Low-income African American Women Research Articles

The impact of the Prime Time Sister Circles® (PTSC) on blood pressure of low-income mid-life African American women in the United States

There is a pressing need to develop and evaluate culturally tailored, community-based interventions that address hypertension management among low-income African American women. We employed a randomized controlled trial to test the effectiveness of the Prime Time Sister Circles® Program in reducing blood pressure and body mass index among low-income African American women ages with hypertension. Study participants (N = 339) were African American women aged 40–75 years who were diagnosed with hypertension and received their primary care at government funded health centers in Washington, D.C. Compared to the usual care group, Prime Time Sister Circles® participation was associated with a reduction in systolic BP by − 2.45 (CI − 6.13, 1.23) mmHg, a reduction in diastolic BP by − 3.66 mmHg (CI − 6.32, − 0.99), and a change in BMI by − 0.26 (CI − 2.00, 1.48) from baseline to 15 months. The results suggest that culturally tailored community-based interventions can improve hypertension management in low-income women.

Video Interventions for Reducing Health Inequity in Cancer Screening Programmes: a Systematic Review.

Health equity can lead to disparities in cancer screening, treatment, and mortality. This systematic review aims to identify and describe interventions that used video or DVD formats to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates compared to usual care conditions. We searched PubMed, Web of Science, Embase, and Cochrane databases for randomized control trials (RCTs) published until 18/01/2023 that compared intervention versus usual care control groups, with the percentage of cancer screening uptake during follow-up as an outcome. The risk of Bias was assessed with the Cochrane Collaboration tool. After screening 4201 abstracts, 192 full texts were assessed for eligibility and 18 were included that focused on colorectal (n = 9), cervical (n = 5), breast (n = 5), and prostate (n = 1) cancer screening. All were based in the USA except one and most focused on ethnicity/race, while some included low-income populations. Most of the video interventions used to increase cervical cancer screening reported positive results. Studies aimed at increasing mammography uptake were mostly effective only in specific groups of participants, such as low-income or less-educated African American women. Results for colorectal cancer screening were conflicting. Videos that were culturally tailored or used emotive format were generally more effective than information-only videos. Video interventions to increase cancer screening among populations with low screening uptake show some positive effects, though results are mixed. Interventions that use individual and cultural tailoring of the educational material should be further developed and investigated outside of the USA.

Life Stress, Depression, and Religious Coping Among Low-Income African American Women

Life Stress, Depression, and Religious Coping Among Low-Income African American Women

Gentrification, Health, and Intermediate Pathways: How Distinct Inequality Mechanisms Impact Health Disparities

Gentrification yields a variety of effects, yet the mechanisms linking gentrification to health are unclear. Although quantitative research has helped to identify some patterns, the processes whereby neighborhood dynamics impact health are layered and span multiple levels of health—individual, family, and community. According to research describing large-scale drivers of health, inequality (e.g., income and social) is a significant risk factor for worse health, morbidity, and mortality. Drawing from an inequality-health framework, this paper explores how inequality created by gentrification (e.g., segregated pockets of wealth alongside relative deprivation) harms health and well-being. The current study presents findings from lower-income African American women across 20 U.S. cities, and examines pathways by which gentrification increases inequality and stress for residents living in gentrifying areas. Results indicate that gentrification contributes to both direct (e.g., material scarcity) and indirect (e.g., displacement, distrust, lack of belonging) pathways that impact health, supporting mediation via four major pathways. Implications for further research, theorization, and policy are discussed.

Barriers to Creating Healthier Home Food Environments: Process Evaluation Results From 2 Home Food Environment Intervention Studies.

Few studies have identified barriers to creating a home environment more supportive of healthy eating. We examined barriers faced by participants in a randomized controlled trial and an adaptation study of the Healthy Homes/Healthy Families intervention, which uses health coaches to support low-income families in creating healthier home food environments. Coaches maintained logs of participant interactions as part of a process evaluation. We thematically analyzed logs from interactions with participants, mostly lower-income African American women (n = 114), to identify barriers for each of 8 healthy actions that serve as core elements of the intervention. Difficulty of changing current habits was a barrier for 5 of the healthy actions. No time/convenience and limited family support each influenced 2 of the healthy actions, with interpersonal barriers also stemming from social situations and visitors, including grandchildren. Cost and economic challenges were barriers for 3 of the actions. Hunger, cravings, and limited access to resources (eg, transportation, fresh fruits and vegetables) were each noted as barriers for 1 healthy action. Overall, these findings provide insight for how to better support families who are trying to improve their home food environments and highlight the need for multilevel interventions.

Text Messaging as a Communication Modality to Promote Screening Mammography in Low-income African American Women.

IntroductionThough text messages are increasingly used in health promotion, the current understanding of text message-based interventions to increase screening mammography in low-income African American women is limited. This study aimed to assess the feasibility and acceptability of a text message-based intervention to increase screening mammography in low-income African American women.Materials and MethodsA 15-item, self-administered, paper-based survey on cell phone ownership, text messaging practices and preferences for future breast health information was administered to 120 female patients at an urban family medicine office. Descriptive analyses and demographic correlates of text messaging practices and preferences were examined. Results and DiscussionThe majority of respondents (95%) were cell phone owners of whom 81% reported texting. Prior receipt of a text message from a doctor’s office was reported by 51% of cell phone owners. Mammography appointment reminders were the most desired content for future breast health text messages. Age (≥ 70 years old) was found to have a significant negative relationship with text messaging practices and perceptions.ImplicationsThe use of text messages to promote mammography was found to be acceptable in this patient population. In addition to age, variables such as the frequency, timing and subject content of text messages also influence their acceptability.

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.

Minority Stress and Sexual Functioning Among African American Women With At-Risk Partners in South Los Angeles

Preliminary evidence indicates that acute and chronic psychological stress affect sexual arousal and satisfaction. African American women, in particular, are vulnerable to the impacts of gender- and race-related stress, given their socially constructed identities as African Americans and as women. We examined associations between minority stress and sexual function using data from 248 African American women. Surveys were conducted with 248 African American women in South LA with male partners at risk for acquiring HIV. We analyzed self-reports on (i) stress indicators: chronic burden, perceived racism/sexism, and histories of trauma/sexual abuse; (ii) Female Sexual Function Index domains: desire, arousal, and satisfaction; and (iii) potential moderators: social support and spirituality. We used multiple regression, adjusting for potential confounding factors, to examine the relationships between stress indictors, potential moderators, and sexual function domains. The outcomes were the female sexual function index domains of desire, arousal, and satisfaction. This largely low-income sample experienced significant chronic and acute stressors, was highly spiritual and reported strong social support. Moderate-high chronic burden and increasing sexism scores were independently associated with decreased arousal (B=-0.38, 95%CI=-0.75, -0.02) and satisfaction (B=-0.03, 95%CI=-0.06, 0.00) scores, respectively. Providers may want to explore chronic burden in patients who complain about low sexual arousal. Additionally, to develop effective HIV- and other STI-related interventions that impact behaviors that can confer sexual risk, prevention strategies are needed that either reduce contextual stressors or mitigate their impact. Strengths of this research are that it focuses on sexual function among previously under-studied, low-income African American women and that it takes into account the unique set of stressors faced by these women. A limitation is that the sample size may have been too small to capture the effects of potential moderators. Low-income African American women accumulate life stressors that may harm sexual function. Schrode K, Poareo E, Li M, et al. Minority Stress and Sexual Functioning Among African American Women With At-Risk Partners in South Los Angeles. J Sex Med 2022;19:603-612.

Intimate Partner Violence, Existential Well-Being, and Africultural Coping in African American Women

ABSTRACT Intimate partner violence (IPV), a significant public health problem among low-income African American women, often has negative sequelae. Despite this, many women in abusive partnerships report having meaningful lives. To advance our understanding of factors that promote resilience in this traumatized population, this investigation aimed to elucidate the potential mediating role of one culturally-salient factor, Africultural coping, in the relation between IPV (physical, non-physical) and existential well-being (i.e., meaning in life). The sample included 213 low-income African American women with a suicide attempt and IPV exposure in the prior year. Results from mediational analyses with bootstrapping partially support the study hypotheses. We found that (1) one form of IPV (nonphysical) was inversely related to existential well-being; (2) one form of IPV (physical IPV) was positively correlated with two of the four dimensions of this culturally-salient form of coping (spiritual-centered, ritual-centered); (3) four dimensions of Africultural coping, as well as the total score, correlated with existential well-being; and (4) Africultural coping as reflected in spiritual- and ritual-centered coping mediated the relation between IPV (physical, but not nonphysical) and existential well-being. The findings suggest that culturally responsive interventions that bolster Africultual coping behaviors may optimize the existing capacity of low-income African American women to manage stressful situations, such as IPV, in a manner that enhances the sense of meaning in their lives.

Low-Income, Older African Americans' Engagement in and Perceptions of a Smartphone-Based Ecological Momentary Assessment Study of Physical Activity and Sedentary Behavior.

Background and ObjectivesSmartphone-based ecological momentary assessment (EMA) methods can provide novel insights into modeling and predicting activity-related behaviors, yet many racial and ethnic minority groups report barriers to participating in mobile health research. We aim to (a) report on strategies used to successfully recruit and retain minority older adults in a smartphone-based physical activity and sedentary behavior EMA study and (b) report on participants’ perceptions of study acceptability.Research Design and MethodsResearchers partnered with trusted individuals and community organizations serving older adults to facilitate recruitment for an 8-day EMA study of minority older adults’ physical activity and sedentary behavior. Additional strategies such as having experienced, culturally competent team members and available technical support were employed to further recruitment and retention efforts. A poststudy questionnaire assessed participants’ perceptions of study acceptability.ResultsIn total, 123 minority older adults were recruited, 102 met inclusion criteria, 91 completed the study, and 89 completed the poststudy questionnaire. The sample consisted of predominantly low-income African American women with an average age of 70 years. Responses to open-ended questions revealed that the most enjoyable aspects of study participation were the ability to learn more about themselves, contribute to science and/or their community, engage in a new activity, and receive financial compensation. Participants reported the least enjoyable aspects of the study included the frequency of EMA questionnaires, apprehension of missing EMA questionnaires, carrying the smartphone, and difficulty wearing the accelerometer. Most participants (97%) expressed interest in being contacted for future studies.Discussion and ImplicationsLow-income, older African Americans reported positive perceptions of a smartphone-based EMA study of physical activity and sedentary behavior. Findings suggest that applying demonstrated strategies to engage this population in technology-based health research can enhance recruitment and retention efforts; however, it is unclear which strategies are most effective in reducing participation barriers.

Childhood maltreatment and resource acquisition in African American women: The role of self-esteem.

Childhood maltreatment (CM) is a public health crisis that results in negative physical, mental health, and psychosocial (e.g., resource attainment) outcomes. Resource attainment is a critical outcome for marginalized populations, such as low-income African American women. This study addresses the gap in the literature regarding the association between CM and effectiveness of resource attainment and the potential mediating role of self-esteem in this association for African American women. Data were gathered from a large public inner-city, university-affiliated health care system in the Southeastern United States. Participants selected were low-income African American women who have experienced intimate partner violence (IPV) and have attempted suicide in the prior year. The participants for this study completed the Childhood Trauma Questionnaire, the Beck Self-Esteem Scale, and the Effectiveness in Obtaining Resources Scale. Mediation analyses using bootstrapping with 213 women revealed the powerful role self-esteem plays in explaining the link between CM and resource attainment in low-income African American women. Specifically, overall CM and four of its subtypes (emotional abuse, physical abuse, emotional neglect, and physical neglect) were all associated with decreased resource attainment via the effect of decreased self-esteem. Sexual abuse was the only subtype of CM not significantly associated with self-esteem nor effectiveness of resource attainment. This research highlights the importance of screening for CM, its subtypes, and resource attainment in this population and bolstering self-esteem through psychological interventions to increase women's capacity to effectively secure necessary community resources. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Childhood Physical Abuse and Antisocial Traits: Mediating Role of Posttraumatic Stress Symptom Clusters.

Posttraumatic stress symptoms (PTSS) are associated with both childhood physical abuse (CPA) and antisocial (AS) traits, yet their potential as mediators of the CPA-AS traits link is understudied and the specific roles of individual symptom clusters in this relation is unknown. The current study aimed to examine the mediational role of PTSS in the relation between CPA and AS traits in a sample of low-income African American women with histories of intimate partner violence (IPV). It was hypothesized that avoidance would emerge as a significant mediator, whereas reexperiencing, numbing, and hyperarousal would not. Participants (N = 150) were recruited from a level-1 trauma public hospital and evaluated as part of a randomized controlled trial of a group therapy intervention for low-income, African American women suicide attempters with histories of IPV. The Childhood Trauma Questionnaire (CTQ), Posttraumatic Diagnostic Scale (PDS), and International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) were used to measure variables of interest. Using bootstrapping analyses, a parallel mediation model compared PTSS clusters as potential mediators of the CPA-AS traits relation, controlling for IPV. When reexperiencing, avoidance, numbing, and hyperarousal were entered simultaneously as potential mediators, only avoidance emerged as a significant mediator of the CPA-AS traits link. Avoidance symptoms may play a unique role in the link between early experiences of CPA and later AS traits among multiply traumatized African American women. Findings have implications for understanding AS traits in the context of early life trauma and suggest that targeting specific PTSS clusters (e.g., avoidance) may improve treatment outcomes for women in this population.

Correlates of cigarette smoking among low-income African American women.

This study examines individual and contextual correlates of cigarette smoking in a randomly selected, community-based sample of low-income African American women. The study sample was selected by using a two-stage area probability sample design. Participants were recruited from > 12,000 housing units selected from 39 census tracts in the city of Detroit. Participants for this study include a total of 921 women who completed the baseline assessment of a randomized clinical trial aimed at improving the oral health of African American families. Past month prevalence of cigarette use and number of cigarettes smoked during this period. Data were analyzed with fixed-effects and multilevel statistics. Social support was the only variable associated, inversely, with current smoking. Self-reported feelings of anger were positively associated, though marginally, with current smoking. Between-neighborhood variance was small, and no neighborhood level variables were associated with cigarette smoking. Previously established risk factors did not predict cigarette use in this randomly selected, community-based sample of low-income African American women. Further research is needed to identify risk and protective factors that might be unique to low-income African American populations in order to better inform preventive and cessation interventions.

Intersectional invisibility experiences of low-income African-American women in healthcare encounters

ABSTRACT Background The disparities that Black/African-American women experience in health care are persistent and staggering. Findings from health outcomes research continue to demonstrate poorer outcomes for African-American women compared to women of other race/ethnicity in several conditions. These racial/ethnic and gender health disparities observed are complex, heavily nuanced and multi-factorial. To understand these, there is a need to apply an ‘intersectionality’ lens. Intersectionality refers to the experience of persons with multiple intersecting statuses. The objective of this exploratory study was to gain insight into the healthcare experiences of low-income African-American women. Methods In-depth one-on-one interviews were conducted with 22 women and 2 focus group discussions with community leaders and advocates. Investigators conducted a thematic analysis of the transcripts. Results The thematic analysis revealed four major themes, which tell the story of the intersectional invisibility experienced by low-income AA women in the healthcare system. These included (1) the perception of ‘not feeling heard’; (2) patient as ‘expert of her own body’; (3) disregard of patient preferences; and (4) the need for self-advocacy. Conclusions Black/African-American women, and particularly those with socioeconomic disadvantage, experience intersectional invisibility resulting from provider implicit bias, stereotypical assumptions, and systemic structures that enable discriminatory practices in healthcare delivery. Healthcare provider education that more explicitly addresses these biases and stereotypes should be complemented with system-level interventions that aim to dismantle the structural racism inherent in healthcare policies and practices.

Childhood maltreatment, revictimization, and stay-leave decision-making

Survivors of childhood maltreatment (CM) are at increased risk of revictimization, including intimate partner violence (IPV). While research has established some mediators of this link, less is known about the process of stay-leave decision-making among CM survivors in abusive partnerships and how these decision-making processes may inform the CM-IPV link. Certain populations of revictimized women are understudied, such as low-income African American women, despite the fact that they experience higher rates of CM and IPV than their White counterparts. The present study is an investigation of stay-leave decision-making among a low-income sample of 121 African American women with recent IPV exposure. Severity of CM, by both type of maltreatment and cumulative maltreatment, was examined as related to salience of distinct stay-leave decision-making factors. Stay-leave decision-making factors were then tested as mediators of the relation between CM and severity of IPV. Using multivariate analyses of variance (MANOVA), experience of physical neglect was found to be especially associated with more consideration of poor social support, while other specific forms of CM were not differently associated with individual stay-leave decision-making factors. Using bootstrapping analyses, associations were found between greater severity of CM and three specific stay-leave factors: concerns related to social embarrassment, poor social support, and financial problems. Further, social embarrassment emerged as the most salient mediator of the relations between CM and three forms of IPV (i.e., physical abuse, nonphysical abuse, and controlling behaviors). The implications of these findings for clinical intervention and future research for this high-risk population are discussed.

Evaluating Depressive Symptoms Among Low-Socioeconomic-Status African American Women Aged 40 to 75 Years With Uncontrolled Hypertension

Depression is one of the leading causes of disability in the United States. African American women of low socioeconomic status with uncontrolled hypertension are at risk of having severe depressive symptoms, yet there is limited research about the mental health of this vulnerable population. Data from the Prime Time Sister Circles randomized clinical trial (PTSC-RCT) study can shed light on the prevalence of depressive symptoms among low-socioeconomic-status older African American women with hypertension. To determine the prevalence of depressive symptoms among low-socioeconomic-status African American women aged 40 to 75 years with uncontrolled hypertension who receive their care from a federally qualified health center (FQHC) and to identify risk factors associated with depressive symptoms. Cross-sectional analysis of data from the PTSC-RCT of depressive symptomology, measured using an adapted version of the 10-item Center for Epidemiological Studies Depression Scale Revised (CES-D-10). Descriptive statistics were used to characterize the study population. We used logistic regression models to investigate the factors associated with participants with or without symptoms of depression. We used baseline data from the PTSC-RCT study, including 316 African American English-speaking women between ages 40 and 75 years with hypertension (systolic blood pressure ≥140 mm Hg or diastolic ≥90 mm Hg), who received their primary care at a FQHC in Washington, DC, in 2017 and 2018 and were flagged by the FQHC as uncontrolled. We used the CES-D-10 from the Center for Epidemiologic Studies Depression Scale to measure presence of depressive symptoms. A total of 57.0% of the women in the study (180 of 316) scored greater than or equal to 10 on the CES-D-10. Depressive symptoms had a negative association with a postsecondary education (adjusted odds ratio [aOR], 0.492; 95% CI, 0.249-0.968) and a positive association with the number of chronic conditions (aOR, 1.235; 95% CI, 1.046-1.460) and smoking (aOR, 1.731; 95% CI, 1.039-2.881). In this study of low-income African American women with uncontrolled hypertension, more than half had symptoms of depression that was associated with less than high-school education, chronic conditions, and smoking. Low-income African American women with uncontrolled hypertension should be screened and adequately treated for depressive symptoms. ClinicalTrials.gov Identifier: NCT04371614.

Does social support moderate between depression and suicidal ideation in low-income African Americans?

Historically rates of death by suicide in African Americans have been lower than in other communities, although no ethno-racial differences have emerged in rates of suicidal ideation. Despite the fact that suicidal ideation impacts millions of people every year and is commonly reported by individuals who have attempted suicide, it has not been a focus of investigation among African American adults. One major predictor of suicidal ideation is depressive symptoms, although this association in African Americans has received little empirical attention. This study examines the impact of one potential culturally relevant moderator, social support, on the link between depressive symptoms and suicidal ideation in a sample of low income, African American adults with a recent suicide attempt (n = 267). Correlational analyses confirmed a positive, significant relation between depressive symptoms and suicidal ideation among the entire sample and separately for women and men. Linear regression analyses revealed that friend, but not family, support moderated the association between depressive symptoms and suicidal ideation, when controlling for homelessness. This moderating effect, however, was only found for the women (n = 152) in the sample. The results highlight the value of social support from friends in fostering resilience against suicidal ideation in high-risk low-income African American women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An activity space approach to understanding how food access is associated with dietary intake and BMI among urban, low-income African American women.

Inconclusive evidence for how food environments affect health may result from an emphasis on residential neighborhood-based measures of exposure. We used an activity space approach to examine whether 1) measures of food access and 2) associations with diet and BMI differ between residential and activity space food environments among low-income African American women in Atlanta, Georgia (n=199). Although residential and activity space environments differed across all dimensions of food access, being located farther away from 'unhealthy' outlets was associated with lower BMI in both environments. Future research should move beyond asking whether residential and activity space environments differ, toward examining if, how, and under what conditions these differences impact the estimation of health effects.

Africultural Coping Systems Inventory: Psychometrics in a Clinical Sample of African American Women

The Africultural Coping Systems Inventory (ACSI) assesses African Americans’ culturally relevant stress coping strategies. Although its factor structure, reliability, and validity of the scores have been examined across ethnic groups of African descent, psychometric properties have not been investigated in an African American clinical sample. Thus, it is unclear if the ACSI is useful for research with African Americans with distress. To assess the ACSI’s psychometrics, we used data from 193 low-income African American women who in the past year encountered interpersonal trauma and attempted suicide. We tested four models: one-factor, four-factor, four-factor hierarchical, and bifactor. None of the models were optimal, suggesting possible revisions to ACSI items. Yet the bifactor model provided a better fit than other models with items loading onto a general factor and onto specific factors. Internal consistency of the scores was above the recommended criterion (i.e., .70), and the ACSI general factor was related to depressive symptoms, suicidal ideation (but not alcohol abuse), providing some support for its concurrent validity. Future directions, limitations, and clinical-counseling implications are discussed.

Using Fruits And Vegetables To Motivate Adherence To Walk With Ease, An Arthritis Focused Walking Program, In Low-income African American Women

Using Fruits And Vegetables To Motivate Adherence To Walk With Ease, An Arthritis Focused Walking Program, In Low-income African American Women