Visible and Invisible Trends in Black Men's Health: Pitfalls and Promises for Addressing Racial, Ethnic, and Gender Inequities in Health

Measurements of Abdominal Obesity are Associated with Metabolic Syndrome Severity Independent of Hypertensive Phenotype in White but not Black Young Adults

PURPOSE

This study sought to determine if metabolic syndrome severity (MetSindex) was differentially associated with abdominal obesity based on waist circumference (WC) site and the presentation of hypertensive phenotypes in a group of young White and Black adults.

METHODS

A total of 139 young adult (22.5 ± 3.3 years) non-Hispanic White (n = 73) and non-Hispanic Black (n = 66) males and females (M 53, 86 F) completed this cross-sectional evaluation. Participants had their WC measured at three distinct locations along the abdomen which were used to calculate waist-to-hip and waist-to-height ratios. Systolic (SBP) and diastolic blood pressure (DBP) were collected and used to calculate mean arterial pressure (MAP). In addition to traditional metabolic syndrome (MetS) risk factors, BP values were individually used to produce three separate MetSindex scores representing three specific hypertensive phenotypes (MetSSBP, MetSDBP, MetSMAP), and each of these were evaluated against each abdominal obesity estimate.

RESULTS

MetSDBP and MetSSBP were significantly higher than all other indices for females (all p ≤ 0.002) and males (all p < 0.001), respectively. MetSDBP was significantly higher than MetSMAP for White females (p = 0.039), and MetSSBP was significantly higher than MetSDBP and MetSMAP (both p < 0.001) for Black males. Standalone and joint estimates of abdominal obesity were uniquely associated with MetSindex across hypertensive phenotypes for White, but not Black males and females.

CONCLUSIONS

Specific hypertensive phenotypes may differentially determine MetSindex, but these estimates are not associated with abdominal obesity in young Black adults regardless of measurement location. Healthcare professionals should address this disparity by providing more comprehensive MetS screening procedures for young Black adults.

CLINICAL TRIALS REGISTRATION

NCT05885672.

Shop Talk: A Qualitative Study to Understand Peer Health-related Communication Among Black Men at the Barbershop

BACKGROUND

While successful health promotion efforts among Black men have been implemented at barbershops, the focus has largely been on outcomes as opposed to the processes by which outcomes are produced. An understanding of processes can be leveraged in the design and implementation of future efforts to improve the health of Black men.

PURPOSE

The objectives of the present study were to: (i) understand peer-derived sources of health-related support at the barbershop and (ii) understand the role of the barbershop in promoting health among Black men.

METHODS

Seven focus groups were conducted at barbershops used predominately by Black men. Each focus group lasted between 45 and 60 min. Using a thematic approach, each focus group was independently coded by two coders using a codebook derived from an inductive and deductive approach. The results were confirmed with members of the community advisory board.

RESULTS

Three themes emerged: (i) dynamic and candid exchange of health-related support at the barbershop; (ii) tailored forms of health-related and judgment-free communication that provide encouragement and increase motivation; and (iii) characteristics of a supportive environment at the barbershop that facilitate health-related communication.

CONCLUSIONS

The findings of the present study offer a potential pathway for public health efforts seeking to improve health among Black men. Those interested in designing and implementing these efforts can create tailored programs for Black men by recognizing and leveraging the unique dynamics of health-related conversations at the barbershop.

Parenting practices and trajectories of proactive coping assets among emerging adult Black men

Positive youth development (PYD) frameworks suggest that a critical response to investigating the challenges young Black men living in resource poor communities experience involves identifying contextual resources in young men's lives and personal assets that promote success. The following study examines heterogeneity in proactive coping assets trajectories, parental practices as predictors of developmental trajectories, and associated outcomes of each trajectory. The study sample consisted of Black emerging adult men living in rural Georgia (N = 504). At baseline, men were between the ages of 19 and 22 (Mage = 20.29; SD = 1.10). At wave four, the participants' mean age was 27.67 (SD = 1.39). Results of growth mixture modeling from waves 1 to 3 discerned three developmental trajectory classes of emerging adults' proactive coping assets: a high and increasing class (n = 247, 49%), a low and stable class (n = 212, 42%), and a moderate and decreasing class (n = 45, 9%). Trajectory classes were linked to baseline levels of parental support, coaching, and expectations. Analysis revealed that parental support and parental coaching predicted proactive coping asset trajectory class identification. Links were then investigated between emerging adults' proactive coping asset trajectory classes and wave four physical health, depression, and alcohol use. Results revealed significant associations between class identification, alcohol use, and physical health. Study findings provide evidence supporting the impact of parenting on emerging adult Black men, underscoring the need to expand resources that support parenting and emerging adult relationships.

Gender health equity: The case for including men's health

United States' federal policy and infrastructure fail to explicitly consider the health of men, particularly the poor health of marginalized men. This inattention to men's health hinders the nation's ability to improve population health, to achieve gender health equity, and to achieve health equity more broadly. Expanding efforts to consider gender in federal policy and infrastructure to include men, naming men as a population whose poor health warrants policy attention, creating offices of men's health in federal agencies, and utilizing an intersectional lens to develop and analyze policies that affect health would likely yield critical improvements in population health and health equity in the United States. Using data from the Centers for Disease Control and Prevention, I illustrate the persistence of sex differences in mortality and leading causes of death, and how these patterns mask gender gaps in health that are driven largely by marginalized men. Given the common practice of presenting data by sex and race separately, it is difficult to recognize when the health of specific groups of men warrants attention. I utilize the case of Black men to illustrate the importance of an intersectional approach, and why men's health is critical to achieving gender and racial equity in health. While a gender mainstreaming approach has enhanced the nation's ability to consider and address the health of women and girls, it has not expanded to be inclusive of boys and men. Consequently, I argue that if our goal is to achieve health equity, it is critical to employ an intersectional approach that simultaneously considers the full range of factors that influence individual and population health and well-being. An intersectional approach would facilitate efforts to simultaneously explore strategies to achieve racial, ethnic, and gender health equity, which are driven by structural determinants beyond sex and gender related factors.

Cultural Sensitivity and Cultural Tailoring: Lessons Learned and Refinements After Two Decades of Incorporating Culture in Health Communication Research

In this article, we examine progress and challenges in designing, implementing, and evaluating culturally sensitive behavioral interventions by tailoring health communication to groups or individuals. After defining common tailoring constructs (i.e., culture, race, and ethnicity), cultural sensitivity, and cultural tailoring, we examine when it is useful to culturally tailor and address cultural sensitivity in health communication by group tailoring or individual tailoring and when tailoring health communication may not be necessary or appropriate for achieving behavior change. After reviewing selected approaches to cultural tailoring, we critique the quality of research in this domain with a focus on the internal validity of empirical findings. Then we explore the ways in which cultural sensitivity, group targeting, and individual tailoring have incorporated culture in health promotion and health communication. We conclude by articulating yet unanswered questions and suggesting future directions to move the field forward.

Cardiovascular Health and Colorectal Cancer Screening in Black Men: A Cross-Sectional Analysis

African American/Black (henceforth Black) men face disproportionate risks of morbidity and mortality from both cardiovascular disease (CVD) and colorectal cancer (CRC). The American Heart Association's Life's Simple 7 (LS7) tool was designed to examine predictors of CVD with included behaviors also linked to CRC risk (i.e., smoking status, weight, diet, and physical activity). However, no studies have combined LS7 assessment alongside CRC screening history, which serves as a proxy for assessing CRC risk, in Black men. In this study, Black men aged 45-75 participating in annual community wellness events were screened for 6 of 7 LS7 measures (excluding diet, LS6) and self-reported CRC screening. Analyses conducted using R 4.0.5. revealed that Black men (N = 680), with an average age of 57.3 years (SD = 7.5), reported poor (39.7%), intermediate (34.6%), or ideal (25.7%) LS6 scores with higher scores corresponding to lower risk for CVD. However, for every 1-point increase in LS6 scores (0-6), there was a 26% lower odds of reported CRC screening (p = .001). In the fully adjusted model, men with 4+ ideal LS6 behaviors had a 60% lower odds of self-reported CRC screening compared to those with two ideal LS6 behaviors (p < .001). These findings underscore the need for culturally relevant interventions for Black men across all levels of cardiovascular health (CVH) to increase CRC screening uptake.

St. Louis Enhancing Engagement and Retention in HIV/AIDS Care (STEER): a participatory intersectional needs assessment for intervention and implementation planning

Background Missouri is one of seven priority states identified by the Ending the HIV Epidemic Initiative, and St. Louis contains almost half of the people living with HIV (PLWH) in Missouri. As St. Louis has a marked history of structural racism and economic inequities, we utilized the Intersectionality Based Policy Analysis (IBPA) framework to guide a participatory needs assessment for planning and program development. Methods The planning team included researchers, the lead implementer from our community partner, and two community representatives, and had biweekly 60-90 minute meetings for 18 months. The planning team discussed and approved all research materials, reviewed and interpreted results, and made decisions about outreach, recruitment, conduct of the needs assessment and development of the planned intervention. The needs assessment integrated information from existing data, (1) interviews with (a) PLWH (n=12), (b) community leaders (n=5), (c) clinical leaders (n=4), and (d) community health workers (CHWs) (n=3) and (e) CHW supervisors (n=3) who participated in a Boston University-led demonstration project on CHWs in the context of HIV and (2) focus groups (2 FG, 12 participants) with front line health workers such as peer specialists, health coaches and outreach workers. A rapid qualitative analysis approach was used for all interviews and focus groups. Results The IBPA was used to guide team discussions of team values, definition and framing of the problem, questions and topics in the key informant interviews, and implementation strategies. Applying the IBPA framework contributed to a focus on intersectional drivers of inequities in HIV services. The effective management of HIV faces significant challenges from high provider turnover, insufficient integration of CHWs into care teams, and organizational limitations in tailoring treatment plans. Increasing use of CHWs for HIV treatment and prevention also faces challenges. People living with HIV (PLWH) encounter multiple barriers such as stigma, lack of social support, co-morbidities, medication side effects and difficulties in meeting basic needs. Conclusions Addressing intersectional drivers of health inequities may require multi-level, structural approaches. We see the IBPA as a valuable tool for participatory planning while integrating community engagement principles in program and implementation design for improving HIV outcomes.

Assessing organizational readiness for the Clean Cuts and Sharp Minds Collective: a barbershop health promotion network

BACKGROUND

Black men have among the lowest life expectancy in the United States. Alarmingly, these men are underrepresented in health promotion efforts. There are well-documented barriers to recruiting and retaining Black men in health promotion efforts, such as exclusionary research practices - many researchers may be hesitant to reach Black men in culturally unique spaces, such as barbershops. Despite these practices, qualitative research among Black men unanimously find that Black men are interested in health promotion efforts. The Clean Cuts and Sharp Minds Collective (CCSMC) was designed to bridge this gap. The objectives of the CCSMC are to train barbers to be lay advocates for their clients, train barbers to be research partners, and serve as a nexus between barbers interested in health promotion at their shops and researchers interested in implementing such efforts. The present study sought to assess the organizational readiness of barbershops in South Carolina (SC) to participate in the CCSMC.

METHODS

Barbers in SC were invited to complete a modified version of the Readiness Thinking Tool to assess organizational readiness to participate in the CCSMC.

RESULTS

Thirty-six (36; mean age = 41.12; 94.4% identified as Black; 91.7% identified as male) barbers completed the organizational readiness assessment. Results indicated that there was a high level of motivation, innovation-specific capacity, and general capacity within barbershops to participate in the CCSMC. Additionally, many barbers indicated that there would be widespread support to join the CCSMC.

CONCLUSIONS

The results from the present study highlight exciting opportunities and future directions for barbershop-academic partnerships. Such partnerships have the potential to promote health equity among, and in partnership with, Black men.

What's missing? Violently injured Black men's narratives around Adverse Childhood Experiences (ACEs)

BACKGROUND

Adverse childhood experiences have been associated with future outcomes; however, Felitti's 1998 ACEs questionnaire fails to capture the experiences of Black populations living in disinvested neighborhoods making it necessary to expand the ACEs questionnaire to examine the life experiences of violently injured Black men.

OBJECTIVE

The aim of the study was to advance the understanding of ACEs among Black male firearm violence survivors using the ACEs questionnaire and semi-structured interviews.

PARTICIPANTS AND SETTING

Ten Black male firearm violence survivors were recruited from an urban HVIP. Case managers conducted recruitment using the HVIP's REDcap database; active and previous HVIP participants were eligible for the study.

METHODS

A qualitative study design was used to understand the childhood experiences of Black male firearm violence survivors using Felitti's ACEs questionnaire and a semi-structured interview examining perceptions of their childhood experiences. Due to the COVID-19 pandemic, recruitment and interviews were conducted over the phone.

RESULTS

All participants experienced at least one ACE. Three themes arose from the interviews: youth incarceration, family separation and loss, and housing transition. Men at risk for violent injury experience ACEs beyond those measured in the current instrument.

The Association between State-Level Structural Racism and Alcohol and Tobacco Use Behaviors among a National Probability Sample of Black Americans

BACKGROUND

Structural racism is how society maintains and promotes racial hierarchy and discrimination through established and interconnected systems. Structural racism is theorized to promote alcohol and tobacco use, which are risk factors for adverse health and cancer-health outcomes. The current study assesses the association between measures of state-level structural racism and alcohol and tobacco use among a national sample of 1,946 Black Americans.

METHODS

An existing composite index of state-level structural racism including five dimensions (subscales; i.e., residential segregation and employment, economic, incarceration, and educational inequities) was merged with individual-level data from a national sample dataset. Hierarchical linear and logistic regression models, accounting for participant clustering at the state level, assessed associations between structural racism and frequency of alcohol use, frequency of binge drinking, smoking status, and smoking frequency. Two models were estimated for each behavioral outcome, one using the composite structural racism index and one modeling dimensions of structural racism in lieu of the composite measure, each controlling for individual-level covariates.

RESULTS

Results indicated positive associations between the incarceration dimension of the structural racism index and binge drinking frequency, smoking status, and smoking frequency. An inverse association was detected between the education dimension and smoking status.

CONCLUSIONS

Results suggest that state-level structural racism expressed in incarceration disparities, is positively associated with alcohol and tobacco use among Black Americans.

IMPACT

Addressing structural racism, particularly in incarceration practices, through multilevel policy and intervention may help to reduce population-wide alcohol and tobacco use behaviors and improve the health outcomes of Black populations.

The Black Men's Health Forum: Improving Health Knowledge and Willingness to Participate in Research

The Black Men's Health Forum, a 6-week online health education intervention for African American men and accountability partners of African American men, was conducted to increase awareness of health issues that disproportionately affect African American men. In this article, we describe the intervention and report on the immediate benefits of the intervention, including changes in health knowledge and perception of research participation. Participants completed a pre-evaluation prior to participating in the forum and a post-evaluation after each session to capture data on sociodemographic information, medical history, health knowledge, and health behaviors. A total of 60 participants (30 African American men and 30 accountability partners) completed the forum. African American men had a mean age of 61.1 years while accountability partners had a mean age of 57.6 years. Overall health knowledge increased by 6.9 points for African American men and 2.8 points for accountability partners. Before the forum began, nine African American men reported ever participating in a research study. The proportion of African American men who reported that they would definitely participate in research in the next 12 months after participating in the forum increased by 40%. Through culturally tailored programming, the Black Men's Health Forum increased access to health information as well as African American male medical professionals and health researchers for African American men in the community. Exposure to health information resulted in significant increases in health knowledge and willingness to participate in health research among African American men.

Barriers to and Recommendations for Equitable Access to Healthcare for Migrants and Refugees in Aotearoa, New Zealand: An Integrative Review

The health system in Aotearoa New Zealand is predicated on equity in access to health services as a fundamental objective yet barriers to equitable access for migrant and refugees continue to exist. There is a paucity of studies that synthesise the experiences and realities of migrants, refugees and healthcare providers that hinder access to healthcare and provide recommendations to improve services. This review synthesised these barriers and recommendations, with an aim to improve equitable access to healthcare to migrants and refugees. An integrative review of 13 peer-reviewed research studies from EBSCOhost research databases published between January 2016 and September 2022. Studies included: (i) related to Aotearoa; (ii) had a focus on equitable delivery of healthcare to migrants and refugees; and (iii) had a full English text available. The PRISMA framework guided the reporting of the review. The findings were thematically analysed and presented using a narrative empirical synthesis. The findings were organised into three broad themes: attitudinal barriers, structural barriers, and recommendations. Attitudinal barriers included the lack of culturally competent healthcare providers, discrimination by healthcare providers, and personal, social, and cultural attributes. Structural barriers referred to policies and frameworks that regulated the accessibility of health services such as the cost of healthcare, accessibility and acceptability of interpreter services, length of allocated appointments and long waiting times for an appointment, difficulties navigating the health system, and logistical barriers. Recommendations focused on promoting a sense of belonging, enabling a whole-of-society approach that brings together all sectors involved in providing health care for collective impact, and advocating for government policies to create a system that addresses the core health service access needs. This review provides rich context-specific findings on the barriers to equitable access to healthcare and proposed interventions to enhance equitable health outcomes for migrants and refugees in Aotearoa. The review contributes to relevant policy decisions and has practical implications to build responsive health systems which are inclusive, equitable and best address the health needs of populations from diverse cultural backgrounds.

Bridging the Gap: Engaging Black Men in Lung Cancer Research Through Barbershop Collaboration

Health disparities persist among Black men, notably in the context of lung cancer and stress-related health outcomes. This study explores these disparities through a community-based participatory research (CBPR) approach, citizen science, and social network theory, leveraging the expertise and trust of Black barbers as community leaders. The purpose is to understand the nuanced connections between stress and lung cancer in this demographic. Engaging 161 Black men across four Chicago neighborhoods, the study successfully collected hair samples and survey data, emphasizing the importance of culturally sensitive recruitment strategies. Findings highlight the effectiveness of the collaboration, showcasing the role of barbershops as community hubs for research. The study concludes by advocating for sustained partnerships with community leaders, emphasizing transparency in research communication, and promoting culturally grounded approaches to address health disparities and enhance research participation among underrepresented populations.

Health Is Power, and Health Is Wealth: Understanding the Motivators and Barriers of African American/Black Male Immigrants With Gastrointestinal Conditions

The digestive health of African American/Black male immigrants in the United States has not been previously studied. Much of what is known about gastrointestinal (GI) concerns in this population is based on studies conducted on the overall Black American population. The purpose of this narrative study was to understand how African American/Black male immigrants with GI concerns navigated their GI condition. Fifteen African American/Black male immigrants from various cities in the United States participated in two remote focus groups to discover what motivates them to take control of their illness. Narrative analysis was used to analyze the qualitative data. Most men, 47% (n = 7), did not have health insurance, and 67% (n = 10) reported their income was less than US$52,000. The themes identified were: (1) lack of knowledge of GI, (2) denial of initial diagnosis, (3) self-discipline, (4) positive provider interactions, (5) health as a priority, and (6) advice to other African American/Black male immigrants experiencing GI. A strengths-based approach is necessary for describing the health-seeking behaviors among African American/Black male immigrants.

Race Disparities in Hypertension Prevalence Among Older Men

This study aimed to examine whether hypertension prevalence varies by race/ethnicity and within age groups in a nationally representative sample of men in the United States. Hypertension was defined as blood pressure (BP) readings of 140 mm Hg and higher for systolic BP, 90 mm Hg and higher for diastolic BP, or self-reports of taking medication for hypertension. Modified Poisson models estimated prevalence ratios (PRs) and 95% confidence intervals (CI) for race and age group associations with hypertension. The prevalence of hypertension was 38% overall and 46% of the men were aged 50 and older. Analyses that focused on older men (50 years of age or older) found that non-Hispanic Black men had a higher prevalence of hypertension (PR  =  1.28, 95% CI: 1.19 - 1.37) compared to non-Hispanic White men. We suggest future research utilize life course perspectives to better identify which cumulative experiences impact hypertension disparities.

Protect and Provide: Perceptions of Manhood and Masculinities Among Disabled Violently Injured Black Men in a Hospital-Based Violence Intervention Program

Exploring the post-injury lives of those who have survived gunshot wounds is essential to understanding the entire scope of firearm violence. The lives of Black male firearm violence survivors are transformed in various ways due to their injuries both visible and invisible. This study explored how Black men who suffer from disabilities via a firearm negotiated their masculine identities. Semi-structured, qualitative interviews were conducted with 10 violently injured Black men participating in a hospital-based violence intervention program. Survivors expressed their thoughts on how their injuries impacted their manhood and masculinities. Three themes emerged: (1) perceptions of manhood, (2) loss of independence and burden on others, and (3) and mobility. These themes highlighted and described how their lives were impacted post-injury and characterized their psychological and physical experience of recovery. The research findings suggest the need for more qualitative studies to further explore the relationship between firearm injury, Black masculinity, and perceptions of manhood. While Black men are understudied in health research and invisible in disability research, they continue to be hyper-invisible when discussing violently acquired disabilities.

Understanding and Promoting Preventive Health Service Use Among Black Men: Community-Driven and Informed Insights

Black men experience high rates of adverse health that can be prevented or mitigated by the regular use of preventive health services. Efforts are urgently needed to promote this type of health service use among Black men. The U.S. Preventive Services Task Force and the Institute of Medicine indicate that such efforts must align with Black men's values, perspectives, and preferences. However, little guidance exists on how to align these efforts for Black men. The present qualitative study was developed to understand factors associated with preventive health service use among Black men and community-informed strategies to promote preventive health service use among these men. An approach rooted in community-based participatory research and ecological theory was used. A core leadership team consisting of five Black men from the area guided the project's development, implementation, and evaluation. The core leadership team conducted 22 interviews with Black men from their communities. Four themes emerged from these interviews: (1) holistic well-being challenges faced by Black men: interaction of mental, physical, and societal forces; (2) the interplay of financial, informational, and gendered barriers/facilitators to using preventative health services among Black men; (3) the importance of shared identity in peer health education about preventive health service use; and (4) the need for community-centered initiatives to improve preventive health service use among Black men that prioritize accessibility and information. Findings of the present study can be used to tailor preventive health service use efforts for Black men. Such efforts have the potential to promote health and mitigate health disparities.

Election-Related Post-Traumatic Stress: Evidence from the 2020 U.S. Presidential Election

The 2020 U.S. presidential election saw rising political tensions among ordinary voters and political elites, with fears of election violence culminating in the January 6 riot. We hypothesized that the 2020 election might have been traumatic for some voters, producing measurable symptoms of post-traumatic stress disorder (PTSD). We also hypothesized that negative sentiment toward the opposing party correlates with PTSD. We measured PTSD using a modified version of the PCL-5, a validated PTSD screener, for 573 individuals from a nationally representative YouGov sample. We modeled the association between affective polarization and PTSD, controlling for political, demographic, and psychological traits. We estimate that 12.5% of American adults (95% CI: 9.2% to 15.9%) experienced election-related PTSD, far higher than the annual PTSD prevalence of 3.5%. Additionally, negativity toward opposing partisans correlated with PTSD symptoms. These findings highlight a potential need to support Americans affected by election-related trauma.

A Health Profile of African Immigrant Men in the United States

African immigrants (AI) are the fastest growing group of immigrants to the U.S. however, their health and health practices remains poorly characterized. Thus, this study aimed to describe the health profile of this under-described U.S. population. In order to contextualize their health profiles, we compared AI (n=95) to other U.S. Black populations, namely African Americans (AA, n=271) and Caribbean American (CA, n=203) immigrants. We used cross-sectional survey data from a prostate cancer health study with 569 Black adult male participants, ages 21 years or older. Demographic characteristics were compared using Chi-square tests and prevalence ratios, and prevalence odds ratios (POR) were estimated for AIs compared to AA and CA immigrants using a log-binomial regression model. Results revealed that AI exhibited significantly lower prevalence of asthma and diabetes, when compared to AA and CA immigrants. Furthermore, AI reported lower consumption of alcohol than AA (POR, 0.43, 95%CI 0.24, 0.75) and lower smoking prevalence than AA (POR, 0.19, 95%CI 0.05, 0.70) and CA immigrants (POR, 0.21, 95%CI 0.05, 0.76). Additionally, AI reported significantly lower medical mistrust than CA (POR, 0.51, 95%CI 0.26, 0.95), significantly low financial strain than CAs immigrants (POR, 1.66, 95%CI 1.00, 2.75) and significantly higher levels of religious coping than both AA (POR, 2.43, 95%CI 1.43, 4.12) and CA immigrant men (POR, 1.78, 95%CI 1.03, 3.08). This study further supports emerging evidence that Blacks in the U.S. are not a monolithic group and that it is necessary to assess the Black subgroups separately. In addition, as one of the fastest growing immigrant populations, it is critical for future research to understand African immigrant's health needs and its correlates.

A community-based participatory protocol to improving communication with Black men about oral and pharyngeal cancers: Research protocol

Black men are disproportionately impacted by oral and pharyngeal cancer (OPC) mortality. This is in part due to a lack of information received about OPCs and their associated risk factors during health encounters. Discussions between dentists and Black men may improve Black men's knowledge, screening, and treatment uptake. Yet, dentists do not commonly communicate with Black men about OPCs due to their own discomfort. This paper describes the protocol for our research project, which proposes an initiative, grounded in community-based participatory research, to adapt a culturally-specific OPC communication tool. This tool will be adapted using a mixed-methods approach to assess the knowledge, attitudes, and experiences of Black men discussing OPCs and associated risk factors with dental providers. The tool will then be assessed for feasibility and acceptability among Black men, as well as dental students and dental providers in community-based clinical settings.

Stroke Experiences and Unmet Needs of Individuals of African Descent Living in High-Income Economy Countries: a Qualitative Meta-Synthesis

BACKGROUND

Stroke service disparities experienced by individuals of African descent highlight the need to optimize services. While qualitative studies have explored participants' unique experiences and service needs, a comprehensive synthesis is lacking. To address current knowledge gaps, this review aimed to synthesize existing literature on the experiences of individuals of African descent impacted by a stroke living in high-income economy countries in terms of stroke prevention, management, and care.

METHODS

A qualitative meta-synthesis incorporating a meta-study approach was conducted to obtain comprehensive and interpretive insights on the study topic. Four databases were searched to identify qualitative English-language studies published in the year 2022 or earlier on the experiences of adults of African descent who were at risk or impacted by a stroke and living in high-income economy countries. Study methods, theory, and data were analyzed using descriptive and interpretive analyses.

RESULTS

Thirty-seven studies met our inclusion criteria, including 29 journal articles and 8 dissertations. Multiple authors reported recruitment as a key challenge in study conduct. Multiple existing theories and frameworks of health behaviours, beliefs, self-efficacy, race, and family structure informed research positionality, questions, and analysis across studies. Participant experiences were categorized as (1) engagement in stroke prevention activities and responses to stroke symptoms, (2) self-management and self-identity after stroke, and (3) stroke care experiences.

CONCLUSIONS

This study synthesizes the experiences and needs of individuals of African descent impacted by stroke. Findings can help tailor stroke interventions across the stroke care continuum, as they suggest the need for intersectional and culturally humble care approaches.

Physical Limitations, Health Rumination/Worry, and Depressive Symptoms: Gender Differences among African Americans

Although studies have documented the relationships between physical health, health rumination/worry, and mental health, few investigations have assessed these linkages within African American communities. Using a community-based sample of residents in historically lower-income, African American communities (N = 306), this study assesses the mediating role of health rumination/worry in the physical limitation-depressive symptom relationship, and the moderating effect of gender on the relationship between health rumination/worry-depressive symptoms. Findings demonstrate that health rumination/worry explains half of the physical limitation-depressive symptom relationship, and the relationship between health rumination/worry and depressive symptoms is stronger for African American men than women. The findings underscore the importance of intersectional research for policy efforts aimed at reducing mental health morbidities within African American communities.

Sociocultural factors associated with physical activity in Black prostate cancer survivors

PURPOSE

Prostate cancer disproportionately affects Black men. Physical activity protects long-term health and quality of life outcomes in prostate cancer survivors. This study aimed to identify sociocultural factors related to physical activity among Black prostate cancer survivors to inform culturally tailored intervention development.

METHODS

This secondary analysis included data from 257 men who identified as Black or African American and were diagnosed with prostate cancer between 2013 and 2018. Participants completed validated self-report measures of perceived history of racial discrimination, religiosity, fatalism, sociodemographic (e.g., age, ethnicity, income) and clinical characteristics (e.g., years since diagnosis, comorbidity burden), and leisure-time physical activity. Regression analyses were conducted to examine the associations between sociocultural factors and mild, moderate, and vigorous physical activity.

RESULTS

Participants were on average 68.7 years old (SD = 7.7), and most were non-Hispanic (97.3%), married (68.9%), reported an annual household income above $50,000 (57.1%), received at least some college education (74.1%), and were overweight or had obesity (78.5%). Participants reported on average 88.1 (SD = 208.6) min of weekly mild physical activity, and most did not meet guidelines for weekly moderate (80.5%) or vigorous (73.0%) physical activity. After adjusting for covariates, older age and greater religiosity were associated with mild physical activity (ps ≤ 0.05). Higher levels of fatalism were associated with lower odds of meeting guidelines for moderate physical activity (OR = 0.87, 95% CI = 0.77-0.99).

CONCLUSIONS

Sociocultural factors such as religiosity and fatalism may be associated with some forms of physical activity in Black prostate cancer survivors. These findings suggest that incorporating faith-based practices into health behavior interventions may be appropriate for this population.

The High School to Higher Education Pipeline Program: A focus on Black male representation in nursing

BACKGROUND

Increasing the number of Black men in nursing can enhance racial, ethnic, and gender diversity within the nursing workforce. However, there is a lack of nursing pipeline programs that specifically focus on Black men.

PURPOSE

The purposes of this article are to describe the High School to Higher Education (H2H) Pipeline Program as an approach to increasing representation of Black men in nursing and to describe H2H Program participants' perspectives of the program after the first year.

METHODS

A descriptive qualitative approach was used to explore Black males' perceptions of the H2H Program. Twelve of the 17 program participants completed questionnaires. Data collected were analyzed to identify themes.

FINDINGS

Four themes emerged during data analysis regarding the participants' perspectives of the H2H Program: 1) Coming to realize, 2) Managing stereotypes, stigma, and social norms, 3) Making connections, and 4) Expressing gratitude.

CONCLUSION

Results indicated that the H2H Program provided participants with a support network that fostered a sense of belonging. The H2H Program was beneficial for program participants in their development and engagement in nursing.

Implementing barbershop-based health-promotion interventions for Black men: A systematic scoping review

OBJECTIVE

Health-promotion efforts among Black men in the United States have been limited in their ability to recruit, retain, and produce meaningful health-related changes. These difficulties have led to Black men being referred to as a "hard-to-reach" population-a designation that places undue blame on these men as opposed to the dissemination and implementation strategies being used by health-promotion specialists. Gender- and race-based strategies that align with the lived experiences of these men are likely to circumvent these challenges. Barbershops are cultural institutions that are uniquely positioned to promote health among Black men. There is little guidance on how to develop, implement, and evaluate barbershop-based efforts. This scoping review seeks to provide this guidance by applying the RE-AIM framework to analyze existing interventions.

METHOD

Information was identified by searching the following bibliographic databases: PubMed, EMBASE PsycINFO, CINAHL, and Web of Science. A grey literature search was conducted using Web of Science and ClinicalTrials.gov. Results were uploaded to Rayyan. Each article was independently and blindly assessed by two reviewers. A third reviewer blindly resolved any discrepancies. Data were then independently extracted by the two reviewers. Discrepancies were flagged and resolved collaboratively.

RESULTS

Results indicate that barbershop-based health-promotion efforts that prioritize community engagement and intentional alignment to the gender- and race-based lived experiences of Black men are likely to result in satisfactory recruitment, retention, and health-related changes among these men.

CONCLUSIONS

More intervention efforts are needed that target young Black adults, rural Black men, mental health outcomes, and which implement peer-to-peer models. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Shared decision making with black patients: A scoping review

OBJECTIVE

The purpose of this review is to explore the breadth of research conducted on SDM in the care of Black patients.

METHODS

We conducted a scoping review following the methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We searched articles related to original research on SDM in the care of Black patients in October 2022 using PubMed, Embase, and Google Scholar databases. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. A standardized data extraction form and thematic analysis were used to facilitate data extraction by two independent reviewers.

RESULTS

After removal of duplicates and screening, 30 articles were included in the final analysis. Black patients and clinician were found to not share the same understanding of SDM, and patients highly valued SDM in their care. Interventions to improve SDM yielded mixed results to enhance intent, participation in SDM, as well as health outcomes. Decision aids were the most effective form of intervention to enhance SDM. The most common barrier to SDM was patient-clinician communication, and was exacerbated by racial discordance, clinician mistrust, past experiences, and paternalistic clinician-patient dynamics.

CONCLUSIONS

SDM has the potential to improve health outcomes in Black patients when implemented contextually within Black patients' experiences and concerns. Significant barriers such as clinician mistrust exist, and the overall perception in the Black community is that SDM does not occur sufficiently. Barriers to SDM seem to be most pronounced when there is patient-clinician racial discordance. Several interventions aimed at improving SDM with Black patients have shown mixed results. Future studies should evaluate larger-scale interventions with longer follow-up. Practice implications Shared decision making (SDM) has been proposed as a useful tool for improving quality and equity in Black patients' care. However, Black patients experience lower rates of SDM compared to other populations. SDM has the potential to improve health outcomes in Black patients when implemented contextually within Black patients' experiences and concerns.

Prevalence and trend of AIDS-defining cancers and non-AIDS-defining cancers and their association with antiretroviral therapy among people living with HIV in South Carolina: a population-based cohort study

ABSTRACTMonitoring cancer trends and risk is critical as cancer remains a growing problem in persons living with HIV (PLWH). Recent population-based data are limited regarding the cancer trends among PLWH. Our study examined the prevalence and trends in the rate of AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC) and their risk factors in PLWH in South Carolina. Utilizing linked population-based HIV data (2005-2020), time-dependent proportional hazards model was used to identify associated risk predictors of developing cancer in PLWH. Among 11,238 PLWH, 250 individuals developed ADC and 454 developed NADC. The median time from HIV diagnosis to cancer diagnosis was 1.9 years for ADC and 3.8 years for NADC. Individuals who developed ADC or NADC were more likely to be older, male, use substances, have hepatitis infection, hypothyroidism, hypertension, and renal disease. Individuals with viral load >100,000 copies/ml were more likely to develop ADC while those with CD4 count >350 cells/mm3 were less likely to develop ADC or NADC. Our findings suggest that long-term viral suppression may contribute to risk reduction for cancer in PLWH. Early HIV diagnosis along with viral load suppression should be a part of ongoing cancer prevention efforts.

Interactive impacts of walkability, social vulnerability, & travel behavior on COVID-19 mortality: A hierarchical Bayesian spatial random parameter approach

While existing research highlights the built and social environment impacts on COVID-19 mortality, no empirical evidence exists on how the built and social environments may interact to influence COVID-19 mortality. This study presents a rigorous empirical assessment of the interactive impacts of social vulnerability and walkability on neighborhood-level COVID-19 mortality rates. Based in King County, WA, a unique data infrastructure is created by spatially integrating diverse census tract-level data on COVID-19 mortalities, walkability characteristics, social vulnerability, and travel behavior measures. Advanced Markov Chain Monte Carlo (MCMC) based Full Bayes hierarchical spatial random parameter models are developed to simultaneously capture spatial and unobserved random heterogeneity. Around 46% of the neighborhoods had opposite levels of walkability and social vulnerability. Compared to low walkability and high social vulnerability, neighborhoods with high walkability and low social vulnerability (i.e., best case scenario) had on average 20.2% (95% Bayesian CI: -37.2% to -3.3%) lower COVID-19 mortality rates. Analysis of the interactive impacts when only one of the social and built environment metrics was in a healthful direction revealed significant offsetting effects - suggesting that the underlying structural social vulnerability issues faced by our communities should be addressed first for the infectious disease-related health impacts of walkable urban design to be observed. Concerning travel behavior, the findings indicate that COVID-19 mortality rates may be reduced by discouraging auto use and encouraging active transportation. The study methodologically contributes by simultaneously capturing spatial and unobserved heterogeneity in a holistic Full Bayesian framework.

Upstream Policy Changes to Improve Population Health and Health Equity: A Priority Agenda

Policy Points Upstream factors-social structures/systems, cultural factors, and public policy-are primary forces that drive downstream patterns and inequities in health that are observed across race and locations. A public policy agenda that aims to address inequities related to the well-being of children, creation and perpetuation of residential segregation, and racial segregation can address upstream factors. Past successes and failures provide a blueprint for addressing upstream health issues and inhibit health equity.

Inequities in surgical outcomes by race and sex in the United States: retrospective cohort study

OBJECTIVE

To assess inequities in mortality by race and sex for eight common surgical procedures (elective and non-elective) across specialties in the United States.

DESIGN

Retrospective cohort study.

SETTING

US, 2016-18.

PARTICIPANTS

1 868 036 Black and White Medicare beneficiaries aged 65-99 years undergoing one of eight common surgeries: repair of abdominal aortic aneurysm, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, hip replacement, knee replacement, and lung resection.

MAIN OUTCOME MEASURE

The main outcome measure was 30 day mortality, defined as death during hospital admission or within 30 days of the surgical procedure.

RESULTS

Postoperative mortality overall was higher in Black men (1698 deaths, adjusted mortality rate 3.05%, 95% confidence interval 2.85% to 3.24%) compared with White men (21 833 deaths, 2.69%, 2.65% to 2.73%), White women (21 847 deaths, 2.38%, 2.35% to 2.41%), and Black women (1631 deaths, 2.18%, 2.04% to 2.31%), after adjusting for potential confounders. A similar pattern was found for elective surgeries, with Black men showing a higher adjusted mortality (393 deaths, 1.30%, 1.14% to 1.46%) compared with White men (5650 deaths, 0.85%, 0.83% to 0.88%), White women (4615 deaths, 0.82%, 0.80% to 0.84%), and Black women (359 deaths, 0.79%, 0.70% to 0.88%). This 0.45 percentage point difference implies that mortality after elective procedures was 50% higher in Black men compared with White men. For non-elective surgeries, however, mortality did not differ between Black men and White men (1305 deaths, 6.69%, 6.26% to 7.11%; and 16 183 deaths, 7.03%, 6.92% to 7.14%, respectively), although mortality was lower for White women and Black women (17 232 deaths, 6.12%, 6.02% to 6.21%; and 1272 deaths, 5.29%, 4.93% to 5.64%, respectively). These differences in mortality appeared within seven days after surgery and persisted for up to 60 days after surgery.

CONCLUSIONS

Postoperative mortality overall was higher among Black men compared with White men, White women, and Black women. These findings highlight the need to understand better the unique challenges Black men who require surgery face.

Black men in white coats - Barriers black men face in medicine, implications to decreased representation, and potential interventions at the uniformed services university of the health sciences

The number of black male applicants to US medical schools has remained stagnant over the last 30 years. The etiology behind the lack of applicants is multifaceted and involves greater systemic barriers, specifically, educational and social barriers. The lack of representation of black males in medicine also has downstream implications for the health of the African American/black community. African Americans exhibit some of the lowest levels of trust in the healthcare system, have less access to care than their non-minority peers, and have, comparatively, poorer healthcare outcomes than other populations in the US. Research has demonstrated that patient-provider race concordance improves communication, outcomes, culturally competent care, and satisfaction with care. The greater the gap between these two populations, the harder it becomes to improve healthcare outcomes, maintain a medically ready fighting force in the US military, and improve trust in the healthcare system. This article provides an analysis of the multifactorial barriers black male applicants face applying, matriculating, and graduating medical school and how decreased representation may affect healthcare delivery. Furthermore, this review explores next steps and potential implementations at the Uniformed Services University of the Health Sciences to address the above deficiencies.

Black men's awareness of peripheral artery disease and acceptability of screening in barbershops: a qualitative analysis

INTRODUCTION

Peripheral artery disease (PAD) disproportionately burdens Black Americans, particularly Black men. Despite the significant prevalence and high rate of associated morbidity and mortality, awareness of and treatment initiation for PAD remains low in this demographic group. Given the well-established social cohesion among barbershops frequently attended by Black men, barbershops may be ideal settings for health screening and education to improve awareness, early detection, and treatment initiation of PAD among Black men.

METHODS

A qualitative study involving 1:1 participant interviews in Cleveland, Ohio assessed perspectives of Black men about barbershop-based screening and education about PAD. Inductive thematic analysis was performed to derive themes directly from the data to reflect perceived PAD awareness and acceptability of screening in a barbershop setting.

RESULTS

Twenty-eight African American/Black, non-Hispanic men completed a qualitative interview for this analysis. Mean age was 59.3 ± 11.2 years and 93% of participants resided in socioeconomically disadvantaged zip codes. Several themes emerged indicating increased awareness of PAD and acceptability of barbershop-based screenings for PAD, advocacy for systemic changes to improve the health of the community, and a desire among participants to increase knowledge about cardiovascular disease.

CONCLUSIONS

Participants were overwhelmingly accepting of PAD screenings and reported increased awareness of PAD and propensity to seek healthcare due to engagement in the study. Participants provided insight into barriers and facilitators of health and healthcare-seeking behavior, as well as into the community and the barbershop as an institution. Additional research is needed to explore the perspectives of additional stakeholders and to translate community-based screenings into treatment initiation.

The role of sense of community in improving the health-related quality of life among Black Americans

Black Americans have the lowest life expectancy and health-related quality of life (HRQoL; a strong predictor of premature mortality) of any racial/ethnic group in the United States. Low rates of physical activity and engagement in healthy eating are two known contributors to low HRQoL. Black Americans are more likely to live in environments that inhibit engagement in these two contributors. The present study examined sense of community as a buffer against the adverse effects of low physical activity and healthy eating on HRQoL among Black Americans. A sample of 290 Black American adults were recruited for the present study. Results indicate that sense of community buffers against the adverse effects of low physical activity on HRQoL. The results of the present study can be used by health promotion interventionists and policy-makers to improve HRQoL and reduce premature mortality among Black Americans.

Predictors of Health-Related Quality of Life Among African American Men

African American men have the lowest life expectancy of any ethnic gender group in the USA. Furthermore, these men endorse having a lower health-related quality of life (HRQoL) than any other group. There have been recent calls from national organizations to improve HRQoL-a multidimensional indicator of health strongly associated with mortality and morbidity. Following these calls, there have been widespread efforts implemented to improve HRQoL among the US population, though no known effort has been implemented that is tailored to the unique experiences of African American men. Health promotion efforts that are not tailored to the unique preferences and experiences of these men are likely to produce limited results. Formative research conducted among African American men is needed in order to design and implement an effective HRQoL-promoting intervention for African American men. The present study constitutes such formative research and was conducted with a sample of 211 African American men. Hierarchical regressions were performed to understand the role of literature-derived predictors of HRQoL among these men. Results found that depression, stress, and physical activity were found to be significant predictors of HRQoL among these men. This is the first known study to examine predictors of HRQoL among African American men-a group that disproportionately experiences health disparities and low HRQoL, though for who few successful health promotions exist. The findings from this study have implications for those seeking to design and implement HRQoL-promoting interventions among African American men.

Intersectionality and Mental Health Among Emerging Adult Black American Men: a Scoping Review

PURPOSE OF REVIEW

We conducted a scoping review to evaluate the degree to which literature published within the past 5 years concerning mental health among Black emerging adult men in the USA engaged with intersectionality.

METHODS

Using scoping review methods, we applied the following a-priori eligibility criteria: (i) sample included Black/African American men who were aged 18-29 years, (ii) pertained to general mental wellness, depression, or anxiety, (iii) published within between 2017 and 2022, (iv) empirical and/or theoretical literature including reviews, pre-prints, and reports from organizations or professional groups, (v) conducted in the USA. In total, 1384 studies were identified from the databases, after which 224 duplicates were removed, resulting in 1160 unique citations that were screened in the title/abstract phase. Overall, 376 sources were assessed for full-text eligibility, and 20 studies were included for extraction. Information pertaining to sample characteristics, intersectionality, and main mental health results were extracted from the included studies.

RECENT FINDINGS

Findings from this review indicate that there is a paucity of research that has investigated the mental health of Black American, emerging adult men. Of the studies that have been conducted in recent years, there are few that have used an intersectional framework to examine how different social identities intersect to affect mental health. This review underscores that the mental health of emerging adult Black men is of considerable concern given the developmental stage, social and historical context as well as intersecting identities that men in this stage embody.

Vicarious Experiences of Major Discrimination and Psychological Distress among Black Men and Women

Racism-related stress frameworks posit that the discriminatory experiences of one's loved ones may threaten one's well-being, but relatively few studies have examined how they may impact mental health beyond childhood and adolescence. Using data from the Nashville Stress and Health Study (N = 1,252), the present study assessed the prevalence of vicarious experiences of discrimination among subsamples of Black men (n = 297) and women (n = 330), examined the association between vicarious experiences of discrimination and psychological distress among Black men and women, and evaluated the impact of vicarious discrimination on psychological distress in the context of other stressors. Results suggest that Black women report more vicarious exposure to specific types of discrimination. Furthermore, vicariously experienced discrimination was associated with higher levels of psychological distress among Black women, but not among Black men. Our findings extend the literature on racism-related stress and offer new insights for interventions aimed at reducing racial disparities in mental health.

Exploring spatial distribution of social vulnerability and its relationship with the Coronavirus disease 2019: the Capital region of South Korea

Background & objective

The ongoing coronavirus disease 2019 (COVID-19) pandemic continues to cause death and socioeconomic problems worldwide. This study examined the spatial distribution of social vulnerability to COVID-19 and its relationship with the number of confirmed COVID-19 cases in 2020, focusing on the Capital region of South Korea.

Methods

A traditional social vulnerability index (SVI), healthy SVI, and the difference of each SVI were constructed in 2015 and 2019. The traditional SVI was constructed across five domains: age, socioeconomic disadvantage, housing, income, and environment. The healthy SVI domains were: prevention, health-related habits, chronic disease, healthcare infrastructure, and mortality. The spatial distribution of the traditional SVI, healthy SVI, and confirmed cases of COVID-19 was explored using ArcGIS 10.5. Pearson correlation was used to identify the relationship between confirmed COVID-19 cases and the two SVIs and their changes between 2015 and 2019. Four multiple linear regression models were used to identify the impact of the changes of the two SVIs on the confirmed COVID-19 cases for the three episodes and total period with control of population using STATA/MP 16.1.

Results

Confirmed COVID-19 cases were concentrated in a specific area of the Capital region. The traditional SVI was more vulnerable in the outer regions of the Capital region, and some central, western, and eastern areas reflected an increase in vulnerability. Healthy SVI was more vulnerable in the northern part of the Capital region, and increase in vulnerability showed in some central areas above Seoul. By multiple regression with the population controlled, the difference of the traditional SVI between 2015 and 2019 showed a positive relationship with the confirmed COVID-19 cases in all models at a significance level of 0.05, and the 2019 integrated SVI showed a negative relationship with confirmed COVID-19 cases in all models.

Conclusions

The results of this study showed that the confirmed COVID-19 cases are associated with increased traditional SVI vulnerability between 2015 and 2019 and have a high positive relationship with the spread of COVID-19. Policy efforts are needed to reduce confirmed COVID-19 cases among the vulnerable in regions with relatively increased traditional SVI.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14212-7.

Illuminating light in the darkness: Black/African-American men in dental education and strategies for change

The purpose of this article is to discuss the challenges surrounding the underrepresentation of Black/African American (BAA) men in dentistry and dental education and present a rationale for anti-racism strategies to address them. Data and insights from the literature are presented to discuss how racism may derail BAA's opportunities to achieve a dental education through stereotyping, social, and academic isolation. Additionally, the authors present commentary and testimonials on the importance of mentorship to guide BAA men into and through dental careers. Additionally, the article describes two examples of successful career pathway programs, and highlights the significance of historically Black colleges and universities to promoting diversity within the dental profession. Anti-racism recommendations for change include more direct attention to how dental school humanistic environments support BAA men, committing human and financial resources for program development, and using data-driven metrics to assess those programs longitudinally. The commitment of dental education to promote oral health equity demands more than appreciation of BAA men's contributions, but a commitment to creating and advancing opportunities that assure their success.

Individually Tailoring Messages to Promote African American Men's Health

In this paper, we describe our approach to individualizing messages to promote the health of middle-aged and older heterosexual, cisgender African American men. After arguing the importance of being population specific, we describe the process we use to increase the salience of health messages for this population by operationalizing the identity concepts of centrality and contextualization. We also present a measure of African American manhood and discuss how manhood is congruent with qualitative research that describes how African American men view their values, identities, goals, and aspirations in ways that can be utilized to create more meaningful and impactful messages to promote and maintain health behaviors. Our tailoring strategy uses an intersectional approach that considers how the centrality of racial identity and manhood and the salience of religiosity, spirituality, and role strains may help to increase the impact of health messages. We highlight the need to consider how the context of health behavior and the meaning ascribed to certain behaviors are gendered, not only from a man's perspective, but also how his social networks, behavioral context, and the dynamic sociopolitical climate may consider gendered ideals in ways that shape behavior. We close by discussing the need to apply this approach to other populations of men, women, and those who are non-gender binary because this strategy builds from the population of interest and incorporates factors that they deem central and salient to their identities and behaviors. These factors are important to consider in interventions using health messages to pursue health equity.

Intersectional invisibility experiences of low-income African-American women in healthcare encounters

BACKGROUND

The disparities that Black/African-American women experience in health care are persistent and staggering. Findings from health outcomes research continue to demonstrate poorer outcomes for African-American women compared to women of other race/ethnicity in several conditions. These racial/ethnic and gender health disparities observed are complex, heavily nuanced and multi-factorial. To understand these, there is a need to apply an 'intersectionality' lens. Intersectionality refers to the experience of persons with multiple intersecting statuses. The objective of this exploratory study was to gain insight into the healthcare experiences of low-income African-American women.

METHODS

In-depth one-on-one interviews were conducted with 22 women and 2 focus group discussions with community leaders and advocates. Investigators conducted a thematic analysis of the transcripts.

RESULTS

The thematic analysis revealed four major themes, which tell the story of the intersectional invisibility experienced by low-income AA women in the healthcare system. These included (1) the perception of 'not feeling heard'; (2) patient as 'expert of her own body'; (3) disregard of patient preferences; and (4) the need for self-advocacy.

CONCLUSIONS

Black/African-American women, and particularly those with socioeconomic disadvantage, experience intersectional invisibility resulting from provider implicit bias, stereotypical assumptions, and systemic structures that enable discriminatory practices in healthcare delivery. Healthcare provider education that more explicitly addresses these biases and stereotypes should be complemented with system-level interventions that aim to dismantle the structural racism inherent in healthcare policies and practices.

Planful Self-Control, Metabolic Risk, and Psychosocial Outcomes Among Young, Black Men: A Test of Skin-Deep Resilience Theory

Research on skin-deep resilience suggests that for youth and young adults from disadvantaged backgrounds, high levels of planful self-control may promote positive psychosocial outcomes while simultaneously conferring vulnerabilities to chronic diseases related to aging. In this study, we investigated the divergent effects of planful self-control on young Black American men’s psychosocial well-being and their metabolic risk. We expected that high levels of planful self-control in emerging adulthood would predict positive outcomes in young adulthood (educational attainment, low depressive symptoms, job satisfaction); however, the combination of high levels of planful self-control and the experience of contextual adversity either in emerging adulthood or in childhood would forecast poor metabolic health. Hypotheses were tested with prospective data from 504 Black American men followed from age 20 to age 26. Planful self-control in emerging adulthood directly forecasted low levels of depressive symptoms, one’s likelihood of obtaining a bachelor’s degree, increased job satisfaction, and increases in metabolic risk. Exposure to childhood deprivation moderated the influence of planful self-control on metabolic risk. Men with high levels of deprivation and high levels of planful self-control exhibited the worst metabolic profiles in the sample. In contrast, men with high levels of childhood deprivation and low levels of planful self-control exhibited the best metabolic profiles. Documenting the health consequences associated with planful self-control provides a foundation from which to identify modifiable psychosocial factors that affect the course of psychosocial problems and health.

The Graying of the Cool Pose: Examining Active Care Strategies Among Older African-American Men With Type 2 Diabetes Mellitus

OBJECTIVES

The influence of masculinity norms on disparate health outcomes has been established in the literature. What is less understood are the specific ways in which African-American men "do health" by engaging in strategies promoting positive health outcomes. This article reframes what has been previously examined through a health deficit perspective by reporting the experiences and positive health maintenance strategies of older, African-American men with type 2 diabetes mellitus (diabetes).

METHODS

We employed an intersectional framework to thematically analyze qualitative interviews with African-American male participants (N = 15) in our National Institute on Aging-funded study of diabetes among older adults in Baltimore. Interviews consisted of a modified version of the McGill Illness Narrative Interview, which included discussions of diabetes experiences and self-management strategies.

RESULTS

The majority of African-American men in our study link their successful diabetes management to purposeful self-care activities, despite structural and personal limitations. These activities include proactively seeking diabetes education, healthy eating, medication management, and engaging in supportive relationships.

DISCUSSION

Active pursuit of a healthy lifestyle often requires redefining Black manhood, defying negative gender stereotypes of what it means to be a Black male. Results are described in the context of the "Cool Pose," a framework for understanding how African-American men and boys cope with systemic racial oppression and the unachievable dominant standards of masculinity in the United States. The results suggest that this framework may be less applicable for older African-American men who promote well-being in the wake of chronic disease as they age.

When Resilience Becomes Risk: A Latent Class Analysis of Psychosocial Resources and Allostatic Load Among African American Men

There is a well-established link between psychosocial risks and psychological health among African American (AA) men. Yet, the psychosocial sources and physical health consequences of resilience (i.e., the ability to maintain good health despite adversity) remain underexplored. Using data from 283 AA men in the Nashville Stress and Health Study, the present study investigated the links between psychosocial resilience and allostatic load (AL), a biological indicator of physiological dysregulation. Latent class analysis (LCA) identified distinct resilience profiles comprising eight psychosocial resources across four categories: coping strategies, sense of control, racial identity, and social support. Analysis of variance (ANOVA) tests determined significant class differences in men’s AL scores. LCA results confirm a four-class model was the best fit: Class 1 (high resources, 32%), Class 2 (high coping but low control, 13%), Class 3 (low resources but high racial identity, 20%), and Class 4 (low resources but high mastery, 34%). Results reveal lower AL (better health) among Classes 1 (m = 0.35) and 4 (m = 0.31) and higher AL (worse health) among Classes 2 (m = 0.44) and 3 (m = 0.44). Findings indicate that the “quality” rather than the “quantity” of psychosocial resources matters for physical health among AA men, as positive health outcomes were observed among both low- and high-resource classes. Results suggest different resource combinations produce distinct patterns of resilience among AA men and underscore the need to further elucidate complex resilience processes among this population.

Social Capital, Black Social Mobility, and Health Disparities

This review aims to delineate the role of structural racism in the formation and accumulation of social capital and to describe how social capital is leveraged and used differently between Black and White people as a response to the conditions created by structural racism. We draw on critical race theory in public health praxis and restorative justice concepts to reimagine a race-conscious social capital agenda. We document how American capitalism has injured Black people and Black communities' unique construction of forms of social capital to combat systemic oppression. The article proposes an agenda that includes communal restoration that recognizes forms of social capital appreciated and deployed by Black people in the United States that can advance health equity and eliminate health disparities. Developing a race-conscious social capital framing that is inclusive of and guided by Black community members and academics is critical to the implementation of solutions that achieve racial and health equity and socioeconomic mobility.

Effectiveness of a Combined Motivational Interviewing and Cognitive Behavioral Intervention to Reduce Substance Use and Improve HIV-Related Immune Functioning

This study evaluated the effectiveness of Project PLUS, a 6-session Motivational Interviewing and Cognitive Behavioral intervention to reduce substance use and improve antiretroviral therapy (ART) adherence among PLWH. In a quasi-experimental design, 84 participants from a network of three comprehensive care clinics in New York City received the intervention immediately post-baseline (the Immediate condition) and 90 were assigned to a Waitlist control. Viral load and CD4 data were extracted from electronic medical records (EMR) for a No-Intervention comparison cohort (n = 120). Latent growth curve analyses did not show a consistent pattern of significant between-group differences post-intervention or across time in ART adherence or substance use severity between Immediate and Waitlist participants. Additionally, Immediate intervention participants did not differ significantly from the Waitlist or No-Treatment groups on viral load or CD4 post-intervention or across time. The potential to detect intervention effects may have been limited by the use of a quasi-experimental design, the high quality of standard care at these clinics, or inadequate intervention dose.Trial Registration: ClinicalTrials.gov (NIH U.S. National Library of Medicine) Identifier: NCT02390908; https://clinicaltrials.gov/ct2/show/NCT02390908.

Investigation of Differences in Allostatic Load among Black Men by Level of Educational Attainment: High School Graduates Experience the Highest Levels of Stress

Allostatic load (AL)—the biological assessment of long-term exposure to stress—may explain mortality-rate disparities among non-Hispanic Black (Black) men. We aimed to investigate AL among Black men with equivalent education status after controlling for income. A cross-sectional study was employed to investigate AL among 4113 Black men who participated in the National Health and Nutrition Examination Survey between 1999–2018. A summation of 8 biomarker factors were used to compute AL, differences in socio-demographic characteristics by education status were evaluated, and health behaviors that may influence AL were examined. To determine the high-risk thresholds for each AL component, we examined each component’s distribution among NHB men for whom complete biomarker data were available in the NHANES sample. High-risk thresholds were determined as either (1) above the 75th percentile for body mass index (BMI), diastolic blood pressure (DBP), glycated hemoglobin, systolic blood pressure (SBP), total cholesterol, and serum triglycerides; or (2) below the 25th percentile for serum albumin and serum creatinine. Modified Poisson regression models were used to estimate prevalence ratios and their associated 95% confidence intervals for high AL risk while adjusting for potential confounders. Black men with a high school diploma/GED had a greater prevalence of high AL compared with Black men who had other levels of education, and a slightly higher prevalence of high AL compared with Black men who had less than a high school education. Black men with college degrees had a lower prevalence of high AL than Black men with the lowest levels of educational attainment. Researchers must further examine the hidden costs stemming from the interplay between discrimination associated with being Black in America and systemic racism in the educational system—which may be preventing Black men from achieving optimal health.

The harmful effects of partisan polarization on health

Partisan polarization significantly drives stress and anxiety among Americans, and recent aggregate-level studies suggest polarization may be shaping their health. This individual-level study uses a new representative dataset of 2,752 US residents surveyed between December 2019 and January 2020, some US residents report more days of poor physical and mental health per month than others. Using negative binomial models, zero inflated models, and visualizations, we find evidence that polarization is linked to declines in physical health: the more distant an individual feels politically from the average voter in their state, the worse health outcomes he or she reports. By uncovering the individual-level political correlates of health, this study aims to encourage further study and attention to the broader consequences of political polarization on American communities.