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Zuelsdorff M, Sonnega A, Barnes LL, Byrd DR, Rose DK, Cox R, Norton D, Turner RW. Childhood and Adulthood Trauma Associate With Cognitive Aging Among Black and White Older Adults. Am J Geriatr Psychiatry 2024; 32:373-385. [PMID: 38288940 PMCID: PMC10922107 DOI: 10.1016/j.jagp.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 02/23/2024]
Abstract
Sociocontextual factors powerfully shape risk for age-related cognitive impairment, including excess risk burdening medically underserved populations. Lifecourse adversity associates with cognitive aging, but harms are likely mitigable. Understanding population-salient relationships and sensitive periods for exposure is crucial for targeting clinical interventions. OBJECTIVE The authors examined childhood and adulthood traumatic events in relation to cognition among Black and White older adults in the Health and Retirement Study (HRS). PARTICIPANTS Participants (N = 13,952) aged 55+ had complete lifetime trauma and cognitive testing data at the 2006/08, 2010/12, and/or 2014/16 waves. MEASURES Trauma indices comprised childhood and adulthood event counts. Outcomes included baseline performance and trajectories on the Telephone Interview for Cognitive Status. DESIGN Main and nonlinear trauma effects were modeled via linear regression, and overall contributions assessed with omnibus likelihood ratio tests. RESULTS Black participants (N = 2,345) reported marginally lower adulthood trauma exposure than White participants (N = 11,607) with no other exposure differentials observed. In White participants only, greater childhood trauma exposure predicted worse baseline cognition but slower change over time. Across race, adulthood trauma robustly associated with baseline cognition. Relationships were frequently nonlinear: low but nonzero trauma predicted highest cognitive scores, with much poorer cognition observed as trauma exposure increased. Relationships between adulthood trauma and trajectory were limited to the White sample. CONCLUSION Traumatic experiences, particularly in adulthood, may impact late-life cognitive health if not addressed. Findings highlight foci for clinical researchers and providers: adverse life events as a source of cognitive risk, and identification of community-specific resources that buffer behavioral, physical, and mental health sequelae of previous and incident trauma.
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Affiliation(s)
- Megan Zuelsdorff
- School of Nursing (MZ), University of Wisconsin-Madison, Madison, WI; Alzheimer's Disease Research Center (MZ), University of Wisconsin-Madison, Madison, WI.
| | - Amanda Sonnega
- Institute for Social Research (AS), University of Michigan, Ann Arbor, MI
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center (LLB), Rush University Medical Center, Chicago, IL
| | - DeAnnah R Byrd
- Edson College of Nursing and Health Innovation (DARB), Arizona State University, Phoenix, AZ; Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation (DARB), Arizona State University, Phoenix, AZ
| | | | - Robynn Cox
- School of Public Policy (RC), University of California, Riverside, CA
| | - Derek Norton
- Department of Biostatistics and Medical Informatics (DN), University of Wisconsin, Madison, WI
| | - Robert W Turner
- School of Medicine & Health Sciences (RWT), The George Washington University, Washington, DC
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Golijanin B, Bhatt V, Homer A, Malshy K, Ochsner A, Wales R, Khaleel S, Mega A, Pareek G, Hyams E. "Shared decision-making" for prostate cancer screening: Is it a marker of quality preventative healthcare? Cancer Epidemiol 2024; 88:102492. [PMID: 38056246 DOI: 10.1016/j.canep.2023.102492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND "Shared decision-making" (SDM) is a cornerstone of prostate cancer (PCa) screening guidelines due to tradeoffs between clinical benefits and concerns for over-diagnosis and over-treatment. SDM requires effort by primary-care-providers (PCP) in an often busy clinical setting to understand patient preferences with the backdrop of patient risk factors. We hypothesized that SDM for PCa screening, given its prominence in guidelines and practical challenges, may be associated with quality preventative healthcare in terms of other appropriate cancer screening and encouragement of other preventative health behaviors. METHODS From the 2020 Behavioral Risk Factor Surveillance Survey, 50-75 year old men who underwent PSA screening were assessed for their participation in SDM, PCa and colorectal cancer (CRC) screening, and other preventative health behaviors, like vaccination, exercise, and smoking status. Adjusted odds ratio of likelihood of PSA testing as a function of SDM was calculated. Likelihoods of SDM and PSA testing as a function of preventative health behaviors were also calculated. RESULTS Screening rates were 62 % for PCa and 88 % for CRC. Rates of SDM were 39.1 % in those with PSA screening, and 16.2 % in those without. Odds of PSA screening were higher when SDM was present (AOR = 2.68). History of colonoscopy was associated with higher odds of SDM (AOR = 1.16) and PSA testing (AOR = 1.94). Health behaviors, like regular exercise, were associated with increased odds of SDM (AOR = 1.14) and PSA testing (AOR = 1.28). History of flu vaccination (AOR = 1.29) and pneumonia vaccination (AOR = 1.19) were associated with higher odds of SDM. Those who received the flu vaccine were also more likely to have PSA testing (AOR = 1.36). Smoking was negatively associated with SDM (AOR = 0.86) and PSA testing (AOR = 0.93). Older age was associated with higher rates of PSA screening (AOR = 1.03, CI = 1.03-1.03). Black men were more likely than white men to have SDM (AOR = 1.6, CI = 1.59 - 1.6) and decreased odds of PSA testing (AOR = 0.94, CI = 0.94 - 0.95). CONCLUSIONS SDM was associated with higher odds of PSA screening, CRC screening, and other appropriate preventative health behaviors. Racial disparities exist in both SDM and PSA screening usage. SDM may be a trackable metric that can lead to wider preference-sensitive care and improved preventative care.
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Affiliation(s)
- Borivoj Golijanin
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Lifespan Academic Medical Center, the Legorreta Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States.
| | - Vikas Bhatt
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Lifespan Academic Medical Center, the Legorreta Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Alexander Homer
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Lifespan Academic Medical Center, the Legorreta Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Kamil Malshy
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Lifespan Academic Medical Center, the Legorreta Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Anna Ochsner
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Lifespan Academic Medical Center, the Legorreta Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Rebecca Wales
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Lifespan Academic Medical Center, the Legorreta Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Sari Khaleel
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Lifespan Academic Medical Center, the Legorreta Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Anthony Mega
- Lifespan Cancer Institute, Department of Hematology and Oncology, The Miriam Hospital, Lifespan Academic Medical Center, the Legorreta Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Gyan Pareek
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Lifespan Academic Medical Center, the Legorreta Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
| | - Elias Hyams
- The Minimally Invasive Urology Institute at The Miriam Hospital, Division of Urology, Lifespan Academic Medical Center, the Legorreta Cancer Center at Brown University, Warren Alpert Medical School of Brown University, Providence, RI 02906, United States
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Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A. Paternal Communication and Sexual Health Clinic Visits Among Latino and Black Adolescent Males With Resident and Nonresident Fathers. J Adolesc Health 2023; 73:567-573. [PMID: 37330708 DOI: 10.1016/j.jadohealth.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/06/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Latino and Black adolescent males experience sexual health inequities, and their engagement in sexual health services remains low. Parents shape adolescent sexual health behavior and other youth outcomes. However, the role of Latino and Black fathers in promoting male adolescent sexual health is understudied, in part because about one in four fathers resides apart from their children and nonresident fathers are presumed to be less influential. We examined associations of paternal communication with sexual health service use and perceived paternal role modeling among Latino and Black adolescent males with resident and nonresident fathers. METHODS We recruited 191 Latino and Black adolescent males aged 15-19 years and their fathers in the South Bronx, New York City, using area sampling methods; dyads completed surveys. We estimated bivariate and adjusted associations of paternal communication with adolescent male sexual health service use and perceived paternal role modeling using logistic and linear regressions. Effect measure modification by paternal residence was assessed. RESULTS A unit increase on a five-point paternal communication scale was associated with approximately twice and 1.7 times the likelihood of clinical sexual health service use during adolescent males' lifetime and in the past 3 months, respectively; there was no significant effect measure modification by paternal residence. Paternal communication was associated with increased levels of perceived paternal role modeling and usefulness of paternal advice, with stronger associations for nonresident fathers. DISCUSSION Both resident and nonresident Latino and Black fathers warrant greater consideration as partners in promoting male adolescent sexual health service use.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Duke University, Durham, North Carolina; School of Nursing, Duke University, Durham, North Carolina; Department of Family Medicine and Community Health, Department of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina; Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services, Washington, D.C..
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Duke University, Durham, North Carolina; School of Nursing, Duke University, Durham, North Carolina
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Duke University, Durham, North Carolina; School of Nursing, Duke University, Durham, North Carolina
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MICHENER JAMILA, FORD TIFFANYN. Racism and Health: Three Core Principles. Milbank Q 2023; 101:333-355. [PMID: 37096599 PMCID: PMC10126969 DOI: 10.1111/1468-0009.12633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/04/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Racism operates in conjunction with interlocking forms of oppression, so it must be addressed relationally. Racism catalyzes processes of cumulative disadvantage as it extends across multiple policy domains along the life course, so it necessitates multifaceted policy solutions. Racism is a function of power relations, so the redistribution of power is a necessary precursor to health equity.
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Abualhaija N. Men's health disparities: Causes and interventions. Nurs Forum 2022; 57:785-792. [PMID: 35701992 DOI: 10.1111/nuf.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/22/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
According to the existing, extensive scientific evidence in the literature, men on average are living sicker and dying younger at a higher rate compared to women. The causes of men's infirmities are complex and multifaceted, contributing to increased morbidity and mortality rates and decreased life expectancy. Despite the statistics of the doomed health status among men, interests to eliminate their health disparities remain inconsistent and ill-defined. Therefore, efforts to eradicate men's health disparities should be positioned in interdisciplinary health education, research, and policy using sex and gender-based health frameworks. The purpose of this paper is to explore men's health generally by discussing common health disparities, the causes of the gender gap in men's health outcomes, proposing some strategies for advancing men's health, and finally providing nursing implications for education, practice, research, and health/public policy. Notably, interdisciplinary, gender-based health education potentially has significant impacts on men's health. The promotion of such initiatives can consequently address the intricacies of men's health, which will provide future healthcare professionals with the knowledge, attitude, and skills necessary to improve men's health.
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Affiliation(s)
- Nashat Abualhaija
- School of Nursing, College of Health Sciences and Human Performance, University of Texas Permian Basin, Odessa, Texas, USA
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Smith NC, Nicholson HL. Perceived discrimination and mental health among African American and Caribbean Black adolescents: ethnic differences in processes and effects. ETHNICITY & HEALTH 2022; 27:687-704. [PMID: 32977736 DOI: 10.1080/13557858.2020.1814998] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
Objectives: Although the relationship between perceived discrimination and mental health among Black youth is well-documented, the mechanisms underlying this association remain unclear. Drawing from the stress process model, this study examines two psychosocial mediators - self-esteem and self-efficacy - in the association between perceived discrimination and mental health among African American and Caribbean Black adolescents. This research addresses three primary research questions: First, how is perceived discrimination associated with mental health? Second, to what extent do self-esteem and self-efficacy mediate the relationship between perceived discrimination and mental health? Finally, do these relationships and processes differ between African American and Caribbean Black adolescents?Design: Data for these analyses come from the National Survey of American Life - Adolescent Supplement. We use generalized structural equation modeling to examine relationships among perceived discrimination, psychosocial resources, and mental health.Results: For both African American and Caribbean Black adolescents, more frequent perceptions of discriminatory events were associated with greater depressive symptoms and a higher likelihood of having an anxiety disorder diagnosis. However, the association between perceived discrimination and depressive symptoms was significantly stronger for Caribbean Black adolescents. Generally, self-esteem and self-efficacy were found to be significant mediators in the association between perceived discrimination and mental health, although mechanisms varied between African American and Caribbean Black youth.Conclusion: African American and Caribbean Black adolescents are highly susceptible to experiences of discrimination that negatively affect their mental health. Heterogeneity among Black youth populations must be considered when developing interventions to reduce exposure to and the effects of discrimination among these adolescents.
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Affiliation(s)
- Nicholas C Smith
- Department of Sociology, Indiana University, Bloomington, IN, USA
| | - Harvey L Nicholson
- Department of Sociology and Criminology and Law, University of Florida, Gainesville, FL, USA
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Tavares CD, Bell CN, Zare H, Hudson D, Thorpe RJ. Allostatic Load, Income, and Race Among Black and White Men in the United States. Am J Mens Health 2022; 16:15579883221092290. [PMID: 35466781 PMCID: PMC9036348 DOI: 10.1177/15579883221092290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Research indicates that income is significantly associated with allostatic load (AL) and that this association may differ between White and Black Americans. Most existing income–AL link work focuses on women and less is known about this association among men. Using data from the National Health and Nutrition Examination Survey (NHANES), we examined whether race moderates the association between income and AL among Black and White men in the United States (n = 5,685). We find that, regardless of income levels, Black men have significantly higher prevalence of being in the high-AL group compared with high-income White men. Our findings suggest that Black men do not receive the same health benefits for increased income relative to their White counterparts.
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Affiliation(s)
- Carlos D Tavares
- Department of Anthropology and Sociology, Lafayette College, Easton, PA, USA
| | - Caryn N Bell
- Department of Social, Behavioral, and Population Sciences, Tulane University, New Orleans, LA, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Global Health Services and Administration, University of Maryland Global Campus, Baltimore, MD, USA
| | - Darrell Hudson
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dupre ME, Farmer HR, Xu H, Navar AM, Nanna MG, George LK, Peterson ED. The Cumulative Impact of Chronic Stressors on Risks of Myocardial Infarction in US Older Adults. Psychosom Med 2021; 83:987-994. [PMID: 34297011 PMCID: PMC8578196 DOI: 10.1097/psy.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between cumulative exposure to chronic stressors and the incidence of myocardial infarction (MI) in US older adults. METHODS Nationally representative prospective cohort data of adults 45 years and older (n = 15,109) were used to investigate the association between the cumulative number of chronic stressors and the incidence of MI in US older adults. Proportional hazards models adjusted for confounding risk factors and differences by sex, race/ethnicity, and history of MI were assessed. RESULTS The median age of participants was 65 years, 714 (4.7%) had a prior MI, and 557 (3.7%) had an MI during follow-up. Approximately 84% of participants reported at least one chronic stressor at baseline, and more than half reported two or more stressors. Multivariable models showed that risks of MI increased incrementally from one chronic stressor (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.20-1.37) to four or more chronic stressors (HR = 2.71, 95% CI = 2.08-3.53) compared with those who reported no stressors. These risks were only partly reduced after adjustments for multiple demographic, socioeconomic, psychosocial, behavioral, and clinical risk factors. In adults who had a prior MI (p value for interaction = .038), we found that risks of a recurrent event increased substantially from one chronic stressor (HR = 1.30, 95% CI = 1.09-1.54) to four or more chronic stressors (HR = 2.85, 95% CI = 1.43-5.69). CONCLUSIONS Chronic life stressors are significant independent risk factors for cardiovascular events in US older adults. The risks associated with multiple chronic stressors were especially high in adults with a previous MI.
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Affiliation(s)
- Matthew E. Dupre
- Department of Population Health Sciences, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
- Department of Sociology, Duke University, Durham, NC
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
| | - Heather R. Farmer
- Department of Human Development and Family Sciences, University of Delaware, DE
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University, Durham, NC
- Duke School of Nursing, Duke University, Durham, NC
| | - Ann Marie Navar
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, TX
| | - Michael G. Nanna
- Duke Clinical Research Institute, Duke University, Durham, NC
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Linda K. George
- Department of Sociology, Duke University, Durham, NC
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
- Department of Psychology and Neuroscience, Duke University, Durham, NC
| | - Eric D. Peterson
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, TX
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Smith NC. Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors. SOCIAL SCIENCE RESEARCH 2021; 99:102593. [PMID: 34429206 DOI: 10.1016/j.ssresearch.2021.102593] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 05/18/2023]
Abstract
Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.
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Affiliation(s)
- Nicholas C Smith
- Indiana University - Bloomington, Department of Sociology Ballantine Hall 744, 1020 East Kirkwood Avenue Bloomington, IN, 47405, USA.
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Masa R, Shangani S, Operario D. Socioeconomic Status and Psychosocial Resources Mediate Racial/Ethnic Differences in Psychological Health Among Gay and Bisexual Men: A Longitudinal Analysis Using Structural Equation Modeling. Am J Mens Health 2021; 15:15579883211001197. [PMID: 33724073 PMCID: PMC7970305 DOI: 10.1177/15579883211001197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A large body of research demonstrates disparities in psychological health attributed to sexual minority identity, racial/ethnic minority identity, and socioeconomic status (SES). Fewer studies have explicated the role of these multiple attributes on psychological health and explored the role of SES and psychosocial resources in determining outcomes. We analyzed data from Project STRIDE, a longitudinal survey involving a diverse sample of gay and bisexual adult men (n = 198). Using structural equation modeling, we tested hypothesized direct and indirect effects of race/ethnicity, SES, and three psychosocial mediational variables (collective self-efficacy, everyday discrimination, internalized homophobia) on two outcome variables-psychological and social well-being-assessed at 1-year follow-up. Our model indicated that: (1) race/ethnicity and SES were significantly associated with each other and with each psychosocial mediator; (2) higher SES was directly and indirectly associated with both measures of well-being; and (3) collective self-esteem and everyday discrimination mediated the association between SES and both measures of well-being. The model also indicated that racial/ethnic associations with psychological mediators and outcomes are evident in the context of SES, but these effects might be suppressed when the model does not consider SES. Findings highlight the critical role of SES and race/ethnicity in determining the psychological and social well-being of sexual minority men. Specification of mediating variables-collective self-efficacy, everyday discrimination, internalized homophobia-indicates potential intervention targets to improve psychological and social health in sexual minority men. Associations between race/ethnicity and SES support the need for intersectional frameworks in addressing the health of sexual minority men.
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Affiliation(s)
- Rainier Masa
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Sylvia Shangani
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Don Operario
- School of Public Health, Brown University, Providence, RI, USA
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Quach E. Identifying and Addressing Health Disparities among African American Men with Prostate Cancer: a Systematic Literature Review. J Racial Ethn Health Disparities 2021; 9:346-349. [PMID: 33474714 DOI: 10.1007/s40615-021-00962-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/21/2020] [Accepted: 01/06/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To answer the research question inquiring which determinants lead to health disparities among African American Men with Prostate Cancer and what factors influence clinical decision making by oncologists when delivering prostate cancer interventions in order to improve morbidity and mortality. METHODS Primary and secondary sources were extracted from articles located using Google Scholar and PubMed databases. Terms included in the literature search were "African American men," "prostate cancer," "determinants," "disparities," and "interventions." Focusing on these specific terms helped narrow the scope of this systematic review by indicating which studies met the inclusion criteria. Only 20 articles were included in this systematic review. Specific inclusion criteria for this review were: 1) a publication date between 2013 and the current year; 2) a focus on African American men diagnosed with prostate cancer; 3), randomized or quasi-randomized controlled trials (RCTs), and; 4) evidence-based interventions used by oncologists. RESULTS The articles included when this systematic review provide evidence that oncologists will need to play more central roles in preventing premature death when African American men who present a higher risk of prostate cancer compared to their White and Hispanic/Latino counterparts. Shared decision-making in screening and diagnosis is also essential to close health disparities as well as improve population-level health outcomes. CONCLUSION The systematic review argues that oncologists will need to integrate population-based interventions capable of presenting strong empirical evidence about which determinants contribute to health disparities among African American men diagnosed with prostate cancer.
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Affiliation(s)
- Emily Quach
- Eastern Virginia Medical School, Norfolk, VA, USA. .,Foundation Medicine, Inc., Boston, MA, USA.
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Schuch HS, Haag DG, Bastos JL, Paradies Y, Jamieson LM. Intersectionality, racial discrimination and oral health in Australia. Community Dent Oral Epidemiol 2020; 49:87-94. [PMID: 33022103 DOI: 10.1111/cdoe.12581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a dearth of studies on the extent to which perceived racial discrimination shapes oral health. Following an intersectional perspective, we estimated the prevalence of perceived racial discrimination in Australia, its association with oral health impairment, and examined whether this association was more severe among low socioeconomic status (SES) groups. METHODS Data came from the 2013 National Dental Telephone Interview Survey (N = 2798), a population-based study of Australian adults. Multivariable Poisson regression models were estimated to test the relationship between perceived racial discrimination and self-reported oral health impairment, as well as to investigate whether the magnitude of this association was greater among low-SES respondents. Relative Excess Risks due to Interaction (RERI) were used to indicate the presence of potentially large discrimination effects within low-SES strata. RESULTS Racial discrimination in the past 12 months was reported by 11.5% of all participants. Australians reporting racial discrimination had 1.4 (95% CI 1.1, 1.7) times the prevalence of impaired oral health. The association between perceived racial discrimination and oral health impairment was stronger among low-SES groups. The RERI was 0.55, indicating a super-additive Effect Measure Modification (EMM) by income on the additive scale. Similar results were observed with the EMM analyses by educational attainment. CONCLUSION Our findings indicate that perceived racial discrimination, as a specific form of widespread inequality, is associated with higher frequencies of oral health impairment among Australian adults. We also suggest that socially marginalized groups bear a greater burden of the oral health effects of racial discrimination.
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Affiliation(s)
- Helena S Schuch
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Dandara G Haag
- Adelaide Dental School, Australian Research Centre for Population Oral Health (ARCPOH), University of Adelaide, Adelaide, Australia
| | - João Luiz Bastos
- Department of Public Health, Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood, Australia
| | - Lisa M Jamieson
- Adelaide Dental School, Australian Research Centre for Population Oral Health (ARCPOH), University of Adelaide, Adelaide, Australia
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Tignanelli CJ, Watarai B, Fan Y, Petersen A, Hemmila M, Napolitano L, Jarosek S, Charles A. Racial Disparities at Mixed-Race and Minority Hospitals : Treatment of African American Males With High-Grade Splenic Injuries. Am Surg 2020; 87:287-295. [PMID: 32931304 DOI: 10.1177/0003134820947369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Racial and socioeconomic disparities in health access and outcomes for many conditions is well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American ([AA] vs White) males with high-grade splenic injuries. METHODS Data from the National Trauma Data Bank were utilized from 2007 to 2015; 24 855 AA or White males with high-grade splenic injuries were included. Multilevel mixed-effects regression analysis was used to evaluate disparities in outcomes and resource allocation. RESULTS Mortality was significantly higher for AA males at mixed-race (OR 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI, 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2, P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). DISCUSSION While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.
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Affiliation(s)
| | - Bradly Watarai
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yunhua Fan
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Mark Hemmila
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lena Napolitano
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephanie Jarosek
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Tignanelli CJ, Watarai B, Fan Y, Petersen A, Hemmila M, Napolitano L, Jarosek S, Charles A. Racial Disparities at Mixed-Race and Minority Hospitals: Treatment of African American Males With High-Grade Splenic Injuries. Am Surg 2020; 86:441-449. [PMID: 32684029 DOI: 10.1177/0003134820918262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Racial and socioeconomic disparities in health access and outcomes for many conditions are well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American (AA) versus white males with high-grade splenic injuries. METHODS Data from the National Trauma Data Bank was utilized from 2007 to 2015. A total of 24 855 AA or white males with high-grade splenic injuries were included. Multilevel mixed effects regression analysis was used to evaluate disparities in outcomes and resource allocation. RESULTS Mortality was significantly higher for AA males at mixed-race (odds ratio [OR] 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2; P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). DISCUSSION While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.
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Affiliation(s)
| | - Bradly Watarai
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yunhua Fan
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Mark Hemmila
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lena Napolitano
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephanie Jarosek
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Hudson D, Sacks T, Irani K, Asher A. The Price of the Ticket: Health Costs of Upward Mobility among African Americans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041179. [PMID: 32069785 PMCID: PMC7068450 DOI: 10.3390/ijerph17041179] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/16/2020] [Accepted: 02/03/2020] [Indexed: 01/09/2023]
Abstract
There is a growing literature that has documented diminishing health returns on upward social mobility among Black Americans. Due to historical policies and practices, upward social mobility is often an arduous, isolating process for Black Americans, especially as they navigate predominately white educational and workplace settings. This paper advances the literature in several meaningful and innovative ways. The goal of this paper is to provide a qualitative account of the health costs of upward social mobility and describe how these costs could diminish health returns despite greater levels of socioeconomic resources. Focus groups and surveys were the data collection methods for the study. Inclusion criteria for the study were that respondents identified as African American or Black, were 24 years or older and had completed college. The total sample was 32 college-educated Black men (n = 12) and women (n = 20). The mean age for men was 39 (range = 26-50) and 33 years of age (range = 24-59) for women. Key findings highlighted in this paper include (1) hypervisibility and subsequent vigilance; (2) uplift stress; and (3) health costs associated with social mobility. The sum of these stressors is posited to affect multiple health outcomes and elucidate the mechanisms through which socioeconomic returns on health are diminished.
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Affiliation(s)
- Darrell Hudson
- Brown School of Social Work, Washington University, St. Louis, MO 63130, USA;
- Correspondence: ; Tel.: +1-314-935-3517
| | - Tina Sacks
- School of Social Welfare, University of California at Berkeley, Berkeley, CA 94720, USA;
| | - Katie Irani
- Brown School of Social Work, Washington University, St. Louis, MO 63130, USA;
| | - Antonia Asher
- School of Public Health, Tulane University, New Orleans, LA 70112, USA;
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Raphael E, Gaynes R, Hamad R. Cross-sectional analysis of place-based and racial disparities in hospitalisation rates by disease category in California in 2001 and 2011. BMJ Open 2019; 9:e031556. [PMID: 31662392 PMCID: PMC6830629 DOI: 10.1136/bmjopen-2019-031556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/09/2019] [Accepted: 09/24/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To study the association of place-based socioeconomic factors with disease distribution by comparing hospitalisation rates in California in 2001 and 2011 by zip code median household income. DESIGN Serial cross-sectional study testing the association between hospitalisation rates and zip code-level median income, with subgroup analyses by zip code income and race. PARTICIPANTS/SETTING Our study included all hospitalised adults over 18 years old living in California in 2001 and 2011 who were not pregnant or incarcerated. This included all acute-care hospitalisations in California including 1632 zip codes in 2001 and 1672 zip codes in 2011. PRIMARY AND SECONDARY OUTCOMES We compared age-standardised hospitalisations per 100 000 persons, overall and for several disease categories. RESULTS There were 1.58 and 1.78 million hospitalisations in California in 2001 and 2011, respectively. Spatial analysis showed the highest hospitalisation rates in urban inner cities and rural areas, with more than 5000 hospitalisations per 100 000 persons. Hospitalisations per 100 000 persons were consistently highest in the lowest zip code income quintile and particularly among black patients. CONCLUSION Hospitalisation rates rose from 2001 to 2011 among Californians living in low-income and middle-income zip codes. Integrating spatially defined state hospital discharge and federal zip code income data provided a granular description of disease burden. This method may help identify high-risk areas and evaluate public health interventions targeting health disparities.
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Affiliation(s)
- Eva Raphael
- Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
| | - R Gaynes
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
| | - Rita Hamad
- Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
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17
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McGrath L. Virtual reality can enhance men's engagement with health screening and awareness. Evid Based Nurs 2019; 22:87. [PMID: 31142566 DOI: 10.1136/ebnurs-2018-103008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Linda McGrath
- School of Nursing. Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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18
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Powell W, Richmond J, Mohottige D, Yen I, Joslyn A, Corbie-Smith G. Medical Mistrust, Racism, and Delays in Preventive Health Screening Among African-American Men. Behav Med 2019; 45:102-117. [PMID: 31343960 PMCID: PMC8620213 DOI: 10.1080/08964289.2019.1585327] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The contribution of medical mistrust to healthcare utilization delays has gained increased public health attention. However, few studies examine these associations among African-American men, who delay preventive healthcare more often and report higher levels of medical mistrust than non-Hispanic White men. Additionally, studies rarely account for other factors reportedly working in tandem with medical mistrust to increase African-American men's preventive health screening delays (i.e., everyday racism and perceived racism in healthcare). We examined associations between medical mistrust, perceived racism in healthcare, everyday racism, and preventive health screening delays. Analyses were conducted using cross-sectional data from 610 African-American men aged 20 years and older recruited primarily from barbershops in four US regions (2003-2009). Independent variables were medical mistrust (MM), everyday racism (ER), and perceived racism in healthcare (PRH). Dependent variables were self-reported routine checkup, blood pressure screening, and cholesterol screening delays. Using multiple logistic regression and tests for mediation, we calculated odds ratios and 95% confidence intervals to assess associations between the independent and dependent variables. After final adjustment, African-American men with higher MM were significantly more likely to delay blood pressure screenings. Men with more frequent ER exposure were significantly more likely to delay routine checkups and blood pressure screenings. Higher levels of PRH were associated with a significant increased likelihood of delaying cholesterol screening. MM did not mediate associations between ER and screening delays. Increasing preventive health screening among African-American men requires addressing medical mistrust and racism in and outside healthcare institutions.
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Affiliation(s)
- Wizdom Powell
- University of Connecticut Health Center, Health Disparities Institute
| | - Jennifer Richmond
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior
| | | | - Irene Yen
- University of California Merced, Public Health Department
| | - Allison Joslyn
- University of Connecticut Health Center, Health Disparities Institute
| | - Giselle Corbie-Smith
- University of North Carolina at Chapel Hill, Departments of Social Medicine and Medicine
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Erving CL. Physical-psychiatric comorbidity: patterns and explanations for ethnic group differences. ETHNICITY & HEALTH 2018; 23:583-610. [PMID: 28277029 DOI: 10.1080/13557858.2017.1290216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This paper examines ethnic differences in the co-occurrence of physical and psychiatric health problems (physical-psychiatric comorbidity) for women and men. The following ethnic groups are included: Non-Latino Whites, African Americans, Caribbean Blacks, Spanish Caribbean Blacks, Mexicans, Cubans, Puerto Ricans, Other Latinos, Chinese, Filipinos, Vietnamese, and Other Asian Americans. In addition, the study assesses the extent to which social factors (socioeconomic status, stress exposure, social support) account for ethnic differences in physical-psychiatric comorbidity (PPC). DESIGN This study uses data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N = 12,787). Weighted prevalence rates of physical-psychiatric comorbidity (PPC) - the co-occurrence of physical and psychiatric health problems - are included to examine ethnic group differences among women and men. Multinomial logistic regression analysis was used to determine group differences in PPC before and after adjusting for social factors. RESULTS Puerto Rican men have significantly higher risk of PPC in comparison to Non-Latino White men. Among women, Blacks and Cubans were more likely than Non-Latino Whites to experience PPC as opposed to 'Psychiatric Only' health problems. Social factors account for the Puerto Rican/Non-Latino White difference in comorbid health among men, but have little explanatory power for understanding ethnic differences in comorbidity among women. CONCLUSION These findings have implications for medical care and can guide intervention programs in targeting a specific constellation of co-occurring physical and psychiatric health problems for diverse ethnic groups in the United States. As comorbidity rates increase, it is crucial to identify the myriad factors that give rise to ethnic group differences therein.
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Affiliation(s)
- Christy L Erving
- a Department of Sociology , University of North Carolina , Charlotte , USA
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Brown TH, Hargrove TW. Psychosocial Mechanisms Underlying Older Black Men's Health. J Gerontol B Psychol Sci Soc Sci 2018; 73:188-197. [PMID: 28977648 PMCID: PMC5927121 DOI: 10.1093/geronb/gbx091] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 06/26/2017] [Indexed: 12/19/2022] Open
Abstract
Objectives To evaluate the psychosocial mechanisms underlying older Black men's self-rated health, we examined: (a) the individual, cumulative, and collective effects of stressors on health; (b) the direct effects of psychosocial resources on health; and (c) the stress-moderating effects of psychosocial resources. Method This study is based on a nationally representative sample of Black men aged 51-81 (N = 593) in the Health and Retirement Study (HRS). Ordinary least squares (OLS) regression models of the psychosocial determinants of self-rated health draw on data from the HRS 2010 and 2012 Core datasets and Psychosocial Modules. Results Each of the six measures of stressors as well as a cumulative measure of stressors are predictive of worse self-rated health. However, when considered collectively, only two stressors (chronic strains and traumatic events) have statistically significant effects. Furthermore, two of the five psychosocial resources examined (mastery and optimism) have statistically significant protective effects, and prayer moderates the harmful effects of traumatic events on self-rated health. Discussion Conventional measures of stressors and coping resources-originally developed to account for variance in health outcomes among predominantly white samples-may not capture psychosocial factors most salient for older Black men's health. Future research should incorporate psychosocial measures that reflect their unique experiences.
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Affiliation(s)
- Tyson H Brown
- Department of Sociology, Duke University, Durham, North Carolina
| | - Taylor W Hargrove
- Department of Sociology, University of North Carolina at Chapel Hill
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Parker LJ, Benjamin T, Archibald P, Thorpe RJ. The Association Between Marijuana Usage and Discrimination Among Adult Black Men. Am J Mens Health 2016; 11:435-442. [PMID: 27561924 DOI: 10.1177/1557988316664896] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Black men may use marijuana as an externalizing coping mechanism to handle the chronic stress of discrimination. The aim of the study was to examine the relationship between everyday and major discrimination and marijuana use among a national sample of Black men. Using the National Survey of American Life, logistic regression analyses was used to determine the association between recent marijuana use and everyday discrimination, major discrimination, and a fully adjusted model that include everyday and major discrimination among adult Black men ( n = 1,833). Additionally, a multinomial logistic regression was used to examine the association between the frequency of marijuana usage and everyday discrimination and major discrimination among men who used marijuana in the past year. Everyday discrimination was not associated with marijuana use. In the fully adjusted model, men who experienced major discrimination had a higher odds of marijuana use ( OR: 1.19, 95% CI [1.05, 1.34]), than those who did not control for everyday discrimination and covariates of interest. Among recent marijuana users, men who used almost every day had a decreased risks for major discrimination (RRR: 0.72, 95% CI [0.56, 0.92]), compared with men who used less than once a month. The findings suggest that recent marijuana use among Black men is associated with experiences of major discrimination. Interestingly, men who used almost every day had a decreased risk for major discrimination. Marijuana may be used as a coping mechanism.
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Affiliation(s)
| | | | - Paul Archibald
- 1 Johns Hopkins University, Baltimore, MD, USA.,2 Morgan State University, Baltimore, MD, USA
| | - Roland J Thorpe
- 1 Johns Hopkins University, Baltimore, MD, USA.,3 Duke University, Durham, NC, USA
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