Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: A latent class approach.

BACKGROUND: The purpose of this study includes: 1) identifying classes of substance-related needs among Black women, and 2) examining the effect of substance-related need classes and culturally-relevant factors on Black women's use of substance use disorder (SUD) treatment and mutual support groups. METHODS: As part of a longitudinal cohort study, Black women were recruited in prison nearing release, on probation, and in the community without involvement in the criminal legal system (CLS, n=565) and followed-up at 18-months. We conducted a baseline latent class analysis of substance-related needs among Black women. Logistic regression models adjusted for culturally-relevant factors to predict the use of treatment and frequency of mutual support group participation over 18-months among Black women who use drugs. RESULTS: Four classes by level of needs were found: low, daily marijuana use, high mental health, and high comorbidity. During the 18-month follow-up, women characterized by the high comorbidity need class and with higher scores of religious well-being were more likely to frequently participate in mutual support groups. Non-CLS-involved women were less likely to engage with both treatment and mutual support groups than women from the prison sample at 18-months. CONCLUSIONS: This study highlights four distinct classes of substance-related needs among Black women, highlighting the complex patterns of behavior and within-racial group differences among Black women. Black women with high comorbidity needs were more likely to participate in mutual support groups, but the latent classes did not predict SUD treatment indicating other non-medical and social contextual need factors may be at play.

Racial and Ethnic Disparities in Mental Health and Mental Health Care During The COVID-19 Pandemic.

During the pandemic, the overall mental health of the US population declined. Given higher rates of COVID-19 infections and deaths experienced by communities of color along with greater exposure to pandemic-related stressors (e.g., unemployment, food insecurity), we expect that the decline in mental health during the pandemic was more pronounced among Black, Hispanic, and Asian adults, with these groups also having less access to mental health services. We examine two nationally representative US surveys: the 2019 National Household Interview Survey (NHIS; N = 30,368) and the 2020-2021 Household Pulse Survey (HPS; N = 1,677,238). We find mental health of Black, Hispanic, and Asian respondents worsened relative to White respondents during the pandemic, with significant increases in depression and anxiety among racialized minorities compared to Whites. There is also evidence of especially high mental health burden for Black adults around the murder of George Floyd by police and for Asian adults around the murder of six Asian women in Atlanta. White respondents are most likely to receive professional mental health care before and during the pandemic, and Black, Hispanic, and Asian respondents demonstrate higher levels of unmet mental health care needs during the pandemic than White respondents. Our results indicate that within the current environment, White adults are at a large and systemic advantage buffering them from unexpected crises-like the COVID-19 pandemic. Without targeted interventions, the long-term social consequences of the pandemic and other co-occurring events (e.g., death of Black and Hispanic people by police) will likely include widening mental health disparities between racial/ethnic groups.

Vicarious experiences of major discrimination, anxiety symptoms, and mental health care utilization among Black Adults.

BACKGROUND: The adverse mental health consequences of discrimination among Black adults, such as anxiety symptoms, are well documented. Prior research establishes anxiety as a risk factor for suboptimal health outcomes among Black adults. Most discrimination and mental health studies, however, have focused on the effects of personal experiences of discrimination. Moreover, of the studies that examine the mental health effects of vicarious exposure to discrimination, few investigate this relationship from a stress and coping perspective beyond the life stages of childhood and adolescence. Thus, the purpose of this study was to assess the effects of vicarious and personal experiences of discrimination on the subjective well-being of Black adults, while observing the potentially moderating effects of utilizing mental health care. METHODS: A subsample of Black adults (N = 627) between the ages of 22-69 years old were drawn from the Nashville Stress and Health Study and analyzed to assess within-group variation. Multivariate linear regression was employed to examine the association between vicarious experiences of major discrimination and self-reported anxiety symptoms. Additionally, we evaluated the moderating effects of lifetime utilization of mental health services on the relationship between discrimination and symptoms of anxiety. RESULTS: Findings revealed that vicarious experiences of major discrimination and personal experiences of everyday discrimination were both associated with higher levels of anxiety symptoms among the participants. Additionally, lifetime utilization of mental health care moderated the effects of vicarious and personal experiences of discrimination. CONCLUSIONS: The secondhand consequences of discrimination must be considered while assessing the racism-related stress experience. Results from this investigation suggest that mental health treatment should be included in programs targeted to reduce the negative effects of discrimination among Black adults. Additionally, culturally-specific strategies should be considered for addressing racism-related adversity.

Lifetime vicarious experiences of major discrimination and depressive symptoms among middle-aged and older black adults.

OBJECTIVES: Racial disparities in later-life depression among Americans are well-documented. Perceived discrimination has been linked to depressive symptoms among aging Black adults, but little research has considered how vicarious exposure to discrimination shapes the mental health of middle-aged and older Black adults. METHODS: A subsample of Black adults aged 50-69 years (N = 273) were drawn from the Nashville Stress and Health Study. Lifetime vicarious exposures to major discrimination were assessed. Additionally, multivariate linear regression was employed to examine the association between vicarious experiences of major discrimination and depressive symptoms. RESULTS: Once the Black adults in the sample had reached ages 50 and older, the most common discriminatory events that they had vicariously experienced in their lifetime occurred as a result of their loved ones' unfair interactions with law enforcement and the job market, respectively. Furthermore, our findings revealed that vicarious experiences of major discrimination were associated with higher levels of depressive symptoms among middle-aged and older Black adults. CONCLUSION: Vicarious, as well as personal, exposures to discrimination shape the mental health of Black Americans over the lifespan. The secondhand effects of discrimination must be considered for interventions aimed at reducing the mental health consequences of racism-related adversity as Black adults age.

Vicarious Experiences of Major Discrimination and Psychological Distress among Black Men and Women.

Racism-related stress frameworks posit that the discriminatory experiences of one's loved ones may threaten one's well-being, but relatively few studies have examined how they may impact mental health beyond childhood and adolescence. Using data from the Nashville Stress and Health Study (N = 1,252), the present study assessed the prevalence of vicarious experiences of discrimination among subsamples of Black men (n = 297) and women (n = 330), examined the association between vicarious experiences of discrimination and psychological distress among Black men and women, and evaluated the impact of vicarious discrimination on psychological distress in the context of other stressors. Results suggest that Black women report more vicarious exposure to specific types of discrimination. Furthermore, vicariously experienced discrimination was associated with higher levels of psychological distress among Black women, but not among Black men. Our findings extend the literature on racism-related stress and offer new insights for interventions aimed at reducing racial disparities in mental health.

Experiencing Burnout: John Henryism, Gender Role Conflict, and Anxiety Among Incarcerated Black Men.

At the intersection of race and gender, Black men encounter conflicting and often stress-inducing gender norms. Research suggests Black men may utilize John Henryism Active Coping (JHAC), a culturally-relevant strategy to manage stress. However, little is known about how incarcerated Black men cope with gender role conflict (GRC) and resulting psychological distress. To better understand stressors and coping strategies among Black male prisoners, the current study examined the relationships between GRC, anxiety, and JHAC among N = 193 incarcerated Black men nearing community reentry. Hierarchical linear regression results showed length of incarceration, GRC, and anxiety were all negatively associated with JHAC. Full-time employment prior to incarceration was positively associated with JHAC. Moderation analyses indicated anxiety increased the strength of the negative association between GRC and JHAC. Implications highlight incarcerated Black men may benefit from interventions that encourage active coping strategies to manage gender-related stress and anxiety.

The neurobiology of social stress resulting from Racism: Implications for pain disparities among racialized minorities.

Extant literature posits that humans experience two types of threat: physical threat and social threat. While describing pain as "physical" or "social" can be helpful for understanding pain origins (i.e., broken bone versus lost relationship), this dichotomy is largely artificial and not particularly helpful for understanding how the human brain experiences pain. One real world example of social exclusion and rejection that is threatening and likely to bring about significant stress is racism. Racism is a system of beliefs, practices, and policies that operates to disadvantage racialized minorities while providing advantage to those with historical power, particularly White people in the United States and most other Western nations. The objective of this Mini-Review is to present evidence in support of the argument that racism promotes physical pain in racialized minorities, which in turn promotes chronic pain disparities. First, we provide a theoretical framework describing how racism is a potent stressor that affects the health and well-being of racialized minorities. We will then address the neurobiological underpinnings linking racism to social threat, as well as that linking social threats and physical pain. Finally, we will discuss how the perception of social threat brought about by racism may undermine pain management efforts.

Does Early Life Racial Discrimination Explain a Mental Health Paradox among Black Adults?

Objectives: To evaluate the impact of early life racial discrimination (ELRD) on mental health among Black adults. Methods: Data were from the Nashville Stress and Health Study (n = 618). Ordinary least squares regression models examined the relationship between ELRD and adult psychological distress; logistic regression estimated the probability of past-year major depressive disorder (MDD). We also assessed whether ELRD moderated the relationship between adult discrimination and mental health. Results: Childhood (b = 1.07, SE = .51, p = .04) and adolescent ELRD (b = 1.32, SE = .42, p = .002) were associated with adult distress. Individuals who experienced childhood ERLD had 88% lower odds of adult MDD than individuals with no ELRD. Significant interactions showed that childhood and adolescent ELRD was protective against adult discrimination. Discussion: While ELRD importantly shapes distress and MDD among Black adults, patterns vary by outcome. Results indicate that adult distress and MDD develop through cumulative adversity processes that are further influenced by sensitive periods in the life course.

Evaluating the Feasibility of Implementing an HIV Prevention Intervention for Incarcerated African American Men: Lessons Learned From a Pilot Study.

This pilot study evaluated the feasibility of implementing an evidence-based, culturally adapted HIV intervention with substance-using African American men in a prison setting. We recruited 60, soon-to-be released African American male prisoners from a larger study (N = 211) to be randomly selected for participation in the group-based HIV intervention, Real Men Are Safe-Culturally Adapted (REMAS-CA). Participants who were not selected for participation in the intervention received standard Centers for Disease Control and Prevention HIV prevention counseling education, provided during participant assessment in the larger study. Nearly all of the participants who were selected to participate (87%) completed the REMAS-CA intervention. To examine feasibility, data were collected about any revisions made to the HIV intervention components for the prison setting, time needed to implement the program in full, details of implementing the intervention to ensure participation and maintain retention, and participant perception of the intervention. Revisions to the intervention included reducing the number of sessions from five to three, modifying the protocol language based on the setting, and removing six activities deemed inappropriate and/or unallowable by the prison officials. The cultural considerations and intervention, overall, were well received by the participants. However, several revisions made specific to the prison and its administration could affect the potential effectiveness of the intervention. Future research is needed to determine the effectiveness of REMAS-CA among this community.

For Better or Worse: an Assessment of the 'Linked Lives' Concept and the Race-Based Effects of Partner Stress on Self-Rated Health Among Older Adults.

OBJECTIVE: The purpose of this study was to assess the utility of the life course framework concept of "linked lives" for examining the effects of partner stress on self-rated health among older adult populations. METHOD: Data were derived from a partner-dyad study of Miami-Dade County residents and their significant others. We limited our analysis to respondents ages 60 or older (n = 409). RESULTS: Regression analyses revealed that greater levels of personally experienced major life events were associated with worse self-rated health. However, the association between a significant other's stress exposure and one's own self-rated health was only statistically significant among Black respondents. DISCUSSION: Extending prior study indicating that Black Americans tend to have worse self-rated health later in life relative to other racial groups, these findings demonstrate the utility of the linked lives concept for furthering an understanding of racial disparities in health based upon loved ones' stressful experiences.

Alcohol-related effects of POST-9/11 discrimination in the context of the great recession: Race/ethnic variation.

OBJECTIVES: This study examined whether race/ethnic variation in discrimination is differentially associated with economic adversity during the period of the Great Recession for Blacks and Latinos compared to non-Hispanic Whites, thereby contributing to higher rates of alcohol use and problematic drinking among these groups. METHODS: Structural equation modeling was used to analyze data from a national mail survey. RESULTS: The association of 9/11-related discrimination with problem-related drinking substantially derives from the association between 9/11-related discrimination and recession-era economic adversity. The association between 9/11-related discrimination and economic adversity is also significantly greater for Blacks and Latinos compared to non-Hispanic Whites, and is more strongly linked with problem-related drinking for both groups in contrast to non-Hispanic Whites. CONCLUSIONS: Overall, the results demonstrate the sustained association of 9/11-related discrimination with alcohol use for Blacks and Latinos compared to non-Hispanic Whites, as well as the differential impact of the Great Recession for these race/ethnic groups. The findings highlight the need to acknowledge macro-level stressors that disproportionately affect disadvantaged groups, such as those occasioned by discriminatory legislation and social policies.

"Us Against Them": Schools, Families, and the Diagnosis of ADHD Among Black Children.

Prior research indicates that attention-deficit/hyperactivity disorder (ADHD) is underdiagnosed, or less likely to be diagnosed, among Black children relative to White children and children in other non-Black racial categories. Scholars have suggested that this may be a result of cultural biases or misconceptions that affect the ways classroom behavior is interpreted. The purpose of this pilot study was to engage a larger theoretical framework that explores the relationships between parents and teachers and to examine some of the ways in which common cultural misconceptions can lead to flawed behavioral ascriptions in the classroom, producing negative social outcomes for Black children. Findings from ethnography and interviews reveal that the most common barriers in this low-income neighborhood school setting included poor parent-teacher rapport, a general lack of basic understanding for how ADHD can affect classroom behavior, and faulty procedures in the school setting based on cultural stereotypes. These findings suggest that school officials' disinclination to recommend ADHD testing for Black children may be largely a result of the aforementioned obstacles. A larger study based on these results may produce more robust findings about the barriers that contribute to racial disparities in ADHD diagnoses.