Qualitative Analysis of Colorectal Cancer Screening for African American and Hispanic Populations in Nebraska: an Application of the PRECEDE Framework.

Nationally and in Nebraska, African Americans (AA) and Hispanics have lower colorectal cancer (CRC) screening rates compared to non-Hispanic Whites. We aimed to obtain perspectives from AA and Hispanic cancer survivors and caregivers in Nebraska about CRC screening to improve outreach efforts. Data from four virtual focus groups (AA female, AA male, Hispanic rural, and Hispanic urban) conducted between April-August 2021 were analyzed using a directed content approach based on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. Most of the 19 participants were female (84%) and survivors (58%). Across groups, awareness of colonoscopy was high, but awareness of fecal testing needed to be higher, with confusion about different types of fecal tests. Predisposing factors were trust in the health system; awareness of CRC screening; machismo; fear of cancer; embarrassment with screening methods; and negative perceptions of CRC screening. Enabling factors included provider recommendations, healthcare access, and insurance. Reinforcing factors included prioritizing personal health and having a support system. Suggestions to improve screening included increasing healthcare access (free or low-cost care), increasing provider diversity, health education using various methods and media, and enhancing grassroots health promotion efforts. Lack of awareness, accessibility issues, attitudes and perceptions of CRC and CRC screening, trust, and cultural and linguistic concerns are major issues that need to be addressed to reduce CRC screening disparities among AA and Hispanic adults.

Racial Discrimination, Mental Health and Behavioral Health During the COVID-19 Pandemic: a National Survey in the United States.

BACKGROUND: While hate crimes rose during the COVID-19 pandemic, few studies examined whether this pandemic-time racial discrimination has led to negative health consequences at the population level. OBJECTIVE: We examined whether experienced and perceived racial discrimination were associated with mental or behavioral health outcomes during the pandemic. DESIGN: In October 2020, we conducted a national survey with minorities oversampled that covered respondents' sociodemographic background and health-related information. PARTICIPANTS: A total of 2709 participants responded to the survey (response rate: 4.2%). MAIN MEASURES: The exposure variables included (1) experienced and encountered racial discrimination, (2) experienced racial and ethnic cyberbullying, and (3) perceived racial bias. Mental health outcomes were measured by psychological distress and self-rated happiness. Measures for behavioral health included sleep quality, change in cigarette smoking, and change in alcohol consumption. Weighted logistic regressions were performed to estimate the associations between the exposure variables and the outcomes, controlling for age, gender, race and ethnicity, educational attainment, household income, eligibility to vote, political party, COVID-19 infection, and geographic region. Separate regressions were performed in the six racial and ethnic subgroups: non-Hispanic White, non-Hispanic Black, Hispanic, East Asian, South Asian, and Southeast Asian respondents. KEY RESULTS: Experienced racial discrimination was associated with higher likelihood of psychological distress (adjusted odds ratio [AOR] = 2.18, 95% confidence interval [95% CI]: 1.34-3.55). Experienced racial discrimination (AOR = 2.31, 95% CI: 1.34-3.99) and perceived racial bias (AOR = 1.05, 95% CI: 1.00-1.09) were both associated with increased cigarette smoking. The associations between racial discrimination and mental distress and substance use were most salient among Black, East Asian, South Asian, and Hispanic respondents. CONCLUSIONS: Racial discrimination may be associated with higher likelihood of distress, and cigarette smoking among racial and ethnic minorities. Addressing racial discrimination is important for mitigating negative mental and behavioral health ramifications of the pandemic.

Effectiveness of incentives to improve the reach of health promotion programs- a systematic review and meta-analysis.

The reach (i.e., enrollment, engagement, and retention) of health promotion evidence-based programs (EBPs) at the participant level has been challenging. Incentives based on behavioral economics may be used to improve EBP reach. We aimed to systematically review and synthesize the evidence of the effectiveness of incentives as a dissemination strategy to increase EBP reach. We conducted a literature search in PubMed, SCOPUS, EMBASE, Cochrane Review and Cochrane CENTRAL for articles published between January 2000 and March 2020 to identify incentive strategies used to increase program reach among health promotion EBPs. Inclusion criteria included studies published in English, experimental or quasi-experimental designs, comparison of incentive to non-incentive or control strategies, and reported on reach (n = 35 health promotion studies). Monetary incentives using cash and a fixed schedule of reinforcement were the most used incentive schemes (71%). Incentives alone or combined with other strategies as a multicomponent approach were effective in improving program enrollment, engagement, and retention. Specifically, incentive strategies were associated with higher odds of program enrollment (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.82-4.24; n = 10) and retention (OR, 2.54, 95% CI, 1.34-4.85; n = 9) with considerable heterogeneity (I2 = 94% and 91%, respectively). Incentives are a promising individual-level dissemination strategy to improve the reach of health promotion EBPs. However, understanding the optimal amount, type, frequency, and target of incentives, and how incentives fit in a multicomponent approach in different contexts requires further research.

Urban American Indian Community Health Beliefs Associated with Addressing Cancer in the Northern Plains Region.

American Indians residing in the Northern Plains region of the Indian Health Service experience some of the most severe cancer-related health disparities. We investigated ways in which the community climate among an American Indian population in an urban community in the Northern Plains region influences community readiness to address cancer. A Community Readiness Assessment, following the Community Readiness Model, conducted semi-structured interviews with eight educators, eight students, and eight community leaders from the American Indian community in Omaha's urban American Indian population and established the Northern Plains region community at a low level of readiness to address cancer. This study reports on a subsequent qualitative study that analyzed all 24 interview transcriptions for emergent themes to help understand the prevailing attitude of the community toward cancer. A synthesis of six emergent themes revealed that the community's perceptions of high levels of severity and barriers, paired with perceptions of low levels of susceptibility and benefits, lead to low levels of self-efficacy, all of which are reflected in minimal cues to action and little effort to address cancer. These findings, interpreted through the lens of the Health Belief Model, can inform the development of more community-based, comprehensive, and culturally appropriate approaches to address the multilevel determinants of health behaviors in relation to cancer among American Indians in the Northern Plains region.

Promoting Condom Use Through a Youth-Focused Community-Wide Free Condom Distribution Initiative.

We describe the implementation of a youth-focused condom distribution initiative in Omaha, Nebraska, developed by the Women's Fund of Omaha. During a 2.5-year period, initiative partners distributed nearly 1.4 million free condoms to community members via outreach events and 197 condom distribution boxes. The Women's Fund of Omaha also implemented seven media campaigns encouraging condom use. The number of condoms distributed per month increased from 9840 in September 2015 to 71 220 in February 2018. Condom distribution initiatives can play an important role in increasing condom access.

The Healthy Community Neighborhood Initiative: Rationale and Design.

OBJECTIVE: To describe the design and rationale of the Healthy Community Neighborhood Initiative (HCNI), a multi-component study to understand and document health risk and resources in a low-income and minority community. DESIGN: A community-partnered participatory research project. SETTING: A low-income, biethnic African American and Latino neighborhood in South Los Angeles. PARTICIPANTS: Adult community residents aged >18 years. MAIN OUTCOME MEASURES: Household survey and clinical data collection; neighborhood characteristics; neighborhood observations; and community resources asset mapping. RESULTS: We enrolled 206 participants (90% of those eligible), of whom 205 completed the household interview and examination, and 199 provided laboratory samples. Among enrollees, 82 (40%) were aged >50 years and participated in functional status measurement. We completed neighborhood observations on 93 street segments; an average of 2.2 (SD=1.6) study participants resided on each street segment observed. The community asset map identified 290 resources summarized in a Community Resource Guide given to all participants. CONCLUSIONS: The HCNI community-academic partnership has built a framework to assess and document the individual, social, and community factors that may influence clinical and social outcomes in a community at high-risk for preventable chronic disease. Our project suggests that a community collaborative can use culturally and scientifically sound strategies to identify community-centered health and social needs. Additional work is needed to understand strategies for developing and implementing interventions to mitigate these disparities.

African American and Hispanic Cancer Survivors' and Caregivers' Experiences in Nebraska.

Racial and ethnic minority populations experience poorer cancer outcomes compared to non-Hispanic White populations, but qualitative studies have typically focused on single subpopulations. We explored experiences, perceptions, and attitudes toward cancer care services across the care continuum from screening through treatment among African American and Hispanic residents of Nebraska to identify unique needs for education, community outreach, and quality improvement. We conducted four focus groups (N = 19), April-August 2021 with people who were aged 30 or older and who self-identified as African American or Hispanic and as cancer survivors or caregivers. Sessions followed a structured facilitation guide, were audio recorded and transcribed, and were analyzed with a directed content analysis approach. Historical, cultural, and socioeconomic factors often led to delayed cancer care, such as general disuse of healthcare until symptoms were severe due to mistrust and cost of missing work. Obstacles to care included financial barriers, transportation, lack of support groups, and language-appropriate services (for Hispanic groups). Knowledge of cancer and cancer prevention varied widely; we identified a need for better community education about cancer within the urban Hispanic community. Participants had positive experiences and a sense of hope from the cancer care team. African American and Hispanic participants shared many similar perspectives about cancer care. Our results are being used in collaboration with national and regional cancer support organizations to expand their reach in communities of color, but structural and cultural barriers still need to be addressed.

Barriers and opportunities for promoting health professions careers among African American students in the Midwest.

The purpose of our study is to examine the barriers and facilitators for urban African American students interested in pursuing health professions careers in the Midwest. In our analysis of the key informant interviews and focus groups, we identified four barriers (lack of preparation, lack of funding, lack of support/isolation, and perceived discrimination) and three facilitators (early preparation, support/mentorship, funding). We provide recommendations for how to leverage these facilitators and address the barriers to increase the representation of African Americans in the healthcare workforce. Novel future directions for this work should include comprehensive interventions tailored to URM students that span the health professions education pipeline and begin as early as elementary school. Interventions that engage mentors should take place at high school, undergraduate, and graduate health professions school levels.

Strengthening Tobacco 21 implementation and enforcement to reduce tobacco-related health disparities: A stakeholder engagement project.

INTRODUCTION: As a part of a priority-setting stakeholder engagement project to strengthen the impact of the federal Tobacco 21 (T21) law, we conducted a qualitative study to solicit input from a nationwide sample of tobacco control stakeholders regarding the implementation, enforcement, and equity implications of the T21 law. METHODS: Following the T21 policy evaluation guidance developed by the Centers for Disease Control (CDC), we identified T21 experts in four domains: policy, evaluation, subject matter, and implementation from a national search of stakeholders (invitations, n=1279) to account for geographical variation. This study presents results from five focus groups conducted in December 2021 among stakeholders (n=31) with experience in T21 policy, evaluation, subject matter, and implementation. RESULTS: Participating T21 stakeholders reported on eight themes from four main topic areas: 1) Implementation, 2) Enforcement, 3) Equity outcomes, and 4) Recommended changes from stakeholders. Stakeholders shared insights on both passive and active implementation methods used in their communities, and highlighted major barriers such as the absence of a standardized tobacco retail licensing mandate and insufficient resources. Regarding T21 enforcement, stakeholders believed that current deterrents for retail violations might not be effective. They noted that vape and tobacco shops and online sales of tobacco products are emerging major challenges in T21 enforcement. Stakeholders also discussed possible health inequities that may be exacerbated by heterogenous implementation of the T21 law. CONCLUSIONS: To strengthen T21 and mitigate potential exacerbation of existing health inequities, greater alignment of federal, state, and local efforts to reduce heterogeneity of implementation and enforcement of the T21 law is recommended.

Factors associated with viral suppression among cisgender women living with human immunodeficiency virus in the United States: An integrative review.

INTRODUCTION: Women account for 23% of new human immunodeficiency virus diagnoses in the United States, yet remain understudied. Adherence to antiretroviral therapy and consequent viral suppression are keys to preventing human immunodeficiency virus transmission, reducing risk of drug resistance, and improving health outcomes. OBJECTIVES: This review identified and synthesized peer-reviewed studies in the United States describing factors associated with viral suppression among cisgender women living with human immunodeficiency virus. METHODS: We searched five databases: Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, Embase, Scopus, and PsycINFO, and reported the findings using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eligible studies included: (1) peer-reviewed English-language articles published since 2010; (2) includes only cisgender women; (3) participants were at least 18 years of age; (4) reported metrics on viral loads; and (5) conducted in the United States. RESULTS: Fourteen studies in total were reviewed. Eight studies had adult women living with human immunodeficiency virus, four recruited only pregnant women, and two included only racial minority women. The most commonly reported factors negatively associated with viral suppression were substance use (n = 4), followed by availability of health insurance, financial constraint, complexity of human immunodeficiency virus treatment regimen (n = 3), and intimate partner violence (n = 2). Other factors were depression, race, and age. In addition, all four studies that included only pregnant women reported early human immunodeficiency virus care engagement as a significant predictor of low viral loads pre- and post-partum. CONCLUSION: Substance use, financial constraint, lack of health insurance, human immunodeficiency virus treatment regimen type, intimate partner violence, and late human immunodeficiency virus care pre-post pregnancy were the most common factors negatively associated with viral suppression. There is a paucity of data on viral suppression factors related to transgender and rural populations. More human immunodeficiency virus research is needed to explore factors associated with human immunodeficiency virus treatment outcomes in transgender women and cisgender women in rural U.S. regions.

Lead Toxicity and Environmental Health Justice Stories in Black and White Woodcut Portraits.

Background: Omaha, Nebraska, has a lead-contaminated superfund site and substandard housing that pose risks for childhood lead exposure. Healthy Housing Omaha (formerly, Omaha Healthy Kids Alliance), an environmental health nonprofit, partnered with the fourth author, an artist, and a newspaper to raise awareness about lead poisoning by publishing portraits and stories of affected community members. Methods: The authors analyzed an interview with the artist, photographs of portraits published in a local newspaper, and quotations from portrait sitters. Results: Shared stories of lead exposure and poisoning conveyed in the portraiture and printmaking processes revealed structural racism as an emergent theme. Conclusions: Arts-based research methods, such as portraiture, can be scaled and applied to support national and international community engagement efforts to advocate for environmental justice and public health.

Vaping Media Literacy, Harm Perception, and Susceptibility of E-Cigarette Use Among Youth.

INTRODUCTION: Exposure to E-cigarette marketing and media advertisements is prevalent among adolescents. A validated vaping media literacy scale is needed to inform effective vaping prevention programs. METHODS: A 6-item vaping media literacy scale was adapted from validated smoking and general media literacy scales with an emphasis on marketing influences. A school-based survey (N=856) was conducted to assess the reliability of vaping media literacy and 3 subscales (i.e., authors and audiences [vaping Authors and Audiences], messages and meanings [vaping Messages and Meanings], and representation and reality [vaping Representation and Reality]). Multivariable logistic regression models were performed to examine the associations of vaping media literacy with perceived harmfulness of E-cigarette use and susceptibility to use E-cigarettes. Analyses were conducted in 2021. RESULTS: The mean vaping media literacy among students was 2.6 (range=0-6). There were significant disparities with lower vaping media literacy among middle-school (versus high-school, p=0.03) students, males (versus females, p=0.003), and racial/ethnic minority students (Blacks, Hispanics, others versus Whites, p=0.0009). A higher vaping media literacy was significantly associated with increased perceived harmfulness of E-cigarette use (AOR=1.2; 95% CI=1.1, 1.2; p<0.0001). All subscales were also associated with E-cigarette harm perception. Among never E-cigarette users, students with a higher (versus those with a lower) vaping media literacy had lower susceptibility to initiating E-cigarettes (AOR=0.90; 95% CI=0.83, 0.97; p=0.005). Both vaping Messages and Meanings and vaping Representation and Reality subscales were adversely associated with susceptibility to vaping. CONCLUSIONS: The vaping media literacy scale may gauge the influence of E-cigarette marketing on adolescents with high reliability and validity. Racial minorities, younger adolescents, and males appear relatively vulnerable to vaping marketing influence. Efforts to increase vaping media literacy are needed to curb youth E-cigarette use.

Stress Correlates Related to Depressive Symptoms Among Young Black Men in Southern California.

Black men experience higher levels of chronic stress, life stressors, and discrimination due to oppressive social and economic conditions. Black men are at greater risk of depression, but most published research on stress and depression has focused on Black people in general, Black women, or older Black men. We sought to determine whether discrimination, perceived stress, major life stress, daily hassles, and social capital were associated with depressive symptoms in young Black men. Survey data were collected from April 2010 to March 2012 in Southern California from a convenience sample of Black men (N = 201). We used two-sample t tests and one-way analysis of variance (ANOVA) to examine the association of stress correlates with depressive symptoms. Logistic regression was conducted to estimate the likelihood of reporting depressive symptoms for each significant correlate. Over half of the sample reported depressive symptoms. Health status, perceived discrimination, urban hassles, perceived stress, and neighborhood trust and safety were significantly related to depressive symptoms. Those who reported higher perceived stress had higher odds of reporting depressive symptoms, whereas lower everyday discrimination experiences were associated with lower odds of depressive symptoms. Future studies should consider examining the effectiveness of embedding coping mechanisms for stress, including perceived discrimination, in health interventions for young Black men to prevent or reduce depression.

Racism Experience Among American Adults During COVID-19: A Mixed-Methods Study.

Purpose: Despite escalating racism in the United States during COVID-19, few studies have identified correlates of racism experience among Americans using nationally representative data. This study seeks to quantitatively identify correlates of racism experience and qualitatively categorize racism experience and its coping using nationally representative survey data. Methods: Based on data from the "Health, Ethnicity and Pandemic Survey" (N=2,506), a nationally representative survey conducted in October 2020, multivariable logistic regression was estimated to examine the association between self-reported racism experience and selected correlates. Thematic analysis was conducted to qualitatively classify types of racism experience and related coping strategies. Results: When asked whether they had been discriminated or unfairly treated during COVID-19 because of their racial/ethnic background, 19% non-Hispanic Asian and Black respondents said yes, followed by 15% among Hispanics and 3% among non-Hispanic Whites. Besides significant correlates of racism experience identified at the individual and household level, three contextual factors at the neighborhood or state level were associated with lower odds of racism experience, including living in a blue state (adjusted odds ratio [AOR]=0.69, 95% confidence interval [CI]: 0.50-0.95; reference category: red state), living in the top third of the neighborhoods in the sample in terms of racial diversity (AOR=0.65%, 95% CI: 0.42-0.99; reference: bottom third), and coming from neighborhoods with a median population age of 35-39 (AOR=0.67, 95% CI: 0.46-0.98; reference: younger than 35). Prevailing coping strategies against experienced racism included social avoidance, direct confrontation, seeking social and religious support, resorting to hobbies for relief, and taking legal actions. Conclusion: Racism experience is not only correlated with factors at individual level, it is also associated with contextual factors such as political climate, neighborhood diversity, and population age structure. Future efforts in supporting victims of racism might be more cost-effective by focusing on the identified vulnerable groups and related contextual factors.

Collective Re-Storying of Mentee and Mentor Experiences in a Cancer Research Education Program for American Indian and Alaska Native Students.

The Youth Enjoy Science program at the University of Nebraska Medical Center has engaged American Indian/Alaska Native youth in mentored cancer research internships from 2017 to 2022. The primary purpose of this study was to examine mentor and mentee lived experiences of participation in Youth Enjoy Science research education internships and to provide insights that can inform mentorship practices in research education programs for American Indians/Alaska Natives. We conducted semi-structured interviews with current and former Youth Enjoy Science mentees (n=8) and mentors (n=8). Following a narrative inquiry research approach, we analyzed interview transcripts and collectively re-storied interview data. Participants described program characters, settings, problems, actions to address the problems identified, and resolutions that led to various recommendations for ways to raise contextual awareness between mentees and mentors.

Sociodemographic Differences and Factors Affecting Patient Portal Utilization.

BACKGROUND: The primary function of the patient portal is to give patients greater access to their personal health information. Granting patients electronic access allows them to make well-informed health care decisions. OBJECTIVE: This study aimed to identify sociodemographic differences in patient portal use and examine factors affecting patient portal utilization following the final stage of the Meaningful Use program which aimed to promote the use of certified electronic health record (EHR) technology. RESEARCH DESIGN: Survey data from Health Information National Trends Survey (HINTS) 5, cycles 1, 2, and 3 were analyzed. The sample included 8291 completed surveys. Multivariable logistic regression on a selected response for each surveyed question was used to assess the racial and ethnic difference after controlling for age, sex, income, and education. SUBJECTS: Subjects included English and Spanish speaking adults in the USA. MEASURES: Measures included assessment of patient portal use, patient portal access, understanding health information, usefulness of health records, and privacy and security. RESULTS: After adjusting for age, sex, income, and education, there was a significant association between race/ethnicity and patient portal non-users responding, "no need to use online medical record" as the reason for not using the patient portal (P = 0.005). Among the portal users, there were significant associations between race/ethnicity and health care provider maintaining an EHR (P = 0.006), being offered access to their portal (P < 0.001), understanding health information in the portal (P = 0.004), finding the portal useful for health monitoring (P < 0.001), reporting concern about unauthorized access (P = 0.017), and keeping information from health care providers (P = 0.012). CONCLUSIONS: Race/ethnicity affects perceptions on the need for the patient portal, being offered access to a portal, and the reasons to access information online. Understanding the factors affecting patient portal use can inform future strategies aimed at increasing adoption.

Recruiting Low-Income African American Men in Mental Health Research: A Community-Based Participatory Research Feasibility Study.

African Americans (AAs) are 20% more likely to develop serious psychological distress compared to Whites but are less likely to use mental health services. The study objective was to evaluate the effectiveness of recruitment strategies to engage AA fathers in a mental health intervention.Using the community-based participatory research (CBPR) approach, a community-academic partnership (CAP) developed and implemented direct and indirect referral strategies to engage AA fathers in a mental health intervention. Direct referral strategies focused on community partner identification of potentially eligible participants, providing information about the study (i.e., study flyer), and referring potential participants to the study. Indirect referrals included posting flyers in local businesses frequented by AA men, radio advertisements, and social media posts from community organizations.From January to October 2019, 50 direct and 1388 indirect referrals were documented, yielding 24 participants screened and 15 enrolled. Of all participants screened, 58% were referred through indirect referral, 38% were referred directly by community partners, and 4% of the participants were referred through both direct and indirect referrals. Twenty percent of those exposed to the direct referral methods and 1% of those exposed to the indirect referral methods were enrolled. The indirect referrals accounted for 60% of enrollment, whereas the direct referrals accounted for 33.3% of enrollment.Collaborating with the community partners to engage hard-to-reach populations in mental health studies allowed for broad dissemination of recruitment methods, but still resulted in low participant accrual. Additional focus on increasing direct referral methods appears to be a fruitful area of CBPR.

Sustaining the reach of a scalable weight loss intervention through financial incentives- a pragmatic, feasibility, online randomized trial protocol.

BACKGROUND: High attrition following initial enrollment in evidence-based weight loss programs is a common, challenging, and under-studied issue. A behavioral economics approach consisting of modest monetary incentives may help to engage participants beyond enrollment to close the initial attrition gap. PURPOSE: To describe the methods and design of a pragmatic, online randomized controlled trial (RCT) of an incentivized, technology-facilitated weight loss program through an innovative research-practice partnership involving primary care, health promotion researchers, and a small business. METHODS: This study is a four-arm (1:1:1:1) RCT that compares the efficacy of outcome-based (weight loss), process-based (weighing in), a combination of outcome- and process-based, or choice-based incentives on sustaining program reach after initial enrollment for an evidence-based weight loss program. The multicomponent weight loss program includes a website, social cognitive theory-based daily health coaching, tailored messaging delivered via email and text messaging, access to online health coaches, and objective weight assessment through a community kiosk. The study will enroll 400 individuals aged 19 and older who have a body mass index ≥25 kg/m2, and have reliable access to the Internet or a smart phone. Participants will be followed for 3, 6, 9, and 12 months to assess program reach and representativeness, and continued participation after enrollment. The secondary outcomes include weight loss and program implementation costs. We will conduct participant focus groups to understand the barriers and facilitators of participation and key informant interviews focusing on clinic managers and care providers to explore the potential for future adoption and implementation of the evidence-based program. DISCUSSION: This study possesses the potential to close the attrition gap after initial enrollment in a web-based digital weight loss intervention in the primary care and community settings. Clinicaltrials.gov registration: NCT04225234.

The Association Between Depressive Symptoms and Accumulation of Stress Among Black Men in the Health and Retirement Study.

BACKGROUND AND OBJECTIVES: Among the multiple factors posited to drive the health inequities that black men experience, the fundamental role of stress in the production of poor health is a key component. Allostatic load (AL) is considered to be a byproduct of stressors related to cumulative disadvantage. Exposure to chronic stress is associated with poorer mental health including depressive symptoms. Few studies have investigated how AL contributes to depressive symptoms among black men. The purpose of the cross-sectional study was to examine the association between AL and depressive symptoms among middle- to old age black men. RESEARCH DESIGN AND METHODS: This project used the 2010 and 2012 wave of the Health and Retirement Study enhanced face-to-face interview that included a biomarker assessment and psychosocial questionnaire. Depressive symptoms, assessed by the endorsement of 3 or more symptoms on the Center for Epidemiological Studies-Depression 8-item scale, was the outcome variable. The main independent variable, AL, score was calculated by summing the number values that were in the high range for that particular biomarker value scores ranging from 0 to 7. black men whose AL score was 3 or greater were considered to be in the high AL group. Modified Poisson regression was used to estimate prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs). RESULTS: There was a larger proportion of black men in the high AL group who reported depressive symptoms (30.0% vs. 20.0%) compared with black men in the low AL group. After adjusting for age, education, income, drinking, and smoking status, the prevalence of reporting 3 or more depressive symptoms was statistically significant among black men in the high AL group (PR = 1.61 [95% CI: 1.20-2.17]) than black men in the low AL group. DISCUSSION AND IMPLICATIONS: Exposure to chronic stress is related to reporting 3 or more depressive symptoms among black men after controlling for potential confounders. Improving the social and economic conditions for which black men work, play, and pray is key to reducing stress, thereby potentially leading to the reporting of fewer depressive symptoms.