In the eye of the storm: Race and genomics in research and practice

What Do We Mean by “Ethnicity” and “Race”? A Consensual Qualitative Research Investigation of Colloquial Understandings

Lack of clarity and questionable congruence between researcher and participant understandings of ethnicity and race challenge the validity and impact of research utilizing these concepts. We aimed to both elucidate the multiple meanings that research participants in the United States might bring to questions about ethnicity and race and examine their relation to formal conceptualizations of these variables. We used consensual qualitative research-modified analyses to conduct thematic content analysis of 151 responses to open-ended survey questions about meanings of ethnicity and race. Participants included a racially diverse sample of 53 males, 87 females, and 11 unidentified gender with a mean age of 28.71 years. Results indicated that the most frequent colloquial meanings of ethnicity included origin, culture, ancestry, related or similar to race, social similarity, religion, and identity. The most frequent colloquial meanings of race included physical characteristics, ethnicity, origin, social grouping, ancestry, and imposed categorization. Results also illustrated how participants approached defining ethnicity and race. Results support the acknowledged and critiqued colloquial confounding of ethnicity and race and indicate a lack of agreed upon meaning between lay representations/meanings and formal meanings used by social scientists. This incongruence threatens valid operationalizations for research and challenges our ability to use these concepts in interventions to promote social justice and psychological health.

Cultural neuroscience and the research domain criteria: Implications for global mental health

A comprehensive understanding of the basic molecular and cellular mechanisms of the brain is important for the scientific discovery of root causes, risk and protective factors for mental disorders in global mental health. Systematic research in cultural neuroscience within the research domain criteria (RDoC) framework investigates the fundamental biobehavioral dimensions and observable behavior across cultures. Cultural dimensions are characterized in elements of circuit-based mechanisms and behavior across a range of analysis. Research approaches in cultural neuroscience within the RDoC framework advance the evidence-based resources for the development and implementation of cures, preventions and interventions to mental disorders in global mental health. This review presents a novel synthesis of foundations in cultural neuroscience within the research domain criteria framework to advance integrative, translational efforts in discovery and delivery science of mental disorders across cultural contexts in global mental health.

Commentary: Perspectives on alcohol-related gene and environment interplay in diverse populations

BACKGROUND AND OBJECTIVES

Racial/ethnic groups comprise more than 20% of the U.S. population, but many experience disproportionately high risk for alcohol misuse, often resulting in higher rates of alcohol-associated consequences. Completion of mapping the human genome has launched rapidly evolving research methods aimed at improved understanding of genetic contribution to disease. Despite decades of research on the influence of genetic and environmental risks on alcohol use disorders and outcomes, few studies have included racial/ethnic subpopulations in sufficient numbers to allow for proper statistical analysis.

METHODS

The papers in this special issue help to elucidate current knowledge on the etiology of genetic and environmental contributors and potential moderators of alcohol use and associated problems among racial/ethnic populations. The lack of racial/ethnic diversity across many genetic studies contributes to challenges in interpretation of findings and eventually applications to precision medicine.

RESULTS

Proposed approaches to overcome disparities in racial/ethnic participant recruitment in genetic studies include methods to address population stratification in allele frequency, improve transparency in subjects' consenting to participate, and engaging interdisciplinary research teams and community involvement to improve recruitment of racial/ethnic minorities.

DISCUSSION AND CONCLUSIONS

The reviews presented underscore various gaps in our knowledge of the genetic influences on alcohol use disorders due to the failure to include racially and ethnically diverse populations in genetic and epigenetic study samples. New directions are suggested to overcome the resulting research challenges and ultimately to inform future personalized intervention approaches for racial/ethnic populations.

SCIENTIFIC SIGNIFICANCE

Inclusion of heterogeneous populations in genomic research will provide a better comprehension of possible unique genetic factors in the broader general population that may be missed due to exclusion of unique and common variants that may be present in racial/ethnic populations. (Am J Addict 2017;26:526-531).

Challenges and Considerations Related to Studying Dementia in Blacks/African Americans

Blacks/African Americans have been reported to be ∼2-4 times more likely to develop clinical Alzheimer's disease (AD) compared to Whites. Unfortunately, study design challenges (e.g., recruitment bias), racism, mistrust of healthcare providers and biomedical researchers, confounders related to socioeconomic status, and other sources of bias are often ignored when interpreting differences in human subjects categorized by race. Failure to account for these factors can lead to misinterpretation of results, reification of race as biology, discrimination, and missed or delayed diagnoses. Here we provide a selected historical background, discuss challenges, present opportunities, and suggest considerations for studying health outcomes among racial/ethnic groups. We encourage neuroscientists to consider shifting away from using biologic determination to interpret data, and work instead toward a paradigm of incorporating both biological and socio-environmental factors known to affect health outcomes with the goal of understanding and improving dementia treatments for Blacks/African Americans and other underserved populations.

Counseling Psychology in the Era of Genetic Testing

The field of genetics and the process of testing for genetic disorders have advanced considerably over the past half century, ushering in significant improvements in certain areas of medical diagnosis and disease prediction. However, genetic discoveries are accompanied by many social, emotional, and psychological implications, and counseling psychologists may be uniquely equipped to help clients deal with these issues. The present overview is intended to raise awareness of the multidimensional issues inherent in situations where clients seek genetic testing to diagnose or predict various medical conditions. Initially, the author presents a framework to help counseling psychologists identify and organize information within a genetic-testing context, followed by suggestions for addressing the various psychological, social, and multicultural issues potentially affecting client decision making, mental health, and behavior. Finally, the author raises considerations for training, continuing education, and professional practice to foster continued discussion among counseling psychologists preparing for, or presently working in, research and applied settings involving clients with genetic concerns.

Culture, Prevention, and the Politics of Disparities

The following article is a response to Adams's (2007 [this issue]) and Griffin and Miller's (2007 [this issue]) reactions to the Major Contribution articles presented on Culturally Relevant Prevention. Each reaction article identifies important implications for engaging in culturally relevant prevention efforts that are relevant to developing this line of research in the future and integrating such work into our training programs. In particular, the importance of defining culture carefully and the politics of disparities are further discussed in this response article. In addition, the importance of learning from other disciplines how to integrate prevention practice and research into counseling psychology training is discussed.

Culture as a variable in neuroscience and clinical neuropsychology: A comprehensive review

Culture is a dynamic system of bidirectional influences among individuals and their environment, including psychological and biological processes, which facilitate adaptation and social interaction. One of the main challenges in clinical neuropsychology involves cognitive, behavioral and functional assessment of people with different sociocultural backgrounds. In this review essay, examining culture from a historical perspective to ethical issues in cross-cultural research, including the latest significant and publications, the authors sought to explore the main features related to cultural variables in neuropsychological practice and to debate the challenges found regarding the operational methods currently in use. Literature findings suggest a more comprehensive approach in cognitive and behavioral neuroscience, including an interface between elementary disciplines and applied neuropsychology. Thus, as a basis for discussion on this issue, the authors analyzed key-topics related to the study of new trends in sociocultural neuroscience and the application of their concepts from a clinical perspective.

Blood politics, ethnic identity, and racial misclassification among American Indians and Alaska Natives

Misclassification of race in medical and mortality records has long been documented as an issue in American Indian/Alaska Native data. Yet, little has been shared in a cohesive narrative which outlines why misclassification of American Indian/Alaska Native identity occurs. The purpose of this paper is to provide a summary of the current state of the science in racial misclassification among American Indians and Alaska Natives. We also provide a historical context on the importance of this problem and describe the ongoing political processes that both affect racial misclassification and contribute to the context of American Indian and Alaska Native identity.

Population disparities in mental health: insights from cultural neuroscience

By 2050, nearly 1 in 5 Americans (19%) will be an immigrant, including Hispanics, Blacks, and Asians, compared to the 1 in 8 (12%) in 2005. They will vary in the extent to which they are at risk for mental health disorders. Given this increase in cultural diversity within the United States and costly population health disparities across cultural groups, it is essential to develop a more comprehensive understanding of how culture affects basic psychological and biological mechanisms. We examine these basic mechanisms that underlie population disparities in mental health through cultural neuroscience. We discuss the challenges to and opportunities for cultural neuroscience research to determine sociocultural and biological factors that confer risk for and resilience to mental health disorders across the globe.

Cultural Neuroscience: Progress and Promise

The nature and origin of human diversity has been a source of intellectual curiosity since the beginning of human history. Contemporary advances in cultural and biological sciences provide unique opportunities for the emerging field of cultural neuroscience. Research in cultural neuroscience examines how cultural and genetic diversity shape the human mind, brain and behavior across multiple time scales: situation, ontogeny and phylogeny. Recent progress in cultural neuroscience provides novel theoretical frameworks for understanding the complex interaction of environmental, cultural and genetic factors in the production of adaptive human behavior. Here, we provide a brief history of cultural neuroscience, theoretical and methodological advances, as well as empirical evidence of the promise of and progress in the field. Implications of this research for population health disparities and public policy are discussed.

Variability in the efficacy of psychopharmaceuticals: contributions from pharmacogenomics, ethnopsychopharmacology, and psychological and psychiatric anthropologies

Psychological and psychiatric anthropology have long questioned the universality of psychiatric diagnoses, bringing to light the fluidity of mental disorder, and recognizing that the experience and expression of psychopathology is influenced by complex and interacting genetic, environmental, and cultural factors. The majority of our discussions, however, have remained centered around the role of culture in shaping mental illness: drawing attention to subjective experiences of mental illness and culturally patterned modes of symptom presentation, and interrogating the cogency of universal diagnostic rubrics. Psychological and psychiatric anthropology have yet to robustly engage the broadly assumed universal validity of psychiatric medications and the ways in which they are prescribed and experienced. This article provides an introduction into the fields of pharmacogenomics and ethnopsychopharmacology, areas of inquiry seeking to understand the ways in which genetic variability occurring between, and within, large population groups influences individual ability to metabolize psychotropic medications. This piece further addresses the complex issue of psychopharmaceutical efficacy, stressing the ways in which, just as with psychopathology, medications and their outcomes are likewise influenced by the complex interactions of genes, environment, and culture. Lastly, ways in which anthropology can and should engage with the growing fields of pharmacogenomics and ethnopsychopharmacology are suggested.

Conceptual approaches to the study of health disparities

Scientific and policy interest in health disparities, defined as systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups, has increased markedly over the past few decades. Like other research, research in health disparities is strongly influenced by the underlying conceptual model of the hypothetical causes of disparities. Conceptual models are important and a major source of debate because multiple types of factors and processes may be involved in generating disparities, because different disciplines emphasize different types of factors, and because the conceptual model often drives what is studied, how results are interpreted, and which interventions are identified as most promising. This article reviews common conceptual approaches to health disparities including the genetic model, the fundamental cause model, the pathways model, and the interaction model. Strengths and limitations of the approaches are highlighted. The article concludes by outlining key elements and implications of an integrative systems-based conceptual model.

Complex systems thinking and current impasses in health disparities research

Complex systems approaches have received increasing attention in public health because reductionist approaches yield limited insights in the context of dynamic systems. Most discussions have been highly abstract. There is a need to consider the application of complex systems approaches to specific research questions. I review the features of population health problems for which complex systems approaches are most likely to yield new insights, and discuss possible applications of complex systems to health disparities research. I provide illustrative examples of how complex systems approaches may help address unanswered and persistent questions regarding genetic factors, life course processes, place effects, and the impact of upstream policies. The concepts and methods of complex systems may help researchers move beyond current impasse points in health disparities research.

Complex systems thinking and current impasses in health disparities research

Complex systems approaches have received increasing attention in public health because reductionist approaches yield limited insights in the context of dynamic systems. Most discussions have been highly abstract. There is a need to consider the application of complex systems approaches to specific research questions. I review the features of population health problems for which complex systems approaches are most likely to yield new insights, and discuss possible applications of complex systems to health disparities research. I provide illustrative examples of how complex systems approaches may help address unanswered and persistent questions regarding genetic factors, life course processes, place effects, and the impact of upstream policies. The concepts and methods of complex systems may help researchers move beyond current impasse points in health disparities research.

The confluence of human genomics, environment, and determinants of health-related quality of life among African American hemodialysis patients

The intersection of human genome sequencing, environmental factors that lend to further understanding of the etiology of complex diseases, and components that constitute the health-related quality of life for African American hemodialysis patients are explored in this article. There are many renal diseases that have genetic components. Even though genetic polymorphisms and allelic variations can explain some of the etiology and disparities in disease susceptibility for African Americans, the role of the environment must also be considered. For African American hemodialysis patients, the environmental influences of religiosity and social support, along with genetic factors, affect their health-related quality of life. A study of 176 African American hemodialysis patients revealed that religiosity and social support had a significant impact on patient's health-related quality of life. Implications of the study mandate that social and behavioral researchers, who tend to focus on environmental issues, be given more freedom and latitude, along with genetic researchers, in designing and implementing studies involving genomic sequencing and the influence on health disparities among persons of African descent.

An education model for integrating genetics and genomics into social work practice

Findings from the Human Genome Project (HGP) suggest that tremendous opportunities exist for increased life expectancies and improved quality of life. The findings also raise enormous concerns about ethical, legal, and psychosocial implications, particularly for underrepresented and vulnerable populations. This article proposes an education model that focuses on genetically informed, ethical practice that will help social worker practitioners and educators play a more effective role as they confront the many implications of genetic and genomic research in the 21st century.

Diabetes and race. A historical perspective

Today, US government sources inform us that Native Americans, Blacks, and Hispanics/Latinos run the greatest risk of developing type 2 diabetes. One hundred years ago, however, Jews were thought to be the population most likely to develop this disease. I evaluated the evidence that the medical and public health communities provided to support the purported link between diabetes and Jews. Diabetes was conceptualized as a Jewish disease not necessarily because its prevalence was high among this population, but because medicine, science, and culture reinforced each other, helping to construct narratives that made sense at the time. Contemporary narratives are as problematic as the erstwhile depiction of diabetes as a disease of Jews.

Theory and methods in cultural neuroscience

Cultural neuroscience is an emerging research discipline that investigates cultural variation in psychological, neural and genomic processes as a means of articulating the bidirectional relationship of these processes and their emergent properties. Research in cultural neuroscience integrates theory and methods from anthropology, cultural psychology, neuroscience and neurogenetics. Here, we review a set of core theoretical and methodological challenges facing researchers when planning and conducting cultural neuroscience studies, and provide suggestions for overcoming these challenges. In particular, we focus on the problems of defining culture and culturally appropriate experimental tasks, comparing neuroimaging data acquired from different populations and scanner sites and identifying functional genetic polymorphisms relevant to culture. Implications of cultural neuroscience research for addressing current issues in population health disparities are discussed.

Cultural neuroscience: a once and future discipline

The study of culture and biology has long stood stratified within the social and natural sciences, a gap that physicist C.P. Snow (1959) famously called "the two cultures." Cultural neuroscience is an emerging, interdisciplinary field that examines the bidirectional influence of culture and genes to brain and behavior across multiple timescales. Integrating theory and methods from cultural psychology, brain sciences, and population genetics, cultural neuroscience is the study of how cultural values, practices and beliefs shape brain function and how the human brain gives rise to cultural capacities and their transmission across macro- (e.g., phylogeny, lifespan) and micro timescales (e.g., situation). The current article presents the aims and methods of cultural neuroscience, highlights recent empirical findings in the field, and discusses the potential implications of this field for bridging the social and natural sciences as well as informing interethnic ideology and population health concerns, more broadly construed.

Family physicians' beliefs about genetic contributions to racial/ethnic and gender differences in health and clinical decision-making

Greater attention towards genetics as a contributor to group health differences may lead to inappropriate use of race/ethnicity and gender as genetic heuristics and exacerbate health disparities. As part of a web-based survey, 1,035 family physicians (FPs) rated the contribution of genetics and environment to racial/ethnic and gender differences in health outcomes, and the importance of race/ethnicity and gender in their clinical decision-making. FPs attributed racial/ethnic and gender differences in health outcomes equally to environment and genetics. These beliefs were not associated with rated importance of race/ethnicity or gender in clinical decision-making. FPs appreciate the complexity of genetic and environmental influences on health differences by race/ethnicity and gender.

Toward Improved Rehabilitation Services for Ethnically Diverse Survivors of Traumatic Brain Injury

Traumatic brain injury is an important public health problem in the United States, especially for individuals from racial and ethnic minorities. The first part of this article provides a synthesis of findings and discussions of cultural issues in the rehabilitation, medical, and psychological scientific literature highlighting the needs and challenges of our diverse population of minority traumatic brain injury survivors in the United States. The second part offers practical recommendations for rehabilitation professionals who desire to improve the healthcare and health outcomes of these individuals. Through an examination of research, guidelines, and resources, we justify the importance of cultural sensitivity in everyday provider interactions with minority clients and their families.

Eliminating health disparities in the African American population: the interface of culture, gender, and power

Since the release of former Secretary Margaret Heckler's Secretary's Task Force Report on Black and Minority Health more than two decades ago, excess death from chronic diseases and other conditions between African Americans and Whites have increased. The conclusion of that report emphasized excess death and thus clinical care, paying little attention to the sociocultural environment and its effects on risk of disease. The authors of this article contend that eliminating health disparities between the African American and White populations in the United States requires a focus on improving the social environment of African Americans. They examine the interface of culture, gender, and power and how those are central to analysis of the root causes of health disparities. The REACH 2010 project of the Centers for Disease Control offers examples on how a coalition of community and research organizations can infuse community interventions with informed considerations of culture, gender, and power to eliminate health disparities.

Public willingness to participate in and public opinions about genetic variation research: a review of the literature

Scientists are turning to genetic variation research in hopes of addressing persistent racial/ethnic disparities in health. Despite ongoing controversy, the advancement of genetic variation research is likely to produce new knowledge and technologies that will substantially change the ways in which we understand and value health. They also may affect the ways in which individuals and groups organize socially, politically, and economically. Addressing concerns that may exist in different communities is vital to the scientific and ethical advancement of genetic variation research. We review empirical studies of public willingness to participate in and opinions about genetic research with particular attention to differences in consent and opinion by racial/ethnic group membership.

Reduction of sample heterogeneity through use of population substructure: an example from a population of African American families with sarcoidosis

Sarcoidosis is a granulomatous inflammatory disorder of complex etiology with significant linkage to chromosome 5, and marginal linkage was observed to five other chromosomes in African Americans (AAs) in our previously published genome scan. Because genetic factors underlying complex disease are often population specific, genetic analysis of samples with diverse ancestry (i.e., ethnic confounding) can lead to loss of power. Ethnic confounding is often addressed by stratifying on self-reported race, a controversial and less-than-perfect construct. Here, we propose linkage analysis stratified by genetically determined ancestry as an alternative approach for reducing ethnic confounding. Using data from the 380 microsatellite markers genotyped in the aforementioned genome scan, we clustered AA families into subpopulations on the basis of ancestry similarity. Evidence of two genetically distinct groups was found: subpopulation one (S1) comprised 219 of the 229 families, subpopulation two (S2) consisted of six families (the remaining four families were a mixture). Stratified linkage results suggest that only the S1 families contributed to previously identified linkage signals at 1p22, 3p21-14, 11p15, and 17q21 and that only the S2 families contributed to those found at 5p15-13 and 20q13. Signals on 2p25, 5q11, 5q35, and 9q34 remained significant in both subpopulations, and evidence of a new susceptibility locus at 2q37 was found in S2. These results demonstrate the usefulness of stratifying on genetically determined ancestry, to create genetically homogeneous subsets--more reliable and less controversial than race-stratified subsets--in which to identify genetic factors. Our findings support the presence of sarcoidosis-susceptibility genes in regions identified elsewhere but indicate that these genes are likely to be ancestry specific.

Do black and white youths differ in levels of psychopathic traits? A meta-analysis of the psychopathy checklist measures

Putative ethnic group differences in various forms of psychopathology may have important theoretical, clinical, and policy implications. Recently, it has been argued that individuals of African descent are more likely to be psychopathic than those of European descent (R. Lynn, 2002). Preliminary evidence from the Psychopathy Checklist: Youth Version (A. Forth, D. Kosson, & R. Hare, 2003) offers some support for this contention, with Black youths rated as moderately higher (Cohen's d = .61) than White youths in a large institutional sample (n = 945). To examine this issue more exhaustively, the authors meta-analyzed adolescent psychopathy data from several studies (combined N = 2,199) and obtained a much smaller mean difference (dw = .20, p = .03), although considerable heterogeneity was evident among the effect sizes.

Uncontested categories: the use of race and ethnicity variables in nursing research

Classifying human beings according to race and ethnicity may seem straightforward to some but it, in fact, belies a difficult process. No standard procedure exists for categorizing according to race and ethnicity, calling into question the variables' use in research. This article explores the use of race and ethnicity variables in the nursing research literature. Content analysis was conducted of a sample of 337 original research studies published in Nursing Research from the years 1952, 1955, and then every 5 years through to 2000. Of the 337 research articles reviewed, 167 mentioned race, ethnicity, or their 81 code words or phrases. Out of the 167 articles, 153 used race or ethnicity to describe the study sample, and 45 of the 167 articles included race or ethnicity as an element of data analysis. Throughout the sample, there was substantial inconsistency related to race and ethnicity categorization, meanings of the terms, and use of these variables. Specificity related to conceptual assumptions, definitions, and context was missing and, as a result, data interpretation and understanding are suspect. The integrity of nursing knowledge requires that nurse researchers recognize and address the difficulties inherent in using race and ethnicity in health research.

The use of racial, ethnic, and ancestral categories in human genetics research

The global dispersal of anatomically modern humans over the past 100,000 years has produced patterns of phenotypic variation that have exerted--and continue to exert--powerful influences on the lives of individuals and the experiences of groups. The recency of our common ancestry and continued gene flow among populations have resulted in less genetic differentiation among geographically distributed human populations than is observed in many other mammalian species. Nevertheless, differences in appearance have contributed to the development of ideas about "race" and "ethnicity" that often include the belief that significant inherited differences distinguish humans. The use of racial, ethnic, and ancestral categories in genetics research can imply that group differences arise directly through differing allele frequencies, with little influence from socially mediated mechanisms. At the same time, careful investigations of the biological, environmental, social, and psychological attributes associated with these categories will be an essential component of cross-disciplinary research into the origins, prevention, and treatment of common diseases, including those diseases that differ in prevalence among groups.

Genes, race, and psychology in the genome era: an introduction

The mapping of the human genome has reawakened interest in the topic of race and genetics, especially the use of genetic technology to examine racial differences in complex outcomes such as health and intelligence. Advances in genomic research challenge psychology to address the myriad conceptual, methodological, and analytical issues associated with research on genetics and race. In addition, the field needs to understand the numerous social, ethical, legal, clinical, and policy implications of research in this arena. Addressing these issues should not only benefit psychology but could also serve to guide such thought in other fields, including molecular biology. The purpose of this special issue is to begin a discussion of this issue of race and genetics within the field of psychology. Several scholars who work in the fields of genetics, race, or related areas were invited to write (or had previously submitted) articles sharing their perspectives.