Chill, be cool man: African American men, identity, coping, and aggressive ideation.

Aggression is an important correlate of violence, depression, coping, and suicide among emerging young African American males. Yet most researchers treat aggression deterministically, fail to address cultural factors, or consider the potential for individual characteristics to exert an intersectional influence on this psychosocial outcome. Addressing this gap, we consider the moderating effect of coping on the relationship between masculine and racial identity and aggressive ideation among African American males (N = 128) drawn from 2 large Midwestern universities. Using the phenomenological variant of ecological systems theory and person-centered methodology as a guide, hierarchical cluster analysis grouped participants into profile groups based on their responses to both a measure of racial identity and a measure of masculine identity. Results from the cluster analysis revealed 3 distinct identity clusters: Identity Ambivalent, Identity Appraising, and Identity Consolidated. Although these cluster groups did not differ with regard to coping, significant differences were observed between cluster groups in relation to aggressive ideation. Further, a full model with identity profile clusters, coping, and aggressive ideation indicates that cluster membership significantly moderates the relationship between coping and aggressive ideation. The implications of these data for intersecting identities of African American men, and the association of identity and outcomes related to risk for mental health and violence, are discussed.

Redefining racial residential segregation and its association with physical activity among African Americans 50 years and older: a mixed methods approach.

Physical inactivity is one of the factors contributing to disproportionate disease rates among older African Americans. Previous literature indicates that older African Americans are more likely to live in racially segregated neighborhoods and that racial residential segregation is associated with limited opportunities for physical activity. A cross-sectional mixed methods study was conducted guided by the concept of therapeutic landscapes. Multilevel regression analyses demonstrated that racial residential segregation was associated with more minutes of physical activity and greater odds of meeting physical activity recommendations. Qualitative interviews revealed the following physical activity related themes: aging of the neighborhood, knowing your neighbors, feeling of safety, and neighborhood racial identity. Perceptions of social cohesion enhanced participants' physical activity, offering a plausible explanation to the higher rates of physical activity found in this population. Understanding how social cohesion operates within racially segregated neighborhoods can help to inform the design of effective interventions for this population.

Forests, Trees, and Streams: Why an Integration of Discursive Psychological Frameworks and Gender Role Strain Paradigms Is Needed.

The current article provides commentary on Wetherell and Edley's (2014) article, "A Discursive Psychological Framework for Analyzing Men and Masculinities." Using examples from their published research, the authors present and challenge methodologies stemming from the gender role strain paradigm (GRSP). The core argument presented in their article is that discursive psychological approach (DP) provides a better framework for capturing situational masculinities. In this commentary, I argue for less methodological essentialism in the psychology of men and masculinities. DP has great utility for examining the ways men talk about situational enactment of masculinities. However, they do not resolve all of our methodological dilemmas. Chiefly, I suggest that we have more to gain from integrating DP frameworks and GRSP than from using either of these methods alone.

Racial Discrimination and Depressive Symptoms Among African-American Men: The Mediating and Moderating Roles of Masculine Self-Reliance and John Henryism.

Despite well-documented associations between everyday racial discrimination and depression, mechanisms underlying this association among African-American men are poorly understood. Guided by the Transactional Model of Stress and Coping, we frame masculine self-reliance and John Henryism as appraisal mechanisms that influence the relationship between racial discrimination, a source of significant psychosocial stress, and depressive symptoms among African-American men. We also investigate whether the proposed relationships vary by reported discrimination-specific coping responses. Participants were 478 African-American men recruited primarily from barbershops in the West and South regions of the United States. Multiple linear regression and Sobel-Goodman mediation analyses were used to examine direct and mediated associations between our study variables. Racial discrimination and masculine self-reliance were positively associated with depressive symptoms, though the latter only among active responders. John Henryism was negatively associated with depressive symptoms, mediated the masculine self-reliance-depressive symptom relationship, and among active responders moderated the racial discrimination-depressive symptoms relationship. Though structural interventions are essential, clinical interventions designed to mitigate the mental health consequences of racial discrimination among African-American men should leverage masculine self-reliance and active coping mechanisms.

Taking it like a man: masculine role norms as moderators of the racial discrimination-depressive symptoms association among African American men.

OBJECTIVES: I examined the association between everyday racial discrimination and depressive symptoms and explored the moderating role of 2 dimensions of masculine role norms, restrictive emotionality and self-reliance. METHODS: Cross-sectional survey data from 674 African American men aged 18 years and older recruited primarily from barbershops in 4 US regions (2003-2010) were used. Direct and moderated associations were assessed with multivariate linear regression analyses for the overall sample and different age groups. Models were adjusted for recruitment site, sociodemographics, masculine role norms salience, and general social stress. RESULTS: Everyday racial discrimination was associated with more depressive symptoms across all age groups. Higher restrictive emotionality was associated with more depressive symptoms among men aged 18 to 29 and 30 to 39 years. Self-reliance was associated with fewer depressive symptoms among men aged 18 to 29 years and 40 years and older. The positive association between everyday racial discrimination and depressive symptoms was stronger among men with high restrictive emotionality, but this moderated effect was limited to men older than 30 years. CONCLUSIONS: Interventions designed to reduce African American men's depression instigated by racism should be life-course specific and address masculine role norms that encourage emotion restriction.

The moderating capacity of racial identity between perceived discrimination and psychological well-being over time among African American youth.

This study examined the influence of racial identity in the longitudinal relation between perceptions of racial discrimination and psychological well-being for approximately 560 African American youth. Latent curve modeling (LCM) and parallel process multiple-indicator LCMs with latent moderators were used to assess whether perceptions of racial discrimination predicted the intercept (initial levels) and the slope (rate of change) of psychological well-being over time, and whether racial identity moderates these relations. The results indicated that African American adolescents who reported higher psychological responses to discrimination frequency levels at the first time point had lower initial levels of well-being. Regressing the slope factor for psychological well-being on the frequency of discrimination also revealed a nonsignificant result for subsequent well-being levels.

Masculinity, medical mistrust, and preventive health services delays among community-dwelling African-American men.

BACKGROUND: The contribution of masculinity to men's healthcare use has gained increased public health interest; however, few studies have examined this association among African-American men, who delay healthcare more often, define masculinity differently, and report higher levels of medical mistrust than non-Hispanic White men. OBJECTIVE: To examine associations between traditional masculinity norms, medical mistrust, and preventive health services delays. DESIGN AND PARTICIPANTS: A cross-sectional analysis using data from 610 African-American men age 20 and older recruited primarily from barbershops in the North, South, Midwest, and West regions of the U.S. (2003-2009). MEASUREMENTS: Independent variables were endorsement of traditional masculinity norms around self-reliance, salience of traditional masculinity norms, and medical mistrust. Dependent variables were self-reported delays in three preventive health services: routine check-ups, blood pressure screenings, and cholesterol screenings. We controlled for socio-demography, healthcare access, and health status. RESULTS: After final adjustment, men with a greater endorsement of traditional masculinity norms around self-reliance (OR: 0.77; 95% CI: 0.60-0.98) were significantly less likely to delay blood pressure screening. This relationship became non-significant when a longer BP screening delay interval was used. Higher levels of traditional masculinity identity salience were associated with a decreased likelihood of delaying cholesterol screening (OR: 0.62; 95% CI: 0.45-0.86). African-American men with higher medical mistrust were significantly more likely to delay routine check-ups (OR: 2.64; 95% CI: 1.34-5.20), blood pressure (OR: 3.03; 95% CI: 1.45-6.32), and cholesterol screenings (OR: 2.09; 95% CI: 1.03-4.23). CONCLUSIONS: Contrary to previous research, higher traditional masculinity is associated with decreased delays in African-American men's blood pressure and cholesterol screening. Routine check-up delays are more attributable to medical mistrust. Building on African-American men's potential to frame preventive services utilization as a demonstration, as opposed to, denial of masculinity and implementing policies to reduce biases in healthcare delivery that increase mistrust, may be viable strategies to eliminate disparities in African-American male healthcare utilization.

Psychosocial factors associated with routine health examination scheduling and receipt among African American men.

INTRODUCTION: African American men often fail to obtain routine health examinations, which increases the probability of disease detection, yet little is known about psychosocial factors that motivate scheduling and receipt among this group. METHODS: We used the Andersen model and theory of reasoned action as frameworks to evaluate the relative contribution of psychosocial factors to self-reported routine health examination scheduling and receipt in a cross-sectional sample of African American men (N = 386) recruited from barbershops (65.3%) and academic institutions/events (34.7%) in Michigan, Georgia, and North Carolina between 2003-2004 and 2007-2009. Participants completed measures assessing demographic factors, physical/mental health status, traditional male role norms, health-promoting male subjective norms, health value, and medical mistrust. Pearson's chi(2), analysis of variance, and multivariate logistic regression analyses were used to investigate associations between these study factors and routine health examination scheduling and receipt in the past year. RESULTS: After final adjustment, the odds of scheduling a routine health examination were increased for men with a usual source of care (OR, 5.48; 95% CI, 3.06-9.78) and more health-promoting male subjective norms exposure (OR, 1.46; 95% CI, 1.02-2.04). Higher medical mistrust (OR, 0.26;; 95% CI, 0.09-0.76) and traditional male role norms (OR, 0.71; 95% CI, 0.52-0.98) reduced the odds of routine health examination receipt. The odds of routine health examination receipt were increased among men who were older (OR=1.05; 95% CI, 1.01-1.10), had a usual source of care (OR, 2.91; 95% CI, 1.54-5.51) and reported more male subjective norms exposure (OR, 1.51; 95% CI, 1.02-2.22). CONCLUSIONS: Improving African American men's uptake of routine health examinations will require addressing medical mistrust, mitigating traditional masculine concerns about disclosing vulnerability, and leveraging male social networks.

Underlying mechanisms in the relationship between Africentric worldview and depressive symptoms.

This study examines underlying mechanisms in the relationship between an Africentric worldview and depressive symptoms. Participants were 112 African American young adults. An Africentric worldview buffered the association between perceived stress and depressive symptoms. The relationship between an Africentric worldview and depressive symptoms was mediated by perceived stress and emotion-focused coping. These findings highlight the protective function of an Africentric worldview in the context of African Americans' stress experiences and psychological health and offer promise for enhancing African American mental health service delivery and treatment interventions.

Psychosocial correlates of medical mistrust among African American men.

The current study proposed and tested a conceptual model of medical mistrust in a sample of African American men (N = 216) recruited primarily from barbershops in the Midwest and Southeast regions of the United States. Potential psychosocial correlates were grouped into background factors, masculine role identity/socialization factors, recent healthcare experiences, recent socioenvironmental experiences (e.g., discrimination), and healthcare system outcome expectations (e.g., perceived racism in healthcare). Direct and mediated relationships were assessed. Results from the hierarchical regression analyses suggest that perceived racism in healthcare was the most powerful correlate of medical mistrust even after controlling for other factors. Direct effects were found for age, masculine role identity, recent patient-physician interaction quality, and discrimination experiences. Also, perceived racism in healthcare mediated the relationship between discrimination experiences and medical mistrust. These findings suggest that African American men's mistrust of healthcare organizations is related to personal characteristics, previous negative social/healthcare experiences, and expectations of disparate treatment on the basis of race. These findings also imply that aspects of masculine role identity shape the tone of patient-physician interactions in ways that impede trust building processes.

The social production of altruism: motivations for caring action in a low-income urban community.

Contemporary social science paints a bleak picture of inner-city relational life. Indeed, the relationships of low-income, urban-residing Americans are represented as rife with distress, violence and family disruption. At present, no body of social scientific work systematically examines the factors that promote loving or selfless interactions among low-income, inner-city American individuals, families and communities. In an effort to fill that gap, this ethnographic study examined the motivations for altruism among a sample of adults (n = 40) who reside in an economically distressed housing community (i.e., housing project) in New York City. Content analyses of interviews indicated that participants attributed altruism to an interplay between 14 motives that were then ordered into four overarching categories of motives: (1) needs-centered motives, (2) norm-based motives deriving from religious/spiritual ideology, relationships and personal factors, (3) abstract motives (e.g., humanism), and (4) sociopolitical factors. The implications of these findings are discussed.

Social isolation, vital exhaustion, and incident heart failure: findings from the Atherosclerosis Risk in Communities Study.

AIMS: Prospective studies have shown that social isolation (i.e. lack of social contacts) predicts incident coronary heart disease (CHD), but it is unclear whether it predicts incident heart failure (HF) and what factors might mediate this association. HF patients may be more susceptible to social isolation as they tend to be older and may have disrupted social relationships due to life course factors (e.g. retirement or bereavement). We prospectively examined whether individuals with higher vs. low social isolation have a higher incidence of HF and determined whether this association is mediated by vital exhaustion. METHODS AND RESULTS: We estimated incident HF hospitalization or death among 14 348 participants from Visit 2 (1990-1992) in the Atherosclerosis Risk in Communities (ARIC) study using Cox proportional hazard models which were sequentially adjusted for age, race/study community, gender, current smoking, alcohol use, and co-morbidities. We conducted mediation analyses according to the Baron and Kenny method. After a median follow-up of 16.9 person-years, 1727 (13.0%) incident HF events occurred. The adjusted hazard of incident HF was greater for those in the higher vs. low social isolation risk group (hazard ratio 1.21, 95% confidence interval 1.08-1.35). Our data suggest that vital exhaustion strongly mediates the association between higher social isolation and incident HF (the percentage change in beta coefficient for higher vs. low social isolation groups after adjusting for vital exhaustion was 36%). CONCLUSION: These data suggest that greater social isolation is an independent risk factor for incident HF, and this association appears to be strongly mediated by vital exhaustion.

Determinants of usual source of care disparities among African American and Caribbean Black men: findings from the National Survey of American Life.

PURPOSE: The Aday-Andersen model was used as a framework for investigating the contribution of immigration status (i.e., nativity and acculturation), socioeconomic factors, health care access, health status, and health insurance to usual source of health care (USOC) in a nationally representative sample of African American (n=551) and Caribbean Black men (n=1,217). METHODS: We used the 2001-2003 National Survey of American Life, a nationally representative household survey of non-institutionalized U.S. Blacks to conduct descriptive and logistic regression analyses. RESULTS: Older age, more health conditions, neighborhood medical clinic access, and health insurance were associated with higher odds of reporting a USOC. Odds were lower for men with lower-middle incomes and poorer mental health status. Having health insurance was associated with higher odds of reporting a USOC for African American men but lower odds among Caribbean Black men. Odds were higher in the presence of more health conditions for African American men than for Caribbean Black men. CONCLUSIONS: Health care reform policies aimed solely at increasing health insurance may not uniformly eliminate USOC disparities disfavoring U.S. and foreign-born non-Hispanic Black men.

Workplace Discrimination and Depressive Symptoms: A Study of Multi-Ethnic Hospital Employees.

Workplace discrimination reports have recently increased in the U.S. Few studies have examined racial/ethnic differences and the mental health consequences of this exposure. We examined the association between self-reported workplace discrimination and depressive symptoms among a multi-ethnic sample of hospital employees. Data came from the prospective case-control Gradients of Occupational Health in Hospital Workers (GROW) study (N = 664). We used the Center for Epidemiological Studies Depression Scale (CES-D) to assess depressive symptoms and measured the occurrence, types, and frequency of workplace discrimination. African Americans were more likely than other racial/ethnic employees to report frequent and multiple types of discrimination exposure. Multivariate relationships were examined while controlling for socio-demographic factors, job strain, and general social stressors. After adjustment, workplace discrimination occurrence and frequency were positively associated with depressive symptoms. The positive association between workplace discrimination and depressive symptoms was similar across racial and ethnic groups. Reducing workplace discrimination may improve psychosocial functioning among racial/ethnic minority hospital employees at greatest risk of exposure.

From homeless to hopeless and healthless?: the health impacts of housing challenges among former foster care youth transitioning to adulthood in California.

A childhood history of placement in the foster care system makes the emerging adult period more complicated and problematic in a variety of ways including meeting basic needs, such as housing and health. We conducted focus groups with 31 former foster youth in San Francisco and Oakland, California to explore their housing and health care circumstances since "aging out" of the foster care system. Five key themes were identified: 1) housing circumstances have direct and indirect impacts on access to health care; 2) housing instability can impede the flow of information between social services staff and youth; 3) housing circumstances and health care differed for men and women; 4) service agency rules and structures may be developmentally mismatched with participant needs; and 5) emerging adults experience repercussions of institutional life including the suspicion of authority and mistrust of medical providers.

"It's the skin you're in": African-American women talk about their experiences of racism. an exploratory study to develop measures of racism for birth outcome studies.

OBJECTIVES: Stress due to experiences of racism could contribute to African-American women's adverse birth outcomes, but systematic efforts to measure relevant experiences among childbearing women have been limited. We explored the racism experiences of childbearing African-American women to inform subsequent development of improved measures for birth outcomes research. METHODS: Six focus groups were conducted with a total of 40 socioeconomically diverse African-American women of childbearing age in four northern California cities. RESULTS: Women reported experiencing racism (1) throughout the lifecourse, with childhood experiences seeming particularly salient and to have especially enduring effects (2) directly and vicariously, particularly in relation to their children; (3) in interpersonal, institutional, and internalized forms; (4) across different life domains; (5) with active and passive responses; and (6) with pervasive vigilance, anticipating threats to themselves and their children. CONCLUSIONS: This exploratory study's findings support the need for measures reflecting the complexity of childbearing African-American women's racism experiences. In addition to discrete, interpersonal experiences across multiple domains and active/passive responses, which have been measured, birth outcomes research should also measure women's childhood experiences and their potentially enduring impact, perceptions of institutionalized racism and internalized negative stereotypes, vicarious experiences related to their children, vigilance in anticipating future racism events, as well as the pervasiveness and chronicity of racism exposure, all of which could be sources of ongoing stress with potentially serious implications for birth outcomes. Measures of racism addressing these issues should be developed and formally tested.