Smoking policies in the home have less influence on cigarettes per day and nicotine dependence level among African American than White smokers: A cross-sectional analysis

BackgroundAfrican American smokers suffer disproportionately from tobacco-related disease caused, in part, by lower rates of smoking cessation. We examined whether smoke-free home policies and delay discounting were differentially associated with cigarettes smoked per day (CPD) and nicotine dependence (ND) among African Americans and Whites.MethodsSecondary data analysis was conducted using data from 65 African American (n = 40) and White (n = 25) smokers who completed measures of CPD, ND, tobacco craving, stress, depression, home smoking policy, and delay discounting.ResultsA significant interaction was found between race and home smoking policy on CPD (B = −11.21, p = 0.002) and ND (B = −3.42, p = 0.004). Smoke-free policies in the home were associated with fewer CPD and lower ND levels among Whites, but not among African Americans. Whites who allowed smoking in their homes had significantly greater mean CPD and higher mean ND than their counterparts who did not allow smoking in the home. Among African American smokers, there were no differences in CPD and ND among those who allowed smoking in their home versus those who did not.ConclusionsThe findings extend the scientific literature by suggesting that a malleable environmental factor (home smoking policy) commonly associated with cessation among Whites does not have the same influence on cessation among African American.     

Racial differences in informal help seeking for mental health problems

The present study examined the hypothesis of greater African American informal help seeking for mental health problems in a comparison of African Americans and Whites. Controlling for sociodemographic factors, symptom distress, and diagnosis, African Americans were less likely than Whites to report turning for assistance to a friend, family member, or religious figure. Nor did African Americans use informal help as a substitute for professional care; they turned to informal helpers in conjunction with formal helpers, and demonstrated complementarity to a greater extent than Whites. Supportive ties found among African Americans may be advantageous for many purposes, but provide no benefit for the face-to-face discussion of emotional problems. © 1998 John Wiley & Sons, Inc.     

Effects of Social Ties on Self-rated Physical Health Among African American Adults

ObjectivesTo examine associations between social ties and self-rated physical health among midlife and older African Americans.MethodsCross-sectional analysis of the 2005-2006 Milwaukee African American oversample of the second Midlife Development in the United States (MIDUS II) study. Multivariate logistic regression examined associations between type of social ties (family or friends), their frequency (number of contacts), and their quality (support and strain) with better self-rated physical health (SRPH). We defined better SRPH to include self-reports of good, very good, or excellent SRPH; this category was compared with fair or poor SRPH. Control variables included demographic factors; social engagement characteristics such as working, volunteering, and caregiving; and measures of social structure such as types of discrimination experience and ratings of neighborhood quality.ResultsIn adjusted results, each additional degree of family support was associated with better self-rated physical health (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.14-2.22). Each additional reported incident of daily discrimination was associated with 9% lower odds of reporting better SRPH (OR, 0.91; CI, 0.83-0.99).DiscussionResults suggest quality of family support may contribute importantly to the health of African Americans. When working with midlife and older African Americans, providers should engage and support families as a vital resource to improve health.     

An integrative review of stakeholder views on Advance Care Directives (ACD): Barriers and facilitators to initiation,documentation, storage,and implementation

ObjectiveTo examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability.MethodAn integrative review of 93 studies, analysed according to their content themes.ResultsContent themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life.ConclusionsThere are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions.Practice ImplicationsIt is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients’ end-of-life care decisions.     

Young,African American adults with asthma: what matters to them?

BackgroundAsthma is a common chronic condition that shows significant health disparities among minority populations. Little research has focused on the management needs and preferences of young African American adults with asthma, a population undergoing dramatic life changes as they transition from adolescence to adulthood.ObjectiveTo understand the experiences and perspectives of young African American adults managing their asthma.MethodsFocus groups were conducted with African American adults (n = 34) 18 to 30 years old with a physician diagnosis of asthma. Focus group sessions were audiotaped, transcribed verbatim, and coded using constant comparative analysis.ResultsSix major domains were identified and some of the salient themes included changes in asthma management needs with the onset of adulthood, career limitations owing to asthma, childcare interference with asthma regimen adherence, and difficulties with medication cost owing to lapses in insurance coverage. Participants also reported feeling discouraged when interacting with physicians as it related to their asthma care; yet ageism and racism were not perceived. Despite poor medication regimen compliance, participants were overwhelmingly interested in participating in asthma self-management programs and had strong preferences that such programs be tailored specifically to young adults with special consideration of the cultural experience of young African Americans with asthma.ConclusionYoung African American adults have specific barriers to optimal asthma care and distinctive ideas for self-management programs. It is important for the asthma care provider to identify and address these population- and age-specific barriers to improve asthma outcomes and decrease health care disparities.     

An advance directive redesigned to meet the literacy level of most adults: A randomized trial

ObjectiveTo determine whether an advance directive redesigned to meet most adults’ literacy needs (fifth grade reading level with graphics) was more useful for advance care planning than a standard form (>12th grade level).MethodsWe enrolled 205 English and Spanish-speaking patients, aged ≥50 years from an urban, general medicine clinic. We randomized participants to review either form. Main outcomes included acceptability and usefulness in advance care planning. Participants then reviewed the alternate form; we assessed form preference and six-month completion rates.ResultsForty percent of enrolled participants had limited literacy. Compared to the standard form, the redesigned form was rated higher for acceptability and usefulness in care planning, P ≤ 0.03, particularly for limited literacy participants (P for interaction ≤0.07). The redesigned form was preferred by 73% of participants. More participants randomized to the redesigned form completed an advance directive at six months (19% vs. 8%, P = 0.03); of these, 95% completed the redesigned form.ConclusionsThe redesigned advance directive was rated more acceptable and useful for advance care planning and was preferred over a standard form. It also resulted in higher six-month completion rates.Practice implicationsAn advance directive redesigned to meet most adults’ literacy needs may better enable patients to engage in advance care planning.     

COVID-19 Vaccine Intentions and Mistrust in a National Sample of Black Americans

BackgroundNational data indicate low intentions for COVID-19 vaccination among a substantial minority of Black Americans, and disproportionately lower vaccination rates among Black Americans than White Americans.MethodsA total of 207 of the 318 Black participants (65%) in the RAND American Life Panel, a nationally representative internet panel, were surveyed about COVID-19 vaccine intentions in November-December 2020. Participants’ census tracts were geocoded using the Centers for Disease Control and Prevention's Social Vulnerability Index.ResultsOverall, 35% agreed or strongly agreed that they would not get a COVID-19 vaccine, 40% agreed or strongly agreed that they would get vaccinated, and 25% reported “don't know.” Significant multivariable predictors of not wanting to get vaccinated included high mistrust of the vaccine itself (e.g., concerns about harm and side effects), OR (95% CI) = 2.2 (1.2–3.9), p = .007, and weak subjective norms for vaccination in one's close social network, OR (95% CI) = 0.6 (0.4–0.7), p < .001. Residence in an area of higher socioeconomic vulnerability was a marginally significant predictor, OR (95% CI) = 3.1 (0.9–11.0), p = .08.ConclusionsHigh mistrust around COVID-19 vaccines may lower vaccine confidence. Social network members’ attitudes can be influential in encouraging vaccination. Public health communications could use transparent and clear messaging on safety and efficacy, and acknowledge historical and ongoing discrimination and racism as understandable reasons for low confidence in COVID-19 vaccines. Future research is needed to consider vaccine access challenges in tandem with mistrust as contributing to low vaccination rates across health conditions.     

Pre-transplant evaluation completion for Black/African American renal patients: Two theoretical frameworks

ObjectiveBlack/African Americans (B/AA) are less likely to complete the pre-transplant evaluation for kidney transplantation despite higher prevalence rates of end-stage renal disease (ESRD). To better understand the barriers and motivators to completing the evaluation process, two qualitative studies were conducted to categorize and elucidate the relationships between these factors.MethodsIn Phase I, semi-structured interviews were conducted with a stratified purposeful sample of transplant professionals (N = 23). Focus groups were conducted during Phase II with a purposeful sample of B/AA patients (N = 30).ResultsThematic analyses assessed using grounded theory revealed a multitude of factors at individual and systemic levels, including health and informational/educational-related factors. Two comprehensive theoretical frameworks, a socio-ecological model of barriers and a model of motivators are presented. Medical mistrust is an example of a community factor identified as impeding completion rates. Systemic motivators included compressed time for testing and fewer intervals between doctor’s appointments.ConclusionsThis study offers a structure for understanding impediments to and facilitators of pre-transplant evaluation completion as seen through the eyes of both B/AA ESRD patients seeking transplant and the providers who work with them.Practice implicationsRecommendations for intervention and systemic changes to narrow health disparities are discussed.     

The prevalence of self-reported lactose intolerance and the consumption of dairy foods among African American adults are less than expected

ObjectiveTo determine the self-reported incidence of lactose intolerance and its influence on dairy choices among African American adults.Design, Setting, and ParticipantsAn online survey closely matched to the 2000 US Census was administered to a nationally representative sample of African Americans (2016 adults) and a comparison sample of the general population (1084 adults). Statistical analyses performed included pair-wise f tests for proportion conducted on percent responses at the 95% confidence level.ResultsAfrican Americans were more likely to eat fewer dairy foods, experience physical discomfort after consumption, and believe they were lactose intolerant. While 49% of African Americans had ever experienced "some type of physical discomfort" after eating dairy foods, 24% believed they were lactose intolerant. Within this group, 85% of African Americans would be willing to consume more dairy products if they could avoid lactose intolerance symptoms.Conclusions and ImplicationsDairy food, calcium, and vitamin D intake in African Americans and the general population are below US recommendations. Deficiencies of these nutrients are associated with chronic diseases that disproportionately affect African Americans. In the United States, dairy foods are the primary source of calcium and vitamin D, and lactose intolerance can be a significant barrier to dairy food intake. However, self-described lactose intolerance is less than commonly reported in African American populations. Low dairy intake may reflect concerns about lactose intolerance, other factors such as learned food habits and cultural preferences. Nutrition recommendations for African Americans and the general population should focus on the health benefits of dairy foods, provide culturally sensitive dietary options, and strategies to increase tolerance.     

Online health information seeking,medical care beliefs and timeliness of medical check-ups among African Americans

ObjectiveThis study aims to investigate the relationship among different types of internet sources for health, medical check-up beliefs and the timeliness of annual medical check-ups among African Americans, accounting for both health TV usage and health service use.MethodsHierarchical linear regression analysis was conducted on data from 1734 African Americans surveyed in the 2013 Consumer Health Multimedia Audience Research Systems national pharmaceutical study of 19,420 U.S. adults.ResultsThe results indicate a positive association between seeking health information on medical websites (β = 0.052, p = 0.04) and consumer-driven health sites (β = 0.066, p < 0.01), and the timeliness of check-ups among African Americans, an association not found in relation to mainstream or news-related sites. Health TV program use was not associated with timeliness of medical check-ups. Medical check-up belief is positively associated with seeking health info on consumer-driven health sites (β = 0.072, p < 0.01) but not on medical sites or on TV.ConclusionSeeking information on health-specific websites was associated with more timely check-ups in African Americans and more positive preventative medical care belief, even after controlling for traditional barriers, such as poor provider relationship.Practice ImplicationsHealth specific websites may provide an avenue for intervention to improve preventative care use in African Americans.     

Effect of race and predictors of socioeconomic status on diet quality in the HANDLS Study sample

PurposeTo examine effects of race and predictors of socioeconomic status (SES) on nutrient-based diet quality and their contribution to health disparities in an urban population of low SES.DesignData were analyzed from a sample of the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study participants examining effects of age, sex, race, income, poverty income ratio, education, employment, and smoking status on nutrient-based diet quality as measured by a micronutrient composite index of nutrient adequacy ratios and a mean adequacy ratio. Regression models were used to examine associations and t tests were used to look at racial differences.SubjectsAfrican American and white adults ages 30 to 64 years residing in 12 predefined census tracts in Baltimore, Maryland.ResultsSex, age, education, poverty income ratio, and income were statistically significant predictors of diet quality for African Americans, while sex, education, and smoking status were statistically significant for whites. African Americans had lower mean adequacy ratio scores than whites (76.4 vs 79.1). Whites had significantly higher nutrient adequacy ratios scores for thiamin, riboflavin, folate, B₁₂, vitamins A and E, magnesium, copper, zinc, and calcium, while African Americans had higher vitamin C scores.ConclusionEducation significantly impacted diet quality in the HANDLS sample, but race cannot be discounted. Whether the racial differences in diet quality are indicative of cultural differences in food preferences, selection, preparation, and availability, or disparities in socioeconomic status remains unclear.     

Headache Disparities in African-Americans in the United States: A Narrative Review

ObjectiveThe goal of this paper is to give a narrative review of the racial/ethnic disparities in African-Americans (AA) found in headache medicine and provide plausible responses to the National Institute of Neurological Disorders and Stroke (NINDS) issued Request for information (RFI); “Soliciting Input on Areas of Health Disparities and Inequities in Neurological Disease and/or Care in the United States (US)” as it relates to AA and headache medicine.BackgroundOn March 31, 2020 the NINDS issued a RFI “Soliciting Input on Areas of Health Disparities and Inequities in Neurological Disease and/or Care in the US Across the Lifespan”, RFI-NOT–NS–20-026, with response date ending June 15, 2020.¹ However as of June 13, 2020, a PubMed search with key terms “African American Headache disparities” yielded few results.MethodsMulti-database search and literature review.Results/DiscussionAs of June 13, 2020, a PubMed search with key terms “African American (or Black) Headache disparities” yielded 13 results. Searches of “Migraine Disparities Race” and “Migraine disparities African American” both yielded three results with one non-specific for migraine. In, “Headache disparities race” yielded one result in the PsycINFO database and 23 results in Web of Science database. Key areas of adult headache disparity and/or inequity were health care services for migraine treatment are less utilized, follow-up appointments are terminated more regularly, inaccurate diagnoses are more common, acute migraine attack medications are prescribed less frequently, mistrust and lower quality communication with physicians is reported, mistrust, increased migraine burden, frequency, and severity and risk for progression more associated depression and lower quality of life in AAs compared to non-Hispanic Whites. Literature on race-based disparities is even more scarce in pediatric populations, however it has been shown that white children are significantly more likely to receive neuroimaging than others which may indicate biases in pediatric populations. Potential determinants of these race-based disparities, research strategies and approaches vary and are discussed.ConclusionsRace-based disparities exist in headache medicine in the US. Research is needed. Research strategies and approaches currently with limited use in neurology and headache medicine may be warranted and appropriate to address race-based headache disparities. Funding is paramount.     

Tools to Measure Health Literacy among US African Americans and Hispanics/Latinos with Type 2 Diabetes: A Scoping Review of the Literature

ObjectiveTo provide an overview of the health literacy tools that have been validated in samples of African Americans and Hispanics/Latinos with type 2 diabetes, growing segments of the US population.MethodsFollowing PRISMA guidelines, three electronic databases were searched. The following inclusion criteria were used: peer-reviewed research; examined validity of a health literacy tool; and included US African American and/or Hispanic/Latino adults with type 2 diabetes.ResultsSixteen studies were selected; none exclusively included African Americans while 3 exclusively included Hispanics/Latinos in the sample. Seventeen health literacy tools were identified. Among African Americans, 2 health literacy screeners, 2 diabetes knowledge, and 3 numeracy tools have been validated. Among Hispanics/Latinos, 1 health literacy screener, 1 diabetes knowledge, and 1 numeracy tool have been validated. However, cross-cultural adaptation principles were rarely considered in the development and validation of these tools.ConclusionIn those with type 2 diabetes, future studies should investigate the validity of health literacy screeners among English-speaking Hispanics/Latinos and general health literacy tools among African Americans and Hispanics/Latinos. Evidence on the validity of diabetes knowledge and numeracy tools was mixed across studies.Practice implicationsFindings can inform the selection of culturally-appropriate health literacy tools in clinical and research settings.     

Do health literacy disparities explain racial disparities in family-centered care for youths with special health care needs?

ObjectiveTo explore the relationship among youth health literacy, parental health literacy, and family-centered care (FCC) for youth with special health care needs (YSHCN) and assess potential racial disparities.MethodsHL and FCC were assessed in 486 Medicaid-enrolled YSHCN (ages 12–18) and their healthcare-responsible parent/caregiver. Analyses assessed racial differences in HL and FCC for parents and youth using logistic regression.ResultsHalf of youth and over 80 percent of parents had adequate HL (REALM score ≥62). Adequate HL was significantly lower in African Americans (AA) for both YSHCN and parents. Only 57 % of parents and 29 % of YSHCN reported FCC. AA YSHCN reported significantly lower levels of FCC compared to White YSHCN. AA parents trended lower for FCC compared to Whites, though the disparity was not significant. AA youth and parents had significantly lower odds of reporting that doctors spent enough time with them compared to Whites.ConclusionResults suggest that AA and those with less than adequate health literacy experience lower FCC, however the relationship between race and health literacy does not explain the racial disparity in FCC.Practical ImplicationsProvider time spent focused on HL may not reduce the racial disparity in FCC, but opportunities for improvement exist.     

Predicting Colonoscopy Screening Behavior and Future Screening Intentions for African Americans Older than 50 Years

Abstract

African Americans experience a disproportionate burden of morbidity and mortality from colorectal cancer, which may be due to low adherence to screening recommendations. Previous studies have found relationships between decision-making factors and screening behavior, but few have looked at both cognitive and affective factors or within a specifically African American sample. To better understand determinants that drive screening behavior, this study examines affective, cognitive, and social variables as predictors of colonoscopy in an age-eligible African American population. Participants completed surveys assessing affective associations with colonoscopy, perceived benefits and barriers, self-efficacy, knowledge, fear of colonoscopy, perceived risk, and colorectal cancer worry and fear. Regression analysis was used to model decision-making constructs as predictors of screening behavior/intentions. Affective, cognitive, and health care experience variables predicted colonoscopy completion and intentions. Provider-level factors and previous cancer screenings predicted prior screening only, but not intentions. Affective and cognitive components of perceived risk were associated with decreased likelihood of colonoscopy behavior, but increased likelihood of colonoscopy intentions. These findings suggest that colonoscopy decision making involves a complex array of both cognitive and affective determinants. This work extends our knowledge of colorectal cancer screening decision making by evaluating the effects of these multiple determinants on screening behavior in an African American sample. Future work exploring the interplay of affect and cognitions as influences on colonoscopy decision making and how health care experiences may moderate this effect is needed to develop effective intervention approaches and reduce screening disparities.     

Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care

Discriminatory treatment of African Americans in healthcare is well recognized, yet the literature is unclear on the specific role that perceived racism and mistrust play in the patient-provider relationship. The purpose of this study was to test a mid-range theoretical model entitled Perceptions of Racism and Mistrust in Health Care (PRMHC). This model hypothesized that perceived racism influences cultural mistrust, which affects trust in providers--and these combined psychosocial aspects of healthcare affect satisfaction with the care received. One-hundred-forty-five African-American subjects participated in structured interviews to collect demographic and psychosocial data. Provider data was obtained through chart audits. In a group of low-income African Americans in two primary care clinics, perceptions of racism and mistrust of whites had a significant negative effect on trust and satisfaction. Perceived racism had both a significant, inverse direct effect on satisfaction as well as a significant indirect effect on satisfaction mediated by cultural mistrust and trust in provider. Structural equation modeling analysis supported the hypothesized theoretical relationships and explained 27% of the variance in satisfaction with care. The findings add to the existing literature by enhancing our understanding of the complex perspectives on trust and overall satisfaction with care among African-American patients. Results suggest that improving health outcomes for African Americans requires a broader understanding of cultural competence, one that addresses societal racism and its impact on provider-patient relationships.     

Perceived racial discrimination as an independent predictor of sleep disturbance and daytime fatigue

Perceived discrimination is a potential cause of racial and ethnic disparities in health. Disturbed sleep may serve as a mechanism linking perceived racism with health consequences. This study investigates data from 7,148 adults from Michigan and Wisconsin who participated in the 2006 Behavioral Risk Factor Surveillance System. Hierarchical logistic regression analyses explored associations between perceived racial discrimination and self-reported sleep disturbance and daytime fatigue. Sleep disturbance and daytime fatigue were reported in 19% and 21% of the sample, respectively. Black/African American respondents (21%) report perceiving worse experiences, compared to people of other races, when seeking health care at higher rates than non-Hispanic White respondents (3%). Results from logistic regression models show that perceived racial discrimination is associated with increased risks of sleep disturbance (odds ratio [OR] = 2.62, p < .0001) and daytime fatigue (OR = 2.07, p < .0001). After adjustment for all covariates, perceived discrimination remains a significant predictor of sleep disturbance (OR = 1.60, p = .04). The interaction between perceived racism and race (Black/African American vs. non-Hispanic White) was nonsignificant. This population-based research adds to the growing body of data, suggesting that perceived racism may impact health via its influence on sleep-wake behaviors.     

Exploring differences in trust in doctors among African American men and women

ObjectivesLow trust in doctors may partially account for African Americans' adverse health outcomes. Understanding the drivers of low trust can guide health care policy to improve trust and delivery of health care for African Americans. This study examines gender differences in trust in doctors among African Americans and explores factors differentially associated with low level trust for men vs women.Methodsand Measures: Cross-sectional analysis of 3649 African Americans using data from the 2003-2004 Community Tracking Study Household Survey, including 4 items measuring trust in doctors (range, 1 = lowest trust and 5 = highest trust). Items were assessed separately and as an index measure. Linear regression analyses adjusted for multiple con-founders and accounted for complex data sampling.ResultsOverall, men were less trusting of doctors than women. However, men differed from women only on 2 trust measures: "doctor influenced by insurance rules" (adjusted mean scores = 2.48 for men and 2.79 for women, p = .001) and "doctor performs unnecessary tests" (adjusted mean score = 4.00 for men and 4.28 for women, p = .010). Common correlates of low trust in men and women included less than high school education, age of at least 65 years, and having no usual source of care. Unique correlates of lower trust for men included rural living and no doctor visit in the preceding year. Unique correlates for women included low income and poorer health status.ConclusionsThere are differential predictors of low trust among African American men vs women, underscoring the need for gender-based and health care system-level approaches to improve African Americans' trust and health outcomes.