Community-engaged ancient DNA project reveals diverse origins of 18th-century African descendants in Charleston, South Carolina.

In this study, we present the results of community-engaged ancient DNA research initiated after the remains of 36 African-descended individuals dating to the late 18th century were unearthed in the port city of Charleston, South Carolina. The Gullah Society of Charleston, along with other Charleston community members, initiated a collaborative genomic study of these ancestors of presumed enslaved status, in an effort to visibilize their histories. We generated 18 low-coverage genomes and 31 uniparental haplotypes to assess their genetic origins and interrelatedness. Our results indicate that they have predominantly West and West-Central African genomic ancestry, with one individual exhibiting some genomic affiliation with populations in the Americas. Most were assessed as genetic males, and no autosomal kin were identified among them. Overall, this study expands our understanding of the colonial histories of African descendant populations in the US South.

Ancestry, health, and lived experiences of enslaved Africans in 18th century Charleston: An osteobiographical analysis.

OBJECTIVES: In 2013, the burials of 36 individuals of putative African ancestry were discovered during renovation of the Gaillard Center in downtown Charleston, South Carolina. The Charleston community facilitated a bioarchaeological and mitogenomic study to gain insights into the lives of these unknown persons, referred to as the Anson Street Ancestors, including their ancestry, health, and lived experiences in the 18th century. METHODS: Metric and morphological assessments of skeletal and dental characteristics were recorded, and enamel and cortical bone strontium stable isotope values generated. Whole mitochondrial genomes were sequenced and analyzed. RESULTS: Osteological analysis identified adults, both females and males, and subadults at the site, and estimated African ancestry for most individuals. Skeletal trauma and pathology were infrequent, but many individuals exhibited dental decay and abscesses. Strontium isotope data suggested these individuals mostly originated in Charleston or sub-Saharan Africa, with many being long-term residents of Charleston. Nearly all had mitochondrial lineages belonging to African haplogroups (L0-L3, H1cb1a), with two individuals sharing the same L3e2a haplotype, while one had a Native American A2 mtDNA. DISCUSSION: This study generated detailed osteobiographies of the Anson Street Ancestors, who were likely of enslaved status. Our results indicate that the Ancestors have diverse maternal African ancestries and are largely unrelated, with most being born locally. These details reveal the demographic impact of the trans-Atlantic slave trade. Our analysis further illuminates the lived experiences of individuals buried at Anson Street, and expands our understanding of 18th century African history in Charleston.

Rural-urban and racial/ethnic trends and disparities in early-onset and average-onset colorectal cancer.

BACKGROUND: Incidence rates (IRs) of early-onset colorectal cancer (EOCRC) are increasing, whereas average-onset colorectal cancer (AOCRC) rates are decreasing. However, rural-urban and racial/ethnic differences in trends by age have not been explored. The objective of this study was to examine joint rural-urban and racial/ethnic trends and disparities in EOCRC and AOCRC IRs. METHODS: Surveillance, Epidemiology, and End Results data on the incidence of EOCRC (age, 20-49 years) and AOCRC (age, ≥50 years) were analyzed. Annual percent changes (APCs) in trends between 2000 and 2016 were calculated jointly by rurality and race/ethnicity. IRs and rate ratios were calculated for 2012-2016 by rurality, race/ethnicity, sex, and subsite. RESULTS: EOCRC IRs increased 35% from 10.44 to 14.09 per 100,000 in rural populations (APC, 2.09; P < .05) and nearly 20% from 9.37 to 11.20 per 100,000 in urban populations (APC, 1.26; P < .05). AOCRC rates decreased among both rural and urban populations, but the magnitude of improvement was greater in urban populations. EOCRC increased among non-Hispanic White (NHW) populations, although rural non-Hispanic Black (NHB) trends were stable. Between 2012 and 2016, EOCRC IRs were higher among all rural populations in comparison with urban populations, including NHW, NHB, and American Indian/Alaska Native populations. By sex, rural NHB women had the highest EOCRC IRs across subgroup comparisons, and this was driven primarily by colon cancer IRs 62% higher than those of their urban peers. CONCLUSIONS: EOCRC IRs increased in rural and urban populations, but the increase was greater in rural populations. NHB and American Indian/Alaska Native populations had particularly notable rural-urban disparities. Future research should examine the etiology of these trends.

African American Women's Recollected Experiences of Adherence to Breast Cancer Treatment.

PURPOSE/OBJECTIVES: To explore African American women's recollected experiences of breast cancer treatment.
. RESEARCH APPROACH: Qualitative description and narrative analysis.
. SETTING: South Carolina Oncology Associates, an outpatient oncology clinic serving rural and urban populations.
. PARTICIPANTS: 16 African American women with breast cancer previously enrolled in the control arm (n = 93) of a completed randomized, controlled trial. 
. METHODOLOGIC APPROACH: Feminist narrative analysis of in-depth individual interviews.
. FINDINGS: The authors identified three themes within the African American breast cancer survivors' recollected experiences of treatment adherence. INTERPRETATION: Although little evidence was presented of shared decision making with providers, patients were committed to completing the prescribed therapies. The narratives highlighted the value of in-depth examination of patients' perspectives, particularly among minority and underserved groups. With the exception of voicing personal choice of surgical treatment, the women trusted providers' recommendations with a resolve to "just do it." Although trust may enhance treatment adherence, it may also reflect power differentials based on gender, race, education, and culture.
. IMPLICATIONS FOR NURSING: Nurses should listen to patients describe their experience with cancer treatment and compare the themes from this study with their patients' story. This comparison will help nurses support patients through various aspect of diagnosis and treatment.

Exploring perceptions of cancer risk, neighborhood environmental risks, and health behaviors of blacks.

Cancer risk perceptions and cancer worry are shaped by race/ethnicity, and social, economic, and environmental factors, which in turn shape health decision-making. A paucity of studies has explored risk perceptions and worry in metropolitan areas with disparate environmental conditions and cancer outcomes. This study examined perceptions of cancer risk, neighborhood environmental health risks, and risk-reducing health behaviors among Blacks. A 59-item survey was administered to respondents in Metropolitan Charleston, South Carolina from March to September 2013. A convenience sample of males and females was recruited at local venues and community events. Descriptive statistics, bivariate analyses (Chi square tests), and logistic regression models were estimated using SAS 9.3 software. Respondents (N = 405) were 100% Black, 81% female (n = 323), and ranged from 18 to 87 years of age (M = 49.55, SD = 15.27). Most respondents reported lower perceptions of cancer risk (37%) and equated their cancer beliefs to direct or indirect (i.e. personal or family) experiences. Low perceived cancer risk (absolute risk) was significantly associated (p < .05) with non-alcohol consumption, having a colon cancer screening test, being female, and being age 25-44 or 45-64. Cancer worry was significantly associated (p < .05) with being a current smoker, having a "fair" diet, non-alcohol consumption, and having any colon cancer screening test. Perceived cancer risk is an important indicator of health behaviors among Blacks. Direct or indirect experiences with cancer and/or the environment and awareness of family history of cancer may explain cancer risk perceptions.

Persistent racial disparity in stroke hospitalization and economic impact in young adults in the buckle of stroke belt.

BACKGROUND AND PURPOSE: Mounting evidence points to a decline in stroke incidence. However, little is known about recent patterns of stroke hospitalization within the buckle of the stroke belt. This study aims to investigate the age- and race-specific secular trends in stroke hospitalization rates, inpatient stroke mortality rates, and related hospitalization charges during the past decade in South Carolina. METHODS: Patients from 2001 to 2010 were identified from the State Inpatient Hospital Discharge Database with a primary discharge diagnosis of stroke (International Classification of Diseases, Ninth Revision codes: 430-434, 436, 437.1). Age- and race-stroke-specific hospitalization rates, hospital charges, charges associated with racial disparity, and 30-day stroke mortality rates were compared between blacks and whites. RESULTS: Of the 84,179 stroke hospitalizations, 31,137 (37.0%) were from patients aged<65 years and 29,846 (35.5%) were blacks. Stroke hospitalization rates decreased in the older population (aged≥65 years) for both blacks and whites (P<0.001) but increased among the younger group (aged<65 years; P=0.004); however, this increase was mainly driven by a 17.3% rise among blacks (P=0.001), with no difference seen among whites (P=0.84). Of hospital charges totaling $2.77 billion, $453.2 million (16.4%) are associated with racial disparity (79.6% from patients aged<65 years). Thirty-day stroke mortality rates decreased in all age-race-stroke-specific groups (P<0.001). CONCLUSIONS: The stroke hospitalization rate increased in the young blacks only, which results in a severe and persistent racial disparity. It highlights the urgent need for a racial disparity reduction in the younger population to alleviate the healthcare burden.

A qualitative study for understanding family and peer influences on obesity-related health behaviors in low-income African-American adolescents.

BACKGROUND: Given the cultural and developmental relevance of family members and peers in the lives of African-American adolescents, the present study used a bioecological framework to qualitatively explore the parenting context as well as specific family factors (support, rules, monitoring) and peer factors (support) related to weight status, physical activity (PA), and healthy eating in low-income African-American boys versus girls. METHODS: Qualitative data were obtained from African-American adolescents through focus groups. Adolescents (n = 45, 100% African American, 51% girls, 12.6 ± 1.2 years, 51% overweight/obese) were from two underserved communities in South Carolina (median income ≈$17,000-$22,000, high crime levels). Sessions were audiotaped, transcribed, and coded by independent pairs of raters (r = 0.75). QSR NVivo 8 was used to analyze data, and themes were categorized separately for boys and girls. RESULTS: Adolescents reported themes of family warmth and control practices consistent with an authoritative style of parenting. Although adolescents wanted increased autonomy, they viewed parental monitoring as a favorable part of their relationship. Boys reported receiving more constructive feedback from parents about weight status and greater overall support for PA and diet than did girls. Girls reported more honest feedback from peers about weight status than did boys. Overall, adolescents acknowledged the unique opportunities of parents and peers in improving their health behaviors. CONCLUSIONS: Findings suggest parents and peers interact in different ways with African-American boys and girls regarding their weight status and health behaviors. Future obesity prevention efforts in minority youth may need to target parenting skills that provide greater support to African-American girls. In addition, given peers influence PA and diet differently in boys and girls, interventions should strategically include parenting strategies that involve monitoring peer-adolescent interactions.

Studs and protest-hypermasculinity: the tomboyism within black lesbian female masculinity.

In this article, I use the ethnographic work I conducted in the summer of 2009 with Black lesbian women from South Carolina to show how Black female masculinity has been influenced by historically based constructions of Black gender. I will argue that these studs strategically construct and perform their masculinity in ways that shield them from sexism, racism, and homophobia both in and out of their Black community. By adopting the particular type of masculinity common among their Black male peers, these studs can gain access to some levels of male privilege and power which, in turn, can act as useful defense mechanisms against multiple types of discrimination and oppression.

Diabetes and the socioeconomic and built environment: geovisualization of disease prevalence and potential contextual associations using ring maps.

BACKGROUND: Efforts to stem the diabetes epidemic in the United States and other countries must take into account a complex array of individual, social, economic, and built environmental factors. Increasingly, scientists use information visualization tools to "make sense" of large multivariate data sets. Recently, ring map visualization has been explored as a means of depicting spatially referenced, multivariate data in a single information graphic. A ring map shows multiple attribute data sets as separate rings of information surrounding a base map of a particular geographic region of interest. In this study, ring maps were used to evaluate diabetes prevalence among adult South Carolina Medicaid recipients. In particular, county-level ring maps were used to evaluate disparities in diabetes prevalence among adult African Americans and Whites and to explore potential county-level associations between diabetes prevalence among adult African Americans and five measures of the socioeconomic and built environment--persistent poverty, unemployment, rurality, number of fast food restaurants per capita, and number of convenience stores per capita. Although Medicaid pays for the health care of approximately 15 percent of all diabetics, few studies have examined diabetes in adult Medicaid recipients at the county level. The present study thus addresses a critical information gap, while illustrating the utility of ring maps in multivariate investigations of population health and environmental context. RESULTS: Ring maps showed substantial racial disparity in diabetes prevalence among adult Medicaid recipients and suggested an association between adult African American diabetes prevalence and rurality. Rurality was significantly positively associated with diabetes prevalence among adult African American Medicaid recipients in a multivariate statistical model. CONCLUSIONS: Efforts to reduce diabetes among adult African American Medicaid recipients must extend to rural African Americans. Ring maps can be used to integrate diverse data sets, explore attribute associations, and achieve insights critical to the promotion of population health.

Influence of age on racial disparities in stroke admission rates, hospital charges, and outcomes in South Carolina.

BACKGROUND AND PURPOSE: Racial disparities among US stroke patients have been well documented. However, the extent to which disparities in outcomes vary by age is unclear. This study's goals were to examine the degree of racial disparities in South Carolina between African Americans (AAs) and Caucasian Americans (CAs) in stroke admission rates, hospital charges, and outcomes and to determine whether racial differences varied by age. METHODS: From the state hospital discharge database, admissions with a primary diagnosis of stroke discharged from 2002 to 2006 were identified. Age group-specific stroke admission rates, hospital charges, length of stay, intensive care unit utilization, medical complications, and discharge disposition (in-hospital death, discharged home, discharge to rehabilitation facility) were compared between AAs and CAs by multiple-linear or logistic-regression analysis. RESULTS: There were 58 272 stroke admissions during the 5-year period. Stroke admission rates were persistently higher for AAs in all age groups except those > or =85 years old. Hospital charges totaled $1.51 billion; 24.0% ($362.5 million) of this total was attributable to racial disparities, 70.8% ($256.5 million) of which stemmed from the 36.6% of patients <65 years old. Most of the acute outcomes were poorer for AAs compared with CAs across age groups. CONCLUSIONS: Racial disparities in stroke admissions are more pronounced in younger age groups and result in significant economic consequences. Although AA stroke patients experienced generally worse acute outcomes than did CAs, these differences appear to be relatively consistent across age groups.

John Lawson's "A New Voyage to Carolina": notes on the publication history of the London (1709) edition.

John Lawson's "A New Voyage to Carolina," an important source document for American colonial natural history, was first printed in 1709 in "A New Collection of Voyages and Travels," a two-volume set that also contained travel books translated by John Stevens. Lawson's publishers were leaders in the book trade of early eighteenth century London, and the "New Voyage" is typical of the resurgent popular interest in foreign travel narratives and exotic flora and fauna that began in the late 1600s. The "New Collection" was among the earliest examples of books published in serial instalments or fascicles, a marketing strategy adopted by London booksellers to broaden the audience and increase sales. Analysis of London issues of the "New Voyage" indicates that the 1709, 1711, 1714, and 1718 versions are simply bindings of the original, unsold sheets from the 1709 "New Collection" edition, differing only by new title-pages, front matter, and random stop-press corrections of type-set errors. Lawson's "New Voyage" illustrates important aspects of the British book trade during the hand press period of the early eighteenth century.

Paradox of precision: bright tobacco as technology of transfer, 1880-1937.

This article compares two episodes of technology transfer in the 1890s: the movement of bright tobacco production technology to south-central Africa with the spread of the crop to eastern North Carolina and South Carolina. It finds similarities in the people who introduced the crop, but significant differences in the methods used to produce it. This is troubling because the type is defined by the cultivation and especially the curing techniques used to produce it; it is also often described in the historical literature as "Virginia tobacco," even when grown elsewhere. the technological differences are the product of different environments, which include not only the climate but also many elements of the technological system beyond immediate human control: the availability and organization of labor, differences in market structures and marketing institutions, and the government incentives provided to buyers. Therefore, this essay takes as its subject the paradox inherent in the official classification of tobacco types regulated by the USDA and argues that varietal types represent a form of market regulation disguised as botanical taxonomy.

Physical activity and the metabolic syndrome in a tri-ethnic sample of women.

OBJECTIVE: To determine the association of moderate-intensity physical activity (PA), vigorous-intensity PA, and maximal treadmill duration with the metabolic syndrome among African-American (n = 49), Native-American (n = 46), and white (n = 51) women (ages, 40 to 83 years), enrolled in the Cross-Cultural Activity Participation Study. RESEARCH METHODS AND PROCEDURES: The metabolic syndrome was defined as three or more of the following risk factors: waist circumference >88 cm, blood pressure > or =130/85 mm Hg, fasting glucose > or =110 mg/dL, hypertriglyceridemia (> or =150 mg/dL), and high-density lipoprotein-cholesterol <50 mg/dL. PA was determined from detailed PA records that included all PA performed during two consecutive 4-day periods. Maximal treadmill duration was determined from a graded exercise test. Women were categorized into quartiles of moderate-intensity PA, vigorous-intensity PA, and maximal treadmill duration. Multiple logistic regression was used to estimate odds ratios of the metabolic syndrome as a function of the four PA categories, adjusted for age, ethnicity, study site, menopausal status, and use of hormone-replacement therapy. RESULTS: The adjusted odds ratio for the metabolic syndrome was 0.18 (95% confidence interval, 0.33 to 0.90) for women in the highest category of moderate-intensity PA compared with women in the lowest category (p = 0.01 for trend). Similar associations were observed for the metabolic syndrome with vigorous-intensity PA (p = 0.01 for trend) and maximal treadmill duration (p = 0.0004 for trend). DISCUSSION: Higher levels of moderate and vigorous-intensity PA and greater maximal treadmill duration were inversely associated with the metabolic syndrome among an ethnically diverse sample of women.

Interest in genetic prostate cancer susceptibility testing among african American men.

Six regions for prostate cancer genes have been identified, and it is anticipated that prostate cancer susceptibility testing will be available in the future. This correlational study identified predictors for interest in prostate cancer susceptibility testing among African American men. Participants were 320 African American men from the African American Hereditary Prostate Cancer Study and the South Carolina Prostate Cancer Education and Screening Study participated. Two questions measured interest in genetic prostate cancer susceptibility testing and family history of prostate cancer. Chi-square analyses by family history as well as demographics (age, education, marital status) were performed. Most of the men (277 [87%]) indicated an interest in genetic prostate cancer susceptibility testing. Interest in undergoing testing did not vary by family history, age, or education. Marital status was the only significant demographic predictor. Men who were married were significantly more likely to respond with a "yes" to interest in prostate cancer susceptibility testing than were men who were not married. The high "yes" response rate and the men's confusion between the genetic prostate cancer susceptibility testing and prostate cancer screening highlight the need for public education once prostate cancer genes are identified and available for public testing.

Support for school-based reproductive health services among South Carolina voters.

In 1997 a statewide random digit-dialed telephone survey of 534 South Carolina registered voters was conducted to determine level of support for school-based reproductive health services. Results indicated most voters supported services in secondary schools that would provide students with information and counseling about contraceptive methods and refer students to community-based agencies for abstinence education and counseling. Voters were less supportive of reproductive health services that would diagnose or treat sexually transmitted diseases, test for pregnancy, refer students to community-based agencies for contraceptives, or make contraceptives available to students at school. Significant associations in support for school-based reproductive health services were reported based on income, personal beliefs, intentions, and outcome expectations regarding sexuality education and contraceptive availability. These data reinforce the need for school-aged youth in South Carolina to have access to reproductive health services within their communities, outside of the school setting.

Black and White women's weight-related attitudes and parental criticism of their childhood appearance.

Black (27%) and White (73%) women (n = 215) completed a survey assessing weight concern, ideal body size beliefs, body dissatisfaction, attitudes toward overweight body size, and parental criticism of their childhood appearance. Sixty-four percent of the women reported they were currently trying to lose weight and 63% desired a body size thinner than their own. High weight concern and negative attitudes toward overweight persons were reported, respectively, by 45% and 17%, of the women. The only significant difference found by race was weight concern as White women rated this significantly higher than Black women. No significant frequencies of choice were associated with the women's socioeconomic level. Self-reported ratings of weight concern were significant and positively associated with those for body dissatisfaction, negative attitudes toward overweight persons, negative attitudes toward one's own overweight, and criticism of childhood appearance by mothers or fathers.

Race and the risk of peritonitis: an analysis of factors associated with the initial episode.

To study how clinical characteristics influence the risk of peritonitis in African American patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis (CAPD), we examined the risk of developing a first episode of peritonitis among 1,595 new dialysis patients initially treated by CAPD over a two year period in North Carolina, South Carolina, and Georgia (Network 6). Characteristics examined were demographic and socioeconomic factors, functional status, serum albumin and comorbid conditions. There were 538 initial episodes of peritonitis during an average of 8.8 patient months of follow-up; the time to peritonitis for the entire cohort was 26 months. Factors found to be independently associated with a risk for peritonitis were student status (Odds Ratio and 95% Confidence Interval = 2.4; 1.4 to 4.3), rental housing (1.2; 1.0 to 1.5), and substance abuse (1.9; 1.1 to 3.2). African Americans were 60% more likely to have an initial episode of peritonitis during follow-up than whites (1.6; 1.3 to 1.8). The time to the initial episode was 21 months for African Americans versus 32 months for whites (P < 0.001). Even after adjusting for other factors, African Americans were significantly more likely to develop peritonitis (1.5; 1.2 to 1.8). Thus, the increased risk of peritonitis of African American patients treated by CAPD is independent of other demographic, socioeconomic and comorbid characteristics.