Teens who believe they'll die young are more likely to engage in risky behavior, University of Minnesota research finds

MINNEAPOLIS / ST. PAUL — University of Minnesota Medical School researcher Iris Borowsky, M.D., Ph.D., and colleagues found that one in seven adolescents believe that it is highly likely that they will die before age 35, and this belief predicted that the adolescents' would engage in risky behaviors.

Borowsky and colleagues analyzed data collected by the National Longitudinal Study of Adolescent Health, a nationally representative sample of more than 20,000 youth in grades 7 through 12 during three separate study years. In the first set of interviews, nearly 15 percent of adolescents predicted they had a 50/50 chance or less of living to age 35. Those who engaged in risky behaviors such as illicit drug use, suicide attempts, fighting, or unsafe sexual activity in the first year were more likely in subsequent years to believe they would die at a young age. Vice versa, those who predicted that they'd die young during the first interview were more likely in later years to begin engaging in these same risky behaviors and have poor health outcomes. Notably, these teens were significantly more likely to be diagnosed with HIV/AIDS just six years later, regardless of their sexual preference.

Four black children in yard Library of Congress Prints and Photographs Division Washington, D.C. 20540 USA

"While conventional wisdom says that teens engage in risky behaviors because they feel invulnerable to harm, this study suggests that in some cases, teens take risks because they overestimate their vulnerability, specifically their risk of dying," Borowsky said. "These youth may take risks because they feel hopeless and figure that not much is at stake."

Nearly 25 percent of youth living in households that receive public assistance and more than 29 percent of American-Indian, 26 percent of African-American, 21 percent of Hispanic, and 15 percent of Asian youth reported believing they would die young—compared to just 10 percent of their Caucasian peers.

"Our findings reinforce the importance of instilling a sense of hope and optimism in youth," Borowsky said. "Strong connections with parents, families, and schools, as well as positive media messages, are likely important factors in developing an optimistic outlook for young people."

She also notes that study findings support physician screening of adolescents for this perceived risk of early death. "This unusually common pessimistic view of the future is a powerful marker for high-risk status and thus deserves attention."

There was no significant relationship between perceived risk of dying before age 35 and actual death from all causes during the six year study period. ###

The study "Health Status and Behavioral Outcomes for Youth Who Anticipate a High Likelihood of Early Death," will be published in the July issue of Pediatrics.

The study was funded by a grant from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies.

Dedicated to excellence, diversity and service, the University of Minnesota Medical School educates the next generation of physicians, advances patient care, and discovers breakthroughs in biomedical research that enhance health in Minnesota and beyond. Its commitment to transform medical education, Rural Physician Associate Program, and success in training Native American physicians are well-known. More than 1,500 Medical School physicians and scientists provide world-class care and carry out nearly $200 million in research, which informs the treatments and care that patients receive. For more information, go to www.med.umn.edu.

Contact: Laura Stroup stro0481@umn.edu 612-624-5680 University of Minnesota

Race origins and health disparites

Today's racial categories evolved from negative assumptions made hundreds of years ago to justify slavery.

Much is often said about the glaring statistics showing that some racial and ethnic minorities face greater risks than whites when it comes to health.

Nina T. Harawa, an Assistant Professor and researcher at Charles Drew University, says today's disparities are linked to many factors, including economics, access to health care and the impact of living in a race conscious society.

But in the recent issue of Ethnicity and Disease, she writes that the concept of race is often misunderstood or inconsistently used when examining differences (or "disparities") in health outcomes.

Caption: Nina T. Harawa, MPH, PhD is a researcher at Charles Drew University. Credit: Charles Drew University. Usage Restrictions: None.

"There is no gold standard for the use of race in health research," said Harawa, who co-wrote the article with Assistant Professor Chandra L. Ford, PhD, of the UCLA School of Public Health. Harawa said there are no readily agreed-upon standards for measuring someone's race, as in the case of gauging someone's age. Nevertheless, race has been used to categorize people since before the country's founding.

Efforts to simplify the complexities of race— including genetic, cultural and socioeconomic variations—have made race-related research "a minefield of often premature and ultimately wrong conclusions," she said.

To understand health disparities in the various population groups, she said, researchers need to understand how today's racial categories evolved from the negative assumptions made hundreds of years ago to justify slavery.

"Advancing our ability to address racial/ethnic disparities in health requires a historically informed understanding of these issues, including how the notion of fixed and distinct races became fixed in the American mind," she wrote.

A report, titled "Health Disparities: A Case for Closing the Gap", recently released by the U.S. Health and Human Services, shows significant disparities:

* 48 percent of all African American adults suffer from a chronic disease compared to 39 percent of the general population.
* Eight percent of White Americans develop diabetes while 15 percent of African Americans, and 14 percent of Hispanics and 18 percent of American Indians develop diabetes.
* African Americans are 15 percent more likely to be obese than Whites.

"Minorities and low income Americans are more likely to be sick and less likely to get the care they need," said Health and Human Services Secretary Kathleen Sebelius after the release of her report earlier this month. However, Dr. Harawa points out there are also exceptions, such as first generation Latino immigrants who have health advantages in many areas despite high levels of poverty and generally low levels of education. Further, Black immigrants frequently experience much better health outcomes than do other Black populations in the US.

Unfortunately, today's race and ethnic categories often fail to make these distinctions. ###

Nina T. Harawa, MPH, PhD, is an epidemiologist. Her research involves both documenting and understanding trends in the distribution of HIV infections and developing effective HIV prevention interventions. She has conducted and led numerous studies examining the prevalence of HIV infection and risky behaviors in a variety of high-risk populations.

"Race Origins and Health Disparities" by Nina Harawa, MPH, PhD, and Chandra Ford, PhD, can be found here in PDF format: Race Origins and Health Disparities

Contact: John L. Mitchell johnmitchell@cdrewu.edu 323-563-4981 Charles Drew University of Medicine and Science

2 studies shed light on racial disparities in cancer survival

Black women diagnosed with breast cancer have a greater chance of dying from the disease than white women, according to a new study published online July 7 in the Journal of the National Cancer Institute.

Age-standardized breast cancer mortality rates in the U.S. have remained higher and declined more slowly among black women. This study was undertaken because the underlying causes of this disparity were unclear.

To explore this, Idan Menashe, Ph.D., of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, in Rockville, Md., and colleagues used the Surveillance, Epidemiology, and End Results program to investigate almost 250,000 women diagnosed with breast cancer from January 1990 through December 2003. Researchers calculated black-to-white ratios of mortality, incidence, hazard of breast cancer death (probability of dying from the disease), and incidence-based mortality, with some analyses stratified by estrogen receptor (ER) status and age.

Idan Menashe

The researchers found a statistically significantly higher hazard of death in black women diagnosed with breast cancer compared to whites, especially in the first few years after diagnosis. Hazard rates of breast cancer death declined substantially for ER-positive tumors and modestly for ER-negative tumors but were persistently higher for blacks than whites.

"These differences in hazard may reflect racial differences in response and access to innovations in breast cancer treatment, as well as other biological and non-biological factors," the authors write. "Hence, greater emphasis should be placed on identifying the reasons for these increased hazards among black women and on developing new therapeutic approaches to address the disparity."

In another study, also published in this issue, Kathy S. Albain, M.D., of Loyola University Medical Center in Maywood, Ill., found that even when African American patients received the same care as all other patients, their survival rates were lower for breast, prostate and ovarian cancers, but were equivalent for all other major cancers.

Albain and colleagues analyzed records of more than 19,000 patients who participated in phase III cancer clinical trials conducted by the Southwest Oncology Group.

"Patients of all races had the same doctors and received the same state-of-the-art treatments," Albain said. "It was a level playing field for everyone. So our findings cast doubt on a widely accepted theory that African Americans' lower survival rates for certain cancers are solely due to such factors as poverty and poor access to quality health care."

Albain's study found no statistically significant association between race and survival for lung cancer, colon cancer, lymphoma, leukemia, or myeloma.

The cancers that did show survival gaps -- breast, prostate and ovarian -- are gender-related and the survival disparity persisted after adjustment for treatment factors, tumor variables, and socioeconomic status. The findings therefore suggest that the survival gap for these cancers is most likely due to an interaction of tumor biologic factors, hormonal environment, and inherited variations genes that control metabolism of drugs, toxins and hormones, Albain said.

In an accompanying editorial, Otis W. Brawley, M.D., of the American Cancer Society, said results of the Albain et al. study provide evidence that racial differences in the U.S. for certain cancers can be attributed to unequal care. He points out that blacks are less likely to have disease detected early and less likely to receive adequate treatment when it is detected.

The Menashe et al. study, according to Brawley, showed clear differences in mortality by race.

"Taken together, the two studies and others do not suggest that blacks have a different kind of breast cancer, but rather that there are multiple kinds of breast cancer and a higher proportion of black breast cancer patients have the worse kinds," the editorialist writes. "No race has a monopoly on the good kind, nor the bad kind of breast cancer, but the prevalences differ." ###

Contacts:

• Menashe et al. study: NCI Press Officers, ncipressofficers@mail.nih.gov, (301)496-6641
• Albain et al. study: Frank DeSanto, fdesanto@med.umich.edu, (734) 998-0114
• Jim Ritter, Loyola University Health System, jritter@lumc.edu, 708-216-2445
• Editorial: David Sampson, David.Sampson@cancer.org, 213.368.8523

Citations:

• Article: Menashe et al. Underlying Causes of the Black – White Racial Disparity in Breast Cancer Mortality: A Population-Based Analysis. J Natl Cancer Inst 2009, 101: 993-1000.
• Article: Albain et al. Racial Disparities in Cancer Survival Among Randomized Clinical Trials of the Southwest Oncology Group. J Natl Cancer Inst 2009, 101: 984-992.
• Editorial: Brawley O. Is Race Really a Negative Prognostic Factor for Cancer? J Natl Cancer Inst 2009, 101: 970-971.

Contact: Steve Graff jncimedia@oxfordjournals.org 301-841-1285. Journal of the National Cancer Institute

Did Bush's court appointments emphasized ideology over diversity?

CORVALLIS, Ore. – The judicial appointments of former president George W. Bush suggests that his motivation for appointing nontraditional judges was driven more by ideology and strategy than concerns for diversity, a new analysis shows.

The examination of all the federal judicial appointments over the two terms of the Bush presidency show that while he did make a number of diverse appointments, especially with Hispanics, overall the federal courts did not gain in the number of minority judges during Bush's tenure.

The analysis appears in an article in the current issue of Judicature and was written by Jennifer Segal Diascro, an assistant professor in the Department of Government at American University, and Rorie Spill Solberg, an associate professor in the Department of Political Science at Oregon State University.

Rorie Spill Solberg, Associate Professor. Contact Information Office: 310 Gilkey Hall Address: Department of Political Science Oregon State University Corvallis, OR 97331-5303. Phone: (541) 737-2811. Fax: (541) 737-2289. Email: Rorie Spill Solberg

"The key is to look at the replacement patterns," said Spill Solberg. "Bush did appoint many minorities, but in order to have a gain in diversity, you have to replace more seats with diverse judges than you started with or else it doesn't equate with a diverse bench." Diascro and Solberg relied on statements from President Bush and members of his administration to determine that ideology played a role in his appointments, and relied on statistical analyses by Carp et al. (published in the same issue of Judicature) that reveal that his appointees to the lower courts were indeed conservative. To assess the relative ideology of Judge Sonia Sotomayor and other women on Obama's short list, Diascro and Solberg utilized the Judicial Common Space scores developed by Lee Epstein and colleagues.

The empirical measurements used to assess ideology are all reliable and valid measures employed by political scientists.

According to the article, when compared with all presidents since Jimmy Carter, Bush maintained the status quo in appointing nontraditional judges to the bench. He appointed more men (78 percent overall) then women (22 percent) and more whites (82 percent) than minorities (18 percent), but as Spill Solberg points out, that pattern was true for Bush's predecessors.

When comparing total appointments, Bush appointed more white females (50) than Carter (32), Ronald Reagan (27) or George H.W. Bush (31), but less than Bill Clinton (83). He appointed more Hispanic females (12) than Clinton (5), but fewer African American females (8 compared to 15) than Clinton, so the overall diversity representation is about the same, or in some cases less than during Clinton's presidency.

In particular, Spill Solberg said, African-American judges did not see a significant increase under the Bush administration. "At the end of eight years in office, African Americans held 8.5 percent of the seats on the court of appeals, an increase of only half a percent from the end of the Clinton administration," the study points out.

Spill Solberg said that like Carter, Reagan and George H.W. Bush, George W. Bush often appointed minorities to seats for political gain or for ideological purposes.

"There is a tendency, and we see this across the political spectrum, to use bench appointments to gain clout with certain voters," she said. "The Bush administration was actively courting the Hispanic vote, so it isn't surprising that he made more appointments of Hispanic judges than African Americans, but it was often also based on judicial philosophy."

In contrast, the study shows that Clinton often stressed diversity and representation over ideology. He often picked moderate and conservative minority and female judges even though they did not necessarily reflect his own political philosophies. Diascro said Democrats have had an easier time appointing a diverse bench that also serves their political and ideological goals as nontraditional candidates tend to come from groups that vote Democratic.

"We suspect that Bush had many Hispanic conservatives from which to choose when filling vacancies on the bench, and he chose to appoint traditional candidates instead," Diascro said. "He cared about diversity, but it was not his first priority."

The study's authors stress that diversity in the federal court system remains important as a way of representing the broad range of experiences of the public that the system is supposed to serve. This is true from a symbolic perspective, lending legitimacy to an otherwise non-democratic branch of government; but it may also be true substantively, said Diascro.

"Personal experiences matter and impact how you view the law," Spill Solberg said. "The experiences of woman may differ from those of a man in the same way that the experiences of a prosecutor may differ from the experiences of other lawyers. It is more complicated as we see with Justice Thomas who brings the experiences of an African American filtered through the lens of a conservative ideology."

Looking ahead, Diascro and Spill Solberg thoughtfully analyze what the judicial legacy of Barack Obama's presidency will be compared to his predecessors. Their conclusion so far is that Obama will emphasize diversity over ideology like Clinton and that his nomination of Judge Sotomayor to the Supreme Court is a demonstration of this.

"His nominations thus far demonstrate his reluctance to appoint ideologues," the authors write. "This is especially true for Judge Sotomayor, who is not the most liberal choice among the female candidates reportedly on the President's short list." ###

Note: For copies of the upcoming issue of Judicature, contact David Richert, editor, Judicature, American Judicature Society (www.ajs.org) 848 Dodge, #468, Evanston, IL 60202 (773) 973-0145 tel; (773) 338-9687 fax; drichert@ajs.org or Laury Lieurance, llieurance@ajs.org, 800-626-4089.

Media contact: Angela Yeager, 541-737-0784; angela.yeager@oregonstate.edu
Sources: Rorie Spill Solberg, 541-737-2811, rorie.spillsolberg@oregonstate.edu; Jennifer Segal Diascro, 202-885-2246, diascro@american.edu

Contact: Rorie Spill Solberg rorie.spillsolberg@oregonstate.edu 541-737-2811 Oregon State University