Using Focus Groups to Explore Older Black Men's Perception of Dietary Interventions

Older Black men are underrepresented in research despite being disproportionately affected by Alzheimer's disease (AD) and cardiovascular (CV) risk factors related to AD compared with non-Hispanic Whites. Although dietary interventions have shown promise to reduce modifiable CV risk factors related to AD, Black Americans have lower adherence likely due to lack of cultural considerations. Using a noninterventional convergent parallel mixed-methods approach, this study examined the cultural contexts that inform perceptions of dietary interventions among older Midwestern Black men. All participants completed an online demographic and dietary habit survey prior to focus group discussions. Two focus group discussion sessions were conducted with a total of 10 cognitively normal Black men aged 55 years and older. Survey data were analyzed using a frequency analysis and qualitative data were analyzed using a six-step thematic analysis process. Most men indicated having hypertension (N = 7, 77.8%) and currently not following a dietary eating pattern (N = 8, 88.9%). Emerging themes identified included (1) knowledge of dementia, (2) perceptions of dietary interventions, (3) barriers impacting participation in dietary interventions, and (4) overcoming barriers to engage Black men in dietary interventions. Findings from this study should inform the design of future dietary interventions for AD prevention to enhance participation among older Black men.

Breaking Down Machismo: Shifting Definitions and Embodiments of Latino Manhood in Middle-Aged Latino Men

There is a notable gap in empirical research regarding how Latino men define and demonstrate machismo, masculinity, and manhood as well as the behavioral consequences associated with these concepts. In our study, we employed a phenomenological thematic approach to analyze 20 semi-structured individual interviews conducted with Latino men residing in South Florida. Our primary objectives were twofold: to examine (1) how do Latino men ages 35 to 60 years describe what it means to be a man and (2) what are the attributes that these men seek to show others that demonstrate their character, cultural values, and gender identity. Findings suggest that Latino men understood expectations associated with machismo and explained that fulfillment of their role as provider, protector, and head of the family was important to their perception of self. While some participants reported a desire to embody characteristics associated with traditional machismo, others strived to demonstrate character, familism, and respect and to provide financial and other instrumental support to their families. Participants reported that their transition into middle age was accompanied by a shift in their perspectives on gender roles, moving away from rigid patriarchal views. Exposure to a more fluid and flexible approach to manhood offered relief from the pressures associated with inflexible manifestations of machismo, which can have negative social, behavioral, and physical health implications. The implications of our research extend to the conceptualization of gender ideals, highlighting the need to incorporate intersectionality, role strain, precarious manhood, and culturally specific notions of manhood as foundational elements in this discourse.

Men of color in the health professions: Proceedings from the 2022 ADEA Men of Color in the Health Professions Summit

The purpose of the American Dental Education Association (ADEA) Men of Color in the Health Professions Summit, held in August 2022 at ADEA's headquarters in Washington, DC, was to gather key thought leaders across a myriad of health professions and healthcare organizations and schools to cultivate intentional cross-disciplinary efforts in championing the need to address the low number of men of color entering not only dental, but also medicine, pharmacy, and health-related research careers. A pivotal follow-up step from the inaugural ADEA President's Symposium on Men of Color in the Health Professions at the March 2022 ADEA Annual Session & Exhibition in Philadelphia, the summit brought together academic health professions leaders, government agencies, health professions associations, and other key stakeholders to develop an action plan to support men of color entering the health professions. Moving the needle forward and increasing opportunities for underrepresented men of color in the health professions requires all academic health professions to work together. Highlights of the Summit included a keynote presentation by David Satcher, MD, PhD, the 16th Surgeon General of the United States; workgroup consensus statement development; health career pathways program presentations; strategic forecasting regarding challenges and opportunities in developing a coalition of health professions organizations to support men of color in the health professions; and frameworks for exploring coalition building.

Establishing an Academic-Community Partnership to Explore the Potential of Barbers and Barbershops in the Southern United States to Address Racial Disparities in HIV Care Outcomes for Black Men Living With HIV

Black men comprise most new HIV infections in the Southern United States and have worse HIV outcomes than their non-Black counterparts. We developed an academic-community partnership in Nashville, Tennessee, to explore opportunities to improve HIV outcomes for Black men. We recruited barbers to an HIV training and focus group discussion about prevention and potential barber/barbershop-based strategies to address HIV-related needs for Black men. We assessed HIV knowledge and stigma with validated scales and conducted thematic analysis on discussion transcripts. HIV-related stigma was low (1.8 of 15 points [SD = 1.69]) among 13 participants of unknown HIV status (12 men and one woman). HIV knowledge increased among eight (67%) participants after receiving a brief HIV didactic. Participants described general health care barriers (e.g., the social norm that Black men do not go to the doctor until they are "damn near dead"), fears about unwanted HIV disclosure when seeking HIV testing or care, and community fears about negative stereotypes associated with HIV. Participants expressed enthusiasm about receiving more HIV-related training and utilizing communication skills and client/community relationships to serve as health educators and navigators. Barbers highlighted opportunities to disseminate HIV information in barbershops and combine HIV interventions with other health issues, such as COVID-19, and suggested that these interventions may help reduce HIV-related stigma. Our findings suggest that barbers and barbershops are an underutilized resource for disseminating HIV-related health information and engaging Black men in HIV and other important prevention and care activities such as COVID-19.

Men of color in the health professions: Proceedings from the 2022 ADEA President's symposium

The purpose of the American Dental Education Association (ADEA) President's Symposium on men of color in the health professions, hosted at the 2022 ADEA Annual Session and Exhibition, was to draw attention to the need to address the low numbers of men of color not only entering dental education but also across medicine and health-related research careers and to identify strategies for change. Stakeholders in health professions education shared their professional insights and best practices. Highlights of the Symposium included discussions of funding for pathway programs, leveraging data-driven metrics through strategic partnerships, mentorship, and accountability among dental schools, medical schools, and health science research organizations.

The Association Between Race, Obesity, and Sperm Quality Among Men Attending a University Physician Practice in Washington, DC

A decades-long decline in sperm counts in Western countries has coincided with an increase in obesity rates, prompting study into their association. Few of these studies have incorporated men of color, the sperm health of whom is relatively unknown. The present exploratory study evaluated the association between body mass index (BMI), race, ethnicity, and sperm parameters among a diverse sample of U.S. men attending a Washington, DC physician practice. Semen samples were collected and processed at a single laboratory and sperm concentration, motility, morphology, and count were evaluated according to World Health Organization (WHO) 5th edition criteria. Multivariate models accounted for covariates related to sperm health. The study population (n = 128) was largely obese (45.3%) or overweight (34.4%), and 36.0% were black or Hispanic. Black men had lower adjusted sperm concentration compared to white men (75.0 million/mL to 107.4 million/mL, p = .01) and were more likely to have oligozoospermia (p = .01), asthenozoospermia (p = .004), and low sperm count (p < .0001). Hispanic men had higher adjusted sperm concentration compared to non-Hispanic men (124.5 million/mL to 62.1 million/mL, p = .007) and were less likely to have teratozoospermia (p = .001). Obesity and BMI were associated with lower sperm motility and count in crude models only. Given the study’s sample size its findings should be interpreted with caution but align with the limited epidemiological literature to date that has evaluated racial and ethnic differences in semen quality. Heightened clinical research attention is needed to ensure men of color are included in representative numbers in studies of urologic and andrologic health.

Talking About Public Health With African American Men: Perceptions of Environmental Health and Infertility

While the past two decades have seen rapid advances in research demonstrating links between environmental health and reproductive capacity, African American men have largely been overlooked as study participants. To give voice to the perceptions of urban African American men, the present qualitative study conducted focus groups of men recruited from street- and internet-based advertisements in Washington, DC. Participants were asked for their perspectives on their environment, reproductive health and fertility, and factors that would influence their participation in public health research. Participants expressed concern about ubiquitous environmental exposures characteristic of their living environments, which they attributed in part to gentrification and urban development. Infertility was seen as a threat to masculinity and a taboo subject in the African American community and several participants shared personal stories describing a general code of silence about the subject. Each group offered multiple suggestions for recruiting African American men into research studies; facilitators for study participation included cultural relevance, incentives, transparent communication, internet- and community-based recruitment, and use of African Americans and/or recruiters of color as part of the research team. When asked whether participants would participate in a hypothetical study on fertility that involved providing a sperm sample, there was a mixed reaction, with some expressing concern about how such a sample would be used and others describing a few facilitators for participation in such a study. These are unique perspectives that are largely missing from current-day evidence on the inclusion of African American men in environmental health and reproductive health research.

Giving Voice to Black Men: Guidance for Increasing the Likelihood of Having a Usual Source of Care

Black men suffer inequalities in health and health-care outcomes relative to other racial/ethnic groups, requiring well-informed efforts for health promotion. Fewer Black men have a usual source of health care, which may be a contributor to these disparities. Increasing access to and the likelihood of a usual source of care among Black men are important to address health and health-care disparities. In this focus group study, we sought to better understand how Black men think about primary care and usual sources of care. A total of six focus groups were conducted with N = 25 men. Groups were a mix of men with and without a usual source of care. Several themes were identified through analysis of the data regarding factors that contribute to Black men going to the doctor. Themes identified in the data analysis included Lack of Health Insurance as a Barrier to Establishing Usual Source of Care; Family Promoting Health Care Use; Relationship With Doctor, Trust, and Empowerment; Age and Maturity in Health Promotion; and Positive Tone of Messaging. Future research should explore if similar findings are obtained among men in different regions of the United States or between Black men of different backgrounds. Taking a step beyond this research, specifically, future research can also examine the impact of particular health messages/messaging on Black men’s health-care-seeking behaviors.

No Longer an Island: A Social Network Intervention Engaging Black Men Through CBPR

The aim of this study was to assess outcomes from a multilevel social network intervention to promote the health of Black men. Through a community–academic collaboration and using a participatory research approach, we implemented the intervention over 4 years in a 110-block area of an urban neighborhood. The project aimed to implement a neighborhood peer outreach and leadership network to strengthen social support of Black men and increase community and family engagement. Intervention activities included three 12-month intergenerational peer support groups (N = 46), a door-to-door outreach campaign (N = 186), media and communication efforts, and a community partner network. Primary outcomes for the peer support groups were measured using a pretest/posttest cohort design and included social support, perceived stress, social capital, and global self-esteem. Primary outcomes for the door-to-door outreach campaign were measured using a repeated cross-sectional design and included a sense of community, neighborhood social interaction, perceived neighborhood control, and self-rated health status. Significant findings from the peer support groups included an increase in social support overall (p = .027), driven by improvements in guidance, reliable alliance, and reassurance of worth; and an improvement in perceived stress (p = .047). Significant findings from the door-to-door outreach campaign included increases in neighborhood social interaction (p < .0001) and perceived neighborhood control (p = .036). This project provides evidence that a participatory approach to planning and delivering a health promotion intervention aimed at creating positive social spaces and enhancing social connections can result in significant outcomes and successful engagement of Black men.

No Ke Ola Pono o Nā Kāne: A Culturally Grounded Approach to Promote Health Improvement in Native Hawaiian Men

In Hawai'i, Native Hawaiian men (kāne) have the highest death rate from colon cancer among all ethnic groups. While screening can prevent 90% of these cancers, data show that >58% of kāne over age 50 have never been screened. Prior research has demonstrated that community-based social networks may help kāne adopt healthy behaviors such as cancer screening, however, few studies have activated such an approach. A cross-sectional study entitled No Ke Ola Pono o Nā Kāne (for the good health of men) was conducted statewide in Hawai'i from 2014 to 2018. The study strived to perpetuate the Native Hawaiian traditional practice of "hale mua" (men's house) to promote healthy behaviors among kāne including the adoption of colon cancer prevention strategies such as fecal immunochemical testing (FIT). The study applied a peer-led intervention model using kāne volunteers to deliver the program's educational components, including standardized materials to help the volunteers confidently conduct the sessions. Of the 378 kāne who were recruited into the study, 232 participated in the colorectal session of which 64% (n = 149) were over age 50. Survey data from the 149 kāne indicated that 31% had not discussed colon health or screening with their doctors but 92% had improved their knowledge about colon health from the session. In addition, 76% (n = 113) agreed to complete a FIT. Session evaluations indicated that >91% of kāne liked the hale mua approach and benefited from talking with other kāne about their health.

Income and Marital Status Interact on Obesity Among Black and White Men

Racial disparities in obesity among men are accompanied by positive associations between income and obesity among Black men only. Race also moderates the positive association between marital status and obesity. This study sought to determine how race, income, and marital status interact on obesity among men. Using data from the 2007 to 2014 National Health and Nutrition Examination Survey, obesity was measured as body mass index ≥30 kg/m2 among 6,145 Black and White men. Income was measured by percentage of the federal poverty line and marital status was categorized as currently, formerly, or never married. Using logistic regression and interaction terms, the associations between income and obesity were assessed by race and marital status categories adjusted for covariates. Black compared to White (OR = 1.19, 95% CI [1.03, 1.38]), currently married compared to never married (OR = 1.45, 95% CI [1.24, 1.69]), and high-income men compared to low income men (OR = 1.26, 95% CI [1.06, 1.50]) had higher odds of obesity. A three-way interaction was significant and analyses identified that income was positively associated with obesity among currently married Black men and never married White men with the highest and lowest probabilities of obesity, respectively. High-income, currently married Black men had higher obesity rates and may be at increased risk for obesity-related morbidities.

Discerning Disparities: The Data Gap

Health disparities that focus on gender and on the ancillary dependent variables of race and ethnicity reflect continually early illness, compromised quality of life, and often premature and preventable deaths. The inability of the nation to eliminate disparities also track along race and gender in communities where a limited number of health-care providers and policymakers identify as being from these traditionally underserved and marginalized population groups. Epidemiologists and other researchers and analysts have traditionally failed to integrate the social determinants of health and other variables known to support upward mobility in their predictive analyses of health status. The poor, and poor men of color particularly, begin a descent to invisibility and separation that has been witnessed since the early days of this nation. This history has the majority of men of color mired in poverty or near poverty and has more substantively and explicitly affected both American Indians and Africans forced into immigration into the United States and into slavery. Other racial and ethnic groups including large distinct ethnic groups of Asian Americans and Hispanics/Latinx do not have their treatment by systems fully reported from a health and social justice perspective simply because the systems do not disaggregate by race and ethnicity. It is axiomatic that examining disparities through the lens of race, ethnicity, and gender provides a unique opportunity to reflect upon what is known about boys’ and men’s health, particularly men from communities of color, and about payment systems. Integration of all populations into the enumeration of morbidity, mortality, and disparity indices is a dynamic reflection of the vision and exclusive actions of decision makers.

Global Trends and Prostate Cancer: A Review of Incidence, Detection, and Mortality as Influenced by Race, Ethnicity, and Geographic Location

Although research has reported that prostate cancer (PCa) incidence and mortality rates are among the highest for African Americans, the data is inconclusive regarding PCa rates in native African men, Black men residing in other countries, and men in Asia, Europe, and the Americas. Data reveals that prostate-specific antigen (PSA) testing and disease incidence have risen significantly in developing and Asian countries, and PCa has become one of the leading male cancers in many of those nations. The objective of this study was to review published peer-reviewed studies that address PCa in different regions of the world to get a better understanding of how PCa incidence, prevalence, detection, and mortality are influenced by race, ethnicity, and geography. A secondary goal was to compare PCa data from various world regions to contextualize how disproportionate the incidence and mortality rates are among men from the African diaspora versus men of European, Hispanic, and Asian descent, as well as to highlight the need for more robust screening and treatment guidelines in developing countries. There are differences in incidence and mortality rates between men of African, Asian, Hispanic, and European ancestry, confirming the involvement of genetic factors. However, differences between men of the same race and ethnicity who live in different countries suggest that environmental factors may also be implicated. Availability and access to diagnostic and health-care services as well as recommendations regarding PCa testing vary from country to country and contribute to the variability in incidence and mortality rates.

"Centering the Margins": Moving Equity to the Center of Men's Health Research

How might the science of men's health progress if research on marginalized or subordinated men is moved from the margins of the literature to the center? This commentary seeks to answer this question, suggesting that if more attention is paid to men of color and other marginalized men, the field will be greatly enriched in its ability to understand determinants of men's health. Reimagining men's health by moving men's health disparities to a primary focus of the field may yield critical new insights that would be essential to moving men's health to the center of health equity research. Focusing on the dual goals of improving the health of marginalized men and examining the determinants of disparities among men and between men and women will yield insights into mechanisms, pathways, and strategies to improve men's health and address health disparities. Current definitions of health disparities limit the nation's ability to dedicate resources to populations that need attention-men of color and other marginalized men-that do not fit these definitions. Moving marginalized men to the center of research in men's health will foster new ways of understanding determinants of men's health that cannot be identified without focusing on populations of men whose health is as influenced by race, ethnicity, and other structures of marginalization as it is by gender and masculinities. Using Black men as a case example, the article illustrates how studying marginalized men can refine the study of men's health and health equity.

Effects of Discrimination on HIV-Related Symptoms in Heterosexual Men of Color

HIV-related symptoms have a deleterious effect on quality of life. One determinant of HIV symptom burden among individuals of color may be discrimination. The aim of this study was to explore whether multiple lifetime discrimination events are associated with a greater number of HIV-related symptoms among heterosexual HIV-positive men of color and to examine the influence of anxiety and social support on this relationship. Data for this study were drawn from a cross-sectional survey of 307 heterosexual HIV-positive men recruited from health and social service agencies in New York City (NYC). This study indicated that the number of discrimination events experienced in one’s lifetime was positively associated with the number of HIV-related symptoms experienced in the past month. Moreover, the direct effect of discrimination on HIV symptoms remained significant after anxiety was included as a mediator in the model, and there was a significant indirect effect of discrimination on HIV symptoms through anxiety. Evidence supported a potential moderated mediation effect involving social support: As social support increased, the indirect effect of discrimination on HIV symptoms through anxiety decreased. The results of this study suggest an association between discrimination and HIV-related symptom burden. Furthermore, the relationship between number of major discrimination experiences and HIV symptom burden was partially mediated by anxiety. Future research should consider how lifetime discrimination might be associated with negative health outcomes among HIV-positive individuals of color.

Power Up for Health: Pilot Study Outcomes of a Diabetes Prevention Program for Men from Disadvantaged Neighborhoods

There is a significant evidence base for the Diabetes Prevention Program, a lifestyle intervention to prevent onset of type 2 diabetes among high-risk individuals; however, translation of this intervention for men has been challenging. This report presents outcomes of the pilot study of an adapted 16-week diabetes prevention program entitled " Power Up for Health." The study goal was to better engage men of color with prediabetes from disadvantaged neighborhoods of New York City. It was implemented at five different recreation centers located in predominantly low-income neighborhoods across New York City. The curriculum was facilitated by male lifestyle coaches only; one group was conducted in Spanish. Primary outcome was weight loss from baseline to 16 weeks. Other measures included lifestyle activities, depressive symptoms, and self-reported health status. Men ( N = 47) were screened by telephone. Of the 29 eligible men who began the program, 25 attended at least 4 sessions (52% non-Latino Black, 32% Latino, mean age 51.7 ± SD 9.9 years, mean body mass index 35 ± SD 6.9 kg/m2). End of program outcomes ( n = 23) varied by site and included a mean weight loss of 3.8% (9.7 lbs); 3 of the 5 sites had a mean weight loss of 5.6%, meeting the national goal of 5%-7%. Men ( n = 23) attended a mean of 11.6 of 16 sessions. Improvement in depressive symptoms, healthy eating and exercise, and health status were also seen. While recruitment was challenging with many lessons learned, the adapted men's diabetes prevention program shows promise of success for participants and their coaches.

Power Up for Health-Participants' Perspectives on an Adaptation of the National Diabetes Prevention Program to Engage Men

The National Diabetes Prevention Program (NDPP) has been effectively translated to various community and clinical settings; however, regardless of setting, enrollment among men and lower-income populations is low. This study presents participant perspectives on Power Up for Health, a novel NDPP pilot adaption for men residing in low-income communities in New York City. We conducted nine interviews and one focus group with seven participants after the program ended. Interview and focus group participants had positive perceptions of the program and described the all-male aspect of the program and its reliance on male coaches as major strengths. Men felt the all-male adaptation allowed for more open, in-depth conversations on eating habits, weight loss, body image, and masculinity. Participants also reported increased knowledge and changes to their dietary and physical activity habits. Recommendations for improving the program included making the sessions more interactive by, for example, adding exercise or healthy cooking demonstrations. Overall, findings from the pilot suggest this NDPP adaptation was acceptable to men and facilitated behavior change and unique discussions that would likely not have occurred in a mixed-gender NDPP implementation.

"Just as Canadian as Anyone Else"? Experiences of Second-Class Citizenship and the Mental Health of Young Immigrant and Refugee Men in Canada

In recent years, the experiences of immigrant and refugee young men have drawn attention worldwide. Human-induced environmental disasters, local and global conflicts, and increasingly inequitable distributions of wealth have shaped transnational migration patterns. Canada is home to a large immigrant and refugee population, particularly in its urban areas, and supporting the mental health and well-being of these communities is of critical importance. The aim of this article is to report findings from a qualitative study on the social context of mental health among immigrant and refugee young men, with a focus on their migration and resettlement experiences. Informed by the conceptual lens of social context, a thematic narrative analysis approach was used to examine qualitative data from individual and group interviews with 33 young men (age 15 to 22 years) self-identified as immigrants or refugees and were living in Greater Vancouver, western Canada. Three thematic narratives were identified: a better life, living the (immigrant) dream, and starting again from way below. The narratives characterized the social context for immigrant and refugee young men and were connected by a central theme of negotiating second-class citizenship. Implications include the need for mental health frameworks that address marginalization and take into account the contexts and discourses that shape the mental health of immigrant and refugee populations in Canada and worldwide.

Self-Rated Health and Health Care Access Associated With African American Men's Health Self-Efficacy

Health self-efficacy, a measure of one's self-assurance in taking care of their own health, is known to contribute to a range of health outcomes that has been under examined among African American men. The purpose of this investigation was to identify and contextualize predictors of general health self-efficacy in this population. A cross-sectional sample of surveys from 558 African American was examined. These men were older than 18 years, could read and write English, and attended a hospital-based community health fair targeting minority men in 2011. The outcome of interest was health self-efficacy, which was assessed by asking, "Overall, how confident are you in your ability to take good care of your health?" Responses ranged from 1 ( not confident at all) to 5 ( completely confident). Covariates included age, self-rated health, health insurance status, having a regular physician, and being a smoker. The mean age of participants was 54.4 years, and 61.3% of participants indicated confidence in their ability to take good care of their health. Older age and being a smoker were inversely associated with the outcome. Good self-rated health, having health insurance, and having a regular doctor were positively associated with reports of health self-efficacy. Findings suggest that multiple points of connection to the health care system increase the likelihood of health self-efficacy for this sample and interventions to support older African American men who may evaluate their own health status as poor and who may face barriers to health care access are implicated.

Young Black Gay/Bisexual and Other Men Who Have Sex With Men: A Review and Content Analysis of Health-Focused Research Between 1988 and 2013

Black young gay, bisexual, and other men who have sex with men (YGBMSM) are at high risk for negative health outcomes, though this population is underrepresented in the health literature. An extensive literature review and content analysis of health-related peer-reviewed articles (1988-2013) was conducted that targeted Black YGBMSM, examining five content areas: sexual health, health care, substance use, psychosocial functioning, and sociostructural factors. A coding sheet was created to collect information on all content areas and related subtopics and computed descriptive statistics. Out of 54 articles, most were published after 2004 ( N = 49; 90.7%) and addressed some aspect of sexual health ( N = 50; 92.6%). Few articles included content on psychosocial functioning, including bullying/harassment, suicide, and racial/ethnic identity. Data on health care delivery/receipt and health insurance were underrepresented; tobacco use and substance abuse were seldom addressed. Important sociostructural factors, including sexual networks and race-based discrimination, were poorly represented. Last, there was a noteworthy deficit of qualitative studies and research exploring intersectional identity and health. This review concludes that studies on Black YGBMSM health places sex at the forefront to the neglect of other critical health domains. More research is needed on the diverse health issues of a vulnerable and underexamined population.

Helicobacter Pylori Infection in Texas Hispanic and Non-Hispanic White Men: Implications for Gastric Cancer Risk Disparities

Chronic Helicobacter pylori ( H. pylori) infection is a major gastric adenocarcinoma (GA) risk factor. GA disproportionately affects U.S. Hispanics compared with non-Hispanic Whites (NHWs). Since H. pylori infection studies in Hispanics are few, infection rates in Hispanic and NHW men in Bexar County were compared, and relationships with ethnicity and obesity examined. Age- and zip code-matched participants from a community-dwelling cohort were randomly selected. Sera from 284 men were analyzed by enzyme immunoassay for H. pylori antibodies. Adjusted risk ratio estimation for matched data was conducted to identify differences. Hispanics had a markedly higher prevalence of infection (30.3%) than NHWs (9.2%). Matched risk ratio (mRR) analyses revealed a strong association between H. pylori seropositivity and Hispanic ethnicity (mRR = 3.31; 95% CI [1.91, 5.73], adjusted by BMI, smoking status, and family history of cancer (mRR range = 3.28-3.89). BMI mRRs (range = 1.19-1.22) were significant in all models. In this cohort, Hispanic men had higher H. pylori infection rates than NHWs, and parallel the disproportionately higher rates of GA; obesity contributes to this higher prevalence. Future studies should address country of origin, acculturation, and other factors influencing obesity to further elucidate risk of GA in Hispanic populations.

Geography, Race/Ethnicity, and Physical Activity Among Men in the United States

Engaging in regular physical activity reduces one’s risk of chronic disease, stroke, cardiovascular disease, and some forms of cancer. These preventive benefits associated with physical activity are of particular importance for men, who have shorter life expectancy and experience higher rates of chronic diseases as compared to women. Studies at the community and national levels have found that social and environmental factors are important determinants of men’s physical activity, but little is known about how regional influences affect physical activity behaviors among men. The objective of this study is to examine the association between geographic region and physical activity among men in the United States, and to determine if there are racial/ethnic differences in physical activity within these geographic regions. Cross-sectional data from men who participated the 2000 to 2010 National Health Interview Survey (N = 327,556) was used. The primary outcome in this study was whether or not men had engaged in sufficient physical activity to receive health benefits, defined as meeting the 2008 Physical Activity Guidelines for Americans. Race/ethnicity and geographic region were the primary independent variables. Within every region, Hispanic and Asian men had lower odds of engaging in sufficient physical activity compared to white men. Within the Northeast, South, and West, black men had lower odds of engaging in sufficient physical activity compared to white men. The key findings indicate that the odds of engaging in sufficient physical activity among men differ significantly between geographic regions and within regions by race/ethnicity.

"We Need Help in the Delta"

The purpose of this study was to better understand the barriers to health promotion among African American older men living in the rural Mississippi Delta. A qualitative, intrinsic case study approach was used to explore the phenomenon of health and the barriers to promoting men’s health within the unique context of the Delta. Data included one key informant interview and two focus group interviews with 14 men, with the majority between the ages of 41 and 55 years. Focus group participants were lay community members as well as members of a volunteer community health advisors men’s group. Findings underscore the extensiveness of the term “health” and the importance of attending to structural barriers in addressing men’s health. Three overarching themes emerged: “men don’t talk about health,” “health care is not just the issue, everything is,” and “we need a strong male to lead.” Implications for future research and health promotion efforts are provided.

Sex and Race/Ethnicity Differences in Following Dietary and Exercise Recommendations for U.S. Representative Sample of Adults With Type 2 Diabetes

This study examined sex by race/ethnicity differences in medical advice received for diet and exercise with corresponding health behaviors of a U.S. representative sample of adults with type 2 diabetes (N = 1,269). Data from the National Health and Nutrition Examination Surveys for 2011-2014 for 185 Mexican Americans, 123 Other Hispanics, 392 non-Hispanic Blacks, 140 non-Hispanic Asians, and 429 non-Hispanic Whites were analyzed using logistic regression analyses. Reporting being given dietary and exercise advice was positively associated with reporting following the behavior. There were differences in sex and sex by race/ethnicity for reporting receiving medical advice and performing the advised health behavior. These results suggest the importance of physicians having patient-centered communication skills and cultural competency when discussing diabetes management.

Acculturation Factors Related to Obesity of Latino American Men Nationwide

Obesity is a public health epidemic, particularly among underrepresented populations. With a large proportion of immigrants, Latino Americans comprise the largest minority population in the United States. This study examined the association of acculturation factors with obesity among Latino American men ( n = 1,127) using the National Latino and Asian American Study. The result identified two acculturation-related factors (being U.S.-born and living in the United States for the longest period/5-10 years) as positive correlates. In contrast, a different study on obesity in Latino American women demonstrated discrimination, but not the above factors, as significant correlates. The men's pattern suggests that the Hispanic/Latino paradox might have greater implications for men with respect to weight issues. Furthermore, Mexican American and Other Latino American men presented a greater likelihood of being obese than Cuban and Puerto Rican men. The findings, if replicated in prospective research, suggest the need for gender- and ethnic-specific intervention for obesity in Latino American men, particularly for the largest subgroup, Mexican Americans.

Prostate Cancer Ambassadors: Process and Outcomes of a Prostate Cancer Informed Decision-Making Training Program

African American men bear a higher burden of prostate cancer than Caucasian men, but knowledge about how to make an informed decision about prostate cancer screening is limited. A lay health advisor model was used to train "Prostate Cancer Ambassadors" on prostate cancer risk and symptoms, how to make an informed decision for prostate-specific antigen screening, and how to deliver the information to members of their community. Training consisted of two, 6-hour interactive sessions and was implemented in three predominantly African American communities over an 8-month period between 2013 and 2014. Following training, Ambassadors committed to contacting at least 10 people within 3 months using a toolkit composed of wallet-sized informational cards for distribution, a slide presentation, and a flip chart. Thirty-two Ambassadors were trained, with more than half being females (59%) and half reporting a family history of prostate cancer. Prostate cancer knowledge improved significantly among Ambassadors ( p ≤ .0001). Self-efficacy improved significantly for performing outreach tasks ( p < .0001), and among women in helping a loved one with making an informed decision ( p = .005). There was also an improvement in collective efficacy in team members ( p = .0003). Twenty-nine of the Ambassadors fulfilled their commitment to reach at least 10 people (average number of contacts per Ambassador was 11). In total, 355 individuals were reached with the prostate cancer information. The Ambassador training program proved successful in training Ambassadors to reach communities about prostate cancer and how to make an informed decision about screening.

Prostate Cancer Education in African American Barbershops: Baseline Client Survey Results and Differences in Decisional Conflict and Stage of Decision Making

There have been very few studies to rigorously evaluate the potential of African American barbers to educate men about prostate cancer in the barbershop setting. This research brief presents baseline data from a cross-sectional survey identifying differences in decisional conflict and stage of decision making by screening status from an efficacy trial to educate African American men about informed decision making for prostate cancer screening. Those men who had already received the prostate-specific antigen (PSA) test were more advanced in their stage of decision making and had less decisional conflict about the PSA test than those men who had never received a PSA test. Educational interventions to increase informed decision making with prostate cancer screening must consider previous PSA test history as a mediating variable affecting decision self-efficacy.

Drinking Patterns and HIV Risk Behaviors Among Black and Latino Men Who Have Sex Within Los Angeles County

Alcohol, the most widely used substance among men who have sex with men (85%), remains an important factor in HIV research among this high-risk population. However, research on alcohol use among Black and Latino men who have sex with men (BLMSM), a population disproportionately affected by HIV in the United States, is limited and inconclusive. This study explored sociodemographic and HIV risk with daily heavy and low-risk drinking patterns among BLMSM. BLMSM (N = 188) aged 18 to 40 years were recruited through social media, local colleges, heteronormative clubs, private men’s groups, gay establishments, and organized events in Los Angeles County. Participants completed self-administered questionnaires. Fisher’s exact tests revealed significant relationships between drinking patterns and condomless insertive anal intercourse (p = .001), race (p < .001), age (p = .02), and perception of alcohol-related HIV risk (p = .007). The Fisher’s exact tests findings for age held true in the multiple regression model (p = .014). Findings suggest that BLMSM who engage in higher risk drinking also engage in alcohol-related HIV risk. Culturally competent interventions should consider including a combined focus to explore the synergy between risky drinking patterns and HIV risk among BLMSM.

Male Contraception: Research, New Methods, and Implications for Marginalized Populations

The majority of research on contraception has focused on manipulating the female reproductive system. Recent studies have identified novel contraceptives for males, including hormonal- and nonhormonal-based therapeutics. Although these new contraceptives are still undergoing clinical trials, their development and potential future use in society necessitate serious consideration of their implications for reproductive health. Through my analysis of the research conducted on male contraception over time and the current therapeutics available, it is clear that male contraception has the potential to shift societal gender dynamics and provide males with greater control over their own reproduction. This article also identifies the implications of these novel contraceptives for marginalized populations, especially men of color and men of lower socioeconomic positions. To overcome barriers to contraception among these populations, public policy efforts are needed in order to motivate the development of programs that facilitate coverage of these new male contraceptives by health plans and to increase their availability to underserved communities. Health care providers will be responsible for educating patients about these novel male contraception options and the need to continue using existing methods (e.g., condoms) in order to prevent sexually transmitted infections. This article analyzes the research conducted on male contraception and identifies the implications of these novel therapeutics for marginalized groups of men in the United States to identify the interventions that will be necessary to help ensure that all men have access to these promising scientific innovations.

Condom-Associated Erection Problems: A Study of High-Risk Young Black Males Residing in the Southern United States

Previous research indicates that young men may experience condom-associated erection loss and that these problems may lead to inconsistent or incomplete condom use. The primary aim of this study was to assess, using a retrospective recall period of 2 months, correlates of condom-associated erection problems among young Black men attending sexually transmitted infection (STI) clinics. Data were collected in clinics treating patients with STIs in three southern U.S. cities. Males 15 to 23 years of age who identified as Black/African American and reported recent (past 2 months) condom use were eligible. A total of 494 men participated. Nineteen percent reported that condom-associated erection problems during condom application occurred at least once, and 17.8% indicated erection difficulties occurred during sexual intercourse at least once in the past 2 months. Multivariate analyses identified that condom-associated erection problems were associated with reports of sex with more than one partner during the recall period, reported problems with condom fit and feel, lower motivation to use condoms, and attempts at condom application before having a full erection. Findings suggest that clinic interventions should address possible condom-associated erection problems among young Black men who are at risk of STIs. Encouraging men who may be vulnerable to erection loss when condoms are used to allow sufficient time for sexual arousal to build may be an effective strategy.

Am I My Brother's Keeper? African American Men's Health Within the Context of Equity and Policy

African American men's health has at times been regarded as irrelevant to the health and well-being of the communities where they are born, grow, live, work, and age. The uniqueness of being male and of African descent calls for a critical examination and deeper understanding of the psycho-socio-historical context in which African American men have lived. There is a critical need for scholarship that better contextualizes African American Male Theory and cultural humility in terms of public health. Furthermore, the focus of much of the social determinants of health and health equity policy literature has been on advocacy, but few researchers have examined why health-related public policies have not been adopted and implemented from a political and theoretical policy analysis perspective. The purpose of this article will be to examine African American men's health within the context of social determinants of health status, health behavior, and health inequalities-elucidating policy implications for system change and providing recommendations from the vantage point of health equity.

Mexican American Men's Experience of Living With Tuberculosis on the U.S.-Mexico Border

The Texas-Mexico border incidence rate of tuberculosis (TB) is 10 times the rate of TB in the United States. Additionally, this area is plagued by antibiotic-resistant TB at a rate that is 70% higher among those living along the border than among nonborder residents. Both the high rate of TB and the emergence of drug-resistant TB increases the importance of controlling TB along the U.S.-Mexico border. Men have higher rates of TB than women, which can be attributed to biological differences and increased environmental exposure. The purpose of this article is to describe the experience of TB for Mexican American men living on the Texas-Mexico border. This a qualitative descriptive study, using participants from a larger study. A purposeful sample was recruited through two south Texas TB clinics. Interviews were audio recorded, transcribed, and translated into English. Data analysis consisted of line-by-line coding, labeling, organizing, and discovering common codes to describe participants' experience of TB and TB treatment. The participants include 13 Mexican American men. Ages ranged from 22 to 76 years. Only one participant was employed during treatment. Years of education ranged from no school to an associate's degree. Five themes were discovered: misinformation, delayed diagnosis, stigma, depression, and loss of community. Participants without social support were further isolated and felt a greater burden of treatment. Two participants contemplated suicide and two others told their families to leave them because they were a burden and infectious. The burden of treatment on the patient is great, especially for Hispanic men.

Elevated sexual risk behaviors among postincarcerated young African American males in the South

The dramatic racial disparities in the rates of HIV/STIs(sexually transmitted infections) among African Americans make understanding broader structural factors that increase the risk for HIV/STIs crucial. The current study of young 564 African American men attending STI clinics investigated whether those who had ever been incarcerated reported recent sexual behaviors relatively more risky than their counterparts who had never been incarcerated. Participants were recruited from clinics treating STIs in three southern U.S. cities. Males 15 to 23 years of age who identified as Black/African American and reported recent (past 2 months) sexual activity were eligible. Linear mixed-effects models and generalized estimating equation models were used to assess associations between baseline incarceration history and sexual risk behavior over a 6-month follow-up period. Mean age was 19.6 years (SD = 1.87). At baseline, 240 (42.6%) men reported history of incarceration. Incarceration history predicted several risk behaviors over a 6-month follow-up period. Compared with those with no incarceration history, men previously incarcerated reported a desire to conceive a pregnancy (β = .40, p = .02), were less likely to have used a condom at last sex act (odds ratio = .91, p = .02) and were more likely to have used drugs and alcohol before sex in the past 2 months (β = .69, p < .001; β = .41, p < .001). A history of incarceration may influence the sexual risk behavior of young African American males. Prevention programs and interventions should intensify support for postincarceration African American males to help mitigate this behavior.

"The black man's country club": assessing the feasibility of an HIV risk-reduction program for young heterosexual African American men in barbershops

Despite increasing HIV/AIDS morbidity and mortality, focus on young heterosexual African American men is limited. Nontraditional community-based prevention programs may be most effective for this demographic. Barbershops are one potential venue; however, barbers' and barbershop owners' views on the concept are less known. This paper describes attitudes and beliefs among barbers and barbershop owners regarding delivering a barber-facilitated, skills-based HIV risk-reduction intervention to their clientele. Participants believed that young heterosexual African American men were at significant risk for HIV and highly regarded the intervention model. This novel work contributes a voice to the literature that is infrequently heard.

Predictors of HIV disclosure to secondary partners and sexual risk behavior among a high-risk sample of HIV-positive MSM: results from six epicenters in the US

This study sought to identify predictors of HIV disclosure and serodiscordant unprotected anal intercourse (SDUAI) among HIV-positive men who have sex with men (MSM). Between January 2005 and April 2006, 675 HIV-positive MSM were recruited into the Positive Connections intervention trial held in six US cities with intentional over-sampling of HIV-positive MSM of Color (74%) and men engaging in unprotected anal intercourse (UAI) in the previous year. Baseline survey data showed 30 and 31%, respectively, of participants disclosed to none or some of their secondary sex partners in the last 90 days. Greater disclosure to secondary partners was associated with having fewer sexual partners, being extremely out as MSM, longer HIV diagnosis, knowledge of CD4 count, detectable viral load and being white. Disclosure to all secondary partners was associated with lower SDUAI. Recommendations for prevention for HIV-positive MSM include the promotion of serodisclosure to all secondary partners and increasing comfort with, and outness about, one's sexuality.