Religious service attendance and mortality among older Black men.

Religious institutions have been responsive to the needs of Black men and other marginalized populations. Religious service attendance is a common practice that has been associated with stress management and extended longevity. The objective of this study was to examine the relationship between religious service attendance and all-cause mortality among Black men 50 years of age and older. Data for this study were from NHANES III (1988-1994). The analytic sample (n = 839) was restricted to participants at least 50 years of age at the time of interview who self-identified as Black and male. Mortality was the primary outcome for this study and the NHANES III Linked Mortality File was used to estimate race-specific, non-injury-related death rates using a probabilistic matching algorithm, linked to the National Death Index through December 31, 2015, providing up to 27 years follow-up. The primary independent variable was religious service attendance, a categorical variable indicating that participants attended religious services at least weekly, three or fewer times per month, or not at all. The mean age of participants was 63.6±0.3 years and 36.4% of sample members reported that they attended religious services one or more times per week, exceeding those attending three or fewer times per month (31.7%), or not at all (31.9%). Cox proportional hazard logistic regression models were estimated to determine the association between religious service attendance and mortality. Participants with the most frequent religious service attendance had a 47% reduction of all-cause mortality risk compared their peer who did not attend religious services at all (HR 0.53, CI 0.35-0.79) in the fully adjusted model including socioeconomic status, non-cardiovascular medical conditions, health behaviors, social support and allostatic load. Our findings underscore the potential salience of religiosity and spirituality for health in Black men, an understudied group where elevated risk factors are often present.

Honoring Dr. Shalon Irving, A Champion for Health Equity.

Shalon Irving's 2017 death brought national attention to maternal mortality among Black women in the US. This essay remembers her life and legacy.

Church Attendance and Mobility Limitation Among Black and White Men With Prostate Cancer.

Prostate cancer is a significant impediment that can reduce physical functional status. Mobility is fundamental for quality of life and church attendance to be associated with improved physical functioning. Few studies have examined how religious participation have implications for mobility limitation among men in general and among prostate cancer survivors in particular. The purpose of this study was to assess the association between church attendance and mobility limitation among Black and White prostate cancer patients and survivors. Data for this investigation were drawn from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 804 Black and White men with complete information on the primary outcome and predictor variables. Mobility limitation was the primary outcome variable, and church attendance was the main independent variable. The analytic sample was almost equally divided between Black (N = 382) and White men (N = 422). The proportion of Black men reporting mobility limitation (30.09%) more than doubled the corresponding percentage for White men (14.7%). Black men had a higher proportion of individuals who reported weekly church attendance (49.2% vs. 45.0%). Fully adjusted modified Poisson regression models produced results indicating that respondents attending church weekly had a lower mobility limitation prevalence (PR = 0.56, 95% CI [0.39, 0.81]) than those never attending church. Results from this study contribute to the body of evidence asserting the health benefits of church attendance. These findings suggest that health providers should consider how religion and spirituality can present opportunities for improved outcomes in prostate cancer patients and survivors.

Religious Coping and Quality of Life Among Black and White Men With Prostate Cancer.

Prostate cancer is a significant impediment in men's lives as this condition often exacerbates stress and reduces quality of life. Faith can be a resource through which men cope with health crises; however, few studies examine how religion or spirituality can have implications for racial disparities in health outcomes among men. The purpose of this study is to assess the associations between religious coping and quality of life among black and white men with prostate cancer. Data for this investigation were drawn from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 624 black and white men with complete information on the primary outcome and predictor variables. The primary outcome for this study was overall quality of life as measured by the Functional Assessment of Cancer Therapy-Prostate questionnaire. The main independent variable was religious coping measured by 2 subscales capturing positive and negative forms of coping. Black men in the study had lower overall quality of life scores (134.6 ± 19.6) than their white peers (139.8 ± 14.1). Black men in the sample also had higher average positive religious coping scores (12.9 ± 3.3) than white men (10.3 ± 4.5). Fully adjusted linear regression models of the total sample produced results indicating that positive religious coping was correlated with an increase in quality of life (ß = .38, standard error [SE] = 0.18, P < .05). Negative religious coping was associated with a reduction in quality of life (ß = -1.48, SE = 0.40, P < .001). Faith-oriented beliefs or perceptions can have implications for quality of life among men with prostate cancer. Sensitivity to the role of religion, spirituality, and faith should be seen by providers of health care as potential opportunities for improved outcomes in patients with prostate cancer and survivors.

The Role of Social Support in Moderating the Relationship between Race and Hypertension in a Low-Income, Urban, Racially Integrated Community.

In the US, African Americans have a higher prevalence of hypertension than Whites. Previous studies show that social support contributes to the racial differences in hypertension but are limited in accounting for the social and environmental effects of racial residential segregation. We examined whether the association between race and hypertension varies by the level of social support among African Americans and Whites living in similar social and environmental conditions, specifically an urban, low-income, racially integrated community. Using data from the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) sample, we hypothesized that social support moderates the relationship between race and hypertension and the racial difference in hypertension is smaller as the level of social support increases. Hypertension was defined as having systolic blood pressure greater than 140 mmHg and/or diastolic blood pressure greater than 90 mmHg, or the participant reports of taking antihypertensive medication(s). The study only included participants that self-reported as "Black/African American" or "White." Social support was measured as functional social support and marital status. After adjusting for demographics and health-related characteristics, we found no interaction between social support and race (DUFSS score, prevalence ratio 1.00; 95% confidence interval 0.99, 1.01; marital status, prevalence ratio 1.02; 95% confidence interval 0.86, 1.21); thus the hypothesis was not supported. A plausible explanation is that the buffering factor of social support cannot overcome the social and environmental conditions which the participants live in. Further, these findings emphasize social and environmental conditions of participants in EHDIC-SWB may equally impact race and hypertension.

Overcoming Barriers to Sustaining Health Equity Interventions: Insights from the National Institutes of Health Centers for Population Health and Health Disparities.

We conducted qualitative semi-structured telephone interviews with the directors of the 10 National Institutes of Health Centers for Population Health and Health Disparities (NIH/CPHHD) to identify factors that were associated with the sustainability of 19 interventions developed to address cancer disparities and 17 interventions developed to address cardiovascular disease disparities in the United States. Interview transcripts were analyzed using the constant comparative method of analysis to identify key themes and synthesize findings. Directors at NIH/CPHHD reported that barriers to sustainability included uncertainty about future funding and insufficient resources to build and maintain diverse stakeholder partnerships. Strategies that helped to overcome these barriers included developing and engaging community partnerships with health care systems; early pursuit of multiple funding sources; and investments in infrastructure to address the social determinants of health. Sustainability planning should be incorporated during the early stages of intervention development to facilitate maintenance of successful programs that address health disparities.

Disentangling Race and Place in Depressive Symptoms in Men.

African American men report lower levels of depressive symptoms that their white peers in national data. However, the value of these studies is often undermined by data that confound race, socioeconomic status, and segregation. We sought to determine whether race differences in depressive symptoms were present after minimizing the effects of socioeconomic status and segregation within a cohort of southwest Baltimore (SWB) men using the data from the Exploring Health Disparities in Integrated Communities (EHDIC), a novel study of racial disparities within communities where African American and non-Hispanic white males live together and have similar median incomes. Using the Patient Health Questionnaire, a standard instrument for assessing mental disorders, we categorized participants as experiencing depressive symptoms (including depressive syndrome and major depression) or not experiencing depressive symptoms. Logistic regression was performed to examine the association between depressive symptoms and race in EHDIC-SWB, adjusting for age, marital status, income, education, insurance, physical inactivity, current smoking or drinking status, poor/fair health, hypertension, heart disease, diabetes, stroke, and obesity. Of the 628 study participants, 12.6% of white men and 8.6% of African American men reported depressive symptoms. African American males had similar odds of reporting depressive symptoms (odds ratio = 0.61, 95% confidence interval = 0.34-1.11) as compared with white men. Within this low-income urban racially integrated community, race differences in depressive symptoms among men were not observed. This finding suggests that social and environmental conditions may impact the race differences in depressive symptoms.

Community Engagement to Address Cancer Health Disparities: A Process EVALUATION using the Partnership Self-Assessment Tool.

BACKGROUND: African Americans suffer disproportionately from cancer health disparities, and population-level prevention is needed. OBJECTIVES: A community-academic partnership to address cancer health disparities in two predominately African American jurisdictions in Maryland was evaluated. METHODS: The Partnership Self-Assessment Tool (PSAT) was used in a process evaluation to assess the partnership in eight domains (partnership synergy, leadership, efficiency, management, resources, decision making, participation, and satisfaction). RESULTS: Mean scores in each domain were high, indicative of a functional and synergistic partnership. However, scores for decision making (Baltimore City's mean score = 9.3; Prince George's County's mean score = 10.8; p = .02) and participation (Baltimore City's mean score = 16.0; Prince George's County's mean score = 18.0; p = .04) were significantly lower in Baltimore City. CONCLUSIONS: Community-academic partnerships are promising approaches to help address cancer health disparities in African American communities. Factors that influence decision making and participation within partnerships require further research.

Web-based versus in-person methods for training lay community health advisors to implement health promotion workshops: participant outcomes from a cluster-randomized trial.

Project HEAL (Health through Early Awareness and Learning) is an implementation trial that compared two methods of training lay peer community health advisors (CHAs)-in-person ("Traditional") versus web-based ("Technology")-to conduct a series of three evidence-based cancer educational workshops in African American churches. This analysis reports on participant outcomes from Project HEAL. Fifteen churches were randomized to the two CHA training methods and the intervention impact was examined over 24 months. This study was conducted in Prince George's County, MD, and enrolled 375 church members age 40-75. Participants reported on knowledge and screening behaviors for breast, prostate, and colorectal cancer. Overall, cancer knowledge in all areas increased during the study period (p < .001). There were significant increases in digital rectal exam (p < .05), fecal occult blood test (p < .001), and colonoscopy (p < .01) at 24 months; however, this did not differ by study group. Mammography maintenance (56% overall) was evidenced by women reporting multiple mammograms within the study period. Participants attending all three workshops were more likely to report a fecal occult blood test or colonoscopy at 24 months (p < .05) than those who attended only one. These findings suggest that lay individuals can receive web-based training to successfully implement an evidence-based health promotion intervention that results in participant-level outcomes comparable with (a) people trained using the traditional classroom method and (b) previous efficacy trials. Findings have implications for resources and use of technology to increase widespread dissemination of evidence-based health promotion interventions through training lay persons in community settings.

A mixed methods exploratory assessment of the usefulness of Baltimore City Health Department's trauma-informed care training intervention.

Youth exposure to trauma is a significant public health problem in the United States, particularly in urban areas. Although trauma-informed care (TIC) training of service providers to address this challenge is increasing nationwide, we lack empirical evidence regarding the feasibility and acceptability of cross-organizational TIC training, including perspectives of training participants. The purpose of our study was to evaluate participating service providers' self-reported changes in knowledge about trauma, attitudes toward traumatized individuals, and beliefs in their capacity to provide referrals to trauma services after completion of the TIC intervention. Intervention participants represented a range of service sectors, including government health and education agencies, social services, law enforcement, as well as nonprofits. Participants completed a pre-post quantitative survey assessing TIC-related knowledge, attitudes, and beliefs (N = 88). A subset of participants was interviewed using a semistructured interview format (n = 16). Mixed methods were used to evaluate the intervention's impact on participants' knowledge about trauma and to understand participants' experience in the training. Quantitative results revealed significant improvements in TIC-related knowledge and attitudes. Five themes emerged from qualitative analysis of interviews: the intervention provided a framework for understanding TIC; useful lessons were learned from other participants; there was a need for outreach to upper-level management; real-life applicability was lacking; and guidance regarding next steps was wanting. Study findings suggest the training may be a starting point for enhancing service providers' capacity to address traumatized youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Association Between Happiness and Self-Rated Physical Health of African American Men: A Population-Based Cross-Sectional Study.

Happiness and self-rated physical health are included in national surveys to assess health perceptions and subjective well-being among individuals. Studies have reported that happiness impacts physical health; however, little is known about the association between happiness and self-rated physical health among African American men (AAM). The objective of this study is to examine this relationship. Participants were 1,263 AAM aged 18+ years from the National Survey of American Life who rated their happiness and physical health. Interviews were conducted between 2001 and 2003. Self-rated physical health was defined as how individuals rated their own physical health and happiness as how individuals perceived their subjective well-being. Three multivariate logistic regression models were used to examine the relationships between happiness and self-rated physical health. It was observed that AAM who were happy were more likely to be married, to be employed, and earn more than $30,000 annually compared to AAM who were not happy. AAM who were happy were less likely to rate their physical health as fair/poor relative to AAM who were not happy. When controlling for demographic and socioeconomic factors, AAM who reported being happy had lower odds of rating their physical health as fair/poor compared to AAM who reported not being happy. Findings suggest that AAM who are happy report better physical health than those who report not being happy. Public health promotion strategies focusing on AAM should consider happiness as a promising influence that may positively impact physical health.

Novel Methods for Environmental Assessment of Pedestrian Injury: Creation and Validation of the Inventory for Pedestrian Safety Infrastructure.

Nationally, 80% of pedestrian fatalities occur in urban environments, yet the distribution of injuries across urban areas is not uniform. Identifying street-level risk factors for pedestrian injury is essential for urban planning and improvement projects, as well as targeted injury prevention efforts. However, creating and maintaining a comprehensive database of a city's traffic safety infrastructure can be cumbersome and costly. The purpose of this study was to create and validate a neighborhood environmental observational assessment tool to capture evidence-based pedestrian safety infrastructure using Google Street View (GSV)-The Inventory for Pedestrian Safety Infrastructure (IPSI). We collected measures in-person at 172 liquor stores in Baltimore City from June to August 2015 to assess the tool's reliability; we then collected IPSI measures at the same 172 locations using GSV from February to March 2016 to assess IPSI reliability using GSV. The majority of items had good or excellent levels of inter-rater reliability (ICC ≥ 0.8), with intersection features showing the highest agreement across raters. Two scales were also developed using exploratory factor analysis, and both showed strong internal consistency (Cronbach's alpha ≥ 0.6). The IPSI provides a valid, economically efficient tool for assessing pedestrian safety infrastructure that can be employed for a variety of research and urban planning needs. It can also be used for in-person or GSV observation. Reliable and valid measurement of pedestrian safety infrastructure is essential to effectively prevent future pedestrian injuries.

Race disparities in cardiovascular disease risk factors within socioeconomic status strata.

PURPOSE: Racial differences in socioeconomic status (SES) explain some, but not all, of racial disparities in cardiovascular disease (CVD) risk. To address this, race disparities among higher SES individuals need to be assessed. The purpose of this study was to assess whether racial disparities in CVD risk factors differ by SES levels. METHODS: Data from the National Health and Nutritional Examination Survey 2007-2014 were used to calculate racial differences in hypertension, high cholesterol, diabetes, and obesity. Interactions between race and SES were assessed. RESULTS: African Americans had higher odds of hypertension (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.72-2.09), diabetes (OR, 1.66; 95% CI, 1.33-2.07), and obesity (OR, 1.64; 95% CI, 1.46-1.83) than whites. Significant interactions between race and income greater than or equal to $100,000 were observed for obesity (OR, 1.55; 95% CI, 1.24-1.94) and between race and education (college graduate or more; OR, 1.58; 95% CI, 1.16-2.15). Disparities in diabetes were observed in the highest SES groups, but not among those in the lowest SES groups. CONCLUSIONS: Race disparities in some CVD risk factors varied by SES levels. Results suggest that race disparities in obesity are larger among those with income greater than or equal to $100,000 and who are college graduates. It is possible that African Americans experience fewer health-related benefits of increased income and education levels compared with whites.

B'More Fit for Healthy Babies: Using Trauma-Informed Care Policies to Improve Maternal Health in Baltimore City.

BACKGROUND: Pregnant obese women have an increased risk for infant mortality and poor maternal outcomes. Environmental and social conditions pose barriers for less-advantaged overweight women to participate in weight loss interventions. The B'more Fit for Healthy Babies Program aimed to address existing gender inequities that persist where exposure to community-level trauma is present. METHODS: A gender-based analysis using qualitative and quantitative approaches informed B'more Fit's intervention and identified opportunities for trauma-informed care policies. Key data sources for analyses included two series of focus groups and a quantitative survey. Review of additional Baltimore-based literature and research also informed policy development. RESULTS: A workgroup formulated policies for B'more Fit staff and participants. Policies involved technical assistance, staff consultation, and gender-sensitive counseling sessions. These activities gained the attention of the Baltimore City Health Department's leadership, and department-wide trainings were conducted. Highly publicized violence in Baltimore led to expanded trauma-informed care training and policy development in all local government agencies through a partnership between the Baltimore City Health Department and Behavioral Health Systems Baltimore, Inc. CONCLUSIONS: The development and monitoring of trauma-informed interventions and policies within governmental and human service agencies can counterbalance social and environmental exposures. Applying a gender-based and trauma-informed program provided B'more Fit participants with strategies for weight loss, improved nutrition, and better parenting. Coordinated policies and interventions are underway in city institutions to address residents' behavioral health needs and improve citywide services.

Motivators, Barriers, and Facilitators to Weight Loss and Behavior Change Among African American Adults in Baltimore City: A Qualitative Analysis.

BACKGROUND: African American adults achieve smaller amounts of weight loss than their white counterparts when exposed to the same intervention and are more likely to regain weight during long-term follow-up. OBJECTIVE: To identify perceived motivators, barriers, and facilitators to weight loss and behavior change among African American adults. METHODS: Two focus groups were conducted between April and May 2015 at an urban community health center in Baltimore City, Maryland. A total of 13 participants took part in the discussions. Eligible participants were obese (BMI 30+) African American adults aged 21-70 who had at least one obesity-related comorbidity. Discussion questions were designed to identify the personal, social, and environmental factors that influence weight loss and behavior change among urban minority populations. RESULTS: Statements were first classified as a motivator, barrier, or facilitator, then divided further as a personal, social, or environmental factor influencing weight loss and behavior change. Among the findings, several novel motivators (reducing or eliminating medication, improving physical intimacy) and barriers (personal transportation, lack of access to scales) emerged that were not previously characterized in the existing literature. CONCLUSIONS: This study was intended to provide preliminary evidence that may be used to guide the development of innovative and culturally relevant weight-loss interventions in the future. Results are applicable to similar urban minority populations.

Intensity of exposure to a patient activation intervention and patient engagement in medical visit communication.

OBJECTIVE: We examined associations between intensity of exposure to a community health worker (CHW) delivered communication activation intervention targeting low-income patients with hypertension. METHODS: We analyzed question-asking behaviors of patients assigned to the intervention arms (n=140) in a randomized controlled trial. Intensity of exposure to the intervention was operationalized as the duration of face-to-face coaching and number of protocol-specified topics discussed. Mixed effects models characterized the relationship between intensity of exposure and patients' communication in a subsequent medical visit. RESULTS: The number of topics discussed during the coaching session was positively associated with patients' asking psychosocial-related questions during their visit. The duration of the coaching session was positively associated with patients' use of communication engagement strategies to facilitate their participation in the visit dialogue. Exposure to a physician trained in patient-centered communication did not influence these relationships. CONCLUSIONS: A dose-response relationship was observed between exposure to a CHW- delivered communication activation intervention and patient-provider communication. PRACTICE IMPLICATIONS: This study supports the use of CHWs in activating patients toward greater communication in the therapeutic exchange.

Differences in Obesity Among Men of Diverse Racial and Ethnic Background.

Racial/ethnic disparities exist in obesity prevalence among men, with Hispanic men exhibiting the highest prevalence compared with non-Hispanic White and non-Hispanic Black men. Most studies do not parse out Hispanic groups; therefore, it is unclear whether the increases in obesity rates among Hispanic men applies to all groups or if there are particular groups of Hispanic men that are driving the increase. The goal of this study is to examine the variations in obesity among men of diverse racial/ethnic backgrounds and determine if obesity is affected by nativity. The data used in this study were from 11 years (2002-2012) of the National Health Interview Survey. Logistic regression was used to examine the relationship between race/ethnicity, obesity, and nativity. After adjusting for covariates, there are differences in obesity prevalence, with the largest prevalence among Puerto Rican men and Mexican American men. Consistent with previous literature, it has been suggested that men born in the United States are more likely to be obese than men born outside the United States. This study underscores the importance of distinguishing Hispanic groups when examining obesity, and provides information for future, targeted intervention strategies related to obesity among high-risk groups.

Ethnic Group Differences in Health Outcomes Among Asian American Men in California.

The numbers of Asian American men are continually increasing, yet limited research exists on this understudied population. Addressing this lack of research is necessary to better inform how best to improve quality of care. This study examined health outcome differences across ethnically diverse groups of Asian American men in California, compared with non-Hispanic White men. Using data from the 2007, 2009, and 2011-2012 California Health Interview Survey, distributions of health status and health-related characteristics across ( n = 43,030) racial/ethnic groups of men (Chinese, Japanese, Korean, Filipino, Vietnamese, Other Asian Americans, and non-Hispanic Whites) were calculated. Compared with non-Hispanic Whites, odds of reporting fair or poor health were higher among Vietnamese, while odds of diabetes were higher among Korean, Filipino, and Other Asian Americans. Odds of high blood pressure were higher among Filipino and Vietnamese but lower among Other Asian Americans, while odds of disability were lower across all ethnic groups except Filipino and Vietnamese. This study's findings highlight the importance of understanding ethnic heterogeneity to develop culturally appropriate health interventions for Asian American men.

The Influence of Religious Attendance on Smoking Among Black Men.

BACKGROUND: Cigarette smoking poses a major public health problem that disproportionately affects Blacks and men. Religious attendance has been shown to be positively associated with health promotion and disease prevention among the Black population. In light of this evidence, this study examined if a similar relationship could be found for religious attendance and smoking in Black men. METHODS: The National Survey of American Life (NSAL) study sampled 1,271 African American men and 562 Black Caribbean men. Multivariate logistic regression was used to determine the association between religious attendance and cigarette smoking. RESULTS: After adjusting for age, marital status, household income, education, foreign born status, importance of prayer and major stress, men who reported attending religious services almost every day (odds ratio (OR) = 0.21, 95% confidence interval (CI) = 0.07, 0.62) and weekly (OR = 0.47, 95% CI = 0.29, 0.77) had lower odds of being a current smoker compared to men who reported never attending religious services. Conclusions/Importance: Findings suggest a health benefit in attending religious services on cigarette smoking among Black men in a nationally representative sample. In spite of lower church attendance in Black men in general, our results demonstrate that religious service attendance may still serve as a buffer against cigarette use. Given the emergent attention on faith-based health promotion among men, this conclusion is relevant and timely.