There is a growing research literature suggesting that racism is an important risk factor undermining the health of Blacks in the United States. Racism can take many forms, ranging from interpersonal interactions to institutional/structural conditions and practices. Existing research, however, tends to focus on individual forms of racial discrimination using self-report measures. Far less attention has been paid to whether structural racism may disadvantage the health of Blacks in the United States. The current study addresses gaps in the existing research by using novel measures of structural racism and by explicitly testing the hypothesis that structural racism is a risk factor for myocardial infarction among Blacks in the United States. State-level indicators of structural racism included four domains: (1) political participation; (2) employment and job status; (3) educational attainment; and (4) judicial treatment. State-level racial disparities across these domains were proposed to represent the systematic exclusion of Blacks from resources and mobility in society. Data on past-year myocardial infarction were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions (non-Hispanic Black: N = 8245; non-Hispanic White: N = 24,507), a nationally representative survey of the U.S. civilian, non-institutionalized population aged 18 and older. Models were adjusted for individual-level confounders (age, sex, education, household income, medical insurance) as well as for state-level disparities in poverty. Results indicated that Blacks living in states with high levels of structural racism were generally more likely to report past-year myocardial infarction than Blacks living in low-structural racism states. Conversely, Whites living in high structural racism states experienced null or lower odds of myocardial infarction compared to Whites living in low-structural racism states. These results raise the provocative possibility that structural racism may not only harm the targets of stigma but also benefit those who wield the power to enact stigma and discrimination.

African Americans are approximately half as likely as their White counterparts to utilize professional mental health services. High levels of religiosity among African Americans may lend to a greater reliance on religious counseling and coping when facing a mental health problem. This study investigates the relationship between three dimensions of religiosity and professional mental health service utilization among a large (n=3,570), nationally representative sample of African American adults. African American adults who reported high levels of organizational and subjective religiosity were less likely than those with lower levels of religiosity to utilize professional mental health services. This inverse relationship was generally consistent across individuals with and without a diagnosable DSM-IV anxiety, mood, or substance use disorder. No association was found between non-organizational religiosity and professional mental health service use. Seeking professional mental health care may clash with sociocultural religious norms and values among African Americans. Strategic efforts should be made to engage African American clergy and religious communities in the conceptualization and delivery of mental health services.

African Americans, compared with white Americans, underutilize mental health services for major depressive disorder. Church-based programs are effective in reducing racial disparities in health; however, the literature on church-based programs for depression is limited. The purpose of this study was to explore ministers' perceptions about depression and the feasibility of utilizing the church to implement evidence-based assessments and psychotherapy for depression. From August 2011 to March 2012, data were collected from three focus groups conducted with adult ministers (n021) from a black mega-church in New York City. Using consensual qualitative research to analyze data, eight main domains emerged: definition of depression, identification of depression, causal factors, perceived responsibilities, limitations, assessment, group interpersonal psychotherapy, and stigma. A major finding was that ministers described depression within a context of vast suffering due to socioeconomic inequalities (e.g., financial strain and unstable housing) in many African American communities. Implementing evidence-based assessments and psychotherapy in a church was deemed feasible if principles of community-based participatory research were utilized and safeguards to protect participants' confidentiality were employed. In conclusion, ministers were enthusiastic about the possibility of implementing church-based programs for depression care and emphasized partnering with academic researchers throughout the implementation process. More research is needed to identify effective, multidisciplinary interventions that address social inequalities which contribute to racial disparities in depression treatment.

Dietary supplements are extensively used in the United States, especially by people age 50 and over. Surveys have shown that magazines and other news media are an important source of information about nutrition and dietary supplements for the American public. It is uncertain, however, whether magazines provide their readers with adequate information about the safety aspects of supplement use. This report presents an analysis of supplement safety information in articles published during 1994-1998 in 10 major magazines popular among older readers. This time period was chosen to allow the impact of the 1994 Dietary Supplement Health and Education Act (DSHEA) to be assessed. The evaluation included 254 magazine articles. More than two-thirds of the articles did not include comprehensive information about the safety aspects of the dietary supplements that were discussed. Information about safety issues such as maximum safe doses and drug-supplement interactions was often lacking even in otherwise informative and well-researched articles. A total of 2,983 advertisements for more than 130 different types of supplements were published in the magazines surveyed. The number of advertisements per year increased between 1995 and 1998. Supplements of particular interest to older adults (such as antioxidants, calcium, garlic, ginkgo biloba, joint health products, liquid oral supplements, and multivitamins) were among the most frequently advertised products. Although magazines popular among older readers contain extensive information about dietary supplements, these publications cannot be relied upon to provide readers with all of the information that they need in order to use supplements safely.

Research has consistently demonstrated that people diagnosed with serious mental illness (SMI) are at increased risk for violent ideation and behavior (VIB) and that this is especially the case for SMI patients with comorbid substance use disorders (SUD). Despite this, what is still largely unknown is the relative prevalence of VIB across diagnostic categories, whether the rates of VIB in SMI groups exceed the rates observed in people with SUD only, and which demographic factors increase the likelihood of VIB under different circumstances for people with SMI. To address these questions, we analyzed the intake records of 63,572 patients diagnosed with SMIs (i.e., schizoaffective disorder, schizophrenia, bipolar disorder, and unipolar depression), substance use disorders, and non-SMI psychiatric disorders. Raw prevalence rates for a combined metric of VIB were established and compared for each group, and a series of logistic regression analyses were performed to estimate how various demographic factors influenced the likelihood of VIB endorsement in each study group. Our results revealed that (a) patients with SMI conditions had higher rates of VIB than both patients with non-SMI psychopathology and those with substance use disorders only; (b) patients with SMI and comorbid substance use pathology were responsible for the majority of VIB within each SMI condition; and (c) men with SMI conditions had higher prevalence rates of VIB than females. In addition, we found that for every SMI diagnosis, comorbid substance use disorders and younger age were related to greater risk for VIB, and where race and gender were found to significantly alter the likelihood of VIB endorsement, African American status and female gender were independently related to greater risk. The implications of these findings and directions for future research are discussed.