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Police violence is a public health issue in need of public health solutions. Reducing police contact through public health–informed alternative response programs separate from law enforcement agencies is one strategy to reduce police perpetration of physical, emotional, and sexual violence. Such programs may improve health outcomes, especially for communities that are disproportionately harmed by the police, such as Black, Latino/a, Native American, and transgender communities; nonbinary residents; people who are drug users, sex workers, or houseless; and people who experience mental health challenges. The use of alternative response teams is increasing across the United States. This article provides a public health rationale and framework for developing and implementing alternative response programs informed by public health principles of care, equity, and prevention. We conclude with recommendations for public health researchers and practitioners to guide inquiries into policing as a public health problem and expand the use of public health–informed alternative response programs. (Am J Public Health. 2023;113(S1):S37–S42. https://doi.org/10.2105/AJPH.2022.307107 )

Despite growing research dedicated to investigating the mental health of Black boys, few directly examine experiences with their perceptions and understanding of mental health conditions such as depression. This study uses data from a social media-based intervention for Black males, the Young Black Men, Masculinities, and Mental Health project. In a focus group with 8th-grade Black boys, facilitators asked open-ended questions about perceptions of mental health and depression, views of manhood, and experiences with social support. Findings revealed this group of Black boys – while well versed in many of the causes, symptoms, and treatments for mental health challenges and depression – preferred to address mental health needs on their own and through informal familial support. It also revealed the boys wrestled with the complex ways in which their racial identity would affect their experiences with mental health. The findings speak to the importance of mental health education for Black boys and the need for further research incorporating Black boys’ voices in their perceptions, experiences, and understandings of mental health. Finally, the study connects Black boys’ perspectives with many of the perspectives of their racially diverse peers.

Background: Racial disparities in access to advanced therapies for heart failure (HF) patients are well documented, although the reasons remain uncertain. We sought to determine the association of race on utilization of ventricular assist device (VAD) and transplant among patients with access to care at VAD centers and if patient preferences impact the effect. Methods: We performed an observational cohort study of ambulatory chronic systolic HF patients with high-risk features and no contraindication to VAD enrolled at 21 VAD centers and followed for 2 years in the REVIVAL study (Registry Evaluation of Vital Information for VADs in Ambulatory Life). We used competing events cause-specific proportional hazard methodology with multiple imputation for missing data. The primary outcomes were (1) VAD/transplant and (2) death. The exposures of interest included race (Black or White), additional demographics, captured social determinants of health, clinician-assessed HF severity, patient-reported quality of life, preference for VAD, and desire for therapies. Results: The study included 377 participants, of whom 100 (26.5%) identified as Black. VAD or transplant was performed in 11 (11%) Black and 62 (22%) White participants, although death occurred in 18 (18%) Black and 36 (13%) White participants. Black race was associated with reduced utilization of VAD and transplant (adjusted hazard ratio, 0.45 [95% CI, 0.23–0.85]) without an increase in death. Preferences for VAD or life-sustaining therapies were similar by race and did not explain racial disparities. Conclusions: Among patients receiving care by advanced HF cardiologists at VAD centers, there is less utilization of VAD and transplant for Black patients even after adjusting for HF severity, quality of life, and social determinants of health, despite similar care preferences. This residual inequity may be a consequence of structural racism and discrimination or provider bias impacting decision-making. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01369407.

This study examined associations between Black youth’s engagement with hip-hop culture and their sociopolitical development (SPD) (e.g., critical social analysis, critical agency, and anti-racist activism). Participants included 499 Black adolescents recruited from across the United States through an online survey panel. Findings from regression analysis revealed the differential effects of rap media (music and music videos) and hip-hop media (e.g., blogs, video shows, radio) on youth’s SPD. Black youth who consumed more hip-hop media and who interacted with artists on social media had more agency to address racism and reported engaging in more racial-justice activism. The frequency of youth’s rap media usage was not consistently related to youth’s SPD. However, youth’s perceptions of rap (e.g., rap is empowering or misogynistic) were found to be directly associated with indicators of SPD. These findings provide insight into the potential influence of hip-hop culture beyond music on youth’s racial-justice beliefs and actions.

While left ventricular assist devices (LVADs) increase survival for patients with advanced heart failure (HF), racial and sex access and outcome inequities remain and are poorly understood.To assess risk-adjusted inequities in access and outcomes for both Black and female patients and to examine heterogeneity in treatment decisions among patients for whom clinician discretion has a more prominent role.This retrospective cohort study of 12 310 Medicare beneficiaries used 100% Medicare Fee-for-Service administrative claims. Included patients had been admitted for heart failure from 2008 to 2014. Data were collected from July 2007 to December 2015 and analyzed from August 23, 2020, to May 15, 2022.Beneficiary race and sex.The propensity for LVAD implantation was based on clinical risk factors from the 6 months preceding HF admission using XGBoost and the synthetic minority oversampling technique. Beneficiaries with a 5% or greater probability of receiving an LVAD were included. Logistic regression models were estimated to measure associations of race and sex with LVAD receipt adjusting for clinical characteristics and social determinants of health (eg, distance from LVAD center, Medicare low-income subsidy, neighborhood deprivation). Next, 1-year mortality after LVAD was examined.The analytic sample included 12 310 beneficiaries, of whom 22.9% (n = 2819) were Black and 23.7% (n = 2920) were women. In multivariable models, Black beneficiaries were 3.0% (0.2% to 5.8%) less likely to receive LVAD than White beneficiaries, and women were 7.9% (5.6% to 10.2%) less likely to receive LVAD than men. Individual poverty and worse neighborhood deprivation were associated with reduced use, 2.9% (0.4% to 5.3%) and 6.7% (2.9% to 10.5%), respectively, but these measures did little to explain observed disparities. The racial disparity was concentrated among patients with a low propensity score (propensity score0.52). One-year survival by race and sex were similar on average, but Black patients with a low propensity score experienced improved survival (7.2% [95% CI, 0.9% to 13.5%]).In this cohort study of Medicare beneficiaries hospitalized for HF, disparities in LVAD use by race and sex existed and were not explained by clinical characteristics or social determinants of health. The treatment and post-LVAD survival by race were equivalent among the most obvious LVAD candidates. However, there was differential use and outcomes among less clear-cut LVAD candidates, with lower use but improved survival among Black patients. Inequity in LVAD access may have resulted from differences in clinician decision-making because of systemic racism and discrimination, implicit bias, or patient preference.

In March 2020, the World Health Organization (WHO) announced that COVID-19 (novel coronavirus) reflected a global pandemic. Early epidemiological analyses demonstrated that boys and men have similar rates of COVID-19 infection to girls and women. However, boys and men appear to be disproportionately impacted with respect to severity and mortality, including those from marginalised or minority backgrounds. Yet, considerations of sex and gender, and their relationship to health and social inequities, have been absent from recent COVID-19 policy and practice pandemic responses. This evidence-based commentary discusses the nexus between COVID-19, equity, and boys and men’s health from a broad public health perspective. Using scholarship about intersections between race and gender; and poverty, social determinants of health, and gender; we explain why a health equity lens is important to address the health and social inequities boys and men face during pandemics. This contribution provides guidance about future global public healthpandemic responses for society’s most vulnerable groups of boys and men.

Recent reports have highlighted disparities in representation of Black men within research, calling for more work to be done with this group. The authors take up this call by exploring whether adherence to masculine norms influences mental health outcomes among young Black men. The sample included survey responses from 18- to 30-year-old Black men (N = 273) enrolled at five colleges and universities in the midwestern United States. Two theoretically relevant subscales from the Conformity to Masculine Norms Inventory (that is, self-reliance and emotional control) were used to measure adherence to masculine norms, and depressive symptoms were measured using the Patient Health Questionnaire. Confirmatory factor analysis results indicate that the model fit the data well. Furthermore, self-reliance was associated with higher rates of depressive symptoms (β = .358, p < .001), but emotional control was not (β = .137, p = .099). Study findings suggest that depression treatment interventions should be tailored to incorporate aspects of masculinity that are most salient to young Black men. In addition, social work researchers, clinicians, and service providers are uniquely positioned to contribute to the promotion of mental wellness among this underserved population and should be prepared to attend to young Black men’s mental health needs.

In the past decade, the number of undergraduate public health programs has increased exponentially. This growth provides a unique opportunity to explore concepts and issues relevant to understanding the determinants of health at a population level using new pedagogical approaches. One of these issues is stigma toward mental disorders. Stigma is a concept that refers to a feature or characteristic that reduces, devalues, and disempowers a person. Given the prevalence of mental and substance use disorders among college students, undergraduate education is an important setting for attempting to address stigmatizing attitudes both for society at large and for faculty, staff, and students, including those experiencing mental health problems. This article describes an effort to develop an undergraduate course in public mental health that explicitly addresses the ways stigma shapes student understanding of this topic and discusses lessons learned from this experience.

OBJECTIVE: Blunted patterns of daily cortisol, an indicator of hypothalamic-pituitary-adrenal (HPA) axis stress response system dysregulation, are implicated in poor health outcomes and racial health disparities. It is unknown how coping—an important, but understudied, component of the stress-health disparities relationship—relates to these biological mechanisms of health. METHODS: This study investigated relationships, including racial differences, between 12 coping strategies and early-day cortisol changes (diurnal cortisol slopes from peak to lunch) among 700 35–85 year old Black and White male participants in the National Survey of Midlife Development in the United States (MIDUS) II. Cognitive-oriented (e.g., positive reinterpretation, denial, religious/spiritual) and behavioral (e.g., stress eating, substance use) coping strategies were examined. RESULTS: Overall, Black and White men used similar coping strategies. Most coping strategies were not associated with men’s cortisol slopes. Religious/spiritual coping was associated with steeper (more robust) cortisol slopes among White (b= −.004, t= −3.28, p=.001) but not Black men. Drug use was associated with steeper cortisol slopes among Black (b= −.095, t= −2.87, p=.004) but not White men. CONCLUSIONS: This exploratory study increases our understanding of relationships between coping and stress-related biological mechanisms underlying racial health disparities among men in later life. With some notable exceptions, men’s coping strategies were not associated with their diurnal cortisol slopes. This suggests that the coping strategies currently used by older Black and White men may not be important factors, as determinants or intervention targets, in disparities in diurnal cortisol slopes and associated health outcomes among men in this age group.

The present study explores the construction of masculinity among young Black men. Of central concern is young Black men’s subjective reflections on the role that popular culture and media have in informing how they understand and define their ideas of masculinity. The study uses interview data from

Black adolescent boys experience mental health challenges because of their exposure to a greater frequency and severity of psychosocial stressors. This study used a sample of Black boys at a high school in southeastern Michigan as a case study to understand the types of resources Black boys might use to support their mental health. After conducting a rigorous analysis of the study data using a rapid and an accelerated data reduction technique, four themes helped us answer the question: What kinds of mental health support resources are Black boys using? Four themes emerged from our analysis: online resources, community and trusted individuals, self-reliance, and additional needs. This case study is a springboard for further work to tailor a mental health education and support intervention, such as the YBMen Project, for Black boys and for building additional support amid the multiple crises occurring that impact their mental health and safety. Findings have implications for future research, practice, and policy to improve the mental health of Black boys in high school.

Commentary

Objective: Psychological distress and physi­ological dysregulation represent two stress response pathways linked to poor health and are implicated in racial disparities in aging-related health outcomes among US men. Less is known about how coping re­lates to these stress responses. The purpose of this exploratory study was to examine whether midlife and older men’s coping strategies and behaviors accounted, in part, for Black-White disparities in men’s psycho­logical and physiological stress responses. Methods: We examined racial differences in 12 coping strategies (COPE Inventory subscales, religious/spiritual coping, and be­haviors such as stress eating and substance use) and their relationships with psycho­logical distress (Negative Affect scale) and physiological dysregulation (blunted diurnal cortisol slopes) using regression models and cross-sectional data from 696 Black and White male participants aged 35-85 years in the National Survey of Midlife Development in the United States (MIDUS) II, 2004-2006. Results: Black men exhibited more psychological distress and physiological dysregulation than White men. Black and White men reported comparable use of most coping strategies, none of which demonstrated similar relationships with both stress responses. Coping strategies explained variations in psychological distress consis­tent with conventional protective-harmful categorizations. Coping accounted for racial disparities in men’s psychological distress, as Black men reported using harmful strategies more often and were more susceptible to their negative effects. Neither differential use of coping strategies nor differing rela­tionships accounted for racial disparities in physiological dysregulation. Conclusions: Findings revealed complex relationships between coping and psycho­logical and physiological stress responses and suggest the importance of differing approaches to reducing associated racial health disparities among men. Ethn Dis . 2020;30(4):563-574; doi:10.18865/ed.30.563

Conventional definitions of mental health, manhood, and social support create barriers to accessing behavioral health care for Black men ages 18 to 30. Targeted behavioral health interventions sensitive to culture, social norms, and gender that circumvent these barriers are desperately needed to improve access and integrated care for this group. This article reports mixed methods findings from the 2017 iteration of the Young Black Men, Masculinities, and Mental Health (YBMen) project, a social media–based, psychoeducational program that promotes mental health, progressive definitions of manhood, and sustainable social support for Black men. Young Black men ( n = 350) across two universities in the Midwest completed baseline surveys on their mental health, definitions of manhood, and social support. Forty of the men participated in the YBMen intervention and at postintervention reported experiencing fewer depressive symptoms on the Patient Health Questionnaire (PHQ-9, Z = −2.05, p < .01) and the Gotland Male Depression Scale (GMDS; Z = −1.76, p < .05). There were also changes on the Conformity to Masculine Norms Inventory (CMNI) for Self-Reliance ( Z = −0.34, p = .26) and Heterosexual Self-Presentation ( Z = −0.18, p = .59), though these changes were not statistically significant. A qualitative review of postintervention interviews revealed participants’ appreciation of the YBMen project and its influence on their mental health, manhood, and social support. Programmatic efforts that support the behavioral health, positive development, and social relationships of Black men translate into positive families, communities, and experiences as they live, learn, love, and work over the life course.

Demand for training in mixed methods is high, with little research on faculty development or assessment in mixed methods. We describe the development of a self-rated mixed methods skills assessment and provide validity evidence. The instrument taps six research domains: "Research question," "Design/approach," "Sampling," "Data collection," "Analysis," and "Dissemination." Respondents are asked to rate their ability to define or explain concepts of mixed methods under each domain, their ability to apply the concepts to problems, and the extent to which they need to improve.We administered the questionnaire to 145 faculty and students using an internet survey. We analyzed descriptive statistics and performance characteristics of the questionnaire using the Cronbach alpha to assess reliability and an analysis of variance that compared a mixed methods experience index with assessment scores to assess criterion relatedness.Internal consistency reliability was high for the total set of items (0.95) and adequate (≥0.71) for all but one subscale. Consistent with establishing criterion validity, respondents who had more professional experiences with mixed methods (eg, published a mixed methods article) rated themselves as more skilled, which was statistically significant across the research domains.This self-rated mixed methods assessment instrument may be a useful tool to assess skills in mixed methods for training programs. It can be applied widely at the graduate and faculty level. For the learner, assessment may lead to enhanced motivation to learn and training focused on self-identified needs. For faculty, the assessment may improve curriculum and course content planning.

Suicide has remained a leading cause of death among African American males, yet empirical investigations that focus on the experiences of this group are limited. Therefore, we aim to interrogate the impact of everyday discrimination as a risk factor for depressive symptoms and suicide ideation among African American men. Data were drawn from the African American male subsample of the National Survey of American Life (

In the United States, Black men have poorer overall health and shorter life spans than most other racial/ethnic groups of men, largely attributable to chronic health conditions. Dysregulated patterns of daily cortisol, an indicator of hypothalamic–pituitary–adrenal (HPA) axis stress–response functioning, are linked to poor health outcomes. Questions remain regarding whether and how cortisol contributes to Black–White differences in men’s health. This exploratory study compared early day changes in cortisol levels (diurnal cortisol slopes from peak to pre-lunch levels) and their associations with medical morbidity (number of chronic medical conditions) and psychological distress (Negative Affect Scale) among 695 Black and White male participants in the National Survey of Midlife in the United States (MIDUS II, 2004–2009). Black men exhibited blunted cortisol slopes relative to White men (−.15 vs. −.21, t = −2.97, p = .004). Cortisol slopes were associated with medical morbidity among Black men ( b = .050, t = 3.85, p < .001), but not White men, and were unrelated to psychological distress in both groups. Findings indicate cortisol may contribute to racial health disparities among men through two pathways, including the novel finding that Black men may be more vulnerable to some negative health outcomes linked to cortisol. Further, results suggest that while cortisol may be a mechanism of physical health outcomes and disparities among older men, it may be less important for their emotional health. This study increases understanding of how race and male sex intersect to affect not only men’s lived experiences but also their biological processes to contribute to racial health disparities among men in later life.

This study reports the secondary analysis of a theme that emerged from a larger study on Black women���s perceptions of Black men���s depression. This emerging theme was concerning the role of Black women in rearing Black boys. Eight focus groups with Black women (N = 46) were used to further explore this theme. Our secondary analysis identified three subthemes, including the (a) presence (or absence) of fathers in parenting Black children, (b) Black women���s role in coddling Black boys, and (c) Black women���s role in ���raising��� Black girls. Study implications include the contextual lens that underscores parenting variations within Black families.

African American men bear a disproportionately high burden from cancer in the U.S. The American Cancer Society reports that for all cancer sites combined, African American men are 32% more likely to die than white men (American Cancer Society, 2011). Having a family history of cancer elevates an individual���s risk for the disease and should inform decision-making around the use of specific cancer screening tests as well as earlier onset and frequency of cancer screening. Adult African American men who attended an annual hospital-based community health fair in the Midwest which targeted minority men, were approached to complete a paper-based survey. Participants were asked ���have you ever talked with any of your relatives about your family history of cancer (about any members of your family who have been diagnosed with cancer)?��� Predictors were evaluated using bivariate analysis and logistic regression; they included socio-demographic, health access, health behavior, health status, and communication variables. Participants were 558 African American men with a mean age of 54 years old. African American men were most likely to have ever discussed their family history of cancer with a relative if they had specific knowledge of their family history of cancer and if they had ever talked to a physician about their family history of cancer. For African American men with a familial predisposition to cancer, further examination of barriers and facilitators to discussion with relatives, specifically those related to health access and knowledge, is warranted.

This chapter provides an opportunity to review mental health disparities that specifically affect men within the context of trauma, depression, and suicidal behaviors—with an eye towards understanding how age, race, sexual orientation, and socioeconomic status function as social determinants of mental health for men from varying social contexts, backgrounds, and positionalities. It focuses on age, race/ethnicity, sexual orientation, and socioeconomic status as several social determinants that shape men’s disparities related to trauma, depression, and suicide. The chapter proposes that gender also serves as a critical force that impacts experiences, beliefs, and perceptions of mental health, as rates of death by suicide are nearly several times higher among men than they are for women. Suicide is a leading cause of death among men worldwide, yet it remains an understudied topic across many disciplines. Thus, additional inquiry is required to critically assess nuances related to suicide ideation and attempt among men individually and collectively.

Black men experience disproportionate mental health challenges due to their exposure to severe psychosocial stressors. Yet, the mental health challenges of Black men have largely been left out of national conversations. Strong theoretical frameworks are important when generating dialogue about the mental health of Black men, as it helps to validate the work on a larger scale while also grounding the work for more practical use. This paper presents the conceptual framework for a five-year initiative aimed at improving the living, learning, and thriving of young Black men through a social media intervention that improves their mental health, expands their definitions of manhood, and helps them to engage in social support. The Young, Black Men, Masculinities, and Mental Health (YBMen) project is a social media-based, health promotion program that targets mental health (e.g., depressive symptoms), masculine norms (e.g., definitions of manhood), and social support for young Black men using culturally-sensitive, age-appropriate, and gender-specific popular culture. The YBMen project has been successfully implemented with over 150+ Black men since 2014, findings demonstrate improved mental health outcomes, progressive definitions of manhood, and stronger social relationships. Reflections from the past and projections for the future are discussed.

Prior research indicates an association between exposure to trauma (e.g., being victimized) and perpetration of crime, especially in the context of chronic victimization. This study examines the relationship between trauma exposure, posttraumatic stress disorder (PTSD), and history of arrest and incarceration among a representative sample of black Americans from the National Survey of American Life (N = 5,189). One-third had a history of arrest, and 18 percent had a history of incarceration. Frequency of trauma exposure was associated with involvement with the criminal justice system. Relative to never experiencing trauma, experiencing ≥4 traumas was associated with elevated odds of arrest (odds ratio [OR] = 4.03), being jailed (OR = 5.15), and being imprisoned (OR = 4.41), all p < .01. PTSD was also associated with likelihood of incarceration among those with a history of trauma (OR = 2.18, p < .01). Both trauma exposure and trauma-associated psychopathology are associated with increased likelihood of arrest and incarceration in adulthood among black Americans.