These findings, published June 4 EDT in The Lancet, are the latest results from ongoing collaborative work by 42 researchers from 17 institutions in the International Warfarin Pharmacogenetics Consortium led by University of Florida Health researcher Julie A. Johnson, a distinguished professor of pharmacy and medicine and director of the UF Center for Pharmacogenomics.

A highly effective blood thinner taken by patients at risk for strokes caused by clotting, warfarin also contributes to nearly one-third of all hospital admissions for adverse drug events.

“Warfarin dose requirements vary substantially among all patients and the perfect dose is critical,” said Johnson, the V. Ravi Chandran professor of pharmaceutical sciences at the UF College of Pharmacy. “A little high might mean bleeding risk, a little low raises a danger of a clot that can cause pulmonary embolism or stroke.”

Also known as Coumadin, warfarin is a low-cost drug option that may be prescribed for short- or long-term blood-thinning therapy. Last month, the IMS Institute for Healthcare Informatics reported that more than 33 million U.S. prescriptions for warfarin were filled in 2012.

Among all patients, warfarin daily doses range anywhere from 1 milligram to 20 milligram, and even a small miscalculation can lead to complications. It may take a couple of weeks to several months to determine the right dose without the use of genetics, leaving patients vulnerable in the process. By compiling genetic data along with other factors that affect dosing, such as patients’ weight, age and other drugs being taken, doctors can prescribe a more accurate dosage for any patient from the start. For African-Americans, however, that wasn’t enough to predict the widely variable dose of warfarin, so the researchers began looking for additional factors. They discovered a difference in one part of the genome that strongly influences how people of African-American descent metabolize these drugs.

After adding this genetic marker to dosing algorithms, co-author Minoli Perera, an assistant professor of medicine at the University of Chicago, showed a 21 percent improved predictability of warfarin dosing for the at-risk population, who often require a higher dosage.

“This finding demonstrates the potential for genetic studies, especially those applied to minority groups, to make a substantial impact on both the population and the personal level,” Perera said. “Physicians will appreciate its impact on the management of this common and difficult-to-dose drug. Patients who carry this mutation will appreciate that their doctors can start them at a lower dose that is closer to what they really require.”

Studies conducted at the University of Illinois at Chicago and the University of Chicago identified novel genetic associations with warfarin dose requirements in African-Americans. Study co-author Larisa H. Cavallari, an associate professor in the UIC department of pharmacy practice, has been a member of the consortium since its early efforts to identify a dosing algorithm for warfarin.

Existing pharmacogenetic algorithms have not accurately predicted the best warfarin dose in African-Americans, said Brian F. Gage, an internist and a professor of medicine at Washington University in St. Louis whose work is independent of the consortium.

Gage developed a website, www.warfarindosing.org, that offers a calculator for his widely used warfarin dosing algorithm for clinicians evaluating new patients or seeking scientific resources, including patient education. Johnson and her colleagues, who also have contributed a dosing algorithm to the site, believe that doctors and their patients will benefit with the addition of the consortium’s newest findings.

The consortium obtained genetic samples African-American participants with an average age of 59. To compare the results of the new dosing predictions, researchers collected genetic samples from several clinical study sites. They analyzed 533 samples from the discovery group and compared them to a 432-validation group of African-American adult volunteers — all taking maintenance dose of warfarin.

“Incorporating this gene variant into pharmacogenetic dosing algorithms could improve warfarin dose prediction in this population and help more patients arrive at their optimal dose more quickly,” said Nita Limdi, an associate professor in the department of neurology at the University of Alabama at Birmingham School of Medicine, and a co-author of the study.

The UAB, with a large demographic population at risk for health care disparities, enrolled the largest number of patients in the study.

“This newly discovered polymorphism will improve prediction substantially,” Gage said. “Furthermore, because it affects warfarin metabolism, accounting for it should significantly decrease the risk of overdosing African-Americans who are initiating warfarin.”

The consortium researchers all hope to improve patients’ outcomes worldwide by taking the next steps to apply what they have learned.

“We are currently genotyping all patients newly starting warfarin at the University of Illinois Hospital & Health Sciences System. We plan to add the new variant, described in the Lancet paper, to our genotyping platform,” Cavallari said.

The survey of 507 Floridians found that although many see undocumented immigrants as threats to their economic well-being and personal safety, they still had “pockets” of sympathetic views toward those trying to establish themselves as U.S. residents, said Tracy Irani, director of the UF/IFAS Center for Public Issues Education, or PIE Center, the research group that led the study.

“They definitely have some concerns and some less favorable perceptions about undocumented immigrants, but despite that, still, the majority feels positively about there being some pathway toward citizenship for undocumented immigrants,” Irani said. “To me, that’s the big takeaway.”

Jack Payne, UF’s senior vice president for agriculture and natural resources, said the immigration survey results point out precisely why the university must take a leading role in studying immigration and educating the public about the pros and cons of immigration reform.

“To solve an issue, you must understand that issue,” Payne said. “Immigration is a critical issue for Floridians – it’s affecting agriculture, which is a key economic driver in our state, it affects our public schools, and our health care system … we can’t separate ourselves from it.”

Irani said the study found significant knowledge gaps about current and pending immigration policy.

Among those gaps: Many respondents knew that undocumented immigrants often work in agriculture or outdoor industries, such as construction or roofing, but only 6 percent of respondents knew that many work in the hospitality industry.

About 58 percent of respondents did not know that babies born in the U.S. to undocumented immigrants are automatically granted U.S. citizenship.

And more than half of the survey’s respondents were unaware of the E-Verify system being considered as a mandatory check to see if potential employees are authorized to work in the United States, she said.

Seventy-three percent of survey respondents said they believe undocumented immigrants are a burden on the economy more than an asset, and 58 percent of respondents agreed with the statement “undocumented immigrants reduce the number of good jobs for Americans.”

Despite those negative feelings, 85 percent said the government should either allow undocumented immigrants to remain in the U.S. and eventually become citizens or require them to leave and return and become citizens only if they meet specific requirements. Only 15 percent said they would prefer the government to force undocumented immigrants out of the U.S. permanently.

The survey showed that 44 percent of respondents reported knowing someone who came to the U.S. in the last 10 years, either documented or undocumented. Thirty-nine percent of those said they consider that person a friend.

Survey respondents were asked to assign levels of importance to a number of topics, and immigration was not among their chief concerns. Only 70 percent of respondents reported it as extremely or highly important, dead last behind the economy, health care, water, the federal budget deficit, housing, K-12 education and higher education.

The survey respondents were selected as a demographically representative sample of adult Florida residents. This is the second of four surveys PIE Center officials hope to conduct every year, to track public sentiment over time. Besides immigration, the other topics include water, endangered species, and perceptions about organic and non-organic foods and agricultural practices used to grow them.

The PIE Center will host a webinar on immigration reform and its implication for agriculture on May 28. To register, go to www.piecenter.com/easy-as-pie/. The center also created an immigration webpage: www.piecenter.com/immigration.

“For years, African-Americans have been underrepresented in research,” said lead investigator Linda Cottler, chair of the department of epidemiology at the University of Florida College of Public Health and Health Professions and the College of Medicine. “Reasons have included mistrust of the medical community and actually not ever being asked to participate in research. Our study shows that while the participation rate among African-Americans has been very low, their level of interest in research is high. This is exciting news and may reflect the influence of the community engagement programs of the National Institutes of Health’s Clinical and Translational Science Awards.”

More than 80,000 clinical trials are conducted each year in the United States, yet less than 2 percent of the population participates in them. Women, the elderly, racial and ethnic minorities and rural residents are often underrepresented.

“If we’re not getting the participation of diverse groups when we’re studying medications or interventions, then we don’t know how those treatments will work in real life in different populations,” said Cottler, associate dean for research and planning at the College of Public Health and Health Professions and co-director of community engagement for UF’s Clinical and Translational Science Institute. “It’s very important for people to have a voice and be represented.”

The new study was designed to learn the health concerns and research perceptions among underrepresented groups with the goal of improving inclusiveness and relevance of health research. The study was conducted by five universities that are recipients of Clinical and Translational Science Awards: Washington University in St. Louis; the University of California, Davis in Davis, Calif.; the
University of Michigan in Ann Arbor, Mich.; Albert Einstein College of Medicine of Yeshiva University in New York City; and the University of Rochester in Rochester, N.Y. Community health workers in those cities interviewed adults at local gathering spots, such as barbershops, parks, bus stops, churches, grocery stores, laundromats and health fairs.

Among the 5,979 people interviewed, the top five health concerns were high blood pressure, diabetes, cancer, weight and heart problems. Safety and crime were two of the highest-ranked neighborhood concerns.

When asked about their overall interest in medical research, 91 percent of African-Americans expressed an interest in participating compared with 85.5 percent of whites, 84.5 percent of Hispanics and 79 percent of Asians. African-Americans were more likely than other racial groups to express a willingness to participate in research even when it may involve providing blood or genetic samples, granting access to medical records or staying overnight in the hospital.

“This is a groundbreaking study that demonstrates that members of minority communities are interested in research, especially around the diseases and risk factors that are most common in their families and communities,” said Dr. Lloyd Michener, chair of the department of community and family medicine at the Duke University School of Medicine, which was not involved in the study. “As many traditional studies struggle with recruitment, this study suggests that the problem may lie with the lack of awareness of researchers with the methods of community engagement, rather than lack of interest or willingness to engage in research among members of these communities.”

The five universities involved in the current study, along with the University of Florida, are now focused on a new study that aims to better understand outcomes of community engagement programs.

There are many barriers to participating in medical research, and not just for minorities, Cottler said, such as the time of day of required study visits and navigating university campuses. HealthStreet, a community engagement program Cottler founded in St. Louis and Gainesville, Fla., seeks to reduce disparities in health care and improve access to research studies among people who are medically underserved by meeting people out in the community and linking them to services and research opportunities.

“We’re trying to do studies in the community so that it’s much easier for people to participate,” Cottler said. “We are bringing the research to the community instead of bringing the community to the research.”

“We wanted to take a step back and do within-group comparisons of black men with prostate cancer who are native-born African-American, African immigrants and Caribbean immigrants,” said Folakemi Odedina, a UF professor of pharmacy and associate director of health disparities for the UF Shands Cancer Center. “These groups are all genetically predisposed to get prostate cancer, but when you look at their experiences in terms of how the disease affects their lives and how they cope with it, there are a lot of differences among them.”

Odedina’s three-year study, funded by a $1.02 million Department of Defense grant, is the first to compare differences in morbidity, quality of life and survival among diverse groups of black men, who experience a 60 percent greater risk of developing prostate cancer than whites, according to the National Cancer Institute. That risk more than doubles for men with a father or brother who has had prostate cancer. Black men also are more likely to be diagnosed when their cancers are at an advanced stage, and they are more than twice as likely as white men to die of the disease.

“Our study will use ‘grounded theory’ to look at the broad continuum of prostate cancer care for these men in an effort to understand how to successfully deal with the disease through every phase, including prevention, detection, diagnosis, treatment, survivorship and advocacy,” Odedina said.

Grounded theory is a form of ethnographical analysis wherein investigators don’t begin with a hypothesis as the theoretical framework for the study. Instead, investigators begin by collecting data — in this case, interviews with black men and their wives or caregivers about their experiences, beliefs and feelings about the detection, treatment and survival of prostate cancer. During the grounded theory process of social-science super sleuthing, hypotheses are then reverse-engineered from the data.

To capture this data, 2,000 black men will be randomly selected from the Florida Cancer Data System database. In 2010, the most recent year for which data are available, that database represented about 38,000 black men in Florida.

Investigators will contact each man via telephone or postcard in an effort to identify which group he may fall into, whether native-born African-American, African immigrant or Caribbean immigrant. Sixty of these men will be asked to participate in in-depth interviews, some of which will use a method called “photo voice.” In this method, each participant is given a disposable camera and asked to take photos over the course of a week of people, places and objects that define his prostate cancer experience. At the end of the week, the photos are printed and each man is asked to tell the stories behind the photos and their impact on his prostate cancer experience.

As part of the prostate cancer care and survivorship model for black men, the study also will produce a video documentary of 30 of the men and their caregivers talking about the full range of their prostate cancer experiences. The team also will explore the process of how men move from being prostate cancer patients to becoming prostate cancer advocates in their communities. Workshops throughout the state will take place during the final phase of the effort, to report findings back to African-American, African and Caribbean communities and to cultivate prostate cancer advocates in those communities.

“I think the whole thing we have to look at, in reality, is that for many people, the word cancer conjures up such fear that the fear often times overrides the individual’s need to get the facts that will enable them to fight the disease,” said Virgil H. Simons, a prostate cancer survivor and founder of The Prostate Net, an international, not-for-profit prostate cancer patient advocacy organization. “This study is important because it will help people understand some of those things can be controlled and dealt with on an individual basis, and identify those things that can be addressed on a community basis.

This is the first accurate estimate of the frequency of the proteins, called autoantibodies, the researchers say. The findings appear online and in an upcoming print edition of the journal Arthritis and Rheumatism.

“This study is a baseline that can help physicians understand, when they identify autoantibodies, how often these proteins indicate disease,” said lead author Edward Chan, a professor of oral biology in the UF College of Dentistry.

The body produces proteins called antibodies to fight against infections, but in some cases, these proteins become turncoats, attacking the body’s own tissues instead. The most common autoantibodies, called antinuclear antibodies, are frequently used as a marker for autoimmune diseases. Although antinuclear antibodies are common, their presence does not always indicate disease.

Chan, and co-lead author Dr. Minoru Satoh, an associate professor of rheumatology and clinical immunology in the UF College of Medicine, along with national colleagues, studied five years’ worth of data from almost 5,000 people, collected through the National Health and Nutritional Examination Survey. The survey amasses a host of health information from adults and children around the country using questionnaires, blood tests and other medical examinations.

No previous researchers have used such a large sample, representative of the general population, to study how frequently autoantibodies occur, Chan said.

The researchers looked for the rogue antibodies in blood serum using an advanced microscope technique that uses a fluorescent dye to selectively light up antinuclear antibodies.

They found that nearly 14 percent of the study population had antinuclear antibodies. The antibodies were more common in African-Americans, women and older adults. The frequency of antinuclear antibodies tends to increase with age then level off over time. And women were more likely to develop antinuclear antibodies as they age.

Unexpectedly, autoantibodies were less common in overweight and obese individuals than in people of normal weight.

“Being obese is often considered a factor contributing to many autoimmune diseases,” Chan said. “So we expected that overweight people might have more autoantibodies. But that is not what we observed.”

Judy Van De Water, a professor of rheumatology and clinical immunology at the University of California, Davis, who was not part of the study, was intrigued that autoantibodies were less common in overweight individuals. She chalks it up to the appetite-reducing hormone leptin — which is produced in fatty tissue and acts as a marker of inflammation. Leptin is often low in people who are obese but high in people who have antibodies that attack the body’s own tissues.

Future studies might look at how exposure to chemicals and other substances in the environment affects the levels of antinuclear antibodies in the immune system, as well as how those levels change over time.

“This is an important study that will serve as the basis for future research on the causes of these antibodies and related diseases,” said the study’s senior author Dr. Fred Miller, acting clinical director of the National Institute of Environmental Health Services, which funded the study. “It’s a first step in the process.”

The county has become a new destination for undocumented immigrants looking for work. With a history of racial conflict and tensions growing between natives and newcomers, it’s not the kind of place that fosters a bright outlook.

But while interviewing an elderly conservative barber for a new book, Williams, a University of Florida professor, discovered some optimism toward the gridlocked discussion on immigration.

The barber asked his grandson how many Hispanic children attended his school. The boy responded, ‘I don’t know, Papa. We’re just all the same.”

The interview with the barber is one among hundreds that went into “Living ‘Illegal,’ The Human Face of Unauthorized Immigration,” a new book that records the stories of both undocumented immigrants and the natives of the communities they inhabit.

Williams, director of the Center of Latin American Studies, and Manuel A. Vásquez, a UF professor of religion, co-authored the book with Marie Friedmann Marquardt and Timothy J. Steigenga. The book is scheduled to be released Oct. 8.

The authors spent 10 years working in immigrant communities in Florida and Georgia, and wrote the book to focus the national conversation about immigration on the human aspects of the issue.

In the past, the topic has produced polarized shouting matches but no “informed, humanized” discussion, Vasquez said.

“This book is an attempt to say that the issue is more complicated than it seems,” he said.

In their research, the authors found that immigration is a moral and ethical issue and cannot be defined in simple “approve and disapprove” terms.

“The attitudes people hold toward immigration are a lot more ambiguous than we think,” Williams said. “The issue isn’t as black and white as our politicians make it seem.”

The book does not advocate for open borders but does suggest a more humane immigration reform that will benefit America as a whole and the immigrants themselves.

“Right now, immigration is a lose-lose situation,” Vasquez said. “These people’s home countries lose their best and brightest people. America loses when it doesn’t accept these skilled people who potentially could add a lot to our society.”

Vasquez and Williams, a professor of political science and Latin American studies, hope the book will help put a human face to the issue.

“We wanted to humanize the debate on immigration,” Williams said. “Our lives are very often entwined with those of immigrants. They are our co-workers. Their kids go to school with our kids. They worship alongside us. They play a huge role in our communities.”

While the authors hope for comprehensive immigration reform, they are not optimistic about its prospects in the short term. Politicians show no sign of rethinking their hardened positions to compromise on the issue, Williams said.

But even if the politics look bleak, Williams holds on to hope that the issue will resolve itself in the future. When he’s pessimistic about the current state of affairs, he remembers the barber’s grandson in Georgia and how every generation seems to be less fixated on cultural differences.

“If I’ve learned anything from this,” he said, “it’s that even in the most unlikely places, there is cause for hope.”

“My husband is still sick,” she responds, as the friend offers Teresa a jar of honey, the only “remedy” at hand for the husband’s ongoing cough, fever, and night-sweats.

That is how the first chapter begins of the Spanish-language novela “¡Vivir a Todo Pulmón!” or “Live Life to the Fullest!,” a 40-page recently released series that addresses misconceptions about tuberculosis, or TB, to better inform communities vulnerable to the disease.

Modeled after the storyline of a stereotypical Latin-American soap opera, the “fotonovela” is less high-drama and more reality TV.

“The idea was to create a story understandable to a Latino audience, but identifiable to the Mexican community,” said Dr. Paula Hamsho-Diaz, a physician with the Southeastern National Tuberculosis Center, part of the University of Florida College of Medicine and UF Emerging Pathogens Institute. “Proportionately, there are more foreign-born cases of TB and that’s why these resources are useful.”

Nearly 10 million new cases of TB appear worldwide each year and about 2 million people will die from the disease. The Florida Department of Health estimates that about 900 people will get active TB this year in the state, and that 60 percent of these cases are among people born in countries with a high incidence of TB, including Latin America and the Caribbean.

In the fotonovela, which is similar to a graphic novel but uses photographs instead of drawings, Teresa accompanies her husband to doctor’s office visits, social events and Mass on Sundays — scenarios in which they then address the concerns and stigmas that family members, friends or co-workers living with TB might face. Hamsho-Diaz led the team that created the fotonovela, which took three years to develop and evaluate how appropriately cultural themes were incorporated into the story.

“This is definitely something you can have on the kitchen table,” said Joseph Brueggen, a disease intervention specialist in Immokalee, Fla.

Brueggen, who educates mostly Spanish-speaking migrant workers about the importance of medication compliance if they contract the illness, added that the novela was the best educational tool he’s used in his more than 25-year career.

“I’ve noticed that it really touches these people in their ordinary lives, and this is important because sometimes a person’s immigration status deters them from going to a health clinic,” he said.

Tuberculosis is an airborne disease caused by strains of mycobacteria that attack the lungs and pose a range of symptoms for people who acquire the illness, most notably a characteristic chronic cough often accompanied by blood-tinged sputum. Although TB is treatable, new strains of the disease are showing resistance to currently available antibiotics, and a patient’s inability to stay on a medication regime promotes resistance in the organism.

However, experts caution that TB should not be seen as an illness exclusive to immigrant communities. In counties outside of Atlanta, for example, Georgia state health officials document a rise in TB among African-American men, who already have a national disease rate eight times above that of U.S.-born whites.

“Reaching out to groups with a high incidence of TB is critical to ensure that all of us are safe from this potentially life-threatening disease,” said Dr. Michael Lauzardo, director of the Southeastern National Tuberculosis Center and chief of the division of mycobacteriology in the UF College of Medicine. “Tuberculosis is a disease that cannot be considered truly controlled anywhere until it is controlled everywhere.”

The Southeastern National Tuberculosis Center is one of four national tuberculosis centers funded by the Centers for Disease Control and Prevention that provide TB training, education, and expert medical consultation to health professionals and TB Control Programs in the United States and abroad.

To access the fotonovela, visit http://sntc.medicine.ufl.edu/Products.aspx.

To assess attitudes among white voters in a southern state about Barack Obama’s historic election to the presidency, two UF political scientists analyzed results from four statewide telephone surveys — each involving between 449 and 829 respondents – conducted in the fall of 2008 and spring of 2009. Their study was published in the August issue of the electronic journal The Forum.

“We didn’t see a lot of evidence that race was paramount in the way people thought about Obama,” said Michael Martinez, a UF political science professor who did the study with UF political scientist Stephen Craig. “In fact, quite a number of white Floridians – both those who are Republicans and those who are Democrats – took pride in a black man being able to secure the nomination and win the election.”

They estimated that two-thirds of white non-Hispanic Floridians surveyed – 65 percent – were “proud or inspired” by a black candidate’s ability to win his party’s nomination for president. While that sentiment was nearly universal among those who preferred Obama – 89 percent – it was also shared by a substantial number of McCain supporters, 47 percent.

“I was surprised by the magnitude of the pride factor and that it extended into the McCain camp at a time when there were plenty of hard feelings on both sides,” Craig said.

Despite these positive feelings, the study found that racism persists. An estimated one-third of the respondents – 34 percent – were upset by “blacks pushing themselves where they are not wanted,” a statement used in the survey to assess racist sentiment.

“There are still racists out there, but they appear not to be applying those attitudes to a political campaign in which one candidate happens to be an African-American,” Craig said. “It could be that for many of these people race is more important when it comes to who their daughter is dating or which family is moving next door to them than it is in a political context.”

Part of the reason that race did not emerge as a major issue in the election may stem from Obama’s biracial background and his efforts not to call attention to his blackness, Martinez said.

“During the campaign Obama went out of his way to try to overcome any anticipated problems with racially conservative white voters by noting that his mother was white and he was raised a good portion of his life by white grandparents,” Martinez said. “It was no accident that he emphasized Midwestern values as a way to connect with white America.”

Perhaps more important than Obama’s image is the growing partisan nature of American politics and tendency for voters to see the last presidential election as a referendum on the Bush administration, illustrated by the Obama campaign’s twin mantras of “change” and “no third term,” he said.

“Many people judge political candidates by the state of the economy,” Martinez said. “In 2008 this country’s economic situation was not doing well prior to September and it was doing terribly afterwards, which really handicapped McCain going into the November election.”

Measuring prejudice can be tricky because people are often reluctant to reveal socially undesirable responses, Craig said. The researchers got around this by using a technique designed to ask about racial attitudes indirectly, he said.

In each survey, participants were divided into different groups. In the first survey, for example, one group was asked to state how many of four statements, such as “the way gasoline prices keep going up” upset them – but without revealing which ones. Another group responded to the same statements as well as one additional one: “a black candidate running for president.”

Any difference in the average number of upset-generating statements given by the two groups was then attributed to the additional item about a black candidate, Craig said.

In two of the other surveys, respondents were asked to respond to the same four statements. In one, the additional statement was whether they were upset by “a black man being elected president,” and in the other if they were upset by “blacks pushing themselves where they are not wanted.”

One survey also asked respondents whether a different set of four statements, such as “American athletes participating in the Olympics” made them proud or inspired. The additional statement some respondents received was “the fact that a black candidate is able to win his party’s nomination for president.”

The study is accessible online at http://www.bepress.com/forum/vol8/iss2/art4/.

GAINESVILLE, Fla. — The story of Christopher Columbus and the people he encountered when he arrived in the Caribbean has yet to be truthfully conveyed in books used by elementary school students, a new University of Florida study finds.

Long before Columbus Day arrives Oct. 12, an overwhelming majority of books used by children in libraries and classrooms have presented outdated information and outright distortions about the explorer’s expeditions, said UF researcher Donna Sabis-Burns. She did the study for her doctoral dissertation in the school of teaching and learning in UF’s College of Education.

“Picture books are usually the first time children are exposed to the story of Columbus, so they need to be truthful,” she said. “Unfortunately, these books are telling our children a history that is filled with omissions and misrepresentations.”

Referring to the native people as savages when Columbus kidnapped hundreds into slavery and his shipmates raped local women are among the most glaring examples of falsehoods, said Sabis-Burns, who is now a team leader with the U.S. Department of Education’s School Support and Technology Program in Washington, D.C.

Within the sample, most of the books are widely outdated at more than 10 years old, Sabis-Burns said. Less than 2 percent of the volumes contain more readily available information that became increasingly visible in 1992 as scholars released new findings to coincide with the 500th anniversary of Columbus’ first expedition to the New World, she said.

The week after Columbus Day in 2008, Sabis-Burns sent an online survey to school districts, teachers and national education listservs in 39 states about which reading materials they used on the explorer. She received responses from 189 teachers and 89 librarians, who provided a list of 182 books, which she analyzed for content.

Six out of 10 books failed to identify the native Taino people whom Columbus encountered by their tribal affiliation, calling them simply “Indians” or “natives” and even “gentle heathens” or “naked, red-skinned savages,” Sabis-Burns said.

“Without these people, Columbus never would have survived,” she said. “Had it not been for the Tainos, his voyages would not have been successful.”

The Tainos showered Columbus with much-needed food and showed him how to navigate the Caribbean islands, Sabis-Burns said.

Many of the books claim that the Tainos became extinct, even though about 600 descendants survive in small pockets of Cuba’s Guantanamo Mountains, she said.

While book publishers are beginning to release books for older children with more details about the Tainos, the practice has not extended to the picture book genre shared in today’s classrooms within the survey sample, she said.

Seventy-seven percent of picture books analyzed in the study use either oversimplified descriptions or primitive depictions of the native people, Sabis-Burns said. Less than half describe Taino trading items, traditional dress, agricultural practices or other aspects of their culture, many of which were never documented as belonging to the Taino, she said.

“It is not my intent to load picture books with men raping women or murdering them in the illustrations,” she said. “My point is that the books don’t tell what happened to the Taino at the hands of the Spanish.

“On his first voyage Columbus kidnapped several Tainos and shipped them back to Spain to be sold into slavery because he was afraid he would not have enough riches to compensate Spanish royalty for financing his trip,” she said.

On his next trip, Columbus seized hundreds more Tainos as slaves, many of whom died and were tossed overboard before his ships reached Spain, she said.

The Tainos killing of 39 men left behind after Columbus’ ship crashed into a reef on the island of Hispaniola was not unprovoked as presented in some of the sample picture books, Sabis-Burns said. Before Columbus returned a year later to the La Navidad settlement to find his men gone, the Europeans forced the Taino to work the fields and raped women, she said.

Sabis-Burns said the two most widely used books were written in 1980 and 1992, despite the publication of at least 150 picture books on Columbus since 1992.

“Dr. Sabis-Burns has brought this country’s deep resistance to correcting the story of Columbus taught to our children to the surface with her research,” said Nancy Rankie Shelton, an education professor at the University of Maryland, Baltimore County. “Year after year, schools across our nation celebrate Columbus Day with the youngest of our citizens, never once thinking about or teaching the destruction he caused the Taino people.”

The study also showed that taking stock of socio-cultural factors might improve our understanding of how genes influence individual health — regardless of race.

Consider high blood pressure, a complex disease governed both by genetic and environmental factors. Not only was social classification better than genetic-based ancestry at predicting disease status, it also brought to light a link between a particular gene and blood pressure that was not apparent when only genetic ancestry was considered.

The study, published today in the journal PLoS ONE, is the first to rigorously combine both socio-cultural and genetic data to simultaneously test the relative contributions of each to racial inequalities in health.

“What’s really groundbreaking is that we’ve got both types of data and they’re of equivalent sophistication,” said co-author Connie Mulligan, an associate professor of anthropology and an associate director of the UF Genetics Institute.

The results suggest that previously reported associations between genetic ancestry and health might be accounted for by socio-cultural factors related to race and racism, and not necessarily to genetic differences between races. It also suggests that including socio-cultural factors can strengthen genetics studies and help reveal how social inequalities can lead to biological differences.

“We have to take seriously the way race shapes people’s experiences, the environments they live in and their life chances,” said lead author Clarence C. Gravlee, an assistant professor of anthropology at UF. “In day to day life, people often assume that race exists as biology. Most anthropologists and geneticists reject that idea and see race instead as a cultural construct. The point of our paper is that race is so embedded in our society that it affects biology by shaping the types of environments that people live in.”

How social and or genetic factors drive racial inequalities in health and the role of race in genetic and biomedical research are the source of much controversy and study. Some scientists see race as useful for pinpointing gene-based susceptibility to complex diseases, but others caution that looking at race from a purely genetic standpoint can mask social causes of racial inequalities.

“We have to look at these in a way that will allow us to tell the whole story, not from one side or the other,” said Jay Kaufman, an associate professor of epidemiology, biostatistics and occupational health at McGill University and author of the upcoming book “Racing in Circles: Myths about Genes and Race in Biomedical Research.” Kaufman was not involved in the UF study.

In general, members of racial minorities in the United States suffer poorer health, and more die prematurely compared with their white counterparts. African-Americans are three times more likely than whites to die from high blood pressure, according to the American Heart Association.

“The sheer scale of inequalities in sickness and death deserves our attention,” Gravlee said. “Researchers have an obligation to explain the origins of these inequalities and to identify social factors that could be targeted for policy change.”

To examine the link between African ancestry and blood pressure, the UF team studied 87 adults in Puerto Rico, using two variables for which “race” is often used as a surrogate: genetic ancestry and social classification.

Genetic ancestry was assessed using gene variants that show large frequency differences among groups from different continents. Social classification was assessed by observers to estimate how people are perceived in everyday life in terms of skin pigmentation, or “color” (pronounced coh-lohr). The researchers found that the three major “color” categories had overlapping genetic ancestry, and that there was a strong link between “color” and blood pressure, but not between genetic ancestry and blood pressure.

Next, they looked at whether taking account of social factors changed our understanding of genes thought to affect hypertension. When only genetic ancestry was considered, no association was evident between candidate genes for hypertension and blood pressure. But when “color” and socio-economic status were included in the analysis, a significant association between the gene variant and blood pressure was uncovered.

“One of the important points here is that you can have an association between two biological variables like genetic ancestry and blood pressure, but it could be that the social and cultural implications of having African ancestry is what is driving this association,” Gravlee said.

Health differences could arise from differing stresses people face based on how society sees and treats them.

“There’s no doubt about the fact that perceptions matter,” Kaufman said. “This article reinforces the idea that if you don’t pay attention to how people are perceived you miss a big chunk of the story.”

The researchers found that the group of people who carried the associated genetic variant also contained multiple categories of “color” and socio-economic status. When these different socio-cultural categories were separated, the protective effect of the genetic variant became evident.

”What’s exciting about our study, is that we can show the value of including socio-cultural data by revealing a genetic association that would otherwise have been missed,” Mulligan said. “This is important in convincing other researchers that it is worthwhile to include nongenetic data in a genetic study rather than simply controlling for nongenetic factors.”

Many pundits claimed that newly registered black voters inspired by Obama’s candidacy to flock to the polls resulted in states narrowly approving amendments that opposed legalizing gay unions, said Daniel Smith, a UF political science professor and the study’s co-author.

However, Smith’s study found that education levels were about five times as important as race in Florida counties’ approval of Amendment 2, which defined marriage as a legal bond strictly between a man and a woman in the state’s constitution. Smith is scheduled to present the findings to the American Political Science Association in Toronto on Thursday.

“Our research challenges the assumption that the surge of black voters who turned out in unusually large numbers in support of Obama were also in favor of banning gay marriage,” Smith said. “We found that it really wasn’t race that led to an increased support for a ban on gay marriage but whether or not someone was educated.”

Controlling for other socioeconomic and political factors, for each additional 1 percent of a county’s population with a bachelor of arts degree, there was nearly an equal 1 percent decrease in support for Amendment 2, Smith said. By comparison, every 1 percent increase in a county’s black population led to only two-tenths of a percentage point increase in support for Amendment 2, he said.

“Education is so important because it increases exposure to those who are different,” he said. “Studies show very clearly that the more educated people are the more tolerant they are of differences.”

Because blacks tend to be conservative on social issues and attend church in large numbers, blacks were expected to hurt prospects for legalizing gay marriage, Smith said. Dozens of post-election news stories and political blogs drew upon exit polls to blame the surge of black voters for the passage of anti-gay marriage measures in California and Florida, he said.

According to CNN exit polls in Florida, 71 percent of black voters cast ballots for Amendment 2, compared with 60 percent of white voters, Smith said. Even among young people between the ages of 18 and 29, who tend to be more supportive of same-sex marriage, 71 percent of blacks supported the measure, compared with 49 percent of whites, he said.

But respondents may feel pressured to give socially acceptable answers in exit polls, and the margin of error is high because of the small sample of blacks, Smith said.

“Our analysis suggests that these public opinion polls may have overstated the extent to which black and white voters differed on the issue of same-sex marriage,” he said. “We found that party identification, education and religiosity were much stronger predictors of a respondent’s attitude toward gay marriage than race was.”

Gay rights groups have questioned whether the black community is worth engaging in their efforts to win approval for same-sex marriages, Smith said. States that have passed these measures, including Iowa, New Hampshire and Maine, are largely white, he said.

“A very vibrant debate is going on in the gay and lesbian community about whether there should be any outreach towards minorities, particularly African-Americans,” he said. “Our research shows that writing off the black community, especially these newly mobilized voters that Obama brought into the fold, is very short-sighted.”

Equality Florida, one of the two major organizations in the state to campaign against Amendment 2, targeted blacks in its efforts to oppose the measure, Smith said. In studying polling data before the election, the group’s leaders believed blacks, though socially conservative, could be persuaded to align themselves with the gay rights cause, he said.

“They were able to approach and engage the African-American community that this is an issue of importance to the black community by making arguments along civil rights lines,” he said. “Equality Florida just lacked the financial resources to make the case to Obama supporters.”

Smith collaborated with Stephanie Slade, a political science graduate student at American University who did the research while an honors undergraduate student at UF.

In a study of 63 elementary schools in Chicago, researchers found there were 29 alcohol ads on average in the two-block radius surrounding schools with larger Hispanic populations compared with an average of four ads around schools where less than one-fifth of students were Hispanic. In all, the researchers counted 771 alcohol ads around the 27 schools with more Hispanic students and only 160 ads around the 36 schools with fewer Hispanic students, the researchers recently reported online in the journal Ethnicity & Health.

“This is a concern because we know from past research that exposure to ads is associated with alcohol use and intentions to use alcohol,” said Kelli Komro, an associate professor of epidemiology in the UF College of Medicine and Institute for Child Health Policy and the study’s principal investigator. “We also know from previous research that Hispanic children are at increased risk for alcohol use at young ages.”

The ads around these schools were also more likely to contain cartoon images and animals, which other studies have shown can influence children, Komro said. Some of the ads, which ranged from billboards to signs around stores and bus stops, also seemed to attempt to tie into Hispanic culture by featuring Spanish words and the colors from the Mexican flag. About 70 percent of Chicago’s Hispanic residents are Mexican, the study states.

The schools the researchers studied were all located within the city limits of Chicago and most housed kindergarten through eighth-grade classes. Most of the students in these schools were from racial minorities — about half the children were African-American, while about 25 percent were Hispanic — and came from low socioeconomic backgrounds.

One key difference was that schools with more Hispanic students tended to have fewer African-American students and vice versa.

Overall, students were about seven times more likely to see advertising if they attended a school with at least a 20 percent Hispanic student body.

There are more than 45 million Hispanic people living in the United States, about 10 million more than there were in 2000, according to the Pew Hispanic Center. A report the center released this month shows that the bulk of the population boom stems from more Hispanic children being born here rather than immigration. About 20 percent of public school students across the country are Hispanic, the report shows.

“According to previous studies, Hispanic youth are at higher risk for alcohol use than either white or African-American youth,” said Keryn Pasch, an assistant professor of kinesiology and health education at the University of Texas and the study’s lead author. “Exposure to alcohol advertising has been shown to increase alcohol use and intention to use alcohol, and marketers are aggressively capitalizing on the rapidly growing Hispanic population, targeting their marketing efforts at this group. Given these facts, I think it’s critical to determine if alcohol advertising around schools is related to the ethnicity of the students and, if it is, to take steps to reduce the exposure of high-risk groups to this negative influence.”

To combat the problem, communities could band together to demand to have fewer alcohol ads around schools. This occurred in several African-American communities in Chicago where organizers were able to successfully lobby for fewer alcohol ads, Komro said. Also, ordinances that limit advertising around schools could be strengthened to further shield children from alcohol advertising, Komro said.

“Policies could be expanded to a wider range around the schools, especially given what we know about how effective ads are, both alcohol and tobacco ads, in influencing children’s behavior,” Komro said.

But before you write off a nonreligious teen as one not bound for college, take note: Researchers still aren’t sure why “religiosity” and college graduation are connected.

“For most religious communities represented in our study, there is a strong correlation between religiosity and degree attainment,” said Ana Puig, research director and affiliate faculty member in counselor education at UF’s College of Education. “However, correlation does not mean causality.”

Puig and UF counselor education professor Mary Ann Clark joined UF alumnus Sang Min Lee in an analysis of data from the National Educational Longitudinal Study, a massive, federally funded study of student outcomes that began 20 years ago. Lee, who is now a professor at Korea University, was the principal investigator on the project.

The study, which appeared late last year in the journal Counseling and Values, won the Biggs-Pine Award for Writing Excellence this spring from the Association for Spiritual, Ethical and Religious Values in Counseling.

The researchers used data from a survey of 11,551 eighth-grade students in 1988 – a survey that asked a number of lifestyle-related questions, including questions about religious faith – and compared it with information collected from the same students eight years after they graduated from high school.

They found that among most religions or denominations, students who self-identified as “very religious” in eighth grade were far more likely to have, or be on their way to getting, a college degree – when compared with students who said they belonged to a religious faith, but identified as “not religious” or “somewhat religious.”

The effect was most pronounced in the Muslim community, with “very religious” Muslim students nearly four times as likely to attain a degree as “nonreligious” Muslims. All other groups in the study showed a statistically significant increase in degree attainment among “very religious” students.

The effect was negligible or nonexistent in groups with high across-the-board degree attainment, including Jewish students, Episcopalians and students who identified as belonging to the broad group of “Eastern religions.”

When the results were broken down by ethnicity, the researchers found that a high degree of religiosity was related to degree attainment in white, African-American and Hispanic students. Lee noted that religiosity was not a significant factor in degree attainment in the Asian-American population.

The researchers say relationship between religiosity and degree attainment may be due to certain positive behavioral effects related to participation in a religious group. They cite previous studies that link religious participation to reduced delinquent behavior – a factor likely to affect educational outcomes.

They also note that some parents of academically successful children cite religious values as a factor in their success. Clark has been conducting interviews with parents of secondary school students for an unrelated study on gender and school achievement, and she says the topic of religiosity comes up quite often.

“I’ve been surprised at how often parents brought up religion as a factor in their child’s academic performance, even though we weren’t even asking about it,” Clark said. Even so, it is possible that good grades and religious involvement stem from the same root cause, such as a specific parenting style, the researchers said. The researchers also note that the survey suffers the same flaws as any other study using self-reported data, and that the results may reflect a tendency, among high-achieving students, to portray themselves in a positive light.

While the study shows outcomes of students who identify with a religion and still describe themselves as “nonreligious,” it does not reflect the religious outcomes of atheists or agnostics. While the survey allowed students to select “none” as their religion, respondents in that category were too few to be included in the analyses. The same was true for Mormon respondents and those who identified as “other Christian” and for Native American students.

However, the study does offer insights that teachers and counselors can use in improving student performance, Clark said. Because religious differences are often too hot a topic for the classroom, Clark said, educators may feel inclined to steer conversation away from the topic of faith. However, it is important that educators listen to what students are saying, and acknowledge the role religion may play in their school lives.

“Students and parents are saying that religion is an important part of their academic lives, and we need to listen to that,” Clark said.

GAINESVILLE, Fla. — For black people, it doesn’t matter whether their color shows up in pigments or pixels. Doctors may be less likely to heed their complaints either way.

So suggests a new study that used virtual patients — computer-generated people able to carry on a limited conversation with human counterparts — to test how medical students respond to white- and dark-skinned patients. The study found that the white third-year students were less empathetic with dark-skinned than light-skinned virtual patients during brief one-on-one interviews, suggesting racial bias extends from real people to their virtual representations.

“You are seeing a transfer of bias come through the screen,” said Benjamin Lok, an assistant professor of computer and information science and engineering.

Lok is one of five authors of a paper on the study set to appear this fall in the journal Intelligent Virtual Agents.

He also is the lead investigator of a four-year-old research project, funded in part by the National Science Foundation, aimed at using racially diverse virtual patients as a new tool to train medical students to identify and avoid racial bias — a kind of human-relations equivalent to the equipment used to train pilots.

“We’re hoping that in the future, we will be able to automatically detect bias and, then and there, help medical students out,” Lok said. “That’s really our goal: An interpersonal simulator, just like a flight simulator, to help people get better at this skill of interacting with people who come from different racial and ethnic backgrounds.”

Deeply embedded racial bias against minorities has been a hot issue in medicine since at least 2002, when “Unequal Treatment,” a national study of the phenomenon commissioned by Congress, was released.

The study found that racial and ethnic minorities consistently receive lower quality health care than their white counterparts and attributed the problem in part to bias or prejudice — bias all the more pernicious because it may be unconscious. Such unequal treatment is thought to be one reason that minorities, especially blacks, consistently suffer higher rates of many serious diseases.

Lok said medical schools use actors or actresses in role-playing scenarios for a wide range of medical training, including helping future doctors combat racial bias. While the actors can be highly effective, they also come with logistical challenges, he said. For one, actors may not be available, especially in states or cities with low minority populations. They are expensive. And they cannot offer all the students exactly the same experience, he said.

Virtual patients pose none of these problems, Lok said. But before educators can embrace them, they must know practitioners respond to virtual people as they do real people.

The researchers used virtual patient technology developed in Lok’s UF laboratory. The technology taps voice recognition software to allow people to speak normally with the virtual patient, who appears on a projected screen. The human subject wears a hat studded with special tape that reflects infrared light. Detectors pick up the reflections, informing the computer of the motions of the subject’s head. This allows the virtual patient to move his or her head in response andmaintain eye contact during conversation.

The researchers divided a group of almost two dozen third-year medical students at medical school in the Southeast, with half the students interviewing a light-skinned virtual woman, the others a dark-skinned woman. But for the skin tone, the virtual women had the same voice, animation and appearance. Medical faculty and other observers watched recorded videos of the students in the interviews, but the observers were blinded to the skin color of the virtual patient. They then rated the students’ empathy toward the woman’s medical complaints, using a standardized scale.

The observers rated the students interviewing the dark-skinned woman as consistently less empathetic. The results correlated with standard psychological tests of the students, tests that showed they had an unconscious bias against minorities.

The technology is so new that Lok said it “barely works” – for example, the virtual patient may misunderstand the human user and respond with a non sequitur. But Lok said he is confident it will improve rapidly.

Brent Rossen, another author of the paper and a UF graduate student, said most of the medical students in the trial were keen to use it, because they recognized its intrinsic value.

“These are people who want to treat others equally, but racial bias is a very subconscious thing, and in the end it really has to be trained out,” Rossen said. “One way to do that is through repeated exposures to the subject of the bias, which is where this research comes in.”

Lok, Rossen and Kyle Johnsen, a graduate student at the time of the study who has since earned his Ph.D., collaborated on the study. The two other authors were Dr. Adeline Deladisma, a medical resident, and Dr. Scott Lind, chief of surgical oncology, both of the Medical College of Georgia.

“Within African-American and Latino families, children follow a cultural tradition that places a high value on respecting, obeying and learning from elders, and in our study they did indeed show more respect for parental authority,” said Julia Graber, a UF psychology professor.

However, when African-American and Latina girls do act up, their mothers consider the arguments more intense than those reported by white mothers who clash with their daughters, said Graber, whose study is published in the February issue of the Journal of Family Psychology.

Hispanic and black mothers, who value strong family connections, a deep sense of family loyalty and the importance of extended family and social support networks, seemed to be much more upset if daughters fell short of cultural, good girl expectations, Graber said. “It may be just the kind of issue that pushes their buttons more, thinking of their daughter as no longer being the good, respectful daughter,” she said.

For all girls, discipline was the only factor that influenced how much conflict they perceived in the relationship. The stricter and harsher mothers were, the less conflict their daughters reported, Graber said. However, as girls get older, stricter discipline may lead to greater conflict if girls try to disagree, she said.

The study differs from other research on mother-daughter conflict in that instead of looking at adolescence, it examines girls in middle to late childhood, at an average age of 8½, Graber said. The teenage years are naturally turbulent times for families, but understanding what happens immediately preceding them sets the stage for a smoother or rockier transition, she said.

Teen conflict is a risk for other behavior-related problems, Graber said. “It does seem that when there are higher levels of conflict, those daughters are more likely to have adjustment problems in terms of feeling more depression, sadness, anxiety and those problems,” she said.

The intensity of the conflicts aside, the study found that mothers’ and daughters’ reports of the frequency of conflict were similar, Graber said. The study, which Graber did with Sara Villanueva Dixon, a St. Edward’s University psychology professor, and Jeanne Brooks-Gunn, a Columbia University child development professor, involved 45 African-American, 23 Latina and 65 white girls recruited through fliers while in the third grade and their mothers. The girls and their families were from racially integrated, working and middle-class communities in a large metropolitan area.

The girls’ respect for authority was observed during a series of videotaped interactions with their mothers. Daughters were scored on their listening behaviors, which included attending to their mothers when their mothers were speaking, acknowledging their mothers’ comments and not interrupting their mothers. They also were evaluated for defiant behaviors, such as disobeying their mothers’ requests, being unwilling to cooperate with their mothers and ignoring their mothers during the interaction.

Not only do children need to be more aware of the expectations their parents have for them, but mothers may also want to reassess their feelings about particular issues, she said.

“The challenge for African-American and Latina mothers is they are in an environment where their children are potentially getting messages at school, on television and elsewhere about what normal childhood behavior is like that may conflict with their own expectations for these behaviors,” Graber said.

“In the higher conflict families where mothers and daughters are arguing much more often there seems to be less productive resolution going on and less learning of those skills,” she said. “Everybody feels mad afterwards rather than feeling the potential of moving forward.”

“This is a fascinating study that enhances our understanding of ethnic and racial differences in parent-child relationships,” said Judi Smetana, a University of Rochester psychologist. “One of its strengths is that it examines in a very careful and detailed way how different cultural values are expressed in mother-daughter interactions and how those values influence the quality of family relationships.”