The Center for Minority Health (CMH), located in the University of Pittsburghs Graduate School of Public Health, was established to promote health and prevent disease. Its mission is to eliminate racial and ethnic health disparities in Pittsburgh by the year 2010. The Healthy Black Family Project (HBFP) was one project designed to meet this goal by reducing the prevalence of diabetes and hypertension in Pittsburgh. The Family Health History Initiative is one part of HBFP; its purpose is to educate participants about the importance of family health history as a risk factor for disease. By providing personalized risk assessments based on family history, genetic counseling students at the University of Pittsburgh hope to encourage individuals to adopt healthy lifestyle behaviors in an effort to reduce their risk for multifactorial conditions like cancer, heart disease, hypertension, and diabetes. This project was designed to assess the ability of a family health history session to encourage participants to increase their physical activity. Using the transtheoretical model, information about the physical activity habits of participants before and after a family health history session was collected. This data was analyzed to determine whether or not individuals increased their physical activity after a family health history session; data collected from individuals who had completed a Health Risk Assessment but not a family health history session was compared. The data show that individuals who complete a family health history session are more likely to increase their physical activity than individuals who complete a Health Risk Assessment. Most individuals who completed a family health history session, however, did not progress along the stages of change, defined as precontemplation, contemplation, preparation, action, and maintenance. Individuals who earned less than $20,000 a year, who perceived themselves to be obese, who intended to increase their physical activity, who had a moderate risk for any disease, and who perceived themselves to be at high risk or reported already having a disease were more likely to improve along the stages of change than other individuals. This study provides public health significance by defining the effectiveness of a family health history as an intervention.

The Huntington Disease Clinic at the University of Pittsburgh Medical Center is dedicated to diagnosing, treating, and supporting patients that are at risk for Huntington disease (HD). This is a progressive disease that causes a multisystem breakdown of the body. Many of these patients grew up knowing the disease and waiting to begin exhibiting symptoms themselves. With the discovery of the gene that causes HD came a predictive gene test that can be performed on symptomatic people or people who are at risk. The test does not come without psychological impacts, though, which is why the clinic was created. The clinic includes a neurologist, a genetic counselor, and at least one social worker. It was formally created in 1999. Before 1999, an informal clinic with rotating doctors saw Huntington patients. It was the desire of the clinic to examine how the services they provide have changed since 1999 and whether they are meeting the patients needs. This study will allow us to assess the response of the public to the clinic and make changes that will improve the service, thus lending public health relevance to the experience. A mailed satisfaction survey created from the questions of the staff was sent to all of the patients who had been through the HD clinic. Of the two hundred and two surveys sent, forty-one were returned and analyzed according to the logistics of the clinic, the medical staff, and the testing experience. It was found that active patients and patients in the support group were more likely than inactive patients and patients not attending the support group to respond to medical staffing questions. It was also found that age of the participants played a role in the satisfaction with the clinic logistics, while length between the time of testing and the time of filling out the survey played a role in the satisfaction with the physician in the clinic. A final finding of the study is that the genetic counselor and the social workers are generally well liked. Overall, the clinic is meeting the needs of the patient population they are serving.

Minor physical anomalies (MPA) are defined as unusual morphological features found in less than 4% of the general population, but with no serious medical or cosmetic significance to the bearer. An increase in MPA has been associated with irritability in newborns, hyperactivity, and adult-onset schizophrenia and bipolar disorders. In our study, we wish to determine whether minor physical anomalies serve as a predictor for behavioral variation and whether certain regions of the body are more likely to manifest anomalies related to behavioral problems. To determine the combination of MPA most predictive of behavioral variation, we performed a meta-analysis of existing literature examining the relationship between schizophrenia and MPA. Additionally, we sought to determine the heritability of this trait in a twin design. Twin pairs were recruited from Twinsburg, Ohio during the 2005 annual Twins Day Festival and from the Pittsburgh Registry of Infant Multiplets (PRIM). The only inclusion criterion was that twin pairs were between 5 and 12 years of age. The Stroop Task and the Continuous Performance test were administered to assess attention and impulsiveness in the twin pairs. A 15-20 minute assessment for minor physical anomalies using an expanded version of the standardized Waldrop Physical Anomaly Scale was performed by two investigators. We determined, via meta-analysis, the subset of MPA that is most predictive of schizophrenia. Using a twin design, we estimated the intraclass correlations and heritability of these MPA in a set of 50 twin pairs. We determined that MPA may not be useful as predictors for behavioral variations but may be more useful in specific psychotic populations, specifically schizophrenia. This study has implications for public health because research into the biological etiology of MPA could identify risk factors that would enable early detection and prevention of later psychosis.

Hereditary pancreatitis is characterized by episodes of pancreatic inflammation accompanied by unrelenting abdominal pain, usually beginning in childhood. Therefore, this emerging population of individuals is affected with a chronic pain condition affecting global quality of life. A multidisciplinary approach, including psychosocial and behavioral factors, is necessary to elicit responses to and treat chronic pain. Improving overall quality of life is an important outcome of interventions for chronic conditions. Health-related quality of life reflects an individual's physical and mental well-being. This study documents the pain levels and quality of life of individuals with both hereditary and sporadic pancreatitis. Data from 73 individuals with hereditary pancreatitis and 271 individuals with sporadic pancreatitis who participated in the Hereditary Pancreatitis Study and the North American Pancreatitis Study 2 were examined for this study. The questionnaires addressed each subject's report of quality of life, severity and duration of pain, alcohol use, tobacco use, and diagnosis of diabetes. Patient responses were analyzed using a battery of comparative analyses. The SF-122 health survey was analyzed using an algorithm for standardizing and weighting the physical and mental health scores. Pain and quality of life measures were compared to each other, as well as to several commonly measured environmental influences on health using correlation analysis, regression analysis, and the Mann-Whitney U test. As hypothesized, individuals with familial pancreatitis reported worse pain and poorer overall quality of life than individuals with sporadic pancreatitis. Factors influencing the measure of pain include the duration, severity, frequency, and character. Other findings include correlations between (a) physical quality of life and gender, smoking, and alcohol, (b) pain and age, and (c) pain frequency and tobacco and alcohol use. This study provides information that can potentially assist health care professionals who work with individuals with pancreatitis and chronic pain, and who are assessing the necessity of psychosocial intervention or support services.

Acute pain from vaso-occlusion that cannot be reduced at home is the most common reason for Emergency Department (ED) visits and hospital admission for patients with Sickle Cell Disease (SCD). Administration of opioids is often necessary to alleviate pain symptoms. Despite health-care providers knowledge of pain episodes that occur in individuals with SCD, poor pain management persists in the health care setting. This may be due to preconceptions and misinformation regarding administration of opioids and general lack of SCD knowledge. The availability of personal computers and access to the World Wide Web in the home and office settings allows for web-based learning as an efficient and convienient method to reach many health-care providers. Clinicians can access concisely presented information that covers the most essential information, and that provides instantaneous access to relevant literature. Consequently, we developed a web-based, interactive educational module that describes a typical presentation and course of a pediatric patient with SCD presenting to the ED with pain. The purpose of this project is to assess whether this type of educational intervention is useful, accessible and effective for enhancing health care providers knowledge. To measure degree of knowledge gained, we compared answer selections from a 5-question pre-test and post-test. An evaluation was administered containing two demographic questions and nine opinion questions. Opinion questions asked subjects to what degree they felt a particular objective was achieved. Answers choices were based on a Likert-type scale ranging from very low to very high. A variety of health care providers have participated in this project, ranging from social workers to hematology attending physicians. Subjects reported feeling a web-based application was useful and that the overall quality of our module was very good. Under-treatment of pain in all patient populations is a public health problem. In the SCD patient population pain episodes recur over a lifetime and significantly impact all areas of life. Web-based educational modules similar to the one we have created can augment knowledge and refine health care providers practice of pain management in SCD to improve efficacy, thereby increasing quality of life for these patients.

Children born prematurely are at risk for perinatal brain injuries (PBI). Both prematurity and PBI confer risk for neurodevelopmental disabilities. We investigated the linguistic and behavioral characteristics of children born prematurely, with and without perinatal brain injuries, at ages 10-15. In total, 16 children born preterm participated. Eight were born at 30-37 weeks and eight were born earlier than 30 weeks gestation. Six children reportedly had PBI and ten children reported no PBI. Clinical tools were used to measure global language skills, vocabulary, reading and comprehension and grammar. Parent questionnaires were used to assess behavior. Children born after 29 weeks of age scored significantly higher on tests for receptive vocabulary, language memory, reading and passage comprehension than children born before 30 weeks gestation (p is less than or equal to 0.05). Scores reported for anxiety and depression symptoms were higher for the children born before 30 weeks than scores reported for the children born after 29 weeks. The mean scores of children with no PBI were significantly higher for expressive language and passage compehension than the mean scores of children with PBI. There were no significant behavior differences between the children with and without PBI. There were no differences between the children with and without PBI. There were no differences measured between groups, by PBI or gestational age, for tests of grammar and sentence comprehension, accuracy and reaction time. The results suggest that children with PBI may have difficulty with reading comprehension and expressive language and that gestational age and not PBI specifically, may have a greater effect on linguistics and behavior. Identifying long-term consequences of prematurity is relevant to public health because it will help a growing population of children at risk for neurodeveloopmental disabilities benefit from early intervention.

Cystic Fibrosis (CF) is the most commonly inherited, life-shortening genetic condition amongst Caucasians, with an incidence of about 1 in 3,800 newborns and currently affecting about 30,000 Americans. It is chronically debilitating and the annual cost of medical care per person makes it a serious public health concern. Airway inflammation contributes to progressive pulmonary disease, the leading cause of morbidity and mortality in patients with Cystic Fibrosis. The mechanism by which the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene affects airway inflammation has not been fully elucidated to date; however, several mechanisms have been proposed. Despite the need for continued study in determining this mechanism, we do know that mutations in the CFTR gene ultimately result in bacterial colonization in the lungs, reduced mucociliary clearance and airway inflammation. Chronic airway inflammation results in continued assault on the lungs and progresses the course of the disease. Airway inflammation can be monitored through the use of bronchoalveolar lavage to evaluate the influx of neutrophils; however, routine bronchoscopy is an invasive procedure and is less than ideal for routine assessment. Exhaled gas as a marker for airway inflammation is useful in that it is minimally invasive and relatively easy to obtain. Some of the data on the clinical utility of exhaled gas measurements has been conflicting with regard to its efficacy in assessing airway inflammation. If exhaled gas measurements can be used to assess airway inflammation, they could provide a non-invasive alternative to monitor inflammation and do so more frequently than invasive methods, with the ultimate goal of being able to detect inflammation earlier with the intent of earlier treatment and possible reduction in progression of lung disease.

The Center for Minority Health at the University of Pittsburgh aims to eliminate racial and ethnic health disparities especially in the areas of diabetes and hypertension. One avenue for eliminating racial and ethnic health disparities is through biomedical and public health research. The CMH strives to increase African American participation in research through community outreach programs including the Healthy Black Family Project. The HBFP is a community based intervention created to promote health and prevent disease through lifestyle behavior change in the African American community in Pittsburgh. The present study recruited individuals from the HBFP for focus groups to assess the perceptions of African Americans in the Pittsburgh area toward genetics and genetics research. Specifically, the study sought to characterize the willingness of African Americans to donate DNA for research examining the roles of genes and environment in disease development. The CMH is interested in this research because it has been suggested that uncovering the genetic and environmental contributions to common diseases such as diabetes and hypertension may help illuminate causes of racial and ethnic health disparities and allow for more effective strategies for prevention and treatment. Transcripts from four focus groups attended by 43 people were read and coded using thematic analysis. Findings suggest participants are acutely aware of potential negative consequences of donating genetic material however, cautious optimism was expressed when discussing benefits of research. Additionally, the results suggest that researchers must actively work to build trust with potential research participants to increase willingness to participate. The findings also suggest a strong association of the term genetics with family history, a limited understanding of the biological aspects of genetics, and a sensationalized view of genetics research. These last three issues may be addressed through a genetics education outreach program. This study is relevant to the field of public health because it provides researchers with direction in their effort to better characterize the willingness of African Americans to donate DNA for genetics research.

Each year 15-20 infants with sickle cell disease and 600 infants with trait are born in western Pennsylvania with no significant decrease in annual incidence. A 2006 study by Childrens Hospital of Pittsburghs Comprehensive Hemoglobinopathy Program surveying African-American women in the prenatal setting found that these women have a high perception of the severity of sickle cell disease and the importance of sickle cell trait screening but a low perceived susceptibility to sickle cell disease. The current research was designed as a qualitative follow-up study to assess African-American community members attitudes and knowledge of sickle cell, prenatal testing, and newborn screening, to characterize barriers to education and awareness of newborn screening and sickle cell, and to determine if a community-based intervention could be developed to improve awareness of these topics. Four focus groups were conducted with 35 participants at the Kingsley Association in a predominantly African-American community of Pittsburgh. Participants were recruited from the Healthy Black Family Project. Transcripts were analyzed using thematic analysis and demographic information was compiled from a pre-discussion survey. Qualitative analysis has demonstrated that participants fall into one of three knowledge categories: the unaware, those with accurate but incomplete information, and those with misinformation. Participants have an understanding of sickle cell disease course. However, inheritance of sickle cell and the personal risk to have children or family members with the condition is not well understood. Participants have knowledge of the methods and indications for prenatal testing and value prenatal testing for the opportunities for choice and awareness. Risks of prenatal testing were identified as miscarriage as well as personal and family stress. Newborn screening was believed to be beneficial for preparation and treatment. Barriers to education and awareness of sickle cell and newborn screening were classified as personal, familial, and societal. The public health significance of this work is the identification of community members who are eager to decrease the prevalence of sickle cell in their community and the potential to design community discussion groups which address genetics topics and provide African-Americans with the tools to communicate with family and physicians about risk for sickle cell.

Systemic lupus erythematosus (SLE) is a major public health problem in the United States. It is estimated that at least 500,000 Americans suffer from (SLE), which is a complex autoimmune disease of primarily unknown etiology. SLE is about three times more common in African Americans (about 1:250 incidence) than in Caucasian Americans (about 1:1000 incidence), and predominantly affects women of child-bearing age (female to male ratio of 9:1). SLE causes a variable amount of morbidity, shortened life expectancy, and substantial total health expenditures, largely due to complications such as thrombosis, atherosclerosis, renal disease, and antiphospholipid syndrome (APS). Genetics plays a significant role in the etiology of SLE; therefore, understanding the underlying genetic influence of this disease is of significant public health importance. This study dealt with the analysis of one of the genes that has been proposed to play a role in the pathogenesis of SLE: apolipoprotein H (APOH gene, apoH protein), also referred to as B2-glycoprotein I (B2-GPI). ApoH is thought to have anti-atherogenic properties and has been shown to be a major target antigen for antiphospholipid antibodies (APA) present in patients with APS. Twelve APOH SNPs (9 TagSNPs and 3 additional functional coding SNPs) were genotyped in 398 women with a clinical diagnosis of SLE and 496 healthy women as controls. The associations of allele and genotype distributions of these 12 SNPs with SLE, race, renal disease in white patients, and APA in black and white patients and controls were analyzed. Significant allelic distribution differences were observed between whites and blacks for 9 of the 12 SNPs, indicating a race-dependent variation. No associations were found between genotype distributions in any of the 12 SNPs and SLE, renal disease, or APA status. However, haplotype analysis revealed six haplotypes that significantly differed in frequency between cases and controls. Of particular interest was one haplotype that was present in 16.2% of cases and 0.6% of controls, suggesting a potential risk factor for SLE. In conclusion, our study suggests that combined effects of APOH SNPs (haplotype) may be implicated in modifying the risk of SLE.