African American Health Research Articles

For Crying Out Loud: Racial Battle Fatigue and Black America: Implications for the Counseling Professions

ABSTRACT Trauma is a far too common familiarity in the lived experiences of Black Americans that can be traced back to the historical and contemporary vestiges of white supremacy and racism in the United States. However, little is known about how persistent trauma from racialized events (e.g. microaggressions, discrimination, anti-Black violence) erodes the mental and physical health of Black Americans, contributing to distress and cumulative exhaustion. In this paper, the authors discuss Racial Battle Fatigue in relation to the experiences of Black Americans as a result of living in a racialized society. Using two case examples, the authors examine and explain how Racial Battle Fatigue takes a toll on Black people, and conclude with implications for counseling professionals.

Understanding racial disparities in health care expenditures for cervical cancer.

Cervical cancer demonstrates a notable efficacy in treatment, evidenced by a 92% 5-year survival rate among cases diagnosed at a localized stage. In 2020, the estimated annual national expenditure for cervical cancer care amounted to $2.3 billion in the United States. Limited real-world data are available for racial disparities in health care expenditures for cervical cancer. To evaluate racial disparities associated with annual health care expenditures among patients diagnosed with cervical cancer in the United States. A retrospective observational cohort study of annual health care expenditures in patients with cervical cancer diagnosed during 2014-2019 was performed using the Medical Expenditure Panel Survey data. In addition to the descriptive weighted analysis, an unadjusted analysis of the annual health care expenditure was conducted. An adjusted linear regression model with log transformation of the outcome variable was used to evaluate the total annual health care expenditure as well as expenditures by category across the racial groups. Overall, 826 patients with cervical cancer were identified from the Medical Expenditure Panel Survey during 2014-2019. The majority were classified as White patients (81.2%) and in the age group of 45-64 years (44.65%). On average, the total annual health care expenditure was $11,537 (95% CI = $9,887-$13,186) among the White cohort, $10,659 (95% CI = $6,704-$14,614) among the African American cohort, and $8,726 (95% CI = $6,113-$11,340) among the Hispanic cohort. After adjusting for covariates, the average total annual health care expenditure for the Hispanic cohort was 35% of the total health care expenditure of the White cohort (P < 0.001) and 46% of the African American cohort's health care expenditure (P = 0.02). Specifically, adjusted costs of office-based and outpatient visits for the Hispanic cohort were 47% (P = 0.009) and 57% (P = 0.005) lower than for the White cohort, respectively. The total annual home health care expenditure for the African American cohort was 49% lower than White patients (P = 0.03), and the Hispanic cohort's total expenditure, excluding prescription medicines, was 57% lower than African American patients (P = 0.02). This study provides valuable information regarding the health care disparities that need to be addressed among certain minority races. Reducing the disparities in health care spending across racial groups should be included as a crucial element in tackling well-established health care inequities.

Implementation and evaluation of a community-based mindful walking randomized controlled trial to sustain cognitive health in older African Americans at risk for dementia

BackgroundWith an increasing proportion of older adults and the associated risk of Alzheimer’s Disease and Related Dementias (ADRD) around the globe, there is an urgent need to engage in ADRD risk reduction efforts. African American (AA) older adults in the U.S. are disproportionally impacted by ADRD compared to other races and ethnicities. Mindful walking integrates two potentially protective factors of ADRD by elevating mindfulness and physical activity (i.e., walking), resulting in a synergistic behavioral strategy that is feasible and safe for older adults. However, the efficacy of applying this intervention for cognitive health outcomes has not been evaluated using experimental designs.MethodsThis paper documents the goal and protocol of a community-based, mindful walking randomized controlled trial to examine the short- and longer-term efficacy on cognitive and other health-related outcomes in ADRD at-risk AA older adults. The study outcomes include various brain health determinants, including cognitive function, quality of life, psychological well-being, physical activity, mindfulness, sleep, and overall health status. In addition, the estimated costs of program implementation are also collected throughout the study period. This study will recruit 114 older adults (ages 60+ years) with elevated ADRD risk from the Midlands region of South Carolina. Older adults are randomly assigned to participate in 24 sessions of outdoor mindful walking over three months or a delayed mindful walking group (n=57 in each group). Participants in both groups follow identical measurement protocols at baseline, after 12 weeks, after 18 weeks, and after 24 weeks from baseline. The outcome measures are administered in the lab and in everyday settings. Costs per participant are calculated using micro-costing methods. The eliciting participant costs for mindful walking engagement with expected results are reported using the payer and the societal perspectives.DiscussionThis study will generate evidence regarding the efficacy of mindful walking on sustaining cognitive health in vulnerable older adults. The results can inform future large-scale effectiveness trials to support our study findings. If successful, this mindful walking program can be scaled up as a low-cost and viable lifestyle strategy to promote healthy cognitive aging in diverse older adult populations, including those at greatest risk.Trial registrationClinicalTrials.gov number NCT06085196 (retrospectively registered on 10/08/2023).

The effects of online and institutional racism on the mental health of African Americans.

Although a wealth of literature has documented the adverse physical and mental health effects associated with exposure to racism, little scholarly attention has focused on the specific impact of online racism. Online experiences of racism have increased significantly over the years, and the intersection of online and "offline" racism makes it difficult for African Americans to find respite from overall experiences of racial discrimination in their daily lives. To address this gap in the literature, the present study was designed to examine the possible compounded effect of online and institutional racism by investigating whether offline institutional racism would serve as a moderator of the effects of online racism on psychological outcomes in a sample of African Americans. One hundred and eighty-two African Americans answered survey data on their experiences of institutional and online racism, as well as their overall mental health. Moderated regressions and simple slope analyses were performed to examine the effects of online, institutional, and the interaction of online and institutional racism on psychological symptoms (i.e., psychological distress and well-being). Online racism was the strongest and most consistent predictor of all outcome variables. The interaction of online and institutional racism was significantly associated with psychological distress but not well-being. Findings suggest that participants who endorsed institutional racism experience increased severity in psychological symptoms in relation to increased exposure to online racism. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

617-P: Impact of Culturally Sensitive, Mobile Health Based Nutrition Platform in Metabolic Health of African Americans in Southeast Virginia

617-P: Impact of Culturally Sensitive, Mobile Health Based Nutrition Platform in Metabolic Health of African Americans in Southeast Virginia

Rationale, design, and participant characteristics of the FAITH! Heart Health+ study: An exploration of the influence of the social determinants of health, stress, and structural racism on African American cardiovascular health

BackgroundAfrican Americans (AAs) face cardiovascular health (CVH) disparities linked to systemic racism. The 2020 police killing of Mr. George Floyd in Minneapolis, Minnesota, alongside the COVID-19 pandemic, exacerbated adverse psychosocial factors affecting CVH outcomes among AAs. This manuscript describes the study protocol and participant characteristics in an ancillary study exploring the relationship between biopsychosocial factors and CVH among AAs. MethodsUsing a community-based participatory approach, a mixed-methods ancillary study of 58 AA participants from an overarching randomized control trial (RCT) was conducted. Baseline RCT health assessments (November 2020) provided sociodemographic, medical, and clinical data. Subsequent health assessments (February–December 2022) measured sleep quality, psychosocial factors (e.g., high-effort coping), biomarkers (e.g., cortisol), and cardiovascular diagnostics (e.g., cardio-ankle vascular index). CVH was assessed using the American Heart Association Life's Simple 7 (LS7) (range 0 to 14, poor to ideal) and Life's Essential 8 (LE8) scores (range 0 to 100, low to high). Correlations between these scores will be examined. Focus group discussions via videoconferencing (March to April 2022) assessed psychosocial and structural barriers, along with the impact of COVID-19 and George Floyd's killing on daily life. ResultsParticipants were predominantly female (67%), with a mean age of 54.6 [11.9] years, high cardiometabolic risk (93% had overweight/obesity and 70% hypertension), and moderate LE8 scores (mean 57.4, SD 11.5). ConclusionThis study will enhance understanding of the associations between biopsychosocial factors and CVH among AAs in Minnesota. Findings may inform risk estimation, patient care, and healthcare policies to address CVD disparities in marginalized populations.

Choosing to End African American Health Disparities in Patients With Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is three times more common and its manifestations are more severe in African American women compared to women of other races. It is not clear whether this is due to genetic differences or factors related to the physical or social environments, differences in health care, or a combination of these factors. Health disparities in patients with SLE between African American patients and persons of other races have been reported since the 1960s and are correlated with measures of lower socioeconomic status. Risk factors for these disparities have been demonstrated, but whether their mitigation improves outcomes for African American patients has not been tested except in self-efficacy. In 2002, the first true US population-based study of patients with SLE with death certificate records was conducted, which demonstrated a wide disparity between the number of African American women and White women dying from SLE. Five years ago, another study showed that SLE mortality rates in the United States had improved but that the African American patient mortality disparity persisted. Between 2014 and 2021, one study demonstrated racism's deleterious effects in patients with SLE. Racism may have been the unmeasured confounder, the proverbial "elephant in the room"-unnamed and unstudied. The etymology of "risk factor" has evolved from environmental risk factors to social determinants to now include structural injustice/structural racism. Racism in the United States has a centuries-long existence and is deeply ingrained in US society, making its detection and resolution difficult. However, racism being man made means Man can choose to change the it. Health disparities in patients with SLE should be addressed by viewing health care as a basic human right. We offer a conceptual framework and goals for both individual and national actions.

Decolonizing Impact Through the Culture-Centered Approach to Health Communication: Mobilizing Communities to Transform the Structural Determinants of Health

ABSTRACT In this issue, we outline the central tenets of the culture-centered approach to health communication. What does the culture-centered approach address when suggesting the co-creation of voice infrastructures? What is the theory’s methodological emphasis for mobilizing and transforming structures that shape health inequalities for communities at the margins? Drawing on examples of culture-centered interventions in over fifty communities spread across 17 countries and three continents, a large number of them housed under the umbrella of the Center for Culture-centered Approach to Research and Evaluation (CARE) at Massey University in Aotearoa, New Zealand, we articulate the communicative processes (referring to actionable sources and targets of communicative action) that shape the building of voice infrastructures mobilizing toward structural transformation. For instance, African American communities organizing under the framework of the culture-centered approach, documented in Dutta, Collins, and colleagues study in 2019, discuss the building of voice infrastructures where community members participate in co-creating heart health information based on comparative effectiveness research, building an African American media ecosystem disseminating the information alongside community-led initiatives growing healthy food, community-led youth activities, and activism addressing the racist structural drivers that adversely impact African American heart health. In this essay, we describe the impact of culture-centered interventions reflected in the voice infrastructures within communities that witness and articulate the oppressions that threaten human health at the margins and in the transformations of these structures that organize various facets of life and livelihood at the global margins linked to health.

The impact of subjective, interpersonal, and structural social isolation on the mental health of African Americans and Black Caribbeans

ABSTRACT Research on social isolation and mental health among Black populations is underdeveloped. Using a nationally representative sample, our study examined the association between social isolation, depressive symptoms and psychological distress among African Americans (AAs) and Black Caribbeans (BCs). For both AAs and BCs, we found interpersonal and subjective isolation were associated with greater depressive symptoms. Greater distress was associated with greater subjective isolation and lower structural isolation for AAs; however, greater interpersonal isolation was associated with greater distress for BCs. Findings from this study may inform evidence-based interventions to mitigate isolation and improve mental health among AAs and BCs.

How well does the Index of Race-Related Stress-brief function in a trauma-exposed Black community sample? An item response theory examination of discrimination and difficulty parameters.

Race-related stress negatively impacts the mental health of Black Americans to a greater degree than other racialized groups. Additionally, trauma exposure is associated with more severe levels of posttraumatic stress disorder for individuals who also experience race-related stress. Therefore, an accurate assessment of race-related stress in a trauma-exposed sample of Black Americans is necessary to ensure the validity and reliability of empirical findings regarding race-related stress and intervention efficacy. The Index of Race-Related Stress (IRRS) is one of the most commonly used measures to assess race-related stress among Black Americans. Due to a lack of psychometric support for the abbreviated version of IRRS-brief (IRRS-B) on a trauma-exposed sample of Black Americans, our study aims to address this gap in literature. We used item response theory (IRT) to assess item difficulty, discrimination, and factor structure in a sample of trauma-exposed Black Americans (n = 226). We employed a multidimensional graded response model with corresponding items loaded on to the three previously established factors of the IRRS. The most discriminating items asked about observing harsh treatment of Black individuals, experiencing less courtesy in establishments, and being stared at as though you do not belong. The item with the lowest difficulty described negative media representation of Black individuals while the item with the highest difficulty described lack of positive media portrayals of Black Americans. These results indicate that items varied considerably in the degree to which they adequately captured race-related stress. Future research should use IRT with newly worded questions to further improve the assessment of race-related stress in Black Americans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Association between psychosocial factors and C-reactive protein across income, race, and sex.

A health disparity is a health difference that adversely affects disadvantaged populations, and thus could plausibly be due to social factors. Biopsychosocial processes that contribute to health disparities are not well-understood. Establishing whether candidate biomarkers are similarly associated with biologically relevant psychosocial constructs across health disparity groups is a current gap in our understanding. This study examined associations between perceived stress, depressive symptoms, and social support with C-reactive protein (CRP) and whether associations varied by race, sex, or income in 24,395 Black and White adults aged 45 years or older from the REGARDS population-based national cohort. The association between depressive symptoms and CRP was slightly larger at higher (vs. lower) income levels and larger for men (vs. women) but did not vary by race. Associations between stress and CRP and social support and CRP were not moderated by income, race, or sex. An interaction between race and income, evidenced that higher income was more strongly associated with lower CRP in White participants compared to Black participants, consistent with the idea of "diminishing returns" of income for the health of Black Americans. Basic associations between these psychosocial factors and CRP are small and generally similar across income, race, and sex. Black and lower-income Americans likely evidence higher CRP due to greater exposure to psychosocial risk factors rather than increased biological vulnerability to these exposures. Additionally, given small associations, CRP should not be used as a proxy for the construct of psychosocial stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

THE MODERATING ROLE OF RACE AND ETHNICITY BETWEEN NEGATIVE FAMILY INTERACTIONS AND MENTAL HEALTH AMONG OLDER ADULTS

Abstract Studies generally show that negative social interactions are detrimental to mental health for older adults. Furthermore, empirical evidence suggests that negative interactions may function differently in relation to mental health across racial/ethnic groups given their unique life circumstances and social conditions. This study examines whether the association between negative family interactions and mental health outcomes varies by race and ethnicity. Samples of older African Americans, Caribbean Blacks, and non-Latino Whites aged 55 and older were drawn from the National Survey of American Life (N = 1,439). Mental health variables included depressive symptoms, any lifetime disorder according to The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and number of lifetime DSM-IV disorders. Regression models were used to test the study aim. Analyses indicated that negative interactions with family were positively associated with all 3 mental health outcomes. Several racial/ethnic differences emerged. The association between negative family interactions and depressive symptoms was stronger among Whites than African Americans. While negative family interactions were positively associated with number of disorders among Caribbean Blacks, negative interactions were unrelated to number of disorders among African Americans. This study demonstrates the racial and ethnic differences in diverse aging populations and the importance of recognizing the heterogeneity of the Black American population in minority research. Clinical practice should focus on reducing negative family interactions, and future research should examine whether psychosocial resources (e.g., stress appraisals, neighborhood social cohesion) can attenuate the association between negative family interactions and mental health for older African Americans.

GEOGRAPHIC AND DEMOGRAPHIC PREDICTORS OF SELF-RATED HEALTH IN OLDER RURAL AFRICAN AMERICANS

Abstract Person-Environment (P-E) fit is a major tenet of environmental gerontology and can predict aspects of physical and mental health. Rural older adults may vary greatly in their P-E fit, but their in-group differences have yet to be explored. The current study examines predictors of self-rated health in middle and older adult African Americans in rural Mississippi. Predictors of self-rated health examined included distance from grocery store, age, education, and income. Participants were 47 African Americans (20 males) over 50 (M = 65.2) who were recruited from two rural, adjacent Mississippi Counties and lived at least five miles outside of a micropolitan town. Consistent with literature on health disparities in African American communities, participants on average rated their health as average to low. Results from a multiple regression model indicate that education and distance to grocery stores are significant predictors of subjective health, where more education and being further from a grocery store predicted higher self-rated health. It appears that within this sample, the further from a grocery store they were, the better the P-E fit. This may be due to an increase in gardening or farming, increased necessity for physical activity, or other aspects of this environment that promote healthy behaviors, despite being further from resources. Future research should continue to pursue aspects that add to P-E fit in rural older adults.

Impact of Pharmacist-Led Health Initiatives in Rural Alabama

Perry County is a predominantly African American community in rural Alabama. The prevalence of cardiovascular risk factors such as obesity, diabetes, and hypertension is higher than average in the Perry County population. The Cardiovascular Risk Reduction Clinic, a collaboration between Samford University McWhorter School of Pharmacy, Sowing Seeds of Hope, and the Perry County Health Department, partnered with the Perry County Department of Transportation (DOT) to offer DOT employees, mostly African American men, health screenings and education delivered at times and locations convenient to their work schedules. The objective of the present study was to evaluate the impact of a community partnership with pharmacist-led health interventions on modifiable cardiovascular risk factors in participants lacking access to other community health initiatives due to work obligations. This study was a retrospective chart review evaluating changes in blood pressure and body mass index (BMI). Participants included DOT employees 18 years of age and older who participated in at least two health screenings 12 weeks apart. Over the course of the intervention, the average systolic blood pressure decreased by 6 mmHg, and the average diastolic blood pressure decreased by 4 mmHg. The baseline BMI average of 35.1 kg/m2 had dropped to 34.5 kg/m2 at 12 weeks. Although modest, the reductions in blood pressure and BMI indicate a potential for cardiovascular disease risk reduction. Lessons learned from this pilot project can inform the initiation of similar programs intended to decrease cardiovascular risk. Pharmacist-led interventions combined with community support can lead to positive cardiovascular results among rural communities.

The Black Men's Health Forum: Improving Health Knowledge and Willingness to Participate in Research.

The Black Men's Health Forum, a 6-week online health education intervention for African American men and accountability partners of African American men, was conducted to increase awareness of health issues that disproportionately affect African American men. In this article, we describe the intervention and report on the immediate benefits of the intervention, including changes in health knowledge and perception of research participation. Participants completed a pre-evaluation prior to participating in the forum and a post-evaluation after each session to capture data on sociodemographic information, medical history, health knowledge, and health behaviors. A total of 60 participants (30 African American men and 30 accountability partners) completed the forum. African American men had a mean age of 61.1 years while accountability partners had a mean age of 57.6 years. Overall health knowledge increased by 6.9 points for African American men and 2.8 points for accountability partners. Before the forum began, nine African American men reported ever participating in a research study. The proportion of African American men who reported that they would definitely participate in research in the next 12 months after participating in the forum increased by 40%. Through culturally tailored programming, the Black Men's Health Forum increased access to health information as well as African American male medical professionals and health researchers for African American men in the community. Exposure to health information resulted in significant increases in health knowledge and willingness to participate in health research among African American men.

Multidisciplinary argument for the decriminalization of drugs

AbstractThis manuscript offers an overview of 11 disciplinary perspectives on the failed and destructive War on Drugs and the salutary prospects from decriminalizing drug use, including History, African American studies, Journalism, Sociology, Political Science, Cost Accounting, Urban Education, Counseling, Psychology, Nursing, and Public Health. This offers a roadmap for counselor social and political advocacy with drug policy and highlights community collaboration opportunities.

Stress indicators in minorities with multiple sclerosis.

Black Americans with multiple sclerosis (MS) experience higher levels of disease-related disability compared to White Americans (Marrie etal., 2006). Comorbidities such as depression and anxiety, which are underdiagnosed and undertreated in this population, negatively impact quality of life and treatment outcomes for people living with multiple sclerosis (plwMS) (D'Alisa etal., 2006; Marrie etal., 2009; Stepleman etal., 2014). Acts of discrimination toward Black Americans is associated with stress, which is a contributing factor for depression (Carter,2017; Nadimpalli, 2015; Williams and Mohammed, 2009). This study compared the severity of multiple sclerosis symptoms amongst Black Americans and White Americans, and whether worsened MS symptoms in Black Americans are associated with increased experiences of discrimination. Data was analyzed from 143 plwMS in the Stress Indicators in Minorities with Multiple Sclerosis (SiMMS) study. Using the Mann-Whitney U test, significant differences were found on the NIH Emotional Distress - Anxiety measure (U=1466.500, p=0.045) and NIH Sleep Disturbance measure (U=1467.000, p=0.044) between the Black participant and the White participant groups. Discrimination was significantly correlated with both NIH Emotional Distress - Anxiety (r=0.677, p < .001) and NIH Sleep Disturbance (r=0.446, p=.007) in Black MS individuals. Additionally, several physiological condition and psychological outcome measures were correlated with the NIH Emotional Distress - Anxiety and NIH Sleep Disturbance measures. This study contributes to literature highlighting the negative impacts of discrimination and race related stress on the physical and mental health of Black Americans.

A Study of COVID‐19 Information Behaviors among Black Americans

ABSTRACTMany Black Americans expressed skepticism and hesitancy about the Covid‐19 vaccine. The objective of this research is to examine whether there is a relationship between Covid‐19 vaccine status, Covid‐19 vaccine knowledge, and information seeking about the coronavirus. A national online questionnaire of 222 Black identified individuals completed the instrument in the Summer of 2021. We conducted data analysis using ANOVA and nonparametric correlation tests among the variables. Findings show that individuals who have received the COVID‐19 vaccine exhibited greater COVID‐19 vaccine‐related knowledge compared to people who declined the vaccine, or were hesitant adopters. There is no significant difference in the level of knowledge between those who are hesitant about the vaccine and those who declined it. Finally, there is a moderate positive correlation between COVID‐19 vaccine knowledge and engagement in COVID‐19‐related information seeking. We conclude with strategies to improve the Black American health information environment by way of practice, policy and action.

Developing and assessing a kin keeping scale with application to identifying central influencers in African American family networks.

Promoting family communication about inherited disease risk is an arena in which family systems theory is highly relevant. One family systems' construct that can support promotion of family communication regarding inherited disease risk is the notion of "kin keeping." However, kin keeping and whether it might be capitalized on to encourage family communication about inherited risk has been understudied. The goal of this report was to propose a broadened conceptualization of kin keeping that distinguishes between a structural functional perspective (role conceptualization) and transitional behaviors (skill conceptualization), and to develop and evaluate a scale that would enable this assertion to be tested among a sample of African American community health workers. We developed a scale using four steps: item development using concept analysis and content validity, scale development among a national sample (n = 312), scale evaluation using exploratory factor analysis (n = 52), and scale reduction. We then posed suppositions of associations that would indicate whether the developed kin keeping measure was assessing a specific family role or set of behaviors. Our results included the development of the first quantitative measure of kin keeping (9- and 15-item scales). Model fit for 9-item scale (CFI = 0.97, AFGI = 0.89, RMSEA = 0.09, SMRM = 0.06) and model fit for 15-item scale (CFI = 0.97, AFGI = 0.89, RMSEA = 0.06, SMRM = 0.05). These findings allow us to move toward more rigorous research about the role of kin keeping on information sharing and health decision making. Results also suggest that, contrary to the historical structural functional conceptualization of kin keeping as a role, kin keeping might also be conceptualized as a behavior or set of modifiable behaviors. Ultimately, the kin keeping scale could be used to operationalize kin keeping in various theoretical models and frameworks, guide intervention development to encourage or train for kin keeping behaviors, and test assumptions of whether families vary in the density of kin keeping.

Association of Preventive Care Attitudes and Beliefs with Colorectal Cancer Screening History among African American Patients of Community Health Centers.

Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer-related death among African Americans in the United States. However, when detected early, CRC is treatable and survival rates are high. CRC health disparities for African Americans compared with other groups may be due in part to lower screening adherence and later stage diagnosis. The objective of this research phase was to test predictors of ever having received CRC screening (i.e., self-report of lifetime receipt of CRC screening) using survey measures in the domains of healthcare communication, trust in doctors, CRC perceived susceptibility, CRC worry, negative cancer beliefs, CRC screening self-efficacy, and cultural constructs for CRC screening in a sample of African American community health center patients. The study recruited 115 African American patients between the ages of 45 to 64years old from community health centers in north Florida to complete the baseline survey. Our results show significant differences in CRC screening history by age, marital status, level of mistrust of healthcare providers, and level of empowerment toward cancer screening. To increase CRC screening in this population, the study findings suggest development of intervention programs that focus on priority populations of younger, unmarried African Americans, especially given the current trend of early onset CRC. Moreover, survival rates are lower for unmarried and younger African Americans relative to older and married individuals. Such interventions should also aim to increase trust in healthcare providers and increase empowerment for CRC screening decision making to increase screening participation.