Introduction to Special Issue on Advancing Health Equity Among Black Communities.

The current paper serves as an introduction to this special issue, Advancing Health Equity among Black Communities, in which we provide an overview of the papers included. Specifically, we summarize the papers covered in the special issue and highlight some of the common themes. The impetus for this special issue originated from a culmination of the COVID-19 pandemic, continued murders of Black people by police officers, and an unsettling political climate (e.g., Galea & Abdalla, 2020). While the impact of individual racism has been studied extensively, the insidious and pervasive impact of structural racism is less understood. Structural racism is a system in which embedded values, practices and policies facilitate and perpetrate the continued differential treatment of people based on race and becomes an almost hidden influence on the way an institution functions. For this special issue, prevention scientists were invited to submit conceptual and empirical research reflecting their understandings of structural racism as it operates in U.S. systems (e.g., education, justice, housing, workforce) and contributes to health inequities in the lives of Black Americans. The submissions also demonstrate how prevention scientists can leverage translational science to impact policies, practices, and procedures to promote equitable and sustainable change for Black communities.

Effect of Early Infant Lactobacillus rhamnosus GG Supplementation in Preventing Viral Respiratory Illness.

The role of early probiotic supplementation in infants for the prevention of respiratory viral illnesses is unclear. We examined the association of Lactobacillus rhamnosus GG (LGG) supplementation during the first 6 months of life with the frequency and severity of viral illnesses during the first 24 months of life. We conducted a secondary analysis of data from the randomized controlled Trial of Infant Probiotic Supplementation (n = 184). Parents reported the number of respiratory viral illnesses, and a composite severity score was created based on symptoms. A negative binomial regression model and a mixed-effects linear regression model assessed for differences in the number of episodes and severity of episodes between treatment groups, respectively. There was no significant difference in the incidence rate of viral illness episodes or symptom severity between treatment groups. Daily supplementation with LGG in early infancy does not decrease the number or severity of viral illnesses during the first 2 years of life.

Mental Health Disparities Among Sexual and Gender Minority Frontline Health Care Workers During the Height of the COVID-19 Pandemic.

Purpose: This study measured mental health disparities in a Bronx, New York sample of frontline health care workers collected May-July, 2020, during the first wave of the COVID-19 pandemic. Methods: Using survey data (N = 741), we compared demographics, COVID-19 stressors, and adverse mental health outcomes between sexual and gender minority (SGM, n = 102) and non-SGM (n = 639) health care workers through chi-square/Kruskal-Wallis tests, crude/adjusted odds, and prevalence ratios. Results: SGM frontline health care workers had significantly higher depression, anxiety, impact of COVID-19, and psychological distress. Income (lower), age (younger), and COVID-19 stressors accelerated differences. Conclusion: Health care systems should support SGM frontline health care workers through affirming trauma-informed programming.

Typologies of mental healthcare discrimination experiences and associations with current provider care ratings: A latent class analysis.

Background: Discrimination is experienced across demographic attributes (e.g., race and gender) and vantage points (e.g., personal and vicarious), yet few studies have classified these different experiences of discrimination within healthcare systems. Moreover, which discriminatory experiences have greater influence on patient-reported quality outcomes remains poorly understood. To address these gaps, we used latent class analysis (LCA) to identify typologies of past experiences with healthcare discrimination among adults with depression-who experience more frequent and stigmatizing healthcare interactions than the general population-and assess the relationship between class membership and current ratings of patient-reported quality outcomes. Methods: We surveyed a nationally representative sample of adults with depression (n = 803) to assess past experiences of discrimination by medical providers in terms of both the characteristics targeted for discrimination and whether healthcare discrimination was experienced personally or by friends and family members. We conducted an LCA to identify discrimination-exposure classes and a modified Poisson regression to identify associations between class membership and patient-reported quality outcomes (e.g., overall medical provider quality, respect, clear communication, and careful listening), while adjusting for covariates. Results: We identified four latent classes of healthcare discrimination: low discrimination (LD; referent class: 72.2% of total sample), vicarious linguistic discrimination (VL; 13.9%), elevated personal and vicarious racial discrimination (EPVR; 10.5%), and high racial/ethnic discrimination (HRE; 3.4%). Compared to those in the LD class, individuals in the EPVR class had higher rates of reporting their current medical provider's respect and careful listening skills as sometimes or never, (Respect aIRR: 1.90, 95% CI: 1.05-3.42; Listening aIRR: 2.18, 95% CI: 1.29-3.66). Those in the HRE class reported higher rates of reporting their medical provider's quality and communication as poor or fair and lower ratings of careful listening (Quality aIRR: 2.06, 95% CI: 1.08-3.93; Communication aIRR: 1.97, 95% CI: 1.00-3.63; Listening aIRR: 2.41, 95% CI: 1.27-4.59), compared to those in the LD class. Those in the VL class had higher rates of reporting that their medical provider never or sometimes respected or carefully listened to them (Respect aIRR: 2.12, 95% CI: 1.20-3.72; Listening aIRR:1.67, 95% CI:1.03-2.71) than those in, the LD class. Conclusions: Healthcare organizations committed to providing equitable patient care should establish more robust quality improvement approaches to prevent discrimination at the medical provider level as well as structures of accountability to reconcile previously embedded social inequities within the healthcare system.

Racial/Ethnic Disparity Trends in Children's Mental Health Care Access and Expenditures From 2010-2017: Disparities Remain Despite Sweeping Policy Reform.

OBJECTIVE: To examine trends in mental health care use for Black and Latinx children and adolescents. METHOD: Data from the Medical Expenditure Panel Survey for 2010-2017 were analyzed to assess trends among youth ages 5-17 in use and expenditures for any mental health care, outpatient mental health care, and psychotropic medication prescription fills. Unadjusted trends for all youth and the subpopulation of youth reporting need for mental health care and disparities adjusting for need were examined. RESULTS: Between 2010 and 2017, Black youth rates of any past year mental health care use decreased (from 9% to 8%), while White (from 13% to 15%) and Latinx (from 6% to 8%) youth rates increased. Among the subpopulation with need and in regression analysis adjusting for need, we identified significant Black-White and Latinx-White disparities in any mental health care use and any outpatient mental health care use in 2010-2011 and 2016-2017, with significant worsening of Black-White disparities over time. White youth were more than twice as likely as Latinx youth to use psychotropic medications, and Latinx-White and Black-White disparities in psychotropic medication prescription fills persisted over time. Black-White disparities existed in overall mental health expenditures (2016-2017) and outpatient mental health expenditures (2010-2011 and 2016-2017). CONCLUSION: Affordable, ubiquitous access to mental health care for Black and Latinx youth remains an elusive target. Significant disparities exist in receiving mental health care despite reforms and policies designed to increase mental health care access in the general population. Additional outreach and treatment strategies tailored to the cultural, linguistic, and structural needs of youth of color are required.

Engaging Young Black Males in Sexual and Reproductive Health Care: A Review of the Literature.

Young Black males (YBM) ages 18 to 24 years are more at risk of contracting sexually transmitted infections (STIs) and have a substantially greater need for sexual reproductive health (SRH) services than other groups. Despite this significant need, the extant literature does not provide a comprehensive picture of how YBM seek preventive care services (e.g., STI testing). Therefore, the purpose of this review is to address YBM's SRH access and use of STI/HIV testing and screening in this population, with a specific emphasis on young heterosexual Black males, by identifying barriers and facilitators of engaging with SRH care. An electronic search was performed using Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, PubMed, and Scopus online databases. Keywords were adapted to each database and included variations of "Black males," "sexual reproductive healthcare services," "youth (18-24 years old)," and "healthcare access and utilization." Studies from the review reported that barriers to engaging in SRH care included lack of health insurance, ideas of masculinity that conflict with SRH care, stigma related to accessing services, and lack of knowledge regarding available services and care options. The top facilitators for utilizing SRH care were engagement on behalf of health clinics, confidence gained from social support, access to quality health care in one's community, and trust in the health care system and providers. This review contributes to the current state of the science and is important to the improvement of high-quality services for this population, including respect, choice in care, confidentially, and compassion.

Reducing HIV/STI Risk Among Adolescents Aged 12 to 14 Years: a Randomized Controlled Trial of Project Prepared.

Despite calls for evidence-based HIV/STI prevention programs for youth aged 12 to 14 transitioning to adolescence, few effective programs exist. In a two-group intent-to-treat randomized trial in the Bronx, NY, 397 participants were randomly assigned to Project Prepared or an attention control, TEEN. Participants completed surveys at baseline, 6 months, and 12 months. Prepared had two components, an 11-session program and a 3-week internship. Content covered sexual risk behavior, social cognitions, gender norms, relationships, and resilience. TEEN built communication skills and had the same intensity and structure as Prepared but no sexual content. In both, boys and girls were trained together in mixed groups of ~ 11 teens. Primary outcomes were HIV knowledge, self-efficacy, condom outcome expectancy, and behavioral intentions. Secondary outcomes were relationship expectations and endorsement of risky gender norms. Generalized estimating equation analyses showed youth randomized to Prepared had significant improvements compared to TEEN at T2 in HIV knowledge, sexual self-efficacy, and outcome expectancy for condom use. At T3, there were significant differences favoring Prepared in outcome expectancy for condom use, sexual self-efficacy, and intention for partner communication about HIV/AIDS or STIs. Analyses by gender showed program effects in both boys (intention to talk to a partner about condom use, abstinence self-efficacy, sexual self-efficacy, and condom outcome expectancy) and girls (gender norms, and abstinence outcome expectancy). Prepared effectively reduced risk in young adolescents. ClinicalTrials.gov ID: NCT01880450, Protocol ID: 2008-551.

Deeply Rooted: Maximizing the Strengths of a Historically Black University and Community-based Participatory Research to Understand Environmental Stressors and Trauma among Black Youth.

This paper explores a partnership between an HBCU (Historically Black Colleges and Universities) and a community to understand trauma given the high rates of reported violence among youth locally. The accumulative stress of living in high-stress, high-poverty environments coupled with the normative developmental tasks of adolescence is thought to place these youths at risk for negative mental and physical outcomes (Murry et al., 2011). The current research uses a community-based participatory research (CBPR) approach and developmental lens to better understand environmental stressors and subsequent trauma among Black youth. Specifically, the paper describes the recruitment, engagement, and equitable partnership between a youth advisory board (YAB), university research team, and community agencies advisory board (CAB). The current work is part of a larger research study designed to explore environmental stressors, coping, and social supports for Black youth residing in low-resource urban communities. The broad objective of the research is to develop a trauma-informed community intervention to improve adolescent mental health. The initial phase of this university-community research, which entails the YAB, CAB, and university discussion groups, is outlined in this paper. Community engagement and trust are key factors described in the literature when collaborating with communities of color. These themes were reiterated by research partners in this study. The research team created coding terms to identify themes from YAB and CAB transcript data, respectively. YAB themes regarding stressors centered around financial strain, anger, and loss/violence. CAB themes regarding adolescent mental health and resources centered around trauma, trust, and sustainability. Initial steps to utilize the themes identified thus far are described. The unique advantages of an HBCU and CBPR to address mental health disparities in ethnic minority communities are also highlighted.

Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences.

As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino (n = 4), non-Hispanic/Latino Black (n = 8), or non-Hispanic/Latino White (n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient-provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.

Type 1 diabetes self-management behaviors among emerging adults: Racial/ethnic differences.

BACKGROUND: Emerging adulthood is a vulnerable period for poor blood glucose control and self-management behaviors (SMBs) among individuals with type 1 diabetes. Racial/ethnic minority young adults have poorer glycemic outcomes than non-Hispanic whites; however, little is known about possible racial/ethnic differences in frequency of SMBs among emerging adults (EAs). OBJECTIVE: To examine racial/ethnic differences in SMBs and to determine associations between SMBs and blood glucose control. METHODS: A sample of EAs (ages 18-25 years; N = 3456) from the type 1 diabetes exchange registry was used to conduct multivariate analyses to examine (a) racial/ethnic differences in SMBs and (b) associations between SMBs and blood glucose control for each racial/ethnic group. RESULTS: Compared to non-Hispanic whites, African Americans and Hispanics less frequently took an insulin bolus for snacks, less frequently checked blood glucose with a meter, and were more likely to not use insulin to carbohydrate ratios. African Americans also less frequently checked blood glucose prior to mealtime boluses and more frequently missed insulin doses. SMBs that were associated with blood glucose control across groups were frequency of checking blood glucose at mealtime, missing an insulin dose, and checking blood glucose with a meter. CONCLUSIONS: Promoting two SMBs: checking blood glucose and taking insulin doses as needed among African American EAs may be important to address racial disparities in glycemic outcomes. Future research should evaluate possible social and contextual mechanisms contributing to low engagement in these behaviors among African Americans to inform strategies to address racial differences in glycemic outcomes.

Disparities in Mental Health Care Utilization and Perceived Need Among Asian Americans: 2012-2016.

OBJECTIVE: The objective was to examine mental health treatment access disparities between Asians and whites in the United States as well as the role of perceived and objective need and barriers to treatment in these disparities. METHODS: Data are five annual cross-sections (2012-2016) of responses from Asian Americans and whites to the nationally representative National Survey on Drug Use and Health. Multivariate logistic regression analyses adjusting for sociodemographic factors were conducted to compare past-year treatment access rates between Asians and whites across three need subgroups: those with perceived need for treatment, those with past-year serious psychological distress, and those with a past-year major depressive episode. Barriers to treatment were compared between Asians and whites with perceived need. RESULTS: Asians were less likely than whites to have accessed mental health treatment in the past year in all analyses. Compared with Asians with need determined by structured diagnostic instruments, Asians with perceived need had higher rates of mental health care access, but even among respondents with perceived need, the disparity between whites and Asians remained. Regarding barriers to treatment, only one barrier (not knowing where to go for treatment) was more likely to be reported for Asians than whites. CONCLUSIONS: Differences between Asians and whites in perceived need for mental health treatment do not explain the wide disparities in mental health care access between these two groups. Clinical interventions improving the relevance and fit of mental health care and community-based outreach interventions increasing awareness of available services are needed to improve access to mental health treatment among Asians.

Developing a Policy Brief on Child Mental Health Disparities to Promote Strategies for Advancing Equity among Racial/Ethnic Minority Youth.

Research has identified a broad range of risk factors during early childhood that have neurobiological consequences and negatively affect children's mental health. Such risk factors disproportionately affect racial/ethnic minority youth. Disparities in children's mental health service use have also been documented for minority youth. Yet, compared with the focus on strategies to address health disparities (including mental health disparities) during adulthood, very little work has concentrated on addressing the roots of health disparities that occur in childhood. The purpose of this commentary is to describe the development and dissemination of a policy brief for policy advocates. The goal of this work is to help achieve the implementation of evidence-based programs, practices, and policies that target and modify risk factors to reduce disparities in child mental health burden.

Translating research to support practitioners in addressing disparities in child and adolescent mental health and services in the United States.

Despite increased recognition of disparities in youth mental health, racial/ethnic disparities in mental health burden and in mental health service use persist. This phenomenon suggests that research documenting disparities alone has not led to extensive action in practice settings in order to significantly reduce disparities. In this commentary, we present a framework to actively target this research-to-practice gap by describing the development of a resource titled, "Addressing the Mental Health Needs of Racial and Ethnic Minority Youth-A Guide for Practitioners." We begin by presenting social justice as the impetus for eliminating disparities and then reviewing current knowledge and efforts aimed at reducing disparities. Subsequently, we describe knowledge transfer frameworks and goals guiding our work. Finally, we detail the steps taken in our approach to translation and implications for subsequent dissemination of this guide. Translation focused on evidence-based information on (a) mechanisms that contribute to disparities, and (b) strategies for providers to address disparities in their work. We reflect on the framework guiding our translation to offer future directions for others interested in bridging research and action. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cognitive and Behavioral Resilience Among Young Gay and Bisexual Men Living with HIV.

PURPOSE: HIV/AIDS disproportionately affects young gay, bisexual, and other men who have sex with men (Y-GBMSM). Resilience remains understudied among Y-GBMSM living with HIV, but represents a potentially important framework for improving HIV-related outcomes in this population. We sought to explore cognitive and behavioral dimensions of resilience and their correlates among Y-GBMSM to gain insights to inform future interventions. METHODS: Our study sample consisted of 200 Y-GBMSM living with HIV enrolled in a multisite study of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). Participants completed a one-time, self-administered structured questionnaire, including validated scales capturing a range of cognitive, behavioral, demographic, and psychosocial data. Utilizing these data, we examined cognitive and behavioral dimensions of resilience and their potential psychosocial correlates using linear regression modeling. RESULTS: Multiple regression analyses demonstrated that education, stigma, social support, ethnic identity, internalized homonegativity, and behavioral resilience were statistically significant predictors of cognitive resilience (P < 0.001, R2 = 0.678). Social support satisfaction and cognitive resilience were significant predictors of behavioral resilience (P < 0.001, R2 = 0.141). CONCLUSIONS: Our findings point to potential strategies for incorporating resilience-promoting features into future interventions to support Y-GBMSM living with HIV. Specifically, strengths-based interventions in this population should seek to enhance social support, promote positive identity development, and encourage education. Future research can also seek to utilize and refine our measures of resilience among youth.

Engaging and sustaining adolescents in community-based participatory research: structuring a youth-friendly community-based participatory research environment.

Community-Based Participatory Research partnerships typically do not include adolescents as full community partners. However, partnering with adolescents can enhance the success and sustainability of adolescent health interventions. We partnered with adolescents to address health disparities in a low-income urban community. In partnering with youth, it is important to consider their developmental stage and needs to better engage and sustain their involvement. We also learned the value of a Youth Development framework and intentionally structuring a youth-friendly Community-Based Participatory Research environment. Finally, we will raise some ethical responsibilities to consider when working with youth partners.

Results from a secondary data analysis regarding satisfaction with health care among African American women living with HIV/AIDS.

OBJECTIVE: To analyze satisfaction with health care among African American women living with HIV/AIDS. DESIGN: Secondary analysis of baseline data of African American women who participated in Protect and Respect, a sexual risk reduction program for women living with HIV/AIDS SETTING: HIV Care Clinic in an urban city in the northeast United States. PARTICIPANTS: One hundred fifty-seven (157) African American women living with HIV/AIDS. METHODS: Regression analyses were used to examine the relationships between demographic variables, self-reported health characteristics, communication with health care providers, and satisfaction with health care provider. RESULTS: A majority of women reported satisfaction with medical services (88%, n = 140). Communication with health care providers, detectable viral load, education, income, self-reported health status, and sexual orientation were significantly bivariately associated with satisfaction with healthcare (all ps < .05). In the multivariate models, no variables significantly predicted satisfaction with healthcare. CONCLUSION: Because satisfaction with health care can influence the quality of care received, health outcomes, and adherence to provider recommendations among patients living with HIV/AIDS, health care providers' ability to elicit satisfaction from their patients is just as important as the services they provide. This project is one of the first studies to find high rates of satisfaction with health care among African American women living with HIV/AIDS. Further examination of satisfaction with health care among African American women living HIV/AIDS may help in narrowing health care disparities and negative treatment outcomes.