Showing papers in "Ethnicity & Disease in 1993"

Promoting physical activity in low-income African-American communities: the PARR project.

Abstract: Data suggest that low-income and minority individuals are less physically active than the general population. We conducted a constituency-based physical activity promotion program, the Physical Activity for Risk Reduction (PARR) project, from 1988 to 1991, with residents of rental communities administered by the Housing Authority of the Birmingham District in Birmingham, Alabama. Data collected through focus groups and by survey of randomly selected residents' exercise practices, beliefs, barriers to and facilitators of physical activity were used to develop specific intervention programs that were implemented and evaluated in six intervention and two control communities through surveys and process evaluations. Trained community residents conducted data collection and interventions. Ninety-nine percent of respondents in the baseline survey were African Americans. Thirty-one percent reported no participation in any of 13 physical activities in the previous year. Significant differences (P < .05) in average attendance by community at group exercise sessions indicated substantial variability in effectiveness of the intervention, due at least in part to factors related to both the communities and the leaders. This variability appeared to explain patterns of change in preintervention and postintervention physical activity scores in intervention communities. Data and experiences from PARR will be applicable to the delivery of similar types of health-related programs in undeserved communities.

Is the risk of coronary heart disease lower in Hispanics than in non-Hispanic whites? The San Luis Valley Diabetes Study.

Abstract: A less favorable cardiovascular risk factor profile, but paradoxically lower coronary heart disease mortality and prevalence have been reported for Hispanic men compared to non-Hispanic white men. Since mortality and prevalence data are susceptible to bias, the patterns of coronary heart disease incidence, as well as prevalence and mortality, were investigated in a biethnic Hispanic and non-Hispanic white population of the San Luis Valley in Colorado. Little evidence was found for lower incidence, prevalence, or mortality due to coronary heart disease among Colorado Hispanics without diabetes. The risk of coronary heart disease among diabetic Hispanics appeared, however, to be approximately 50% lower than among non-Hispanic whites, especially in men. Adjustment for selected cardiovascular risk factors (age, gender, diabetes, hypertension, cigarette smoking, body mass index, and high-density lipoprotein cholesterol and triglycerides levels) did not change this ethnic pattern. The plausible explanations of a lower coronary heart disease risk among diabetic Hispanics, compared to non-Hispanic whites, include both biologic mechanisms and artifacts due to deficiencies of mortality classification or differential access to health care. The existing evidence is insufficient to conclude that the risk of coronary heart disease in the general population differs between Hispanics and non-Hispanic whites. The ethnic patterns of coronary heart disease incidence should be investigated further through population-based incidence studies.

Is race a risk factor or a risk marker for preterm delivery

Abstract: Reasons for the persistent difference in rates of preterm delivery among black and white women are not clear. Known risk factors explain very little of the variance. Recent studies have shown that social class does not fully account for poor pregnancy outcomes among black women. Cultural and environmental factors that vary between the races, but not between the different socioeconomic levels within a race, may account for some of the unexplained ethnic differences in preterm delivery. Any potentially negative exposure that is distributed differentially between racial groups warrants particular attention. The major hypothesis of this research is that US black women are chronically exposed to specific stressors that adversely affect the outcomes of their pregnancies. A psychosocial stress model has been proposed to explain the complex interactions of social, environmental, and medical factors that are unique among women of color. To generate data for the stress model, a research strategy has been designed to identify psychosocial and behavioral risk factors that have a physiologic impact on pregnancy outcome. We propose that race is a marker for this stress but is not in itself a risk factor for preterm delivery.

Risk factors for suicidal behavior among Hispanic, African-American, and non-Hispanic white boys in early adolescence.

Abstract: Using survey data from a longitudinal study of adolescents (n = 6760) in Miami, Florida, we assessed prevalence and risk factors for suicide ideation and attempts among a sample of Cuban-American, Nicaraguan, other Hispanic, African-American, and non-Hispanic white 6th- and 7th-grade boys The results indicated that African-American boys had the highest level of suicide ideation (192%) during the past 6 months and that Nicaraguans and other Hispanics had the highest levels of lifetime suicide attempts (78%) The risk factor analyses indicated a differential distribution of risk factors by ethnic-racial subsamples, with blacks scoring higher than the other subsamples Cumulative risk factors were related to increased suicidal ideation and attempts in all subsamples However, the highest percentage of attempts among boys with eight or more risk factors was among other Hispanics (569%), and the lowest percentage was among non-Hispanic white boys (217%) An odds ratio analysis predicting attempts indicated that depressive symptoms, low self-esteem, and teacher and parent derogation were relatively higher for African-American and Hispanic subsamples, and deviancy-delinquency was relatively higher for non-Hispanic whites High acculturation was associated with higher levels of suicide attempts in the three Hispanic subsamples (P < 05)

Diabetes in adults is now a Third World problem. World Health Organization Ad Hoc Diabetes Reporting Group.

Abstract: Since 1988, the World Health Organization has been collecting standardized information on the prevalence of diabetes mellitus and impaired glucose tolerance in adult communities worldwide. Within the age range 30 to 64 years, diabetes and impaired glucose tolerance were found to be absent or rare in some traditional communities in Melanesia, East Africa, and South America. In communities of European origin, the prevalences of diabetes and impaired glucose tolerance were in the range of 3% to 10% and 3% to 15%, respectively, but migrant Indian, Chinese, and Hispanic American groups were at higher risk (15% to 20%). The highest risk was found among the Pima Indians of Arizona and the urbanized Micronesians of Nauru, where up to half of the population aged 30 to 64 years had diabetes. The prevalence of total glucose intolerance (diabetes and impaired glucose tolerance combined) was greater than 10% in almost all populations, and was within the 11% to 20% range for European and US white populations. However, the prevalence of total glucose intolerance reached almost 30% in Arab Omanis and US blacks and affected one third of all adult Chinese Mauritians, migrant Indians, urban Micronesians, and lower-income urban US Hispanics. In Nauruans and Pima Indians, approximately two thirds of all adults aged 30 to 64 years were affected. These results lead to three important conclusions. (1) An apparent epidemic of diabetes has occurred--or is occurring--in adults through the world. (2) This trend appears to be strongly related to life-style and socioeconomic change.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypertension, diabetes, and obesity in Barbados: findings from a recent population-based survey

Abstract: A stratified random sample of 464 persons aged 40 to 79 years, drawn from enumeration registers in the Bridgetown area of Barbados, participated in this survey. The prevalence of hypertension (defined as systolic blood pressure of at least 160 mm Hg, diastolic blood pressure of at least 95 mm Hg, or use of antihypertensive medication) was 47% and 43% for women and men, respectively. Diabetes was present in 17% of all subjects (18% of women and 15% of men). Of the 209 hypertensive subjects, 82% were aware of their blood pressure status. The proportion of previously diagnosed hypertensive subjects on medication was 72% for men and 68% for women. Fifty-three percent of men and 42% of women were overweight (body mass indices [weight in kilograms divided by height in meters squared] between 25 and 30). However, 30% of women and 10% of men were obese (body mass indices over 30), supporting the growing recognition of the marked gender disparity in obesity among persons of African origin in the Caribbean. Body mass index was positively associated with hypertension (OR = 1.33; 95% CI: 1.1-1.6). Obese persons experienced a 2.6 times greater risk of hypertension compared to those with body mass indices below 25. Similar statistically significant associations were observed between diabetes and body mass index: OR comparing body mass index over 30 with body mass index under 25 was 2.5 (95% CI: 1.3-5.1) for all subjects, 1.0 (0.3-4.1) for men only, and 5.2 (1.9-14) for women only. Preventing obesity in this population could reduce the incidence of hypertension and diabetes by approximately 30% and 33% among men and women, respectively.

Community-based high blood pressure programs in sub-Saharan Africa.

Abstract: We studied residents of urban and rural areas of Ghana from 1972 through 1987 to evaluate the health burden of cardiovascular diseases, especially high blood pressure, in these African communities. Among urban adults, the prevalence of hypertension was 8% to 13%, compared to only 4.5% among rural adults. Overall, rates were higher among men than among women. However, the rate of hypertension was the same for men and women over 40 years old. The prevalence of hypertension was 29% for persons aged 35 and older, compared to 3.9% for persons under 35 years of age. Of the 24% of the study participants who were aware of their hypertension status, only a third were undergoing treatment, and only half of those were receiving adequate treatment. The determinants of hypertension include age, family history, body mass index, parity, and alcohol use. On a continent where over 80% of the health budget is spent on communicable diseases such as malaria, this study represents one of the few early attempts to understand the magnitude of the health burden of noncommunicable diseases in Africa.

Acute myocardial infarction and coronary heart disease mortality among Mexican Americans and non-Hispanic whites in Texas, 1980 through 1989.

Abstract: We calculated acute myocardial infarction and chronic coronary heart disease mortality rates for Mexican Americans and non-Hispanic whites in Texas for the 10-year period from 1980 through 1989 in an examination of ethnicity-related differences in death rates and trends according to vital statistics for the state of Texas. During the study period, acute myocardial infarction mortality decreased significantly in all four sex-ethnic groups, between 5.1% and 7.4% per year. Chronic coronary heart disease mortality rates decreased less, but significantly, for women in both ethnic groups, decreasing 3.4% and 1.8% per year for Mexican-American and non-Hispanic white women, respectively. We found no significant trend of changes in chronic coronary heart disease mortality rate among men in either ethnic group. For both acute myocardial infarction and chronic coronary heart disease mortality, rates were significantly lower among Mexican-American men than among non-Hispanic white men. Age-adjusted rate ratios for Mexican-American men in relation to non-Hispanic white men were 0.78 (95% CI: 0.65-0.93) and 0.75 (0.65-0.86) for acute myocardial infarction and chronic coronary heart disease mortality, respectively. No significant ethnicity-related mortality difference was seen among women. This previously observed interaction of ethnicity and sex in relation to coronary heart disease mortality remains unexplained. Despite apparently adverse cardiovascular risk factor profiles, Mexican Americans have acute myocardial infarction and chronic coronary heart disease mortality rates equal to or lower than their non-Hispanic white counterparts on the basis of death certificate data. This paradox deserves further attention.

HIV knowledge, communication, and risk behaviors among white, Chinese-, and Filipino-American adolescents in a high-prevalence AIDS epicenter: a comparative analysis.

Abstract: We conducted a comparative analysis of human immunodeficiency virus (HIV) knowledge, communication, and risk behaviors among 1272 white, Chinese-, and Filipino-American 10th and 11th graders in San Francisco, California, a high-prevalence AIDS epicenter. We performed principal components analysis on an epidemiologic survey instrument, and we identified five factors: HIV prevention knowledge, sexual behavior risk index, drug use risk index, HIV misconceptions, and communication about HIV. White students had higher HIV prevention scores than did Chinese and Filipino students, and whites had significantly greater ability to communicate with others about HIV disease and prevention. Chinese- and Filipino-American students had fewer misconceptions about HIV than did white students. Ethnicity did not have a significant influence on sexual behavior or drug use risk indices. Findings are discussed with reference to culturally sensitive HIV education.

Racial differences in the use of invasive coronary procedures after acute myocardial infarction in Medicare beneficiaries.

Abstract: We examined differences in the use of invasive diagnostic and therapeutic coronary procedures between white and black Medicare beneficiaries following acute myocardial infarction. We used Medicare hospitalization data for patients aged 65 years or older who were hospitalized with an acute myocardial infarction in 1988, and we followed them through the calendar year to determine whether they received invasive coronary procedures. We used multivariate logistic regression to control simultaneously for multiple potential confounding factors including age, geographic region, poverty, comorbid conditions, access to hospitals equipped to provide invasive procedures, and short-term survival. We calculated odds ratios for racial differences in use of invasive diagnostic procedures (coronary arteriography, cardiac catheterization) and, separately, of myocardial revascularization procedures (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty). We found that the odds of receiving an invasive diagnostic procedure after acute myocardial infarction were 2.0 times greater for white men than for black men (95% CI: 1.8-2.1); for white women, the odds were 1.5 times greater than for black women (95% CI: 1.4-1.6). Following an invasive diagnostic procedure, the odds of myocardial revascularization were 1.8 times greater among white than among black men (95% CI: 1.6-2.0), and 1.7 times greater among white than among black women (95% CI: 1.6-2.0). We conclude that invasive diagnostic and therapeutic coronary procedures are used more often among white than among black Medicare beneficiaries following acute myocardial infarction. Further investigation of this discrepancy will require detailed clinical and attitudinal information from medical records, patients, and physicians.

Hypertension in Africa: an overview of prevalence rates and causal risk factors

Abstract: The goal of this paper has been to summarize the existing data on the epidemiology of hypertension in Africa and to provide the basis for designating important known risk factors. We hope that this document will serve as the basis for a comprehensive evaluation of the disease burden from hypertension on the continent and the potential for prevention to reduce the health risk from this condition. Given the difficulty in maintaining long-term drug therapy in the African setting, and the increasing scientific basis for primary prevention, the time has clearly come to organize community campaigns to control the causal risk factors for hypertension.

Excess incidence of known non-insulin-dependent diabetes mellitus (NIDDM) in Hispanics compared with non-Hispanic whites in the San Luis Valley, Colorado.

Abstract: Non-insulin-dependent diabetes mellitus is between two and five times more prevalent among Hispanic Americans than among non-Hispanic whites (NHW). Incidence data for Hispanic populations will help to determine whether this excess prevalence is due to increased incidence, survivorship, or other factors. Incident cases were identified through concurrent surveillance of all local medical practices from 1983 to 1988 in two southern Colorado counties in which the population was 46% Hispanic. All identified subjects were invited for an oral glucose tolerance test. Among the subjects who attended clinic, 83% were confirmed as having diabetes, using WHO criteria. The standardized average annual incidence rates per 1000 for confirmed non-insulin-dependent diabetes, accounting for nonresponse, were 3.7 and 1.6 for Hispanic and NHW males, and 4.5 and 1.2 for Hispanic and NHW females, respectively. The age and nonresponse adjusted rate ratio comparing Hispanics to NHWs was 3.1 (95% CI: 2.3-4.2), indicating a significant excess risk of diabetes incidence for the Hispanic population in southern Colorado. Peak age-specific incidence among Hispanics occurred in persons 50 to 59 years old, a decade earlier than among NHWs. These results are consistent with data from the Mexican-American population in Texas and suggest that the previously observed excess in diabetes prevalence is due to higher incidence rates. The earlier age-specific peak in incidence has also been observed in Mexican-American and American Indian populations, suggesting that risk factors may operate at earlier ages.

An ultrasound survey of gallbladder disease among Mexican Americans in Starr County, Texas: frequencies and risk factors.

Abstract: The Mexican-American population of south Texas has been shown previously to have elevated frequencies of gallbladder disease, based on medical history In the present study, ultrasonography was employed to screen 1004 randomly selected individuals aged 15 to 74 years Among women, the frequency of previous cholecystectomy was 100%; the frequency of stones on ultrasound was 122% In men, the respective frequencies were 17% and 63% Highest frequencies of gallbladder disease occurred among those aged 45 years or above: 402% and 192% among women and men, respectively Non-insulin-dependent diabetes mellitus, obesity, and hypertension were also markedly elevated in this population Overall, more than 40% of the population had either gallbladder disease, non-insulin-dependent diabetes, obesity, or hypertension Among those older than 45 years, 70% had one or more of these chronic conditions Examining the associations of gallbladder disease with other chronic diseases or measures of lipids, lipoproteins, and apolipoproteins demonstrates that factors predictive of or associated with cholecystectomy are different from those for gallstones by ultrasound Diabetes and obesity show the strongest associations with cholecystectomy among women under 45 years (women with diabetes being 68 times as likely to have had a cholecystectomy than those without diabetes) Testing an extensive array of lipid-related measures resulted in no clear patterns, with the possible exception of alpha-lipoprotein and related measures That the Mexican-American population is relatively young and experiencing extremely rapid growth indicates that the burden of chronic disease in general and gallbladder disease in particular will increase dramatically in the coming years

Maternal ethnicity and birthweight among blacks.

Abstract: This paper examines the association of ethnicity and birthweight, adjusted for other maternal and infant characteristics, among black women who gave birth in Massachusetts from 1987 through 1989. Data are drawn from the standard certificate of live birth, which includes questions on race and ethnicity/ancestry as well as birthweight; maternal sociodemographic and biological characteristics; access to prenatal care; and infant characteristics. The study cohort consists of 18,571 black infants and a comparison group of 206,358 non-Hispanic white infants. Infants whose mothers reported their race as black were further categorized into six ethnic groups: American, Haitian, West Indian, Cape Verdean, Hispanic, and other black. In addition to descriptive analyses, we used multiple linear regression to measure the association between ethnicity, other characteristics, and birthweight; and we used multiple logistic regression to measure the odds ratio of low birthweight (ranging from 500 g to 2499 g) for the six black ethnic groups, adjusted for other characteristics. Results indicate that Americans have lower mean birthweight and generally higher levels of risk than other black ethnic groups. Compared to the reference group of non-Hispanic whites, Americans (OR = 1.49), other blacks (OR = 1.41), and West Indians (OR = 1.37) have significantly elevated relative risks of low birthweight.

Comparison of coronary heart disease mortality risk between black and white people with diabetes.

Abstract: Coronary heart disease (CHD) is the leading cause of mortality among people with diabetes. Although diabetes is more prevalent among blacks than among whites, little is known about CHD risk among black people with diabetes. We performed a case-control analysis to assess CHD mortality risk among people with diabetes. Coronary heart disease mortality cases were identified from the 1986 National Mortality Followback Survey, and controls were taken from behavioral risk factor surveys conducted in 35 states in 1988. In the young age groups (men younger than 45 years and women younger than 55), both white and black people with diabetes and no other CHD risk factors had about a thirteen-fold greater risk of CHD mortality compared to people without diabetes and with no other CHD risk factors. In the older age groups, diabetes was associated with a lower risk of CHD mortality among blacks (OR = 1.6) than among whites (OR = 2.5). With the exception of smoking in young people with diabetes, we found smoking, high blood pressure, and body mass to carry generally similar relative risks of CHD mortality in black people with diabetes as in white people with diabetes. Further study of other CHD risk factors is needed in black people with diabetes.

Ethnic differences in mortality from cerebrovascular disease among New Mexico's Hispanics, Native Americans, and non-Hispanic whites, 1958 through 1987.

Abstract: We analyzed vital statistics data collected from 1958 through 1987 to determine time trends and ethnic differences in cerebrovascular disease mortality rates in New Mexico's Hispanic, Native American, and non-Hispanic white populations. Over the 30-year period of our study, cerebrovascular disease mortality rates decreased in all three major ethnic groups in the state, comparable to national trends. We found that Native Americans of both sexes had the lowest cerebrovascular disease mortality rates, followed by Hispanics, during the initial 25-year span of our data. In the most recent 5-year period that we examined, 1983 through 1987, Hispanics had the highest cerebrovascular disease mortality rates of the three groups. Our data suggest that Hispanics in New Mexico are now at higher risk for cerebrovascular disease-related mortality than are non-Hispanic whites, and that prevention strategies aimed at decreasing cerebrovascular disease rates should be focused on this segment of the state's population.

A comparison of three methods for assessing Amerindian admixture in Mexican Americans.

Abstract: Epidemiologic studies have revealed that Mexican Americans experience an excess of non-insulin-dependent diabetes mellitus, gallbladder disease, and obesity relative to non-Hispanic whites. It has been hypothesized that the greater susceptibility of Mexican Americans to these disorders may be related to their greater degree of Amerindian genetic admixture. We evaluate the comparability of three different methods of assessing individual genetic admixture in Mexican Americans. Subjects were enrolled as part of the San Antonio Heart Study and were examined between 1979 and 1988 (n = 3301). Three different methods were used to assess Amerindian admixture: we queried subjects about their ancestors' ethnic origin, we measured subjects' skin color, and we estimated genetic admixture directly by analysis of polymorphic blood markers. These measures were generally poorly correlated with each other, with the highest correlations observed between skin color and proportion of Mexican-origin grandparents. In men, none of these three measures of genetic admixture was associated with the prevalence of diabetes, gallbladder disease, or obesity. In women, consistent positive associations were observed between admixture and all three diseases, regardless of the admixture measure used (ie, disease prevalence was higher among women with more Amerindian admixture). In both sexes, height was negatively correlated with all three measures of admixture, and admixture was also significantly correlated with body mass index and central adiposity in women. These data suggest that the three measures considered may assess different dimensions of admixture, but that for epidemiologic research, no one may be claimed to be superior to the others.

Rose Questionnaire responses among black and white inpatients admitted for coronary heart disease: findings from the Birmingham-BHS Project.

Abstract: Evidence of higher coronary heart disease mortality rates among blacks than among whites raises questions concerning differences in health care-seeking for heart disease between blacks and whites. As part of a larger project evaluating health care-seeking behavior for coronary heart disease, we interviewed hospitalized patients who had diagnoses of coronary artery disease, ischemic heart disease, chest pain, or myocardial infarction, or who were admitted to rule out myocardial infarction. The sample included 1140 white men, 347 black men, 574 white women, and 355 black women. The interview included demographic information, usual care, access to usual care, and chest pain items. Demographic and medical care access differences emerged between African-American and white participants. We also compared the prevalence of Rose Questionnaire angina between blacks and whites. Among patients who scored positively for Rose angina, black men reported more recent onset of their angina and fewer episodes during the past 6 months compared to all other groups, and they sought medical care less often compared with white men. Multiple logistic regression analyses suggest that African-American respondents were less likely to score positively for Rose angina and were less likely to seek treatment for their symptoms among those who had angina, when controlled for demographic, risk factor, and access to care variables. Blacks and whites in our sample also differed in factors associated with scoring positive for angina and seeking medical care for their symptoms, among those who reported angina. We interpret these findings as suggesting that promoting routine usual care among whites may be an important approach for increasing care-seeking for coronary heart disease symptoms. For blacks, improved coronary heart disease case identification and/or educational approaches to promote greater awareness of symptoms and of the need for seeking treatment for symptoms may be important to increase the likelihood that they will seek medical care for their symptoms.

Acculturation and hypertension in Mexican Americans.

Abstract: In this analysis, we employ data from the Hispanic Health and Nutrition Examination Survey to examine the association between level of acculturation into the larger society and rates of hypertension in Mexican Americans. Analyses conducted separately by gender in three broad age groups (ages 20 to 39, 40 to 59, and 60 to 74 years) fail to indicate a linear effect of acculturation on hypertension after controlling for age, education, marital status, employment, smoking, alcohol consumption, and body mass index. A nonlinear hypothesis was subsequently examined and found partial support among middle-aged men. Other things equal, middle-aged men at the middle of the acculturation continuum have significantly higher rates of hypertension than persons at the low end of the continuum. Lower rates are also observed among men at the high end of the acculturation continuum, but these rates are not significantly lower than those among men in the middle acculturation group when other variables are controlled. These findings for middle-aged men support an "acculturative stress" model that suggests that stress is higher at the middle of the acculturation continuum. Research on the influence of acculturation on health outcomes should go beyond simply examining linear effects to investigate the viability of nonlinear effects.

Mortality after hospitalization for myocardial infarction among Mexican Americans and non-Hispanic whites: the Corpus Christi Heart Project.

Abstract: We compared short- and long-term mortality among 334 Mexican Americans and 348 non-Hispanic whites hospitalized for myocardial infarction in the Corpus Christi Heart Project. Age-adjusted 28-day case fatality rates were 37% and 68% greater among Mexican-American women (6.7%) and men (6.2%) than among their non-Hispanic white counterparts (4.9% and 3.7%). Age-adjusted all-cause mortality rates over the next 25-month period, among those who survived the initial 28 days, were similar among Mexican-American and non-Hispanic white women (17.8% and 18.1%), but were 70% higher among Mexican-American men than among non-Hispanic white men (17.4% and 10.2%, respectively). Age-adjusted 25-month coronary mortality rates among initial 28-day survivors were 40% greater among Mexican-American women than among non-Hispanic white women (12.5% vs 9.0%), and 129% greater among Mexican-American men than among non-Hispanic white men (11.4% vs 5.0%, respectively). Thus, nearly all measures of post-myocardial infarction mortality indicated a survival disadvantage for Mexican Americans compared to non-Hispanic whites.

Body mass index as a predictor of systolic blood pressure in a multiracial sample of US schoolchildren.

Abstract: We examine the relationship between body mass index (weight divided by height squared) and systolic blood pressure and the implications of using obesity as a criterion for blood pressure screening in a multiracial sample of 11,370 schoolchildren. For the entire sample, the zero-order correlation between body mass index and systolic blood pressure was 0.39. Correlations were strongest among Hispanics (r = .51) and weakest among blacks (r = .29). Among white, black, Asian, and Hispanic boys with body mass index values in the upper decile, the odds of having elevated systolic blood pressure (above the 95th percentile) were significantly higher than among individuals in the bottom decile. Among girls with body mass index values in the top decile, higher odds of hypertension were observed only for whites and Hispanics. For the entire population, the sensitivity of screening only children with body mass index values in the top quartile was 52%. The sensitivity of this cutpoint was higher for Hispanics, although 36% of those with elevated systolic blood pressure would still be missed. These data confirm that overweight children are significantly more likely to have elevated systolic blood pressure and total blood cholesterol levels and that weight reduction may play an important role in the primary prevention of coronary heart disease among children of various ethnic backgrounds. Selective screening of overweight children, however, does not appear warranted.

Mexican Americans' intrauterine growth retardation and maternal risk factors.

Abstract: This study was designed to evaluate the prevalence of intrauterine growth retardation (IUGR) in Mexican Americans compared to non-Hispanic whites in Arizona. Data were compiled from birth certificates documenting live births in 1986 and 1987. A total of 25,289 Mexican-American and 71,139 white newborns were classified by IUGR. Two methods of IUGR classification were used: the fetal growth ratio (FGR) and the 10th percentile of birthweight by gestational age. A reference growth-distribution data set from the state of California was used to determine IUGR vs non-IUGR newborns. Maternal risk factors were also used to compare IUGR and non-IUGR samples. Overall, Mexican Americans had a lower risk (OR: 0.91) for IUGR than did whites, after controlling for maternal risk factors. Regardless of the IUGR classification method used, more than 88% of IUGR infants were born at term, and more than 60% of IUGR infants had birthweights equal to or greater than 2500 g. Maternal risk factors significantly discriminated between IUGR and non-IUGR infants. Finally, after controlling for maternal risk factors, US-born Mexican mothers were 1.21 times more likely to have an IUGR infant than were Mexico-born mothers. The problem of IUGR and its determinants in Mexican Americans deserves attention in clinical settings.

Establishing the epidemiologic basis for prevention of cardiovascular diseases in Africa.

Abstract: A child born today in the rich countries of the world will inherit the expectation of living into the mid-70s In Africa, of those surviving to the age of 5 years, the expectation of reaching the mid-50s remains in doubt Inequality in the opportunity to experience life itself remains the cruelest inequality of all As in many other fields, the technological experience accumulated by the economically wealthy countries can be put to useful purposes in underdeveloped regions Given the longer history of chronic disease epidemiology in wealthy societies, much has been learned and many successes have been achieved These lessons are, to a large extent, exportable An opportunity to avoid the transition to high rates of CVDs and cancer therefore exists through implementation of primary prevention programs Despite the competing priorities, a coordinated and sustained effort to achieve this goal should be initiated without further delay

Interactive effect of race and marital status in low birthweight.

Abstract: Although unmarried mothers are at risk of delivering low-birthweight (LBW) infants, the meaning and significance of this variable need to be explored in depth. With data on 216,285 infants born to white and black mothers aged 10 to 49 years in Atlanta, Georgia, between 1980 and 1987, we examined the association of LBW and marital status and the effect of race on the association. Education and age were controlled in the analysis in an attempt to isolate the effect of race on the marital status and birthweight association. The crude LBW rate among infants born to unmarried mothers was about twice the rate among infants born to married mothers (132.8 vs 63.9 per 1000 live births). Adjustment singly for maternal race, age, and education gave risk ratios (unmarried vs married) of 1.50, 2.03, and 1.78, respectively. Simultaneous control for all factors led to a hierarchy of education-adjusted risk: unmarried black adult mothers had the highest risk of delivering an LBW infant (2.49), followed by married black adults (1.93), unmarried black teenagers (1.90), married black teenagers (1.67), unmarried white adults (1.65), unmarried white teenagers (1.35), married white teenagers (1.08), and married white adults (1.0; reference group, with an LBW rate of 51.2/1000 live births). Thus, these data demonstrate both a consistently higher risk for black women and an interactive effect of age on the association of marital status and LBW: unmarried status appears to increase the risk of LBW much more among adult women than among younger women. This finding has implications for research and prevention of LBW.

Indirect discrimination and breast screening.

Abstract: Uptake of screening services in inner-city communities has been low, particularly in older age groups, lower social classes, and ethnic minorities. In Leicester City, where up to 25% of the population belong to ethnic minorities, this may have important implications for breast screening. We randomly sampled 701 inner-city women aged 45 to 64 years, stratified by neighborhood and by women's "likely home language." Trained interviewers succeeded in interviewing 79% of those eligible, and we report here a preliminary analysis of 413 respondents. Knowledge of breast cancer and screening varied markedly and significantly by actual language: 60.4% of English-speaking and 12.5% of non-English-speaking women correctly answered 10 or more questions (of 14) about breast cancer and screening (chi 2(1) = 89.884; P = .000). Despite that, 80% or more women stated their intention to attend for screening and assessment if necessary, irrespective of neighborhood, language, age, or social class. We suggest that the difference in knowledge between language groups arose from indirect discrimination in the way in which health-related information is disseminated in British society. However, after providing appropriate screening information, we report similarly high intended acceptance rates in the two language groups.

The social context of HIV transmission in the African-American community.

Abstract: The concept of acquired immune deficiency syndrome (AIDS) as a behavioral problem, and the emphasis placed by researchers on race and ethnicity as "risk factors," have led to research focused on the "risk behaviors" of historically oppressed groups and a continuing social policy thrust that "blames the victim." Disproportionate numbers of AIDS cases have been reported among African Americans, and these cases are not evenly distributed throughout the nation. This geographical variation and distribution of AIDS among African Americans suggests that there are forces in society that impact African-American communities in differential ways. A review of alternate models presented in the scientific literature reveals that some attention is being given to reconceptualizing AIDS as a disease to be understood within the context of factors that affect the African-American community, rather than as a problem of personal behavior. The current status of "contextual approaches" found in the health and social science literature over a 5-year period (1987 to 1992) was assessed. Literature surveyed includes studies from the fields of social epidemiology, public health, and social science that address the issue of AIDS in the African-American community from a contextual perspective--that is, studies that seek to explain key issues within a framework that allows a "community-in-environment" analysis, as opposed to a behavioral perspective. Analysis of these contextual approaches indicates that dynamics external to individuals must be clarified to better understand the disparate pattern of AIDS among African Americans and whites.

Alanine aminotransferase levels in Hispanics.

Abstract: To prevent posttransfusion viral hepatitis, screening of potential blood donors includes the measurement of serum alanine aminotransferase (ALT) levels The current use of single system-wide ALT cutoffs to determine acceptability of a blood unit or donor may not be appropriate, since male and Hispanic blood donors have much higher rejection rates than other donors, based solely on ALT level Serum ALT measurements from the Hispanic Health and Nutrition Examination Survey were used to confirm these ALT elevations within general population samples of Mexican Americans, Cubans, and Puerto Ricans Until specific tests are available to detect all hepatitis viral infections, testing blood donors for ALT levels will likely continue Health personnel should be cautious in their interpretation of "elevated" ALT levels in these Hispanic populations

Correlates of blood pressure in Yanomami Indians of northwestern Brazil.

Abstract: We determined associations of measures of body habitus with blood pressure for 100 adult Yanomami Indians (61 men, 39 women) examined during February and March 1990. Measurements included body weight and height, four skinfolds (triceps, subscapular, suprailiac, abdomen), four circumferences (wrist, upper arm, abdomen, hip), systolic and diastolic blood pressures, pulse rate, and estimated age. Various indices of fat distribution were determined from the measurements of skinfolds, circumferences, weight, and height. Estimated age averaged 35.0 years in men and 33.4 years in women (range: 15 to 63 years). Mean systolic and diastolic blood pressures were low in both men (104.8/70.4 mm Hg) and women (94.8/63.5 mm Hg), as was body mass index (men: 20.7; women: 21.4 kg/m2). In Yanomami women, all four skinfolds, wrist circumference, and the indices of hip and abdominal fat were significant correlates of systolic blood pressure, while the abdominal skinfold and wrist and hip circumferences correlated significantly with diastolic blood pressure. Among men, there was a negative correlation between estimated age and systolic blood pressure and a positive correlation between BMI and upper arm and hip circumferences and systolic blood pressure. There was a significant positive correlation between wrist, upper arm, and hip circumferences and diastolic blood pressure among Yanomami men. We used stepwise regression to generate sex-specific predictive equations for blood pressure. For men, estimated age and hip circumference, and for women, abdominal skinfold measurement and age were included in the model for systolic blood pressure. Among men, wrist circumference and height, and among women, wrist circumference alone entered the model for diastolic blood pressure. On the basis of these results, we suggest that even in a low-blood pressure, low-body fat, no-salt setting, systolic blood pressure is associated with the amount and placement of adipose tissue. However, diastolic blood pressure is more closely correlated with skeletal size.

Blood pressure responses to dietary salt in rural and urban African men.

Abstract: The purpose of this study was to test the hypothesis that urban Africans exhibit more pressor sensitivity to dietary sodium than do their rural counterparts. We studied short-term sodium sensitivity of nonrandomized representatives of rural and urban population groups in which the overall prevalence of hypertension was 7% and 24% respectively. The rural group (mean age: 39 +/- 3 years) had 20 subjects and the urban group (mean age: 37 +/- 2 years) 21 subjects. Sodium sensitivity was assessed by measuring the blood pressure response to acute dietary restriction and sodium loading. In addition, hormonal responses to the dietary sodium changes were observed. We restricted the study to normotensives. Subjects were studied on baseline diet, after 4 days of a low-salt diet providing 10 mEq sodium per day, and after 4 days of a high-salt diet providing 800 mEq sodium per day. On the high-salt diet, half of the subjects received 100 mEq supplemental potassium per day. Mean arterial pressure in rural and urban subjects increased from 79 +/- 2 to 87 +/- 2 and 82 +/- 2 to 89 +/- 2 mm Hg (+/- SEM) respectively when subjects changed from low to high salt. Pulse pressure of rural and urban subjects also increased with the high-salt diet. Potassium supplementation did not influence the pressor response. Using a 10% increase in mean arterial pressure when going from low-salt to high-salt diets as an index of sodium sensitivity, we found that 33% of urban and 35% of rural subjects were sensitive to sodium. We conclude that the sensitivities of rural and urban normotensive men to the pressor effects of sodium are not different.

Apolipoprotein H polymorphism and serum lipoprotein and apolipoprotein levels in two Asian populations.

Abstract: The apolipoprotein H (apo H) is a constituent of several lipoprotein particles and, therefore, may play an important role in lipid metabolism. In this study, we have investigated the role of common apo H structural polymorphism in determining serum total cholesterol; high-density lipoprotein cholesterol; triglycerides; and apolipoproteins A-I, A-II, and B in 655 Chinese and 126 Dravidian Indians from Singapore. Serum lipoprotein and apolipoprotein levels were adjusted for significant concomitant variables for age and body mass index, and the quantitative mean values between different apo H genotypes were compared by an analysis of covariance. The distributions of serum lipoprotein and apolipoprotein levels were found to be comparable between the three common apo H genotypes in both ethnic groups, indicating that the apo H polymorphism may not play a significant role in lipid metabolism.