# data[].attributes.body
1. I am a human that classifies as female. I am a soul that wonders the corners of Earth. I am a young Black woman that aspires to leave something on this Earth that people will remember me by.
2. I pretend to be this happy soul as if everything is all peaches and cream when it really isn’t. Things happen and get to us which is totally okay. Sometimes it has to rain and pour in order to grow some more.
3. People definitely think I’m this sweetheart with a lot of brain and a world of success. Some think I am this witch because I do things that aren’t normal to society such as cleansing with sage and crystals.
4. I wish I could be free. Simply a free soul that doesn’t not have to follow society’s standards. I wish to be someone who can be role model to girls and boys in my position too.
5. I really don’t know how to answer this because I’m still trying to find my true ethnic identity.  But, I believe that the culture around my race has definitely played a huge role. Somethings I’ve experienced being Black could have also played a role in my responses.

# data[].attributes.body
1. My first experience with race was at a 7 eleven I believe. I was going to meet my mom with my siblings  after she got off work and she said we could get something to snack on. So I went to go grab some snacks (it was after school and a lot of kids were hanging out). We were in this neighborhood where the houses and apartments looked nice and it was fewer Black kids. I guess you can say it was between middle class and wealthy. Anyways, the cashier thought I was stealing because at the counter I put my binder in my backpack and my school snack was showing. She asked to see the snack and I pulled out for her. She then proceeded to say “ Oh, that looks like what we have here. Your total is $18.74.”  This was the only time I opened my backpack. She didn’t say anything to the boys in the store who kept opening their backpacks for no other reason but to steal.
2. Well I was in the 6th grade so like around 11 or 12.
3. Now, I associate anger and sadness with this experience because it happened so young.
4. I actually told my mom about it as soon as I seen her.
5. In the beginning, it negatively shaped my view of the world. As I grew older, I realized sometimes people are just ignorant and I have to do the best I can to avoid situations like that.

# data[].attributes.body
Someone who has a negative view of their sense of self can actually have a positive sense of ethnic identity because they always didn’t have a negative view. One event or many events or just simply mental illness could’ve triggered the negative view. If they dug deep enough, there can be a positive sense of their ethnic identity. Unless they are unable to remember certain things after a period of time or any other unfortunate circumstances.
2.I think if someone positively identifies with African American Psychology it depends on whether they have a stronger or weaker sense of self and/or ethnic identity. I believe your environment and education plays a huge role in this. Your environment can have you thinking one thing that may lead to a stronger sense of self and/or ethnic identity, but your education may have you rethinking everything you learning from your environment which may lead to a weaker sense of self and/or ethnic identity.

# data[].attributes.body
According to the video, the spirit of Ubuntu is respect, helpfulness, sharing ,community, caring, trust, and unselfishness. The spirit of Ubuntu is slightly alive and well in African American culture. For example, when death hits a family the community you’re apart of comes together. Death can be unbearable especially if you try to go through it alone. This is where the community comes in to support you and your family. Sometimes you don’t even have to ask for anything or answer their questions about what you need. They already bring you things that you need, mainly food. This is where I think Ubuntu is alive. It’s unfortunate that it takes death to bring a community together when we should already be together.

# data[].attributes.body
The most present concept of Afrocentric Psychology that appears in the African American community is spiritness. Spiritness means to be full of life. I’ve witnessed this a lot when there’s family reunions, participation in sports, and even creative events. They put soul and their life into everything they do. It’s very similar to “go big or go home.”  For example, Simone Biles when she participates in anything gymnastic related. She shows up to her events and shows out no matter how  hard the routine she’s doing can be. The least present concept of Afrocentric Psychology that appears in the African American is Veneration of the Person. Veneration of the Person means value of all life.  All life means everyone no matter what you identify as or even who you are attracted to. I’ve noticed that the African American community has a hard time accepting and valuing all life. Mainly people who identify with the LGBTQ+ group. Instead of accepting and loving these people, they get publicly bashed, beaten by family members or random people, or even they get taken to church in attempt to wash off the devil/ the devil’s plans.

# data[].attributes.body
Out of the 7 Principles of Nguzo Saba, I chose Kujichangulia. Kujichagulia means self determination. This resonates with me because I am very self determined with pretty much everything. It’s really hard for me not to have self determination, especially with school. I’ve seen this value in action in the African American community frequently. A lot of people within the African American community are starting to wake up and realize their potential and that the sky isn’t the limit. They are determined to make life better for them and the generations to come. Especially this generation now, they have a lot of self determination when it comes to their livelihood and future.

# data[].attributes.body
1.
2. In the Strengths, Coping, and Parenting Patterns, the author stated " Hill (1971) describes five strengths of African American families: (a) strong achievement orientation, (b) strong work orientation, (c) flexible family roles, (d) strong kinship bonds, and (e) strong religious orientation.” I agree with the author about a-e. Black families having a strong achievement orientation is a strength because it takes alot mentally, physically, and emotionally to get where they want to even when most people around them say they won’t make it. Having a string work orientation is also a strength because it means things will done and these are strengths that you can pass down to the next generation. Allowing flexible family roles can also be a strength because it kind of means no family members left behind. They pick up the slack or fill empty roles. Having strong kinship bonds is definitely a strength because it means you are never alone and it kind of brings back the whole “it takes a village” thing. In the Parenting Among Lesbian, Gay, Bisexual, and Transgender (LGBT) Couples section, the author states “This may be even more of an issue among African American families, which tend to be less accepting of gay and lesbian relationships and parenting than other racial and ethnic groups (Newport,2008)” This is one of the biggest challenges because most African American families focus on trying to convert their kid back instead of, worrying about actual issues that the child or family is going through.
3. Referring back to the Google slides video and the reading, racial socialization can affect parents and children of the Black family negatively or positively. It can affect them negatively because some of the way we do things, have been stemmed from slavery. The more you think about it, it can hurt/ scar a child mentally and emotionally whereas the parents may or may not change their ways. From here a lot of judgement will be done and can lead to possible family ties being cut. Racial socialization can positively affect them because it might start a change between the parent and child with the way they do things. Although it’s wrong for a Black person to work 10 times harder to get what they want, this encourages them to push themselves to be the best they can be.
4. In the Families During Enslavement section, the author stated “ During slavery, the mother-child relationship rather than the husband-wife relationship was primary to family life. Within slave communities, members helped to raise children of single mothers.” I believe that this has impacted Black families the most since slavery. Although fathers are very much present in some Black kid’s lives, you tend to see a lot of single mothers. Majority of the time you see these mothers getting help from family members or even the sister or a female cousin will step in and fill that other parental role which I’ve heard this position being called “Auntie Daddy”. Seriously, it might not be as big of a community now, but there’s part of the community that will lend a helping hand to mothers that need it.
5. Page 103-106 of the given link.

# data[].attributes.body
1. The imposter syndrome is "the inability to absorb one's accomplishments and the persistent fear that one will be exposed as a fraud."
2. The imposter syndrome can negatively affect a student in their educational journey and into their career experiences. If someone is continuously being accused of cheating, it will hinder their ability to do certain things over time. For example, if your English teacher keeps accusing you of cheating for every essay you have turned in so far. As time progresses, you will overthink every essay and change how you write. So now, you are writing below your skill level because of what you constantly heard from your teacher.  A student will begin to question all their accomplishments and the work they have done.
3. The imposter syndrome will also negatively affect the self-esteem and mental health of African American women in the workplace. This can be a result of a lack of people that identify as the same thing as you or even look like you. You also might feel like you're in the shadows because you're an African American woman. This alone can lead to low self-esteem. When you don't see many people representing you, you might feel like you aren't good enough to be there and this takes a toll on your mental health. It's okay, you got there fair and square!
4. Race and gender can either make or break an African American woman's experience in the workplace. Usually, most workplaces can be toxic for them because they expect you to know way less than what you know. They also might treat you like an animal as if you were at the zoo when they ask to touch your hair if you're African American. Or if they touch your hair without permission. Just because you come across another woman doesn't necessarily mean you'll have someone that understands being a woman in the workplace. So take this and combine it with race. Woman are perceived as not so smart human beings that are only good at making a house, a home. An African American is perceived as a human being that was raised with no sense and has very little education. So, in the workplace, an African American woman is most likely perceived as both of these things.
5. One strategy would be actual consequences for people who belittle women of color. Actual consequences, not a slap on the wrist. If it keeps happening, that person should be fired. This will show women of color that what they feel and how they feel are important. It would show them that people actually are working to better their workspace.

# data[].attributes.body
One of the most important things I learned was the reasoning behind why Black women have a harder time getting married with an education. It didn't really deepen my understanding because it's new material to me but it goes to show that Black women don't exaggerate when they say that they have problems finding a good man (in terms of education, etc).
2. Long-standing stereotypes in the media of African American females being portrayed as property negatively affects the psyche of those watching those seeing these images. In terms of African American dating, this is negatively affected as well because African American women aren't expected to be smart or have sense about them.
3. The factors that contribute to single Black unmarried are education, economic instabilities, pain and fear that developed from past relationships.
4. There is a stigma because of racism and how Black people were treated in the past. from here, there was homophobia. Usually, Black Christians think it's the devil taking over.
5. https://voxeu.org/article/incarceration-unemployment-and-black-white-marriage-gap-us (This has to do with Black women and marriage. This helps me understand the underlying reasons a bit more. )

# data[].attributes.attachment_link.readable_text
Incarceration, unemployment, and the black-white marriage gap in the US

Elizabeth Caucutt, Nezih Guner, Christopher Rauh

The black-white differences in marriage in the US are striking. In 2006, 67% of white women between ages 25 and 54 were married, while only 34% of black women were - a gap of 33 percentage points. And as Figure 1 shows, the racial marriage gap has been increasing - it was 17 percentage points in 1980. The differences in family structure between black and white households have been an ongoing concern for policymakers. In his famous report, Moynihan (1965) saw a clear link between family structure and growing social problems, such as poverty and crime, among the black population. Today, the growing racial gap in marital status of the US population has led some researchers to question whether marriage is only for white people (Banks 2011).

Figure 1 Share of married or cohabiting black and white women across time

This dramatic racial gap in marriage matters because marital structure has important implications for the living arrangements and well-being of children. In 2015, about 54% of black children lived with a single mother, while the share of white children living with a single mother was about 22%. ¹ Differences in family structure are a contributing factor to differences in economic resources. In 2006, 33% of black children were living below the poverty line, while only 14% of white children were. ² A growing body of literature suggests that the conditions under which children grow up matter for their well-being as adults. Carneiro and Heckman (2003) and Cunha et al. (2006), among others, show that differences between children appear at very early ages and that the family environment plays a significant role in generating these differences.

Why do black individuals marry at lower rates than white individuals? Wilson (1987) suggests that characteristics of the black male population, and in particular the lack of marriageable black men due to high rates of unemployment and incarceration, are an important factor contributing to the black-white differences in marital status. This is usually referred to as the 'Wilson hypothesis'.

Figure 2 illustrates this hypothesis. The horizontal axis shows by how much more the share of incarcerated or non-employed men increased for black men than for white men from 1980 to 2006 across US states, while the vertical axis shows by how much more the share of never-married women declined for black than for white women. In Pennsylvania, for instance, the share of men without a job or in prison increased by 8 percentage points more for black men than for white men. At the same time, the share of women who were never married dropped by 23 percentage points more for black women than for white women. Larger increases in incarceration for men are associated with larger declines in marriage for women.

Figure 2 Changes in non-employment and incarceration of males in relation to the decline in ever married females

Since the 1970s, there have been two major developments disproportionately affecting the riskiness of black men as spouses.

First, there has been a large withdrawal of major industries from the inner cities due to skill-biased technological change and globalisation, leaving many low-skilled men without jobs. Between 1980 and 2000, the US lost two million manufacturing jobs and the decline has accelerated significantly since 2000 (Charles et al. 2018). These losses have been most pronounced for those with low levels of education. Batistich and Bond (2018) find that Japanese import competition in the 1970s and 1980s was associated with skill-upgrading in manufacturing and generated a shift of employment from low-skilled black workers to high-educated white workers. As a consequence, black men between the ages of 25 and 54 are less likely to be employed (60% versus 85% in 2006) and more likely to be unemployed (7.3% versus 3.6% in 2006) than their white counterparts.

Why did incarceration skyrocket? The development can be traced back to a press conference in 1971, in which President Richard Nixon declared illegal drugs as public enemy number one. In 1982, President Ronald Reagan officially announced the 'War on Drugs', leading to the introduction of several policy packages. These reforms entailed a substantial increase in anti-drug funding and incentives for police agencies to arrest drug offenders, and sentencing reforms including harsh punishments for crack distribution and possession. As a consequence, the prison population soared. In 2010 more than one in ten black men between the ages of 25 and 54 were incarcerated. This is more than five times as high as the incarceration rate for white men of the same age. Prison has become a common feature of a black man's life. For black men born between 1965 and 1969, the cumulative risk of imprisonment by ages 30 to 34 was 20.5% compared to only 2.9% for white men (Western 2006). More than half of black men with less than a high school education pass through prison at some point before they turn 34.

Even when focusing on the civilian, non-institutionalised population, there are more black women than men due to higher mortality rates of black men. The numbers of white men and women of marriageable ages are about even, i.e. there is one man for every woman. In contrast, there are around 15% more black women between the ages of 25 and 54 than black men. This skewed sex ratio for the black population makes it less likely black women will marry.

In a recent paper (Caucutt et al. 2018), we take a dynamic look at the Wilson hypothesis in order to understand the sources of the racial marriage gap. We develop an equilibrium model of marriage, divorce, and labour supply that takes into account the transitions between employment, unemployment, and prison. Our analysis differentiates between the lack of opportunities for black women to meet black men and their decision to enter into a marriage. Given current incarceration policies and labour market prospects, black men are riskier spouses than white men. They are more likely to be, and to become, unemployed or incarcerated than their white counterparts. As a result, marriage is a risky investment for black women.

In the model economy, single men and women, who differ by earning potentials, are matched in a marriage market segmented by race. They decide whether or not to marry taking into account their next best option. Husbands and wives also decide whether to stay married and whether the wife works in the labour market. There is a government that taxes and provides welfare benefits to poor households. Men in the model move exogenously among three labour market states (employment, non-employment, and prison).

Black and white individuals differ along three key dimensions. First, there are more black women than black men, so the sex ratio for the black population is not one. Second, black men are much more likely to go to prison than white men. Third, black men are also more likely to lose their jobs. Because there are more black women than black men and a large number of black men are in prison, single black women might not meet anyone in the marriage market. Furthermore, because black men are more likely to go to prison or lose their jobs, when meetings do take place they are less likely to be end up in marriage, and existing marriages are more likely to end in divorce.

The model economy is estimated to be consistent with key marriage and labour market statistics by gender, race, and educational attainment for the US economy in 2006. Without imposing racial differences in taste parameters, the model is able to generate a racial marriage gap of 24 percentage points for currently married females. We then study how much the different components of the Wilson hypothesis - the sex ratio, and the dynamic impacts of the prison and employment transitions - contribute to this racial marriage gap. Table 1 documents our results.

Table 1 Accounting for the black-white marriage gap (fraction married)
Notes: Column 'Black' shows the share of married black women (above) and men (below) by education in the benchmark economy, while the column 'White' shows the same for white women and men. Column 'Sex Ratio' shows the counterfactual marriage rates of blacks if the sex ratio were equal to one. Column 'Emp' shows the counterfactual marriage rates of blacks if black men had the same employment transitions as white men of equal education. Column 'Prison' shows the counterfactual marriage rates of blacks if black men had the same prison transitions as white men of equal education. The bottom rows show the share of the marriage gap explained through the respective counterfactual experiments and the associated 90% confidence interval. '<HS' denotes education level of 'less than high school', 'HS' is high school, 'SC' is 'some college', and 'C' is college.
The first column of Table 1 shows the fraction of the black population that is married in the model economy, while the last column shows the fraction of the white population that is married. At every education level, a larger fraction of the white population are married. For women with less than a high school degree, for example, almost 50% of white women are married, while just 17% of black women are.

In each column between the first and the last one, we eliminate the gap for one key racial difference. First, we give an equal sex ratio to the black population ('Sex Ratio'). Next, we give black men the employment opportunities of white men ('Emp.'). Finally, we give black men the incarceration rates of white men (column 'Prison'). In each of these columns the marriage rate among the black population increases and approaches the marriage rate for the white population in the model economy. The last row in the table shows how much of the racial marriage gap each factor closes. We find that the sex ratio accounts for 21.2% of the gap. The effect of employment is larger 38.4%, while the effect of prison is smaller 10.4%. Next, we consider the different factors together. If black men face the employment and prison dynamics of white men, the racial marriage gap is reduced by more than 50%. Finally, putting together all three pieces of the Wilson hypothesis (eliminating black-white differences in the sex ratio, incarceration transitions, and unemployment transitions) closes more than 80% of the racial marriage gap.

Conclusions

A racial marriage gap of 33 percentage points is wide. In our research, we study the potential drivers of this gap. Changes in US labour markets in recent decades left many low-skilled workers jobless. The number of people behind bars has increased so that the US now holds 25% of the world's prison population, while only accounting for about 5% of the world's population. Both the decline in low-skilled jobs and the era of mass incarceration have disproportionately affected black communities, and in particular black men. We investigate whether the current bleak labour market prospects of black men and the considerable risk of being incarcerated can explain why so many black women are not marrying. Using an equilibrium model of marriage, divorce and labour supply that takes into account transitions between employment, unemployment, and prison, we are able to disentangle and quantify the key contributors to the racial marriage gap.

References

Banks, R R (2011), Is marriage for white people? How the African American marriage decline affects everyone, Dutten: New York.

Batistich, M K, and T N Bond (2018), "Symptoms before the syndrome? Stalled racial progress and Japanese trade in the 1970s and 1980s", mimeo.

Carneiro, P, and J J Heckman (2003), "Human capital policy", in J J Heckman, A B Krueger and B M Friedman (eds.), Inequality in America: What Role for Human Capital Policies?, MIT Press.

Caucutt, E, N Guner and C Rauh (2018), " Is marriage for white people? Incarceration, unemployment, and the racial marriage divide ", CEPR Discussion Paper 13275.

Charles, K K, E Hurst and M Schwartz (2018), "The transformation of manufacturing and the decline in US employment", NEBR working paper w24468.

Cunha, F, J J Heckman, L J Lochner and D V Masterov (2006), "Interpreting the evidence on life cycle skill formation", in E A Hanushek and F Welch (eds.), Handbook of the Economics of Education, North-Holland-Elsevier.

Moynihan, D P (1965), "The Negro family: The case for national action", Office of Policy Planning and Research, United States Department of Labor.

Western, B (2006), Punishment and inequality in America, Russell Sage Foundation.

Wilson, W J (1987), The truly disadvantaged: The inner city, the underclass, and public policy, Chicago University Press.

Endnotes

[1] The US Census data on the Living Arrangements of Children, Tables CH2 and CH3 ( https://www.census.gov/data/tables/time-series/demo/families/children.html)

[2] The US Census data on Historical Poverty Tables: People and Families - 1959 to 2015. Table 3 (http://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-people.html).

# data[].attributes.attachment_link.title
Incarceration, unemployment, and the black-white marriage gap in the

# data[].attributes.attachment_link.description
In 2006, 67% of white women in the US between the ages of 25 and 54 were married, compared with only 34% of black women. This column examines the link between this and the decline in low-skilled jobs and the era of mass incarceration that have disproportionately affected black communities.

# data[].attributes.body
1. Code switching means changing the way you speak/ express yourself around others. This can make or break an African American's success path in life. If you don't watch how you say things, you may never get hired or taken seriously.
2. Expecting code-switching threatens diversity because it's not always easy to code switch when you need to. Your accent or even the slang words you use can slip out when talking. This can lead to consequences in the workplace because now you're stuck in the same place for years while your coworkers who don't have to code switch, move on up the ladder of promotions.
3. The effects of code switching intersect with a persons' mental health because from now on, they are going to feel like they always have to hide parts of who they really are in order to be accepted. It can also be very stressful because sometimes your code switching is the deal breaker for almost everything. If you are constantly hiding yourself and changing who you are to meet certain social criteria, you will always feel like you aren't good enough once you've come across a incident that doesn't require you to code switch. It just really plays with your mental health because it's always a million different opinions that you care about.
4. https://www.yesmagazine.org/opinion/2019/12/17/culture-code-switching
Part of this article helps me understand some of the effects of code-switching. "I understand that my ability to not code-switch is a privilege, but it’s also a privilege my people died for, therefore for me, I have to [be myself] or else I feel as if I’m doing my ancestors a disservice.” At the end of this quote, it relates to one of the negative effects code-switching has. We are always taught to express ourselves and not to let anyone steal our shine but that's exactly what's happening in code-switching.
5. One strategy I think that would help be successful in addressing the misconceptions about code-switching within the African American community would be hosting workshops that allow them to see hands on how code-switching can destroy or open up new doors. People tend to take things seriously when it happens to them or someone they are close to.
6.One thing that stood out to me was in the code-switching video. When the speaker was talking about how she began to change the way she dressed, I related to that even though there's a difference in time from when she first did it to when I first did it. I also didn't know that changing your hair was a form of code-switching.

# data[].attributes.attachment_link.readable_text
The voice that sprung from my throat was unfamiliar as I introduced myself to a classroom of White students. Its tone was high-pitched and enthusiastic-a far cry from my naturally soft raspiness.

It wasn't the first time I was unsettled by being the sole Black person in a room, but these moments had a profound effect on me. Without thought, I'd shifted my demeanor and speech. My thoughts were calculated, quickened, and in search of the "right" things to say. The words poured from my mouth pointed and stiff. I enunciated each consonant and vowel, and stressed each syllable. The production of it all, though a departure from my normal self, was seamless.

It was the first time I noticed I had code-switched.

Admittedly, I was later ashamed for abandoning my native tongue-African American Vernacular English-and sense of self in an effort to assimilate into a space of teaching and learning, particularly because, as the instructor, I was an authority figure.

Code-switching is an age-old practice that is familiar to many Black people-and people of color-in the United States. Though when sociolinguist Einar Haugen coined the term in 1954, it was to describe language alternation, or the mixing of two or more languages, or dialects. Albeit, the practice had been known since the early 20 th century. Linguists studied code-switching to examine when it occurs, while sociologists studied why it occurs. The findings differed across ethnic and racial demographics. According to Bridging Differences: Effective Intergroup Communication, code-switching facilitates several functions: to mask fluency and memory in a second language, go between formal and informal conversation, exert power over another, and align and unify among familiar group in certain settings.

In the '70s, the phenomenon gained traction in African-American spaces-academic and otherwise-to describe the relationships between people of color-particularly Black people-and the colonial other. In the text, Language and Interracial Communication in the United States: Speaking in Black and White, George B. Ray describes African-American code-switching as "a skill that holds benefits in relation to the way success is often measured in institutional and professional settings." And though, at times, the performance is superficially understood as a lingual phenomenon that often occurs vis-a-vis a range of social settings, similar to my experience in the classroom, for many African Americans code-switching is a skillset that is integral to our survival.

For African Americans, code-switching is a performative expression that has not only helped some of us thrive in mainstream culture, it has helped many of us simply survive.

The late W.E.B Dubois, world-renowned scholar and civil rights advocate, alluded to the concept of code-switching more than a century ago, when he wrote about African Americans reckoning with dual identities-Blackness and Americanness-while navigating everyday Whiteness in his most celebrated book, The Souls of Black Folk:

"It is a peculiar sensation, this double-consciousness, this sense of always looking at one's self through the eyes of others, of measuring one's soul by the tape of a world that looks on in amused contempt and pity. One ever feels his two-ness, an American, a Negro; two souls, two thoughts, two unreconciled strivings; two warring ideals in one dark body, whose dogged strength alone keeps it from being torn asunder."

Dubois speaks to how this sense of being is a testament of resilience. However, code-switching goes beyond "feeling." For African Americans, it is a performative expression that has not only helped some of us thrive in mainstream culture-it has helped many of us simply survive.

I consider the "talk" many African American parents have with their children to warn them of, and prepare them for potential encounters with law enforcement, an element of code-switching. The conversation involves clear directives on how to switch up behavior when approached by police. It goes a little something like this:

"Turn down loud music."

"Adjust your posture."

"Keep your hands visible."

"Exercise good manners."

"Speak properly."

Such conversations are a response to the dominant culture's attitude toward Blackness-Black people, Black culture. Unfortunately, for Black citizens, such a perverse attitude remains present during quite a few brushes with the law. A recent study conducted by Stanford researchers revealed that Black motorists experience traffic stops at significantly higher rates than their White counterparts, and were 20% more likely to be ticketed by authorities. Mere traffic run-ins can escalate and sometimes result in death for Black people.

In the case of Sandra Bland and Philando Castile -whose police encounters were recorded and publicly consumed-I often wonder how code-switching may have preserved their lives. If for one moment, like myself standing in the center of that classroom, they had ordered their words, tweaked their voice, or code-switched in the more ironic way I've only read about, when the enslaved and the oppressed dumbed down their literacy and downplayed their dignity when faced with the crack of the slaver's whip or the scrag of Jim Crow's noose.

The ability to code-switch back into our Black selves is another way we subsist, feel whole and in some regard redeemed. Derrick Harriell, a poet who is the director of M.F.A. Creative Writing Program and associate professor of English and African American Studies at the University of Mississippi, like me, says he experienced personal disappointment when he switched up being himself.

"I know certain forms of code-switching have been responsible for saving our lives as Black people and key to our survival, so in that way I'm not judgmental," Harriell says. "I understand that my ability to not code-switch is a privilege, but it's also a privilege my people died for, therefore for me, I have to [be myself] or else I feel as if I'm doing my ancestors a disservice."

Harriell affirms that for a number of Black Americans, despite the conviction of "selling out" oneself in an effort to assimilate into White culture, code-switching is a form of pointed privilege and power.

The privilege speaks to the once-denied prerogative to be audibly and visibly one's authentic self, or masked and acculturated for one's own advantage. However, how we wield that power varies from person to person.

Dr. Dione Mahaffey, an Atlanta-based business psychologist and coach, says the very notion of code-switching is draining, but asserts that the practice has been most beneficial as she progressed in her career.

"It's exhausting, but I wouldn't go as far to call it inauthentic, because it's an authentic part of the Black American experience," Mahaffey says. "Code-switching does not employ an inauthentic version of self, rather, it calls upon certain aspects of our identity in place of others, depending on the space or circumstance. It's exhausting because we can actually feel the difference."

For Mahaffey, code-switching is about exchange, a give and take of sorts. Much of her participation is predicated on how much of herself she is willing to negotiate. She says she doesn't share the things that make her a dynamic woman, or the remarkable professional she is.

"I save that for my village," she says. In the professional sphere, Mahaffey flips those feelings on their head. She has mastered the performative niceties of code-switching and uses it to her own advantage, particularly when working in White spaces. The business coach says she "consider[s] double consciousness to be a part of the laws of power: Play the perfect courtier, and grace your way to the top."

She uses it to get her way, Mahaffey says of code-switching.

"[White folks] don't see me coming because I've made them comfortable. I blend in enough to get my way, to learn what I need, to secure what I came for and then I go on and create and build in an unconventional way."

While I am unsure that code-switching in a classroom of fresh-faced White students was disarming or caught them off guard like Mahaffey's did her colleagues, I am certain it caught me off guard and complicated self-doubt.
My code-switching in the classroom occurred because I doubted that my authentic self was enough to be in the room, and that further complicated how I felt about myself. Because I'm now more consciously aware of the impact code-switching had on me, I'm almost certain I won't do it again. However, I realize that code-switching, for some, is not about assimilating but surviving, and well, I'm not sure how to feel about that.

Inspiration in Your Inbox.

Sign up to receive email updates from YES!

# data[].attributes.attachment_link.title
Opinion | Code-Switching Is Not Trying to Fit in to White Culture, It's Surviving It

# data[].attributes.attachment_link.description
The voice that sprung from my throat was unfamiliar as I introduced myself to a classroom of White students. Its tone was high-pitched and enthusiastic-a far cry from my naturally soft raspiness. It wasn't the first time I was unsettled by being the sole Black person in a room, but these moments had a profound effect on me.

# data[].attributes.body
1. The significant differences would be that African Americans are more religious than most, in terms of like actually believing in God, praying, attending church services.
2.Black Millenials exhibit different religious habits compared to older African Americans because of the number of churches that have become accessible. While the older African Americans probably only had access to a handful of churches, times are changing where everyone doesn't believe in one church and their preachings.  According to the first article given for this theme, the author states "Today, the largest historically black church in the U.S. is the National Baptist Convention U.S.A. Inc"  Every church might have similar teachings but sometimes never the same preachings.
3. Attending church can positively affect the mental health of an African American. Being at church can influence one to get help from members or even actual mental care help from professionals despite how poorly they get treated in the healthcare system.
4. https://khn.org/news/amid-covid-and-racial-unrest-black-churches-put-faith-in-mental-health-care/
In this article, I learned that churches are actually opening their doors to mental health advocates and even taking it upon themselves to talk about mental health. This is shocking because I've noticed particularly in Baptist Churches that they put you on the prayer list, pray for you every chance they get, if you attend church then you will get some more prayers and extra "holy" oil places on your forehead. Usually, it's "Let God handle your problems, the pain doesn't last always."
5. Honestly, finding out that Black men are still more religious than others except Black women shocked me. Growing up, in my family the men hardly went to church unless it was for a wedding or a funeral. But they seemed to call on God when it was very necessary. I'd see a few men at the church too but they were in the process of becoming preachers and pastors. I think that men hide their religion and religious beliefs.

# data[].attributes.attachment_link.readable_text
This story also ran on This story can be republished for free ( CNN. details).

Wilma Mayfield used to visit a senior center in Durham, North Carolina, four days a week and attend Lincoln Memorial Baptist Church on Sundays, a ritual she's maintained for nearly half a century. But over the past 10 months, she's seen only the inside of her home, the grocery store and the pharmacy. Most of her days are spent worrying about COVID-19 and watching TV.

It's isolating, but she doesn't talk about it much.

When Mayfield's church invited a psychologist to give a virtual presentation on mental health during the pandemic, she decided to tune in.

The hourlong discussion covered COVID's disproportionate toll on communities of color, rising rates of depression and anxiety, and the trauma caused by police killings of Black Americans. What stuck with Mayfield were the tools to improve her own mental health.

"They said to get up and get out," she said. "So I did."

The next morning, Mayfield, 67, got into her car and drove around town, listening to 103.9 gospel radio and noting new businesses that had opened and old ones that had closed. She felt so energized that she bought chicken, squash and greens, and began her Thanksgiving cooking early.

"It was wonderful," she said. "The stuff that lady talked about [in the presentation], it opened up doors for me."

As Black people face an onslaught of grief, stress and isolation triggered by a devastating pandemic and repeated instances of racial injustice, churches play a crucial role in addressing the mental health of their members and the greater community. Religious institutions have long been havens for emotional support. But faith leaders say the challenges of this year have catapulted mental health efforts to the forefront of their mission.

Some are preaching about mental health from the pulpit for the first time. Others are inviting mental health professionals to speak to their congregations, undergoing mental health training themselves or adding more therapists to the church staff.

"COVID undoubtedly has escalated this conversation in great ways," said Keon Gerow, senior pastor at Catalyst Church in West Philadelphia. "It has forced Black churches - some of which have been older, traditional and did not want to have this conversation - to actually now have this conversation in a very real way."

At Lincoln Memorial Baptist, leaders who organized the virtual presentation with the psychologist knew that people like Mayfield were struggling but might be reluctant to seek help. They thought members might be more open to sensitive discussions if they took place in a safe, comfortable setting like church.

It's a trend that psychologist Alfiee Breland-Noble, who gave the presentation, has noticed for years.

Through her nonprofit organization, the AAKOMA Project, Breland-Noble and her colleagues often speak to church groups about depression, recognizing it as one of the best ways to reach a diverse segment of the Black community and raise mental health awareness.

This year, the AAKOMA Project has received clergy requests that are increasingly urgent, asking to focus on coping skills and tools people can use immediately, Breland-Noble said.

"After George Floyd's death, it became: 'Please talk to us about exposure to racial trauma and how we can help congregations deal with this,'" she said. "'Because this is a lot.'"

Across the country, mental health needs are soaring. And Black Americans are experiencing significant strain: A study from the Centers for Disease Control and Prevention this summer found 15% of non-Hispanic Black adults had seriously considered suicide in the past 30 days and 18% had started or increased their use of substances to cope with pandemic-related stress.

Yet national data shows Blacks are less likely to receive mental health treatment than the overall population. A memo released by the Substance Abuse and Mental Health Services Administration this spring lists engaging faith leaders as one way to close this gap.

The Potter's House in Dallas has been trying to do that for years. A megachurch with more than 30,000 members, it runs a counseling center with eight licensed clinicians, open to congregants and the local community to receive counseling at no cost, though donations are accepted.

Since the pandemic began, the center has seen a 30% increase in monthly appointments compared with previous years, said center director Natasha Stewart. During the summer, when protests over race and policing were at their height, more Black men came to therapy for the first time, she said.

Recently, there's been a surge in families seeking services. Staying home together has brought up conflicts previously ignored, Stewart said.

"Before, people had ways to escape," she said, referring to work or school. "With some of those escapes not available anymore, counseling has become a more viable option."

To meet the growing demand, Stewart is adding a new counselor position for the first time in eight years.

At smaller churches, where funding a counseling center is unrealistic, clergy are instead turning to members of the congregation to address growing mental health needs.

At Catalyst Church, a member with a background in crisis management has begun leading monthly COVID conversations online. A deacon has been sharing his own experience getting therapy to encourage others to do the same. And Gerow, the senior pastor, talks openly about mental health.

Recognizing his power as a pastor, Gerow hopes his words on Sunday morning and in one-on-one conversations will help congregants seek the help they need. Doing so could reduce substance use and gun violence in the community, he said. Perhaps it would even lower the number of mental health crises that lead to police involvement, like the October death of Walter Wallace Jr., whose family said he was struggling with mental health issues when Philadelphia police shot him.

"If folks had the proper tools, they'd be able to deal with their grief and stress in different ways," Gerow said. "Prayer alone is not always enough."

Laverne Williams recognized that back in the '90s. She believed prayer was powerful, but as an employee of the Mental Health Association in New Jersey, she knew there was a need for treatment too.

When she heard pastors tell people they could pray away mental illness or use blessed oil to cure what seemed like symptoms of schizophrenia, she worried. And she knew many people of color were not seeing professionals, often due to barriers of cost, transportation, stigma and distrust of the medical system.

To address this disconnect, Williams created a video and PowerPoint presentation and tried to educate faith leaders.

At first, many clergy turned her away. People thought seeking mental health treatment meant your faith wasn't strong enough, Williams said.

But over time, some members of the clergy have come to realize the two can coexist, said Williams, adding that being a deacon herself has helped her gain their trust. This year alone, she's trained 20 faith leaders in mental health topics.

A program run by the Behavioral Health Network of Greater St. Louis is taking a similar approach. The Bridges to Care and Recovery program trains faith leaders in "mental health first aid," suicide prevention, substance use and more, through a 20-hour course.

The training builds on the work faith leaders are already doing to support their communities, said senior program manager Rose Jackson-Beavers. In addition to the tools of faith and prayer, clergy can now offer resources, education and awareness, and refer people to professional therapists in the network.

Since 2015, the program has trained 261 people from 78 churches, Jackson-Beavers said.

Among them is Carl Lucas, pastor of God First Church in northern St. Louis County who graduated this July - just in time, by his account.

Since the start of the pandemic, he has encountered two congregants who expressed suicidal thoughts. In one case, church leaders referred the person to counseling and followed up to ensure they attended therapy sessions. In the other, the root concern was isolation, so the person was paired with church members who could touch base regularly, Lucas said.

"The pandemic has definitely put us in a place where we're looking for answers and looking for other avenues to help our members," he said. "It has opened our eyes to the reality of mental health needs."

# data[].attributes.attachment_link.title
Amid COVID and Racial Unrest, Black Churches Put Faith in Mental Health Care

# data[].attributes.attachment_link.description
This story also ran on This story can be republished for free ( CNN. details). Wilma Mayfield used to visit a senior center in Durham, North Carolina, four days a week and attend Lincoln Memorial Baptist Church on Sundays, a ritual she's maintained for nearly half a century.

# data[].attributes.body
https://docs.google.com/document/d/1xV_duQomD-_X0_7fB-rMct3EbTORo6iW922ao_wiqB0/edit?usp=sharing

# data[].attributes.attachment_link.title
 Film Analysis Outline Template (Taj Patterson)

# data[].attributes.body
1. There is a difference between the number of pain meds that an African American woman receives because Black women are seen as strong. It dates back to the past where Black women were having procedures done and going through horrific things and didn't show as much emotion (well at least to the naked eye).  It is also believed that Black people feel less pain than whites do.
2. One of the factors is medical gaslighting Black women during their pregnancy journey.
3. One solution is teaching healthcare providers that Black people and Black women indeed do feel pain as much as others do. Everyone may have a different pain tolerance but everyone feels pain.
4.https://www.endofound.org/the-disparities-in-healthcare-for-black-women
This resource explains the disparities and has some steps on what people can do to stop it.
5. What I found interesting was that even celebs get emergency c-sections. If the doctors would've listened to them, they would've had a somewhat normal vaginal birth.

# data[].attributes.attachment_link.provider_name
Endometriosis : Causes - Symptoms - Diagnosis - and Treatment

# data[].attributes.attachment_link.readable_text
Like so many people across the United States and around the world, my colleagues and I at Celmatix feel deeply outraged by the brutal and senseless murders of Breonna Taylor, Ahmaud Arbery, and George Floyd. We stand in solidarity with the millions of people lifting their voices in protest and also join countless more in reflecting on what we can do to make this a turning point for racial inequality.

Inequality comes in many forms for People of Color, both here and abroad, but race-related health disparities are among the starkest and most resistant to progress. Being a Black female further amplifies these inequities, which is particularly troubling and ironic given the fact that Women of Color make up the majority of healthcare workers. Over the last few months, the COVID-19 pandemic has brought this unfortunate reality into even more clear focus.

An often-cited quote in the business world is "you can't manage what you can't measure." At Celmatix, we have been working for over a decade to address critical gaps in data collection for women's health. This has included thinking outside of the bubble of traditional research metropolises like Boston and San Francisco, and expanding our research partnerships to reproductive health centers of excellence across the US and to biological repositories that allow us to reach women at community health centers and urban hospitals which serve women who may not have access to reproductive specialist care. In addition to investing in diversified data for our scientific and clinical research studies, we've also made significant investments in our "Next Gen Women's Project," an ambitious two-year consumer research effort that interviewed or surveyed more than 4K millennial women to understand how their healthcare needs differ from earlier generations of women and to discern their attitudes concerning their reproductive health and fertility. As part of this research, we had the privilege of collaborating with the Black Women's Health Imperative, Women's Health Magazine, and Oprah Magazine to better understand why Black women are facing higher infertility rates, greater stigma around reproductive challenges, and larger barriers to accessing fertility care.

1. Maternal mortality and injury rates are higher for Black females, irrespective of income or education level: Black women are 3-4 times more likely to die from pregnancy-related complications than White women. Black women are also 3-4 times more likely to suffer from a severe disability resulting from childbirth than White women (source).

2. Black women experience disparities in infertility rates, stigmatization, and access to fertility care: Infertility affects at least 12 percent of women of childbearing age, and studies suggest this number doubles for Black women in the US. However, while more than 20 percent of Black women may experience infertility, only 8 percent of them seek medical help to get pregnant compared to 15 percent of White women. (source)

3. Health conditions that disproportionately impact Black women, such as uterine fibroids, receive very little government research funding: Estimates reveal that nearly a quarter of Black women between the ages of 18 and 30 have fibroids - compared with 7 percent of white women. By age 35, that number increases to 60 percent. However, NIH annual funding for the condition is $17 million - compared to $86 million for cystic fibrosis, which impacts far fewer people each year (though the great majority of those impacted are Caucasian).

4. Black women are underrepresented in clinical trials that require consent and are overrepresented in studies that do not: While all women may be underrepresented in clinical research and trials for new drugs, this situation is even more critical for Black women. In fact, Black women (who as we mentioned are disproportionately impacted by uterine fibroids) only comprise 15 percent of participants in published clinical trials for the condition. (source) In addition, data from the FDA shows that in trials for 24 of the 31 cancer drugs approved since 2015, fewer than 5 percent of participants were Black. This diversity in study patients is needed to ensure that new drugs are both safe and effective for all patients. (source). Unfortunately, in contrast, Black participants are disproportionately over-represented in studies that do not require consent. (source)

5. Black women are significantly underrepresented in key biomedical research datasets, including genomic data repositories and related analyses: Nearly 80 percent of all individuals included in genomic studies are of European descent. While this may be a decrease from 20 years ago (when it was as high as 96 percent), this change is mostly driven by a higher number of studies being done in Asia on populations of Asian ancestry. The increase in participants of African ancestry has barely shifted in the last two decades. (source)

Taken together, the picture is clear: the disparities we see in women's health funding, research, delivery, innovation, data collection, and outcomes are consistently amplified multifold for women of color. As we reflect on policy changes that could have an outsized impact on addressing centuries of racial inequality in the US, we can think of no better place to start than with improving the health of black women.

1. Anti-racism and implicit bias training must be made mandatory for healthcare professionals working with black mothers: Anti-racism and implicit bias training needs to be incorporated into medical school education, but in the short term, state licensing boards and the American Board of Obstetrics and Gynecology (ABOG) should take the lead here to address disparities in maternal health. For maintenance of board certification, 35 hours of annual CME training is required for all OB/GYNs. The licensing bodies and ABOG should immediately require that a certain number of hours of CME training be mandated to include bias and anti-racism curriculum. This re-education needs to happen at every level of care, including for nurses and other healthcare professionals who interact with black women during labor and delivery. Recent initiatives are a good start, but we need to go further, faster. Relying on voluntary measures may mean we will have to wait a long time to see the impact of these recommendations.

2. Data about health outcomes for Black mothers should be tracked and reported: Hospitals and birthing centers should be required to publicly disclose health outcomes for labor and delivery for different demographic groups, and individual physicians and staff members should be presented with their own statistics to review on an annual basis as part of their institutional performance reviews.

3. The US NIH and FDA should update their policies to confront the underlying reasons for low clinical trial and voluntary research participation by Black women: The FDA should update its policies guiding clinical trial enrollment to better incentivize drug companies to increase enrollment of black clinical trial participants. The NIH should also revisit policies and incentives to expand research and address data disparities for People of Color. However, we also need to have a real open dialog about how Black people have been misused in clinical trials to date. The US has a long history of mistrust, with horrific examples such as American physician J. Marion Sims, who honed his techniques by performing surgery on enslaved Black women without the use of anesthesia. In the 1900s, poor Black women also endured forced sterilizations as birth control. And, for the last 70 years, some of the medical community's largest findings and largest profits were made possible through a Black woman named Henrietta Lacks. Lacks' cells have been cultured and used in experiments and commercialized without her, or her family's consent. (source) And as we mentioned, even today, Black Americans are overrepresented in studies that do not require their consent (source), nearly 30 percent compared to the making up just 13 percent of the US population. Importantly, in order to see real change, we must also correct the funding discrepancy for Black research investigators. An NIH study team found that taking into account factors including education, training, and experience, Black investigators are nearly 11 percent less likely to receive NIH funding compared to their White counterparts. (source) As researchers from these Black communities are more likely to study underrepresented communities and engender their trust, this lack of diversity in funding can also directly impact the inclusion of Black study participants. (source)

4. Black women should not be left behind in the march toward precision and personalized medicine: All stakeholders (public and private) generating and leveraging genomic datasets for both basic research and commercial product development should pledge to increase diversity in their datasets, even if it comes at a cost to profitability. This includes investing in diversity for analysis as well. As an extension, scientific journals should reward research groups that publish results from non-Northern European cohorts, even if the population sizes and power of those studies are impacted as a result of focusing on underserved and understudied populations.

5. Congress and citizens should exert pressure on government funding bodies like the NIH to dedicate more research funding for conditions that disproportionately impact black women: Conditions such as uterine fibroids and sickle cell anemia are grossly under-funded relative to their impact on large numbers of American women. More NIH and private sector funding must be generated for medical conditions that impact the lives of Black women.

Black Women's Health ImperativeThe country's first nonprofit organization created by Black women to help protect and advance the health and wellness of Black women and girls

Black Mamas Matter AllianceThe alliance helps advocate for better legislation to reduce black maternal mortality, highlights necessary areas of research and spreads information about the social determinants of health that influence outcomes like traumatic birth or maternal and infant mortality.

Sister SongSisterSong is a Southern-based, national membership organization; its purpose is to build an effective network of individuals and organizations to improve institutional policies and systems that impact the reproductive lives of marginalized communities

Fertility for Colored GirlsProvides services for underserved Black women and couples. This includes educational programming about treatment options, resources to connect with counselors, financial grants, and monthly support group meetings hosted by seven different chapters across the country,

Linda Villarosa: Journalist

Patrice Peck: Journalist

Laurie Zephyrin, MD: Obgyn, VP Health Care Delivery System Reform at Commonwealth Fund

Reproductive Injustice: Racism, Pregnancy, and Preterm Birth. Davis DA.NY: NYU Press:

Black Lives Matter: Claiming a Space for Evidence-Based Outrage in Obstetrics and Gynecology. Eichelberger KY, Doll K, Ekpo GE, Zerden ML. Am J Public Health. 2016 Oct;106(10):1771-2. doi: 10.2105/AJPH.2016.303313.

Key Facts on Health and Health Care by Race and Ethnicity, Samantha Artiga and Kendal Orgera. KFF, Published: Nov 12, 2019

When Maternity Wards in Black Neighborhoods Disappear:NYT, Kelly Glass, May 4, 2020

A Preventable Cancer is on the Rise in Alabama: The New Yorker, Eyal Press, March 30, 2020
This article originally appeared on Celmatix, where Dr. Piraye Yurttas Beim, who is also an EndoFound Board Member, is the founder and CEO. If you have additional data to share or organizations you would like us to highlight here, please reach out to at info@celmatix.com or info@endofound.org. Please also check back as we plan to expand on this list in the coming weeks. And finally, we urge you to help us raise awareness about this important issue by sharing this in your networks.

# data[].attributes.attachment_link.title
The Disparities in Healthcare for Black Women

# data[].attributes.attachment_link.description
Like so many people across the United States and around the world, my colleagues and I at Celmatix feel deeply outraged by the brutal and senseless murders of Breonna Taylor, Ahmaud Arbery, and George Floyd.

# data[].attributes.body
1. African Americans face higher COVID 19 rates because the lack of trust between doctors and scientists. It is also because pre-existing health conditions which is a result from the lack of proper care in our communities.
2. The mistrust is negatively affecting the African American community because it makes African Americans hesitant to seek help, mainly during emergency events. Then, it increased the community's  chances of contracting COVID 19 because they think that there are deep lies to things like vaccines. This is a result of past incidents where African Americans thought they were receiving a shot for something but instead, they were being injected with something else (a disease I think).
3. One strategy that can be used is info sessions that educate the African American community about what vaccines can do for their health. The next strategy is making sure every part of the community has access to affordable healthcare that has workers who are willing to build trust and treat them like humans. Another strategy would be to place disciplinary actions on healthcare workers that don't take African Americans seriously and their fears or even for healthcare workers that lie to the African American community.
4.https://hbr.org/2018/08/research-having-a-black-doctor-led-black-men-to-receive-more-effective-care
This can help shine some light on the treatment side of COVID 19 and the African American community (this article talks about males but the thinking is very similar with women). Basically, if the community sees more of them in the healthcare field, they are more likely to get answers and feel comfortable enough to share any health concerns/history.
5. I was shocked at the stats in the first article given. I was expecting was less than 61% of Black adults to have a positive view on medical doctors because of the constant fear that lingers in everyone's head about receiving the best care.

# data[].attributes.attachment_link.readable_text
In the U.S., racial and ethnic minorities have higher rates of chronic disease, obesity, and premature death than white people. Black patients in particular have among the worst health outcomes, experiencing higher rates of hypertension and stroke. And black men have the lowest life expectancy of any demographic group, living on average 4.5 fewer years than white men.

A number of factors contribute to these health disparities, but one problem has been a lack of diversity among physicians. African Americans make up 13% of the U.S. population, but only 4% of U.S. doctors and less than 7% of U.S. medical students. ( Of active U.S. doctors in 2013, 48.9% were white, 11.7% were Asian, 4.4% were Hispanic or Latinx, and 0.4% were American Indian or Alaska Native.) Research has found that physicians of color are more likely to treat minority patients and practice in underserved communities. And it has been argued that sharing a racial or cultural background with one's doctor helps promote communication and trust.

A new NBER study looks at how changing this ratio might improve health outcomes - and save lives. Researchers set up an experiment that randomly assigned black male patients to black or nonblack male doctors, to see whether having a doctor of their race affected patients' decisions about preventive care. They found that black men seen by black doctors agreed to more, and more invasive, preventive services than those seen by nonblack doctors. And this effect seemed to be driven by better communication and more trust.

Increasing demand for preventive care could go a long way toward improving health. A substantial part of the difference in life expectancy between white and black men is due to chronic diseases that are amenable to prevention. By encouraging more preventative screenings, the researchers calculate, a workforce with more black doctors could help reduce cardiovascular mortality by 16 deaths per 100,000 per year - resulting in a 19% reduction in the black-white male gap in cardiovascular mortality and an 8% decline in the black-white male life expectancy gap.

A Field Experiment in Oakland

The researchers - Drs. Marcella Alsan of Stanford University, Owen Garrick of Bridge Clinical Research, and Grant C. Graziani of the University of California, Berkeley - wanted to conduct a community-based study, so they recruited black men from 20 barbershops and two flea markets in Oakland, California. "These are very special places in the black community," Dr. Garrick told me. "There's a wide income, educational, and age range. If you have hair, you're going to visit the barbershop every week or two."

They were able to enroll more than 1,300 black men to participate. First, the participants received a monetary ($25) incentive to complete a baseline survey, which asked about socio-demographics, health care, and medical mistrust. Then they received a coupon for a free health screening for blood pressure, BMI, cholesterol, and diabetes at a clinic. They were offered another incentive ($50) to go, as well as a ride if they needed one.

The researchers couldn't find a freestanding clinic with a mix of black and nonblack doctors to partner with, so they created one themselves. They hired 14 male doctors (eight nonblack and six black) to provide these screenings, telling them that the study - officially called the Oakland Men's Health Disparities Project - aimed to improve the uptake of preventive health screening services for black men. What they didn't tell the doctors was that their race was being randomized.

About half of the participants showed up to the clinic for a screening. Those who did tended to be older, have lower self-reported income and health, be unemployed, have less education, and not have a primary care doctor. Once participants got to the clinic and to their private patient room, they were given a tablet showing a photo of their (randomly assigned) doctor, his name, and a list of the services they could select. They saw that two of these screenings, for diabetes and cholesterol, required a finger prick of blood. Then they saw that they could get a flu shot, and some were randomly assigned to see an incentive of $5 or $10 to agree to it.

Participants then talked to their doctor. Doctors were only allowed to provide these five preventive services - all highly recommended, cost-effective interventions - and were told to encourage patients to agree to all of them. During the consultation, patients could revise their selections and have the services done. After the visit, patients filled out a feedback form. Then researchers compared the services provided with the services the men chose before talking to the doctor.

The results were fascinating. In the first stage, before meeting their doctor, participants selected the same number of preventive services, regardless of whether the doctor they saw on the tablet was black. "We hypothesized that if there was aversion, like 'I just don't like a doctor of this type,' that would be elicited at this stage. Because you don't actually interact with someone yet," Dr. Alsan said.

But in the second stage, after talking to their doctor, men who met with black doctors elected to receive more preventive services - especially more invasive services that required a blood sample or injection - than men who met with nonblack doctors. This held even controlling for duration of the visit and physician characteristics. "We can only speak to our study and our population. But it was a very striking and strong finding," Dr. Alsan said.

For example, participants assigned to black doctors were more likely to have their blood pressure and BMI measured than those who saw nonblack doctors. And for invasive tests, only men who saw a black doctor agreed to take up more services than they had initially selected. A participant who saw a black doctor was 20 percentage points (47%) more likely to agree to a diabetes screening and 26 percentage points (72%) more likely to accept a cholesterol screening than those who saw a nonblack doctor.

Men were 10 percentage points (56%) more likely to agree to the flu shot if their doctor was black. "Even among men who had been offered the opportunity to get a $5 or $10 incentive to say yes to the flu shot, some of those men had turned that money down, saying, 'No, I really don't want a flu shot. I just don't want a flu shot,'" Dr. Alsan said. "The African-American doctors were able to convince some of those men who had turned down the money to obtain a flu shot."

The researchers also found that the effects were most pronounced for men with greater mistrust of the medical system. They were the most reluctant to have services done in the beginning, and they were the most likely to change their minds after talking to a black doctor and to have more services done. This is meaningful, as other research has found that black men are more likely to distrust the U.S. health care system than white men, and that this distrust leads to delayed preventive care and worse outcomes.

Trust and Communication

Why would black men choose more services after seeing a black doctor? Looking at doctor notes, patient feedback, and data from a separate survey, the researchers point to a few pieces of evidence suggesting that better trust and communication between black doctors and black patients was what made the difference.

First, because the study was focused on offering preventive care, as opposed to curative care treating illness, the role of the doctor was mostly limited to explaining the benefits of the preventive services and then providing them. Participants knew this, but they were 10 percentage points (29%) more likely to talk about other health or personal issues with black doctors than with nonblack doctors. And black doctors also wrote longer notes about their patients than nonblack doctors.

Second, the researchers gathered additional data by surveying a similar sample of 1,490 black and white men on doctor preferences. Respondents saw a set of black, white, and Asian male doctors, and selected which doctor they thought was most qualified, which they'd feel more comfortable with, and which was most accessible to them.

Both white and black men thought that doctors of their race were about as qualified as other doctors. There wasn't a clear sign of preference. "But when it came to communication, when we asked, Which doctor would you feel more comfortable with? Which doctor would understand you the best? That's when we saw a shift." Dr. Alsan said. Nearly 65% of black respondents and 70% of white respondents reported that a doctor of the same race would understand their concerns best.

"A lot of our job as doctors is to talk to people, and to understand where they're coming from," Dr. Alsan said. "They're sharing some of the most intimate regions of their lives and their concerns with you."

Of course, the precise mechanisms here are difficult to pin down, and the researchers acknowledge that other factors besides communication and trust could be at play. They didn't script doctors' interactions and weren't in the room to observe differences in their care. Perhaps black doctors were somehow better-quality, or maybe discrimination played a role. But the evidence they did have doesn't support these interpretations - on feedback forms, for instance, patients rated both black and nonblack doctors equally positively.

"We think [better communication] is a mechanism behind our results, and we have suggestive findings that support that interpretation. But it would be a great follow-on study to figure out what type of communication [mattered]," Dr. Alsan said. "Seeing what can be taught and what one can learn would be a wonderful next-generation study."

How Diversity Can Improve Care

This study supports the push to increase diversity in the health care workforce. Many racial and ethnic minority patients seek out doctors of the same background - but access is an issue. The survey found that white men were 20 percentage points more likely than black men to say they could access a doctor of their race.

But the researchers and others advise against interpreting these results to mean that black patients should be treated by black doctors preferentially. "We certainly don't want people to take away from this that, hey, if you're not black, you can't relate to black patients," Dr. Garrick said. "If anything, you might think, what may I be missing here?"

Dr. Anupam Jena, a physician at MGH and an economist affiliated with NBER, who was not associated with the study, urged similar caution. However, he said, "We should be aware that empathy and understanding of your patient, perhaps through shared experiences, might have an important causal impact on health," he said.

Dr. Jena noted that what he liked most about the study was that it was so ambitious - it randomized across a large number of patients and set up a separate clinic. He also pointed out that because it focused on preventive care, it's hard to know whether the findings would generalize to care that is provided to sick patients in need of treatment.

But black men are less likely to seek routine and preventative care than other groups, and increasing their uptake could yield significant health benefits. "Prevention is the unsung hero of medicine," Dr. Alsan said. "The amount of premature mortality that you can save or spare is quite remarkable with comprehensive preventive intervention."

And it's not just prevention. "It's also much earlier diagnosis and awareness if there is disease," Dr. Garrick said. "If you look at lower life expectancy for African-American men, there's a lot of late diagnosis of disease, from prostate cancer to cardiovascular disease. And getting these preventative services doesn't just help prevent the diseases, in the case of vaccines, but it also serves as more of an early detection, an early warning system, which is one of the big factors impacting minority health and health equity."

# data[].attributes.attachment_link.title
Research: Having a Black Doctor Led Black Men to Receive More-Effective Care

# data[].attributes.attachment_link.description
In the U.S., racial and ethnic minorities have higher rates of chronic disease, obesity, and premature death. Black patients in particular have among the worst health outcomes, and black men have the lowest life expectancy of any demographic group. A number of factors contribute to these health disparities, but one problem has been a lack of diversity among physicians.

# data[].attributes.body
1. My first measure is Situation-contextual. I chose this because I spend most of my time in school, at work, or at home which I find the most important to my ethnic-self identity.
2. My second measure is Natal. I chose this because being around your family or around where you were born is where you first get a sense of ethnic-self identity. This is the second most important aspect of my ethnic-self identity.
3. My third measure is Behavioral. I chose this because I do occasionally participate in cultural or religious activities which helped me set a behavioral pattern. The friendships I've acquired have also helped me set basic respect patterns to use with others.
4. My fourth measure is Subjective. I chose this because my own preferences have led me to choose my own ethnic group. This is a result of exploring the ethnic world on my own along with influences from people around who think like me. For example, role models who aren't afraid to self identify with the groups they are apart of/ belong to.

# data[].attributes.body
1. The Black church plays a huge role between mental health and the African American community. It is the main source for healing or the place where your healing and overcoming mental illness process starts.
2. Culturally competent care is vital because it's where the provider and patient develop trust. If the provider shows (directly or indirectly) that they don't care about their patient's health circumstances then, the patient will be discouraged from seeking help.
3. One strategy would be to educate older people that hold power in the church so that they can be of more help and prevent any horrific events from happening. Another strategy would be making patient prep courses mandatory. Not the usual prep courses but preparatory measures where the provider is taught some background information about people of color and what they deal with when looking for healthcare. The third strategy would be involving actual trained and certified people within the Black church to help those who feel like it's the last straw to go or even people who attend church in hopes that their issues will fade away.
4. https://www.mcleanhospital.org/essential/how-can-we-break-mental-health-barriers-communities-color
The first section talks about the stigma around mental health in the Black community. I can connect this with the video because it's like a deeper explanation as to why people in this community keep their problems at home, to themselves, or at church
5. One thing that stood out to me was the fact that some church people are willing to go the extra mile to help someone suffering mentally. I think as time progresses a lot more church members will be willing to help. In the past, the older members (most of them) would just say pray it away or to get baptized.

# data[].attributes.attachment_link.title
Understanding Mental Health in Black Communities | McLean Hospital

# data[].attributes.attachment_link.description
The topic of mental illness is often taboo in Black communities. If we eliminate this stigma, can we help people get the mental health care they need?

# data[].attributes.body
1.My score for the Multigroup Ethnic Identity Measure was 40.
2. To me, this score means that I somewhat know what my Ethnic Identity is and I have found a group that I fit into.
3. I think that I am in the middle of a strong and weak bond with the Black/ African American group because I am still learning about myself along with the group’s history.
4. What surprised me was that I am in the middle of strong and weak when I expected my results to be a lower score because I'm still young and learning.

# data[].attributes.body
1.For Rosenberg’s Self-Esteem Scale, my score was 17.
2.My score tells me that I’m almost borderline of having low self-esteem. This helped me better understand my self-esteem through very simple questions about my thoughts and feelings.
3.I believe my score was almost borderline because of personal reasons, the events I go through being a young Black woman, and the results of things I have witnessed for just being Black.

# data[].attributes.body
1. I am in the fifth stage which is called Internalization.
2. I believe that I am in the Internalization stage is because of what I have learned about racism and the conclusions I have come to. Within the last two years, I have concluded that assuming all White people are bad people, adds to the problem and we end up moving 2 steps backward in the process of coming up with a solution.
3. I know I passed through the other stages because of this one event.  I used to avoid all White people on the train because I thought all White people had some kind of hate towards Black people. One morning, this guy would not stop staring me down and trying to talk to me. I believe this middle-aged White lady caught on and got up to come sit next to me until my stop came. She did attempt to small talk with me and asked me if I was okay. After I got off the train, this is when I realized that not every White person has that hatred in their heart.

4. I learned that you cannot carry stereotypes about people with you because one day that person you are stereotyping might actually save your life.

# data[].attributes.body
https://youtu.be/1LYA1KZnT-0