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IMPROVING THE HEALTH STATUS OF AFRICAN-AMERICAN MALES.

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Explores the interaction of health & prison life that creates serious health problems .... More...
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Paper Abstract:
Explores the interaction of health & prison life that creates serious health problems. Cites statistics including mortality & incarceration rates. Links to poverty. Discusses problems African-Americans encounter in criminal justice system, family, schools, employment, & substance abuse. Discusses health problems of HIV infection, stress, addiction, prison life. Recommends a holistic perspective & programs to reduce or prevent recidivism & improve health & survival rates of African-American men. Abstract.

Paper Introduction:
The Interaction of High Incarceration Rates with the Health and Life Expectancy of African-American Men and the Role of Early Prevention/Intervention Abstract African-American male adolescents and adults are embedded in a context that is less supportive of their health and well being than of any other group in this country. They have lower life expectancies, high-risk exposure, and higher levels of incarceration than any other group. African-Americans are disproportionately residents of large cities which seem to have higher homicide rates and higher rates of alcohol and drug abuse (along with availability). When they do drink, they tend to have worse consequences from their drinking, including incarceration and addiction.

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Gorman, D.M., Speer, P.W., Labouvie, E.W., Subaiya, A.P. Literacydoes not seem a particularly relevant issue, since literacy rates in thiscountry are high. There have been numerous studies looking atthe interaction between power, ill-health, and life expectancy. 2. Thorburn (1995) noted that health care for prisonersactually improved dramatically during the 197 s, but that public policytrends beginning in the early 198 s affected the demographics and healthstatus of jail and prison populations. Journal of Public Health Policy, 19(3), 3 3-318. They also used a control group of age and race-matched children from Public Use Samples from both of those censuses. and Lindquist, C.A. Dubik-Unruh, S. The intentin this paper is to explore the interaction of incarceration and healthrisk, to develop a holistic perspective on the well-being of African-American males at the beginning of the 21st century, and to begin to thinkabout improving the health of that community. Urban backgrounds mayalways have been more dangerous for African-Americans, or for whiteAmericans, for that matter. Alcohol Health and Research World, 22(4), 26 -264. In looking specifically at astress model within a sample of 1,933 African-American and white adults,Cooper et al. Lindquist, C.H. Prisoners bring their healthproblems with them and in some instances those problems are exacerbated bylack of care and attention, or exposure to new health risks (such as HIV orhepatitis infection). Journal of Substance Abuse, 7,331-344. If Physicians for Social Responsibility can view the nuclear bomb asa public health care issue, racism surely qualifies. (1999). (1998). In general, male inmates expressed more ease in accessinghealth care services, but less satisfaction with the quality of thoseservices than female inmates. Social Problems, 4 , 314-327. In the meantime, what we do know from the literature is that prisonconditions are not conducive to good health. The situation has been exacerbated byan increase in the prevalence of HIV, hepatitis, and other infectiousdiseases in prisons and jails, while at the same time prevention andeducation programs have been cut or reduced (Dubik-Unruh, 1999). In other words, this is a population which is increasing its healthrisks both through drug use and through risky sexual behavior, either ofwhich can lead to early death. This is a pivotal factor in the healthof young African-American males. Fingerhut et al. For example, Preston et al.(1998) used a unique study design to explore the socioeconomiccircumstances in childhood which leant themselves to long-term survival forAfrican-Americans. Excess mortality among blacks and whites in the UnitedStates. Scribner, R., Cohen, D., Kaplan, S., Allen, S.H. At this point, African-American men comprise 3 .6 percent of all male cases, up from 25.2 percentof cases only five years earlier (CDC, 1996). They are, however, difficult to sell in apolitical climate that wants to emphasize a booming economy, get tough oncrime, and reduce both welfare roles and public services. Literature review The intent in this review is to provide an overview of the literatureon common health issues of African-American males, including poverty,alcohol and drug abuse, and HIV/AIDS, while also exploring the high ratesof incarceration in the community and the links between poverty and otherhealth issues and incarceration. Improving the health status of African-American males requires amulti-faceted approach, including support of a two-adult family structure,continuing emphasis on the negative impacts of racism, reduction of drugand alcohol abuse, intervention in prison health systems, and improvedrecidivism programs. Racism ensuresthat an appeal on behalf of African-American male adolescents - who are asource of fear and connected to gang violence in the public mind - is adifficult one. Journal of Abnormal Psychology, 1 1(1), 139-152. The gains of the 197 s began to bereversed during the 198 s, and as the population continued to increase,health services became inadequate. However, the rates also variedby gender and by race, with the highest rate associated with black males.For black males the rates of mortality attributable to poverty 8.6 timeshigher for black men than for white women (Hahn et al., 1996). (1995). Theyused the first National Health and Nutrition Examination Survey to look atthe population between age 25 and age 75, using estimate of mortalityassociated with poverty during 1971-1984 and in 1991. In their study, 1 percent higher off-saleoutlet density accounted for approximately a 2.4 percent higher homiciderate in that geographic tract. percent of U.S. It lessens the quality of life ofthe prisoner, increases the chance of later problems that the health caresystem will have to address, decreases the individual's life expectancy,increases the risk of exposure to other inmates, and increases the risk ofexposure to other individuals after the prisoner as been released from thecriminal justice system. Support family structure in whatever way possible, includingtwo-parent, or even two-adult, family constellations. Single-female-headed households tend to be poorer households. As Jones-Webb (1998)noted, there is also need for further research on the effect of alcoholoutlet density and media exposure on African-American men, and more theory-based research on the drinking patterns and drinking problems of African-American males to address gaps in knowledge. In one ofthese Hahn et al. As noted in previous pages, thispopulation tends to do somewhat more heavy drinking than its white peers,with that heavy drinking concentrated among the lower income population,and it tends to suffer disproportionately then from drinking consequencesand alcohol dependence symptoms. Gillies, P., Tolley, K. In looking at the reason for the high homicide rate among adolescentAfrican-American males in the central cities, Aday (1993) suggested that itmight be the outward expression of their inner rage about the conditionsaround them, and the apparently unchanging racial and socioeconomiccondition of the black community. The result for black males issteadily worsening health prospects and comparatively low life expectancyrates. (1996). In terms of measurable costs, Lotke and Schiraldi (1996) noted thatthe juvenile justice system is simply overwhelmed by the rapidly increasingjuvenile crime rates among African-American males along with the challengeof developing programs to meet the culturally diverse needs of thatpopulation. The result is that this population suffers more from substance abuseand drinking consequences, such as job loss, family problems, schoolproblems, relationship problems, and problems with the criminal justicesystem. U.S. Another influence on heavy drinking and the development of drinkingconsequences or addiction seems to be stress. Programs to prevent recidivism Since prisons in themselves are so hazardous to the health ofinmates, a major step could be taken in improving African-American malehealth outcomes by reducing the recidivism rate. 4. Since African-American males tend to be disproportionatelyimprisoned, imprisoned for longer periods of time, and reincarcerated atrates much higher than their white or Hispanic peers, this seems toindicate that they would suffer disproportionately from increasing healthproblems directly related to their encounter with the criminal justicesystem (Booker, 1999). San Francisco, CA:Jossey-Bass Publishers. Results indicated homicide rates within this population ranging from6.5 and 7.3 per 1 , in the non-metropolitan and small counties,respectively, to 9.6 and 13.3 per 1 , in the fringe and medium strata,to 33.5 per 1 , in the core stratum. They studied mortality among whites in areas of New York City,Detroit, Kentucky, and Alabama, also looking at one low-income and onehigher-income area for each location. Drug and alcohol issues. Some new dying trick: African-Americanyouths ÒchoosingÓ HIV/AIDS. Caetano, R. Incarceration and health issues. It seems part of a vicious cycle. This is a social problem,and a public health problem, and the nursing profession can play a role inameliorating it. As will be noted in the following section, African-Americancommunities tend to have more alcohol outlets per capita and to be targetedas a population for increased alcohol use. In general, jail and prison inmates experience disproportionatelyhigh levels of chronic and acute physical health problems (Lindquist andLindquist, 1999). (1999). Journal Assoc.Nurses AIDS Care, 1 (6), 53-62. They have to deal with inadequateschools, pressures from gang activity, high alcohol and drug use,neighborhood crime and violence, sustained unemployment, low employmentrates, and many other issues that create an environment that does not lenditself to easy optimism. Bureau of the Census. (1998).Violent crime and alcohol availability: Relationships in an urbancommunity. Barr, K.E.M., Farrell, M.P., Barnes, G.M. (1999). The health care profession can intervene directlyhere, working to change policies and provide the caregivers who can godirectly to the source and provide prisoners with the care that they needto limit negative impacts. Many ofthe consequences of his behaviors will lead him into the criminal justicesystem, where those behaviors are often continued, and out again into thestreet to continue the cycle. At a minimum,health care professionals should be asking young African-American malesabout their drug and alcohol use during routine office visits andphysicals. They usedfive urbanization strata: core, counties with a primary central city withan MSA of l million or more; fringe, counties with an MSA of 1 million ormore; medium, counties with an MSA of 25 , to 999,999; small, countieswith an MSA of less than 25 , , and non-metropolitan. Alcoholavailability and homicide in New Orleans: Conceptual considerations forsmall area analysis of the effect of alcohol outlet density. That, too, is a political questionthat needs to be asked by health care providers of politicians seekingelection. These drinking problems also seem to be associated with social class. Yet, the health care profession, as a whole, needs torecognize the problem of juvenile recidivism as a matter of concern forpublic health and a subject for the development of health care policyrelated to poverty, education, prevention of high-risk behaviors, andalcohol and drug abuse program. (1993).Race, class and gender differences in substance abuse: evidence of middleclass/underclass polarization among black males. (1998). Jones-Webb, R. Qualitative Health Research, 8(2), 149-167. (1998) for Los Angeles County and Gorman et al. For some regions, homicide rates aredecreasing, including for African-American males. (1992) concluded that stress seemed to more stronglyinfluence high-avoidance African-Americans than high-avoidance whitesubjects, leading to a disproportionate increase in alcohol use anddrinking problems among the African-American subjects who coped with stressthrough avoidance. The only African-American area studythat had mortality rates comparable to those of standardized national ratesfor white American was the Queens-Bronx area in which the mortality ratefor men was 1.18 (Geronimus et al., 1996). This has several negative impacts. The Interaction of High Incarceration Rates with the Health and Life Expectancy of African-American Men and the Role of Early Prevention/Intervention Abstract African-American male adolescents and adults are embedded in acontext that is less supportive of their health and well being than of anyother group in this country. In addition, it is more exposed toalcohol than the general population, with targeted advertising andincreased alcohol outlet density. Iwould stress, though, that prevention programs cannot begin too early andthat alcohol and drug prevention efforts would have a significant impact onjuvenile arrests, juvenile crime rates, assaultive violence, incarceration,and recidivism, along with general levels of health and the mortality ofadolescent African-American males. Another means of coping with stress isthrough pleasurable activity, of which sex is one. Centers for Disease Control and Prevention. Certainly reducing the violence inthe African-American community, limiting problem drinking and drug abuse,and reducing exposure to HIV would be important steps. They suggested that any communities dealingwith high rates of assaultive violence consider policy interventions aimedspecifically at alcohol outlet-related factors. Significance of the Problem There are many reasons for taking this problem seriously, not leastof which is the loss of so many young lives to death and years ofincarceration. Finally,recidivism rates are longer for African-American males as are jailsentences. However, in all instances, African-Americans are morelikely to die from alcohol-related illnesses and injuries, and may havelonger and heavier drinking "careers" (Jones-Webb, 1998). In California, 17 timesas many were imprisoned under this law as white males in Los Angeles(Booker, 1999). When they do drink, they tend tohave worse consequences from their drinking, including incarceration andaddiction. Even more disturbing is a report by Tourigny (1998) which told thestory of African-American young men and women from families with memberswho were HIV positive who actually sought out HIV exposure andseroconverted themselves. Dubik-Unruh (1999) further noted that despite the increase inprevalence of HIV, hepatitis, and other infectious diseases in U.S.prisons, and the proximity of the infected and high-risk prisoners, mostfederal and state prisons have actually reduced or eliminated preventionand intervention programs. That is an incalculable cost to the whole community. To take a hypothetical case, if a young man seeks to deal with thestress of living in a ghetto amongst considerable violence and in a familywith substance abuse problems by mimicking the behaviors he sees aroundhim, he is likely to enter into that cycle of heavy drinking (or drugging),drinking and drugging consequences, and substance abuse problems. One important association that is frequently made is between alcoholand drug use and increased risk of violence, up to and including homicide.Another association that needs further study is the availability of alcoholand drugs related to the rate of homicide in specific populations. Gorman, D.M., Labouvie, E.W., Speer, P.W., Subaiya, A.P. HIV Infection Rates and Risk. In other words, homicide ratesvary widely according to density, with the highest rates in the corestratum, which also contain the highest percentage of African-Americancitizens. Dubik-Unruh's (1999) suggestion of a peer education program incorrections is a good one. While the emphasis is on firearms - andthis is an important issue, too - the ongoing use and abuse of drugs andalcohol by young African-American males is probably the most significantlyrisky behavior in which they engage for the purposes of both long-termhealth effects and their risk of incarceration. Homicide rates. However, there is an ethical issue involved here of greatimportance to the public health, and larger, community. Another measurable cost is to the health care system, which must dealwith the gunshot wounds, knife wounds, beatings, alcohol and drug abuse,HIV and AIDS problems of this young population. (1996). Clearly, this can contribute toan increased homicide rate in those geographic areas, along with associateddrug and alcohol problems. As noted in the problem statement, the leading caseof death for African-American male adolescents was homicide by the early199 s. The intent of these andother programs is to prevent juveniles from moving through the juvenilejustice system and entering the adult criminal justice system. Two of the major indicators of substance abuse issues are drinkingconsequences and alcohol dependence symptoms. It isalso a population with an ever-increasing incarceration rate. Although there are many factors relatedto long-term survival, the factors that were most significantly associatedwith living over age 85 were coming from a farm background, having literateparents, and living in a two-parent household. Cooper, M.L., Russell, M., Skiner, J.B., Frone, M.R. Individuals may choose to become involved withBig Brother or Big Sister programs, or with Boys and Girls Clubs or otherorganizations. Another important factor is racism itself. Scribner, R.A., MacKinnon, D.P., Dwyer, J.H. These provideadvantages in extra income, extra attention to children, and extramonitoring of children's behavior which may enable them to avoid theinitial involvement in activities which lead to incarceration. Certainly this is tied toreducing substance abuse and improving employment opportunities, amongother things. Instead, that population is moreconcentrated in the urban environment all the time as white people continueto move out from the cities into suburbs and rural environments. With incarceration, comes additional problems of exacerbated healthissues and exposure to new, life-threatening infections. Furthermore, recidivism compounds the problem. (1998) for thesignificant benefits to be gained from two-parent families - for whateverreasons - in this case, the benefits are a significant improvement insurvival rates and life expectancy. Booker, C. At the community-wide level,clinics, caregivers, and hospitals could link up with other groups tochange land-use policies and zoning ordinances in ways that would reducealcohol-outlet density. (1998) for New Jersey,Scribner et al. 3. Are thesecommunities going to allow a generation, and a population, to be decimatedwithout intensive effort at support? The recommendations for improvement seem like obvious ones: 1. She suggested peer education programs teaching other inmates peerprevention and risk reduction strategies to avoid spreading infection. drinking patterns: Results of the 1992 NationalLongitudinal Alcohol epidemiologic Study. (1991). Clearly alcohol availability is another important issue inassaultive violence which leads to homicides, other physical traumas, andincarceration among the African-American adolescent population. There are other interesting indications of what supports long,healthy lives for African-American males. Services havebeen cut for education and prevention in prisons and jails. (1996). Is AIDS adisease of poverty? However, high-risksexual activity, particularly multiple sexual partners without properprotection, leads to another major health problem in the African-Americancommunity. Poor, violent environments lead children tofeel hopeless and they respond by abusing alcohol, drugs, and each other,frequently winding up incarcerated. There are indications that even such brief interventions mayimpact alcohol and drug use, reducing it when young people receive goodinformation and are the subject of attention of health care professionals. While not as dramaticin its short-term effects, over the long-term, racism has undercut the lifequality and quantity of millions of Americans. Journal of Studies onAlcohol, 56(5), 558-565. Interventions by health careprofessionals could occur at two levels. They have lower life expectancies, high-riskexposure, and higher levels of incarceration than any other group. (1996). mortality among bothblacks and whites was attributable to poverty, while in 1991, theproportion was approximately 5.9 percent. Interestingly enough, both African-Americanmen and African-American women report higher abstention rates than theirwhite counterparts, with a 35 percent abstention rate among African-American men compared to 28 percent among white men (Caetano and Kaskutas,1995; Dawson et al., 1995). In any event, it does not seem likely that most African-Americans aregoing to move back to a farm background. However, one factor that certainly has been repeatedly emphasized asproblematic for the African-American community is the lack of two-parentfamilies. (1998). There seems to have been a general reduction in drinking, and heavydrinking, during the past decade, along with a reduction of alcohol-relatedmortality rates. Results indicated that 6. According to the United States Census Bureau (1991), at the beginningof the 199 s, one in three of all African-American males between the agesof 18-3 was either incarcerated or under the control of the court system.During that same period of time, the leading cause of death amongadolescent African-American males was homicide, with a reported rate ofdeaths between 1978-1987 of 2 ,316. New England Journal of Medicine, 335(21), 1552-1558. (1995). The risk ofassaultive violence and alcohol availability in Los Angeles County.American Journal of Public Health, 85(3), 335-34 . Hahn, R.A., Eaker, E.D., Barker, N.D., Teutsch, S.M., sosniak, W.A.,and Krieger, N. Conclusions and recommendations In reviewing and analyzing the literature, it becomes apparent thateverything is linked together. Nonetheless, an important element of changing the life prospects ofAfrican-American male adolescents is providing early intervention programswhich reduce juvenile violence, delinquency, and recidivism at the juvenilelevel. How can the healthcare system impact racism? Each entry into theprison system represents a new exposure to the infections that are notbeing controlled and treated. Again, we see support in Petersen et al. Problem Statement The population of African-American males is an at-risk population forserious health problems and diminished life expectancy (Aday, 1993). Similar results were obtained by Speer et al.(1998) for Newark, New Jersey, Gorman et al. An even more direct way that the health care profession canhelp with the health conditions of African-American males is to get intothe justice system and improve health conditions there. What isinteresting about their study is their finding that the experience ofincarceration itself seems to influence the physical health of inmates,with self-reported health problems increasing with the length ofincarceration. Int.Journal of Health Serv., 26(4), 673-69 . (1993). Drinking patterns and problems among African-Americans: Recent findings. (1998)did a distribute study to explore homicide trends from 1987 through 1995for people from age 15 through age 24 by level of urbanization. However, firearm and non-firearm homicide rates did begindeclining between 1993 and 1995 among all strata and among white and black,males and females (Fingerhut et al., 1998). (1998). Clearly,prisons are hazardous to the health in themselves, while the conditions oflife of African-American males seem to lead a sizable minority of theminexorably in that direction. Poverty and death in the United States. Improving survival. Intheir study of homicides in New Orleans during 1994 and 1995 and anassociation with on-sale and off-sale alcohol outlets, Scribner et al.(1999) found that adding off-sale alcohol outlet density to their models asoutlets per square mile or outlets per person indicated strong, significantgeographic relations with homicide and increased the amount of varianceexplained among census tracts. On the other hand, the situation was reversedat the upper income levels. For example, in a wide-based survey of data from New York, Barr et al.(1993) indicated that African-American men with low incomes weresignificantly more likely than their white peers to have high rates ofalcohol dependence symptoms. The research was reported qualitatively,providing an in-depth look at how young men and women turn to high-riskbehaviors through feelings of futility and hopelessness, exercisingviolence on their own bodies in a symbolic representation of the violenceand crime that surrounds them. The results are interesting. This involves a mentoringcomponent and is supported through state grants. It is the heavy drinking, however, that causes mostof the problems for people, or is indicative of a substance abuse problem(Jones-Webb, 1998). Beyond this, there is the need for even better alcohol prevention andintervention programs, which would require an entire article in itself. and Kaskutas, L.A. Tourigny, S.C. Health problems tend toincrease with length of stay. At an individual level, health care professionals can intervene byspotting early signs of alcohol consumption, and abuse. One of the major risk factors - multiple heterosexual risk behavior -is particularly pronounced within the population of male intravenous drugusers. (1996) used a survival analysis to explore the impact ofpoverty on mortality among a national sample of blacks ad whites. and Pickering, R.P. Washington, D.C.: U.S.Government Printing Office. According to Brunswick and Flory (1998), the incidence ofinfection is rising in that community and resembles the global infectionrate more than the national one at this point in time. Speer, P.W., Gorman, D.M., Labouvie, E.W., and Ontkush, M.J. Added to this is the fact that the low-income population tends tobe under greater stress and that avoidance is often chosen as the copingstyle with this stress, reinforcing the tendency toward heavy drinking,drinking consequences, and alcoholism. Changes in drinking pattersamong whites, blacks, and Hispanics, 1984-1992. Journal ofCommunity Health, 24(4), 285-3 3. As Booker (1999) noted, African-Americanmales are one-third more likely to receive prison sentences than whites,their prison sentences were longer, and Three Strikes law in California andelsewhere disproportionately impacted black males. It is in exploring this kind of deadly cyclethat it becomes apparent that prevention and early intervention programsfrom the health care system could be vital in improving the health ofAfrican-American males and their life expectancy. Thorburn noted that correctional healthservices are a neglected issue within the health policy and health carereform field. As noted above, inmate health problems seemed to increase with lengthof stay. Considering the historicalcontext, this does not seem too surprising, because one would assume thatthe majority of African-Americans at that time came from rural backgrounds,certainly, and lived in two-parent households. Analysis of the Literature In looking at the literature, a good place to begin is with anexploration of alcohol and drug use among the African-American malepopulation in urban areas specifically. All of these recommendations are fairly commonsensical. (1999). Dubik-Unruh (1999) suggested that nurses canserve an important role in pushing for education programs for both inmatesand staff. Drinking consequences areproblems that rise directly from the person's drinking, while alcoholdependence symptoms refer to behaviors and experiences, such as blackoutsand withdrawal symptoms, which lead to an assumption that the individual isaddicted or an alcoholic. Health care in correctional facilities.Western Journal of Medicine, 163(6), 56 -564. There are other issues involved that are extremelypolitical and which could involve putting pressure on the beer, wine, andspirits companies to reduce their advertising targeting of the poor and theAfrican-American community. They can advocate for prisoners for better health care and morereadily gain prison trust for education programs than other prison staffmembers. Poverty and mortality. and Wolstenholme, J. More recently, investigators havebegun identifying the new population of HIV/AIDS as suffering from adisease of poverty (Gillies et al., 1996). On the other hand, one would think that healthcare is more readily available in an urban environment then a ruralenvironment. (1998) forlinkage with domestic violence. In many instances, the role for health care professionals in workingon recidivism is personal. This rise in infection rates is associated with other factors thathave already been mentioned, including low income and high-risk behaviorsassociated with alcohol and drug use. Lindquist and Lindquist contended that gender in particular hasbeen assumed to influence health care utilization. The state of black male America: 1998.Internet: (http://www.pressroom.com/~afrimale/stbm98.htm. According to Thorburn (1995), prisonerservices have deteriorated since the early 198 s, while at the same timethe prison population is increasing. The office of Justice and Delinquency already offers some programs,such as the Juvenile Mentoring Program, which is a federally-fundedprogram. They studied mortality among blacks and whites in themetropolitan areas of New York, Detroit, Los Angeles, and the state ofAlabama, choosing one low-income and one higher-income area in eachlocation. Health care availability and health care utilizationvaries along several variables, including institution, gender, age, andrace. They are notremarkable innovations. They looked at records from both the censuses of 19 and 191 , matching those records to survivors aged 85 or older in theAfrican-American community. Peer education programs in corrections:Curriculum, implementation, and nursing interventions. Geronimus et al. HIV/AIDSsurveillance report, 8(1). Benignneglect was never a very effective prescription. childhoodconditions that predict survival to advanced ages among African-Americans.Social Science Medicine, 47(9), 1231-1246. Homicide ratesamong US teenagers and young adults: Differences by mechanism, level ofurbanization, race, and sex, 1987 through 1995. Again, thechildren are more vulnerable to the dangers and temptations of the street.The path leads back to incarceration. However, in terms of problem drinking, whichmeans consuming five or more drinks at one sitting at least once per week,African-American men report somewhat more heavy drinking than white men,with 15 percent in comparison to 12 percent for their white peers (Caetanoand Kaskutas, 1995). (1996) reported on excess mortality rates betweenblack and white populations, looking at gender and age as importantfactors. Single-parent families have less time to watch, or monitor children. One also would think that being from a farm background wouldbe associated with lower income levels, although that may not be the case,and that would contribute to lower levels of survival rates and diminishedhealth care. Nurses can work with other prison staff toidentify likely candidates for training and provide support for those peereducators within the prison community, advocating for increased services tothose prisoners that need them. Dawson, D.A., Grant, B.F., Chou, S.P. 5. Journal ofStudies in Alcohol, 6 (3), 31 -316. Results indicated that mortality rates were excessive for both menand women in all of the poverty areas, especially among African-Americans.For example, boys in Harlem who reached the age of 15 had only a 37 percentchance of surviving to the age of 65. Thorburn, K.M. This is apolicy issue, as well as a health care issue. (1995). According to Jones-Webb (1998), the researchexploring differences in drinking consequences and alcohol dependencesymptoms is ambiguous, with some studies reporting significantly greaterproblems for African-Americans and others reporting no significantdifferences between the two groups. and Mudar, P.(1992). (1998).Risk of assaultive violence and alcohol availability in New Jersey.American Journal of Public Health, 88(1), 97-1 . (1995).Subgroup variation in U.S. There are several ways, including recruitingmore African-Americans into the health care professions and providing themwith culturally sensitive training, recruiting more health careprofessionals of high quality into African-American communities and, again,joining with other organizations to impact public policy limiting thedepredations of racism past and present. Stress and alcohol use: Moderating effects of gender, coping, andalcohol expectancies. The problem is significant for study because it is costing lives,stressing institutions, and it is not going away on its own. Preston, S.H., Hill, M.E., Drevenstedt, G.L. After they are freed, they aregenerally returned to the same environments, without necessarily beingprovided any services that would allow them to cope more effectively. From reviewing the literature, there are someobvious factors that would improve the health of African-Americans malesand lengthen average life expectancy. and Welte, J.W. There is clearevidence that prisoners within the criminal justice system are notreceiving the testing nor treatment they need, including for such life-threatening conditions as hepatitis and HIV. (1998). This trend has continued, but the rate is very much contingent uponthe location of the subject. Health behind bars:Utilization and evaluation of medical care among jail inmates. Nonetheless, this is an area that could be explored. The Safe Futures initiative is funded at six separate sites, twoin California (SafeFutures Community, 1998). Am.Journal of Drug and Alcohol Abuse, 24(4), 661-673. African-Americans are disproportionately residents of large citieswhich seem to have higher homicide rates and higher rates of alcohol anddrug abuse (along with availability). References Aday, L.A. They conducted a studyexploring the physical health status of a sample of 198 male and femaleinmates in a large county jail in a medium-sized Southern city. At risk in America: The health and health careneeds of vulnerable populations in the United States. Geronimus, A.T., Bound, J., Waidmann, T.A., Hillemeier, M.M., Burns,P.B. AIDS Care, 8, 351-363. Fingerhut, L.A., Ingram, D.D., Feldman, J.J.

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