Inequities in the distribution of adverse childhood experiences and their association with health among transgender people of color.

BACKGROUND: Racism and cisgenderism expose transgender people of color to adversity across the life course. However, little is known about the prevalence of adverse childhood experiences (ACEs) in this population or their association with health in comparison to other groups. OBJECTIVE: Guided by the structural trauma framework, we examined race/ethnicity/gender group differences in the prevalence of ACEs and their association with adult mental and physical health. PARTICIPANTS AND SETTING: 2019-2021 Behavioral Risk Factor Surveillance Survey. METHODS: Transgender participants (n = 551) were matched with two cisgender men (n = 1102) and two cisgender women (n = 1102) on key covariates. We compared age-adjusted predicted probabilities of nine ACEs by race/ethnicity/gender group. We then fit adjusted logistic regression models predicting poor mental and physical health by each ACE and compared marginal effects between groups. RESULTS: Transgender people of color had higher age-adjusted probabilities of six ACEs than at least one other group; for example, household incarceration was 0.16 (95 % CI: 0.11-0.22) compared to 0.09 (95 % CI: 0.06-0.13) for cisgender men of color (p = 0.032). The relationship between five ACEs and poor mental health was greater for transgender people of color than at least one other group. For instance, the marginal effect of household alcoholism on poor mental health was 0.28 (95 % CI: 0.11-0.45) compared to 0.07 (0.01-0.14) for White cisgender men (p = 0.031). There were no statistically significant differences regarding effects on poor physical health. CONCLUSIONS: ACEs inequitably impact transgender people of color, reflecting the need to restructure the interlocking systems that drive adversity among transgender children of color and exacerbate ACEs' health effects among adults.

James S. Jackson and the program for research on Black Americans: Contributions to psychology and the social sciences.

James S. Jackson (1944-2020) is remembered as a groundbreaking social psychologist whose career contributions in scholarship, research, and service were fundamental to the field of psychology. This article briefly outlines his career-long work and contributions. A strong believer in interdisciplinary work, his research spanned other related social science disciplines (e.g., sociology, political science), as well as health and social welfare professions (public health, social work, medicine). As the founding director of the Program for Research on Black Americans at the Institute for Social Research, James Jackson initiated and led a long-standing program with a dual focus on research and training and mentoring doctoral students, postdoctoral scholars, and early career scientists. Jackson's efforts in the development of several nationally representative surveys of the Black population in the United States (e.g., National Survey of Black Americans, National Survey of American Life) revolutionized research focusing on the lives of Black Americans. James Jackson's international influence and reputation included numerous prestigious positions within national science organizations and honors and awards for his scientific contributions. Among James S. Jackson's most enduring legacies is the vast network of current scientists, researchers, and academics who were trained under his direction and leadership. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Racial and Ethnic Differences in Major and Everyday Discrimination Among Older Adults: African Americans, Black Caribbeans, and Non-Latino Whites.

OBJECTIVES: This study examined differences in major and everyday discrimination between African Americans, Black Caribbeans, and non-Latino White older adults. METHODS: Data are taken from the National Survey of American Life. Measures of major (e.g., unfairly fired and harassed by police) and everyday (e.g., treated with less courtesy, insulted, and followed in stores) discrimination were examined. RESULTS: Both African Americans and Black Caribbeans reported more major and everyday discrimination than non-Latino Whites. However, there were no significant differences between African Americans and Whites with regards to being fired, neighbors making life difficult and receiving poor service. There were no significant differences between African Americans and Black Caribbeans in major or everyday discrimination. DISCUSSION: The discussion notes the importance of examining racial as well as within group ethnic differences within the Black American population in the types of discrimination. It also notes the importance of examining indicators of both major and everyday discrimination.

The Intersection of Pain Outcomes and Social Isolation Among African Americans.

There is increasing evidence suggesting the influence social isolation has on health outcomes and mental well-being. Chronic medical conditions, such as pain, have been shown to impact social relationships and isolation among majority populations, but there is little evidence documenting this relationship among African Americans. To address this lack of scholarly work, the current study aimed to examine subjective and objective social isolation, pain interference with daily life, and problems with pain in a sample of African American adults 18 + years of age. Taken from the National Survey of American Life: Coping with Stress in the 21st Century (NSAL), results showed that participants who were objectively isolated from family only were more likely to have a chronic health problem that was associated with increased pain. Data further showed that those reporting subjective isolation from both family and friends experienced greater interference from pain than those who were not isolated from family and friends. Findings from this study acknowledge a larger issue that addresses the impact social isolation has on health, quality of life, and general well-being. Recognizing the influence of such may allow systems to acknowledge the determinants that perpetuate social isolation, while still recognizing the needs of marginalized groups.

Older Black Americans During COVID-19: Race and Age Double Jeopardy.

The concept of "double jeopardy"-being both older and Black-describes how racism and ageism together shape higher risks for coronavirus exposure, COVID-19 disease, and poor health outcomes for older Black adults. Black people and older adults are the two groups most affected by COVID-19 morbidity and mortality. Double jeopardy, as a race- and age-informed analysis, demonstrates how Black race and older age are associated with practices and policies that shape key life circumstances (e.g., racial residential segregation, family and household composition) and resources in ways that embody elevated risk for COVID-19. The concept of double jeopardy underscores long-standing race- and age-based inequities and social vulnerabilities that produce devastating COVID-19 related deaths and injuries for older Black adults. Developing policies and actions that address race- and age-based inequities and social vulnerabilities can lower risks and enhance protective factors to ensure the health of older Black Americans during the COVID-19 pandemic.

Moving Health Education and Behavior Upstream: Lessons From COVID-19 for Addressing Structural Drivers of Health Inequities.

In this Perspective, we build on social justice and emancipatory traditions within the field of health education, and the field's long-standing commitment to building knowledge and shared power to promote health equity, to examine lessons and opportunities for health education emerging from the COVID-19 pandemic. Examining patterns that emerged as the pandemic unfolded in Metropolitan Detroit, with disproportionate impacts on African American and low-income communities, we consider conditions that contributed to excess exposure, mortality, and reduced access to critical health protective resources. Using a life course framework, we consider enduring impacts of the pandemic for health equity. Finally, we suggest several strategic actions in three focal areas-environment, occupation, and housing-that can be taken by health educators working in partnership with community members, researchers, and decision makers, using, for example, a community-based participatory research approach, to reduce adverse impacts of COVID-19 and promote long-term equity in health.

Social isolation from family and friends and mental health among African Americans and Black Caribbeans.

Social isolation is a significant social problem in the United States that many health and welfare organizations have begun to acknowledge and address. Unfortunately, extremely little research focuses on social isolation among ethnic minority populations. This study investigated the association between social isolation from family and friends and the mental health of African Americans and Black Caribbeans. Using data from the National Survey of American Life (2001-2003), we explore 2 indicators of mental health: depressive symptoms (CES-D) and serious psychological distress (Kessler 6). The negative binomial regression analysis examined both objective isolation (infrequent contact) and subjective isolation (lack of emotional closeness) from family and friends. Overall study findings indicated that infrequent contact (objective social isolation) and diminished emotional closeness (subjective social isolation) from family and friends were associated with higher levels of depressive symptoms and serious psychological distress for both African Americans and Black Caribbeans. The addition of subjective social isolation to regression models attenuated the association between objective social isolation and depressive symptoms for both groups. However, the addition of subjective social isolation attenuated the association between serious psychological distress for African Americans but not for Black Caribbeans. These findings contribute to the very limited, but growing body of research on the negative association between social isolation and the mental and physical health of ethnic minorities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Professional service use among older African Americans, Black Caribbeans, and Non-Hispanic Whites for serious health and emotional problems.

This study examined racial and ethnic differences in professional service use by older African Americans, Black Caribbeans, and Non-Hispanic Whites in response to a serious personal problem. The analytic sample (N = 862) was drawn from the National Survey of American Life. Findings indicated that African Americans and Black Caribbeans were less likely to use services than Whites. Type and race of providers seen varied by respondents' race and ethnicity. Among respondents who did not seek professional help, reasons for not seeking help varied by ethnicity. Study findings are discussed in relation to practice implications.

Everyday Discrimination Typologies Among Older African Americans: Gender and Socioeconomic Status.

OBJECTIVES: Discrimination is associated with several negative social, economic, and health consequences. Past research focuses on the impact of discrimination while less is known about both the type and correlates of discrimination, particularly among older adults. METHODS: Using the National Survey of American Life, we used latent class analysis to identify discrimination typologies (frequency and type) among African Americans aged 55 and older. We then used multinomial logistic regression to identify demographic correlates of discrimination types, including a statistical interaction between gender and educational attainment. RESULTS: We identified three discrimination typologies. Increasing age was associated with lower probability of belonging to the high discrimination and disrespect and condescension subtypes. Men and non-Southern residents were most likely to belong in the high discrimination subtype. Higher levels of education increased the probability of belonging in the high discrimination and disrespect and condescension subtypes for older men, but not women. DISCUSSION: Older African American men, particularly those with more education, are vulnerable to both high-frequency discrimination and discrimination characterized by disrespect and condescension. This finding suggests that, for men with more years of education, increased exposure to discrimination reflects efforts to maintain social hierarchies (male target hypothesis).

A Person-Centered Approach to the Study of Black Adolescent Religiosity, Racial Identity, and Sexual Initiation.

Decreasing the number of adolescents who have never had sexual intercourse is one way to address sexual health disparities. We used intersectionality to explore the joint effects of religiosity and racial identity on Black adolescent sexual initiation. Data originated from the National Survey of American Life-Adolescent (n = 1,170), a nationally representative study of Black adolescents. Latent profile analysis and survival analysis were used to evaluate study hypotheses. Results showed four distinct profiles of religiosity and racial identity. These profiles explained 19% of the variability in sexual initiation. Additional analyses revealed sociodemographic differences in profile membership. Findings contribute to understanding ethnic heterogeneity among Black adolescents and racial identity and religiosity as sociocultural factors that influence sexual initiation; and support reconceptualizing Black adolescent religiosity.

Prevalence and correlates of everyday discrimination among black Caribbeans in the United States: the impact of nativity and country of origin.

OBJECTIVES: Black Caribbeans in the United States have been the victims of major discrimination (e.g. unfairly fired, denied a promotion, denied housing). What is not known is the degree to which they also experience more routine forms of everyday discrimination such as receiving poor restaurant service, being perceived as dishonest, and being followed in stores. This paper investigates the distribution and correlates of everyday discrimination among a national sample of black Caribbeans in the U.S. DESIGN: This analysis used the black Caribbean sub-sample (n = 1,621) of the National Survey of American Life. Demographic and immigration status correlates of ten items from the Everyday Discrimination Scale were investigated: being treated with less courtesy, treated with less respect, receiving poor restaurant service, being perceived as not smart, being perceived as dishonest, being perceived as not as good as others, and being feared, insulted, harassed, or followed in stores. RESULTS: Roughly one out of ten black Caribbeans reported that, on a weekly basis, they were treated with less courtesy and other people acted as if they were better than them, were afraid of them, and as if they were not as smart. Everyday discrimination was more frequent for black Caribbeans who were male, never married, divorced/separated, earned higher incomes, and who were second or third generation immigrants. Black Caribbeans attributed the majority of the discrimination they experienced to their race. CONCLUSION: To our knowledge, this is the first study to provide an in-depth investigation of everyday discrimination among the black Caribbean population. It provides the frequency, types and correlates of everyday discrimination reported by black Caribbeans in the United States. Understanding the frequency and types of discrimination is important because of the documented negative impacts of everyday discrimination on physical and mental health.

Race and Objective Social Isolation: Older African Americans, Black Caribbeans, and Non-Hispanic Whites.

OBJECTIVES: Social isolation is a major risk factor for poor physical and mental health among older adults. This study investigates the correlates of objective social isolation among older African Americans, Black Caribbean immigrants, and non-Hispanic Whites. METHODS: The analysis is based on the older subsample (n = 1,439) of the National Survey of American Life. There are eight indicators of objective social isolation: no contact with neighbors, neighborhood groups, friends, family members, religious congregation members, not being married and no romantic involvement, living alone, and not being a parent. RESULTS: Very few older Americans are socially isolated from family and friends. Non-Hispanic Whites are more likely than both African Americans and Black Caribbeans to live alone, to be childless, and have limited contact with religious congregation members. For both African Americans and Black Caribbeans, being female is protective against social isolation, but for both populations, men are more likely to be married or have a romantic partner. For African Americans, residing in the South is also protective against social isolation. DISCUSSION: This analysis provides greater clarity on racial and ethnic differences in social isolation among older adults, as well as within-group differences in objective social isolation among African Americans and Black Caribbeans.

Depressive symptoms and psychological distress among rural African Americans: The role of material hardship and self-rated health.

BACKGROUND: Despite experiencing conditions associated with higher risk for depression and psychological distress, the mental health of rural African Americans remains understudied. This brief report examines the association between sociodemographic characteristics, self-rated health, and material hardship, and depressive symptoms and psychological distress among rural African Americans. METHOD: Data are from the rural African American subsample (N = 250) of the National Survey of American Life (NSAL; 2001-2003). The Center for Epidemiological Studies-Depression Scale (CES-D) was used to assess depressive symptoms. Psychological distress was measured using the Kessler 6 (K6). Negative binominal regression analyses were performed. RESULTS: Rural African Americans reporting more material hardship and poorer self-rated physical health had higher levels of depressive symptoms and psychological distress compared to counterparts with less hardship and better self-rated health. Findings also suggest rural African American women had more depressive symptoms compared to male peers. Older rural African Americans and African Americans with fewer years of education had more symptoms of psychological distress than their respective counterparts. LIMITATIONS: Though the NSAL represents the only national probability survey on African Americans' mental health; the timeliness of the data, collected between 2001 and 2003 is a limitation. CONCLUSIONS: Material hardship and worse self-rated health emerged as risk factors for depression and psychological distress among this population. This suggests the need for systems of care and integrated healthcare models across service providers within rural African American communities to promote adequate screening, intervention, and referrals related to economic, physical, and mental health needs.

Discrimination Fully Mediates the Effects of Incarceration History on Depressive Symptoms and Psychological Distress Among African American Men.

AIM: Using a nationally representative sample of African American men, this study investigated the associations between lifetime history of incarceration, discrimination, and mental health (e.g., depressive symptoms and psychological distress). We hypothesized that discrimination would fully mediate the association between incarceration history and mental health outcomes among African American men. METHODS: Using a cross-sectional design, our analysis included 1271 African American men who participated in the National Survey of American Life (NSAL), 2001-2003. Incarceration history was the main independent variable. Depressive symptoms and psychological distress were the dependent variables. Everyday discrimination was the mediator. Age, education, and income were covariates. Structural equation models (SEMs) were used for data analysis. RESULTS: Among African American men, incarceration history was positively associated with perceived discrimination, depressive symptoms, and psychological distress. Everyday discrimination fully mediated the associations between incarceration history and both depressive symptoms and psychological distress. CONCLUSION: Discrimination may play an important role in the mental health problems of African American men with a history of incarceration. These findings have public policy implications as well as clinical implications for mental health promotion of African American men. Policies that reduce preventable incarceration or at least reduce subsequent discrimination for those who have been incarcerated may enhance mental health of previously incarcerated African American men.

Professional Service Use for a Serious Personal Problem: Comparing Older African Americans, Black Caribbeans, and Non-Hispanic Whites Using the National Survey of American Life.

OBJECTIVES: Examines combinations of professionals visited for a serious personal problem. METHOD: The sample includes those aged 55 and above (N = 862) from the National Survey of American Life (NSAL). Latent class analysis was used to identify groups of respondents based on types of professionals visited. Multinomial logistic regression was used to identify factors associated with group membership. RESULTS: Classes included health provider plus clergy, physician plus mental health provider, and limited provider use. Whites were more likely than African Americans to fall into the health provider plus clergy and physician plus mental health provider classes. Those with physical and emotional problems were more likely to be in the health provider plus clergy and physician plus mental health provider classes, respectively. DISCUSSION: Most respondents were in the limited provider use class suggesting that for many problems, minimal professional help is utilized. Physicians and clergy were important across all three classes.

Suicide, negative interaction and emotional support among black Americans.

OBJECTIVES: This study is the first to investigate the relationship between perceived emotional support and negative interaction with family members and suicide ideation and attempts among African American and Caribbean black adults. METHOD: Cross-sectional epidemiologic data from the National Survey of American Life and multivariable logistic regression analyses were used to examine the association between perceived emotional support and negative interaction and suicide behaviors among 3,570 African Americans and 1,621 Caribbean blacks age 18 and older. RESULTS: Multivariate analyses found that perceived emotional support was associated with lower odds of suicide ideation and attempts for African Americans and Caribbean blacks. Negative interaction with family was associated with greater odds of suicide ideation among African Americans and Caribbean blacks. Ethnicity moderated the impact of emotional support and negative interaction on suicide attempts; among Caribbean blacks, those who reported more frequent emotional support from their family had a significantly greater reduced risk for suicide attempts than African Americans. The effect of negative interaction on suicide attempts was also more pronounced for Caribbean blacks compared to African Americans. DISCUSSION: Negative interaction was a risk factor for suicide ideation and emotional support was a protective factor for attempts and ideation. These associations were observed even after controlling for any mental disorder. The findings demonstrate the importance of social relationships as both risk and protective factors for suicide and ethnic differences in suicidal ideation and attempts among black Americans.

Church-based social support and suicidality among African Americans and Black Caribbeans.

This study explores the relationship between church-based informal social support and lifetime prevalence of suicide ideation and attempts within a representative national sample of African American and Black Caribbean adults. Characteristics of church-based social support networks, as well as emotional support and negative interaction with church members were examined in relation to lifetime suicide ideation and attempts. This study used data from the National Survey of American Life (2001-2003). Frequency of interaction with church members was positively associated with suicide attempts, while subjective closeness to church members was negatively associated with suicide ideation. Emotional support, service attendance, and negative interaction with church members were unrelated to both suicide ideation and attempts. Findings are discussed in relation to research on church-based support networks, different models linking church support and suicidality, and the mechanisms by which church-based networks deter suicide ideation and attempts.

Prevalence and sociodemographic correlates of spiritual healer use: findings from the National Survey of American Life.

OBJECTIVES: This study investigates sociodemographic and health-related correlates of use of a spiritual healer for medical help. A large national, multiracial-multiethnic data source permits a more comprehensive investigation than was possible in previous studies. It also enables a closer focus on socioeconomic disadvantage and health need as determinants of utilization. DESIGN AND SETTING: Respondents are from the National Survey of American Life: Coping with Stress in the 21st Century (NSAL), a nationally representative multi-stage area-probability survey of U.S. adult African Americans, Caribbean Blacks, and non-Hispanic Whites conducted from 2001 to 2003. The sample contains 6082 adults aged 18 and over. MAIN OUTCOME MEASURES: NSAL respondents were surveyed about lifetime use of alternative providers for medical care or advice. Response categories included two types of spiritual healers: faith healers and psychics. These outcomes were logistically regressed, separately, onto 10 sociodemographic or health-related indicators: race/ethnicity, age, gender, marital status, education, household income, region, medical care use, insurance coverage, and self-rated health. RESULTS: Lifetime utilization of a faith healer is more prevalent among respondents in good health and less prevalent among Caribbean Blacks and never married persons. Users of a psychic healer are more likely to be educated, residents of the Northeast or West, and previously married, and less likely to report excellent health. CONCLUSIONS: Use a spiritual healer is not due, on average, to poor education, marginal racial/ethnic or socioeconomic status, dire health straits, or lack of other healthcare options. To some extent, the opposite appears to be true. Use of a spiritual healer is not associated with fewer social and personal resources or limitations in health or healthcare.

Use of ministers for a serious personal problem among African Americans: findings from the national survey of American life.

This study examined use of ministers for assistance with a serious personal problem within a nationally representative sample of African Americans (National Survey of American Life-2001-2003). Different perspectives on the use of ministers-social stratification, religious socialization, and problem-oriented approach-were proposed and tested using logistic regression analyses with demographic, religious involvement, and problem type factors as predictors. Study findings supported religious socialization and problem-oriented explanations indicating that persons who are heavily invested in religious pursuits and organizations (i.e., women, frequent attenders) are more likely than their counterparts to use ministerial assistance. Contrary to expectations from the social stratification perspective, positive income and education effects indicated that higher status individuals were more likely to report use of ministers. Finally, problems involving bereavement are especially suited for assistance from ministers owing to their inherent nature (e.g., questions of ultimate meaning) and the extensive array of ministerial support and church resources that are available to address the issue.