Social Determinants of Diabetes Self-Management, and Diabetes Health Care Utilization in African American and Latino Men with Type 2 Diabetes.

Diabetes is among one of the leading causes of death in the United States. This dissertation seeks to identify psychosocial and structural factors that influence self-care and health care utilization in Latino and African American men with diabetes on regional and national levels. My dissertation also explores how gender identity is conceptualized among Latino and African American men with diabetes, and examines how conceptualizations of masculinity influence self-care and health care utilization behaviors. Three empirical chapters examined different aspects of these topics. Chapter two identified differences in predictors of diabetes self-management and health care use in Latinos and African Americans with type 2 diabetes participating in a Detroit-based diabetes lifestyle intervention. Regression model results showed that older age increased diabetes self-management, while low levels of diabetes knowledge significantly decreased it, but these associations did not exist for health care utilization. Chapter three used data collected from three focus groups with African American and Latino men with type 2 diabetes to explore structural and psychosocial factors that influence health care use and self-management. Three themes emerged that characterize gender identity and its relationship to health behavior in men: 1) men’s beliefs about being men; 2) manhood’s influence on health behavior; and 3) men’s role in diabetes education. Results suggest that the way men define gender roles may have implications for how they engage in their care. Chapter four explored whether social support and social integration mediate or buffer the relationship between race and health care utilization among U.S. men, using cross-sectional data from the 2001 National Health Interview Survey. My findings showed that non-Hispanic black men with high levels of social integration were less likely to forego care than their non-Hispanic white counterparts with high social integration. Also, non-Hispanic black men who did not attend church had higher odds of foregoing care compared to men Hispanic and non-Hispanic white men who did attend church services. The implications of my work highlight a need for more research on the direct impact of masculine roles, social integration and heterogeneity in predictors of diabetes self-management versus health care use on diabetes care for men.PhDSocial Work and SociologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/111356/1/jachawk_1.pd

The discipline’s escalating whisper: Social work and black men’s mental health.

http://deepblue.lib.umich.edu/bitstream/2027.42/117270/1/29. Watkins Hawkins Mitchell, 2014.pdfDescription of 29. Watkins Hawkins Mitchell, 2014.pdf : Main articl

Factors associated with cancer family history communication between African American men and their relatives

http://deepblue.lib.umich.edu/bitstream/2027.42/117265/1/Cancer family history communicaton 2013 JMS.pdfDescription of Cancer family history communicaton 2013 JMS.pdf : Main articl

Investigating Diversity in Social Work Doctoral Education in the United States

Despite its emphasis on social justice, social work in the United States has not always attended to issues of diversity in doctoral education. This article examines the state of the discipline’s research on traditionally underrepresented students in U.S. doctoral social work programs. An analysis of relevant peer-reviewed articles from social work journals revealed that this research has focused on demographic trends, degree motivation, student barriers, existing supports, and career navigation. Diversity in U.S. doctoral social work education is vastly understudied with the majority of scholarship focusing on ethnoracial difference. The limitations of this study are discussed, and future research directions are proposed including the need to examine various kinds of social differences and a wider range of support initiatives

Older African American Men’s Perspectives on Factors That Influence Type 2 Diabetes Self-Management and Peer-Led Interventions

Older African American men are at increased risk of Type 2 Diabetes (T2D) but demonstrate high rates of poor illness management. They also participate in interventions targeting illness management at extremely low rates and are at high risk for dropout from clinical trials. One modifiable factor that has been identified in the literature that contributes to these disparities is health beliefs particular to men. Yet, despite the fact that illness management interventions have been developed to meet the needs of African Americans, none have followed recommendations to use gender-sensitive programming to meet the needs of men. The primary aim of this study was to advance our understanding of the intersection of age, race/ethnicity and gender on T2D self-management among older African American men, and to explore their preferences for a peer-led T2D self-management intervention. Two focus groups were conducted with older African American men (n = 16) over a 6-month period. Sessions lasted 90 min, were audiotaped, and analyzed using thematic content analysis techniques. The most prominent themes included: (a) the influence of gendered values and beliefs on health behavior; (b) quantity and quality of patient-provider communication; (c) social and structural barriers to T2D self-management; and (d) preferences for peer-led T2D self-management interventions. Results suggest that these themes may be particularly salient for T2D self-management in older African American men, and that this population may be receptive to a peer-led T2D self-management intervention

Identifying subgroups of Black, Hispanic and Asian men at increased risk for comorbid depression and overweight or obesity

Comorbid depression and overweight or obesity increase risk for developing many chronic diseases. Investigating men of color without using a non-Hispanic White male reference group will capture a more nuanced picture of how socio-demographic factors contribute to increased risk for comorbid depression and overweight or obesity among and between men of color. This study used the U.S.-based 2014 National Health Interview Survey (n = 1363) in May 2018 to examine associations between race/ethnicity and comorbid overweight or obesity and depression in men. Men were more likely to be obese or overweight and depressed if they were older (31–54 years old and 55+) [OR = 2.387, 95% CI: 1.526, 3.873, p = 0.000; OR = 2.220, 95% CI: 1.355, 3.635, p = 0.002], Black [OR = 2.745, 95% CI: 1.622, 4.646, p < 0.001], Hispanic [OR = 2.967, 95% CI: 1.762, 4.995, p < 0.001], or earned $35,000–$74,999 [OR = 1.987, 95% CI: 1.255–3.152, p = 0.004]. We identified socio-demographic sub-groups of men at increased risk for comorbid depression and overweight or obesity. Examining intra-group differences among men of color will help clinicians and researchers to address more nuanced socio-demographic characteristics of groups of men who are more at risk for developing a chronic disease. Keywords: Depression, Overweight, Obesity, Men's health, Race, Chronic illnes

Racial/Ethnic Differences in Predictors of Mental Health Treatment in Persons with Comorbid Diabetes and Depression

Diabetes and depression are two of the most frequently diagnosed health conditions in the United States and often co-occur. The present study examines racial/ethnic differences in predictors of mental health service use among a national sample of African Americans, Hispanics, and non-Hispanic Whites with a self-reported diabetes and depression diagnosis. Multiple logistic regression was used to analyze a cross-sectional sample (N = 3377) of the 2012 National Health Interview Survey (NHIS), a nationally representative, cross-sectional survey. African Americans were less likely to have visited a mental health professional in the last 12 months (odds ratio [OR] = .634, confidence interval [CI] [0.429, 0.911]). Significant odds ratios also uncovered results for the “never married” (OR = 1.737, CI [1.322, 2.281]) category. Also for the entire sample, being 55 years or older (OR = .352, CI [0.234, 0.533]) was found to be strongly associated with mental health service use for individuals with diabetes. Being unemployed or not in the labor force increased the odds of mental health service use in persons with diabetes and depression, whereas having less than a high school diploma or Graduate Equivalency Diploma decreased odds of visits (OR = .611, CI [0.394, 0.945]) as did not having health insurance (OR = .540, CI [0.365, 0.800]). Racial/ethnic variation in mental health service utilization exists among persons with self-reported diabetes and depression. Due to the challenges associated with comorbid depression and diabetes, as well as the impact depression can have on diabetes self-management, it is imperative that more strategies for managing both depression and diabetes be explored.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171499/1/Racial Ethnic Differences in Predictors of Mental Health Treatment in Persons with Comorbid Diabetes and Depression.pd

The Role of Age and Multimorbidity in Shaping Older African American Men’s Experiences with Patient–Provider Communication

This study investigated factors associated with older African American men&#8217;s unmet health communication needs in the context of patient&#8315;provider interactions. Responses to a health survey were analyzed for 430 African American men attending a Midwest community health fair. The outcome measure was the extent to which men could get their health-related questions answered during recent medical visits. Men&#8217;s mean age was 54; 39% had one chronic condition and 22% had two or more comorbidities. The 53% who usually or always had their questions answered were older, had less comorbidity, higher educational attainment, higher annual incomes, were more likely to be married and have any type of insurance, and have a personal physician. Access to care was the primary factor in shaping men&#8217;s opportunities to ask health-related questions, and older multimorbid and low-income African American men may face increased barriers to healthcare access, and thus barriers to patient-centered care and communication

Michigan Men’s diabetes project (MenD): protocol for a peer leader diabetes self-management education and support intervention

Abstract Background Black men are more likely to be diagnosed with type 2 diabetes (T2D) compared to non-Hispanic White men, and this disparity increases among men over the age of 55. A growing body of literature demonstrates the critical role of gender in the management of health behaviors such as T2D and shows that male gender norms can conflict with healthy behaviors. These studies suggest that tailoring diabetes self-management interventions to address the needs of Black men may be critical to helping them to achieve optimal health outcomes. Further, our own research on Blacks with T2D found gender disparities in participation in diabetes interventions, with males participating at significantly lower rates than females. Peer leaders are trained lay individuals who are used to provide ongoing diabetes self-management support to people with diabetes, particularly in minority communities. However, despite studies showing that diabetes management interventions using peer leaders have been successful, the majority of peer leaders as well as the participants in those studies are women. The limited studies to date suggest that Black men with T2D prefer peer-led, male-to-male T2D programs, however, this research consists primarily of nonrandomized, small sample feasibility studies calling for additional studies to establish the efficacy of these approaches. The proposed study will develop and preliminarily validate the effectiveness of an adapted peer leader diabetes self-management support (PLDSMS) intervention designed to improve diabetes-related lifestyle and self-management behaviors in Black men (over 55) with T2D. Method We propose to tailor an existing intervention by 1) our using male peers and 2) modifying the peer leader training content to focus on material appropriate for men. The proposed study includes a developmental phase (development of the intervention with expert feedback, followed by feasibility testing with Black men) and a validation phase [randomized clinical trial (RCT)]. Discussion If successful, this study will lead to the development and dissemination of an intervention that will address the unique needs of Black men with T2D, helping them to achieve optimal diabetes self-management and health outcomes. Trial registration Registered at ClinicalTrials.gov with an ID NCT04760444 on February 17, 2021http://deepblue.lib.umich.edu/bitstream/2027.42/173493/1/12889_2021_Article_10613.pd

Psychosocial Factors That Influence Health Care Use and Self-Management for African American and Latino Men With Type 2 Diabetes: An Exploratory Study

The purpose of this study was to explore the psychosocial factors that influence diabetes self-management and health care utilization among men of color with type 2 diabetes. Data were collected from focus groups with African American men (n = 9) and Latino men (n = 13) who were part of a diabetes intervention. Sessions were analyzed using thematic content analysis techniques. Five themes were discussed in focus groups, including (a) social support as a motivator, (b) patient–provider relationships as facilitators of healthy behaviors, (c) immigration status and access to resources, (d) waiting until symptoms became severe before seeking medical attention, and (e) structural barriers. Public health interventions may need to tailor interventions to address the specific needs of men of color.The National Institute of Diabetes and Digestive and Kidney Disease (Grant R18DK0785501A1)The Centers for Disease Control and Prevention (Cooperative Agreement No. U50/CCU417409)The Michigan Diabetes Research and Training Center (NIH Grant 5P60-DK20572)The Robert Wood Johnson Foundation Clinical Scholars ProgramPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171494/1/Psychosocial Factors.pd