Transformative Consciousness of Health Inequities: Oppression is a Virus and Critical Consciousness is the Antidote

Critical Dialogue and Capacity-Building Projects Reduced Alcohol and Substance Use in a Randomized Clinical Trial Among Formerly Incarcerated Men

Background: Rates of alcohol and/or substance use (ASU) among residents of predominantly Black and marginalized communities are similar to ASU rates in White communities. Yet ASU has worse consequences in predominantly Black and marginalized communities (e.g., higher incarceration). Objective: We randomized participants to one of 16 intervention conditions using a 24 full factorial design to optimize a multilevel intervention reducing ASU among 602 formerly incarcerated men with substance-use-disorders (SUD). Candidate intervention components included (1) critical dialogue (CD; six weekly 2-hour-long group sessions vs. no CD sessions), (2) Quality of Life Wheel (QLW; six weekly 1-hour-long group sessions vs. no QLW sessions), (3) capacity building projects (CBP; six weekly 1-hour-long group sessions vs. no CBP sessions), and (4) delivery by a trained peer versus licensed facilitators. Outcome was percentage of days in which participants used alcohol, cocaine, opioid, and/or cannabis in previous 30 days. Results: Intent-to-treat analysis did not meet a priori component selection criteria due to low intervention attendance. After controlling for intervention group attendance (percentage of sessions attended), peer-delivered CD and CBP produced statistically and clinically significant main and interaction effects in ASU over 5 months. Per the multiphase optimization strategy framework, we selected peer-delivered CD and CBP for inclusion as the optimized version of the intervention with a cost of US$1,380 per 10 individuals. No adverse intervention effects occurred. Conclusion: CD and CBP were identified as the only potentially effective intervention components. Future research will examine strategies to improve attendance and test the optimized intervention against standard of care in a randomized-controlled-trial.

A Qualitative Exploration of the Built Environment as a Key Mechanism of Safety and Social Cohesion for Youth in High-Violence Communities

The characteristics of a neighborhood's built environment may influence health-promoting behaviors, interactions between neighbors, and perceptions of safety. Although some research has reported on how youth in high-violence communities navigate danger, less work has investigated how these youth perceive the built environment, their desires for these spaces, and how these desires relate to their conceptions of safety and perceptions of other residents. To fill this gap, this study used focus group data from 51 youth ages 13-24 living in New Orleans, Louisiana. Four themes were developed using reflexive thematic analysis: community violence is distressing and disruptive, youth use and want to enjoy their neighborhood, systemic failure contributes to negative outcomes, and resources and cooperation create safety. This analysis indicates that young people desire to interact with the built environment despite the threat of community violence. They further identified built environment assets that facilitate socialization and recreation, such as local parks, and social assets in the form of cooperation and neighbor-led civic engagement initiatives. In addition, the youth participants demonstrated awareness of structural inequities that influence neighborhood health and violence-related outcomes. This study contributes to efforts to understand how youth with high levels of community violence exposure understand and interact with the built and social environments.

Validation of the Black Community Activism Orientation Scale with racially and ethnically diverse college students

This study fills a methodological gap in racial justice research by assessing the utility and validity of the Black Community Activism Orientation Scale (BCAOS) in a racially and ethnically diverse sample of college-going young adults (N = 624, M = 19.4 years, SD = 1.89) from 10 colleges in the United States. Confirmatory factor analysis was conducted to estimate the goodness of fit of the proposed three-factor model and assess the validity of the BCAOS. Findings from the confirmatory factor analysis provide statistical support for use of the BCAOS as a measure of racial justice activism in support of Black communities among racially and ethnically diverse college-going young adults. Findings from the study also suggest that White college students and men are less oriented toward racial justice activism than women and racially marginalized students. Convergent and discriminant validity were established through bivariate correlations of the BCAOS factors with other civic development measures. As more and more young people consider the importance of standing against racial oppression, the BCAOS has utility as an assessment instrument in future racial justice research, education, intervention, and youth programming efforts.

Pilot Trial of a Critical Consciousness-Based Intervention for Black Young Gay and Bisexual Men Living with HIV: Mobilizing Our Voices for Empowerment (MOVE)

HIV in the USA disproportionately affects Black young gay and bisexual men (Y-GBM). This article presents outcomes of a pilot randomized controlled trial comparing Mobilizing our Voices for Empowerment (MOVE), a culturally and developmentally tailored critical consciousness-based intervention for Black Y-GBM living with HIV (ages 16-24), with a comparison health promotion intervention. Black Y-GBM (n = 54) from four cities participated. Mixed effects models across four assessment points revealed participants in MOVE showed greater increases over time in perceived stress of HIV disclosure, self-efficacy for limiting HIV risk behavior, and condom use self-efficacy. Examining mean difference scores separately, participants in MOVE demonstrated increases in self-efficacy for HIV disclosure, perceived policy control, and self-efficacy for limiting HIV risk behavior. Immediately post-intervention, MOVE participants reported greater decreases in condomless intercourse with negative/unknown partners. MOVE may have potential to improve the health of Black Y-GBM living with HIV and reduce further transmission.

Online Dating and Mental Health among Young Sexual Minority Black Men: Is Ethnic Identity Protective in the Face of Sexual Racism?

Racialized Sexual Discrimination (RSD), also known as 'sexual racism,' is pervasive within online dating venues. RSD is associated with poor mental health outcomes among young sexual minority Black men (YSMBM), and there is limited research on factors that may mitigate this association. Ethnic identity has been identified as a potential protective factor for racial/ethnic minorities who encounter racialized stressors, though some evidence suggests that ethnic identity may also intensify the negative effects of racial discrimination. Using data from a cross-sectional web-survey of YSMBM (n = 690), a series of linear regression models were estimated to examine the moderating effect of ethnic identity search and ethnic identity commitment on the relationship between RSD and depressive symptoms/feeling of self-worth. Results indicated that having moderate-to-high scores on commitment attenuated the association between being physically objectified by White men and higher depressive symptoms. However, having high scores on commitment intensified the association between being rejected by Black men and lower feelings of self-worth. Stronger identity commitment may be protective against objectification from White men, though it may also exacerbate negative outcomes related to in-group discrimination. These findings may have important implications for the development of individual and group-level interventions addressing ethnic identity among YSMBM.

Work-in-progress: Focus groups evaluate and inform revisions of a socio-behavioral health intervention

African American men and women are disproportionately impacted by HIV/STI risk. Particularly, African American women are more likely to be infected with HIV from heterosexual sex. Yet, much of the intervention research has focused on men who have sex with men. This article describes the development and feasibility study of a six-session socio-behavioral health intervention that utilized sociodrama to reduce substance use and HIV/STI risk among heterosexual, African American men and women who have multiple sex partners. The intervention was developed based on theories and models of critical consciousness, social scripts, and group work practice. Content and delivery were informed by qualitative data collection with a range of stakeholders including service providers and members of the target population. The resulting intervention was six group sessions, delivered by two licensed social workers, with one of the facilitators trained in sociodrama. The results of the qualitative study explored the feasibility of conducting this six-week intervention and evaluated a trial run of the intervention. The data was obtained through focus group interviews and observations. Findings revealed that the intervention could be delivered with fidelity and was acceptable to participants and indicated that the intervention's innovative components of sociodrama and critical consciousness resonated with the participants and has potential to reduce HIV/STI risk and substance use. Reported barriers and suggested revisions need to be examined further and addressed to develop and implement a sustainable program that can be delivered in community-based settings. A future randomized control trial of the revised intervention will evaluate the intervention's efficacy.

The Critical Dialogue Cornerstone: Suggested Practices to Guide Implementation, Facilitation and Evaluation

There has been an increased focus on utilizing critical consciousness-focused interventions to address complex, multidimensional socio-cultural problems, particularly health inequities. These interventions usually incorporate a critical dialogue component. However, there's little guidance on how to implement, facilitate and evaluate critical dialogue to develop critical consciousness (i.e., reflecting and acting on sociopolitical inequities). This conceptual paper: 1) introduces critical dialogue and the tools used to implement critical dialogue from the literature; 2) details the development of the Community Wise intervention to present how Community Wise incorporated a critical dialogue component; 3) provides a brief overview of a proposed framework of critical consciousness development that the critical dialogue component of Community Wise could support; 4) provides an anecdotal exploration of the critical dialogue sessions used in the first pilot test of the intervention through the proposed framework of Transformative Consciousness; and 5) suggests practice guidelines for group work that incorporates facilitated critical dialogue.

Using Ecological Momentary Assessments to Understand Black Youths' Experiences of Racism, Stress, and Safety

Anti-Black racism, both interpersonal and systemic, is pervasive. Individual- and neighborhood-level expressions of anti-Black racism have been explored in many studies; however, Black youths' experiences of racism across routine activity locations have not been examined as extensively. To address this gap, a Youth Research Advisory Board (YRAB) recruited 75 Black youths (M (SD) = 15.53 (1.77)), living in a segregated neighborhood (93% African American) with 42% of residents living below the poverty line, to participate in research on this topic. Participants in the study completed surveys three times a day for a month (ecological momentary assessment) about their positive and negative emotions and perceptions of racism and social support in routine activity locations (n = 2041). Youths reported more racism when attending school and walking on the street. A relationship between perceptions of racism and social support in routine activity locations and positive and negative momentary emotions was found. This paper will present implications for supporting adolescent development and interrupting anti-Black racism at the level of routine activity locations, along with opportunities for engaging youth-led community-based solutions.

Linking critical consciousness and health: The utility of the critical reflection about social determinants of health scale (CR_SDH)

Introduction

Critical consciousness (CC) theory has been proposed as a framework to inform health interventions targeting a wide variety of health conditions. Unfortunately, methodological limitations have made it difficult to test CC as a mediator of health outcomes. Specifically, standardized and widely accepted measures of health-related CC are needed. The goal of this study was to develop and test a measure of critical reflection on social determinants of health (SDH). This measure focused on critical reflection, an essential dimension of CC.

Methods

Community-based participatory research principles and a mixed methods design were used with three samples: (1) experts in SDH and CC, (2) 502 individuals completing online surveys, and (3) 602 men with histories of substance use disorder and incarceration. All participants were over 18 years of age. Analysis included descriptive frequencies, exploratory factor analyses (EFA), confirmatory factor analysis (CFA), generalized linear regression models, correlations, and Cronbach's alpha calculations.

Results

The Critical Reflection about SDH scale (CR_SDH) is a short, unidimensional, and reliable scale (α = 0.914). Construct validity was supported and known-groups validity showed that the scale discriminated different levels of CR_SDH based on political views, educational level, knowledge of health inequities, and gender.

Conclusion

The CR_SDH is a standardized measure that can assess critical reflection about the impact of SDH on health among providers and consumers of health care. The CR_SDH can be used to identify critical reflection related training needs and inform decisions about development and testing of critical reflection related health interventions and health care policy.

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Social determinants of health contribute to health inequities that pose significant costs to nations throughout the world.

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Critical consciousness theory is a framework with potential to address social determinants of health and health inequities.

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This study developed a standardized tool to measure critical reflection about the impact of social determinants of health.

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The CR_SDH can be used as a mediator of treatment outcomes.

'I can't leave everything in the hands of my husband': Economic constraints and gender roles in care-seeking in post-Ebola Guinea

The 2014-2016 Ebola epidemic in West Africa had enduring effects on health systems and healthcare utilisation. This study explores the intersection of economic constraints and gender roles in Guinea to understand delays in care-seeking post-Ebola. In-depth interviews (n = 45) and focus group discussions (n = 24) were conducted with mothers, male heads of household, grandmothers, and health workers in rural and urban areas in Basse-Guinée and Guinée Forestière. A thematic analysis identified salient themes related to gender and economic constraints on health care-seeking. Participants, particularly men, emphasised the high cost of seeking care, which led to delays as women secured funds. Men's engagement in care-seeking included providing funds and permission, picking up medication, and giving appointment reminders. As principal actors when 'navigating' the healthcare system, women were intimately involved in economic decisions and responsible for securing funds for services - even when lacking direct financial control. Essentialist descriptions of men as 'providers' and women as 'navigators', therefore, masked nuances in care-seeking and economic responsibilities. Programmes must acknowledge men's engagement in care-seeking and address both the economic barriers women face when seeking care and their economic roles. Greater attention to the complex intersection of economic constraints and gender roles could address care-seeking delays.

Comparing Macro Influences on Individuals' Initial Coping and Response to COVID-19 in Canada and USA

It is a responsibility of national leadership to provide guidance and provisions to their citizens during a pandemic. National responses to the COVID-19 pandemic have greatly varied internationally. The purpose of this study was to compare how people in Canada and the USA coped to the COVID-19 pandemic, with an eye towards discerning if any differences relate to macro systems differences between the neighboring countries. Data were analyzed from an online, cross-sectional survey administered to people (N = 1405) living in Canada and the USA in June 2020. Significant results show that respondents from Canada were felt more prepared, adapted/coped better to the pandemic, had less life disruption, fewer challenges with healthcare and financially, and were personally less affected by the pandemic than respondents from the USA. Those from Canada also showed significant higher levels of support for both their national and provincial/state leadership and belief in the necessity of preventative measures than those in the USA. Respondents from the USA were more likely to use family and friends as a source of information and as a basis for their personal preventative practices, whereas those in Canada were more likely to follow the official government recommendations. There were no significant differences in methods of coping. These results support the need for a clear role of government and for government to respond to individuals in a way that promotes equity and social justice, and thus, ensuring human rights.

Healing Is Rhizomatic: A Conceptual Framework and Tool

This paper offers a conceptual framework and a set of tools that use rhizomes as a metaphor for healing in the context of oppressive violence. Existing conceptualizations of trauma, trauma recovery, and healing offer important tools for framing and addressing the impacts of oppression on individuals and groups. These exist in a fractured practice ground where practitioners are socialized into divisions such as “micro” vs. “macro” practice and “self-care” vs. “the work.” The Healing is Rhizomatic conceptual framework identifies five nodes (body, felt sense, relationships, place, story) and three dimensions of healing-oriented engagement (recognition, readying the ground, (re)generation) that exist across these approaches. Adaptable to multiple levels of analysis, the conceptual framework focuses on fracture, blockage, and connection as core experiences. These experiences occur in, through, and between the nodes and dimensions. This paper explores use of the conceptual framework and tools for applying it as a mechanism for assessment and reflection about internalized and operational definitions and approaches to healing. Thereby, the framework and tools offer a view of a common practice ground for practitioners engaged in healing work in the context of oppressive violence and is intended to support deeper awareness, collaboration, and coordination of approaches.

Transforming responses: Exploring the treatment of substance-using African American women

This article explores how intrapersonal and structural oppression may impact treatment and the recovery process of 23 self-identified African American women with histories of incarceration and substance use. Using a critical consciousness (CC) framework and content-based thematic analysis, researchers systematically coded and extracted themes and patterns from focus group data to evaluate how marginalizing processes-such as race-based discrimination-impact treatment, the therapeutic relationship, and service provision. Results indicate that participants' health and treatment were negatively impacted by oppressive factors, specifically the oppressive process of silencing. The authors discuss research and practice implications.

From Sculpting an Intervention to Healing in Action

Blacks/African Americans have the most severe and disproportionate burden of HIV of all racial/ethnic groups in the United States. Oppression (i.e., socio-structural (macro), institutional (exo), community (meso), and interpersonal (micro)), operates as four interrelated prongs that perpetuate the HIV epidemic in Black/ African American communities. Oppressive (i.e., racist and sexist) cultural scripts transferred to individuals through community, family and interpersonal relationships may play a role in HIV/STI risk. However, socio-behavioral health interventions or behavioral risk reduction interventions have traditionally focused solely on individual-level health risk behaviors allowing invisible, inequitable socio-structural factors to continue unchallenged. A new intervention, Black Men and Women: Empowering Self, Relationships and Community, was sculpted from two existing interventions Community Wise and Men of African American Legacy Empowering Self (MAALES) to develop awareness of oppressive cultural scripts operating on interpersonal and intrapersonal levels and to take action against these oppressive messages to reclaim identity, restore relationships, and build community. This paper summarizes the theory and selected sociodramatic components of the intervention that promote healing in action to reduce HIV/STI risk among heterosexually identified, low-income African American men and women with multiple sex partners. Lessons learned in theory, research and practice are also discussed.

Perceived Race as Variable: Moderating Relationship Between Perceived Discrimination in the Workplace and Mentally Unhealthy Days

Since race is a social construct, the experience of racial discrimination occurs based on perceived race. This study explores the moderating effects of self-identified race and perceived racial identity on the relationship between perceived discrimination in the workplace and mentally unhealthy days using data derived from the four states (Arizona, Minnesota, Mississippi, and New Mexico) that responded to the 2014 Reactions to Race module of the Behavioral Risk Factor Surveillance System. The study hypothesized that self-identified White people, also perceived as White (WW), would have less perceived workplace discrimination and less mentally unhealthy days than self-identified non-White people perceived as White (NWW); NWW would have less perceived discrimination associated with mentally unhealthy days than self-identified White perceived as non-White (WNW); and, WNW would have less perceived discrimination associated with mentally unhealthy days than self-identified non-White perceived as non-White (NWNW). The study was conducted under the regulating body of the City University of New York in 2017. Findings suggest that being perceived as White is a protective factor as analysis determined that NWW experienced less discrimination in the workplace associated with mentally unhealthy days than NWNW.