Resilience and Its Limits: The Roles of Individual Resilience, Social Capital, Racial Discrimination, and Binge Drinking on Sexual Behavior Among Black Heterosexual Men.

In response to the increased recognition of racism as a public health crisis, we assessed links between racial discrimination and HIV-related risk behavior for Black men. Specifically, using survey data from 530 Black heterosexual men (18-44 years old, M = 31.0, SD = 7.8), we tested two moderated-mediation models: (1) a protective model, in which resilience and social capital protected against the indirect effect of racial discrimination on alcohol-related sexual behavior via binge drinking, and (2) a bounded model, in which racial discrimination limited the indirect effects of resilience and social capital on alcohol-related sexual behavior via binge drinking. We found support for the bounded model only. Specifically, resilience was indirectly associated with decreased alcohol-related sexual behavior via lower binge drinking when racial discrimination was low to moderately high, but not when racial discrimination was at its highest levels. Resilience was not directly associated with alcohol-related sexual behavior. Social capital was directly related to lower odds of alcohol-related sexual behavior. At high levels of racial discrimination, however, social capital was indirectly related to increased alcohol-related sexual behavior via binge drinking. High levels of racial discrimination limit beneficial effects of resilience on alcohol-related sexual behavior. Social capital maintains a beneficial effect if social bonds are not associated with binge-drinking norms or behaviors. Results highlight the limitations of individual-level resilience and the need to conceptualize and support resilience as a social-structural resource.

Intersectionality Policymaking Toolkit: Key Principles for an Intersectionality-Informed Policymaking Process to Serve Diverse Women, Children, and Families.

Health and economic inequities among U.S. racial/ethnic minority women and children are staggering. These inequities underscore a dire need for intersectionality-informed, social-justice-oriented maternal and child (MCH) policies and programs for U.S. women and children. In response, we developed the "Intersectionality Policymaking Toolkit: Key Principles for an Intersectionality Informed Policymaking Process to Serve Diverse Women, Children and Families" to assist U.S. policymakers/aides, practitioners, and other stakeholders in developing more equitable MCH policies/programs. This article describes the Toolkit development process and initial assessments of acceptability and feasibility for use in MCH policymaking. Between 2018 and 2021, we utilized the process that the World Health Organization (WHO) used to develop its WHO Surgical Safety Checklist to develop the content (e.g., case studies) and format (i.e., structure), make strategic decisions (e.g., core items, primary audiences, timing of utilization), test concepts, and receive feedback. We convened a 2-day planning meeting with experts (n = 8) in intersectionality, policymaking, and MCH to draft the Toolkit. Next, we convened half-day workshops with policymaking and program leadership and staff in Washington, DC, New Orleans, LA, and Santa Fe, NM, to refine the Toolkit (n = 37). Then we conducted an initial assessment of the Toolkits' acceptability and feasibility using surveys (n = 21), followed by focus groups (n = 7). The resulting Toolkit distills Critical Race Theory's and intersectionality's most critical elements into a user-friendly modality to promote and enhance equitable MCH policies and programs for diverse U.S. women and families.

Methods in HIV-Related Intersectional Stigma Research: Core Elements and Opportunities.

Researchers are increasingly recognizing the importance of studying and addressing intersectional stigma within the field of HIV. Yet, researchers have, arguably, struggled to operationalize intersectional stigma. To ensure that future research and methodological innovation is guided by frameworks from which this area of inquiry has arisen, we propose a series of core elements for future HIV-related intersectional stigma research. These core elements include multidimensional, multilevel, multidirectional, and action-oriented methods that sharpen focus on, and aim to transform, interlocking and reinforcing systems of oppression. We further identify opportunities for advancing HIV-related intersectional stigma research, including reducing barriers to and strengthening investments in resources, building capacity to engage in research and implementation of interventions, and creating meaningful pathways for HIV-related intersectional stigma research to produce structural change. Ultimately, the expected payoff for incorporating these core elements is a body of HIV-related intersectional stigma research that is both better aligned with the transformative potential of intersectionality and better positioned to achieve the goals of Ending the HIV Epidemic in the United States and globally. (Am J Public Health. 2022;112(S4):S413-S419. https://doi.org/10.2105/AJPH.2021.306710).

A Systematic Review of Neighborhood-Level Influences on HIV Vulnerability.

A better understanding of the social-structural factors that influence HIV vulnerability is crucial to achieve the goal of ending the HIV epidemic by 2030. Given the role of neighborhoods in HIV outcomes, synthesis of findings from such research is key to inform efforts toward HIV eradication. We conducted a systematic review to examine the relationship between neighborhood-level factors (e.g., poverty) and HIV vulnerability (via sexual behaviors and substance use). We searched six electronic databases for studies published from January 1, 2007 through November 30, 2017 (PROSPERO CRD42018084384). We also mapped the studies' geographic distribution to determine whether they aligned with high HIV prevalence areas and/or the "Ending the HIV Epidemic: A Plan for the United States". Fifty-five articles met inclusion criteria. Neighborhood disadvantage, whether measured objectively or subjectively, is one of the most robust correlates of HIV vulnerability. Tests of associations more consistently documented a relationship between neighborhood-level factors and drug use than sexual risk behaviors. There was limited geographic distribution of the studies, with a paucity of research in several counties and states where HIV incidence/prevalence is a concern. Neighborhood influences on HIV vulnerability are the consequence of centuries-old laws, policies and practices that maintain racialized inequities (e.g., racial residential segregation, inequitable urban housing policies). We will not eradicate HIV without multi-level, neighborhood-based approaches to undo these injustices. Our findings inform future research, interventions and policies.

Police Violence and Public Health.

Despite their enormous potential impact on population health and health inequities, police violence and use of excessive force have only recently been addressed from a public health perspective. Moving to change this state of affairs, this article considers police violence in the USA within a social determinants and health disparities framework, highlighting recent literature linking this exposure to mental health symptoms, physical health conditions, and premature mortality. The review demonstrates that police violence is common in the USA; is disproportionately directed toward Black, Latinx, and other marginalized communities; and exerts a significant and adverse effect on a broad range of health outcomes. The state-sponsored nature of police violence, its embedding within a historical and contemporary context of structural racism, and the unique circumstances of the exposure itself make it an especially salient and impactful form of violence exposure, both overlapping with and distinct from other forms of violence. We conclude by noting potential solutions that clinical psychology and allied fields may offer toalleviate the impact of police violence, while simultaneously recognizing that a true solution to this issue requires a drastic reformation or replacement of the criminal justice system, as well as addressing the broader context of structural and systemic racism in the USA.

Intersecting Structural Oppression and Suicidality Among Black Sexual Minority Male Adolescents and Emerging Adults.

This study examined associations between structural racism, anti-LGBTQ policies, and suicide risk among young sexual minority men (SMM). Participants were a 2017-2018 Internet-based U.S. national sample of 497 Black and 1536 White SMM (ages 16-25). Structural equation modeling tested associations from indicators of structural racism, anti-LGBTQ policies, and their interaction to suicide risk factors. For Black participants, structural racism and anti-LGBTQ policies were significantly positively associated with depressive symptoms, heavy drinking, perceived burdensomeness, thwarted belongingness, self-harm, and suicide attempt. There were significant interaction effects: Positive associations between structural racism and several outcomes were stronger for Black participants in high anti-LGBTQ policy states. Structural racism, anti-LGBTQ policies, and their interaction were not significantly associated with suicide risk for White SMM.

Disrupting the Systems: Opportunities to Enhance Methodological Approaches to Address Socio-Structural Determinants of HIV and End the Epidemic Through Effective Community Engagement.

A world without HIV is only possible by addressing the socio-structural determinants of health. Our understanding of socio-structural determinants is constantly changing, and parallel changes must occur with the methodologies used to explain the drivers of the HIV epidemic. We argue for the need to engage communities in the planning, implementation, and dissemination of research on the socio-structural determinants of HIV. Community engagement should cross-cut various types of research including rigorous measurement development of socio-structural determinants and novel analytic techniques to model their role in the trajectory of the epidemic and the impact of interventions. Considering the role of place, we recommend collaboration between scientists and communities in the interpretation of results from studies that map HIV-related behaviors and movement. As we collectively delve into historically oppressive systems with colonial antecedents, we must be ready to challenge these systems and replace them with collaborative models. The success of research-driven HIV policy and programming will best be evaluated with methodologies derived from the insights of the very individuals that these policies and programs aim to serve.

RESUMEN: Un mundo sin VIH es posible sólo si atendemos los determinantes socio-estructurales de la salud. Nuestra comprensión sobre determinantes socio-estructurales cambia constantemente y cambios similares deben ocurrir en las metodologías utilizadas para explicar los factores que rigen la epidemia del VIH. Argumentamos sobre la necesidad de involucrar las comunidades en la planificación, implementación y diseminación de investigaciones sobre los determinantes socio-estructurales del VIH. La participación comunitaria debe ser transversal en varios tipos de investigaciones, incluyendo el desarrollo riguroso de métricas sobre los determinantes socio-estructurales y técnicas noveles para la modelación de su rol en las trayectorias de la epidemia y el impacto de intervenciones. Considerando el rol que tiene el lugar físico, recomendamos la colaboración de científicos y comunidades en la interpretación de resultados de estudios que crean mapas de las conductas relacionadas al VIH y la movilidad de las personas. En la medida en que examinamos sistemas históricamente opresivos con antecedentes coloniales, debemos estar listos para retar estos sistemas y remplazarlos con modelos colaborativos. El logro de políticas y programas de VIH informados por la investigación sería evaluado mejor si se utilizan metodologías guiadas por el conocimiento de las personas a las cuales estas políticas y programas persiguen servir.

How black heterosexual men's narratives about sexual partner type and condom use disrupt the main and casual partner dichotomy: 'we still get down, but we not together'.

Sexual partner types and partnership dynamics have important implications for condom use. Yet most HIV prevention research conceptualises condom use as individual-level rather than dyadic-level behaviour. Evidence of a generalised HIV epidemic in urban predominantly low-income US Black heterosexual communities highlights the need for a culturally and contextually-grounded understanding of partner types, partnership dynamics and condom use from the perspective of Black heterosexual men. We conducted individual interviews with 30 self-identified men between the ages of 18 and 44, 18 (60%) of whom reported at least two partner types in the last 6 months. Key findings include: (1) 'main and casual' partner types per the HIV prevention literature; (2) three casual-partner subtypes: primary, recurrent, and one-time casuals; (3) overlapping partnership dynamics between main partners, primary-casual partners and recurrent-casual partners, but not one-time casual partners; and (4) consistent condom use reported for one-time casual partners only. The study underscores the critical need for more condom promotion messages and interventions that reflect the dyadic and culturally-grounded realities of US Black heterosexual men's sexual partner types and partnership dynamics.

Negative Police Encounters and Police Avoidance as Pathways to Depressive Symptoms Among US Black Men, 2015-2016.

Objectives. To examine negative police encounters and police avoidance as mediators of incarceration history and depressive symptoms among US Black men and to assess the role of unemployment as a moderator of these associations.Methods. Data were derived from the quantitative phase of Menhood, a 2015-2016 study based in Washington, DC. Participants were 891 Black men, 18 to 44 years of age, who completed computer surveys. We used moderated mediation to test the study's conceptual model.Results. The results showed significant indirect effects of incarceration history on depressive symptoms via negative police encounters and police avoidance. Unemployment moderated the indirect effect via police avoidance. Participants with a history of incarceration who were unemployed reported significantly higher police avoidance and, in turn, higher depressive symptoms. Moderation of unemployment on the indirect effect via negative police encounters was not significant.Conclusions. There is a critical need to broaden research on the health impact of mass incarceration to include other aspects of criminal justice involvement (e.g., negative police encounters and police avoidance) that negatively affect Black men's mental health.

Intersectional analysis of life stress, incarceration and sexual health risk practices among cisgender Black gay, bisexual and other men who have sex with men in the Deep South of the US: the MARI Study.

Objectives The purpose of the present study was to examine associations between life stress and incarceration history in relation to sexual health risk practices among a sample of cisgender Black gay, bisexual and other men who have sex with men (MSM) in the Deep South. METHODS: Using data from a sample of 355 cisgender Black MSM in Mississippi and Georgia, multivariable logistic regression analyses were conducted to examine associations between life stress and sexual risk practices. In addition, we assessed whether stress may interact with experiences of incarceration to influence sexual health risk practices. RESULTS: After controlling for sociodemographic characteristics, stress was associated with some sexual risk practices (e.g. alcohol and drug use during sex and group sex). Further, when an interaction with incarceration was assessed, among participants who had been incarcerated, high compared with low levels of stress were associated with alcohol use during sex (adjusted odds ratio (aOR) 4.59, 95% confidence interval (CI) 2.11-9.99, P < 0.001), drug use during sex (aOR 3.92, 95% CI 1.79-8.60, P < 0.001), condomless sex with casual partners (aOR 2.83, 95% CI 1.31-6.12, P < 0.001), having six or more casual partners (aOR 2.77, 95% CI 1.09-7.06, P = 0.02) and participating in group sex (aOR 5.67, 95% CI 2.07-15.51, P < 0.001). Stress and incarceration produced a dose-response effect for each association; similar associations with stress were not observed among men who had not been incarcerated. CONCLUSIONS: Among people with experiences of incarceration, there are several possible ways our findings could be applied practically, including through safer sex and stress management interventions designed specifically for Black MSM following their release.

Daily multidimensional racial discrimination among Black U.S. American adolescents.

This study examined frequencies and psychological effects of daily racial discrimination experienced individually, vicariously, online, offline, and through teasing. Participants were 101 Black U.S. American adolescents for this ecological momentary assessment study that measured daily racial discrimination and 14-day depressive symptoms slopes. Confirmatory factor analyses specified subscales, t-test analyses compared subscale means, and hierarchical linear analyses tested associations between subscales and depressive symptoms slopes. Results showed that six subscales fit the data well: individual general, vicarious general, individual online, vicarious online, individual teasing, and vicarious teasing. Participants reported 5606 experiences of racial discrimination during the study and averaged 5.21 experiences per day across the six subscales. The two online subscales were more frequent than the offline subscales. Aside from online vicarious experiences, all subscales were positively associated with depressive symptoms slopes. Findings underscore the multidimensional, quotidian, and impactful nature of racial discrimination in the lives of Black adolescents in the U.S.

Measuring Black men's police-based discrimination experiences: Development and validation of the Police and Law Enforcement (PLE) Scale.

OBJECTIVES: Although social science research has examined police and law enforcement-perpetrated discrimination against Black men using policing statistics and implicit bias studies, there is little quantitative evidence detailing this phenomenon from the perspective of Black men. Consequently, there is a dearth of research detailing how Black men's perspectives on police and law enforcement-related stress predict negative physiological and psychological health outcomes. This study addresses these gaps with the qualitative development and quantitative test of the Police and Law Enforcement (PLE) Scale. METHOD: In Study 1, we used thematic analysis on transcripts of individual qualitative interviews with 90 Black men to assess key themes and concepts and develop quantitative items. In Study 2, we used 2 focus groups comprised of 5 Black men each (n = 10), intensive cognitive interviewing with a separate sample of Black men (n = 15), and piloting with another sample of Black men (n = 13) to assess the ecological validity of the quantitative items. For Study 3, we analyzed data from a sample of 633 Black men between the ages of 18 and 65 to test the factor structure of the PLE, as we all as its concurrent validity and convergent/discriminant validity. RESULTS: Qualitative analyses and confirmatory factor analyses suggested that a 5-item, 1-factor measure appropriately represented respondents' experiences of police/law enforcement discrimination. As hypothesized, the PLE was positively associated with measures of racial discrimination and depressive symptoms. CONCLUSIONS: Preliminary evidence suggests that the PLE is a reliable and valid measure of Black men's experiences of discrimination with police/law enforcement. (PsycINFO Database Record