When you look at very young boys of color, they look like everyone else once you control for socioeconomic status, according to Oscar Barbarin, PhD, a psychology professor at Tulane University.
"But by the time they reach adolescence, we see stark differences on almost every measure you can imagine," he told participants at a conference co-sponsored by APA and the Substance Abuse and Mental Health Services Administration (SAMHSA) in March. "On everything that's positive, they tend to be the lowest group, and on everything negative, they tend to be the highest."
Exploring what causes these health, educational and other disparities and what to do about them was the purpose of "Pathways to Behavioral Health Equity: Addressing Disparities Experienced by Boys and Men of Color." Designed to explore emerging research and practices that could improve life outcomes for boys and men of color, the event brought 120 clinicians, academics, researchers, advocates, representatives from community programs, state and federal government representatives and others to APA headquarters in Washington, D.C.
"With the tremendous expertise gathered for this meeting, we have a special opportunity to clearly articulate the challenges and systematically bring together the interventions and strategies presented here in order to have a positive collective impact on the life trajectories of boys and young men of color," said psychologist Larke Huang, PhD, director of SAMHSA's Office of Behavioral Health Equity.
Next steps will include efforts to maintain the connections among researchers, community members and others made at the meeting. APA and SAMHSA also plan to explore the idea of developing resources to help people better understand disparities in boys and men of color and identify effective interventions at all levels. In addition, APA plans to pursue advocacy activities with interested partners, said Lula Beatty, PhD, senior director for health disparities at APA.
Understanding gender and identity
While the meeting featured diverse perspectives, psychologists played a major role. Several psychologists, for example, discussed the role of gender and identity in understanding boys and men of color.
Masculinity — the idea that men should be self-reliant, tough and aggressive — can prompt unhealthy behavioral patterns in all men, said psychologist Wizdom Powell, PhD, an assistant professor of health behavior and health education at the University of North Carolina at Chapel Hill. But for men of color, she said, the dynamic is more complex. Historically, she said, black men have shut down their emotions and expressed stoicism to avoid appearing vulnerable to social threats. However, that approach also results in poorer health outcomes.
In one study, for example, Powell and colleagues found that masculinity norms increased African-American men's medical distrust. "The more you felt that you should hold your feelings tight to your chest or disavow closeness, the more likely you were to distrust medical providers," said Powell, adding that such distrust is linked to significant delays in preventive screenings.
In another study, Powell found that believing you should shut down your emotions in the face of everyday racism increased depression symptoms among African-American men.
Suppressing emotions may also lead men to try to numb themselves through high-risk sex and substance use, she said. Plus, men trying to prove their masculinity may engage in gang violence or violence against women and children.
Barbarin called for more attention to a crucial but often-overlooked period in the lives of boys of color: middle school.
Depression, anxiety and other internalizing problems are a major but often ignored problem in this population, said Barbarin. While it's true that girls are generally more depressed than boys, that's not the case for African-American boys, for example. They also have increasing difficulties with emotional regulation until age 15, when the data start showing declines.
Earlier in his career when Barbarin volunteered in schools, religious education programs and community groups, teachers and others would always place him with middle-school boys. While he used to believe that teachers and others were simply irritated by boys in this age group, Barbarin now has more respect for those who knew these boys needed extra help.
"There really is something happening in middle school," said Barbarin, calling for longitudinal studies of boys of color. "While early childhood is very important, because that's when you see the assembling of some of the ingredients, the ‘cooking' happens in middle school."
It isn't just African-American boys and men who face challenges, emphasized Kevin Nadal, PhD, president-elect of the Asian American Psychological Association and executive director of the center for LGBTQ Studies at the Graduate Center–City University of New York. Asian-Americans are frequently overlooked in discussions of disparities even though they are the nation's fastest-growing racial and ethnic-minority group, he said.
One problem is the "model minority" myth, said Nadal. That myth defines Asian-Americans as being very well-educated, successful, law-abiding citizens, he said, explaining that many Asians arrived in the United States in the 1960s as professionals in search of the American dream.
But while some subgroups may be doing better than others, Nadal said, many face disparities in income, education, health and the criminal justice system. Asian-Americans are extremely diverse, Nadal said, pointing out that there are 30 to 40 Asian ethnic groups in the United States.
"Asian-Americans might not even look like each other, yet we lump them into this one homogeneous group and oftentimes don't look at the within-group differences," he said. By failing to disaggregate data for specific subgroups, he said, it's difficult to know how those subgroups are faring. And because people continue to believe the myth that Asian-Americans don't have problems, he said, they tend not to allocate scholarships and other resources to Asian-Americans.
The myth also fuels tension among communities of color, he added. "It tends to create competition for resources, with people trying to debate who's more oppressed," he said.
Changing social determinants
Conference attendees explored possible solutions to the disparities affecting boys and men of color.
Psychologist Howard Stevenson, PhD, a professor of urban education and Africana studies at the University of Pennsylvania, described several interventions he has developed.
In one study of new and veteran teachers, for example, Stevenson has explored how teachers react to what he calls "racial stress." Teachers who feel they have someone they can turn to for help when they have racial conflicts with students of color — and feel less anxious when they and their students don't get along because of racial misunderstandings — are better at managing their classrooms and motivating their students.
"The differences are quite stark with respect to those who feel very threatened by these encounters," said Stevenson.
Stevenson's PLAAY (Preventing Long-term Anger and Aggression in Youth) project uses basketball as a way to teach African-American boys how to cope with anger and conflict. They can then transfer the "in-the-moment" stress reduction and emotional empowerment techniques they learn to situations where they face racial rejection.
A program called SHAPE-UP trains African-American barbers in Philadelphia to be health educators. The program has trained 150 barbers to talk to young heterosexual men about how to reduce their risk of HIV infection and retaliation violence as they cut hair. The idea, said Stevenson, is to use African-American cultural style to help deliver information that can save these young men's lives.
Psychologist Shantel Meek, PhD, a policy advisor for early childhood development in the Administration for Children and Families at the U.S. Department of Health and Human Services, offered suggestions for intervening even earlier in the lives of boys of color.
Take expulsion and suspension in early learning programs, for example. Research shows that children in early learning programs — 3- and 4-year-olds — are suspended and expelled at three to four times the rate of K–12 students, said Meek. And boys of color are suspended and expelled at much higher rates than their peers, setting them on the wrong trajectory even before they begin kindergarten.
To combat this growing trend, the U.S. Department of Education and Department of Health and Human Services issued a policy statement on expulsion and suspension practices in early learning settings last year. The statement offers recommendations to help families, early childhood learning programs and states prevent these harmful practices.
Word acquisition is another area ripe for intervention, said Meek, citing research showing that children from families on public assistance have heard 30 million fewer words than other children by the time they're 3, for example. This so-called "word gap" makes an enormous difference, said Meek, citing lost opportunities for building neural connections and laying the groundwork for future academic achievement.
"The word gap is not a child skill gap; it's an environmental exposure gap," said Meek, adding that communities have launched home visiting programs and public awareness campaigns. "We need to start our investments at birth, before these gaps start to form."
Rebecca A. Clay is a journalist in Washington, D.C.
