Living race together: the role of partner's race in racial/ethnic differences in smoking.

Objective: Crossing racial lines provides a unique context for understanding racial patterns in smoking. This research explores whether adults whose unions cross racial lines behave more similarly to their own group or their partner'sDesign: Using a sample of respondents from the National Health Interview Survey (2001-2011), we compare the likelihood of current smoking and quitting smoking among adults in mixed-race unions to adults in same-race unions.Results: Adults with different-race partners generally mirror their partner's group; people of color with White partners have a higher likelihood of being current smokers, similar to Whites, while Whites partnered with Asians and Latina/os are, like other Asians and Latino/as, less likely to smoke. There are fewer differences in the likelihood of quitting smoking.

Measuring perceived mistreatment across diverse social groups: An evaluation of the Everyday Discrimination Scale.

RATIONALE: Research assessing the health-related consequences of perceived discrimination depends upon high quality measures of perceived discrimination. The Everyday Discrimination Scale (EDS) is among the most frequently used instruments to assess perceptions of discrimination in general, as well as specific types of discrimination (e.g., based on race/ethnicity or age). While numerous studies attest to its validity and reliability for racial/ethnic minority groups, no existing study has examined its psychometric equivalence across gender, age, or socio-economic groups. This study fills this gap. HYPOTHESIS: We hypothesize that because social hierarchies of race/ethnicity, age, gender and class have different histories and are differently organized and institutionalized in contemporary United States, racial/ethnic, age, gender, and education-based groups differ in the types of discrimination they experience and perceive. As a result, the EDS may not be equivalent across these social groups. METHOD: We test this hypothesis by analyzing data from the 2015 US Texas Diversity Study (N=1,049), a telephone survey of English- and Spanish-speaking adults. We examine two forms of the EDS - one focusing on discrimination regardless of attribution and one focusing specifically on discrimination attributed to respondents' race/ethnicity. RESULTS: Multi-group confirmatory factor analyses revealed that neither version of the scale generates estimates of discrimination that can be meaningfully compared across all racial/ethnic, age, gender, and education-based groups. CONCLUSIONS: Our results urge caution when drawing comparisons of perceived discrimination across diverse social groups based on the EDS and point to avenues for future scale development.

Incorporating a location-based socioeconomic index into a de-identified i2b2 clinical data warehouse.

OBJECTIVE: Clinical research data warehouses are largely populated from information extracted from electronic health records (EHRs). While these data provide information about a patient's medications, laboratory results, diagnoses, and history, her social, economic, and environmental determinants of health are also major contributing factors in readmission, morbidity, and mortality and are often absent or unstructured in the EHR. Details about a patient's socioeconomic status may be found in the U.S. census. To facilitate researching the impacts of socioeconomic status on health outcomes, clinical and socioeconomic data must be linked in a repository in a fashion that supports seamless interrogation of these diverse data elements. This study demonstrates a method for linking clinical and location-based data and querying these data in a de-identified data warehouse using Informatics for Integrating Biology and the Bedside. MATERIALS AND METHODS: Patient data were extracted from the EHR at Nebraska Medicine. Socioeconomic variables originated from the 2011-2015 five-year block group estimates from the American Community Survey. Data querying was performed using Informatics for Integrating Biology and the Bedside. All location-based data were truncated to prevent identification of a location with a population <20 000 individuals. RESULTS: We successfully linked location-based and clinical data in a de-identified data warehouse and demonstrated its utility with a sample use case. DISCUSSION: With location-based data available for querying, research investigating the impact of socioeconomic context on health outcomes is possible. Efforts to improve geocoding can readily be incorporated into this model. CONCLUSION: This study demonstrates a means for incorporating and querying census data in a de-identified clinical data warehouse.

Race, Immigration, and Exogamy among the Native-born: Variation across Communities.

Did rising immigration levels change racial and ethnic exogamy patterns for young adults in the United States? Adding local demographics to Qian & Lichter's (2007) national results, we examine the relationship between the size of the local immigrant population in urban and rural areas and U.S.-born individuals' exogamy patterns in heterosexual unions, controlling for the area's racial composition. Using Census 2000 race, ethnicity, and nativity data and log-linear models, we test hypotheses about the relationship between high levels of immigration from Asia and Latin America and endogamy rates for U.S.-born Latino/as and Asians. We find that U.S.-born Latino/as and Asians are not consistently more endogamous in high-immigrant areas once we control for population composition differences across local areas. Surprisingly, U.S.-born Blacks and Native Americans are significantly less endogamous in areas with more immigrants.

I wouldn't, but you can: Attitudes toward interracial relationships.

Using the 2008 Cooperative Congressional Election Study (CCES), we study Whites' attitudes towards dating, cohabiting with, marrying, and having children with African Americans and Asian Americans. We find that 29% of White respondents reject all types of relationships with both groups whereas 31% endorse all types. Second, Whites are somewhat less willing to marry and bear children interracially than to date interracially. These attitudes and behaviors are related to warmth toward racial outgroups, political conservatism, age, gender, education, and region. Third, White women are likely to approve of interracial relationships for others but not themselves, while White men express more willingness to engage in such relationships personally, particularly with Asians. However, neither White men nor White women are very likely to actually engage in interracial relationships. Thus, positive globalattitudes toward interracial relationships do not translate into high rates of actual interracial cohabitation or marriage.

Knowing the family: interpretations of family nursing in oncology and palliative care.

PURPOSE: Families are acknowledged as a focus of care in oncology nursing in many countries but the meaning of "family nursing" in this practice setting has received little attention from researchers and theorists. In this article, we report the findings of a study that explored family nursing practices in three adult cancer care settings: ambulatory care (medical and radiation oncology clinics), a palliative care service, and an in-patient unit. METHOD: Data included in-depth interviews with 30 nurses and 19 families, as well as participant observations in each practice setting. The interviews were transcribed verbatim and the analyses guided by philosophical hermeneutics. RESULTS: We identified several narratives related to family nursing practices, and in this article we offer the interpretations of two of these narratives: 1) knowing the family and being known; and 2) addressing family concerns and distress. In knowing the family and being known nurses opened relational space for families to become involved in the care of their loved ones and gained an understanding of the family by "reading" non-verbal and para-verbal cues. Knowing the family created opportunities for nurses to address family concerns and distress in meaningful ways. These included guiding families by being a bridge, helping families to conserve relationships, and negotiating competing family agendas. Nurses relied on questioning practices to create relational space with, and among, family members. CONCLUSIONS: Implications for the development of family nursing practice, theory, and education are discussed.

Racial segregation and disparities in health care delivery: conceptual model and empirical assessment.

OBJECTIVE: This study examines two dimensions of racial segregation across hospitals, using a disease for which substantial disparities have been documented. DATA SOURCES: Black (n=32,289) and white (n=244,042) patients 67 years and older admitted for acute myocardial infarction during 2004-2005 in 105 hospital markets were identified from Medicare data. Two measures of segregation were calculated: Dissimilarity (i.e., dissimilar distribution by race across hospitals), and Isolation (i.e., racial isolation within hospitals). For each measure, markets were categorized as having low, medium, or high segregation. STUDY DESIGN: The relationship of hospital segregation to residential segregation and other market characteristics was evaluated. Cox proportional hazards regression was used to evaluate disparities in the use of revascularization within 90 days by segregation level. RESULTS: Agreement of segregation category based on Dissimilarity and Isolation was poor (kappa=0.12), and the relationship of disparities in revascularization to segregation differed by measure. The hazard of revascularization for black relative to white patients was lowest (i.e., greatest disparity) in markets with low Dissimilarity, but it was unrelated to Isolation. CONCLUSIONS: Significant racial segregation across hospitals exists in many U.S. markets, although the magnitude and relationship to disparities depends on definition. Dissimilar distribution of race across hospitals may reflect divergent cultural preferences, social norms, and patient assessments of provider cultural competence, which ultimately impact utilization.

Mutations in the gene encoding capillary morphogenesis protein 2 cause juvenile hyaline fibromatosis and infantile systemic hyalinosis.

Juvenile hyaline fibromatosis (JHF) and infantile systemic hyalinosis (ISH) are autosomal recessive conditions characterized by multiple subcutaneous skin nodules, gingival hypertrophy, joint contractures, and hyaline deposition. We previously mapped the gene for JHF to chromosome 4q21. We now report the identification of 15 different mutations in the gene encoding capillary morphogenesis protein 2 (CMG2) in 17 families with JHF or ISH. CMG2 is a transmembrane protein that is induced during capillary morphogenesis and that binds laminin and collagen IV via a von Willebrand factor type A (vWA) domain. Of interest, CMG2 also functions as a cellular receptor for anthrax toxin. Preliminary genotype-phenotype analyses suggest that abrogation of binding by the vWA domain results in severe disease typical of ISH, whereas in-frame mutations affecting a novel, highly conserved cytoplasmic domain result in a milder phenotype. These data (1) demonstrate that JHF and ISH are allelic conditions and (2) implicate perturbation of basement-membrane matrix assembly as the cause of the characteristic perivascular hyaline deposition seen in these conditions.

Ehlers-Danlos syndrome with severe early-onset periodontal disease (EDS-VIII) is a distinct, heterogeneous disorder with one predisposition gene at chromosome 12p13.

Ehlers-Danlos VIII (EDS-VIII) is an autosomal dominant disorder characterized by severe early-onset periodontal disease in conjunction with the features of Ehlers-Danlos syndrome (EDS). We performed a genomewide linkage search in a large Swedish pedigree with EDS-VIII and established linkage to a 7-cM interval on chromosome 12p13, generating a maximum multipoint LOD score of 5.17. Analysis of four further pedigrees with EDS-VIII revealed two consistent with linkage to 12p13 and two in which linkage could be excluded, indicating that EDS-VIII is a genetically heterogeneous disorder. Chromosome 12p13 has not previously been implicated in either EDS or periodontal disease and contains no known collagen genes or collagen-processing enzymes. Mutational screening of the microfibril-associated glycoprotein-2 gene, a strong candidate within the minimal interval, did not reveal any likely pathogenic mutations.