Difference in All-Cause Mortality between Unemployed and Employed Black Men: Analysis Using the National Health and Nutrition Examination Survey (NHANES) III.

The Black-White racial employment disparity and its link to mortality have demonstrated the health benefits obtained from employment. Further, racial/ethnic mortality disparities existing among men with different employment statuses have been previously documented. The purpose of this study was to examine the association between employment status and all-cause mortality among Black men. Data for the study was obtained from the National Health and Nutrition Examination Survey (NHANES) III 1988-1994 linked to the NHANES III Linked Mortality File. Cox proportional hazard models were specified to examine the association between health behaviors and mortality in Black men by employment status. Among those who were assumed alive (n = 1354), 41.9% were unemployed. In the fully adjusted model, unemployed Black men had an increased risk of all-cause mortality (Hazard Ratio [HR] 1.60, 95% confidence interval or CI [1.33, 1.92]) compared to Black men who were employed. These results highlight the impact of employment on all-cause mortality among unemployed Black men and underscore the need to address employment inequalities to reduce the mortality disparities among Black men.

COVID-19 broken access: implications for individuals with substance use disorders.

The impact of the COVID-19 (coronavirus) pandemic created a paradigm shift in the delivery of substance abuse treatment services. Still, it also provided an opportunity for healthcare workers and professionals, and treatment providers to adjust, problem-solve, and meet these challenges head-on. The pandemic led practitioners and healthcare professionals to change how they deliver treatment options but still ensuring that their clients received access to adequate and effective clinical services. It is suggested that during the ongoing COVID-19 pandemic, healthcare professionals should make every effort to ensure accessibility and availability of substance abuse treatment services through critical actions. This paper will address the physical health implications, as well as the trauma-stress related effects of COVID-19 on individuals with substance use disorders (SUD). In all, this article will identify barriers to treatment access, accentuate treatment strategies, and provide measures and recommendations for maintaining and improving services for substance-dependent patients.

The impact of obesity in patients hospitalized with opioid/opiate overdose.

Background: Although a direct link between opioid use in obese patients and risk of overdose has not been established, obesity is highly associated with higher risk for opioid/opiate overdose. Evidence for clinical impact of obesity on patients with opioid/opiate overdose is scarce. The aim of this study was to determine effects of obesity on health-care outcomes and mortality trends in hospitalized patients who presented with opioid/opiate overdose in the United States between 2010 and 2014. Design: Multivariate logistic and linear regression analysis compared clinical outcomes and hospital resource utilization between obese and nonobese patients. Trend analysis of in-hospital mortality was also analyzed. Setting: United States. Participants: 302,863 adults ≥ 18 years and hospitalized with a principle diagnosis of opioid/opiate overdoses between 2010 and 2014. Measurements: Primary measurement was in-hospital mortality. Secondary measurements included respiratory failure, cardiogenic shock, mechanical ventilations/intubations, hospital charges, and length of stay. Findings: Prevalence for in-hospital mortality was lower in patients with obesity (2.2% vs 2.9%). Obese patients had higher adjusted odds for respiratory failure (aOR = 1.7, [(CI) 1.6-1.8]) and mechanical ventilation/intubation (aOR = 1.17, [(CI) 1.10-1.2]). They also had longer length of stays (aMD = 0.4 days, [(CI) 0.25-0.58 days] and higher total hospital charges (aMD = $5,561, [(CI) $3,638-$7,483]. Trends of in-hospital mortality for patients with obesity did not significantly increase (2.1% in 2010 to 2.4% in 2014, p trend = 0.37), but significantly increased for obese patients (2.4% in 2010 to 3.4% in 2014; p trend <0.01). Conclusions: Prevalence and trends of mortality were lower in patients with obesity hospitalized for opiate/opioid overdose compared to those without obesity between 2010 and 2014 in the United States.

Factors Influencing the Relationship Between Work-Related Stress and Posttraumatic Stress Disorder Among Working Black Adults in the United States.

Introduction: Work-related stress (WRS) and posttraumatic disorder (PTSD) is higher among Black adults relative to their White counterparts. Trauma exposure is not the only connection to increased risk for PTSD as WRS is highly associated with risk for PTSD. However, the factors that link WRS and PTSD among working Black adults is not well understood. Materials and Methods: Cross-sectional data from the National Survey of American Life was used to examine the relationship between WRS and PTSD among 2,139 working Black adults and to determine whether there are influencing factors. Results: Logistic regression analyses revealed that working Black adults who reported experiencing WRS was associated with higher odds of PTSD than those who reported no WRS (OR: 1.24, 95% CI: 1.04-1.48). The relationship was attenuated when depression, alcohol abuse, and major discrimination were added to the model (OR: 1.09, 95% CI: 0.87-1.36). Mediation analyses show that the average indirect effect of WRS on PTSD were 0.09 ± 0.04 for alcohol abuse, 0.14 ± 0.06 for depression, and 0.35 ± 0.10 for major discrimination. Conclusion: The results underscore the need for culturally responsive trauma-informed public health interventions for working Black adults. Public health practitioners should be alerted to the relationship between WRS and PTSD among working Black adults and the potential contributing factors (alcohol abuse, depression, and major discrimination). Special attention should be given to working Black females with their worse PTSD status and major discrimination experiences which demonstrated greater effect on the relationship between WRS and PTSD.

Chronic Medical Conditions as Predictors of the Likelihood of PTSD among Black Adults: Preparing for the Aftermath of COVID-19.

The relationship between chronic medical conditions and PTSD within-race in Black adults is not well understood and there exists a dearth of empirical research investigating the gender differences. Cross-sectional data from the National Survey of American Life were used to examine the relationship between PTSD and obesity, hypertension, diabetes, heart disease, and asthma (five of the most commonly identified COVID-19 underlying medical conditions) among Black adults in the United States. Results from modified Poisson regression analyses revealed that Black adults across all three groups (overall, male, and female samples) who reported two or more chronic medical conditions had a higher prevalence of PTSD than those who reported zero or one. Black men with obesity, diabetes, or heart disease and Black women with asthma had a higher prevalence of PTSD than those who did not report obesity, diabetes, heart disease, or asthma. Findings from this study underscore the need to alert social workers to the potential relationship between obesity, diabetes, or heart disease and PTSD for Black men and asthma and PTSD for Black women to help develop culturally appropriate biopsychosocial-spiritual assessments, with a measured focus on Black men based on their comparatively worse health status.

Life Stressors and Sleep Problems as Predictors of the Likelihood of Lifetime Cannabis Use among Black Adults with Criminal Justice Contact.

Background: The criminal justice system is the second largest referral source to publicly funded marijuana use disorder treatment. Individuals with criminal justice contact (being unfairly treated or abused by the police, lifetime arrest, incarceration, or parole) have reported notably high levels of stress, sleep problems, and marijuana use. There are well-known race and sex disparities in marijuana use and criminal justice contact. However, understanding is limited on the role that stressors and sleep problems contribute to marijuana use among Black adults who experience criminal justice contact. Objectives: To determine whether life stressors and sleep problems contribute to lifetime marijuana use among Black adults with criminal justice contact and if there are sex differences. Methods: We performed multivariate logistic analysis, using nationally representative data of a non-institutionalized population sample (n=1508) of the National Survey of American Life from 2001 to 2003. We compared life stressors and sleep problems between Black adults with criminal justice contact who had lifetime marijuana use and those who did not have lifetime marijuana use. All analyses were stratified by sex. Results: In the sample of Black males with criminal justice contacts, individuals who reported financial stress (PR: 1.34, 95% CI: 1.12-1.60) had a higher prevalence of experiencing lifetime marijuana use than Black males who reported no financial stress. Black males who reported that they were spiritual (PR: .76, 95% CI: .61-.93) had a lower prevalence of experiencing lifetime marijuana use than Black males who indicated that they were not spiritual. Black females who reported family stress (PR: 1.38, 95% CI: 1.04-1.82) had a higher prevalence of experiencing lifetime marijuana use than Black females who reported no family stress. Conclusions: These results underscore the importance of considering sex differences in life stressors when developing etiologic models of marijuana use disorder for Black adults who have experienced criminal justice contact.

The Association Between Depressive Symptoms and Accumulation of Stress Among Black Men in the Health and Retirement Study.

BACKGROUND AND OBJECTIVES: Among the multiple factors posited to drive the health inequities that black men experience, the fundamental role of stress in the production of poor health is a key component. Allostatic load (AL) is considered to be a byproduct of stressors related to cumulative disadvantage. Exposure to chronic stress is associated with poorer mental health including depressive symptoms. Few studies have investigated how AL contributes to depressive symptoms among black men. The purpose of the cross-sectional study was to examine the association between AL and depressive symptoms among middle- to old age black men. RESEARCH DESIGN AND METHODS: This project used the 2010 and 2012 wave of the Health and Retirement Study enhanced face-to-face interview that included a biomarker assessment and psychosocial questionnaire. Depressive symptoms, assessed by the endorsement of 3 or more symptoms on the Center for Epidemiological Studies-Depression 8-item scale, was the outcome variable. The main independent variable, AL, score was calculated by summing the number values that were in the high range for that particular biomarker value scores ranging from 0 to 7. black men whose AL score was 3 or greater were considered to be in the high AL group. Modified Poisson regression was used to estimate prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs). RESULTS: There was a larger proportion of black men in the high AL group who reported depressive symptoms (30.0% vs. 20.0%) compared with black men in the low AL group. After adjusting for age, education, income, drinking, and smoking status, the prevalence of reporting 3 or more depressive symptoms was statistically significant among black men in the high AL group (PR = 1.61 [95% CI: 1.20-2.17]) than black men in the low AL group. DISCUSSION AND IMPLICATIONS: Exposure to chronic stress is related to reporting 3 or more depressive symptoms among black men after controlling for potential confounders. Improving the social and economic conditions for which black men work, play, and pray is key to reducing stress, thereby potentially leading to the reporting of fewer depressive symptoms.

Criminal Justice Contact, Stressors, and Obesity-Related Health Problems Among Black Adults in the USA.

Criminal justice contact-defined as lifetime arrest, parole, or incarceration, seems to exacerbate chronic conditions, and those who are most likely to have had contact with the criminal justice system, such as Black adults, often already have pre-existing disproportionately high rates of stress and chronic conditions due to the social determinants of health that affect underrepresented minorities. Findings from this study suggest that there is a mechanism that links the stressors among Black adults manifested by such factors as family, financial, neighborhood, and personal problems with criminal justice contact to obesity-related health status. Using the National Survey of American Life (NSAL), modified Poisson regression analyses were used to determine the association between criminal justice contact, stressors, and obesity-related health problems among a national sample of Black adults (n = 5008). In the full model, the odds of experiencing obesity-related health problems for Black adults who had criminal justice contact was reduced (PR, 1.23 to 1.14) and not statistically significant. Black adults who reported experiencing family stressors (PR, 1.21; 95% CI, 1.08, 1.36), financial stressors (PR, 1.30; 95% CI, 1.16, 1.47), and personal stressors (PR, 1.16; 95% CI, 1.02, 1.31) were statistically significant and higher than those who reported not experiencing any of these stressors; neighborhood stressors was not statistically significant. The evidence suggests a relationship between the stressors associated with criminal justice contact and obesity-related health status. These findings emphasize the need to further explore the family, financial, and personal stressors for Black adults with criminal justice contact in order to further our understanding of their obesity-related health problems.ᅟ.

Exploring social work student education: The effect of a harm reduction curriculum on student knowledge and attitudes regarding opioid use disorders.

BACKGROUND: This study evaluates the degree to which a harm reduction intervention course module impacted Master of Social Work (MSW) students' knowledge and attitudes towards addressing opioid use disorder issues and clients. METHODS: Using a mixed-methods approach, data from 124 MSW students were collected between 2011 and 2015. Students completed a 3-hour course module that focused on harm reduction philosophy and interventions specifically for opioid use disorders. Students completed pre- and posttest of the Harm Reduction Attitude Scale. Students were also engaged in focus groups to gain a better understanding of how and if their knowledge and attitudes changed. Results: Overall, attitudes towards harm reduction approaches for opioid use disorder shifted favorably following the course module. Paired t-test results show a statistically significant difference in the mean scores for pretest attitudes (M = 2.64, SD = 0.16) and posttest attitudes (M = 2.86, SD = 0.12) among social work students. This trend remained consistent despite treatment orientation and having a family history of substance use. Conclusion: Given the increased capacity for social work students to encounter clients with opioid use disorders, it is important to ensure that students are provided with relevant and accurate information related to client-centered approaches such as the harm reduction model to address opioid use disorders. Moreover, given the dearth of social work programs that have and required substance use disorder courses, it is imperative for schools of social work to ensure that students are provided with more than practical information, which is often gained during field placement.

The Association Between Marijuana Usage and Discrimination Among Adult Black Men.

Black men may use marijuana as an externalizing coping mechanism to handle the chronic stress of discrimination. The aim of the study was to examine the relationship between everyday and major discrimination and marijuana use among a national sample of Black men. Using the National Survey of American Life, logistic regression analyses was used to determine the association between recent marijuana use and everyday discrimination, major discrimination, and a fully adjusted model that include everyday and major discrimination among adult Black men ( n = 1,833). Additionally, a multinomial logistic regression was used to examine the association between the frequency of marijuana usage and everyday discrimination and major discrimination among men who used marijuana in the past year. Everyday discrimination was not associated with marijuana use. In the fully adjusted model, men who experienced major discrimination had a higher odds of marijuana use ( OR: 1.19, 95% CI [1.05, 1.34]), than those who did not control for everyday discrimination and covariates of interest. Among recent marijuana users, men who used almost every day had a decreased risks for major discrimination (RRR: 0.72, 95% CI [0.56, 0.92]), compared with men who used less than once a month. The findings suggest that recent marijuana use among Black men is associated with experiences of major discrimination. Interestingly, men who used almost every day had a decreased risk for major discrimination. Marijuana may be used as a coping mechanism.

Explaining African-Americans' depressive symptoms: a stress-distress and coping perspective.

Findings from five community surveys suggest that the depressive symptom scores of African-Americans are the same as, or lower than, those of Whites. This seems at odds with the minority status hypothesis that predicts higher rates of mental disorders for African-Americans. However, little is known about the role of African-American coping capacity during the life stress process which may shed light on the seeming contradiction. This cross-sectional survey examined the role of spirituality-coping, sense of control, and stress in predicting depressive symptoms among 3570 African-Americans. The findings showed that sense of control mediates the relationship between spirituality, life stressors, and depressive symptoms.

Merging community and faith-based organizations to empower African American males.

The Holistic Needs of African American Men (HAAM) Program provides information and resources that allow African American men to take full control of their lives and tell "their" story. The majority of the participants indicated they did not trust the current service or health care systems in the United States because they felt these systems robbed them of their "voice." HAAM provided the African American men with needed support and assisted them in repositioning their lives for success.

Late presentation of a paranasal sinus glass foreign body: a case report.

Foreign bodies in the paranasal sinuses are rare and mostly related to maxillo-facial trauma. We treated a 47-year-old man with a late complication arising from a foreign body in the nasoethmoid sinus present for 16 years after a road traffic accident. Patients presenting with maxillo-facial injuries, especially those with lacerations due to glass or car wind-screen trauma should have thorough examination and appropriate imaging of the injury.