the trunk (%TrFM) than Whites or Blacks (P < 0.001), and Whites and Blacks were similar with respect to %TrFM (P > 0.67). Females had less %TrFM than males in all three ethnic groups (all P < 0.001). Based on multiple regression analysis, ethnicity did not affect the relationship of trunk and total FM among males (P > 0.16), but the coefficient for total FM was larger for Puerto Rican compared to Black females (P = 0.043). Trunk FM increased with age in Whites and Puerto Ricans (P < 0.02), but not Blacks (P > 0.24). The effects of age did not differ by gender or ethnicity among Whites and Puerto Ricans (P > 0.10). Adjustment for total FM and age eliminated ethnic and gender differences in trunk FM (all P > 0.37). The results suggest that the high levels of central adiposity observed among Blacks and Hispanics relative to Whites reflect patterns of generalized obesity observed in the respective populations. Patterns of accumulation of truncal FM with increasing age and obesity may not be generalizable to all ethnic groups. Am. J. Hum. Biol. 10:361–369, 1998. © 1998 Wiley-Liss, Inc.     

Race/ethnic differences in the prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND: Very few large national epidemiologic surveys have examined the prevalence of psychiatric disorders among Asians and Native Americans due to small sample sizes. Very little is also known about the co-occurrences between substance use disorders and mood and anxiety disorders among these two minority groups and how their rates compare to Whites, Blacks, and Hispanics. METHOD: Analyses were based on a large (n = 43093) nationally representative survey of the adult (18+ years), U.S. population supplemented by a group quarters sampling frame. Prevalences and associations of major DSM-IV mood, anxiety and substance use disorders were examined among all major race/ethnic subgroups of the population. RESULTS: Twelve-month rates of most mood, anxiety and substance use disorders were generally greatest among Native Americans and lowest among Asians. For most race/ethnic subgroups, alcohol and drug dependence, but not abuse, were significantly associated with mood disorders. With few exceptions, there were no significant associations between alcohol and drug abuse and anxiety disorders. In contrast, alcohol dependence was associated with most anxiety disorders among Whites, Blacks and Asians, but not among Native Americans. CONCLUSIONS: The 12-month prevalence of substance use, mood, and anxiety disorders varied greatly across the five major race/ethnic subgroups of the population. Twelve-month co-occurrence of substance use disorders and mood and anxiety disorders was pervasive among all race/ethnic subgroups. Future research is also needed to understand race/ethnic differentials in prevalence and co-occurrence of these disorders with a particular focus on factors that may give rise to them.     

Influence of maternal ethnicity on infant mortality in Chicago, 1989-1996

This study compared infant mortality rates between large ethnic groups in Chicago from 1989-1996. Infant mortality information about ethnic groups was compared using data from annual reports published by the Epidemiology Program, Department of Public Health, City of Chicago and vital statistics documents in Illinois, which include information on ethnicity. Chi-squared analysis was used to evaluate the differences between the proportions. A P value of < .05 was considered significant. During the study period, there were 461,974 births and 6407 infant deaths in Chicago. African Americans contributed 212,924 (46.1%) births and 4387 (68.5%) deaths; Hispanics 132,787 (28.7%) births and 1166 (18.2%) deaths; and whites 99,532 (21.6%) births and 780 (12.2%) infant deaths. Compared with the other groups. African Americans suffered a twofold increased mortality (P < .00001) for five of the six most common causes of infant mortality. Deaths from congenital malformations, although significant, were not excessively increased among African Americans (P = .014). Hispanics demonstrated a higher mortality rate than whites (P = .01), especially for postnatal mortality and respiratory distress syndrome. These data confirm excessive infant mortality among African Americans. Further studies are needed to evaluate the apparent low mortality among some Hispanics compared with the other groups studied.     

Central Serous Chorioretinopathy in African Americans at Wilmer Eye Institute

Objective

To evaluate the frequency of central serous chorioretinopathy (CSC) in African Americans/blacks within an academic center in a predominantly African American city, as the current belief is that CSC is rare in this population.

Ethnic differences in self-reported sleep problems in older adults.

STUDY OBJECTIVES: To date, conflicting observations have been made regarding ethnic differences in sleep patterns. Plausibly, differing sampling strategies and disparity in the cohorts investigated might help explain discrepant findings. To our knowledge population-based studies investigating ethnic differences in sleep complaints have not addressed within-group ethnic heterogeneity, although within-group health disparities have been documented. DESIGN: Volunteers (n =1118) in this study were community-residing older European Americans and African Americans residing in Brooklyn, New York, which were recruited by a stratified, cluster sampling technique. Trained interviewers of the same race as the respondents gathered data during face-to-face interviews conducted either in the respondent's home or another location of their choice. Data included demographic and health risk factors, physical health, social support, and emotional experience. Relationships of demographic and health risk factors to sleep disturbances were examined in multiple linear regression analyses. Within-group differences in sleep complaints were also explored. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Of the factors showing significant associations with sleep disturbance, European American ethnicity was the most significant predictor (r2 = 0.20). Worse sleep and greater reliance on sleep medicine were observed among European Americans. Caribbean Americans reported less sleep complaints than did U.S.-born African Americans, and immigrant European Americans reported greater complaints than did US-born European Americans. CONCLUSIONS: As expected several health risk factors were predictive of sleep disturbance among urban community-dwelling older adults, but ethnicity was the most significant predictor. The present data suggest both between-group and within-group ethnic differences in sleep complaints. Understanding of demographic and cultural differences between African Americans and European Americans may be critical in interpreting subjective health-related data.     

Sleep disorders in African Americans and Caucasian Americans: a meta-analysis

Previous research suggests that ethnic groups differ in the prevalence and severity of disordered sleep symptoms. This study used meta-analysis to determine the magnitude of ethnic differences between African Americans (AAs) and Caucasian Americans (CAs) in insomnia symptoms and sleep-disordered breathing (SDB). It also used moderator analyses to explore the variability in these effect sizes. Thirteen studies measuring insomnia symptoms and 10 studies measuring SDB met inclusion criteria and represented thousands of adult AAs and CAs. Results indicate AAs have a higher prevalence and greater severity of SDB, but CAs report more insomnia symptoms. These results indicate a need for a multi-ethnic approach to the assessment and treatment of sleep disorders.     

Ethnicity, alcohol drinking and changes in transaminase activity among heavy drinkers

BACKGROUND: Liver cirrhosis mortality differs by ethnicity in the United States. Some studies suggest alcohol sensitivity may contribute to this finding. This analysis evaluated if alcohol-associated changes in aspartate aminotransferase (AST) and alanine transaminase (ALT) differed by ethnicity among heavy drinkers. METHODS: Subjects included 1691 subjects from Project MATCH, a multicenter alcohol use disorders treatment trial. Changes in AST and ALT over 15 months were modeled as functions of ethnicity, age, gender, time, study site and alcohol use. The main focus was on ethnic differences in changes in transaminase activity occurring with changes in alcohol use. RESULTS: At all levels of alcohol consumption AST was lower in non-Hispanic whites relative to African Americans and Mexican Americans. Changes in AST associated with changes in alcohol use did not vary by ethnicity. ALT significantly differed only between Mexican Americans and non-Hispanic whites. Similar to AST, alcohol-associated ALT change did not differ by ethnicity. CONCLUSIONS: Among individuals with alcohol use disorders participating in a treatment trial, the effect of alcohol drinking on transaminase activity did not vary by ethnicity. However, in the general population, alcohol may still interact with other factors in mediating ethnic differences in cirrhosis mortality.     

Clinical aspects of narcolepsy-cataplexy across ethnic groups

STUDY OBJECTIVES: The objectives of this study were to compare severity and clinical presentation for narcolepsy-cataplexy across various ethnic groups. A large sample of narcoleptic patients was also used to further describe symptomatology and natural history for this sleep disorder. DESIGN: Retrospective review of clinical data ascertained from the Stanford Sleep Inventory, polysomnography and MSLT data, as well as clinical notes. Ethnicity was narrowly defined as African (Black) Americans, Caucasians, Asians, and Latinos when both parents and the subject identified with a given ethnic group. SETTING: N/A. PARTICIPANTS: We compared the severity and clinical presentation of narcolepsy in 64 African Americans, 353 Caucasians, 32 Asians, 26 Latinos, and 9 subjects of mixed ethnicity. Subjects were recruited through the Stanford center for narcolepsy research. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: A striking similarity in symptomatology, age of onset, and disease severity was found across ethnic groups. Mean age of onset for sleepiness, hypnagogic hallucinations, sleep paralysis and cataplexy were 19.20, 19.50, 20.11 and 23.02 years old. We also found that narcoleptic patients have slightly but significantly elevated body mass index relative to normative data (106.6% of matched controls, p<0.005) and are born slightly more frequently during the month of March. A tight correlation between our previously validated cataplexy scale and DQB1*0602 positivity was observed. Two thirds of patients reported having cataplexy with laughing, 92% of those being DQB1*0602 positive independent of ethnicity. CONCLUSIONS: These results confirm the similarities in clinical presentation and natural history of narcolepsy-cataplexy in a large number of patients of various ethnic groups and cultural backgrounds.     

The influence of acculturation on the Wisconsin Card Sorting Test by Mexican Americans.

This study examined the speculation that the Wisconsin Card Sorting Test (WCST) might be a relatively culture-free neuropsychological test. The relationship between level of acculturation and performance on the Spanish version of the WCST was investigated, using a sample of Mexican American adults (N=52). When the sample was divided into two groups based on level of acculturation as measured by the Acculturation Rating Scale for Mexican Americans--2nd Edition, within-group contrasts demonstrated that higher levels of acculturation significantly improved performance on the WCST. The performance of this sample was compared to select Spanish norms, finding no clinically significant differences. Contrasts with English norms for the WCST yielded significant differences on a majority of the WCST measures, demonstrating that the English norms are inappropriate for use with this population. This study concludes that the WCST is not a culture-free neuropsychological test.     

Incorporating ethnicity into genetic risk assessment for Alzheimer disease: the REVEAL study experience

PurposeTo describe how investigators in a multisite randomized clinical trial addressed scientific and ethical issues involved in creating risk models based on genetic testing for African American participants.MethodsThe following informed our decision whether to stratify risk assessment by ethnicity: evaluation of epidemiological data, appraisal of benefits and risks of incorporating ethnicity into calculations, and feasibility of creating ethnicity-specific risk curves. Once the decision was made, risk curves were created based on data from a large, diverse study of first-degree relatives of patients with Alzheimer disease.ResultsReview of epidemiological data suggested notable differences in risk between African Americans and whites and that Apolipoprotein E genotype predicts risk in both groups. Discussions about the benefits and risks of stratified risk assessments reached consensus that estimates based on data from whites should not preclude enrolling African Americans, but population-specific risk curves should be created if feasible. Risk models specific to ethnicity, gender, and Apolipoprotein E genotype were subsequently developed for the randomized clinical trial that oversampled African Americans.ConclusionThe Risk Evaluation and Education for Alzheimer Disease study provides an instructive example of a process to develop risk assessment protocols that are sensitive to the implications of genetic testing for multiple ethnic groups with differing levels of risk.     

Atrial fibrillation among African Americans, Hispanics and Caucasians: clinical features and outcomes from the AFFIRM trial

The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study concluded that rate control with anticoagulation was equivalent overall to rhythm control with cardioversion for long-term survival and that anticoagulation reduced the risk of stroke. We compared baseline and follow-up data for three ethnic groups: Caucasians (n=3,599), African Americans (n=265) and Hispanics (n=132). Caucasians were older and more likely male, African Americans were more likely female and hypertensive, and Hispanics had higher prevalence of cardiomyopathy. Survival was better for rate control than rhythm control in Caucasians, equivalent in African Americans and better for rhythm control in Hispanics. Outcomes may be influenced by differential baseline characteristics, but low numbers of African Americans and Hispanics warrant caution in data interpretation. BACKGROUND: The AFFIRM study compared a rate-control strategy to a rhythm-control strategy for the treatment of atrial fibrillation (AF) in patients at high risk for stroke or death. It concluded that the rhythm-control strategy offered no survival advantage, and it also confirmed the value of anticoagulation to prevent complications of AF. Data have not previously been available for specific racial ethnic populations. METHODS: We compared baseline and follow-up data for the patients randomized to rate-control versus rhythm-control in three population groups-Caucasian, African-American and Hispanic. RESULTS: Among 4,060 total patients, 3,599 were Caucasian, 265 were African-American and 132 were Hispanic. At baseline, Caucasians were older and had a higher percentage of males, normal ejection fractions, AF as their only cardiac diagnosis, a prior antiarrhythmic drug failure and less congestive heart failure. African Americans were more likely to be female, had more hypertension and qualified for the study with a first episode of AF, compared to Caucasians. Hispanics had more cardiomyopathy at baseline than Caucasians. Overall survival in Caucasians at five years for the rate-control and rhythm-control groups was 78.9% vs. 76.4%, respectively (p=0.04); for African Americans, 79.0% vs. 69.4% (p=0.22); and for Hispanics, 66.5% vs. 83.9% (p=0.01). Overall, survival was not different between the three populations. However, lower rates of event-free survival were recorded for Hispanics and for African Americans (p=0.0182). CONCLUSIONS: Different survival rates were found for rate-control versus rhythm-control in African-American and Hispanic patients, compared to Caucasian. These findings may be influenced by differences in baseline characteristics, but must be interpreted with caution because of the small sample sizes for African-American and Hispanic participants.