A Call to Action for Health Disparities in Boys and Men: Innovative Research on Addiction, Trauma, and Related Comorbidities

Males experience greater morbidity and mortality than females worldwide; however, boys and men from US health disparity populations (e.g., racial/ethnic minority and socioeconomically disadvantaged groups) have significantly poorer health compared with US women and White men.¹ Alarmingly, these differences in sickness and death are not only stubbornly persistent but are, in many cases, deepening.² While the incidence of disease can be similar in many cases for diverse groups of males, boys and men from health disparity populations can experience more severe consequences and outcomes with high risk for illness, trauma, and early death. Poorer health and increased risk of certain health threats (e.g., drug involvement, violence, HIV/AIDS, and incarceration) among males from health disparity populations can impact their full engagement as productive citizens with economic, social, and emotional costs for themselves, their families, their communities, and the nation.

Three generations enjoy a happy moment together: a young boy wrapped in his father’s arms smiles at his grandfather. Printed with permission of Corbis.

Rapid immigration trends in the United States reveal complex health disparities related to factors such as nativity and country of origin. Research suggests that males who are first generation (foreign-born) and second generation (US-born living with at least one foreign-born parent) may differ on various socioeconomic, educational, and health risk factors. Health status, outcomes, utilization, and insurance patterns illustrate interesting paradoxes for immigrant males as they enter and reside over time in the United States. For example, national data from the National Health Interview Survey have shown that although foreign-born Black men were in better overall health than their US-born Black counterparts, they were less likely to be insured.³ Researchers have continued to appeal for better integration of the heterogeneity within immigrant groups incorporating gender, socioeconomic status, and neighborhood contexts in study designs.⁴

Culturally relevant research on risk and protective factors has revealed potential targets for prevention for health disparities in boys and men. Promising prevention programs have been launched in communities across the nation in response to the needs of boys and men who may face negative education, justice, economic, and family outcomes. However, community prevention efforts often lack a strong evidence base, are too small in scale to evaluate effectiveness, and are not economically or organizationally feasible for long-term implementation and sustainability.

HOW CAN PUBLIC HEALTH IMPROVE THE HEALTH OF BOYS AND MEN?

Health disparities in males have been understudied, although data on negative health outcomes across their life span warrant attention. Research suggests a range of factors contributing to poorer health and higher health risks for diverse males including economic opportunity, stress, health care access, and personal responsibility.⁵ The dearth of research specifically addressing the concerns of boys and men and health disparities has left several key questions unanswered for public health: 1) What mechanisms cause poorer health status of males from health disparity populations? 2) How can health disparities in males be prevented? 3) Are there effective health interventions for diverse males? 4) What future public health research priorities are needed to address these disparities in boys and men?

PURPOSE OF THIS SPECIAL ISSUE

To address these questions, in November of 2010 in Washington, DC, a meeting, Health Disparities in Boys and Men: Innovative Research to Reduce Addiction, Trauma and Related Co-morbidities, was convened by federal agencies seeking perspectives from multidisciplinary scientists and community partners to examine conditions that disproportionately negatively impact males. Research and community experts prioritized issues of immediate concern including alcohol and drug use, addiction and comorbid disorders, and the lower likelihood of seeking substance abuse and mental health services. Themes emerged highlighting specific individual, social, and psychological challenges that contribute to disparities in male health and wellness such as historical and interpersonal trauma and violence, detrimental notions of masculinity as barriers to self-care, gender differences in the socialization of boys, and polices that systematize and sustain structural inequalities.

Of particular alarm were the current health disparities for substance use treatment needs of criminal justice populations. There are lower rates of treatment referral for men of color and fewer opportunities for men of color to participate in drug court and diversion programs. Despite advances in domestic HIV interventions, reducing HIV disparities in men of color remains a significant challenge for research and intervention efforts. Culturally relevant, effective intervention and prevention programs that have demonstrated effectiveness and are ready for implementation are sorely needed, particularly for substance use, trauma, HIV, and related comorbidities.

Strategies that focus on significant changes in developmental life stages such as the transition from adolescence to adulthood and the onset of fatherhood for boys to men show exciting promise for dissemination. Together, both research and community partners agreed that meaningful community-based participatory research for health disparities is a commonly desired methodological approach that can integrate cultural responsiveness and a life course perspective for boys and men of color at risk.⁶ The purpose of this special issue is to bring focused attention on health disparities in boys and men examining etiology and approaches to their prevention and treatment particularly in the areas of substance abuse, trauma, and HIV to improve public health. Articles in this special issue are the result of a call to public health researchers and communities to respond to the disquieting issues concerning health disparities in boys and men.

FUTURE RESEARCH CONSIDERATIONS

Current research efforts often lack sufficient inclusion of males of color and diverse attributes (e.g., age, income, nativity) for meaningful analysis. Nonetheless, promising studies have indicated potential risk and resiliency factors worthy of further investigation for health outcomes across development for diverse males. Adequate study participant inclusion can facilitate the conduct of sufficiently powered studies for new discoveries and the advancement of prevention, intervention, and treatment efforts relevant to these groups. Increased, targeted research is needed to unravel the complexities of health disparities in boys and men. Ensuring that adequate numbers of participants representing both genders and health disparity population groups are included in research studies will allow for comprehensive analyses of data by gender and health status outcome. Diverse participant enrollment is necessary and has greatly improved, but it is not sufficient to address health disparities in boys and men. Attention to diversity within groups and points of intersection is crucial.

Boys and men of color hold a unique status in their communities that has yet to be fully realized in evidence-based programs to improve effectiveness. For example, boys and men may be an untapped resource for change as unique opinion leaders and behavioral change agents⁷ for peer- and community-based prevention programs for drug abuse, violence, trauma, and HIV. Communities may need increased capacity and infrastructure to participate in research endeavors and to implement innovative evidence-based treatments personalized for the specific needs of diverse boys and men. Health disparities in boys and men requires thoughtful consideration of research methodology and implementation issues for diverse populations as well the varying gender, family, and socioenvironmental contexts needed for analyses of heterogeneity.

The National Institutes of Health (NIH) has provided unprecedented support and leadership for health disparities through The NIH Strategic Research Plan and Budget to Reduce and Ultimately Eliminate Health Disparities, the National Center of Minority Health and Health Disparities⁸ and new community-based participatory initiatives. Recent research initiatives seek researchers who can study the genetic and environmental factors involved in the genesis of substance use disorders across racial, ethnic, and gender groups, with the potential for new knowledge on disparities in boys and men. In addition, the goals of health care reform may not only provide an opportunity to reduce health gaps and improve health equity, but also include culturally relevant, evidence-based practices for boys and men. The authors propose a call to action for improved research to uncover and resolve the complex and paradoxical health disparities for boys and men of African American, Asian, Latino, and Native American/American Indian heritage to reduce addiction, trauma, and comorbidities.