Can Religion and Socioeconomic Status Explain Black-White Differences in Alcohol Abuse?

Backgroud: Drinking to a level that causes harm to oneself or others is characterized by several terms in the alcohol literature. These include: alcohol abuse, alcoholism, excessive drinking, heavy drinking, and problem drinking. The latter is the term used throughout the dissertation. Findings across various alcohol measures and across time show that Blacks have lower prevalence rates of problem drinking than Whites. These results appear paradoxical. First Blacks have poorer health status than Whites for many health outcomes such as diabetes, hypertension, and cirrhosis of the liver--a chronic condition attributed to heavy alcohol use. Blacks lower problem drinking than Whites seem contrary to the way social determinants and tension-reduction theories are thought to influence health. According those theories and frameworks, exposure to poor economic and social circumstances are considered socioeconomic status-related stressors, which are risk factors for problem drinking. Blacks therefore would be expected to have higher prevalence rates of problem drinking because they are exposed to a greater number and frequency of poor socioeconomic status conditions, and greater frequency of stressors relative to Whites. Quite often, the typical investigation of Black-White differences in health aims to understand why Blacks have poorer health than Whites. I investigated problem drinking for my dissertation because I thought it was equally important to understand health and behavioral outcomes for which Blacks do better than Whites and to learn about what contributes to that better health. Levels of religious involvement, the salience of religion among groups, and the potential strength of religion to regulate the lives of individuals differ across social statuses such as race/ethnicity and socioeconomic status. That rationale is discussed through historical evolution of religion among Blacks, beginning slavery, through theories attributed to Max Weber and Karl Marx, and through analysis of a passage within the Holy Bible. Given that measures of religion differ across social status, it is plausible then that religion's protective effect on health too is expected to be different across social statuses. My second hypothesis is that the protective benefits of religion on problem drinking will be stronger among Blacks than Whites. My third hypothesis is that lower socioeconomic status is associated with higher levels of religious involvement. My fourth hypothesis is that the protective benefits of religion on problem drinking are stronger among persons with low compared to high socioeconomic status. Finally, I argue that the dual social location of low socioeconomic status and Black race creates an opportunity where the protective effects of religious involvement on problem drinking become compounded. My fifth hypothesis is that the protective effects of religious involvement on problem drinking among Black low socioeconomic status would explain their lower prevalence rates of drinking compared to Whites. Methods: A secondary data analysis was conducted using Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) among a sample of Non-Hispanic Blacks (n=6, 587) and Non-Hispanic Whites (n=20,161). The main dependent variable was DSM-IV alcohol abuse. A second variable, heavy drinking, which was used for sensitivity analyses, was derived from two variables (1) frequency of consuming 5+ drinks in a single day and (2) largest number of drinks in a single day. The exposure variables were four measures of religious involvement: (1) currently attending religious services, (2) frequency of religious service attendance, (3) count of the number of religious members one interacted with on a social basis, and (4) importance of spirituality in one's daily life. Education and income were the socioeconomic status (SES) variables. Race/ethnicity was a binary variable indicating Non-Hispanic Blacks versus Non-Hispanic Whites. Results: Detailed results of this analysis are presented in this dissertation. Conclusions: Overall, religion measures had a protective effect on problem drinking, but service attendance had the most robust association. It appears that religion and socioeconomic status are not competing factors that potentially explain race-differences, in fact, they work together. There appears to be some support for the perspective that Black-White differences are explained, or at least better understood, when socioeconomic status and religion operate in an interaction model framework. The lack of finding of Black-White differences across all combinations of religion and socioeconomic status, and those differences being dependent on the type of problem drinking measure used limits the ability to generalize to an overall hypothesis. There are some noteworthy contributions this dissertation that advances the state of knowledge on this topic. It appears that the effect of religion on DSM-IV alcohol abuse for Blacks operates under different model assumptions than for Whites. Therefore, statistical comparisons may not tell the full story of Black-White differences and I recommend a renewed focus on race-specific analyses. Two main theoretical contributions emerge from this study. First, these findings suggest that individual religiosity plays an important protective role on problem drinking for equally for Blacks and Whites. The study adds more evidence as to which dimensions of religiosity most salient for protecting against problem are drinking, which is lacking in the research literature. Second, sensitivity analyses showed that the type of alcohol measure one uses to characterize problem drinking has potential implications racial disparities in alcohol research

Social capital and health status:longitudinal race and ethnicity differences in older adults from 2006 to 2014

Objectives: We examined the longitudinal associations of social capital on self-rated health and differences by race/ethnicity in older adults. Methods: We used Health and Retirement Study, a nationally representative sample of US adults aged ≥ 50 years evaluated every 2 years (2006–2014) (N = 18,859). We investigated the relationship between social capital indicators (neighborhood social cohesion/physical disorder, positive/negative social support) with self-rated health accounting for age, gender, education and stratified by race/ethnicity. We used structural equation multilevel modeling estimating the associations: within-wave and between-persons. Results: We observed between-persons-level associations among social capital indicators and self-rated health. Individuals with overall levels of positive social support and neighborhood social cohesion tended to have overall better self-rated health [correlations 0.21 (p < 0.01) and 0.29 (p < 0.01), respectively]. For Hispanics, the correlations with self-rated health were lower for neighborhood social cohesion (0.19) and negative social support (− 0.09), compared to Whites (0.29 and − 0.20). African-Americans showed lower correlations of positive social support (0.14) compared to Whites (0.21) and Hispanics (0.28). Conclusions: Interventions targeting social capital are in need, specifically those reinforcing positive social support and neighborhood social cohesion and diminishing neighborhood physical disorder and negative social support of older adults

Social Capital and Risk of Concurrent Sexual Partners Among African Americans in Jackson, Mississippi

Concurrent sexual partnerships (i.e., relationships that overlap in time) contribute to higher HIV acquisition risk. Social capital, defned as resources and connections available to individuals is hypothesized to reduce sexual HIV risk behavior, including sexual concurrency. Additionally, we do not know whether any association between social capital and sexual concurrency is moderated by gender. Multivariable logistic regression tested the association between social capital and sexual concurrency and efect modifcation by gender. Among 1445 African Americans presenting for care at an urban STI clinic in Jackson, Mississippi, mean social capital was 2.85 (range 1–5), mean age was 25 (SD=6), and 62% were women. Sexual concurrency in the current year was lower for women compared to men (45% vs. 55%, χ2 (df=1)=11.07, p=.001). Higher social capital was associated with lower adjusted odds of sexual concurrency for women compared to men (adjusted Odds Ratio [aOR]=0.62 (95% CI 0.39–0.97), p=0.034), controlling for sociodemographic and psychosocial covariates. Interventions that add social capital components may be important for lowering sexual risk among African Americans in Mississippi

Associations of online religious participation during COVID-19 lockdown with subsequent health and well-being among UK adults.

Background In-person religious service attendance has been linked to favorable health and well-being outcomes. However, little research has examined whether online religious participation improves these outcomes, especially when in-person attendance is suspended. Methods Using longitudinal data of 8951 UK adults, this study prospectively examined the association between frequency of online religious participation during the stringent lockdown in the UK (23 March –13 May 2020) and 21 indicators of psychological well-being, social well-being, pro-social/altruistic behaviors, psychological distress, and health behaviors. All analyses adjusted for baseline socio-demographic characteristics, pre-pandemic in-person religious service attendance, and prior values of the outcome variables whenever data were available. Bonferroni correction was used to correct for multiple testing. Results Individuals with online religious participation of ≥1/week (v. those with no participation at all) during the lockdown had a lower prevalence of thoughts of self-harm in week 20 (odds ratio 0.24; 95% CI 0.09–0.62). Online religious participation of <1/week (v. no participation) was associated with higher life satisfaction (standardized β = 0.25; 0.11–0.39) and happiness (standardized β = 0.25; 0.08–0.42). However, there was little evidence for the associations between online religious participation and all other outcomes (e.g. depressive symptoms and anxiety). Conclusions There was evidence that online religious participation during the lockdown was associated with some subsequent health and well-being outcomes. Future studies should examine mechanisms underlying the inconsistent results for online v. in-person religious service attendance and also use data from non-pandemic situations

Social capital and HIV/AIDS in the United States: Knowledge, gaps, and future directions

Purpose Social capital is a well-established predictor of several behavioral health outcomes. However, we know less about the relationship with prevention, transmission, and treatment of HIV/AIDS outcomes in the United States (US). Methods In 2017, we conducted a scoping review of empirical studies investigating the relationships between social capital and HIV/AIDS in the US by searching PubMed, Embase, PsycINFO, Web of Science, and Sociological Abstracts with no restriction on publication date, for articles in English language. Sample search terms included: HIV infections OR HIV OR AIDS OR acquired immunodeficiency syndrome OR human immunodeficiency virus AND social capital OR social control, informal OR social participation OR social cohesion OR generalized trust OR social trust OR collective efficacy OR community mob* OR civic participation. Results We identified 1581 unique manuscripts and reviewed 13 based on eligibility criteria. The earliest eligible study was published in 2003. More than half (n=7/13) focused on HIV or AIDS diagnosis, then prescribing ART and/or adherence (n=5/13), then linkage and or engagement in HIV care (n=4/13). Fifty eight percent (58%) documented a protective association between at least one social capital measure and an HIV/AIDS outcome. Seven studies used validated social capital scales, however there was substantial variation in conceptual/operational definitions and measures used. Most studies were based on samples from the Northeast. Three studies directly focused on or stratified analyses among subgroups or key populations. Studies were cross-sectional, so causal inference is unknown. Conclusion Our review suggests that social capital may be an important determinant of HIV/AIDS prevention, transmission, and treatment outcomes. We recommend future research assess these associations using qualitative and mixed-methods approaches, longitudinally, examine differences across subgroups and geographic region, include a wider range of social capital constructs, and examine indicators beyond HIV diagnosis, as well as how mechanisms like stigma link social capital to HIV/AIDS

Longitudinal cohort of HIV-negative transgender women of colour in New York City: protocol for the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study.

IntroductionIn the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT ('Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour') study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention.Methods and analysesTURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation.Ethics and disseminationThe TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population's health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour

Stereotyping across intersections of race and age: Racial stereotyping among White adults working with children

This study examined the prevalence of racial/ethnic stereotypes among White adults who work or volunteer with children, and whether stereotyping of racial/ethnic groups varied towards different age groups. Participants were 1022 White adults who volunteer and/or work with children in the United States who completed a cross-sectional, online survey. Results indicate high proportions of adults who work or volunteer with children endorsed negative stereotypes towards Blacks and other ethnic minorities. Respondents were most likely to endorse negative stereotypes towards Blacks, and least likely towards Asians (relative to Whites). Moreover, endorsement of negative stereotypes by race was moderated by target age. Stereotypes were often lower towards young children but higher towards teens.The WK Kellogg Foundation provides funding to the National Voices Project as part of the America Healing initiative

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement

High neighborhood social capital could facilitate earlier diagnosis of HIV and higher rates of linkage and HIV care engagement. Multivariate analysis was used to examine whether social capital (social cohesion, social participation, and collective engagement) in 2004/2006 was associated with lower 5-year average (2007–2011) prevalence of (a) late HIV diagnosis, (b) linked to HIV care, and (c) engaged in HIV care within Philadelphia, PA, United States. Census tracts (N = 332). Higher average neighborhood social participation was associated with higher prevalence of late HIV diagnosis (b = 1.37, se = 0.32, p < 0.001), linked to HIV care (b = 1.13, se = 0.20, p < 0.001) and lower prevalence of engaged in HIV care (b = −1.16, se = 0.30, p < 0.001). Higher collective engagement was associated with lower prevalence of linked to HIV care (b = −0.62, se = 0.32, p < 0.05).The findings of different directions of associations among social capital indicators and HIV-related outcomes underscore the need for more nuanced research on the topic that include longitudinal assessment across key populations

Religion, faith, and spirituality influences on HIV prevention activities: A scoping review.

IntroductionStrategies to increase uptake of next-generation biomedical prevention technologies (e.g., long-acting injectable pre-exposure prophylaxis (PrEP)) can benefit from understanding associations between religion, faith, and spirituality (RFS) and current primary HIV prevention activities (e.g., condoms and oral PrEP) along with the mechanisms which underlie these associations.MethodsWe searched PubMed, Embase, Academic Search Premier, Web of Science, and Sociological Abstracts for empirical articles that investigated and quantified relationships between RFS and primary HIV prevention activities outlined by the United States (U.S.) Department of Health and Human Services: condom use, HIV and STI testing, number of sexual partners, injection drug use treatment, medical male circumcision, and PrEP. We included articles in English language published between 2000 and 2020. We coded and analyzed studies based on a conceptual model. We then developed summary tables to describe the relation between RFS variables and the HIV prevention activities and any underlying mechanisms. We used CiteNetExplorer to analyze citation patterns.ResultsWe identified 2881 unique manuscripts and reviewed 29. The earliest eligible study was published in 2001, 41% were from Africa and 48% were from the U.S. RFS measures included attendance at religious services or interventions in religious settings; religious and/or spirituality scales, and measures that represent the influence of religion on behaviors. Twelve studies included multiple RFS measures. Twenty-one studies examined RFS in association with condom use, ten with HIV testing, nine with number of sexual partners, and one with PrEP. Fourteen (48%) documented a positive or protective association between all RFS factors examined and one or more HIV prevention activities. Among studies reporting a positive association, beliefs and values related to sexuality was the most frequently observed mechanism. Among studies reporting negative associations, behavioral norms, social influence, and beliefs and values related to sexuality were observed equally. Studies infrequently cited each other.ConclusionMore than half of the studies in this review reported a positive/protective association between RFS and HIV prevention activities, with condom use being the most frequently studied, and all having some protective association with HIV testing behaviors. Beliefs and values related to sexuality are possible mechanisms that could underpin RFS-related HIV prevention interventions. More studies are needed on PrEP and spirituality/subjective religiosity