Prevalence and Correlates of Exposure (Direct and Indirect) to Perceived Racism-Based Police Violence among Black Emerging Adult College Students.

A growing body of evidence makes plain that exposure to perceived racism-based events, particularly for Black emerging adults aged 18-29, represents a major public health concern in the United States given its widespread prevalence and documented association with adverse health outcomes. However, research on the prevalence and correlates of exposure to perceived racism-based police violence (RPV) for Black emerging adults is scant. The current study examines the prevalence and correlates of RPV exposure among a sample of 300 Black emerging adult college students, utilizing computer-assisted surveys. Univariate, bivariate, and multiple linear regression analyzes were conducted. We found moderately low rates for direct RPV exposure (Mean = 5.85) and moderately high rates (Mean = 10.4) for indirect exposure. Being younger and having incomes greater than $10,000 were significant predictors of direct RPV exposure, whereas being female and older were significant predictors of indirect RPV exposure. Our findings provide implications for future research and underscore the need for social work clinicians to include the RPV scales during their assessments for traumatic experiences.

"We need a little strength as well": Examining the social context of informal caregivers for Black women with breast cancer.

BACKGROUND: Informal caregivers (e.g., partners, other family members, friends) often provide social support to Black women with breast cancer, and caregivers find both benefits and challenges in their caregiving role. METHODS: In this qualitative study, twenty-four caregivers for Black women with breast cancer participated in focus groups and interviews. Participants responded to a brief close-ended questionnaire as well as semi-structured questions about their experiences as cancer caregivers. Demographic information was collected, and relationship satisfaction was measured by the Relationship Assessment Scale-General scale (RAS-G). Focus groups and interviews were recorded, transcribed verbatim, and coded by two independent coders. Using an iterative, discussion-based process, the study team developed and refined themes. RESULTS: All caregivers described themselves as Black/African American, and the majority identified as female (79%). The mean RAS-G score was 4.5 (SD = 0.5), indicating high levels of relationship satisfaction. Qualitative themes included using a range of strategies to provide emotional support; shifting between roles; needing time and space; and trying to stay strong. Several female caregivers described how the cumulative experiences of providing care for multiple family members and friends could be draining, as could their own experiences in the patient role. CONCLUSIONS: These findings show a complex, multilayered social context that affects both the patient-caregiver relationship and the health and wellbeing of caregivers. Clinicians providing treatment and support for Black women with breast cancer should be mindful of how the health context of the family may affect patient and caregiver outcomes.

Physical and Mental Health Outcomes of Black Emerging Adults with Community Violence Exposure: An Integrative Review.

Community violence exposure (CVE) and its health impact is a public health crisis. Violent crime has steadily increased over recent years and has disproportionately affected Black communities. Emerging adulthood (18-29 years old) is a vulnerable period of development and Black emerging adults may be at increased risk for negative physical and mental health consequences from CVE. This integrative review was conducted to evaluate available evidence on health outcomes in Black emerging adults exposed to CVE. This review appraised published studies (2012-2022) addressing physical and mental health outcomes of Black emerging adults with CVE. Articles were identified using structured search terms in several databases (CINAHL, PubMed, PsycInfo, and Web of Science), a gray literature search, and citation mining. A total of 177 studies were identified for screening and 19 studies met inclusion criteria and were included in the review. The majority of studies found a significant positive association between CVE and adverse mental (n = 12) and physical (n = 7) health outcomes. CVE appears to have both mental and physical health consequences for Black emerging adults. Given that violent crime disproportionately increased in Black communities and Black people are more likely to develop chronic health conditions at younger ages, more work is needed to elucidate the relationship between CVE and health outcomes.

Prevalence and Correlates of Adverse Mental Health Outcomes among Male and Female Black Emerging Adults with a History of Exposure (Direct versus Indirect) to Police Use of Force.

Anxiety, depression, and psychological distress are public health concerns for Black emerging adults ages 18-29, given their prevalence in this population. However, we have scant empirical research investigating the prevalence and correlates of negative mental outcomes among Black emerging adults with a history of exposure to police use of force. Thus, the current study examined the prevalence and correlates of depression, anxiety, and psychological well-being and how they vary among a sample of Black emerging adults with a history of direct or indirect exposure to police use of force. Computer-assisted surveys were administered to a sample of Black emerging adults (N = 300). Univariate, bivariate, and multiple linear regression analyses were conducted. Black women with a history of direct or indirect exposure to police use of force had significantly less favorable scores on the depression and anxiety scales compared with Black men. Study findings suggest that Black emerging adults, particularly women, with a history of exposure to police use of force are at risk of experiencing adverse mental health outcomes. Future research with a larger and ethnically diverse sample of emerging adults that examines the prevalence and correlates of adverse mental health outcomes and how they vary by gender, ethnicity, and exposure to police use of force is warranted.

Development, construct validity, and measurement invariance of the Modified Classes of Racism Frequency of Racial Experiences Measure (M-CRFRE) to capture direct and indirect exposure to perceived racism-based police use of force for Black emerging adults.

OBJECTIVES: To utilize focus groups, cognitive interviews, content expert panel, and computer-assisted surveys to develop and pilot survey items assessing exposure to perceived racism-based police violence to enhance the Classes of Racism Frequency of Racial Experiences (CRFRE). METHOD: Focus groups and cognitive interviews were conducted with Black emerging adults (n = 44) in St. Louis, Missouri. Utilizing a grounded theory approach, a thematic analysis of the focus group and cognitive interview transcripts was conducted to identify key items to be added to the CRFRE. Three content experts assessed the face and content validity of survey items. Computer-assisted surveys were conducted to pilot the modified CRFRE with a sample of Black emerging adults (n = 300). Confirmatory factor analyses and structural paths were used to examine the construct validity of the modified CRFRE. RESULTS: Participant's qualitative data and suggestions from content experts resulted in the development of 16 additional survey items regarding exposure to perceived racism-based police violence across three domains (victim, witness in person, and seen in media). The modified CRFRE measure showed construct validity, internal reliability, and measurement invariance between men and women. CONCLUSIONS: This study advances our epidemiological methodology for quantifying exposure to perceived racism-based police violence. Future research is necessary to assess the prevalence of exposure to perceived racism-based police violence and associated mental and behavioral outcomes for Black emerging adults in the U.S. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An Examination of Suicidal Behavior among Black College Students with Exposure to Police Violence.

There is limited research about suicidal behaviors among Black emerging adults (peak age of suicide risk) who report exposure to police violence. The current study applies an integrated approach to examine individual, immediate environment, and community-based risk and protective factors of suicide among Black college students who reported previous exposure to police violence. A purposive sample of Black college students (N = 300) was analyzed using bivariate analyses and binary logistic regression. Outcome variables investigated were lifetime suicidal ideation and suicide attempt. Twenty-eight percent of participants reported lifetime suicidal ideation and 14 percent reported lifetime attempts. Female students were significantly more likely to report lifetime suicidal ideation and recent symptoms of anxiety and to engage in emotional social support than male peers. Logistic regression results demonstrated that higher income and greater depression symptoms were associated with lower reporting of lifetime suicidal ideation. Reporting of more grit, the trait of perseverance and passion for long-term goals, was associated with a lower reporting of both lifetime suicidal ideation and suicide attempt. Findings have implications for how social workers in higher education are encouraged to address suicidal behavior among Black students, including the cultivation of grit.

Perceived Racism-based police use of force and cannabis use among Black emerging adults.

Background: Racial discrimination and cannabis use among Black emerging adults in America is a growing public health concern. However, research examining the relationship between exposure to perceived racism-based police use-of-force and cannabis use for this population is scant. This study examined the frequency of exposure (direct and indirect) to racism-based police use-of-force and its relationship with past 30-day cannabis use for a sample of Black emerging adult men and women 18-29 years of age. Methods: Black emerging adults (N = 300; 49% males, 51% females) in St. Louis, Missouri completed computer assisted surveys on frequency of exposure to perceived racism-based police use-of-force and cannabis use. Multivariate logistic regression analysis was used to examine the association between frequency of exposure to perceived racism-based police use-of-force and cannabis use, controlling for covariates (sociodemographic, police contacts, and community violence). Results: Our findings revealed that females reported significantly higher rates of indirect exposure to perceived racism-based police use-of-force than males. Relative to Black females, indirect exposure to perceived racism-based police use-of-force increased the odds of cannabis use among Black males. Conclusions: Study findings advance our understanding of the prevalence of exposure to perceived racism-based police use-of-force and its influence on cannabis use for Black emerging adults, specifically males. Results highlight the need for future research, behavioral health interventions, and policy targeting the interplay between indirect exposure to perceived racism-based police use-of-force and cannabis use.

Lessons Learned as Thomas Jefferson University's Rural Physician Shortage Area Program (PSAP) Approaches the Half-Century Mark.

To help increase the supply and retention of rural family physicians, Thomas Jefferson University initiated the Physician Shortage Area Program (PSAP) in 1974. The program selectively admits medical school applicants who both grew up in a rural area and plan to practice in a rural area. During medical school, PSAP students have ongoing mentoring and rural clinical experiences. As the program now approaches the half-century mark, this commentary summarizes several important lessons learned. First, outcomes research is critical, and program leaders have been able to publish 15 papers and a book about the PSAP and its outcomes. Second, these studies have shown that the program has been highly successful, with PSAP graduates 8.5-9.9 times more likely to enter rural family medicine than their peers, and that the PSAP contributed 12% of all rural family physicians in Pennsylvania. Other similar medical school rural programs have had comparable success, with more than half of all graduates combined (including PSAP graduates) practicing rural. Third, long-term retention has a multiplicative impact. Long-term retention of PSAP graduates in rural family medicine was greater than 70% after 20-25 years. Fourth, research has shown that the admissions component accounted for approximately three-quarters of the PSAP's success. Three factors available at the time of matriculation (rural background, plans for rural practice, and plans for family medicine) identified almost 80% of all Jefferson graduates in rural practice 3 decades later. Having a peer group with similar backgrounds, mentoring, and the rural curriculum were also very important. Fifth, wanting to live rural appears key to the rural practice decision. Finally, given that medical school programs like the PSAP produce substantial increases in the supply and retention of rural physicians while requiring modest resources, medical schools can have a critical role in addressing the rural physician shortage.

Reopening a Student-Run Free Clinic During the COVID-19 Pandemic to Provide Care for People Experiencing Homelessness.

PROBLEM: Student-run free clinics (SRFCs) provide health and outreach services to underserved populations while offering medical students opportunities for service and education. Many SRFCs were forced to suspend in-person operations in early 2020 due to the COVID-19 pandemic. Before March 2020, JeffHOPE, the SRFC at Sidney Kimmel Medical College at Thomas Jefferson University, operated an evening clinic at 5 locations throughout Philadelphia each week. APPROACH: JeffHOPE's response to challenges posed by COVID-19 focused on a redesign for a pilot clinic at a shelter site that expressed interest in resuming operations. The student leaders conducted a needs assessment with shelter stakeholders, including administrators and long-term residents, to identify service priorities. They also developed a list of key components for safe patient engagement and care delivery. A hybrid telehealth approach was developed to reduce in-person exposure for patients and volunteers and to involve preclinical medical students remotely. Three iPads were acquired via an internal grant. OUTCOMES: The pilot clinic reopened in September 2020. Over the first 13 weeks of operation, 44 unique patients received care across 98 visits. Of these visits, 21 were in-person only with a clinical student and preceptor, while 77 also used the hybrid telehealth model to connect via iPad with a preclinical student. Patient visit volume was approximately 35%-40% of the pre-COVID-19 level. Of the 58 total volunteers, 11 were preclinical students who participated remotely. NEXT STEPS: Three additional JeffHOPE clinic sites have reopened since December 2020 using this hybrid telehealth model. Patient feedback, via surveys and interviews, will determine which components are retained. Other SRFCs should be encouraged to innovate and develop plans for safe resumption of services, with an appropriate approach and organizational support, despite the challenges posed by the pandemic.

Mask Use During COVID-19: A Social-Ecological Analysis.

To limit the spread of coronavirus disease 2019 (COVID-19), the Centers for Disease Control and Prevention issued recommendations that individuals wear face masks in public. Despite these recommendations, the individual decision to adhere and wear a mask may not be a simple decision. In this article, we examine the decision to wear a mask from a social-ecological perspective. Through critical analysis of societal, interpersonal and community, and intrapersonal influences, it is clear that the decision to wear a mask is multifaceted and influenced by constructs including public health recommendations and government mandates, racism and cultural norms, geography, household income, age, and personal attitudes. Understanding the multifactorial influences on mask wearing during COVID-19 is crucial for informing the creation and distribution of inclusive public health messaging regarding mask wearing now in the midst of an unprecedented health crisis, and in future unforeseen public health emergencies.

Black Males, Trauma, and Mental Health Service Use: A Systematic Review.

OBJECTIVE: To systematically review the evidence of and synthesize results from relevant studies that have examined barriers and facilitators to professional mental health service use for Black male trauma survivors ages 18 and older. METHODS: A thorough search of selected databases that included EBSCO, ProQuest, and Web of Science Core Collection and careful consideration of inclusion and exclusion criteria yielded a final six studies for detailed review. RESULTS: Black male trauma survivors were significantly less likely to be utilizing mental health services than other sex-ethnic groups. High levels of daily crises, a lack of knowledge of steps to obtain services, and service eligibility issues were significant individual barriers to mental health service use for Black males, whereas social support, occupational disability, and PTSD symptoms severity were significant facilitators for mental health service use. CONCLUSION: Exposure to trauma, whether through witnessing or direct victimization, is often a daily reality for many Black males. Findings from this review suggest that 56-74% of Black males exposed to traumatic events may have an unmet need for mental health services. Future research examining the relationship between trauma and mental health service use for Black men and factors that moderate and/or mediate this relationship is warranted.

Police Use of Force by Ethnicity, Sex, and Socioeconomic Class.

OBJECTIVE: Disparities in police responses to Black and White people have received significant research and public attention in recent years. This study examines self-reported accounts of exposure to and perceptions of police use of force among Black and White ethnic groups by sex and income level. METHOD: Using bivariate and multivariate approaches, we analyzed data from the Bureau of Justice Statistics 2011 Police-Public Contact Survey, a measure administered to a nationally representative sample of U.S. residents. Participants were asked a series of questions about their most recent contact with police during a 12-month period. Our analyses were limited to Black (n = 59; mean age 28.8 years) and White (n = 366; mean age 34.6 years) participants whose most recent involuntary contact with police included a street stop. RESULTS: For Black residents, being male and having an income under $20,000 significantly increased the risk for exposure to police use of force during a street stop. For White residents, being male, having an income under $20,000, or being age 35 or older significantly increased the risk for exposure to police use of force during a street stop. CONCLUSIONS: Future research will benefit from additional attention to the cumulative impact of police use of force and how experience with police use of force shapes U.S. residents' understanding of and expectations for procedural justice.

Community Violence Exposure and Risk Taking Behaviors Among Black Emerging Adults: A Systematic Review.

Black emerging adults ages 18-29, particularly those residing in predominantly black urban communities, are at risk for community violence exposure (CVE). This potentially traumatic event may induce traumatic stress reactions for black emerging adults that contribute to their engagement in violence perpetration, substance use and/or sexual risk-taking behaviors as a way to cope with their experiences. To address these identified concerns and make recommendations for future research, this article identifies and synthesizes results from studies that have examined CVE and its association with violence perpetration, substance use, and sexual risk-taking behaviors among black emerging adults. We use the term "black" throughout the article to refer to a socially constructed racial group or identity and recognize that this group, like all other racial groups in the United States, are ethnically heterogeneous. A systematic review of the literature was conducted to identify studies that (1) included a measure of CVE (2) included a measure of violence perpetration, substance use, or sexual risk-taking behaviors, and (3) included primarily black emerging adults. Results showed CVE rates as high as 83% for black emerging adults. CVE was significantly associated with substance use, but findings on the association of CVE with violence perpetration and sexual risk-taking behaviors were mixed. Also, there was a lack of consistency in measures used to assess CVE, suggesting that future research should seek to identify "gold standard" measures and consider whether they have been examined with black emerging adults or similar populations and whether they capture the experiences of this unique population. Furthermore, studies investigating factors that might moderate and/or mediate the relationship between CVE, violence perpetration, substance use, and sexual risk-taking behaviors among black emerging adults are warranted.

Using focus groups to identify characteristics of an ideal work environment for Advanced Practice Clinicians.

Advanced Practice Clinicians (APCs) in collaborative practice represent a diverse and valuable group of health care professionals, including nurse practitioners, physician assistants, nurse anesthetists, and nurse midwives. Because these healthcare professionals have been identified as part of the solution to physician shortages, it is critical for health networks to examine and address issues affecting collaborative relationships. We invited our network APCs to participate in focus group sessions to determine both attributes and barriers to an ideal work environment. Four major themes emerged: (1) compensation, (2) network representation, (3) employment structure, and (4) workplace culture. While issues relating to compensation and representation were prevalent, discussions also revealed the importance of relationships and communication. To ensure successful collaboration and, thereby, reduce clinician turnover, leaders must address gaps between the existing and ideal states in structural factors affecting job satisfaction (Themes 1-3) as well as the behavioral factors represented in workplace culture (Theme 4).