Health Outcomes For African Americans Research Articles

Socioeconomic factors and self-reported health outcomes in African Americans with rheumatoid arthritis from the Southeastern United States: the contribution of childhood socioeconomic status

Socioeconomic factors and self-reported health outcomes in African Americans with rheumatoid arthritis from the Southeastern United States: the contribution of childhood socioeconomic status

Exploring Physical Health of African Americans: A Social Determinant Model

The objective was to examine the relationships between socioeconomic, structural, community, and individual factors and health outcomes of African Americans in the United States using a modified version of the social determinants of health model in a nationally representative sample of 2,926 non-elderly African American adults. This empirical evidence supports the hypothesis that there is a positive relationship between socioeconomic/structural determinants and health outcomes of African Americans. Results show poor housing and low income contribute to poorer health outcomes; therefore, in order to improve the health outcome, programs are needed that provide their residents with adequate and safe housing and employment. Moreover, local, state, and federal governmental entities need to work together to rebuild and revitalize the housing in African American communities.

Residential Segregation, Health, and Health Care: Answering the Latino Question

The literature on the relationship between residential segregation and health outcomes for African Americans is well developed, but less is known about this association for Latinos in the USA. The literature for Latinos is limited, demonstrates mixed results, and suffers from data limitations. Using geographic concentration of poverty theory, we analyze the impact of Latino segregation on a series of health and health-care outcomes in order to better establish this relationship. This study uses data from the 2011 to 2012 Behavioral Risk Factor Surveillance System nested within metropolitan area-level data in a set of partial proportional odds and binary logistic multilevel regression models. We examine the relationship between Latino segregation and three health and health-care outcomes for 164 metropolitan areas in the USA. Overall, we find that Latino segregation is negatively related to good self-rated health, having a personal physician, and having health insurance for Latino respondents. Furthermore, for White respondents, no such association exists. As a result, residential segregation for Latinos contributes to the Latino–White health gap.

Transgenerational Consequences of Racial Discrimination for African American Health.

Disparities in African American health remain pervasive and persist transgenerationally. There is a growing consensus that both structural and interpersonal racial discrimination are key mechanisms affecting African American health. The Biopsychosocial Model of Racism as a Stressor posits that the persistent stress of experiencing discrimination take a physical toll on the health of African Americans and is ultimately manifested in the onset of illness. However, the degree to which the health consequences of racism and discrimination can be passed down from one generation to the next is an important avenue of exploration. In this review, we discuss and link literature across disciplines demonstrating the harmful impact of racism on African American physical health and the health of their offspring.

Influence of a Community Health Worker Intervention on Mental Health Outcomes among Low-Income Latino and African American Adults with Type 2 Diabetes.

This study investigated the influence of a community health worker (CHW) diabetes lifestyle intervention on mental health outcomes. Our study was guided by the principles of community-based participatory research. Data were collected from 164 African American (N = 94) and Hispanic adults (N = 70) participating in a randomized, 6-month delayed intervention group design for improving glycemic control. The intervention time periods were baseline to 6 months for the treatment group and 6-12 months for the delayed group. Linear mixed models were used to conduct longitudinal analyses of the Problem Areas in Diabetes (PAID) and Patient Health Questionnaire (PHQ) scales. In the model adjusted for demographics, the PAID dropped significantly from pre-intervention to post-intervention within both the treatment and delayed groups (p < 0.05) with an average intervention effect of -6.4 (p < 0.01). The PAID dropped even further within the immediate group from 6 to 12 months. Although the PHQ did not change significantly, the PHQ-2 had an average intervention effect of -0.3 (p < 0.05) in the model adjusted for demographics. This study contributes to an understanding of how a CHW-led diabetes intervention can result in positive mental health outcomes for Latinos and African Americans with Type 2 diabetes. It also highlights the importance of further exploring what factors may contribute to racial/ethnic variation in mental health outcomes for African Americans and Latinos with diabetes and the role CHWs can play.

Salient beliefs about eating and buying dark green vegetables as told by Mid-western African–American women

Vegetables in the dark green group are the most nutritious, yet intake is low. Studies suggest that an increase in fruit and vegetables may improve diet-related health outcomes of African Americans. The aim of this exploratory study was to use the Reasoned Action Approach (RAA) to qualitatively assess salient, top-of-the-mind, beliefs (consequences, circumstances and referents) about eating and buying more dark green leafy vegetables each week over the next 3months. Adult (n=30), Midwestern African–American women, who buy and prepare food for their household participated in a face-to-face salient belief elicitation. A content analysis of verbatim text and a descriptive analysis were conducted. Findings suggest that the RAA can be used to identify salient consequences, circumstances and referents about eating and buying more dark green leafy vegetables. The use of the RAA allowed for the extraction of specific beliefs that may aid in the development of nutrition education programs that consider the varying priorities, motivators and barriers that subgroups within the population have in regard to buying and consuming dark green leafy vegetables.

Psychometric properties of the Cook Medley Hostility Scale and its association with inflammatory markers in African Americans

Dispositional hostility as measured by the Cook Medley Hostility (Ho) Scale has been associated with inflammation and cardiovascular disease (CVD) risk. There is evidence that suggests that factors of hostility are more useful in predicting poor cardiovascular health outcomes than a single hostility construct. The purpose of this study was to investigate the latent factors of hostility and their association with inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) in an African-American community sample. This racial/ethnic group has been largely excluded from this line of research despite their disproportionate burden of CVD and its risk factors. Blood samples for plasma IL-6 and CRP were collected on the same day the Ho Scale was administered. Plasma IL-6 and CRP levels were determined using enzymatic-linked immunosorbent assay. Confirmatory factor analysis revealed three latent main factors of hostility: Neuroticism, Manichaeism and Moral Primitiveness, and seven intermediary subfactors. Of the subfactors, hostile affect was significantly associated with greater CRP levels and predatory self interest was significantly associated with greater IL-6 levels. Findings suggest that African Americans have a unique pattern of hostility and two latent subfactors are associated with a marker of CVD. Based on the findings, future studies should aim to further delineate how hostility influences health outcomes in African Americans.

Race and Vitamin D Status and Monitoring in Male Veterans

African Americans have lower vitamin D levels and reduced health outcomes compared to white Americans. Vitamin D deficiency may contribute to adverse health outcomes in African Americans. We hypothesized that race would be associated with vitamin D status and testing in African Americans veterans, and that vitamin D status is a major contributor to health care costs in African American veterans compared to white veterans. A retrospective analysis of the medical data in the Veterans Integrated Service Network 9 (southeastern United States) was performed, and 14148 male veterans were identified. Race was designated by the patient and its relationship to vitamin D levels/status and costs was assessed. Vitamin D levels were significantly lower and the percent of patients with vitamin D deficiency was significantly higher in African American veterans. This difference was independent of latitude and seasonality. Vitamin D testing was done significantly more in white veterans compared to African American veterans (5.4% vs 3.8%). While follow-up testing was 42% more likely if a patient was found to be vitamin D deficient, white veterans were 34% more likely than African American veterans to have at least 1 follow-up 25-hydroxyvitamin D performed. African American veterans had significantly higher health care costs, which were linked to lower vitamin D levels; however, the cost differential persisted even after adjusting for vitamin D status. Vitamin D deficiency is highly prevalent in African American veterans and needs improved management within the Veteran Administration system. Vitamin D status appears not to be the sole contributor to increased health care costs in African American veterans.

Under the Skin: Using Theories From Biology and the Social Sciences to Explore the Mechanisms Behind the Black–White Health Gap

Equity and social well-being considerations make Black-White health disparities an area of important concern. Although previous research suggests that discrimination- and poverty-related stressors play a role in African American health outcomes, the mechanisms are unclear. Allostatic load is a concept that can be employed to demonstrate how environmental stressors, including psychosocial ones, may lead to a cumulative physiological toll on the body. We discuss both the usefulness of this framework for understanding how discrimination can lead to worse health among African Americans, and the challenges for conceptualizing biological risk with existing data and methods. We also contrast allostatic load with theories of historical trauma such as posttraumatic slavery syndrome. Finally, we offer our suggestions for future interdisciplinary research on health disparities.

Is segregation bad for your health?

For decades, racial residential segregation has been observed to vary with health outcomes for African Americans, although only recently has interest increased in the public health literature. Utilizing a systematic review of the health and social science literature, the authors consider the segregation-health association through the lens of 4 questions of interest to epidemiologists: How is segregation best measured? Is the segregation-health association socially or biologically plausible? What evidence is there of segregation-health associations? Is segregation a modifiable risk factor? Thirty-nine identified studies test an association between segregation and health outcomes. The health effects of segregation are relatively consistent, but complex. Isolation segregation is associated with poor pregnancy outcomes and increased mortality for blacks, but several studies report health-protective effects of living in clustered black neighborhoods net of social and economic isolation. The majority of reviewed studies are cross-sectional and use coarse measures of segregation. Future work should extend recent developments in measuring and conceptualizing segregation in a multilevel framework, build upon the findings and challenges in the neighborhood-effects literature, and utilize longitudinal data sources to illuminate opportunities for public health action to reduce racial disparities in disease.

Coping as Predictor of Psychiatric Functioning and Pain in Patients with Sickle Cell Disease (SCD)

Coping is recognized as an increasingly important consideration in the management of chronic disease. Prayer, hostility and John Henryism appeared to be the most frequently discussed but least understood coping strategies associated with health outcomes in African Americans. The current study evaluated if prayer, hostility and John Henryism (JH) predicted psychiatric morbidity and pain in 67 adult African American patients with Sickle Cell Disease. We used a set of simple regressions to analyze continuous predictors (hostility and JH) and Analyses of Variance (ANOVA) to analyze the categorical predictor (prayer). Each of the coping variables was a statistically significant predictor of psychiatric morbidities. However, coping did not exert effects on the absolute value of pain. In summary, coping influenced reactions to pain but not reports of pain itself.

Weight Loss and Health Outcomes in African Americans and Whites After Gastric Bypass Surgery

The objective was to describe differences in weight loss, dietary intake, and cardiovascular risk factors between white and African-American patients after gastric bypass (GBP). This was a retrospective database review of a sample of 84 adult patients (24 African-American and 60 white women and men) between the ages of 33 and 53 years. All subjects had GBP surgery in 2001 at the Bariatric Surgery Program at Boston Medical Center in Boston, MA, and were followed for one year postoperatively. Patients were excluded if weight data were missing at baseline, 3 months, or 1 year after GBP. A total of 9 African Americans and 41 whites provided data at all 3 time-points and were included in the study. Differences in weight loss, diet, and cardiovascular risk factors were analyzed. There were no differences in baseline characteristics between African Americans and whites. Mean weight loss for the entire sample was 36 +/- 9%, with a range of 8% to 54% relative to initial body weight. Whites lost more weight (39 +/- 8%) than African Americans (26 +/- 10%) (p < 0.05). Dietary parameters, as well as improvements in blood pressure and lipid profiles, were similar in the two racial groups. Differences in weight loss between severely obese African Americans and whites undergoing open GBP are unlikely to be related to postoperative dietary practices. Our data are consistent with previous reports implicating metabolic differences between the two racial groups.

The Relationship of Racism, Chronic Stress Emotions, and Blood Pressure

To test a middle-range theory of chronic stress emotions to examine the effects of perceived racism and emotion-focused coping on psychological and physiological health outcomes in African Americans. A descriptive-correlational, causal modeling study was conducted with a convenience sample of 162 community-dwelling adults. Participants completed the Racism and Life Experience Scale; Krieger Racial Discrimination Questionnaire; Toronto Alexithymia Scale; Emotional Approach Coping Scale; State-Trait Personality Inventory; and a demographic data sheet. Automated blood pressure (BP) readings were obtained. Structural equation modeling techniques were used to examine the hypothesized causal and correlational links between the theoretical constructs, as well as to examine the relationship between the observed variables and the latent constructs measured. FINDING AND CONCLUSIONS: The proposed model fits the sample data. Racism was a commonly experienced stressor associated with chronic stress emotions, but not with BP. Emotion-focused coping was strongly associated with socioeconomic status and chronic stress emotions but not with BP.

The disproportionate impact of hypertensive cardiovascular disease in African Americans: getting to the heart of the issue.

The prevalence of hypertension in African Americans is among the highest in the world. Persons in this group develop hypertension at a younger age than non-African Americans and develop more severe complications, including stroke, cardiovascular disease, and renal failure. The factors that impart this high risk to this population remain poorly understood and, undoubtedly, environmental factors overshadow genetic predisposition. While identifying the pathophysiologic and environmental factors that contribute to ethnic disparity in disease is important, finding a long-term solution is crucial. Steps that can have an important impact on health outcomes of African Americans are presently available. Awareness of ethnicity as a risk factor for hypertension can allow health care providers to identify persons who are likely to benefit most from early, aggressive intervention. Modifiable factors such as smoking, diet, and sedentary lifestyle, as well as undertreatment of hypertension by physicians, can be targeted immediately.

Methodological Issues in Conducting Community-Based Health and Social Services Research Among Urban Black and African American LGBT Populations

Health and social service utilization experiences of disenfranchised groups have recently gained renewed public attention. Reducing and eliminating racial disparities in health care has become a major national agenda. While a fairly substantial literature on Black and African American health outcomes and social service utilization does exist, and may help to influence interventions to reduce disparities, there is no comparable literature for Black and African American lesbian, gay, bisexual, and transgender (LGBT) persons. In this article the author examines factors affecting research with urban Black and African American LGBT populations. A brief case study is included that demonstrates the viability of the recommended research methods and discusses the possible negative consequences of deviating from these methodological suggestions.

Life Course Influences on African American Men's Depression

What are the processes from adolescence to adulthood that shape the mental health prospects of African American males? This research considers factors over the life course that specifically affect levels of depression in Black men. Regarding how processes that contribute to adult depression differ by race, previous research on depression has been limited in three important ways. First, relatively little research has been done on how factors over the life course influence depression in African Americans, and even less research has specifically investigated the case of African American males. Second, because studies of depression tend to rely on crosssectional data collected at a single time point, it is very difficult to know which past elements of individuals' lives contribute to current levels of depression. Third, studies typically use pooled samples to assess the effects of factors on the mental health outcomes of African Americans. It is possible that with large sample sizes, even controlling for race, that the effects of variables pivotal to understanding the status of African American males are masked or exaggerated. Given the disproportionate number of psychosocial stressors faced by African American males (Gibbs, 1993) compared to their White counterparts, it is especially important to clearly understand how the processes revealed in subsample analyses may differ from those in a pooled sample. The current study contributes to our knowledge of the factors that mold the mental

Improving Health Outcomes of African Americans: A Challenge for African American Psychologists

Improving Health Outcomes of African Americans: A Challenge for African American Psychologists