Many health communications target African Americans in an attempt to remediate race-based health disparities. Such materials often assume that African Americans are culturally homogeneous; however, research indicates that African Americans are heterogeneous in their attitudes, behaviors, and beliefs. The Black Identity Classification Scale (BICS) was designed as a telephone-administered tool to segment African American audiences into 16 ethnic identity types. The BICS was pretested using focus groups, telephone pretests, and a pilot study (n=306). The final scale was then administered to 625 Black adults participating in a dietary intervention study, where it generally demonstrated good internal consistency reliability. The construct validity of the BICS was also explored by comparing participants’ responses to culturally associated survey items. The distribution of the 16 BICS identity types in the intervention study is presented, as well as select characteristics for participants with core identity components. Although additional research is warranted, these findings suggest that the BICS has good psychometric properties and may be an effective tool for identifying African American audience segments.
In 1998, community leaders prompted members of the Black and Hispanic Congressional Caucuses to urge President Clinton to declare HIV/AIDS a crisis in the African American and Latino communities; their advocacy resulted in the formation of the Minority AIDS Initiative. As part of this initiative, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Agency funded the Substance Abuse and HIV Prevention Youth and Women of Color Initiative (CSAP Initiative). The CSAP Initiative is the first major federal effort to develop community-based integrated HIV and substance abuse prevention approaches targeting racial/ethnic populations that have been disproportionately impacted by HIV/AIDS. This article describes the current state of HIV prevention research involving racial/ethnic minority populations and the current status of the CSAP Initiative. The data collected through the CSAP Initiative, implemented by 47 community organizations, will help to fill the existing knowledge gap about how to best prevent HIV in these communities. This data collection effort is an unparalleled opportunity to learn about risk and protective factors, including contextual factors, that are critical to the prevention of HIV/AIDS in African American, Latino, and other racial/ethnic minority communities but that are often not investigated.
The Geriatric Depression Scale (GDS) is one of the most widely used self-rated mood questionnaires for older adults. It is highly correlated with clinical diagnoses of depression and has demonstrated validity across different patient populations. However, the reliability of the GDS among African American older adults remains to be firmly established. In a baseline sample of 401 African American adults age 51 and over, the GDS-15 item short form demonstrates good internal consistency (KR20=.71). Stability over a 15-month interval in a retest sample of 51 adults is deemed adequate (r=.68). These findings support the use of the GDS-15 item short form as a reliable mood questionnaire among African American older adults.
Geriatric depression scale; GDS; Depression; African American; Reliability
Few measures exist to assess risky behaviors and consequences as they relate to substance use in juvenile delinquents. This study sought to validate such a measure on a racially and ethnically diverse sample (N = 175). Results indicate that alcohol-related risky behaviors and consequences comprise a single scale as do marijuana-related risky behaviors and consequences. Furthermore, results suggest that the retention of common items for both scales produces reliable and valid scales and maintains parsimony. Internal consistencies were more than adequate (0.72 – 0.83) and test-retest stabilities, even across several months were acceptable (0.52 - 0.50). The scales evidenced a high degree of concurrent and predictive incremental validity in predicting conduct disorder, dependence symptoms, and consumption patterns. Researchers can use these scales to measure a generalized construct tapping risks and consequences as related to alcohol and marijuana use. Ease of use may make these scales appealing to clinicians who can provide feedback to clients regarding risky behaviors involving alcohol and marijuana.
Substance-related consequences; adolescence; delinquents
Donor authorizations tend to be especially low among African Americans and other minority and ethnic groups. This study assessed and compared the beliefs, attitudes, and rates of participation regarding organ donation among a sample of racially and ethnically mixed university students. A 64-item survey questionnaire regarding organ/tissue donation issues was administered to 683 undergraduate students from different racial and ethnic backgrounds at a state-assisted university in the Midwest. The findings from the study indicated that African-American students differ significantly from white students in their attitudes and beliefs toward organ donation, while Asian-American, Hispanic, and international students were similar to white students in their attitudes and beliefs regarding organ donation. However, a greater percentage of African-American students have granted permission for organ donation compared to African Americans in the general population.
Among 224 African American adolescents (mean age 14), the associations between interracial, intraracial contact and school-level diversity on changes in racial identity over a 3-year period were examined. Youths were determined to be diffused, foreclosed, moratorium or achieved; and change or stability in identity status was examined. Contact with Black students, Black friends, and White friends predicted change in identity status. Further, in racially diverse schools, more Black friends were associated with identity stability. Students reporting low contact with Black students in racially diverse schools were more likely to report identity change if they had few Black friends. Students reporting high contact with Blacks in predominately White schools, identity was less likely to change for students with fewer White friends.
Previous research has shown the performance of the CJDATS Co'-Occurring Disorders Screening Instruments (CODSI-MD and SMD)—six- and three-item instruments to screen for any mental disorder (CODSI-MD) and for severe mental disorders (CODSI-SMD), respectively—to be comparable or superior to other, longer instruments. This study tested the stability of the performance of the CODSI-MD and SMD across three racial/ethnic groups of offenders entering prison substance abuse treatment programs (n = 353), consisting of 96 African American, 120 Latino, and 137 White admissions. The Structured Clinical Interview (SCID) was used to obtain DSM-IV Axis I and II diagnoses; a lifetime SCID diagnosis of a mental disorder or a severe mental disorder was the criterion against which the CODSI-MD and SMD were validated. Results showed no statistical differences in sensitivity or specificity for either the CODSI-MD or SMD across the African American, Latino, and White prisoner groups. The value of the CODSI-MD and SMD as brief screens for mental disorders among offenders with diverse racial/ethnic backgrounds is discussed.
Recent reports suggest that providers’ implicit attitudes about race contribute to racial and ethnic health care disparities. However, little is known about physicians’ implicit racial attitudes. This study measured implicit and explicit attitudes about race using the Race Attitude Implicit Association Test (IAT) for a large sample of test takers (N = 404,277), including a sub-sample of medical doctors (MDs) (n = 2,535). Medical doctors, like the entire sample, showed an implicit preference for White Americans relative to Black Americans. We examined these effects among White, African American, Hispanic, and Asian MDs and by physician gender. Strength of implicit bias exceeded self-report among all test takers except African American MDs. African American MDs, on average, did not show an implicit preference for either Blacks or Whites, and women showed less implicit bias than men. Future research should explore whether, and under what conditions, MDs’ implicit attitudes about race affect the quality of medical care.
Racial and ethnic health care disparities; implicit and explicit attitudes about race; physician racial bias; physicians; gender; race; ethnicity
This study examines the impact of ancillary health and social services matched to client needs in substance abuse treatment for African Americans, Latinos and Whites. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3142 clients (1812 African Americans, 486 Latinos, 844 Whites) from 59 treatment facilities. Results show that racial/ethnic minorities are underserved compared to Whites in the substance abuse service system. Different racial/ethnic groups come into treatment with distinct needs and receive distinct services. Although groups respond differentially to service types, substance abuse counseling and matching services to needs is an effective strategy both for retaining clients in treatment and for reducing post-treatment substance use for African Americans and Whites. Receipt of access services was related to reduced post-treatment substance use for Latinos. Study findings are relevant to planning special services for African Americans and Latinos.
Substance abuse; Social service delivery; Treatment process; Racial/ethnic groups; Matched services; Special services
Due to disparities in the use of genetic services, there has been growing interest in examining beliefs and attitudes related to genetic testing for breast and/or ovarian cancer risk among women of African descent. However, to date, few studies have addressed critical cultural variations among this minority group and their influence on such beliefs and attitudes.
We assessed ethnic, racial and cultural identity and examined their relationships with perceived benefits and barriers related to genetic testing for cancer risk in a sample of 160 women of African descent (49% self-identified African American, 39% Black-West Indian/Caribbean, 12% Black-Other) who met genetic risk criteria and were participating in a larger longitudinal study including the opportunity for free genetic counseling and testing in New York City. All participants completed the following previously validated measures: (a) the multi-group ethnic identity measure (including ethnic search and affirmation subscales) and other-group orientation for ethnic identity, (b) centrality to assess racial identity, and (c) Africentrism to measure cultural identity. Perceived benefits and barriers related to genetic testing included: (1) pros/advantages (including family-related pros), (2) cons/disadvantages (including family-related cons, stigma and confidentiality concerns), and (3) concerns about abuses of genetic testing.
In multivariate analyses, several ethnic identity elements showed significant, largely positive relationships to perceived benefits about genetic testing for breast and/or ovarian cancer risk, the exception being ethnic search, which was positively associated with cons/disadvantages, in general, and family-related cons/disadvantages. Racial identity (centrality) showed a significant association with confidentiality concerns. Cultural identity (Africentrism) was not related to perceived benefits and/or barriers.
Ethnic and racial identity may influence perceived benefits and barriers related to genetic testing for breast and/or ovarian cancer risk among at-risk women of African descent. Genetic counseling services may want to take into account these factors in the creation of culturally-appropriate services which best meet the needs of this heterogenous population.
Breast cancer; Cultural identity; Ethnic identity; Genetic testing; Racial identity
The purpose of this pilot study was to describe the knowledge of HIV/AIDS, attitudes about condom use, and the sexual behavior of African-American adolescents who reside in a children's emergency homeless shelter. The Attitudes Toward Condom Usage Questionnaire, the AIDS Knowledge and Attitude Survey, and a Perceived Risk of HIV/AIDS Scale were modified and administered to 37 African-American male and female adolescents who reside in an emergency shelter. HIV/AIDS knowledge and attitudes about condoms among these respondents were comparable to those of other adolescents described in the literature in that there was a strong knowledge of HIV/AIDS, although sexual behavior and attitudes toward condoms were not consistent with this knowledge. Significant differences between male and female respondents were only found on three items of the Attitudes Toward Condom Usage Questionnaire and on the Perceived Risk of HIV/AIDS Scale at the 0.05 level. The knowledge, attitudes, and sexual behavior of homeless, African-American adolescents should be examined to develop and implement appropriate programs to address the specific needs of this population. Further research should focus on this population and expand on this preliminary data.
Studies examining associations between racial discrimination and cardiovascular health outcomes have been inconsistent, with some studies finding the highest risk of hypertension among African Americans who report no discrimination. A potential explanation of the latter is that hypertension and other cardiovascular problems are fostered by internalization and denial of racial discrimination. To explore this hypothesis, the current study examines the role of internalized negative racial group attitudes in linking experiences of racial discrimination and history of cardiovascular disease among African American men. We predicted a significant interaction between reported discrimination and internalized negative racial group attitudes in predicting cardiovascular disease. Weighted logistic regression analyses were conducted among 1216 African American men from the National Survey of American Life (NSAL; 2001– 2003). We found no main effect of racial discrimination in predicting history of cardiovascular disease. However, agreeing with negative beliefs about Blacks was positively associated with cardiovascular disease history, and also moderated the effect of racial discrimination. Reporting racial discrimination was associated with higher risk of cardiovascular disease among African American men who disagreed with negative beliefs about Blacks. However, among African American men who endorsed negative beliefs about Blacks, the risk of cardiovascular disease was greatest among those reporting no discrimination. Findings suggest that racial discrimination and the internalization of negative racial group attitudes are both risk factors for cardiovascular disease among African American men. Furthermore, the combination of internalizing negative beliefs about Blacks and the absence of reported racial discrimination appear to be associated with particularly poor cardiovascular health. Steps to address racial discrimination as well as programs aimed at developing a positive racial group identity may help to improve cardiovascular health among African American men.
USA; African American men; cardiovascular disease; racial discrimination; racial identity
The Multidimensional Inventory of Black Identity-teen (MIBI-t) is designed to assess the three cross-situationally stable dimensions (Centrality, Regard, and Ideology) of the Multidimensional Model of Racial Identity (MMRI; Sellers, Smith, Shelton, Rowley, & Chavous, 1998) within teenagers. Adolescent responses (N = 489) to the MIBI-t were subjected to several analyses to evaluate the psychometric character of the measure. Findings indicated that the MIBI-t represents a valid framework for African American adolescents, that its internal structure is consistent with the conceptual framework of the MMRI, and support its construct validity. Findings also indicate model invariance across grade level and gender, as well as suggest evidence of predictive validity. Further information about the MIBI-t and the full set of items are presented.
Racial Identity; Ethnic Identity; Measurement Identity Development African American; Black; Self-Concept
Motivation for Addiction Treatment-Hindi scale was developed as a ‘generic’ scale applicable across different substances of abuse. This 46-item self-report Likert scale was administered to 262 treatment-seeking men with a diagnosis of alcohol or opioid dependence as per International Classification of Diseases-10th revision. Factor analysis generated 15 factors that covered all 46 items and explained 63.7% of the total variance. Factors I (12 items) and II (6 items), reflected acceptance and rejection of the existence of the problem of addiction and the treatment offered and, explained 20.7% and 7.6% of the variance respectively. Test-retest reliability and measures of internal consistency yielded satisfactory results. While the whole scale but not Factors I & II differentiated alcohol and opioid dependent groups, Factors I & II but not the whole scale differentiated relapsed from non-relapsed cases at>6 month follow-up. With some limitations, this scale presents a new tool to assess motivation for addiction treatment in Hindi speaking population in terms of two global dimensions of acceptance and rejection of the problem of addiction and the treatment offered.
Substance abuse; treatment; motivation; factor analysis
Community attitudes about suicide and their relationship to suicidal behavior have not been adequately investigated in low- and middle-income countries.
Compare acceptability of suicide in different population cohorts in China, identify factors that affect the degree of acceptability, and assess the relationship of cohort-specific acceptability of suicide and suicide rates.
A multi-stage stratified random sample of 608 rural residents, 582 urban residents and 629 college students were administered a 25-item scale in which respondents stated the likelihood they would consider suicide (on a 5-point Likert scale) if they experienced a variety of stressors ranging from ‘being disciplined at work’ to ‘developing a chronic mental illness’. The internal consistency and test-retest reliability for the scale are excellent (Cronbach’s α =0.92, ICC=0.75).
College students had the most permissive attitudes about suicide and urban residents were significantly more accepting of suicide as a response to serious life stressors than rural residents. Multivariate analysis found that the overall acceptability score was higher in women, decreased with age, and increased with years of education.
There was no clear relationship between cohort-specific acceptance of suicide and reported rates of suicide, highlighting the complexity of the relationship between attitudes about suicide (of which acceptability is only one component) and suicidal behavior.
suicide; attitudes; acceptability; cross-sectional survey; China
Brief screening instruments for co-morbid personality disorders could potentially have great value in substance abuse treatment settings.
We assessed the psychometric properties of the 8-item Standardised Assessment of Personality – Abbreviated Scale (SAPAS) in a sample of 58 methadone maintenance patients.
Internal consistency was modest, but similar to the original value (alpha = 0.62), and test-retest correlation at four months follow-up was moderately encouraging for a short instrument such as this (n = 31, test retest intraclass correlation = 0.58), and change at the mean level was minimal, but marginally significant (from an average of 3.3 to 3.8, p = 0.06). Analyses of nurse ratings of patients' behaviour at the clinic showed that SAPAS was significantly correlated with nurse ratings of externalizing behaviour (r = 0.42, p = 0.001), and Global Assessment of Functioning (r = -0.36, p = 0.006), but unrelated to intoxication (r = 0.02, NS), or withdrawal (r = 0.20, NS).
There is evidence that the SAPAS is a modestly valid and relatively reliable brief screening measure of personality disorders in patients with ongoing substance abuse undergoing methadone maintenance. It can be used in situations where limited resources are available, and researchers or others wish to get an impression of the degree of personality pathology in a clinical population, as well as for screening purposes.
Responses from 205 subjects to a 51 -item self-report Likert scale for assessment of attitudes toward drinking and alcoholism (SAADA-I) were subjected to a principal component factor analysis with varimax rotation. The resultant 29 item modified version of the scale (SAADA-II) had four factors named “Acceptance1”, “Rejection”, “Avoidance” and “Social dimension”, and explaining 8.59%, 8.35%, 4.76% and 3.79% of the variance respectively (total variance explained 25.49%. Measures of internal consistency and stability over time both yielded overall satisfactory results. The complex, multidimensional nature of the attitudes toward drinking and alcoholism is emphasized by this study. Also, the scale, after further modifications, may be used as a sound psychometric index for measuring such attitudes especially in the care-givers, professionals and burdensharers dealing with alcohol dependent persons.
Attitude; drinking; alcohol; alcoholism; scale; factor analysis
Previous research suggests that lack of knowledge of hospice is a barrier to the use of hospice care by African Americans. However, there is little data examining racial differences in exposure to hospice information.
Examine racial differences in self-reported exposure to hospice information and determine how this exposure impacts beliefs about hospice care.
We surveyed 200 community-dwelling older adults (65 or older). We used Spearman's correlations to examine the relationship between responses to individual items on the Hospice Beliefs and Attitudes Scale (HBAS) and self-reported exposure to hospice information (never heard of hospice, heard a little, or heard a lot). We used multivariate analyses to examine predictors of exposure to hospice information and beliefs about hospice care (total score on HBAS).
Compared to whites (n = 95), African Americans (n = 105) reported significantly less exposure to hospice information (p = 0.0004). Nineteen percent of African Americans and 4% of whites had never heard of hospice; 47.6% of African Americans and 71.6% of whites had heard a lot about hospice. In multivariate analysis controlling for demographics and health status, African Americans had a two times higher odds of reporting that they had never heard of hospice or heard only a little about hospice versus heard a lot about hospice (odds ratio [OR] = 2.24 [1.17, 4.27]. Greater exposure to hospice information was associated with more favorable beliefs about hospice care (outcome: total score on HBAS; parameter estimate 1.34, standard error 0.44, p = 002).
African Americans reported less exposure to information about hospice than whites. Greater exposure to hospice information was associated with more favorable beliefs about some aspects of hospice care. Because knowledge is power, educational programs targeting older African Americans are needed to dispel myths about hospice and to provide minorities with the tools to make informed choices about end-of-life care.
OBJECTIVE: This article reviews the literature on racial, ethnic, and socioeconomic disparities in morbidity and mortality, focusing on substance use and abuse. OBSERVATIONS: In most populations and societies, people of higher social position live longer and remain healthier than those of lower position. Disparities in morbidity and mortality across ethnic groups also exist. Mortality rates for African Americans are about 1.6 times higher than those for white, with much higher disparities for certain causes, such as HIV/AIDS and diabetes. Disparities also exist in the level of substance use and abuse. CONCLUSION: Racial and ethnic differences in health and health behaviors, including substance use and abuse, may partly reflect biological differences, but it is more likely that they can be explained largely by socioeconomic differences, cultural factors, and prejudice and discrimination, both institutional and individual.
Compared to published norms, African Americans endorse significantly more items intended to assess pathological anxiety about contamination on self-report instruments for obsessive-compulsive disorder. The current study suggests this is not due to greater psychopathology in African Americans, but rather to differences in normal attitudes about cleanliness that also influence responses to items intended to assess anxiety pathology. Contamination items from OCD scales including the Padua Inventory (Behav Res Ther. 26:2 (1988) 169) were supplemented with cleanliness attitude items and administered to Black and White participants (N=1483). An exploratory factor analysis suggested a three-factor solution: one factor that encompassed pathological anxiety, and two that expressed attitudes about cleanliness, grooming, and domestic animals. African Americans scored significantly higher on all three factors. A confirmatory factor analysis demonstrated that the difference between Black and White participants on the pathological anxiety factor was eliminated when differences on the attitude factors were controlled statistically.
factor analysis; assessment; obsessive-compulsive disorder; ethnic differences; contamination; anxiety; attitudes
Normative neuropsychological data for U.S. racial/ethnic minorities is limited. Extant norms are based on small, regional groups that may not be nationally representative. The objectives of this study were to 1) provide norms for a modified Symbol Digit Modalities Test (M-SDMT) based on a nationally representative sample of African Americans, Caribbean Blacks and non-Latino Whites (NLW) living in areas with large populations of Blacks, and 2) determine significant correlates of M-SDMT performance. The M-SDMT was administered to a subset of respondents from the National Survey of American Life in standard, face-to-face interviews. M-SDMT performance was influenced by race/ethnicity, age, education, and gender. African Americans and NLW groups had similar M-SDMT performances, which differed from Caribbean Blacks. The Black ethnic differences in M-SDMT were not explained by the sociodemographic factors considered in this study. Unlike previous work, this study supports the consideration of Black ethnicity when evaluating Black neuropsychological test performance.
African Americans; Caribbean Blacks; Blacks; Neuropsychological Tests
The Wisconsin Smoking Withdrawal Scale (WSWS) is a valid and reliable scale among non-Latino Whites but has not been validated for use among other racial/ethnic groups despite increasing use with these populations. The current study examined the structural invariance and predictive equivalency of the WSWS across three racial/ethnic groups.
The WSWS scores of 424 African American, Latino, and White smokers receiving smoking cessation treatment were analyzed in a series of factor analyses and multiple-group analyses. Additionally, hierarchical logistic regression analyses were conducted to determine whether WSWS scores differentially predicted smoking relapse across racial/ethnic groups. These analyses were consistent with a step-down hierarchical regression procedure for examination of test bias.
The 7-factor structure of the WSWS was largely confirmed in the current study, with the exception of the removal of two offending items. Evidence of full invariance across race/ethnicity was found in multiple-group analyses. The WSWS total score and subscales measuring anger, anxiety, concentration, and sadness predicted relapse, whereas the hunger, craving, and sleep subscales did not. None of these scales displayed differential predictive ability across race/ethnicity. The WSWS sleep subscale showed a significant interaction with race/ethnicity such that it was a significant predictor of relapse among Whites but not African Americans or Latinos.
Overall, the WSWS is similar in structure and predictive of relapse across racial/ethnic groups. Caution should be exercised when using the WSWS sleep subscale with African Americans and Latinos.
This study examines patterns of racial socialization practices in a sample of 212 African American mothers. We investigate the relation between parent profiles of racial socialization messages with child and parent demographic factors and race-related experiences, as well as parent racial identity attitudes. Using latent class analyses, we identified three patterns of parent-reported racial socialization experiences: Multifaceted, Low Race Salience, and Unengaged. In general, our findings indicate that mothers in the Multifaceted profile were more educated, experienced more racial discrimination, and talked about race during their childhood more than mothers in the Unengaged profile. The Multifaceted profile also differed from the Low Race Salience and Unengaged profiles on several racial identity dimensions. While the patterned approach used in this study lends itself to a more complex study of racial socialization in future research, it also highlights the associations between parent's race-relevant experiences and the messages they communicate to their children about race.
OBJECTIVE: This study tested the effectiveness of two culturally appropriate substance abuse prevention intervention programs for African American girls. METHODS: Project Naja recruited 210 girls ages 10-12 from schools in a low-income ward in Washington, D.C., to participate in a 2.5- year, three-phase intervention to develop strong ethnic and gender identity. The Cultural Enhancement Project recruited sixth grade girls in Richmond, Virginia, for a 15-week curriculum. The author collected pre- and post-test data on cultural, drug, and sex measures. RESULTS: Project Naja participants in the intervention group scored significantly higher on Africentric values and racial identity than comparison group participants. They also had more positive concepts of their physical appearance. In the Cultural Enhancement Project, girls in the intervention group scored higher on the global African American identity scale. There was a trend toward significance in increased percentage of androgyny for girls in the intervention group. CONCLUSIONS: Prevention programs should include a component directed at strengthening ethnic identity and other protective factors (self-esteem, positive peer support, and skill-enhancement).
This paper examines whether children of marginalized racial/ethnic groups have an awareness of race at earlier ages than youth from non-marginalized groups, documents their experiences with racial discrimination, and utilizes a modified racism-related stress model to explore the relationship between perceived racial discrimination and self-esteem. Data were collected for non-Hispanic black, non-Hispanic white, and Hispanic children aged 7 – 12 using face-to-face interviews (n = 175). The concept of race was measured by assessing whether children could define race, if not a standard definition was provided. Racial discrimination was measured using the Williams Every-day-Discrimination Scale, self-esteem was measured using the Rosenberg Scale, and ethnic identity was assessed using the Multi-group Ethnic Identity Measure. Non-Hispanic black children were able to define race more accurately, but overall, Hispanic children encountered more racial discrimination, with frequent reports of ethnic slurs. Additionally, after accounting for ethnic identity, perceived racial discrimination remained a salient stressor that contributed to low self-esteem.
race; racism; children; ethnic-identity; self/other; ethnicity