The concrete jungle: city stress and substance abuse among young adult African American men

The importance of community engagement in experimental stress and substance use research with marginalized groups: Lessons from research with sexual and gender minority populations

There is a growing need for experimental stress paradigms tailored for use with marginalized groups to better understand the impact of experiencing minoritized stress on substance use outcome. Experimental stress research that examines the role of minority stress in substance use is not only innovative, but also has the potential to improve health equity. However, this research also has anticipated risks. As a result, community-engaged research (CEnR) is critical. CEnR can improve experimental stress and substance use research by engaging applicable communities in research design, recruitment, data interpretation, and dissemination. When conducting CEnR, there are also unique challenges and considerations that need to be taken into account. Recommendations are provided based on prior experiences in experimental stress induction and alcohol research with SGM (sexual and gender minority) groups.

Adaptation of Adolescent Behavioral Activation Program and Investigation of Its Effectiveness by Mixed Method

In this study, the Adolescent Behavioral Activation Program (A-BAP) based on behavioral activation (BA) therapy to reduce depressive symptoms in adolescents was adapted to Turkish culture, and its effectiveness was tested with intervention design, one of the mixed method designs. In this direction, experimental and control groups were formed with 20 students studying in three different high schools in Turkey and with highly elevated depressive symptoms. The study group was determined by nested sampling from mixed-method sampling strategies. The starting point of this study is the absence of any BA-based practice to reduce adolescent depression in Turkey. In this direction, experimental and control groups were formed with 20 students studying in three different high schools in Turkey and with highly elevated depressive symptoms. The adapted A-BAP was applied individually to the students in the experimental group for 12 weeks. Three sessions were also held with the parents of the students in the experimental group. In the quantitative phase of the study, pre-test and post-test control groups paired patterns from semi-experimental designs, and a case study was used in the qualitative stage. The qualitative data of the study were collected from adolescents and their parents through semi-structured interviews and session evaluation forms. It was determined that the adapted BA-based A-BAP was an effective intervention in reducing depressive symptoms in the Turkish adolescent sample and provided a significant decrease in the depression scores of the participants in the experimental group . The qualitative findings show that adolescents perceive the A-BAP process as a factor contributing to making them feel better. Adolescents have reported that A-BAP is effective in reducing avoidance behavior, achieving anger control, and increasing self-esteem and social interaction. Parents consider A-BAP as a developer, educator, and practice that reduces depressive symptoms in their children. In addition, it was determined that the qualitative findings obtained supported the quantitative results. Since the study is the first application of BA therapy in Turkey, it is thought that it will contribute to new studies in Turkey and intercultural studies at the international level.

Stress Correlates Related to Depressive Symptoms Among Young Black Men in Southern California

Black men experience higher levels of chronic stress, life stressors, and discrimination due to oppressive social and economic conditions. Black men are at greater risk of depression, but most published research on stress and depression has focused on Black people in general, Black women, or older Black men. We sought to determine whether discrimination, perceived stress, major life stress, daily hassles, and social capital were associated with depressive symptoms in young Black men. Survey data were collected from April 2010 to March 2012 in Southern California from a convenience sample of Black men (N = 201). We used two-sample t tests and one-way analysis of variance (ANOVA) to examine the association of stress correlates with depressive symptoms. Logistic regression was conducted to estimate the likelihood of reporting depressive symptoms for each significant correlate. Over half of the sample reported depressive symptoms. Health status, perceived discrimination, urban hassles, perceived stress, and neighborhood trust and safety were significantly related to depressive symptoms. Those who reported higher perceived stress had higher odds of reporting depressive symptoms, whereas lower everyday discrimination experiences were associated with lower odds of depressive symptoms. Future studies should consider examining the effectiveness of embedding coping mechanisms for stress, including perceived discrimination, in health interventions for young Black men to prevent or reduce depression.

Continuity and change in neighborhood disadvantage and adolescent depression and anxiety

We used data from the Fragile Families and Child Wellbeing Study which includes a sample of adolescents of age 15 at the most recent wave (between 2014 and 2017) from mainly low-income urban families in the United States, to examine the association between neighborhood poverty entries and exits and adolescent depression and anxiety. In addition, we examined whether these associations differed by gender. Adolescents who consistently lived in disadvantaged neighborhoods had the highest level of depression and anxiety. Those who entered poor neighborhoods were more depressed than those who never lived in poor neighborhoods. Those who exited poor neighborhoods showed no significant difference in depression and anxiety compared to those never lived in poor neighborhoods. Furthermore, these associations applied to adolescent girls only and were not statistically significant for boys. The results suggest that neighborhood poverty has cumulative negative impacts on adolescent mental health and disproportionally affects adolescent girls. Reducing neighborhood poverty would substantially improve the health of adolescents, especially girls, which would reduce health disparities.

Urban upbringing and psychiatric disorders in the United States: A racial comparison

BACKGROUND

Studies that link urbanicity to mental health are mixed depending on outcome and context. More research is needed to examine whether the urban upbringing effect holds true across racial populations in a large and diverse country like the United States.

METHODS

We analyzed two large datasets that were administered contemporaneously with similar methods: The National Comorbidity Survey-Replication (NCS-R, Whites) and the National Survey of American Life (NSAL, Blacks). We ran multivariable logistic regression models to examine the associations between area of upbringing (urban/large city, other, rural) and six psychiatric disorders, controlling for sex, age, years of education and income-to-poverty ratio (and ethnicity in the NSAL). We performed these analyses in both the NCS-R and the NSAL separately.

RESULTS

The majority (58.97%) of the White sample grew up in the 'other' category (i.e. small town, small city, or suburb of a large city), whereas a much larger percentage (39.89%) of the Black sample grew up in a large city. In the White sample, urban upbringing was not associated with any of the psychiatric disorders at a conventional level of statistical significance. In the Black sample, urban upbringing was associated with greater odds of having mood disorder, alcohol use disorder and drug use disorder, but was not significantly associated with anxiety disorders, PTSD, or eating disorders.

CONCLUSIONS

Urban upbringing was not associated with psychiatric disorders among Whites, but was associated with greater odds of mood disorders, alcohol us disorder and drug use disorder among Blacks. Future research can elucidate how differences in urban upbringing between Whites and Blacks are linked to differences in risk for psychiatric disorders.

Community violence and African American male health outcomes: An integrative review of literature

Community violence exposure is essential when considering African American male adult health outcomes. This integrative review of literature is guided by the research questions: (a) How has community violence been measured in African American male adults? and (b) What impact does community violence have on African America male health outcomes? This study synthesises eight current articles identified by the search terms-community violence, impact, African Americans, care, and men. Of the eight identified articles, there were quantitative (n = 5), qualitative (n = 1) and mixed methods (n = 2). Findings indicate a wide array of screening tools for violent experiences and highlight the potential negative impacts of violence in communities; however, literature regarding strategies for identification and treatment of psychosocial and physical health status of African American male adults experiencing direct and indirect community violence remains limited. Further work in clinical care and community health settings related to violence is warranted.

Exposure to personal and community violence and associated drug use outcomes in African American young adults

BACKGROUND

Exposure to violence (ETV) during one's life has been associated with increased risk for substance abuse. Adolescent ETV is also related to substance abuse into adulthood, and has been shown to have a cumulative effect. This study adds to the understanding of how ETV relates to a range of substance use outcomes by specifying how different types of violence affects substance use behaviors in African American young adults, and examines how this exposure is moderated by other life stressors, and health and social experiences.

METHOD

Factor analysis was conducted to identify unique types of ETV in 638 African American men and women ages 18-25. The resulting factors represent 1) childhood ETV and 2) community ETV as adults. These were regressed upon substance abuse outcomes.

RESULTS

78% of the respondents were exposed to some form of violence during their childhood. Lower childhood ETV were significantly associated with a lower risk of engaging in dangerous substance use behaviors. Adult experiences of community violence had more significant predictors of drug use than childhood ETV. Witnessing gunfire or an assault, witnessing or being a victim of sexual assault, and carrying a weapon were consistent risk factors for dangerous drug behaviors, although specific drug use behaviors differed across genders.

CONCLUSIONS

ETV served as an independent explanatory factor for specific drug use behaviors at different stages of life. Future research is needed to understand how these factors put respondents at risk for drug use behaviors or make them less likely to engage in dangerous use patterns.

Violence Exposure, Drug Use and HIV/AIDS Risk Taking Behaviors: The Role of Gender

OBJECTIVE

To examine gender differences among African American young adults in their exposure to violence (ETV) before age 18 and community violence as an adult, and the relationship of these exposures to drug use and HIV risk taking behaviors (HIVRTB).

METHOD

We detail these experiences in 440 self-identified African Americans, ages 18 to 25, from socio-economically disadvantaged wards in Washington, DC. Factor analysis was used to identify the types of violence experienced before age 18 and as adults. Regression was used to identify which types of violence had the greatest impact on subsequent drug use and HIVRTB.

RESULTS

We found gender differences in the types of violence experienced and their effects on drug use and HIVRTB. For women, the strongest ETV factors were direct personal violence, and exposure to drug sales or physical violence as adults. For men, the strongest factors were feeling unsafe in different situations as adults and exposure to violence among adults before age 18.

CONCLUSIONS

We identified the specific kinds of violence that are most likely to impact drug use and risky sexual behaviors that can leave one vulnerable to HIV and how these differ between women and men exposed to both childhood violence and community violence as an adult. Our findings point toward the need for trauma-informed programs that are tailored to gender.

Factors related to life satisfaction among urban African American adults receiving care at a publicly-funded sexual health clinic

Life satisfaction is linked to premature morbidity and mortality and it may be compromised for individuals living in economically-disadvantaged, urban neighborhoods. The present study explores how behavioral and social-environmental health factors are associated with life satisfaction among a sample of African American young adults. Participants (N = 307, M_age = 26.6 years, 53% male) were recruited from a publicly-funded clinic for a randomized controlled trial (RCT). Data from the baseline assessment of the RCT, which included measures of sleep, depression, anxiety, social support, alcohol and drug use problems, city stress, and life satisfaction, were used for the current study. Correlation analyses assessed bivariate associations between life satisfaction and the demographic and health-related factors. Linear regression using backward elimination determined the best fitting model of factors associated with life satisfaction. Backward elimination resulted in the following variables remaining as significantly associated with life satisfaction: age (b = -2.40, p = .017), anxiety (b = -5.32, p < .001), and social support (b = 2.89, p = .004). Feeling rested upon waking also remained in the best fitting model, although this association did not achieve statistical significance (p = .099). The results suggest that African American adults who are younger, less anxious, and report adequate social support are more likely to report satisfaction with life. These findings add to the literature aimed at examining health and social factors impacting the well-being of African Americans living in low-income, urban communities.

Community trauma as a predictor of sexual risk, marijuana use, and psychosocial outcomes among detained African-American female adolescents

Social determinants contribute to health disparities. Previous research has indicated that community trauma is associated with negative health outcomes. This study examined the impact of community trauma on sexual risk, marijuana use and mental health among African-American female adolescents in a juvenile detention center. One hundred and eighty-eight African-American female adolescents, aged 13-17 years, were recruited from a short-term detention facility and completed assessments on community trauma, sexual risk behavior, marijuana use, symptoms of posttraumatic stress disorder and psychosocial HIV/STD risk factors. Findings indicate that community trauma was associated with unprotected sex, having a sex partner with a correctional/juvenile justice history, sexual sensation seeking, marijuana use, affiliation with deviant peers and posttraumatic stress disorder symptoms at baseline and longitudinally. Findings reinforce the impact of community-level factors and co-occurring health issues, particularly in high-risk environments and among vulnerable populations. Structural and community-level interventions and policy-level changes may help improve access to resources and improve adolescents' overall health and standard of living in at-risk communities.

Does change in readiness influence retention among African American women and men in substance abuse treatment?

African Americans are less likely than other racial groups to engage in and complete outpatient substance abuse treatment. The current study, conducted as a secondary analysis of a multisite randomized clinical trial, examined whether readiness to change (RTC) over time influences retention and whether gender moderates the relationship between changes in RTC and retention among 194 African American women and men. Participants completed the University of Rhode Island Change Assessment at baseline and at the end of the 16-week study. Findings revealed a significant relationship between RTC over time and retention. Specifically, the more RTC increased throughout the 16-week study, the longer participants remained in treatment. In addition, gender moderated the relationship between changes in RTC and retention, with a stronger association between changes in RTC and retention among men relative to women. One approach to improving substance abuse treatment retention rates is to focus on increasing RTC during treatment, especially among African American men.

Association between hair cortisol concentration and perceived stress in female methamphetamine addicts

OBJECTIVE

The present study aims to explore whether hair cortisol concentration is associated with explicit stress or implicit stress in female methamphetamine addicts.

METHODS

Hair samples were collected from 51 female methamphetamine addicts from inpatient addiction treatment programs. Perceived stress was assessed by both explicit and implicit measures through the Perceived Stress Scale (PSS) and the Implicit Association Test (IAT), respectively.

RESULTS

The positive relationship between hair cortisol concentration with D-scores of the IAT reached statistically significant difference. A marginal correlation between hair cortisol concentration and scores of the PSS was observed. Additionally, linear regression analysis indicated that D-scores of the IAT are strongly predictive of hair cortisol concentration.

CONCLUSION

Hair cortisol concentration is strongly related to implicit stress but only weakly related with explicit stress.

Exploring Experiences and Perceptions of Older African American Males Aging With HIV in the Rural Southern United States

The HIV (human immunodeficiency virus) epidemic in the United States remains a serious public health concern. Despite treatment and prevention efforts, approximately 50,000 new HIV cases are transmitted each year. Estimates indicate that 44% of all people diagnosed with HIV are living in the southern region of the United States. African Americans represent 13.2% of the United States population; however, 44% (19,540) of reported new HIV cases in 2014 were diagnosed within this ethnic group. The majority of cases were diagnosed in men (73%, 14,305). In the United States, it is estimated that 21% of adults living with HIV are 50 years or older. There exists limited data regarding how well African American men are aging with HIV disease. The purpose of this study was to explore the perceptions and experiences of older African American men living with HIV in rural Georgia. Data were collected from 35 older African American men living with HIV using focus groups and face-to-face personal interviews. Qualitative content analysis revealed six overlapping themes: (1) Stigma; (2) Doing Fine, Most of the Time; (3) Coping With Age-Related Diseases and HIV; (4) Self-Care; (5) Family Support; and (6) Access to Resources. The findings from this study provide new insights into the lives of rural HIV-infected African American men, expands our understanding of how they manage the disease, and why many return to or remain in rural communities.

Risk Profiles of Women Experiencing Initial and Repeat Incarcerations: Implications for Prevention Programs

Incarcerated women experience myriad individual, interpersonal, and structural factors leading to arrest and rearrest. This study examined risk profiles of women experiencing initial and repeat incarcerations. The sample included 521 women recruited from two prisons in North Carolina and enrolled in a HIV/STD risk-reduction intervention trial. Variables included socio-demographics, structural/economic factors, sexual and substance use behaviors, STDs, victimization history, and depressive symptoms. Bivariate and multivariable analyses identified risk differences. Compared to women incarcerated for the first time, women with repeat incarcerations reported significantly greater economic instability, substance use and sexual risk behaviors, laboratory-confirmed STDs, and victimization during childhood and adulthood. Multivariable logistic regression found women with repeat incarcerations experienced greater unstable housing, injection drug use, crack cocaine use, concurrent sex partners, and childhood sexual victimization. Findings can inform the development of prevention programs by addressing economic instability, sexual risk, and substance use among women prisoners.

Psychosocial determinants of marijuana use among African American youth

This study examines the psychosocial determinants of marijuana use among youth. A total of 7,488 African American middle and high school students from 133 metropolitan private and public schools completed a survey assessing psychosocial factors associated with annual marijuana use. The PRIDE survey, a nationally recognized survey on substance use, was used to assess the frequency of marijuana use and the influence of psychosocial factors on marijuana use among African American students. Results indicated that 18.5% of African American youth used marijuana in the past year. Males were significantly more likely than females to report using marijuana. Engaging in risky behaviors, such as getting in trouble at school and with police and attending a party with alcohol and other drugs, were significantly correlated with annual marijuana use. Conversely, having multiple parent, teacher, and school protective factors reduced annual marijuana use in this population. Such findings may assist prevention specialists in developing interventions to reduce and prevent marijuana use.

The role of neighborhood in urban black adolescent marijuana use

BACKGROUND

The present study examined the influence of neighborhood factors on transitions in marijuana involvement during adolescence in a sample of primarily low-income, urban Black youth.

METHODS

556 Black adolescents were interviewed annually beginning in first grade as part of a longitudinal study. Latent class analysis (LCA) was used to examine stages of marijuana involvement from 6th to 9th grades. The influence of neighborhood disorder, drug activity, violent crime, safety and disadvantage on transitions in marijuana involvement was tested using latent transition analysis (LTA).

RESULTS

There was evidence for three stages of involvement: no involvement, offered, and use and problems. Involvement increased steadily during adolescence with a slightly greater risk to transition from offers to use between 6th and 7th grades. Neighborhood disorder (AOR=1.04, CI=1.00, 1.08), drug activity (AOR=1.12, CI=1.02, 1.22) and disadvantage (AOR=1.44, CI=1.10, 1.92) were associated with the transition from marijuana offers to use and problems. Neighborhood disorder (AOR=1.07, CI=1.02, 1.11), drug activity (AOR=1.19, CI=1.10, 1.29) and violent crime (AOR=1.17, CI=1.03, 1.32) were associated with transitioning rapidly from no involvement to use and problems.

CONCLUSIONS

Understanding how neighborhoods could be organized and provided with supports to discourage marijuana use and promote non-drug using behaviors should be an important goal of any prevention program in low-income, urban Black neighborhoods. Enhancing citizen participation and mobilization to address the social processes of neighborhood disorder has the potential to reduce marijuana involvement in these neighborhoods.

Social network and census tract-level influences on substance use among emerging adult males: An activity spaces approach

Social network and area level characteristics have been linked to substance use. We used snowball sampling to recruit 90 predominantly African American emerging adult men who provided typical locations visited (n=510). We used generalized estimating equations to examine social network and area level predictors of substance use. Lower social network quality was associated with days of marijuana use (B=-0.0037, p<0.0001) and problem alcohol use (B=-0.0050, p=0.0181). The influence of area characteristics on substance use differed between risky and non-risky spaces. Peer and area influences are important for substance use among men, and may differ for high and low risk places.

Twitter chatter about marijuana

PURPOSE

We sought to examine the sentiment and themes of marijuana-related chatter on Twitter sent by influential Twitter users and to describe the demographics of these Twitter users.

METHODS

We assessed the sentiment and themes of a random sample (n = 7,000) of influential marijuana-related tweets (sent from February 5, 20114, to March 5, 2014). Demographics of the users tweeting about marijuana were inferred using a social media analytics company (Demographics Pro for Twitter).

RESULTS

Most marijuana-related tweets reflected a positive sentiment toward marijuana use, with pro-marijuana tweets outnumbering anti-marijuana tweets by a factor of greater than 15. The most common theme of pro-marijuana tweets included the Tweeter stating that he/she wants/plans to use marijuana, followed by tweeting about frequent/heavy/or regular marijuana use, and that marijuana has health benefits and/or should be legalized. Tweeters of marijuana-related content were younger and a greater proportion was African-American compared with the Twitter average.

CONCLUSIONS

Marijuana Twitter chatter sent by influential Twitter users tends to be pro-marijuana and popular among African-Americans and youth/young adults. Marijuana-related harms may afflict some individuals; therefore, our findings should be used to inform online and offline prevention efforts that work to target individuals who are most at risk for harms associated with marijuana use.

Neighborhood environment and urban African American marijuana use during high school

African American male high school students have the highest rates of marijuana use among all racial, ethnic, and gender groups, yet there is limited research examining contextual factors salient to the African American community. The purpose of this study was to examine how neighborhood environment measured in 8th grade is related to longitudinal transitions in marijuana use during high school (9th to 12th grades) in a sample of urban African Americans. Four hundred and fifty-two African American children were interviewed annually beginning in 1st grade as part of a longitudinal field study in Baltimore city. Latent transition analysis indicated early in high school posed the greatest risk for initiation and progression of marijuana use. Community violence exposure was associated with an increased likelihood of transitioning from no marijuana use to infrequent use (adjusted odds ratios (AOR) = 2.40, p < 0.001). Higher perceived neighborhood disorder (AOR = 3.20, p = 0.004), drug activity and sales in the neighborhood (AOR = 2.28, p = 0.028), and community violence exposure (AOR = 4.54, p < 0.001) were associated with an increased risk of transitioning from no use to frequent/problematic marijuana use. There was evidence for partial mediation of these associations by perceptions of harm and depressed mood. Drug activity and sales was associated with progression from infrequent to frequent and problematic use (AOR = 2.87, p = 0.029). African American youth living in urban environments with exposure to drug activity, violence, and neighborhood disorder are at increased risk for both initiation and progression to more frequent and problematic marijuana use during high school. These findings highlight the need to develop interventions for African American youth that are mindful of the impact of the additional stressors of living in a high-risk urban environment during a critical developmental transition period. Reducing exposure to drug activity and violence in high-risk urban neighborhoods may be the first step to potentially halt increasing rates of marijuana use among African Americans.

Neighborhood context and Black heterosexual men's sexual HIV risk behaviors

The effects of neighborhood context on sexual risk behavior are understudied, particularly for Black heterosexual men who do not inject drugs or report heavy drug use. Evidence of a generalized HIV epidemic (>1 %) among Black heterosexuals in low-income urban U.S. communities underscores the importance of examining the effects of neighborhood context on Black heterosexual men's sexual risk, however. We used structural equation modeling to test the pathways between neighborhood context (neighborhood disorder, personal violence, neighborhood threats), depression, substance use, and sexual risk behavior. Participants were 526 self-identified Black heterosexual men, ages 18-45, recruited via randomized venue-based probability sampling in Philadelphia, PA. Analyses of model fit statistics from Mplus indicated statistically significant direct pathways between neighborhood context, depression, substance use, and sexual risk behavior. The total indirect effect of neighborhood context on sexual risk behavior through substance use was also significant. The study's results highlight a need for more research on neighborhood context and sexual HIV risk, and for multilevel interventions to address the effects of negative neighborhood context on Black heterosexual men's sexual HIV risk.

A narrative review of binge eating and addictive behaviors: shared associations with seasonality and personality factors

Binge-eating disorder and seasonal affective disorder were first described as clinically relevant conditions in very close temporal proximity a few decades ago. Both disorders have a higher prevalence rate in woman than in men, are characterized by a high proneness-to-stress and manifest heightened responsiveness to high-calorie, hyper-palatable foods. In recent years, a compelling body of evidence suggests that foods high in sugar and fat have the potential to alter brain reward circuitry in a manner similar to that seen when addictive drugs like alcohol and heroin are consumed in excess. These findings have led to suggestions that some cases of compulsive overeating may be understood as an addiction to sweet, fatty, and salty foods. In this paper, it is proposed that high seasonality is a risk factor for binge eating, especially in those characterized by anxious and impulsive personality traits - associations that could only occur in an environment with a superfluity of, and easy access to, rich and tasty foods. Given the well-established links between binge eating and addiction disorders [Ref. (1-3) for reviews], it is also suggested that seasonality, together with the same high-risk psychological profile, exacerbates the likelihood of engaging in a broad range of addictive behaviors. Data from a community sample (n = 412) of adults tested these models using linear regression procedures. Results confirmed that symptoms of binge eating and other addictive behaviors were significantly inter-correlated, and that seasonality, gender, and addictive personality traits were strong statistical predictors of the variance in binge-eating scores. Seasonality and addictive personality traits also accounted for a significant proportion of the variance in the measure of addictive behaviors. Conclusions are discussed in the context of brain reward mechanisms, motivational alternations in response to chronic over-consumption, and their relevance for the treatment of excessive appetitive behaviors.