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Jail incarceration remains an overlooked yet crucial component of the U.S. carceral system. Although a growing literature has examined the mortality costs associated with residing in areas with high levels of incarceration, far less is known about how local jails shape this burden at the intersection of race, sex, and age. In this study, I examine the relationship between county-level jail incarceration and age-specific mortality for non-Hispanic Black and White men and women, uniquely leveraging race-specific jail rates to account for the unequal racial distribution of jail exposures. This study finds evidence of positive associations between mortality and jail incarceration: this association peaks in late adulthood (ages 50–64), when increases in jail rates are associated with roughly 3% increases in mortality across all race–sex groups. However, patterns vary at the intersection of race, sex, and age. In particular, I find more marked and consistent penalties among women than among men. Additionally, a distinctly divergent age pattern emerges among Black men, who face insignificant but negative associations at younger ages but steep penalties at older ages—significantly larger among those aged 65 or older relative to their White male and Black female counterparts. Evidence further suggests that the use of race-neutral incarceration measures in prior work may mask the degree of harm associated with carceral contexts, because the jail rate for the total population underestimates the association between jail rates and mortality across nearly all race–age–sex combinations. These findings highlight the need for future ecological research to differentiate between jail and prison incarceration, consider the demographic distribution of incarceration's harms, and incorporate racialized measures of exposure so that we may better capture the magnitude of harm associated with America's carceral state. [ABSTRACT FROM AUTHOR]

Introduction: Patients with long bone fractures often present to the emergency department (ED) with severe pain and are typically treated with opioid and non-opioid analgesics. Historical data reveals racial disparities in analgesic administration, with White patients more likely to receive analgesics. With the diversifying US population, health equity is increasingly crucial. In this study we aimed to evaluate the early administration of opioid and non-opioid analgesia among Black and White patients with long bone and femur fractures in EDs over different time frames using a substantial database. Methods: We retrospectively extracted Information from 57 US healthcare organizations within the TriNetX database, encompassing 95 million patients. The ED records from 2003–2023 were subjected to propensity score matching for age and gender. We focused on four cohorts: two comprising Black and White patients diagnosed with long bone fractures, and another two with Black and White patients diagnosed solely with femur fractures. We examined analgesic administration rates over 20 years (2003–2023) at five-year intervals (2003–2008; 2008–2013; 2013–2018; 2018–2023), and further analyzed the rates for the most recent two-year period (2021–2023). Results: Disparities in analgesic administration significantly diminished over the study period. For patients with long bone fractures (1,095,052), the opioid administration gap narrowed from 6.3% to 1.1%, while non-opioid administration disparities reduced from 4.4% to 0.3%. Similar trends were noted for femur fractures (265,181). By 2021–2023, no significant differences in analgesic administration were observed between racial groups. Conclusion: Over the past 20 years, the gap in early administration of opioid and non-opioid analgesics for Black and White patients presenting with long bone fractures or femur fractures has been disappearing. [ABSTRACT FROM AUTHOR]

Limited information is available regarding the knowledge of Cardiovascular Disease (CVD) risk factors and the actual risk behaviors among African American (AA) older women living in rural areas of Alabama. A pilot study of needs assessment for CVD prevention behaviors was conducted to collect such data from rural AA women. This paper reports the quantitative part of the needs assessment of this pilot study. We recruited participants (N = 30) using convenience sampling. Data collection measures included: i) American Heart Association's CVD‐related knowledge questionnaire, ii) Five Times Sit to Stand Test to measure dynamic balance and iii) Six minute walk test (6MWT) to assess exercise endurance iv) standard weighing scale to measure body weight and v) standard measurements scale to measure height. Descriptive and inferential statistics were used to analyze the data. The majority (76%) of participants had hypertension (70%), diabetes (60%), poor balance (70%), and low exercise endurance (100%). Most of the participants had low knowledge related to CVD risk factors. This study demonstrated the need to conduct a large‐scale study to assess knowledge related to heart health and the actual needs and preferences of these individuals. Conducting such a study would lay the foundation for developing a need‐based program for these underserved individuals while incorporating their preferences and the strategies that would help engage them in a heart health intervention. [ABSTRACT FROM AUTHOR]

Simple Summary: Head and neck cancer disparities in outcomes for Black Americans have been well recognized. However, the specific drivers of the inferior outcomes remain poorly understood. We investigated the biologic features of patient oral cancers and performed a follow-up study of the patient post-surgery recurrences and metastases aiming to explore potential mechanisms that might underpin the poorer outcomes among Black American patients. It was found that high levels of tumor stemness and tumor-promoting stromal characteristics were linked to patient recurrence and metastasis. There were more cases of Black American than White American exhibiting high stemness traits and strong tumor-promoting stromal features associated with tumor recurrences and metastases, although the investigated cases displayed comparable clinical diagnoses. Our findings revealed that the differences in tumor stemness and stromal property among cancers with similar diagnoses contribute to patient outcome disparities. Black Americans (BAs) with head and neck cancer (HNC) have worse survival outcomes compared to the White patients. While HNC disparities in patient outcomes for BAs have been well recognized, the specific drivers of the inferior outcomes remain poorly understood. Here, we investigated the biologic features of patient tumor specimens obtained during the surgical treatment of oral cancers and performed a follow-up study of the patients' post-surgery recurrences and metastases with the aim to explore whether tumor biologic features could be associated with the poorer outcomes among BA patients compared with White American (WA) patients. We examined the tumor stemness traits and stromal properties as well as the post-surgery recurrence and metastasis of oral cancers among BA and WA patients. It was found that high levels of tumor self-renewal, invasion, tumorigenesis, metastasis, and tumor-promoting stromal characteristics were linked to post-surgery recurrence and metastasis. There were more BA than WA patients demonstrating high stemness traits and strong tumor-promoting stromal features in association with post-surgery tumor recurrences and metastases, although the investigated cases displayed clinically comparable TNM stages and histological grades. These findings demonstrated that the differences in tumor stemness and stromal property among cancers with comparable clinical diagnoses contribute to the outcome disparity in HNCs. More research is needed to understand the genetic and molecular basis of the biologic characteristics underlying the inferior outcomes among BA patients, so that targeting strategies can be developed to reduce HNC disparity. [ABSTRACT FROM AUTHOR]

There are significant racial disparities in obesity and diabetes such that prevalence rates are higher among Black Americans than White Americans. This study examined effects of communicating the prevalence of obesity/diabetes and comparing race-specific prevalence rates between White and Black Americans to highlight racial health disparities. We conducted two preregistered, between-subjects randomized online experiments with an analytic sample of 1,232 U.S. adults (n = 609 for the obesity study and n = 623 for the diabetes study) stratified by race. In each experiment, we randomly assigned respondents to read an obesity/diabetes message 1) without disease prevalence information, 2) with the national obesity/diabetes prevalence rate, 3) with the race-specific obesity/diabetes prevalence rate among White Americans, 4) with the race-specific prevalence rate among Black Americans, or 5) comparing the race-specific prevalence rates between White and Black Americans, or 6) to a no-message condition. Results showed that diabetes prevalence information reduced the overestimation of race-specific diabetes prevalence. Comparing the obesity prevalence rate among White Americans to that of Black Americans increased support for policies to reduce racial health disparities, but also made Black respondents less likely to cut calories. Race-specific disease prevalence information and intergroup disease prevalence comparisons may have both positive and unintended consequences on message recipients. Health educators should be more cautious when communicating disease prevalence information. [ABSTRACT FROM AUTHOR]

Background: Syndemic models have been used in previous studies exploring HIV-related outcomes; however, these models do not fully consider intersecting psychosocial (e.g., substance use, depressive symptoms) and structural factors (unstable housing, concentrated housing vacancy) that influence the lived experiences of women. Therefore, there is a need to explore the syndemic effects of psychosocial and structural factors on HIV risk behaviors to better explain the multilevel factors shaping HIV disparities among black women. Methods: This analysis uses baseline data (May 2009–August 2010) from non-Hispanic black women enrolled in the HIV Prevention Trials Network 064 Women's Seroincidence Study (HPTN 064) and the American Community Survey 5-year estimates from 2007 to 2011. Three parameterizations of syndemic factors were applied in this analysis a cumulative syndemic index, three syndemic groups reflecting the level of influence (psychosocial syndemic group, participant-level structural syndemic group, and a neighborhood-level structural syndemic group), and syndemic factor groups. Clustered mixed effects log-binomial analyses measured the relationship of each syndemic parameterization on HIV risk behaviors in 1,347 black women enrolled in HPTN 064. Results: A higher syndemic score was significantly associated with increased prevalence of unknown HIV status of the last male sex partner (adjusted prevalence ratio (aPR) = 1.07, 95% confidence interval or CI 1.04–1.10), involvement in exchange sex (aPR = 1.17, 95% CI: 1.14–1.20), and multiple sex partners (aPR = 1.07, 95% CI: 1.06–1.09) in the last 6 months. A dose–response relationship was observed between the number of syndemic groups and HIV risk behaviors, therefore, being in multiple syndemic groups was significantly associated with increased prevalence of reporting HIV risk behaviors compared with being in one syndemic group. In addition, being in all three syndemic groups was associated with increased prevalence of unknown HIV status of the last male sex partner (aPR = 1.67, 95% CI: 1.43–1.95) and multiple sex partners (aPR = 1.53, 95% CI: 1.36–1.72). Conclusions: Findings highlight syndemic factors influence the lived experiences of black women. [ABSTRACT FROM AUTHOR]

Despite the persistence of relationships between historical racist violence and contemporary Black–White inequality, research indicates, in broad strokes, that the slavery–inequality relationship in the United States has changed over time. Identifying the timing of such change across states can offer insights into the underlying processes that generate Black–White inequality. In this study, we use integrated nested Laplace approximation models to simultaneously account for spatial and temporal features of panel data for Southern counties during the period spanning 1900 to 2018, in combination with data on the concentration of enslaved people from the 1860 census. Results provide the first evidence on the timing of changes in the slavery–economic inequality relationship and how changes differ across states. We find a region-wide decline in the magnitude of the slavery–inequality relationship by 1930, with declines traversing the South in a northeasterly-to-southwesterly pattern over the study period. Different paces in declines in the relationship across states suggest the expansion of institutionalized racism first in places with the longest-standing overt systems of slavery. Results provide guidance for further identifying intervening mechanisms—most centrally, the maturity of racial hierarchies and the associated diffusion of racial oppression across institutions, and how they affect the legacy of slavery in the United States. [ABSTRACT FROM AUTHOR]

Asthma, and chronic obstructive pulmonary disease (COPD) are significant health problems that have disparate effects on many Americans. Misdiagnosis and underdiagnosis are common and lead to ineffective treatment and management. This study assessed the feasibility of applying a two-step case-finding technique to identify both COPD and adult asthma cases in urban African American churches. We established a community-based partnership, administered a cross-sectional survey in step one of the case-finding technique and performed spirometry testing in step two. A total of 219 surveys were completed. Provider-diagnosed asthma and COPD were reported in 26% (50/193) and 9.6% (18/187) of the sample. Probable asthma (13.9%), probable COPD (23.1%), and COPD high-risk groups (31.9%) were reported. It is feasible to establish active case-finding within the African American church community using a two-step approach to successfully identify adult asthma and COPD probable cases for early detection and treatment to reduce disparate respiratory health outcomes. [ABSTRACT FROM AUTHOR]

• Black subjects are under-reported in lipid-lowering ASCVD outcomes trials. • Black subjects are under-represented in lipid-lowering ASCVD outcomes trials. • Inclusion of Black persons will help to address disparities in preventive care. Non-Hispanic (NH) Black participants have been under-represented in studies of cardiovascular disease. We sought to determine the trends of reporting and representation of NH Black subjects in randomized controlled trials (RCTs) of lipid-lowering therapies demonstrating atherosclerotic cardiovascular disease (ASCVD) risk reduction benefit. The electronic databases of MEDLINE, EMBASE and ClinicalTrials.gov were searched from 1990-2020. Studies of lipid-lowering therapies (i.e., statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors [PCSK9], and icosapent ethyl) with proven ASCVD benefit, sample sizes of at least 1000 subjects and follow-up of at least 1 year were included (40 RCTs, N=306 747 total participants). We examined articles and supplementary material for participant-level race data. Using United States disease prevalence data, the participation-to-prevalence ratio (PPR) metric was used to estimate the representation of NH Black subjects compared with their reported disease burden (i.e., < 0.8 indicated under-representation; > 1.2, over-representation; and 0.8 to <1.2, adequate representation). The median (interquartile range) number of participants per trial was 4871 (2434-10077). NH Black enrollees comprised 7.3% (95% CI, 0.9%-15.4%) of the total number of subjects reported. During the time intervals 1990-1995, 1996-2000, 2001-2005, 2006-2010, 2011-2015 and 2016-2020, NH Black participation was 0%, 1.1%, 4.4%, 4.8%, 0.2% and 0.7% respectively (P for trend <0.001). For statin trials, the participation of NH Black subjects was reported in 0 studies between 1990-1995 and in 9 of 28 trials from 1996-2020. For ezetimibe and icosapent ethyl, NH Black participants were reported in 0 of 3 and 0 of 1 studies, respectively. For trials of PCSK9 inhibitors, NH Black subjects were reported in 2 of 5 (40%). NH Black participants were under-represented compared with their disease burden in studies evaluating subjects with diabetes, hypercholesterolemia, stable coronary artery disease, and acute coronary syndrome (PPR < 0.8 for all). NH Black participants are markedly under-represented, and results are under-reported. The inclusion of population and disease specific representation of NH Black persons and their related social determinants of health will help to address the disparity in preventive care for this historically undertreated population. [Display omitted] [ABSTRACT FROM AUTHOR]

Little is known about representation in trials aimed at addressing Opioid Use Disorder. This is a crucial issue given high mortality rates overall and substantial differences in death rates across racial/ethnic groups. We analyzed data from clinical trials, data on Census population, data on new admissions to treatment facilities with a diagnosis of Opioid Use Disorder, and mortality data. We found that Native American people (who face the highest opioid-related mortality burden in the United States) were under-represented in clinical trials. Black people (who face the second highest mortality rate) were enrolled at levels that exceeded those expected. Our results suggest the need for increased efforts to include Native Americans in OUD clinical trials and also that researchers should consider the possibility that high levels of enrollment among black Americans may represent an undue burden. We found ambiguous results for Asian American and Hispanic people. Our analysis also suggests that White people were represented at levels below those expected, although they were a majority of clinical trials participants. Overall, these findings highlight the importance of equity in clinical trials and major gaps in terms of representation. • American Indians and Alaska Natives were under-represented in clinical trials dealing with Opioid Use Disorder. • Black Americans were enrolled in clinical trials for opioid use disorder at levels that exceeded those expected. • White people were enrolled in clinical trials for opioid use disorder at levels that were lower than those that were expected. [ABSTRACT FROM AUTHOR]

Objective: Untreated depression among Temporary Assistance for Needy Families (TANF) participants greatly reduces chances of securing and holding gainful employment.Method: Logistic regression models were estimated on data describing 1,000 African American and Caribbean Black TANF recipients and 2,123 African American and Caribbean Black non-TANF recipients obtained from the National Survey of American Life (NSAL).Results: Black TANF participants were more likely than Black non-TANF participants to be depressed and treated. Treatment odds were lower for Caribbean Black than for U.S.-born Black TANF participants.Conclusion: Results indicated that mental health treatment was likely among Black TANF participants if depression was identified. TANF participants working less than full-time did not receive as much treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Objective: Immigrants, especially refugees, face unique barriers to accessing health care relative to native born Americans. In this study, we examined how immigration status, health, barriers to access, and knowledge of the health care system relate to the likelihood of having a regular health care provider.Methods: Using logistic regression and data from a community-based participatory study, we estimated the relative likelihood that an African immigrant woman would have a regular health care provider compared with an African American woman.Results: Immigrant status remains a powerful predictor of whether a woman had a regular health care provider after controlling for covariates. African immigrants were 73% less likely to have a regular health care provider than were otherwise similar African American women.Conclusion: Expanding health care educational efforts for immigrants may be warranted. Future research should examine how cultural beliefs and time in residence influence health care utilization among US immigrants. [ABSTRACT FROM AUTHOR]

Screening for colorectal cancer has been demonstrated to reduce colorectal cancer mortality. Blacks have a higher mortality from this malignancy, particularly men, yet screening rates in this population are often found to be lower than in whites. A modest literature demonstrates effective interventions that can increase screening rates in blacks; however, results are not consistent and ongoing work is required. Most work has not addressed specific barriers to screening in black men. Given the lack of studies on black men only, this study evaluated the state of research in the black population using a PubMed search. The authors provide commentary that proposes increased (1) state and local government support for collaborative programs with healthcare organizations, including patient navigation; (2) augmented community-organizing efforts to generate more attention to the need for colorectal cancer screening in the black community, with a focus on black men; and (3) federal research funding to promote investigation into new interventions and evaluation of existing ones. Specific recommendations for black men include lowering the screening age to 45years, increasing access to health care, the use of patient navigators, and improved reporting and monitoring of colorectal cancer screening rates. SUPPLEMENT INFORMATION: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Introduction: In the past several years, high profile events have drawn attention to the longstanding problem of violent encounters between police and young black men in the U.S. This paper highlights the results of a 1-year qualitative study to describe (1) perceptions of police-youth violence prevention policies, programs, and practices; and (2) existing infrastructures that can be leveraged to strengthen police-youth violence prevention efforts.Methods: Semi-structured interviews were conducted with 48 key stakeholders from four groups (young black men aged 14-24years, parents and educators, police officers, and staff in youth serving organizations) in 2017. Stakeholders were asked to (1) identify any policies, programs, or practices aimed at police-youth violence prevention; (2) evaluate the effectiveness of these efforts and how they might be improved; and (3) envision any new efforts to prevent future violent encounters between police and young black men. Data were collected and analyzed in 2017 using content analysis methods.Results: Key stakeholders demonstrated high awareness of efforts, particularly programs to deter youth violence. However, none of them were able to identify specific efforts to reduce violent encounters between local police and young black men. Responses differed across key stakeholder groups. Young people often stated that police needed to become more involved in the communities they serve; however, police believed they were building relationships with the community.Conclusions: Future violence prevention efforts must incorporate policies, programs, and practices that explicitly address violent encounters between police and young black men.Supplement Information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Introduction: Racial disparities have been both published and disputed in trauma patient mortality, outcomes, and rehabilitation. In this study, the objective was to assess racial disparities in patients with penetrating colon trauma.Methods: The National Trauma Data Bank was searched for males aged ≥14years from 2010 through 2014 who underwent operative intervention for penetrating colon trauma. The primary outcomes for this study were stoma formation and transfer to rehabilitation; secondary outcomes were postoperative morbidity and mortality. Analyses were performed in 2016-2018.Results: There were 7,324 patients identified (4,916 black, 2,408 white). Black and white patients underwent fecal diversion with stoma formation at a similar rate (19.6% vs 18.5%, p=0.28). Black patients were more likely than white patients to be uninsured (self-pay; 37.1% vs 29.9%) and more likely to be injured by firearms (88.3% vs 70.2%, p<0.001), but had a lower overall postoperative morbidity rate (52.6% vs 55.3%, p=0.04). The odds of stoma formation (OR=0.92, 95% CI=0.78, 1.09, p=0.35) and the odds of transfer to rehabilitation (OR=1.03, 95% CI=0.82, 1.30, p=0.78) were similar for black versus white patients.Conclusions: Black patients experienced similar rates of stoma formation and transfer to rehabilitation as white patients with penetrating colon trauma. Multivariate analysis confirmed expected findings that trauma severity increased the odds of receiving an ostomy and rehabilitation placement. The protocol-based management approach to emergency trauma care potentially decreases the risk for the racial biases that could lead to healthcare disparities.Supplement Information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Introduction: Disparities in healthcare outcomes between races have been extensively described; however, studies fail to characterize the contribution of differences in distribution of covariates between groups and the impact of discrimination. This study aims to characterize the degree to which clinicodemographic factors and unmeasured confounders are contributing to any observed disparities between non-Hispanic white and black males on surgical outcomes after major urologic cancer surgery.Methods: Non-Hispanic white and black males undergoing radical cystectomy, nephrectomy, or prostatectomy for cancer in the American College of Surgeons National Surgical Quality Improvement Program database from 2007 to 2016 were included in this analysis. The outcome of interest was Clavien III-V complications. Analysis was conducted in 2017 using the Peters-Belson method to compare the disparity in outcomes while adjusting for 13 important demographic and clinical characteristics.Results: Of the 15,693 cases included with complete data, 13.0% (n=2,040) were black. There was a significantly increased rate of unadjusted Clavien III and V complications between white versus black males for radical cystectomy (21.9% vs 10.1%, p=0.005); nephrectomy (6.4% vs 3.9%, p=0.028); and radical prostatectomy (2.3% vs 1.6%, p=0.046). Adjusting for differences in age, BMI, American Society of Anesthesiologists score, functional status, smoking history, and comorbidities including diabetes, chronic obstructive pulmonary disease, heart failure, renal failure, bleeding disorder, steroid use, unintentional weight loss, and hypertension between the groups could not explain the disparity in complications after radical cystectomy; the unexplained discrepancy was an absolute excess of 11.8% (p=0.01) in black males. There was an unexplained excess of complications in black males undergoing radical prostatectomy and nephrectomy but neither reached statistical significance.Conclusions: Black males undergoing radical cystectomy for cancer experienced higher complication rates than white males. Unexplained differences between the black and white males significantly contributed to the disparity in outcomes, which suggests that unmeasured factors, such as the quality of surgical or perioperative care, are playing a considerable role in the observed inequality.Supplement Information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Introduction: Black patients who experience acute myocardial infarction and receive care in high minority-serving hospitals have higher readmission rates. This study explores how hospital system affiliation (centralized versus decentralized/independent) impacts 30-day readmissions after acute myocardial infarction in black men.Methods: In 2018, the Healthcare Cost and Utilization Project State Inpatient Database (2009-2013) was used to observe 30-day readmission for acute myocardial infarction by race, and data from the American Hospital Association Annual Survey of Hospitals (2009-2013) to determine hospital system affiliation for the states Arizona, California, North Carolina, and Wisconsin. A series of hierarchic logistic regressions were conducted to determine if hospital system affiliation mediates the relationship between race and 30-day readmission.Results: Of 63,743 hospitalizations for acute myocardial infarction among men between 2009 and 2013, black men accounted for 7.1% of hospitalizations and 8.0% of readmissions. In both models, race significantly predicted 30-day readmission (unadjusted OR=1.25, 95% CI=1.14, 1.37, p<0.001; AOR=1.13, 95% CI=1.03, 1.25, p=0.046). After controlling for system type, black men were more likely to be readmitted after acute myocardial infarction than white men in both models (unadjusted OR=1.25, 95% CI=1.14, 1.38, p<0.001; AOR=1.14, 95% CI=1.03, 1.25). There was no difference in odds of being readmitted by race and hospital system type (unadjusted OR=0.88, 95% CI=0.25, 3.07, p=0.84, AOR=1.02, 95% CI=0.21, 5.10, p=0.98).Conclusions: Black men appear to be more likely to be readmitted after acute myocardial infarction. Centralization does not appear to mediate the relationship between race and 30-day readmissions for acute myocardial infarction.Supplement Information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Introduction: Black men are diagnosed with prostate cancer at nearly twice the rate of white men and are underrepresented in prostate cancer research, including validation studies of new clinical tools (e.g., genomic testing). Because healthcare system mistrust has contributed to these disparities for centuries, black men may be less inclined to pursue novel testing, and identification of facilitators to their participation in prostate cancer research studies remains warranted.Methods: A community-engaged approach involving a partnership with a community organization was used to conduct seven focus groups in Minnesota, Alabama, and California to explore black men's attitudes toward prostate cancer research participation and genomic testing for prostate cancer. Data were collected and analyzed from April 2015 to April 2017.Results: Identified genomic testing barriers included a lack of terminology understanding, healthcare system mistrust, reluctance to seek medical care, and unfavorable attitudes toward research. Facilitators included family history, value of prevention, and the desire for health education. Lack of prostate cancer knowledge, prostate-specific antigen testing confusion, healthcare system distrust, and misuse of personal health information were barriers to research study participation. Some black men were motivated to participate in research if it was seen as constructive and transparent.Conclusions: Disparities for black men can both motivate and disincentivize participation depending upon a positive or negative view of research. Confusion over prostate cancer clinical care has fueled some mistrust among black men affecting both clinical care and research participation. With increased education, health literacy, and assurances of research integrity and transparency, black men may be more willing to participate in prostate cancer testing and research.Supplement Information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health. [ABSTRACT FROM AUTHOR]

Background: African Americans typically perform worse than European Americans on cognitive testing. Contributions of cardiovascular disease (CVD) risk factors and educational quality to cognitive performance and brain volumes were compared in European Americans and African Americans with type 2 diabetes.Methods: Association between magnetic resonance imaging-determined cerebral volumes of white matter (WMV), gray matter (GMV), white matter lesions (WMLV), hippocampal GMV, and modified mini-mental state exam (3MSE), digit symbol coding (DSC), Rey Auditory Verbal Learning Test (RAVLT), Stroop, and verbal fluency performance were assessed in Diabetes Heart Study Memory in Diabetes (MIND) participants. Marginal models incorporating generalized estimating equations were employed with serial adjustment for risk factors.Results: The sample included 520 African Americans and 684 European Americans; 56 per cent female with mean ± SD age 62.8 ± 10.3 years and diabetes duration 14.3 ± 7.8 years. Adjusting for age, sex, diabetes duration, BMI, HbA1c, total intracranial volume, scanner, statins, CVD, smoking, and hypertension, WMV (p = .001) was lower and WMLV higher in African Americans than European Americans (p = .001), with similar GMV (p = .30). Adjusting for age, sex, education, HbA1c, diabetes duration, hypertension, BMI, statins, CVD, smoking, and depression, poorer performance on 3MSE, RAVLT, and DSC were seen in African Americans (p = 6 × 10-23-7 × 10-62). Racial differences in cognitive performance were attenuated after additional adjustment for WMLV and nearly fully resolved after adjustment for wide-range achievement test (WRAT) performance (p = .0009-.65).Conclusions: African Americans with type 2 diabetes had higher WMLV and poorer cognitive performance than European Americans. Differences in cognitive performance were attenuated after considering WMLV and apparent poorer educational quality based on WRAT. [ABSTRACT FROM AUTHOR]

Higher asthma rates are one of the more obvious ways that health inequalities between African American and other children are manifested beginning in early childhood. In 2010, black asthma rates were double non-black rates. Some but not all of this difference can be explained by factors such as a higher incidence of low birth weight (LBW) among blacks; however, even conditional on LBW, blacks have a higher incidence of asthma than others. Using a unique data set based on the health records of all children born in New Jersey between 2006 and 2010, we show that when we split the data by whether or not children live in a "black" zip code, this racial difference in the incidence of asthma among LBW children entirely disappears. All LBW children in these zip codes, regardless of race, have a higher incidence of asthma. Our results point to the importance of residential segregation and neighborhoods in explaining persistent racial health disparities. [ABSTRACT FROM AUTHOR]

Background: African Americans (AAs) suffer the widest gaps in chronic kidney disease (CKD) outcomes compared to Caucasian Americans (CAs) and this is because of the disparities that exist in both health and healthcare. In fact, the prevalence of CKD is 3.5 times higher in AAs compared to CAs. The disparities exist at all stages of CKD. Importantly, AAs are 10 times more likely to develop hypertension-related kidney failure and 3 times more likely to progress to kidney failure compared to CAs.Summary: Several factors contribute to these disparities including genetic and social determinants, late referrals, poor care coordination, medication adherence, and low recruitment in clinical trials. Key Messages: The development and implementation of CKD-related evidence-based approaches, such as clinical and social determinant assessment tools for medical interventions, more widespread outreach programs, strategies to improve medication adherence, safe and effective pharmacological treatments to control or eliminate CKD, as well as the use of health information technology, and patient-engagement programs for improved CKD outcomes may help to positively impact these disparities among AAs. [ABSTRACT FROM AUTHOR]

Since the release of the National HIV/AIDS Strategy (NHAS) (1) and the establishment of the federal Human Immunodeficiency Virus (HIV) Care Continuum Initiative (2), federal efforts have accelerated to improve and increase HIV testing, care, and treatment and to reduce HIV-related disparities in the United States. National HIV Surveillance System (NHSS)* data are used to monitor progress toward reaching NHAS goals,† and recent data indicate that blacks have lower levels of care and viral suppression than do persons of other racial and ethnic groups (3). Among persons with HIV infection diagnosed through 2012 who were alive at year-end 2013, 68.1% of blacks received any HIV medical care compared with 74.4% of whites (3). CDC used NHSS data to describe HIV care outcomes among blacks who received a diagnosis of HIV. Among blacks with HIV infection diagnosed in 2014, 21.9% had infection classified as HIV stage 3 (acquired immunodeficiency syndrome [AIDS]) at the time of diagnosis compared with 22.5% of whites; 71.6% of blacks were linked to care within 1 month after diagnosis compared with 79.0% of whites. Among blacks with HIV infection diagnosed through 2012 who were alive on December 31, 2013, 53.5% were receiving continuous HIV medical care compared with 58.2% of whites; 48.5% of blacks achieved viral suppression compared with 62.0% of whites. Intensified efforts and implementation of effective interventions and public health strategies that increase engagement in care and viral suppression among blacks (1,4) are needed to achieve NHAS goals. [ABSTRACT FROM AUTHOR]

Although cigarette smoking has substantially declined since the release of the 1964 Surgeon General's report on smoking and health,* disparities in tobacco use exist among racial/ethnic populations (1). Moreover, because estimates of U.S. adult cigarette smoking and tobacco use are usually limited to aggregate racial or ethnic population categories (i.e., non-Hispanic whites [whites]; non-Hispanic blacks or African Americans [blacks]; American Indians and Alaska Natives [American Indians/Alaska Natives]; Asians; Native Hawaiians or Pacific Islanders [Native Hawaiians/Pacific Islanders]; and Hispanics/Latinos [Hispanics]), these estimates can mask differences in cigarette smoking prevalence among subgroups of these populations. To assess the prevalence of and changes in cigarette smoking among persons aged ≥18 years in six racial/ethnic populations and 10 select subgroups in the United States,(†) CDC analyzed self-reported data collected during 2002-2005 and 2010-2013 from the National Survey on Drug Use and Health (NSDUH) (2) and compared differences between the two periods. During 2010-2013, the overall prevalence of cigarette smoking among the racial/ethnic populations and subgroups ranged from 38.9% for American Indians/Alaska Natives to 7.6% for both Chinese and Asian Indians. During 2010-2013, although cigarette smoking prevalence was relatively low among Asians overall (10.9%) compared with whites (24.9%), wide within-group differences in smoking prevalence existed among Asian subgroups, from 7.6% among both Chinese and Asian Indians to 20.0% among Koreans. Similarly, among Hispanics, the overall prevalence of current cigarette smoking was 19.9%; however, within Hispanic subgroups, prevalences ranged from 15.6% among Central/South Americans to 28.5% among Puerto Ricans. The overall prevalence of cigarette smoking was higher among men than among women during both 2002-2005 (30.0% men versus 23.9% women) and 2010-2013 (26.4% versus 21.1%) (p<0.05). These findings highlight the importance of disaggregating tobacco use estimates within broad racial/ethnic population categories to better understand and address disparities in tobacco use among U.S. adults. [ABSTRACT FROM AUTHOR]

Background: The US National HIV/AIDS Strategy defines national objectives related to HIV prevention and care. The extent to which US cities are meeting those objectives is uncertain.Methods: We analyzed King County, WA, HIV surveillance data collected between 2004 and 2013. The study population included 9539 persons diagnosed as having and living with HIV infection and 3779 persons with newly diagnosed HIV infection.Results: Between 2004 and 2013, the rate of new HIV diagnosis decreased from 18.4 to 13.2 per 100,000 residents (decline of 28%); AIDS diagnosis rates declined 42% from 12 to 7 per 100,000; and age-adjusted death rates decreased from 27 to 15 per 1000 persons living with HIV/AIDS (decline of 42%; P<0.0001 for all 3 trends). The rate of new HIV diagnosis declined 26% among men who have sex with men (MSM; P=0.0002), with the largest decline occurring in black MSM (44%). Among 8679 individuals with laboratory results reported to National HIV Surveillance System from 2006 through 2013, viral suppression (viral load<200 copies/mL) increased from 45% to 86% (P<0.0001), with all racial/ethnic groups achieving greater than 80% viral suppression in 2013.Interpretation: The rates of new HIV diagnosis, AIDS diagnoses, and mortality in persons living with HIV in King County, WA, have significantly declined over the last decade. These changes have occurred concurrent with a dramatic increase in HIV viral suppression and have affected diverse populations, including MSM and African American MSM. These findings demonstrate substantial local success in achieving the goals of the National HIV/AIDS Strategy. [ABSTRACT FROM AUTHOR]

Background: Clinical studies have shown that exposure to fine particulate matter (PM2.5) can increase insulin resistance and blood pressure. The epidemiologic evidence for an association of PM2.5 exposure with the incidence of type 2 diabetes or hypertension is inconsistent. Even a modest association would have great public health importance given the ubiquity of exposure and high prevalence of the conditions.Methods: We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident type 2 diabetes and hypertension associated with exposure to PM2.5 in a large cohort of African American women living in 56 metropolitan areas across the US, using data from the Black Women's Health Study. Pollutant levels were estimated at all residential locations over follow-up with a hybrid model incorporating land use regression and Bayesian Maximum Entropy techniques.Results: During 1995 to 2011, 4,387 cases of diabetes and 9,570 cases of hypertension occurred. In models controlling for age, questionnaire cycle, and metro area, there were positive associations with diabetes (HR = 1.13, 95% CI = 1.04, 1.24) and hypertension (HR = 1.06, 95% CI = 1.00, 1.12) per interquartile range of PM2.5 (2.9 μg/m). Multivariable HRs, however, were 0.99 (95% CI = 0.90, 1.09) for diabetes and 0.99 (95% CI = 0.93, 1.06) for hypertension.Conclusions: Our results provide little support for an association of PM2.5 with diabetes or hypertension incidence. [ABSTRACT FROM AUTHOR]

In 2015, black women represented 61% of human immunodeficiency virus (HIV) diagnoses among women (1). HIV diagnosis rates among women declined during 2010-2014 (1); however, whether the decline resulted in a decrease in the disparities between black women and Hispanic and white women was unknown. To assess whether a change in disparities occurred, CDC used three different measures of disparity: 1) the absolute rate difference (the difference between the group with the lowest rate and the group with the highest rate) (2); 2) the diagnosis disparity ratio* (the ratio of the difference between the group rate and the overall population rate to the overall rate); and 3) the Index of Disparity (the average of the differences between rates for specific groups and the total rate divided by the total rate, expressed as a percentage) (3). The absolute rate difference between black women and white women decreased annually, from 36.9 in 2010 to 28.3 in 2014. The diagnosis disparity ratio for black women decreased from 1.7 in 2010 to 1.2 in 2014. The Index of Disparity increased during 2010-2011, and then decreased each year during 2012-2014. Although disparities still exist, these findings indicate improvement. Expanding access to biomedical and behavioral interventions and research guided by social and structural determinants frameworks could close the remaining gap. [ABSTRACT FROM AUTHOR]

Background: Higher rates of cardiovascular disease (CVD) and its risk factors are well documented among those with objective indicators of lower socioeconomic status (SES), such as income, education, and occupation. However, relatively little is known about the relationship of subjective SES to CVD risk, particularly within different racial groups.Methods: Subjective SES and Framingham 10-year CVD risk profile were examined in 1,722 socioeconomically diverse Black and White adults enrolled in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. The sample had a mean age of 47.7 years, was 57% female, 56% African American, and 39% living in poverty.Results: Subjective SES was associated with greater CVD risk after adjustment for poverty status, substance use, BMI, depression, antihypertensives, and co-morbidities (B = -.059, t[1,1711] = -2.44, P = .015). However, when the analysis was race-stratified, subjective SES was associated with CVD risk in Whites (B = -.074, F[1,787] = -2.01, P = .045), but not Blacks.Conclusions: These results suggest that subjective SES may aid in predicting CVD risk in Whites, but not Blacks. It is important to note that these analyses were adjusted for poverty status, a potent indicator of objective SES. Thus, these findings further suggest that for Whites, subjective SES may influence CVD risk beyond that associated with objective SES. These findings highlight the potential importance of patients' subjective SES in CVD risk detection. [ABSTRACT FROM AUTHOR]

The conventional wisdom on the Black metropolis of the early 20th century holds that urban Black communities in the South lagged far behind their counterparts in the North in terms of providing opportunities for Blacks to enter occupations that were associated with Blacks’ socioeconomic progress. Yet, analyses of census data in the present study offer mixed support for this wisdom. The odds of Black participation in art, show business, public service and professions were, as expected, lower in the urban South. Yet surprisingly, the odds of Black participation in most entrepreneurial ventures were approximately similar in the urban South and urban North. The results imply that the conventional wisdom should be modified to indicate that, at the beginning of the Great Migration, the benefits to Blacks of the large Black communities of northern cities were more cultural and political than economic. [ABSTRACT FROM PUBLISHER]

Objective: We examined the risk of depression as it relates to social support among individuals from African American, Caribbean black, and non-Hispanic White backgrounds.Methods: 6,082 individuals participated in the national survey of American life (NSAL), a nationally representative, psychiatric epidemiological, cross-sectional survey of household populations. The survey is designed to explore racial and ethnic differences in mental disorders. NSAL survey questions were used as a proxy for social support. Logistic regression analysis was used to examine the correlates between having a DSM-IV diagnosis of major depressive disorder in the past year, demographic variables, and social support.Results: African American race/ethnicity was associated with decreased odds of depression when compared to non-Hispanic whites, even when controlling for social support variables and demographics (OR = 0.51, 95% CI = 0.43-0.60). We found a three-fold increase in risk of depression among individuals who reported feeling "not very close at all" with family members compared to those who reported feeling "very close" to family (OR = 3.35, 95% CI = 1.81-6.19).Conclusions: These findings reinforce previous research documenting the important relationship between social support and depression, and perhaps should lead us to reexamine the individualistic models of treatment that are most evaluated in United States. The lack of evidence-based data on support groups, peer counseling, family therapy, or other social support interventions may reflect a majority-culture bias toward individualism, which belies the extensive body of research on social support deficits as a major risk factor for depression. [ABSTRACT FROM AUTHOR]

This study explores the relationship between religious denomination, four dimensions of religious involvement, and suicidality (lifetime prevalence of suicide ideation and attempts) within a nationally representative sample of African American and Black Caribbean adults. The relationship between religious involvement and suicide for African Americans and Black Caribbeans indicated both similarities and differences. For both groups, religious involvement was largely protective against suicidal ideation and attempts, although, in some instances, specific measures were associated with higher suicidality. Looking to God for strength, comfort, and guidance was protective against suicidal attempts and ideation, whereas stating that prayer is important in stressful situations was associated with higher levels of ideation for both groups and higher attempts among Black Caribbeans. For African Americans, reading religious materials was positively associated with suicidal ideation. Among Black Caribbeans, subjective religiosity was negatively associated with ideation, and being Catholic was inversely associated with attempts, whereas being Pentecostal was inversely associated with ideation. These findings are discussed in relation to previous research and current conceptual frameworks that specify multiple (e.g., prevention and resource mobilization) and often divergent pathways of religious effects on physical and mental health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To examine trends in prevalence and odds of elevated body mass index (BMI) and obesity among ethnically diverse adolescents.Design and Setting: Data from countywide (Miami-Dade) health screenings from 1999-2005. Weight, height, days/week of vigorous activity, hours/day of sedentary activity, parental hypertension, and eating habits were reported.Participants: 77,050 adolescents, average age 15.6 years (51% girls, 9.4% White non-Hispanic, 59.2% White Hispanic, 16.4% African American, 7% Black Hispanic, and 8% Black Caribbean).Outcome Measures: Prevalence and ethnic differences in odds of obesity (BMI > or = 95th percentile) and elevated BMI (BMI > or = 85th percentile), adjusting for academic years, days/week of vigorous activity, and hours/day of sedentary activity.Results: Prevalence of elevated BMI and obesity increased from 1999-2005. Overall, White non-Hispanics had lower odds of obesity and elevated BMI than African Americans and White Hispanics. African American girls displayed higher odds of obesity and elevated BMI than Black Hispanic girls and higher odds of elevated BMI than Black Caribbean girls. African American boys showed higher odds of obesity and elevated BMI than Black Caribbean boys. Black Hispanic girls had greater odds of obesity and elevated BMI than White Hispanic girls, but boys were similar.Conclusions: This study is among the first to examine BMI status in both Black and Hispanic subgroups. Viewing Black and Hispanic ethnic subgroups as homogeneous obscures important weight-related differences. Further research is warranted to determine factors contributing to differential risk. [ABSTRACT FROM AUTHOR]

The article examines how thoughts on criminal justice and racial justice in the U.S. have evolved since 1910. Racial disparities within the application of criminal law are examined from the period of lynching to modern imprisonment statistics. The author attests that, in 2010, there are almost one million African-Americans in prison. By referencing pertinent literature such as the book entitled “The New Jim Crow” by Michelle Alexander, the author examines criminal law, arrest procedures, and legislative efforts such as the U.S. War on Drugs. The paper concludes by suggesting that racial progress in criminal justice is possible.

A primary goal of the national human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) Strategy is to reduce HIV-related health disparities (1). Among all HIV diagnoses among women in the United States in 2014, non-Hispanic black or African American (black) women accounted for an estimated 62% of diagnoses, despite constituting only 13% of the female population (2,3). Although HIV diagnoses continue to occur disproportionately among black women, HIV surveillance data indicate a 13.5% decrease in diagnoses from 2012 to 2014 (2,4). However, widespread HIV testing and early linkage to care are critical for persons with HIV to achieve viral suppression and improved health outcomes, and to reduce transmission of HIV to others (5). Analysis of CDC-funded program data on HIV testing services provided to black females and submitted by 61 state and local health departments during 2012-2014 revealed that the number of new HIV diagnoses among black females decreased 17% from 2,177 in 2012 to 1,806 in 2014. Among black females with newly diagnosed HIV infection, the percentage who were linked to HIV medical care within 90 days of diagnosis increased 48.2%, from 33.8% in 2012 to 50.1% in 2014. However, in 2010 the National HIV/AIDS Strategy established a goal to link 85% of persons with newly diagnosed HIV infection to HIV medical care (1). Enhanced efforts to diagnose HIV infection among black females and link them to HIV medical care are critical to address HIV infections in the United States. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe the perceptions of Southern, rural, African American women regarding personal and environmental factors that affect their hypertension.Design: A purposive sample of 25 African American women aged 40-74 years, who lived in rural Alabama, participated in seven Talking Circles for 60 minutes.Results: Most felt that hypertension was a "common occurrence" and that it was "typical in the African American community." They associated hypertension with stroke and heart attacks and referred to hypertension as the "silent killer." Barriers to following the treatment plan were low income, high medical expenses, and lack of insurance. Barriers to medication were cost, dislike for taking medication, running out of medication, side effects, forgetting, and being tired; and barriers to exercise were being tired, busy schedule, and safety. Walking paths, fitness centers, or malls to walk around were not available in all communities, and not all sidewalks were well-lit, limiting their walking exercise opportunities after work hours. Healthcare facilities were accessible, but it was easier to get an appointment and receive respect from healthcare providers if the women had money or insurance. Blood pressure monitors were available in their homes, at grocery stores and at Wal-Mart. No church health programs were available, but some churches had nurses on duty who offered blood pressure and cholesterol screening; however, no medication was provided. Grocery stores were accessible, and they had a flea market with fresh fruits and vegetables. Social environment/support by families and friends for persons with hypertension was not always positive.Conclusion: The findings of this study indicate that personal and environmental factors play important roles in hypertensive status. The modified ecological framework used in this study may help us explore perspectives of family members and friends regarding their support for persons with hypertension. More serious efforts and resources need to be made available for preventive measures of hypertension in this population. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is an important public health problem that disproportionately affects minorities. Using a cross sectional, convenience sample, we estimated the prevalence of self-reported diabetes for Whites (n = 212), Arabs (n = 1,303), Chaldeans (n = 828), and Blacks (n = 789) in southeast Michigan. In addition, using a logistic regression model, we estimated odds ratios and 95% confidence intervals for the association between ethnicity and diabetes before and after adjusting for demographic, socioeconomic status, health care, chronic conditions, and health behavior variables. The overall age- and sex-adjusted prevalence of diabetes was 7.0%. Estimates were highest for Blacks (8.0%) followed by Arabs and Whites (7.0% for each group) and Chaldeans (6.0%). In the fully adjusted model, the association between ethnicity and diabetes was not statistically significant. Future studies should collect more detailed socioeconomic status, acculturation and health behavior information, which are factors that may affect the relationship between race/ethnicity and diabetes. [ABSTRACT FROM AUTHOR]

The article reports on the unchanged number of U.S. residents without health insurance in the first three months of 2013. According to the National Center for Health Statistics (NCHS), the number remained at 46 million. Also presented are the percentages of Hispanic, African American, white and Asian residents who were uninsured during the period.

Objective: To provide information on the characteristics of eating disorders based on nationally representative samples of African American and Caribbean Black adults and adolescents. Method: Conducted between 2001 and 2003 the National Survey of American Life (NSAL) interviewed adults (n = 5,191) and adolescents (n = 1,170) in their homes. Professionally trained interviewers used the WMH Composite International Diagnostic Interview (WMH-CIDI-WHO Organization 2004-modified) to assess DSM-IV TR eating disorders. Results: Anorexia was the rarest eating disorder among African American adults and adolescents, with age of onset for adults in mid adolescence. No 12-month case of anorexia was found among Caribbean Black adults. Binge eating was the most prevalent eating disorder among adults and adolescents. Persistence of disorders was lowest for anorexia and highest for binge eating disorder among adults. Conclusion: Prevalence of eating disorders within the U.S. Black population varies by type of disorder, age cohort, gender, and ethnic group among adults, and by type of disorder among adolescents. Clinicians need preparation and training to recognize and treat eating disorders in ethnically-diverse patient populations. Int J Eat Disord 2007 © 2007 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]