Racism Aggravates Treatment-Resistant Asthma

Harassment, Antagonism Big Factors for African-Americans with Poorly Controlled Disease, UCSF-Led Study Shows

Racial discrimination experienced by African-American children and young adults exacerbates a type of asthma known to be resistant to standard treatment, according to a study headed by researchers at UC San Francisco.

The 576 study participants, who were African-Americans with asthma, aged between 8 and 21, were asked if they had been hassled, made to feel inferior or prevented from doing something “because of your race, ethnicity, color or language,” in situations including at school, getting medical care and getting services in a store or restaurant. Close to half (281) reported experiences of racial discrimination in any setting at some point in their lives.

The participants were questioned about their symptoms and medication use and were tested to gauge their response to albuterol, an inhaled bronchodilator that opens inflamed airways, the hallmark of asthma. Albuterol is the mainstay rescue therapy for asthma, but patients requiring regular doses are typically prescribed inhaled corticosteroids as a preventive treatment to improve symptoms and lung function. They also underwent blood tests to measure the amount of tumor necrosis factor-alpha (TNF-alpha), a cell-signaling protein involved in a number of diseases and identified at high levels in some asthma patients with poor response to standard treatment.

The study was published June 13, 2017, in the journal PLOS One.

“In asthma that is well controlled, you would expect a low response to albuterol since the patient is not having a lot of symptoms and their airways are not inflamed,” said co-senior author Neeta Thakur, MD, assistant professor of medicine at UCSF. “But in people who are not prescribed control medications, or are under-dosed, you might see a higher response. In addition, for people with high TNF-alpha, inhaled corticosteroids are typically less effective.”

Psychosocial Stress a Factor in Some Patients

The researchers found that participants who reported that they had not experienced racial discrimination were close to twice as likely to have controlled asthma (37 percent) compared to those who said they did (21 percent). The average bronchodilator response was 1.7 per cent higher in the discriminated group.

This disparity was amplified when researchers compared bronchodilator response among 136 discriminated participants with higher TNF-alpha. The discriminated group averaged 2.78 percent greater response to bronchodilators than the non-discriminated group. “While this amount seems small, it is enough to move this group from being classified as ‘non-responders’ to ‘responders,’ which changes the way we think about the treatment-resistant group and opens up the opportunity for other therapies,” noted Thakur.

“Our results corroborate previous studies that show self-reported racial discrimination as a psychosocial stressor may affect health in youth, including asthma outcomes,” said first author, Sonia Carlson, MD, formerly of UCSF School of Medicine.

“Our study shows that screening for racial discrimination might be important for those with moderate-to-severe asthma,” said Carlson, who will start a medical residency at Case Western Reserve University in Cleveland.

“Patients reporting racial discrimination have been shown to have high TNF-alpha, as well as elevated levels of other cytokines,” said Thakur. “Psychosocial stress secondary to racial discrimination may enhance airway inflammation by modulating immune cell function through hormonal pathways.”

Read more from the story from the University of California San Francisco and access the report from PLUS One.

Suicide and Immigrants: The Fight to Overcome Cultural Barriers

(See this chart enlarged on the Philadelphia NBC10 website.)

Culture, religion and language play a part in how immigrants think and speak about suicide, according to experts.

In the case of Latino immigrants in particular, suicide (or its ideation) may be stigmatized as a sin or as a sign of cowardice. It is rarely spoken about as a health concern.

Many people think that suicide is a reaction to something bad that happens to a person, but actually it has well-defined biological basis,” said Dr. Maria Oquendo, president of the American Psychiatric Association, and professor and chairman of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania.

While the primary suicide trigger remains unknown, Oquendo said, “we know that suicide has a genetic basis and runs in families.”

“In those families where there have been suicides, the children have a higher susceptibility,” she added. “It is the same as, for example, hypertension or diabetes. It is not one hundred percent certain that they will have the disease, but it does increase the probability.”

Among the Latino population, Dr. Oquendo says, adolescents are the most vulnerable.

“We know that teenage girls have a certain vulnerability due to family conflicts — because of the cultural clash they experience. In some cases, they are required to behave in a more traditional way at home, and outside of the home it is very different. Like every teenager, [the Latina adolescent] wants to fit in.”

Those who leave the home — whether because they marry at an early age, leave to study or simply seek a different way — they don’t necessarily escape suicide ideation, however, because they are sometimes abused, or exposed to abuse.

Waleska Maldonado of the Philadelphia Department of Human Services, who for many years worked as a social worker at the Latino community organization Congreso, says that many teenagers who seek help for suicide prevention are affected by drug addiction, domestic violence or a poor socio-economic status.

“Money is lacking in many homes,” Maldonado said, “but the truth is, that if they understand where to look for help, things can improve.”

“Many of the girls we worked with gained confidence and trust through therapy. And they themselves tell of their experiences because that is one of the ways in which the treatment works,” she said.

Maldonado is convinced that the mental health of immigrants, especially Latinos, can improve through open communication.

Read the full story on Philadelphia NBC10.

Female Genital Mutilation Isn’t a Muslim Issue. It’s a Medical Issue.

Politicization of the topic is masking a bigger problem: Many women in the U.S. need medical care regarding it, and we’re ill-equipped to help them.

Last week, news emerged that an emergency medicine physician from Michigan had been charged with performing female genital mutilation. Dr. Jumana Nagarwala, who practices at the Henry Ford Hospital in Detroit, has been accused of doing the procedure on two 7-year-old girls at a medical clinic in Livonia, Michigan, this past February. The clinic is owned by Dr. Fakhruddin Attar, who has also been charged along with his wife, Farida Attar. Investigators additionally allege that other minors may have been victimized furtively by Nagarwala between 2005 and 2007.

The accused are part of a South Asian Muslim sect known as the Dawoodi Bohras, a Shiite branch of Islam whose adherents number 1.2 million and are dispersed all over the world. Considered mandatory by the sect to curb the sexual promiscuity of Bohra girls, female genital mutilation leaves its victims irrevocably scarred with lurid memories of the experience.

Though performed for nonmedical reasons, its medical consequences (pain, hemorrhage, shock, infection, obstetric complications, death) and costs are jarring. As Tasneem Raja recounts, “We were cut. Some of us bled and ached for days, and some walked away with lifelong physical damage.” A study based on data from six African countries found that female genital mutilation–related obstetric complications accounted for 0.1 to 1 percent of total government spending on women of reproductive age (15-45 years of age). Another study from Nigeria found that the cost of treating post–female genital mutilation complications was $120 per girl in a pediatric clinic.

This was the first arrest related to the practice in the U.S., but it was not an isolated case. Although the practice was outlawed here in 1996, according to the Population Reference Bureau, in 2013 alone, 507,000 women and girls in the United States were either subjected to genital mutilation or were at risk for the procedure.

Considering these numbers, the fact that this was the first arrest is perhaps even more surprising—or perhaps not. As the news began to circulate, it seemed that many were focusing not on the ghastly procedure, but on Nagarwala’s identity as a Muslim. Potentially lost in the periphery were details and actual discussion of the continued prominence of FGM, which is still performed in 30 disparate countries, as documented by the World Health Organization. Instead of lighting a fuse behind the indisputable need to bolster women’s rights and access to proper medical care, the hysteria around Islam’s role is ratcheting up as the story becomes a magnet for Islamophobes looking to buttress their case of why the religion is irreconcilable with American life and values.

Michigan Republican state Rep. Michele Hoitenga used the opportunity to resuscitate talk for the need of an anti-Sharia bill, which is a perpetual bogeyman for those vigilantly guarding against some mythical Islamic law supplanting American law. In an email sent to the Michigan state House, she wrote, “If you have not heard by now, a doctor in Detroit is being charged with operating an underground clinic that actively engaged in genital mutilation on young girls, essentially practicing a fundamentalist version of Sharia Law. I believe we must send a message that these practices shall not be tolerated in the state of Michigan.”

Read the full piece in Slate.

US News and World Report: White House Report Focuses on Challenges Faced by Women and Girls of Color 

The third annual report shows more work needs to be done to address structural disadvantages in school and at work.

First lady Michelle Obama hosted the stars and director of the new film “Hidden Figures” at the White House on Thursday, encouraging women and girls to take inspiration from a decades-old story of achievement in the face of discrimination and sexism that, despite the progress of the past half-century, not entirely relegated to the past.

Reflecting on the waning days of her husband’s administration, the first lady used the opportunity to offer her own spin on American exceptionalism, as demonstrated by the film’s dramatization of the true story of three African-American women working at NASA whose math skills helped launch the first manned American spaceflight.

“What we saw in this film is that when we pull together men and women, people of every background and color and faith, immigrants who’ve come here from across the globe to make America their home – when we bring all of that brainpower to the table, anything is possible, even going to the moon, right?” she said. “That is how America won the space race in the 1960s and, as I said, that approach is just as important today.”

The first lady’s comments, in the light of the incoming Trump administration, were a plea for private partners and nonprofit groups to continue press forward on efforts launched by the Obama administration to focus on the lifting marginalized groups, in particular the White House Council on Women and Girls, established shortly after Barack Obama took office in 2009.

The morning following the film screening, at a less star-studded event at the Executive Office Building next to the White House, the council released its third annual report – “Advancing Equity for Women and Girls of Color” – detailing the unique challenges women and girls of color face in school and in the workforce, part of a targeted effort to address the structural disadvantages that keep them persistently behind their white and male peers.

The report, and the multi-year initiative, focused on five objectives: reducing teen pregnancy; encouraging success in school; making science, technology, engineering and math – or STEM – education more inclusive; opening avenues to economic prosperity; and reducing the risk factors for vulnerable girls.

“We have made significant progress across these five objectives … but are aware that there is still work to that needs to happen in the years to come to strengthen the voices and capacities of women and girls of color and their peers,” the report said.

Amid the lists of programs launched and grant funds disbursed was the recognition that the obstacles facing women and girls of color remain stubbornly in place.

Students of color remain targeted at significantly higher rates for discipline and punishments meted out are often harsher.

Compared to their white peers, data collected by the Department of Education’s Office of Civil Rights, black boys were three times as likely as the overall student population to be suspended during the 2013-2014 school year. Black girls were five times as likely as white girls to receive out-of-school suspensions.

“The data show clear racial disparities in school discipline; while 6 percent of all K-12 students received one or more out-of-school suspensions, the percent is 18 percent for black boys; 10 percent for black girls,” the report notes.

African-American girls make up more than half of girls suspended in preschool, even though they comprise less than half the female preschool enrollment.

White House Report: Advancing Equity for Women and Girls of Color

Download the full report.

WASHINGTON, DC – Today, the White House Council on Women and Girlsreleased a report and will host a forum on the Administration’s work to advance equity for women and girls of color and highlight the innovative solutions and exciting place-based work that is happening throughout the country.  The forum will bring together a range of stakeholders from the academic, private, government and philanthropic sectors to discuss ways that we can break down barriers to success and create more ladders of opportunity for all Americans, including women and girls of color.  The event will be livestreamed at www.whitehouse.gov/live and the full report is available HERE.

The Council on Women and Girls, since its inception, has focused on the needs and challenges of all women and girls. In 2014, as part of the effort to take into account the distinctive concerns of women and girls, the Council on Women and Girls launched a specific work stream called “Advancing Equity” to ensure that policies and programs across the federal government take into account the unique obstacles faced by women and girls, including women and girls of color and women and girls from marginalized communities.

In November 2014, the Council on Women and Girls released a report titled “Women and Girls of Color: Addressing Challenges and Expanding Opportunities” to identify barriers and disparities facing women and girls of color. This report addressed work done over the first six years of the Administration to improve the lives of women and girls of color. It discussed important issues, such as educational attainment, economic security, health and safety, violence against women, and criminal and juvenile justice. It also included a call to action for the establishment of a federal interagency working group to develop opportunities for advancement, which commenced in March of 2015.

One year later, in November 2015, the Council released a new report “Advancing Equity for Women and Girls of Color” to highlight some of the additional steps taken by the Administration on issues faced by women and girls of color from 2014 through 2015. In that report, the Council on Women and Girls identified five data-driven issue areas where interventions can promote opportunities for success at school, work, and in the community for women and girls of color. The five issues included:

  1. Fostering school success and reducing unnecessary exclusionary school discipline by implementing supportive school discipline strategies and policies, including through public awareness of the impact on girls of color;
  2. Meeting the needs of vulnerable and striving youth by recognizing and responding appropriately to the finding that many girls enter intervening public systems through a route that begins with sexual abuse and trauma;
  3. Increasing access to inclusive STEM education to meet 21st century workforce demands and reducing opportunity gaps that affect women broadly in science, technology, engineering and math education and fields, but often affect women and girls of color the most;
  4. Sustaining reduced rates of teen pregnancy and building on successthrough expanded access to knowledge about birth control and preventive health services;
  5. Expanding pathways to economic prosperity through opportunities for job mobility and investments in fair, equitable workplace policies.

This updated report serves as a follow-up to the 2014 and 2015 reports, and as the culmination of the Advancing Equity work stream of this Administration. The Obama Administration has taken important steps forward in elevating, and addressing, key issues that cause disparities for women and girls of color, and women and girls from marginalized and underserved populations. Moreover, the call to action around this work has inspired philanthropic leaders, academic institutions, and non-profit organizations to continue efforts that sustain and build upon the successes achieved in improved life outcomes for women and girls of color and their peers.

Study: NYC Girls from Low-Income Backgrounds Face Poor Health

Low-income girls in New York City face a precarious future even before they hit their tweens, according to a report set to be released Tuesday.

The study by the New York Women’s Foundation found that by age 8, a “solid segment” of black and Latina girls start to struggle with malnutrition, obesity or asthma.

Researchers, who spoke with more than 100 experts and parents, said low-income families — especially those headed by single mothers — are not getting the support they need.

The report found many mothers, stuck at low-paying jobs , are forced to use informal, untrained caregivers because that is all they can afford.

Read the full article on NY Daily News.

Suicides of Northern Saskatchewan Indigenous Girls on Minds of Leaders

Political and indigenous leaders in Saskatchewan are heading to a northern community to try to understand why so many young girls are committing suicide.

Premier Brad Wall and Bobby Cameron, chief of Saskatchewan’s Federation of Sovereign Indigenous Nations (FSIN), are scheduled to be in La Ronge on Wednesday.Since the middle of October, six girls between the ages of 10 and 14 have taken their own lives in northern Saskatchewan, including four from the Lac La Ronge Indian band.

Cameron says one immediate step that could help is the creation of youth centres with programs after hours and on the weekend when young people are most vulnerable.

But he says there also needs to be long-term political support.

Wall said there were plans in the works to increase mental health resources in the north before the suicides, but the premier says he’s also interested in the idea of a mental health and addictions centre in the north.

“We’re going to be meeting with health care professionals,” Wall said. “We’re going to be meeting with local leaders. I’m sure we’re going to talk to families that are concerned and some of them that have gone through these unspeakable tragedies.”

Read the full article in Global News/Canadian Press.

Stand Up For Women And Girls Of Color

“Our country is not just all about the Benjamins – it’s about the Tubmans, too.”

President Obama uttered these words at the United State of Women Summit, calling to mind the thousands of women who have shaped our history in incredible ways.

As attendees of the Summit, we were delighted to hear these words, because we also took them as a reminder that we must do more to tackle the disparities that persist for women and girls of color.

Nowhere is this problem more clearly seen than here in Washington, DC – a city of great inequalities. While our region is home to some of the wealthiest and most educated people in the world, one in four women and girls here are living at or near the poverty line. And 16 percent of African-American women, and 14 percent of Latinas are more likely to live below the poverty threshold – compared with only 6 percent of white women.

At a pivotal moment when women’s educational attainment increasingly outpaces men’s, and their earning potential continues to grow, too many women and girls of color in our region lack access to the cornerstones of economic opportunity: affordable child care, workforce training for sustainable careers, and education about asset and wealth-building.

We know that however, when women and girls are given the opportunities and resources they need the impact is transformative. “Marie” is a perfect example. Growing up east of the Anacostia River in the 1990’s, she dropped out of school in the 9th grade because she was told she’d have to repeat a year. With so little formal education, she soon found herself homeless, abusing drugs and alcohol, and in an abusive relationship. Over the years, a little voice kept telling her that she had to make a change for the better, but life kept getting in the way.  Finally, at the recommendation of a friend, Marie learned that she could get the help she needed for free at the YWCA.  She enrolled in the YWCA’s education and workforce program in 2014.  Just a year later, Marie had completed her GED, received her professional certification for customer service and sales, and started interviewing for living-wage jobs that would put her on a career pathway for success.

Read the full piece in the Weekly Challenger.

African American girls’ opinions of hairstyle choices and physical activity


Received: 12 May 2015
Accepted: 10 June 2016
Published: 1 July 2016


Obesity prevalence is higher among African American adolescent (AAA) girls than among non-black girls. Lower levels of physical activity (PA) likely contribute to this disparity; this may be impacted by hairstyle concerns.

In 2011, focus groups were conducted with AAA girls 14-17 years old (n = 36) in Michigan (n = 9), California (n = 11), and Georgia (n = 16). Groups addressed perceptions of hairstyles, exercise, and relationships between the two. Groups were recorded, transcripts reviewed, and themes identified. Adolescents completed a standardized ethnic identity (EI) measure and a survey addressing demographics and PA. Linear regression was used to examine associations between self-reported activity and participants’ characteristics.

Four themes emerged: 1) between ages 8 and 15, when concerns about hairstyles began, participants changed from “juvenile” (natural) styles to “adult” (straightened) styles; 2) participants avoided getting wet or sweating during exercise because their straightened hair became “nappy;” 3) braids with extensions and natural styles were viewed as better for exercise but not very attractive; 4) participants almost universally selected long, straight hairstyles as most attractive. In Michigan and California, EI was positively associated with levels of PA (p < 0.05) and overall having extensions was also positively associated with levels of PA.

A preference for straight hair may contribute to AAA girls avoiding certain activities due to concerns about sweat affecting their hair. Furthermore, EI and hairstyle choice appear to be associated with levels of PA for some participants. Efforts to increase AAA girls’ PA may benefit from approaches that address hairstyle choices and EI.

Read the report published on BioMed Central.

Latina Teens in Milwaukee Confront Depression

Latinos born in the U.S. have a higher rate of depression and anxiety than Latino immigrants, according to studies in several medical journals.

“What has been consistent across those studies is the idea of the immigrant paradox where we find Latinos who are U.S. born have (double the rate) of depression than their immigrant or foreign-born counterparts,” said Lucas Torres, an assistant professor in the psychology department at Marquette University.

According to Torres, this paradox exists because U.S.-born Latinos are more embedded in American culture, adding stressors that immigrants do not experience. For girls such as Montes, the risk of being diagnosed with a mental illness is even higher than the general Latino population.

“Just looking at depression rates in general across ethnic groups, it is around ages 11 to 13 that there is a spike in girls,” Torres said.

At an age when identity development, which relies on the intersection of gender, sexuality, socioeconomic and ethnic backgrounds, is at its peak, the way a girl manages the stress of negotiating gender roles and pressures in her Latino household is crucial to her mental health. And for Latinas specifically, mental illnesses are more likely to lead to fatal results.

According to a 2008 study in the Journal of School Health, Latinas have disproportionately high rates of anxiety, suicidal ideation and suicide attempts. “Depressive symptoms among Hispanic adolescent females are especially alarming, with suicidal and self-harm behavior nearly three times higher than adolescents from the general population,” wrote Ritika Batajoo, an MD/MPH candidate at University of Wisconsin School of Medicine and Public Health, in her dissertation on the topic.

Listen to the story and read the full article at WUWM / NPR News for Milwaukee.