Health Outcomes For African Americans Research Articles

Resilience and Self-Management of Hypertension in African American Adults Using a Conceptualized Resilience Framework: An Exploratory Analysis.

Hypertension rates have increased worldwide, with the most significant increase in morbidity and mortality observed among African Americans. Resilience is a potential factor influencing how individuals manage health-related challenges or self-management tasks for hypertension. Research is scarce related to resilience and self-management frameworks in African Americans with hypertension. We aimed to describe a conceptualized resilience framework and preliminary findings of the association among resilience precursors, stress response, hypertension self-management behaviors, and health outcomes in African Americans with hypertension. This cross-sectional, descriptive-correlational study included African American adults with hypertension, aged 25 years and older, recruited from an academic university and surrounding urban communities in the Midwest. Participants completed standardized, validated questionnaires to examine the association among resilience precursors, stress response, hypertension self-management behaviors, health-related quality of life (HRQOL), and blood pressure at baseline. Descriptive statistics were used to describe the sample demographic characteristics, whereas Pearson's correlational and multiple regression analyses were conducted to determine the associations among the variables. African Americans with hypertension (N = 30) were included in this preliminary study, with a mean age of 59.17 years; 66.7% were female. The mean systolic blood pressure was 136 (SD = 16.8) mmHg; the mean diastolic blood pressure was 78.1 (SD = 13) mmHg. Pearson's correlation analysis revealed significant relationships between resilience precursors, stress response, hypertension self-management behaviors and capability, and health outcome components. Multiple regression analysis showed that poor perceived resilience significantly predicted depression. Low dispositional optimism and low perceived resilience were significant predictors of stress. Higher perceived resilience significantly predicted self-efficacy. Perceived stress was negatively and significantly associated with HRQOL. Finally, higher self-efficacy significantly predicted better HRQOL. This study underscores the significant association between resilience, stress, self-management behaviors, and health outcomes in African Americans with hypertension. Further research with larger sample sizes and longitudinal designs is warranted to confirm and expand upon these findings.

"A cuff is not enough": A community-based participatory research approach to soliciting perspectives of African Americans with hypertension and their family members on self-management intervention features.

We aimed to solicit the perspectives of African Americans with hypertension and their family members on the desired features of a behavioral hypertension self-management intervention. Using a community-based participatory approach to intervention design, we conducted four dyadic focus groups, including African American community members with hypertension (n = 23) and their family members (n = 23), recruited from African American-serving Christian churches in a large, southern metropolitan area. We used open-ended questions to elicit participants' perspectives regarding program features they would recommend, intervention delivery, and barriers necessary to address. Our grounded theory analysis identified themes reflecting participants' recommendations for hypertension self-management interventions to enhance health literacy and provide communication training via an accessible, population-tailored, family-based approach, which they believed has the potential to create family-level impact on health across generations. Participants also recommended intervention researchers engage in advocacy (i.e., via physician education and policy change) as part of a broader impact on structural inequities driving worse hypertension and health outcomes for African Americans. The perceptions and recommendations of African Americans with a lived experience of hypertension, as well as their family members, aid in shaping acceptable and efficacious behavioral interventions aiming to promote hypertension self-management behavior while leveraging the unique power of family relationships to create sustained behavior change.

Abstract P651: Assessing the Pathway Between Health Care Utilization and Hypertensive Outcomes Among Young Adult African American Medicaid Beneficiaries in Delaware

Introduction: African Americans have been studied to underutilize medical care in comparison to other groups due to a variety of factors, including lack of access and medical mistrust, both attributable long-standing systemic oppression. Thus, African Americans bare a disproportionate burden of chronic conditions, including hypertension, which is more than two times more prevalent among African Americans in comparison to other groups. To date, the health care utilization behaviors of African American young adults, ages 18-30, are understudied. Addressing this relationship in a young sample may be informative in fostering long-term improvement of health outcomes for African Americans. Question: Among African Americans aged 18-30. is there an association between hypertension diagnosis and recent receipt of a general adult medical exam? Methods: We conducted a cross-sectional case control study using data from a sample of African American Medicaid recipients living in Delaware, aged 18-30. Following an assessment of demographic characteristics, we performed logistic regression adjusted for gender and zip code to investigate the association between hypertension diagnosis and receipt of a general adult medical exam within the study period. Results: Among patients aged 18-30, those with hypertension (n=2,506) had 1.4 times the odds of reporting to have received a general adult medical exam during the study period when compared to those without hypertension (n=24526; p<.0001). The difference between the mean number of visits between strata (.379 vs. .302) is statistically significant (p<.0001). Conclusion: Our findings suggest that young adult African American patients living with hypertension are more likely to have a general adult medical exam during the study period than clients of the same age group without hypertension. We believe this may implicate that those with poorer health tend to seek care more often, though further research is needed to better understand motivations for seeking care. Improved understanding of the pathway between health care utilization and hypertension through a younger lens will be critical in targeting self-advocacy programs that address aversion to care-seeking behaviors for generations to come.

Perspectives on a Novel Culturally Tailored Diabetes Self-Management Program for African Americans: A Qualitative Study of Healthcare Professionals and Organizational Leaders.

Background: There is an urgent need for culturally tailored diabetes self-management education to improve health outcomes in African Americans, especially given the disproportionate prevalence of diabetes and medication non-adherence. Stakeholder engagement can guide and enrich the development of these interventions by integrating content directly addressing barriers to African Americans’ adherence with existing community-based diabetes self-management education programs. The aim of this study is to explore stakeholder perspectives on a novel culturally tailored diabetes self-management program for African Americans. Methods: Thirteen semi-structured individual interviews were conducted in a large Midwestern U.S. city with healthcare professionals and organizational leaders serving African American communities and/or providing diabetes education. Transcripts were analyzed using directed content analysis with the Consolidated Framework for Implementation Research and inductive content analysis. Results: Five overarching themes were identified: (1) fulfill needs among stakeholders, (2) creating a supportive and trusting environment to address distrust, (3) building relationships and empowering peers, (4) logistical organization barriers to program implementation and (5) challenges to program acceptance by participants. Conclusion: Stakeholders delineated how the new culturally tailored diabetes self-management program aligned with the needs of African American patients. Perceived challenges and corresponding strategies to address barriers to participation were identified to inform program implementation and sustainability.

Commentary: Infant Mortality Among African Americans, Using Life Course Perspective to Encourage Transformation.

Commentary: Infant Mortality Among African Americans, Using Life Course Perspective to Encourage Transformation.

The compounded effects of classism and racism on mental health outcomes for African Americans.

Much research exists demonstrating that experiences of racism are detrimental to the mental health of African Americans; however, Lewis and Van Dyke (2018) argued that examining the effects of racism alone neglects the intragroup diversity (and thus intersectional oppression) of African Americans. Thus, and given the economic oppression experienced by African Americans, the present study sought to examine the compounded effects or racism and classism on African Americans' mental health. African American participants (N = 113) were recruited from an online crowdsourcing platform. A multivariate multiple regression was performed to examine the effects of racism, classism, and the interaction of racism and classism on depression, stress, and well-being. After controlling for gender, age, and employment status, classism, but not racism, was significantly related to stress, well-being, and depression. The interaction effect of racism and classism was also significantly related to stress and well-being, with participants endorsing more of both racism and classism reporting better mental health outcomes, consistent with the resilience (rather than the greater risk) perspective. Findings suggested that experiences of classism are detrimental to the mental health and well-being of African Americans, but that greater experiences of both racism and classism were actually related to better, not poorer, mental health and well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Forms and frequency of vicarious racial discrimination and African American parents’ health

BackgroundAfrican Americans often witness or learn about others’ racial discrimination experiences (i.e., vicarious racial discrimination). Vicarious racial discrimination may contribute to adverse physical and psychological health outcomes for African Americans. We examined relations between four types of vicarious racial discrimination and depressive symptoms and self-rated health among African American parents. MethodsPath analyses were conducted to examine the linkage between each type of vicarious racial discrimination and both depressive symptoms and self-rated health. Chi-square difference tests were conducted to determine if the four forms of vicarious racial discrimination significantly differed in their relations to both depressive symptoms and self-rated health. ResultsWitnessing or learning about their children's racial discrimination experiences was significantly related to higher parental depressive symptoms. Witnessing or learning about a racial discrimination experience of a stranger through the news or social media was significantly related to lower self-rated health. ConclusionsThe findings highlight the importance of examining the health implications of vicarious racial discrimination. Different types of vicarious racial discrimination experiences matter concerning depressive symptoms and self-rated health.

The Impact of Racial Microaggressions Across Educational Attainment for African Americans

ABSTRACT While separate bodies of research have emerged regarding racial microaggressions in postsecondary settings and the relationship between race-related stressors and health outcomes for African Americans, there is a dearth of empirical investigations that test the effects of “general happiness,” “job satisfaction,” and race-related stress based on the educational attainment of African Americans. This study examines the experiences of 3,320 African Americans who participated in the National Survey of American Life (NSAL) conducted by the Program for Research on Black Americans at the University of Michigan. Using a multigroup structural equation modeling approach, findings suggest that experience with more racial microaggressions tends to lead to less general happiness. Furthermore, greater racial microaggressions lead to less job satisfaction regardless of educational attainment. Findings demonstrate that racial microaggressions are entrenched in many parts of society that impact the health and education of African Americans. Authors provide suggestions for addressing racial microaggressions and disrupting whiteness.

The Impact of Health Narratives on Persuasion in African American Women: A Systematic Review and Meta-Analysis

ABSTRACT African American women (AAW) experience higher burdens of disease and have the highest rate of heart disease, cancer, stroke, and diabetes when compared to females of other ethnic groups. Health narratives are a communication strategy that has been used to improve population health outcomes. Narrative storytelling is considered to be effective for improving health outcomes in African Americans because of the strong cultural storytelling background. The purpose of this study was to determine if health narratives have a significant effect on persuasion among AAW, as measured by changes in attitudes, beliefs, intentions, and behaviors. Meta-analysis of health narrative experiments (k = 13) for AAW (N = 2,746) revealed that health narratives have a significant overall effect on persuasion (d = .243; p < .01). Sub-group analyses revealed no significant difference between audio-visual and written-based narratives, and no significant difference between general health topics and cancer topics. Narrative communication was effective for promoting health in AAW. These findings imply that narratives can effectively be used as an audio-visual or written-based communication for AAW, and that health topic may not impact outcomes of narrative communication.

Diagnosis Race: Troubling Etiologies in Claudia Rankine's American Lyrics.

"Diagnosis Race" provides an analysis of poet Claudia Rankine's representations of "John Henryism" and "weathering," public health terms for persistent disparities in health outcomes for African Americans, regardless of socio-economic status and education level. I argue that Rankine's experimental multi-media collections Don't Let Me Be Lonely: An American Lyric (2004) and Citizen: An American Lyric (2014) create a necessary new genre for our times: a "public lyric" that works to place the individual or "private" injured Black body in the public square, expose the deleterious effects of racial bias on the mental and physical health of many Black Americans, and uncover harmful bias behind even the most well-meaning diagnostic language.

EXPERIENCES OF DISCRIMINATION ARE ASSOCIATED WITH DECREASED FUNCTIONAL ABILITY IN AFRICAN IMMIGRANT OLDER ADULTS

Discrimination impacts functional health outcomes of African Americans and other racial/ethnic minorities in the United States; yet this is understudied in African immigrants whose population has risen by 137% since 2000. We examined the relationship between discrimination and physical function with a convenience sample of first-generation African immigrants age 50+ recruited through community-based organizations (N=124). Discrimination was measured with the Everyday Discrimination scale with higher scores indicating more experiences of discrimination (range=0-23). High versus low levels of discrimination were categorized at the mean. Physical function was measured using the PROMIS Physical Function measure with high scores indicating greater functional ability (range=11-50). Raw function scores were converted to standardized T-scores with a population mean of 50 and standard deviation (SD) of 10. Linear regression was used for analyses. Mean age of the sample was 61.4(SD=7.9) years. About two-thirds (63%) were female, more than half (52.4%) immigrated in search of better opportunities and half of the sample had high levels of discrimination. The mean function score was 44.2(SD=8.3) indicating that this sample had functional ability 6 points less than the population average. After adjusting for demographic and migration factors, the mean physical function score was 2.5 points lower (b=-2.53, 95% CI= -5.04, -0.01) for participants with more experiences compared to those with fewer experiences of discrimination. In conclusion, discrimination was associated with poor physical function in African immigrant older adults after adjusting for covariates. Longitudinal studies of discrimination and physical functioning should be pursued in more diverse, larger samples of African immigrants.

RACIAL BIAS IN STAFF OPTIMISM ABOUT ADL IMPROVEMENT AMONG NURSING HOME RESIDENTS

Research on bias in health care has shown disparity in provision of care to and health outcomes of African Americans. Patient optimism was associated with improved physical and psychosocial outcomes, and nurse optimism was correlated with patient perceptions of care. We estimated effects of race using logistic regression, controlling for ADLs, cognitive impairment, and gender on both staff optimism and resident optimism about capacity for improvement in ADLs in a probability sample (n=2604) of nursing home residents who were evaluated with the resident assessment instrument (RAI). We found no difference between African American and White residents’ optimism about their own capacity for improvement. Staff findings were quite different. Staff were most optimistic about the potential of residents who needed ADL assistance OR=1.82; 95% CI [1.42-2.32] over those who were ADL dependent or those who only needed oversight. Most importantly, it was in the oversight category of ADL impairment where the greatest indication of racial prejudice occurred. Staff were much less likely to be optimistic about African American residents (16%) compared to White residents (30%). With all control variables entered, staff were still less willing to be optimistic about African American resident improvement (AOR=0.65; 95% CI [0.44-0.96]. The implications of these findings are troubling. It is unlikely that staff would expend energy on improving the functioning of the African American residents whom they believe cannot improve. Further research is needed on the extent to which prejudice in nursing homes is accompanied by discrimination and how the bias can be overcome.

Self-Management as a Mediator of the Relationship between Social Support Dimensions and Health Outcomes of African American Adults with Type 2 Diabetes.

Social support promotes behavior change and self-management that leads to improved health outcomes. The purpose of this study was to evaluate the role of self-management in mediating the relationship between social support dimensions and health outcomes of African Americans with type 2 diabetes (T2D). Cross-sectional data were collected from 102 African Americans with T2D at an outpatient clinic. The majority of the participants were female, single, unemployed, and having low income. Functional support, the quality of the primary intimate relationship, and the number of support persons were negatively correlated with depression. Functional support and satisfaction with support explained a significant small amount of the variance in self-management. However, self-management did not mediate the relationships between social support dimensions and the health outcomes. The results of this study shed the light on the unique relationships of social support dimensions with health outcomes of African Americans with T2D.

Collective ethnic-racial identity and health outcomes among African American youth: Examination of promotive and protective effects.

Racial discrimination is associated with numerous negative health outcomes, including increased risk for depression and anxiety symptoms and substance use. Positive affect toward of one's ethnic or racial group (i.e., ethnic-racial identity affirmation) has been shown to buffer the negative effects of racial discrimination on health outcomes. The extent to which one believes his or her group is valued by others (i.e., positive collective ethnic-racial identity) has also been proposed to be protective. However, to date a limited body of research has examined the moderating effect of collective ethnic-racial identity on health, and among available studies, findings are mixed. African American youth (N = 612; 58.2% female, M grade = 8) completed measures on experiences of discrimination, mood symptoms, substance use, ethnic-racial identity affirmation, and collective ethnic-racial identity (assessed using the Collective Self-Esteem Scale). Controlling for demographic variables and affirmation, a significant main effect was found for collective ethnic-racial identity, such that believing that others viewed your group positively was associated with better health outcomes among African American youth. However, collective ethnic-racial identity was not found to buffer the effects of discrimination on health outcomes. These findings highlight the importance of examining collective ethnic-racial identity and the promotive effect it can have on health outcomes for African Americans. More research is needed to better understand if there are health outcomes in which collective ethnic-racial identity may also mitigate risk as a consequence of racial discrimination. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Dying for Equal Protection

When health policy experts noticed that health outcomes for African Americans were consistently worse than those of their White counterparts, many in the health care community assumed that the poor outcomes could be blamed on poverty and lifestyle choices. Subsequent research told a different story. Studies repeatedly showed that neither money, nor marriage, nor educational achievement protect African American men, women, or children from poor health. Instead, the disparities were more likely explained by racism. Specifically, multiple studies have shown that experiencing racism has been linked to increased infant and maternal mortality rates, elevated stress levels, and an increased risk of numerous diseases, including cardiovascular disease, high blood pressure, and breast cancer. Mounting evidence makes it clear that health disparities cannot be eliminated simply by changes in diet or socioeconomic status; it requires eliminating racism and building a more just society. A just society starts with a just government, but racially-biased government policies and practices have existed since the founding of our country and have had—and continue to have—a direct and devastating impact on the health of African American individuals and communities. This Article traces the racially discriminatory laws and policies enacted or tolerated by state and federal governments in America from colonial times to the present—including slavery, Black Codes, convict leasing, lynching, segregation, and discriminatory policing—and links that racism to poorer health outcomes for African Americans. It concludes by discussing the need for criminal justice and social reforms to explicitly consider their impact on the health of the African American community.

High Income Protects Whites but Not African Americans against Risk of Depression.

Background: Built on the Blacks’ diminished return theory, defined as smaller effects of socioeconomic status (SES) on a wide range of health outcomes for African Americans compared to Whites, the current study compared African Americans and Whites for the association between household income and risk of lifetime, 12-month, and 30-day major depressive disorder (MDD). Methods: For the current cross-sectional study, we used data from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003. With a nationally representative sampling, CPES included 4746 non-Hispanic African Americans and 7587 non-Hispanic Whites. The dependent variables were lifetime, 12-month, and 30-day MDD, measured using Composite International Diagnostic Interview (CIDI). The independent variable was household income. Age, gender, education, chronic medical conditions, and obesity were covariates. Race was the focal moderator. Logistic regression models were used to test the protective effects of household income against MDD in the overall sample and also by race. Results: In the overall sample, household income was inversely associated with the risk of 12-month and 30-day MDD. We found a significant interaction between race and household income on 12-month and 30-day MDD, suggesting a smaller protective effect of household income against MDD for African Americans compared to Whites. Conclusion: In line with the Blacks’ diminished return theory, household income better protects Whites than African Americans against MDD. The contribution of diminished return of SES as an underlying mechanism behind racial disparities in health in the United States is often overlooked. Additional research is needed on why and how SES resources generate smaller health gain among minority groups.

African American nurses describe pre-licensure education experiences: A qualitative study.

Greater diversity in the healthcare workforce enhances cross-cultural communication, diminishes bias and stereotyping, thereby improving health outcomes for African Americans. Diversifying the nursing profession has been a persistent challenge and the experiences of African American nursing students in not yet well understood. The aims of this study were to describe the experiences of pre-licensure nursing school, and the meaning of those experiences, retrospectively for African American nurses. The sample for this qualitative descriptive study included 14 African American nurses who reflected on their nursing school experiences. A salient theme of standing out emerged from the data with subthemes of being watched and being ignored. Laying low and being noticed emerged as success strategies for nursing school. African American student experiences are complex and at times appear dichotomous. Improving African American nursing student success necessitates the creation of a more hospitable learning environment to mitigate the effects of standing out.

A Qualitative Inquiry of Lower Extremity Disease Knowledge Among African Americans Living With Type 2 Diabetes.

The purpose of this study was to investigate how personal illness representations of type 2 diabetes affected the level of foot care knowledge and self-care strategies among African Americans adults. Thirteen African Americans (ages 32-72 years) participated in individual semistructured qualitative interviews regarding self-care practices and lower extremity disease knowledge related to type 2 diabetes. Using phenomenological methodology, all interviews were transcribed and analyzed by the research team for themes. Three major themes emerged from the interviews: basic foot care knowledge, lower extremity disease knowledge, and patient-provider communication. The study yielded that the majority of the participants lacked understanding of basic diabetic foot care as well as how lower extremity complications can evolve from uncontrolled type 2 diabetes. Diabetes self-management education is an essential component that could aid in the improvement of poor health outcomes of African Americans. Diabetes self-management education programs should consider implementing more detailed foot care educational tools, especially those individuals who are affected with complications due to the disease and that can lead to lower extremity amputations. This study provided insight on the importance of this knowledge as it relates to making common sense assumptions about the disease and self-management strategies.

Abstract 214: Is Goal-Striving Stress Associated With Cardiovascular Disease Among Jackson Heart Study Participants?

Introduction: It is known that psychosocial stress is associated with cardiovascular disease (CVD). Recent research has reported that goal-striving stress (GSS) is associated with poor health outcomes for African Americans. GSS is the “¼discrepancy between aspiration and achievement, and the level of disappointment experienced if goals are not reached.” As far as we know, no research has examined the relationship between GSS and CVD prevalence among African Americans. Thus, the purpose of the current study was to investigate the association between GSS and CVD prevalence among a large sample of African Americans. Methods: The Jackson Heart Study (JHS) includes 5,181 men (37%) and women who completed a baseline survey to capture data on psychosocial variables, CVD history, demographic variables, and CVD risk factors. It was hypothesized that higher levels of GSS would be associated with CVD prevalence. The average GSS level was 4.49. GSS was categorized into tertiles with CVD prevalence and associations assessed cross-sectionally by multivariable logistic regression analysis that adjusted for demographic, behavioral and clinical risk factors. Results: It was found that GSS was significantly associated with CVD for tertiles 1, 2, and 3 at 41.26%, 36.25%, and 22.49% respectively. Additionally, GSS was significantly associated with CVD prevalence per unit increase after adjusting for age and sex (OR 1.03, 95% CI 1.02-1.05), SES (OR 1.03, 95% CI 1.02-1.05), and smoking, diet, physical activity, and sleep (OR 1.03, 95% CI 1.01-1.05). However, there was slight attenuation after adjustment for CVD risk factors (OR 1.01, 95% CI 0.99-1.04). Conclusions: The present study represents an important contribution to the literature in that it appears to be the first to empirically investigate the link between GSS and CVD prevalence among African American men and women.

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

BackgroundThere is abundant evidence that low socioeconomic status (SES) is associated with worse health outcomes among people with Rheumatoid Arthritis (RA); however, the influence of socioeconomic disadvantage in early life has yet to be studied within that population.MethodsData originated from the cross-sectional arm of the Consortium Evaluation of African-Americans with Rheumatoid Arthritis (CLEAR II), which recruited African-Americans with RA from six sites in the Southeastern United States. We used linear regression models to evaluate associations of parental homeownership status and educational level at participant time of birth with participant-reported fatigue (Visual Analog scale, cm), pain (Visual Analog scale, cm), disability (Health Assessment Questionnaire) and helplessness (Rheumatology Attitudes Index), independently of participant homeownership status and educational level. Models included random effects to account for intra-site correlations, and were adjusted for variables identified using backward selection, from: age, disease-duration, sex, medication use, body-mass index, smoking history.ResultsOur sample included 516 CLEAR II participants with full data on demographics and covariates. 89 % of participants were women, the mean age was 54.7 years and mean disease duration was 10.8 years. In age adjusted models, parental non-homeownership was associated with greater fatigue (β = 0.75, 95 % CI = 0.36–1.14), disability (β = 0.12, 95 % CI = 0.04–0.19) and helplessness (β = 0.12, 95 % CI = 0.03–0.21), independently of participant homeownership and education; parental education had a further small influence on self-reported fatigue (β = 0.20, 95 % CI = 0.15–0.24).ConclusionsParental homeownership, and to a small extent parental education, had modest but meaningful relationships with self-reported health among CLEAR II participants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0882-5) contains supplementary material, which is available to authorized users.