Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease: Development of a Situation-Specific Theory for African American Emerging Adults

BACKGROUND

Emerging adulthood (18-25 years old) is a distinct developmental period in which multiple life transitions pose barriers to engaging in healthy lifestyle behaviors that reduce cardiovascular disease risk. There is limited theory-based research on African American emerging adults.

OBJECTIVE

This article introduces a synthesized empirically testable situation-specific theory for cardiovascular disease prevention in African American emerging adults.

METHODOLOGY

Im and Meleis' integrative approach was used to develop the situation-specific theory.

RESULTS

Unlocking Population-Specific Treatments to Render Equitable Approach and Management in Cardiovascular Disease is a situation-specific theory developed based on theoretical and empirical evidence and theorists' research and clinical practice experiences.

DISCUSSION

African American emerging adults have multifaceted factors that influence health behaviors and healthcare needs. Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease has the potential to inform theory-guided clinical practice and nursing research. Recommendations for integration in nursing practice, research, and policy advocacy are presented. Further critique and testing of the theory are required.

Social Determinants of Health are Associated with Coping of Informal Caregivers of Adults with Heart Failure

We explored the influence of social determinants of health (SDH) risk on stress and coping style in heart failure (HF) caregivers. In this cross-sectional study, data from 250 caregivers were analyzed. Multivariable linear regression analyses were performed to determine the extent to which SDH risk (measured using a modified PRAPARE tool (National Association of Community Health Centers), range 0-22) predicted stress (Perceived Stress Scale, 0-56) and coping style (active (0-45), avoidance (0-30), and minimization (0-30)) while accounting for caregiver burden (HF Caregiver Questionnaire (HF-CQ) 0-100). Multivariable regression analysis with backwards elimination variable selection approach was used to identify which SDH risk factors best predicted coping styles. SDH risk was significantly associated with avoidance and minimization coping styles. Each unit increase in SDH risk was associated with an increase of 0.6 ± 0.2 units (p = .0008) in avoidance and 0.7 ± 0.2 units (p < .0001) in minimization coping style. Race and "supporting others" significantly predicted avoidance coping style; scores were 3.3 ± 0.8 units greater for caregivers who were not White (p < .0001) and 1.4 ± 0.5 units greater (p < .01) for each additional person whom they supported. Race significantly predicted minimization coping style; scores were 4.4 ± 0.7 units greater for caregivers who were not White (p < .0001). Caregivers with higher SDH risk may avoid and minimize to cope with caregiving challenges.

Proactive coping with discrimination: A mediator between ethnic-racial socialization and Latinx youth's internalizing symptoms

There is a dearth of knowledge in the coping literature on how minoritized youth cope with racism-related stressors and the predictors of effective coping responses. This two-wave study examined the direct and indirect effects of ethnic-racial socialization on depressive and anxiety symptoms via proactive coping with discrimination in a community sample of 135 Latinx adolescents (Mage  = 16, SD = 1.27; 59% female). Results indicate that cultural socialization was related to higher use of proactive coping with discrimination 6 months later, which in turn, was related to fewer depressive and anxiety symptoms. There were no direct or indirect effects between preparation for bias and mental health outcomes.

Relationships Between Strong Black Woman Belief, Coping Behaviors, Perceived Social Support, and Psychological Distress Symptoms for Black Mothers After Stillbirth

INTRODUCTION

Psychological distress symptoms (symptoms of depression, anxiety, and posttraumatic stress) are common following stillbirth. Black women who experience stillbirth are less likely to seek support than White women, consistent with the strong Black woman (SBW) construct, which expects Black women to tolerate stress and trauma gracefully, without seeking help.

METHODS

In this cross-sectional study we sought to determine the relative contributions of SBW belief, perceived lack of social support, and culturally relevant coping behaviors to psychological distress symptoms in Black women bereaved by stillbirth. We partnered with a stillbirth support organization to recruit a sample of 91 Black women bereaved by stillbirth in the 3 years prior to study participation. The online study survey measured SBW belief, culturally relevant coping behaviors, perceived social support, and psychological distress symptoms along with sociodemographics, pregnancy history, and stillbirth characteristics. We used stepwise selection in multiple linear regression to determine the relative contributions of SBW belief, perceived social support, and coping behaviors to measures of psychological distress symptoms in our sample.

RESULTS

Higher SBW belief, lower perceived social support, and higher collective coping (coping behaviors involving other people) were associated with increases in all 3 measures of psychological distress symptoms, controlling for age and other traumatic events.

DISCUSSION

Further understanding of the influence of SBW belief on Black women's psychological distress following stillbirth may assist with the development of culturally appropriate interventions to mitigate psychological distress symptoms in this group.

Examining Racial/Ethnic Disparities in Coping and Stress Within an Environmental Riskscape

Existing research on racial/ethnic differences in stress and coping is limited by small samples, single-item measures, and lack of inclusion of Mexican Americans. We address these gaps by analyzing data from the Texas City Stress and Health Study, a cross-sectional sample of Black (N = 257), White (N = 304), US-born (N = 689), and foreign-born (N = 749) Mexican Americans residing in proximity to a petrochemical complex. We compared active and avoidant coping by race/ethnicity and explored multivariable associations between coping and perceived stress. Black and foreign-born Mexican American respondents had the highest stressor exposure yet displayed different patterns of coping and perceived stress patterns. Active coping may be particularly effective for African Americans but may not offset extreme stress disparities. For Mexican Americans, the lack of association between coping and stress underscores the need for more work focused on the culturally diverse coping experiences.

Promoting Racial/Ethnic Identity in Child and Adolescent Mental Health Treatments

Over the last decade, state and city legislative efforts have underscored that racism is a public health crisis. These legislative shifts have been in concert with several professional medical organizations, including the National Academy of Medicine, the United States Department of Health and Human Services, the Centers for Disease Control, and the National Institute of Health, which have collectively called for structural change to address race inequity in health, from research to patient care. The adverse effects of racism (eg, interpersonal, structural, institutional, and internalized) on health have been documented to include negative effects across the lifespan and developmental continuum, particularly for ethnoracially minoritized youth. Indeed, several studies have specifically identified racism's impact on youths' psychosocial functioning and emotional well-being, particularly around anxiety, depression, and academic functioning. The effects of interpersonal racism on mental health in adolescents and, in particular, Black youth is telling. Although the child and adolescent mental health establishment and literature have advocated for strengths-based (eg, cultural assets) and community engaged (eg, community-based participatory research) frameworks to advance evidence-based treatments for diverse communities, the development of culturally responsive and antiracist interventions remain a gap in our treatment armamentarium for ethnoracially minoritized youth. As in other papers, we have highlighted the criticality of health equity, cultural humility, and culturally informed and responsive clinical practices. We have also underscored that, as a field, child mental health practitioners need to move toward being antiracist to truly address well-being, a shift that requires pivoting toward approaches that promote racial/ethnic identity (REI), which includes racial/ethnic connectedness and racial/ethnic pride. Race-conscious interventions, particularly those that focus on racial/ethnic connectedness and racial/ethnic pride, can not only be protective and health promoting in their ability to mitigate the emotional harms of experiencing racism, but can also foster social-emotional functioning and successful academic outcomes among ethnoracially minoritized individuals.

Coping with Ethnic-racial Discrimination: Short-term Longitudinal Relations Among Black and Latinx College Students

Little is known about how Black and Latinx young adults cope with experiences of ethnic-racial discrimination, particularly over short periods of time. A multigroup path model examined the relations between discrimination and five strategies for coping with ethnic-racial discrimination (talking with others, being proud, working hard, being rude, and ignoring) among Black and Latinx young adults (N = 145) at two time points over a six-week period. Experiences of discrimination were positively associated with the coping strategies of being proud of oneself and working hard to prove discriminatory people wrong. There was moderate stability in coping strategy use over time. Models did not vary by race-ethnicity, suggesting discrimination related to coping in similar ways among Black and Latinx young adults.

Psychosocial Predictors of Chronic Musculoskeletal Pain Outcomes and their Contextual Determinants Among Black Individuals: A Narrative Review

Black communities are disproportionally affected by Chronic Musculoskeletal Pain (CMP), but little is known about the psychological predictors of CMP outcomes and their contextual determinants among Black individuals. To address this gap, we conducted a narrative review of extant literature to (1) report the major conceptual models mentioned in prior work explaining the link between contextual determinants and psychological responses to pain among Black individuals with CMP; and (2) describe psychological factors related to CMP outcomes in this population that are highlighted in the literature. We searched 4 databases (APA PsycNet, PubMed/MEDLINE, Scopus, and Google Scholar) using the following search terms: musculoskeletal pain, chronic pain, mental health, psychological, coping, health disparities, contextual factors, conceptual models, psychosocial, Black, African American, pain, disability, and outcomes. We illustrate 3 relevant conceptual models - socioecological, cumulative stress, and biopsychosocial - related to contextual determinants and several psychological factors that influence CMP outcomes among Black individuals: (1) disproportionate burden of mental health and psychiatric diagnoses, (2) distinct coping strategies, (3) pain-related perceived injustice and perceived racial/ethnic discrimination, and (4) preferences and expectations related to seeking and receiving pain care. The detailed clinical and research implications could serve as a blueprint for the providers and clinical researchers to address health disparities and improve care for Black individuals with CMP. PERSPECTIVE: This narrative review illustrates conceptual models explaining the link between contextual determinants and psychological responses to pain among Black individuals with chronic musculoskeletal pain. We discuss 3 relevant conceptual models - socioecological, cumulative stress, biopsychosocial -, and 4 psychological factors: disproportionate burden of mental health, distinct coping strategies, perceived injustice/discrimination, preferences/expectations.

Resilience and Family Socialization Processes in Ethnic Minority Youth: Illuminating the Achievement-Health Paradox

Youth in marginalized communities who "strive" to rise above adversity, including systemic racism and poverty, are considered "resilient." African-American, Latinx, and Asian-American youth often achieve admirable academic success despite limited social capital and high early life stress by adopting a "striving persistent behavioral style" (SPBS). SPBS may be supported by family socialization processes that facilitate reliance on self-regulation processes. Unfortunately, a young person's resilience in one domain (i.e., academic) can come at a cost in other domains, including physical and mental health morbidities that are under-identified and under-treated. Indeed, research suggests a link between SPBS in the face of adversity and later health morbidities among ethnic minority youth. Herein, we describe SPBS as an adaptation to minority stress that not only promotes social mobility but may also stoke physical and mental health disparities. We review how family processes related to academic, emotional, and ethnic-racial socialization can facilitate the striving persistent behavioral style. We emphasize the double bind that ethnic minority families are caught in and discuss directions for future research and clinical implications for individual and family-level interventions. While needed, we argue that individual and family-level interventions represent a near-term work around. Solutions and factors that shape the need for SPBS and its cost must be addressed structurally.

Ethnic-racial Socialization, Perceived Neighborhood Quality, and Psychosocial Adjustment among African American and Caribbean Black Adolescents

Ethnic-racial socialization is employed by ethnic minority parents to support their children's psychosocial adjustment. These socialization messages may be associated differently with psychosocial adjustment for Black youth according to ethnicity and qualities of the neighborhood context. This research examined whether associations between ethnic-racial socialization messages and psychosocial adjustment vary by ethnicity and perceived neighborhood quality in a nationally representative sample of Black adolescents who participated in the National Survey of American Life Adolescent supplement study. The effects of promotion of mistrust messages varied by ethnicity, and the effects of egalitarianism messages varied depending on perceived neighborhood quality. These findings help clarify prior research which has yielded equivocal results for the effects of these messages for Black youth's psychosocial adjustment.

From Antiblackness to Cultural Health in Higher Education

Antiblackness has a long and storied history in higher education in the United States, and unfortunately, antiblack attitudes and practices continue in the 21st century. With implications for countering antiblackness in higher education and institutionalizing support for cultural health and wellness, we documented experiences of antiblackness in the African American Student Network (AFAM). AFAM was a weekly networking group, co-facilitated by Black faculty and graduate students, where Black undergraduates could come together and share their experiences. Participation in AFAM was associated with Black holistic wellness, and AFAM was a source of cultural health, where we conceptualized cultural health as having a sense of pride and resilience in one’s cultural background. We analyzed notes of 277 AFAM discussions from 2005–2006 to 2017–2018 using an adaptation of consensual qualitative research methods to identify four domains of antiblackness: racial trauma (n = 51), racial microaggressions (n = 34), racial rejection (n = 33), and systemic racism (n = 25). In moving from antiblackness to cultural health, we advocate for institutional resources in higher education, such as an institute for cultural health on campus, that values the cultures of Black students and students of color, and that focuses on building communities in which students can generate a wellspring of pride and resilience in their cultural backgrounds.

Meaning in Life Predicts Decreased Depressive Symptoms and Increased Positive Affect over Time but Does Not Buffer Stress Effects in a National Sample of African-Americans

Few studies have specifically focused on meaning in life in African Americans and many important questions remain, including whether effects of meaning in life are direct or moderated by levels of stress. In a national sample of 909 African Americans, we tested meaning in life as a prospective predictor of changes in depressive symptoms and positive affect over a 2.5-year period. Controlling for demographics and hassles, meaning in life predicted decreased depressive symptoms and increased positive affect across the span of 2.5 years. Moderation effects were not found for hassles, age, or income. Gender moderated the effect of meaning on positive affect such that effects were stronger for women than for men. These results suggest that, for African Americans, meaning in life appears to robustly protect against future depressive symptoms and promote positive affect over time unaffected by amount of stress experienced or most demographic factors.

What's Race Got to Do With It? Racial Socialization's Contribution to Black Adolescent Coping

While youth generally experience stressors from developmental milestones, Black youth also face racialized stressors. Racial socialization has been found to help Black youth cope with racialized stressors, but research has yet to show its contribution to coping beyond general socialization practices. This study examines how racial socialization contributes beyond that of general coping socialization to coping behaviors. Fifty-eight third-eighth-grade (Mage  = 11.3, SD = 1.54) youth reported general coping socialization and racial socialization practices and coping behaviors. Results indicate that for engagement coping, racial socialization messages contributed significantly to parent-provided engaged socialization strategies. Implications are considered for the ways in which Black youth experience stress and require culturally specific practices for successful coping with frequently encountered stressors.

Racial discrimination, John Henryism coping, and behavioral health conditions among predominantly poor, urban African Americans: Implications for community-level opioid problems and mental health services

The current study examined the relationship between John Henryism Active Coping (JHAC), experiences of racial discrimination, and behavioral health outcomes in a community sample of 319 Black adults. Assessments included primary health care screenings as well as self-reported survey questions to assess JHAC, experiences of discrimination, and self-reported behavioral health. Logistic regression models, adjusted for control variables, found a significant relationship between JHAC and having an opioid problem (odds ratio [OR] = 0.95, p = 0.003) and needing mental health services (OR = 0.95, p < 0.001), such that higher levels of coping were associated with lower odds of reporting an opioid problem and needing mental health services. Notably, racial discrimination was not significantly independently associated with behavioral health. Implications for interventions and community programming are discussed.

Religiosity, Education, John Henryism Active Coping, and Cardiovascular Responses to Anger Recall for African American Men

The present study examined if high levels of religious attendance (ORG), private religious activity (NOR), or intrinsic religiosity (SUB) buffer cardiovascular responses to active speech and anger recall lab stressors alone and by John Henryism Active Coping (JHAC) and educational attainment. A sample of 74 healthy African American males, aged 23 to 47 years, completed psychosocial surveys and a lab reactivity protocol involving active speech and anger recall with a 5-minute baseline and ensuing recovery periods. Measures of religiosity, JHAC, and education were related to continuous measures of systolic and diastolic blood pressure (BP), for each task and rest period with repeated measures ANOVA tests. The period by education by JHAC interaction effect was significant for diastolic BP responses at low but not higher NOR. At low education and low NOR, diastolic BP levels increased significantly during anger recall and ensuing recovery for high but not low JHAC persons. Thus, being deprived of education and private religious activity may put these African American men in a vulnerable situation where higher effort coping may exacerbate their cardiovascular reactivity and recovery to anger induction.

An Exploratory Study of Attitudes Toward Psychological Help Seeking Among African American Men

Disparities in health care are a significant social problem affecting millions of racial and ethnic minorities in the United States. To better understand these disparities, the current study explored the relationship between self- and social stigma, John Henryism, hardiness, and attitudes toward seeking professional psychological help in a community sample of 120 Black men ( Mage = 42.72 years, SD = 13.26). Additionally, participants completed measures of potential covariates, which included occupation, highest education, and income. Results suggest that self-stigma is a major deterrent to seeking help for psychological issues. This relationship is moderated by both age and occupation. Hardiness negatively influenced self-stigma for help seeking and had a positive indirect influence on attitudes toward help seeking. Findings support previous research on help-seeking attitudes among African American men and suggest that personal characteristics, such as age, occupation, and coping style can influence help-seeking behaviors.