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.
The purpose of this study was to develop a brief, reliable, and valid self-report measure of attitudes toward sexual partner concurrency. Focus groups, conducted with 59 participants, yielded 26 common attitudes. STD clinic patients (n = 370) reported their sexual risk history, and rated the 26 attitude statements. This sample was randomly divided into two subsamples, with some participants completing the items on two occasions (separated by 3 months) to evaluate test-retest reliability. Both exploratory and confirmatory factor analyses confirmed a one-factor model. The final scale consisted of 10 items, with higher scores reflecting more positive attitudes toward sexual partner concurrency. This scale is internally consistent (α = .92) and stable over time (3-month retest ICC = 0.82), with a factor structure that is equivalent for men and women. Evidence of validity was also obtained by confirming hypothesized correlations with sexual risk history. Continued research is needed to confirm the usefulness of this measure as an antecedent of sexual risk behavior.
concurrency; sexual behavior; attitudes; measurement
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
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
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
Prospective data tested a “differential mediation” hypothesis: The relations (found in previous research) between perceived racial discrimination and physical health status versus health-impairing behavior (problematic substance use) are mediated by two different types of affective reactions, internalizing and externalizing.
The sample included 680 African American women from the Family and Community Health Study (M age = 37 at Time 1; 45 at Time 4). Four waves of data were analyzed. Perceived discrimination was assessed, along with anxiety and depression (internalizing) and hostility / anger (externalizing) as mediators, and physical health status and problematic substance use (drinking) as outcomes.
Structural equation modeling indicated that discrimination predicted increases in both externalizing and internalizing reactions. These affective responses, in turn, predicted subsequent problematic substance use and physical health status, respectively, also controlling for earlier reports. In each case, the indirect effects from discrimination through the affective mediator to the specific health outcome were significant and consistent with the differential mediation hypothesis.
Perceived racial discrimination is associated with increases in internalizing and externalizing reactions among Black women, but these reactions are related to different health outcomes. Changes in internalizing are associated with self-reported changes in physical health status, whereas changes in externalizing are associated with changes in substance use problems. Discussion focuses on the processes whereby discrimination affects health behavior and physical health status.
Discrimination; Physical Health; Substance Use
It isunclear whether racial differences in treatment effect exist for individuals in substance abuse and domestic violence programs.
This study examined racial differences in treatment effect among substance dependent Caucasian and African-American male intimate partner violence (IPV) offenders court mandated to an integrated substance abuse and domestic violence treatment.
From baseline to completion of treatment (week 12), 75 participants (39 Caucasian; 36 African-American) were assessed on demographics, substance use, legal characteristics, and use of violence (physical, verbal, and psychological).
African-American men served more months incarcerated in their life than Caucasian men. Both groups showed decreases in their use of physical violence and alcohol abuse over treatment. Caucasian men also showed a decrease in their use of verbal abuse.
Conclusions and Scientific Significance
At treatment completion, both groups showed a reduction in physical abuse and alcohol abuse. Caucasian men showed a reduction in their use of verbal abuse, but African-American men did not. Substance dependent African-American male IPV offenders may benefit from interventions that thoroughly target communication skills in addition to issues of substance abuse and IPV to reduce use of verbal abuse and improve treatment outcomes among African American men.
domestic violence; intimate partner violence; racial differences; substance abuse
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.
This study tested the longitudinal association between perceptions of racial discrimination and racial identity among a sample of 219 African American adolescents, aged 14 to 18. Structural equation modeling was used to test relations between perceptions of racial discrimination and racial identity dimensions, namely racial centrality, private regard, and public regard at three time points. The results indicated that perceived racial discrimination at Time 1 was negatively linked to public regard at Time 2. Nested analyses using age were conducted and perceptions of racial discrimination at Time 2 were negatively linked to private regard at Time 3 among older adolescents. The findings imply that perceived racial discrimination is linked to negative views that the broader society has of African Americans.
Racial Discrimination; Racial Identity; African Americans/Blacks; Adolescents; Longitudinal
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
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.
The present study examined the influence of racial identity in the longitudinal relationship between perceptions of racial discrimination and psychological well-being for approximately 560 African American youth. Latent curve modeling (LCM) and parallel process multiple-indicator LCMs with latent moderators were used to assess whether perceptions of racial discrimination predicted the intercept (initial levels) and the slope (rate of change) of psychological well-being over time, and whether racial identity moderates these relationships. The results indicated that African American adolescents who reported higher psychological responses to discrimination frequency levels at the first time point had lower initial levels of well-being. Regressing the slope factor for psychological well-being on frequency of discrimination also revealed a non-significant result for subsequent well-being levels.
Incarceration affects the lives of many African American men and often leads to poverty, ill health, violence, and a decreased quality of life. There has been an unprecedented increase in incarceration among African American males since 1970. In 2009, the incarceration rate among black males was 6.7 times that of white males and 2.6 times of Hispanic males. Substance abuse in African American males leads to higher mortality rates, high rates of alcohol-related problems, more likely to be victims of crimes, and HIV/AIDS. African Americans comprised only 14% of the U.S. population but comprised 38% of the jail population. The cost of incarcerating persons involved in substance related crimes has increased considerably over the past two decades in the U.S. A reduction in the incarceration rate for non-violent offences would save an estimated $17 billion per year. Substance use disorder makes the individual more prone to polysubstance use and leads to impulse control problems, selling drugs, and other crimes. The high rate of incarceration in U.S. may adversely affect health care, the economy of the country, and will become a burden on society. Implementation of good mental health care, treatment of addiction during and after incarceration will help to decrease the chances of reoffending. Therapeutic community programs with prison-based and specialized treatment facilities, cognitive behavioral therapy treatment for 91–180 days, and 12-step orientation with staff specialized in substance abuse can be helpful. It is essential for health care professionals to increase public awareness of substance abuse and find ways to decrease the high rates of incarceration.
substance use disorder; incarceration; African American; males; crime; alcohol; illicit drugs
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
Racial and ethnic minorities and injection drug users (IDUs) are at increased risk of HIV infection. To date, the associations between these caseload characteristics and availability of onsite HIV testing in substance use disorder treatment programs are unknown. This uses data collected in 2008–2009 from 198 program administrators of treatment programs participating in the National Institute on Drug Abuse’s Clinical Trials Network to address this gap in the literature. Results show positive associations between the percentages of African American, Hispanic, and IDU patients and the odds of non-rapid onsite HIV testing versus no onsite testing. The associations between racial/ethnic composition and the availability of rapid HIV testing were more complicated. These findings suggest that many programs are responding to the needs of at-risk populations. However, programs and their patients may benefit from greater adoption of rapid testing which is less costly and better ensures that patients receive their results.
In this exploratory study, we examined differences in the legal characteristics of Caucasian and African-American female offenders (n = 122) who were diverted into substance abuse treatment, to identify any racial disparities. We also examined the differences between groups in demographics and in substance abuse, family, and violence histories. In terms of legal characteristics, the results showed that African-American female offenders were significantly more likely to have been incarcerated at the time of their substance dependency evaluation than were Caucasian female offenders. Also, African-American women were more likely to have served 13 months for the current legal charge in comparison to the 4 months served by Caucasian women, although no differences were found between groups in the severity of the current legal charge. Comparison of demographics and substance abuse, family, and violence histories indicated that African-American women were more likely to be undereducated, crack cocaine dependent, and overly exposed to violence. Overall, the sample of female offenders evidenced severe substance dependency problems, a strong need for inpatient substance abuse treatment, and chronic legal and social difficulties. Implications of these findings are discussed in relation to unbalanced sentencing policies and increasing awareness of the treatment needs of this unique population.
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