Sojourner syndrome and health disparities in African American women

Building the African American/Black Community's Capacity to Elucidate Factors for High Smoking Rates in Jackson, MS: Results from Implementing a Community-Led Needs Assessment

INTRODUCTION

Although smoking has decreased dramatically over the last 50 years, reductions are uneven by race and income, specifically in the Southern United States. There is a need for intentional collaboration with communities located where large tobacco disparities exist to make lasting change. Using community-based participatory research principles, we provided intensive capacity building to a community advisory group (CAG) of 14 Jackson, MS, residents to conduct a community-led needs assessment. The aim of the community-led needs assessment was to investigate firsthand why the community smokes and the impacts of smoking-giving the CAG voice and choice to work towards reducing tobacco-related harms and inequities.

METHODS

From October 2020 to September 2021, CAG members conducted thirteen interviews and nine focus groups, reaching 54 residents. We analyzed the data using a thematic and in vivo approach.

RESULTS

Participants reported smoking is used to cope with systemic socio-economic issues (e.g., racism, poverty). Smoking is normalized in the community through continued use, ease of purchase, visibility of tobacco retailers, and lack of conversations or questioning surrounding smoking. Participants felt that peer and family use, addiction, and inaccessible smoking resources were the most influential factors driving smoking behaviors.

CONCLUSION

This community engagement approach empowered residents to design and implement a comprehensive needs assessment resulting in rich data-a needed approach for a community experiencing enduring health inequities. Communities need to be engaged and invested in from the beginning as equal partners to learn, investigate, and develop community-relevant and innovative solutions to address tobacco social norms.

Examining the Perceptions of mHealth on Racial and Ethnic Disparities in Postpartum Health for Black Women: A Scoping Review

Background. Several disparities exist for Black mothers during the postpartum period, including but not limited to increased maternal mortality and morbidity rates, decreased access to care, and limited access to resources. Given the racial discrepancies in attention to postpartum care, coupled with the critical importance of the postpartum period for preventing adverse maternal health outcomes, research is warranted to explore how mobile health (mHealth) applications may help to alleviate maternal health disparities by optimizing postpartum care and addressing barriers to care for postpartum Black women. Thus, this review examines the perceptions of mHealth applications and their utility in health outcomes among postpartum Black women. Methods. We undertook a comprehensive literature search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included peer-reviewed articles published between 2010 and 2022 that were written in English, utilized mHealth as a primary intervention, and focused on postpartum health and access to resources, primarily among Black women in the United States. Results. A total of eight articles were included in our synthesis, encompassing mobile phone-based interventions for Black women. Cultural tailoring was included in five studies. Interventions that incorporated tailored content and fostered interactions reported high rates of follow-up. Conclusions. Tailored mHealth interventions can effectively promote behavior change and improve health care outcomes for Black women. However, there is a critical need for more research to assess user engagement and retention and whether these improvements indicate long-term sustainability.

Social determinants of health and obstetric outcomes: A report and recommendations of the workshop of the Society for Maternal-Fetal Medicine

This article is a report of a 2-day workshop, entitled "Social determinants of health and obstetric outcomes," held during the Society for Maternal-Fetal Medicine 2022 Annual Pregnancy Meeting. Participants' fields of expertise included obstetrics, pediatrics, epidemiology, health services, health equity, community-based research, and systems biology. The Commonwealth Foundation and the Alliance of Innovation on Maternal Health cosponsored the workshop and the Society for Women's Health Research provided additional support. The workshop included presentations and small group discussions, and its goals were to accomplish the following.

'The only way out': how self-care is conceptualized by Black women

OBJECTIVE

Discrimination in the lives of Black women often leads to maladaptive coping strategies that negatively influence health. Self-care encompasses practices that promote well-being; however, little is known about how Black women conceptualize and practice self-care.

DESIGN

This article reports qualitative findings from 10 semi-structured interviews conducted with 10 Black women subject-matter experts (SMEs) from throughout the US. There were eight individual interviews with SMEs who provided self-care services/content to other Black women and two group interviews with SME organizations that provided self-care and other wellness programs to Black women. This approach utilized both expert and personal lived experiences of SMEs.

RESULTS

Using the constant comparison analysis method, there was saturation with four concepts that describe the role of structural racism and sexism on the health outcomes of Black women, and the potential for self-care to mediate the negative relationship of these stressors on health. SME practices of self-care overlapped, comprising a 5-part theory of self-care.

CONCLUSION

Ultimately, self-care may help to combat the impact of structural influences on the health of Black women. Using self-care as a healthier approach to coping with stress can aid in the reduction of health disparities.

Shouldering the load yet again: Black women's experiences of stress during COVID-19

Black women in the United States experience considerable amounts of stress, which has been exacerbated by the COVID-19 pandemic. Prior studies have linked stress to adverse mental and physical outcomes for Black women and, moreover, shown that Black women are more susceptible to maladaptive coping, which compounds these risks. Research on the Superwoman Schema and Sojourner's Syndrome, for instance, shows how Black women are compelled to portray strength and resilience while suffering internally and experiencing poor health outcomes. These phenomena can be attributed to the historical expectations of Black women to be pillars of their families and sources of strength despite adversity and persistent institutional discrimination. During the COVID-19 pandemic, Black women's greater likelihood of holding “essential worker” roles has further increased their risk of both COVID-19 exposure and heightened stress. Additionally, the COVID-19 pandemic has aggravated long standing structural inequities and disparities between Black women and other racial/ethnic groups. Drawing on journal entries submitted by Black women participating in the Pandemic Journaling Project (PJP), a combined online journaling platform and interdisciplinary research study, this paper illuminates the voices of Black women during the COVID-19 pandemic. Seventy-two Black women created journal entries using the PJP platform. We analyze the stories, idioms, and feelings they recorded during a global pandemic. We identify three prominent domains of stress: work and school, caregiving, and social (dis)connectedness. In addition to exploring manifestations of stress across these domains, we, discuss some of the mental health implications of COVID-19 and explore the potential for regular journaling as a possible mode of stress management among Black women.

Experiencing, anticipating, and witnessing discrimination during the COVID-19 pandemic: Implications for health and wellbeing among Asian Americans

The onset of the COVID-19 pandemic spurred increased racial animus toward Asians and Asian Americans (A/AA) who have since been contending with increased racism and violence. While some of the harm associated with this increased prejudice may derive from personally experienced discrimination, the COVID-19 pandemic has also been marked by an increase in vicarious exposure to discrimination as well as increased anticipation of discrimination, both of which may be taxing for the mental and physical health of A/AA. The goal of this study, accordingly, was to examine the effects of personal experiences of discrimination, vicarious exposure to discrimination, and anticipated discrimination on depressive symptoms, physical health symptoms, sleep quality, and sleep disturbances among A/AA. Results from our two-wave field survey demonstrated that experiencing and anticipating discrimination were associated with mental and physical health symptoms as well as sleep disturbances. Further, personal experiences of discrimination interacted with vicarious discrimination to determine physical health symptoms such that greater vicarious exposure weakened the relationship between experienced discrimination and physical health symptoms. These findings demonstrate the need to mobilize resources to combat the multipronged, negative implications of the recent rise in anti-Asian prejudice during the COVID-19 pandemic.

Congregational health needs by key demographic variables: Findings from a congregational health needs assessment tool

Health needs assessments identify important issues to be addressed and assist organizations in prioritizing resources. Using data from the Mid-South Congregational Health Survey, top health needs (physical, mental, social determinants of health) were identified, and differences in needs by key demographic variables (age, sex, race/ethnicity, education) were examined. Church leaders and members (N = 828) from 92 churches reported anxiety/depression (65 %), hypertension/stroke (65 %), stress (62 %), affordable healthcare (60 %), and overweight/obesity (58 %) as the top health needs in their congregations. Compared to individuals < 55 years old and with a college degree, individuals ≥ 55 years old (ORrange=1.50-1.86) and with ≤ high school degree (ORrange=1.55-1.91) were more likely to report mental health needs (anxiety/depression; stress). African Americans were less likely to report physical health needs (hypertension/stroke; overweight/obesity) than individuals categorized as Another race/ethnicity (ORrange=0.38-0.60). Individuals with ≤ high school degree were more likely to report affordable healthcare as a need compared to individuals with some college or a college degree (ORrange=1.58). This research highlights the need for evaluators and planners to design programs that are comprehensive in their approach to addressing the health needs of congregations while also considering demographic variation that may impact program participation and engagement.

COVID-19, "A Gift and a Curse" in Unsettling Times: A Qualitative Study

The objectives of this study were to rapidly explore the perceptions of female-headed African American families on "stressors," "stress reactions," and "opportunities" amid the COVID-19 pandemic lockdown mandates. Semistructured telephone interviews were conducted with 9 African American women in a rural Midwestern (US) community, who were single parents/grandparents and cared for at least one child/grandchild aged 5 to 17 years. A thematic analytical approach was used to review, code, and analyze phone interview transcripts. Coding schemes were developed through an interactive iterative process. Three main themes emerged-pandemic as a curse, de-stressors and coping mechanisms, and the pandemic as a gift. Most participants reported increased stress for themselves and their children and adopted several coping strategies. However, for most mothers, COVID-19 was paradoxical because it also provided opportunities for families to bond despite these stressors. Public health actions such as social and physical distancing infringe on personal freedoms and can have negative effects on the health of those affected. There is a need to proactively address important areas such as health education and economic and social support to mitigate common sociopsychological effects of a pandemic.

Prevalence and predictors of symptoms of Perinatal Mood and anxiety Disorders among a sample of Urban Black Women in the South

OBJECTIVES

Data are scarce regarding the prevalence and predictors of perinatal mood and anxiety disorders (PMADs) among Black women. The purpose of this study was to examine the prevalence and predictors of symptoms of PMADS among Black women.

METHODS

Black women completed a paper survey between August 2019 and October 2019. Binomial logistic regression was employed to examine predictors of PMAD symptoms.

RESULTS

The prevalence of symptoms of PMADs was 56%. A higher proportion of women with PMADs had experienced depression (16% vs. 32%, p = 0.006); physical (18% vs. 31%, p = 0.030), emotional (35% vs. 61%, p = 0.000), or sexual abuse (12% vs. 29%, p = 0.002); and symptoms of depression or anxiety before pregnancy (18% vs. 46%, p = 0.000). After adjusting for socio-demographics in multivariate analysis, experiencing symptoms of depression or anxiety before pregnancy (adjusted odds ratio [aOR] = 3.445, p = 0.001) was positively associated with experiencing symptoms of PMADs, whereas higher levels of self-esteem (aOR = 0.837, p = 0.000) were negatively associated with experiencing symptoms of perinatal mood and anxiety disorders.

CONCLUSIONS FOR PRACTICE

The prevalence of PMAD symptoms among this sample of Black women was alarmingly high. Women who experienced PMADs were more likely to report adverse childhood experiences (e.g., physical, emotional, and/or sexual abuse). By understanding the prevalence of PMADs and the factors associated with these disorders, healthcare professionals can improve diagnosis and treatment rates among this understudied and underserved population.

“I’m a Strong Independent Black Woman”: The Strong Black Woman Schema and Mental Health in College-Aged Black Women

The Strong Black Woman Schema (SBWS) is a cultural expectation for Black women to unfailingly display signs of strength and caretaker qualities, while suppressing their emotions. Although this schema is a purported source of strength for Black women, quantitative explorations of its psychological impact have been limited. In the present study, we examined associations between endorsement of the SBWS and several indicators of mental health and resilience in Black women. We analyzed responses from 212 college-aged, Black women assessing psychological distress, suicidal behaviors, resilience, and SBWS endorsement. Findings indicated that endorsement of the SBWS was positively related to both psychological distress and self-reported suicidal behaviors. In addition, the SBWS’ link to suicidal behaviors was mediated by psychological distress. Lastly, results from moderated mediation analysis supported a buffering effect of resilience. That is, when resilience was high, the association between psychological distress and suicidal behaviors, as well as the conditional indirect effects of the SBWS, was lessened. Implications of these findings suggest that prevalent endorsement of SBWS within Black communities may be harmful to Black women’s mental health. We call for additional research and provide recommendations on how the media, mental health professionals, and community leaders can mitigate its negative effects.

A Qualitative Assessment of Gender- and Race-Related Stress Among Black Women

Background: Chronic psychological stress has been associated with several adverse health outcomes, including obesity. Black women report higher levels of psychological stress than White women and carry a disproportionate burden of chronic conditions associated with psychological stress, including obesity. Research also suggests that in addition to generic stressors, Black women also experience race- and gender-related stress. To further explore this, we conducted structured focus groups to examine Black women's perspectives about stress.

Materials and Methods: Using the nominal group technique, three sessions (total, n = 33) were conducted exclusively with Black women to solicit responses to the following questions: (1) What are the top sources of stress for women? (2) What are the top stressors specifically for Black women? and (3) How do these stressors affect weight? Using a systematic method, participants ranked responses in order of importance. Responses were compiled and tabulated to identify which statements were viewed as most important by respondents.

Results: Mean age and body mass index of participants were 43.0 ± 10.1 years and 35.1 ± 7.9 kg/m², respectively. The top 3 responses for question 1 were health, family, and relationships. Safety of children and raising Black children, being the head of the family, and finances were the top responses for question 2. Emotional eating, not enough time for exercise, and eating fast food due to lack of time or money were voted as the top reasons as to how stressors influence women's weight.

Discussion: Our findings are consistent with previous work reporting that, along with generic stress, race- and gender-related stress contribute to the overall experiences of Black women. This work adds qualitative depth to allow for a better understanding of the unique sources of stress for Black women. These gender- and race-related stressors should be considered when offering stress management interventions for weight loss and general health promotion among Black women.

Do intersecting identities structure social contexts to influence life course health? The case of school peer economic disadvantage and obesity

Scholarship linking social contextual measures to health outcomes has grown in recent decades, but the role of individuals' intersecting identities in structuring social contexts to influence health remains unclear. Building on an existing intersectionality framework, we conceptualize how this may occur through social relationships. Then, we apply this framework to analyze whether adolescent peer social contextual disadvantage influences life-course obesity heterogeneously by individual gender, race, and early-life income. We take a life course approach as adolescence is a sensitive period for both social development and adult obesity development. In our analysis, we use cohort data from the National Longitudinal Study of Adolescent to Adult Health and leverage quasi-experimental variation in adolescent peers to addresses common sources of bias in prior observational studies. We find that among Black men from lower-income households in adolescence, there is a strong negative relationship between adolescent peer economic disadvantage and adult obesity that strengthens over time. By contrast, among Black women across adolescent household income levels, we find a strong positive relationship between adolescent peer economic disadvantage and obesity that emerges as women leave high school and endures into mid-adulthood. Among non-Black women, a more modest positive relationship appears between peer disadvantage and obesity. Among non-Black men, we find no relationship. These diverging patterns suggest that the pathways through which adolescent peer economic disadvantage influences health may differ or produce differential effects based on intersecting race, gender, and socioeconomic identities. Such heterogenous effects offer new insights, and future directions, for better understanding social life-course determinants of adult health and addressing inequities.

The Weight of Racial Discrimination: Examining the Association Between Racial Discrimination and Change in Adiposity Among Emerging Adult Women Enrolled in a Behavioral Weight Loss Program

BACKGROUND

Non-Hispanic Black (NHB) emerging adult (EA) women are at disproportionate risk for obesity but experience limited benefit from behavioral weight loss (BWL) programs. Race-related stress could play a role; the goal of this study was to examine the association between racial discrimination (RD) and early (3 months) changes in adiposity, and to explore potential protective factors, among EA in an adapted BWL program.

METHODS

This is an ancillary study of non-Hispanic White (NHW) and NHB EA women enrolled in an adapted BWL trial (N = 49; 55.1% NHB; Age 21.2 (2.1); BMI = 33.0 + 4.3 kg/m²). At baseline, group- and personal-level RD (RD-group and RD-personal), racial identity (NHB women only), vigilant coping, and social support were assessed via validated questionnaires. Weight and waist circumference were measured objectively at 0 and 3 months.

RESULTS

NHW women manifested greater reductions in waist circumference relative to NHB women (p = .004). RD-personal did not predict change in waist circumference at 3 months (p = .402); however, the association between RD-group and change in waist circumference was statistically significant (p = .015), such that reporting greater group-level discrimination predicted a smaller decrease in waist circumference; the model explained 22% of the variance. Social support and vigilant coping were not statistically significant in the model. Among NHB women only, higher racial identity-centrality predicted greater reduction in waist circumference (p = .019).

CONCLUSION

Findings suggest racial discrimination could contribute to greater cardiometabolic risk during this developmental period. Future research should examine how experiences of racial discrimination unfold in the daily lives of NHB women to inform mechanistic interventions to enhance health and well-being.

TRIAL REGISTRATION

NCT02736981. Low Intensity Weight Loss for Young Adults.

Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression

OBJECTIVE

To estimate racial and ethnic differences in rates of hospital-based care associated with postpartum depression.

METHODS

This is a retrospective cohort study using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes within data from the Office of Statewide Planning and Development in California. We included primiparous women who underwent delivery hospitalization from 2008 to 2012. The primary outcome was the first postpartum hospital encounter with a ICD-9-CM code for depression over a 9-month period after delivery. We examined the cumulative incidence of hospital-based care for postpartum depression by race/ethnicity. Logistic regression was used to estimate relative risk.

RESULTS

The study cohort consisted of 984,167 primiparous women: 314,037 (32%) were non-Hispanic White; 59,754 (6%) were non-Hispanic Black; 150,855 (15%) were non-Hispanic Asian; 448,770 (46%) were Hispanic; and 10,399 (1%) were other races. The cumulative incidence of hospital-based care for postpartum depression was highest for Black women (39; 95% CI = 34-44 per 10,000 deliveries) and lowest for Asian women (7; 95% CI = 5-8 per 10,000 deliveries). Compared with White women, hospital-based care for postpartum depression was more likely to be provided to Black women (OR = 2.3; 95% CI = 1.9-2.7), whereas care was less likely for Asians (OR = 0.4; 95% CI = 0.3-0.5) and Hispanics (OR = 0.8; 95% CI = 0.7-1.0). Similar findings were observed after excluding women with antepartum depression, adjusting for sociodemographic and clinical variables, and stratifying according to care settings.

CONCLUSION

Compared with White women, hospital-based care for postpartum depression more frequently impacts Black women. Identifying and improving inequities in access to and utilization of mental health care for postpartum women should be a maternal health priority.

Living with the financial consequences of cancer: A life course perspective

PURPOSE

Financial hardship can be a major cause of distress among persons with cancer, resulting in chronic stress and impacting physical and emotional health. This paper provides an analysis of the lived experience of cancer patients' financial hardship from diagnosis to post-treatment.

METHODS

In-depth interviews were conducted with 26 cancer survivors who reported financial hardship during and/or after treatment. The interviews were analyzed using Dedoose^TM as an organizational tool, the life course perspective as an organizing theoretical framework, and a thematic analysis tool ¹ to answer our research questions. Our analysis identified that timing and sequencing of life transitions and stress proliferation furthered the process of financial stress over time.

FINDINGS

Cancer survivors do not experience financial toxicity as a singular process; the experience can be quite different depending on age and life transitions.

PRACTICE/POLICY IMPLICATIONS

These findings provide psychosocial oncology providers with a framework for identifying patients at risk for financial distress and addressing the critical needs related to their life stage.

What The Health (WTH)?: Theorising Southern Black Feminisms in the US South

The everyday lived experiences of Southern Black American women in the United States (US) are rarely explicitly characterised in Black Feminisms' discourse. The lack of an active discourse surrounding the Southern Black women's identity is a glaring weakness in the broader discussion of feminism (Rushing, 2009; 2017). From Black women who historically worked as day workers, cleaning the homes of white families while their families fended for themselves, to the contemporary phenomena of home health care aid workers charged with cleaning and caring for individuals, often older and white, Southern Black women's ways of knowing have framed not only the civil rights movement (Emmons et al, 2013); but also contemporary social movements such as #SayHerName and the agency of digital social phenomena such as Black Twitter. Past social movements emphasised space and the meaningfulness of the South concerning civil rights, yet current discourse fails to integrate region and location in the narrative of these movements, thus missing opportunities to explore the "complexity and explanatory power" place contributes (Rushing, 2017:1). The proliferation of digital platforms such as podcasts, videos, social media stories focused on health demonstrate how Black women are reclaiming their health, and bringing others along with them. However, the theorisation of what we term Southern Black Feminisms, specifically as it relates to Black women's health, is lacking. This theoretical article, informed by qualitative and quantitative data from both authors' previous research, will build a profile for Southern Black women in the US, characterise Southern Black Feminisms and propose a Southern Black woman informed, evidence-based framework addressing health inequities among Southern Black women. The goal is to demonstrate how the experiences of everyday Black women in the US South and the Global South are connected, especially with African Diasporic women, and consider how potential alliances can contribute to collective resistance and action.

Changing rate orders of race-gender heart disease death rates: An exploration of county-level race-gender disparities

A holistic view of racial and gender disparities that simultaneously compares multiple groups can suggest associated underlying contextual factors. Therefore, to more comprehensively understand temporal changes in combined racial and gender disparities, we examine variations in the orders of county-level race-gender specific heart disease death rates by age group from 1973-2015. We estimated county-level heart disease death rates by race, gender, and age group (35-44, 45-54, 55-64, 65-74, 75-84, ≥ 85, and ≥ 35) from the National Vital Statistics System of the National Center for Health Statistics from 1973-2015. We then ordered these rates from lowest to highest for each county and year. The predominant national rate order (i.e., white women (WW) < black women (BW) < white men (WM) < black men (BM)) was most common in younger age groups. Inverted rates for black women and white men (WW Collapse

Key Words

• BM, black men
• BW, black women
• CDC, Centers for Disease Control and Prevention
• County-level
• Gender
• Heart disease mortality
• ICD, International Classification of Diseases
• MCMC, Markov chain Monte Carlo
• NCHS, National Center for Health Statistics
• Race
• Spatiotemporal
• Temporal trends
• WM, white men
• WW, white women

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MESH Headings Collapse

Grants

• K01 HD074726 NICHD NIH HHS

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Affiliation(s)

Adam S. Vaughan Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States
Harrison Quick Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA 19104, United States
Linda Schieb Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States
Michael R. Kramer Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States
Herman A. Taylor Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, United States
Michele Casper Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States

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The feminist perspective of intersectionality in the field of public health: a narrative review of the theoretical-methodological literature

The intersectionality approach emerged in the late 1990s in the field of black feminist activism in the USA, as a critique of one-dimensional analyses of social inequalities. This descriptive-analytical narrative review presents the current state of theoretical-methodological inclusion of intersectionality in public health. Seven scientific literature databases were consulted: Web of Science, Embase, Cinahl, Scopus, Sociological Abstracts, Lilacs, and Medline, resulting in 1763 papers. After duplicates were eliminated and the titles and abstracts screened, 30 papers produced in five countries between 2006 and 2017 were selected. The analysis, structured into three central themes (theoretical-methodological debates, social markers - gender, race, ethnicity and sexual orientation - and health policies and practices), shows intersectionality to be a promising analytical resource for understanding and facing the global challenge of inequalities in health.

Theories for Race and Gender Differences in Management of Social Identity-Related Stressors: a Systematic Review

Sociodemographic group-specific strategies for stress management may contribute to racial and gender disparities in health outcomes in the USA. We aimed to systematically review theoretical and empirical investigations of factors influencing variation in response to and management of identity-related stress among black and white Americans. OvidPsychInfo and PubMed databases were searched to identify eligible studies. Criteria were participant age of ≥ 18 years, conducted in the US sampling black or white participants, and published in English in a peer-reviewed journal. The final sample included 167 articles. Theories suggesting social status inequities as the primary contributor to disparate strategies employed by black and white women and men to manage social identity-related stress were most frequently tested and supported. Studies disproportionally focused on how women and black persons cope as targets of prejudice and discrimination rather than on how management strategies of men or white persons are affected as perpetrators. Finally, there was theoretical support for an interactive effect of race and gender on stress management, but empirical evidence was lacking, particularly among black men, white women, and white men. The literature could be strengthened through the use of prospective cohorts and nationally representative samples, as well as study designs accounting for potential within-race and within-gender variation in the effects of social identity-related stressors on coping. With greater consistency in methodology, future empirical studies may yield additional information regarding group differences in stress management pertinent to clarifying mechanisms for the health consequences of exposure to social inequity among black and white women and men.

"As a Community, We Need to be More Health Conscious": Pastors' Perceptions on the Health Status of the Black Church and African-American Communities

BACKGROUND

Churches are recognized for their potential capacity to provide health services and interventions to address health disparities in African-Americans (blacks). Since pastors are central community leaders, their support and involvement can influence both implementation and outcomes for church-based health programs. The purpose of this qualitative study was to explore pastors' perceptions of congregant health status within the black church.

METHODS

Semi-structured interviews were conducted with 11 pastors whose female congregants participated in a physical activity intervention. Thematic analysis techniques were used to analyze interview data.

RESULTS

Three major themes emerged: (1) health risks in the African-American community, (2) health promotion in the black church, and (3) the importance of women in the black family and the church. Pastors noted numerous health disparities affecting their congregants and the African-American community at large, including obesity and infant mortality. They viewed health holistically and included faith in their perspectives. According to pastors, holistic health was promoted through health ministry programming in black churches. Women were described as the cornerstone of the black church, yet faced unique health concerns from their roles as family caretakers and congregants.

DISCUSSION

Pastors shared their major concerns for congregant health status and the African-American community. Health interventions focusing on African-Americans in church settings should include pastor involvement and should incorporate holistic approaches to address health risks.

Resilience mediated the association between acculturation and psychological growth in college students from Hong Kong to Guangzhou, China

BACKGROUND

The number of Hong Kong citizens living in mainland China is increasing. The process of acculturation may create opportunities for psychological growth.

AIMS

This study aimed at examining whether resilience mediated the effects of acculturation on psychological growth in college students from Hong Kong to Guangzhou.

METHOD

In this cross-sectional survey, 164 college students in Guangzhou who were Hong Kong permanent residents (female: 46%, age: 21.09 ± 1.50) joined the study.

RESULTS

The integration group reported more psychological growth than the assimilation, separation, and marginalization groups. Resilience partially mediated the effect of integration on psychological growth and fully mediated the effect of marginalization on psychological growth.

CONCLUSIONS

Resilience represents one of the mechanisms to explain beneficial effects of integration on psychological growth in college students from Hong Kong to Guangzhou. Theoretical considerations to rethink the acculturation model, implications for developing intervention programs, and recommendations for future research are discussed.

Engaging African American women in research: an approach to eliminate health disparities in the African American community

OBJECTIVE

To explore the success of community-based participatory research [CBPR] in engaging African American women to achieve health equity by elucidating community, trust, communication and impact. Recommendations helpful for researchers interested in engaging communities to achieve health equity in the USA are included.

INRODUCTION

African American women experience health disparities of multifactorial etiology and are underrepresented in research. CBPR is a collaborative approach that incorporates perspectives, which address the intricate determinants of health and has been reported as an effective means to address health disparities. Yet, the science of CBPR seems elusive to researchers in the medical field. The opportunity exists to better understand and expand the use of the principles of engagement, replication, and sustainability in engaging African American women in health research.

METHODS

A variety of literature regarding engaging African American women in community-based participatory research was reviewed.

RESULTS

CBPR focused on robust engagement of marginalized groups continues to be validated as a vital approach to the elimination of disparities and improved health for all, especially ethnic and racial minority populations. However, limited evidence of focused engagement of African American women was found. Making specific outreach to African American women must be a community and patient engagement priority to achieve health equity.

CONCLUSIONS

Continued research is needed which specifically focuses on building and sustaining engagement with African American women and their communities. This research can transform healthcare access, experiences and outcomes by yielding actionable information about what African American women need and want to promote wellness for themselves and their communities.

The differential impact of discrimination on health among Black and White women

Despite a large body of research examining the impact of discrimination on health, the ways in which perceived discrimination may lead to disparate health outcomes through a sense of self and system consciousness is less understood. The current paper is concerned with both mental and physical health consequences of discrimination, as well as mediating pathways among African American and White women. Indirect effects analyses examine mediating paths from discrimination to health outcomes via structural awareness and self-esteem, using data from the Women's Life Path Study (N = 237). Our findings suggest that discrimination is both directly and indirectly associated with health outcomes for both Black and White women, mediated by individual (self-esteem) and group-level (structural awareness) processes. Evidence from this study indicates that discrimination is associated with heightened structural awareness, as well as lower self-esteem - both of which are related to poorer health. Discrimination negatively affected health across three domains, although the mechanisms varied somewhat for Black and White women. Broad implications of this research for interdisciplinary scholarship on the effects of discrimination on health and health disparities are discussed.

Perspectives on Stress, Parenting, and Children's Obesity-Related Behaviors in Black Families

Objective In an effort to develop targets for childhood obesity interventions in non-Hispanic-Black (Black) families, this study examined parental perceptions of stress and identified potential links among parental stress and children's eating patterns, physical activity, and screen-time. Method Thirty-three self-identified Black parents or grandparents of a child aged 3 to 7 years were recruited from a large, urban Black church to participate in semistructured interviews. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Results Parents/grandparents described a pathway between how stress affected them personally and their child's eating, structured (sports/dance) and unstructured (free-play) physical activity, and screen-time usage, as well as strategies to prevent this association. Five themes emerged: stress affects parent behaviors related to food and physical activity variably; try to be healthy even with stress; parent/grandparent stress eating and parenting; stress influences family cooking, food choices, and child free-play; and screen-time use to decrease parent stress. Negative parent/grandparent response to their personal stress adversely influenced food purchases and parenting related to child eating, free-play, and screen-time. Children of parents/grandparents who ate high-fat/high-sugar foods when stressed requested these foods. In addition to structured physical activity, cooking ahead and keeping food in the house were perceived to guard against the effects of stress except during parent cravings. Parent/child screen-time helped decrease parent stress. Conclusion Parents/grandparents responded variably to stress which affected the child eating environment, free-play, and screen-time. Family-based interventions to decrease obesity in Black children should consider how stress influences parents. Targeting parent cravings and coping strategies that utilize structure in eating and physical activity may be useful intervention strategies.

Considering the Role of Stress in Populations of High-Risk, Underserved Community Networks Program Centers

BACKGROUND

Cancer disparities are associated with a broad range of sociocultural determinants of health that operate in community contexts. High-risk populations may be more vulnerable to social and environmental factors that lead to chronic stress. Theoretical and empirical research indicates that exposure to contextual and sociocultural stress alters biological systems, thereby influencing cancer risk, progression, and, ultimately, mortality.

OBJECTIVE

We sought to describe contextual pathways through which stress likely increases cancer risk in high-risk, underserved populations.

METHODS

This review presents a description of the link between contextual stressors and disease risk disparities within underserved communities, with a focus on 1) stress as a proximal link between biological processes, such as cytokine responses, inflammation, and cancer and 2) stress as a distal link to cancer through biobehavioral risk factors such as poor diet, physical inactivity, circadian rhythm or sleep disruption, and substance abuse. These concepts are illustrated through application to populations served by three National Cancer Institute-funded Community Networks Program Centers (CNPCs): African Americans in the Deep South (the South Carolina Cancer Disparities Community Network [SCCDCN]), Native Hawaiians ('Imi Hale-Native Hawaiian Cancer Network), and Latinos in the Lower Yakima Valley of Washington State (The Center for Hispanic Health Promotion: Reducing Cancer Disparities).

CONCLUSIONS

Stress experienced by the underserved communities represented in the CNPCs is marked by social, biological, and behavioral pathways that increase cancer risk. A case is presented to increase research on sociocultural determinants of health, stress, and cancer risk among racial/ethnic minorities in underserved communities.

The mediating role of social support, cognitive appraisal, and quality health care in black mothers' stress-resilience process following loss to gun violence

Although much attention has been granted to the perpetrators and victims of gun violence, limitations exist in our understanding of the psychological well-being of parents grieving children lost to gun violence. The purpose of this study was to examine the mediating effects of social support, cognitive appraisal, and quality health care on the relationship between traumatic stress and resilience among Black mothers bereaving children to gun violence. A cross-sectional design and network sampling method were used to recruit 48 Black mothers living in a large Canadian city. Participants completed a survey either by phone or in person. Social support and positive appraisal were found to be protective factors of resilience for study participants. The traumatic stress experienced by the sample decreased with increased social support (beta = -.291, p = .045), leading to an increase of their resilience (beta = .297, p = .032). With positive appraisal of the loss, the stress levels of study participants decreased (beta = -.334, p = .023), leading to increased resilience (beta = .441, p = .003). Quality health care showed a significant positive relationship with the resilience of the women (beta = .313, p = .023) but did not mediate the relationship between their stress and resilience. For Black mothers who experience loss of a child to gun violence, policy and social change efforts should focus on strengthening their access to formal and informal supports and improving their abilities to find meaning in their loss.

Theory of perceived access to breast health care in African American women

The theory presented in this article proposes an alternative view of access to care on the basis of an African American woman's perception of the necessity, availability, and appropriateness of breast health care. The theory of perceived access to breast health care in African American women may also be useful in framing future research studies exploring the relationship between access to care and utilization of primary, secondary, and tertiary clinical preventive services related to breast health care.

Cushioning, weathering, place, and community in rural grandmother-mothering

Place influences rural women's health when distance and lack of anonymity contribute to a reluctance to seek care. A qualitative design was used to explore relationships between place and the health of rural grandmothers raising grandchildren. The study generated findings concerning theory related to perceptual experience of rurality, identifying "Cushioning," as a basic social concept and "Weathering," "Paradoxical Place," and "Community Mothering" as subconcepts. Physical and mental wear and tear, distance, isolation and unraveling community mothering undermined "Cushioning" and reflected in self-health neglect narratives. Findings underscore the importance of place to the health of rural women raising grandchildren.

Coping profiles common to older African American cancer survivors: relationships with quality of life

CONTEXT

Cancer survivors use distinct sets of coping behaviors that vary in their associations with psychological health and quality of life. However, existing research has largely focused on Caucasian and middle-class subjects.

OBJECTIVES

This study explores whether clusters with differing coping profiles could be identified among older African American cancer survivors and whether these profiles varied on cultural factors and physical, psychological, and relationship well-being.

METHODS

Four hundred forty-nine older African American cancer survivors recruited from outpatient oncology clinics completed a questionnaire booklet containing the Ways of Helping Questionnaire (WHQ), the Brief Index of Race-Related Stress, the Religious Involvement Scale, Mutuality Scale, and the Short Form-12 Health Survey Questionnaire. A k-means cluster analysis was conducted using the WHQ.

RESULTS

Four distinct coping profiles were identified and labeled as high coping, low encouraging healthy behaviors, low coping, and strong/distracting behaviors. Coping profiles were associated with participant's gender, age, and living-alone status. Controlling for these demographic differences, the coping profiles were associated with religiosity; experiences with racism; and physical, psychological, and relationship well-being.

CONCLUSIONS

The findings from this study lend support for examining coping profiles and health outcomes among African American cancer survivors. This research also suggests that these profiles vary on cultural factors. This information should prove useful to researchers as they develop culturally appropriate interventions for this underserved population.