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Human papillomavirus (HPV) vaccination can prevent numerous cancers, yet uptake remains low for adolescents. Given disproportionate burden of cancers among African Americans, it is important to identify factors that influence HPV vaccination decisions among African American parents, specifically the role and preferences of vaccine campaign messages. The objectives of this study were to (1) identify the predictors of parents’ decisions to get their children vaccinated against HPV, (2) assess parents’ evaluation of current HPV vaccination campaign messages, and (3) uncover message strategies or themes parents consider to be effective and motivating to vaccinate their children against HPV. Focus groups were conducted with African American mothers and fathers (n = 18) in person. Several themes emerged regarding HPV vaccine acceptability including the desire to be informed, the unfamiliarity of vaccination, and mistrust toward government, pharmaceutical companies, and healthcare providers. Parental review of existing campaign messages highlighted the importance of clarifying risks and benefits of vaccination, including cancer prevention, and the preference for straightforward language. When brainstorming strategies to craft effective messages, parents highlighted need for the inclusion of diverse groups across race, gender, and age. Additionally, parents recommended clear language on side effects, eligibility, and additional resources for further information. Our findings highlight concerns and potential strategies to promote HPV vaccination tailored to African American parents and their children. Targeted interventions to increase vaccination need to consider the importance of building trust and representation in health promotional materials. Considerations for how messages were shared were also discussed such as physical locations, word of mouth, and social media.

This review describes stress-related biological mechanisms linking interpersonal racism to life course health trajectories among African Americans. Interpersonal racism, a form of social exclusion enacted via discrimination, remains a salient issue in the lives of African Americans, and it triggers a cascade of biological processes originating as perceived social exclusion and registering as social pain. Exposure to discrimination increases sympathetic nervous system activation and upregulates the HPA axis, increasing physiological wear and tear and elevating the risks of cardiometabolic conditions. Consequently, discrimination is associated with morbidities including low birth weight, hypertension, abdominal obesity, and cardiovascular disease. Biological measures can provide important analytic tools to study the interactions between social experiences such as racial discrimination and health outcomes over the life course. We make future recommendations for the study of discrimination and health outcomes, including the integration of neuroscience, genomics, and new health technologies; interdisciplinary engagement; and the diversification of scholars engaged in biosocial inequities research.

Objective To examine the life experiences of African American and Hispanic adults whose personal chronic illness and/or that of a family member is the biggest health problem for their families. Data source Telephone (landline and cell phone) interviews of random, nationally representative samples of 1081 African-American and 1478 Hispanic adults, age 18 and older. We evaluated the responses of 757 African-American and 697 Hispanic participants who reported a chronic illness as the biggest health problem in their families. Methods Weighted analysis of cross-sectional survey responses from African-American and Hispanic adults. Results African Americans and Hispanics with chronic illness in their families reported experiencing challenges with the health care delivery system, with financial/economic insecurity, and with their communities that may influence how they live with chronic disease. Discussion Policymakers and clinicians should be aware that some African-American and Hispanic patients face obstacles within and beyond the health care system that are relevant to how they live with chronic conditions affecting their families. Additional tools and supports may need to be identified and supplied to effectively manage chronic illness in these communities. The payment system for physicians should account for the supplementary supports and services these patients might require.

Few past studies have used conjoint analysis to assess message design features and even fewer have looked at health issues. This research applies conjoint analysis to the quest to design motivational messages for African Americans at risk for diet-related adverse health outcomes (e.g., heart disease) in Kentucky. African American health in the state of Kentucky can benefit from a diet high in fruit and vegetable consumption, but little past research has been conducted with African American Kentuckians to explore the best message structure for communicating about increased fruit and vegetable consumption. This study reports on the outcome of the final phase of formative campaign research. We use an adaptive conjoint analysis to identify the most important elements of message design for this group of Kentucky residents. Results indicate that the message’s source (i.e., the person delivering the message) is the most important design element for creating persuasive health messaging about fruit and vegetables for African Americans in Kentucky, followed by the stated benefit of eating more fruit and vegetables and the manner in which the behavior is described, respectively. To our knowledge, this study is the first to treat campaign message features as the subject of a conjoint analysis in order to identify which combination of features might be most motivating for a specific target audience. Recommendations for future health communication campaign application, as well as future research are discussed.

This article is a reflection of the individual and collective experiences of university professors of color whose work addresses African American health disparities. As instructors with the responsibility of introducing undergraduate students to the concept of health disparities, we believe it is beneficial for students to examine health disparities within the historical context of race. From our collective experiences, we offer selected resources to help students (1) understand race as a social construct and (2) understand that health disparities are not a consequence of inherent race-based biological differences. This is paramount to initiating a discussion of African American health disparities. Furthermore, this challenges students to think critically about social determinants of health and the broader ecological factors associated with health disparities. In preparing future professionals in health promotion, this results in more well-rounded practitioners who are better able to engage with more diverse communities.

The Chicago south side, even more so than national populations, continues to be burdened with widening gaps of disparities in cancer outcomes. Therefore, Chicago community members were engaged in addressing the following content areas for a cancer disparities curriculum: (1) the south side Chicago community interest in participating in curriculum design, (2) how community members should be involved in designing cancer disparities curriculum, and (3) what community members believe the curriculum should address to positively impact their community.Eighty-six community members from 19 different zip code areas of Chicago attended the deliberative session. A survey composed of three quantitative and three short-answer content questions was analyzed.The majority of participants were from the south side of Chicago (62 %) and females (86 %). Most, 94 %, believed community members should be involved in cancer disparities curriculum development. Moreover, 56 % wanted to be involved in designing the curriculum, and 61 % reported an interest in taking a course in cancer disparities. Three categorical themes were derived from the qualitative questions: (1) community empowerment through disparities education-"a prescription for change," (2) student skill development in community engagement and advocacy training, and (3) community expression of shared experiences in cancer health disparities.The community provided valuable input for curricular content and has an interest in collaborating on cancer disparities curriculum design. Community participation must be galvanized to improve disparities curricular development and delivery to successfully address the challenges of eliminating disparities in health.

Objective Depression may be a predictor and consequence of obesity. However, available evidence for racial minorities has been inconsistent, and more prospective studies are needed. Thus, this study's objective was to examine whether depressive symptom severity is a predictor and/or consequence of total adiposity over a 9-year period in a representative sample of late middle-aged African-Americans. Methods A total of 410 participants (aged 49–65 years; baseline) in the prospective cohort African American Health study were examined. Depressive symptom severity was assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D). Total body fat percent (BF%) and body mass index (BMI; kg/m2) were assessed. Structural equation models were tested. Results All model fit statistics, other than χ2, indicated good fit (RMSEA ≤ 0.058, SRMR ≤ 0.052, CFI ≥ 0.95). Baseline CES-D did not predict 9-year changes in BF% (β = −0.01, P = 0.78) or BMI (β = −0.01, P = 0.77). Baseline BF% (β = 0.05, P = 0.39) and BMI (β = 0.08, P = 0.095) did not predict 9-year change in CES-D. Conclusions Depressive symptom severity was not a predictor or consequence of excess total adiposity in late middle-aged African-American adults. Including a depression module in obesity prevention and treatment programs specifically designed for late middle-aged African-Americans may not have a beneficial effect on obesity outcomes.

Reduction and elimination of African American health disparities, a major challenge of our society for the past 20 years, has not been realized, although empirical studies, clinical practice and policy initiatives have made progress in their attempt to achieve this goal. Behavioral health risks are a significant component of such disparities. In this paper the authors maintain that the precise lack of understanding of how much behavioral health is influenced by worldview, and the importance of historical roots of African American people, and the challenges they face in the 21st century need to be explored and understood within the context of worldview. Specifically, the allocentric worldview should be considered an essential component in discussions surrounding behavioral health disparities. This paper argues that anything less than an historical assessment of the conditions leading up to behavioral health ills in African American urban and rural communities today will be incomplete, inaccurate and fall short of achieving the goals of reducing behavioral health disparities in this population. The purpose of this manuscript is to present the allocentric worldview and explore how its adoption is critical to behavioral health recovery among African Americans today. It is proposed that knowing and adopting a cultural and historical worldview that is indigenous to African descended peoples may significantly improve motivation and action among African Americans to adopt healthier behavioral health life styles.

There are many misconceptions about African American health that have subtle and continuing influence on health policy debates. Unfortunately, many of the misconceptions surrounding African American health have an implicit historical dimension, and the usual response for the lack of evidence in support of any myth is that “the data does not exist” to shed full light on the given question. This is unfortunate as there is now a growing body of evidence pertaining to the historical health of the African American population, and this data is currently being used to uncover a number of facts about the historical dynamics of African American health. In this paper, we show that our historical data on the health of African Americans is wholly lacking and at the same time show that one prominent myth about trends in African American health does not stand up to historical investigation. We conclude with a brief note about where this research is headed and what future topics should be explored in African American economic and health history.

Disparities in African American health remain pervasive and persist transgenerationally. There is a growing consensus that both structural and interpersonal racial discrimination are key mechanisms affecting African American health. The Biopsychosocial Model of Racism as a Stressor posits that the persistent stress of experiencing discrimination take a physical toll on the health of African Americans and is ultimately manifested in the onset of illness. However, the degree to which the health consequences of racism and discrimination can be passed down from one generation to the next is an important avenue of exploration. In this review, we discuss and link literature across disciplines demonstrating the harmful impact of racism on African American physical health and the health of their offspring.

Lung cancer is a leading cause of cancer-related deaths in the United States and globally. African Americans experience significant differences in lung cancer incidence and mortality. Smoking is the single greatest risk for lung cancer, making smoking cessation programs a potentially fruitful approach for reducing the risk of lung cancer. Despite clinical practice guidelines that prompt nurses to advise patients to quit smoking, only a small percentage of nurses do so. Minority patients are less likely than Whites to receive smoking cessation advice. This article discusses recent findings on the pathophysiology and risks for lung cancer. The literature on smoking cessation research is examined to determine the features of successful cessation interventions. Recommendations are offered for enhancing tobacco cessation efforts in nursing practice, education, and research.

Older adult frail diabetics have high mortality risk, but data are limited regarding frail late middle-aged diabetics, especially for African-Americans. The aim of this study is to examine the association of diabetes with health outcomes and frailty in the African American Health (AAH) study.AAH is a population-based longitudinal cohort study. Participants were African Americans (N=998) ages 49 to 65 years at baseline. Cross-sectional comparisons for diabetes included disability, function, physical performance, cytokines, and frailty. Frailty measures included the International Academy of Nutrition and Aging [FRAIL] frailty scale, Study of Osteoporotic Fractures [SOF] frailty scale, Cardiovascular Health Study [CHS] frailty scale, and Frailty Index [FI]). Longitudinal associations for diabetes included new ADLs ≥ 1 and mortality at 9-year follow-up.Diabetics were more likely to be frail using any of the 4 frailty scales than were non-diabetics. Frail diabetics, compared to nonfrail diabetics, reported significantly increased falls in last 1 year, higher IADLs and higher LBFLs. They demonstrated worse performance on the SPPB, one-leg stand, and grip strength; and higher Tumor Necrosis Factor receptors (sTNFR1 and sTNFR2). Mortality and 1 or more new ADLs also were increased among frail compared to nonfrail diabetics when followed for 9 years.Frailty in middle-aged African American persons with diabetes is associated with having more disability and functional limitations, worse physical performance, and higher cytokines (sTNFR1 and sTNFR2 only). Middle-aged African Americans with diabetes have an increased risk of mortality and frail diabetics have an even higher risk of death, compared to nonfrail diabetics.

Deeply embedded in everyday discourse, social interactions, and institutional practices, racism negatively affects the health and well-being of Black people in the United States. Theory and empirical research on the impact of racism on health have focused on stressful events and individual perceptions of racism, although racism is not expressed only as racist acts. Racism subordinates people and diminishes their importance; stereotyping is one of the most insidious forms of such subordination. The stereotypes that underlie social discourse about race influence how others perceive Black people and, to some extent, how Black people perceive themselves. Thus stereotypes help maintain and promote racism. Despite the importance of stereotypes in understanding racism and its effects on Black people, little attention has been paid to the impact of stereotypes on health. This paper explores the adverse effects of stereotypes on African American health, focusing on the psychological and structural pathways through which stereotyping operates. Psychological pathways are salient for these reasons: stereotyping constitutes a form of racism that may be experienced vicariously; stereotypes induce vigilance and rumination as people caricatured by them anticipate their use and spend time trying to disconfirm them; stereotypes may be internalized. Structural pathways occur because stereotypes that portray Black people as deviant, undeserving, and ultimately less human negatively affect opportunity structures and physical environments.

This article offers a model that clarifies the degree of interdependence between social ecology and genomic processes. Drawing on principles from nonlinear dynamics, the model delineates major lines of bifurcation involving people's habitat, their family health history, and collective catastrophes experienced by their community. It shows how mechanisms of resource acquisition, depletion, and preservation can lead to disruptions in basic metabolism and in the activity of cytokines, neurotransmitters, and protein kinases, thus giving impetus to epigenetic changes. The hypotheses generated from the model are discussed throughout the article for their relevance to health problems among African Americans. Where appropriate, they are examined in light of data from the National Vital Statistics System. Multiple health outcomes are considered. For any one of them, the model makes clear the unique and converging contributions of multiple antecedent factors.

This article is the result of inquiries and ethnographic encounters over a 15-year period, with the governmental agency known as the Tennessee Office of Minority Health (TOMH), a division of the Tennessee Department of Health. This article concerns the innovative and participatory response of TOMH to support African American health in Tennessee. For the purposes of this article, an innovative and participatory response to alleviate any form of human suffering is defined as mutual aid. How TOMH uses mutual aid will be considered. The intent of this article is to show that mutual aid has historic roots in African American communities and the Black Church. Yet today, government agencies like TOMH use mutual aid to create outputs-altering processes that support health and redress health needs for African American communities.

This article reviews the literature on African American women’s obesity and physical inactivity with the goals of analyzing common themes and explanations in order to develop and provide better prevention. In addition, literature about body mass index (BMI), waist circumference, and body size satisfaction is included in this review. These factors have importance in gaining an understanding about obesity and inactivity among African American women. The author introduces the other articles that are included in this special issue of the Journal of African American Studies that are related to African American health, specifically the health of African American women.

Black youth residing in high-poverty areas have dramatically lower probabilities of surviving to age 65 if they are urban than if they are rural. Chronic disease deaths contribute heavily. We begin to probe the reasons using the Harlem Household Survey (HHS) and the Pitt County, North Carolina Study of African American Health (PCS). We compare HHS and PCS respondents on chronic disease rates, health behaviors, social support, employment, indicators of health care access, and health insurance. Chronic disease profiles do not favor Pitt County. Smoking uptake is similar across samples, but PCS respondents are more likely to quit. Indicators of access to health care and private health insurance are more favorable in Pitt County. Findings suggest rural mortality is averted through secondary or tertiary prevention, not primary. Macroeconomic and health system changes of the past 20 years may have left poor urban Blacks as medically underserved as poor rural Blacks.

Black-White differences in health are large, persistent, and in some cases, worsening over time. Racial segregation is a central determinant of Black-White differences in health. The physical separation of the races in residential areas is an institutional mechanism of racism that remains a primary determinant of racial differences in economic circumstances. These differences in social and economic conditions are largely responsible for racial differences in health status. Reparations are a potentially effective strategy to rebuild the infrastructure of disadvantaged, segregated communities. Such investment would enhance the economic circumstances of African American families and communities and also improve their health.

•Historical segregation shaped the African American health paradigm in many North American cities.•ES research should focus on understanding potentials and impediments address EJ issues.•ES approaches to EJ should be spatially explicit and have immediate health benefits.

African American men and women suffer from health problems such as hypertension, cardiovascular disease, diabetes, AIDS, sickle cell anemia, and various forms of cancer, often at a higher rate than the rest of the population. There is a need for information about these and other health problems affecting this particular community. This annotated bibliography includes recent articles, books, Internet resources, and Web sites. The audience for this essay includes the layperson, health‐care professionals, and information specialists who wish to provide information to patrons on these important health issues.

Employing a narrative framework, this article explores President Clinton's speech of apology for the Tuskegee Syphilis Experiment. Catalysts leading to the experiment, how the experiment was enacted, and the lingering impact of the experiment on African Americans' perceptions of the public health system are described. The U.S. government's rhetorical stance toward the experiment is analyzed in terms of how it creates a narrative of remembrance, redefinition, and reconciliation. The article argues the discourse serves to redefine the role of the Tuskegee Institute in the experiment while embracing the grand narrative of modernism.

Despite the numerous health benefits of breastfeeding, data reveal that African Americans have lower breastfeeding rates than any other race/ethnicity in the United States. Moreover, those that do initiate breastfeeding report doing so for a shorter duration and with less exclusivity. The purpose of this study was to examine breastfeeding behaviors among asample of women participating in the Start More Infants Living Equally Healthy (SMILE) Program, a nurse home visitation program promoting maternal-infant health among African Americans/Blacks residing in Montgomery County, Maryland. The examination was done in partnership with the African American Health Program in order to provide program relevant information that could assist the program in understanding and improving outcomes.

Preparation for birthing has focused primarily on Caucasian women. No studies have explored African American women’s birth preparation. From the perceptions of 12 African American maternity health-care providers, this study elicited perceptions of the ways in which pregnant African American women prepare for childbirth. Focus group participants answered seven semistructured questions. Four themes emerged: connecting with nurturers, traversing an unresponsive system, the need to be strong, and childbirth classes not a priority. Recommendations for nurses and childbirth educators include: (a) self-awareness of attitudes toward African Americans, (b) empowering of clients for birthing, (c) recognition of the role that pregnant women’s mothers play, (d) tailoring of childbirth classes for African American women, and (e) research on how racism influences pregnant African American women’s preparation for birthing.

The purpose of this handbook is to share information about evidence-based approaches for the reduction of health disparities in the USA. It brings information about intervention research that affects African Americans. For this project, there are three initial concepts: African Americans, health disparities, and intervention. This chapter reviews selected literature to provide definitions and framing. In this process, the chapter offers conceptual, operational, and theoretical reconsiderations.

Objective: This study examines 3-year weight change in African Americans. Method: Nine hundred and ninety-eight participants 49 to 65 years old were assessed at baseline and 3 years later. Weight was measured, and weight change was defined as clinically meaningful increases or decreases (± 5 kg). Potential risk factors were investigated using multinomial logistic regression. Results: In-home measured weights were available for 752 participants (75%): 504 (67%) had stable weights, 131 (17%) gained more than 5 kg, and 117 (16%) lost more than 5 kg. Among all participants, the risks for weight gains were cancer, chronic obstructive pulmonary disease, lower income, and Medicaid status; the risks for weight losses were angina, cancer, high measured systolic blood pressure, asthma, and physical inactivity. Sex-stratified analyses reveal differences involving age, socioeconomic status, cancer, blood pressure, and lower body function. Discussion: Three-year weight changes in middle-aged African Americans were frequent and significantly associated with several risk factors.

The author investigated the treatment patterns for hypertension among 285 African Americans in the Detroit Metropolitan area. Data analyses showed that sociocultural and psychosocial factors determine the degree to which African Americans adhere to their folk medicine system. The persistence of folk medicine provides a meaningful alternative to allopathic medicine for many African Americans because of its role in maintaining a sense of ethnic identity. It also indicates a pattern of adaptation to social and economic conditions, both within the African American community and in the larger society. Once health professionals recognize, understand, and decide to work within the framework of the multitude of factors that influences African American health care practices, increased adherence to hypertension, cancer, dental, and prenatal treatment programs can be encouraged.

This chapter outlines a multidimensional life-course framework to help clarify the psychological mechanisms that may contribute to poor physical and psychological health outcomes among African-Americans. We suggest how the framework clarifies major health issues at each life stage and how it might help in designing programs that promote health among African-Americans.

BACKGROUND: The prevalence of fear of falling and related activity restriction, and their joint distribution with falls and falls efficacy, have been inadequately addressed in population-based studies of middle-aged and African-American groups. METHODS: The African American Health project is a population-based panel study of 998 African Americans born in 1936-1950 from two areas of metropolitan St. Louis (an impoverished inner-city area and a suburban area). Fear of falling, fear-related activity restriction, and 24 frailty-related covariates were assessed during in-home evaluations in 2000-2001. RESULTS: We found that 12.6% of participants reported having fear of falling without activity restriction, 13.2% had fear of falling with activity restriction, and 74.2% had no fear of falling. Neither fear of falling nor fear-related activity restriction varied significantly across three birth cohorts (1946-1950, 1941-1945, and 1936-1940). Lack of overlap of these two phenomena with having a fall in the past 2 years and low falls efficacy was considerable. When examined across three groups (no fear, fear without activity restriction, and fear with activity restriction), a consistent pattern of decreasing health status and social, emotional, and physical functioning was demonstrated. CONCLUSIONS: In this population-based sample of 49- to 65-year-old African Americans, fear of falling and fear-related activity restriction were surprisingly common and not well explained by prior falls or low falls efficacy. These phenomena were already evident by age 49-55. Further study is warranted, including detailed qualitative investigations examining the timing, precursors, and consequences of fear of falling and fear-related activity restriction in minority and majority populations.

Race and Medicine in Nineteenth- and Early-Twentieth-Century America is a collection of papers that chronicle African American health issues from the mid 1860s to the early 1900s. The collection was authored by Todd L. Savitt, PhD, professor of medical humanities and history at Brody School of Medicine of East Carolina University. Dr Savitt has written extensively on this subject, including 3 other books and numerous articles. His first book, Medicine and Slavery: TheDiseases and Health Care of Blacks in Antebellum Virginia, documents African American health issues during that time. This current volume further continues his research by looking at the health care of African American patients as well as at African American physicians and the medical schools at which they trained. In his preface, the author states that the progression of themes in this book developed as his research uncovered relevant topics related to African American health issues.