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From the Editor-in-Chief: Section Previews
Keith C. Norris, MD

Original Reports: Metabolic Syndrome
Is High Density Lipoprotein Cholesterol Useful in Diagnosis
of Metabolic Syndrome in Native Africans with Type 2 Diabetes?
Simeon A. Isezuo, MBBS, FMCP

Although high-density lipoprotein (HDL) hypocholesterolemia predicts metabolic syndrome among Caucasians, it may not be as highly correlated among persons from African decent. S. Isezuo assessed clinical metabolic characteristics among 254 indigenous Nigerians. Prevalence of metabolic syndrome did not differ significantly between patients with HDL hypocholesterolemia and those with normocholesterolemia (P5.08). Linear regression analysis showed no association between HDL cholesterol and metabolic syndrome (P5.2), body mass index (P5.4), waist circumference (P5.42), and microalbuminuria (P5.8). High-density lipoprotein cholesterol may not be a reliable diagnostic tool for diagnosing metabolic syndrome among Nigerians.

Ethnic, Gender, and Age-Related Differences in Treatment and Control of Dyslipidemia in Hypertensive Patients
Katharine H. Hendrix, PhD; Jessica E. Riehle, RN; Brent M. Egan, MD

A focused analysis by Hendrix et al on dyslipidemia among 72,351 hypertensives revealed women and patients ,40 years old were less likely to have an annual cholesterol measurement. Thirty-five percent of all hypertensive dyslipidemic patients had not been prescribed any anti-lipidemic medication and women received fewer statin prescriptions than men. African Americans and those ,40 years old were less likely to reach LDL levels of ,100 or ,130 mg/dL. This treatment pattern can be used to inform primary care providers to improve hyper-tensionrelated treatment outcomes and reduce disparities.

Original Reports: Cardiovascular Health Race Differences in Cardiovascular and Cortisol Responses to an Interpersonal Challenge in Women Who Are Family Caregivers
Sara Wilcox, PhD; Melissa Bopp, MS; Dawn K. Wilson, PhD; Laura J. Fulk, MS; Gregory A. Hand, PhD, MPH

Chronic illness can levy a significant burden on not only the patient, but the caregiver. Wilcox et al examined psychosocial and psychophysiological responses among 28 female caregivers to a family member with dementia. Af-rican- American women showed greater task-related reactivity for SBP, HR, and cortisol than Caucasian women. This pattern of physiologic responses suggests that care-giving may be perceived as more stressful among African-American women.

Prevalence, Treatment, and Control of Hypertension Among African Americans and Caucasians at Primary Care Sites for Medically Under-served Patients
Nina Sheats; Yan Lin, MD; Wenle Zhao, PhD; DeAnna E. Cheek, MD; Daniel T. Lackland, DrPH; Brent M. Egan, MD

Hypertension remains a major contributor to ethnic disparities in cardiovascular disease. Sheats et al evaluated clinical data from more than 7,500 medical records from 31 primary care clinics caring for underserved patients in South Carolina. The prevalence of hypertension was greater in African Americans than Caucasians despite similar rates of receiving BP medications. In addition, the number of BP medications was similar between groups. Despite similar treatment intensity African Americans had higher rates of poor blood pressure control than Caucasians. Poor blood pressure control may contribute to higher rates of cardiovascular disease among African Americans. More aggressive treatment will be needed to achieve optimal control rates.

Rural and Semi-Urban Differences in Salt Intake, and Its Dietary Sources, in Ashanti, West Africa
Sally M. Kerry, MSc; Lynsey Emmett, MSc; Frank B. Micah, MB, ChB; Ruby Martin-Peprah, MB, ChB; Sampson Antwi, MB, ChB, MWACP; Richard O. Phil-lips, MB, ChB; Jacob Plange-Rhule, MB, ChB, MRCP; John B. Eastwood, MD, FRCP; Francesco P. Cappuccio, MD, FRCP

Increased salt intake has been associated with elevations in blood pressure. To better understand the relationship between urbanization, sources of dietary salt and blood pressure, Kerry et al evaluated more than 1000 adults across 6 rural and 6 semi-urban villages. They describe many of the physical characteristics that characterize rural and semi-urban communities in Ashanti. Semi–urban villagers had higher systolic blood pressure than rural villagers, 129 vs 121 mm Hg. They found salt is almost in-variably added to food in cooking in both communities and added at the table more often in rural villages than in semi-urban settings. However, urinary sodium excretion was similar between communities suggesting the total salt consumed did not differ. By contrast, urine potassium levels were higher in rural villages suggesting that difference in potassium intake may be important in the noted blood pressure elevation for members of semi-urban communities.

Racial/Ethnic Disparity and Predictors of Leisure-Time Physical Activity Among US Men
Nasar U. Ahmed, PhD; Gary L. Smith, MS; Ann M. Flores, PhD, PT; Rubens J. Pamies, MD; Hyacinth R. C. Mason, PhD, MPH, CHES; Kristy F. Woods, MD, MPH; Steven C. Stain, MD

Leisure-time physical activity (LTPA) is an important cardiovascular risk factor. Ahmed et al examined predictors of LTPA among men in a US representative sample of 23,459 adult males. After adjusting for multiple demo-graphic and clinical factors Hispanics were significantly less likely to engage in regular LTPA than Whites, while differences between Whites and Blacks were less pronounced. Non-citizenship was associated with an in-creased likelihood of inactivity among Hispanics, more so than White non-citizens, but among Blacks, non-citizens were less likely to be inactive. Racial/ethnic disparities in LTPA exist after accounting for sociodemographic characteristics. LTPA influence by citizenship is variable across race/ethnicity suggesting differences in acculturation. Understanding these differences will help better target intervention strategies.

A Short Acculturation Scale for Mexican-American Populations
Gloria D. Coronado, PhD; Beti Thompson, PhD; Dale McLerran, MS; Stephen M. Schwartz, PhD; Thomas D. Koepsell, MD, MPH

Dr. Coronado and co-workers present data on validating a short acculturation scale using a population-based sample of Mexican-origin adults. This scale is an important tool for examining variables that differentiate members of ethnic groups so that interventions can be appropriately targeted. The eight-item acculturation instrument included domains such as language spoken most of the time and birthplace. Future studies will be needed to compare this tool with other multidimensional scales.

Original Reports: Cancer
Cigarette Advertising in Black, Latino, and White Magazines, 1998–2002: An Exploratory Investigation

Hope Landrine, PhD; Elizabeth A. Klonoff, PhD; Senaida Fernandez, MS; Norval Hickman, BA; Kennon Kashima, PhD; Bina Parekh, PhD; KaMala Thomas, MA; Catherine R. Brouillard, BA; Michelle Zolezzi, BA; Jennifer A. Jensen, MPH; Zorahna Weslowski

Concerns continue to linger over the promotion of menthol cigarettes to the Black communities. To assess this issue, Landrine and colleagues compared the appearance of cigarette ads among three popular magazines targeted to Black, White and Hispanic communities over a 4.5- year period from 1998 to 2002. They found ads for menthol cigarette were nearly three times more common in the Hispanic magazine (People in Spanish) and nearly ten times more common in a Black magazine (Ebony) when compared to a magazine that targets a predominantly White audience (People). Also there were more ads directed toward woman in the Black and Hispanic magazines. Their findings indicate that the tobacco industry not only continues to target Blacks with menthol cigarette ads, but now appears to be targeting Latinos. There also appears to be an emphasis on encouraging minority woman to smoke as well. These data may be useful in developing public health strategies to reduce the burden of cigarette related health complications.

Perceptions of Participation in an Observational Epidemiologic Study of Cancer Among African Americans
Kyna M. Gooden, MPH; Lori Carter-Edwards, PhD; Cathrine Hoyo, PhD; Jabar Akbar, MPH; Rebecca J. Cleveland, MPH; Veronica Oates, MPH; Ethel Jackson, MPH; Helena Furberg, PhD; Marilie D. Gammon, PhD

Recruitment and retention of minority participants in cancer research studies remains a challenge. Gooden and coworkers performed a series of focus groups to better understand factors bearing on recruitment and retention for African Americans towards participation in an observational study of cancer. From their analysis four key themes emerged: 1) fear of cancer prognosis; 2) conflicts between mistrust and trust in researchers; 3) comprehension of prospective study purpose, structure, and participation strategies; and 4) the necessity for and obligation to provide feedback. Addressing these themes will likely increase the willingness of African Americans to participate in observational cancer studies and several of these themes may be useful in minority participation in other types of clinical investigation.

Racial Ethnic Differences in Screening for Colon Cancer:
Report from the New York Cancer Project

David Vlahov, PhD; Jennifer Ahern, MS; Tara Vazquez, BS; Stephen Johnson, PhD; Laura A. Philips, PhD; Denis Nash, PhD; Maria K.Mitchell, PhD; Harold Freeman, MD

Vlahov and colleagues examined more than 5500 adults older than 50 years of age for sigmoidoscopy or colonoscopy within the prior five years. Blacks and Hispanics were less likely to have been screened than Whites after adjusting for age, gender, access to care (income and insurance), and risk profile (family history of cancer, smoking, and obesity). Sociocultural or other factors may underlie differences in colon screening

Reproducibility of Self-Reported Pap Test Utilization in Middle-Aged African-American Women
Cathrine Hoyo, PhD; Truls Ostbye, MD, PhD; Celette S. Skinner, PhD; Kimberly S. H. Yarnall, MD; Jaspreet Chowdhary, MPH

Many decisions around Pap tests re-screens rely on patient self-report. To ascertain the validity of these reports, Hoyo and co-workers conducted two in-person interviews three to six weeks apart. Reproducibility of self-reported Pap test was substantial with the highest agreement among women who were younger, had greater income and higher educational attainment. Self-reports appear useful, particularly in selected subgroups. Validation of reproducibility after longer intervals is still needed.

Collecting Information on Race, Hispanic Ethnicity, and Birthplace of Cancer Patients: Policies and Practices in Connecticut Hospitals
Anthony P. Polednak, PhD

Hospital medical records are important data sources for determining cancer incidence, treatment, and prognosis. Many studies have shown important disparities by race, Hispanic ethnicity, and birthplace. Dr. Polednak surveyed 30 hospitals within a state with a high-quality population-based cancer registry. While race was regarded as ‘‘very important’’ or ‘‘important’’ by staff at 89% of hospitals, ethnicity was regarded as such less than 50% of the time and birthplace only 61% of the time. Nearly 70% of hospitals reported using only a single item for both race and ethnicity. Hospital staff education is needed to rein-force the importance, and improve the quality of, collecting valid demographic information to ensure the validity of analyses and subsequent recommendations.

Original Reports: Healthcare Access and Utilization Who Trusts Healthcare Institutions? Results from a Community-Based Sample
Corrine I. Voils, PhD; Eugene Z. Oddone, MD; Kevin P. Weinfurt, PhD; Joe¨lle Y. Friedman, MPA; Kevin A. Schulman, MD; Hayden B. Bosworth, PhD

The trust of healthcare institutions is an important factor in the formation of health beliefs and practices. Voils et al performed a telephone survey of more than 1000 per-sons to better understand the level of trust with different components of the healthcare system. They found Whites and Latinos were significantly more likely to trust physicians more often than Blacks, while Latinos trusted the health department, insurance companies, and both government entities more often than Whites and Blacks. These relationships persisted after controlling for marital status, financial status, and education. These data suggest understanding the cultural underpinnings of these beliefs, which differ across components of the healthcare system, will be important in designing interventions to improve health outcomes across a diverse racial and ethnic nation.

Access to Health Care in a Rural Area of the Philippines
Cielito C. Reyes-Gibby, DrPH; Lu Ann Aday, PhD

Reyes-Gibby et al performed a household survey to ex-amine the extent and determinants of access to care in a rural town in the Philippines. They found that despite 63% reporting a family history of chronic diseases only 15% had a check-up in the previous year. Having a usual source of care and greater educational attainment were predictors of having had a checkup the previous year. Their findings provide support for health programs that will improve access to care and routine monitoring of chronic illness in this and likely other under-served, rural communities.

Suicidal Ideation Among African-American Non-Injection Drug Users
Jennifer R. Havens, PhD; Danielle C. Ompad, PhD; Carl A. Latkin, PhD; Crystal M. Fuller, PhD; Amelia M. Ar-ria, PhD; David Vlahov, PhD; Steffanie A. Strathdee, PhD

Havens and colleagues performed an interview-administered questionnaire with 148 young African-American adults with substance abuse to identify factors associated with suicidal ideation. Suicidal ideation was reported by more than 20% of participants who were also more likely to be dependent on two or more drugs. Their findings support the need to integrate treatment for psychiatric comorbidity and drug dependence in this population.
Racial Differences in Analgesic/Anti-inflammatory Medication Adherence Among Patients with Osteoarthritis
Kelli L. Dominick, PhD; Yvonne M. Golightly, PT; Hay-den B. Bosworth, PhD

In a cross-sectional survey of 156 veterans, Dominick et al examined the prevalence of self-reported adherence to medications for osteoarthritis (OA). One quarter of participants reported sometimes forgetting to take their OA medications and 16% were sometimes careless about taking medications. More than 25% sometimes stopped taking their medications when they felt better and nearly one half reported at least one of these three behaviors. In a multivariable analysis Black patients were more than twice as likely to report at least one nonadherent behavior, while persons with greater participatory decision making scores were slightly less likely to report nonadherent behavior. These findings provide insights into risk factors for nonadherence and highlight the need to better understand racial differences in adherence, to guide effective interventions.

Original Reports: Research Design
Successfully Recruiting a Multicultural Population: The DASH-Sodium Experience
Betty M. Kennedy, PhD; Paul R. Conlin, MD; Denise Ernst, MA; Patrice Reams; Jeanne B. Charleston, RN, MSN; Lawrence J. Appel, MD, MPH

Kennedy and colleagues examined recruiting practices employed by the four clinical centers participating in the Dietary Approaches to Stop Hypertension (DASH)-Sodium trial. Recruitment strategies included mass mailing brochures (direct, coupon packs, or other) and mass media (advertisements in newspapers, radio, and television spots). Sixty four percent of randomized participants responded to the mass distribution of brochures, 15% from mass media, and 21% were prior study participants, referred by word-of-mouth, or reported coming from screening events and presentations. Although mass mailing brochures was the most successful method of recruitment for multicultural communities, the researchers not-ed that three times as many brochures were distributed to obtain similar success as in the initial DASH trial. Future studies for hypertension will benefit from under-standing the successful experiences from these four clinical centers.

Can a Culturally Responsive Model for Research Design Bring Us Closer to Addressing Participation Disparities? Lessons Learned from Cancer Survivorship Studies
Kimlin Tam Ashing-Giwa, PhD

The inclusion of traditionally excluded communities in clinical research remains a key element in the effort to reduce health disparities. Dr. Ashing-Giwa presents the governing principles and practices of a culturally responsive model for research design for cancer research. This paper highlights a movement to articulate practical models for designing culturally responsive, multicultural re-search.

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