The problem. Men tend to underreport health problems, underuse health services, have less trust in medical care, and die sooner than women. African American men are less likely to get care, including routine screenings, than other men and than African American women.
Grantee perspective. Clinical psychologist Wizdom Powell Hammond, PhD, MPH, MS, was about 9 years old when her grandfather died from a preventable cancer. "The impact of his loss was uniquely felt by my mom and family," she recalled. "I never got a chance to know him well. I always wondered why he died at age 50."
The family's personal tragedy resonated with Powell Hammond years later when she was a graduate student at the University of Michigan and saw epidemiological data that clearly showed health disparities for African American men. Powell Hammond decided to focus her research on the health of African American men with the goal of helping them "live longer, healthier lives so families and communities can be healthier."
Her research goals meshed with her long-standing interests in human motivation. "I was interested in understanding the psychological factors causing or leading to those disproportionately poor health outcomes. What drives people to do things that are good for them and things that are not so good or health damaging?" she wondered. "If we don't change human motivation or figure out why people engage in health-damaging behaviors, we might be able to build a structure for policy change, but it wouldn't move the needle enough. I wanted to develop more holistic strategies for eliminating disparities—those that would focus on the context and the individual."
Powell Hammond chose the University of Michigan to pursue her MS and PhD degrees in clinical psychology because she could simultaneously obtain her MPH degree. She received her doctorate degree in 2005, but continued to question how psychosocial factors (e.g., age, education, income, health insurance status, and health status)—as well as norms and attitudes about health and masculinity—impact the health of African American men. Although she already combined psychology and public health in her work, she wanted to gain an even broader disciplinary perspective.
In the Robert Wood Johnson Foundation Health & Society Scholars program, Powell Hammond gained exposure to researchers from many fields. She began her two-year interdisciplinary fellowship at the University of California, San Francisco/Berkeley, one of the six universities participating in the Health & Society Scholars program, in 2005. For more information on the program, read the Program Results.
"I was enthralled by this laboratory of scientists who combined their disciplines to solve population health challenges," she said. "It was one of the most transformative career experiences I've had to date."
Research examining health care among African American men. As a Health & Society scholar, Powell Hammond continued the research she had done for her doctoral dissertation focused on the preventive health behaviors of African American men surveyed in barbershops in Michigan and Georgia, as well as at a community college in Southeastern Michigan. Under a competitive research grant from the RWJF program, she expanded this research to California, collecting other data related to psychosocial factors and attitudes about health and masculinity in Oakland and San Francisco.
After Powell Hammond completed her fellowship, she joined the faculty of the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill as an assistant professor of health behavior. In her new position, she expanded her Health & Society scholar's research to include African American men surveyed in barbershops and in a historically black university in North Carolina.
Powell Hammond combined the data from all of her research to inform various analyses, conceptual models, and journal articles. She focused on the impact of psychosocial factors, norms, and attitudes on the use of health care and trust in the medical system among African American men. Along with the Health & Society Scholars research grant, Powell Hammond had support from the National Institute for Minority Health and Health Disparities, the National Cancer Institute, Blue Cross and Blue Shield of Michigan Foundation, and the University of North Carolina Cancer Research Fund.
Results and findings. African American men delay going to the doctor because they do not trust the health care system, not because they want to appear tough or self-reliant, Powell Hammond and colleagues found in one study of 610 Black men aged 20 and older in the four states. Perceived racism and past racial discrimination is the primary cause of this mistrust, according to Hammond and her colleagues.
As reported in the Journal of General Internal Medicine (Vol. 25(12), 2010) Powell Hammond discovered that men who were highly mistrustful of the medical system were more than twice as likely to delay routine check-ups and cholesterol screenings, and three times more likely to delay having their blood pressure checked than men who were more trusting. She also reported that men who believed more strongly in traditional masculinity norms "discouraging emotion disclosure" were less likely to delay getting preventive health services, like blood pressure and cholesterol checks, than men with a weaker belief in such norms.
When combined, these findings, say Powell Hammond, point the way to developing interventions designed to improve the health of African American men. "It's very difficult to modify sociodemographic status, but we can intervene on patient-physician interactions to increase trust, and masculinity norms that push men back from the health care system" she said.
In another study, Powell Hammond and her colleagues evaluated how psychosocial factors contributed to whether or not African American men scheduled and received routine health exams. They reported on findings from research on 386 men that those with a usual source of care and more exposure to health-promoting male subjective norms (perceived social pressure to do or not do something) were more likely than other men to schedule a routine health exam (Journal of the National Medical Association, Vol. 102(4), 2010). Men who had higher medical mistrust and traditional male role norms discouraging disclosure were less likely to get a routine health exam. Men who were older, had a usual source of care, and were exposed more to health-promoting norms were more likely to get a routine health exam.
Powell Hammond noted that male social networks can be used to encourage more men to get preventive screening, and that policy work should focus on ensuring that they have a regular source of primary care.
Continuing research on norms and medical mistrust. The Health & Society Scholars grant has been the "the gift that kept on giving," says Powell Hammond. She used this research in subsequent work that focused on masculine role norms in moderating depression related to racial discrimination and modeling medical mistrust.
By February 2013, Powell Hammond had reported these additional results:
- "Taking it like a man" and dealing with racism through stoicism and emotional control increases depression among African American men, according to a study based on data from 674 men (American Journal of Public Health, Vol. 102(S2), 2012,). The University of North Carolina Center for AIDS Research also provided support for this study, along with Powell Hammond's current research using these data to study sexual risk behavior among African American men.
- Perceived racism in health care is most strongly linked to medical mistrust, Powell Hammond found in a study based on data from 216 African American men (published in the American Journal of Community Psychology, Vol. 45(1–2), 2010). She concluded the men's mistrust is likely to be related to personal characteristics, previous negative experiences (social and health care), and expectations of different treatment by healthcare professionals because of their race.
An emerging leader in population health. Powell Hammond was a 2011–2012 White House Fellow, providing expertise on military mental health based on her experience treating veterans with post-traumatic stress disorder and military sexual trauma during her clinical training. She reported to Secretary of Defense Leon Panetta and worked with senior White House staff, Cabinet secretaries, and other top-ranking government officials. "I had the opportunity to sit at the feet of our nation's leaders as they grapple with issues like returning veterans," she said.
As a result of the experience, Powell Hammond has decided to focus some of her work on males in the military. Under a government contract, she is a consultant to the U.S. Department of Defense on military mental health.
The White House Fellowship and the Health & Society Scholars program were both transformative career experiences for Powell Hammond. "The program has an impeccable reputation," she said of her Health & Society Scholars experience. "People know if you come from that program you've been well trained and are an emerging leader in the field of population health," she said.
At the University of North Carolina, Powell Hammond is also a faculty member at the Lineberger Comprehensive Cancer Center, one of only 40 National Cancer Institute-designated comprehensive cancer centers, and director of the Men's Health Research Lab, which facilitates collaborative dialogue and research on issues surrounding men's health. Under a grant from the university, she is building a research partnership with the University of Kwa-Zulu Natal in South Africa to study masculinity and HIV risk behavior among Black South African men. She is also a junior investigator on several HIV grants from the National Institutes of Health.
Powell Hammond's expanding roles in health research are a direct result of her leadership and research development opportunities, including the Health & Society Scholars program. "The other scholars," she said, "pushed me to think outside of my disciplinary silos. We, as a group of scholars, are so grateful for the gift of the program. None of us would be where we are without it."
In December 2013, Powell Hammond received a 2014-2016 Kaiser Permanente Burch Minority Leadership Development Award. The program aims to enhance the voices and leadership development of minority researchers committed to improving service to the underserved and reducing health and healthcare inequalities by strengthening support for public hospitals and other safety net providers.
RWJF perspective. RWJF created the Health & Society Scholars program in 2001 to build the field of population health. "There is a growing recognition that health is the result of the interaction of multiple factors including socioeconomic and physical environmental factors and health behaviors," said Pamela G. Russo, MD, MPH, senior program officer. "The evidence shows that these types of factors play a much larger role in determining health at the population level than do the traditionally considered health care and biological determinants of health."
"The program seeks to integrate paradigms and knowledge from a variety of disciplines to develop an understanding of how these determinants affect the health of populations, and thereby to design interventions with greater power to reduce health disparities," said Russo.
#HSS Powell Hammond research: African-American men delay health care because they do not trust the system
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