Jamie A. Mitchell

Examining the Influence of Social Ecological Factors on Prostate Cancer Screening in Urban African-American Men

African-American men experience a disparate burden of prostate cancer (PC). Little is known about how social factors influence PC screening in this population. Methods: African-American men over the age of 18 (N = 229) were recruited from a community health fair and anonymously surveyed about their PC screening behavior and conditions of their social environment. Analysis included logistic regression. Findings: Fifty one percent of respondents reported receiving any form of PC screening within the past five years. Older age, higher levels of education, and access to a usual health care provider were associated with PC screening. Conclusions: Social workers in preventive and community health settings should be increasingly attentive to the PC screening barriers facing African-American men, particularly those who may be undereducated and lack access to care.

The Discipline's Escalating Whisper: Social Work and Black Men's Mental Health.

Objective: Though sparse in previous years, research on the mental health of Black men has recently experienced a gradual increase in social work journals. This article systematically organizes and critically examines peer-reviewed, social work evidence on the mental health of Black men. Methods: Twenty-two peer-reviewed articles from social work journals were examined based on their contribution to social work research and practice on the mental health of Black men. Results: The social work evidence on Black men’s mental health can be grouped into one of four categories: psychosocial factors; mental health care and the role of clinicians; fatherhood; and sexual orientation, HIV status, and sexual practices. Conclusions: This representation of the social work literature on Black men’s mental health neglects critical areas germane to social work research and practice with this population. Implications include ways to extend current social work research and practice to improve the health for Black men.

Financial Hardship, Unmet Medical Need, and Health Self-Efficacy Among African American Men

Background. Health self-efficacy (the confidence to take care of one’s health) is a key component in ensuring that individuals are active partners in their health and health care. The purpose of this study was to determine the association between financial hardship and health self-efficacy among African American men and to determine if unmet medical need due to cost potentially mediates this association. Method. Cross-sectional analysis was conducted using data from a convenience sample of African American men who attended a 1-day annual community health fair in Northeast Ohio (N = 279). Modified Poisson regression models were estimated to obtain the relative risk of reporting low health self-efficacy. After adjusting for sociodemographic characteristics, those reporting financial hardship were 2.91 times, RR = 2.91 (confidence interval [1.24, 6.83]; p < .05), more likely to report low health self-efficacy. When unmet medical need due to cost was added to the model, the association between financial hardship and low health self-efficacy was no longer statistically significant. Conclusion. Our results suggest that the association between financial hardship and health self-efficacy can be explained by unmet medical need due to cost. Possible intervention efforts among African American men with low financial resources should consider expanding clinical and community-based health assessments to capture financial hardship and unmet medical need due to cost as potential contributors to low health self-efficacy.

Inclusion of Underserved Racial and Ethnic Groups in Cancer Intervention Research Using New Media: A Systematic Literature Review

BACKGROUND An increasing number of behavioral and psychosocial cancer interventions incorporate new media elements that are digital, networked, and interactive. However, it is unclear to what extent new media is being leveraged to benefit underserved racial and ethnic groups who disproportionately bear the burden of cancer. This inquiry is timely in light of growing evidence that these groups are receptive to new media. A systematic literature review was conducted to assess the inclusion of these groups in research on cancer-related new media interventions and use of new media to reduce racial and ethnic cancer disparities. METHODS A systematic search of three databases was conducted for articles published between January 2000 and March 2012 that presented studies of user experience with a behavioral or psychosocial cancer-related intervention with at least one new media component. RESULTS Thirty-six articles were included in the final review. In about one-quarter of the studies, less than 20% of participants were African American, Latino, Asian American, or American Indian. In less than 10% of the studies, 80% or more of the samples were members of the aforementioned groups. Almost one-third of the studies reviewed were categorized as disparity focused but limited data were available on racial and ethnic differences in responses to new media interventions. CONCLUSIONS Findings suggest that the promise and potential of new media cancer interventions are largely unrealized among the underserved. Additional research is needed to investigate a wide range of issues related to the development and delivery of such interventions in diverse racial and ethnic groups.

Clues to the Blues: Predictors of Self-Reported Mental and Emotional Health Among Older African American Men:

The mental health needs of aging African American men have been overlooked and few studies have distinguished between more severe clinically diagnosable mental health challenges and less severe emotional states for this population. African American men may not identify with or internalize the terminology of “depression” despite exhibiting the symptom criteria. This exploratory cross-sectional study examined correlates of “downheartedness” as an alternative indicator of emotional health. The authors examined the self-reported responses of 1,666 older African American men on a baseline questionnaire from a larger longitudinal study. Demographic, physical, mental and emotional health, and health system factors were examined as possible correlates of downheartedness. The mean age of participants was 73.6 years and 74.8% of men described themselves as “downhearted and blue” most or all of the time while only 18.5% of them reported feeling moderate to severe anxiety or depression. When other factors were controlled, mobility problems (odds ratio [OR] = 2.36), problems getting health care (OR = 2.69), having a doctor who never listens (OR = 2.18), physical or mental problems that interfere with social activities (OR = 1.34), accomplishing less due to physical health (OR = 1.35), and accomplishing less due to mental/emotional health (OR = 1.57) were all associated with greater odds of being downhearted. The current findings indicate that this sample more closely identified with language accurately describing their emotional health state (i.e., downhearted) and not with clinical mental health terminology (i.e., depression) that may be culturally stigmatized.

Perceptions and Receptivity of Nonspousal Family Support A Mixed Methods Study of Psychological Distress Among Older, Church-Going African American Men

The purpose of this study was to explore the role of nonspousal family support on mental health among older, church-going African American men. The mixed methods objective was to employ a design that used existing qualitative and quantitative data to explore the interpretive context within which social and cultural experiences occur. Qualitative data (n = 21) were used to build a conceptual model that was tested using quantitative data (n = 401). Confirmatory factor analysis indicated an inverse association between nonspousal family support and distress. The comparative fit index, Tucker–Lewis fit index, and root mean square error of approximation indicated good model fit. This study offers unique methodological approaches to using existing, complementary data sources to understand the health of African American men.

Fatalistic Beliefs About Cancer Prevention Among Older African American Men

Objectives: Evidence suggests that minority groups are more likely to exhibit fatalistic beliefs about cancer prevention (FBCP), which are defined as confusion, pessimism, and helplessness about one’s ability to prevent cancer. This study examines the socioeconomic and psychosocial predictors of FBCP among older African American men (AAM). Methods: AAM (N = 1,666) enrolled in Medicare and participating in a longitudinal study on patient navigation were surveyed. Measures included three FBCP constructs, namely demographic items and physical and mental health variables. Binary logistic regression was performed. Results: The average participant was 73.6 years old; 76.5% felt helpless, 44.2% were confused, and 40.7% were pessimistic about the ability to prevent cancer. As education increased, so did all three FBCP. Being downhearted was predictive of confused and helpless beliefs. Discussion: It is critical for health practitioners to understand how psychosocial and economic challenges influence beliefs that may impede cancer prevention efforts for older AAM.

Factors Associated with Cancer Family History Communication between African American Men and Their Relatives

African American men bear disproportionately high burden from cancer in the U.S. The American Cancer Society reports that for all cancer sites combined, African American men are 32% more likely to die than white men (American Cancer Society, 2011). Having family history of cancer elevates an individuals risk for the disease and should inform decision-making around the use of specific cancer screening tests as well as earlier onset and frequency of cancer screening. Adult African American men who attended an annual hospital-based community health fair in the Midwest which targeted minority men, were approached to complete paper-based survey. Participants were asked “have you ever talked with any of your relatives about your family history of cancer (about any members of your family who have been diagnosed with cancer)?” Predictors were evaluated using bivariate analysis and logistic regression; they included socio-demographic, health access, health behavior, health status, and communication variables. Participants were 558 African American men with mean age of 54 years old. African American men were most likely to have ever discussed their family history of cancer with relative if they had specific knowledge of their family history of cancer and if they had ever talked to physician about their family history of cancer. For African American men with familial predisposition to cancer, further examination of barriers and facilitators to discussion with relatives, specifically those related to health access and knowledge, is warranted.

Social Determinants Associated with Colorectal Cancer Screening in an Urban Community Sample of African-American Men

Background African-American men are disproportionately burdened with colorectal cancer (CRC). Research is scarce on the social determinants that may influence CRC screening as the primary strategy for early detection among African-American males. Methods African-American men over the age of 18 years (n = 558) were recruited from a community health fair and anonymously surveyed about their health and cancer screening behaviors. A social ecological theoretical framework was utilized to identify intrapersonal, interpersonal, organizational, and community predictors of CRC screening, which may be associated with social determinants of health and health behaviors. Analysis included correlations and logistic regression. Results The mean age of participants was 54.3 years with 85.8% of men being over 40 years of age. Regarding CRC screening: 50.5% (n = 282) of African-American male participants had received any type of CRC screening at any time. Positive predictors of CRC screening included: health insurance status, older age, having spoken with a health provider about family cancer risk, and having a regular doctor. However, employment status and poor self-rated health were negative predictors of the outcome. Conclusions Social determinants of health, such as healthcare access and interactions with health systems, along with employment play a critical role in facilitating CRC screening completion in high-risk underserved populations such as African-American men.

Integrating Education on Addressing Health Disparities into the Graduate Social Work Curriculum

The purpose of this article is to propose an elective social work course as a means of better preparing social workers entering practice in healthcare to meet the challenges of promoting health and reducing health disparities in minority and underserved communities. Course offerings specifically targeting health or medical social work training vary widely. The additional training provided at places of employment and through continuing education after the masters degree is often inadequate for competently addressing the issues clinicians face in practice.