Commentary: An Equitable Approach to Serving Structurally Marginalized Communities.

As the United States grapples with social injustices, greater attention is being placed on the historical lack of equity practices among health and social service organizations that serve marginalized and predominantly racially minoritized communities. We describe strategies health and social service organizations that partner with community-led organizations must take to ensure actionable equitable changes. The opportunity and promise are upon us to resolve health inequities and promote equity-oriented practices, policies, systems, and social-environmental changes.

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

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

Relationship between Religious Support and Major Depressive Episode for Adult Non-Medical Prescription Opioid Users and Non-Users.

Background: Non-medical prescription opioid use (NMPOU) is linked with poor mental health outcomes. Previous research has shown that religious support is protective for mental health. Objectives: To fill the gap in knowledge about how to assist NMPOU users decrease or prevent depression symptoms by incorporating religious support and to identify whether the suppressor model or the health effects model reflects the relationship between religious support and major depressive episode (MDE) for NMPOU users. Methods: Data from the 2016 National Survey on Drug Use and Health were analyzed for 42,625 adults aged 18 years and older. Weighted binary logistic regression analyses were conducted using STATA 15 to examine the odds of NMPOU and religious support on MDE, all within the past year. Results: NMPOU was associated with increased odds of having a past-year MDE (OR = 2.99, 95% CI: 2.47, 3.62). Two significant associations were found among non-users: (a) between MDE and the importance of one's religious beliefs (OR = 0.78, 95% CI: 0.64, 0.94) and (b) between MDE and sharing one's religious beliefs with friends (OR = 0.66, 95% CI: 0.56, 0.78). However, the association of religious support and MDE among NMPOU users was not statistically observed. Conclusions: Religious support from friends and believing religious beliefs are essential in life appeared to be protective factors against MDE among non-users. Further research is needed to explore protective factors that can effectively address the association between opioid misuse and mental health and be incorporated into health interventions targeting the opioid epidemic.

Mental health care treatment seeking among African Americans and Caribbean Blacks: what is the role of religiosity/spirituality?

OBJECTIVES: As adults increase in age, the likelihood for using mental health care services decrease. Underutilization, expecially among racial/ethnic minorities such as African American and Caribbean Blacks, can result in a decrease in quality of life, as well as significant costs to families, employers, and health systems. METHODS: The study explored the differences in relationships between mental health care usage and strength of religious/spiritual beliefs between African American and Caribbean Black older adults (54 years or older) and adults (18-53 years) using data from the National Survey of American Life (NSAL). Descriptive statistics and logistic regression analyses were conducted using Stata version 13.1. RESULTS: Subjective ratings about the strength of religious/spiritual beliefs (OR = 1.26; 95 CI: 0.99, 1.61), age (OR = 0.62; 95 CI: 0.48, 0.81), and sex (OR = 1.59; 95 CI: 1.25, 2.02) were significantly associated with the odds of seeking mental health care. Additionally, persons living in the South were less likely to seek mental health care services (OR = 0.47; 95 CI: 0.37, 0.60). CONCLUSION: Strong religious/spiritual beliefs may promote mental health care usage. Future studies should examine the strength of religious/spiritual beliefs on mental health care usage among different demographic groups.

Mental health treatment and work among African American and Caribbean Black welfare recipients.

OBJECTIVE: Untreated depression among Temporary Assistance for Needy Families (TANF) participants greatly reduces chances of securing and holding gainful employment. METHOD: Logistic regression models were estimated on data describing 1,000 African American and Caribbean Black TANF recipients and 2,123 African American and Caribbean Black non-TANF recipients obtained from the National Survey of American Life (NSAL). RESULTS: Black TANF participants were more likely than Black non-TANF participants to be depressed and treated. Treatment odds were lower for Caribbean Black than for U.S.-born Black TANF participants. CONCLUSION: Results indicated that mental health treatment was likely among Black TANF participants if depression was identified. TANF participants working less than full-time did not receive as much treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

African Americans and Caribbean Blacks: Perceived neighborhood disadvantage and depression.

The purpose of this study was to advance a theoretical understanding of the effects of impoverished neighborhoods on mental health and to inform policy measures encouraging residents to leave such neighborhoods. To do this, we investigated whether individuals' perceived neighborhood disadvantage served as a risk factor for clinical depression in a nationally representative sample of African Americans and Caribbean Blacks. We performed logistic regression analysis on stratified socioeconomic status (SES) subsamples from the National Survey of American Life sample of 5,019 African Americans and Caribbean Blacks. The association between perceived neighborhood social disorder and past-year depression was statistically significant for low-SES individuals (at or below the federal poverty line; odds ratio [OR] = 1.73, 95% confidence interval [CI] [1.07, 2.81], p = 0.026) and at the boundary of significance for middle-SES individuals (between 100% and 300% of the poverty line; OR = 1.74, 95% CI [1.00, 3.02], p = 0.052), but not for high-SES individuals (at or above 300% of the poverty line). Results suggest, at least for low- and middle-income African Americans, perceived neighborhood social disorder is a risk factor for depression. U.S. housing policies aimed at neighborhood improvement and poverty de-concentration may benefit the mental health of low-income African Americans and Caribbean Blacks.

Veggie Rx: an outcome evaluation of a healthy food incentive programme.

OBJECTIVE: One challenge to healthy nutrition, especially among low-income individuals, is access to and consumption of fresh fruits and vegetables. To address this problem, Veggie Rx, a healthy food incentive programme, was established within a community clinic to increase access to fresh produce for low-income patients diagnosed with obesity, hypertension and/or type 2 diabetes. The current research aimed to evaluate Veggie Rx programme effectiveness. DESIGN: A retrospective pre/post design using medical records and programme data was used to evaluate the programme. The study was approved by the University of Albany Institutional Review Board and the Patient Interest Committee of a community clinic. SETTING: The study was conducted in a low-income, urban neighbourhood in upstate New York. SUBJECTS: Medical record data and Veggie Rx programme data were analysed for fifty-four eligible participants. An equal-sized control group of patients who were not programme participants were matched on age, ethnicity and co-morbidity status. RESULTS: A statistically significant difference in mean BMI change (P=0·02) between the intervention and the control group was calculated. The intervention group had a mean decrease in BMI of 0·74 kg/m2. CONCLUSIONS: Greater improvement in BMI was found among Veggie Rx programme participants. This information will guide programme changes and inform the field on the effectiveness of healthy food incentive programmes for improving health outcomes for low-income populations.

Social Drivers of Mental Health: A U.S. Study Using Machine Learning.

INTRODUCTION: Social drivers of mental health can be compared on an aggregated level. This study employed a machine learning approach to identify and rank social drivers of mental health across census tracts in the U.S. METHODS: Data for 38,379 census tracts in the U.S. were collected from multiple sources in 2021. Two measures of mental health problems-self-reported depression and self-assessed poor mental health-among adults and three domains of social drivers (behavioral, environmental, and social) were analyzed on the basis of the unit of census tracts using the Extreme Gradient Boosting machine learning approach in 2022. The leading social drivers were found in each domain in the main sample and in the subsamples divided on the basis of poverty and racial segregation. RESULTS: The three domains combined explained more than 90% of the variance of both mental illness indicators. Self-reported depression and self-assessed poor mental health differed in major social drivers. The two outcome indicators had one overlapping correlate from the behavioral domain: smoking. Other than smoking, climate zone and racial composition were the leading correlates from the environmental and social domains, respectively. Census tract characteristics moderated the impacts of social drivers on mental health problems; the major social drivers differed by census tract poverty and racial segregation. CONCLUSIONS: Population mental health is highly contextualized. Better interventions can be developed on the basis of census tract-level analyses of social drivers that characterize the upstream causes of mental health problems.

Reconsidering Community-Engaged Research Through a Syndemic Theoretical Framework: Lessons from COVID-19.

BACKGROUND: Community-engaged research is a well-established approach to tackling health disparities in communities of color. However, the devastation caused by coronavirus disease 2019 (COVID-19) calls for a reexamination of the practice of community-engaged research. Syndemic framework characterizes the clustering and synergistic interactions between two or more diseases amid an underlay of social and environmental threats. This framework has been used to explain the disproportionately higher rates of COVID-19 in communities of color and may have utility in guiding future community-engaged research. OBJECTIVES: This article describes the process by which a syndemic framework was used to generate discussions on lessons learned from COVID-19 and describes the ensuing collaborative writing process that emerged from this discourse. METHODS: This article was developed by the Community Engagement Working Group (CEWG) of the Jackson Heart Study, a community-based epidemiologic study focused on cardiovascular disease among African Americans in the Jackson, Mississippi Metropolitan Area. By drawing upon a syndemic framework and lessons from COVID-19, the CEWG identified gaps and opportunities to enhance community-engaged research. CONCLUSIONS: Using syndemic framework as a starting point, the CEWG identified the following as aspects of community-engaged research that may warrant further consideration: 1) the need to examine multiple dimensions and assets of a community, 2) the need to view communities through an intersectionality lens, 3) the need to acknowledge the impact of historical and current trauma on the community, and 4) the need to provide support to community-engaged researchers who may be members of minoritized groups themselves and therefore, experience similar trauma.

Heterogeneity in comorbidity between major depressive disorder and generalized anxiety disorder and its clinical consequences.

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly comorbid and, as diagnoses, problematic because they are heterogeneous, may impair functioning even in subclinical manifestations, and may not predict important external criteria as well as empirically-derived classifications. The present study employed a latent class analysis using data from National Comorbidity Survey (1990-1992) and focused on respondents who endorsed at least 1 screening question for MDD and 1 for GAD (N = 1009). Results revealed 4 symptom domains (somatic anxiety, somatic depression, psychological anxiety, and psychological depression) reflecting the heterogeneity of MDD and GAD, and 7 respondent classes. Analysis revealed that people in classes with a high prevalence of either somatic anxiety or somatic depression symptoms presented with the highest levels of disability, distress, and service utilization. Evidence also was found for clinically meaningful subthreshold comorbid conditions. Anxiety-related and depression-related symptoms can be meaningfully differentiated, but differentiating between somatic and psychological symptoms has the greatest practical significance.

Increasing body weight and the transition from welfare to work: findings from the National Survey of American Life.

OBJECTIVE: Few studies focus on employment outcomes for overweight and obese low-income women. We describe the relationship between body mass index and employment status among African American, Caribbean Black and White women who receive assistance through the Temporary Assistance for Needy Family program. METHODS: This was a secondary analysis of data from the National Survey of American Life dataset. We analyzed a sample of 1039 community-dwelling adult women who reported that they received public assistance. RESULTS: African Americans and Whites reported the highest rates of obesity, 45% and 48%, respectively. Logistic regression analyses for the entire sample revealed that being overweight or obese did not significantly predict employment status, controlling for known covariates. This aggregate effect concealed ethnic differences. African American women who were overweight (OR 1.60, P < .05) and Caribbean Black women who were obese (OR 3.41, P < .05) were more likely to be employed, but overweight White women (OR .09, P<.01) were less likely to be employed. CONCLUSION: Overweight was as an employment barrier only to White women. By contrast, overweight African American women and obese Caribbean Black women were more likely than were women of a normal weight to be employed.

Comparing the Self-Rated Health Effects of Obesity on the Health of African Americans and Caribbean Blacks.

The Black population is more likely to experience obesity and to be debilitated by associated illnesses. Much evidence exists linking obesity to many chronic diseases, but the relationship with self-reported health is not clear. The study aims were to examine the relationship between obesity and self-reported health across four race- and gender-specific groups of Black Americans and to assess whether health disparities are race or gender driven. Data were drawn from the National Survey of American Life (NSAL) to estimate separate multivariate logistic regression models for 5,191 persons. Using logistic regression analysis, odds of reporting reduced health in obese individuals were compared with those for healthier weight individuals, adjusting for known controls. Among African American men, African American women, and Caribbean Black women, there was a statistically significant association between obesity and self-rated health (p < .001). The proportion of persons reporting excellent health decreased with increasing level of obesity in all groups, but more pronounced among both racial groups of women. The results of this study provide evidence that obesity has a negative impact on self-rated health among Black Americans, excluding Caribbean Black men, even in the absence of a chronic disease such as diabetes. Health professionals should focus on preventive healthy weight strategies and interventions that are culturally specific and relevant in order to address the obesity health disparity in African American and Caribbean Black women.

Religion, spirituality, coping, and resilience among African Americans with diabetes.

Study aims were to explore how religion and spirituality impacted attitudes about self-management practices among African Americans with homelessness histories and to understand resilience in diabetes care practices. Qualitative semi-structured face-to-face interviews were conducted with 42 African Americans older than 18 years. All audio-taped interviews lasted between 1-1.5 hr, transcribed verbatim, and analyzed using ATLAS.ti (version 7.0). Five resilience themes emerged. While participants recognized diabetes as an illness requiring professional treatment, the context of balancing treatment with religion and spiritual practices mattered. The study findings highlight the importance of spirituality, religious beliefs, and coping strategies in diabetes self-care activities.

Diabetes and Tooth Loss among Working-Age African Americans: A National Perspective.

Natural teeth are still lost in adults despite improvements in dental care and access to treatment across the life span. The study examined whether tooth loss can be mitigated in adults experiencing diabetes. National online survey data from the Service Utilization among African Americans with Co-morbid Depression and Diabetes (n = 275) were analyzed using logistic regression analyses. Diabetes was most prevalent among men (73.5%) and least prevalent among women (40.6%). In general and among the women, those without diabetes have approximately 50% fewer missing teeth than those with diabetes (odds ratio = .50; 95% confidence interval: 0.30, 0.83). Tooth loss is a traumatic experience and a serious life event that requires professional attention.

Building Mobile Apps for Underrepresented Mental Health care Consumers: A Grounded Theory Approach.

Cell phone mobile application ("app") use has risen dramatically within the past several years. Many individuals access apps to address mental health issues. Unlike individuals from privileged backgrounds, individuals from oppressed backgrounds may rely on apps rather than costly mental health treatment. To date, very little research has been published evaluating mental health apps' effectiveness. This paper focuses on three methods through which grounded theory can facilitate app development and evaluation for people underrepresented in mental health care. Recommendations are made to advance mobile app technology that will help clinicians provide effective treatment, and consumers to realize positive treatment outcomes.

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.

Health insurance and diabetes among multiracial men: the mediation effects of usual source of care.

BACKGROUND: Health insurance and having a usual source of care is important in diabetes management for multiethnic men. Few studies focus on determining whether usual source of care mediates the association between health insurance and diabetes among men. METHODS: Using data from the 2005 California Health Interview Survey, responses from 17,472 men were analyzed to examine the extent to which a usual source of health care mediates the relationship between health insurance and diabetes. RESULTS: Sobel-Goodman tests for mediation indicated the largest effects between Latino and White men. For African American and Asian men, usual source of care did not serve as a significant mediation factor between health insurance and diabetes. DISCUSSION: Findings highlight a need for more research on the importance of having a usual source of care along with consistent health insurance type for multiracial men.

Overrepresentation of black Americans in psychiatric inpatient care.

OBJECTIVE: Numerous studies have documented overrepresentation of the black population in psychiatric inpatient settings, but none have included certain important covariates or examined heterogeneity within the black population. After controlling for key social, demographic, and clinical factors, the investigators sought to determine whether blacks are overrepresented in inpatient psychiatric settings; they examined differences within the black population by separately examining the prevalence of inpatient treatment of African Americans and U.S.- and foreign-born Caribbean blacks. METHODS: Secondary analysis was performed on data from two population-based household surveys, the National Survey of American Life (NSAL) and the National Comorbidity Survey Replication (NCS-R), which provided a population-based sample of 9,371 community-dwelling adults, including 3,570 African Americans, 1,621 blacks of Caribbean descent, and 4,180 non-Hispanic whites. Using logistic regression, the investigators estimated self-reported lifetime psychiatric hospitalization as a function of racial-ethnic background after controlling for sociodemographic differences and differences in lifetime counseling or therapy and psychiatric diagnosis. RESULTS: With controls for demographic and clinical factors, both African Americans (odds ratio [OR]=2.52, 95% confidence interval [CI]=1.91-3.33) and Caribbean blacks (OR=2.74, CI=1.98-3.82) had higher odds than whites of having a psychiatric hospitalization in their lifetime. U.S.-born Caribbean blacks had much higher odds of hospitalization (OR=5.47, CI=3.60-8.32) than whites, whereas the likelihood of hospitalization of foreign-born Caribbean blacks did not differ from that of whites (OR=.96, CI=.51-1.82). CONCLUSIONS: Disparities between blacks and whites in the prevalence of psychiatric inpatient treatment appear to be persistent, but global comparisons mask important heterogeneity within the black population.

The status of low-income families in the post-welfare reform environment: mapping the relationships between poverty and family.

Low-income families face an enormous burden to achieve economic security since the deterioration of a guaranteed safety net. Health insurance coverage is uneven, affordable childcare falls short of demand, and wage earnings insufficiently support family needs. This analysis focuses on recent trends in family formation, the impact of policy changes on families of color and of immigrant status, and explores the daily challenges and coping strategies low-income families use to survive despite insufficient resources. Four key findings emerge from this body of knowledge: (1) Low-income families experience severe hardships when relying on cash assistance, work, or a combination of both; (2) Low-income families are resilient and resourceful; (3) Low-income families face significant barriers to using public and private services along with increasing earnings from work; and (4) The quality of life for families of color and immigrant families is directly affected by employment and service sector practices. Future research needs to focus on identifying the critical unmet needs of low-income families.