Low-income African American Women Research Articles

Perceived Barriers to Type 2 Diabetes Prevention for Low-Income Women With a History of Gestational Diabetes: A Qualitative Secondary Data Analysis.

The purpose of this qualitative study was to examine perceived barriers to adoption of lifestyle changes for type 2 diabetes prevention among a diverse group of low-income women with a history of gestational diabetes mellitus (GDM). A secondary data analysis of 10 semistructured focus group discussions was conducted. Participants were low-income African American, Hispanic, and Appalachian women ages 18 to 45 years who were diagnosed with GDM in the past 10 years. A qualitative content analysis was conducted to identify key themes that emerged within and between groups. Four key themes emerged on the role of knowledge, affordability, accessibility, and social support in type 2 diabetes prevention. Women discussed a lack of awareness of the benefits of breastfeeding and type 2 diabetes prevention, inaccessibility of resources in their local communities to help them engage in lifestyle change, and the desire for more culturally relevant education on healthful food options and proper portion sizes. Study findings suggests that to improve effectiveness of type 2 diabetes prevention efforts among low-income women with GDM history, health care providers and public health practitioners should avoid using "one-size-fits-all" approaches to lifestyle change and instead use tailored interventions that address the cultural and environmental factors that impact women's ability to engage in recommended behavior change.

From sculpting an intervention to healing in action

ABSTRACT Black/African Americans have the most severe and disproportionate burden of HIV of all racial/ethnic groups in the United States. Oppression operates at four interrelated levels (i.e., socio-structural (macro), institutional (exo), community/family (meso), and inter- and intrapersonal (micro)) that perpetuate the HIV epidemic in Black/African American communities. Oppressive (e.g., racist and sexist) cultural scripts transferred to individuals through community, family and interpersonal relationships may play a role in HIV/STI risk. However, socio-behavioral health interventions or behavioral risk reduction interventions have traditionally focused solely on individual-level health risk behaviors allowing invisible, inequitable socio-structural factors to continue unchallenged. A new intervention, Black Men and Women: Empowering Self, Relationships and Community, was sculpted from two existing interventions Community Wise and Men of African American Legacy Empowering Self (MAALES) to develop awareness of oppressive cultural scripts operating on interpersonal and intrapersonal levels and to take action against these oppressive messages to reclaim identity, restore relationships, and build community. This paper summarizes the theory and selected sociodramatic components of the intervention that promote healing in action to reduce HIV/STI risk among heterosexually identified, low-income African American men and women with multiple sex partners. Lessons learned in theory, research and practice are also discussed.

Abstract P533: Food Shopping Practices of Low-income African American Women: Associations With Features of the Food Environment

Introduction: The food environment has received considerable attention as a potential correlate of diet-related CV health. Features of the food environment are assumed to influence the places where people shop, which in turn affect the types of foods purchased and ultimately consumed. However, this assumption remains largely untested due to limited data on where people actually shop. Leveraging unique spatial data on food shopping destinations, we examine whether features of the food environment are associated with the food shopping practices of low-income African American women in Atlanta, Georgia (n=199). Hypothesis: Access to food retailers will be positively associated with their use. Methods: We collected spatial data on locations visited in the past month using a Google Maps-driven questionnaire. Food shopping practices, including the number of retailers, trip frequency, and average distance traveled from home, were assessed separately for supermarkets, convenience stores, and discount (e.g. dollar) stores. We used secondary data on retail food outlets to calculate three measures of food access: density, proximity, and quality. GEE estimated adjusted associations between food access and food shopping practices, controlling for correlation within census tracts. Adjusted models examined supermarket shopping practices, the only outlet used by a majority of women. Results: Only 12.1% of women had a supermarket located within 1 mile of home, compared to 53.8% for convenience and 22.6% for discount stores. Women lived farthest from supermarkets ( Mdn =1.6 mi, IQR =0.9-2.3), followed by discount ( Mdn =1.0 mi, IQR =0.6-1.3) and convenience ( Mdn =0.4 mi, IQR =0.2-0.7) stores. Women also traveled farthest to shop at supermarkets ( Mdn =3.6 mi, IQR =2.5-5.3), traveling over twice the distance of the closest outlet. Nearly all women (97%) shopped at supermarkets, 33% at discount stores, and 25% at convenience stores. In adjusted models, exposure to higher supermarket density was associated with a 13% decrease in distance traveled from home to utilized supermarkets ( e β =0.87, 95% CI : 0.80-0.94). Living farther away from a supermarket was weakly associated with distance traveled from home to utilized supermarkets ( e β =1.04, 95% CI : 1.03-1.06). Conclusions: Women may seek to overcome limited access to supermarkets, rather than rely on more accessible, but less healthy retailers. While women exposed to a higher density of supermarkets used supermarkets closer to home, living in closer proximity to a supermarket minimally affected how close to home they shopped. Higher retail density offers a greater number of supermarket choices, making it more likely that women will find one closer to home aligned with their personal preferences (e.g. affordability, hours, access from public transport). Interventions to improve food access must acknowledge that proximity alone may not drive outlet use.

Childhood abuse, posttraumatic stress symptoms, and alcohol misuse among African-American women

The study explored associations among childhood abuse, post-traumatic stress symptoms (PTSS), and alcohol misuse in a sample of low-income African-American women (N = 172). Using bootstrapping techniques, a mediation effect was found of childhood physical and emotional abuse on alcohol misuse via PTSS symptom severity, avoidance, and hyperarousal, as well as for childhood sexual abuse on alcohol misuse via PTSS symptom severity and hyperarousal. Our results suggest that PTSS indicators, particularly symptom severity and hyperarousal, may be important mechanisms underlying the association of experiences of abuse during childhood and alcohol misuse in adulthood.

"We get double slammed!": Healthcare experiences of perceived discrimination among low-income African-American women.

Background:On account of their racial/ethnic minority status, class, and gender, African-American women of low socioeconomic status are among the least privileged, underserved, and most marginalized groups in the United States. Generally, African Americans continue to experience poorer health outcomes, in which disparities have been attributed to socioeconomic inequities and structural racism. This objective of this study was to explore the lived experiences of low-income African-American women in interacting with the healthcare system and healthcare providers.Methods:Twenty-two in-depth one-on-one interviews were conducted with low-income African-American women. The audio-recorded interviews were transcribed verbatim. An inductive content analysis was performed, using an analytical software, Dedoose® to enabled hierarchical coding. Codes were grouped into categories which were further analyzed for similarities that led to the emergence of themes.Results:A key finding was the experience of discriminatory treatment. The three themes that emerged relevant to this category were (1) perceived discrimination based on race/ethnicity, (2) perceived discrimination based on socioeconomic status, and (3) stereotypical assumptions such as drug-seeking and having sexually transmitted diseases.Conclusion and Recommendations:Low-income African-American women experience less than satisfactory patient care, where participants attribute to their experience of being stereotyped and their perception of discrimination in the healthcare system and from providers. Patients’ experiences within the healthcare system have implications for their healthcare-seeking behaviors and treatment outcomes. Healthcare personnel and providers need to be more aware of the potential for implicit bias toward this population. Healthcare workforce training on culturally responsive patient care approaches and more community engagement will help providers better understand the context of patients from this population and more effectively meet their healthcare needs.

Access to Health Care for Low-Income African American Women: Lived Experiences and Expectations.

Women of color and people of low socioeconomic status continue to have poorer health outcomes than their counterparts. This study explored patientsatisfaction and perceptions of low-income African American women regarding access to care. The study took a mixed-methods approach. Ninety-five women were surveyed using the Short-form Patient Satisfaction Questionnaire (PSQ-18). Two sub-scales assessed satisfaction with access to care. Qualitative data were collected using one-on-one interviews (n=22) and two focus groups of community leaders. A thematic analysis was then conducted. On a 5-point scale, patient-satisfaction with access was moderate (accessibility and convenience -2.99; financial aspects -3.35). Emerging themes included obtaining insurance, dynamics of insurance eligibility, adequacy and scope of insurance coverage, scheduling appointments, and transportation. Providing insurance coverage for people with low incomes is not sufficient to close the racial/ethnic disparities gap in access to care. Understanding the challenges from patients' perspectives can help to make health care resources and services more accessible.

Impulsivity Mediates the Link between Childhood Sexual Abuse and Juvenile Incarceration among Low-Income African American Women

ABSTRACT A history of childhood trauma has been found to have a robust influence on juvenile delinquency, and evidence suggests that childhood sexual abuse is particularly common among female youth involved in the juvenile justice system. The current study sought to investigate impulsivity as a potential mediator of the relationship between childhood sexual abuse (CSA) and juvenile incarceration amongst a community sample of low-income, urban, African American adult women. Although impulsivity has been studied among justice-involved youth, few studies have examined the influence of impulsivity within the relationship between CSA and juvenile incarceration and no known studies have explored their relationship in community populations of African American women with histories of juvenile incarceration. Results revealed that impulsivity mediated the relationship between CSA and previous juvenile incarceration. As an exploratory analysis, overall emotion dysregulation as well as other facets of emotion dysregulation did not serve as significant mediators in this relationship. These findings suggest that difficulties in impulse control may be one mechanism through which childhood sexual abuse increases risk for juvenile justice system involvement among African American women.

My Life as a Female Leader in the Academy: Lessons Learned

In this article, I share my story as a clinical psychologist in academic medicine and as a female leader within organized psychology. I discuss how my sociocultural background impacts and is impacted by the care I provide at an inner-city, safety net hospital and my clinical-research with low-income African American women and families. I offer my thoughts on how my personal and professional identities are informed by my dedication to supervising and mentoring women from diverse backgrounds. I address how these identities led me to embrace a collaborative, transformational, and courageous leadership approach and to engage in social justice advocacy.

Factors Influencing Recommended Cancer Screening in Low-Income African American Women in Tennessee.

This study examined the factors that predict recommended screening compliance to cervical, breast, and colorectal cancers in low-income African American women. It also examined obstacles to screenings by geographic region and screening status. As a part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n = 308) were selected from the Meharry CNP community survey database. There were several predictors to recommended screening such as being employed and having health insurance (P < 0.05). Additionally, the obstacles to screening posed a similar level of difficulty for participants from different geographic areas. Sociodemographic differences and obstacles of screening need to be addressed in educational interventions aimed at improving cancer screenings.

‘If only I had known – I would have done anything to keep my baby’. Assumption of care at birth, who's story is it?

This study was undertaken in partnership with a publicly funded reproductive healthcare organization to better understand barriers to utilization of its services as perceived by low income African American women in its community and how those barriers might be managed. The study uses a place-based, ecological perspective to theorize privacy challenges across different levels of the communication ecology. Analysis of participant observation, interviews, and focus group data identified three key public-private problematics in African American women's experience of reproductive healthcare seeking in a smaller urban setting: a public-private problematic of organizational identity, of organizational regions, and of organizational members. Potential strategies are identified for managing these problematics by the organization and community members.

Psychosocial Mediators Between Intimate Partner Violence and Alcohol Abuse in Low-Income African American Women.

Intimate partner violence (IPV) exposure can increase alcohol use. Although African Americans use less alcohol compared with European Americans, African American women experience disparate rates of IPV, potentially intensifying their alcohol abuse. We used data from 171 African American women to test if IPV was related to alcohol abuse and if psychosocial factors-loneliness, embarrassment, fear of harm, hope, social support, childcare needs, and finances-mediated this link. IPV and alcohol abuse were related, and several factors were related to either IPV or alcohol abuse. Social support was related to both, and it mediated the IPV-alcohol abuse link, explaining women's alcohol abuse relating to IPV.

A preliminary study of early childhood parenting and adult past month drug use risk in low-income African American women

PurposeThis preliminary study was designed to assess the feasibility of examining early childhood parenting factors and their relationship with adult past month drug use among low-income African American women. MethodsA cross-sectional survey of 156 low-income African American women was conducted. Measures included the childhood parental bonding scale, frequency of exposure to corporal punishment (CP) in childhood, The Drug Abuse Screening Test (DAST) and The Differentiation of Self Scale. Structural equation modeling (SEM) was used to assess the relationship between the primary predictors, latent parental bonding and corporal punishment exposure, with past month drug use. The intermediary construct, emotional reactivity, was also included in the SEM model to test mechanisms of mediation. ResultsThere was a significant main effect for maternal care on lower emotional reactivity patterns in adulthood. There was also a significant main effect for frequent CP on higher emotional reactivity patterns in adulthood. The relationship between both parenting measures and drug use were mediated by emotional reactivity. ConclusionChildhood maternal factors are a strong predictor of adult past month drug use, and this may be accounted for, in part, by the influence that parenting patterns in childhood have on adult emotional reactivity patterns. These observations should be examined in a longitudinal study to determine the stability of our observation that CP in childhood, even when controlling for positive maternal bonding patterns, influences emotional reactivity patterns that predispose an individual to negative coping strategies, such as drug use, in adulthood, among low-income African American women.

Problematic Eating Behaviors Are More Prevalent in African American Women Who Are Overweight or Obese Than African American Women Who Are Lean or Normal Weight.

Problematic eating behaviors such as overeating and loss of control over consumption can lead to obesity. Problematic eating behaviors among women of differing body mass indexes were explored through focus group methodology, the Palatable Eating Motives Scale (PEMS), and a taste test in a sample of low-income African American women (n = 45). Women who were overweight or obese (W-O/O) reported more problematic eating behaviors including eating in the absence of hunger, frequent overeating, and increased food thoughts than women who were lean or normal weight (W-L/N). The W-O/O appear to possess more problematic eating behaviors than W-L/N.

Food Insecurity and Maternal Mental Health among African American Single Mothers Living with HIV/AIDS in the Alabama Black Belt.

Little is known about the relationship between food insecurity and depression among African American low-income single mothers living with HIV/AIDS in rural Alabama. Food insecurity is a neglected variable in bioethics, biomedical, behavioral, and health disparities research. Regression analyses of data from a survey of African American single mothers living with HIV/AIDS in Alabama's Black Belt were used to evaluate the association between food insecurity and depression. As determined by the USDA food insecurity scale, about 53% of the sample was classified as food insecure. In the bivariate regression model, food insecurity was associated with depression. After controlling for sociodemographic variables, food insecurity remained positively associated with depression in this sample. Food insecurity places low-income African American women at risk of depression. Given widespread poverty among HIV-positive individuals in the Black Belt, access to food should be considered in HIV-related prescriptions and in health disparities research.

Cardiovascular and Metabolic Risk in Women in the First Year Postpartum: Allostatic Load as a Function of Race, Ethnicity, and Poverty Status.

Allostatic load (AL) represents multisystem physiological "wear-and-tear" reflecting emerging chronic disease risk. We assessed AL during the first year postpartum in a diverse community sample with known health disparities. The Eunice Kennedy Shriver National Institute for Child Health and Human Development Community Child Health Network enrolled 2,448 predominantly low-income African-American, Latina, and White women immediately after delivery of liveborn infants at ≥20 weeks' gestation, following them over time with interviews, clinical measures, and biomarkers. AL at 6 and 12 months postpartum was measured by body mass index, waist:hip ratio, blood pressure, pulse, hemoglobin A1c, high-sensitive C-reactive protein, total cholesterol and high-density lipoprotein, and diurnal cortisol slope. Adverse AL health-risk profiles were significantly more prevalent among African-American women compared with non-Hispanic Whites, with Latinas intermediate. Breastfeeding was protective, particularly for White women. Complications of pregnancy were associated with higher AL, and disparities persisted or worsened through the first year postpartum. Adverse AL profiles occurred in a substantial proportion of postpartum women, and disparities did not improve from birth to 1 year. Breastfeeding was protective for the mother.

Stress and Coping Profiles and Cardiometabolic Risk in Low-Income African American Women.

Background: The complex interplay of psychological stress appraisal, biology, chronically stressful environments, and individual coping mechanisms can impact and tax physiological adaptive processes. This can result in increased cardiometabolic risk (CMR), type 2 diabetes, and cardiovascular disease. Underlying mechanisms are not entirely clear and appear to differ significantly based on age, sex, race, and ethnicity. This crosssectional descriptive study explored stress profiles of psychological and behavioral adjustment to determine the extent to which patterns of stressors, coping, and CMR differentiated these profiles. Materials andMethods: African American (AA) women (N = 110; M age = 38.61 years, SD = 6.94 years) were recruited from low-income communities and participated in two home visits to complete stress and coping and cardiovascular risk measures. Results: Three distinct stress and coping adjustment profiles were associated with differences in CMR. The "holding steady" profile had less insulin resistance (IR) and substance use compared to "high substance users" and "high internalizers" profiles. Women who were "holding steady" used less avoidant coping than "high internalizers." Conclusions: Less favorable adjustment processes were associated with IR, as well as significantly higher levels of avoidant coping and substance use. In AA women, awareness of and attention to stress and coping patterns may help attenuate CMR.

Correction: Pullen, E. and Oser, C. Disadvantaged Status and Health Matters Networks among Low-Income African American Women. Soc. Sci. 2017, 6(3), 108

The authors wish to make the following change to their paper (Pullen and Oser 2017). [...]

Utilizing Deep Learning and Genome Wide Association Studies for Epistatic-Driven Preterm Birth Classification in African-American Women

Genome-Wide Association Studies (GWAS) are used to identify statistically significant genetic variants in case-control studies. The main objective is to find single nucleotide polymorphisms (SNPs) that influence a particular phenotype (i.e., disease trait). GWAS typically use a p-value threshold of 5*10-8 to identify highly ranked SNPs. While this approach has proven useful for detecting disease-susceptible SNPs, evidence has shown that many of these are, in fact, false positives. Consequently, there is some ambiguity about the most suitable threshold for claiming genome-wide significance. Many believe that using lower p-values will allow us to investigate the joint epistatic interactions between SNPs and provide better insights into phenotype expression. One example that uses this approach is multifactor dimensionality reduction (MDR), which identifies combinations of SNPs that interact to influence a particular outcome. However, computational complexity is increased exponentially as a function of higher-order combinations making approaches like MDR difficult to implement. Even so, understanding epistatic interactions in complex diseases is a fundamental component for robust genotype-phenotype mapping. In this paper, we propose a novel framework that combines GWAS quality control and logistic regression with deep learning stacked autoencoders to abstract higher-order SNP interactions from large, complex genotyped data for case-control classification tasks in GWAS analysis. We focus on the challenging problem of classifying preterm births which has a strong genetic component with unexplained heritability reportedly between 20-40 percent. A GWAS data set, obtained from dbGap is utilised, which contains predominantly urban low-income African-American women who had normal and preterm deliveries. Epistatic interactions from original SNP sequences were extracted through a deep learning stacked autoencoder model and used to fine-tune a classifier for discriminating between term and preterm births observations. All models are evaluated using standard binary classifier performance metrics. The findings show that important information pertaining to SNPs and epistasis can be extracted from 4,666 raw SNPs generated using logistic regression (p-value = 5*10-3) and used to fit a highly accurate classifier model. The following results (Sen = 0.9562, Spec = 0.8780, Gini = 0.9490, Logloss = 0.5901, AUC = 0.9745, and MSE = 0.2010) were obtained using 50 hidden nodes and (Sen = 0.9289, Spec = 0.9591, Gini = 0.9651, Logloss = 0.3080, AUC = 0.9825, and MSE = 0.0942) using 500 hidden nodes. The results were compared with a Support Vector Machine (SVM), a Random Forest (RF), and a Fishers Linear Discriminant Analysis classifier, which all failed to improve on the deep learning approach.

Patient satisfaction with pharmacy related experiences among low-income African American women

Patient satisfaction with pharmacy related experiences among low-income African American women

Enhancing Healthier Birth Outcomes by Creating Supportive Spaces for Pregnant African American Women Living in Milwaukee.

Objectives Nationwide, African American women report higher stress levels and less access to pre- and postnatal resources. Wisconsin mirrors national infant mortality trends that show a persistent four-decade gap in infant survival between African American and White populations. The objective of the Milwaukee Birthing Project (MBP) was to implement a community-based health promotion intervention to improve birth outcomes for pregnant, low-income African American women, evaluate its effectiveness, and document its usefulness to inform development of future interventions. The project involved a mentoring and supportive relationship between 28 volunteer mentors (Sister Friends) and 20 pregnant women (Little Sisters). Methods The project implementation and evaluation were informed by the lifecourse perspective and a postcolonial feminist framework. Thematic analysis was used to analyze ethnographic data from monthly meetings and interviews with pregnant Little Sisters and Sister Friends. Results Our findings showed patterns both in community spaces and spaces created during the MBP. Program spaces contrasted with everyday life spaces and allowed women to experience community support. Based on our analysis, we classify these spaces as: (1) community spaces lacking support, (2) safe spaces of belonging and understanding, (3) spaces that foster meaningful interaction, and (4) safe, supportive spaces for other women in the future. Conclusions for Practice Future interventions should consider intentionally developing safe spaces to attain health goals. From a postcolonial feminist perspective, the voices of women who are at greatest risk for experiencing poor birth outcomes are crucial to the development of effective policies.