Proximal and distal minority stressors and mental health among young gay and bisexual men and other men who have sex with men (GBMSM) in Kisumu, Kenya
Young gay and bisexual men and other men who have sex with men (GBMSM) in Kenya experience pervasive intersectional stigma and discrimination, contributing to elevated levels of negative mental health symptoms. Grounded in the Minority Stress Model, this paper explores associations of proximal and distal minority stressors with three types of negative mental health outcomes among young HIV-negative GBMSM (n = 63) between the ages of 19-34 who participated in a pilot trial of a sexual health intervention. Using the PHQ-9, GAD-7, and PC-PTSD-5 screening measures, levels of clinically significant symptoms were reported as follows: 15.8% depressive symptoms, 12.7% anxiety symptoms, 31.7% posttraumatic stress symptoms. Results from stepwise linear regression analyses suggest that GBMSM-related stigma (distal stressor) was the strongest correlate for all three mental health outcomes, and concealment motivation (proximal stressor) was an additional significant correlate only in the depressive symptoms model. These findings should be viewed with caution and seen as initial observations given the small sample which limits our interpretations of the findings. Structural-level interventions are needed to decrease GBMSM's exposure to intersectional stigma and discrimination, such as decriminalization of same-sex sexual activity, as well as individual and group-level interventions that assist GBMSM with improving their adaptive coping strategies.
Applying a community-engaged participatory machine learning model
Although predictive algorithms have been described as the definitive solution to bias in health care, machine learning techniques may also propagate existing health inequities within the community context. However, there may be ways in which machine learning techniques can help community psychologists, public health researchers and practitioners identify patterns in data in a way that empowers improved outcomes. Incorporating community insight in all stages of machine learning research mitigates bias by positioning members of underrepresented communities as the experts of their lived experiences. As community psychologists already prioritize community-based participatory practices, we propose three core guiding principles for a community-engaged participatory model for research using machine learning techniques: shared decision-making, reflexivity and structural humility, and flexibility and adaptability. Guided by these three principles, we emphasize grounding priority setting, problem formation, model assumptions, and interpretation of the resulting algorithmic patterns in the truths born from the lived experiences of people closest to the problem. We also suggest opportunities for bidirectional and mutually empowering partnerships between algorithmic scientists and the communities to which their algorithms will be applied. Inclusion of community stakeholders in all stages of machine learning for health research provides an opportunity to develop algorithms that are both highly effective and ethically grounded in the lived experiences of target populations.
Future considerations for implementation and impact of community narrative initiatives
In response to communities where individuals experience both disproportionate numbers of Adverse childhood experiences (ACEs) and other health inequities, narrative change has emerged as a powerful tool to change how ACEs are viewed and addressed by communities. The special issue presents a set of papers examining efforts to use narrative change to address ACEs. In this commentary, we offer reflections on the introduction and three articles of the special issue and point to future considerations for implementation and impact of community narrative initiatives. For example, we assert that to prevent and address the outcomes of ACEs such as substance use and mental health problems, communities need to include and amplify the voices of those with lived experience during decision-making about policy. We also espouse using research models of resilience in communities as a way to further uptake of narrative change strategies in the literature on ACEs and health disparities in communities. Using trauma-informed outcomes and measures are also critical to measure how narrative change can move the needle to promote health equity.
Mentorship for young gay men in Hong Kong: A pilot mixed-methods randomized controlled trial
This study examined whether mentorship could promote young gay men's identities and well-being, and whether a mentor's sexual orientation matters. A randomized control trial compared outcomes across three conditions: Arm A (a mentee matched with a sexual minority mentor), Arm B (a mentee matched with a heterosexual mentor), and a control arm receiving psychoeducation only. A community sample of 60 mentees aged 18-25 years was randomly allocated to the three arms and completed questionnaires at baseline, 3 months into the intervention, and at the end of the 6-month program. Fifteen mentees recounted their mentoring experiences through in-depth interviews. Linear mixed effects models showed that for both intervention and control conditions, internalized homonegativity declined while resilience, loneliness, and body acceptance improved over time. No time and group interactions were found. Meanwhile, a mentor's sexual orientation did not drive differential quality and outcomes of mentorship. Interviewees cited various benefits of mentorship, including providing companionship, enriching connection with lesbian, gay, bisexual (LGB) communities, and adding knowledge and perspectives of LGB lives and identities. Although quantitative data did not support any exclusive benefits of mentorship, most mentees recognized mentorship as a vital source of affirmation and companionship. Implications for research and mentoring programs are discussed.
What do recently housed young people imagine for the future of third places? Using game-based inquiry to (re)imagine affirming, youth-centered third places
Third places-public and community settings like parks and libraries-are theorized to serve as sources of social connection, community, and play. Yet, young people who hold marginalized identities, such as those experiencing homelessness and housing instability, often endure discrimination in third place settings. This study used game-based inquiry to partner with recently housed young people who have experienced chronic housing instability (N = 21) to understand how they would (re)imagine future third places. We then analyzed transcripts from these game sessions through qualitative thematic analysis. Participants suggested that certain tenets must be present in third places: they must offer opportunities for agency and individualization; they must meet everyday needs; and they must be explicitly inclusive. To actualize these tenets, participants imagined places that meet many needs and do many things; portable and adaptable physical spaces; freedom to choose how to play; attending to and subverting oppressive social hierarchies; providing choice for privacy or connection; knowing people will be around; and free amenities. These findings have implications for theoretical development, practices in present and future third places, and methodological development of games in research.
Geographic and psychosocial correlates of homelessness or unstable housing among US veterans in the Midwest
The purpose of this study was to explore (1) the prevalence of physical and mental health conditions among veterans stratified by homelessness and unstable housing (HUH) in several Midwestern states, and (2) the correlation between HUH and sociodemographic, military, financial, risky behavior, health, and geographical characteristics. The study cohort consisted of 7260 HUH veterans and stably housed veterans in 2018-2022 in Veterans Integrated Service Network (VISN) 23. A multivariate logistic regression analysis was performed which revealed the strongest associations with HUH were any incarceration experience (adjusted odds ratio [AOR] = 0.21) and rural location (AOR = 0.33). Frontier and remote location scores (AOR = 1.23) were associated with increased risk of HUH among veterans. Our results suggest potential differences in risk for HUH among veterans living in rural versus frontier and remote locations, which may be important to consider to provide care to the many veterans in these areas.
Healing and wellbeing outcomes of services for Aboriginal people based on cultural therapeutic ways: A systematic scoping review
Aboriginal Australians experience disproportionately high rates of mental health problems as the result of European colonisation, and Western evidence-based treatment has been strikingly ineffective in improving the situation. Cultural Therapeutic Ways is a culturally specific healing and wellbeing practice framework developed by the Victorian Aboriginal Child and Community Agency that focuses on culturally based practices, trauma awareness, and self-determination. Despite wide recognition of the importance of these elements in Indigenous healing and wellbeing programs, its measurable empirical impact is currently unclear. This paper summarises findings from a systematic scoping review to ascertain the published knowledge base for Cultural Therapeutic Ways and the gaps in knowledge that can inform future evaluation. Forty-two studies of programs that applied Cultural Therapeutic Ways with Indigenous participants from Australia, Canada, New Zealand, and the United States of America were identified from the literature search. Services based on Cultural Therapeutic Ways contributed to healing and wellbeing because they create safety, strengthen cultural connections, develop empowerment and provide opportunities to release emotion, and increase social and spiritual support. As the review set out to determine the published evidence base for Cultural Therapeutic Ways, other effective approaches may have been overlooked. To develop the evidence base for Cultural Therapeutic Ways, service design must clearly describe target groups, whether the program is delivered by Aboriginal people, the processes of Cultural Therapeutic Ways utilised in service delivery, and how they are blended with Western approaches. Research efforts could also productively be focused on identifying or constructing culturally appropriate outcome measures.
Social ecological predictors and correlates of Latinos' IPV behaviors: A systematic review and critique of the research literature
The current paper utilizes an ecological level of analysis framework to review and critique the literature surrounding predictors, correlates, and antecedents of Latinos' intimate partner violence (IPV) behaviors. More specifically, the ecological levels of analysis framework was employed to demonstrate how Latino males' IPV perpetration is being understood and studied. A total of n = 34 peer-reviewed articles were reviewed and critiqued. Findings indicated that most IPV research is being conducted at and comprehended from the individual (n = 33; 97%) and microsystem/small group (n = 24; 71%) levels of analysis, while linkages to organizational, locality, and institutional levels of analysis are largely neglected. Researchers and interventionists appear to view Latinos' IPV behaviors through deficit models, employ decontextualized and homogenized representations of the population, and neglect higher ecological levels of analysis. These three shortcomings in IPV research as it pertains to Latino populations must be addressed in future research studies if investigators desire to end the stigmatization and demonization of Latinos as a cultural and people group, and to maximize battering intervention effectiveness and efficiency for men of Latino origin.
Gender, race, and space: A qualitative exploration of young Black women's perceptions of urban neighborhoods
How people think and feel about their neighborhood impacts the way they think of themselves and their futures. These linkages are especially important to understand in the case of urban-residing young Black women. Researchers know very little about what contributes to young Black adults' urban neighborhood perceptions and often rely on "expert" definitions of markers of neighborhood quality. These definitions and subsequent explorations of residents' neighborhood assessment have not adequately considered intersecting oppressive systems that structure urban spaces both physically and socially. Further, within-group diversity of young Black adults based on other social identities, such as gender and class, has gone underexplored in research on residents' neighborhood assessment. We used theory from Black feminist geography and sociology to guide our thematic analysis of interviews with young Black women (N = 9) regarding their urban neighborhood quality. We sought to explore the aspects or features of the neighborhood that young Black women discussed and how social identities may play a role in young Black women's descriptions of their urban neighborhoods. We argue three themes tell an overarching story of young Black women's urban spatial critical analysis: (1) outsiders' perceptions versus our realities, (2) gendered safety, and (3) visibility of young Black women. Young Black women's narratives highlighted communal aspects of neighborhood evaluation and attention to dominant narratives regarding marginalized groups and urban spaces.
Freedom dreaming in carceral spaces: Youth care workers' imagined alternatives to anti-Black racism in residential facilities
Although youth-adult partnerships (Y-APs) have been linked to a wide range of positive youth and community outcomes, the possibility of Y-AP occurrence in spaces of racialized social control such as youth residential facilities remains unknown. Rooted in a social justice and rights-based ethos, Y-APs represent an innovative conceptual and practice model of youth engagement that challenges longstanding patterns of control that characterize adult-youth relationships in these settings. This study uses narrative thematic inquiry and counter storytelling to examine frontline youth care workers' narratives (N = 21) of Y-AP enactment against the backdrop of anti-Black racism in youth residential facilities. Workers' narratives include instances of both enhanced and diminished forms of partnership, and explanations for Y-AP diminishment depict an interplay of racist (anti-Black) ideologies and organizational processes, including selective racial cognizance in hiring practices, color-evasive and elitist training, and racialized blame-shifting. Importantly, workers' narratives suggest that although flourishing Y-APs remain elusive, it is not a foregone conclusion that Y-APs cannot occur to realize youth development and social change in these extreme contexts.
Is cultural appropriateness culturally specific? Intersectional insights from a community-based participatory mental health intervention study conducted with diverse cultural groups
Growing evidence supports the importance of culturally appropriate mental health interventions, yet it is not always feasible to develop culturally grounded interventions or adapt existing interventions for each cultural group. In addition, these approaches do not recognize the multiple intersecting aspects of culture and identity that individuals, families, and communities possess. Thus, an essential question is whether culturally appropriate mental health interventions have to be culturally specific. We address this question by examining processes of the Refugee Well-being Project (RWP), a community-based mental health intervention for refugees resettled in the United States, which included people from multiple cultural groups (Afghanistan, Great Lakes region of Africa, Iraq, and Syria) and was grounded in common experiences of forcibly displaced people from marginalized backgrounds. RWP incorporates a practice-based concept of culture, an intersectional view of identity, and a multilevel approach to address postmigration stressors. Semistructured qualitative interviews were conducted with 290 participants at preintervention, followed by interviews at three timepoints with a purposively selected subsample (n = 66). Additional interviews (n = 101) were conducted with refugee and student partners. Four themes demonstrated key principles for creating culturally appropriate interventions with diverse groups: (a) recognize cultural complexity in practice; (b) focus on how racism and discrimination are experienced in everyday life; (c) de-center dominant US culture; and (d) create an egalitarian, inclusive space to put principles into action. We conclude that mental health interventions implemented with multiple, diverse groups can be culturally appropriate and effective without being culturally specific.
Parental political engagement and self-efficacy: An exploratory study
Political engagement (PE) is associated with a sense of empowerment. PE by parents affects children's lives. This study explored parents' attitudes about inclusion of political engagement discussion in well-child care. Because voting is an expression of empowerment, we hypothesized that voting would be related to higher parenting self-efficacy. We administered a brief questionnaire to a convenience sample of parents/guardians at well-child visits at an urban hospital. The questionnaire included 10 Likert scale questions touching on parenting efficacy; beliefs about political engagement; voting behaviors; and demographics. Analysis included descriptive statistics, correlations, and factor analysis. Among the 70 respondents 84% were mothers; 55% self-identified as low income; 62% self-identified as a "person of color." Voting in the 2020 national election was reported by 37%. Most parents (54%) said they would feel comfortable discussing voting with a doctor. Factor analysis identified two main factors: self-efficacy and engagement. Engagement, but not self-efficacy, was related to voting behavior. Contrary to our hypothesis, PE did not appear related to parenting self-efficacy. Notably, more than half of parents felt comfortable discussing PE with their child's doctor. Given the critical role of parents in shaping the world their children inhabit, further exploration could prove to be of value.
"My resistance melts away": The role of mindfulness in supporting participatory researchers' efforts to share power with youth co-researchers
Youth participatory action research (YPAR) is an approach widely utilized in various social science disciplines (e.g., community psychology, social work, public health), which requires researchers to share power with youth co-researchers and to collaborate across identities to work equitably. Understanding what approaches and practices support YPAR adult facilitators' ability to share power is a vital area of knowledge that can support greater freedom in how researchers approach YPAR. Mindfulness offers a powerful set of tools for adult researchers to track their reactions and equitably collaborate with youth co-researchers. Drawing on insights from our youth participatory research, the present study employed a collaborative autoethnography to integrate our unique experiences as YPAR facilitators. We reflected on a core research question: How does mindfulness inform and support our YPAR work? Two major themes emerged that relate to power-sharing in YPAR: (1) Mindfulness supports our ability to overcome barriers to being present in facilitating YPAR groups; (2) Facilitator presence fosters deeper connection with youth co-researchers and stronger collaboration. Mindfulness can provide researchers a holistic, strengths-based approach in youth collaboration, and may also provide skillful tools for researchers to counter the pressures of White supremacy culture in academia.
Protective effects of ethnic enclaves: Testing pathways to alcohol use and use disorders in Mexican American young adults
Ethnic enclave residence is associated with decreased risk for drinking and related problems, but less is known about the mechanisms that explain this association. Informed by theories of social control, we used a multilevel framework to examine whether negative attitudes toward drinking mediated associations between ethnic enclave residence (i.e., neighborhood linguistic isolation) and alcohol outcomes among Mexican American young adults (N = 628) in Southern California. Model 1 assessed mediation effects in the pathways from linguistic isolation to current drinking and alcohol use disorder (AUD). Model 2 adjusted for parental drinking attitudes and neighborhood alcohol availability. There were differential associations by gender in direct effects of linguistic isolation and negative drinking attitudes on both drinking and AUD. Among women only, linguistic isolation was related to greater abstinence and decreased AUD after accounting for social control proxies of parent attitudes and alcohol availability. Young adults' own drinking attitudes did not mediate relationships between linguistic isolation and alcohol outcomes. This study offers evidence on the importance of disaggregating Hispanic national groups by gender to uncover social mechanisms within ethnic enclave settings for tailored supports in reducing risk of drinking and alcohol-related harms.
Parenting practices and trajectories of proactive coping assets among emerging adult Black men
Positive youth development (PYD) frameworks suggest that a critical response to investigating the challenges young Black men living in resource poor communities experience involves identifying contextual resources in young men's lives and personal assets that promote success. The following study examines heterogeneity in proactive coping assets trajectories, parental practices as predictors of developmental trajectories, and associated outcomes of each trajectory. The study sample consisted of Black emerging adult men living in rural Georgia (N = 504). At baseline, men were between the ages of 19 and 22 (M = 20.29; SD = 1.10). At wave four, the participants' mean age was 27.67 (SD = 1.39). Results of growth mixture modeling from waves 1 to 3 discerned three developmental trajectory classes of emerging adults' proactive coping assets: a high and increasing class (n = 247, 49%), a low and stable class (n = 212, 42%), and a moderate and decreasing class (n = 45, 9%). Trajectory classes were linked to baseline levels of parental support, coaching, and expectations. Analysis revealed that parental support and parental coaching predicted proactive coping asset trajectory class identification. Links were then investigated between emerging adults' proactive coping asset trajectory classes and wave four physical health, depression, and alcohol use. Results revealed significant associations between class identification, alcohol use, and physical health. Study findings provide evidence supporting the impact of parenting on emerging adult Black men, underscoring the need to expand resources that support parenting and emerging adult relationships.
"I was already there once": Cumulative attempt capital of marginalized women exiting substance use and street prostitution contributes to their recovery capital
Despite a move to view substance use as a disease of the brain, relapse into drugs is still often viewed as a personal failure. Low recovery capital has been used to explain relapse among certain marginalized populations. Recovery capital is a recent framework that refers to the individual's sum of all internal and external assets that may assist in their recovery process. It includes four categories: physical, human, social, and cultural capital. However, this framework does not relate to the role of actual relapses in the recovery process, despite their common occurrence. To bridge this gap, in-depth interviews with 29 women formerly engaged in substance use and street prostitution in a large urban area were used to probe women about their relapse and recovery experiences. The current study demonstrates the value in repeat recovery setbacks, what I term "cumulative attempt capital": lessons learned from previous recovery attempts. I argue that previous attempts improve women's social and professional networks, help them learn from past mistakes, improve and maintain their health, and provide them with a sense of self-efficacy. This research expands our understanding of the positive role failed attempts play in one's recovery. Such reframing by service providers can alleviate a sense of shame and low self-worth for women in street prostitution and substance use and has implications for policy and program development.
"We are mothers, sisters, and lovers too": Examining young Black women's experiences navigating sex and sexual health
In Canada, there is a lack of research that addresses the sexual health and well-being of African, Caribbean, and Black young women. This paper aims to gather perspectives of young Black women to address the social contexts of how young Black women navigate issues related to sex and sexual health. Young Black women experience unique dynamics in navigating their sexualities and sexual healthcare. The nuanced experiences stem from social contexts with historical underpinnings, such as the perception of Black women's bodies, Black identity, gender roles, and sexual double standards. This Community-Based Participatory Research study (N = 24) utilized focus groups to examine young Black women's experiences navigating sexual health. Employing a thematic analysis, participants identified four themes representing their narratives of navigating sexual health. The themes included the perceptions and hypersexuality of Black women's bodies, navigating sexual double standards and gender roles as Black women, diverse Blackness, and migration experiences concerning sexual health and surveillance of Black women's bodies. This paper is intended to add to scholarly discourse and will include practical strategies for use by researchers and community practitioners in sexual health within the Black community.
Societal and community factors facilitating cultural adaptation and mental health of North Korean refugee women in South Korea
North Korean (NK) refugee women face unique challenges in their acculturation process in South Korea (SK), often leading to higher rates of depression among them. This study uses the Multidimensional Individual Difference Acculturation (MIDA) model to examine the role of societal and local community factors in facilitating cultural adaptation and influencing mental health issues, such as depression, among NK refugee women. The study focuses on three predictors from the MIDA model: out-group social support, attachment to NK culture, and daily life experience of discrimination. Data from a sample of 212 NK refugee women in SK were analyzed using structural equation modeling. The findings highlight the crucial role of the social and community environment in attaining a balance between embracing a new culture and preserving one's connection to one's heritage culture. This balance is essential for promoting stable cultural adaptation, sound mental health, and overall well-being, so as to reduce the incidence of depression among NK refugee women. Based on the results, specific intervention strategies are proposed to support the acculturation journey of NK refugee women in SK.
Racialization processes and depressive symptoms among pregnant Mexican-origin immigrant women
This study examines how racialization processes (conceptualized as multilevel and dynamic processes) shape prenatal mental health by testing the association of discrimination and the John Henryism hypothesis on depressive symptoms for pregnant Mexican-origin immigrant women. We analyzed baseline data (n = 218) from a healthy lifestyle intervention for pregnant Latinas in Detroit, Michigan. Using separate multiple linear regression models, we examined the independent and joint associations of discrimination and John Henryism with depressive symptoms and effect modification by socioeconomic position. Discrimination was positively associated with depressive symptoms (β = 2.84; p < .001) when adjusting for covariates. This association did not vary by socioeconomic position. Women primarily attributed discrimination to language use, racial background, and nativity. We did not find support for the John Henryism hypothesis, meaning that the hypothesized association between John Henryism and depressive symptoms did not vary by socioeconomic position. Examinations of joint associations of discrimination and John Henryism on depressive symptoms indicate a positive association between discrimination and depressive symptoms (β = 2.81; p < .001) and no association of John Henryism and depressive symptoms (β = -0.83; p > .05). Results suggest complex pathways by which racialization processes affect health and highlight the importance of considering experiences of race, class, and gender within racialization processes.
The role of housing stability in predicting social capital: Exploring social support and psychological integration as mediators for individuals with histories of homelessness and vulnerable housing
Social capital is a collective asset important for individual and population well-being. Individuals who experience homelessness may face barriers in accessing social capital due to health challenges, small social networks, and social exclusion. Data from a 4-year longitudinal study was used to determine if housing stability predicted greater social capital and if this relationship was mediated by social support and psychological integration for a sample of 855 homeless and vulnerably housed participants living in three Canadian cities. Findings showed that housing stability was not associated with trust and linking social capital. However, higher levels of social support and psychological integration had a mediating effect on the association between housing stability and trust and linking social capital. These findings highlight the importance of social support and psychological integration as means of promoting social capital for people who experience homelessness and vulnerable housing. Social interventions for housed individuals with histories of homelessness may be an avenue to foster greater social capital by building relationships with neighbors and connections to community resources and activities.
Algorithmic surveillance in the era of the mental health appsphere
Digital mental health applications, also known as mHealth apps, are designed to help users manage their mental health using technology such as mobile devices and smartphones. However, there has been little critical engagement surrounding their impact on marginalized communities, and Black people in Canada. This article aims to explore how state and private actors conceptualize the digitalization of mental health access, leading to the creation and implementation of these apps. It is important to consider the links and interconnections between the platform and the app, and to be cautious and curious before adopting yet another app that claims to manage and mitigate moods and address mental health needs. We should be considering the implications of what comes with this access and apparent ease of use.