It is a truism of health education that programs and interventions will be more effective when they are culturally appropriate for the populations they serve. In practice, however, the strategies used to achieve cultural appropriateness vary widely. This article briefly describes five strategies commonly used to target programs to culturally defined groups. It then explains how a sixth approach, cultural tailoring, might extend these strategies and enhance our ability to develop effective programs for cultural groups. The authors illustrate this new approach with an example of cultural tailoring forcancer prevention in a population of lower income urban African American women.

Do you have a multicultural practice? Do you understand the attitudes and expectations African Americans hold about mental health services? The attitudes and beliefs of 201 African Americans regarding psychotherapists, psychotherapy, and barriers to treatment were explored by means of focus groups. Key barriers to service utilization included stigma, lack of knowledge, lack of affordability, lack of trust, impersonal service, and lack of cultural understanding. Participants reported that race should not matter in therapy, but they often believed that psychologists were insensitive to the African American experience. The implications of participants' reports for meeting African American mental health and therapy needs are considered.Although psychologists are aware of the differential pattern of use and response to mental health services among ethnic clients, the in-depth understanding that would permit development of appropriate responses and programs is limited. Psychologists often struggle with whether, when, and how efforts to address issues of race, ethnicity, and culture will affect mental health attitudes and therapeutic response. The focus group is a qualitative research strategy that uses a semistructured discussion format to elicit a more in-depth understanding of the attitudes, values, and beliefs that affect behavior (Stewart & Shamdasani, 1990). Although this strategy sacrifices the rigor and precision of quantitative studies, it is a useful preliminary strategy that allows members of communities to share their insights on relevant issues and their opinions about how needs and concerns might be addressed. The current study represents a preliminary effort to understand what values and concerns may affect African American mental health attitudes and service use, as well as what efforts by the psychological community may prove beneficial in promoting an image of multicultural sensitivity and competence.African Americans have been identified as a group that uses mental health services inconsistently (Kessler et al., 1994;D. W. Sue & Sue, 1990). Research has documented the overuse of inpatient services and the over-and underuse of outpatient services depending on the setting and problem (Atkinson, Morten, & Sue, 1998). More recently, Snowden (1999) noted a mixed pattern of usage when sociodemographic differences and diagnoses were not controlled. However, controlled analyses indicated that African Americans in a community sample were consistently less likely than White Americans to seek mental health services.The National Survey of Black Mental Health (Jackson, Neighbors, & Gurin, 1986) indicated that African Americans sought services as a result of referrals by physicians, family members, or friends and tended to contact physicians, ministers, and hospitals; only 9% of those surveyed used the services of psychologists, psychiatrists, or community mental health facilities. African Americans have been found to average fewer sessions and to terminate from outpatient mental health services earlier than White ...

In this commentary, we discuss the science of stakeholder engagement in research. We propose a classification system with definitions to determine where projects lie on the stakeholder engagement continuum. We discuss the key elements of implementation and evaluation of stakeholder engagement in research posing key questions to consider when doing this work. We commend and critique the work of Hamilton et al. in their multilevel stakeholder engagement in a VA implementation trial of evidence-based quality improvement in women's health primary care. We also discuss the need for more work in this area to enhance the science of stakeholder engagement in research.

Discrimination based on group characteristics other than mental illness does not diminish the impact of stigma associated with mental illness. Antistigma programs need to target not only discrimination related to mental illness but also that associated with other group characteristics, such as race, gender, sexual orientation, and physical disability.

Background-This study examined gender and racial/ethnic differences in sexual debut.Study Design-We analyzed 1999-2007 data from the Youth Risk Behavior Surveillance System (YRBSS), a cross-sectional, nationally representative survey of students in Grades 9-12 established by the Centers for Disease Control and Prevention. The Kaplan-Meier method was used to compute the probability of survival (not having become sexually active) at each year (age 12 through 17), and separate estimates were produced for each level of gender and racial/ethnic group.Results-African-American males experienced sexual debut earlier than all other groups (all tests of significance at p<.001) and Asian males and females experienced sexual debut later than all groups (all tests of significance at p<.001). By their 17th birthday, the probability for sexual debut was less than 35% for Asians (females 28%, males 33%) and less than 60% for Caucasians (58% females, 53% males) and Hispanic females (59%). The probability for sexual debut by their 17th birthday was greatest for African Americans (74% females, 82% males) and Hispanic males (69%).Conclusions-These results demonstrate a need for sexual education programs and policy to be sensitive to the roles of race and ethnicity in sexual debut.

Although the importance of community engagement in research has been previously established, there are few evidence-based approaches for measuring the level of community engagement in research projects. A quantitative community engagement measure was developed, aligned with 11 engagement principles (EPs) previously established in the literature. The measure has 96 Likert response items; 3–5 quality items and 3–5 quantity items measure each EP. Cronbach’s alpha is used to examine the internal consistency of items that measure a single EP. Every EP item group had a Cronbach’s alpha > .85, which indicates strong internal consistency for all question groups across both scales (quality and quantity). This information determines the level of community engagement, which can be correlated with other research outcomes.

Little is known about how minority groups react to public information that highlights racial disparities in cancer. This double-blind randomized study compared emotional and behavioral reactions to four versions of the same colon cancer (CRC) information presented in mock news articles to a community sample of African-American adults (n = 300). Participants read one of four articles that varied in their framing and interpretation of race-specific CRC mortality data, emphasizing impact (CRC is an important problem for African-Americans), two dimensions of disparity (Blacks are doing worse than Whites and Blacks are improving, but less than Whites), or progress (Blacks are improving over time). Participants exposed to disparity articles reported more negative emotional reactions to the information and were less likely to want to be screened for CRC than those in other groups (both P < 0.001). In contrast, progress articles elicited more positive emotional reactions and participants were more likely to want to be screened. Moreover, negative emotional reaction seemed to mediate the influence of message type on individuals wanting to be screened for CRC. Overall, these results suggest that the way in which disparity research is reported in the medium can influence public attitudes and intentions, with reports about progress yielding a more positive effect on intention. This seems especially important among those with high levels of medical mistrust who are least likely to use the health care system and are thus the primary target of health promotion advertising. (Cancer Epidemiol Biomarkers Prev 2008;17(11):2946 -53)

In this commentary, we focus on violence against women of color. Although African American women experience higher rates of intimate partner homicide than White women, the cumulative rates for nonfatal intimate partner violence are similar and do not vary between urban and rural locations (though access to services may vary by location). Much of the research about intimate partner violence is based on women with low socioeconomic status and on interventions that were developed by and for White women. Current primary prevention strategies focus on violence that is perpetrated by strangers rather than their primary perpetrators--intimate partners. We recommend the development and rigorous evaluation of prevention strategies that incorporate the views of women of color and attention to primary prevention.