The sleep of African Americans: a comparative review

Researchers have not thoroughly assessed the sleep of African Americans (AAs) despite the recent increased attention to ethnic research. This article reviews the sleep and epidemiological literatures to assess AA sleep. Although the limited data were sometimes inconsistent, they suggest that AAs sleep worse than Caucasian Americans. AAs take longer to fall asleep, report poorer sleep quality, have more light and less deep sleep, and nap more often and longer. AAs have a higher prevalence of sleep-disordered breathing and exhibit more risk factors for poor sleep. These differences are concentrated in young- and middle-age adults. There are no sleep disorders treatment data for AAs. These data support further research into ethnic differences in both normal and disturbed sleep.     

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.     

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.     

Diabetes, depression, and healthcare utilization among African Americans in primary care

PURPOSE: This study tested for an association between diabetes and depressive symptoms and assessed the effect of co-occurring diabetes and depressive symptoms on healthcare utilization outcomes among African-American patients. PROCEDURE: The sample consisted of 303 adult African-American patients age 40 and over from a primary care clinic serving the low-income population in Nashville, TN. Measures were based on self-reports during a structured interview. Multivariate analyses adjusted for age, gender, socioeconomic status, and comorbid chronic conditions. FINDINGS: African-American patients with and without diabetes did not differ on the presence or severity of depressive symptoms. However, the co-occurrence of major depressive symptoms with diabetes among African Americans was associated with nearly three times more reported emergency room visits and three times more inpatient days, but was only marginally associated with a lower number of physician visits. CONCLUSIONS: In contrast to previous studies with predominantly white samples that found a positive association between diabetes and depression, no association was found in this African-American sample. Nevertheless, the results did concur with research findings based on other samples, in that the co-occurrence of depression with diabetes was associated with more acute care utilization, such as emergency room visits and inpatient hospitalizations. This pattern of utilization may lead to higher healthcare costs among patients with diabetes who are depressed, regardless of race.     

Cardiovascular risk reduction among African Americans: a call to action

African Americans are at greater risk for cardiovascular morbidity and mortality than European Americans or Asians. They also bear a disproportionately greater burden from type-2 diabetes mellitus. Not as much access to healthcare and less intensive use of available therapies may explain some of these disparities. However, the high prevalence of potentially modifiable risk factors, particularly hypertension and dyslipidemia, in African Americans also provides great opportunity for the prevention and treatment of cardiovascular disease in this population. In addition to lifestyle approaches, achieving aggressive goals for blood pressure (< or =130/80 mmHg) and low-density-lipoprotein cholesterol (<100 mg/dL, or <70 mg/dL for patients at very high cardiovascular risk, including those with diabetes) will necessitate the use of effective pharmacologic therapies. Clinical trial data indicate that antihypertensive regimens, particularly those that include a diuretic, are as effective in African Americans as in other racial/ethnic groups. Moreover, potent statins have been shown to decrease low-density-lipoprotein cholesterol to goal levels in African-American patients.     

Informed and patient-centered decision-making in the primary care visits of African Americans with depression

Objective

We examined the prevalence and extent of informed decision-making (IDM) and patient-centered decision-making (PCDM) in primary care visits of African Americans with depression.

A pilot community-based intensive smoking cessation intervention in African Americans: feasibility, acceptability and early outcome indicators

Few intensive and community-based smoking cessation treatment programs have been designed for African-American smokers, a group who experiences numerous health disparities associated with cigarette smoking. The purpose of this study was to examine the feasibility, acceptability and biochemically verified early outcome indicators in a community-based comprehensive smoking cessation program in 50 urban, low- and middle-income African-American smokers. The intervention was an intensive six-session group program delivered in the community and a one-month supply of the transdermal nicotine patch. Results showed 74% of enrolled participants completed the program and 51% of participants were highly adherent to patch use guidelines. Intent-to-treat analyses revealed that 34% of participants were biochemically confirmed as having quit smoking at one month post quit date. Smoking urges and depressive symptoms also declined significantly during the first month. At three- and six-month follow-up, biochemically confirmed quit rates were 22% and 18%, respectively. Adherence to nicotine patch use, higher ratings of the perceived helpfulness of self-monitoring tasks (wrap sheets) and lower depression scores at baseline all significantly predicted quitting success during the first month of treatment (all p's<0.05). Larger studies are warranted to examine targeted treatment elements and individual difference factors to enhance cessation outcomes in African-American smokers.     

Smoking, depression, and gender in low-income African Americans with HIV/AIDS

Individuals with HIV/AIDS have disproportionately high depression and smoking prevalence rates. Smokers with HIV/AIDS are more susceptible to opportunistic infections, smoking-related illnesses, and mortality. African Americans (AAs) comprise nearly half of newly diagnosed HIV+ cases. We examined the relationship among smoking, depression, and gender in un- or under-insured AA patients (N = 289) at an urban community HIV/AIDS clinic in the southeastern US. Approximately 33% met criteria for a depressive disorder and 37% endorsed current smoking status. Men were more likely than women to be current smokers and depressed participants were more likely to smoke than non-depressed participants. Women had significantly higher rates of depression compared to men. Both depression and male gender independently predicted current smoking status. Depression and smoking are likely to co-occur in HIV/AIDS patients; however, standard smoking cessation interventions often exclude smokers with comorbid psychiatric and/or medical illnesses. Interventions addressing these comorbidities are warranted.     

The Sleep of African Americans: A Comparative Review

Researchers have not thoroughly assessed the sleep of African Americans (AAs) despite the recent increased attention to ethnic research. This article reviews the sleep and epidemiological literatures to assess AA sleep. Although the limited data were sometimes inconsistent, they suggest that AAs sleep worse than Caucasian Americans. AAs take longer to fall asleep, report poorer sleep quality, have more light and less deep sleep, and nap more often and longer. AAs have a higher prevalence of sleep-disordered breathing and exhibit more risk factors for poor sleep. These differences are concentrated in young- and middle-age adults. There are no sleep disorders treatment data for AAs. These data support further research into ethnic differences in both normal and disturbed sleep.     

A critical approach to stress-related disorders in African Americans

This article outlines an integrative, dynamic approach to stress and is, in part, a response to emergent debates within social science research and practice that suggest that African Americans are currently experiencing the reverberating psychological effects of slavery and oppression. It is the product of the work of an African-American mental health think tank situated at the Community Mental Health Council, Chicago, Illinois. We suggest the need to attend to biopsychosocial, environmental, and cultural factors that inform both exposure and responses to stress. Finally, consideration is given to matters of resiliency.     

Cardiotoxicities of paclitaxel in African Americans

PURPOSE: To assess the cardiac disturbances in African-American patients treated with paclitaxel. PATIENTS AND METHODS: One-hundred-nineteen African-American patients received paclitaxel for various cancers at Howard University Hospital during the years 1993-2001. Medical records of 100 patients were available for review. Sixty-seven percent were women and 33% were men. Ages ranged between 26-85 years (mean age 51 years). Medical records were reviewed for demographics, types of cancer, dosage and frequency of paclitaxel and other chemotherapeutic agents, events during paclitaxel infusion, initial and subsequent EKGs, and hospital admissions. We used the Chi-square test to compare EKG changes in patients with and without cardiac risk factors. RESULTS: Ninety patients received paclitaxel as second-line chemotherapy, and 10 patients were treated with paclitaxel as a single agent. Dosage of paclitaxel ranged from 75-200 mg/square meter and was administered every 1-3 weeks. The electrocardiogram readings revealed the following cardiac events: 26% sinus tachycardia, 13% non-specific T-wave changes, 6% myocardial infarction, 4% prolonged QT interval, 4% left-bundle branch block, 3% right-bundle branch block, 3% sinus bradycardia, 2% premature atrial contractions, 2% premature ventricular contractions, 2% atrial flutter, and 1% atrial fibrillation. Eighty percent of the patients had risk factors for coronary artery disease. These cardiac disturbances were observed from day one to a maximum of eight years after receiving the chemotherapy and were independent of dosage of paclitaxel. Sixty percent of our study population had underlying co-morbid conditions, such as dehydration, anemia, sepsis, and hypoxia. The EKG changes observed in patients with underlying cardiac risk factors were statistically significant (p<0.0001). CONCLUSION: Paclitaxel was not associated with significant symptomatic cardiac disturbances during infusion in our study population. Caution should be exercised in patients with underlying cardiac disease and risk factors for coronary artery disease. However more prospective studies with closer follow-up during paclitaxel infusion are needed to assess its cardiotoxicities.     

The status of medical education for black Americans

Health-care priorities are changing throughout the United States, and the quality of American medicine is dependent on the quality of medical education. While a surplus of doctors is anticipated, a shortage of minority doctors remains. Published data sources provide information on enrollment, distribution, and specialties of black Americans in medical education programs. These data provide understanding of the process that has created the shortage of blacks in medicine. The tabular data suggest that the proportion of blacks in medical education programs has remained very low over time, and in some cases, it has actually declined. Funding needs, recruitment efforts, and educational information are essential considerations in changing the racial make-up of medical education and health care.     

The health-care system and African Americans in Indianapolis.

In order to critically assess the health-care system in Indianapolis, it is important to analyze this African-American population from two major perspectives. First, the local African-American population must be viewed in the context of the local health-care system in its present and historical setting. Second, the local African-American population must be viewed in conjunction with other urban African-American populations. These two perspectives will show how the region''s economic, social, cultural, and political climate have affected the health-care status of African Americans in Indianapolis.