Low-income African American Community Research Articles

Factors Associated with Beneficiary Outcomes from Community Health Programs in Predominantly Low-Income African American Communities in Mississippi USA.

Community health programs (CHPs) can improve the conditions of disadvantaged populations through direct health and support services. We examine factors associated with two CHP beneficiary outcomes including program needs being met and satisfaction in the low-income and predominantly African American cities of Belzoni and Jackson in Mississippi, USA. A retrospective and cross-sectional design is implemented using chi squared tests and regression analysis of 108 survey responses from a convenience sample. Chi-squared test results associate program meeting needs with gender, participation, efforts towards financial success, and financial condition. Satisfaction is also associated with age, marital status, gender, years at address, degree of participation, ethnicity, efforts at financial success, and financial condition. Equally, logistic regression analysis associates satisfaction with marital status, gender, years at address, age group, ethnicity, education, and efforts at financial success. The negative relationship between participation in program activities and satisfaction, and the large size of participants (42-57%) who areless likely to report satisfaction with services, calls for an investigation of the causes of low levels of satisfaction. Immediate and long-term improvements needed to strengthen the fit between CHP services and beneficiary needs in Belzoni and Jackson are recommended.

Peer mentoring for smoking cessation in public housing: A mixed-methods study.

Tobacco use disproportionately affects low-income African American communities. The recent public housing smoke-free policy has increased the demand for effective smoking cessation services and programs in such settings. This mixed-method pilot study explored feasibility and potential impact of a peer-mentoring program for smoking cessation in a public housing unit. The quantitative study used a quasi-experimental design while qualitative data were collected via focus group discussions with peer mentors and participants. Three residents of the public housing complex were trained as peer mentors. Each peer mentor recruited up to 10 smokers in the residence and provided them individual support for 12 weeks. All participants were offered Nicotine Replacement Therapy (NRT). A follow-up investigation was conducted 3 months after completion of the 12-week intervention. At baseline and follow-up, the participants' smoking status was measured using self-report and was verified using exhaled carbon monoxide (eCO) monitoring. The intervention group was composed of 30 current smokers who received the peer-mentoring intervention. The control group was composed of 14 individuals. Overall mean eCO levels dropped from 26 ppm (SD 19.0) at baseline to 12 (SD 6.0) at follow-up (P < 0.01). Participants who were enrolled in our program were more likely to have non-smoking eCO levels (<7 ppm) at follow-up (23.3%) compared to those who did not enroll (14.3%). Our program is feasible for low-income predominantly African American communities. Using peers as mentors may be helpful in providing services for hard-to-reach populations. Given the non-randomized design of our study, randomized trials are needed to test the efficacy of our program in the future.

Examining changes to food and beverage availability and marketing in a low-income community after the opening of a new supermarket.

In 2016, a Whole Foods Market© opened in the Englewood community of Chicago, IL - a predominately low-income African American community. This study aimed to examine changes to food and beverage availability and marketing in Englewood's existing food stores after the opening of this supermarket. Quasi-experimental study. Two low-income African American communities in Chicago, IL. Fieldworkers audited all small grocery and limited service stores (e.g. convenience stores, liquor stores and dollar/discount stores) located within one-square mile of the new supermarket and a one-square mile area of a demographically comparable community that also lacked a supermarket. Stores were audited before (2016) and after (2017 and 2018) the supermarket opened. Of the 78 stores audited at baseline, 71·8 % were limited service stores and 85·9 % accepted Supplemental Nutrition Assistance Program (SNAP) benefits. Overall, the availability of healthy food and beverage options in nearby small stores was low at baseline and both follow-up periods. Difference-in-difference regression models revealed a significant increase in: (1) the percentage of stores in the intervention community (i.e. Englewood) offering regular cheese and promoting salty snacks at check-out from 2016 to 2017; and (2) the percentage of stores in the comparison community with interior store promotions for other sweetened beverages from 2016 to 2018. Minimal changes in food and beverage availability and marketing occurred 1 and 2 years after the opening of a new supermarket. However, the wide range of staple food items offered by the supermarket expanded healthy food retail in Chicago's Englewood community.

Mediators of the Relationship Between Functional Limitations and Loneliness Among Homebound African Americans

Physical/functional limitations are known to lead to loneliness, but there is little research on protective factors that may mediate their adverse association, particularly in vulnerable populations. This study used cross-sectional survey data from 147 (aged 58-90 years; 75% females) predominantly low-income African American homebound community dwellers to investigate the role of resilience and social connectedness in mediating the effect of physical/functional limitations on loneliness. Items from validated instruments were used to measure four latent variables (physical/functional limitations, resilience, loneliness and social connectedness). Structural parallel mediator models estimated each path in the mediation analysis controlling for gender, education, and age. Confidence intervals for mediation effects were generated via bias-corrected bootstrapping with 10,000 replications. The total effect of physical/functional limitations on perceived loneliness was significant. Social connectedness and resilience fully and significantly mediated the relationship between physical/functional limitations and loneliness. The indirect effect (B =.143; 95% CI = .047, .280) for the physical/functional limitations-resilience-loneliness pathway indicated that the positive effect of physical/functional limitations on loneliness was approximately 0.143 points lower as mediated by higher resilience. The indirect path of physical/functional limitations on loneliness through the mediation of social connectedness (B =.077; 95% CI = .010, .168) yielded a reduction of .077 points. The total amount of variance in feelings of loneliness accounted for by the overall model, which included the proposed mediators and control variables, was 48.6%. Interventions to build resilience and social interactions may attenuate the effects of physical/functional disability and loneliness on health outcomes in individuals at risk.

Can Social Connections Improve Dementia Knowledge Among Homebound Community-Dwelling Older African Americans?

Despite the clear and compelling association between social connections and well-being, the underlying mechanisms that help stave off adverse health impacts are not well understood, particularly among older adults in disadvantaged groups. Social relationships in older age may be instrumental for exchanging and gaining knowledge that further influence health and help increase awareness about misconceptions and lifestyle behaviors known to delay or reduce cognitive decline. This study used cross-sectional survey data from 147(aged 58-90 years; 75% female) low-income African American homebound community dwellers to investigate heterogeneity in dementia literacy profiles and its association with social connectedness. Eleven items (false=0, true=1, don’t know=2) from a validated instrument were used to measure dementia literacy (DL). The Lubben’s social network scale was used for a social connectedness construct. We employed a 2-stage latent class modeling approach to examine heterogeneity in DL and estimate the regressions among the derived classes and the predictors (social connectedness, education level and age). A 3-class model produced a reasonable fit and classification (entropy=0.852) of “dementia literacy patterns” labeled as (high-literacy:37%), moderate-literacy:45.2%), low-literacy:17.8%)). Social connectedness was highly predictive of class membership. A high level of social relationships increased the probability of being in the “high-dementia-literacy” class compared to the “low-dementia-literacy” class (OR=2.189, p=0.016). For a unit increase in social connectedness, the odds of being in the “high-dementia-literacy” class compared to the “low-dementia-literacy” class increased by a factor of 2.2. Tailored and focused interventions to reduce social disconnectedness may also help increase dementia awareness and reduce barriers to early diagnosis.

Neighborhood Influences on Physical Activity Among Low-Income African American Adults With Type 2 Diabetes Mellitus.

The purpose of the study was to explore the influences of the neighborhood environment on physical activity (PA) among people living with type 2 diabetes mellitus (T2DM) in a community with limited resources. Participants were adults with T2DM and their family members or friends who help in the management of T2DM and who were living in a low-income African American (AA) community. Health care providers working in the neighborhood were also included. Using an emergent design, qualitative data were collected through 7 focus group discussions (N = 63) and 13 in-depth interviews. Verbatim transcriptions were analyzed via thematic coding to explore contextual factors that limit PA and meaning around neighborhood features that promote or discourage PA. Levels of PA were strongly limited by neighborhood insecurity and a lack of recreational facilities in the neighborhood. People with T2DM and physical/mobility disabilities were more affected by the neighborhood environment than those without disabilities, particularly due to perceived safety concerns and social stigma. Despite socioeconomic inequalities within neighborhoods, participants showed resilience and made efforts to overcome social-environmental barriers to PA, applied various coping strategies, and received social support. Results suggested that in an underserved neighborhood, individual barriers to physical activity were amplified by neighborhood-level factors such as crime, especially among individuals who have T2DM and disabilities. Socioeconomic inequalities should be addressed further to improve management of T2DM and its complications.

A population health dietary intervention for African American adults with chronic kidney disease: The Fruit and Veggies for Kidney Health randomized study

BackgroundChronic kidney disease (CKD) is commonly asymptomatic until its late stages, reduces life quality and length, is costly to manage, and is disproportionately prevalent in low-income, African American (AA) communities. Traditional health system strategies that engage only patients with symptomatic CKD limit opportunities to prevent progression to end stage kidney disease (ESKD) with the need for expensive kidney replacement therapy and to reduce risk for their major mortality cause, cardiovascular disease (CVD). Published studies show that giving fruits and vegetables (F&V) to AA with early-stage CKD along with preparation instructions slowed CKD progression. This effective, evidenced-based, and potentially scalable dietary intervention might be a component of a community-based strategy to prevent CKD progression. DesignThis study supported by NIH grant (R21DK113440) will test the feasibility of an innovative screening strategy conducted at community-based institutions in low-income AA communities and the ability to intervene in individuals identified to have CKD and increased CVD risk with F&V, with or without preparation instructions. ObjectivesThe study will prospectively compare changes in urine indices predictive of CKD progression and CVD in participants receiving, compared to those not receiving, preparation instructions along with F&V, six months after the intervention. DiscussionAddressing the challenge of increasing progression of early to more advanced stages of CKD with its increased CVD risk requires development of effective strategies to screen, identify, and intervene with individuals found to have CKD with effective, comparatively inexpensive, community-based, and scalable strategies to prevent CKD progression, particularly in low-income, AA communities.

Stress-Related Outcomes after a Period of Unrest in Two Low-Income African American Communities

We examined the association of civil unrest with potentially stress-related outcomes among two low-income, African American communities in Baltimore following the death of Freddie Gray in police custody and whether neighborhood proximity to unrest moderated these associations. We leveraged data from a cross-sectional survey of randomly selected households in two public housing communities (n=342) collected before, during, and after the civil unrest (August 2014 to August 2015). We used multivariate regression to explore the association of unrest with depressive symptoms and elevated blood pressure adjusting for potential confounders and community attributes. After the 2015 civil unrest event in Baltimore, those living in a low-income community near the epicenter demonstrated higher rates of depressive symptoms, but not elevated blood pressure, compared with those living in a comparable neighborhood three miles away. Low-income communities in Baltimore could benefit from mental health services after periods of civil unrest.

Community-Driven Priorities in Smartphone Application Development: Leveraging Social Networks to Self-Manage Type 2 Diabetes in a Low-Income African American Neighborhood.

Social networks have the potential to enhance Type 2 Diabetes Mellitus (T2DM) self-management. We used qualitative methods to study if and how mobile application (app) functions that mobilize social resources to improve T2DM management would be desired in a low-income African American community. Data were collected through community discussions and in-depth interviews with 78 participants in 2016–2018. Participants included individuals with self-reported pre-diabetes, T2DM, close family members or friends of a T2DM patient, and healthcare providers. Open-ended questions solicited information about challenges with T2DM management and gathered ideas on features of a mobile app that could address them. Data were transcribed and thematically coded by two coders using Atlas-ti. Regarding types of app functions, main themes included: (1) the importance of having support in diabetes self-care; (2) using informal networks to help to each other; and (3) monitoring one another through an app. Suggested app features included reminders for and transportation to medical visits, sharing information and exercise companionship, and providing opportunities for monitoring by friends/family members, especially in case of emergencies. Participants viewed an app as a potential vehicle for reinforcing accomplishments in T2DM self-management. Future research should implement and test an app with these features in this or similar communities.

A preliminary study of a composite sleep health score: associations with psychological distress, body mass index, and physical functioning in a low-income African American community

ObjectivesAlthough multiple individual sleep measures (eg, sleep duration, satisfaction) have been linked to a wide range of physical and mental health conditions, scant research has examined how individual sleep dimensions may act independently or additively to influence health. The current study investigates associations of 5 sleep dimensions (duration, satisfaction, efficiency, timing, and regularity), analyzed separately and simultaneously, with psychological distress, body mass index, and physical functioning among a low-income, predominantly African American population. DesignWe constructed a composite sleep health (SH) score from the sum of scores, representing “good’ and “poor” ranges of 5 sleep measures (range 0-5). SettingTwo low-income, predominantly African American neighborhoods in Pittsburgh. ParticipantsParticipants included 738 community-dwelling adults (78% female and 98% black). MeasurementsActigraphy-based measures of sleep duration, regularity, timing, and efficiency, and self-reported sleep satisfaction. Outcomes included self-reported psychological distress, physical functioning, and measured body mass index (BMI). ResultsEach 1-unit higher SH score was associated with 0.55-unit lower psychological distress score (range 0-24) and 2.23-unit higher physical functioning score. Participants with at least 2, 3, or 4 sleep dimensions in the “healthy” range, vs fewer, had lower psychological distress scores. Greater sleep satisfaction was associated with higher physical functioning, and longer sleep duration was associated with lower physical functioning. Neither the composite SH score nor any of the individual sleep dimensions were associated with BMI. ConclusionsAssessing multiple sleep dimensions may provide a more comprehensive understanding of associations of sleep with psychological distress than assessing any single sleep dimension. Although no sleep measures were related to BMI in the current sample, analyses should be replicated in other samples to determine generalizability.

Portrayals of parental involvement: descriptions of family and school relationships in a low-income African American community

ABSTRACTThis sociocultural research investigated parent involvement in young children’s schooling in a low-income African American community. The study adopted an emic approach, using semistructured interviews to examine 14 caregivers’ involvement practices from their perspectives. Analyses were based on verbatim transcriptions of the interviews. Qualitative and frequency analyses based on each caregivers’ portrayal revealed these families were intimately involved in their children’s schooling and worked to offset potential involvement barriers. More research examining parent involvement from caregiver and community perspectives is needed to better understand the relationship between their involvement and their goals and values for their children’s development and education.

Developing a Mass Media Campaign to Promote Mammography Awareness in African American Women in the Nation's Capital.

This study developed and examined the reach and impact of a culturally appropriate mass media campaign pilot, designed to increase awareness about the importance of mammography screening and the available community mammography services for low-income African American women ages 40 and above. We conducted formative research using focus groups to inform campaign development, resulting in five emergent themes-good breast health, holistic views of healthiness, cancer fatalism, fear of mammogram machines, and mammogram affordability. The campaign targeted specific low-income African American communities in the District of Columbia via print ads in Metro stations and on buses, print ads in the Washington Informer, and online ads on a local TV network website. Data were collected before, during, and after campaign implementation to assess reach and impact. Reach was measured by number of impressions (number of people exposed to the campaign), while impact was assessed via online ad click-through rates, website use and referrals, and mammography center calls. The campaign was successful in reaching the target audience, with a total combined reach from all media of 9,479,386 impressions. In addition, the mammography center received significant increases in new website visitors (1482 during the campaign, compared to 24 during the preceding period) as well as 97 calls to the dedicated phone line. Further research involving a more long-term investment in terms of funding and campaign run time, coupled with a more robust evaluation, is needed to assess if culturally appropriate mass media campaigns can generate increased mammography screening rates and decrease breast-cancer-related mortality.

‘We need a safe, walkable way to connect our sisters and brothers’: a qualitative study of opportunities and challenges for neighborhood-based physical activity among residents of low-income African-American communities

ABSTRACTObjective: The purpose of this study was to explore perceptions of the benefits of and influencing factors for neighborhood-based physical activity (PA), and elicit suggestions for increasing neighborhood-based PA among primarily Black residents living in lower income neighborhoods.Design: Eight focus groups were conducted in low-income, predominantly Black neighborhoods (n = 8) in Greenville, SC during Spring 2014. Using a semi-structured focus group guide with open-ended questions, residents were asked to describe benefits of PA, neighborhood factors associated with PA, and ways to increase PA within their neighborhoods. Trained research assistants transcribed audio recordings verbatim. Using grounded theory and an ecological perspective, emergent coding was employed to generate initial categories with open and axial coding used to achieve consensus on themes.Results: Primarily Black (95%), female (72%), and older (M = 61.5 years) residents (N = 76) participated in the study. Seven themes were identified across the three main focus group topics: physical and mental health benefits of neighborhood PA, safety/hazards and social factors as influencing neighborhood PA, and improving safety, structural opportunities, and programing support to improve neighborhood PA. Most participants reported walking within their communities, despite describing several community-level barriers (e.g. drugs, safety). Residents desired structured neighborhood-based opportunities for increasing PA, including walking tracks and walking groups, and reported social benefits to being active, including increased awareness within the community and trust. Participants conveyed that walking strengthened the social environment of their community as well as the health of residents.Conclusion: Few studies of contextual factors and PA have focused on African-American, low-income neighborhoods. Despite diverse environmental constraints, residents reported walking within their communities as part of a healthy lifestyle. Social ecological interventions tailored to promote PA and reduce health disparities among residents of low-income communities should highlight neighborhood-based opportunities for PA, focusing on personal and collective social benefits of neighborhood walking.

Participatory Design of a Social Networking App to Support Type II Diabetes Self-Management in Low-Income Minority Communities.

Participatory design (PD) is an emerging alternative to existing methods of user-centered design (UCD), and may be a more appropriate approach for designing patient-facing products in the health care sector than conventional UCD. Type 2 Diabetes Mellitus (T2D) is a serious chronic illness that requires life-long treatment and life-long self-management of food intake, physical activity, and self-testing to avoid complications. T2D disproportionately affects low-income minority communities. Using PD, we have developed an app to help T2D patients. Called the Diabetes Networking Tool (DNT), the app is intended to help patients better self-manage by empowering their network of family and friends to better contribute and support the patient's self-management needs. PD was used to involve a low-income African American community into the process of identifying the specific problems and issues DNT needed to address. We then used multiple complementary analytical methods to condense and abstract the community inputs to yield a functional and user interface design for DNT.

Does a Crossover Age Effect Exist for African American and Hispanic Binge Drinkers? Findings from the 2010 to 2013 National Study on Drug Use and Health.

Among general population studies, lower rates of binge drinking tend to be found among African Americans and Hispanics compared to Whites. However, among older adult populations, minority groups have been shown to be at higher risk for binge drinking, suggesting the presence of a crossover effect from low to high risk as a function of age. To date, limited research has examined the crossover effect among African American and Hispanic populations compared to non-Hispanic Whites across large developmental time frames or explored variation in risk based on income or gender. This study aimed to fill these gaps in the literature. Data were compiled from the 2010 to 2013 National Survey on Drug Use and Health surveys, which provide annual, nationally representative data on substance use behaviors among individuals aged 12 and older. Hispanic, non-Hispanic African American, and non-Hispanic White respondents were included (N=205,198) in the analyses. A crossover effect was found for African American males and females among the lowest income level (i.e., incomes less than $20,000). Specifically, after controlling for education and marital status, compared to Whites, risk for binge drinking was lower for African American males at ages 18 to 24 and for females at ages 18 to 34, but higher for both African American males and females at ages 50 to 64. No crossover effect was found for Hispanic respondents. Although African Americans are generally at lower risk for binge drinking, risk appears to increase disproportionately with age among those who are impoverished. Explanatory factors, such as social determinants of health prevalent within low-income African American communities (e.g., lower education, violence exposure, housing insecurity) and potential areas for intervention programming are discussed.

Early Onset of Sexual Intercourse and Parental Incarceration among African American Youth Living in Urban Public Housing.

Mass incarceration, substance use, and adolescent early onset of sex (e.g., initiate sexual intercourse at 13years of age or younger) are social problems with disparate impacts on low-income African American communities. Two out of every five inmates in state and federal prisons are African American and the vast majority of these inmates are from low-income communities. Furthermore, this population experiences more severe consequences of substance use and abuse compared to other populations. In sum, African American youth endure the lion share of problems that mass incarceration and substance use leave in their wake. It is likely that the early onset of sex reported by African American youth in national data is related to mass incarceration and substance use in their communities. Using a sample of 142 African American youth, this paper assesses whether parental incarceration or substance, or both, are related to the likelihood of early onset of sex. Analytic procedures included chi-square and sequential logistic regression. The sample reported a mean age of 19 and 36% reported early onset of sex. Being male, paternal incarcerated, and maternal alcohol problems were associated with an increased likelihood of early onset of sex. Results point to a need for supportive services for the children of incarcerated parents, particularly those living in urban public housing developments.

Meaning-Less Differences: Exposing Fallacies and Flaws in “The Word Gap” Hypothesis That Conceal a Dangerous “Language Trap” for Low-Income American Families and Their Children

ABSTRACTThe present article compares and contrasts linguistic findings from longitudinal studies of low-income Americans derived from evidence of recorded family speech interactions. Hart and Risley (1995) employed research assistants who spent 1 hour per month observing language usage among families from different socioeconomic backgrounds in their homes for 2.5 years. Baugh (1983) spent 40 hours per week during seven consecutive summers between 1969 and 1976 as a participant observer in a low-income African American community, conducting tape recorded interviews with African American families in various social circumstances during the final 4 years, which always included recorded interviews within each family home. Comparison of the linguistic results derived from the alternative data collection procedures allow for a reinterpretation of Hart and Risley’s (1995, 2003) conclusions, casting doubt on their findings as well as their speculations about future linguistic prospects for Americans from diverse racial and socioeconomic backgrounds due to false positive interpretations of their results that wrongly conclude deceptively enticing causalities. Regrettably, the alleged “word gap” is another incarnation of a deficit language hypothesis that is fundamentally flawed and woefully uninformed by decades of extensive linguistic research that has been conducted by many different linguists in various American inner-city communities since 1968.

Epistemological inclusiveness in researching the African American community

African American communities have experienced negative effects from a history of medical abuse, lack of proper research procedures, and misinterpretations of study findings because of racism. These past injustices have led to a mistrust of research and researchers. This paper focuses on how some methodological challenges, in a study funded by a National Institutes of Health grant on two low-income African American communities in Kentucky, were mediated through the collaboration of a multi-racial/ethnic team of researchers engaged in cross-disciplinary research. The information for this paper is based on the reflections of key members of the research team. The reflections show that having researchers with different epistemologies resulted in a culturally aware and sensitive study in which emic and etic research approaches were adopted. The inclusion of race-based epistemologies and close community ties were found to be particularly useful in building trust and getting the support of the two communities. However, these outcomes were only possible because research team members provided each other latitude for intellectual freedom and leadership.

Economic preferences and obesity among a low-income African American community

Obesity has reached epidemic proportions in the US, with a significantly higher fraction of African Americans who are obese than whites. Yet there is little understanding of why some individuals become obese while others do not. We conduct a lab-in-field experiment in a low-income African American community to investigate whether risk and time preferences play a role in the tendency to become obese. We examine the relationship between incentivized measures of risk and time preferences and weight status (BMI), and find that individuals who are more tolerant of risk are more likely to have a higher BMI. This result is driven by the most risk tolerant individuals. Patience is not independently statistically related to BMI in this sample, but those who are more risk averse and patient are less likely to be obese.

Perceptions of Food Intake, Physical Activity, and Obesity Among African-American Children in the Lower Mississippi Delta.

To explore the nutrition and physical activity perceptions of children for planning a healthy weight curriculum to address childhood obesity in African-American children living in the Lower Mississippi Delta (LMD). Six children's focus group sessions. Two Louisiana parishes in the LMD. Seventy 8- to 13-year-old African-American children, 46 (66%) females and 24 (44%) males, participated in the focus group sessions. Interview questions were based on personal and environmental determinants and content and strategies for a healthy lifestyle program for children. Focus group discussions were audio recorded and transcribed, observer recorded, and analyzed to identify recurring trends and patterns among focus groups. Content analysis consisted of coding focus group transcripts for recurrent themes and review of data by an independent reviewer to confirm the themes. Emerging themes were categorized as healthy lifestyle opinions within the social cognitive theory constructs of personal and environmental determinants and curriculum content. LMD youth recognized a healthy eating pattern and that overweight and obesity result from poor eating habits and physical inactivity. Children's food intake pattern did not reflect this understanding, suggesting a need for culturally tailoring an intervention to impact the poor food intake and physical inactivity in two low-income African-American Delta communities.