Search

Health equity research has identified fundamental social causes of health, many of which disproportionately affect Black Americans, such as early life socioeconomic conditions, neighborhood disadvantage, and racial discrimination. However, the role of life course factors in premature mortality among Black Americans has not been tested extensively in prospective samples into later adulthood. To better understand how social factors at various life stages impact mortality, this study examines the effect of life course poverty, neighborhood disadvantage, and discrimination on mortality and factors that may buffer their effect (i.e., education, social integration) among the Woodlawn cohort (N = 1242), a community cohort of urban Black Americans followed since 1966. Taking a life course perspective, we analyze mortality data for deaths through age 58 years old, as well as data collected at ages 6, 16, 32, and 42. At age 58, 204 (16.4%) of the original cohort have died, with ages of death ranging from 9 to 58.98 (mean = 42.9). Cox proportional hazard models adjusting for confounders show statistically significant differences in mortality risk based on timing and persistence of poverty; those who were never poor or poor only in early life had lower mortality risk at ages 43–58 than those who were persistently poor from childhood to adulthood. Education beyond high school and high social integration were shown to reduce the risk of mortality more for those who did not experience poverty early in their life course. Findings have implications for the timing and content of mortality prevention efforts that span the full life course. [ABSTRACT FROM AUTHOR]

Objective : Post-migration stress and trauma impact the way Latino/a immigrants in the USA experience everyday life. Mindfulness-based interventions (MBIs) reduce stress and strengthen mental health by improving the response to stressors and promoting physical and psychological well-being; however, they have not been tested extensively with Latino/a immigrants in the USA, particularly MBIs implemented online. Thus, more information is needed about the feasibility of online MBIs adapted for Latino/a immigrants. Method: This study focuses on the feasibility of an online MBI for Latina mothers and community staff members working with them (n = 41). Qualitative (three focus groups) data were collected to assess feasibility, appropriateness, acceptability, and quantitative (questionnaires) data asking about self-reported changes on stress, mindfulness, mind–body connection, subjective well-being, and perceived physical and mental health after the program. Results: Participants in the three groups indicated the program was appropriate, feasible, and acceptable for Latina immigrant mothers and the staff serving them. Mothers' and Promotoras' (community health workers) mean scores for subjective well-being and perceived physical and mental health increased significantly from baseline to post-test. No significant changes were observed in surveys completed by the staff, even though focus group participants reported meaningful improvement. Conclusion: Overall, the feasibility study was well received and relevant for the organization and the population they serve. The study's findings provide guidance to others who are implementing online mindfulness practices with Latina immigrants and the staff that work with them. Preregistration: This study is not preregistered. [ABSTRACT FROM AUTHOR]

This study examined sex, racial, and ethnic differences in the short- and long-term associations between adverse childhood experiences (ACEs), mental health, and risk behaviors in a nationally representative sample. Analysis was based on the National Longitudinal Study of Adolescent to Adult Health, a longitudinal cohort of U.S. adolescents followed in five waves of data collection from adolescence to adulthood. Analysis included design-based regression models to examine the associations between ACEs and proximal and distal outcomes (i.e., depression, suicidal ideation, number of sexual partners, binge drinking, current smoker) assessed in the transition to adulthood (mean age 21; 2001–2002) and adulthood (mean age 38; 2016–2018). Sex, racial, and ethnic interactions were included in regression models to examine effect modification in the association of ACEs, mental health, and risk behaviors. In this analytical sample (N = 9,690), we identified a graded association between ACEs and depression, suicide ideation, and current smoker status at both time points (i.e., mean age 21 and 38). Sex moderated the relationship between ACEs and depression at mean age 21, while race (i.e., American Indian versus White) moderated the relationship between ACEs and number of sexual partners at mean age 38. A greater number of cumulative traumatic experiences in childhood may amplify adverse health outcomes among women and adults of American Indian descent in particular. [ABSTRACT FROM AUTHOR]

Substance use and mental health problems are associated with academic difficulties among high school and undergraduate students, but little research has been conducted on these relationships among graduate students. The sample consisted of 2683 graduate students attending two large, public universities. Standard measures were used to collect data on demographic and program characteristics, mental health, substance use, advisor satisfaction, and burnout (i.e., exhaustion, cynicism, and inefficacy). Linear regression models evaluated the relationships between each mental health and substance use variable with burnout, as well as the moderating role of advisor satisfaction. Students with a greater number of substance use and mental health problems had higher levels of exhaustion, cynicism, and inefficacy. No statistically significant relationships between substance use and burnout were found. High levels of stress, moderate or severe anxiety symptoms, and moderate or severe depressive symptoms were associated with increased levels of burnout. Advisor support moderated the relationships between stress and both cynicism and inefficacy such that the effects of stress on these dimensions of burnout were lower among those who were satisfied with their advisor. Graduate students with mental health problems might be at increased risk for burnout; however, having a supportive advisor might buffer this association. [ABSTRACT FROM AUTHOR]

While there is a growing literature on the relationship between incarceration and health, few studies have expanded the investigation of criminal justice system involvement and health to include the more common intervention of arrest. This study uses a quasi-experimental design to evaluate the long-term effect of arrest in young adulthood on health behaviors in midlife for African Americans. We use propensity score matching methods and gender-specific multivariate regression analyses to equate those who did and did not incur an arrest in young adulthood from a subsample (n = 683) of the Woodlawn cohort, an African American community cohort followed from childhood into midlife. The results suggest that, for men, having been arrested in young adulthood has a direct effect on smoking, daily drinking, and risky sexual behaviors into midlife while young adult arrest does not seem to impact midlife health risk behaviors for women. This study adds health risk behaviors to the growing list of detrimental outcomes, such as crime, drug use, education, and mental health that are related to criminal justice contact for African American men, in particular. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is an important public health concern with higher prevalence among women. Community health workers (CHWs) are trusted frontline public health workers that bridge gaps between communities and healthcare services. Despite their effectiveness in delivering services and improving outcomes for different chronic conditions, there is a dearth of understanding regarding CHW management of IPV. The purpose of this study is to examine knowledge, attitudes, practices, and readiness to manage IPV among a sample of CHWs (n = 152). Participants completed an online version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), which was modified for CHW practice. Psychometrics of the newly adapted tool, along with empirical relationships between knowledge, attitudes, and readiness to manage IPV were examined. Most sub-scales yielded moderate to high reliability (0.70 < α's < 0.97), some sub-scales had low reliability (0.57 < α's < 0.64), and construct validity was established for several of the subscales. On average, many CHWs had low scores on objective knowledge of IPV (mean = 15.4 out of 26), perceived preparation to manage IPV (mean = 3.8 out of 7), and perceived knowledge of IPV (mean = 3.7 out of 7). About 56% of CHWs indicated having no previous IPV training, 34% did not screen for IPV, and 65% were in the contemplation stage of behavior change. Multiple regression models indicated that knowledge, staff capabilities and staff preparation were significant predictors of perceived preparedness to manage IPV (all p's < 0.05). Results can inform future credentialing requirements and training programs for CHWs to better assist their clients who are victims of IPV. [ABSTRACT FROM AUTHOR]

Extant research has typically examined neighborhood characteristics in isolation using variable-centered approaches; however, there is reason to believe that perceptions of the neighborhood environment influence each other, requiring the use of person-centered approaches to study these relationships. The present study sought to determine profiles of youth that differ in their perceptions of their neighborhoods and objective neighborhood characteristics, and whether these profiles are associated with youth coping. Participants were low-income, African American youth (N= 733; 51.0% female, M age = 18.76 years, SD = 1.71) from a metropolitan city who were originally recruited for the Youth Opportunity program in Baltimore, Maryland. A latent profile analysis was conducted which included self-reported neighborhood social cohesion, collective efficacy, disorder, violence, and disadvantage derived from census data. Coping behaviors, specifically positive cognitive restructuring, problem-focused coping, distraction strategies, and avoidant behaviors were assessed via self-reported questionnaires. Four neighborhood profiles were identified: highest disorder (20.0%); highest violence/highest disadvantage (5.2%); high violence (26.6%); and highest cohesion/lowest disorder (48.2%). Individuals in the highest violence/highest disadvantage profile reported higher positive cognitive restructuring and problem-focused coping than the other profiles. These findings warrant an investigation into the individual assets and contextual resources that may contribute to more positive coping behaviors among youth in more violent and disadvantaged neighborhoods, which has the potential to improve resilient outcomes among youth in similar at-risk settings. [ABSTRACT FROM AUTHOR]

Urban populations disproportionately experience poor sexual outcomes, including high rates of teenage pregnancy and sexually transmitted infections. However, the contribution of substance use across adolescence to poor sexual outcomes in young adulthood has not been investigated in depth, despite offering opportunities for more targeted prevention. This study aimed to estimate joint trajectories of adolescent alcohol and marijuana use to determine if they relate differently to four sexual outcomes: multiple sexual partners, sex without a condom, teenage pregnancy, and contraction of a sexually transmitted infection in young adulthood (by age 25). Data came from a longitudinal study of urban youth followed from age 6 to age 25, with annual assessments during adolescence and young adulthood (n = 608). The sample showed high levels of sexual risk, with young adults on average having sex without a condom once in the past month, 28.5% having multiple sexual partners in the past month, one quarter having contracted a sexually transmitted infection, and over 60% of the women being pregnant as a teenager and 36% of the men having gotten a partner pregnant. Applying longitudinal latent profile analysis to estimate joint trajectories of alcohol and marijuana use from grades 8-12, we identified four classes representing high dual use, moderate alcohol use, moderate alcohol use with increasing marijuana use, and non-use. Class membership differently predicted all four outcomes investigated with high dual users having the highest level of teenage pregnancy and the increasing marijuana trajectory having the highest risk of engaging with multiple sexual partners in the past month. Results suggest implications for both sexual risk and substance use prevention for urban youth. [ABSTRACT FROM AUTHOR]

Background: Understanding racial differences in teenage fathers' early risk factors and later outcomes is critical to inform programs for teenage fathers as our knowledge base on this population remains limited. Objective: The goal of this study was to assess how teen fathers' characteristics, including family background, delinquency, living arrangements, socioeconomic resources, and arrests, vary over time by race and ethnicity. Method: We analyzed National Longitudinal Study of Adolescent to Adult Health data. The analytic sample consisted of self-identified African American, Latino, and White males who fathered a child before the age of 20 (n = 313). Data come from three time points: adolescence, transition to adulthood, and young adulthood. Results: Latino teen fathers came from families with lower educational attainment and greater reliance on public assistance. No statistically significant differences by race and ethnicity were found in parental involvement, school connectedness, marijuana use, and delinquency during adolescence. By their early 20s, a lower proportion of African American teen fathers were married compared to White and Latino teen fathers. By young adulthood, adjusted regression analyses showed that African American teen fathers were more likely to be arrested and earned a lower mean income than White teen fathers. Conclusions: Findings suggest that African American teen fathers, while no more disadvantaged or delinquent than the other two groups in their adolescence, experience greater accumulation of disadvantages over the life course. Intervention programs must consider the broader social and institutional context that may contribute to the disproportionate disadvantage among African American teen fathers in their young adulthood. [ABSTRACT FROM AUTHOR]

Although there is little difference in rates of marijuana use between White and Black youth, Blacks have significantly higher rates of marijuana use and disorder in young adulthood. Theory suggests that factors tied to social disadvantage may explain this disparity, and neighborhood setting may be a key exposure. This study sought to identify trajectories of marijuana use in an urban sample during emerging adulthood, neighborhood contexts that predict these trajectories and social role transitions or "turning points" that may redirect them. Data are from a longitudinal cohort study of 378 primarily Black emerging adults who were first sampled in childhood based on their residence in low-income neighborhoods in Baltimore City and followed up annually. Group-based trajectory modeling identified three groups: No Use (68.8%), Declining Use (19.6%), and Chronic Use (11.7%). Living in close proximity to an alcohol outlet, and living in a neighborhood with more female-headed households and higher rates of violent crime increased the odds of membership in the Chronic Use group relative to No Use. Living in a neighborhood with more positive social activity increased the odds of membership in the Declining Use group relative to No Use. Not receiving a high school diploma or GED, pregnancy, and parenting also increased the odds of membership in the Declining Use group relative to No Use. These findings provide support that minority youth living in socially toxic and disordered neighborhoods are at increased risk of continuing on a trajectory of marijuana use during emerging adulthood while positive social activity in neighborhoods has the potential to redirect these negative trajectories. Besides taking on the responsibilities of parenting, emerging adults in the marijuana user groups had similar educational and family outcomes, suggesting that early marijuana use may have long-term implications. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the geographic clustering of African American adolescent marijuana use in urban neighborhoods. Methods of the study to determine whether neighborhood-level characteristics are related to the geographic clustering of marijuana use and whether neighborhood crime, violence, and poverty impacts clustering of marijuana use are offered. Results which highlight the link between substance abuse problems and neglect or lack of parental guidance are noted.

African American male high school students have the highest rates of marijuana use among all racial, ethnic, and gender groups, yet there is limited research examining contextual factors salient to the African American community. The purpose of this study was to examine how neighborhood environment measured in 8th grade is related to longitudinal transitions in marijuana use during high school (9th to 12th grades) in a sample of urban African Americans. Four hundred and fifty-two African American children were interviewed annually beginning in 1st grade as part of a longitudinal field study in Baltimore city. Latent transition analysis indicated early in high school posed the greatest risk for initiation and progression of marijuana use. Community violence exposure was associated with an increased likelihood of transitioning from no marijuana use to infrequent use (adjusted odds ratios (AOR) = 2.40, p < 0.001). Higher perceived neighborhood disorder (AOR = 3.20, p = 0.004), drug activity and sales in the neighborhood (AOR = 2.28, p = 0.028), and community violence exposure (AOR = 4.54, p < 0.001) were associated with an increased risk of transitioning from no use to frequent/problematic marijuana use. There was evidence for partial mediation of these associations by perceptions of harm and depressed mood. Drug activity and sales was associated with progression from infrequent to frequent and problematic use (AOR = 2.87, p = 0.029). African American youth living in urban environments with exposure to drug activity, violence, and neighborhood disorder are at increased risk for both initiation and progression to more frequent and problematic marijuana use during high school. These findings highlight the need to develop interventions for African American youth that are mindful of the impact of the additional stressors of living in a high-risk urban environment during a critical developmental transition period. Reducing exposure to drug activity and violence in high-risk urban neighborhoods may be the first step to potentially halt increasing rates of marijuana use among African Americans. [ABSTRACT FROM AUTHOR]

Depression among African Americans residing in urban communities is a complex, major public health problem; however, few studies identify early life risk factors for depression among urban African American men and women. To better inform prevention programming, this study uses data from the Woodlawn Study, a well-defined community cohort of urban African Americans followed from age 6 to 42 years, to determine depression prevalence through midlife and identify childhood and adolescent risk factors for adult depression separately by gender. Results indicate that lifetime depression rates do not differ significantly by gender (16.2 % of men, 18.8 % of women) in contrast to findings of a higher prevalence for women in national studies. Furthermore, rates of depression in this urban African American population are higher than those found in national samples of African Americans and more comparable to the higher rates found nationally among Whites. Regarding early predictors, for both men and women, family conflict in adolescence is a risk factor for adult depression in multivariate regression models. For women, vulnerability to depression has roots in early life, specifically, low maternal aspirations for school attainment. Females displaying more aggressive and delinquent behavior and those growing up in a female-headed household and a household with low maternal education have elevated rates of depression. Males growing up in persistent poverty, those engaging in greater delinquent behavior, and those with low parental supervision in adolescence also have elevated rates of depression. Effective prevention programming for urban African Americans must consider both individual characteristics and the family dynamic. [ABSTRACT FROM AUTHOR]

Although there has been much discussion about the persistence of poverty and welfare receipt among child-rearing women in the US, little is known about long-term patterns of poverty and welfare receipt or what differentiates those who remain on welfare from those who do not. Furthermore, are there distinctions between child-rearing women who are poor but not on welfare from those who do receive welfare? This study examined trajectories of welfare receipt and poverty among African-American women ( n = 680) followed from 1966 to 1997. A semiparametric group-based approach revealed four trajectories of welfare receipt: no welfare (64.2%), early leavers (12.7%), late leavers (10.1%), and persistent welfare recipients (10.1%). The “no welfare” group was further divided into a poverty group and a not poverty group to distinguish predictors of welfare from predictors of poverty. Multivariate analyses revealed differences in predictors of trajectory groups in terms of education, physical and psychological health, and social integration. In addition, earlier chronic illness and social integration were important predictors to differentiate between long-term users (i.e., late leavers, persistent recipients) and short-term users (i.e., early leavers). Trajectories did not differ in teenage motherhood, substance use, or family history of welfare receipt. Implications for public policy are discussed. [ABSTRACT FROM AUTHOR]