Publications (45)178.06 Total impact
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Article: Race and glomerulonephritis in patients with and without hepatosplenic Schistosomiasis mansoni.
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ABSTRACT: United States investigators have shown evidence of higher susceptibility to focal segmental glomerulosclerosis (FSGS) in blacks than in whites. This association between race and FSGS has not been assessed outside the US. The present study assesses the association between race and type of glomerulonephritis in a sample of Brazilian patients, taking into account the presence of the hepatosplenic form of Schistosomiasis mansoni (HSM). Eighty patients with focal segmental glomerulosclerosis (FSGS) were compared to 50 with membranoproliferative glomerulonephritis (MPGN). The association between race (i.e. black versus white) and type of glomerulonephritis was adjusted for age, gender and HSM by logistic regression. Blacks were more likely than whites to have FSGS (as compared to MPGN), both among patients with HSM (odds ratio (OR) = 2.67; 95% confidence interval (CI) = 0.81 - 8.81) and without HSM (OR = 2.19; 95% CI = 0.79 - 6.05). After adjustment for age, gender and HSM, the odds of FSGS remained significantly greater for blacks (OR = 2.49; 95% CI = 1.05 - 5.95). The increased likelihood of FSGS in Brazilian blacks is consistent with findings from US patients. The association between race and type of glomerulonephritis was similar between patients with and without HSM. Future investigations should focus on the mediators factors that might explain these findings.Clinical nephrology 12/2002; 58(5):333-6. · 1.17 Impact Factor -
Article: Primordial prevention of cardiovascular disease among African-Americans: a social epidemiological perspective.
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ABSTRACT: The primordial prevention of cardiovascular disease (CVD) among African-Americans represents a formidable challenge for public health. This paper discusses the nature of this challenge, highlighting the role that economic and cultural factors play in shaping the distributions of major CVD risk factors among African-Americans. The paper concludes with specific suggestions for research. Data from recent national health surveys on black/white differences in major CVD risk factors like hypertension, obesity, cholesterol, cigarette smoking, and physical inactivity were reviewed for the purpose of identifying promising avenues for primordial prevention research among African-Americans. Cigarette smoking has a delayed onset among African-Americans compared to whites. Black/white differences in "vigorous" leisure-time physical activity (e.g., social dancing and team sports) are not apparent until around age 40. These findings have relevance for primordial prevention work in black communities since they suggest the existence of broad-based, health-relevant cultural norms which could support primordial prevention programs, such as regular physical activity, across the life cycle. CVD primordial prevention programs among African-Americans must be grounded in an understanding of how cultural values as well as economic conditions shape CVD risk factor distributions in this population. Ultimate success will depend on the strength of the partnerships that public health researchers, primary care providers, and community residents are able to build.Preventive Medicine 01/2000; 29(6 Pt 2):S84-9. · 3.22 Impact Factor -
Article: The contribution of baseline weight and weight gain to blood pressure change in African Americans: the Pitt County Study.
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ABSTRACT: The positive association between obesity and blood pressure has been less consistent in African Americans than whites. This is especially true for African American men. This study investigated the sex-specific associations between baseline body mass index (BMI), weight change (kilograms), and five-year hypertension incidence and changes in blood pressure in a cohort of African Americans ages 25-50 years at baseline. The Pitt County Study is a longitudinal investigation of anthropometric, psychosocial, and behavioral predictors of hypertension in African Americans. Data were obtained through household interviews and physical examinations in 1988 and 1993. Baseline BMI was positively and independently associated with changes in blood pressure after controlling for weight change and other covariates. When participants were stratified by sex-specific overweight vs. nonoverweight status at baseline, weight gain was significantly associated with increases in blood pressure only among the initially nonoverweight. Baseline weight for all respondents, and weight gain among the nonoverweight at baseline, were independent predictors of blood pressure increases in this cohort of African Americans.Annals of Epidemiology 12/1998; 8(8):497-503. · 3.21 Impact Factor -
Article: Physical activity and NIDDM in African-Americans. The Pitt County Study.
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ABSTRACT: Studies directly examining the association between physical activity and NIDDM in African-Americans are rare. Consequently, the strength of this association in this ethnic minority group remains unclear. The current study broadly characterizes the types of physical activity engaged in by a community sample of working-class African-Americans and then quantifies the association between physical activity and NIDDM risk in this population. During the 1993 reexamination of participants in the Pitt County Study in North Carolina, data on NIDDM history, current use of insulin or oral hypoglycemic drugs, and approximately 12-h overnight fasting blood glucose (FBG) were obtained from 598 women and 318 men, ages 30-55 years. The presence of NIDDM was determined by current insulin or medication use and FBG > or = 140 mg/dl. Study participants were assigned to one of four categories of physical activity: strenuous, moderate, low, or inactive. The weighted prevalence of NIDDM in the sample was 7.1%. After adjustment was made for age, sex, education, BMI, and waist-to-hip ratio, NIDDM risk for moderately active subjects was one-third that for the physically inactive subjects (odds ratio [OR], 0.35; 95% CI, 0.12-0.98). The ORs for low (OR, 0.51; 95% CI, 0.20-1.29) and strenuous (OR, 0.65; 95% CI, 0.26-1.63) activity also tended to be lower. A summary OR that contrasted any activity versus no activity was 0.51 (95% CI, 0.23-1.13). Moderate physical activity was strongly associated with reduced risk for NIDDM in this sample. While replication of these findings is needed, public health interventions designed to increase moderate (leisure-time) physical activity in black adults should be strongly encouraged.Diabetes Care 04/1998; 21(4):555-62. · 8.09 Impact Factor -
Article: Alcohol consumption and changes in blood pressure among African Americans. The Pitt County Study.
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ABSTRACT: The Pitt County Study is a longitudinal investigation of anthropometric, psychosocial, and behavioral predictors of hypertension in African Americans who were aged 25-50 years at baseline in 1988. At baseline, a strong dose-response gradient was observed for alcohol consumption and blood pressure for both sexes. The current study investigated whether baseline alcohol consumption or, alternatively, changes in drinking status predicted 5-year changes in blood pressure among the 652 women and 318 men who satisfied all inclusion criteria for the longitudinal analyses. In multivariate regression analyses, baseline alcohol consumption was not significantly associated with changes in blood pressure or hypertension incidence (systolic/diastolic blood pressure > or = 160/95 mmHg) by 1993. Change in drinking status, however, was significantly associated with changes in systolic pressure. The systolic pressure increase among individuals who initiated alcohol consumption was 6.2 mmHg (95% confidence interval (CI) 1.1-6.4) greater than abstainers, while that for individuals who reported drinking at both time points was 3.8 mmHg (95% CI 1.3-11.1) greater. Blood pressure increases for persons who discontinued drinking were comparable to those of abstainers. Results were independent of baseline age, body mass index, blood pressure, and sex. Social and economic disadvantage in 1988 was significantly associated with continuation and initiation of alcohol consumption by 1993.American Journal of Epidemiology 11/1997; 146(9):727-33. · 5.22 Impact Factor -
Article: Social support, stress, and blood pressure in black adults.
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ABSTRACT: Psychosocial factors arising from socioeconomic disadvantage and discrimination may contribute to the excess risk of elevated blood pressure in African-Americans. The purpose of this study was to assess the association of social support and stress with blood pressure in a community-based sample of 25-to 50-year-old black adults in Pitt County, NC. A stratified random sample of dwellings was selected in 1988, and 1,784 black adults (80% of those eligible) were interviewed. Analyses were sex specific and adjusted for age, obesity, and waist/hip ratio. In separate analyses of emotional support, instrumental support, and stress with blood pressure, all associations were in the predicted direction (inverse for support, direct for stress) but were stronger for systolic than for diastolic blood pressure. Differences in systolic blood pressure associated with low support or high stress ranged from 5.2 to 3.6 mmHg in women and 3.5 to 2.5 mmHg in men. In simultaneous regression analyses of support and stress, each of the separate effects was reduced for women, but a sizable aggregate effect of low support and high stress remained [+7.2 mmHg (95% confidence limits = +1.3, +13.1) for systolic blood pressure and +4.0 mmHg (95% confidence limits = +0.1, +7.9) for diastolic blood pressure.Epidemiology 10/1997; 8(5):482-7. · 5.57 Impact Factor -
Article: Job strain and blood pressure in African Americans: the Pitt County Study.
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ABSTRACT: This report examined whether job strain (or its components, decision latitude and job demands) was associated with elevated blood pressure levels in a community-based sample of 726 African-American adults. Blood-pressure, anthropometric, behavioral, demographic, and psychosocial data were collected for the current cross-sectional analyses during home interviews conducted for the second wave (1993) of the Pitt County Study (North Carolina), a prospective cohort study of hypertension among African Americans. Job strain was not associated with blood pressure among men or women in this study. However, men in the 80th percentile of decision latitude had more than a 50% decrease in the prevalence of hypertension compared with men in the 20th percentile (odds ratio = .46, 95% confidence interval = .22, .96). These results indicate that decision latitude may be important for hypertension risk among African-American men. More research is needed on African Americans to determine why job strain and its two component variables differ in their associations with blood pressure for men and women.American Journal of Public Health 09/1997; 87(8):1297-302. · 3.93 Impact Factor -
Article: Determinants of hypertension in West Africa: contribution of anthropometric and dietary factors to urban-rural and socioeconomic gradients.
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ABSTRACT: The determinants of hypertension in West Africa have not been well defined. The authors sampled 598 participants aged 45 years or more from a recent population-based survey in southwest Nigeria (190 rural men and women, 205 urban poor men and women, and 203 retired railway workmen). The estimated mean age was 61 (10) years. Mean pressures were low relative to westernized societies: systolic blood pressure = 124 (24) mmHg, diastolic blood pressure = 72 (13) mmHg. Both men and women were remarkably lean: body mass index = 21.3 (3.6) and 23.0 (5.2) kg/m2, respectively. Hypertension prevalence increased across the gradient from rural farmers to urban poor to railway workers: 14, 25, and 29 percent, respectively, had a blood pressure of 140/90 mmHg or greater, and 3, 11, and 14 percent, respectively, had a blood pressure of 160/95 mmHg or greater (p for trend < 0.01 for both cutpoints). On the basis of a 24-hour urine sample, daily electrolyte excretion was 110 (57) mEq of sodium and 46 (24) mEq of potassium. Mean sodium:potassium ratio was 2.6 (1.0) and was higher among the urban residents (p < 0.01) and correlated with systolic and diastolic pressures (r = 0.16-0.18, p < 0.01). These findings provide quantitative estimates of the impact of known hypertension risk factors in West Africa and demonstrate the basis for increased prevalence with urbanization and associated economic and dietary change. These results also provide support for recommendations for prevention in West Africa and provide a benchmark against which to compare populations in the African diaspora.American Journal of Epidemiology 06/1996; 143(12):1203-18. · 5.22 Impact Factor -
Article: Depression in black and white women. The role of marriage and socioeconomic status.
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ABSTRACT: The degree to which the relationship between race and depression in US black and white women is modified by socioeconomic and marital status was investigated. Data on 534 black and 836 white women, 25 to 64 years old, obtained from the 1986 Americans' Changing Lives national survey were utilized. Depression was measured by the Centers for Epidemiologic Studies Depression scale. Poverty status and education were used as indicators of socioeconomic status (SES). For both black and white women, the prevalence of depression was higher among those with lower as compared to higher SES, and among the unmarried as compared to the married. The unstratified, age-adjusted odds of depression for black women was twice that for white women (odds ratio (OR) = 2.2; 95% confidence interval (CI), 1.7 to 2.8); however, when stratified by poverty status, race effects were observed for nonpoor (OR = 2.2; 95% CI, 1.6 to 3.0) but not for poor women (OR = 1.3; 95% CI, 0.7 to 2.1). Race effects were also more pronounced among married (OR = 2.0; 95% CI, 1.4 to 2.9) than unmarried women (OR = 1.6; 95% CI, 1.1 to 2.4). Controlling for known confounders did not alter these results. Additional analyses revealed that the black excess risk for depression was concentrated among higher SES, married women, with marital difficulties appearing to pay a major role in their elevated depression scores.Annals of Epidemiology 12/1995; 5(6):455-63. · 3.21 Impact Factor -
Article: The joint effects of race and age on the risk of end-stage renal disease attributed to hypertension.
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ABSTRACT: To describe the joint effects of race and age on the risk of end-stage renal disease (ESRD) attributed to hypertension (ESRD-HT), we analyzed data for white and black adults, 20 to 84 years of age, reported by the United States Renal Data System during the period 1987 to 1990. The risk of ESRD-HT increased substantially with age for both blacks and whites; however, at each age, the risk was greater for blacks. A more in-depth description of the combination of effects involving race and age on ESRD-HT incidence was provided by two models of joint effects, one additive and the other multiplicative. Both models used the 20- to 24-year age group as the referent. Under the additive model the risk of ESRD-HT in blacks attributable to the joint effects between race and age increased continuously from younger to older groups. This indicates that although ESRD-HT risk increases with age for both blacks and whites, the increase for blacks is greater than expected if the effects of race were independent of the effects of age. However, the multiplicative model indicated that the proportional increase with age in ESRD-HT risk among blacks, as compared with whites, was more striking for younger ages (< or = 50 years among women and < or = 40 years among men), and especially so for men. This suggests a more accelerated course of hypertension toward ESRD for blacks (especially younger men) than for whites. A conceptual model to explain these patterns of race-age joint effects is proposed.(ABSTRACT TRUNCATED AT 250 WORDS)American Journal of Kidney Diseases 10/1994; 24(4):554-60. · 5.43 Impact Factor -
Article: John Henryism and the health of African-Americans.
Culture Medicine and Psychiatry 07/1994; 18(2):163-82. · 1.29 Impact Factor -
Article: Association between maternal education and infant diarrhea in different household and community environments of Cebu, Philippines.
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ABSTRACT: Maternal education is one of the strongest determinants of infant survival in developing countries, however, questions remain regarding the extent to which its effects vary as a function of contextual variables. In this study, a multi-level interactive model is used to assess whether the protective effect of maternal education on the risk of infant diarrhea is modified by three aspects of the mother's familial and community environment: household assets, community economic resources and the availability of mothers' clubs. 2484 study participants were interviewed in 1984 as part of the Cebu Longitudinal Infant Health and Nutrition Study. The findings suggest that the protective effect of maternal education on infant diarrhea varies according to the socio-economic environment in which the mother lives: maternal education protects against infant diarrhea in the more economically and socially advantaged communities but has no effect in the more disadvantaged communities. The results also indicate that the protective effect of maternal education is smaller in the wealthier households. These data suggest that improvement in maternal education level, alone, may not always have the expected beneficial effects on infant health. Corollary measures to improve access of mothers and children to basic community resources and efforts to help mothers be more effective in their various social roles may be necessary preconditions for higher levels of maternal education to result in improved infant health.Social Science [?] Medicine 02/1994; 38(2):343-50. · 2.70 Impact Factor -
Article: The excess risk of treated end-stage renal disease in blacks in the United States.
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ABSTRACT: Analysis of national data from the United States Renal Data System for 1988 revealed an important joint effect of age and race in determining the higher risk of ESRD for blacks as compared with whites. For adults, both hypertension and diabetes made important contributions to the combined effect of age and race. In contrast, glomerulonephritis was not considered to be an important contributor to this joint effect. The combined effect of gender and race was weaker than that of age and race; however, among blacks, differences in the proportions of ESRD attributed to hypertension and diabetes across gender were observed. The age-race joint effect is consistent with the hypothesis that a combined effect of lack of treatment and aging on the process that leads to ESRD may play an important role in the excess risk for ESRD among blacks.Journal of the American Society of Nephrology 07/1993; 3(12):1961-71. · 9.66 Impact Factor -
Article: The independent effects of obesity and body fat distribution on blood pressure in black adults: the Pitt County study.
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ABSTRACT: The relationship of obesity measures to blood pressure and hypertension prevalence was assessed in a community probability sample of 25-50-year-old black adults (1101 women and 655 men) who were examined in 1988 in Pitt County, North Carolina. Among black women, both body mass index and waist-to-hip ratio had independent relationships with systolic and diastolic blood pressures and hypertension prevalence after controlling for the effects of age, socio-economic status, physical activity, alcohol, and the other obesity measure (P < 0.05). Body mass index also had independent relationships with blood pressure levels and hypertension prevalence in black men (P < 0.05), while waist-to-hip ratio was associated with hypertension prevalence (P = 0.05) and diastolic blood pressure (P < 0.05), but not with systolic blood pressure. The relationships of waist-to-hip ratio with blood pressure and hypertension prevalence were considerably reduced in both sex groups after controlling for body mass index. This study presents new evidence that waist-to-hip ratio is related to hypertension and blood pressure level independent of body mass index, in young to middle-aged black adult women and men.International Journal of Obesity 07/1993; 17(7):391-7. · 4.69 Impact Factor -
Article: Racial and ethnic differences in infant mortality and low birth weight. A psychosocial critique.
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ABSTRACT: Recent studies on differences in infant mortality and low birth weight (LBW) among non-Hispanic whites, African Americans, and Mexican Americans were reviewed. Despite similar socioeconomic profiles, infant mortality among Mexican Americans (8/1000 live births) is less than half that of African Americans (18/1000 live births). In fact, the rate for Mexican Americans is identical to that of non-Hispanic whites. The data for LBW follow a similar pattern. What accounts for this unexpectedly low frequency of poor birth outcomes among Mexican Americans, especially given their economic disadvantages, reduced access to prenatal care, and exposure to discrimination based on ethnicity? Does adherence to a traditional Mexican cultural orientation protect otherwise high-risk Mexican Americans from poor pregnancy outcomes, as has been suggested? What is the "protective" social and psychological content of a traditional Mexican cultural orientation? And what are the implications of this line of reasoning for understanding the excess risk for poor birth outcomes among African Americans? This article explores these and related questions and concludes that new conceptual models are needed to guide research in this area.Annals of Epidemiology 04/1993; 3(2):130-6. · 3.21 Impact Factor -
Article: Socioeconomic and behavioral correlates of body mass index in black adults: the Pitt County Study.
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ABSTRACT: Obesity is more prevalent among Black women than Black men, but there is little information on the correlates of obesity in Blacks. This study describes the relations of sociodemographic factors and health behaviors to body mass index in a southern, Black population. In 1988, a community probability sample of 1784 Black adults, aged 25 to 50, was examined in Pitt County, NC. More women than men were at least 20% overweight (57% vs 36%). The relation of socioeconomic status (a composite of education and occupation) to age-adjusted body mass index level was inverse in women but not in men. Body mass index did not differ with either current energy intake or energy expenditure. Smokers and drinkers had lower age-adjusted levels than non-smokers and abstainers. Since the excess body mass index levels associated with low socioeconomic status in women could not be explained after controlling for adverse health behaviors, further epidemiologic study of risk factors for obesity in Black women is recommended.American Journal of Public Health 07/1992; 82(6):821-6. · 3.93 Impact Factor -
Article: Distribution and correlates of waist-to-hip ratio in black adults: the Pitt County Study.
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ABSTRACT: A 1988 community-based survey of 1,784 black adults aged 25-50 years in Pitt County, North Carolina, found mean waist-to-hip ratios of 0.890 for men and 0.852 for women. Based on guidelines from the US Department of Agriculture, 20% of the men and 76% of the women had an elevated waist-to-hip ratio. Sedentary behavior was associated with elevated waist-to-hip ratio in men, while a similar excess was associated with alcohol consumption in women. Weak, nonsignificant associations with waist-to-hip ratio were observed for smoking. Socioeconomic status was unrelated to waist-to-hip ratio in men, but it had a strong inverse relation for women.American Journal of Epidemiology 04/1992; 135(6):678-84. · 5.22 Impact Factor -
Article: Socioeconomic status, John Henryism, and blood pressure in black adults. The Pitt County Study.
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ABSTRACT: The joint influence of socioeconomic status and John Henryism on blood pressure was examined in a probability sample of 1,784 black adults aged 25-50 years in Pitt County, North Carolina, in 1988. John Henryism was measured by means of the John Henryism Active Coping Scale. Socioeconomic status (low, medium, and high) was based on respondents' education and occupation. Prior research indicated that, for blacks, the inverse association between socioeconomic status and hypertension may be stronger for individuals who score high in John Henryism. In this more urban sample of blacks, the hypothesized interaction achieved modest statistical support (p less than 0.08) only for hypertension prevalence. For individuals with high levels of John Henryism, adjusted prevalences declined with increasing socioeconomic status (29.4%, 26.2%, and 20.5% for low, medium, and high socioeconomic status, respectively); for individuals with low levels of John Henryism, hypertension prevalence was similar in the low (22.6%) and medium (22.8%) socioeconomic categories but higher in the high socioeconomic category (25.9%). Elevated psychological stress in white-collar workers was probably responsible for the nonsignificant inverse gradients between socioeconomic status and mean blood pressures and for the weak interaction between socioeconomic status and John Henryism with regard to hypertension prevalence.American Journal of Epidemiology 02/1992; 135(1):59-67. · 5.22 Impact Factor -
Article: Socioeconomic status and electrolyte intake in black adults: the Pitt County Study.
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ABSTRACT: Although the inverse association between socioeconomic status (SES) and blood pressure has often been observed, little is known about the relationship between SES and dietary risk factors for elevated blood pressure. Therefore, this study described the distribution of dietary intakes of sodium, potassium, and calcium and examined the association between electrolyte intake and SES among 1784 Black men and women aged 25 to 50 residing in eastern North Carolina. Household interviews were conducted in 1988 to obtain information on psychosocial and dietary correlates of blood pressure. Electrolyte intake (mg/day) was assessed using a food frequency questionnaire adapted to reflect regional and ethnic food preferences. SES was categorized into three levels defined by the participant's educational level and occupation. After adjustment for age and energy intake, potassium and calcium intake increased with increasing SES for both sexes. Sodium intake was high for all groups and did not vary markedly with SES, but sodium to potassium and sodium to calcium ratios decreased with increasing SES. In addition, high SES individuals were more likely to believe that diet affects risk for disease and to report less salt use at the table and less current sodium consumption than in the past. These data indicate that nutritional beliefs as well as the consumption of electrolytes are associated with SES in Black adults.American Journal of Public Health 01/1992; 81(12):1608-12. · 3.93 Impact Factor -
Article: Physical activity and hypertension in black adults: the Pitt County Study.
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ABSTRACT: The relation of physical activity to hypertension was examined in 1751 Black adults in Pitt County, NC. More women (65%) than men (44%) were classified as sedentary. Sedentary behavior was not associated with the prevalence of hypertension in men, but was associated with a 31% increase in prevalence for women (sedentary-26.2%; active-20.0%; P less than .01). The association in women was independent of other risk factors for hypertension.American Journal of Public Health 12/1991; 81(11):1477-9. · 3.93 Impact Factor
Top co-authors
Top Journals
Institutions
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1991–2000
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University of Michigan
- • School of Public Health
- • Department of Epidemiology
Ann Arbor, MI, USA
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1983–1991
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University of North Carolina at Chapel Hill
- • Department of Psychiatry
- • Department of Epidemiology
Chapel Hill, NC, USA
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