Racialization processes and depressive symptoms among pregnant Mexican-origin immigrant women.

This study examines how racialization processes (conceptualized as multilevel and dynamic processes) shape prenatal mental health by testing the association of discrimination and the John Henryism hypothesis on depressive symptoms for pregnant Mexican-origin immigrant women. We analyzed baseline data (n = 218) from a healthy lifestyle intervention for pregnant Latinas in Detroit, Michigan. Using separate multiple linear regression models, we examined the independent and joint associations of discrimination and John Henryism with depressive symptoms and effect modification by socioeconomic position. Discrimination was positively associated with depressive symptoms (ß = 2.84; p < .001) when adjusting for covariates. This association did not vary by socioeconomic position. Women primarily attributed discrimination to language use, racial background, and nativity. We did not find support for the John Henryism hypothesis, meaning that the hypothesized association between John Henryism and depressive symptoms did not vary by socioeconomic position. Examinations of joint associations of discrimination and John Henryism on depressive symptoms indicate a positive association between discrimination and depressive symptoms (ß = 2.81; p < .001) and no association of John Henryism and depressive symptoms (ß = -0.83; p > .05). Results suggest complex pathways by which racialization processes affect health and highlight the importance of considering experiences of race, class, and gender within racialization processes.

Efficacy to avoid violence and parenting: A moderated mediation of violence exposure for African American urban-dwelling boys.

We took a risk and resilience approach to investigating how witnessing physical violence influences adolescent violent behaviors overtime. We proposed efficacy to avoid violence as a major path of influence in this negative trajectory of adolescent development. We also focus on the protective roles of parenting behaviors for African American boys living in disadvantaged contexts. Most of our sample of 310 African American adolescent males (M age = 13.50, SD = .620) had experienced significant amounts of violence, but they also reported continued efficacy to avoid violence. We tested a first stage dual moderated mediation model and found that higher levels of witnessing violence lead to more violent behavior and less efficacy to avoid violence, and that efficacy was the mediator in that link. Youth who witness more violence may feel that engagement in violence is inescapable and thus may themselves end up engaging in it. These problematic long-term trajectories were moderated by parent's communication about violence and monitoring revealing possible protections for youth, and an enhancement of youths' internal strengths. Our findings propose pathways that can inform interventions that may protect African American adolescent boys against the vicious cycle of exposure to, and acts of, violence.

Application of ADAPT-ITT: adapting an evidence-based HIV/STI mother-daughter prevention intervention for Black male caregivers and girls.

BACKGROUND: Black girls are disproportionately impacted by HIV and sexually transmitted infections (STIs), underscoring the urgent need for innovative strategies to enhance the adoption and maintenance of HIV/STI prevention efforts. Historically, Black male caregivers have been left out of girls' programming, and little guidance exists to inform intervention development for Black girls and their male caregivers. Engaging Black male caregivers in Black girls' sexual and reproductive health may reduce sexual risk-taking and improve the sustainability of preventative behaviors. OBJECTIVE: This paper describes the formative phases, processes, and methods used to adapt an evidence-based mother-daughter sexual and reproductive health intervention for Black girls 9-18 years old and their male caregivers. METHODS: We used the ADAPT-ITT model to tailor IMARA for Black girls and their male caregivers. Diverse qualitative methods (interviews, focus groups, and theater testing) were used throughout the adaption process. RESULTS: Findings support using the ADAPT-ITT model to tailor an evidence-based HIV/STI intervention for Black girls and their Black male caregivers. Findings highlight the importance of community engagement and the use of qualitative methods to demonstrate the acceptability and feasibility of the adapted intervention. Key lessons learned are reviewed. CONCLUSIONS: Adapting evidence-based interventions to incorporate Black girls and their Black male caregivers should be driven by a relevant theoretical framework that aligns with the target population(s). Adapting the intervention in partnership with the community has been shown to improve acceptability and feasibility as it is responsive to community needs. Using a systematic process like the ADAPT-ITT model will ensure that the new program is ready for efficacy trials.

Ethnic-racial Socialization, Perceived Neighborhood Quality, and Psychosocial Adjustment among African American and Caribbean Black Adolescents.

Ethnic-racial socialization is employed by ethnic minority parents to support their children's psychosocial adjustment. These socialization messages may be associated differently with psychosocial adjustment for Black youth according to ethnicity and qualities of the neighborhood context. This research examined whether associations between ethnic-racial socialization messages and psychosocial adjustment vary by ethnicity and perceived neighborhood quality in a nationally representative sample of Black adolescents who participated in the National Survey of American Life Adolescent supplement study. The effects of promotion of mistrust messages varied by ethnicity, and the effects of egalitarianism messages varied depending on perceived neighborhood quality. These findings help clarify prior research which has yielded equivocal results for the effects of these messages for Black youth's psychosocial adjustment.

LET's CONNECT Community Mentorship Program for Adolescents with Peer Social Problems: A Randomized Intervention Trial.

This study examined the effectiveness of LET's CONNECT (LC), a community mentorship program based on the positive youth development model. Participants were 218 youth (66.5% girls), ages 12 to 15, who reported peer victimization, bullying perpetration, and/or low social connectedness. These youth were randomized to LC or the control group (community resource information). The LC program linked youth to community mentors who connected with youth and facilitated their involvement in social growth activities across a 16-month period. Outcomes were assessed at 6 and 16 months with self-report measures of social and community connectedness, thwarted belongingness, depression, self-esteem, and suicidal ideation and behavior. In intent-to-treat analyses, LC was associated with modest positive effects for social connectedness, self-esteem, and depression. It had no effects on suicidal ideation or behavior. Results suggest that LC has the potential to positively impact the developmental trajectories of youth dealing with the interpersonal challenges of victimization, bullying perpetration, or low social connectedness. LC implementation challenges and directions for further research are also discussed.

Mediating role of self-esteem: Black Caribbean and African American adolescents' initiation of sex.

To determine how self-esteem mediates the relationship between family support and initiation of sex for US-born Black Caribbean compared to African American adolescents. Secondary data analyses were performed on responses from 1170 adolescents from the National Survey of American Life-Adolescents supplement (2003-2004). Weighted descriptive statistics and logistic regression analyses were performed to examine whether initiation of sex on perceived family support is mediated by self-esteem. The study population consists of 360 Black Caribbean and 810 African American adolescents. Sexual initiation prevalence was higher for Black Caribbean adolescents (42.1%) than African American adolescents (36.75%). The adjusted odds ratio for Black Caribbean adolescents' initiation of sex was 0.85 (95% confidence interval [CI]: 0.16-4.51) compared to African American adolescents' 0.59 (95% CI: 0.35-1.00). Self-esteem represented a statistically significant mediation path and might be more important for African American adolescents' sexual health than the Black Caribbean. The unfounded mediating role of self-esteem between perceived family support and Black Caribbean adolescents' sexual initiation suggests possible influences of Black heterogeneity stemming from ethnic identity differences in sexual health decision-making.

Risk and protective family factors during childhood on youth violence among African American males: The role of mothers and nonresident fathers.

African American male youth experience disproportionately higher levels of violence. We examined parental depression among African American mothers and nonresident fathers on parenting stress and school involvement in their adolescent sons' school connectedness and violent behaviors. Using a longitudinal study design, parent factors were assessed when sons were 9 years old on youth outcomes at age 15. We found that maternal depression was associated with maternal stress, and maternal stress was indirectly associated with sons' violent behaviors through school connectedness. School involvement among nonresident fathers was positively associated with sons' school connectedness, which was linked to less youth violent behaviors. Maternal stress and nonresident fathers' school involvement are influential for understanding youth violence. Future interventions should incorporate a more nuanced approach when including family factors.

Examining contextual and relational factors influencing perceptions of societal and interpersonal mattering among rural youth.

Researchers have shown that interpersonal and societal mattering have important implications for adolescent development. Yet, few researchers have focused on what predicts mattering, particularly societal mattering, and even fewer have studied mattering among rural youth. Thus, the purpose of this study is to explore how perceived contextual and relationship factors affect rural youths' perceptions of societal and interpersonal mattering. Participants for this study were 381 middle school youth from two rural school districts in Michigan. Using structural equation modeling, we found that more positive perceptions regarding opportunities for youth involvement, availability of community resources, student input in decision-making at school, and support for autonomy at school were associated with greater perceptions of societal mattering. In addition, greater support from friends, higher quality parent-child communication, and more parental involvement were associated with a greater sense of interpersonal mattering. This study identifies important relational and contextual factors that can be enhanced in an effort to foster greater perceptions of interpersonal and societal mattering among rural youth, and ultimately help us to promote positive youth development.

Psychological pathway from racial discrimination to the physical consequences of alcohol consumption: Religious coping as a protective factor.

While racial discrimination (RD) is associated with increased alcohol-related problems among African Americans (AAs), researchers have not examined how RD contributes to the physical consequences of alcohol consumption over time. In addition, the protective role of religious coping has been discussed but not formally tested in pathways connecting RD to the physical consequences of alcohol consumption. To address this gap, we estimated latent growth mediation models in a sample of 465 AA emerging adults. We found that RD increased physical consequences of alcohol consumption over time through psychological distress. After identifying two profiles of religious coping (i.e., low and high religious coping), RD indirectly influenced the physical consequences of alcohol consumption through psychological distress among AAs in the low religious coping group. Our results signal the importance of developing alcohol-misuse prevention programs that address the psychological consequences of RD. Integrating culturally tailored coping strategies (e.g., religious coping) may bolster the efficacy of these prevention programs.

Violence Victimization Predicts Body Mass Index One Decade Later among an Urban Sample of African American Young Adults: Sex as a Moderator and Dehydroepiandrosterone as a Mediator.

Psychological stressors such as violence victimization are known contributors to obesity. However, moderators and mediators of this association have not been studied, although they might offer pathways for intervention or prevention. Using a sample of African American young adults, this study tested: (1) the moderating effect of sex on the effect of violence victimization on trajectories of body mass index (BMI), and (2) the mediating effect of dehydroepiandrosterone (DHEA) on this association. This 13-year longitudinal study followed 73 male and 80 female African American young adults who lived in an urban area from 1999 to 2012 when the youth were 20-32 years old. The independent variable was violence victimization measured in 1999 and 2000. The dependent variable was BMI measured in 2002 and 2012. The mediator was DHEA measured in 2001 and 2002. Multilevel path analysis was used to test if males and females differed in violence victimization predicting change in BMI (Model I) and the mediating effect of DHEA change on the above association (Model II). The results of Model I suggested that the change in violence victimization from 1999 to 2000 predicted change in BMI from 2002 to 2012 for females, but not males. Based on Model II, the DHEA change from 2000 to 2001 for females fully mediated the association between violence victimization from 1999 to 2000 and increases in BMI from 2002 to 2012. Our findings suggest that violence victimization in urban areas contributes to the development of obesity among African American female young adults and change in DHEA mediates this link. Violence prevention may have important implications for obesity prevention of African American young women who live in unsafe urban areas. This study also suggests that DHEA may be involved in the violence victimization-obesity link for African American women.

Blacks' Diminished Health Return of Family Structure and Socioeconomic Status; 15 Years of Follow-up of a National Urban Sample of Youth.

The protective effect of family structure and socioeconomic status (SES) on physical and mental health is well established. There are reports, however, documenting a smaller return of SES among Blacks compared to Whites, also known as Blacks' diminished return. Using a national sample, this study investigated race by gender differences in the effects of family structure and family SES on subsequent body mass index (BMI) over a 15-year period. This 15-year longitudinal study used data from the Fragile Families and Child Wellbeing Study (FFCWS), in-home survey. This study followed 1781 youth from birth to age 15. The sample was composed of White males (n = 241, 13.5%), White females (n = 224, 12.6%), Black males (n = 667, 37.5%), and Black females (n = 649, 36.4%). Family structure and family SES (maternal education and income to need ratio) at birth were the independent variables. BMI at age 15 was the outcome. Race and gender were the moderators. Linear regression models were run in the pooled sample, in addition to race by gender groups. In the pooled sample, married parents, more maternal education, and income to need ratio were all protective against high BMI of youth at 15 years of age. Race interacted with family structure, maternal education, and income to need ratio on BMI, indicating smaller effects for Blacks compared to Whites. Gender did not interact with SES indicators on BMI. Race by gender stratified regressions showed the most consistent associations between family SES and future BMI for White females followed by White males. Family structure, maternal education, and income to need ratio were not associated with lower BMI in Black males or females. The health gain received from family economic resources over time is smaller for male and female Black youth than for male and female White youth. Equalizing access to economic resources may not be enough to eliminate health disparities in obesity. Policies should address qualitative differences in the lives of Whites and Blacks which result in diminished health returns with similar SES resources. Policies should address structural and societal barriers that hold Blacks against translation of their SES resources to health outcomes.

"I think that's all a lie I think It's genocide": Applying a Critical Race Praxis to Youth Perceptions of Flint Water Contamination.

Background: In April 2014, the emergency manager of Flint, Michigan switched the city's water supplier from Detroit's water department to the Flint River. The change in water source resulted in the Flint Water Crisis (FWC) in which lead (Pb) from the city's network of old pipes leached into residents' tap water. Residents of Flint reported concerns about the water to officials; however, the concerns were ignored for more than a year. Objective: This study sought to understand how Black youth in Flint conceptualize, interpret, and respond to racism they perceive as part of the normal bureaucracy contributing to the FWC. Methods: In 2016, we conducted four community forums with Flint youth aged 13 to 17 years. Sixty-eight youth participated with 93% self-identifying as Black. Participants completed a brief survey. We audio-recorded the forums and transcribed them verbatim. Critical Race Theory (CRT) guided the development of the interview protocol and Public Health Critical Race Praxis (PHCRP) served as an interpretive framework during qualitative data analysis. Content analyses were completed using software. Results: Many youth viewed the FWC through a racially conscious frame. They described Flint as a Black city where historical and contemporary forms of racial stratification persist. Some described the contamination of the city's water as a form of genocide targeting Blacks. Conclusions: The findings from this exploratory study suggest some Black youth in Flint have difficulty coping with the FWC. Those who perceive it through a racial frame attribute the crisis to racism. They feel distressed about this and other traumas (eg, failure to address high rates of crime) they perceived as racism-related. Future research should examine the implications for specific mental health outcomes among youth.

The Effects of Multiple Dimensions of Risk and Protective Factors on Depressive Symptoms Among Nonresident African American Fathers.

Compared to other groups, African American men experience proportionately greater adverse social and economic circumstances, which have been linked to poor mental health. A growing body of literature has begun to examine depressive symptoms among African American men; however, limited literature has examined the concurrent contributions of risk and protective factors among nonresident African American fathers. This study examined the relative contribution of perceived financial strain, perceived neighborhood characteristics, and interpersonal stress on depressive symptoms among 347 nonresident African American fathers. Social support was examined as a protective factor for depressive symptoms. Results from hierarchical regression analyses indicated interpersonal stress was associated with depressive symptoms even after controlling for perceived financial strain, perceived neighborhood characteristics, and specific sociodemographic factors. Additionally, among fathers with high interpersonal stress, having more social support buffered the negative effect of interpersonal stress on depressive symptoms. Findings suggest experiencing strain from multiple dimensions can increase the risk of depressive symptoms among nonresident African American fathers. We also found that interpersonal stress was especially harmful for mental health. Family service providers and mental health professionals should incorporate stress management techniques to reduce stressful interpersonal relationships as a way to lower depressive symptoms among nonresident African American fathers.

Catalytic Leadership in Food & Fitness Community Partnerships.

Catalytic leadership is a type of multidimensional leadership that facilitates cross-sector collaboration to enact systems and policy changes within communities. Catalytic leaders provide opportunities for stakeholders to partner and merge their efforts to create new opportunities for their work. Catalytic leaders are individuals, organizations, and collaborative partnerships that stimulate partnership alliances. Additionally, catalytic partnerships facilitate the process of collaboration through encouraging and supporting stakeholders to work together effectively and successfully. This article provides examples of catalytic leadership roles that emerged from the Food & Fitness community partnerships. These partnerships were funded by the W.K. Kellogg Foundation to increase access to locally grown food and safe places to play for children and families through systems and policy changes in communities throughout the United States. Key strategies and types of support (i.e., informational and instrumental support) provided through Food & Fitness catalytic leadership that sustained the work of these partnerships was discussed. Based on catalytic leadership strategies identified and types of support provided, outcomes that emerged from this work were also described. We conclude with key recommendations for community partnerships interested in serving as catalytic leaders for large-scale initiatives in their communities.

Organized Activity Participation and Relational Aggression: The Role of Positive Youth Development.

Relational aggression among early adolescents is a pervasive problem that negatively influences the health and well-being of youth. Strength-based approaches such as positive youth development (PYD) are a promising way to reduce risk of detrimental outcomes such as relational aggression. Participation in organized activities is a key way that youth build assets related to PYD. Yet, few researchers have examined empirically assets related to PYD as a mechanism by which organized activity participation may help reduce risk of relational aggression. In this study, we used structural equation modeling to investigate if assets associated with PYD mediate the relationship between organized activity participation and relational aggression using survey data from a diverse, school-based sample of early adolescents (N = 196; mean age = 12.39 years; SD = 0.52; 60% female; 45% African American, 27% White, 21% multiracial, and 7% other, 71% economically disadvantaged). We tested 2 competing models, 1 with decomposed PYD factors and 1 with an integrated PYD factor. Our results suggest that PYD better fit as an integrated versus decomposed construct, providing support for the notion that youth benefit most from assets related to PYD when they operate collectively. Our results also provide support for PYD-related factors as a mechanism by which participation may reduce risk of relational aggression. Limitations of this study, and implications for prevention are discussed.

Meaning-based coping, chronic conditions and quality of life in advanced cancer & caregiving.

OBJECTIVE: This study examined the relationship between the number of co-existing health problems (patient comorbidities and caregiver chronic conditions) and quality of life (QOL) among patients with advanced cancer and their caregivers and assessed the mediating and moderating role of meaning-based coping on that relationship. METHODS: Data came from patients with advanced cancers (breast, colorectal, lung, and prostate) and their family caregivers (N = 484 dyads). Study hypotheses were examined with structural equation modeling using the actor-partner interdependence mediation model. Bootstrapping and model constraints were used to test indirect effects suggested by the mediation models. An interaction term was added to the standard actor-partner interdependence model to test for moderation effects. RESULTS: More patient comorbidities were associated with lower patient QOL. More caregiver chronic conditions were associated with lower patient and caregiver QOL. Patient comorbidities and caregiver chronic conditions had a negative influence on caregiver meaning-based coping but no significant influence on patient meaning based coping. Caregiver meaning-based coping mediated relationships between patient comorbidities and caregiver health conditions and patient and caregiver QOL. No significant moderating effects were observed. CONCLUSIONS: Despite the severity of advanced cancer for patients and caregivers, the co-existing health problems of one member of the dyad have the potential to directly or indirectly affect the wellbeing of the other. Future research should consider how the number of patient comorbidities and caregiver chronic conditions, as well as the ability of patients and caregivers to manage those conditions, influences their meaning-based coping and wellbeing. Copyright © 2016 John Wiley & Sons, Ltd.

The influence of dyadic symptom distress on threat appraisals and self-efficacy in advanced cancer and caregiving.

PURPOSE: Physical and psychological symptoms experienced by patients with advanced cancer influence their well-being; how patient and family caregiver symptom distress influence each other's well-being is less understood. This study examined the influence of patient and caregiver symptom distress on their threat appraisals and self-efficacy to cope with cancer. METHODS: We conducted a secondary analysis of baseline data from an RCT that enrolled patients with advanced cancer and their family caregivers (N = 484 dyads). Structural equation modeling and the actor-partner interdependence mediation model (APIMeM) were used to examine two models: threat appraisals as a mediator of the relationship between symptom distress and individual and family-related self-efficacy; and, self-efficacy (individual and family dimensions) as mediators of the relationship between symptom distress and threat appraisals. RESULTS: Data suggest the self-efficacy mediation model was the preferred model. More patient and caregiver symptom distress was directly associated with their own lower self-efficacy and more threatening appraisals. Patient and caregiver individual self-efficacy also mediated the relationship between their own symptom distress and threat appraisals. There were also significant interdependent effects. More patient symptom distress was associated with less caregiver family-related self-efficacy, and more caregiver symptom distress was directly associated with more threatening patient appraisals. CONCLUSIONS: Patient and caregiver symptom distress influenced their own and in some cases each other's cognitive appraisals. Limitations of this study include the use of cross-sectional data and assessments of individually-focused (vs. family-focused) threat appraisals. These findings highlight the need to consider the management of patient and caregiver symptoms during advanced cancer.

Engagement in health-promoting behaviors and patient-caregiver interdependence in dyads facing advanced cancer: an exploratory study.

Diet and exercise are important for the wellbeing of people with cancer and their family caregivers. Unfortunately, little is known about their behaviors over time or factors that may influence their engagement in these behaviors. This exploratory study examined the influence of chronic conditions, symptom distress, and perceived social support on exercise and diet behaviors of patients with advanced cancer and their caregivers using the actor-partner interdependence mediation model (APIMeM) and interdependence theory as guiding frameworks. This secondary analysis uses self-report data from a large RCT (N = 484 patient-caregiver dyads) at three time points: baseline data was collected within three months of the diagnosis, at 3 months post-baseline, and 6 months post-baseline. A number of actor effects were observed: patient and caregiver prior exercise and diet were significant predictors of their own future exercise and diet behaviors; more patient-reported social support was associated with less patient exercise; more patient symptom distress was associated with poorer patient diet; and, more caregiver-reported social support was associated with more caregiver exercise and better caregiver diet. Partner effects were also observed: more patient exercise was positively associated with more caregiver exercise; more patient comorbidities were associated with better caregiver diet; more caregiver-reported social support was associated with better patient diet; and, more patient-reported social support was associated with better caregiver diet. Despite the challenges of advanced cancer and caregiving, past exercise and diet behavior remained a significant predictor of future behavior. Other health problems and perceptions of social support within the dyad may exert a positive or negative influence on patient/caregiver diet and exercise.

Family Efficacy within Ethnically Diverse Families: A Qualitative Study.

Family efficacy, which refers to a family's belief in its ability to produce a desired outcome, has been shown to protect adolescents from risky health behaviors. Few studies have examined family efficacy within diverse populations, however, and understanding of how efficacy is framed and formed within the context of cultural and familial values is limited. This descriptive qualitative study examined sources of family efficacy within ethnically and socioeconomically diverse families, evaluating how such families develop and exercise family efficacy with the intent to protect adolescents from risky health behaviors (i.e., marijuana and alcohol use and early sexual activity). We collected qualitative data via two semi-structured interviews, 4-6 months apart, with 31 adolescents (ages 12-14) and their parent/s, for total of 148 one-on-one interviews. Thematic analysis identified three distinct domains of family efficacy: relational, pragmatic, and value-laden. Prior experiences and cultural background influenced the domain/s utilized by families. Significantly, families that consistently tapped into all three domains were able to effectively manage personal and family difficulties; these families also had family strategies in place to prevent adolescents from risky behaviors. Health professionals could utilize this concept of multidimensional family efficacy to promote health within culturally diverse families.

Neighborhood Context and Preterm Delivery among African American Women: the Mediating Role of Psychosocial Factors.

Preterm delivery (PTD), or birth before 37 completed weeks of gestation, is a serious public health issue, and racial disparities persist. In a recently published study, perceptions of the residential environment (or neighborhood context) were associated with PTD rates among urban African American women with low educational attainment (≤12 years); however, the mechanisms of these associations are unknown. Given this gap in the literature, we used data from the Life Influences on Fetal Environments Study of postpartum African American women from Metropolitan Detroit, Michigan (2009-2011; n = 399), to examine whether psychosocial factors (depressive symptomology, psychological distress, and perceived stress) mediate associations between perceptions of the neighborhood context and PTD. Validated scales were used to measure women's perceptions of their neighborhood safety, walkability, healthy food availability (higher=better), and social disorder (higher=more disorder). The psychosocial indicators were measured with the Center for Epidemiologic Studies-Depression Scale, Kessler's Psychological Distress Scale (K6), and Cohen's Perceived Stress Scale. Statistical mediation was assessed using an unadjusted logistic regression-based path analysis for estimating direct and indirect effects. The associations between perceived walkability, food availability, and social disorder were not mediated by psychosocial factors. However, perceptions of neighborhood safety were inversely associated with depressive symptoms which were positively associated with PTD rates. Also, higher perceived neighborhood social disorder was associated with higher PTD rates, net of the indirect paths through psychosocial factors. Future research should identify other mechanisms of the perceived neighborhood context-PTD associations, which would inform PTD prevention efforts among high-risk groups.