title: Racial Composition Over the Life Course: Examining Separate and Unequal Environments and the Risk for Heart Disease for African American Men.
abstract: OBJECTIVE
  Studies have demonstrated the effects of segregated social and physical environments on the development of chronic diseases for African Americans. Studies have not delineated the effects of segregated environments specifically on the health of African American men over their lifetime. This study examines the relationship between life course measures of racial composition of social environments and diagnosis of hypertension among African American men.
  
  
  METHODS
  We analyzed cross-sectional data from a convenience sample of African American men seeking health care services in an outpatient primary care clinic serving a medically underserved patient population (N=118). Multivariable logistic regression analyses were used to examine associations between racial composition of multiple environments across the life course (eg, junior high school, high school, neighborhood growing up, current neighborhood, place of employment, place of worship) and hypertension diagnosis.
  
  
  RESULTS
  The majority (86%) of participants were not currently in the workforce (retired, unemployed, or disabled) and more than half (54%) reported an annual household income of <$9,999; median age was 53. Results suggest that African American men who grew up in mostly Black neighborhoods (OR=4.3; P=.008), and worked in mostly Black environments (OR=3.1; P=.041) were more likely to be diagnosed with hypertension than those who did not.
  
  
  CONCLUSIONS
  We found associations between mostly Black residential and workplace settings and hypertension diagnoses among African American men. Findings suggest exposure to segregated environments during childhood and later adulthood may impact hypertension risk among African American men over the life course.
authors.affiliation: 1. Department of Behavioral Science and Health Education at Saint Louis University, College for Public Health and Social Justice.
authors.forename: Keon L
authors.initials: KL
authors.lastname: Gilbert
authors.affiliation: 2. Department of Health Management and Policy at Saint Louis University, College for Public Health and Social Justice.
authors.forename: Keith
authors.initials: K
authors.lastname: Elder
authors.affiliation: 3. Washington University School of Medicine Division of Public Health Sciences.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lyons
authors.affiliation: 5. University of Utah, Department of Communication, Huntsman Cancer Institute.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kaphingst
authors.affiliation: 4. Department of Internal Medicine/Primary Care at Washington University School of Medicine.
authors.forename: Melvin
authors.initials: M
authors.lastname: Blanchard
authors.affiliation: 3. Washington University School of Medicine Division of Public Health Sciences.
authors.forename: Melody
authors.initials: M
authors.lastname: Goodman
mesh_terms: D001741:Black or African American; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D006331:Heart Diseases / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D044469:Racial Groups; D012931:Social Environment; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: African American Men’s Health; Health Disparities; Hypertension; Racial Composition; Segregation