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Thirty-seven years ago, the Secretary's Task Force on Black and Minority Health called attention to a "national paradox" of persistent Black-White health disparities despite overall health improvements for the nation (HHS, 1985). Subsequent updates to the "Heckler Report" came to the same conclusion; Black Americans continued to exhibit poorer health in comparison to White Americans (Satcher et al., 2005). Current population health statistics demonstrate Black-White health disparities comparable to 1985 (AHRQ, 2018; Shiels et al., 2021; Wall et al., 2018). Although psychological, behavioral, social, and economic factors all contribute to Black-White differences in health, there is a noticeable increase in discussions about the importance of systemic racism in producing racial health disparities. This article addresses three questions relevant to research on racism and the health of Black Americans: (1) Why has academic public health research on racism failed to reduce racial health disparities? (2) What can academic public health scientists do differently to reduce the impact of systemic racism on inequities among Black and White Americans? (3) What can Black Americans do in the face of present-day anti-Black systemic racism? We argue that to convert the vision of health equity into a visible reality, health equity research scientists must move beyond discussion, observation, and description. We also argue that to demonstrate progress in reducing racial health disparities, health equity scientists will need to work much more directly on eradicating racism as a fundamental cause of health differences between Black and White Americans. As scientists, the challenge we face is how to accomplish this mission without leaving the realm of science. Racism is a social determinant of Black health and social determinants are political problems. Political problems require political solutions.

Caregiving can be both distressing and physically demanding, especially among African Americans. This study uses data from the National Survey of American Life (NSAL) to examine the relationship between religion and spirituality experiences on health ratings among African American caregivers. Logistic regression analyses were performed on a sample including 4461 African American and white participants. All analyses were weighted and used STATA 14. African American participants who endorsed religiosity (OR 1.44, 95% confidence interval [CI] 1.06, 1.97) and white participants who endorsed religiosity (OR 2.40, CI 1.07, 5.40) recorded higher ratings of physical health than those who did not endorse being religious. Maintaining family closeness for African Americans is significantly associated with higher ratings of physical health (OR 2.02, CI 1.39, 2.94). Overall, the findings underscore how maintaining a religious or spiritual lens can enhance health outcomes among African Americans caregivers who need support.

OBJECTIVES: As adults increase in age, the likelihood for using mental health care services decrease. Further, the literature suggests that racial/ethnic minorities, such as African American and Caribbean Blacks, are less likely to use mental health care services, in general and more specifically as age increases. Underutilization of mental health services by older adults can result in a decrease in quality of life, and significant costs to families, employers, and health systems. As such, this underutilization appears to be a social problem that requires research attention. METHODS: The study explored the differences in relationships between mental health care usage and strength of religious/spiritual beliefs between African American and Caribbean Black older adults (54 years or older) and adults (18–53 years) living in the US using data from the National Survey of American Life (NSAL). Descriptive statistics and logistic regression analyses were conducted using Stata version 13.1. RESULTS: Subjective ratings about the strength of religious/spiritual beliefs (OR = 1.26; 95 CI: 0.99, 1.61), age (OR = 0.62; 95 CI: 0.48, 0.81), and sex (OR = 1.59; 95 CI: 1.25, 2.02) were significantly associated with the odds of seeking mental health care. Additionally, the results show that those living in the South were less likely to seek mental health care services (OR = 0.47; 95 CI: 0.37, 0.60). CONCLUSION: Strong religious/spiritual beliefs may promote mental health care usage. Future studies should examine the strength of religious/spiritual beliefs on mental health care usage among different demographic groups.

This paper uses the National Survey of American Life (NSAL) to examine within group differences regarding help-seeking for substance disorders among a U.S. sample of African American and Caribbean Black men and women. We examined ethnic and gender differences in the type of providers sought for substance disorder treatment, as well as reasons for avoiding treatment. Results indicate that overall, few ethnic differences exist; however, African Americans are more likely than Caribbean Blacks to seek help from human service professionals (including a religious or spiritual advisor) and from informal sources of treatment such as self-help groups. Black men with a substance disorder were more likely to see a psychiatrist than Black women. Findings regarding reasons for avoiding treatment suggest that there may be a need to provide better education about the utility of substance disorder treatment, even before problems reach a high level of severity.

Background: The minorities’ diminished return theory suggests that socioeconomic position (SEP) generates smaller health gains for racial/ethnic minorities compared to Whites. The current study was a Black–White comparison of the association between household income and self-rated mental health (SRMH). Methods: This cross-sectional study used data from the 2017 State of the State Survey (SOSS). With representative sampling, the SOSS generates results that are generalizable to the state of Michigan. This study included 881 adults, (n = 92) Black and (n = 782) White. The independent variable was household income. The dependent variable was SRMH, measured using a single item. Age, gender, and participation in the labor force were covariates. Race/ethnicity was the focal moderator. Logistic regression models were used for data analysis. Results: Overall, higher household income was associated with better SRMH, net of covariates. An interaction was found between race/ethnicity and household income on SRMH, suggesting a smaller, or nonexistent, protective effect for Blacks compared to Whites. In race/ethnicity-stratified models, higher household income was associated with better SRMH for Whites but not Blacks. Conclusion: Supporting the minorities’ diminished return theory, our study documents differential effects for income on SRHM for Blacks and Whites, where Whites but not Blacks appear to benefit from their income. Given this, researchers and policy makers are cautioned against making assumptions that racial groups benefit equally from similar economic resources.

Depression is one of the most common, costly, and debilitating psychiatric disorders in the United States. One of the most persistent mental health disparities is the underutilization of treatment services among African American men with depression. Little is known about appropriateness or acceptability of depression care among African American men. The purpose of this study was to examine perceptions of depression and determine barriers to depression treatment among African American men. A series of four focus groups were conducted with 26 African American men. The average age of the sample was 41 years and most participants reported that they had completed high school. Nearly half of the participants reported that they are currently unemployed and most had never been married. The most common descriptions of depression in this study were defining depression as feeling down, stressed, and isolated. A small group of participants expressed disbelief of depression. The majority of participants recognized the need to identify depression and were supportive of depression treatment. Nonetheless, most men in this sample had never sought treatment for depression and discussed a number of barriers to depression care including norms of masculinity, mistrust of the health care system, and affordability of treatment. Men also voiced their desire to discuss stress in nonjudgmental support groups. Research findings highlight the need to increase the awareness of symptoms some African American men display and the need to provide appropriate depression treatment options to African American men.

Evidence from previous studies indicates that racial discrimination is significantly associated with depression and that African Americans with higher levels of socioeconomic status (SES) report greater exposure to racial discrimination compared to those with lower SES levels. Coping strategies could alter the relationship between racial discrimination and depression among African Americans. This study first examined whether greater levels of SES were associated with increased reports of racial discrimination and ratings of John Henryism, a measure of high-effort coping, among African Americans. Second, we examined whether high-effort coping moderated the relationship between racial discrimination and depression. Data were drawn from the National Survey of American Life Reinterview ( n = 2,137). Analyses indicated that greater levels of education were positively associated with racial discrimination ( p < .001) and increased levels of racial discrimination were positively related to depression ( p < .001), controlling for all sociodemographic factors. Greater levels of John Henryism were associated with increased odds of depression but there was no evidence to suggest that the relationship between discrimination and depression was altered by the effects of John Henryism.

Objective Although increased frequency of physical activity is associated with fewer depressive symptoms in African-Americans, most studies do not focus on a specific type of activity. Identifying the activity can provide helpful information for designing interventions that focus on depressive symptoms. The objective of this study was to examine the odds of depressive symptoms in relation to walking in African-Americans. Design and Sample A secondary analysis was performed on the National Survey of American Life. The sample was made up of community-dwelling African-American women (n = 1,903) and men (n = 1,075) who did not meet the DSM-IV-TR criteria for depression. Measures Walking was measured by self-reported frequency (i.e., never, rarely, sometimes, often). Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Logistic regression for complex samples was used to examine the odds of depressive symptoms in relation to walking. Results Women who reported often walking had lower odds for depressive symptoms than women who reported never walking (OR = 0.56, 95% CI = 0.38–0.82). Walking frequency was not related to depressive symptoms in men. Conclusions Walking frequency is a modifiable risk factor for elevated depressive symptoms in African-American women.

In this case scenario, a medical student, Jenny, is conducting congenital heart disease research in a resource-limited setting faced with water insecurity. She has concerns about how ethical it is for her to conduct advanced clinical research in a region with more basic health needs. The first commentary argues that advanced clinical research in resource-limited settings follows the ethical principle of beneficence and interactional justice but violates the principle of distributive justice. The second commentary questions whether beneficence is enough, since the Belmont Report states that beneficence is the obligation to simultaneously reduce harm and increase benefit. It calls upon public health physician-scientists to think deeply about how to involve communities in their research-and how to insert themselves into health policy development processes.

This study used qualitative methods and quantitative statistical analyses to examine whether race and gender are associated with reasons for which adults perceive a situation or object as fearful. The sample consists of 197 African-American and White adults (ages 18–85) recruited through a convenience sample and community sources in the Midwest. A cognitive interviewing instrument was utilized to examine respondents understanding of words and phrases from a mental health instrument. Using qualitative methods, free-response answers were content coded using 5 “fear-codes” (i.e., harm/danger, external locus of control, self-perception, and past experience), developed by the researchers. Results from logistic regression analyses indicate that race significantly predicts usage of specific fear codes (p

Over the last decade, obesity has increased significantly among men but few national studies have empirically examined racial and socioeconomic differences in obesity among men. In this paper, we utilized logistic regression to evaluate the potential associations that race and socioeconomic status may have with obesity among men in the National Survey of American Life: an in-person household survey of non-institutionalized U.S. blacks and whites who lived in communities where at least 10% of the community residents were black Americans. A greater proportion of black men were likely to be obese than white men, but no interaction among race, SES, and obesity was detected when potential confounding variables were included. There was not a relationship between SES and obesity for white men, but there was an apparent positive relationship between SES and obesity for black men that did not remain significant in adjusted models. No relationship was found between age and obesity among black men, though white men who were 55 and older were more likely than those 18–34 to be obese in confounder adjusted models. Among white men, no relationships were found between obesity and education, household income, or marital status. Black men in the lowest income category were less likely to be obese than those in the highest income category, in bivariate but not adjusted models. These findings suggest that the way racial, economic, stress and behavioral factors combine to affect obesity in black and white men may be different.

This study investigated the associations among goal-striving stress, racial related stressors, and mental health. Goal-striving stress was defined as the discrepancy between aspiration for and achievement of a better way of life, weighted by the subjective probability of success, and the level of disappointment experienced if those life goals were not realized. Data are from the National Survey of American Life’s African American (N = 3,570) and non-Hispanic white (N = 891) adult samples. Regression analysis was used to assess the relationship between goal-striving stress and five mental health outcomes: happiness, life satisfaction, self-esteem, psychological distress, and depressive symptoms. After controlling for socio-demographic factors, a personal problems checklist, and racial discrimination, goal-striving stress was significantly related to all mental health measures such that as goal-striving stress increased, mental health worsened. Additionally, the relationship of goal-striving stress to mental health was found to be conditional upon race. Specifically, goal-striving stress had a stronger effect among white Americans than African Americans. Goal-striving stress was associated differentially with lower levels of mental health for black and white Americans. Racial differences in the impact of goal-striving stress suggest a need for analyses exploring resilience and coping in relation to the impact of goal-striving stress on black–white differences in mental health.

This study examined use of ministers for assistance with a serious personal problem within a nationally representative sample of African Americans (National Survey of American Life—2001–2003). Different perspectives on the use of ministers—social stratification, religious socialization, and clinical/problem-oriented approach—were proposed and tested using logistic regression analyses with demographic, religious involvement, and problem type factors as predictors. Study findings supported religious socialization and clinical/problem-oriented explanations indicating that persons who are heavily invested in religious pursuits and organizations (i.e., women, frequent attenders) are more likely than their counterparts to use ministerial assistance. Contrary to expectations from the social stratification perspective, positive income and education effects indicated that higher status individuals were more likely to report use of ministers. Finally, problems involving bereavement are especially suited for assistance from ministers owing to their inherent nature (e.g., questions of ultimate meaning) and the extensive array of ministerial support and church resources that are available to address the issue.

The present study examined the relationship between goal-striving stress and well-being in a survey of 399 college-educated Black American men who were members of a Black fraternal organization. Regression analyses revealed that goal-striving stress was associated with decreased psychological well-being, controlling for demographics and various psychosocial factors. When asked to explain their failure to reach life goals, half of the men attributed setbacks to racial discrimination. The association of goal-striving stress with diminished well-being was stronger among those who did not attribute setbacks to race than among those who did. These findings suggest that even with material success, Black men face blocked opportunities that could be consequential to their well-being.

We examine if commonly used distress measures, rates of psychiatric disorders, and chronic health conditions are affected by alternate measures of race-ethnicity for African Americans and Caribbean blacks. We examined two alternative self-identification measures to investigate if their influence might differ. A study on national household probability sample of non-institutionalized African Americans (n = 3,570) and blacks from Caribbean countries, who now live in the United States (n = 1,621), was conducted between February 2001 and June 2003, using a slightly modified version of the Composite International Diagnostic Interview. The method used to measure black race and ethnicity has influence on physical and mental health outcomes. The distributions of depressive symptoms are not affected, while the distributions of DSM IV disorders and chronic health conditions vary by race and ethnic self-identifications among the African American and Caribbean black populations. There are serious implications of using alternate measures of race-ethnicity on the distribution of physical and mental health morbidity among African Americans and Caribbean blacks. The conceptualization and assessment of race-ethnicity should be carefully considered when studying mental and physical health statuses and service needs in the American black population.

Prior research has shown that minority groups experience greater levels of disability associated with psychiatric and substance use conditions due to barriers to treatment. Treatment delays are an important part of the overall problem of service utilization and access to treatment, yet little work has been done to understand the factors associated with treatment delays among ethnic minorities. This study compares African Americans, Caribbean Blacks and non-Hispanic Whites regarding their probability of making treatment contacts over time, using a combined sample of African Americans and Caribbean Blacks from the National Survey of American Life (NSAL) and non-Hispanic Whites from the National Comorbidity Survey-Replication (NCS-R). Alcohol and other drug use disorders (abuse and dependence) were assessed using the World Mental Health Composite International Diagnostic Interview. Cumulative lifetime probability curves were used to examine race differences in treatment contact. Cox regression analysis was used to test the association between race and treatment groups while controlling for other potential confounding variables. Significant delays in making treatment contact were observed across all disorders. However, no evidence of delays was found for racial differences. In the multivariate analysis, race was not significantly associated with delays. However, comorbid anxiety disorders were found to be a consistent factor associated with a faster time to treatment.

Objectives This study examined the religious correlates of psychiatric disorders. Design The analysis is based on the National Survey of American Life (NSAL). The African American sample of the NSAL is a national representative sample of households with at least one African American adult 18 years or over. This study uses the older African American subsample (N = 837). Methods Religious correlates of selected measures of lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric disorders (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress, major depressive disorder, dysthymia, bipolar I & II disorders, alcohol abuse/dependence, and drug abuse/dependence) were examined. Participants Data from 837 African Americans aged 55 years or older are used in this analysis. Measurement The DSM-IV World Mental Health Composite International Diagnostic Interview was used to assess mental disorders. Measures of functional status (i.e., mobility and self-care) were assessed using the World Health Organization Disability Assessment Schedule-Second Version. Measures of organizational, nonorganizational and subjective religious involvement, number of doctor diagnosed physical health conditions, and demographic factors were assessed. Results Multivariate analysis found that religious service attendance was significantly and inversely associated with the odds of having a lifetime mood disorder. Conclusions This is the first study to investigate the relationship between religious participation and serious mental disorders among a national sample of older African Americans. The inverse relationship between religious service attendance and mood disorders is discussed. Implications for mental health treatment underscore the importance of assessing religious orientations to render more culturally sensitive care.

Objectives The objective of this study was to examine mental health services utilization of older African Americans using data from the National Survey of American Life. Methods A subsample of African American respondents aged 55 years or older (N = 837) was used for this study. Thirteen mental disorders, including mood, anxiety, and substance disorders, were assessed using the Diagnostic Statistical Manual-IV World Mental Health Composite International Diagnostic Interview. Seventy-four respondents (9.6%) met criteria for a disorder. Self-reported service use included psychiatric and nonpsychiatric mental health services, general medical care, and nonhealth care (e.g., human services and complementary-alternative medicine). Results Overall, 46.5% (N = 30) of older African Americans with any one 12-month disorder used some form of services in the last year; 47.2% (N = 12) with two or more disorders used any services. Those reporting any mood disorder had higher service use in every sector compared with those with any anxiety or any substance disorder. Age was significantly related with each service sector except for nonhealth care. There were no significant gender or work status differences, and marital status was only significant in nonhealth care use. Those aged 55–64, married, and not residing in the south were more likely to report any service use than their respective counterparts. Conclusions These findings reveal that a significant proportion of African American older adults with mental health disorders do not receive professional help. Future research on system, provider, and patient factors is needed to clarify and explain underutilization of mental health services.

The pervasiveness of health disparities by socioeconomic status (SES) in the United States has been documented for years.1–6 Regardless of race or ethnicity, health outcomes for individuals of lower SES continue to be poorer than those of their higher-SES counterparts.3,7 This is also true for periodontal health: for years, the data have shown significant SES differences across racial/ethnic groups.8–18 Many previous studies documenting differences in periodontal health have included SES indicators (i.e., income and education) in their analyses. Some studies have provided cross-tabulations between periodontitis and categories for each SES indicator,19–25 whereas others have included these indicators as covariates in multivariable analysis approaches.22,23,25–29 The first group of studies has reported higher prevalences and severity of periodontitis for those with lower SES compared with their higher-SES counterparts. The second group has documented the persistence of racial/ethnic differences after adjusting for SES indicators. However, the incommensurability of these indicators across racial/ethnic groups has not been discussed in these studies. To date, SES indicators have not been investigated as the main independent covariates in studies of periodontal health. Therefore, their contribution to the existing racial/ethnic differences or to the disparity in the prevalence of periodontitis in general remains unknown. To address these issues and expand our previous work on racial/ethnic differences in periodontitis, we ascertained prevalences of periodontitis for (1) income and (2) education among non-Hispanic Black, Mexican-American, and non-Hispanic White adults aged 50 years or older using data from the third National Health and Nutrition Examination Survey (NHANES III). In addition, we investigated the combined effect of income and education on the prevalence of periodontitis. Finally, in this article we discuss the pathways by which SES indicators intertwined with race/ethnicity to affect periodontal health.

The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health.

Objectives. We sought to estimate the prevalence of substance disorders for African Americans and Caribbean Blacks in the United States using data from the National Survey of American Life. Methods. A national household probability sample of noninstitutionalized African Americans (n=3570) and Caribbean Blacks (n=1621) was obtained between February 2001 and June 2003 using a slightly modified version of the Composite International Diagnostic Interview. Results. Overall differences in prevalence of substance disorders between the ethnic groups were not significant. Prevalence rates of substance disorders among African Americans exceeded that of Caribbean Blacks among women, those aged 45 to 59 years, and those who were divorced. African Americans in major metropolitan areas had higher prevalence rates, and those in the South had lower ones, compared with those living in other areas. Overall, first-generation Caribbean Blacks were significantly less likely, but second-generation more likely, than were African Americans to meet criteria for overall substance disorders. Conclusions. Failure to distinguish between African Americans and Caribbean Blacks masks important differences in substance use patterns among the Black population in the United States.

Background: A limited number of studies have examined the knowledge, attitudes, and beliefs of young Black men, particularly with regard to their mental health. This study used focus groups to explore the complexities of the Black male experience and capture young Black men's understanding of and comfort with discussing their mental health. Methods: Forty-six Black male college students in a southern US state were recruited for this study. Participants were asked a series of mental health-related questions to determine their understanding of and comfort with discussing their mental health. Questions included: (1) What is mental health? and (2) How comfortable do you feel talking about your mental health? A taxonomy was created to organize results based on participant responses. Results: Emerging themes included stigma in the Black community, the origin of stoic behaviors, and cultural stereotypes of Black Americans and mental health. During the discussions, participants articulated mental health ...

We used data from the adult reinterview portion of the National Survey of American Life (Jackson, Torres, et al., 2004) to investigate the relationships of John Henryism Active Coping Scale (James, Hartnett, & Kalsbeek, 1983), Social Dominance, and Stratification Beliefs to depressive symptoms as measured by the Center for Epi-demiologic Studies Depression Scale (Radloff, 1977). Social Dominance and Stratification Beliefs (American Values) were identified from a factor analysis. The results indicate significant interaction effects for John Henryism and American Values for White Americans and Caribbean Blacks but not for African Americans. We found a strong positive effect between John Henryism and depressive symptoms for Whites with high levels of Stratification Beliefs. For Whites with low Stratification Beliefs, depressive symptoms remained constant as John Henryism increased. Among Caribbean Blacks, John Henryism showed a significant interaction with Social Dominance. Among Caribbean Blacks, there was ...

Objectives. We examined the use rates and correlates of formal psychiatric services among the US-born and immigrant Caribbean Black population. Methods. We compared overall mental health service use in samples of Caribbean Blacks and African Americans and examined the within-sample ethnic variation among Caribbean Blacks, including for ethnic origin (Spanish Caribbean, Haiti, and English Caribbean), nativity status (those born in or outside the United States), number of years spent living in the United States, age at the time of immigration, and generational status. Results. African Americans and Caribbean Blacks used formal mental health care services at relatively low rates. Among Caribbean Blacks, generational status and nativity showed the greatest effects on rates of reported use, satisfaction, and perceived helpfulness. Of those study participants who met the criteria for disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, about one third used formal mental health care services. The US-born subjects were more likely to receive care than were first-generation immigrants. Conclusions. Our study underscores the importance of ethnicity, immigration, and migration-related factors, within racial categorization, as it pertains to the use of mental health services in the United States. Our findings suggest that timing of migration and generational status of Caribbean Black immigrants and ancestry groups contribute to important differences in rates and sources of use, relative satisfaction, and perception of helpfulness, with regard to formal mental health services.

This study examined the impact of discrimination and legal acculturative stress on Major Depression Episode lifetime among Asian American immigrants. It further examined the role of immigration related-factors (age at immigration, reason for immigration, and years spent in the U.S.) on the relationship of acculturative stress and Major Depression Episode lifetime. The National Latino and Asian American Study 2002-2003 dataset was used. The study findings were: (1) high discrimination and legal acculturative stress were associated with Major Depression Episode lifetime; (2) age at immigration buffered the relationship of discrimination acculturative stress and Major Depression Episode lifetime as well as the relationship of legal acculturative stress and Major Depression Episode lifetime; and (3) years spent in the U.S. buffered the relationship of discrimination acculturative stress and Major Depression Episode lifetime only. These findings highlight the complex relationship of factors that impact the mental health of the Asian American immigrants.

Background The purpose of this study was to examine the frequency of gardening/yard work in relation to depressive symptoms in African-Americans while controlling for biological and social factors. Methods A secondary analysis was performed on the National Survey of American Life (n=2,903) using logistic regression for complex samples. Gardening/Yard work was measured by self-reported frequency. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Results Biological and social factors, not gardening/yard work, were associated with depressive symptoms. Conclusions Biological and social factors may need to be addressed before the association between gardening/yard work and depressive symptoms can be determined.

The high prevalence of co morbid chronic conditions among minorities and underserved individuals is a public health problem that deserves research attention. We used the Design Science Research approach to iteratively build a persuasive mobile phone texting (SMS) based behavior change support intervention (OH-Buddy) that (1) addresses co morbid diabetes and periodontal chronic conditions, (2) uses the ubiquitous SMS as an intervention delivery channel to make it accessible to underserved populations, (3) and uses an informal caregiver ("buddy") as a supplementary means of support for patients. We are currently evaluating the OH-Buddy intervention in terms of its ability to engage participants and enable them to better self-manage their conditions. Expected outcomes include improvement in oral hygiene, blood glucose monitoring, medication adherence, physical activity, and healthy eating. Preliminary results based on self-reported performance data indicates the existence of moderate but steady improvement in patient engagement and self-management.

The authors examined clinician race differences in symptom attribution patterns in diagnosing psychiatric inpatients from a low-income, African American community. Different decision models were applied to patients based on clinician race. African American clinicians diagnosed schizophrenia with higher odds than non-African American clinicians when they believed hallucinations were present and avoided that diagnosis with lower odds when they considered substance abuse issues. Non-African American clinicians usually related the attribution of negative symptoms to the diagnosis of schizophrenia while African American clinicians did not make this linkage. The study highlights the need for more detailed examination of cultural influences on diagnostic judgments.

This research examined clinicians' consideration of situational factors in diagnostic decisions of mood vs. schizophrenia disorders among psychiatric inpatients from a low-income, African American community. Clinicians completed questionnaires describing their diagnostic decisions. Responses reflecting the usage of situational information were investigated. African American clinicians used situational information more than non-African American clinicians. However, this increased attention to situational information was not uniquely associated with a particular diagnostic decision for African American clinicians. In contrast, consideration of situational attributions by non-African American clinicians did increase the probability of a mood diagnosis. Logistic regression analyses suggested differential application of a diagnostic standard among African American and non-African American clinicians. Implications for enhancing the cultural sensitivity of diagnosis practices are discussed.

This paper provides an overview of the conceptualization and methods used in the National Survey of American Life (NSAL). The objectives of the NSAL are to investigate the nature, severity, and impairment of mental disorders among national samples of the black and non‐Hispanic white (n = 1,006) populations in the US, including African American (N = 3,570), and Afro‐Caribbean (N = 1,623) immigrant and second and older generation, populations. National multi‐stage probability methods were used in generating the samples and race/ethnic matching of interviewers and respondents were employed in the largely face‐to‐face interview, lasting on average 2 hours and 20 minutes. Two methodological approaches are described for addressing sampling coverage of individuals attached to, but not residing in, selected households at the time of the study. The paper also describes two approaches used to address concerns about the interpretations of standard symptom probe information in assessing serious mental disorders. This included a clinical reappraisal study designed to ascertain differences in symptom responding and ascertainment of cases (N = 677) in a subset of the same NSAL respondents. Finally, an abbreviated, novel method for estimating the prevalence of mental disorders in first‐degree family members is described and the preliminary results from this new approach are reported. Copyright © 2004 Whurr Publishers Ltd.

OBJECTIVE: This retrospective study explored the interrelationship among aftercare, length of hospital stay, and rehospitalization within six months of discharge in a sample of psychiatric inpatients. METHODS: Data were analyzed for 1,481 patients who had received inpatient care at a state psychiatric hospital from November 1991 to July 1994. Logistic regression models were estimated to predict the likelihood of referral to aftercare and of readmission to a hospital within six months of the index discharge. Variables controlled for were patients' characteristics; psychiatric status at the time of discharge, including length of stay; and the availability of informal support. RESULTS: Sixteen percent of the patients received a referral to aftercare, and about 13 percent of the patients were readmitted within six months of discharge. White patients were twice as likely as African Americans to receive a referral to aftercare. Length of hospitalization and having a diagnosis of schizophrenia were also predicto...

To examine racial-ethnic differences in the endorsement and attribution of psychotic-like symptoms in a nationally representative sample of African-Americans, Asians, Caribbean Blacks, and Latinos living in the USA.Data were drawn from a total of 979 respondents who endorsed psychotic-like symptoms as part of the National Latino and Asian American Study (NLAAS) and the National Survey of American Life (NSAL). We use a mixed qualitative and quantitative analytical approach to examine sociodemographic and ethnic variations in the prevalence and attributions of hallucinations and other psychotic-like symptoms in the NLAAS and NSAL. The lifetime presence of psychotic-like symptoms was assessed using the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) psychotic symptom screener. We used logistic regression models to examine the probability of endorsing the four most frequently occurring thematic categories for psychotic-like experiences by race/ethnicity (n100). We used qualitative methods to explore common themes from participant responses to open ended questions on their attributions for psychotic-like symptoms.African-Americans were significantly less likely to endorse visual hallucinations compared to Caribbean Blacks (73.7% and 89.3%, p.001), but they endorsed auditory hallucinations symptoms more than Caribbean Blacks (43.1% and 25.7, p.05). Endorsing delusions of reference and thought insertion/withdrawal were more prevalent for Latinos than for African-Americans (11% and 4.7%, p.05; 6.3% and 2.7%, p.05, respectively). Attribution themes included: supernatural, ghosts/unidentified beings, death and dying, spirituality or religiosity, premonitions, familial and other. Respondents differed by race/ethnicity in the attributions given to psychotic like symptoms.Findings suggest that variations exist by race/ethnicity in both psychotic-like symptom endorsement and in self-reported attributions/understandings for these symptoms on a psychosis screening instrument. Ethnic/racial differences could result from culturally sanctioned beliefs and idioms of distress that deserve more attention in conducting culturally informed and responsive screening, assessment and treatment.

Most epidemiologic studies of race and psychological distress are conducted on data sets containing few black respondents. As a result, the amount of data on risk groups within the black population is limited. Furthermore, the epidemiologic information that we do have is usually confined to demographic correlates of distress only, with no appreciation for exploring variables which might link race and socioeconomic status to psychological distress. In this paper, data are analyzed from the National Survey of Black Americans, a nationally representative sample of the adult black population. The paper explores how help seeking and receipt of financial assistance impact upon psychological distress among blacks with economic problems. Results revealed that while 89% seek outside help, only 21% are successful in obtaining financial assistance. Regression analyses revealed that receipt of financial assistance does not eliminate the negative relationship between socioeconomic status and distress. Results did show, however, that the ability to obtain money decreases distress by reducing the severity of the economic problem. The implications for how psychiatric epidemiology can be used as a basis for public health-related interventions among blacks are discussed.

The association between racial discrimination and mental health was examined using Wave 2 (1987–1988) and Wave 3 (1988–1989) panel data from the National Survey of Black Americans (NSBA). Mental health status was assessed by psychological distress and depression. In cross-sectional analyses, the perception of racial discrimination was related to high levels of psychological distress at Waves 2 and 3. Experiencing racial discrimination was marginally related to a high likelihood of depression at Wave 2. In longitudinal analyses, reports of racial discrimination at Wave 2 were associated with high levels of psychological distress at Wave 3. High psychological distress or depression at Wave 2 was not associated with reports of racial discrimination at Wave 3—indicating that poor mental health did not predict subjective reports (perceptions) of discrimination. The Discussion focused on possible directions for a more comprehensive program of research on mental health, stress, and experiences of racially based discrimination.

Goal-striving stress refers to the discrepancy between aspirations and achievements, hard work and accomplishment, options and opportunities, and perhaps provides a pathway linking social structure and mental health. Although a number of scholars have speculated about the relationship between blocked opportunities and psychopathology, few studies have empirically examined associations between striving efforts and mental health among black Americans. 1–5 In addition, existing studies have often used community samples, considered a single aspect of mental health, or were unable to operationalize goal-striving stress in a more nuanced fashion. 2,4 This study examines the influence of goal-striving stress on the mental health of a national sample of black Americans.

Using data from the National Survey of Black Americans, this article explores the role of African American ministers in the help seeking of African Americans for serious emotional problems. The authors explore which demographic characteristics and psychosocial factors are related to contacting Black clergy for help, whether certain types of personal problems increase the likelihood of clergy contact, and whether those who go to ministers are also likely to seek help from other professional help sources. Results indicate that women are more likely than men to seek help from ministers. People with economic problems are less likely to contact clergy, while those with death or bereavement problems are more likely to seek help from the clergy. Regardless of the type or severity of the problem, those who contact clergy first are less likely to seek help from other professionals. It is recommended that African American clergy and mental health professionals engage in a mutual exchange of information to increase access to professional care among African Americans with serious personal problems.

The issues related to recruiting African American psychiatric inpatients are discussed in the context of a study on the influence of ethnicity on psychiatric diagnosis. Ethnically diverse psychiatric residents interviewed 960 Black and White inpatients in 2 urban psychiatric hospitals. Despite the obstacles cited in the literature about recruiting and retaining African Americans into research, 78% of this sample were African American. In addition, interview completion and refusal rates did not differ by patient ethnicity. Results suggest that matching interviewer and patient ethnicity did not influence African Americans' likelihood of participating in or of refusing an interview. This article summarizes a number of guidelines that others may find useful in conducting clinical research with African Americans, ranging from the formation of academic-public liaisons to interviewer training.

Purpose. Self-help among African-Americans is that tradition of individual and group efforts aimed toward racial progress and defending against a hostile society. The purpose of this paper is to encourage African-Americans, regardless of income, to take personal responsibility for their health. This review discusses each side of the individual versus societal responsibility issue and provides a rationale for integrating these two perspectives. It argues that the tradition of community-based self-help among African-Americans is a mechanism for personal empowerment that can lead to collective action; it therefore has important implications for the improvement of African-American health. Search Methods. The search made use of a computer-based inquiry with self-help, community health empowerment, and African-American or blacks used as descriptors. We also used a computerized search by the last names of key authors writing in the area of minority health. The review was limited to references between 1964 and 1994. The review also relied on our own professional libraries. Finally, 15 knowledgeable individuals employed at universities around the country were queried about their work, focusing on this subject. They were asked about their perceptions of the issues pertinent to the role of personal and societal responsibility in modifying health behaviors of African-Americans. Summary of Important Points. Effective health behavior change strategies with black populations will require an integration of personal responsibility and advocacy for social systems change. The formation of effective self-help community-based coalition partnerships is a viable strategy for forging systemic changes to address the health disparity problem. Major Conclusions. The discussion concludes that blacks should hold themselves more personally responsible for solving their own problems while rejecting debilitating forms of extreme self-blame. Affiliation with self-help organizations and community coalitions for health empowerment is offered as a strategy for community infrastructure development with potential for improving quality of life.

To examine the frequency of leisure-time physical activity (LTPA) in relation to depressive symptoms in a nationally representative sample of African American (AA) women and AA men with guidance by Stokols' Social Ecological Framework.A secondary analysis of AA women (n=1811) and AA men (n=1038) was performed on the National Survey of American Life, where a four stage national area probability sampling was conducted. Interviews were conducted 2001-2003. Clinically depressed AA were excluded from the current study. LTPA was measured by self-report frequency (never, rarely, sometimes, often) of participation in sports/exercise. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale. Logistic regression for complex samples was used to examine the relationship between LTPA and depressive symptoms, adjusting for biopsychobehavioral and sociophysical environmental factors.Compared with AA women and AA men who reported never participating in LTPA, the multivariate OR for depressive symptoms in AA women and AA men who reported participating in LTPA often was 0.42 (95% CI=0.24-0.72) and 0.41 (95% CI=0.25-0.69) respectively.Increased frequency of LTPA was associated with fewer depressive symptoms in a nationally representative sample of non-clinically depressed AAs.

OBJECTIVES: Randomized trials found physical activity (PA) effective in decreasing depressive symptoms. Few studies included Black participants. The purpose of this systematic literature review was to determine the effects of PA on depressive symptoms in Black adults. METHODS: Articles were abstracted by conducting a computer and hand search of eligible studies. RESULTS: Eight of 13 studies found a significant inverse relationship between PA and depressive symptoms in Black adults. Sources for the heterogeneity were explored. CONCLUSION: Future studies should include representative samples of Black adults, incorporate a theory which considers multiple levels of influence, account for genetic factors in the etiology of depressive symptoms, include individuals diagnosed with depression and with health conditions which may increase the risk of depressive symptoms, account for intra-group ethnic heterogeneity, measure and differentiate between social support and social network, consider aspects of the physical environment and use standardized measurements of PA.

To contribute to the growing understanding of U.S. black-white health disparities by examining psychosocial stress as an important contributor to physical health problems.Data are from the National Survey of American Life, an integrated national household probability sample of White Americans, African Americans, and Caribbean blacks. Regression analysis was used to assess associations between goal-striving stress and hypertension, BMI, physical health problems, and self-rated health.After accounting for sociodemographic factors and three additional stressors--personal problems, lifetime racial discrimination, and everyday racial discrimination-goal-striving stress was a significant predictor of hypertension, physical health problems, and diminished self-rated health. Ethnicity moderated the relationship; the negative association between goal-striving stress and physical health problems was strongest for Caribbean blacks.This study extends the research on goal-striving stress and adds to a growing literature documenting relationships between social processes and disease.

African Americans are disproportionately diagnosed as having schizophrenia, and the factors that contribute to this disparity are poorly understood. This study utilized data from the 1995 MacArthur Violence Risk Assessment Study to examine the impact of racial differences in sociodemographic characteristics, clinical presentation, and perceived honesty on disparities in the diagnosis of schizophrenia among African Americans.Researchers using structured assessments of diagnostic, sociodemographic, and clinical measures interviewed African Americans (N=215) and whites (N=537) receiving inpatient care for a severe mental illness. The impact of interviewers' perceptions of the participants' honesty on racial disparities in the diagnosis of schizophrenia was assessed.African Americans (45%) were more than three times as likely as whites (19%) to be diagnosed as having schizophrenia. Disparities in sociodemographic and clinical characteristics modestly contributed to disparities in diagnostic rates. In contrast, interviewer-perceived honesty proved to be a significant predictor of racial disparities in schizophrenia diagnoses. After adjustment for perceived honesty, diagnostic disparities between African Americans and whites were substantially reduced. Mediator analyses confirmed that interviewer-perceived honesty was the only consistent mediator of the relationship between race and schizophrenia diagnosis.Interviewers' perceptions of honesty among African-American participants are important contributors to disparities in the diagnosis of schizophrenia. Clinicians' perceptions of dishonesty among African-American patients may reflect poor patient-clinician relationships. Methods of facilitating a trusting relationship between patients and clinicians are needed to improve the assessment and treatment of persons from minority groups who are seeking mental health care. (Psychiatric Services 63:875-880, 2012; doi: 10.1176/appi.ps.201100388).

BACKGROUND: conventional wisdom suggests that increased socioeconomic resources should be related to better health. Considering the body of evidence demonstrating the significant association between racial discrimination and depression, we examined whether exposure to racial discrimination could attenuate the positive effects of increased levels of socioeconomic position (SEP) among African Americans. Specifically, this paper investigated the joint interactive effects of SEP and racial discrimination on the odds of depression among African Americans. METHODS: racial discrimination was measured using two measures, major and everyday discrimination. Study objectives were achieved using data from the National Survey of American Life, which included a nationally representative sample of African Americans (n =3570). Logistic regression models were used to estimate the effects of SEP and racial discrimination on the odds of depression. RESULTS: reports of racial discrimination were associated with increased risk of depression among American African men who possessed greater levels of education and income. Among African American men, significant, positive interactions were observed between education and experiences of major discrimination, which were associated with greater odds of depression (P = 0.02). Additionally, there were positive interactions between income and both measures of racial discrimination (income x everyday discrimination, P = 0.013; income x major discrimination, P = 0.02), which were associated with increased odds of depression (P = 0.02). CONCLUSIONS: it is possible that experiences of racial discrimination could, in part, diminish the effects of increased SEP among African American men.

Context Rates of clinical diagnoses of schizophrenia in African American individuals appear to be elevated compared with other ethnic groups in the United States, contradicting population rates derived from epidemiologic surveys. Objective To determine whether African American individuals would continue to exhibit significantly higher rates of clinical diagnoses of schizophrenia, even after controlling for age, sex, income, site, and education, as well as the presence or absence of serious affective disorder, as determined by experts blinded to race and ethnicity. A secondary objective was to determine if a similar pattern occurred in Latino subjects. Design Ethnicity-blinded and -unblinded diagnostic assessments were obtained in 241 African American individuals (mean [SD] age, 34.3 [8.1] years; 57% women), 220 non-Latino white individuals (mean [SD] age, 32.7 [8.5] years; 53% women), and 149 Latino individuals (mean [SD] age, 33.5 [8.0] years; 58% women) at 6 US sites. Logistic regression models were used to determine whether elevated rates of schizophrenia in African American individuals would persist after controlling for various confounding variables including blinded expert consensus diagnoses of serious affective illness. Settings Six academic medical centers across the United States. Participants Six hundred ten psychiatric inpatients and outpatients. Main Outcome Measure Relative odds of unblinded clinical diagnoses of schizophrenia in African American compared with white individuals. Results A significant ethnicity/race effect (χ 2 2 = 10.4, P = .01) was obtained when schizophrenia was narrowly defined, controlling for all other predictors. The odds ratio comparing African American with non-Latino white individuals was significant (odds ratio = 2.7; 95% CI, 1.5-5.1). Similar differences between African American and white individuals occurred when schizophrenia was more broadly defined (odds ratio = 2.5; 95% CI, 1.4-4.5). African American individuals did not differ significantly from white individuals in overall severity of manic and depressive symptoms but did evidence more severe psychosis. Conclusions African American individuals exhibited significantly higher rates of clinical diagnoses of schizophrenia than non-Latino white subjects, even after controlling for covariates such as serious affective disorder.

The educational, employment, and financial status of African Americans differs from that of other US race/ethnic groups, particularly White Americans. For example, in July 2006, it was estimated that 23.8 million Americans aged between 18 and 64 years, or 12.6% of the total US population, were African American. Of the African American noninstitutionalized, civilian population, 11.3 million (47.5%) were male, and 12.5 million (52.5%) were female (US Census Bureau 2006d). According to the 2004 Current Population Survey, the majority of African American adults (54%) reside in the South. In 2006, 8.2 million African American adults aged 18–64 years (36.1%) earned a high school diploma, while 2.7 million (11.9%) earned a bachelor’s degree compared to 30.3 and 20.4% of non-Hispanic White Americans who earned a high school diploma or bachelor’s degree, respectively (US Census Bureau 2006b). The average African-American family median income in 2006 was US$ 32,372 in comparison to US$ 52,375 for non-Hispanic White families (US Census Bureau 2006a). In 2006, the US Census Bureau reported that 25.3% of African Americans were living at or below the poverty level, compared to 9.3% for White Americans. Forty-eight percent of African Americans owned their own home, while over three-quarters of White Americans were homeowners in 2006 (US Census Bureau 2006c). As of July 2007, the unemployment rate for African Americans (8%) was twice that of White Americans (4%) (Bureau of Labor Statistics, Current Employment Statistics Survey 2007). One-third (33%) of African-American adults aged 19–64 years were uninsured or experiencing a gap in coverage during 2005 compared to 20% for their White American counterparts(Doty and Holmgren 2006). It is not difficult to conclude that many of the benefits derived from improved socioeconomic standing vary by racial group membership (Conley 1999; Krieger et al. 1997; Oliver and Shapiro 1995; Shapiro 2004; Williams and Collins 1995).