The Ecology of Multilevel Interventions to Reduce Social Inequalities in Health

Health inequities persist and, in some cases, are increasing. Multilevel interventions involve efforts to change aspects of social contexts related to the creation and maintenance of health inequities among varied groups. Momentum for conducting multilevel interventions to achieve health equity is found across professional fields as well as scientific and funding organizations. This article discusses the rationale for multilevel interventions, briefly reviews their evolution over time with respect to health inequities, and provides an ecological “way of thinking” about some of the conceptual and pragmatic challenges they raise for social science. This perspective frames community interventions as multilevel, ecologically based, collaboratively conducted, culturally situated, and designed to increase community capacity. Implications of this perspective are drawn for the development, implementation, and evaluation of multilevel interventions

No Place to Belong: Contextualizing Concepts of Mental Health Among Undocumented Immigrant Youth in the United States

This article examines the consequences of undocumented immigration status for those who grow up in the United States. The aim is to examine the relationship between undocumented immigrant status and mental and emotional health. Our efforts focus on undocumented immigrants who arrive as children and spend most of their formative years in the United States. The experiences of these undocumented members of the 1.5 generation are quite different from those who migrate as adults. We are interested in better understanding the effects confusing and conflicting experiences of inclusion and exclusion have on their mental and emotional health as well as the protective factors that may shape resilience. While previous scholarship has drawn some important implications to experiences of stress among undocumented youth and young adults, to our knowledge, no work has been done to explicitly draw the link to mental and emotional health. The article concludes with some suggestions for future research on the topic

Social Inequality and Health Across the Life Course

Social inequalities in health persist across the life course, but the magnitude of these differences differs for children, young adults, and those in mid and later life. Longitudinal data confirm that health disparities do change as individuals move through the life course, that these processes are intertwined with selection and causation between socioeconomic status (SES) and health and from variation across cohorts representing vastly different historical contexts. Variations in health disparities across the life course offer unique opportunities to gain traction into understanding the production of these disparities. The life course perspective provides a rich set of concepts, methods, and a theoretical framework for guiding our inquiry into how SES disparities in health unfold as people live their lives. This article focuses attention on how socioeconomic conditions experienced as one is growing up relate to health and mortality across the adult life course. We first review recent work exploring the association between childhood SES and adult health and mortality, examining the evidence, and the types of questions raised, for early, mid, and later life. We then turn to a growing body of evidence examining accumulative processes between health and SES across the life course. We conclude with a discussion of three major gaps and promising directions that draw upon advances in life course research to advance our understanding of how inequality shapes health throughout the life cours

Inequality, Family Processes, and Health in the "New" Rural America

Rural America is commonly viewed as a repository of virtuous and patriotic values, deeply rooted in a proud immigrant history of farmers and industrious working-class White ethnics from northern Europe. These views are not always consistent with the population and socioeconomic realities of rural terrains. Exceptions to these stereotypes are self-evident among large poor racial/ethnic minorities residing in rural ghettos in the “dirty” South and among poor Whites living in remote, mountainous areas of Appalachia. For these disadvantaged populations, sociocultural and economic isolation, a lack of quality education, too few jobs, and poor health have taken a human toll, generation after generation. Moreover, the past several decades have brought dramatic shifts in the spatial distribution and magnitude of poverty in these areas. And, America’s persistent racial inequalities have continued to fester as rural communities become home to urban-origin racial minority migrants and immigrants from Mexico and Latin America. As a result, the face of rural America has changed, quite literally. In this article, we address the primary question these changes pose: How will shifting inequalities anchored in poverty and race shape health disparities in a “new” rural America? Guided by fundamental cause theory, we explore the scope and sources of poverty and race inequalities in rural America, how patterns in these inequalities are transduced within families, and what these inequalities mean for the future of health disparities within and across rural U.S. terrains. Our goal is to review and interrogate the extant literature on this topic with the intent of offering recommendations for future research

Racial Formation in Perspective: Connecting Individuals, Institutions, and Power Relations

Over the past 25 years, since the publication of Omi & Winant's Racial Formation in the United States, the statement that race is socially constructed has become a truism in sociological circles. Yet many struggle to describe exactly what the claim means. This review brings together empirical literature on the social construction of race from different levels of analysis to highlight the variety of approaches to studying racial formation processes. For example, macro-level scholarship often focuses on the creation of racial categories, micro-level studies examine who comes to occupy these categories, and meso-level research captures the effects of institutional and social context. Each of these levels of analysis has yielded important contributions to our understanding of the social construction of race, yet there is little conversation across boundaries. Scholarship that bridges methodological and disciplinary divides is needed to continue to advance the racial formation perspective and demonstrate its broader relevance

"Their Depression Is Something Different . . . It Would Have to Be": Findings From a Qualitative Study of Black Women's Perceptions of Depression in Black Men

This study reports findings from the Black Women’s Perceptions of Black Men’s Depression (BWP) study, which included eight focus groups with Black women (N = 46) from southeastern Michigan. Four themes illustrated the impressions of Black women from different socioeconomic backgrounds: Black men’s depression is a cultured and gendered phenomenon, the role of Black women in Black men’s depression, intergenerational differences with how depression is handled by Black men, and the need (and ways) to reach Black men with depression resources. Results underscore not only the importance of understanding the kind of depression in Black men that meets criteria described by the Diagnostic and Statistical Manual of Mental Disorders (DSM) but also the psychological distress that may coexist with (or be separate from) DSM depression. Implications for interventions that educate, diagnose, and treat depression in Black men are discussed

Felon Disenfranchisement in the United States: A Health Equity Perspective

Approximately 13% of African American men are disqualified from voting because of a felony conviction. I used ecosocial theory to identify how institutionalized racism helps perpetuate health disparities and to explore pathways through which felon disenfranchisement laws may contribute to racial health disparities in the United States. From a literature review, I identified 2 potential pathways: (1) inability to alter inequitable public policies that differentially allocate resources for health; and (2) inability to reintegrate into society by voting, which contributes to allostatic load

An Intersectional Approach to Social Determinants of Stress for African American Men: Men's and Women's Perspectives

Stress is a key factor that helps explain racial and gender differences in health, but few studies have examined gendered stressors that affect men. This study uses an intersectional approach to examine the sources of stress in African American men’s lives from the perspectives of African American men and important women in their lives. Phenomenological analysis was used to examine data from 18 exploratory focus groups with 150 African American men, ages 30 years and older, and eight groups with 77 African American women. The two primary sources of stress identified were seeking to fulfill socially and culturally important gender roles and being an African American man in a racially stratified society. A central focus of African American men’s daily lives was trying to navigate chronic stressors at home and at work and a lack of time to fulfill roles and responsibilities in different life domains that are traditionally the responsibility of men. Health was rarely mentioned by men as a source of stress, though women noted that men’s aging and weathering bodies were a source of stress for men. Because of the intersection of racism and economic and social stressors, men and women reported that the stress that African American men experienced was shaped by the intersection of race, ethnicity, age, marital status, and other factors that combined in unique ways. The intersection of these identities and characteristics led to stressors that were perceived to be of greater quantity and qualitatively different than the stress experienced by men of other races