"It Takes Some Empathy, Sympathy, and Listening": Telephone Outreach to Older Detroiters in a Pandemic as a Modality to Gain an Understanding of Challenges and Resiliency.

This manuscript describes a telephone outreach project for members of a research registry program for older adults in Detroit, Michigan. From April until December 2020, the Healthier Black Elders Center designed and implemented a telephone outreach program, calling 1204 older adults utilizing 15 staff and volunteers. The calls served to check in on registry members and collect data on mental health, coping mechanisms, access to services, masks, testing, and tele-health. This paper details the methods of developing and implementing an innovative engagement program that collected time-sensitive data from older Black adults that has directly been applied to create virtual health education programs, share resource information, and create a program to reduce social isolation.

Improving Antibody-Tubulysin Conjugates through Linker Chemistry and Site-Specific Conjugation.

Tubulysins have emerged in recent years as a compelling drug class for delivery to tumor cells via antibodies. The ability of this drug class to exert bystander activity while retaining potency against multidrug-resistant cell lines differentiates them from other microtubule-disrupting agents. Tubulysin M, a synthetic analogue, has proven to be active and well tolerated as an antibody-drug conjugate (ADC) payload, but has the liability of being susceptible to acetate hydrolysis at the C11 position, leading to attenuated potency. In this work, we examine the ability of the drug-linker and conjugation site to preserve acetate stability. Our findings show that, in contrast to a more conventional protease-cleavable dipeptide linker, the ß-glucuronidase-cleavable glucuronide linker protects against acetate hydrolysis and improves ADC activity in vivo. In addition, site-specific conjugation can positively impact both acetate stability and in vivo activity. Together, these findings provide the basis for a highly optimized delivery strategy for tubulysin M.

Novel Auristatins with High Bystander and Cytotoxic Activities in Drug Efflux-positive Tumor Models.

Auristatins, a class of clinically validated anti-tubulin agents utilized as payloads in antibody-drug conjugates, are generally classified by their membrane permeability and the extent of cytotoxic bystander activity on neighboring cells after targeted delivery. The drugs typically fall within two categories: membrane permeable monomethyl auristatin E-type molecules with high bystander activities and susceptibility to efflux pumps, or charged and less permeable monomethyl auristatin F (MMAF) analogs with low bystander activities and resistance to efflux pumps. Herein, we report the development of novel auristatins that combine the attributes of each class by having both bystander activity and cytotoxicity on multidrug-resistant (MDR+) cell lines. Structure-based design focused on the hydrophobic functionalization of the N-terminal N-methylvaline of the MMAF scaffold to increase cell permeability. The resulting structure-activity relationships of the new auristatins demonstrate that optimization of hydrophobicity and structure can lead to highly active free drugs and antibody-drug conjugates with in vivo bystander activities.

Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study.

BACKGROUND: A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample. METHODS: We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men's mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health. RESULTS: Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency. IMPLICATIONS: Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.

Enhancing vocational training in corrections: A type 1 hybrid randomized controlled trial protocol for evaluating virtual reality job interview training among returning citizens preparing for community re-entry.

The Michigan Department of Corrections operates the Vocational Villages, which are skilled trades training programs set within prisons that include an immersive educational community using virtual reality, robotics, and other technologies to develop employable trades. An enhancement to the Vocational Villages could be an evidence-based job interview training component. Recently, we conducted a series of randomized controlled trials funded by the National Institute of Mental Health to evaluate the efficacy of virtual reality job interview training (VR-JIT). The results suggested that the use of VR-JIT was associated with improved job interview skills and a greater likelihood of receiving job offers within 6 months. The primary goal of this study is to report on the protocol we developed to evaluate the effectiveness of VR-JIT at improving interview skills, increasing job offers, and reducing recidivism when delivered within two Vocational Villages via a randomized controlled trial and process evaluation. Our aims are to: (1) evaluate whether services-as-usual in combination with VR-JIT, compared to services-as-usual alone, enhances employment outcomes and reduces recidivism among returning citizens enrolled in the Vocational Villages; (2) evaluate mechanisms of employment outcomes and explore mechanisms of recidivism; and (3) conduct a multilevel, mixed-method process evaluation of VR-JIT implementation to assess the adoptability, acceptability, scalability, feasibility, and implementation costs of VR-JIT.

Identifying disparities in patient-centered care experiences between non-Latino white and black men: results from the 2008-2016 Medical Expenditure Panel Survey.

BACKGROUND: Patient-centered healthcare in the context of a medical home (PCMH) is an important pathway to reducing healthcare inequities. To date, no work has examined the prevalence of care experiences associated with PCMH among non-elderly Black males. METHODS: We analyzed data, on 22 indicators representative of six healthcare domains associated with PCMH experiences, from non-Latino White (NLW) and Black males aged 18-64 from the 2008-2016 Medical Expenditure Panel Survey (n = 47,405). We used generalized linear models to test whether Behavioral Model factors attenuate any differences in access to these domains between NLW and Black males, and decomposition techniques to examine the contribution of these factors to reported differences. RESULTS: Black males reported 1) lower access to personal primary care providers, 2) poorer quality communication with providers, and 3) lower levels of care comprehensiveness (all p < 0.05). Differences between groups were attenuated but not eliminated by accounting for the Behavioral Model factors particularly through enabling and predisposing factors. Group health characteristics were not a primary driver of racial differences in care experiences across all the considered domains. CONCLUSIONS: Black men, in the U.S, continue to face barriers to accessing high quality, patient-centered care, specifically as it relates to accessing specialty care, medical tests, and patient-provider communication.

Intergenerational Mobility and Goal-Striving Stress Among Black Americans: The Roles of Ethnicity and Nativity Status.

Goal-striving stress refers to the psychological consequences of seeking but failing to reach upward mobility and is more common among low-income and people of color. Intergenerational mobility-or improved socioeconomic standing relative to one's parents-may be an important predictor of goal-striving stress for Blacks. We used the National Survey of American Life to investigate the association between intergenerational mobility and goal-striving stress among U.S.-born African Americans, U.S.-born Caribbean Blacks, and foreign-born Caribbean Blacks. Intergenerational mobility was associated with lower goal-striving stress and U.S.-born African Americans and Caribbean Blacks reported lower goal-striving stress than foreign-born Caribbean Blacks. Goal-striving stress was relatively high among foreign-born Blacks, regardless of level of intergenerational mobility attained. Goal-striving is an important stressor for foreign-born Caribbean Blacks, regardless of their level of educational success. Given increasing Black migration, future studies should disaggregate the Black racial category based on ethnicity and nativity.

Characterizing Mobility Limitations Among Older African American Men.

This study represents an effort to contribute to the limited body of research on biopsychosocial contextual factors that influence or contribute to mobility limitations for older African American men. Specifically, we were interested in examining associations between socio-demographic, physical and emotional health experiences with mobility limitations. A secondary analysis of 1666 older African American men was performed to investigate socio-demographic, mental and physical health correlates to a specific measures of mobility limitation. In the final model, difficulty with self-care, severe pain interference, and problems with usual activities were most strongly associated with mobility limitations. Men who were married were significantly less likely to experience mobility limitations. Findings highlighted the relationship between mobility limitations and difficulty performing activities of daily living. Additional research should examine the impact of poor emotional health and the buffering effects of marriage on mobility for older African American men, a population at high risk of experiencing disparate health outcomes.

The Role of Age and Multimorbidity in Shaping Older African American Men's Experiences with Patient⁻Provider Communication.

This study investigated factors associated with older African American men's unmet health communication needs in the context of patient-provider interactions. Responses to a health survey were analyzed for 430 African American men attending a Midwest community health fair. The outcome measure was the extent to which men could get their health-related questions answered during recent medical visits. Men's mean age was 54; 39% had one chronic condition and 22% had two or more comorbidities. The 53% who usually or always had their questions answered were older, had less comorbidity, higher educational attainment, higher annual incomes, were more likely to be married and have any type of insurance, and have a personal physician. Access to care was the primary factor in shaping men's opportunities to ask health-related questions, and older multimorbid and low-income African American men may face increased barriers to healthcare access, and thus barriers to patient-centered care and communication.

The Paradoxical Impact of Companionship on the Mental Health of Older African American Men.

Objectives: African Americans comprise 9% of the 46 million U.S. adults over age 65. Two thirds of older African American men (AAM) reside with companions. This study investigated the assumption that frequent contact with companions confers mainly health-related benefits for AAM. Methods: Utilizing secondary data from the National Alzheimer's Coordinating Center, the relationship between older AAM's mental health and related conditions (depression, anxiety, and sleep disturbances), companion living arrangements, and frequency of contact with the participants for 3,423 older AAM and their 1,161 companions, was examined. Results: The mean age of participants and companions was 74 years and 90% of AAM lived in a private residence. Logistic regression models indicated that an increased risk for anxiety was found when companions lived in (OR = 1.66), called daily (OR = 1.089), or visited daily (OR = 1.079). Finally, AAM had an increased likelihood of nonmedical sleep disturbances when companions lived in (OR = 1.67), called daily (1.105), or visited daily (1.078). Discussion: The frequency of contact with companions may be consequential for select mental health outcomes and associated physiological conditions for older AAM; the timing of contact requires further investigation.

Perceptions and receptivity of non-spousal family support: A mixed methods study of psychological distress among older, church-going African American men.

The purpose of this study was to explore the role of non-spousal family support on mental health among older, church-going African American men. The mixed methods objective was to employ a design that used existing qualitative and quantitative data to explore the interpretive context within which social and cultural experiences occur. Qualitative data (n=21) were used to build a conceptual model that was tested using quantitative data (n= 401). Confirmatory factor analysis indicated an inverse association between non-spousal family support and distress. The comparative fit index, Tucker-Lewis fit index, and root mean square error of approximation indicated good model fit. This study offers unique methodological approaches to using existing, complementary data sources to understand the health of African American men.

Clues to the Blues: Predictors of Self-Reported Mental and Emotional Health Among Older African American Men.

The mental health needs of aging African American men have been overlooked and few studies have distinguished between more severe clinically diagnosable mental health challenges and less severe emotional states for this population. African American men may not identify with or internalize the terminology of "depression" despite exhibiting the symptom criteria. This exploratory cross-sectional study examined correlates of "downheartedness" as an alternative indicator of emotional health. The authors examined the self-reported responses of 1,666 older African American men on a baseline questionnaire from a larger longitudinal study. Demographic, physical, mental and emotional health, and health system factors were examined as possible correlates of downheartedness. The mean age of participants was 73.6 years and 74.8% of men described themselves as "downhearted and blue" most or all of the time while only 18.5% of them reported feeling moderate to severe anxiety or depression. When other factors were controlled, mobility problems (odds ratio [ OR] = 2.36), problems getting health care ( OR = 2.69), having a doctor who never listens ( OR = 2.18), physical or mental problems that interfere with social activities ( OR = 1.34), accomplishing less due to physical health ( OR = 1.35), and accomplishing less due to mental/emotional health ( OR = 1.57) were all associated with greater odds of being downhearted. The current findings indicate that this sample more closely identified with language accurately describing their emotional health state (i.e., downhearted) and not with clinical mental health terminology (i.e., depression) that may be culturally stigmatized.

Masculinity, Racism, Social Support, and Colorectal Cancer Screening Uptake Among African American Men: A Systematic Review.

Colorectal cancer (CRC) is highly preventable when CRC screening is utilized, yet CRC screening completion among African American men is relatively low and their mortality rates remain 50% higher juxtaposed to their White counterparts. Since a growing body of literature indicates masculinity, racism, and social support each have strong influences on CRC screening uptake, this systematic review examined the connections between these three sociocultural factors and CRC screening uptake among African American men. Potential studies were retrieved from MEDLINE, CINAHL, EMBASE, and PsycINFO. Cited reference searching for the final sample was employed to identify and assess additional studies for inclusion using Scopus. The methodological quality of the reviewed evidence was also evaluated. Nineteen studies met inclusion/exclusion criteria. Thirteen studies employed nonexperimental research designs; a quasi-experimental design was present in four, and two utilized experimental designs. Studies were published between 2000 and 2014; the majority between 2009 and 2013. Social support was most frequently addressed (84%) while masculinity and racism were equally studied with paucity (11%) for their influence on CRC screening. After evaluating conceptual and methodological characteristics of the studies, 42% fell below average in quality and rigor. The need for increased attention to the sociocultural correlates of CRC screening for African American men are highlighted in this systematic review, and important recommendations for research and practice are provided. Alongside a call for more rigorous research, further research examining the influence of masculinity and racism on CRC screening completion among African American men is warranted.

Self-Rated Health and Health Care Access Associated With African American Men's Health Self-Efficacy.

Health self-efficacy, a measure of one's self-assurance in taking care of their own health, is known to contribute to a range of health outcomes that has been under examined among African American men. The purpose of this investigation was to identify and contextualize predictors of general health self-efficacy in this population. A cross-sectional sample of surveys from 558 African American was examined. These men were older than 18 years, could read and write English, and attended a hospital-based community health fair targeting minority men in 2011. The outcome of interest was health self-efficacy, which was assessed by asking, "Overall, how confident are you in your ability to take good care of your health?" Responses ranged from 1 ( not confident at all) to 5 ( completely confident). Covariates included age, self-rated health, health insurance status, having a regular physician, and being a smoker. The mean age of participants was 54.4 years, and 61.3% of participants indicated confidence in their ability to take good care of their health. Older age and being a smoker were inversely associated with the outcome. Good self-rated health, having health insurance, and having a regular doctor were positively associated with reports of health self-efficacy. Findings suggest that multiple points of connection to the health care system increase the likelihood of health self-efficacy for this sample and interventions to support older African American men who may evaluate their own health status as poor and who may face barriers to health care access are implicated.

The Retrospective Roles of Black Women in the Coddling of Black Boys.

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

Fatalistic Beliefs About Cancer Prevention Among Older African American Men.

OBJECTIVES: Evidence suggests that minority groups are more likely to exhibit fatalistic beliefs about cancer prevention (FBCP), which are defined as confusion, pessimism, and helplessness about one's ability to prevent cancer. This study examines the socioeconomic and psychosocial predictors of FBCP among older African American men (AAM). METHODS: AAM (N = 1,666) enrolled in Medicare and participating in a longitudinal study on patient navigation were surveyed. Measures included three FBCP constructs, namely demographic items and physical and mental health variables. Binary logistic regression was performed. RESULTS: The average participant was 73.6 years old; 76.5% felt helpless, 44.2% were confused, and 40.7% were pessimistic about the ability to prevent cancer. As education increased, so did all three FBCP. Being downhearted was predictive of confused and helpless beliefs. DISCUSSION: It is critical for health practitioners to understand how psychosocial and economic challenges influence beliefs that may impede cancer prevention efforts for older AAM.

Financial hardship, unmet medical need, and health self-efficacy among African American men.

BACKGROUND: Health self-efficacy (the confidence to take care of one's health) is a key component in ensuring that individuals are active partners in their health and health care. The purpose of this study was to determine the association between financial hardship and health self-efficacy among African American men and to determine if unmet medical need due to cost potentially mediates this association. METHOD: Cross-sectional analysis was conducted using data from a convenience sample of African American men who attended a 1-day annual community health fair in Northeast Ohio (N = 279). Modified Poisson regression models were estimated to obtain the relative risk of reporting low health self-efficacy. After adjusting for sociodemographic characteristics, those reporting financial hardship were 2.91 times, RR = 2.91 (confidence interval [1.24, 6.83]; p < .05), more likely to report low health self-efficacy. When unmet medical need due to cost was added to the model, the association between financial hardship and low health self-efficacy was no longer statistically significant. CONCLUSION: Our results suggest that the association between financial hardship and health self-efficacy can be explained by unmet medical need due to cost. Possible intervention efforts among African American men with low financial resources should consider expanding clinical and community-based health assessments to capture financial hardship and unmet medical need due to cost as potential contributors to low health self-efficacy.

The Discipline's Escalating Whisper: Social Work and Black Men's Mental Health.

OBJECTIVE: Though sparse in previous years, research on the mental health of Black men has recently experienced a gradual increase in social work journals. This article systematically organizes and critically examines peer-reviewed, social work evidence on the mental health of Black men. METHODS: Twenty-two peer-reviewed articles from social work journals were examined based on their contribution to social work research and practice on the mental health of Black men. RESULTS: The social work evidence on Black men's mental health can be grouped into one of four categories: psychosocial factors; mental health care and the role of clinicians; fatherhood; and sexual orientation, HIV status, and sexual practices. CONCLUSIONS: This representation of the social work literature on Black men's mental health neglects critical areas germane to social work research and practice with this population. Implications include ways to extend current social work research and practice to improve the health for Black men.

Disparities in health-related Internet use among African American men, 2010.

Given the benefits of health-related Internet use, we examined whether sociodemographic, medical, and access-related factors predicted this outcome among African American men, a population burdened with health disparities. African American men (n = 329) completed an anonymous survey at a community health fair in 2010; logistic regression was used to identify predictors. Only education (having attended some college or more) predicted health-related Internet use (P < .001). African American men may vary in how they prefer to receive health information; those with less education may need support to engage effectively with health-related Internet use.

Social epidemiology: a tool for examining prostate cancer early-detection decision making among older African American men.

The article explores the disparate burden of prostate cancer among older African American men, and this population's minimal use of cancer early-detection strategies. Social epidemiology is introduced as an emerging field that studies the social context of disease with an emphasis on how macrostructural forces and human interactions affect population health. A conceptual model is presented as a social epidemiological tool for investigating complex health and social issues and developing culturally relevant programs and interventions based on empirical findings. The model is then applied to the problem of prostate cancer early-detection decision making among older African American men.