Education, Race/Ethnicity, and Causes of Premature Mortality Among Middle-Aged Adults in 4 US Urban Communities: Results From CARDIA, 1985-2017

Objectives. To assess causes of premature death and whether race/ethnicity or education is more strongly and independently associated with premature mortality in a diverse sample of middle-aged adults in the United States.Methods. The Coronary Artery Risk Development in Young Adults study (CARDIA) is a longitudinal cohort study of 5114 participants recruited in 1985 to 1986 and followed for up to 29 years, with rigorous ascertainment of all deaths; recruitment was balanced regarding sex, Black and White race/ethnicity, education level (high school or less vs. greater than high school), and age group (18-24 and 25-30 years). This analysis included all 349 deaths that had been fully reviewed through month 348. Our primary outcome was years of potential life lost (YPLL).Results. The age-adjusted mortality rate per 1000 persons was 45.17 among Black men, 25.20 among White men, 17.63 among Black women, and 10.10 among White women. Homicide and AIDS were associated with the most YPLL, but cancer and cardiovascular disease were the most common causes of death. In multivariable models, each level of education achieved was associated with 1.37 fewer YPLL (P = .007); race/ethnicity was not independently associated with YPLL.Conclusions. Lower education level was an independent predictor of greater YPLL.

Epigenome-wide association study for perceived discrimination among sub-Saharan African migrants in Europe - the RODAM study

Sub-Saharan African (SSA) migrants in Europe experience psychosocial stressors, such as perceived discrimination (PD). The effect of such a stressor on health could potentially be mediated via epigenetics. In this study we performed an epigenome-wide association study (EWAS) to assess the association between levels of PD with genome-wide DNA methylation profiles in SSA migrants. The Illumina 450 K DNA-methylation array was used on whole blood samples of 340 Ghanaian adults residing in three European cities from the cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) study. PD was assessed using sum scores of the Everyday Discrimination Scale (EDS). Differentially methylated positions and regions (DMPs and DMRs) were identified through linear regression analysis. Two hypo-methylated DMPs, namely cg13986138 (CYFIP1) and cg10316525(ANKRD63), were found to be associated with PD. DMR analysis identified 47 regions associated with the PD. To the best of our knowledge, this survey is the first EWAS for PD in first generation SSA migrants. We identified two DMPs associated with PD. Whether these associations underlie a consequence or causal effect within the scope of biological functionality needs additional research.

Use of Mentholated Cigarettes and Likelihood of Smoking Cessation in the United States: A Meta-Analysis

INTRODUCTION

Previous qualitative reviews have summarized evidence of an association between menthol cigarette use and likelihood of smoking cessation. The objective of this meta-analysis was to provide a quantitative summary of effect sizes, their variability, and factors related to the variability in effect size for the association between menthol use and likelihood of smoking cessation.

METHODS

We systematically searched Medline, PsycINFO, and Embase for prospective and cross-sectional studies of the association between menthol use and smoking cessation. We analyzed data with random effects meta-analyses and meta-regression.

RESULTS

Our review identified 22 reports from 19 studies of the association between menthol use and cessation. All identified study samples included only US smokers, with one exception that included both Canadian and US smokers. Our overall model did not demonstrate a significant association between menthol use and cessation; however, menthol users were significantly less likely to quit among blacks/African American smokers (odds ratio = 0.88).

CONCLUSIONS

Among blacks/African Americans predominantly in the US menthol users have approximately 12% lower odds of smoking cessation compared to non-menthol users. This difference is likely the result of the tobacco industry's ongoing marketing influence on the black/African American Community, suggesting that a menthol ban may have a unique public health benefit for black/African American smokers by encouraging quitting behavior.

IMPLICATIONS

This study adds a quantitative summary of the association between menthol cigarette use and smoking cessation in the United States. Findings of an association with lower likelihood of cessation among black/African American smokers, likely resulting from the tobacco industry's marketing influence, support the ban of menthol flavoring as part of a comprehensive tobacco control effort to increase cessation among black/African American smokers.

Understanding Social Determinants of Cardiometabolic Disease Risk in Rural Women

Women living in rural America experience significant disparities in cardiometabolic diseases warranting research to aid in understanding the contextual factors that underlie the rural and urban disparity and in planning effective primary prevention interventions. While research has established a general understanding of cardiometabolic risks individually, the combination or bundling of these risk behaviors is not clearly understood. The purpose of this study is to explore the association of social determinants of health on obesity and adiposity related cardiometabolic disease risk among rural women. Data were from the multi-state Rural Families Speak about Health Study. A total of 399 women were included in the analyses. Data were collected using a self-administered questionnaire on women's demographics, economic stability, education, and health and healthcare. Food insecurity, education, healthcare access and comprehension health literacy were associated with higher obesity and adiposity-related cardiometabolic risk. Health behaviors, tobacco use and physical activity were not associated with higher cardiometabolic risk in this sample of rural women. This is one of the first studies to focus on multiple social determinants of health and cardiometabolic risk in rural American women. Understanding combinations of risk behaviors can assist health care providers and community health professionals in tailoring multiple health behavior change interventions to prevent cardiometabolic disease among rural women. The findings support a focus on community and societal level factors may be more beneficial for improving the cardiometabolic health of rural women.

Two Threats to Precision Medicine Equity

In January 2015, President Barack Obama unveiled the "Precision Medicine Initiative," a nationwide research effort to help bring an effective, preventive, and therapeutic approach to medicine. The purpose of the initiative is to bring a precise understanding of the genetic and environmental determinants of disease into clinical settings across the United States.¹ The announcement was coupled with $216 million provided in the President's proposed budget for a million-person national research cohort including public and private partnerships with academic medical centers, researchers, foundations, privacy experts, medical ethicists, and medical product innovators. The Initiative promises to expand the use of precision medicine in cancer research and modernize regulatory approval processes for genome sequencing technologies. In response, Congress passed the 21st Century Cures Act in December 2016, authorizing a total of $1.5 billion over 10 years for the program.² Although the Precision Medicine Initiative heralds great promise for the future of disease treatment and eradication, its implementation and development must be carefully guided to ensure that the millions of federal dollars expended will be spent equitably. This commentary discusses two key threats to the Precision Medicine Initiative's ability to proceed in a manner consistent with the United States Constitutional requirement that the federal government shall not "deny to any person . . . the equal protection of the laws."³ In short, this commentary sounds two cautionary notes, in order to advance precision medicine equity. First, achieving precision medicine equity will require scientists and clinicians to fulfill their intellectual, moral, and indeed legal duty to work against abusive uses of precision medicine science to advance distorted views of racial group variation. Precision medicine scientists must decisively denounce and distinguish this Initiative from the pseudo-science of eugenics - the immoral and deadly pseudo-science that gave racist and nationalist ideologies what Troy Duster called a "halo of legitimacy" during the first half of the 20th century.⁴ Second, to combat the social threat to precision medicine, scientists must incorporate a comprehensive, ecological understanding of the fundamental social and environmental determinants of health outcomes in all research. Only then will the Precision Medicine Initiative live up to its potential to improve and indeed transform health care delivery for all patients, regardless of race, color, or national origin.

Building on the biocultural syntheses: 20 years and still expanding

Building a New Biocultural Synthesis: Political Economic Perspectives in Human Biology called for an integration of political economy with ecological and adaptability perspectives in biocultural anthropology. A major goal of this volume was to explore the utility of including political-economic and sociocultural processes in analyses of human biological variation, nutrition, and health. A second goal was to enhance collaboration among subfields and work against the "chasm" that separated complementary perspectives in cultural and biological anthropology. Twenty years hence, new ways to link social inequalities and human biology have emerged in part through contributions of developmental origins of health and disease, epigenetics, microbiomes, and other new methods for tracing pathways of embodiment. Equally important, notions of "local/situated biologies" and "reactive genomes," provide frameworks for understanding biology and health at the nexus of ecologies, societies, and histories. We review and highlight these contributions toward expanding critical approaches to human biology. Developments over the past two decades have reinforced the central role of social environments and structural inequalities in shaping human biology and health. Yet, within biocultural approaches, a significant engagement with historical, political-economic, and sociocultural conditions remains relatively rare. We review potential barriers to such analyses, focusing on theoretical and methodological challenges as well as the subfield structure of anthropology. Achieving politically and socially contextualized and relevant critical biocultural approaches remains a challenge, but there is reason for optimism amid new theoretical and methodological developments and innovations brought by new generations of scholars.

Detecting the Effects of Early-Life Exposures: Why Fecundity Matters

Prenatal exposures have meaningful effects on health across the lifecourse. Innovations in causal inference have shed new light on these effects. Here, we motivate the importance of innovation in the characterization of fecundity, and prenatal selection in particular. We argue that such innovation is crucial for expanding knowledge of the fetal origins of later life health. Pregnancy loss is common, responsive to environmental factors, and closely related to maternal and fetal health outcomes. As a result, selection into live birth is driven by many of the same exposures that shape the health trajectories of survivors. Lifecourse effects that are inferred without accounting for these dynamics may be significantly distorted by survival bias. We use a set of Monte Carlo simulations with realistic parameters to examine the implications of prenatal survival bias. We find that even in conservatively specified scenarios, true fetal origin effects can be underestimated by 50% or more. In contrast, effects of exposures that reduce the probability of prenatal survival but improve the health of survivors will be overestimated. The absolute magnitude of survival bias can even exceed small effect sizes, resulting in inferences that beneficial exposures are harmful or vice-versa. We also find reason for concern that moderately sized true effects, underestimated due to failure to account for selective survival, are missing from scientific knowledge because they do not clear statistical significance filters. This bias has potential real-world costs; policy decisions about interventions to improve maternal and infant health will be affected by underestimated program impact.

Population Demography, Ancestry, and the Biological Concept of Race

For more than 50 years, biological anthropology has argued against the use of the biological race concept. Despite such efforts, aspects of the concept remain in circulation within society and within the discipline itself. As commonly articulated, anthropology's rejection of the biological race concept lacks an evolutionarily based explanatory grounding. Biological patterns of variation in living humans do not map onto commonly utilized categorizations of race, but this knowledge does not explain why human evolution has not produced such structures. This article attempts to offer one such explanation by constructing a biocultural framing of race around ancestry. By examining ancestry through two related lenses, genealogical and genetic, it is shown that the coherence of race as a biological concept has been disrupted by demographic changes in our recent evolutionary past. The biological construction of race is invalid not because it is impossible but because evolutionary forces have actively worked against such patterns in our evolutionary past.

Epigenetics, ethics, law and society: A multidisciplinary review of descriptive, instrumental, dialectical and reflexive analyses

Epigenetics, defined as 'the study of mitotically and/or meiotically heritable changes in gene function that cannot be explained by changes in DNA sequence', has emerged as a promissory yet controversial field of scientific inquiry over the past decade. Scholars from many disciplines have formulated both optimistic and cautionary claims regarding its potential normative implications. This article provides a comprehensive review of the nascent literature at the crossroads of epigenetics, ethics, law and society. It describes nine emerging areas of discussion, relating to (1) the impact of epigenetics on the nature versus nurture dualism, (2) the potential resulting biologization of the social, (3) the meaning of epigenetics for public health, its potential influence on (4) reproduction and parenting, (5) political theory and (6) legal proceedings, and concerns regarding (7) stigmatization and discrimination, (8) privacy protection and (9) knowledge translation. While there is some degree of similarity between the nature and content of these areas and the abundant literature on ethical, legal and social issues in genetics, the potential implications of epigenetics ought not be conflated with the latter. Critical studies on epigenetics are emerging within a separate space of bioethical and biopolitical investigations and claims, with scholars from various epistemological standpoints utilizing distinct yet complementary analytical approaches.

Association Between Stress and Coping with DNA Methylation of Blood Pressure-Related Genes Among African American Women

Background

Exposure to psychosocial stress and employment of high effort coping strategies have been identified as risk factors that may partially explain the high prevalence of hypertension among African Americans. One biological mechanism through which stress and coping may affect risk of hypertension is via epigenetic modifications (e.g., DNA methylation) in blood pressure-related genes; however, this area remains understudied in African Americans.

Methods

We used data from the ongoing Intergenerational Blood Pressure Study, a longitudinal study designed to investigate factors that contribute to hypertension risk in African American women (n = 120) and their young children, to investigate the association between stress overload, problem-solving coping, avoidance coping, and social support coping with DNA methylation in 25 candidate genes related to blood pressure. Multivariable linear regression and multilevel modeling were used to conduct methylation site-level and gene-level analyses, respectively.

Results

In site-level analyses, stress overload, problem-solving coping, social support coping, and avoidance coping were associated with 47, 63, 66, and 61 sites, respectively, at p < 0.05. However, no associations were statistically significant after multiple testing correction. There were also no significant associations in gene-level analyses.

Conclusions

As human social epigenomics is an emerging, evolving area of research, there is much to be learned from studies with statistically significant findings as well as studies with null findings. Factors such as characteristics of the social stressor, source of DNA, and synchronization of exposure and outcome are likely important considerations as we move the field forward.

Maternal experiences of ethnic discrimination and subsequent birth outcomes in Aotearoa New Zealand

Background

Interpersonal discrimination experience has been associated with adverse birth outcomes. Limited research has evaluated this relationship within multicultural contexts outside the United States where the nature and salience of discrimination experiences may differ. Such research is important in order to help identify protective and risk factors that may mediate the relationship between discrimination experience and adverse birth outcomes.

Methods

Evaluated the relationship between perceived discrimination, as measured in pregnancy, with birth weight and gestation length among Māori, Pacific, and Asian women from Aotearoa New Zealand (N = 1653).

Results

Thirty percent of the sample reported some type of unfair treatment that they attributed to their ethnicity. For Māori women specifically, unfair treatment at work (β = − 243 g) and in acquiring housing (β = − 146 g) were associated with lower birth weight when compared to Māori women not experiencing these types of discrimination, while an ethnically motivated physical attack (β = − 1.06 week), and unfair treatment in the workplace (β = − 0.95 week), in the criminal justice system (β = − 0.55 week), or in banking (β = − 0.73 week) were associated with significantly shorter gestation.

Conclusions

Despite a high prevalence of discrimination experience among women from all ethnic groups, discrimination experience was a strong predictor of lower birth weight and shorter gestation length among indigenous Māori women only. Additional research is needed to better understand the risk and protective factors that may moderate the relationship between discrimination experience and adverse birth outcomes among women from different ethnic groups.

The role of biocultural approaches in assessing interventions for maternal weight and gestational weight gain

Public health and other researchers express growing concern for the role of maternal adiposity and gestational weight gain in driving the obesity epidemic and health disparities based on race and class. Biocultural scholars must continue to contribute to conversations on how best to address issues of population health including the developmental context of obesity, drawing from both evolutionary and social theory. I discuss a number of intervention studies designed to address gestational weight gain in low-income and minority women and consider the degree to which they address the social, political, and economic context, and developmental history of mothers. I further examine the potential for these interventions, focused on the individual behavior of mothers, to contribute to stigma based on socially defined race, class, and body shape and size, and to draw attention away from the powerful economic interests that contribute to and benefit from the obesity epidemic. I end with a discussion of the value of developmental systems theory for thinking critically about obesity and other health interventions.

Race, again: how face recognition technology reinforces racial discrimination

Purpose

This study aims to explore whether face recognition technology – as it is intensely used by state and local police departments and law enforcement agencies – is racism free or, on the contrary, is affected by racial biases and/or racist prejudices, thus reinforcing overall racial discrimination.

Design/methodology/approach

The study investigates the causal pathways through which face recognition technology may reinforce the racial disproportion in enforcement; it also inquires whether it further discriminates black people by making them experience more racial discrimination and self-identify more decisively as black – two conditions that are shown to be harmful in various respects.

Findings

This study shows that face recognition technology, as it is produced, implemented and used in Western societies, reinforces existing racial disparities in stop, investigation, arrest and incarceration rates because of racist prejudices and even contributes to strengthen the unhealthy effects of racism on historically disadvantaged racial groups, like black people.

Practical implications

The findings hope to make law enforcement agencies and software companies aware that they must take adequate action against the racially discriminative effects of the use of face recognition technology.

Social implications

This study highlights that no implementation of an allegedly racism-free biometric technology is safe from the risk of racially discriminating, simply because each implementation leans against our society, which is affected by racism in many persisting ways.

Originality/value

While the ethical survey of biometric technologies is traditionally framed in the discourse of universal rights, this study explores an issue that has not been deeply scrutinized so far, that is, how face recognition technology differently affects distinct racial groups and how it contributes to racial discrimination.

Systematic Review of Chronic Discrimination and Changes in Biology During Pregnancy Among African American Women

Profound racial health disparities in maternal and infant health exist in the USA. Discrimination based on race may contribute to these disparities, but the biological pathways through which racial discrimination acts on health are not fully known. Even less is known about these pathways during development. Examining how racial discrimination becomes biology is paramount because it may shed light on how and when such social forces result in lasting biological consequences for health and wellbeing. To begin exploring this issue, we performed a systematic review of the relationships between experiences of chronic racial discrimination and relevant biomarkers measured during pregnancy among African American women. The literature search included studies published prior to August 2018 in the MEDLINE, Embase, and PsycINFO databases, and 11 studies met our inclusion criteria. We evaluated the articles based on the biological system that the authors investigated, which included the immune, neuroendocrine, and cardiovascular systems. We found that the current literature provides preliminary evidence that experiences of chronic racial discrimination are associated with changes in maternal biology during pregnancy. However, the literature was limited in both quantity and quality. We found only 11 studies that addressed this subject, four of which only provided indirect evidence, and many studies had small sample sizes. Future work in this area should develop more informative methods that consider the interaction between interpersonal and structural racial discrimination, individual variation, and sociocultural factors. We conclude researchers should continue to work in this area and focus on developing more effective study designs and larger sample sizes.

Exploring associations between perinatal depression, anxiety, and urinary oxytocin levels in Latinas

Perinatal depression has been associated with lower oxytocin (OT) levels. However, few studies have explored this topic in relation to Latinas who are at high risk of perinatal depression. The objective of this study was to explore these associations in Latinas. A total of 108 Latinas in the third trimester of pregnancy participated in the study. Depression and urinary OT levels were assessed in pregnancy and 6 weeks postpartum. Nonparametric tests were implemented to test the proposed associations. Results revealed that 28% of the participants had probable depression in pregnancy, and 23% at 6 weeks postpartum. OT levels significantly decreased from prenatal to postpartum in the whole sample; however, participants with probable prenatal depression did not exhibit a significant change in OT levels. Participants who were depressed or anxious at 6 weeks postpartum exhibited persistently higher mean OT levels over time. A distinct pattern of higher levels of OT in depressed Latinas suggests that OT levels may be an important neuroendocrine factor contributing to depressive and anxious symptoms.

Environmental Politics of Reproduction

What constitutes "human reproduction" is under negotiation as its biology, social nature, and cultural valences are increasingly perceived as bound up in environmental issues. This review maps the growing overlap between formerly rather separate domains of reproductive politics and environmental politics, examining three interrelated areas. The first is the emergence of an intersectional environmental reproductive justice framework in activism and environmental health science. The second is the biomedical delineation of the environment of reproduction and development as an object of growing research and intervention, as well as the marking off of early-life environments as an "exposed biology" consequential to the entire life span. Third is researchers' critical engagement with the reproductive subject of environmental politics and the lived experience of reproduction in environmentally dystopic times. Efforts to rethink the intersections of reproductive and environmental politics are found throughout these three areas.

Understanding Embodiment in Place-Health Research: Approaches, Limitations, and Opportunities

Research on how place affects health continues to grow. Within the place-health research field, there is increasing focus on how place becomes embodied-i.e., how place-based social and environmental experiences and exposures "get under our skin" to affect physiological functioning and health. While much has been learned, currently favored place-embodiment research approaches present limitations that inhibit continued gains in understanding. This article presents a brief summary of place-health literature related to place-embodiment, highlighting common approaches. Core limitations are then discussed with an eye towards improving research going forward, highlighting mixed-method, spatially dynamic, and participatory intergenerational approaches as promising considerations.

Explaining the Relationship Between Minority Group Status and Health Disparities: A Review of Selected Concepts

Purpose: There is growing concern that value-based payment for health care may disadvantage health care organizations that serve populations with social risk. In the broader investigation of social risk factors, including income, education, neighborhood deprivation, and other risks, the focus on race and ethnicity as a risk factor for disparities in health and health care has diminished. Understanding the independent contribution of minority group status is critical to this discussion. This narrative review discusses four concepts-minority stress, resilience, epigenetics, and life course-that may help explain the contribution of minority group status and its association with health disparities. Methods: We briefly describe each concept and the supporting evidence. Results: Our results indicate that all four concepts have potential relevance for understanding and addressing health disparities. The life course perspective emphasizes the importance of understanding explanatory mechanisms and factors that contribute to health-including biological, physical, and social factors-over a person's life span. Both minority stress and resilience may influence health in either a negative or positive manner that potentially underlies health changes. Exposure to these factors and others may interact with and modify epigenetic regulation-biological processes that impact how our genes are expressed. This may increase the risk of disease and negative health outcomes, particularly among groups that may be at disproportionate risk because of social circumstances and environmental exposure over the life course. Conclusion: Despite these concepts' relevance, more research is needed to assess how they may explain the relationship between minority status and disparities in health. Such evidence is needed to focus interventions and to inform the design of delivery and payment models that can spur actions to reduce disparities.

Prenatal Exposure to an Acute Stressor and Children's Cognitive Outcomes

Exposure to environmental stressors is highly prevalent and unequally distributed along socioeconomic lines and may have enduring negative consequences, even when experienced before birth. Yet, estimating the consequences of prenatal stress on children's outcomes is complicated by the issue of confounding (i.e., unobserved factors correlated with stress exposure and with children's outcomes). I combine a natural experiment-a strong earthquake in Chile-with a panel survey to capture the effect of prenatal exposure on acute stress and children's cognitive ability. I find that stress exposure in early pregnancy has no effect on children's cognition among middle-class families, but it has a strong negative influence among disadvantaged families. I then examine possible pathways accounting for the socioeconomic stratification in the effect of stress, including differential exposure across socioeconomic status, differential sensitivity, and parental responses. Findings suggest that the interaction between prenatal exposures and socioeconomic advantage provides a powerful mechanism for the intergenerational transmission of disadvantage.

Genome-wide analysis of DNA methylation in relation to socioeconomic status during development and early adulthood

OBJECTIVES

Socioeconomic status (SES) is a powerful determinant of health, but the underlying biological mechanisms are poorly understood. This study investigates whether levels of DNA methylation at CpG sites across the genome are associated with SES in a cohort of young adults in the Philippines.

METHODS

DNA methylation was assayed with the Illumina HumanMethylation450 Bead Chip, in leukocytes from 489 participants in the Cebu Longitudinal Health and Nutrition Survey (mean age = 20.9 years). SES was measured in infancy/childhood and adulthood, and was based on composite measures of income, assets, and education. Genome-wide analysis of variable probes identified CpG sites significantly associated with SES after adjustment for multiple comparisons. Functional enrichment analysis was used to identify biological pathways associated with these sites.

RESULTS

A total of 2,546 CpG sites, across 1,537 annotated genes, were differentially methylated in association with SES. In comparison with high SES, low SES was associated with increased methylation at 1,777 sites, and decreased methylation at 769 sites. Functional enrichment analysis identified over-representation of biological pathways related to immune function, skeletal development, and development of the nervous system.

CONCLUSIONS

Socioeconomic status predicts DNA methylation at a large number of CpG sites across the genome. The scope of these associations is commensurate with the wide range of biological systems and health outcomes that are shaped by SES, and these findings suggest that DNA methylation may play an important role.

The Immigrant Health Differential in the Context of Racial and Ethnic Disparities: The Case of Diabetes

PURPOSE

Social and economic disparities between racial/ethnic groups are a feature of the American context into which immigrants are incorporated, and a key determinant of population health. We ask whether racial/ethnic disparities in diabetes vary by nativity and whether native-immigrant disparities in diabetes vary by race and over time in the United States.

METHODS

Using the 2000-2015 National Health Interview Survey, we estimate logistic regressions to examine the interaction of race/ethnicity, nativity, and duration in the U.S. in shaping diabetes patterns.

RESULTS

Relative to their native-born co-ethnics, foreign-born Asian adults experience a significant diabetes disadvantage, while foreign-born Hispanic, Black, and White adults experience a significant advantage. Adjusting for obesity, education, and other covariates eliminates the foreign-born advantage for Black and White adults, but it persists for Hispanic adults. The same adjustment accentuates the disadvantage for foreign-born Asian adults. For Black and Hispanic adults, the protective foreign-born effect erodes as duration in the U.S. increases. For foreign-born Asian adults, the immigrant disadvantage appears to grow with duration in the U.S. Relative to native-born White adults, all non-white groups regardless of nativity see a diabetes disadvantage because the racial/ethnic disadvantage either countervails a foreign-born advantage or amplifies a foreign-born disadvantage.

DISCUSSION

Racial/ethnic differentials in diabetes are considerable, and are influenced by each group's nativity composition. Obesity and (for the foreign-born) time in the U.S. influence these disparities, but do not explain them. These findings underscore the importance of unmeasured, systemic determinants of health in America's race-conscious society.

Nutrition, the visceral immune system, and the evolutionary origins of pathogenic obesity

The global obesity epidemic is the subject of an immense, diversely specialized research effort. An evolutionary analysis reveals connections among disparate findings, starting with two well-documented facts: Obesity-associated illnesses (e.g., type-2 diabetes and cardiovascular disease), are especially common in: (i) adults with abdominal obesity, especially enlargement of visceral adipose tissue (VAT), a tissue with important immune functions; and (ii) individuals with poor fetal nutrition whose nutritional input increases later in life. I hypothesize that selection favored the evolution of increased lifelong investment in VAT in individuals likely to suffer lifelong malnutrition because of its importance in fighting intraabdominal infections. Then, when increased nutrition violates the adaptive fetal prediction of lifelong nutritional deficit, preferential VAT investment could contribute to abdominal obesity and chronic inflammatory disease. VAT prioritization may help explain several patterns of nutrition-related disease: the paradoxical increase of chronic disease with increased food availability in recently urbanized and migrant populations; correlations between poor fetal nutrition, improved childhood (catch-up) growth, and adult metabolic syndrome; and survival differences between children with marasmus and kwashiorkor malnutrition. Fats and sugars can aggravate chronic inflammation via effects on intestinal bacteria regulating gut permeability to visceral pathogens. The extremes in a nutrition-sensitive trade-off between visceral (immune-function) vs. subcutaneous (body shape) adiposity may have been favored by selection in highly stratified premedicine societies. Altered adipose allocation in populations with long histories of social stratification and malnutrition may be the result of genetic accommodation of developmental responses to poor maternal/fetal conditions, increasing their vulnerability to inflammatory disease.

Maternal Pre-Pregnancy Cardiovascular Risk Factors and Offspring and Grandoffspring Health: Bogalusa Daughters

Both maternal pre-pregnancy body mass index (BMI) and gestational weight gain have been associated with cardiovascular health in the offspring beyond two generations. A total of 274 daughters (aged 12⁻54) of 208 mothers who participated in the Bogalusa Heart Study were interviewed about their reproductive history. Mothers' data was taken from the original study, and cardiovascular measures at the visit prior to pregnancy were correlated with daughter's measures. Maternal pre-pregnancy BMI, skinfold, and waist circumference were examined as a predictor of daughters' blood pressure, lipids, and glucose, as well as a predictor of birthweight and gestational age of grandchildren. Maternal pre-pregnancy BMI was associated with higher blood pressure and lower low-density lipoprotein (LDL) and cholesterol in the daughters. Most maternal cardiometabolic risk factors were not associated with grandchildren's birth outcomes, even though higher cholesterol and LDL was associated with lower gestational age, and higher BMI and skinfold thickness with an increased risk of preterm birth. In this pilot study, some associations were found between maternal adiposity and cardiovascular risk, daughters' cardiovascular risk, and grandchild birth outcomes. Lack of conclusive associations could be due to a true lack of effect, effects being primarily mediated through daughter's BMI, or the low power of the study.

Reliability of birth weight recall by parent or guardian respondents in a study of healthy adolescents

Objective

Birth weight, which can be an indicator for risk of chronic diseases throughout the lifespan, is one of the most commonly used measures in the study of developmental origins of health and disease. There is limited information on the reliability of parent/guardian reported birth weight by race or by respondent type (i.e., mother, father, other caregiver).

Results

Birth weight was reported by a respondent for 309 of the 333 (92.8%) study participants; of these, chart obtained birth weight was available for 236 (76.4%). There was good agreement between respondent report and chart obtained birth weight. Over half (N = 145, 61.4%) of respondents reported a birth weight within ± 100 g of what was in the chart; 60.9% of black participants (n = 81) and 62.1% of white participants (n = 64) fell within 100 g. Overall, mothers were 3.31 (95% CI 1.18, 9.33) times more likely than fathers to correctly recall the child’s birthweight within ± 100 g (p = 0.023). Respondent reported birth weight is a reliable alternative to chart obtained birth weight. Mothers were found to be most accurate in reporting birth weight of the child. Race/ethnicity was not significantly associated with reliability of birth weight reporting.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3977-2) contains supplementary material, which is available to authorized users.

Cardiovascular disease in racial/ethnic minority populations: illness burden and overview of community-based interventions

Cardiovascular disease, the leading cause of death in the USA, poses a unique and multilateral burden to racial/ethnic minorities. The admixture of comorbid conditions, structural barriers, and psychosocial standing complicates the prevention, diagnosis, and management of cardiovascular disease in racial/ethnic minority populations and requires newer approaches to reduce existing disparities. A discussion of the cardiovascular disease risk burden is presented, along with an overview of multi-stratified considerations for improving racial/ethnic minority cardiovascular health via community engagement.

Moving beyond individual choice in policies to reduce health inequalities: the integration of dynamic with individual explanations

Background

A strong focus on individual choice and behaviour informs interventions designed to reduce health inequalities in the UK. We review evidence for wider mechanisms from a range of disciplines, demonstrate that they are not yet impacting on programmes, and argue for their systematic inclusion in policy and research.

Methods

We identified potential mechanisms relevant to health inequalities and their amelioration from different disciplines and analysed six policy documents published between 1976 and 2010 using Bacchi's 'What's the problem represented to be?' framework for policy analysis.

Results

We found substantial evidence of supra-individualistic and relational mechanisms relevant to health inequalities from sociology, history, biology, neuroscience, philosophy and psychology. Policy documents sometimes expressed these mechanisms in policy rhetoric but rarely in policy recommendations, which continue to focus on individual behaviour.

Discussion

Current evidence points to the potential of systematically applying broader thinking about causal mechanisms, beyond individual choice and responsibility, to the design, implementation and evaluation of policies to reduce health inequalities. We provide a set of questions designed to enable critique of policy discussions and programmes to ensure that these wider mechanisms are considered.

Early post-conception maternal cortisol, children’s HPAA activity and DNA methylation profiles

The hypothalamic–pituitary–adrenal axis (HPAA) plays a critical role in the functioning of all other biological systems. Thus, studying how the environment may influence its ontogeny is paramount to understanding developmental origins of health and disease. The early post-conceptional (EPC) period could be particularly important for the HPAA as the effects of exposures on organisms’ first cells can be transmitted through all cell lineages. We evaluate putative relationships between EPC maternal cortisol levels, a marker of physiologic stress, and their children’s pre-pubertal HPAA activity (n=22 dyads). Maternal first-morning urinary (FMU) cortisol, collected every-other-day during the first 8 weeks post-conception, was associated with children’s FMU cortisol collected daily around the start of the school year, a non-experimental challenge, as well as salivary cortisol responses to an experimental challenge (all Ps<0.05), with some sex-related differences. We investigated whether epigenetic mechanisms statistically mediated these links and, therefore, could provide cues as to possible biological pathways involved. EPC cortisol was associated with >5% change in children’s buccal epithelial cells’ DNA methylation for 867 sites, while children’s HPAA activity was associated with five CpG sites. Yet, no CpG sites were related to both, EPC cortisol and children’s HPAA activity. Thus, these epigenetic modifications did not statistically mediate the observed physiological links. Larger, prospective peri-conceptional cohort studies including frequent bio-specimen collection from mothers and children will be required to replicate our analyses and, if our results are confirmed, identify biological mechanisms mediating the statistical links observed between maternal EPC cortisol and children’s HPAA activity.

The biological embedding of early-life socioeconomic status and family adversity in children's genome-wide DNA methylation

Aim:

To examine variation in child DNA methylation to assess its potential as a pathway for effects of childhood social adversity on health across the life course.

Materials & methods:

In a diverse, prospective community sample of 178 kindergarten children, associations between three types of social experience and DNA methylation within buccal epithelial cells later in childhood were examined.

Results:

Family income, parental education and family psychosocial adversity each associated with increased or decreased DNA methylation (488, 354 and 102 sites, respectively) within a unique set of genomic CpG sites. Gene ontology analyses pointed to genes serving immune and developmental regulation functions.

Conclusion:

Findings provided support for DNA methylation as a biomarker linking early-life social experiences with later life health in humans.

Perceived discrimination is associated with the inflammatory response to acute laboratory stress in women at risk for cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of death in the United States and exacts a disproportionate toll on minorities. Growing evidence demonstrates that perceived discrimination is a significant contributing factor to psychological distress, chronic low-grade inflammation, and cardiovascular health. However, little is known regarding the extent to which perceived discrimination contributes to the inflammatory response to acute stress. Therefore, the purpose of this study was to examine the influence of perceived discrimination on the inflammatory response to a laboratory acute stress paradigm in women at risk for CVD. A cross-sectional sample of 99 postmenopausal women (50 African American and 49 non-Hispanic White) (mean age 60.2 years) with at least two risk factors for CVD underwent the Trier Social Stress Test (TSST). Subjects completed the Detroit Area Study Discrimination Scale (DAS-DS) Everyday Discrimination subscale and provided blood and saliva samples prior to the TSST and every 15 min up to 90 min post-TSST to measure a pro-inflammatory cytokine, interleukin-6 (IL-6). Perceived discrimination was significantly associated with the salivary IL-6 response to the TSST (b = 0.49, SE = 0.13, p = <0.001) controlling for age, race, marital status, household income, BMI, statin use, childhood maltreatment, depressive symptoms, and subjective social status. Women who reported higher levels of perceived discrimination had higher levels of salivary IL-6 at baseline and following the TSST as compared to women who reported lower levels of perceived discrimination. Results suggest that higher levels of perceived discrimination, regardless of race and socioeconomic status, may heighten levels of inflammation, prior to and following an acute stress exposure. The circulating Il-6 response was associated with BMI only and did not correlate with salivary IL-6. These data suggest that perceived discrimination may contribute to the salivary-IL-6 acute stress response. However, more research is needed to help clarify the complex relationships among stress and salivary proinflammatory cytokines.

A pedagogy of social justice for resilient/vulnerable populations: Structural competency and bio-power

BACKGROUND

Nursing schools frequently assert the importance of social justice curriculum, but little information is available about specifics for such a class.

PURPOSE

The purpose of this article is to describe a class that builds a foundation for the understanding of social justice and the pedagogical frameworks on which it rests.

METHODS

The authors develop a class grounded in bio-power and structural competency.

DISCUSSION

Described are topics presented to students, the rationale for their selection along with class activities and implementation challenges. Highlighted is the use of praxis as students incorporate the components of structural competency and bio-power. The focus is on the potential for public health and advanced practice registered nurses to recognize and evaluate structural factors in patient and population-based care.

CONCLUSION

Faculty meet substantive challenges in teaching social justice, including lack of recognition of societal forces which affect student's ability to provide care. Focused effort incorporating newer structural and philosophical frameworks in a social justice class may improve the provision of health services. The frameworks of structural competency and bio-power provide a critical paradigm salient in social justice pedagogy.

Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity

Background: The sexual and reproductive health of African American women has been compromised due to multiple experiences of racism, including discriminatory healthcare practices from slavery through the post-Civil Rights era. However, studies rarely consider how the historical underpinnings of racism negatively influence the present-day health outcomes of African American women. Although some improvements to ensure equitable healthcare have been made, these historical influences provide an unexplored context for illuminating present-day epidemiology of sexual and reproductive health disparities among African American women. Methods: To account for the unique healthcare experiences influenced by racism, including healthcare provision, we searched online databases for peer-reviewed sources and books published in English only. We explored the link between historical and current experiences of racism and sexual and reproductive health outcomes. Results: The legacy of medical experimentation and inadequate healthcare coupled with social determinants has exacerbated African American women's complex relationship with healthcare systems. The social determinants of health associated with institutionalized and interpersonal racism, including poverty, unemployment, and residential segregation, may make African American women more vulnerable to disparate sexual and reproductive health outcomes. Conclusions: The development of innovative models and strategies to improve the health of African American women may be informed by an understanding of the historical and enduring legacy of racism in the United States. Addressing sexual and reproductive health through a historical lens and ensuring the implementation of culturally appropriate programs, research, and treatment efforts will likely move public health toward achieving health equity. Furthermore, it is necessary to develop interventions that address the intersection of the social determinants of health that contribute to sexual and reproductive health inequities.

A Postgenomic Body: Histories, Genealogy, Politics

This article sets the stage for a genealogy of the postgenomic body. It starts with the current transformative views of epigenetics and microbiomics to offer a more pluralistic history in which the ethical problem of how to live with a permeable body - that is plasticity as a form of life - is pervasive in traditions pre-dating and coexisting with modern biomedicine (particularly humoralism in its several ramifications). To challenge universalizing narratives, I draw on genealogical method to illuminate the unequal distribution of plasticity across gender and ethnic groups. Finally, after analysing postgenomics as a different thought-style to genomics, I outline some of its implications for notions of plasticity. I argue that postgenomic plasticity is neither a modernistic plasticity of instrumental control of the body nor a postmodernist celebration of endless potentialities. It is instead closer to an alter-modernistic view that disrupts clear boundaries between openness and determination, individual and community.

Coping with Pain in the Face of Healthcare Injustice in Patients with Sickle Cell Disease

To evaluate the pain coping strategies of patients with sickle cell disease (SCD) who experience healthcare injustice from either physicians or nurses during medical visits for pain management. It is unknown how patients' coping with pain relates to their experiences of healthcare injustice from physicians or nurses. This descriptive comparative study included adult outpatients with SCD who completed the PAINReportIt^®, Healthcare Justice Questionnaire^©, and Coping Strategies Questionnaire-SCD. Data were analyzed using independent t tests. Frequent coping strategies of patients who experienced healthcare justice from physicians were praying-hoping and from nurses were praying-hoping, calming self-statements, diverting attention, and increasing behavioral activity. In contrast, frequent coping strategies of patients who experienced healthcare injustice from physicians were catastrophizing and isolation and from nurses were isolation. Patients who experienced healthcare justice used different sets of pain coping strategies than those who experienced healthcare injustice during medical visits for pain management.

Stress-Related Biosocial Mechanisms of Discrimination and African American Health Inequities

This review describes stress-related biological mechanisms linking interpersonal racism to life course health trajectories among African Americans. Interpersonal racism, a form of social exclusion enacted via discrimination, remains a salient issue in the lives of African Americans, and it triggers a cascade of biological processes originating as perceived social exclusion and registering as social pain. Exposure to discrimination increases sympathetic nervous system activation and upregulates the HPA axis, increasing physiological wear and tear and elevating the risks of cardiometabolic conditions. Consequently, discrimination is associated with morbidities including low birth weight, hypertension, abdominal obesity, and cardiovascular disease. Biological measures can provide important analytic tools to study the interactions between social experiences such as racial discrimination and health outcomes over the life course. We make future recommendations for the study of discrimination and health outcomes, including the integration of neuroscience, genomics, and new health technologies; interdisciplinary engagement; and the diversification of scholars engaged in biosocial inequities research.

From the West Indies to Africa: A universal generational decline in health among blacks in the United States

Research shows that foreign-born blacks have better health profiles than their U.S.-born counterparts. Less is known, however, regarding whether black immigrants' favorable health outcomes persist across generations or whether these patterns differ across the diverse sending regions for black immigrants. In this study, we use data from the 1996-2014 waves of the March Current Population Survey (CPS) to investigate generational differences in self-rated health among blacks with West Indian, Haitian, Latin American, and African ancestry. We show that first-generation black immigrants have a lower probability of reporting fair/poor health than third/higher generation blacks. The health advantage of the first generation over the third/higher generation is slightly more prounced among the foreign-born who migrated to the United States after age 13. Second-generation immigrants with two foreign-born parents are generally less likely to report their health as fair/poor than the third/higher generation. However, we find no evidence that self-reported fair/poor health varies between second-generation immigrants with mixed nativity parents (only one foreign-born parent) and the third/higher generation. These general patterns hold across each of the ancestral subgroups in the study sample. In summary, our findings highlight a remarkable convergence in health across immigrant generations among blacks in the United States.

Income and Self-Rated Mental Health: Diminished Returns for High Income Black Americans

Background: The minorities' diminished return theory suggests that socioeconomic position (SEP) generates smaller health gains for racial/ethnic minorities compared to Whites. The current study was a Black⁻White comparison of the association between household income and self-rated mental health (SRMH). Methods: This cross-sectional study used data from the 2017 State of the State Survey (SOSS). With representative sampling, the SOSS generates results that are generalizable to the state of Michigan. This study included 881 adults, (n = 92) Black and (n = 782) White. The independent variable was household income. The dependent variable was SRMH, measured using a single item. Age, gender, and participation in the labor force were covariates. Race/ethnicity was the focal moderator. Logistic regression models were used for data analysis. Results: Overall, higher household income was associated with better SRMH, net of covariates. An interaction was found between race/ethnicity and household income on SRMH, suggesting a smaller, or nonexistent, protective effect for Blacks compared to Whites. In race/ethnicity-stratified models, higher household income was associated with better SRMH for Whites but not Blacks. Conclusion: Supporting the minorities' diminished return theory, our study documents differential effects for income on SRHM for Blacks and Whites, where Whites but not Blacks appear to benefit from their income. Given this, researchers and policy makers are cautioned against making assumptions that racial groups benefit equally from similar economic resources.

DNA Methylation and Histone Modification in Hypertension

Systemic hypertension, which eventually results in heart failure, renal failure or stroke, is a common chronic human disorder that particularly affects elders. Although many signaling pathways involved in the development of hypertension have been reported over the past decades, which has led to the implementation of a wide variety of anti-hypertensive therapies, one half of all hypertensive patients still do not have their blood pressure controlled. The frontier in understanding the molecular mechanisms underlying hypertension has now advanced to the level of epigenomics. Particularly, increasing evidence is emerging that DNA methylation and histone modifications play an important role in gene regulation and are involved in alteration of the phenotype and function of vascular cells in response to environmental stresses. This review seeks to highlight the recent advances in our knowledge of the epigenetic regulations and mechanisms of hypertension, focusing on the role of DNA methylation and histone modification in the vascular wall. A better understanding of the epigenomic regulation in the hypertensive vessel may lead to the identification of novel target molecules that, in turn, may lead to novel drug discoveries for the treatment of hypertension.

Transgenerational epigenetic inheritance and social responsibility: perspectives from the social sciences

Research in environmental epigenetics explores how environmental exposures and life experiences such as food, toxins, stress or trauma can shape trajectories of human health and well-being in complex ways. This perspective resonates with social science expertise on the significant health impacts of unequal living conditions and the profound influence of social life on bodies in general. Environmental epigenetics could thus provide an important opportunity for moving beyond long-standing debates about nature versus nurture between the disciplines and think instead in 'biosocial' terms across the disciplines. Yet, beyond enthusiasm for such novel interdisciplinary opportunities, it is crucial to also reflect on the scientific, social and political challenges that a biosocial model of body, health and illness might entail. In this paper, we contribute historical and social science perspectives on the political opportunities and challenges afforded by a biosocial conception of the body. We will specifically focus on what it means if biosocial plasticity is not only perceived to characterize the life of individuals but also as possibly giving rise to semi-stable traits that can be passed on to future generations. That is, we will consider the historical, social and political valences of the scientific proposition of transgenerational epigenetic inheritance. The key question that animates this article is if and how the notion of transgenerational epigenetic inheritance creates new forms of responsibilities both in science and in society. We propose that, ultimately, interdisciplinary conversation and collaboration is essential for responsible approaches to transgenerational epigenetic inheritance in science and society.