Public Health Commons^™

Reducing Psychosocial And Behavioral Pregnancy Risk Factors: Results Of A Randomized Clinical Trial Among High-Risk Pregnant African American Women, Jill G. Joseph, Ayman El-Mohandes, Michele Kiely, M. Nabil El-Khorazaty, Marie G. Gantz, Allan A. Johnson, Kathy S. Katz, Susan M. Blake, Maryann W. Rossi, Siva Subramanian

Publications and Research

Objectives. We evaluated the efficacy of a primary care intervention targeting pregnant African American women and focusing on psychosocial and behavioral risk factors for poor reproductive outcomes (cigarette smoking, secondhand smoke exposure, depression, and intimate partner violence).

Methods. Pregnant African American women (N=1044) were randomized to an intervention or usual care group. Clinic-based, individually tailored counseling sessions were adapted from evidence-based interventions. Follow-up data were obtained for 850 women. Multiple imputation methodology was used to estimate missing data. Outcome measures were number of risks at baseline, first follow-up, and second follow-up and within-person changes in risk from baseline to the …

High Burden Of Prevalent And Recently Acquired Hiv Among Female Sex Workers And Female Hiv Voluntary Testing Center Clients In Kigali, Rwanda, Sarah L. Braunstein, Chantal M. Ingabire, Eveline Geubbels, Joseph Vyankandondera, Marie-Michele Umulisa, Elysee Gahiro, Mireille Uwineza, Coosje J. Tuijn, Denis Nash, Janneke H. H. M. Va De Wijgert

Publications and Research

Methods: We conducted a cross-sectional survey of 800 FSW and 1,250 female VCT clients in Rwanda, which included interviewing and testing for HIV-1/2, HSV-2 and pregnancy, and BED-CEIA and Avidity Index (AI) to identify recent infections among HIV-infected women.

Results: Prevalence of HIV-1, HSV-2, and pregnancy were 24% (95% CI: 21.0–27.0), 59.8% (56.4–63.2), and 7.6% (5.8–9.5) among FSW, and 12.8% (10.9–14.6), 43.2% (40.4–46.0), and 11.4% (9.7–13.3) among VCT clients, respectively. Thirty-five percent of FSW and 25% of VCT clients had never been HIV tested. Per national guidelines, 33% of newly HIV-diagnosed FSW and 36% of VCT clients were already eligible …

Relationships Between Self-Reported Smoking, Household Environmental Tobacco Smoke Exposure And Depressive Symptoms In A Pregnant Minority Population, Sylvia Tan, Lauren P. Courtney, Ayman El-Mohandes, Susan M. Blake, Marie G. Gantz, Jutta Thornberry, M. Nabil El-Khorazaty, David Perry, Michele Kiely

Publications and Research

This study sought to examine relationships between depressive symptoms and prenatal smoking and/or household environmental tobacco smoke exposure (HHETSE) among urban minority women. We analyzed private, audio computer-assisted self interview data from a clinic-based sample of 929 minority pregnant women in Washington, DC. Depressive symptoms were assessed via the Beck Depression Inventory Fast Screen. HH-ETSE, current smoking, and former smoking were assessed via self-report. Depression levels and demographic characteristics were compared: (1) among nonsmokers, for those reporting HH-ETSE versus no HH-ETSE; and (2) among smokers, for those reporting current smoking (in last 7 days) versus former smokers. Measures associated with …

Effectiveness Of A Combined Home Visiting And Group Intervention For Low Income African American Mothers: The Pride In Parenting Program, Kathy S. Katz, Marian H. Jarrett, Ayman El-Mohandes, Susan Schneider, Doris Mcneely-Johnson, Michele Kiely

Publications and Research

Intervention strategies are needed to improve maternal and infant outcomes in minority populations living in poverty. Home visiting by nurses has improved outcomes for mothers and young children, but use of professional staff makes these programs expensive. Pride in Parenting was a randomized controlled trial of paraprofessional home visitation to provide health and developmental intervention for high-risk African American mothers in Washington, DC. This study proposed to test whether paraprofessional visitors drawn from the community could effectively influence health and mothers; parenting behaviors and attitudes. African American mothers with inadequate prenatal care were recruited at delivery and randomized to intervention …

Smoking Cessation And Relapse Among Pregnant African-American Smokers In Washington, Dc, Ayman El-Mohandes, M. Nabil El-Khorazaty, Michele Kieley, Marie G. Gantz

Publications and Research

Smoking is the single most preventable cause of perinatal morbidity. This study examines smoking behaviors during pregnancy in a high risk population of African Americans. The study also examines risk factors associated with smoking behaviors and cessation in response to a cognitive behavioral therapy (CBT) intervention. This study is a secondary analysis of data from a randomized controlled trial addressing multiple risks during pregnancy. Five hundred African-American Washington, DC residents who reported smoking in the 6 months preceding pregnancy were randomized to a CBT intervention. Psycho-social and behavioral data were collected. Self-reported smoking and salivary cotinine levels were measured prenatally …

Understanding Depressive Symptoms Among High-Risk Pregnant African American Women, Kristine M. Molina, Michele Kiely

Publications and Research

Much has been written about depression and its risk factors, particularly among women. However, a growing body of literature on prenatal depression has begun to emerge, given that depression during pregnancy presents a major public health concern, since it is found to be a common experience among childbearing aged women (Gaynes et al., 2005; Marcus, 2009). In fact, the onset of depressive symptoms is most likely to occur between 20 to 40 years of age, the range when most women become pregnant (Marcus & Heringhausen, 2009). Further, prior studies have found rates of depression among pregnant women to range from …

Dual Testing Algorithm Of Bed-Ceia And Axsym Avidity Index Assays Performs Best In Identifying Recent Hiv Infection In A Sample Of Rwandan Sex Workers, Sarah L. Braunstein, Denis Nash, Andrea A. Kim, Ken Ford, Lambert Mwambarangwe, Chantal M. Ingabire, Joseph Vyankandondera, Janneke H. H. M. Van De Wijgert

Publications and Research

Background

To assess the performance of BED-CEIA (BED) and AxSYM Avidity Index (Ax-AI) assays in estimating HIV incidence among female sex workers (FSW) in Kigali, Rwanda.

Methodology and Findings

Eight hundred FSW of unknown HIV status were HIV tested; HIV-positive women had BED and Ax-AI testing at baseline and ≥12 months later to estimate assay false-recent rates (FRR). STARHS-based HIV incidence was estimated using the McWalter/Welte formula, and adjusted with locally derived FRR and CD4 results. HIV incidence and local assay window periods were estimated from a prospective cohort of FSW. At baseline, 190 HIV-positive women were BED and Ax-AI …

The Impact Of Bisphenol A And Triclosan On Immune Parameters In The U.S. Population, Nhanes 2003–2006, Erin M. Rees Clayton, Megan Todd, Jennifer B. Dowd, Allison E. Aiello

Publications and Research

Background: Exposure to environmental toxicants is associated with numerous disease outcomes, many of which involve underlying immune and inflammatory dysfunction.

Objectives: To address the gap between environmental exposures and immune dysfunction, we investigated the association of two endocrine-disrupting compounds (EDCs) with markers of immune function.

Methods: Using data from the 2003–2006 National Health and Nutrition Examination Survey, we compared urinary bisphenol A (BPA) and triclosan levels with serum cytomegalovirus (CMV) antibody levels and diagnosis of allergies or hay fever in U.S. adults and children ≥ 6 years of age. We used multivariate ordinary least squares linear regression models to examine …

Seropositivity To Cytomegalovirus, Inflammation, All-Cause And Cardiovascular Disease-Related Mortality In The United States, Amanda M. Simanek, Jennifer Beam Dowd, Graham Pawelec, David Melzer, Ambarish Dutta, Allison E. Aiello

Publications and Research

Background: Studies have suggested that CMV infection may influence cardiovascular disease (CVD) risk and mortality. However, there have been no large-scale examinations of these relationships among demographically diverse populations. The inflammatory marker C-reactive protein (CRP) is also linked with CVD outcomes and mortality and may play an important role in the pathway between CMV and mortality. We utilized a U.S. nationally representative study to examine whether CMV infection is associated with all-cause and CVD-related mortality. We also assessed whether CRP level mediated or modified these relationships.

Methodology/Principal Findings: Data come from subjects $25 years of age who were tested for …

Very Preterm Birth Is Reduced In Women Receiving An Integrated Behavioral Intervention: A Randomized Controlled Trial, Ayman El-Mohandes, Michele Kiely, Marie G. Gantz, M. Nabil El-Khorazaty

Publications and Research

Background This study examines whether an integrated behavioral intervention with proven efficacy in reducing psycho-behavioral risks (smoking, environmental tobacco smoke exposure (ETSE), depression, and intimate partner violence (IPV)) in African-Americans is associated with improved pregnancy outcomes

Methods A randomized controlled trial targeting risks during pregnancy was conducted in the District of Columbia. African-American women were recruited if reporting at least one of the risks mentioned above. Randomization to intervention or usual care was site and risk specific. Sociodemographic, health risk and pregnancy outcome data were collected. Data on 819 women, and their singleton live born infants were analyzed using an …

Suicide And Suicide Risk In Lesbian, Gay, Bisexual, And Transgender Populations: Review And Recommendations, Ann P. Haas, Mickey Eliason, Vickie M. Mays, Robin M. Mathy, Susan D. Cochran, Anthony R. D'Augelli, Morton M. Silverman, Prudence W. Fisher, Tonda Hughes, Margaret Rosario, Stephen T. Russell, Effie Malley, Jerry Reed, David A. Litts, Ellen Haller, Randall L. Sell, Gary Remafedi, Judith Bradford, Annette L. Beautrais, Gregory K. Brown, Gary M. Diamond, Mark S. Friedman, Robert Garofalo, Mason S. Turner, Amber Hollibaugh, Paula J. Clayton

Publications and Research

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.

Mrna Transcript Quantification In Archival Samples Using Multiplexed, Color-Coded Probes, Patricia Reis, Levi Waldron, Rashmi S. Goswami, Wei Xu, Yali Xuan, Bayardo Perez-Ordonez, Patrick Gullane, Jonathan Irish, Igor Jurisica, Suzanne Kamel-Reid

Publications and Research

Background: A recently developed probe-based technology, the NanoString nCounter™ gene expression system, has been shown to allow accurate mRNA transcript quantification using low amounts of total RNA. We assessed the ability of this technology for mRNA expression quantification in archived formalin-fixed, paraffin-embedded (FFPE) oral carcinoma samples.

Results: We measured the mRNA transcript abundance of 20 genes (COL3A1, COL4A1, COL5A1, COL5A2, CTHRC1, CXCL1, CXCL13, MMP1, P4HA2, PDPN, PLOD2, POSTN, SDHA, SERPINE1, SERPINE2, SERPINH1, THBS2, TNC, GAPDH, RPS18) in 38 samples (19 paired fresh-frozen and FFPE oral carcinoma tissues, archived from 1997-2008) by both NanoString and SYBR Green I fluorescent dye-based quantitative …

Maternal Exposure To The Holocaust And Health Complaints In Offspring, Janine D. Flory, Linda M. Bierer, Rachel Yehuda

Publications and Research

Although the link between chronic stress and the development of cardiovascular and metabolic diseases of adulthood has been known for some time, there is growing recognition that early environmental influences may result in developmental programming via epigenetic mechanisms, thereby affecting the developmental trajectory of disease progression. Previous studies support the idea that offspring of Holocaust survivors may have been subjected to early developmental programming. We evaluated the relationship between parental exposure to the Holocaust and selfreported health ratings and disorders made by their adult offspring (i.e., second generation Holocaust survivors). A total of 137 subjects were evaluated. Regression analyses demonstrated …

The Relationship Of Race And Social Integration On The Health Status Of Older Adults In An Urban City, Thomas T. Jordan

Dissertations, Theses, and Capstone Projects

Durkheim argues that an individual is more vulnerable to self-destruction the more s/he is detached from the collective. This dissertation will explore the relative impact of social integration on older adults who have transitioned into their new roles in the social structure in relationship to their physical (obesity) and psychological (stress) health status. Additionally, the dissertation examines how social integration varies in its impact from one racial group to another, and how such variations influence the health status of the older adults who are members of these groups.

This dissertation employs data from the Brookdale Center for Healthy Aging and …

Building Capacity For Public And Population Health Research In Africa: The Consortium For Advanced Research Training In Africa (Carta) Model, Alex C. Ezeh, Chimaraoke O. Izugbara, Caroline W. Kabiru, Sharon Fonn, Kathleen Kahn, Lenore Manderson, Akinyinka Omigbodun, Margaret Thorogood, Ashiwel S. Undieh

Publications and Research

Background: Globally, sub-Saharan Africa bears the greatest burden of disease. Strengthened research capacity to understand the social determinants of health among different African populations is key to addressing the drivers of poor health and developing interventions to improve health outcomes and health systems in the region. Yet, the continent clearly lacks centers of research excellence that can generate a strong evidence base to address the region’s socio-economic and health problems. Objective and program overview: We describe the recently launched Consortium for Advanced Research Training in Africa (CARTA), which brings together a network of nine academic and four research institutions from …

Public Health Insurance Utilization In New York City, 2008, Rachael Varra

Center for Latin American, Caribbean, and Latino Studies

Introduction: This study examines demographic and socioeconomic factors of racial/ethnic groups in New York City between as of 2008 – particularly the utilization of public health insurance (PHI) benefits.

Methods: Data on Latinos and other racial/ethnic groups were obtained from the U.S. Census Bureau American Community Survey, reorganized for public use by the Minnesota Population Center, University of Minnesota, IPUMSusa. Cases in the dataset were weighted and analyzed to produce population estimates.

Results: Of the 25% of New Yorkers receiving PHI in 2008, the absolute number of whites, blacks and Latinos receiving PHI was similar. However, greater proportions of Latinos …

Editor’S Farewell, Irvin Sam Schonfeld

Publications and Research

No abstract provided.

Weighing In: A Critical Analysis Of New York City’S Calorie Labeling Law, Josephine Barnett

Publications and Research

The ‘obesity’ epidemic has The health of New York City Residents has been a significant concern of public health officials with the rates of obesity and diabetes ranking eighth of all cities nationally. The New York City (NYC) Board of Health laid the foundation and influenced the legislative efforts of means to address the ‘obesity-diabetes’ epidemic for public health officials consider this to be one of the major health concerns among Americans and particularly NYC residents. The major initiatives implemented by NYC official include: (1) a ban on trans-fat (2) a city registry of those with diabetes, and (3) menu-labeling. …

A History And One Or Two Things I’Ve Learned, Irvin Sam Schonfeld

Publications and Research

No abstract provided.

Estimated Birth Weight And Adult Cardiovascular Risk Factors In A Developing Southern Chinese Population: A Cross Sectional Study, C. Mary Schooling, C. Q. Jiang, T. H. Lam, B. J. Cowling, S. L. Yeung, W. S. Zhang, K. K. Cheng, G. M. Leung

Publications and Research

Background: Birth weight is negatively associated with cardiovascular diseases and diabetes, but the associations are less well-established in developing populations where birth weight is often unavailable. We studied the association of birth weight and cardiovascular risk, using birth rank as an instrumental variable, in Southern China.

Methods: We used published data on birth weight by birth rank from an appropriate population and baseline data from the Guangzhou Biobank Cohort Study phases 2 & 3 (2005-8) to examine the adjusted associations, using instrumental variable analysis, of birth weight with clinically measured cardiovascular risk factors and the metabolic syndrome in older …

Comparing The Validity Of Five Participation Instruments In Persons With Spinal Conditions, Vanessa K. Noonan, Jacek A. Kopec, Luc Noreau, Joel Singer, Louise C. Mâsse, Hongbin Zhang, Marcel F. Dvorak

Publications and Research

Objective: To evaluate and compare the construct validity of 5 participation instruments developed using the International Classification of Functioning, Disability and Health (ICF). Methods: A total of 545 subjects diagnosed and treated for a spinal condition at an acute hospital were followed-up and consented to complete a questionnaire. Subjects completed 5 participation instruments (Impact on Participation and Autonomy (IPA), Keele Assessment of Participation (KAP), Participation Measure-Post Acute Care (PM-PAC), Participation Objective Participation Subjective (POPS), World Health Organization Disability Assessment Schedule II (WHODAS II)). In addition, each subject completed a health status instrument and a quality of life instrument. The dimensionality, …

An Intervention To Reduce Environmental Tobacco Smoke Exposure Improves Pregnancy Outcomes, Ayman El-Mohandes, Michele Kiely, Susan M. Blake, Marie G. Gantz, M. Nabil El-Khorazaty

Publications and Research

Objective—We tested the efficacy of a cognitive-behavioral intervention in reducing environmental tobacco smoke exposure (ETSE) and improving pregnancy outcomes among African-American women.

Methods—We recruited 1,044 women to a randomized controlled trial during 2001-2004 in Washington, DC. Data on 691 women with self-reported ETSE were analyzed. A subset of 520 ETSE women and salivary cotinine levels (SCLs)/ml was also analyzed. Individually tailored counseling sessions adapted from evidence-based interventions for ETSE and other risks, were delivered to the intervention group. The usual care group received routine prenatal care as determined by their provider. Logistic regression models were used to predict …

Campaigns To Change Health Damaging Corporate Practices, Nicholas Freudenberg

Publications and Research

When corporations claim the same citizenship rights as human citizens, they exercise an undue influence on health policy and democratic processes. Surprisingly, the same basic repertoire of tactics has been found to be employed by corporations to effect this influence, regardless of the specific industry at work. In this book, authors from around the world reveal the range of tactics used across the corporate world that ultimately favor the bottom line over the greater good.

The Bottom Line or Public Health deconstructs some of the most ubiquitous tactics at play, including public relations, political influence, legal maneuvering, and financial power, …

An Integrated Intervention To Reduce Intimate Partner Violence In Pregnancy: A Randomized Trial, Michele Kiely, Ayman El-Mohandes, M. Nabil El-Khorazaty, Marie G. Gantz

Publications and Research

OBJECTIVE: We estimated the efficacy of a psycho-behavioral intervention in reducing intimate partner violence (IPV) recurrence during pregnancy and postpartum, and in improving birth outcomes in African-American women

METHODS: We conducted a randomized controlled trial in which 1,044 women were recruited. Individually-tailored counseling sessions were adapted from evidence-based interventions for IPV and other risks. Logistic regression was used to model IPV victimization recurrence, to predict minor, severe, physical and sexual IPV.

RESULTS: Women randomized to the intervention were less likely to have recurrent episodes of IPV victimization (OR=0.48, 95%CI=0.29-0.80). Women with minor IPV were significantly less likely to experience further …

Optimization And Analysis Of A Quantitative Real-Time Pcr-Based Technique To Determine Microrna Expression In Formalin-Fixed Paraffin-Embedded Samples, Rashmi S. Goswami, Levi Waldron, Jerry Machado, Nilva K. Cervigne, Wei Xu, Patricia Reis, Denis Bailey, Igor Jurisica, Michael R. Crump, Suzanne Kamel-Reid

Publications and Research

Background: MicroRNAs (miRs) are non-coding RNA molecules involved in post-transcriptional regulation, with diverse functions in tissue development, differentiation, cell proliferation and apoptosis. miRs may be less prone to degradation during formalin fixation, facilitating miR expression studies in formalin-fixed paraffin-embedded (FFPE) tissue.

Results: Our study demonstrates that the TaqMan Human MicroRNA Array v1.0 (Early Access) platform is suitable for miR expression analysis in FFPE tissue with a high reproducibility (correlation coefficients of 0.95 between duplicates, p < 0.00001) and outlines the optimal performance conditions of this platform using clinical FFPE samples. We also outline a method of data analysis looking at differences in miR abundance between FFPE and fresh-frozen samples. By dividing the profiled miR into abundance strata of high (Ct35), we show that reproducibility between technical replicates, equivalent dilutions, and FFPE vs. frozen samples is best in the high abundance stratum. We also demonstrate that the miR expression profiles of FFPE samples are comparable to those of fresh-frozen samples, with a correlation of up to 0.87 (p < 0.001), when examining all miRs, regardless of RNA extraction method used. Examining correlation coefficients between FFPE and fresh-frozen samples in terms of miR abundance reveals correlation coefficients of up to 0.32 (low abundance), 0.70 (medium abundance) and up to 0.97 (high abundance).

Conclusion: Our study thus demonstrates the utility, reproducibility, and optimization steps needed in miR expression studies using FFPE samples on a high-throughput quantitative PCR-based miR …

Family Structure, Parent-Child Conversation Time And Substance Use Among Chinese Adolescents, Kwok-Kei Mak, Sai-Yin Ho, G Neil Thomas, C Mary Schooling, Sarah M. Mcghee, Tai-Hing Lam

Publications and Research

Background: The family plays a vital role in shaping adolescent behaviours. The present study investigated the associations between family structure and substance use among Hong Kong Chinese adolescents.

Methods: A total of 32,961 Form 1 to 5 (grade 7-12 in the US) Hong Kong students participated in the Youth Smoking Survey in 2003-4. An anonymous questionnaire was used to obtain information about family structure, daily duration of parent-child conversation, smoking, alcohol drinking and drug use. Logistic regression was used to calculate the adjusted odds ratios (OR) for each substance use by family structure.

Results: Adjusting for sex, age, type of …

Introducing A Multi-Site Program For Early Diagnosis Of Hiv Infection Among Hiv-Exposed Infants In Tanzania, Harriet Nuwagaba-Biribonwoha, Bazghina Werq-Semo, Aziz Abdallah, Amy Cunningham, John G. Gamaliel, Sevestine Mtunga, Victoria Nankabirwa, Isaya Malisa, Luis F. Gonzalez, Charles Massambu, Denis Nash, Jessica Justman, Elaine J. Abrams

Publications and Research

Background: In Tanzania, less than a third of HIV infected children estimated to be in need of antiretroviral therapy (ART) are receiving it. In this setting where other infections and malnutrition mimic signs and symptoms of AIDS, early diagnosis of HIV among HIV-exposed infants without specialized virologic testing can be a complex process. We aimed to introduce an Early Infant Diagnosis (EID) pilot program using HIV DNA Polymerase Chain Reaction (PCR) testing with the intent of making EID nationally available based on lessons learned in the first 6 months of implementation.

Methods: In September 2006, a molecular biology laboratory at …

Acceptance, Communication Mode And Use Of Audio Computer- Assisted Self Interview Using Touchscreen To Identify Risk Factors Among Pregnant Minority Women, Jutta S. Thornberry, Kennan B. Murray, M. Nabil El-Khorazaty, Michele Kiely

Publications and Research

This paper evaluates the acceptability, communication mode and use of audio computer-assisted self-interview (A-CASI) among minority pregnant women receiving prenatal care in six Washington, DC sites. A total of 2,913 women were screened for demographic eligibility (18+ years old,gestation, Black/African-American or Hispanic) and risk (smoking, environmental tobacco smoke exposure, depression, intimate partner violence). Questions were displayed on touch screen laptop monitors and heard through earphones. The mean length of time to complete the screener was almost 6 minutes.

A-CASI experience, which included difficulty in using the computer, acceptability (enjoyment), and preferred communication mode, was compared across sites, the eligibility and …

Psychological Care For Persons Of Diverse Religions: A Collaborative Continuum, Glen Milstein, Anne Marie Yali

Publications and Research

The purpose of this paper is to describe to psychologists and other clinicians a continuum of mental health care for persons of diverse religions. The continuum delineates boundaries between clinical care provided by mental health professionals and religious care provided by clergy, as well as describes pathways of collaboration across these boundaries. A prevention science based model of Clergy Outreach and Professional Engagement (COPE) is offered to guide this collaboration. The model describes a continuum that moves from the care already present in religious communities, through professional clinical care provided in response to dysfunction and returns persons to their own …

Health Insurance Patterns Among Latinos In Comparative Perspective, 2004 — 2007, Rachael Varra

Center for Latin American, Caribbean, and Latino Studies

Introduction: This report examines the rates at which the four major racial/ethnic groups in the United States — Latinos, non-Hispanic Whites, non-Hispanic Blacks and Asians — lacked health insurance from 2004- 2006 in the U.S. overall and in the ten states with the largest Latino populations: California, Texas, Florida, New York, Illinois, Arizona, New Jersey, Colorado, New Mexico and Georgia.

Methods: The “lack of insurance data” in this report were derived from Health Statistics Data obtained by the Center for Disease Control from 2004 to 2006. In September 2008 these data became available by race, age and ethnicity/race on a …