Suicide among African Americans: reflections and a call to action

Suicide among African Americans is increasing at an alarming rate, and it deserves attention from numerous sectors in the society. This paper discusses some of the historical issues related to mental health care and African Americans. It suggests that sociocultural contexts are significant developmental shapers in the lives of African Americans. Several theoretical perspectives on suicide are presented, and Durkheim's concept of fatalism is useful in helping to unravel the dynamics of suicide. Issues related to the mental health system as currently experienced by African Americans conclude the discussion, along with a brief list of helpful resources.     

College Student Suicide: A Call To Action

This article examines current issues related to the topic of college student suicide and why it continues to be an issue of major concern. The nature/extent of the problem, risk and protective factors, responses to college student suicide, legal issues, and training issues are discussed. The importance of addressing the issue of college student suicide and its prevention on college campuses is emphasized as is the importance of protective factors. Although more is being done to address this issue than has been done in the past, it remains a major concern, and it is an issue that requires a strong national response.     

Mortality Among Low-Income African Americans and Whites With Diabetes

OBJECTIVE

To estimate mortality rates and risk factors for mortality in a low-socioeconomic status (SES) population of African Americans and whites with diabetes.

RESEARCH DESIGN AND METHODS

We determined mortality among African Americans and whites aged 40–79 years with (n = 12,498) and without (n = 49,914) diabetes at entry into a cohort of participants recruited from government-funded community health centers. Multivariable Cox analysis was used to estimate mortality hazard ratios (HRs) (95% CI) among those with versus those without diabetes and among those with diabetes according to patient characteristics.

RESULTS

During follow-up (mean 5.9 years), 13.5% of those with and 7.3% of those without diabetes died. All-cause mortality risk was higher among those with versus without diabetes for both African Americans (HR 1.84 [95% CI 1.71–1.99]) and whites (1.80 [1.58–2.04]), although among those with diabetes, mortality was lower among African Americans than whites (0.78 [0.69–0.87]). Mortality risk increased with duration of diabetes and was greater among patients on insulin therapy and reporting histories of cardiovascular disease (CVD), hypertension, and stroke. The HRs associated with these multiple risk factors tended to be similar by sex and race, with the exception of a differentially higher impact of prevalent CVD on mortality among African Americans (interaction P value = 0.03), despite a lower baseline prevalence of CVD.

CONCLUSIONS

In this population with similarly low SES and access to health care, strong and generally similar predictors of mortality were identified for African Americans and whites with diabetes, with African Americans at a moderately but significantly lower mortality risk.Population studies have consistently shown increased all-cause mortality among individuals with type 2 diabetes (1–4). Several reports have also shown that the impact of diabetes on mortality varies by socioeconomic status (SES) (5–7), race (8–10), and/or sex (4,11). However, scant literature exists on the mortality experience of diabetic patients within low-SES populations in the U.S. and whether within these vulnerable populations mortality varies by sex or race. We have previously reported that the prevalence of diabetes is only slightly higher among African Americans than whites once SES and other risk factors are accounted for (12). We now describe mortality patterns and risk factors for mortality by sex and race in a large, low-SES population of southern U.S. African Americans and whites with type 2 diabetes.     

Family Support and Colorectal Cancer Screening Among Urban African Americans

Colorectal cancer (CRC) is the third leading cause of cancer death among African Americans. Less than 50% of African Americans have had CRC screening. This study examined the relationships between family support and influence, cultural identity, CRC beliefs, and a screening informed decision among 129 urban African Americans. Family support (P < .01) significantly predicted CRC beliefs and CRC beliefs significantly predicted informed decision (P < .01). Based on study results, practitioners should routinely assess family support and CRC beliefs with African Americans patients. This may improve patient-provider shared decision-making satisfaction and CRC screening adherence among African American patients.     

Translation to Practice of an Intervention to Promote Colorectal Cancer Screening Among African Americans

In a previous report, we demonstrated the efficacy of an intervention to promote colorectal cancer screening among African Americans in a controlled community intervention trial. Participants in the intervention, named EPICS (Educational Program to Increase Colorectal Cancer Screening), were twice as likely to be screened after six months as those in the control group. In the current project, we put the intervention into practice through an academic‐health department partnership, and the intervention performed as well as it had in the controlled trial. This success may be due to the community‐based participatory methods used in designing and testing the intervention. Clin Trans Sci 2012; Volume 5: 412–415     

Community-based research: barriers to recruitment of African Americans

The elimination of health disparities for African Americans requires culturally relevant, empirical knowledge, which in turn requires including African Americans in research studies. However, power-difference barriers and conceptual barriers continue to inhibit the recruitment of African Americans. The purpose of this article is to define and discuss certain barriers to the recruitment of African Americans into research studies and to present culturally and contextually sensitive strategies to overcoming these barriers. Power-difference barriers reflect unequal authority and often generate mistrust. Conceptual barriers reflect researchers' need for better understanding about African Americans. Effective strategies include collaboration with the community through a community advisory board and conducting community-based participatory action research. Also, integrating alternative conceptual frameworks with mainstream frameworks may reduce researchers' ideological assumptions about African Americans. To promote optimal recruitment of African Americans, researchers must be aware of power-difference barriers and conceptual barriers and move toward active collaboration with African American communities.     

Theories of spouse abuse: relevance to African Americans

This article reviews several sociocultural theories of spouse abuse. However, their relevance to ethnic people of color, and African Americans in particular, is questionable because of different cultural and historical experiences. It is suggested that the use of unidimensional sociocultural theories may not adequately explain spousal abuse cross culturally. Recommendations are made for the development and testing of multidimensional theoretical frameworks that consider the unique cross-cultural variations related to abusive relationships among ethnic people of color. Additionally, studies that are conducted by culturally competent researchers may better explain cultural similarities and differences regarding spouse abuse and thus ultimately lead to more culturally competent nursing care.     

HIV health crisis and African Americans: a cultural perspective.

While incidence of new HIV infections have decreased in the overall population, the numbers continue to rise in African-Americans creating a serious health emergency. Studies seem to imply that part of the rise is due to HIV beliefs and high risk behaviors among African Americans. Due to certain societal factors, African Americans appear to be at greater risk for contracting the virus. This article will examine these critical social factors and their impact on this current state of emergency in the African American community using Leininger's theory of Culture Care and Universality. Implications for health providers are also addressed.     

Epidemiology of stroke in African Americans and Hispanic Americans

Many minorities continue to experience disparities in the level of their personal health and overall health care in the United States. This article explores disparities in stroke as they relate to two minority populations: African Americans and Hispanic Americans. These two groups have been chosen for review and discussion because the available epidemiologic databases are relatively broad, and the authors have personal experience in the conduct of research studies in these populations.     

Pain and Opioids: Call for Policy Action

Opioids were once the cornerstone in treating severe disabling pain and are now known to underlie an epidemic of substance use disorders and overdose deaths. Nurse practitioners are in key positions to influence opioid and pain management policy. As clinicians in primary care and specialty settings, nurse practitioners frequently encounter patients in pain. A white paper developed through the Nurse Practitioner Healthcare Foundation titled Managing Chronic Pain with Opioids: A Call for Change 2017 offers a multifaceted approach to pain management and provides timely recommendations to move policies and practices forward. Key recommendations from the white paper are highlighted.     

Overcoming barriers to hypertension control in African Americans

Barriers to blood pressure control exist at the patient, physician, and system levels. We review the current evidence for interventions that target patient- and physician-related barriers, such as patient education, home blood pressure monitoring, and computerized decision-support systems for physicians, and we emphasize the need for more studies that address the effectiveness of these interventions in African American patients.     

Racism and hypertension among African Americans

The purpose of this study was to examine the relationship of racism and blood pressure (BP). Participants were 162 urban African American adults. Measurements included the Racism and Life Experiences Scale, Krieger Racial Discrimination Questionnaire, State-Trait Personality Inventory (anxiety and depression), State-Trait Anger Expression Inventory, and automated measures of BP. Correlational and multiple regression analyses were done to examine relationships among key variables, t tests and ANOVA tested group differences by age, gender, and racism category. There was a high prevalence of perceived racism, which was not associated with higher BP. The racism/BP relationship was moderated by age with significant age related differences noted. Older participants (40 years or older) experienced more distress from racism, more anger suppression, and higher BP but lower levels of stress emotions. The highest levels of BP were noted in older adults reporting the lowest level of perceived racism, raising the issue of "internalized oppression."