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An excerpt is presented of the paper "From Information to Action: Prospects for Eliminating Health Disparities in African Americans", which was presented at the November 12, 2000 meeting of the Society for the Analysis of African-American Public Health Issues, which was held in Boston, Massachusetts.

Antecedents of racist treatments of Black patients by the psychiatric profession in the United States affect the way they view treatment today. Specifically, in this essay, we explore the enduring consequences of racial science on various treatment practices. We examined a range of primary sources on the history of racial theories about the mind, medical and psychiatric publications, and hospitals. We contextualize this analysis by examining the secondary literature in the history and sociology of psychiatry. Through analyzing racial thinking from the antebellum through the Jim Crow periods, we show how US medicine and psychiatry have roots in antebellum racial science and how carceral logics underpinned the past and present politics of Black mental health. Changing this trajectory requires practitioners to interrogate the historical foundations of racist psychiatric concepts. This essay urges them to reject biological racial realism, which bears reminiscences to 19th-century racial science, and embrace the variable of race as a social construct to study social inequalities in health as a first step toward moving away from the legacies of past injustices in medicine. (Am J Public Health. 2024;114(S3):S250–S257. https://doi.org/10.2105/AJPH.2023.307554) [ABSTRACT FROM AUTHOR]

An examination of the lives and careers of physician-activists Dorothy Boulding Ferebee (1898-1972) and Virginia M. Alexander (1899-1949) demonstrates how Black physicians in the first half of the 20th century used public health to improve the health of Black Americans and provides insights into the experiences of Black women physicians. I discuss their professional and personal backgrounds and analyze their divergent strategies to address health inequities. Ferebee used her leadership in Black women's organizations to develop public health programs and become a national advocate for Black health. Alexander, a Quaker, used her religious connections to urge Whites to combat racism in medicine. She also conducted public health research and connected it to health activism. Both were passionate advocates of health equity long before it gained prominence as a major public health issue. An analysis of their work illuminates past efforts to improve the health of Black Americans. [ABSTRACT FROM AUTHOR]

The Family Smoking Prevention and Tobacco Control Act exempted menthol from a flavoring additive ban, tasking the Tobacco Products Safety Advisory Committee to advise on the scientific evidence on menthol. To inform future tobacco control efforts, we examined the public debate from 2008 to 2011 over the exemption. Health advocates regularly warned of menthol’s public health damages, but inconsistently invoked the health disparities borne by African American smokers. Tobacco industry spokespeople insisted that making menthol available put them on the side of African Americans’ struggle for justice and enlisted civil rights groups to help them make that case. In future debates, public health must prioritize and invest in the leadership of communities most affected by health harms to ensure a strong, unrelenting voice in support of health equity. [ABSTRACT FROM AUTHOR]

Objectives. To better understand racial and ethnic disparities in US maternal mortality. Methods. We analyzed 2016–2017 vital statistics mortality data with cause-of-death literals (actual words written on the death certificate) added. We created a subset of confirmed maternal deaths that had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. We examined racial and ethnic disparities both overall and by primary cause. Results. The maternal mortality rate for non-Hispanic Black women was 3.55 times that for non-Hispanic White women. Leading causes of maternal death for non-Hispanic Black women were eclampsia and preeclampsia and postpartum cardiomyopathy with rates 5 times those for non-Hispanic White women. Non-Hispanic Black maternal mortality rates from obstetric embolism and obstetric hemorrhage were 2.3 to 2.6 times those for non-Hispanic White women. Together, these 4 causes accounted for 59% of the non-Hispanic Black‒non-Hispanic White maternal mortality disparity. Conclusions. The prominence of cardiovascular-related conditions among the leading causes of confirmed maternal death, particularly for non-Hispanic Black women, necessitates increased vigilance for cardiovascular problems during the pregnant and postpartum period. Many of these deaths are preventable. [ABSTRACT FROM AUTHOR]

We describe how mass incarceration directly undermines the core values of reproductive justice and how this affects incarcerated and nonincarcerated women. Mass incarceration, by its very nature, compromises and undermines bodily autonomy and the capacity for incarcerated people to make decisions about their reproductive well-being and bodies; this is done through institutionalized racism and is disproportionately done to the bodies of women of color. This violates the most basic tenets of reproductive justice—the right to have a child, not to have a child, and to parent the children you have with dignity and in safety. By undermining motherhood and safe pregnancy care, denying access to abortion and contraception, and preventing people from parenting their children at all and by doing so in overpoliced, unsafe environments, mass incarceration has become a driver of forms of reproductive oppression for people in prison and jails and in the community. [ABSTRACT FROM AUTHOR]

Background. Transgender women (transwomen) in the United States have been shown to have high HIV risk with Black and Hispanic transwomen being particularly vulnerable. Growing research on transgender men (transmen) also shows increased HIV risk and burden, although not as much is known for this transgender population. Objectives. This systematic review estimates the prevalence of self-reported and laboratory-confirmed HIV infection, reported sexual and injection behaviors, and contextual factors associated with HIV risk of transgender persons living in the United States. Search Methods. We searched the HIV Prevention Research Synthesis database and MEDLINE, EMBASE, PsycINFO, CINAHL, and Sociological Abstracts databases from January 2006 to March 2017 and January 2006 to May 2017, respectively. Additional hand searches were conducted in December 2017 to obtain studies not found in the literature searches. Selection Criteria. Eligible reports were published US-based studies that included transgender persons and reported HIV status. Data collection and analysis. Data were double-coded and quality assessed. We used random-effects models employing the DerSimonian–Laird method to calculate overall prevalence of HIV infection, risk behaviors, and contextual factors for transwomen, transmen, and race/ethnicity subgroups. Main Results. We reviewed 88 studies, the majority of which were cross-sectional surveys. Overall laboratory-confirmed estimated prevalence of HIV infection was 9.2% (95% confidence interval [CI] = 6.0%, 13.7%; κ = 24). Among transwomen and transmen, HIV infection prevalence estimates were 14.1% (95% CI = 8.7%, 22.2%; κ = 13) and 3.2% (95% CI = 1.4%, 7.1%; κ = 8), respectively. Self-reported HIV infection was 16.1% (95% CI = 12.0%, 21.2%; κ = 44), 21.0% (95% CI = 15.9%, 27.2%; κ = 30), and 1.2% (95% CI = 0.4%, 3.1%; κ = 7) for overall, transwomen, and transmen, respectively. HIV infection estimates were highest among Blacks (44.2%; 95% CI = 23.2%, 67.5%; κ = 4). Overall, participation in sex work was 31.0% (95% CI = 23.9%, 39.0%; κ = 39). Transwomen (37.9%; 95% CI = 29.0%, 47.7%; κ = 29) reported higher participation in sex work than transmen (13.1%; 95% CI = 6.6%, 24.3%; κ = 10; P =.001). Most outcomes indicated high heterogeneity in the overall and subgroup analyses. Conclusions. The availability of more data allowed us to calculate estimates separately for transwomen and transmen. HIV prevalence estimates for US transwomen were lower than previous estimates, but estimates for HIV prevalence and participation in sex work were higher when compared with transmen. Evidence gaps remain for transmen and the syndemic relationship of HIV, risky behaviors, and contextual factors specific to the transgender experience. Public Health Implications. This study highlights gender disparities for HIV and risky sexual behavior, as well as evidence gaps that exist for transmen. Tailored programs and services for the transgender population need to be developed to encourage use of and access to HIV prevention services. [ABSTRACT FROM AUTHOR]

Objectives. To determine the proportion of restaurants that will be required to post calorie information under the Food and Drug Administration’s menu-labeling regulations in 4 New Jersey cities. Methods. We classified geo coded 2014 data on 1753 restaurant outlets in accordance with the Food and Drug Administration’s guidelines, which will require restaurants with 20 or more locations nationwide to post calorie information. We used multivariate logistic regression analyses to assess the association between menu-labeling requirements and census tract characteristics. Results. Only 17.6% of restaurants will be affected by menu labeling; restaurants in higher-income tracts have higher odds than do restaurants in lower-income tracts (odds ratio [OR] = 1.55; P = .02). Restaurants in non-Hispanic Black (OR = 1.62; P = .02) and mixed race/ethnicity (OR = 1.44; P = .05) tracts have higher odds than do restaurants in non- Hispanic White tracts of being affected. Conclusions. Additional strategies are needed to help consumers make healthy choices at restaurants not affected by the menu-labeling law. These findings have implications for designing implementation strategies for the law and for evaluating its impact. [ABSTRACT FROM AUTHOR]

Objectives. To estimate the cumulative probability (c) of arrest by age 28 years in the United States by disability status, race/ethnicity, and gender. Methods. I estimated cumulative probabilities through birth cohort life tables with data from the National Longitudinal Survey of Youth, 1997. Results. Estimates demonstrated that those with disabilities have a higher cumulative probability of arrest (c = 42.65) than those without (c = 29.68). The risk was disproportionately spread across races/ethnicities, with Blacks with disabilities experiencing the highest cumulative probability of arrest (c = 55.17) and Whites without disabilities experiencing the lowest (c = 27.55). Racial/ethnic differences existed by gender as well. There was a similar distribution of disability types across race/ethnicity, suggesting that the racial/ethnic differences in arrest may stem from racial/ethnic inequalities as opposed to differential distribution of disability types. Conclusions. The experience of arrest for those with disabilities was higher than expected. Police officers should understand how disabilities may affect compliance and other behaviors, and likewise how implicit bias and structural racism may affect reactions and actions of officers and the systems they work within in ways that create inequities. [ABSTRACT FROM AUTHOR]

Objectives. To test the effectiveness of a preclinical, telephone-based patient navigation intervention to encourage colorectal cancer (CRC) screening among older Black men. Methods. We conducted a 3-parallel-arm, randomized trial among 731 self-identified Black men recruited at barbershops between 2010 and 2013 in New York City. Participants had to be aged 50 years or older, not be up-to-date on CRC screening, have uncontrolled high blood pressure, and have a working telephone. We randomized participants to 1 of 3 groups: (1) patient navigation by a community health worker for CRC screening (PN), (2) motivational interviewing for blood pressure control by a trained counselor (MINT), or (3) both interventions (PLUS). We assessed CRC screening completion at 6-month follow-up. Results. Intent-to-treat analysis revealed that participants in the navigation interventions were significantly more likely than those in the MINT-only group to be screened for CRC during the 6-month study period (17.5% of participants in PN, 17.8% in PLUS, 8.4% in MINT; P < .01). Conclusions. Telephone-based preclinical patient navigation has the potential to be effective for older Black men. Our results indicate the importance of community-based health interventions forimprovinghealth among minoritymen. [ABSTRACT FROM AUTHOR]

Objectives. To examine trends in and correlates of fighting and violence among youths from the 3 largest racial/ethnic groups in the United States. Methods. We derived race/ethnicity-specific prevalence estimates for fighting, group fighting, and attacks with intent to harm from the National Survey on Drug Use and Health, a population-based study of youths aged 12 to 17 years. Results. The prevalence of youth fighting and violence decreased significantly in all racial/ethnic groups over the study period (2002-2014), dropping from a high of 33.6% in 2003 to a low of 23.7% in 2014, reflecting a 29% decrease in the relative proportion of young people involved in these behaviors. However, there was also a clear severity gradient in which year-by-year point estimates for fighting and violence were consistently highest among non-Hispanic African American youths, followed by Hispanic and then non-Hispanic White youths. Conclusions. Although fighting and violence are on the decline among young people in general and across racial/ethnic subgroups, there is a stable pattern of disparities in youth involvement in these behaviors. [ABSTRACT FROM AUTHOR]

In this article, I examine how African American soldiers and veterans experienced and shaped federally sponsored health care during and after World War I. Building on studies of the struggles of Black leaders and health care providers to win professional and public health advancement in the 1920s and 1930s, and of advocates to mobilize for health care rights in the mid-20th century, I focus primarily on the experiences and activism of patients in the interwar years. Private and government correspondence, congressional testimony, and reports from Black newspapers reveal that African American soldiers and veterans communicated directly with policymakers and bureaucrats regarding unequal treatment, assuming roles as "policy actors" who viewed health and medical care as "politics by other means." In the process, they drew attention to the paradoxes inherent in expanding government entitlements in the era of Jim Crow, and helped shape a veterans' health system that emerged in the 1920s and remained in place for the following century. They also laid the groundwork for the system's precedent-setting desegregation, referred to by advocates of the time as "a shining example to the rest of the country.". [ABSTRACT FROM AUTHOR]

Objectives.To evaluate the Teen Outreach Program, a pregnancy prevention program, in 2 community-based settings. Methods. We evaluated the Teen Outreach Program, a 9-month positive youth development program, in 3 cohorts of youths from 2012 to 2015 in 2 states. In Louisiana, 7 agencies participated in an individualized randomized controlled trial, with youths randomly assigned to a treatment or control condition. Fourteen agencies in Rochester, New York, participated in a cluster randomized controlled trial. Results. We found no differences between the intervention and control youths on delay of sexual onset in Louisiana (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.62, 1.03) or in Rochester, New York (AOR = 0.89; 95% CI = 0.45, 1.77), or for sex with no effective means of birth control (Louisiana, AOR = 1.18; 95% CI = 0.78, 1.78; Rochester, AOR = 0.41; 95% CI = 0.13, 1.27) after controlling for relevant covariates. Conclusions. We found no short-term effects for the offer of the intervention. Research might be needed for the long-term and intermediate impacts of youth development programs on these and other adolescent risk behaviors. [ABSTRACT FROM AUTHOR]

Objectives. We investigated how racial/ethnic shifts in the urban landscape influence race-specific violence by considering changes in the size of the Hispanic population, racial/ethnic contact, and racial segregation patterns. Methods. We used a time-series approach incorporating 4 decennial periods (1980, 1990, 2000, and 2010) to determine whether racial/ethnic demographic changes in 144 US cities influenced White and Black homicide rates. Sources included census and Uniform Crime Reports Supplemental Homicide Report data. Results. The growing diversity in the residential population of US cities contributed to the dramatic decline in homicide rates over time, but the effects differed by racial group. Exposure between Hispanics and Blacks and the growing presence of Hispanics led to a reduced Black homicide trend but had no impact on Whites, after adjustment for economic shifts and other important structural features in US cities. Conclusions. Our research highlights the importance of paying closer attention to exposure and integration between immigrants and existing racial groups. Failure to consider racial/ethnic contact and the racial nature of urban violence may produce misleading results in studies of associations between Hispanic immigration and crime. [ABSTRACT FROM AUTHOR]

Objectives. We estimated HIV prevalence and risk factors among persons receiving mental health treatment in Philadelphia, Pennsylvania, and Baltimore, Maryland, January 2009 to August 2011. Methods. We used a multisite, cross-sectional design stratified by clinical setting. We tested 1061 individuals for HIV in university-based inpatient psychiatric units (n = 287), intensive case-management programs (n = 273), and community mental health centers (n = 501). Results. Fifty-one individuals (4.8%) were HIV-infected. Confirmed positive HIV tests were 5.9% (95% confidence interval [CI] = 3.7%, 9.4%) for inpatient units, 5.1% (95% CI = 3.1%, 8.5%) for intensive case-management programs, and 4.0% (95% CI = 2.6%, 6.1%) for community mental health centers. Characteristics associated with HIV included Black race, homosexual or bisexual identity, and HCV infection. Conclusions. HIV prevalence for individuals receiving mental health services was about 4 times as high as in the general population. We found a positive association between psychiatric symptom severity and HIV infection, indicating that engaging persons with mental illness in appropriate mental health treatment may be important to HIV prevention. These findings reinforce recommendations for routine HIV testing in all clinical settings to ensure that HIV-infected persons receiving mental health services are identified and referred to timely infectious disease care. [ABSTRACT FROM AUTHOR]

Objectives. We tested the efficacy of a brief intervention to promote correct and consistent use of condoms among Black male youths attending sexually transmitted infection (STI) clinics in 3 southern US cities. Methods. In 2010 to 2012, we screened (n = 1102) and enrolled (n = 702) youths aged 15 to 23 years who identified as Black and reported recent (past 2 months) sexual activity and randomized them to a private, brief, interactive intervention (n = 349) or an attention-equivalent control condition (n = 353). Assessments occurred at baseline and 2 and 6 months after the intervention. Results. At 6 months, with adjustment for age and pretest nonequivalence of the outcome variable, an estimated odds ratio (EOR) of 1.63 (95% confidence interval [CI] = 1.07, 2.49; P = .02) indicated efficacy for correct condom use. An adjusted generalized estimating equations model with both 2- and 6-month condom use variables produced an EOR of 1.49 (95% CI = 1.06, 2.08; P = .02). We did not observe significant effects on chlamydia and gonorrhea incidence. Conclusions. This brief intervention, delivered as part of STI clinical care, could help alleviate the disproportionate STI–HIV burden among young Black men. [ABSTRACT FROM AUTHOR]

Objectives. We examined associations between the relative and absolute availability of healthier food and beverage alternatives at food stores and community racial/ethnic, socioeconomic, and urban–rural characteristics. Methods. We analyzed pooled, annual cross-sectional data collected in 2010 to 2012 from 8462 food stores in 468 communities spanning 46 US states. Relative availability was the ratio of 7 healthier products (e.g., whole-wheat bread) to less healthy counterparts (e.g., white bread); we based absolute availability on the 7 healthier products. Results. The mean healthier food and beverage ratio was 0.71, indicating that stores averaged 29% fewer healthier than less healthy products. Lower relative availability of healthier alternatives was associated with low-income, Black, and Hispanic communities. Small stores had the largest differences: relative availability of healthier alternatives was 0.61 and 0.60, respectively, for very low-income Black and very low-income Hispanic communities, and 0.74 for very high-income White communities. We found fewer associations between absolute availability of healthier products and community characteristics. Conclusions. Policies to improve the relative availability of healthier alternatives may be needed to improve population health and reduce disparities. [ABSTRACT FROM AUTHOR]

The article profiles the Society for the Analysis of African-American Public Health Issues, an organization made up of primarily African American public health researchers which was developed in 1990 and conducts research on health disparities in the U.S. A discussion of the events that led up to the development of the association, and of the role that the association has played in improving the health of African Americans in the U.S., is presented INSETS: Accomplishments of the Society for the Analysis for...;Member Research of the Society for the Analysis for....

Objectives. We evaluated the role of poverty in racial/ethnic disparities in HIV prevalence across levels of urbanization. Methods. Using national HIV surveillance data from the year 2009, we constructed negative binomial models, stratified by urbanization, with an outcome of race-specific, county-level HIV prevalence rates and covariates of race/ethnicity, poverty, and other publicly available data. We estimated model-based Black–White and Hispanic–White prevalence rate ratios (PRRs) across levels of urbanization and poverty. Results. We observed racial/ethnic disparities for all strata of urbanization across 1111 included counties. Poverty was associated with HIV prevalence only in major metropolitan counties. At the same level of urbanization, Black–White and Hispanic–White PRRs were not statistically different from 1.0 at high poverty rates (Black–White PRR = 1.0, 95% confidence interval [CI] = 0.4, 2.9; Hispanic– White PRR = 0.4, 95% CI = 0.1, 1.6). In nonurban counties, racial/ethnic disparities remained after we controlled for poverty. Conclusions. The association between HIV prevalence and poverty varies by level of urbanization. HIV prevention interventions should be tailored to this understanding. Reducing racial/ethnic disparities will require multifactorial interventions linking social factors with sexual networks and individual risks. [ABSTRACT FROM AUTHOR]

Objectives. We examined national and state-specific disparities in health insurance coverage, specifically employer-sponsored insurance (ESI) coverage, for adults in same-sex relationships. Methods. We used data from the American Community Survey to identify adults (aged 25-64 years) in same-sex relationships (n = 31 947), married opposite-sex relationships (n = 3 060 711), and unmarried opposite-sex relationships (n = 259 147). We estimated multinomial logistic regression models and state-specific relative differences in ESI coverage with predictive margins. Results. Men and women in same-sex relationships were less likely to have ESI than were their married counterparts in opposite-sex relationships. We found ESI disparities among adults in same-sex relationships in every region, but we found the largest ESI gaps for men in the South and for women in the Midwest. ESI disparities were narrower in states that had extended legal same-sex marriage, civil unions, and broad domestic partnerships. Conclusions. Men and women in same-sex relationships experience disparities in health insurance coverage across the country, but residing in a state that recognizes legal same-sex marriage, civil unions, or broad domestic partnerships may improve access to ESI for same-sex spouses and domestic partners. [ABSTRACT FROM AUTHOR]

Objectives. We explored associations between the abolition of Jim Crow laws (i.e., state laws legalizing racial discrimination overturned by the 1964 US Civil Rights Act) and birth cohort trends in infant death rates. Methods. We analyzed 1959 to 2006 US Black and White infant death rates within and across sets of states (polities) with and without Jim Crow laws. Results. Between 1965 and 1969, a unique convergence of Black infant death rates occurred across polities; in 1960 to 1964, the Black infant death rate was 1.19 times higher (95% confidence interval [CI] = 1.18, 1.20) in the Jim Crow polity than in the non-Jim Crow polity, whereas in 1970 to 1974 the rate ratio shrank to and remained at approximately 1 (with the 95% CI including 1) until 2000, when it rose to 1.10 (95% CI = 1.08, 1.12). No such convergence occurred for Black-White differences in infant death rates or for White infants. Conclusions. Our results suggest that abolition of Jim Crow laws affected US Black infant death rates and that valid analysis of societal determinants of health requires appropriate comparison groups. [ABSTRACT FROM AUTHOR]

Objectives. The recently developed social resistance framework addresses a widespread pattern in which members of some nondominant minorities tend to engage in various risky and unhealthy behaviors more than the majority group. This pilot study tested the core hypotheses derived from this innovative framework. Methods. We conducted in 2011 a nationally representative Web-based survey of 200 members of a nondominant minority group (African Americans) and 200 members of a majority group (Whites). Results. The preliminary findings supported the main premises of the framework and suggested that nondominant minorities who felt discriminated and alienated from society tended also to have higher levels of social resistance. Those with higher levels of social resistance also engaged more in risky and unhealthy behaviors--smoking, drinking, and nonuse of seat belts--than did those with lower levels of social resistance. These associations were not found in the majority group. Conclusions. These preliminary results supported the framework and suggested that social resistance might play a meaningful role in risky and unhealthy behaviors of nondominant minorities, and should be taken into account when trying to reduce health disparities. [ABSTRACT FROM AUTHOR]

The article discusses efforts to address racism and inequities that the authors argue exist in Medicaid and other safety net health care providers in the U.S. It examines options provided by the Centers for Medicare & Medicaid Services (CMS), the overrepresentation of Black Americans and Latinx Americans in Medicaid, and the concept of retroactive eligibility.

Objectives. We report lessons derived from implementation of the Social Network Strategy (SNS) into existing HIV counseling, testing, and referral services targeting 18- to 64-year-old Black gay, bisexual, and other men who have sex with men (MSM). Methods. The SNS procedures used in this study were adapted from a Centers for Disease Control and Prevention-funded, 2-year demonstration project involving 9 community-based organizations (CBOs) in 7 cities. Under the SNS, HIV-positive and HIV-negative men at high risk for HIV (recruiters) were enlisted to identify and recruit persons from their social, sexual, or drug-using networks (network associates) for HIV testing. Sites maintained records of modified study protocols for ascertaining lessons learned. The study was conducted between April 2008 and May 2010 at CBOs in Washington, DC, and New York, New York, and at a health department in Baltimore, Maryland. Results. Several common lessons regarding development of the plan, staffing, training, and use of incentives were identified across the sites. Collectively, these lessons indicate use of SNS is resource-intensive, requiring a detailed plan, dedicated staff, and continual input from clients and staff for successful implementation. Conclusions. SNS may provide a strategy for identifying and targeting clusters of high-risk Black MSM for HIV testing. Given the resources needed to implement the strategy, additional studies using an experimental design are needed to determine the cost-effectiveness of SNS compared with other testing strategies. [ABSTRACT FROM AUTHOR]

Women of lower socioeconomic status and women of color in the United States have higher rates of abortion than women of higher socioeconomic status and White women. Opponents of abortion use these statistics to argue that abortion providers are exploiting women of color and low socioeconomic status, and thus, regulations are needed to protect women. This argument ignores the underlying causes of the disparities. As efforts to restrict abortion will have no effect on these underlying factors, and instead will only result in more women experiencing later abortions or having an unintended childbirth, they are likely to result in worsening health disparities. We provide a review of the causes of abortion disparities and argue for a multifaceted public health approach to address them. [ABSTRACT FROM AUTHOR]

Objectives. We examined differences in self-reported mental health (SRMH) between US-born and Somalia-born Black Americans compared with White Americans. We tested how SRMH was affected by stigma toward seeing a mental health provider, discrimination in the health care setting, or symptoms of depression. Methods. Data were from a 2008 survey of adults in Minnesota and were limited to US-born and Somalia-born Black and White Americans (n = 938). Results. Somalia-born adults were more likely to report better SRMH than either US-born Black or White Americans. They also reported lower levels of discrimination (18.6%) than US-born Black Americans (33.4%), higher levels of stigma (23.6% vs 4.7%), and lower levels of depressive symptoms (9.1% vs 31.6%). Controlling for stigma, discrimination, and symptomatology, Somaliaborn Black Americans reported better SRMH than White and Black Americans (odds ratio = 4.76). Conclusions. Mental health programming and health care providers who focus on Black Americans' mental health might be missing important sources of heterogeneity. It is essential to consider the role of race and ethnicity, but also of nativity, in mental health policy and programming. [ABSTRACT FROM AUTHOR]

Objectives. We determined whether racial/ethnic disparities existed in coverage by type of 100% smoke-free private workplace, restaurant, and bar laws from 2000 to 2009. Methods. We combined US census population data and the American Nonsmokers' Rights Foundation US Tobacco Control Database to calculate the percentage of individuals in counties covered by each type of law by race/ ethnicity from 2000 to 2009. Results. More of the US Hispanic and Asian populations were covered by 100% smoke-free restaurant and bar laws than non-Hispanic White and non- Hispanic Black populations. Asian coverage by smoke-free bars laws increased from 36% to 75%, and Hispanic coverage increased from 31% to 62%, compared with 6% to 41% for non-Hispanic Blacks and 8% to 49% for non-Hispanic Whites. Conclusions. Hispanics and Asians benefited more from the rapid spread of smoke-free law coverage, whereas non-Hispanic Blacks benefited less. These ethnic disparities suggest a likely effect of geographic region and may provide a basis for more effective, community-based, and tailored policy-related interventions, particularly regarding areas with high concentrations of non- Hispanic Blacks. [ABSTRACT FROM AUTHOR]

Objectives. We assessed public support for a potential Food and Drug Administration (FDA)-mandated reduction in cigarette nicotine content. Methods. We used nationally representative data from a June 2010 cross-sectional survey of US adults (n = 2649) to obtain weighted point estimates and correlates of support for mandated nicotine reduction. We also assessed the potential role of political ideology in support of FDA regulation of nicotine. Results. Nearly 50% of the public supported mandated cigarette nicotine reduction, with another 28% having no strong opinion concerning this potential FDA regulation. Support for nicotine reduction was highest among Hispanics, African Americans, and those with less than a high school education. Among smokers, the odds of supporting FDA nicotine regulation were 2.77 times higher among smokers who intended to quit in the next 6 months than among those with no plans to quit. Conclusions. Mandating nicotine reduction in cigarettes to nonaddictive levels may reduce youth initiation and facilitate adult cessation. The reasons behind nicotine regulation need to be communicated to the public to preempt tobacco industry efforts to impede such a regulation. [ABSTRACT FROM AUTHOR]

It has been suggested that people in racial/ethnic minority groups are healthier when they live in areas with a higher concentration of people from their own ethnic group, a so-called ethnic density effect. Ethnic density effects are still contested, and the pathways by which ethnic density operates are poorly understood. The aim of this study was to systematically review the literature examining the ethnic density effect on physical health, mortality, and health behaviors. Most studies report a null association between ethnic density and health. Protective ethnic density effects are more common than adverse associations, particularly for health behaviors and among Hispanic people. Limitations of the literature include inadequate adjustment for area deprivation and limited statistical power across ethnic density measures and study samples. [ABSTRACT FROM AUTHOR]

Objectives. We assessed support for a ban by the Food and Drug Administration on menthol in cigarettes and behavioral intentions among menthol smokers in the event of such a ban. Methods. We surveyed 2649 never, former, and current smokers and used ordinal logistic regression to calculate weighted point estimates and predictors of support for a menthol ban among the adult population and menthol smokers only. For menthol smokers, we also calculated weighted point estimates and predictors of behavioral intentions. Results. Overall, 28.2% of adults opposed, 20.0% supported, and 51.9% lacked a strong opinion about a menthol ban. Support was highest among Hispanics (36.4%), African Americans (29.0%), never smokers (26.8%), and respondents with less than a high school education (28.8%). Nearly 40% of menthol smokers said they would quit if menthol cigarettes were no longer available, 12.5% would switch to a nonmenthol brand, and 25.2% would both switch and try to quit. Conclusions. Support for a menthol ban is strongest among populations with the highest prevalence of menthol cigarette use. A menthol ban might motivate many menthol smokers to quit. [ABSTRACT FROM AUTHOR]

In 2001, Maryland's court of appeals was asked to decide whether researchers at Johns Hopkins University had engaged in unethical research on children. During the 1990s, Johns Hopkins's Kennedy Krieger Institute had studied 108 African American children, aged 6 months to 6 years, to find an inexpensive and "practical" means to ameliorate lead poisoning. We have outlined the arguments in the case and the conundrum faced by public health researchers as they confront new threats to our health from environmental and industrial insults. We examined the case in light of contemporary public health ideology, which prioritizes harm reduction over the historical goals of prevention. As new synthetic toxins-such as bisphenyl A, polychlorinated biphenyls, other chlorinated hydrocarbons, tobacco, vinyl, and asbestos-are discovered to be biologically disruptive and disease producing at low levels, lead provides a window into the troubling dilemmas public health will have to confront in the future. [ABSTRACT FROM AUTHOR]

Objectives. We compared reported safety belt use, for both drivers and passengers, among teenagers with learner's permits, provisional licenses, and unrestricted licenses in states with primary or secondary enforcement of safety belt laws. Methods. Our data source was the 2006 National Young Driver Survey, which included a national representative sample of 3126 high-school drivers. We used multivariate, log-linear regression analyses to assess associations between safety belt laws and belt use. Results. Teenaged drivers were 12% less likely to wear a safety belt as drivers and 15% less likely to wear one as passengers in states with a secondary safety belt law than in states with a primary law. The apparent reduction in belt use among teenagers as they progressed from learner to unrestricted license holder occurred in only secondary enforcement states. Groups reporting particularly low use included African American drivers, rural residents, academically challenged students, and those driving pickup trucks. Conclusions. The results provided further evidence for enactment of primary enforcement provisions in safety belt laws because primary laws are associated with higher safety belt use rates and lower crash-related injuries and mortality. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the association between masculinity and the health of US men of color aged 18 years and older. We identified 22 population-based studies that included a measure of masculinity and a measure of health behavior, mental health, or physical health. The associations between masculinity and health were complex and varied by construct and health outcome, though they generally were significant in the hypothesized directions. Future research should explore the centrality of masculinity versus other identities and characteristics, how the relationship between masculinity and health varies by health outcome, and the identification of the conceptions and aspects of masculinity that are most relevant to and associated with specific health behaviors and health outcomes. [ABSTRACT FROM AUTHOR]

Objectives. We examined the impact of social discrimination and financial hardship on unprotected anal intercourse with a male sex partner of serodiscordant or unknown HIV status in the past 3 months among 1081 Latino and 1154 Black men who have sex with men (MSM; n = 2235) residing in Los Angeles County, California; New York, New York; and Philadelphia, Pennsylvania. Methods. We administered HIV testing and a questionnaire assessing 6 explanatory variables. We combined traditional mediation analysis with the results of a path analysis to simultaneously examine the direct, indirect, and total effects of these variables on the outcome variable. Results. Bivariate analysis showed that homophobia, racism, financial hardship, and lack of social support were associated with unprotected anal intercourse with a serodiscordant or sero-unknown partner. Path analysis determined that these relations were mediated by participation in risky sexual situations and lack of social support. However, paths between the explanatory variable and 2 mediating variables varied by participants' serostatus. Conclusions. Future prevention research and program designs should specifically address the differential impact of social discrimination and financial hardship on lack of social support and risky sexual situations among Latino and Black MSM. [ABSTRACT FROM AUTHOR]

Objectives. We considered interactions between physical activity and body mass index (BMI) and neighborhood factors. Methods. We used recursive partitioning to identify predictors of low recreational physical activity (<2.5 hours/week) and overweight and obesity (BMI‡25.0 kg/m2) among 118 315 women in the California Teachers Study. Neighborhood characteristics were based on 2000 US Census data and Reference US business listings. Results. Low physical activity and being overweight or obese were associated with individual sociodemographic characteristics, including race/ethnicity and age. Among White women aged 36 to 75 years, living in neighborhoods with more household crowding was associated with a higher probability of low physical activity (54% vs 45% to 51%). In less crowded neighborhoods where more people worked outside the home, the existence of fewer neighborhood amenities was associated with a higher probability of low physical activity (51% vs 46%). Among non-African American middle-aged women, living in neighborhoods with a lower socioeconomic status was associated with a higher probability of being overweight or obese (46% to 59% vs 38% in high-socioeconomic status neighborhoods). Conclusions. Associations between physical activity, overweight and obesity, and the built environment varied by sociodemographic characteristics in this educated population. [ABSTRACT FROM AUTHOR]

The physical infrastructure and housing make human interaction possible and provide shelter. How well that infrastructure performs and which groups it serves have important implications for social equity and health. Populations in inadequate housing are more likely to have environmental diseases and injuries. Substantial disparities in housing have remained largely unchanged. Approximately 2.6 million (7.5%) non-Hispanic Blacks and 5.9 million Whites (2.8%) live in substandard housing. Segregation, lack of housing mobility, and homelessness are all associated with adverse health outcomes. Yet the experience with childhood lead poisoning in the United States has shown that housing-related disparities can be reduced. Effective interventions should be implemented to reduce environmental health disparities related to housing. [ABSTRACT FROM AUTHOR]

Adult cigarette smoking prevalence trends among African Americans (AAs) and Whites are similar. However, during the decline in youth smoking that occurred between the mid-1970s and the early 1990s, the drop in smoking rates among AA adolescents was more than double that among Whites. We examined the evidence for potential explanations for this phenomenon. On the basis of our findings, we propose that racial differences in parental attitudes, religious ties, negative perceptions and experiences of the health effects of smoking, worsening poverty, increased use of food stamps, and price sensitivity were major factors contributing to the more rapid decrease in and continued lower rates of smoking among AA youths. [ABSTRACT FROM AUTHOR]

Objectives. We examined patterns in cigar use among young adults, aged 18-25 years, focusing on race/ethnicity and brand. Methods. We conducted a secondary data analysis of cross-sectional waves of the National Survey on Drug Use and Health, 2002-2008, using multivariate logistic regression to assess time trends in past 30 days cigar use, past 30 days use of a "top 5" cigar brand, cigar use intensity, and age at first cigar use. Results. Cigar use has increased among White non-Hispanic men aged 18 to 25 years, from 12.0% in 2002 to 12.7% in 2008. Common predictors of all outcomes included male gender and past 30 days use of cigarettes, marijuana, and blunts. Additional predictors of past 30 days cigar and "top 5" brand use included younger age, non-Hispanic Black or White race, lower income, and highest level of risk behavior. College enrollment predicted intensity of use and "top 5" brand use. Conclusions. Recent legislative initiatives have changed how cigars are marketed and may affect consumption. National surveys should include measures of cigar brand and little cigar and cigarillo use to improve cigar use estimates. [ABSTRACT FROM AUTHOR]

Objectives. We used nationally representative data to examine racial/ethnic disparities in smoking behaviors, smoking cessation, and factors associated with cessation among US adults. Methods. We analyzed data on adults aged 20 to 64 years from the 2003 Tobacco Use Supplement to the Current Population Survey, and we examined associations by fitting adjusted logistic regression models to the data. Results. Compared with non-Hispanic Whites, smaller proportions of African Americans, Asian Americans/Pacific Islanders, and Hispanics/Latinos had ever smoked. Significantly fewer African Americans reported long-term quitting. Racial/ethnic minorities were more likely to be light and intermittent smokers and less likely to smoke within 30 minutes of waking. Adjusted models revealed that racial/ethnic minorities were not less likely to receive advice from health professionals to quit smoking, but they were less likely to use nicotine replacement therapy. Conclusions. Specific needs and ideal program focuses for cessation may vary across racial/ethnic groups, such that approaches tailored by race/ ethnicity might be optimal. Traditional conceptualizations of cigarette addiction and the quitting process may need to be revised for racial/ethnic minority smokers. [ABSTRACT FROM AUTHOR]

Objectives. People who are incarcerated exhibit high rates of disease, but data evaluating the delivery of medical services to inmates are sparse, particularly for jail settings. We sought to characterize the primary medical care providers for county jail inmates in New York State. Methods. From 2007 through 2009, we collected data on types of medical care providers for jail inmates in all New York State counties. We obtained data from state monitoring programs and e-mail questionnaires sent to county departments of health. Results. In counties outside New York City (n=57), jail medical care was delivered by local providers in 40 counties (70%), correctional medical corporations in 8 counties (14%), and public providers in 9 counties (16%). In New York City, 90% of inmates received medical care from a correctional medical corporation. Larger, urban jails, with a greater proportion of Black and Hispanic inmates, tended to use public hospitals or correctional medical corporations as health care vendors. Conclusions. Jail medical services in New York State were heterogeneous and decentralized, provided mostly by local physician practices and correctional medical corporations. There was limited state oversight and coordination of county jail medical care. [ABSTRACT FROM AUTHOR]

Objective. We investigated whether the proportion of Black very low-birthweight (VLBW) infants treated by hospitals is associated with neonatal mortality for Black and White VLBW infants. Methods. We analyzed medical records linked to secondary data sources for 74050 Black and White VLBW infants (501 g to 1500 g) treated by 332 hospitals participating in the Vermont Oxford Network from 1995 to 2000. Hospitals where more than 35% of VLBW infants treated were Black were defined as "minority-serving." Results. Compared with hospitals where less than 15% of the VLBW infants were Black, minority-serving hospitals had significantly higher risk-adjusted neonatal mortality rates (White infants: odds ratio [OR] = 1.30, 95% confidence interval [CI] = 1.09, 1.56; Black infants: OR = 1.29, 95% CI = 1.01, 1.64; Pooled: OR = 1.28, 95% CI = 1.10, 1.50). Higher neonatal mortality in minority-serving hospitals was not explained by either hospital or treatment variables. Conclusions. Minority-serving hospitals may provide lower quality of care to VLBW infants compared with other hospitals. Because VLBW Black infants are disproportionately treated by minority-serving hospitals, higher neonatal mortality rates at these hospitals may contribute to racial disparities in infant mortality in the United States. (Am J Public Health. 2005;95:2206-2212.) [ABSTRACT FROM AUTHOR]

Objectives. This study examined Chicago residents' progress toward the Healthy People 2000 goal of reducing racial disparities in health and compared the results with a recent analysis of US data. Methods. Non-Hispanic Black-to-non-Hispanic White rate ratios were computed for 14 health status indicators for 1990 and for 1998. Results. Nationally and in Chicago, indicators for both Blacks and Whites improved between 1990 and 1998; however, Whites consistently fared better. Nationally, gaps narrowed on 10 indicators; for Chicago, they widened on 10 indicators. Conclusions. Nationally, there is apparent progress in reducing Black-White disparities; this is not true for Chicago. Whether failure to reduce racial disparities is unique to Chicago or is common to other urban centers remains an open question with important implications. (Am J Public Health. 2004;94:116-121) [ABSTRACT FROM AUTHOR]

US infant death rates for 1960 to 1980 declined most quickly in (1) 1970 to 1973 in states that legalized abortion in 1970, especially for infants in the lowest 3 income quintiles (annual percentage change = -11.6; 95% confidence interval = -18.7, -3.8), and (2) the mid-to-late 1960s, also in low-income quintiles, for both Black and White infants, albeit unrelated to abortion laws. These results imply that research is warranted on whether currently rising restrictions on abortions may be affecting infant mortality. [ABSTRACT FROM AUTHOR]

Nutrient intakes were investigated for Blacks and Whites using data from the NHANES II survey (1976-80). Intake of energy, total fat, saturated fat, dietary cholesterol, P/S ratio, and per cent of calories derived from total and saturated fat are examined by sex and age, both in absolute terms and per unit of body weight. For most age and sex categories, Blacks are found to have a lower intake of energy and fats than Whites; however, Blacks have a consistently higher intake of dietary cholesterol. The ratio of polyunsaturated fats to saturated fats is higher in females than in males, but all age-sex groups are substantially below recommended levels. Per cent of calories from total and saturated fat are similar in most age-sex groups. Possible explanations of the observed patterns include activity level and metabolic differences. (Am J Public Health 1988; 78:1150-1155.) [ABSTRACT FROM AUTHOR]

The editorial focuses on disparities in health care in the U.S., noting the U.S. has the highest rate of infant mortality among affluent industrialized countries as of February 2014. The discussion topics include the racial and class factors that contribute to the high rate of African American infant mortality, the importance of health disparity impact assessments in understanding health outcomes, and 20th century trends that have impacted public health policy.

The editorial focuses on improving mother and child health in the U.S., noting the decline in infant mortality from 2005 through 2011, and discusses the persistent racial disparities in health care and birth outcomes. The discussion topics include African American infant death rates, the effects of structural racism and epigenetics, and five approaches to improving maternal and child health. The article notes Cuba's universal health care system and its policy on prenatal care.

Conclusions. In the United States, infectious diseases account for nearly 10% of the excess all-cause mortality rates in Blacks compared with Whites. (Am J Public Health. 2001;91:1251-1253) [ABSTRACT FROM AUTHOR]

The article estimates and compares the prevalence of disability and institutionalization in 1982, 1984 and 1989 among the older Black and White populations of the United States. It is well known that older Blacks are three times as likely as older Whites to be in poverty and half as likely to have completed high school and that these socioeconomic differences generally account for a significant portion of racial differences in health status. Unfortunately, education and income measures are not available in the National Long Term Care Survey screen sample, and no other data are currently available to test these trends further. Nonetheless, the disability trends reported here are consistent with the diverging mortality trends of populations of low-and middle-socioeconomic status recently reported in the literature. Substantial and perhaps, and perhaps increasing racial disparities in disability coupled with a growing and aging older Black population are likely to lead to considerable increases in the relative and absolute costs of caring for the older Black population of the U.S.

The article profiles the Society for the Analysis of African-American Public Health Issues, an organization made up of primarily African American public health researchers which was developed in 1990 and conducts research on health disparities in the U.S. A discussion of the events that led up to the development of the association, and of the role that the association has played in improving the health of African Americans in the U.S., is presented.