Lifelong discrimination linked to high blood pressure in black people

AHA news: lifelong discrimination linked to high blood pressure in black people

Enduring a lifetime of discrimination may increase the risk of high blood pressure in Black people but not in Hispanic, Chinese or white people, a new study suggests.

Previous research has linked lifelong discrimination to the development of high blood pressure, also known as hypertension, in Black people. This new study, however, is among the first to look at multiple types of discrimination in a large multi-ethnic group over a period of time.

The study included 3,297 Black, Hispanic, Chinese and white adults from 45 to 84 years old. They did not have high blood pressure at the start of the study. Participants were asked to report experiences of lifetime and everyday discrimination.

Lifetime discrimination measures included six items, such as being denied a promotion or having life made difficult by neighbors. Everyday discrimination, meanwhile, consisted of nine items, such as being treated with less respect than others or being harassed in day-to-day life.

After nearly two decades, almost half of participants developed high blood pressure. Black participants who reported lifetime discrimination had a 35% increased risk of hypertension, even after accounting for age, income, education, body mass index, physical activity and other factors. Everyday discrimination, however, did not appear to contribute to risk for hypertension.

“Discrimination impacts the health of Black Americans and it should be recognized as a major public health problem,” said Allana T. Forde, lead author of the study published last week in the Journal of the American Heart Association. In November, the American Heart Association issued a “call to action” advisory acknowledging structural racism as “a fundamental cause of poor health and disparities in cardiovascular disease.”

“Health professionals should look beyond traditional risk factors, such as diet and physical activity, and acknowledge discrimination as another risk factor,” said Forde, a researcher at the National Institutes of Health’s National Institute on Minority Health and Health Disparities.

Surprising for researchers, she said, was that lifetime discrimination did not reach the level of statistical significance for contributing to high blood pressure among Chinese and Hispanic participants, even after accounting for being born outside the United States.

Studies in other areas of the U.S. are needed to confirm the findings, researchers said, because the new study was limited to those living in five large cities and one county. In addition, the study only assessed discrimination experiences once at the start of the study, making it unclear what impact changes in discrimination exposure might have had on hypertension development during the follow-up period.

“There is always a concern that not enough subjects were included in the study to show differences in populations or that not all relevant variables were accounted for,” said Dr. Willie Lawrence, chief of cardiology at the Research Medical Center in Kansas City, Missouri. He was not involved in the study.

When measuring decades of discrimination that leads to hypertension, other social determinants of health also must be accounted for. These include health care access, transportation options and a person’s neighborhood.

“Whether communities have sidewalks and green spaces impacts health,” Lawrence said. “If we want to make people healthier, we have to not only eliminate disparities in health care delivery, but we must also seek equity in housing, neighborhoods and education.”

Overall, the study found Black people reported the highest levels of discrimination. About 65% reported lifetime discrimination compared to 42% of Hispanic people, 40% of white people and 23% of Chinese people. Black people most often attributed the unfair treatment to race, whereas white people by far attributed it to non-racial factors such as age, sex or religion. Hispanic and Chinese people were about evenly split between feeling the discrimination was motivated by race versus other factors.

For everyday discrimination, 52% of Black people, 32% of white people, 26% of Hispanic people and 20% of Chinese people reported high levels of exposure.

“Race is complicated in America. It is not genetic,” Lawrence said. “So, I’m not ready to believe that when people of other colors are treated the way Black Americans have been treated for decades that they won’t have higher rates of high blood pressure.”

Even so, he said, “it’s an important study that adds to our belief that social factors impact health.”

Certain, however, is that Black people have higher rates of high blood pressure than other racial and ethnic groups. According to AHA statistics, about 58% of Black adults in the U.S. have the condition, which increases the risk for heart attack and stroke.

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National experts stress importance of COVID-19 vaccination for Black community

Importance of COVID-19 Vaccination for Black Community Stressed by National Experts including Dr. Cato T. Laurencin

This week in the New York Times a national group of leading Black health experts shined a light on the critical importance of the Black community receiving the COVID-19 vaccination. Amongst the 60 elected members of the National Academy of Medicine were UConn Health Surgeon-Scientist Dr. Cato T. Laurencin and other top experts bringing the critical issue to the national forefront urging the Black community to protect themselves and get vaccinated once available.

Read UConn Today’s Q & A on this important awareness topic with Laurencin who chairs the National Academies Roundtable on Black Men and Black Women in Science, Engineering and Medicine, and serves as the Albert and Wilda Van Dusen Distinguished Endowed Professor of Orthopaedic Surgery at UConn Health and University Professor at UConn.

Q: Are Blacks contracting the COVID-19 virus at higher rates?

A: Our research data show that yes, Blacks not only have higher rates of contracting COVID-19, but also are dying of COVID-19 at high rates. Our team at the University of Connecticut published the first paper in the peer-reviewed literature presenting data showing higher rates of cases and deaths involving COVID-19 in Blacks. Our paper is entitled The COVID-19 Pandemic: A Call to Action to Identify and Address Racial and Ethnic Health Disparities. Since the latest data show that Blacks are continuing to die from high rates of COVID-19, a team of Black members of the National Academy of Medicine are hoping as trusted, reputable medical faces in the community we have a positive impact on the Black community making the choice to get vaccinated.

Q: How may racism in the healthcare system influence medical mistrust in the Black Community?

A: Racism in the healthcare system, whether it be called conscious bias, unconscious bias, stereotyping, or prejudice, contributes to healthcare disparities and high rates of morbidity and deaths among the Black population, and is a driver of mistrust. In order to build trust within the Black community, The National Academies Roundtable on Black Men and Black Women in Science, Engineering and Medicine suggests increasing the number of Black men and women in Medicine and Science. In 2018, the National Academies produced the landmark proceedings entitled An American Crisis: The Growing Absence of Black Men in Medicine and Science.

Q: How do we address medical mistrust right now and urge the Black community to get vaccinated?

A: Established in 2019, the Roundtable on Black Men and Black Women in Science, Engineering and Medicine convenes a broad array of stakeholders to tackle various issues facing the Black community. As a trusted source of information, Roundtable leadership and the COVID-19 Action Group of the Roundtable recorded an informational webinar video focused on addressing common questions and concerns around vaccine hesitation in the Black community. The hope is that this video will be a key resource for the Black community to learn more about the importance of being vaccinated.

Q: Where do we go from here?

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Amid COVID and Racial Unrest, Black Churches Put Faith in Mental Health Care

Wilma Mayfield used to visit a senior center in Durham, North Carolina, four days a week and attend Lincoln Memorial Baptist Church on Sundays, a ritual she’s maintained for nearly half a century. But over the past 10 months, she’s seen only the inside of her home, the grocery store and the pharmacy. Most of her days are spent worrying about COVID-19 and watching TV.

It’s isolating, but she doesn’t talk about it much.

When Mayfield’s church invited a psychologist to give a virtual presentation on mental health during the pandemic, she decided to tune in.

The hourlong discussion covered COVID’s disproportionate toll on communities of color, rising rates of depression and anxiety, and the trauma caused by police killings of Black Americans. What stuck with Mayfield were the tools to improve her own mental health.

“They said to get up and get out,” she said. “So I did.”

The next morning, Mayfield, 67, got into her car and drove around town, listening to 103.9 gospel radio and noting new businesses that had opened and old ones that had closed. She felt so energized that she bought chicken, squash and greens, and began her Thanksgiving cooking early.

“It was wonderful,” she said. “The stuff that lady talked about [in the presentation], it opened up doors for me.”

As Black people face an onslaught of grief, stress and isolation triggered by a devastating pandemic and repeated instances of racial injustice, churches play a crucial role in addressing the mental health of their members and the greater community. Religious institutions have long been havens for emotional support. But faith leaders say the challenges of this year have catapulted mental health efforts to the forefront of their mission.

Some are preaching about mental health from the pulpit for the first time. Others are inviting mental health professionals to speak to their congregations, undergoing mental health training themselves or adding more therapists to the church staff.

“COVID undoubtedly has escalated this conversation in great ways,” said Keon Gerow, senior pastor at Catalyst Church in West Philadelphia. “It has forced Black churches — some of which have been older, traditional and did not want to have this conversation — to actually now have this conversation in a very real way.”

At Lincoln Memorial Baptist, leaders who organized the virtual presentation with the psychologist knew that people like Mayfield were struggling but might be reluctant to seek help. They thought members might be more open to sensitive discussions if they took place in a safe, comfortable setting like church.

It’s a trend that psychologist Alfiee Breland-Noble, who gave the presentation, has noticed for years.

Through her nonprofit organization, the AAKOMA Project, Breland-Noble and her colleagues often speak to church groups about depression, recognizing it as one of the best ways to reach a diverse segment of the Black community and raise mental health awareness.

This year, the AAKOMA Project has received clergy requests that are increasingly urgent, asking to focus on coping skills and tools people can use immediately, Breland-Noble said.

“After George Floyd’s death, it became: ‘Please talk to us about exposure to racial trauma and how we can help congregations deal with this,’” she said. “‘Because this is a lot.’”

Across the country, mental health needs are soaring. And Black Americans are experiencing significant strain: A study from the Centers for Disease Control and Prevention this summer found 15% of non-Hispanic Black adults had seriously considered suicide in the past 30 days and 18% had started or increased their use of substances to cope with pandemic-related stress.

Yet national data shows Blacks are less likely to receive mental health treatment than the overall population. A memo released by the Substance Abuse and Mental Health Services Administration this spring lists engaging faith leaders as one way to close this gap.

Two congregants expressed suicidal thoughts to Carl Lucas, pastor at God First Church in northern St. Louis County. “The pandemic has definitely put us in a place where we’re looking for answers and looking for other avenues to help our members,” he says. (Evelyn Lucas)

The Potter’s House in Dallas has been trying to do that for years. A megachurch with more than 30,000 members, it runs a counseling center with eight licensed clinicians, open to congregants and the local community to receive counseling at no cost, though donations are accepted.

Since the pandemic began, the center has seen a 30% increase in monthly appointments compared with previous years, said center director Natasha Stewart. During the summer, when protests over race and policing were at their height, more Black men came to therapy for the first time, she said.

Recently, there’s been a surge in families seeking services. Staying home together has brought up conflicts previously ignored, Stewart said.

“Before, people had ways to escape,” she said, referring to work or school. “With some of those escapes not available anymore, counseling has become a more viable option.”

To meet the growing demand, Stewart is adding a new counselor position for the first time in eight years.

At smaller churches, where funding a counseling center is unrealistic, clergy are instead turning to members of the congregation to address growing mental health needs.

At Catalyst Church, a member with a background in crisis management has begun leading monthly COVID conversations online. A deacon has been sharing his own experience getting therapy to encourage others to do the same. And Gerow, the senior pastor, talks openly about mental health.

Recognizing his power as a pastor, Gerow hopes his words on Sunday morning and in one-on-one conversations will help congregants seek the help they need. Doing so could reduce substance use and gun violence in the community, he said. Perhaps it would even lower the number of mental health crises that lead to police involvement, like the October death of Walter Wallace Jr., whose family said he was struggling with mental health issues when Philadelphia police shot him.

“If folks had the proper tools, they’d be able to deal with their grief and stress in different ways,” Gerow said. “Prayer alone is not always enough.”

Laverne Williams got worried when she heard pastors tell people they could pray away mental illness. She created a multimedia presentation to educate faith leaders about mental health ― to show that faith and mental health can coexist. (Laverne Williams)

Laverne Williams recognized that back in the ’90s. She believed prayer was powerful, but as an employee of the Mental Health Association in New Jersey, she knew there was a need for treatment too.

When she heard pastors tell people they could pray away mental illness or use blessed oil to cure what seemed like symptoms of schizophrenia, she worried. And she knew many people of color were not seeing professionals, often due to barriers of cost, transportation, stigma and distrust of the medical system.

To address this disconnect, Williams created a video and PowerPoint presentation and tried to educate faith leaders.

At first, many clergy turned her away. People thought seeking mental health treatment meant your faith wasn’t strong enough, Williams said.

But over time, some members of the clergy have come to realize the two can coexist, said Williams, adding that being a deacon herself has helped her gain their trust. This year alone, she’s trained 20 faith leaders in mental health topics.

A program run by the Behavioral Health Network of Greater St. Louis is taking a similar approach. The Bridges to Care and Recovery program trains faith leaders in “mental health first aid,” suicide prevention, substance use and more, through a 20-hour course.

The training builds on the work faith leaders are already doing to support their communities, said senior program manager Rose Jackson-Beavers. In addition to the tools of faith and prayer, clergy can now offer resources, education and awareness, and refer people to professional therapists in the network.

Since 2015, the program has trained 261 people from 78 churches, Jackson-Beavers said.

Among them is Carl Lucas, pastor of God First Church in northern St. Louis County who graduated this July — just in time, by his account.

Since the start of the pandemic, he has encountered two congregants who expressed suicidal thoughts. In one case, church leaders referred the person to counseling and followed up to ensure they attended therapy sessions. In the other, the root concern was isolation, so the person was paired with church members who could touch base regularly, Lucas said.

“The pandemic has definitely put us in a place where we’re looking for answers and looking for other avenues to help our members,” he said. “It has opened our eyes to the reality of mental health needs.”

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Coronavirus infection odds twice as high among Black, Latinx hospital workers

Support staff and Black and Latinx hospital employees with and without patient care responsibilities are at highest risk for SARS-CoV-2 infection in health care settings, a Rutgers study found.

After screening 3,904 employees and clinicians at a New Jersey hospital between late April and late June for the SARS-CoV-2 virus and for lgG-antibodies to the virus, whose presence suggests past recent infection, the study, published in the journal Open Forum Infectious Diseases, found that these employees are at higher risk than previously thought.

“The risk to workers in health care settings with little or no patient contact has attracted relatively little attention to date, but our results suggest potentially high infection rates in this group,” said lead author Emily S. Barrett, an associate professor at Rutgers School of Public Health and a member of the Environmental and Occupational Health Sciences Institute. “By contrast and to our surprise, physicians, nurses and emergency medical technicians showed much lower infection rates.”

Health care workers who live in highly impacted communities may have been susceptible to becoming infected outside of the hospital during the early surge of COVID-19, according to co-lead author Daniel B. Horton, an assistant professor at Rutgers Robert Wood Johnson Medical School and a member of the Institute for Health, Health Care Policy and Aging Research.

“In the early phase of the pandemic, support staff in the hospital may also have had less access to personal protective equipment or less enforcement of safety protocols,” he said. “Going forward, as cases of COVID-19 in the hospital rise again, protecting these and all hospital workers from infection both in and out of the hospital is critical.”

In the hospital-based study, researchers found that 13 participants tested positive for the virus and 374 tested positive for the antibody, which suggests recent past infection—nearly 10 percent of those studied—and that Black and Latinx workers had two times the odds of receiving a positive test for the virus or antibody compared to white workers.

Phlebotomists had the highest proportionate rate of positive tests—nearly 1 in 4 tested—followed by those employed in maintenance/housekeeping, dining/food services and interpersonal/support roles. By comparison, positivity rates were lower among doctors (7 percent) and nurses (9 percent).

Regardless of whether the infections originated in the hospital or in the community, Barrett said, the results suggest a need to enact safety protocols for hospital employees to protect the health care workforce from future waves of infection.

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Why it's so important for Black and Asian people to access therapists of colour

When you’re choosing a therapist, it’s important that you find someone who can understand your perspective of the world.

But for people from ethnic minority groups, there is a distinct lack of professionals who are able to relate to their specific life experiences – including issues of race, religion and culture – because the overwhelming majority of therapists are white.

People from Black, Asian and other ethnic minority communities have a higher risk of developing mental health conditions than white people – but they are less likely to be able to access mental health services.

Black Brits are four times more likely to be sectioned than white patients, and ethnic minority patients are more likely to be given medication than be offered talking therapies like counselling or psychotherapy.

Put simply, mental health services in the UK are consistently failing people of colour. And the stark lack of diversity within the profession may be a significant contributing factor.

An American study found that in 2015 86% of psychologists in the US workforce were white. It is a similar story here in the UK. Only 9.6% of qualified clinical psychologists in England and Wales are non-white, in contrast to 13% of the population.

The impact of not seeing yourself reflected in the mental healthcare system can be really damaging. It can be isolating and it can prevent people from getting the help they need.

Shalanah, a fashion buyer from south London, has struggled with anxiety and OCD for most of her adult life. She started seeing a white therapist soon after she graduated from university, as her mental health took a sharp downturn.

‘It was the first time I realised I needed some professional help, and I was actually feeling really proud of myself for being proactive with my mental health,’ Shalanah tells Metro.co.uk.

‘At first it was fine, it was good. My therapist illuminated a lot of underlying issues for me, and helped me understand some of my triggers. It felt like things were moving in the right direction.

‘But as time went on, I just felt there was a bit of a disconnect between us. And I didn’t know how to address it.’

Shalanah says that experiencing microaggessions and racism – as a dark-skinned Black woman – at university and when she started work were contributing factors in her anxiety and low self-esteem. But she struggled to find the words to explain this to her therapist.

‘I’m not going to lie, it felt awkward,’ she says.

‘I didn’t know how to tell this white woman about my daily lived experiences as a Black woman. I just got the sense that she wouldn’t get it. And when I did try to explain, I felt like she was minimising.

‘When I told her that I felt I would never progress in my job because there were literally no senior Black women I could look up to, she made it all about my own self-esteem, and she wasn’t able to acknowledge the realities of structural and systemic inequalities.

‘Therapy is supposed to be this completely safe space where you can be open and honest, right? So how am I meant to do that if I feel like I have to leave part of myself outside the door?’

Shalanah stopped going to therapy after about six months. She started using medication for her anxiety, alongside mindfulness exercises like meditation, breathing exercises and yoga. But she does miss the release of talking to somebody face to face. She says she is now looking for a Black, female therapist – but they can be hard to come by.

In response to this lack of diverse therapists, qualified therapist Sharnade George has launched a new directory to help people find therapists who aren’t white.

Cultureminds Therapy Platform is an online booking platform for diverse communities offering safe and secure counselling and psychotherapy. The aim is to match people from marginalised communities with suitable therapists who will offer them a deeper cultural understanding.

‘In the past, when people would think about therapy, what would come to mind is – “that’s for white people”,’ Sharnade tells Metro.co.uk.

‘I remember working in a psychiatric hospital and telling a nurse I wanted to become a clinical psychologist and she replied: “You won’t be able to do that, it’s a white, middle-class job”.

‘This has stayed with me all my life and has been one of the reasons why I won’t give up in being a representative for Black culture and ensuring that we are seen, heard and helped within the healthcare industry.’

Sharnade says that finding suitable mental health services is more important than ever for ethnic minority communities, thanks to the pressures of the pandemic and the disproportionate impact it has had on Black and Asian people.

‘We have to see people from these cultures represented more in the media,’ says Sharnade. ‘There is a lack of representation, which is why people feel uncomfortable to seek help – they feel like they are alone.’

The Mental Health Foundation reported in 2019 that people from Black and minority ethnic groups in the UK are more likely to experience a poor outcome from mental health treatment and more likely to disengage from mainstream mental health services, leading to social exclusion and a deterioration in their mental health.

‘Mainstream mental health services often fail to understand or provide services that are acceptable and accessible to non-white British communities and meet their particular cultural and other needs,’ the report concluded.

This is exactly what Sharnade hopes to tackle with her therapy directory. She says traditional mental health options often fail people of colour because of a fundamental cultural disconnect.

‘Therapists of colour are not automatically in a position to better serve clients of colour, but they are often more equipped by tradition of being able to identify with the realities of people of colour,’ she explains.

‘Cultural competence plays a big role in therapy. For example, seeing a Black therapist who is self-aware and has an understanding your cultural lens, cultural differences, practices, and world views, whilst being able to comprehend, communicate and effectively interact, can be very impactful with the client’s journey.

‘Having a professional who understands our cultural upbringing, history and oppression can be healing for clients, who may finally feel as though they are being understood.

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Identifying hotspots of low mammography screening in Black, Hispanic women

A young cancer epidemiologist who has already helped identify hotspots for geographic, racial and ethnic disparities in breast cancer mortality in the United States, is now looking at mammography screening rates in those hotspots.

Identifying the hotspots, combined with personal insight from some of the women there about barriers to screening, will enable better targeting of women most at risk of dying from this common, largely treatable cancer, says Dr. Justin Xavier Moore, cancer epidemiologist in the Department of Population Health Sciences at the Medical College of Georgia at Augusta University.

While Black and white women get breast cancer at about the same rate, Black women have a higher rate of death from breast cancer, according to the Centers for Disease Control and Prevention. Black and Hispanic women are 20% more likely to be diagnosed with advanced stage breast cancer, and they have, respectively, up to 70% and 14% increased risk of death, Moore says.

“If we know that people are getting later diagnoses, if we know these data for the last 20 years, then we need to do something about making sure people get in a little earlier and are screened better so we can try to mitigate the burden before it is too far downstream,” Moore says.

Moore has received a $646,332 Mentored Research Scientist Career Development Award, or K01 Award, from the National Institute on Minority Health and Health Disparities to enable him to find these women by looking at race specific estimates of mammography screening.

“We know these are problem areas in terms of people dying, but I want to know if they align with access to screening. Screening is always important,” Moore says, and mammography is one of the most definitive breast cancer screening tools. But while mammography may be free and even mobile sometimes, access is more multifactorial.

Living in areas of high racial segregation and decreased access to mammography is known to significantly increase the risk of late stage breast cancer, Moore says. Meanwhile screening mammography is associated with at least a 20% reduction in breast cancer mortality. But there is little geospatial (data associated with a specific location) information on mammography screening by race. But it is known that both Black and Hispanic women are less likely than white women to receive adequate mammography screening, including at the recommended ages, and there tend to be longer time intervals between screenings and lack of timely follow-up to a suspicious finding, Moore says.

Moore and his colleagues published in June 2018 in the journal Cancer Causes & Control the study looking at geographic, racial and ethnic variations in breast cancer mortality and whether differences they found could be explained by the characteristics of the counties they lived in.

“The incidence may not be that different among Black and white women but the death rate differences are dramatic,” Moore says of geospatial mapping that showed groupings of higher death rates primarily in the Southern portion of the country.

“If you are Black, your health is predicted to be poorer,” Moore says. “If you are Black and rural, which is what we are seeing with COVID-19, it’s even more exponentiated.” It’s what is called an interaction or multiplicative effect in epidemiology, he says. “You compound it because you are in both the risk groups.”

Later diagnosis generally means catching the disease at a more advanced, aggressive and less treatable stage. Black women already are known to have a higher incidence of the most aggressive breast cancers: inflammatory breast cancer, which causes breast swelling and redness, and so-called triple negative breast cancer, which is not fueled by hormones like most breast cancers are, so is tougher to treat.

Problems like inadequate screening and a disconnect of services also likely are factors in these high mortality hotspots, Moore says, like in his home state of Georgia where the contiguous counties of Putnam, Morgan and Jasper are among the top 1% of hotspots in the nation.

“That is problematic,” he says. “The thing you want to do is bring services to people and meet them where they are, geographically, and in how you approach them to break down barriers and build trust,” Moore says. Much like targeted cancer treatment, the work he is doing should provide insight on what issues and approaches need to be targeted to enable Black and Hispanic women to feel comfortable seeking the screening and care they need. He reasons that fear and distrust are likely factors, which he will ask the women about. “If we don’t know your risk then you don’t have an opportunity to mitigate the burden,” he says.

After the initial intensive number crunching and mapping, Moore will be gaining additional insight from the affected woman in the latter years of the new grant. He plans to survey 200 women from the high-risk counties identified to ask about personal, interpersonal and community barriers as well as facilitators for screening mammography. Then, he will sit down with about 40 of these women in the beauty salons and churches in their communities to gain additional understanding.

“We might find things that I would not think about as a cancer disparities researcher,” Moore says. These might include related issues like the struggles of living paycheck to paycheck, and perhaps newer factors like trying to help four children continue their education at home in the midst of a pandemic.

He hopes the insight this study will enable will springboard into a larger community-based participatory research program that will recruit thousands of women from these hotspots and focus on early screening and detection, healthy lifestyle intervention, and otherwise trying to mitigate the heavy breast cancer burden these women bear.

The hotspots for low screening will be identified by combining data from the National Health Interview Survey, which has more than 60 years of data on a broad range of health topics obtained through personal interviews, and the Behavioral Risk Factor Surveillance System, which collects state data related to risk behaviors, chronic health conditions and use of preventive services. Together the datasets will provide what Moore calls the Breast Cancer Disparity, or BCAD, Index, which will enable ranking of individual counties with the highest concerns about breast cancer among minority women.

The United States, including the District of Columbia, has 3,141 counties and county equivalents and for the mortality rate study the investigators looked at 3,108 contiguous counties from 2000-15. They identified 119 counties mostly in the Southern region of the country, including clusters in the Mississippi Valley River region, coastal Carolinas and the three Georgia counties of Putnam, Jasper and Morgan clustered in the middle of the state, as hotspots for breast cancer deaths in Black women. The 83 hotspots for Hispanic women were primarily in the Southwest, including the southern-most tip of Texas, a big block that covered much of the western portion of New Mexico, the southern portion of Arizona, as well as a swath of Florida, primarily along the Atlantic coastline.

The high death rates correlated with lower education levels and household income, higher unemployment and uninsured residents, and a higher proportion of individuals who indicated that cost was a barrier to medical care.

At that time, Moore could not find a national picture of rates of minority mammography screening. He expects, now that he is looking, once he merges findings on both, to find overlap with death rate hotspots, but low-screening regions need to be objectively identified.

When the investigators looked at only white women, they didn’t see similar clustering, which is good, Moore says, but indicates you can’t use geography as a determinant of their breast cancer mortality. White women have a five-year survival rate of about 91%.

Dr. Steven S. Coughlin, interim chief of the Division of Epidemiology in the MCG Department of Population Health Sciences, is Moore’s primary mentor on the new project.

His community based approach in the study will mirror the barbershop tours he experienced working with established service organizations like 100 Black Men of St. Louis, where they would provide standard health checks like blood pressure and glucose levels, as they learned more about the community’s health needs. “The beauty of those barbershop tours is you are getting feedback,” Moore says. He volunteered with the St. Louis group while doing his postdoctoral training in cancer prevention and control at Washington University, right before joining the MCG faculty in 2019. Now he is a volunteer with 100 Black Men of Augusta.

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