Disadvantaged African Americans Research Articles

Unraveling the Multifaceted Narratives of Mixed-Race Identity in Natasha Trethewey's Bellocq’s Ophelia and Thrall

Trethewey's poetry is an intervention into a worldwide debate about defining and socially restricting mixed-race identities; therefore, this research addresses these issues. In Gulfport, Mississippi, Trethewey was raised by relatives whose mixed-race marriage was unlawful. Her poetry has several allusions to both her dad, a writer, academic, and Canadian immigrant, and her mom, a caseworker. Trethewey's poetry intertwines the tale of her personal mixed ancestors with the racial history of America, even while combining this story with lyricism. "I'm capable of getting closer to the inner reality of a poem when the poetry leans towards the poetic," Trethewey remarked in her address. She used a poem entitled "Incident" from her Pulitzer Prize-winning book Native Guard as an instance. Her grandma sponsored a voting registration campaign for disadvantaged African Americans in the 1960s, and the Ku Klux Klan burned a symbol in her family's yard as a result. Trethewey reconstructed an early form of the poem to encapsulate the complete tale of the occurrence in the first four lines. This allowed her to utilize the rest of the poem to emphasize additional psychological realities. Unraveling the Multifaceted Narratives of Mixed-Race Identity in Natasha Trethewey's Bellocq’s Ophelia and Thrall is the ground upon which this study stands.

Heart Rate Variability and Inflammatory Stress Response in Young African American Men: Implications for Cardiovascular Risk.

Background: African American men have a disproportionately higher incidence of and suffer greater severity and earlier death from cardiovascular disease (CVD). A common feature of many diseases, which disproportionately afflict disadvantaged African Americans, is inflammation. In particular, inflammation plays a decisive role in the pathogenesis of CVD in that persistent inflammation contributes to plaque evolution and destabilization. Adverse childhood experiences increase the risk for adult inflammatory based disease, particularly cardiovascular disease. This inflammatory burden becomes evident during stressful events and may be related to alterations in autonomic nervous system (ANS) activity. We previously reported that African American men who experienced childhood adversity exhibited a greater inflammatory (IL-6) response to acute stress challenge (Trier Social Stress Test – TSST). The purpose of this study was to determine whether altered ANS activity, as measured by heart rate variability (HRV), contributes to a greater proinflammatory response to stress in those exposed to childhood adversity.Methods: Thirty-four African American adult males underwent the TSST while instrumented with Holter monitors to record continuous heart rate for HRV determination. HRV was calculated as the low frequency (LF) to high frequency (HF) heart rate ratio (LF/HF), with higher LF/HF ratios corresponding to higher sympathetic vs. parasympathetic activity. Salivary samples were collected pre- and post-TSST to measure the proinflammatory cytokine IL-6. Childhood adversity was assessed by the Childhood Trauma Questionnaire.Results: Hierarchical linear modeling demonstrated that higher levels of physical abuse were related to a steeper rise in LF/HF ratio during the TSST. Further, a higher LF/HF ratio, in combination with greater exposure to emotional and physical abuse was associated with a greater IL-6 response to the TSST.Conclusions: These findings suggest that adverse childhood experiences associate with an adult phenotype characterized by an altered ANS response to stress as well as a greater proinflammatory (IL-6) response to an acute stressor. Elevations in salivary inflammatory markers have been associated with increased CVD risk. In conclusion, these findings suggest a role for the ANS in the underlying neuro-biological processes whereby childhood adversity predisposes to a more intense inflammatory response to stressful challenge during adulthood.

Mediating roles of psychological factors and physical and social environments between socioeconomic status and dietary behaviors among African Americans with overweight or obesity.

The study aim was to examine the relationship between socioeconomic status (SES) and dietary behaviors through psychological and environmental mediators among African Americans with overweight or obesity. We conducted a cross-sectional study in 225 African American men and women. Data were analyzed using structural equation modeling with bootstrapping procedures. In the multiple mediation model, SES had a significant indirect effect on dietary behaviors through psychological and environmental factors (β = -.27; p = .01; 95% confidence interval [CI] = -0.59--0.10), but it had no significant direct effect on dietary behaviors (β = .06; p = .70; 95% CI = -0.21-0.39). SES had significant direct effects on psychological (β = .52;p = .01; 95% CI = 0.31-0.77) and environmental factors (β = -.40; p = .03; 95% CI = -0.53--0.25). Psychological (β = -.31; p = .02; 95% CI = -0.68--0.04) and environmental factors (β = .26; p = .01; 95% CI = 0.04-0.47) also showed significant direct effects on dietary behaviors. Thus, psychological and environmental factors mediated the relationship between SES and dietary behaviors in African Americans with overweight or obesity. Interventions that enhance psychological and environmental factors such as self-efficacy, perceived barriers to healthy eating, health perceptions, and physical and social environments may improve dietary behaviors among socioeconomically disadvantaged African Americans.

The Dynastic Benefits of Early Childhood Education

This paper monetizes the life-cycle intragenerational and intergenerational benefits of the Perry Preschool Project, a pioneering high-quality early childhood education program implemented before Head Start that targeted disadvantaged African-Americans and was evaluated by a randomized trial. It has the longest follow-up of any experimentally evaluated early childhood education program. We follow participants into late midlife as well as their children into adulthood. Impacts on the original participants and their children generate substantial benefits. Access to life-cycle data enables us to evaluate the accuracy of widely used schemes to forecast life-cycle benefits from early-life test scores, which we find wanting.

The Dynastic Benefits of Early Childhood Education

This paper monetizes the life-cycle intragenerational and intergenerational benefits of the Perry Preschool Project, a pioneering high-quality early childhood education program implemented before Head Start that targeted disadvantaged African-Americans and was evaluated by a randomized trial. It has the longest follow-up of any experimentally evaluated early childhood education program. We follow participants into late midlife as well as their children into adulthood. Impacts on the original participants and their children generate substantial benefits. Access to life-cycle data enables us to evaluate the accuracy of widely used schemes to forecast life-cycle benefits from early-life test scores, which we find wanting.

Medication Complexity among Disadvantaged African American Seniors in Los Angeles.

Background. Several publications highlight data concerning multiple chronic conditions and the medication regimen complexity (MRC) used in managing these conditions as well as MRCs’ association with polypharmacy and medication non-adherence. However, there is a paucity of literature that specifically details the correlates of MRC with multimorbidity, socioeconomic, physical and mental health factors in disadvantaged (medically underserved, low income) African American (AA) seniors. Aims. In a local sample in South Los Angeles, we investigated correlates of MRC in African American older adults with chronic disease(s). Methods. This was a community-based survey in South Los Angeles with 709 African American senior participants (55 years and older). Age, gender, continuity of care, educational attainment, multimorbidity, financial constraints, marital status, and MRC (outcome) were measured. Data were analyzed using linear regression. Results. Higher MRC correlated with female gender, a higher number of healthcare providers, hospitalization events and multimorbidity. However, there were no associations between MRC and age, level of education, financial constraint, living arrangements or health maintenance organization (HMO) membership. Conclusions. Disadvantaged African Americans, particularly female older adults with multimorbidity, who also have multiple healthcare providers and medications, use the most complex medication regimens. It is imperative that MRC is reduced particularly in African American older adults with multimorbidity.

Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial.

Effective hypertension self-management interventions are needed for socially disadvantaged African Americans, who have poorer blood pressure (BP) control compared to others. We studied the incremental effectiveness of contextually adapted hypertension self-management interventions among socially disadvantaged African Americans. Randomized comparative effectiveness trial. One hundred fifty-nine African Americans at an urban primary care clinic. Participants were randomly assigned to receive (1) a community health worker ("CHW") intervention, including the provision of a home BP monitor; (2) the CHW plus additional training in shared decision-making skills ("DoMyPART"); or (3) the CHW plus additional training in self-management problem-solving ("Problem Solving"). We assessed group differences in BP control (systolic BP (SBP) < 140 mm Hg and diastolic BP (DBP) < 90 mmHg), over 12 months using generalized linear mixed models. We also assessed changes in SBP and DBP and participants' BP self-monitoring frequency, clinic visit patient-centeredness (i.e., extent of patient-physician discussions focused on patient emotional and psychosocial concerns), hypertension self-management behaviors, and self-efficacy. BP control improved in all groups from baseline (36%) to 12 months (52%) with significant declines in SBP (estimated mean [95% CI] - 9.1 [- 15.1, - 3.1], - 7.4 [- 13.4, - 1.4], and - 11.3 [- 17.2, - 5.3] mmHg) and DBP (- 4.8 [- 8.3, - 1.3], - 4.0 [- 7.5, - 0.5], and - 5.4 [- 8.8, - 1.9] mmHg) for CHW, DoMyPART, and Problem Solving, respectively). There were no group differences in BP outcomes, BP self-monitor use, or clinic visit patient-centeredness. The Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 18.7 [4.0, 87.3]) and self-efficacy scores (OR [95% CI] 4.7 [1.5, 14.9]) at 12 months compared to baseline, while other groups did not. Compared to DoMyPART, the Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 5.7 [1.3, 25.5]) at 12 months. A context-adapted CHW intervention was correlated with improvements in BP control among socially disadvantaged African Americans. However, it is not clear whether improvements were the result of this intervention. Neither the addition of shared decision-making nor problem-solving self-management training to the CHW intervention further improved BP control. ClinicalTrials.gov Identifier: NCT01902719.

College completion predicts lower depression but higher metabolic syndrome among disadvantaged minorities in young adulthood

Individuals with higher educational attainment live healthier and longer lives. However, not everyone benefits equally from higher education. In particular, the black-white gap in life expectancy is greater at higher levels of educational attainment. Furthermore, recent research suggests that disadvantaged African Americans in the rural Southeast who attend college have worse physical health than their similarly disadvantaged peers who do not attend college. The extent to which this pattern generalizes to a nationally representative, mixed-race sample is unknown. Using data from the National Longitudinal Study of Adolescent to Adult Health, we test whether the health benefits associated with college completion vary by level of childhood disadvantage for depression and metabolic syndrome in young adulthood, across race/ethnicity. We find uniform lower depression associated with college completion regardless of childhood disadvantage, and across non-Hispanic white, non-Hispanic black, and Hispanic young adults. College completion is associated with lower metabolic syndrome for whites across all levels of childhood disadvantage. In contrast, college completion is associated with higher metabolic syndrome among black and Hispanic young adults from disadvantaged childhood environments. Our findings suggest that, for minorities from disadvantaged backgrounds, finishing college pays substantial dividends for mental health but simultaneously exacts costs with regard to physical health. This pattern contrasts starkly with whites and minorities from more privileged backgrounds, for whom college completion is associated with benefits to both mental and physical health. These results suggest that racial disparities in health may persist in part because the health of upwardly mobile minorities is compromised in young adulthood.

Sleep continuity, architecture and quality among treatment-seeking cannabis users: An in-home, unattended polysomnographic study.

The objective of the study was to describe self-report and objectively measured sleep characteristics of adult treatment-seeking cannabis users. Study participants (n = 87) were adults who were screened for a 12-week outpatient cannabis treatment research program in Baltimore, MD. Participants completed objective and self-report measures of sleep quality. Data were analyzed for the sample overall and after stratifying by sex (54 men, 33 women). Participants were primarily urban, socioeconomically disadvantaged African Americans. Participants were frequent, heavy cannabis users; among a subset of participants assessed, 76.7% used cannabis on the day/night of the assessment. Participants had low rates of other substance abuse and of psychiatric comorbidities. Polysomnography indicated 19.5% of participants received the recommended 7 to 9 hr of sleep, with women averaging more sleep than men. One third (31.0%) had sleep latencies >30 min, one half spent >30 min awake after sleep onset, and more than one half of the sample (55.2%) had sleep efficiency scores of <85%. Most participants met criteria for subthreshold (36.8%) or clinical insomnia (25.3%) on the Insomnia Severity Index, 77.0% had scores of >5 on the Pittsburgh Sleep Quality Index. Most had average scores on the Dysfunctional Beliefs and Attitudes About Sleep (DBAS) questionnaire (M = 51.1, SD = 18.8) that were higher than average among clinical insomnia patients. Women had higher DBAS scores than men. Most participants exhibited characteristics of disordered sleep, and sex differences were observed on polysomnography and self-report measures. Findings extend prior research concerning the association between cannabis use and disordered sleep. Data presented in this article come from Clinical Trial NCT01685073. (PsycINFO Database Record

The impact of sexuality concerns on teenage pregnancy: a consequence of heteronormativity?

In countries such as the USA, a substantial percentage of teenage pregnancies are intentional, and desire for pregnancy increases risk. Black US Americans have been found to be less accepting of homosexuality than their non-Black peers, which may result in minority ethnic teenagers demonstrating heterosexual orientation through attempting pregnancy. Young, socioeconomically disadvantaged African Americans were surveyed longitudinally regarding attitudes about their sexuality, pregnancy intentions and other psychosocial factors. Young people who reported being somewhat concerned about their sexual orientation were nearly four times more likely to report attempting pregnancy compared to those who were not at all concerned. This relationship held true while accounting for the significant effect of religion, sense of community, hopelessness and numerous demographic factors. The current study suggests that uncertainty regarding sexual orientation, potentially due to social stigma, may impact pregnancy attempts among young Black people from disadvantaged communities.

Early life conditions of overall and cause-specific mortality among inner-city African Americans.

We examined how early life conditions influence midlife overall and cause-specific mortality in a community cohort of disadvantaged African Americans. Using a prospective design, we assessed first-grade children and their teachers and families when children were 6 years old, with follow-up at ages 16, 32, and 42 years. We obtained information on death from family members, neighbors, and the National Death Index (NDI). We conducted a survival analysis and competing risk analysis to examine early life predictors of mortality. Of 1242 participants, 87 (7%) had died by 2004. In multivariate Cox proportional hazards regression, males who lived in foster care and females with lower math grades in first grade were more likely to die by age 42 years. In multivariate competing risks analysis, hospitalization by the time of first grade was related to mortality from acute and chronic illness. Male gender, being in foster care, and aggressive behavior in first grade were related to mortality from drug use, violence, or suicide. Early classroom, environmental, and family-level interventions are potentially beneficial in reducing later overall and cause-specific mortality.

Maternal familism predicts birthweight and asthma symptoms three years later

There are marked ethnic and socioeconomic differences in birthweight and childhood asthma, conditions which may be linked causally or via a third variable. Cultural resources are often credited with diminished health disparities in infancy and childhood among subsets of poor and minority populations; yet direct empirical tests of this hypothesis are needed. In this study, ethnicity, lifespan family socioeconomic position (FSEP), and the cultural resource of familism were compared as predictors of birthweight and expression of asthma symptoms (AE) by age three. Familism and lifespan FSEP were assessed in 4633 socioeconomically disadvantaged African Americans, White Americans, and Latinas upon giving birth, as was offspring birthweight. AE was assessed in offspring through age three. Asthma diagnosis by age three was likelier in very low (≤1500 g) and low (≤2500 g) birthweight infants compared to infants born at average (2501–3999 g) or larger (≥4000 g) birthweights. Asthma risk associated with lower birthweight was higher for Latinos (17–35%) and African Americans (19–23%) than for White Americans (13–14%). As predicted, maternal familism was higher among White Americans than among African Americans and Latinas, an effect that was largely driven by ethnic disparities in lifespan FSEP. Familism predicted continuous birthweight (p = .003) and AE (p = .001) by age three independently of ethnicity and lifespan FSEP accounting for appropriate control variables, including maternal biomedical risk, maternal acculturation, parental marital status, and infant sex. There was a 71-g gain in birthweight for every one-unit increase in familism. The protective effect of familism on AE by age three was strongest for participants of lower lifespan FSEP. Maternal familism is one cultural resource that may reduce reproductive and intergenerational health disparities in both U.S.- and foreign-born Americans. Consistent with our previous work, familism and other nonmaterial resources covary with material resources. Nevertheless, culture is distinguishable from lifespan FSEP and ethnicity, and has health implications beyond associations to ethnicity, lifespan FSEP, and related biomedical and sociodemographic factors.

Use of ethnogenetic layering to identify and quantify geographically localized sources of chronic stress and their impact on health among African Americans

Economically and socially disadvantaged African Americans have faced a number of important sources of chronic physiological and psychological stressors that have contributed to an increased vulnerability to poor health. Although there appears to be a direct relationship between economic and social disadvantage and health disparities, the sources and precise impact of such stressors often remain inadequately quantified. The strain of discrimination is associated with unequal exposures to stress and unequal access to ameliorative interventions throughout the lifespan, across geographical space, and over multiple generations. Applying the allostatic stress process model to GIS‐facilitated ethnogenetic layering, we present data that suggests that stress and its sequelae can be predicted, identified, and quantified for the purposes of addressing health disparities. Protracted adversity responses are correlated with increased vulnerabilities to infection, injury, and disease and increases in the associated selective coefficients for exposed groups. We report on the development of computer‐assisted models that quantify the intensity and duration of particular stressors and detail their roles in health disparities.

Health Services Determinants of the Duration of Untreated Psychosis Among African-American First-Episode Patients

The duration of untreated psychosis is associated with poor outcomes in multiple domains in the early course of nonaffective psychotic disorders, although relatively little is known about determinants of this critical period, particularly health services-level determinants. This study examined three hypothesized predictors of duration of untreated psychosis (lack of insurance, financial problems, and broader barriers) among urban, socioeconomically disadvantaged African Americans, while controlling for the effects of three patient-level predictors (mode of onset of psychosis, living with family versus alone or with others before hospitalization, and living above versus below the federally defined poverty level). Analyses included data from 42 patient-family member dyads from a larger sample of 109 patients with a first episode of nonaffective psychosis. The duration of untreated psychosis and all other variables were measured in a rigorous, standardized fashion in a study designed specifically to examine determinants of treatment delay. Survival analyses and Cox regression assessed the effects of the independent predictors on time from onset of psychosis to hospital admission for initial evaluation and treatment. The median duration of untreated psychosis was 24.5 weeks. When the analyses controlled for the three patient-level covariates, patients without health insurance, with financial problems, or with barriers to seeking help had a significantly longer duration of untreated psychosis. Health services-related factors, such as lack of insurance, are predictive of longer treatment delay. Efforts to eliminate uninsurance and underinsurance, as well as minimize barriers to treatment, would be beneficial for improving the prognosis of young patients with emerging nonaffective psychotic disorders.

Relationship between caregiver’s and child’s caries prevalence among disadvantaged African Americans

To assess the relationship between African-American caregivers' and children's caries levels adjusting for sociodemographic factors. A representative sample of 1021 children (0-5 years) and their caregivers were recruited using a stratified two-stage area probability sample of households in Detroit. The response rate was 73.7%. Caries was measured using the International Caries Detection and Assessment System. Caries was defined as D1S/d1s (noncavitated) or D2S/d2s (cavitated lesions) for both caregivers and children. Sociodemographic data included caregivers' employment status, sex, age, income and education. Negative binomial regression techniques were used for the multivariable analyses because of the highly skewed distribution of caries among the children. 48% of the children were male, 39% had employed caregivers, 46% had caregivers with less than a high school education and 44% had family incomes less than $10,000. A total of 47% of the children had at least one noncavitated lesion and 31% had a cavitated lesion. Younger children (ages 0-3 years) had lower caries rates with 24% having one or more noncavitated lesion,18% having a cavitated lesion and 31% with any lesion compared with 78%, 51% and 81%, respectively, among the 4- to 5-year olds. Because of these differences in prevalence in the age groups, subsequent analyses were conducted separately for the two age groups. Multivariable analyses found that the number of cavitated surfaces among the caregivers was significantly related to the number of cavitated and noncavitated lesions among their children for both age groups. The prevalence of children's caries increased with increasing caregivers' caries score when demographic characteristics of caregivers were controlled. Younger children with family incomes of less than $10,000 had a significantly increased risk of higher caries prevalence compared with children in families with incomes greater than or equal to $20,000. Caregivers' caries levels were modestly correlated with children's caries. However, higher caries prevalence among caregivers significantly increased the risk of caries prevalence among their children. Thus, efforts aimed at improving caregiver's oral health could result in reducing caries risk among their children, regardless of whether the mechanism was biologically or behaviorally based. Efforts also should be aimed directly at reducing caries risk among children by increasing fluoride exposure among children and improving access to preventive dental care. Finally, even the poorest of the poor experienced additional health disadvantages associated with income suggesting even small increases in family income raising families could have a significant effect on reducing caries risk among young children.

The Paradoxes of Desegregation: Race, Class, and Education, 1935-1975

This article uses the African-American campaign for equality and access to explore the historical origins of high-stakes testing. Although decades of NAACP litigation eliminated legalized discrimination, many of the policies and practices that govern education today have their origins in responses to the NAACP's campaign against segregated education. In the years after 1945, educational authorities adopted new teacher licensure requirements; began requiring that applicants to colleges, universities, and the professions submit standardized test scores; and broadened the use of testing and tracking in elementary and secondary schools. As new, more rational restrictions replaced those once required by law, the legacies of caste--and the class divisions that developed within the black caste--shaped educational opportunities and outcomes. Although advantaged African Americans, heirs of a historic black elite, gained access to the most prestigious institutions and the most valuable programs within them, most blacks were limited by the legacies of discrimination and remained isolated in institutions, programs, and classes that became segregated by class as well as race. During the 1970s and 1980s, educational authorities built upon the foundation constructed in the 1940s and 1950s, expanding teacher, university admissions, and minimum competency testing. Instead of promoting equality, as proponents of tests argued, greater reliance on standardized exams widened the distance between advantaged and disadvantaged African Americans, shaping paradoxical patterns of inclusion and isolation.

Potential for community-based screening, treatment, and antibiotic prophylaxis for syphilis prevention.

The recent syphilis epidemic in Louisiana occurred predominantly among disadvantaged African Americans who may distrust public health agencies and prevention efforts. To determine community perceptions regarding trust and use of public health clinics, to assess whether race of provider is important to persons at risk for syphilis, and to assess the willingness of persons to participate in syphilis screening, treatment, and antibiotic prophylaxis. Qualitative interviews were conducted with 18 community leaders and 38 community members who were at risk for syphilis. Quantitative surveys were completed by persons with primary or secondary syphilis (n = 92), their sexual contacts (n = 56), and with neighborhood controls (n = 143). Three possible programs for syphilis screening and antibiotic prophylaxis were proposed (1) bar setting; (2) home setting, and (3) mobile health-van setting in high-risk communities. In qualitative interviews, community leaders and community members reported a high degree of trust in the public sexually transmitted disease clinic. A majority of respondents felt that race was not a factor in choosing healthcare providers. Respondents favored the provision of services in a mobile health van over in a bar or in their homes. In quantitative interviews, more than 80% of community members surveyed reported that they would go to a mobile health van for syphilis testing. Nearly two thirds of respondents reported that they would be willing to take oral prophylaxis for syphilis, and more than half of respondents reported that they would accept an injection. Community members trust the public sexually transmitted disease (STD) clinic, are generally not concerned with the race of healthcare providers, and are supportive of community-based STD screening, treatment, and antibiotic prophylaxis provided from a mobile clinic.

Black America: from community health care to crisis medicine.

This study traces the major policy shifts in medical care that have affected disadvantaged African-Americans and the response of this community's medical leadership to these changes. Since World War II policy has passed through three major phases. The first--engagement--ran from the mid-1960s through the mid-1970s. During this phase a community health policy orientation prevailed as national government targeted resources to health care programs for needy blacks and other poor Americans. From the late 1970s to the mid-1980s the period of submersion occurred: black community health professionals and political leaders experienced a new-found inclusion in health policy debate, but, at the same time, broader policy-making circles in government and health care reduced medical resources for the inner-city poor. Finally, in the third phase--crisis recognition--a network developed of community health advocates who seek to reorient the health system so that it addresses needs within urban American's "New Ghettos."