Wizdom Powell Hammond

‘‘It’s The Skin You’re In’’: African-American Women Talk About Their Experiences of Racism. An Exploratory Study to Develop Measures of Racism for Birth Outcome Studies

Objectives Stress due to experiences of racism could contribute to African-American women’s adverse birth outcomes, but systematic efforts to measure relevant experiences among childbearing women have been limited. We explored the racism experiences of childbearing African-American women to inform subsequent development of improved measures for birth outcomes research. Methods Six focus groups were conducted with a total of 40 socioeconomically diverse African-American women of childbearing age in four northern California cities. Results Women reported experiencing racism (1) throughout the lifecourse, with childhood experiences seeming particularly salient and to have especially enduring effects (2) directly and vicariously, particularly in relation to their children; (3) in interpersonal, institutional, and internalized forms; (4) across different life domains; (5) with active and passive responses; and (6) with pervasive vigilance, anticipating threats to themselves and their children. Conclusions This exploratory study’s findings support the need for measures reflecting the complexity of childbearing African-American women’s racism experiences. In addition to discrete, interpersonal experiences across multiple domains and active/passive responses, which have been measured, birth outcomes research should also measure women’s childhood experiences and their potentially enduring impact, perceptions of institutionalized racism and internalized negative stereotypes, vicarious experiences related to their children, vigilance in anticipating future racism events, as well as the pervasiveness and chronicity of racism exposure, all of which could be sources of ongoing stress with potentially serious implications for birth outcomes. Measures of racism addressing these issues should be developed and formally tested.

Masculinity, Medical Mistrust, and Preventive Health Services Delays Among Community-Dwelling African-American Men

The contribution of masculinity to men’s healthcare use has gained increased public health interest; however, few studies have examined this association among African-American men, who delay healthcare more often, define masculinity differently, and report higher levels of medical mistrust than non-Hispanic White men. To examine associations between traditional masculinity norms, medical mistrust, and preventive health services delays. A cross-sectional analysis using data from 610 African-American men age 20 and older recruited primarily from barbershops in the North, South, Midwest, and West regions of the U.S. (2003-2009). Independent variables were endorsement of traditional masculinity norms around self-reliance, salience of traditional masculinity norms, and medical mistrust. Dependent variables were self-reported delays in three preventive health services: routine check-ups, blood pressure screenings, and cholesterol screenings. We controlled for socio-demography, healthcare access, and health status. After final adjustment, men with a greater endorsement of traditional masculinity norms around self-reliance (OR: 0.77; 95% CI: 0.60–0.98) were significantly less likely to delay blood pressure screening. This relationship became non-significant when a longer BP screening delay interval was used. Higher levels of traditional masculinity identity salience were associated with a decreased likelihood of delaying cholesterol screening (OR: 0.62; 95% CI: 0.45–0.86). African-American men with higher medical mistrust were significantly more likely to delay routine check-ups (OR: 2.64; 95% CI: 1.34–5.20), blood pressure (OR: 3.03; 95% CI: 1.45–6.32), and cholesterol screenings (OR: 2.09; 95% CI: 1.03–4.23). Contrary to previous research, higher traditional masculinity is associated with decreased delays in African-American men’s blood pressure and cholesterol screening. Routine check-up delays are more attributable to medical mistrust. Building on African-American men’s potential to frame preventive services utilization as a demonstration, as opposed to, denial of masculinity and implementing policies to reduce biases in healthcare delivery that increase mistrust, may be viable strategies to eliminate disparities in African-American male healthcare utilization.BACKGROUNDThe contribution of masculinity to men’s healthcare use has gained increased public health interest; however, few studies have examined this association among African-American men, who delay healthcare more often, define masculinity differently, and report higher levels of medical mistrust than non-Hispanic White men.OBJECTIVETo examine associations between traditional masculinity norms, medical mistrust, and preventive health services delays.DESIGN AND PARTICIPANTSA cross-sectional analysis using data from 610 African-American men age 20 and older recruited primarily from barbershops in the North, South, Midwest, and West regions of the U.S. (2003-2009).MEASUREMENTSIndependent variables were endorsement of traditional masculinity norms around self-reliance, salience of traditional masculinity norms, and medical mistrust. Dependent variables were self-reported delays in three preventive health services: routine check-ups, blood pressure screenings, and cholesterol screenings. We controlled for socio-demography, healthcare access, and health status.RESULTSAfter final adjustment, men with a greater endorsement of traditional masculinity norms around self-reliance (OR: 0.77; 95% CI: 0.60–0.98) were significantly less likely to delay blood pressure screening. This relationship became non-significant when a longer BP screening delay interval was used. Higher levels of traditional masculinity identity salience were associated with a decreased likelihood of delaying cholesterol screening (OR: 0.62; 95% CI: 0.45–0.86). African-American men with higher medical mistrust were significantly more likely to delay routine check-ups (OR: 2.64; 95% CI: 1.34–5.20), blood pressure (OR: 3.03; 95% CI: 1.45–6.32), and cholesterol screenings (OR: 2.09; 95% CI: 1.03–4.23).CONCLUSIONSContrary to previous research, higher traditional masculinity is associated with decreased delays in African-American men’s blood pressure and cholesterol screening. Routine check-up delays are more attributable to medical mistrust. Building on African-American men’s potential to frame preventive services utilization as a demonstration, as opposed to, denial of masculinity and implementing policies to reduce biases in healthcare delivery that increase mistrust, may be viable strategies to eliminate disparities in African-American male healthcare utilization.

Psychosocial Factors Associated With Routine Health Examination Scheduling and Receipt Among African American Men

INTRODUCTION African American men often fail to obtain routine health examinations, which increases the probability of disease detection, yet little is known about psychosocial factors that motivate scheduling and receipt among this group. METHODS We used the Andersen model and theory of reasoned action as frameworks to evaluate the relative contribution of psychosocial factors to self-reported routine health examination scheduling and receipt in a cross-sectional sample of African American men (N = 386) recruited from barbershops (65.3%) and academic institutions/events (34.7%) in Michigan, Georgia, and North Carolina between 2003-2004 and 2007-2009. Participants completed measures assessing demographic factors, physical/mental health status, traditional male role norms, health-promoting male subjective norms, health value, and medical mistrust. Pearsons chi(2), analysis of variance, and multivariate logistic regression analyses were used to investigate associations between these study factors and routine health examination scheduling and receipt in the past year. RESULTS After final adjustment, the odds of scheduling a routine health examination were increased for men with a usual source of care (OR, 5.48; 95% CI, 3.06-9.78) and more health-promoting male subjective norms exposure (OR, 1.46; 95% CI, 1.02-2.04). Higher medical mistrust (OR, 0.26;; 95% CI, 0.09-0.76) and traditional male role norms (OR, 0.71; 95% CI, 0.52-0.98) reduced the odds of routine health examination receipt. The odds of routine health examination receipt were increased among men who were older (OR=1.05; 95% CI, 1.01-1.10), had a usual source of care (OR, 2.91; 95% CI, 1.54-5.51) and reported more male subjective norms exposure (OR, 1.51; 95% CI, 1.02-2.22). CONCLUSIONS Improving African American mens uptake of routine health examinations will require addressing medical mistrust, mitigating traditional masculine concerns about disclosing vulnerability, and leveraging male social networks.

The Moderating Capacity of Racial Identity Between Perceived Discrimination and Psychological Well-Being Over Time Among African American Youth

This study examined the influence of racial identity in the longitudinal relation between perceptions of racial discrimination and psychological well-being for approximately 560 African American youth. Latent curve modeling (LCM) and parallel process multiple-indicator LCMs with latent moderators were used to assess whether perceptions of racial discrimination predicted the intercept (initial levels) and the slope (rate of change) of psychological well-being over time, and whether racial identity moderates these relations. The results indicated that African American adolescents who reported higher psychological responses to discrimination frequency levels at the first time point had lower initial levels of well-being. Regressing the slope factor for psychological well-being on the frequency of discrimination also revealed a nonsignificant result for subsequent well-being levels.

Racial discrimination and depressive symptoms among African-American men: The mediating and moderating roles of masculine self-reliance and John Henryism

Despite well-documented associations between everyday racial discrimination and depression, mechanisms underlying this association among African-American men are poorly understood. Guided by the Transactional Model of Stress and Coping, we frame masculine self-reliance and John Henryism as appraisal mechanisms that influence the relationship between racial discrimination, a source of significant psychosocial stress, and depressive symptoms among African-American men. We also investigate whether the proposed relationships vary by reported discrimination-specific coping responses. Participants were 478 African-American men recruited primarily from barbershops in the West and South regions of the United States. Multiple linear regression and Sobel-Goodman mediation analyses were used to examine direct and mediated associations between our study variables. Racial discrimination and masculine self-reliance were positively associated with depressive symptoms, though the latter only among active responders. John Henryism was negatively associated with depressive symptoms, mediated the masculine self-reliance-depressive symptom relationship, and among active responders moderated the racial discrimination-depressive symptoms relationship. Though structural interventions are essential, clinical interventions designed to mitigate the mental health consequences of racial discrimination among African-American men should leverage masculine self-reliance and active coping mechanisms.

Social isolation, vital exhaustion, and incident heart failure: Findings from the Atherosclerosis Risk in Communities Study

Prospective studies have shown that social isolation (i.e. lack of social contacts) predicts incident coronary heart disease (CHD), but it is unclear whether it predicts incident heart failure (HF) and what factors might mediate this association. HF patients may be more susceptible to social isolation as they tend to be older and may have disrupted social relationships due to life course factors (e.g. retirement or bereavement). We prospectively examined whether individuals with higher vs. low social isolation have a higher incidence of HF and determined whether this association is mediated by vital exhaustion.

Disease prevalence and use of health care among a national sample of black and white male state prisoners

U.S. prisons have a court-affirmed mandate to provide health care to prisoners. Given this mandate, we sought to determine whether use of prison health care was equitable across race using a nationally-representative sample of Black and White male state prisoners. We first examined the prevalence of health conditions by race. Then, across all health conditions and for each of 15 conditions, we compared the proportion of Black and White male prisoners with the condition who received health care. For most conditions including cancer, heart disease, and liver-related disorders, the age-adjusted prevalence of disease among Blacks was lower than among Whites (p<.05). Blacks were also modestly more likely than Whites to use health care for existing conditions (p<.05), particularly hypertension, cerebral vascular accident/brain injury, cirrhosis, flu-like illness, and injury. The observed racial disparities in health and health care use are different from those among non-incarcerated populations.

Determinants of usual source of care disparities among African American and caribbean black men: Findings from the national survey of american life

Purpose. The Aday-Andersen model was used as a framework for investigating the contribution of immigration status (i.e., nativity and acculturation), socioeconomic factors, health care access, health status, and health insurance to usual source of health care (USOC) in a nationally representative sample of African American (n = 551) and Caribbean Black men (n = 1,217).Methods. We used the 2001–2003 National Survey of American Life, a nationally representative household survey of non-institutionalized U.S. Blacks to conduct descriptive and logistic regression analyses.Results. Older age, more health conditions, neighborhood medical clinic access, and health insurance were associated with higher odds of reporting a USOC. Odds were lower for men with lower-middle incomes and poorer mental health status. Having health insurance was associated with higher odds of reporting a USOC for African American men but lower odds among Caribbean Black men. Odds were higher in the presence of more health conditions for African American men than for Caribbean Black men.Conclusions. Health care reform policies aimed solely at increasing health insurance may not uniformly eliminate USOC disparities disfavoring U.S. and foreign-born non-Hispanic Black men.

From homeless to hopeless and healthless?: the health impacts of housing challenges among former foster care youth transitioning to adulthood in California.

A childhood history of placement in the foster care system makes the emerging adult period more complicated and problematic in a variety of ways including meeting basic needs, such as housing and health. We conducted focus groups with 31 former foster youth in San Francisco and Oakland, California to explore their housing and health care circumstances since “aging out” of the foster care system. Five key themes were identified: 1) housing circumstances have direct and indirect impacts on access to health care; 2) housing instability can impede the flow of information between social services staff and youth; 3) housing circumstances and health care differed for men and women; 4) service agency rules and structures may be developmentally mismatched with participant needs; and 5) emerging adults experience repercussions of institutional life including the suspicion of authority and mistrust of medical providers.

Antihypertensive medication nonadherence in black men: Direct and mediating effects of depressive symptoms, psychosocial stressors, and substance use

Black men suffer disproportionately from hypertension. Antihypertensive medication nonadherence is a major contributor to poor blood pressure control, yet few studies consider how psychosocial functioning may impact black men’s medication adherence. The authors examined the direct and mediating pathways between depressive symptoms, psychosocial stressors, and substance use on antihypertensive medication nonadherence in 196 black men enrolled in a clinical trial to improve hypertension care and control. The authors found that greater depressive symptoms were associated with more medication nonadherence (β=0.05; standard error [SE], 0.01; P<.001). None of the psychosocial stressor variables were associated with antihypertensive medication nonadherence. Alcohol misuse was associated with increased medication nonadherence (β=0.81; SE, 0.26; P<.01), but it did not mediate the association between depressive symptoms and medication nonadherence. Clinicians should consider screening for depressive symptoms and alcohol misuse if patients are found to be nonadherent and should treat or refer patients to appropriate resources to address those issues.