Cancer Fatalism—Spiritual Perspectives

Cancer fatalism is a deterrent to participation in cancer screening. Cancer fatalism represents a surrender of the human spirit to perceptions of hopelessness, powerlessness, worthlessness, and social despair. In contrast, spirituality enhances hope and coping abilities. This correlational pilot study investigated the relationship between cancer fatalism and spirituality among rural, elderly individuals. This knowledge may provide insight into ways to negate the influence of cancer fatalism. The majority of the sample were African-American and female. A prevailing sense of fatalism and spirituality existed. However, the relationship was not statistically significant. Philosophical implications and areas for future research are explored.     

The Prevalence of Spirituality, Optimism, Depression, and Fatalism in a Bi-ethnic Stroke Population

To provide insight into the reduced post-stroke all-cause mortality among Mexican Americans, we explored ethnic differences in the pre-stroke prevalence of (1) spirituality, (2) optimism, (3) depression, and (4) fatalism in a Mexican American and non-Hispanic white stroke population. The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke surveillance study in Nueces County, Texas. Seven hundred ten stroke patients were queried. For fatalism, optimism, and depression scales, unadjusted ethnic comparisons were made using linear regression models. Regression models were also used to explore how age and gender modify the ethnic associations after adjustment for education. For the categorical spirituality variables, ethnic comparisons were made using Fisher's exact tests. Mexican Americans reported significantly more spirituality than non-Hispanic whites. Among women, age modified the ethnic associations with pre-stroke depression and fatalism but not optimism. Mexican American women had more optimism than non-Hispanic white women. With age, Mexican American women had less depression and fatalism, while non-Hispanic white women had more fatalism and similar depression. Among men, after adjustment for education and age, there was no ethnic association with fatalism, depression, and optimism. Spirituality requires further study as a potential mediator of increased survival following stroke among Mexican Americans. Among women, evaluation of the role of optimism, depression, and fatalism as they relate to ethnic differences in post-stroke mortality should be explored.     

Intrinsic Religiousness as a Mediator Between Fatalism and Cancer-Specific Fear: Clarifying the Role of Fear in Prostate Cancer Screening

Understanding factors that influence screening receptivity may enhance African-American men’s receptivity to prostate cancer screening. Men of African descent (N = 481) between the ages of 40 and 70 were recruited. The hypotheses that Fatalism would be related to Intrinsic Religiousness and Fear, Intrinsic Religiousness would act as a mediator between Fatalism and Fear, and Fatalism as well as Prostate Cancer-Specific Fear would be negatively related to past Prostate-Specific Antigen Testing and Screening Intent were supported. This meditational finding suggests that when religious beliefs are a motivating force, the fear-inducing effects of fatalism are reduced.     

Social embeddedness and psychological well-being among African Americans and whites

Using data from the National Medical Expenditure Survey, a household survey of more than 18,000 respondents, this study examined racial and gender differences in social embeddedness, an indicator of community well-being and social support. The study hypothesized that higher levels of social embeddedness would be found among African Americans than among Whites and that the association between social embeddedness and psychological well-being would be stronger among African Americans than among Whites. African American men reported themselves more socially embedded overall than White men and, in one instance, their social involvement was especially important in predicting psychological well-being. African American women were more likely than White women to report attending meetings of churches and community groups, but otherwise were less socially involved than White women. There was no evidence of a difference between African American and White women in strength of the connection between social embeddedness and psychological well-being. African American social involvement is more selective than previously believed and generalizations must be qualified on the basis of gender.     

African American Single Mothers and Children in Context: A Review of Studies on Risk and Resilience

This paper presents a comprehensive review of research linking single-parent family structure to parenting processes, maternal well-being, and child developmental outcomes among African Americans. The approaches used to study these families, related methodological and conceptual concerns, and the factors linked to maternal well-being, effective parenting processes, family functioning, and child outcomes are addressed. Much work remains to be done on conceptualizing and assessing parenting processes among African Americans in general and single African American mothers in particular. Researchers must examine more carefully the circumstances that foster or impede successful parenting among these mothers. Studies also are needed to disentangle the interactions between economic stress and parenting behavior and to determine the extent to which the findings can be applied to middle-income single African American parents.     

Improving multiple behaviors for colorectal cancer prevention among african american church members.

The WATCH (Wellness for African Americans Through Churches) Project was a randomized trial comparing the effectiveness of 2 strategies to promote colorectal cancer preventive behaviors among 587 African American members of 12 rural North Carolina churches. Using a 2 X 2 factorial research design, the authors compared a tailored print and video (TPV) intervention, consisting of 4 individually tailored newsletters and targeted videotapes, with a lay health advisor (LHA) intervention. Results showed that the TPV intervention significantly improved (p <.05) fruit and vegetable consumption (0.6 servings) and recreational physical activity (2.5 metabolic task equivalents per hour) and, among those 50 and older (n = 287), achieved a 15% increase in fecal occult blood testing screening (p =.08). The LHA intervention did not prove effective, possibly because of suboptimal reach and diffusion.     

Horizontal and vertical dimensions of individualism-collectivism: a comparison of African Americans and European Americans

The current study examined ethnic differences in horizontal and vertical dimensions of individualism and collectivism among 96 African American and 149 European American college students. Participants completed the 32-item Singelis et al. (1995) Individualism/Collectivism Scale. Multivariate analyses of variance results yielded a main effect for ethnicity, with African Americans being significantly higher on horizontal individualism and European Americans being higher on horizontal collectivism and vertical individualism. A moderated multiple regression analysis indicated that ethnicity significantly moderated the relationship between individualism and collectivism. Individualism and collectivism were significantly and positively associated among African Americans, but not associated among European Americans. In addition, collectivism was related to grade point average for African Americans but not for European Americans. Contrary to the prevailing view of individualism-collectivism being unipolar, orthogonal dimensions, results provide support for individualism-collectivism to be considered as unipolar, related dimensions for African Americans.     

An Examination of Race Differences in Patients' Psychological Adjustment to Cancer

Although African Americans are at increased risk of cancer morbidity and mortality, very little is known about their psychological adjustment. African American males may be at especially high psychological risk, considering their disproportionately higher cancer mortality. Subjects were 42 African American and 56 White adults similar in age, cancer stage, marital status, and socioeconomic status. Analyses revealed no significant race or gender effects on global indices of psychological adjustment, depression, or anxiety. However, African Americans were more likely than Whites (a) to use avoidant coping strategies in dealing with the exigencies of their illness, (b) to report more cancer-related disruption in family relations, and (c) to identify fewer individuals in their social support network. No significant race differences were found on a measure of health care satisfaction. These findings highlight the need to provide a more comprehensive examination of individual, family, and socioecological variables and their relationship to psychological adaptation among minorities with cancer.     

As I See It: A Study of African American Pastors’ Views on Health and Health Education in the Black Church

The Black Church is the only institution that has consistently served the interest of African Americans, and there is no other institution in the African American community that rivals its influence (Camara, 2004). The spiritual well-fare, social support, health, and well-being of its people have been one of its main goals. With health disparities of African Americans still at an alarming rate, the Black Church has used informal education as a means to impart knowledge on health, as well as other non-religious and religious topics. One of the avenues least researched within the Black Church is the pastor’s perception of its educational role in health and wellness and its efforts to reduce health discrimination and health disparities between African American and European Americans in the U.S. Since social justice appears as a theme and concern in the traditions of many churches, it is only appropriate that, among other things, the Black Church should address the issue of health education and interventions. The purpose of this study was to explore African American pastors’ perceptions of the role of the Black Church in providing health care, health education, and wellness opportunities to African Americans. Many pastors reported their church provided some form of health education and/or health screenings. Their perceptions about the important issues facing their congregants versus African Americans in general were quite similar.     

Assessing the Role of Spirituality in Coping Among African Americans Diagnosed with Cancer

Spirituality plays an important role in cancer coping among African Americans. The purpose of this study was to report on the initial psychometric properties of instruments specific to the cancer context, assessing the role of spirituality in coping. Items were developed based on a theoretical model of spirituality and qualitative patient interviews. The instruments reflected connections to self, others, God, and the world. One hundred African American cancer survivors completed the instruments by telephone. The instruments showed adequate internal reliability, mixed convergent validity, discriminant validity, and interpretable factor structures.     

Clinical Utility of the Rorschach With African Americans

In this study we sought to identify Rorschach differences between African Americans and White Americans and to understand these differences within a social and cultural framework. Data from the Exner (1993) Comprehensive System normative sample (N = 700) was used to form a group of 44 African Americans and 44 White Americans matched for age, sex, education, and socioeconomic status. Twenty-three Rorschach variables were chosen a priori and group differences were analyzed. The only clinically significant difference found was that African Americans offered significantly less cooperative movement. This lower frequency of cooperative movement may suggest African Americans do not anticipate cooperative interactions with others as a routine event. This may reflect a shared feeling among African Americans that most members of our society are less likely to be sensitive to or responsive to their needs relative to others. However, the study demonstrates a striking similarity between the groups, supporting the clinical use of the Rorschach with African Americans.     

Clinical utility of the Rorschach with African Americans.

In this study we sought to identify Rorschach differences between African Americans and White Americans and to understand these differences within a social and cultural framework. Data from the Exner (1993) Comprehensive System normative sample (N = 700) was used to form a group of 44 African Americans and 44 White Americans matched for age, sex, education, and socioeconomic status. Twenty-three Rorschach variables were chosen a priori and group differences were analyzed. The only clinically significant difference found was that African Americans offered significantly less cooperative movement. This lower frequency of cooperative movement may suggest African Americans do not anticipate cooperative interactions with others as a routine event. This may reflect a shared feeling among African Americans that most members of our society are less likely to be sensitive to or responsive to their needs relative to others. However, the study demonstrates a striking similarity between the groups, supporting the clinical use of the Rorschach with African Americans.     

Race-related stress,quality of life indicators,and life satisfaction among elderly African Americans

This article examined the relationships among race-related stress, quality of life indicators, and life satisfaction among elderly African Americans. A sample of 127 elderly African Americans, consisting of 87 women and 26 men (and 14 missing values), were administered the Index of Race-Related Stress, the Satisfaction With Life Scale, and the 36-item Short-Form Health Survey. Results indicated that elderly African American men and women differed significantly with regard to institutional and collective racism-related stress. In addition, the authors found that institutional racism-related stress was a significant predictor of psychological health in this sample of elderly African Americans.     

African Americans and High Blood Pressure: The Role of Stereotype Threat

We examined the effect of stereotype threat on blood pressure reactivity. Compared with European Americans, and African Americans under little or no stereotype threat, African Americans under stereotype threat exhibited larger increases in mean arterial blood pressure during an academic test, and performed more poorly on difficult test items. We discuss the significance of these findings for understanding the incidence of hypertension among African Americans.     

Similarities and Differences Between African Americans’ and European Americans’ Attitudes,Knowledge, and Willingness to Communicate About Organ Donation1

While little is known about African Americans’ attitudes and knowledge about organ donation, even less is known about how African Americans’ attitudes, values, and beliefs affect their behavior and behavioral intentions regarding organ donation; or how African Americans’ views are similar to or different from those of European Americans. Adults working 2 sites of a national corporation were randomly selected to complete a survey about organ donation willingness, intention to sign an organ donor card, knowledge and attitudes toward organ donation, and level of altruism. Results indicate that African Americans differ significantly from Whites on several individual attitude and knowledge items. However, the basic relationship between knowledge, attitudes, values, and behaviors regarding organ donation between the 2 groups appears the same. Furthermore, these results indicate that future organ donation promotion campaigns must focus on increasing basic knowledge and countering myths about organ donation for both populations.     

Severity of homelessness and adverse birth outcomes.

Predictors and the prevalence of adverse birth outcomes among 237 homeless women interviewed at 78 shelters and meal programs in Los Angeles in 1997 were assessed. It was hypothesized that they would report worse outcomes than national norms, that African Americans would report the worst outcomes because of their greater risk in the general population, and that homelessness severity would independently predict poorer outcomes beyond its association with other adverse conditions. Other predictors included reproductive history, behavioral and health-related variables, psychological trauma and distress, ethnicity, and income. African Americans and Hispanics reported worse outcomes than are found nationally, and African Americans reported the worst outcomes. In a predictive structural equation model, severity of homelessness significantly predicted low birth weight and preterm births beyond its relationship with prenatal care and other risk factors.     

Social Networks and Forgiveness: The Role of Trust and Efficacy

We examine the link between social network size and forgiveness, as well as mediating effects of self-efficacy and trust. Data are from the Detroit Community Study, which include three racial/ethnic groups: African Americans, Arab Americans, and White Americans (N=907). Results indicated that larger network size is associated with more forgiveness, but is mediated by trust. Patterns varied within racial/ethnic group: among Arab Americans self-efficacy mediated the effect of network size on forgiveness; among African Americans there were no direct or mediating effects; among White Americans an indirect effect of trust on forgiveness was identified. Findings suggest complex associations with forgiveness.     

Spirituality Among Older African Americans

Recent changes in gerontology have drawn attention to the role of spirituality among older adults. Demographic trends suggest that the number of African Americans over the age of 65 is increasing, with the largest shift to occur in persons 85 years of age and older. Given the paucity of information available regarding the relationship between spirituality and aging along with the increase in the number of older African Americans, a literature review of these concepts is sorely needed. This paper provides a thorough profile of older African Americans, with a review of historical and cultural factors that have informed the spiritual development of this population. Additionally, attention is given to methodological issues such as definitions, measures, sampling, and research designs at the interface of development and spirituality in this population. The paper also reviews findings to date about the effects of spirituality on physical and mental health among older African Americans.     

Ethnicity and Gender Stereotypes of Emotion

In three studies we investigated gender stereotypes of emotions among four ethnic groups in the U.S., using persons from these groups as informants about their own groups. European Americans’ reports of stereotypes were compared to those of African Americans (Study 1), Hispanic Americans (Study 2), and Asian Americans (Study 3). The examination of group differences was interpreted based on variations across ethnicities in norms concerning emotional expression and gender roles. Overall, gender stereotypes of emotion were evident among all ethnic groups studied, but European Americans’ gender stereotypes were the most gender differentiated. For example, European American stereotypes held that men express more pride than women do, but African Americans’ stereotypes of pride for men and women did not differ. Similarly, whereas among European Americans, women were stereotyped to express much more love than men do, the gender difference was smaller among Hispanic Americans and Asian Americans. These different norms may pose challenges for inter-cultural interactions, and they point to the importance of considering both gender and ethnicity simultaneously in the study of emotions.     

Combined Medication and CBT for Generalized Anxiety Disorder With African American Participants: Reliability and Validity of Assessments and Preliminary Outcomes

Using data from a study of combined cognitive behavioral therapy (CBT) and venlafaxine XR in the treatment of generalized anxiety disorder (GAD), the current article examines the reliability and convergent validity of scales, and preliminary outcomes, for African American compared with European American patients. Internal consistency and short-term stability coefficients for African Americans (n = 42) were adequate and similar or higher compared with those found for European Americans (n = 164) for standard scales used in GAD treatment research. Correlations among outcome measures among African Americans were in general not significantly different for African Americans compared with European Americans. A subset of patients with DSM-IV–diagnosed GAD (n = 24 African Americans; n = 52 European Americans) were randomly selected to be offered the option of adding 12 sessions of CBT to venlafaxine XR treatment. Of those offered CBT, 33.3% (n = 8) of the African Americans and 32.6% (n = 17) of the European Americans accepted and attended at least one CBT treatment session. The outcomes for African Americans receiving combined treatment were not significantly different from European Americans receiving combined treatment on primary or secondary efficacy measures.