RACIAL AND ETHNIC DIFFERENCES IN THE NEIGHBORHOOD CONTEXT OF MASTERY

Residents of poor, non‐white neighborhoods experience high rates of neighborhood stressors like crime, violence, and disorder. Stress process theory suggests that mastery is important for understanding how neighborhood stressors affect resident mental health. This research examines the relationship between neighborhood stressors and mastery with a focus on racial and ethnic differences in a multi‐ethnic sample of Chicago residents. Because Black and Hispanic residents disproportionately live in high stressor neighborhoods and have more difficulty escaping them than Whites, a compound disadvantage model is proposed and tested using multilevel models with cross‐level interactions. Findings suggest race‐specific neighborhood antecedents of mastery and support for the compound disadvantage hypothesis. In highest stress neighborhoods, Blacks have lower mastery than Whites. In average and lower stress neighborhoods, Blacks have a mastery advantage.     

THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS’ EXPERIENCES OF MENTAL HEALTH TREATMENT

Clinicians and researchers have pointed to the need for culturally sensitive mental health interventions. Yet it has not been determined if the inclusion of cultural elements affects the way mental health clients experience services. This study examined 102 clients who had received mental health treatment from outpatient mental health clinics to investigate whether culturally related elements involving race and ethnicity were important to clients and whether they were related to client satisfaction and perceived treatment outcomes. Ethnic minority clients generally felt that issues regarding race and ethnicity were more important than did White clients. When these elements were considered important but were not included in their care, clients were less satisfied with treatment. Consistent with the notion of cultural responsiveness, these findings provide empirical evidence that culturally relevant aspects of the mental health service experience are salient to ethnic minority clients and can affect how they respond to services.     

Community violence and posttraumatic stress disorder symptoms in urban youth: The moderating influence of friend and parent support

Separate lines of research have demonstrated that community violence predicts posttraumatic stress disorder (PTSD) symptoms in youth and that social support is one protective factor against the development of PTSD symptoms. The current study sought to examine the associations between primary and secondary exposure to community violence and the moderating role of parent and friend support on these relations. Participants were 96 urban youths (aged 6–17 years; 58.4% racial/ethnic minority; 51% female) and a caregiver recruited from a university mental health clinic. Results indicated that both primary and secondary exposure to community violence predicted PTSD symptoms. Friend support, but not parent support, moderated the association between primary, but not secondary, exposure to community violence and PTSD symptoms. The findings suggest that friend support is a salient protective factor for urban youth who may be at risk of PTSD symptoms due to exposure to community violence.     

US health journal editors' opinions and policies on research in race, ethnicity, and health.

Health research on race and ethnicity has been criticized for lacking rigor in conceptualization, terminology, and analysis. Scientific journals'' editorial processes help determine research quality. This survey assessed editors'' awareness of current debates, attitudes toward recent recommendations, and involvement in developing editorial policies. Twenty-nine editors of health journals with impact factors of > or = 1 (based on citation ratings) were sent a questionnaire including four key problems identified in research literature and recommendations from federal agencies; 23 (79%) responded. Seven editors relevant policies. Two had read the federal directive on racial and ethnic classification; one was aware of its current review. Most perceived the four key problems as uncommon. The majority agreed with Public Health Service recommendations on race and ethnicity research, except for analyzing effects of racism. Approximately 20% had discussed issues with co-editors, editorial boards, or reviewers. About 40% saw further discussion as beneficial; four planned to draft guidelines. Editors'' potential for helping resolve problems in race/ethnicity research is not being realized. Greater participation would be beneficial to public health research and practice.     

Young sexual minority women's definition of community: Toward addressing health disparities in the LGBTQQ community

In accord with Healthy People 2020 goals, the elimination of lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) health disparities will require community‐level strategies to address stigma, discrimination, and prejudice linked to poor health. We explored how young sexual minority women (YSMW) define LGBTQQ community, community connection, community engagement, and community tensions because these concepts have implications for development and evaluation of health disparities interventions. A total of 30 YSMW (aged 18–24 years) from Michigan participated in semistructured, in‐depth interviews. Participants varied by sexual identity, residency, and race/ethnicity. We analyzed transcribed interviews using thematic analysis and compared emergent themes across sexual identity, residency, and race/ethnicity. Women described community connection in terms of organizational involvement, participation in LGBTQQ spaces, and collective social identity. Participants noted how community connections were linked to stigma towards the LGBTQQ community. YSMW highlighted how divisive tensions exist within subgroups constituting the LGBTQQ community, hindering opportunities for social advocacy, unified policy priorities, and community‐level interventions. The heterogeneity of YSMW's experiences identifying with the LGBTQQ community and engaging within LGBTQQ spaces suggest that researchers should attend to the role of community dynamics when developing health disparities interventions and policies. Efforts to reconcile tensions within the LGBTQQ community may strengthen and advance policymakers’ ability to address sexuality‐related disparities.     

Developmental commentary: ecological perspectives on parental influences during adolescence.

Adolescence is marked by change and renegotiation in almost every arena -- biological, social, and cognitive development; identity development; changes in peer relations and friendships; a renegotiation of family relationships, especially the parent-adolescent relationship; and school transitions. Further, for African Americans, adolescence is also marked by the exploration of ethnic or racial identity, which is shaped by parents' ethnic socialization and interactions with an increasingly diverse peer group. This article provides a developmental, cultural, and contextual framework for understanding changes in parenting and parental influences vis-a-vis peers. The normative developmental changes in adolescent outcomes, parenting, and parent-adolescent relationships are discussed as they are shaped by neighborhood characteristics, family-level socioeconomic status, and ethnicity and are related to mental health and developmental outcomes across late childhood through adolescence.     

Poor social integration and suicide: fact or artifact? A case-control study

BACKGROUND: Sociological studies have shown that poor social integration confers suicide risk. It is not known whether poor integration amplifies risk after adjusting statistically for the effects of mental disorders and employment status. METHOD: A case-control design was used to compare 86 suicides and 86 living controls 50 years of age and older, matched on age, gender, race, and county of residence. Structured interviews were conducted with proxy respondents for suicides and controls. Social integration was defined in reference to two broad levels of analysis: family (e.g. sibship status, childrearing status) and social/ community (e.g. social interaction, religious participation, community involvement). RESULTS: Bivariate analyses showed that suicides were less likely to be married, have children, or live with family. They were less likely to engage in religious practice or community activities and they had lower levels of social interaction. A trimmed logistic regression model showed that marital status, social interaction and religious involvement were all associated with suicide even after statistical adjusting for the effects of affective disorder and employment status. Adding substance abuse to the model eliminated the effects of religious involvement. CONCLUSIONS: The association between family and social/community indicators of poor social integration and suicide is robust and largely independent of the presence of mental disorders. Findings could be used to enhance screening instruments and identify problem behaviors, such as low levels of social interaction, which could be targeted for intervention.     

MINORITY IN THE MAJORITY: COMMUNITY ETHNICITY AS A CONTEXT FOR RACIAL BULLYING AND VICTIMIZATION

The present study explored the relationships between individual ethnicity and community ethnicity factors and the prevalence of racial bullying. It was hypothesized that individuals belonging to the majority ethnic group in a community were less racially victimized than in a community in which they were minority members. Data were collected from 20,021 students in Grades 6 to 10 as part of the 2009/2010 Health Behaviour in School‐aged Children Survey, from Geographical Information Systems data, and from census data. Community diversity was associated with prevalence of racial victimization, although relationships differed by type of religious organization. Those of East/Southeast Asian, Caucasian, and South Asian ethnicity were more likely to be racially victimized in communities in which they were the minority ethnic group than when they were in the majority group. The importance of considering ethnicity characteristics that are related to racially focused bullying in the community context is discussed.     

Methodological and Logistical Considerations to Study Design and Data Collection in Racial/Ethnic Minority Populations Evaluating Outcome Disparity in Hematopoietic Cell Transplantation

Outcome disparity associated with race or ethnicity in the United States has been observed in hematopoietic cell transplantation (HCT). The underlying reasons for such disparity are not known. In the United States, an optimal study of health care disparity by race or ethnicity involves consideration of both biologic and psychosocial determinants, which requires an adequately powered, prospective cohort study design. To better characterize the nature and quantify the magnitude of the many impediments relevant to conducting a successful prospective study involving racial or ethnic minorities in HCT, we conducted a feasibility study to help guide planning of a larger scale outcome and disparity study in HCT. The primary questions to be addressed in the study were: (1) can we establish a racially or ethnically diverse patient sample that will respond to a survey focused on sociodemographic, economic, health insurance, cultural, spiritual, and religious well-being, and social support information? (2) What is the retention rate in the study over time? (3) What is the quality of the data collected from the patients over time? The challenges we faced in conducting this multicenter feasibility study are summarized in this report. Despite the difficulty in conducting disparity studies in racial and ethnic minorities, such studies are essential to ensure that people of all ethnic and racial backgrounds have the best chance possible of benefiting from HCT.     

Perceived risk for breast cancer and its relationship to mammography in Blacks, Hispanics, and Whites

A challenge for health behavior science is to develop theory and best practices that take cultural diversity into account. Using data from Black, Hispanic, and White respondents to the 2003 Health Information National Trends Survey, we examined racial/ethnic differences in: (1) breast cancer risk perceptions/worry; (2) the associations between perceived risk/worry and ever having received a mammogram; and (3) perceived risk/worry and having had at least 2 mammograms over a 4-year period (consecutive mammography). Compared to White race/ethnicity, Black race/ethnicity was associated with lower perceived absolute risk and comparative risk for developing cancer. For the sample as a whole, higher perceived risk (both absolute risk and comparative risk) and worry predicted greater odds of mammography use; however, this was not true for Hispanics. In stratified analyses, perceived risk and worry were not associated with mammography use for either Hispanics or Blacks whereas they were for Whites; however, this interaction effect was significant only for Hispanics vs. Whites. Results support the need for formative research to identify determinants of health behavior prior to cancer prevention message planning for diverse audiences in order to accommodate racial/ethnic differences not only in the level of perceived risk, but also the association between risk perception to behavior change in that community.     

ADOLESCENT MOTHERHOOD AND CAPITAL: INTERACTION EFFECTS OF RACE/ETHNICITY ON HARSH PARENTING

This study used large, longitudinal data to examine the moderating effects of race and ethnicity of mothers on the associations between (a) adolescent motherhood, (b) human, social, and cultural capital factors, and (c) harsh parenting. The study sample included adolescent mothers who were 19 years old or younger (n = 379) and adult mothers 26 years old or older (n = 881). Of these, about 31% were White, 48% Black, and 21% Hispanic. The Parent to Child version of the Conflict Tactics Scales was used as a proxy for maternal harsh parenting when their children were 3 years old. Results indicated that adolescent motherhood and different capital factors contributed to the prediction of maternal harsh parenting for each racial/ethnic group. The findings suggest the importance of differentiating strategies for preventing adolescent motherhood and for reducing the likelihood of harsh parenting among different racial/ethnic groups of mothers.     

Relationships between family structure,adolescent health status and substance use: Does ethnicity matter?

We examined the variations of adolescent health status and risk involvement– prevalence of mental health disabilities, chronic health conditions, substance use, and exposure to tobacco–between 6 family structures in a school‐based sample of Latino, Somali, Hmong, and White students and whether ethnicity moderated these associations. Data were collected from the 2013 Minnesota Student Survey, comprising a sample of 29,345 from 8^th, 9^th, and 11^th grades. Logistic regression investigated relationships between family structure and health variables. Adolescents in nuclear families reported better health outcomes in most models; odds of mental disabilities were 1.64 for single parent and 2.45 for other family structures. Significant effect modification was noted for all health outcomes; extended families were consistently protective for Hmong youth and offered some protection for Latino and Somali youth. Policies and programs that support parents and guardians are essential, and may be especially beneficial for ethnic minority youth in single‐parent, grandparent‐only, and other family structures.     

Barriers to the use of genetic testing: A study of racial and ethnic disparities

PurposeRacial and ethnic disparities in health are evident among a range of diseases and health care services. New genetic technologies are likely to increase these disparities as access to expensive genetic tests further widens the gap.MethodsOur analysis used data from a national representative sample collected in 2000. The total sample size for our analysis was 1724 men and women (consisting of 946 non-Hispanic whites, 392 Latinos, and 386 blacks) aged 18 to 91 years. Ordered logistic regression and binary logistic regression analysis were applied to investigate differences by race/ethnicity.ResultsResults showed significant differences by racial/ethnic groups in knowledge and concerns about the potential misuse of genetic testing. A significant difference was also found between the types of health insurance coverage by race/ethnicity as well as significantly higher levels of mistrust in a physician and the medical system.ConclusionOur findings raise concern about several barriers among minorities and calls for a development of educational and communication strategies that facilitate in narrowing the gap between racial and ethnic groups.     

Racial differences in adolescent distress: Differential effects of the family and community for blacks and whites

Using a sample of 15,885 adolescents derived from the National Longitudinal Study of Adolescent Health, this study examined (1) unique additive influences of race, family, and community and (2) various multiplicative influences among race, family, and community factors on adolescent distress. Community characteristics such as community poverty and ethnic composition were included in the analysis. Community poverty, family poverty, single parenthood, family size, and race/ethnicity all uniquely contributed to adolescent distress. There were significant black–white differences in additive and multiplicative influences of these predictors. The detrimental influence of family poverty was stronger for whites than for blacks. Among blacks, the detrimental influence of community poverty is greater for poor families than for nonpoor families. In contrast, among whites, the detrimental influence of community adversity is greater for nonpoor families than for poor families. Although ethnic composition had no significant impact on adolescent distress for the total sample, it showed a beneficial effect for black adolescents, after controlling for the poverty levels of the communities. Seemingly, community poverty and ethnic composition influence adolescent distress differently through different mechanisms. Understanding these complex processes raise some practical questions about programs aimed at minorities. For example, do black children fare better if their family overcomes persistent poverty and moves out of adverse communities? © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 261–282, 2005.     

Discrimination,crime, ethnic identity,and parenting as correlates of depressive symptoms among African American children: a multilevel analysis

This study investigated the correlates of childhood depressive symptoms in an African American sample. We included processes that are likely to operate for all children, regardless of race or ethnicity, as well as events and circumstances that are largely unique to children of color. These various constructs were assessed at both the individual and community level. The analyses consisted of hierarchical linear modeling with a sample of 810 African American families living in Iowa and Georgia. Three individual-level variables were associated with childhood depressive symptoms: uninvolved parenting, racial discrimination. and criminal victimization. At the community level, prevalence of both discrimination and criminal victimization were positively related and community ethnic identification was negatively related to depressive symptoms. Further, there was evidence that community ethnic identification and neighborhood poverty serve to moderate the relationship between criminal victimization and depressive symptoms. Overall, the findings underscore the importance of considering factors unique to the everyday lives of the cultural group that is the focus of study, while demonstrating the dangers of a 'one model fits all" approach to studying children of color.     

Genetic Influence on Literacy Constructs in Kindergarten and First Grade: Evidence from a Diverse Twin Sample

Historically, twin research on reading has been conducted on older children and the generalizability of results across racial/ethnic/socioeconomic groups is unclear. To address these gaps, early literacy skills were examined among 1,401 twin pairs in kindergarten and 1,285 twin pairs in first grade (ages 5–7). A multi-group analysis was conducted separately for subsamples defined by neighborhood income while controlling for race/ethnicity within each grade. Substantial additive genetic and shared environmental effects were found for early literacy skills measured in kindergarten. In first grade, variance in early reading was associated with large additive genetic effects for middle and high neighborhood income twins, but shared environmental influence was substantial for low neighborhood income twins. Results suggest that the etiological architecture of some early literacy skills may differ across economic contexts.     

Racial and ethnic disparities in perinatal mortality: applying the perinatal periods of risk model to identify areas for intervention

OBJECTIVES: To determine the feto-infant mortality rate for New York City, assess racial/ethnic variations and identify areas for intervention using the Perinatal Periods of Risk (PPOR) approach. METHODS: The PPOR model examines fetal and infant deaths by age at death (fetal, neonatal, postneonatal) and birthweight (500-1499, > or =1500 g). It groups age at death and birthweight into four categories to identify problems hypothesized to lead to the death: factors related to Maternal Health and Prematurity, Maternal Care, Newborn Care and Infant Health. The model was applied to fetal and infant deaths occurring in New York City using Vital Records data from 1996-2000. Analysis was completed for the entire city and by race/ethnicity (white non-Hispanic, black non-Hispanic, Hispanic, Asians/Pacific Islander). RESULTS: The overall feto-infant mortality rate was 11.5/1,000 live births plus fetal deaths. This rate varied by race/ethnicity; black non-Hispanics had a higher rate than other racial/ethnic groups. Conditions related to maternal health and prematurity were the largest contributing factors to feto-infant mortality (5.9/1000) in New York City. Among blacks and Hispanics, problems related to maternal health and prematurity contributed a larger share than among whites and Asians/Pacific Islanders. CONCLUSION: The use of the PPOR approach shows that the racial/ethnic disparities in feto-infant mortality that exist in New York City are largely related to maternal health and prematurity. Interventions to reduce the feto-infant mortality rate should include preconception care and improvements in women's health.     

On treating adolescent girls: focus on strengths and resiliency in psychotherapy

This strength-based psychotherapy with adolescent girls and their families is derived from feminist psychology, positive psychology, and strength-based interventions with teens. Research reviewed by the American Psychological Association's Presidential Task Force on Adolescent Girls formed the basis of specific interventions within this approach. Research findings that contributed are the effects on teen girls of positive parental relationships; utilizing strengths of their race, ethnicity, class, and gender; positive body images; being outspoken in relationships; problem-solving skills that foster independence; and family support for independence. The strength-based approach is illustrated by a case example of a 13-year-old European American girl with acting-out behaviors, depression, and subclinical attention-deficit/hyperactivity disorder. The case illustrates how to empower adolescent girls within therapy, when and how to include parents, how to change the focus to strengths, and how to help the parents assess and build upon their daughters' strengths.     

Conditional risk for PTSD among Latinos: A systematic review of racial/ethnic differences and sociocultural explanations

Conditional risk for Posttraumatic Stress Disorder (PTSD)—defined as prevalence, onset, persistence, or severity of PTSD after traumatic exposure—appears to be higher among Latinos relative to non-Latinos after accounting for sociodemographic factors. This systematic review focuses on differences in conditional risk for PTSD between Latinos and non-Latinos (White, Black, or combined) and across Latino subgroups in studies that adjust for trauma exposure. We discuss methodological characteristics of existing articles and sociocultural explanatory factors. Electronic bibliographic searches were conducted for English-language articles published in peer-reviewed journals between 1991 and 2012. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-eight articles met inclusion criteria. Consistent support was found for elevated rates of PTSD onset and PTSD severity among Latinos relative to non-Latino Whites. The evidence on racial/ethnic differences in conditional risk for PTSD prevalence and PTSD persistence is mixed. Twenty-four articles evaluated sociocultural explanations, with the strongest support found for racial/ethnic variation in peri-traumatic responses and structure of PTSD. There were also consistent main effects for social disadvantage in studies that simultaneously adjusted for effects of race/ethnicity. Future research should use theoretically-driven models to formally test for interactions between sociocultural factors, race/ethnicity, and PTSD probability.     

A qualitative investigation to inform yoga intervention recruitment practices for racial/ethnic minority adolescents in outpatient mental health treatment

ObjectiveYoga is recognized as an effective approach to improving overall physical and mental health; however, there may be perceived barriers to yoga participation, particularly among populations most at risk for mental health issues. We conducted qualitative formative research to help inform recruitment practices for a future study and to specifically understand the barriers and facilitators to engagement in yoga practice among racial/ethnic minority adolescents, as well as adolescents in outpatient mental health treatment.MethodsQualitative data were collected at a community health clinic that serves low income families in southeastern Florida. Using semi structured interviews with racial and ethnic minority adolescents between 12 and 17 years old, participants were asked about beliefs and perceptions about yoga, as well as recommendations on recruiting peers. A thematic analysis approach was used to identify and examine common themes.ResultsTwenty interviews were conducted and eight major themes emerged from the data. Themes were grouped as (1) Facilitators to recruitment and (2) Barriers to recruitment.InterpretationAdvertising free yoga that emphasizes the social, physical, and mental benefits can help assuage negative perceptions of yoga and promote the advantages of yoga among teenagers. Having recruitment materials and modalities that highlight inclusivity of all genders and physical abilities in the yoga classes are also important in facilitating participation. Understanding perceptions of yoga, as well as perceived barriers and facilitators, among racially/ethnically diverse adolescents in outpatient mental health treatment, can assist recruitment efforts, increase yoga intervention participation, and ultimately, improve mental health outcomes for underserved populations.