African American Men's Health: Research, Practice, and Policy

Abstract

The Center for Healthy African American Men through Partnerships (CHAAMPS, U54MD 008620), led by investigators at the University of Alabama at Birmingham and the University of Minnesota, is a National Transdisciplinary Collaborative Center funded in 2013 by the National Institute on Minority Health and Health Disparities of NIH. The overarching goal of CHAAMPS is to address health disparities affecting black males. Specifically, CHAAMPS seeks to identify the socioeconomic, behavioral, and biological factors driving and sustaining the pronounced health disparities experienced by black males, specifically targeting unintentional and violence-related injuries, along with chronic diseases—cardiovascular disease, cancer, and stroke. This is accomplished through a life course approach, pinpointing critical periods in a black male's life, such as youth/adolescence, young adulthood, middle age, and old adulthood, when social context may be more salient in the way it affects physiology or shapes health behavior. The ultimate goal of CHAAMPS is to develop, implement, and evaluate interventions that will improve the health of black males through research, outreach, and training. Racial disparities in men's health in the U.S. are well documented, with consistently higher prevalence and poorer outcomes observed in black males across the age spectrum—from unintentional and violence-related injuries at the lower end to chronic illnesses at the upper end.1Griffith DM Metzl JM Gunter K Considering intersections of race and gender in interventions that address U.S. men's health disparities.Public Health. 2011; 125: 417-423https://doi.org/10.1016/j.puhe.2011.04.014Crossref PubMed Scopus (70) Google Scholar Black men have the highest age-adjusted all-cause mortality rate and arguably the worst health status of any race–gender group in the U.S.2Ravenell JE Johnson Jr., WE Whitaker EE African-American men's perceptions of health: a focus group study.J Natl Med Assoc. 2006; 98: 544-550PubMed Google Scholar Although it should be noted that the mortality rate in black men decreased 25% from 1999 to 2015,3African American health: creating equal opportunities for health. CDC. www.cdc.gov/vitalsigns/aahealth/index.html. Published 2017. Accessed July 13, 2018.Google Scholar profound racial disparities persist. In 2015, black men had an age-adjusted mortality rate of 1,070.1 per 100,000 population, compared with 881.3 per 100,000 population in white men.4Murphy SL Xu J Kochanek KD Curtin SC Arias E Deaths: final data for 2015.Natl Vital Stat Rep. 2017; 66: 1-75PubMed Google Scholar Furthermore, in 2015, life expectancy at birth in black men was 71.8 years, compared with 76.3 years in white men.4Murphy SL Xu J Kochanek KD Curtin SC Arias E Deaths: final data for 2015.Natl Vital Stat Rep. 2017; 66: 1-75PubMed Google Scholar The burden of risk factors for chronic disease is substantially higher in black men compared with their white counterparts. Black men have a higher prevalence of obesity (including severe [grade 3] obesity) and hypertension.5Flegal KM Carroll MD Ogden CI Curtin LR Prevalence and trends in obesity among U.S. adults, 1999–2008.JAMA. 2010; 303: 235-241https://doi.org/10.1001/jama.2009.2014Crossref PubMed Scopus (5312) Google Scholar, 6Benjamin EJ Virani SS Callaway CW et al.Heart disease and stroke statistics—2018 update: a report from the American Heart Association.Circulation. 2018; 137: e67-e492https://doi.org/10.1161/CIR.0000000000000558Crossref PubMed Scopus (4418) Google Scholar Lifestyle factors also place black males at greater risk of disease. For example, data from multiple National Health and Nutrition Examination Surveys reveal that black men consistently report significantly lower intake of fruits and vegetables (which generally have been inversely associated with risk of chronic disease) than their white counterparts.7Kant AK Graubard BI Kumanyika SK Trends in black-white differentials in dietary intake of U.S. adults, 1971–2002.Am J Prev Med. 2007; 32: 264-272https://doi.org/10.1016/j.amepre.2006.12.011Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar As would be expected, the higher risk factor burden in black men has translated into a greater chronic disease burden in this segment of the population. For example, the prevalence of type 2 diabetes in black men is nearly double that in white men.6Benjamin EJ Virani SS Callaway CW et al.Heart disease and stroke statistics—2018 update: a report from the American Heart Association.Circulation. 2018; 137: e67-e492https://doi.org/10.1161/CIR.0000000000000558Crossref PubMed Scopus (4418) Google Scholar Black men also are more likely to be afflicted with cardiovascular disease compared with white men,6Benjamin EJ Virani SS Callaway CW et al.Heart disease and stroke statistics—2018 update: a report from the American Heart Association.Circulation. 2018; 137: e67-e492https://doi.org/10.1161/CIR.0000000000000558Crossref PubMed Scopus (4418) Google Scholar and the percentage of black men with cardiovascular disease who die prematurely is nearly double that of white men.8Barnett E, Casper ML, Halverson JA, et al. Men and Heart Disease: An Atlas of Racial and Ethnic Disparities in Mortality. 1st ed. Morgantown, WV and Atlanta, GA: Office for Social Environment and Health Research, West Virginia University and National Center for Chronic Disease and Health Promotion, CDC. https://ftp.cdc.gov/pub/publications/mens_atlas/00-atlas-all.pdf. Published 2001. Accessed June 6, 2018.Google Scholar The prevalence of stroke in black men is nearly 80% higher than that in white men, and black men have a stroke mortality rate that is nearly 60% higher than that in white men.6Benjamin EJ Virani SS Callaway CW et al.Heart disease and stroke statistics—2018 update: a report from the American Heart Association.Circulation. 2018; 137: e67-e492https://doi.org/10.1161/CIR.0000000000000558Crossref PubMed Scopus (4418) Google Scholar Finally, black men exhibit a greater burden of cancer than white men, whether one looks at incidence, mortality, or 5-year survival. This disparity is particularly notable for prostate cancer.9American Cancer Society. Cancer Facts & Figures 2018. Atlanta, GA: American Cancer Society. www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf. Published 2018. Accessed June 7, 2018.Google Scholar Racial disparities extend to risk factors for violence-related injuries and mortality in younger ages. The total delinquency case rate for black juveniles is approximately three times the rate for white juveniles,10Hockenberry S, Puzzanchera C. Juvenile Court Statistics 2015. Pittsburgh, PA: National Center for Juvenile Justice. www.ncjj.org/pdf/jcsreports/jcs2015report.pdf. Published 2018. Accessed June 20, 2018.Google Scholar and black boys are more likely to be suspended or expelled from school as a form of discipline compared with white boys.11Wallace JM Goodkind S Wallace CM Bachman JG Racial, ethnic, and gender differences in school discipline among U.S. high school students: 1991–2005.Negro Educ Rev. 2008; 59: 47-62PubMed Google Scholar Black males in high school are more likely to carry a gun than their white counterparts.12Centers for Disease Control and Prevention (CDC). Youth risk behavior surveillance system. CDC. www.cdc.gov/healthyyouth/yrbs/index.htm. Accessed June 8, 2018.Google Scholar In 2014, the homicide rate among black males aged 10–24 years in the U.S. was 18 times greater than in white males.13Centers for Disease Control and Prevention (CDC). Youth violence. CDC. www.cdc.gov/violenceprevention/youthviolence/index.html. Accessed June 8, 2018.Google Scholar The importance of socioeconomic factors for driving and sustaining health disparities is increasingly recognized. WHO identifies the social determinants of health as the circumstances in which people are born, grow up, live, work, and age.14Marmot M Friel S Bell R Houweling TAJ Taylor S Commission on Social Determinants of HealthClosing the gap in a generation: health equity through action on the social determinants of health. Lancet . 2008; 372: 1661-1669https://doi.org/10.1016/S0140-6736(08)61690-6Abstract Full Text Full Text PDF PubMed Scopus (2121) Google Scholar These circumstances are shaped by social and economic policies, the distribution of power and resources, schooling and education, and other overarching fundamental factors. Health disparities in black men are associated with socioeconomic factors, such as high poverty, low education level, lack of health insurance, and widespread unemployment. For example, in 2016 a total of 13.7% of black men aged 65 years or younger were uninsured compared with 8.3% of white men.15Lucas JW, Benson V. Tables of summary health statistics for the U.S. population: 2016 National Health Interview Survey. National Center for Health Statistics. Atlanta, GA: CDC. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2016_SHS_Table_P-11.pdf. Published 2018. Accessed July 13, 2018.Google Scholar In 2018, with unemployment overall hitting record lows, unemployment in black men aged 20 years or older remains twice that observed in white men.16Bureau of Labor Statistics. Economic news release: employment status of the civilian population by race, sex, and age. Bureau of Labor Statistics. www.bls.gov/news.release/empsit.t02.htm. Updated June 1, 2018. Accessed June 9, 2018.Google Scholar In exploring the factors responsible for the differential outcomes of black males in unintentional and violence-related injuries and chronic diseases, CHAAMPS promotes an integrative approach that accounts for multiple simultaneous pathways to poor health outcomes, including fundamental social factors as well as behavioral and biological factors. The complex interplay of socioenvironmental, behavioral, and biophysiological influences involved in the etiology, management, and amelioration of chronic diseases and the prevalence of unintentional and violence-related injuries cannot be underestimated. Thus, CHAAMPS consists of a trans-disciplinary team of investigators with expertise in diverse fields, including public health, epidemiology, cancer control and prevention, surgical oncology, psychosocial motivations, adolescent risk taking, and community-based participatory research. In addition, academic investigators work closely with three national partners: the National USA Foundation Inc., which works with collaborative partners to provide and develop innovative approaches to improve men's health and well-being17National USA Foundation, Inc. http://nufi.org. Accessed June 11, 2018.Google Scholar; 100 Black Men of America, Inc., whose mission it is to improve the quality of life in black communities18100 Black Men of America, Inc. https://100blackmen.org. Accessed June 11, 2018.Google Scholar; and the National Football League, which supports various community initiatives impacting the health of black men.19National Football League. www.nfl.com. Accessed June 22, 2018.Google Scholar These national community partners were involved in the process of assessing needs around decreasing health disparities in black men in order to conduct innovative research that originates in, is supported by, and directly benefits the black community throughout the U.S. In addition to the traditional structure common to most Transdisciplinary Collaborative Centers—Administrative Core, Collaborations and Partnerships Core, Research Core, Intervention Implementation/Diffusion Core, Biostatistics Design and Analysis Support Group, and Evaluation Group—CHAAMPS funded two 5-year collaborative research subprojects (Table 1), an annual Pilot Project Program that funded three to five pilot projects per year (Table 2), and the CHAAMPS Disparities Scholars Program, in which recipients conducted disparities-related analyses using data from one of several national databases (Table 3). Pilot project and CHAAMPS Disparities Scholars Program applicants responded to requests for applications issued by CHAAMPS, and proposals were subjected to a competitive peer-review process. For pilot projects, academic investigators were required to develop their proposals in cooperation with, and inclusive of, one of the national community partners mentioned above.Table 1Research Sub-projects Funded by the Center for Healthy African American Men Through PartnershipsProject titleInitiating academic institutionCommunities Invested in Healthy Life Trajectories of African American BoysUMNPatient NAVIgation to Reduce Readmissions Among Black Men with Heart Failure (NAVI-HF)UABUAB, University of Alabama at Birmingham; UMN, University of Minnesota. Open table in a new tab Table 2Pilot Projects Funded by the Center for Healthy African American Men Through PartnershipsProject titleNational community partnerBiological processes Evaluation of the CCP Score Risk-stratification Tool in African American Men with Prostate Cancer100 BMOA Novel Biomarker that Discriminates Indolent from Aggressive Phenotype in African American Men100 BMOA Fibrinolytics for Improving Lung Cancer Outcomes in African American Men100 BMOA Regulation of Cardiac Gene Expression in African American Men in Heart FailureNUFI DNA 5-Hydroxymethylcytosine: Guarding the Prostate Epigenome From Malignant Progression in African American Men100 BMOACommunity-based Healthy Eating, Activity & Resting Together (HEART) Matters100 BMOA Understanding Hypertension Among Black Men in a Faith-based SettingNUFI Developing and Testing a New Model to Reduce Risks for Heart Disease and StrokeNUFI Improving Diabetes Medication Management Through Face to Face and Social Media Support Among African American MenNUFI Characterizing Healthcare Utilization in Black Males to Improve HCV Outcomes100 BMOA Violence and Related Injury Among African American Male Youth: Pathways to Prevention Articulated by Community Members and Police Officers100 BMOA Universal Screening for HIV, Hepatitis C Infection and Colorectal Cancer Among African American Men: A Collaboration Between UAB's Comprehensive Cancer Center and 100 Black Men100 BMOA Attitudes, Perceptions, and Psychosocial Determinants of Cancer Screening Among East African Communities100 BMOA Reducing Violence Among High Risk African American Men Through Individual Support100 BMOA Leveraging the Family Influence of Women in a Community-Based Health Education Intervention to Promote Prostate Health and General Well-being Among African American Men100 BMOA A Community Engaged Approach to Reducing Violence and Improving the Health of African American Men in a Southeastern Community100 BMOA Bariatric Surgery in African American MalesNUFI100 BMOA, 100 Black Men of America, Inc.; CCP, cell cycle progression; HCV, hepatitis C virus; HIV, human immunodeficiency virus; NUFI, National USA Foundation, Inc.; UAB, University of Alabama at Birmingham. Open table in a new tab Table 3Secondary Data Analyses Funded by the Center for Healthy African American Men Through PartnershipsProject titleDatabase accessedDo African American Men Undergo a Higher Rate of Anal-Sphincter-Sacrificing Surgery for Rectal Cancer Compared to Non-African American Men?SEER – MedicareWhat Are the Racial Disparities in Outcomes of Hepatocellular Carcinoma Among Individuals Living in Deep South Areas?SEERAre African American Men More Likely to Receive an Ostomy After Treatment for Penetrating Abdominal Trauma than Other Races?NTDDoes Hospital System Affiliation Mediate the Relationship Between Race and 30-Day Hospital Readmissions After an Acute Myocardial Infarction (AMI)?SIDAnal Squamous Cell Carcinoma Treatment and African AmericansSEERRace Differences in the Use of Intracranial Pressure Monitoring and Inpatient Rehabilitation Among Young Men With Traumatic Brain InjuryNTDDoes Rurality Impact Depression in African American Men Diagnosed with Prostate Cancer?NHISDisparities in Clinical Outcomes After InjuryMTQIPMTQIP, Michigan Trauma Quality Improvement Project; NHIS, National Health Interview Survey; NTD, National Trauma Databank; SEER, Surveillance Epidemiology and End Results; SID, State Inpatient Database. Open table in a new tab UAB, University of Alabama at Birmingham; UMN, University of Minnesota. 100 BMOA, 100 Black Men of America, Inc.; CCP, cell cycle progression; HCV, hepatitis C virus; HIV, human immunodeficiency virus; NUFI, National USA Foundation, Inc.; UAB, University of Alabama at Birmingham. MTQIP, Michigan Trauma Quality Improvement Project; NHIS, National Health Interview Survey; NTD, National Trauma Databank; SEER, Surveillance Epidemiology and End Results; SID, State Inpatient Database. In this supplement, CHAAMPS presents results from several of our most compelling projects, including those focused on racial disparities in medical outcomes,20Skube SJ, Lindgren B, Fan Y, et al. Penetrating colon trauma outcomes in black and white males. Am J Prev Med. 2018;55(5S1):S5--S13.Google Scholar, 21Sathianathen NJ, Jarosek SL, Fan Y, Krishna SR, Konety BR. Racial disparities in surgical outcomes among males following major urologic cancer surgery. Am J Prev Med. 2018;55(5S1):S14--S21.Google Scholar, 22Williams JH, Jarosek S, Carroll N, Fan Y, Hall AG. Health system affiliation and 30-day readmission after heart attack in black men. Am J Prev Med. 2018;55(5S1):S22--S30.Google Scholar, 23Lo AX, Donnelly JP, Durant RW, et al. A national study of U.S. emergency departments: racial disparities in hospitalizations for heart failure. Am J Prev Med. 2018;55(5S1):S31--S39.Google Scholar, 24Franco RA, Fan Y, Jarosek S, Bae S, Galbraith J. Racial and geographic disparities in hepatocellular carcinoma outcomes. Am J Prev Med. 2018;55(5S1):S40--S48.Google Scholar community prevention initiatives,25Carter-Edwards L, Lindquist R, Redmond N, et al. Designing faith-based blood pressure interventions to reach young black men. Am J Prev Med. 2018;55(5S1):S49--S58.Google Scholar, 26Parker CJ, Winston W, Simpson T, Brady SS. Community readiness to adopt the Communities That Care prevention system in an urban setting. Am J Prev Med. 2018;55(5S1):S59--S69.Google Scholar, 27Brady SS, Parker CJ, Jeffries EF, Simpson T, Brooke-Weiss BL, Haggerty KP. Implementing the Communities That Care prevention system: challenges, solutions, and opportunities in an urban setting. Am J Prev Med. 2018;55(5S1):S70--S81.Google Scholar, 28Phillips JM, Branch CJ, Brady SS, Simpson T. Parents speak: a needs assessment for community programming for black male youth. Am J Prev Med. 2018;55(5S1):S82--S87.Google Scholar, 29Jones-Webb R, Calvert C, Brady SS. Preventing violent encounters between police and young black men: a comparative case study. Am J Prev Med. 2018;55(5S1):S88--S94.Google Scholar and disease screening.30 Kwaan MR, Jones-Webb R. Colorectal cancer screening in black men: recommendations for best practices. Am J Prev Med. 2018;55(5S1):S95--S102.Google Scholar, 31Rogers CR, Rovito MJ, Hussein M, et al. Attitudes toward genomic testing and prostate cancer research among black men. Am J Prev Med. 2018;55(5S1):S103--S111.Google Scholar, 32Kempf MC, Ott C, Wise JM, et al. Universal screening for HIV and hepatitis C infection: a community-based pilot project. Am J Prev Med. 2018;55(5S1):S112--S121.Google Scholar These studies demonstrate not only the breadth and extent of disparities affecting the health of black men of all ages, but also the innovative initiatives being developed to address them within CHAAMPS. Publication of this article was supported by a grant from the National Institute on Minority Health and Health Disparities, National Institutes of Health [grant number U54MD008620]. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the National Institute on Minority Health and Health Disparities or the National Institutes of Health. The Center

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