Urban African American Adults Research Articles

Social connectedness in older Urban African-American adults during the COVID-19 pandemic: the roles of education and partnership

Objective This study examined education, partnership status, and the moderating role of the lockdown period on social connectedness during the COVID-19 pandemic in a sample of urban African-American older adults. Methods Five hundred thirty-four African-American adults living in Detroit (91.0% female, Mage = 74.53) reported demographic information pre-pandemic and answered one social connectedness questionnaire between April and December 2020. Results Participants interviewed after the lockdown (post-June 2020) reported more loneliness than those interviewed during the lockdown (April–June, 2020). Married/partnered participants reported less loneliness and social isolation. Loneliness did not differ between those with high education levels interviewed during the lockdown compared to post-lockdown. However, among individuals with low education levels, those interviewed after the lockdown reported more loneliness than those interviewed during the lockdown period. Conclusion Our findings suggest partnership status is associated with more social connectedness during the pandemic and education accentuates the effects of forced isolation related to loneliness among urban African-American older adults.

The heart of Detroit study: a window into urban middle-aged and older African Americans’ daily lives to understand psychosocial determinants of cardiovascular disease risk

BackgroundCardiovascular disease disproportionately affects African Americans. Psychosocial factors, including the experience of and emotional reactivity to racism and interpersonal stressors, contribute to the etiology and progression of cardiovascular disease through effects on health behaviors, stress-responsive neuroendocrine axes, and immune processes. The full pathway and complexities of these associations remain underexamined in African Americans. The Heart of Detroit Study aims to identify and model the biopsychosocial pathways that influence cardiovascular disease risk in a sample of urban middle-aged and older African American adults.MethodsThe proposed sample will be composed of 500 African American adults between the ages of 55 and 75 from the Detroit urban area. This longitudinal study will consist of two waves of data collection, two years apart. Biomarkers of stress, inflammation, and cardiovascular surrogate endpoints (i.e., heart rate variability and blood pressure) will be collected at each wave. Ecological momentary assessments will characterize momentary and daily experiences of stress, affect, and health behaviors during the first wave. A proposed subsample of 60 individuals will also complete an in-depth qualitative interview to contextualize quantitative results. The central hypothesis of this project is that interpersonal stressors predict poor cardiovascular outcomes, cumulative physiological stress, poor sleep, and inflammation by altering daily affect, daily health behaviors, and daily physiological stress.DiscussionThis study will provide insight into the biopsychosocial pathways through which experiences of stress and discrimination increase cardiovascular disease risk over micro and macro time scales among urban African American adults. Its discoveries will guide the design of future contextualized, time-sensitive, and culturally tailored behavioral interventions to reduce racial disparities in cardiovascular disease risk.

0338 A Naturalistic within and between Subjects Comparison of the effects of Cannabis on Sleep among Young Adult, African Americans

Abstract Introduction Cannabis use is increasing, despite limited knowledge of its potential benefits and adverse effects. Reducing sleep disturbance appears to be a frequent motivation for nighttime cannabis use yet its effects on sleep are poorly documented. We leveraged data from an observational study of urban residing young adult African Americans where pre-bedtime cannabis use was variably endorsed with digital ecological momentary assessment (EMA) to conduct within and between subjects’ comparisons of sleep with and without preceding cannabis use. Methods Participant were recruited from an ongoing observational study that enrolls African Americans living in urban environments. 20 participants endorsed cannabis use on some but not all nights and were included in the within subjects’ comparison. 25 participants who used cannabis on 2 or more nights were compared with 28 participants who did not endorse prebedtime substance use. Total sleep time (TST), and wake after sleep onset WASO were derived from actigraphy monitoring; sleep quality (SQ) (scale: 1 “not at all rested”-10 “very rested”) and time in bed (TIB) were obtained from the EMA. Results While TST and WASO were very similar in both conditions and groups, within subjects’ SQ was superior on nights without cannabis (7.2 + 1.7 vs. 6.4 + 2.2, t=2.2, p=.04) and cannabis users spent more time in bed (minutes) than their non-cannabis using counterparts (447.6 + 77.1 vs. 373.6 + 66.1; t= 2.4, p=.04). Conclusion Among urban residing young African American adults, cannabis does not appear to improve sleep. Support (if any) This research was supported by the NIHLB grant R01HL136626 to Dr. Thomas A. Mellman.

Anxiety, depression and global distress among African American young adults with uncontrolled asthma

Background Anxiety and depression are mental health disorders that are often comorbid with asthma. Urban African American young adults with asthma often experience increased risk of anxiety and depression. Objective To explore relationships between symptoms of psychological distress and asthma-related anxiety with asthma outcomes among urban African American young adults with poorly controlled persistent asthma. Methods A secondary analysis of baseline data from a larger study of 141 African American young adults with uncontrolled persistent asthma was examined. Participants completed the Brief Symptom Inventory (BSI-18), Youth Asthma-related Anxiety Scale, Asthma Control Test (ACT), a daily diary to assess asthma symptoms; and number of asthma attacks. Spirometry assessed airway obstruction. Generalized linear models tested associations. Results In multivariable models testing, higher somatization scores were significantly associated with lower ACT scores (adjusted β = −0.49; 95% CI = −0.69, −0.28; p < 0.01), and higher symptoms (adjusted β = 0.39; 95% CI = 0.14, 0.65; p < 0.01). After adding asthma-related anxiety to the model, the somatization subscale and asthma-related anxiety were significantly associated with ACT scores (adjusted β = −0.36; 95% CI = −0.57, −0.15; p < 0.01), (adjusted β = −0.32; 95% CI = −0.50, −0.14; p < 0.01), respectively. Asthma-related anxiety was also significantly associated with asthma attacks (adjusted β = 0.24; 95% CI = 0.05, 0.43; p < 0.05). Conclusion This study suggests, asthma-related anxiety may differ from general anxiety and be related to poorly controlled asthma among African American young adults.

Vaccination beliefs in older African Americans in Detroit during the Covid‐19 pandemic

BackgroundThe COVID‐19 pandemic has devastated multiple Countries targeting vulnerable populations. In Michigan there have been over 550,000 confirmed cases and over 14,000 deaths that forced health officials to rapidly develop and distribute COVID‐19 vaccines (MDHHS, 2021). As researchers study the COVID‐19 virus and vaccines, it is important to understand the educational needs of the public in deciding intent to accept the vaccine.MethodWe analyzed factors correlated with generalized anxiety rates in 150 African Americans age 65 and older, recruited from Wayne State Institute of Gerontology Healthier Black Elders Center and surrounding communities. Participants completed telephone questionnaires measuring demographics, stressors associated with COVID‐19 pandemic, and emotions. A scale was designed using the Health Belief Model assessing beliefs, susceptibility, severity, conspiracy beliefs of Covid‐19 (man‐made), and intent to be vaccinated. Applying factor analysis, questions were divided into: fear of COVID‐19 (I am worried about the likelihood of getting COVID‐19, My chances of getting COVID‐19 in next few months is great, I will be very sick if I get COVID‐19, Vaccinations decrease chances of infections or complications, I will get the vaccine if I receive adequate information), vaccination safety (I am concerned the vaccine will not work, I am concerned the vaccine will not be safe, Side effects from the vaccine interfere with activities and, Vaccinations make me less worried). Participants responded to these questions on 5‐point Likert scale (from “Strongly Disagree” to “Strongly Agree”).ResultOf 150 participants, 67% expressed intention to get vaccinated while only 15% were reluctant to vaccinate. Stepwise regression analysis showed that fear of COVID‐19 and vaccination safety explained 49% variance of intent to vaccinate. Vaccination safety was predicted by age, loneliness, vulnerability, and positive emotions (R2 = 20%). Fear of COVID‐19 was predicted by anxiety and positive emotions (R2 = 8%).ConclusionThis study provides a snapshot of urban African American older adults who are generally eager to get vaccinated for COVID‐19, and predictors of intent to get vaccinated. More research is needed to understand the scope of educational needs to increase the likelihood of older African Americans to get vaccinated.

Mental Health History and DECIDE (Decision-Making Education for Choices in Diabetes Everyday) Diabetes Support Program Outcomes Among African Americans With Type 2 Diabetes.

The purpose of this study was to determine behavioral and clinical outcomes of the DECIDE (Decision-Making Education for Choices in Diabetes Everyday) diabetes support program trial participants with and without a mental health (MH) history by treatment arm. A secondary analysis was conducted of data from the DECIDE trial sample of urban African American adults with type 2 diabetes (T2DM; N = 137) who received the DECIDE diabetes support program in 1 of 3 delivery formats: self-study (n = 46), individual (n = 45), and group (n = 46). Positive screen on the Patient Health Questionnaire-2 and/or reported MH diagnosis were coded as MH history. Self-management, knowledge, problem-solving, and A1C data at baseline and 1 week and 6 months postintervention were analyzed for participants with and without MH history. Prevalence of MH history was 37% in the sample. Among those with no MH history, knowledge and problem-solving improved at 6 months postintervention in all intervention arms. For those with MH history, knowledge and problem-solving improved in the self-study and individual arms but not in the group arm. Clinically but not statistically significant changes in A1C were observed at 6 months. In an urban minority T2DM sample, those with an MH history benefited from the intervention, but delivery format mattered, with robust improvements when participants with an MH history received self-directed or one-on-one formats rather than group.

Associations between race, APOE genotype, cognition, and mortality among urban middle-aged white and African American adults

We examined associations between cognition and mortality and how these relationships vary by race and Apolipoprotein E (APOE) genotype, in a longitudinal study of 2346 middle-aged White and African American adults (30–64 years at baseline) from the Healthy Aging in Neighborhoods of Diversity across the Life Span cohort study. Baseline cognition spanned global mental status, and several domains obtained using principal components analysis (PCA; PCA1: verbal memory/fluency; PCA2: attention/working memory; PCA3: executive function/visuo-spatial abilities). Cox regression models evaluated associations between cognition and all-cause and cardiovascular disease (CVD)-mortality. Interactions between cognition and APOE2 as well as APOE4 allelic dose were tested, and race was a key effect modifier. Higher APOE4 dose was associated with increased CVD-mortality (hazard ratio [HR] per allele = 1.37; 95% CI 1.01–1.86, p = 0.041); APOE2 dosage’s association with CVD-mortality was non-significant (HR = 0.60; 95% CI 0.35–1.03, p = 0.065). Higher PCA3 was associated with lower all-cause (HR = 0.93; 95% CI 0.87–0.99, p = 0.030) and CVD (HR = 0.85; 95% CI 0.77–0.95, p = 0.001) mortality risks, the latter association being more pronounced among Whites. PCA2 interacted synergistically with APOE2 dosage, reducing risks for all-cause mortality (PCA2 × APOE2: − 0.33 ± 0.13, p = 0.010) and CVD mortality (PCA2 × APOE2: − 0.73 ± 0.31, p = 0.019). In conclusion, greater executive function/visuo-spatial abilities were associated with reduced CVD-specific mortality, particularly among Whites. Greater “attention/working memory” coupled with higher APOE2 dosage was linked with reduced all-cause and CVD mortality risks.

Childhood Socioeconomic Status and Cardiometabolic Health: A Test of the John Henryism Hypothesis in African American Older Adults.

John Henryism (JH) is a form of active high-effort coping. Low-socioeconomic status (SES) African Americans adopting JH to deal with structural racism and other chronic stressors might be more likely to display cardiovascular disease risk factors. Previous tests of this hypothesis have mostly focused on the moderating role of current SES and hypertension as the outcome variable. Furthermore, most of the previous work has been conducted among young and middle-aged adults. This study aimed at extending work on the JH hypothesis by testing the combined effect of JH and childhood SES on metabolic syndrome and systemic inflammation among African American older adults. One hundred seventy urban African American older adults (Mage = 67.64 years, 75.9% female) were recruited. Participants completed questionnaires assessing JH, childhood SES, and other variables used as covariates (ie, demographic information, chronic conditions, medication use, and health behaviors). Blood pressure, waist circumference, and blood were also collected. Triglycerides, high-density lipoprotein cholesterol, hemoglobin A1C, and C-reactive protein levels were measured from the blood samples. JH was positively associated with metabolic syndrome symptoms among participants reporting low childhood SES levels, but not among those reporting high childhood SES levels. The same pattern did not emerge when we considered current SES. Similar patterns of results did not emerge as far as systemic inflammation was concerned. Our findings highlight the importance of considering the joint impact of objective conditions early in life and individual psychological proclivities in explaining increased risk for cardiovascular disease risk in this population.

Latent triple trajectories of substance use as predictors for the onset of antisocial personality disorder among urban African American and Puerto Rican adults: A 22-year longitudinal study

Background Antisocial personality disorder (ASPD) incurs a high cost to society due to the high risk of violent and nonviolent offenses associated with this personality disorder, thus making the examination of the etiology and the onset of ASPD an important public health concern. Method: The present study consisted of five waves of data collection of the Harlem Longitudinal Development Study (N = 674). In the Cox proportional hazard model, latent multiple substance use trajectories from mid-adolescence to emerging adulthood (mean age 14 to mean age 24) were used as a predictor for the onset of ASPD during emerging adulthood to the mid-thirties (mean age 24 to mean age 36). The control variables were gender, ethnicity, problem behaviors, and victimization. Results: In the multiple Cox proportional hazard model, the high (HR = 2.74, p < 0.001) and the increasing frequency of (HR = 2.55, p < 0.001) use on alcohol, cigarette, and cannabis latent trajectory groups were associated with an increased hazard of ASPD onset as compared with the no or low frequency of use on alcohol, cigarette, and cannabis latent trajectory group after controlling for demographic factors and earlier problem behaviors as well as victimization. Conclusions: The implications of this study for the prediction of adult ASPD onset time may focus on the early use of alcohol, cigarette, and cannabis from mid adolescence to emerging adulthood.

Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults.

Chronic low back pain is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. The existing low back pain research has relied almost exclusively on White/Caucasian participant samples. This study examines the correlates of chronic low back pain among a sample of underserved urban African American and Latino older adults. Controlling for age, gender, race/ethnicity, education, living arrangement, and number of major chronic conditions, associations between low back pain and the following outcome variables are examined: (1) healthcare utilization, (2) health-related quality of life (HR-QoL) and self-rated quality of health; and (3) physical and mental health outcomes. Methods: We recruited nine hundred and five (905) African American and Latino older adults from the South Los Angeles community using convenience and snowball sampling. In addition to standard items that measure demographic variables, our survey included validated instruments to document HR-QoL health status, the Short-Form McGill Pain Questionnaire-2, Geriatric Depression Scale, sleep disorder, and healthcare access. Data analysis includes bivariate and 17 independent multivariate models. Results: Almost 55% and 48% of the Latino and African American older adults who participated in our study reported chronic low back pain. Our data revealed that having low back pain was associated with three categories of outcomes including: (1) a higher level of healthcare utilization measured by (i) physician visits, (ii) emergency department visits, (iii) number of Rx used, (iv) a higher level of medication complexity, (v) a lower level of adherence to medication regimens, and (vi) a lower level of satisfaction with medical care; (2) a lower level of HR-QoL and self-assessment of health measured by (i) physical health QoL, (ii) mental health QoL, and (iii) a lower level of self-rated health; and (3) worse physical and mental health outcomes measured by (i) a higher number of depressive symptoms, (ii) a higher level of pain, (iii) falls, (iv) sleep disorders, (v) and being overweight/obese. Discussion: Low back pain remains a public health concern and significantly impacts the quality of life, health care utilization, and health outcomes of underserved minority older adults. Multi-faceted and culturally sensitive interventional studies are needed to ensure the timely diagnosis and treatment of low back pain among underserved minority older adults. Many barriers and challenges that affect underserved African American and Latino older adults with low back pain simply cannot be addressed in over-crowded EDs. Our study contributes to and raises the awareness of healthcare providers and health policymakers on the necessity for prevention, early diagnosis, proper medical management, and rehabilitation policies to minimize the burdens associated with chronic low back pain among underserved older African American and Latino patients in an under-resourced community such as South Los Angeles.

Fostering spirituality and psychosocial health through mind-body practices in underserved populations

BackgroundThis study examined changes in spirituality and psychosocial outcomes among African American and rural adults participating in a culturally-adapted mind-body intervention. MethodsAfrican American (n = 22) and rural (n = 38) adults in Harmony & Health attended mind-body sessions twice a week for eight weeks and completed questionnaires on spirituality and psychosocial distress at baseline and post-intervention. Linear regression and repeated measures analyses were used to examine associations between intervention attendance and spirituality. ResultsAttendance was significantly associated with increased spirituality (β=0.168, p = 013). Repeated measures analyses revealed a significant three-way interaction between attendance, spirituality, and study site (F(9,31)=2.891, p = 013). Urban African American participants who attended ≥75% of sessions reported greater increases in spirituality. ConclusionFindings suggest that mind-body practices may foster spirituality in urban African American adults. Additional adaptations are needed to strengthen spirituality in rural residents and to improve psychosocial health and wellbeing in this underserved population.

Healthy Behaviors Associated with Changes in Mental and Physical Strength in Urban African American and White Adults.

Over time, adherence to healthy behaviors may improve physical and mental strength which is essential for successful aging. A plausible mechanism is the reduction of inflammation. Research on the association of risky health behaviors on change in strength with age is limited. This study examined changes in the inflammatory potential of the diet, smoking, illicit drug use with changes in strength in a racially and socioeconomically diverse adult sample from the Healthy Aging in Neighborhoods of Diversity Across the Life Span study. The dietary inflammatory index (DII) was calculated from 35 food components derived from multiple 24-h dietary recalls. Strength was evaluated by handgrip strength (HGS), SF-12 PCS and SF-12 MCS (physical and mental component scores). Repeated measures analyses were used to examine associations. At baseline, mean age was 48.4 ± 0.25 years, 56% of the sample were women, and 58% African American. Significant 4-way interactions were found between age, race, socioeconomic status, and DII for women, on change in HGS (p < 0.05) and in SF-12 PCS (p < 0.05) and for men, in change in SF-12 PCS (p < 0.05). Improvements in SF-12 MCS were associated with all three health behaviors as main effects. This study provided evidence that changes towards improving healthy behaviors, diet with anti-inflammatory potential, not smoking cigarettes and not using illicit drugs, were associated with improved strength. Health professionals, especially registered dietitians and health coaches, should create lifestyle interventions to reduce inflammation targeting change in more than one risky health behavior.

Low-dose aspirin for primary prevention of cardiovascular disease: Trends in use patterns among African American adults in Minnesota, 2015–2019

Cardiovascular disease (CVD) disproportionately affects African Americans. Aspirin has long been recommended to reduce cardiovascular events. However, national guideline changes in 2016 limited the aspirin recommended population and several clinical trials questioning the utility of primary prevention aspirin were published in 2018. In light of the recent guidelines and study findings, we investigated primary prevention aspirin use among urban African American adults. Using three cross-sectional surveys, we collected data from self-identified African Americans with no CVD in 2015, 2017 and 2019, querying information on CVD risk factors, health behaviors and beliefs, and aspirin use. Poisson regression modeling was used to estimate age- and risk-factor adjusted aspirin prevalence, trends and associations. A total of 1491 African Americans adults, ages 45–79, were included in this analysis; 61% were women. There was no change in age- and risk factor-adjusted aspirin use over the 3 surveys for women (37%, 34% and 35% respectively) or men (27%, 25%, 30% respectively). However, fewer participants believed aspirin was helpful in 2019 compared to 2015—75% versus 84% (p < 0.001). Aspirin discussions with a health care practitioner were highly associated with aspirin use (adjusted RR 2.97, 95% CI 2.49–3.54) and aspirin use was 2.56 times higher (adjusted RR 95% CI 2.17–3.03) in respondents who agreed that people close to them thought they should take aspirin compared with those who disagreed or did not know. Despite major changes in national guidelines, overall primary prevention aspirin use did not significantly change in these African American samples from 2015 to 2019.

A Pharmacist and Health Coach-Delivered Mobile Health Intervention for Type 2 Diabetes: Protocol for a Randomized Controlled Crossover Study.

BackgroundAggressive management of blood glucose, blood pressure, and cholesterol through medication and lifestyle adherence is necessary to minimize the adverse health outcomes of type 2 diabetes. However, numerous psychosocial and environmental barriers to adherence prevent low-income, urban, and ethnic minority populations from achieving their management goals, resulting in diabetes complications. Health coaches working with clinical pharmacists represent a promising strategy for addressing common diabetes management barriers. Mobile health (mHealth) tools may further enhance their ability to support vulnerable minority populations in diabetes management.ObjectiveThe aim of this study is to evaluate the impact of an mHealth clinical pharmacist and health coach–delivered intervention on hemoglobin A1c (HbA1c, primary outcome), blood pressure, and low-density lipoprotein (secondary outcomes) in African-Americans and Latinos with poorly controlled type 2 diabetes.MethodsA 2-year, randomized controlled crossover study will evaluate the effectiveness of an mHealth diabetes intervention delivered by a health coach and clinical pharmacist team compared with usual care. All patients will receive 1 year of team intervention, including lifestyle and medication support delivered in the home with videoconferencing and text messages. All patients will also receive 1 year of usual care without team intervention and no home visits. The order of the conditions received will be randomized. Our recruitment goal is 220 urban African-American or Latino adults with uncontrolled type 2 diabetes (HbA1c ≥8%) receiving care from a largely minority-serving, urban academic medical center. The intervention includes the following: health coaches supporting patients through home visits, phone calls, and text messaging and clinical pharmacists supporting patients through videoconferences facilitated by health coaches. Data collection includes physiologic (HbA1c, blood pressure, weight, and lipid profile) and survey measures (medication adherence, diabetes-related behaviors, and quality of life). Data collection during the second year of study will determine the maintenance of any physiological improvement among participants receiving the intervention during the first year.ResultsParticipant enrollment began in March 2017. We have recruited 221 patients. Intervention delivery and data collection will continue until November 2021. The results are expected to be published by May 2022.ConclusionsThis is among the first trials to incorporate health coaches, clinical pharmacists, and mHealth technologies to increase access to diabetes support among urban African-Americans and Latinos to achieve therapeutic goals.International Registered Report Identifier (IRRID)DERR1-10.2196/17170

Association between GDF15, poverty and mortality in urban middle-aged African American and white adults.

Mortality disparities are influenced by race and poverty. There is limited information about whether poverty influences biologic markers of mortality risk. Emerging data suggests that growth differentiation factor 15 (GDF15) is associated with mortality; however, the interplay between GDF15, sociodemographic factors and mortality is not known. We sought to evaluate the interactions between GDF15 and sex, race and poverty status on mortality. Serum GDF15 was measured in 1036 African American and white middle-aged men and women above and below 125% of the Federal poverty status from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Multivariable adjusted Cox regression models were used to assess the association between log-transformed GDF15 (logGDF15) and 12-year mortality outcomes (all-cause, cardiovascular- and cancer-specific outcomes) and interactions with sex, race and poverty status. Likelihood ratio tests were used to assess significance of the interaction terms. Median GDF15 was 655.2 pg/mL (IQR = 575.1). During 12.2 years of follow-up, 331 died of which 94 cardiovascular- and 87 were cancer-specific deaths. One unit of increase in logGDF15 was associated with a hazard ratio for all-cause mortality, cardiovascular- and cancer-specific mortality of 2.26 (95% confidence interval [CI], 1.94–2.64), 2.74 (95%CI, 2.06–3.63) and 1.41 (95%CI, 1.00–2.00), respectively. There was an interaction between logGDF15 and poverty status on all-cause mortality (p<0.05). The GDF15×poverty status interaction term improved model calibration for all-cause mortality. Our study provides the first evidence that the effect of elevated GDF15 on all-cause mortality is modified by poverty status.

818-P: Mental Health History and DECIDE Self-Management Support Program Outcomes in an African American Sample with T2DM

Objective: To evaluate changes in behavioral and clinical outcomes from the DECIDE (Decision-making Education for Choices in Diabetes Everyday) self-management support program trial among participants with and without a mental health (MH) history. Methods: Participants were urban African American adults with type 2 diabetes (T2DM) (N=182). DECIDE is a problem solving diabetes self-management support program. Participants were randomized to 1 of 4 intervention arms: Self Study (n=46), Individual (n=45), Group (n=46), or Enhanced Print Education (EPE; n=45). Those who screened positive on the Patient Health Questionnaire 2 or reported a mental health diagnosis were coded as having MH history. Outcomes were self-management, knowledge, problem solving, and A1C assessed at baseline and 6 months post intervention, stratified by MH history status. Results: 72 participants (40%) reported a MH history, including depression, bipolar, and schizophrenia. Among those with no MH history, knowledge and problem solving improved at 6 months post intervention in all intervention arms (knowledge: Self Study p&amp;lt;.001, Individual p=.011, Group p=.004, EPE p=.026; problem solving: Self Study p=.023, Individual p=.015, Group p=.010, EPE p=.015). For those with MH history, knowledge and problem solving improved in the Self Study and Individual arms (diabetes knowledge: Self Study p=.018, Individual p=.037; health problem solving: Self Study p=.006, Individual p=.011) but not in the Group or EPE arms (ps≥.10). Although changes in A1C were not significant in any group (ps≥.20), A1C decreased by 1% among those with MH history in the Self Study arm (baseline A1C=9.1%; 6 month A1C=8.1%; p=.20). Conclusion: In an urban minority sample with T2DM, those with a MH history benefited from a diabetes self-management intervention, but delivery modality mattered. Robust improvements in skills and A1C were observed when those with a MH history had self-paced or one-on-one formats rather than group. Disclosure E.A. Vrany: None. A. Jennings: None. F. Hill-Briggs: None. Funding National Heart, Lung, and Blood Institute (R01HL089751, 5T32HL007180)

Enhancing Adolescent and Young Adult Health Services! A Review of the Community Needs Assessment Process in an Urban Federally Qualified Health Center.

Background: Urban African American adolescents and young adults (AYAs) face multiple barriers to effective engagement in health care, including access to primary and specialty care services resulting in significant disparities in care.Purpose: To conduct a needs assessment to enhance service delivery of AYAs at an urban federally qualified health center (FQHC) organization in Detroit.Methods: Semistructured interviews were conducted among pediatric staff members (N=11) using the community needs assessment approach specified for FQHCs.Results: The needs assessment determined the following priorities for AYAs seeking care at this FQHC organization: (1) mental health (e.g., depression and anxiety), (2) obesity, and (3) sexual health (e.g., sexually transmitted infection testing).Conclusion: When analyzing a population to learn about community-based issues, a needs assessment is a valuable tool. The information here has been used as supplemental information to address the health inequities that African American youth face within Detroit.

Socioeconomic Status, Ecologically Assessed Social Activities, and Daily Cortisol Among Older Urban African Americans.

Objectives: Higher socioeconomic status (SES) individuals report more social activities than their lower SES counterparts. Yet, SES and racial health disparities are often confounded. Here, we tested whether the frequency of engagement in social activities contributed to the association between SES and daily cortisol secretion among urban African American older adults. Methods: Ninety-two community-dwelling African Americans aged 55 years and older reported what they were doing at regular intervals across the day on an Android smartphone for seven consecutive days. They also provided four saliva samples at four time points a day during the same period. Results: Higher SES older adults engaged in proportionally more social activities than their lower SES counterparts. A greater relative frequency of weekly social activities was associated with a steeper diurnal cortisol decline. Higher SES was indirectly linked to a steeper cortisol decline via increased relative frequency of weekly social activities. Discussion: Our findings suggest that engagement in weekly social activities represents a behavioral intermediary for SES health disparities in endocrine function among older urban African American adults.

Flavonoid Intakes of Urban African American and White Adults

Flavonoid Intakes of Urban African American and White Adults

A comparison of urban and non-urban African American older adults on health-related characteristics

ABSTRACTAlthough residential geographic health disparities have been noted in the previous literature, studies are specifically lacking on intra-group health comparisons of African American older adults by residential geography. The purpose of this study was to determine if health-related characteristics of African American older adults varied by residential geography. Socioeconomic demographics, medical conditions, primary care use, and self-ratings of general health, social activity, and physical activity were compared in a community-dwelling sample of 327 urban and non-urban African American older adults. Urban and non-urban African American older adults were compared on health-related factors. Compared to urban African American older adults, those in non-urban areas had lower incomes, lower self-ratings of general health, social activity, and physical activity, and a higher frequency of arthritis and gastroenterological and urological conditions. Despite poorer general health and medical conditions, non-urban African American older adults were less likely to visit the doctor when needed. Study findings suggest residential geography may be an underappreciated underlying contributing factor to inter-group health disparities between African American and white older adults and not race alone. Therefore, social workers in public health, health care, and clinical settings should be aware of the interaction between race and residential geography.