Urban Black Men Research Articles

Association between sleep difficulties, bodily symptoms, and subjective cognitive decline in urban Black men

AbstractBackgroundSleep has been linked to subjective cognitive decline (SCD) in older adults, which may indicate an onset of cognitive decline to Alzheimer’s disease and related dementia. There is a dearth of studies on the role of sleep difficulties and bodily symptoms in influencing cognitive status of middle‐age and older Black men. This limits our understanding of the potential role of sleep and bodily symptoms on Black men’s brain health.MethodThis cross‐sectional study examined factors predicting subjective cognitive decline in Black men living in urban settings. Participants (N = 117, Mage = 48.45) responded to a survey assessing sleep difficulties, sleep comorbidities, bodily symptoms, self‐rated health, sociodemographic characteristics, and subjective cognitive decline. SCD was operationalized as a self‐reported experience with increasing confusion or memory loss in the last 12 months.ResultHierarchical regression revealed that in Model 1 with sociodemographic characteristics, only education was a significant predictor of SCD (F (4,112) = 6.33, p<.05), accounting for 18% of the variation in SCD. In Model 2 with self‐rated health and bodily symptoms added, socioeconomic status, education, and bodily symptoms were significant predictors of SCD (F (6,110) = 11.82, p<.001) and explained an additional 39% of the variation in SCD. When sleep difficulties and sleep comorbidities were added to Model 3, sleep difficulties, sleep comorbidities, bodily symptoms, socioeconomic status, and education were significant predictors of SCD (F (8,108) = 13.79, p<.001), accounting for 50% of the variation in SCD.ConclusionOur findings may be used as a groundwork for future research examining the causal link between cognitive decline, sleep, and bodily functions. It can also inform health intervention programs for middle‐aged and older Black American men.

Spiritual coping behaviors among injured urban black men in Philadelphia

PurposeHigh rates of firearm injury among urban Black men in the US can lead to long physical and psychological recovery times, worsened by limited access to mental health services. Spirituality can propel positive thoughts, actions, perceptions and behaviors about self and others yet how it is used among Black men recovering from firearm injury is underexplored. This study examined the role of spirituality in the recovery of Black male survivors of firearm injury. MethodTen injured urban Black men in Philadelphia were interviewed using descriptive phenomenology. A subset of participants from the Emotional Responses and Recovery from Injury in Urban Black Men study who agreed to be recontacted for future studies were enrolled. Informed consent was obtained, semi-structured interviews were conducted via phone and were audiotaped, transcribed, and de-identified. Thematic content analysis was used to understand perceptions of spirituality and to identify spiritual coping behavior themes. ResultsFindings suggest that injured urban Black men engaged in theistic and non-theistic spiritual activities that resulted in positive character development, reduced risk of re-injury, hope, improved mental health and social bonds. ConclusionSpirituality may serve as a protective factor against firearm re-injury or retaliation by promoting desired behaviors and mental health among injured urban Black men. Combining culturally sensitive spiritual resources and psychotherapy may lead to effective trauma-informed care in addressing spiritual and existential challenges of injured urban Black men who may find spirituality important.

V.S. Naipaul and His All-Male 4H Club

Slavery’s bloodstained gates simultaneously, and paradoxically, birthed a heritage of white hegemonic masculinity as well as the Afro-Caribbean man’s longing for retribution for Empire’s acute psychological emasculation. A subsequent emergent counter-hegemonic masculine figure claimed a heroism that was instrumental in creating an imperative of resistance. Many urban black men of the lower socioeconomic stratum utilized a hypermasculinity of sorts to assert this resistance. Humor became his coping technique as he grappled with the tensions, contentions, and collisions of colonial and postcolonial life. This article explores the interconnectedness of heritage, hegemony, hypermasculinity, and humor in shaping identities among representations of Empire-resistant Afro-Caribbean masculinities in V.S. Naipaul’s Miguel Street. The overarching aim is to underscore Naipaul’s implied androcentric philosophy regarding bodies, sexualities, and masculinities that plagued lower strata Afro-Caribbean men then and, quite possibly, today.

Enacted Sexual Minority Stigma, Psychological Distress, and Sexual and Drug Risk Behaviors Among Urban Men Who Have Sex with Men (MSM)

Urban Black men who have sex with men (MSM) bear a disproportionate burden of HIV and syphilis in the U.S. Experiences of enacted sexual minority stigma and psychological distress among these men may be associated with HIV/STI sexual and drug risk behaviors. The objective was to determine the associations between enacted sexual minority stigma, psychological distress, and sexual and drug risk behaviors. In an urban prospective cohort study, survey measures assessed past 3-month exposure to enacted sexual minority stigma, psychological distress, and sexual and drug risk behaviors. Multivariable logistic regression models were utilized for hypothesis testing. The Black MSM (N = 140) reported the following: 22.1% experiences of enacted sexual minority stigma, 39% high levels of psychological distress, 48.6% > 1 sex partner, 8.6% transactional sex, and 6% injection drug use (IDU). In models adjusted for age and education, enacted sexual minority stigma significantly increased the odds of reporting > 1 sex partner, transactional sex, and IDU. Adjusting additionally for homelessness, the association between enacted sexual minority stigma and transactional sex remained significant. Adding psychological distress to this model showed a significant association between psychological distress and transactional sex, while the association was no longer significant for transactional sex. These findings highlight some of the complex psycho-social relationships that may be associated with sexual and drug risk behaviors among Black MSM placing them at increased risk for HIV and syphilis.

BarberED then screened: Disrupting the colorectal cancer disparity in urban Black men.

Colorectal cancer (CRC) is the third most common diagnosed cancer among non-Hispanic Black people in the United States. Alarmingly, this population is also 40% more likely to succumb to the disease. Black men get diagnosed younger, present with late-stage disease, and have poor 5-year survival rates. In total, 42% of the racial disparity is due to differences in screening. In Rochester, New York, there are eight zip codes where less than 47% of the population completed CRC screening and six zip codes where men have 15% to 49% above expected cases of CRC. This qualitative improvement project took place in a barbershop in a zip code with subpar screening rates and higher-than-expected cases of CRC. Black men, 45-75 years of age, not current with CRC screening guidelines were recruited to participate after they received barber services. CRC screening was considered complete once a colonoscopy was scheduled. Colorectal cancer education was provided by a nurse practitioner to barbers, who then provided education to their eligible patrons. After the education, patrons who decided to undergo screening were connected to a local gastroenterology group where a colonoscopy was scheduled. Thirteen participants agreed to participate in the project. Nine participants scheduled CRC screening, and seven completed the colonoscopy evaluation. Barbers and nurse practitioners are an ideal partnership when seeking to disrupt the CRC health care disparity. Members of the Black community who may not routinely participate in preventive care can be innovatively educated to improve their health status.

Strengths despite stress: Social-structural stressors and psychosocial buffers of depressive symptoms among U.S. Black men.

We examined the association between social-structural stressors-racial discrimination, incarceration, and unemployment-and depressive symptoms among 578 predominantly low-income urban Black men, ages 18-45. We also examined the extent to which two protective factors-social support and problem-solving coping-moderated the relationship between social-structural stressors and depressive symptoms. Results showed that more everyday racial discrimination and incarceration, but not unemployment, significantly predicted more depressive symptoms. The links between discrimination, incarceration, and depressive symptoms were stronger for men who reported lower levels of problem-solving coping and social support than those with higher levels. Our study suggests that interventions emphasizing protective factors may help Black men cope with some of the deleterious effects of racial discrimination and incarceration. It also underscores a need for structural interventions that reduce racial discrimination and incarceration. Depression among Black men is not simply a biomedical or psychological condition, but also a critical health equity issue. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Stroman Effect: Participants in MEN Count, an HIV/STI Reduction Intervention for Unemployed and Unstably Housed Black Heterosexual Men, Define Its Most Successful Elements.

Interventionists often prioritize quantitative evaluation criteria such as design (e.g., randomized controlled trials), delivery fidelity, and outcome effects to assess the success of an intervention. Albeit important, criteria such as these obscure other key metrics of success such as the role of the interactions between participants and intervention deliverers, or contextual factors that shape an intervention’s activities and outcomes. In line with advocacy to expand evaluation criteria for health interventions, we designed this qualitative study to examine how a subsample of Black men in MEN Count, an HIV/STI risk reduction and healthy relationship intervention with employment and housing stability case management for Black men in Washington, DC, defined the intervention’s success. We also examined the contextual factors that shaped participation in the study’s peer counseling sessions. We conducted structured interviews with 38 Black men, ages 18 to 60 years (M = 31.1, SD = 9.33) who completed at least one of three peer counseling sessions. Analyses highlighted three key themes: (a) the favorable impact of Mr. Stroman, the lead peer counselor, on participants’ willingness to participate in MEN Count and disclose their challenges—we dubbed this the “Stroman Effect”; (b) the importance of Black men intervention deliverers with relatable life experiences; and (c) how contextual factors such as the HIV/AIDS epidemic, needs for housing and employment services and safe spaces to talk about challenges, and absentee fathers shaped participation. We discuss the study’s implications for sustainable programs after funding ends and future multilevel health interventions to promote health equity for poor urban Black men.

Foretelling the Future: Predicting STI Diagnosis and Its Implications for Ending the HIV Epidemic among Black Men Who Have Sex with Men.

Despite evidence of the link between STI and HIV transmission, STI rates remain alarmingly high, particularly among racial/ethnic minorities. This study examined the relationship between earlier STI diagnoses (gonorrhea and chlamydia) and future STI acquisition and its implications for HIV prevention among a sample of urban Black men who have sex with men (Black MSM). Data from a cohort of 600 Black MSM (15-29years of age) residing in a medium-size Southern city enrolled in a HIV prevention intervention were analyzed. We used multivariate logistic regression to assess the association between STI diagnosis (baseline: Time 1) and subsequent STI diagnosis (90-day post-diagnosis: Time 2). Repeated measures analyzed at Time 1 and Time 2 included condomless sex, insertive and receptive sex, concurrent sexual partnerships, multiple partners, and age of partner. Independent of socio-demographic factors, we found having a prior GC/CT increased the likelihood of a future GC/CT by a factor of 15 (OR = 15.2, p = 0.01). Participants were statistically more likely to have been diagnosed with an extragenital STI (OR = 2.3, p = 0.05). Present findings suggest that time of initial STI diagnosis is a critical period in which to intervene to reduce future STI/HIV acquisition. Screening guidelines should be expanded to include testing for extragenital infection. STI screening and treatment and counseling programs should be culturally appropriate to account for the unique needs and the social and environmental context of the population. Additional research is needed to design STI prevention interventions that address social and environmental factors to reduce sexual risk behaviors that increase HIV vulnerability for Black MSM.

Neighborhood Environment and Health of Injured Urban Black Men.

Urban black males are at disproportionately high risk of poor health outcomes; thus, we need to measure neighborhood environments appropriately in order to understand aspects of neighborhoods that influence their mental and physical health. We explored associations between physical and mental health of injured, urban black men with objectively measured and perceived neighborhood characteristics. In 2017-2018, we analyzed data from 486 black, adult males in Philadelphia admitted to a trauma center with injury between January 2013 and February 2017. Area-level measures of social, economic, and built environments were obtained from multiple sources. At enrollment, participants answered questions about neighborhood environment and self-reported physical and mental health 30days before injury. We conducted factor analysis to identify neighborhood characteristics, then estimated odds of poor physical or mental health, accounting for spatial correlation of participants. Poor physical and mental health was reported by 12% and 22% of participants, respectively. In participants' neighborhoods, 29% of adults lived in poverty. Individually, 73% of men reported abandoned buildings, and 31% reported not feeling safe walking around their neighborhood. Physical health was associated with neighborhood poverty and disconnectedness. Mental health was associated with neighborhood economics and individual perceptions of social disorder and safety. Individual-level factors were not correlated with area-level factors. We found both area-level and individual-level measures were associated with health, perhaps operating through different mechanisms, but individual experiences may not be easily extrapolated from area-level data. By identifying important components of neighborhood environments, we may better understand how neighborhoods contribute to health in vulnerable populations.

Contributors to Postinjury Mental Health in Urban Black Men With Serious Injuries

Physical injury is associated with postinjury mental health problems, which typically increase disability, cost, recidivism, and self-medication for symptoms. To determine risk and protective factors across the life span that contribute to depression and posttraumatic stress symptom severity at 3 months after hospital discharge. This prospective cohort study used a 3-month postdischarge follow-up of patients who had been treated at an urban, level 1 trauma center in the Northeastern United States. Men with injuries who were hospitalized, self-identified as black, were 18 years or older, and resided in the Philadelphia, Pennsylvania, region were eligible and consecutively enrolled. Those who were experiencing a cognitive dysfunction or psychotic disorder, hospitalized because of attempted suicide, or receiving current treatment for depression or posttraumatic stress disorder (PTSD) were excluded. Data were collected from January 2013 to October 2017. Data analysis took place from January 2018 to August 2018. A serious injury requiring hospitalization; adverse childhood experiences, childhood neighborhood disadvantage, and preinjury physical and mental health; and emotional resources, injury intent, and acute stress responses. Depression and PTSD symptom severity were assessed with the Quick Inventory of Depressive Symptoms-Self-report and the PTSD Check List-5. The a priori hypothesis was that risk and protective factors are associated with depression and PTSD symptom severity. The analytic approach was structural equation modeling. A total of 623 black men were enrolled. Of these, 502 participants (80.6%) were retained at 3-month follow-up. Their mean (SD) age was 35.6 (14.9) years; 346 (55.5%) had experienced intentional injuries, and the median (range) Injury Severity Score was 9 (1-45). Of the 500 participants with complete primary outcome data, 225 (45.0%) met the cut point criteria for mental health diagnoses at 3 months. For both mental health outcomes, the models fit the data well (depression: root mean square error of approximation [RMSEA], 0.044; comparative fit index [CFI], 0.93; PTSD: RMSEA = 0.045; CFI = 0.93), and all hypothesized paths were significant and in the hypothesized direction. Outcomes were associated with poor preinjury health (standardized weights: depression, 0.28; P < .001; PTSD, 0.17; P = .02), acute psychological reactions (depression, 0.34; PTSD, 0.38; both P < .001), and intentional injury (depression, 0.16; PTSD, 0.24; both P < .001). Acute psychological reactions were associated with childhood adversity (depression, 0.33; PTSD, 0.36; both P < .001). A history of prior mental health challenges (depression, 0.70; PTSD, 0.70; both P < .001) and psychological or emotional health resources (depression, -0.22; PTSD, -0.23; both P = .003) affected poor preinjury health, which was in turn associated with acute psychological reaction (depression, 0.44; PTSD, 0.42; both P < .001). The intersection of prior trauma and adversity, prior exposure to neighborhood disadvantage, and poorer preinjury health and functioning are important, even in the midst of acute medical care for traumatic injury. These results support the importance of trauma-informed health care and focused assessment to identified patients with injuries who are at highest risk for poor postinjury mental health outcomes.

Different adiposity indices and their association with blood pressure and hypertension in middle-aged urban black South African men and women: findings from the AWI-GEN South African Soweto Site

BackgroundTo report associations between different adiposity indices [anthropometric and dual-energy X-ray absorptiometry (DXA) measures] and blood pressure (BP) and hypertension in urban black South African adults.MethodsAnthropometric and DXA whole body measures were performed on 1026 men and 982 women. Participants were classified as being hypertensive if they had a systolic BP (SBP) ≥ 140 mmHg and/or diastolic (DBP) ≥ 90 mmHg. Within each gender the relationship of adiposity with BP and hypertension risk was assessed using linear and logistic regression models respectively. Bivariate models were computed for each body composition variable. Furthermore, we computed a multiple regression model to illustrates how body composition parameters are associated with the outcome variables independent of each other.ResultsThe males were significantly taller and had a higher fat free soft tissue mass (FFSTM), DBP and socio-economic status, and were more likely to use tobacco and be hypertensive (48.0% vs. 38.8%). The females had higher body mass index (BMI), waist circumference (WC), fat mass (FM), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), FM/FFSTM ratio and body fat % than males. All body composition parameters were positively associated with hypertension. In both males and females, the FM/FFSTM ratio associated the strongest with hypertension illustrating the following odds ratios [males: 70.37 (18.47, 268.16) p ≤ 0.001; females 2.48 (0.86,7.21) p = 0.09]. The multiple regression model, indicated that the VAT and WC significantly associated with both SBP and DBP in the men and women respectively, whilst WC was the only significant predictor for hypertension.ConclusionsAll body composition parameters were associated with hypertension and FM/FFSTM ratio showed the strongest relationship. It was reassuring that WC remains a useful measure of central adiposity that can be used as a risk indicator for hypertension if more sophisticated measures are not available. Furthermore, our data in part, implies that reducing abdominal adiposity in aging adults could contribute to reducing the risk of elevated blood pressure and hypertension.

Emotional responses to unintentional and intentional traumatic injuries among urban black men: A qualitative study

PurposeThe burden of injuries is disproportionately concentrated among Black men in the United States. Previous studies suggest that the mental health effects of trauma may vary by the intentionality of the injury (intentional vs. unintentional), yet little is known about this experience among Black men. We explored the emotional responses to traumatic injuries in the context of injury intentionality among Black men in an urban area. MethodsWe conducted semi-structured, qualitative interviews with 74 Black men who were traumatically injured. The interviews took place three months after discharge from the hospital and they were audiotaped, transcribed, and de-identified. We used systematic thematic analysis to identify themes about post-trauma emotional responses to intentional and unintentional injuries. ResultsThe narratives of intentionally injured men revealed persistent exposure to neighborhood violence and their distrust of others including the people they knew and to whom they felt close. Survivors of unintentional injuries did not express a similar distrust of others. Our findings suggest that survivors of intentional injuries experience loss of social support following their injuries. ConclusionsEmotional responses can differ by intentionality of traumatic injury among urban Black men. Intentional injuries may be a marker for chronic exposure to violence and limited social support for recovery. Additional resources should be targeted to survivors of intentional injury who return to disadvantaged communities after medical treatment to decrease risk of re-traumatization and adverse emotional responses.

Moving up matters: Socioeconomic mobility prospectively predicts better physical health.

Low socioeconomic status (SES) in childhood confers risk for poor physical health later in life. This study prospectively examines whether improvements in family SES protect youth from developing physical health problems by adulthood and whether such effects differ by race or age. Participants are a school-based sample of urban Black (53%) and White (47%) men (N = 311). Using latent growth curve modeling, we prospectively examined whether changes in family SES measured annually between Ages 7 and 16 predicted physical health diagnoses in adulthood (Age 32). Family SES was assessed as a weighted composite of parental education and occupational status. Physical health diagnoses were assessed as a count of self-reported medical conditions from a health history interview. Consistent with macroeconomic trends, on average, family SES increased until the early 1990s, then remained flat until rising again in the mid-1990s. During each of 3 independent developmental periods, boys raised in families who experienced more positive changes in SES reported fewer physical health diagnoses in adulthood. These effects did not vary significantly by race and remained after controlling for initial childhood SES, childhood health problems, concurrent adult SES, and weight (Body Mass Index or reported overweight). Initial childhood SES did not predict physical health, whereas relative improvements in SES over a 10-year period did. If the families of Black and White boys were upwardly mobile, it appeared to protect them from developing physical disease, and upward mobility was additively protective across developmental periods examined here. (PsycINFO Database Record

Measuring the Pros and Cons of What It Means to Be a Black Man: Development and Validation of the Black Men's Experiences Scale (BMES).

Although extensive research documents that Black people in the U.S. frequently experience social discrimination, most of this research aggregates these experiences primarily or exclusively by race. Consequently, empirical gaps exist about the psychosocial costs and benefits of Black men's experiences at the intersection of race and gender. Informed by intersectionality, a theoretical framework that highlights how multiple social identities intersect to reflect interlocking social-structural inequality, this study addresses these gaps with the qualitative development and quantitative test of the Black Men's Experiences Scale (BMES). The BMES assesses Black men's negative experiences with overt discrimination and microaggressions, as well their positive evaluations of what it means to be Black men. First, we conducted focus groups and individual interviews with Black men to develop the BMES. Next, we tested the BMES with 578 predominantly low-income urban Black men between the ages of 18 and 44. Exploratory factor analysis suggested a 12-item, 3-factor solution that explained 63.7% of the variance. We labeled the subscales: Overt Discrimination, Microaggressions, and Positives: Black Men. Confirmatory factor analysis supported the three-factor solution. As hypothesized, the BMES's subscales correlated with measures of racial discrimination, depression, resilience, and social class at the neighborhood-level. Preliminary evidence suggests that the BMES is a reliable and valid measure of Black men's experiences at the intersection of race and gender.

Seriously Injured Urban Black Men's Perceptions of Clinical Research Participation.

Black men are uniquely vulnerable in American society and our health care system: they bear a disproportionate burden of injury, yet are underrepresented in clinical research. This study aimed to explore the reasons why urban Black men with serious injuries chose to participate in clinical research and their concerns about research participation. This qualitative study was conducted within the context of a larger study focused on psychological effects of serious injury in urban Black men; 83 Black men with serious injuries were recruited while hospitalized in an urban trauma center. Informed consent was obtained. Semi-structured interviews were conducted in participants' homes three months after discharge from the hospital and were audiotaped, transcribed, and de-identified. Thematic content analysis was used to identify themes about perceptions of participating in clinical research. The mean age of our sample was 38.2years, and the mean injury severity score was 10.7 (SD 9.6). The majority (53.2%) of injuries was due to interpersonal violence, and 47% were due to unintentional mechanisms. Eight reasons for research participation emerged from the data: human connection, altruism/community, self-improvement,compensation, gaining knowledge, curiosity/interest, low risk, and reciprocity. A major finding was that injured urban Black men participated in clinical research for the opportunity for human and therapeutic connection. Despite some expressions of mistrust, participants were willing to participate for altruistic reasons rooted in community priorities, and as part of their recovery process post-injury.

Racial discrimination and posttraumatic stress symptoms as pathways to sexual HIV risk behaviors among urban Black heterosexual men

In light of evidence that racial discrimination and posttraumatic stress symptoms (PTSS) are neither rare nor extraordinary for many Black urban men, we examined the relationship between everyday racial discrimination and sexual HIV risk behaviors in a predominantly low-income sample of 526 urban Black heterosexually identified men; 64% of whom were unemployed and 55% of whom reported a history of incarceration. We tested the hypothesis that PTSS would mediate the relationship between everyday racial discrimination and sexual risk. Participants in the predominantly low-income urban sample ranged in age from 18 to 45 (M = 28.80, SD = 7.57). Three multiple regression models were used to test the study's mediational model. As hypothesized, PTSS mediated the relationship between everyday racial discrimination and sexual risk behaviors. Most participants (97%) reported experiences with everyday racial discrimination. Results empirically support the notion of racial discrimination-based traumatic stress as a pathway to Black heterosexual men's increased sexual risk behaviors. Results also highlighted key demographic differences with older men reporting fewer PTSS and sexual risk behaviors compared with younger men. Incarceration was related to both PTSS and sexual risk, underscoring the role that incarceration may play in Black heterosexual men's adverse health outcomes. Our study highlights the need for more qualitative and quantitative research to understand the nature of PTSS in Black heterosexual men and mechanisms such as substance use that may link traumatic experiences and sexual risk. Future research could also assess experiences with childhood sexual abuse, violence, and incarceration to gain a more in-depth understanding of the sources of traumatic stress in Black heterosexual men's lives. We advocate for the development of community-based individual and structural-level interventions to help Black heterosexual men in urban areas develop effective strategies to cope with racial discrimination-based traumatic stress to reduce sexual HIV risk behaviors in Black communities.

Experiences of Racial Discrimination and Relation to Sexual Risk for HIV among a Sample of Urban Black and African American Men

This study aimed to examine racial discrimination and relation to sexual risk for HIV among a sample of urban black and African American men. Participants of this cross-sectional study were black and African American men (N = 703) between the ages of 18 and 65 years, recruited from four urban clinical sites in the northeast. Multivariate logistic regression models were used to analyze the relation of reported racial discrimination to the following: (1) sex trade involvement, (2) recent unprotected sex, and (3) reporting a number of sex partners in the past 12 months greater than the sample average. The majority of the sample (96%) reported racial discrimination. In adjusted analyses, men reporting high levels of discrimination were significantly more likely to report recent sex trade involvement (buying and/or selling) (adjusted odds ratio (AOR) range = 1.7-2.3), having recent unprotected vaginal sex with a female partner (AOR = 1.4, 95% confidence interval (CI), 1.1-2.0), and reporting more than four sex partners in the past year (AOR = 1.4, 95% CI, 1.1-1.9). Findings highlight the link between experiences of racial discrimination and men's sexual risk for HIV.

Social determinants of cardiovascular disease risk factor presence among rural and urban Black and White men

BackgroundSocial determinants of health are increasingly being addressed as a causal factor for disparities in health. The purpose of this study was to assess the effects of specified social determinants of health on cardiovascular disease (CVD) clinical risk factors in Black and White men residing in rural and urban Georgia. MethodsSelf-report data were collected on a total of 548 Black and White men aged >18 years from 2004–2005. Data were derived from a random telephone survey. Separate logistic regression models were conducted to examine the effects of specified social determinants on the presence of two or more CVD clinical risk factors. In addition, differences within rural and urban men were also assessed. ResultsLower education, unemployment, lower income, and higher general stress were all significantly related to the presence of two or more CVD clinical risk factors. As expected, the covariates of age, race, and residential location also played a significant role in cardiovascular health. Rural men were nearly twice as likely to have two or more CVD risk factors compared to urban men (P <0.01). Models examining location separately found urban Black men to be 2.6 times as likely to have more than two CVD risk factors (P <0.02). ConclusionFindings reveal social determinants are associated with CVD risk factor differences between Black and White men and between rural and urban residents. It is important for policymakers and the healthcare industry to address these social determinants of health as they try to improve the health of the people they serve.

Coping and metabolic syndrome indicators in urban black South African men

Urbanisation is associated with obesity, hypertension and development of the metabolic syndrome (MS). We aimed to assess the use of different coping styles and their influence on increases in MS indicators and target end-organ damage (TOD) in urban black African men. A sample of 53 men was classified as clear high active (AC, n = 30) or passive coping (PC, n = 23) responders, using the Amirkhan African validated coping style indicator. Blood pressure (BP) was recorded with an aneroid sphygmomanometer and waist circumference (WC) was determined. Carotid intima-media thickness (CIMT) and microalbuminuria were analysed to determine TOD. Fasting serum and eight-hour urine samples revealed elevated MS indicators in AC men. Strong associations existed between MS indicators and TOD in AC but not PC men. To conclude, only BP and seeking social support were positively associated with TOD in urban PC African men, while in urban AC African men, most MS indicators were positively associated with TOD, i.e. sub-clinical atherosclerosis and renal impairment.

Relation of misperception of healthy weight to obesity in urban black men.

This study examined the relation between misperception of healthy weight and obesity, as well as moderators of this relation, in a sample of middle-aged black men. Survey data from 404 mostly immigrant, black males living in greater New York City were collected as part of a larger randomized controlled trial. Data included measures of health status, BMI, perceived healthy weight, and misperception of healthy weight. Misperception of healthy weight was more frequent among obese men (90.2%) than nonobese men (48.7%) (P < 0.001). Mean level of misperception was also significantly higher in obese men than nonobese men (P < 0.001). Health status moderated the relation between misperception of healthy weight and obesity: obese men who felt healthy or who had fewer comorbid conditions had greater misperception of healthy weight than obese men who felt unhealthy or had relatively more comorbid conditions (P < 0.01). Our findings demonstrate that misperception of healthy weight discriminates between obese and nonobese black men, and the magnitude of this relation is exacerbated in obese men who are relatively healthy. Future studies should determine the prevalence of misperception of healthy weight in more diverse populations and identify potential mediators of the relation between misperception of healthy weight and obesity.