The War on Drugs, Racialized Capitalism, and Health Care Utilization Among White People Who Use Drugs in 22 Rural Appalachian Counties.

Objectives. To analyze War on Drugs encounters and their relationships to health care utilization among White people who use drugs (PWUD) in 22 Appalachian rural counties in Kentucky, West Virginia, Ohio, and North Carolina. Methods. We recruited White PWUD using chain referral sampling in 2018 to 2020. Surveys asked about criminal-legal encounters, unmet health care needs, and other covariates. We used generalized estimating equations to regress unmet need on criminal-legal encounters in multivariable models. Results. In this sample (n = 957), rates of stop and search, arrest, incarceration, and community supervision were high (44.0%, 26.8%, 36.3%, and 31.1%, respectively), as was unmet need (68.5%). Criminal-legal encounters were unrelated to unmet need (stops: adjusted prevalence ratio [APR] = 1.13; 95% confidence interval [CI] = 0.97, 1.32; arrest: APR = 0.95; 95% CI = 0.78, 1.15; incarceration: APR = 1.01; 95% CI = 0.89, 1.14; community supervision: APR = 0.99; 95% CI = 0.90, 1.09). Conclusions. Contrasting with findings from predominantly Black urban areas, criminal-legal encounters and unmet need were unrelated among White Appalachian PWUD. Research should explore whether and under what conditions White supremacy's benefits might buffer adverse impacts of the War on Drugs in Appalachia. (Am J Public Health. 2024;114(10):1086-1096. https://doi.org/10.2105/AJPH.2024.307744).

"Who is our real enemy?" internalized racism in the Puerto Rican diaspora and the role of political education within community health intervention.

RATIONALE: Puerto Ricans experience disproportionately high levels of emotional distress and co-occurring adverse health outcomes. Our study sought to elicit Puerto Rican men's perceptions of health disparities while centering dialogue on stressors, coping mechanisms, and general well-being. This paper focuses on one pronounced finding in our study, that of internalized racism and the effect it has on both individual well-being and intra-group cohesion. A significant gap within racial health disparity work is the role of internalized racism and its connection to psychological distress, ruptures in social unity, and resulting ill-health of racial and ethnic populations. Based on this, we probed this particular finding to further understand internalized racism within this Puerto Rican population. METHODS: Using a hybrid thematic analysis approach, this study presents qualitative findings from in-depth interviews with Latino (92.5% Puerto Rican) men living in Springfield, Massachusetts and conducted between October 2019 and January 2020. RESULTS: Our findings reveal a duality throughout: The acceptance and propagation of negative Latinx stereotypes and consequent intragroup division exists alongside expressions of community pride and desire for Latinx unity. This duality is analyzed by using W.E.B. Du Bois's theory of double consciousness. Double consciousness not only explains the self-disparagement toward oneself and one's own racial and ethnic group, but also elucidates a liberatory pathway toward political consciousness and well-being. The concept of "second sight" within double consciousness is particularly germane, speaking to one's awakening to the learned self-subjugation imposed by White supremacy. CONCLUSIONS: Internalized racism contributes to the persistent propagation of disparate health burdens in minoritized communities. Remediation can and should include community-led frameworks for the development of efficacious multilevel health interventions. The Young Lords community health activism provides such a model. These findings provide viable evidence-based examples of how the academy can synergize with community-led efforts to achieve collective agency.

Uncovering Historical Legacies to Contextualize Health Inequities in Puerto Rican Men: An Expansion of the Minority Stress Model.

Background: Low/no-income Latino men are disproportionately burdened by chronic disease morbidity and mortality, which is often compounded by persistent exposure to stress. Chronic stress is a key mediating factor in pathways linking macro-level socio-structural forces to micro-level behavioral factors with negative health outcomes. Being that Latinxs continue to be one of the fastest growing populations in the U.S., it is imperative to better understand the roots of stress pathways and explore multi-level interventions. Methods: This study presents qualitative findings from in-depth interviews with Puerto Rican men (95%) living in Springfield, Massachusetts. We utilized the Minority Stress Model (MSM) first posited by Ilan Meyers, as a framework to understand stress and stress processes amongst Puerto Rican men. We mapped our data onto Meyers' MSM, which allowed us to find diverging themes and identify areas for expansion. Results: As expected, participants reported stress rooted in experiences of racism and prejudice, expectations of rejection, English-language acquisition, family relationships, insecure housing, precarious employment, and lack of resources. Nevertheless, the MSM did not account for the historical contexts that, as our findings indicate, are used to filter and understand their experiences with everyday stressors. Participants described and linked histories of colonial violence and movement and migration to their stress and community wellbeing. Discussion: Findings suggest the need to expand the current MSM and our conceptualization of the stress process to include historical understandings when contextualizing present-day stress and future interventions. We propose an expanded heuristic model that delineates the impact of distinctive historical trajectories that aid in interpreting racial health disparities amongst minoritized populations. Future multi-level interventions should give weight to highlighting history and how this impacts the present, in this case including the culpability of U.S. policy regarding Puerto Rico and the adverse health effects for Puerto Rican men on the mainland.

Precarious Work, Health, and African-American Men: A Qualitative Study on Perceptions and Experiences.

Precarious work has steadily grown in the United States since the rise of neoliberal policies. The continued expansion of this type of work has led to precarious employment as a recognized category within social determinants of health work and to a growing literature within public health research. African-American men are disproportionately vulnerable to precarious work, which in turn contributes to adverse health effects. Nevertheless, African-American men's experiences of employment and the perceived impact on their well-being remain underexplored. This study was part of the formative exploratory phase of a 5-year community-based participatory research project to examine the biopsychosocial determinants of stress among low/no-income, African-American men. Through thematic analysis of 42 semi-structured interviews, 3 themes emerged: (a) occupational hazards and health, (b) internalization of neoliberal ideology, and (c) constraints of structural factors. Neoliberal economic policies cause material deprivation and exacerbate systemic injustices that disproportionately affect communities of color. The accompanying neoliberal ideology of personal responsibility shapes men's perceptions of success and failure. Public health research must continue to push against health promotion practices that predominantly focus on individual behavior. Rather than exploring only the granularities of individual behaviors, health problems must be examined through prolonged historical, political, economic, and social disenfranchisement.

Community mobilization for rural suicide prevention: Process, learning and behavioral outcomes from Promoting Community Conversations About Research to End Suicide (PC CARES) in Northwest Alaska.

RATIONALE: This study evaluates the process and preliminary outcomes of Promoting Community Conversations About Research to End Suicide (PC CARES), an intervention that brings key stakeholders together so they can discuss suicide prevention research and find ways to put it into practice. Originally piloted in remote and rural Alaskan communities, the approach shows promise. METHOD: Using a multi-method design, the study describes a series of locally-facilitated "learning circles" over 15 months and their preliminary results. Sign-in sheets documented participation. Transcriptions of audio-recorded sessions captured facilitator fidelity, accuracy, and the dominant themes of community discussions. Linked participant surveys (n=83) compared attendees' perceived knowledge, skills, attitudes, and their 'community of practice' at baseline and follow-up. A cross-sectional design compared 112 participants' with 335 non-participants' scores on knowledge and prevention behaviors, and considered the social impact with social network analyses. RESULTS: Demonstrating feasibility in small rural communities, local PC CARES facilitators hosted 59 two to three hour learning circles with 535 participants (376 unique). Local facilitators achieved acceptable fidelity to the model (80%), and interpreted the research accurately 81% of the time. Discussions reflected participants' understanding of the research content and its use in their lives. Participants showed positive changes in perceived knowledge, skills, and attitudes and strengthened their 'community of practice' from baseline to follow-up. Social network analyses indicate PC CARES had social impact, sustaining and enhancing prevention activities of non-participants who were 'close to' participants. These close associates were more likely take preventive actions than other non-participants after the intervention. CONCLUSION: PC CARES offers a practical, scalable method for community-based translation of research evidence into selfdetermined, culturally-responsive suicide prevention practice.

Decoloniality as a Framework for Indigenous Youth Suicide Prevention Pedagogy: Promoting Community Conversations About Research to End Suicide.

Indigenous youth suicide remains a substantial health disparity in circumpolar communities, despite prevention efforts through primary health care, public health campaigns, school systems, and social services. Innovations in prevention practice move away from expert-driven approaches to emphasize local control through processes that utilize research evidence, but privilege self- determined action based on local and personal contexts, meanings, and frameworks for action. "Promoting Community Conversations About Research to End Suicide" is a community health intervention that draws on networks of Indigenous health educators in rural Alaska, who host learning circles in which research evidence is used to spark conversations and empower community members to consider individual and collective action to support vulnerable people and create health-promoting conditions that reduce suicide risk. The first of nine learning circles focuses on narratives of local people who link the contemporary youth suicide epidemic to 20th century American colonialism, and situates prevention within this context. We describe the theoretical framework and feasibility and acceptability outcomes for this learning circle, and elucidate how the educational model engages community members in decolonial approaches to suicide prevention education and practice, thus serving as a bridge between Western and Indigenous traditions to generate collective knowledge and catalyze community healing.