For forty years, the Tuskegee Study of Untreated Syphilis in the Negro Male passively monitored hundreds of adult black males with syphilis despite the availability of effective treatment. The study's methods have become synonymous with exploitation and mistreatment by the medical community. We find that the historical disclosure of the study in 1972 is correlated with increases in medical mistrust and mortality and decreases in both outpatient and inpatient physician interactions for older black men. Our estimates imply life expectancy at age 45 for black men fell by up to 1.4 years in response to the disclosure, accounting for approximately 35% of the 1980 life expectancy gap between black and white men.

The Sourcebook is the result of ongoing Veterans Health Administration (VHA) efforts aimed at understanding the effects of military service on women’s lives.  The first in a series, Sourcebook Vol. 1 describes women Veterans receiving VHA care in Fiscal Year 2009 overall and within key subgroups (by age and by service-connected disability status). It also presents gender comparisons between women and men in FY09. Finally, it presents longitudinal trends in utilization over the decade (FY00–FY09). Future volumes will include information on the use of fee basis care, rural status, race and ethnicity, and diagnoses.

Key findings of Sourcebook Vol. 1 include:

• The number of women Veterans using VHA has increased from 159,360 in FY00 to 292,921 in FY09, representing a near doubling over the decade.
• The age distribution turned from bi-modal to tri-modal over the decade.  In 2000, the age distribution of women showed two peaks, at ages 44 and 76. In FY09, there were three peaks, at ages 27, 47 and 85. 
• Women Veteran VHA users have high levels of service-connected disability status.
• Among women Veteran VHA users, 37% use mental health services. 

BACKGROUND: Type 2 Diabetes (T2D) and other chronic diseases are caused by a complex combination of many genetic and environmental factors. Few methods are available to comprehensively associate specific physical environmental factors with disease. We conducted a pilot Environmental-Wide Association Study (EWAS), in which epidemiological data are comprehensively and systematically interpreted in a manner analogous to a Genome Wide Association Study (GWAS).

METHODS AND FINDINGS: We performed multiple cross-sectional analyses associating 266 unique environmental factors with clinical status for T2D defined by fasting blood sugar (FBG) concentration > or =126 mg/dL. We utilized available Centers for Disease Control (CDC) National Health and Nutrition Examination Survey (NHANES) cohorts from years 1999 to 2006. Within cohort sample numbers ranged from 503 to 3,318. Logistic regression models were adjusted for age, sex, body mass index (BMI), ethnicity, and an estimate of socioeconomic status (SES). As in GWAS, multiple comparisons were controlled and significant findings were validated with other cohorts. We discovered significant associations for the pesticide-derivative heptachlor epoxide (adjusted OR in three combined cohorts of 1.7 for a 1 SD change in exposure amount; p<0.001), and the vitamin gamma-tocopherol (adjusted OR 1.5; p<0.001). Higher concentrations of polychlorinated biphenyls (PCBs) such as PCB170 (adjusted OR 2.2; p<0.001) were also found. Protective factors associated with T2D included beta-carotenes (adjusted OR 0.6; p<0.001).

CONCLUSIONS AND SIGNIFICANCE: Despite difficulty in ascertaining causality, the potential for novel factors of large effect associated with T2D justify the use of EWAS to create hypotheses regarding the broad contribution of the environment to disease. Even in this study based on prior collected epidemiological measures, environmental factors can be found with effect sizes comparable to the best loci yet found by GWAS.

BACKGROUND AND OBJECTIVES: Rates of dialysis withdrawal are higher among the elderly and lower among Blacks, yet it is unknown whether preferences for withdrawal and engagement in advance care planning also vary by age and race or ethnicity. DESIGN, SETTING, PARTICIPANTS AND METHODS: We recruited 61 participants from two dialysis clinics to complete questionnaires regarding dialysis withdrawal preferences in five different health states. Engagement in advance care planning (end-of-life discussions), completion of advance directives and 'do not resuscitate' or 'do not intubate' (DNR/DNI) orders were ascertained by a questionnaire and from dialysis unit records. RESULTS: The mean age was 62 +/- 15 years; 38% were Black, 11% were Latino, 34% were White and 16% of participants were Asian. Blacks were less likely to prefer dialysis withdrawal as compared with Whites (odds ratio 0.16, 95% confidence interval 0.03-0.88) and other race/ethnicity groups, and this difference was not explained by age, education, comorbidity and other confounders. In contrast, older age was not associated with preferences for withdrawal. Rates of engagement in end-of-life discussions were higher than for documentation of advance care planning for all age and most race/ethnicity groups. Although younger participants and minorities were generally less likely to document treatment preferences as compared with older patients and Whites, they were not less likely to engage in end-of-life discussions. CONCLUSIONS: Preferences for withdrawal vary by race/ ethnicity, whereas the pattern of engagement in advance care planning varies by age and race/ethnicity. Knowledge of these differences may be useful for improving communication about end-of-life preferences and in implementing effective advance care planning strategies among diverse haemodialysis patients.

Background and objectives. Rates of dialysis withdrawal are higher among the elderly and lower among Blacks, yet it is unknown whether preferences for withdrawal and engagement in advance care planning also vary by age and race or ethnicity.

Design, setting, participants and methods. We recruited 61 participants from two dialysis clinics to complete questionnaires regarding dialysis withdrawal preferences in five different health states. Engagement in advance care planning (end-of-life discussions), completion of advance directives and ‘do not resuscitate' or ‘do not intubate' (DNR/DNI) orders were ascertained by a questionnaire and from dialysis unit records.

Results. The mean age was 62 ± 15 years; 38% were Black, 11% were Latino, 34% were White and 16% of participants were Asian. Blacks were less likely to prefer dialysis withdrawal as compared with Whites (odds ratio 0.16, 95% confidence interval 0.03-0.88) and other race/ethnicity groups, and this difference was not explained by age, education, comorbidity and other confounders. In contrast, older age was not associated with preferences for withdrawal. Rates of engagement in end-of-life discussions were higher than for documentation of advance care planning for all age and most race/ethnicity groups. Although younger participants and minorities were generally less likely to document treatment preferences as compared with older patients and Whites, they were not less likely to engage in end-of-life discussions.

Conclusions. Preferences for withdrawal vary by race/ ethnicity, whereas the pattern of engagement in advance care planning varies by age and race/ethnicity. Knowledge of these differences may be useful for improving communication about end-of-life preferences and in implementing effective advance care planning strategies among diverse haemodialysis patients.

OBJECTIVE: To examine developmental and behavioral status of children in child welfare (CW) over time, by intensity of CW involvement using a national probability sample.

METHODS: As part of the National Survey of Child and Adolescent Well-being (NSCAW), data were collected on 1,049 children 12-47 months old investigated by CW agencies for possible abuse or neglect. Analyses used descriptive statistics to characterize developmental and behavioral status across four domains (developmental/cognitive, language, adaptive functioning, and behavior) by intensity of CW involvement (in-home with CW services, in-home with no CW services or out-of-home care) over time. Multivariate analyses were used to examine the relationship between independent variables (age, gender, home environment, race/ethnicity, maltreatment history, intensity of CW involvement) and follow-up domain scores.

RESULTS: On average, children improved in developmental/cognitive, communication/language status over time, but these improvements did not differ by intensity of CW involvement. Analyses revealed a positive relationship between the home environment and change in language and adaptive behavior standard scores over time, and few predictors of change in behavioral status. An interaction between intensity of CW involvement and initial developmental/cognitive status was present.

CONCLUSIONS: Across domains, intensity of CW involvement does not appear to have a significant effect on change in developmental and behavioral status, although out-of-home care does have differential relationships with children's developmental/cognitive status for those with very low initial cognitive/developmental status. Facilitating development in children in CW may require supportive, enriched care environments both for children remaining at home and those in foster care. P

RACTICE IMPLICATIONS: Toddler and preschool age children known to child welfare are likely to have difficulties with development whether they are removed from their homes or not. It would be helpful if child welfare workers were trained to screen for developmental, language, adaptive behavior and behavioral difficulties in children in foster care, and those remaining at home. Additional support for biological, foster, and kinship caregivers in encouraging development is important for the attainment of critical developmental skills, especially for children with developmental difficulties.

To compare health care access, utilization, and perceived health status for children with SHCN in immigrant and nonimmigrant families. This cross-sectional study used data from the 2003 California Health Interview Survey to identify 1404 children (ages 0-11) with a special health care need. Chi-square and logistic regression analyses were used to examine relations between immigrant status and health access, utilization, and health status variables. Compared to children with special health care needs (CSHCN) in nonimmigrant families, CSHCN in immigrant families are more likely to be uninsured (10.4 vs. 4.8%), lack a usual source of care (5.9 vs. 1.9%), report a delay in medical care (13.0 vs. 8.1%), and report no visit to the doctor in the past year (6.8 vs. 2.6%). They are less likely to report an emergency room visit in the past year (30.0 vs. 44.0%), yet more likely to report fair or poor perceived health status (33.0 vs. 16.0%). Multivariate analyses suggested that the bivariate findings for children with SHCN in immigrant families largely reflected differences in family socioeconomic status, parent's language, parental education, ethnicity, and children's insurance status. Limited resources, non-English language, and limited health-care use are some of the barriers to staying healthy for CSHCN in immigrant families. Public policies that improve access to existing insurance programs and provide culturally and linguistically appropriate care will likely decrease health and health care disparities for this population.

Objective: The study examined the influence of parent involvement and family factors on body mass index (BMI) change in a pediatric obesity treatment program.

Methods: A total of 104 children and their caregivers were examined during a 12-week obesity intervention. Participants (mean age = 11.42 years; SD = 2.83) and their caregivers completed measures of family environment and depression prior to enrollment. Children's BMI and parental involvement were rated weekly during the intervention. Logistic regressions were conducted to examine the role of sociodemographic factors, family characteristics, and parent involvement on weight.

Results: Children with the lowest parent involvement were less likely to lose any weight or have clinically significant (>/=2 kg) weight loss. Demographics and family factors did not predict BMI change. Parent involvement related to ethnicity, absences and physical activity.

Conclusions: Parental involvement may be helpful in identifying who is likely to do well in a weight loss program.