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. Author manuscript; available in PMC: 2016 Jul 1.
Published in final edited form as: Psychol Men Masc. 2015 Feb 9;16(3):274–283. doi: 10.1037/a0038730

Unheard Voices: African American Fathers Speak about their Parenting Practices

Otima Doyle 1, Trenette T Clark 1, Qiana Cryer-Coupet 1, Von E Nebbitt 1, David B Goldston 1, Sue E Estroff 1, Ifrah Magan 1
PMCID: PMC4562768  NIHMSID: NIHMS658707  PMID: 26366126

Abstract

Researchers have called for qualitative investigations into African American fathers’ parenting practices that consider their social context and identify specific practices. Such investigations can inform the way we conceptualize African American fathers’ parenting practices, which can in turn contribute to prevention interventions with at-risk youth. We conducted semi-structured, qualitative interviews about parenting with 30 self-identified, African American, biological fathers of pre-adolescent sons at-risk for developing aggressive behaviors, depressive symptoms, or both. Fathers provided descriptions of their parenting practices, which were at times influenced by their environmental context, fathers’ residential status, and masculine ideologies. Our systematic analysis revealed four related themes that emerged from the data: managing emotions, encouragement, discipline, and monitoring. Of particular note, fathers in the current sample emphasized the importance of teaching their sons to manage difficult emotions, largely utilized language consistent with male ideologies (i.e., encouragement rather than love or nurturance), and engaged in high levels of monitoring and discipline in response to perceived environmental challenges and the developmental needs of their sons. The findings provide deeper insight into the parenting practices of African American fathers who are largely understudied, and often misunderstood. Further, these findings highlight considerations that may have important implications for father-focused prevention interventions that support African American fathers, youth, and families.

Keywords: African American fathers, parenting practices, prevention, at-risk youth, qualitative


Fathers play an important role in families and have both direct and indirect effects (e.g., via their relationships with the youth’s mother) on youths’ well-being (Lamb & Tamis-LeMonda, 2004). Fathers engage in multiple roles within families, such as child care providers, protectors, moral guides, and financial providers. The importance of these roles vary by context, evolve over time, and across racial and cultural groups (Lamb & Tamis-LeMonda, 2004). Nonetheless the parenting literature to date has been based to a large extent on research with mothers. Although some overlap may exist in the roles of mothers and fathers in families, fathers’ roles likely differ from mothers’ roles in some respects. Moreover, understanding cultural variations in fathering requires investigations among subgroups of fathers. One group of interest is African American fathers.

Many African American fathers are involved in their children’s lives, often regardless of their residential or socioeconomic status, relationship status with their child’s mother, and sometimes more often than White or Hispanic fathers (Edin, Tach, & Mincy, 2009; Jones & Mosher, 2013; King, 1994; King, Harris, & Heard, 2004; Nebbitt, Lombe, Doyle, & Vaughn 2013; Seltzer, 1991). Further, many African American fathers show relatively equitable childrearing responsibilities with their children’s mothers (McAdoo, 1988). The prevalence and extent of African American fathers’ involvement in parenting offers an opportunity to engage them in prevention interventions for at-risk youth that may enhance fathers’ capacity to buffer their children against negative outcomes (Caldwell, Bell, Brooks, Ward, & Jennings, 2011; Caldwell, Rafferty, Reischl, De Loney, & Brooks, 2010). This may be particularly important as many African American youth are often at high risk for negative outcomes such as violence and depression (Reingle, Jennings, Lynne-Landsman, Cottler, & Maldonado-Molina, 2013; Roberts, Roberts, & Chen, 1997).

African American Fathers’ Parenting Practices

Fathers of various racial and ethnic backgrounds engage in parenting practices, such as supervision, monitoring, discipline, encouragement, and support, which are associated with decreases in depressive symptoms, aggression, and delinquency among youth (Amato & Gilbreth, 1999; Hoeve et al., 2009; Plunkett, Henry, Robinson, Behnke, & Falcon, 2007). Specifically, some African American fathers have been found to be accepting, affectionate, nurturing (Doyle, Pecukonis, & Lindsey, 2013; Schwartz & Finley, 2005), and to have close relationships with their children (King, Harris, & Heard, 2004). Higher emotional support from fathers has been associated with less depressive symptoms and lower levels of depression among African American adolescents (Bean, Barber, & Crane, 2006; Zimmerman, Ramirez-Valles, Zapert, & Maton, 2000; Zimmerman, Salem, & Maton, 1995). Fathers’ behavioral control has also been associated with less delinquency among African American youth (Bean, Barber, & Crane).

Some African American fathers use an authoritative parenting style; that is, they may display both parental acceptance (e.g., support, affection) and parental control (e.g., supervision, discipline; Toth & Xu, 1999). High levels of encouragement and supervision among fathers also have been associated with low levels of delinquency among African American youth living in public housing projects (Nebbitt et al., 2013). Low-income African American fathers in one study tended to prefer physical punishment over verbal discipline. However, even when they used physical punishment, they continued to provide affection (Staples & Johnson, 1993). In a qualitative study investigating parenting in violent neighborhoods, it was found that African American biological fathers and father figures, such as grandfathers, stepfathers, and uncles, engage in an array of parenting practices centered on keeping their pre-school children safe (Letiecq & Koblinsky, 2004). Some of these practices appear relatively consistent with previously identified parenting practices among African Americans such as high levels of parental monitoring (i.e., consistent supervision, restricting youth’s contacts within the neighborhood), whereas others were newly identified. The latter included educating children about safety and survival tactics, and engaging in efforts to improve the community such as confronting trouble makers or engaging in community activism.

African American Fathers’ Parenting and Masculinity

African American fathers’ constructions of fatherhood reflect beliefs about masculinity or masculine ideologies endorsed by many African American men. Examples of African American males’ masculine ideologies include restricted emotionality as well as emotional connectedness, self-reliance or autonomy, family connectedness and responsibility, toughness or physical strength, and competitiveness (Hammond & Mattis, 2005; Hunter & Davis, 1992; 1994; Hammond, 2012; Caldwell, Antonakos, Tsuchiya, Assari, & De Loney, 2013; Roberts-Douglass & Curtis-Boles, 2013). Nonresident African American fathers in one sample highly endorsed three specific masculine ideologies identified via an exploratory factor analysis of Hammond and Mattis’ (2005) Masculinity Salience Scale (Caldwell et al.). The first, culturally based masculinity includes expressing love for family and friends, being a good provider, and being a good parent. The second, hegemonic masculinity refers to having power, being physically strong, and being in control of a relationship. Third, interconnected masculinity is defined as fighting for the rights of others and giving something back to the community. The authors found that culturally based masculinity ideals among nonresident African American fathers, were related to fathers’ depression and mental health (Caldwell et al.). In one study, African American men reported that many of their own ideas about what it means to be a man and to be masculine were learned from their own fathers (Roberts-Douglass & Curtis-Boles). Some authors note differences in adolescents’ levels of traditional gender role orientations based on whether or not African American fathers, particularly those from low-income backgrounds, reside in the youths’ home. More specifically adolescents who did not reside with their fathers perceived themselves to be less masculine than adolescents who resided with their fathers, despite their desires to be as masculine as their comparison group (Mandara, Murray, & Joyner, 2005). Unfortunately, none of these studies linked masculinity ideals with parenting practices, leaving a gap in our understanding of the masculinity ideals-parenting practices interplay.

Accounts of parenting from the perspectives of African American fathers are particularly rare despite the fact that such accounts can clarify considerably our understanding of the unique aspects of their parenting practices, particularly for fathers of pre-adolescent youth. Qualitative investigations conducted with African American fathers can highlight specific parenting practices important to fathers, as well as provide a broader undersanding of the gendered, cultural, and social contexts that influence their parenting practices. In an attempt to address these topics, our objective was to gain a broader understanding of African American fathers’ perceptions of their parenting practices. Specifically, we were interested in how fathers describe their efforts to promote healthy behaviors and emotions, as well as positive coping in their at-risk, pre-adolescent sons.

Methodology

The data presented in this study were collected as a part of a broader pilot study that focused on African American fathers’ perceptions of their parenting experiences and father focused prevention interventions. This information was gathered as an initial step in the process of developing father-focused prevention interventions for at-risk, pre-adolescent African American male youth. We focus on male youth because fathers likely have differential effects on sons and daughters (Caldwell, Wright, Zimmerman, Walsemann, Williams, & Isichei, 2004; Mandara, Murray, & Joyner, 2005). The study was informed by an ecological systems perspective, which calls for the exploration of individual, family, neighborhood, and societal influences (Robbins, Chatterjee, & Canda, 1998) on fathers’ parenting experiences and perspectives of father-focused programs. Our approach to studying these matters from a contextual perspective was influenced by conversations with community liaisons and stakeholders, and related fatherhood literature (e.g., Hawkins & Dollahite, 1997; Jarrett, Roy, & Burton, 2002; Roopnarine, 2004). The current analysis is focused on African American fathers’ descriptions of their parenting practices, particularly their efforts to promote healthy emotions, behaviors, and coping in their sons. As a relatively new area of research, a qualitative approach is appropriate for examining how African American fathers perceive their parenting practices, the parenting constructs they consider important, and the masculine ideologies that might influence or be reflected in fathers’ parenting practices. The information derived from such an investigation can contribute to prevention and treatment intervention development in a number of ways including clarifying the needs of the target population and helping us to better understand the processes that might lead to better outcomes among this population (Rounsaville, Carroll, & Onken, 2001).

Procedure

Participants were recruited from a small Mid-Atlantic city and its surrounding areas. Community liaisons and research staff utilized flyers and word of mouth to advertise in local businesses, such as barbershops, churches, community centers, and during neighborhood youth activities such as baseball games. Those interested completed a screening interview to determine eligibility based on their sons’ risk status. We intentionally defined youths’ risk for developing aggressive behaviors or depressive symptomology broadly and in the context of community, family, or individual risk. Youth were considered at-risk if fathers reported any of the following as “at least somewhat of a problem” in their communities: crime and violence, drug use or drug dealing, inadequate public transportation, poor quality schools, tension between the police and the community, or tension between residents in the community. Youth were considered at family-level risk if fathers reported that their financial resources were “not enough to get by” or “barely enough to get by” in response to the following question: “How would you describe your financial situation today?” Youth also were considered to be at family-level risk if their biological father was non-residential. Non-residential father status was assumed to reflect a level of disruption in the parents’ relationship. Individual risk was operationalized by fathers’ expressed concern about the potential for future behavioral problems based on their sons’ current functioning (e.g., already displaying some aggression). Fathers were ineligible for the study if they appeared to be actively psychotic, under the influence of substances, or reported involvement in an active domestic violence or child abuse case. The number of participants recruited was based on our teams’ capacity to conduct interviews and analysis, the duration of the study period, and on our estimation of a sample of sufficient size to include diverse experiences and allow for commonalities to emerge (Tuckett 2004).

Eligible fathers were invited to participate in an individual interview at a location and time convenient for them. Interviews were primarily conversational with follow up probes based on interview guide topics that arose in prior work with similar fathers and our review of extant literature (see Appendix 1). Interviews lasted approximately 1–1.5 hours and were conducted by African American female mental health professionals. With the consent of participants, the interviews were digitally recorded. To triangulate self report information and to characterize the sample (Bryman 2006), we included demographic questions such as race, income, and household dynamics; and a parental monitoring scale (Caldwell et al., 2010; Jacobson & Crockett, 2000). Parental monitoring was measured using a five-item scale that assesses fathers’ knowledge of their sons’ whereabouts and activities. The scale ranges from five to 20, with higher scores indicating more monitoring (Caldwell et al.; Jacobson & Crockett). In the current sample, the mean of the parental monitoring scale was 16.30 (SD = 2.49; range = 9.30–18.43). In order to reduce respondent burden and maintain consistency across interviews, fathers with more than one son were asked to focus on their oldest son as the focal child for the interview. Fathers were compensated $25 at the conclusion of their interview.

Participants

Participants included 30 self-identified, African American, biological fathers of a pre-adolescent (8–12 years of age) son who was at broad risk for developing aggressive behaviors, depressive symptomatology, or both. Of those who were screened for participation, one father declined, two were no shows, and one expressed interest, but was unable to participate due to circumstances beyond his control. Fathers were diverse in terms of age, income, neighborhood context, and residential status (see Table 1). Five of the fathers had primary or sole custody for the target son and were no longer romantically involved with the target sons’ mothers. Thirteen fathers identified themselves as the primary disciplinarian of their sons in response to the following open-ended question: “Please tell us who is the main person to discipline your son.” Another 12 indicated that they shared the disciplinarian role with their sons’ mothers. Of these, a small group indicated that though disciplinary responsibilities were shared, the bulk of this responsibility remained the fathers’. Only five fathers identified their sons’ mothers as the sons’ primary disciplinarian.

Table 1.

Sample Demographics (N = 30)

Range M SD
Age 28–60 40.67 8.66
Income $7,800–$175,000 $60,361.54 $42,785.91
Number of biological children 1–7 3.00 1.58
Number of biological sons 1–6 2.03 1.07
Number of women fathered children with 1–5 1.73 0.98
Parental Monitoring (target son) 9.30–18.43 16.30 2.49

N

Financial Situation*
  No enough or barely enough to get by 11
Neighborhood Concerns*
  Poor quality schools 15
  Not enough police protection 12
  Crime and violence 12
  Drug use or dealing 12
  Inadequate public transportation 9
  Tension between police 9
  Tension between residents 8
Concerned about son’s future behavior problems* 13
Residential fathers (at the time of interview)* 20
Disciplinarian-Primary role 13
Disciplinarian- Shared role 12

Note: Responses to items marked with an asterisk were used to determine eligibility. Frequencies for neighborhood concerns represent responses ranging from “at least somewhat of a problem” to “a big problem.”

Data Analysis

The recorded interviews were transcribed verbatim. The QSR NVIVO software package (Version 9; QSR, 2008) was used to manage and organize the text data for coding, comparison, and analysis. Using an inductive approach, emergent themes were systematically identified by the research team (Schutt 2012; Padgett, 1998; Strauss & Corbin, 1998). The team consisted of a PhD social worker researcher (also a licensed clinical social worker), a psychiatry resident physician, and two bachelor-level volunteers. All coders were Black females (i.e., African American and Cape Verdean) who had a myriad of lifelong experiences with a diverse range of Black men and fathers. None were mothers.

Codes and codebook development

The codes and subsequent code book were developed via an iterative process (DeCuir-Gunby, Marshall, & McCulloch, 2011). We began by randomly selecting nine transcripts for open reading by each team member. After this open reading, we met to nominate codes that were broadly inclusive of emerging themes across the interviews. We coded these nine transcripts in two phases. In the first phase each member of the coding team independently coded the first transcript, subsequently met to discuss common, recurrent themes, and develop the first iteration of the codebook. This process was repeated for the second and third transcripts. In the second phase, the remaining six of the nine randomly selected transcripts were divided and assigned to each coder to be independently coded (i.e., two per coder) using the most recent iteration of the codebook. Subsequently, the team met to refine the codebook in an ongoing process of concept testing, theme definition, and component identification as a way to concentrate and organize the material. The codebook was finalized when: 1) no additional codes emerged from the transcripts; 2) codes were consolidated and reduced into themes, with components and dimensions of those themes similarly organized; and 3) the coders reliably applied the codebook to the transcripts (see coding reliability below). Open coding and consensus (see below) were also used in this process (Sanders & Cuneo 2010).

Coding reliability

Throughout the codebook development and during the coding process, we assessed inter-rater reliability (IRR) using five transcripts. After each measurement of IRR, we held a team meeting to discuss sections of transcript that fell below 2/3 agreement. Coding differences were resolved via consensus and if necessary, the codebook was revised. To further ensure that we captured relevant themes during the coding process, six of the transcripts were subsequently coded by two coders. We kept detailed notes regarding the data analysis, audiotaped team meetings (Bloomberg, 2008), and searched for cases within the sample that were not consistent with (or disconfirmed) developing themes to ensure methodological transparency (Campbell et al., 2013). We employed several techniques to examine the assumptions and interpretations of the team and explore alternate explanations of the data including coder debriefing, open discussions about researcher biases and assumptions, consultation with an expert qualitative researcher, and participant feedback regarding findings (Bloomberg; Padgett, 1998).

Open, axial, and selective coding

We used open coding, which is a process of identifying themes, their properties and dimensions (Strauss & Corbin, 1998). We also used axial coding, which is the process of examining the relationship between themes and subthemes based on their properties and dimensions (Strauss & Corbin). Open and axial coding, though often described as distinct processes for educational purposes, are better described as iterative processes that often overlap (Strauss & Corbin). Finally, we used selective coding (i.e., the integration of major themes) to develop a preliminary conceptualization of study participants’ parenting practices (Ryan & Bernard 2003; Strauss & Corbin).

Results

Four interrelated themes about African American fathers’ parenting emerged from the data analysis: managing emotions, encouragement, discipline, and monitoring. As the analysis is presented, we make specific note of themes which differ based on environmental factors and fathers’ residential status. Themes and exemplar quotes are presented in the vernacular in which they were spoken. Names have been replaced by pseudonyms. Given the risk status of the sample and our interest in informing father-focused prevention interventions, we intentionally inquired about fathers’ efforts to assist youth in managing their emotions. As such, we describe this theme first; no further significance is attributed to the order in which themes are presented.

Managing Emotions

Fathers reported that assisting their sons with the regulation and appropriate expression of emotions was an important fathering task. Some fathers expressed concerns about their sons suppressing emotions such as anger. Jay explained “That’s not good for you because you’re internalizing a feeling; you’re angry and you need to express that.” Noting the importance from a gendered perspective, Chester said “we as men have been handicapped emotionally. So I encourage them to express themselves, talk. I let them share their viewpoint or how they’re feeling because a lot of times we don’t. And that can hurt you.”

Rather than suppressing emotions, fathers often described their efforts to promote their sons’ verbalization of their emotions, which sometimes included “coach[ing] them through whatever he’s going through” (Charles). Similar to other fathers, Lorenzo gave his son permission to express his emotions. Lorenzo noted “…to kind of defuse the moment…. I always told ‘em ‘It’s fine if you wanna yell, shout, scream, cry.”

Fathers also said that they emphasized the temporary nature of difficult situations and the importance of having positive expectations for the future. Jay stated “And it’s something else I try to tell him too; get over it, those things you gotta get over as quick as possible, because when you carry that, it hinders you. It’ll hurt you.” Thomas encouraged his son to mourn the loss of his friend, and also cautioned him, “Being sad is alright, but you shouldn’t let it… take over your whole…feeling for that day and for that week. You be sad for a period, and then try to find a positive out of it.’

Fathers described strategies that they suggested or taught to help their sons manage their emotions particularly those related to anger and resulting from conflicts. When dealing with difficult emotions, several fathers suggested the use of relaxation strategies. For example, many fathers suggested that their sons “breathe through it” (Dominick). Jeffery stated “I’m like if he frustrated, just don’t be angry about it; if you can, just walk away from the situation and just try to relax yourself.”

Fathers also suggested other outlets to help their sons manage their emotions. Norman said he teaches his son “how to release [his] frustration through music.… It’s fun and you learning, and it’s serious, and it’s therapeutic.” Thomas stated “I tell him if he’s angry, it’s okay to be angry; it’s just what you do with the anger. You can either be positive or negative. And that positive, you can go exercise, workout, stuff like that; or you can draw or you can write music or you could do that with the anger verses throwing something, punching something, kicking something.” Dominick discussed a preventative approach to teaching his son how to manage his stress and anger. He stated “So it’s through our daily physical exercise, our activities; we go through meditation…breathing… stretching….why we eat…the food that we eat. So now it’s habit for them, so even if they’re apart from me.”

Encouragement

Fathers noted that another important aspect of parenting was encouraging their sons to develop their interests in sports or hobbies, to keep trying despite challenges, and to always do their best. Jay stated “He loves to debate. So, alright - if that’s what you want to do, you can do it. Just put your mind to it.” Stuart noted the importance of “patience and time and showing interest” in his son. He stated “If your son is good at something, especially a sport…encouragement goes a long ways…Is he smart…? He’s not a nerd, he’s smart.” Lorenzo stated “He loves to play basketball and loves to play football. He’s a little guy, but so what…I encourage him to play….” This sentiment was echoed by Kevin who noted that “affirmation is essential. So we have to constantly encourage as well as affirm him in certain areas.” With regard to trying and failure, Kevin further stated “there’s nothing wrong with trying. And you won’t always fail. And failure comes from not trying. So because you tried and failed doesn’t make you a failure.”

Some fathers’ comments have highlighted the relationship they perceived between encouragement, support, providing love and affection, and “being there;” that is, being available and present in their sons’ lives. Jay stated “I tell him every day, ‘I believe in you.’…And I think to prepare him, we need to say that 20 times a day, ‘I love you; I believe in you; I love you; I believe in you.” Stuart stated “I mean being there, you know, support… keep his spirit up high, complementing him, to never give up.” Several additional fathers made comments about the importance of providing love, affection or support, independent of encouragement per se. The similarities and differences between these terms (i.e., love, affection, support, encouragement), from the perspective of African American fathers, is not clear at this time.

Discipline

African American fathers saw discipline as a very central paternal task, and as a means to shape desired behaviors and to help their sons develop as healthy African American males. Several approaches to discipline were described including “old school” methods such as spanking and physical exercise; removing privileges such as the phone, computer, or sports participation; and providing incentives and rewards for desired behaviors.

“Old school” disciplinary methods such as spanking or physical exercise were described relatively often. Reflecting on a conversation with his now preadolescent son, Dominick stated,

When he was 5 or 6, he asked me why do I have to spank him. Why can’t I just love him? And I was like, ‘Well if you do what you’re supposed to do, then you won’t get the spanking. A spanking is a reminder, it’s to get your attention and it comes with instruction. It’s like when you learn how to follow the instruction without needing me to remind you or get your attention, you’ll no longer get it.’

A couple of fathers explained that these methods were reserved for particular circumstances, specifically in response to severe behavioral infractions. For example, Wallace noted that he spanked “…only if he do something real serious to the point that I strongly disagree with it.” Similarly Rodney stated “it’s gotta be really bad, he’ll get a spanking.” Lee also supported the use of spanking by his son’s step-father. He recalls telling the step-father “And if he do something wrong, you don’t have to call me. If you feel like he deserve a [spanking, spank him].” Despite the frequent references to methods of corporal discipline, several other fathers specifically noted that they did not spank their sons because it “wasn’t effective” or because they “don’t believe in spanking … because it’s not necessary.”

Some fathers also removed privileges, lectured or explained consequences for behaviors, and provided incentives for desired behaviors. Fathers removed privileges such as use of video games, computer, television, or participation in sports’ games or practices. Fathers who endorsed this approach often noted its usefulness. They made statements such as “Taking the things that he likes the most … does it every time” (Reggie) and “That gets his attention pretty good” (Rodney). Some fathers also used monetary or other incentives to promote and reinforce desired behaviors. Damon described his “version of time out where I just have him sit down and I’ll have him write what he did and why it was wrong. Why he felt like he needed to do that to get his point across and … what other things can he do to get his point across other than yelling at people and talking to people in a disrespectful way.”

Several, but not all fathers explained to their sons the consequences for inappropriate behavior and provided rationales for limit setting and expected behaviors. For example, Jackson recalled saying ‘Son, look, this is why you’re in trouble ‘or… ‘This is why I’m reacting this way.’” Ronald reported being very careful to distinguish between his disapproval of his son’s actions versus his son himself. He stated “I…make it clear, ‘You understand; you’re not stupid, you’re extremely intelligent. But that was a stupid act. And do you know the difference?’”

Monitoring

The last important facet of parenting emphasized by fathers was monitoring of their sons’ activities in a variety of areas. These included homework, television and music exposure, activities, friends (and friends’ parents), and their sons’ whereabouts. Fathers’ descriptions of monitoring practices sometimes reflected their residential status, neighborhood context, or both. Regarding homework, fathers reported monitoring it to ensure that it was complete, correct, and neat. Muhammad stated “I’m really aggressive with him.…When I come home, I check in with homework, how was the day at school.” Thomas, a nonresidential father, utilized the phone to monitor his son’s school work. He stated “And I try to talk to him every day but if not, at least 3 times a week while I’m at work. So I call him soon as he get home from school and he’ll tell me if he has homework, if he don’t have homework, what he’s working on. And what I do if he’s got a problem with something, I go to the library, check a book out.”

With regard to friends, fathers generally reported that they knew their sons’ friends and their parents. Some also reported attempts to influence the type of friends to whom their sons were exposed. For example, David stated “I try to surround them with kids I want them to be like.” He described those kids (and their parents) as people who have “a foundation of God in they life, which is the foundation for right and wrong.” Fathers also described attempts to keep their sons away from youth they viewed as negative influences. David stated “I’m just keeping it real, if I can’t see no goodness in you, I’m not gonna let you associate with my kids.” Similarly, Danny stated “I try to keep ‘em from around people I deem potentially negative to them.” According to Rodney one of his son’s friends is “very mannerable…but…doesn’t necessarily live in like the best neighborhood.” As a result of this concern, the friend tended to go to Rodney’s house to play.

The study participants also reported monitoring their sons’ interactions with their peers. Keith stated “I keep my eyes on him. All his friends, I scan ‘em down, question them and everything.” Danny stated “Like when I come outside, they’re not free to just go outside and just play; they can’t go outside unless I’m sitting outside….” Some fathers described the explanations they provided to their sons with regard to setting limits on their sons’ interactions with peers and within the neighborhood. Theron noted “There’s a lot of gangs out there and I try to talk with him all the time about the different gangs and organizations that’s out there that I don’t want him to be involved with, and that peer pressure is really strong out there. So I talk with him a lot about that.” Also regarding gangs, Dennis stated

‘Cause the ones you see over there ganged up like that’, I point it out to him, I said ‘They don’t even suppose to be over there; they over there doing something illegal …. Cause every time they see the police car …they running and ducking … behind bushes and apartments and stuff like that.’ So I say, ‘Just stay away from that activity; keep your distance, cause at some point somebody’s gonna come by there shooting. …You remember that.’

Fathers also reported the need to “monitor what’s around us, what are we doing, and how we’re doing it” (Reggie). Expressing concerns about his son’s environment, Omar stated “he got a lot of people that don’t know how to treat kids like kids no more. They … just do anything around him…they don’t respect a child no more. And I try to keep him from that type of stuff.” Due to concerns about gangs and violence in his neighborhood Dennis reported diligently monitoring his son’s whereabouts. He stated “So I try not to let him get too far out of sight. I usually check on him ‘bout every 30 minutes or hour if he’s out in the community…make sure he’s where he’s supposed to be… if something happens, I can get to him.” When he observes that “too many of the friends keep coming around there that I’m not that familiar with” or that people are “arguing and fussing,” Dennis indicated that he removes his son and son’s friends from the situation. He stated “I don’t really explain to them all the time what I’m doing it for, but I’ll just figure, ‘Come on; let’s go for a ride or something.’ You know, like that. Just that way they won’t be around.”

Discussion

We sought to expand our understanding of African American fathers’ perceptions of their parenting practices by interviewing a sample of 30 African American fathers with biological, pre-adolescent sons at-risk for aggression, depression, or both. Specifically, we were interested in how African American fathers promote healthy development and positive coping in their sons. In detailed, semi-structured interviews, African American fathers elaborated on four facets of fathering they considered important in relation to their pre-adolescent biological sons’ healthy development.

Three of four of these themes are consistent with the sparse yet growing literature documenting African American fathers’ engagement in the following parenting practices: monitoring ( Letiecq & Koblinsky, 2004; Nebbitt et al., 2013; Toth & Xu, 1999); encouragement (Nebbitt et al.), and discipline ( Denby & Alford, 1996; Staples & Johnson, 1993; Toth & Xu). Consistent with and reflecting the qualitative data analysis, monitoring was highly endorsed by fathers in their responses to the parental monitoring questionnaire. In our study, fathers’ degree of monitoring, particularly with regard to frequency and level of vigilance was influenced by their neighborhood context. That is, many fathers of sons living in neighborhoods marked by gang activity and crime described parenting practices that involved higher levels of monitoring than other fathers. At least one father described a creative way of removing his son and sons’ friends from risky situations (i.e., taking them for a ride). This component of monitoring is similar to the practices described in a sample of African American biological and social fathers who attempted to restrict pre-school youths’ neighborhood contacts and educate youth about safety and survival tactics (Letiecq & Koblinsky, 2004). The current findings extend the evidence for these types of practices to fathers of pre-adolescent at-risk youth.

Fathers also appeared to take discipline seriously, which was evidenced not only in their interview conversation, but also by the large percentage of fathers who felt they played a major, if not primary, role as their sons’ disciplinarian. Study fathers’ use of physical discipline was also consistent with previous literature that documents a greater use and acceptance of spanking among low-income and African American parents (primarily mothers), compared to others (McLoyd & Smith, 2002; Thomas & Detlaff, 2011; Horn, Joseph, & Chen 2004). The descriptions of African American fathers’ use for and limits of spanking appear to be consistent with the description of spanking practices provided by Denby and Alford (1996). That is, spanking is enacted for the good of the child in an effort to develop a child’s sense of self control and responsibility, rather than as an expression of the parents’ anger or frustration (Denby & Alford). Interestingly, research demonstrates that, for some African American parents, use of physical discipline such as non-abusive spanking is not necessarily associated with negative youth outcomes, and may in fact, yield some benefit (e.g., Horn, Joseph, & Chen). Notably, even those who used physical punishment also used an array of additional discipline techniques.

The empirical literature exploring the parenting practices endorsed in our sample, are largely consistent with conceptual underpinnings that include two widely accepted dimensions of parenting practices described by multiple researchers: parental acceptance (i.e., encouragement, warmth, nurturance) and parental control (i.e., discipline, monitoring; Baumrind, 1971; Rohner & Khaleque, 2005). The findings from this study seem particularly consistent with parental control, whereas the findings appear only partially consistent with Baumrind’s conceptualization of parental acceptance. Specifically some fathers in the current sample discussed warmth, and the provision of love and support in conjunction or interchangeably with encouragement. The majority of fathers, however, overwhelmingly emphasized only encouragement, without referencing love or support as a parenting practice.

Fathers’ focus on encouragement in the current sample may reflect the vocabulary of maleness and masculine ideologies that call for the restriction of emotional expression (Hammond, 2012) and the rejection of feminine ideals or characteristics (Courtenay, 2000). Arguably, words such as nurturance, warmth, and love may reflect feminine traits, and therefore, not be frequently endorsed by many African American fathers, particular in relation to other males. Emphasizing encouragement may be seen as an acceptable way of expressing care and concern (i.e., warmth and support) within a masculine context. The notion of “being-there” may be another example of acceptable masculine expression, and may reflect the social realities of some African American fathers. “Being-there” was also described interchangeably with encouragement by some fathers in the current sample, and the importance of “being there,” has been noted in previous research with African American fathers (Nelson, Clampet-Lundquist, & Edin, 2002; Lemay, Cashman, Elfenbein, & Felice, 2010). It is also possible that fathers engage in or describe emotional components of parenting in father-son relationships differently than researchers. Our study suggests that the narration of maleness and parenting by research participants could sharpen and inform future research. The configurations, vocabularies, and practices of our participants are a contribution to empirical grounding for understanding how African American men parent their sons.

Masculine ideologies also appear to be reflected in final theme that emerged from the data analysis: managing emotions. That fathers promote healthy coping strategies to help their sons manage their emotions implies that they are aware of masculine ideologies which call for stoicism or emotional restrictiveness, and intentionally counter these messages by giving their sons permission to express their emotional selves albeit sometimes within certain limits, for example restricting grief or sadness to short time periods. It is notable however that rather than emphasizing emotions such as sadness, the majority of fathers who spoke about managing emotions focused primarily on anger. This may also reflect a rejection of a perceived feminine characteristic of sadness, weakness, or helplessness. Fathers’ concerns about their sons suppressing negative emotions suggest awareness that suppression is harmful to one’s health. Indeed, studies have begun to demonstrate such a relationship among African American males (Caldwell et al., 2013; Hammond, 2012). Further, among males in general, anger may be an alternate expression of depressive symptoms (Genuchi & Valdez, 2014; Martin, Neighbors, & Griffith, 2013). Managing emotions is not typically included in conceptualizations of parenting practices; however, as endorsed by fathers in the current sample, and because males may express anger when depressed, it may be a critical component of both fathering and prevention efforts.

Implications for Prevention Interventions and Future Research

African American fathers will likely participate in interventions if they perceive a need for the program and agree with the program components (Julion, Breitenstein, & Waddell, 2012). As such, disallowing or shaming spanking in parenting interventions may create conflicts for fathers who value spanking. Because fathers may not always express this conflict (Gross, Garvey, Julion, & Fogg, 2007), it may be useful to frame additional strategies presented in prevention interventions as a way for fathers to broaden their tool set for shaping their sons’ behavior (Gross et al.). Further, it is important that content in prevention interventions include language to which fathers can relate (Julion et al.). Based on the current findings, fathers may relate to terms such as encouragement and being-there, and yet caution must be taken to not assume African American fathers will not talk directly about providing love and affection to their pre-adolescent sons.

Our understanding about the emotional aspects of fathering among African Americans warrants further investigations. Future research should focus on gaining a better understanding of the relationship between encouragement and affection or nurturance as described by African American fathers. That is, do African American fathers perceive encouragement as similar to or even synonymous with affection, nurturance or love? How do factors such as SES, residential status, or education level impact which fathers are more likely to describe or endorse encouragement, rather than affection, nurturance, love, or support? Investigations into the emotional aspects of fathering are consistent with parenting behaviors described by African American fathers in the current sample, as well as the focus in the literature on the fathers’ displays of nurturance and warmth (Lamb & Tamis- LeMonda, 2004; Rohner & Khaleque, 2005).

Strengths and Limitations

In addition to the potential contributions and strengths of the study, a number of limitations are acknowledged. Due to our use of a convenience sample of volunteer participants, the current findings may not be generalizable to all African American fathers of at-risk pre-adolescent youth. Findings might be different for pre-adolescent female youth, for example, because fathers likely have differential effects on sons and daughters (Caldwell, Wright, Zimmerman, Walsemann, Williams, & Isichei, 2004; Mandara, Murray, & Joyner, 2005). As a preliminary study, we focused on recruiting a sample with the highest potential to yield a range of views and experiences directly relevant to our research interests. A less pragmatic sampling frame may have produced a different cohort of participants. Despite these limitations, the results of the current study provide evocative descriptions of fathers’ parenting practices that are influenced by environmental contexts and fathers’ residential status. Unlike many previous studies that focus primarily on mothers’ perspectives, we were able to obtain first-hand reports from African American fathers. These findings make a unique contribution to the empirical literature on African American fathers’ parenting by providing deeper insight into the parenting practices of fathers who are largely understudied, and often misunderstood.

Acknowledgements

We appreciate the assistance provided to all aspects of the study by the Voices ‘n Visions Community Liaisons; Stephanie Coard, PhD; Cleopatra Caldwell, PhD; Christopher L. Edwards, MD, PhD; Keith E. Whitfield, PhD; Erikka Dzirasa, MD; Monique Fontes, BA; and James Key, BA.

Funding/Support: Data collection was supported by the PREMIER Postdoctoral Fellowship Program (Partnership for Excellence in Mental Health Interventions Education and Research; T32MH065742-8; Dr. David Steffens, PI) and by an NIMH Mid-Career Investigator Award (K24MH066252; Dr. David B. Goldston, PI). Data analysis and manuscript development were supported by a National Institute of Mental Health Diversity Supplement (R01-MH-081947-02S2; Recipient Otima Doyle, PhD), amended to the Impact of Adolescents Hospitalizations on Parents Study (IMPACT; R01-MH-081947; PI, David Goldston, PhD).

Appendix 1. Topic Guide Questions and Prompts Related to Fathers’ Parenting Practices

  1. What do you do as a father to make sure that your son grows up to be healthy and well adjusted?

  2. Are there certain things you do to help him:

    1. Develop positive or healthy behaviors?

    2. Deal with stress in positive ways?

    3. Improve mood or prevent depressive symptoms (sadness)?

References

  1. Amato PR, Gilbreth JG. Nonresident fathers and children's well-being: A meta-analysis. Journal of Marriage and the Family. 1999;61(3):557–573. [Google Scholar]
  2. Baumrind D. Current patterns of parental authority. Developmental Psychology Monogram. 1971;4(1) [Google Scholar]
  3. Bean RA, Barber BK, Crane DR. Parental support, behavioral control, and psychological control among African American youth. Journal of Family Issues. 2006;27(10):1335–1355. [Google Scholar]
  4. Bloomberg LD. Completing your qualitative dissertation: A roadmap from beginning to end. Los Angeles, CA: Sage Publications; 2008. [Google Scholar]
  5. Bryman A. Integrating quantitative and qualitative research: How is it done? Qualitative Research. 2006;6:97–113. [Google Scholar]
  6. Caldwell CH, Antonakos CL, Tsuchiya K, Assari S, De Loney EH. Masculinity as a moderator of discrimination and parenting on depressive symptoms and drinking behaviors among nonresident African-American fathers. Psychology of Men & Masculinity. 2013;14(1):47–58. [Google Scholar]
  7. Caldwell CH, Bell L, Brooks CL, Ward JD, Jennings C. Engaging nonresident African American fathers in intervention research: What practitioners should know about parental monitoring in nonresident families. Research on Social Work Practice. 2011;21(3):298–307. [Google Scholar]
  8. Caldwell CH, Rafferty J, Reischl TM, De Loney EH, Brooks CL. Enhancing parenting skills among nonresident African American fathers as a strategy for preventing youth risky behaviors. American Journal of Community Psychology. 2010;45(1–2):17–35. doi: 10.1007/s10464-009-9290-4. [DOI] [PubMed] [Google Scholar]
  9. Caldwell CH, Wright JC, Zimmerman MA, Walsemann KM, Williams D, Isichei PAC. Enhancing adolescent health behaviors through strengthening non-resident father-son relationships: A model for intervention with African American families. Health Education Research. 2004;19(6):644–656. doi: 10.1093/her/cyg078. [DOI] [PubMed] [Google Scholar]
  10. Campbell JL, Quincy C, Osserman J, Pedersen OK. Coding in-depth semistructured interviews: Problems of unitization and intercoder reliability and agreement. Sociological Methods & Research. 2013;42(3):294–320. [Google Scholar]
  11. Courtenay WH. Constructions of masculinity and their influence on men's well-being: A theory of gender and health. Social Science & Medicine. 2000;50(10):1385–1401. doi: 10.1016/s0277-9536(99)00390-1. doi: http://dx.doi.org/10.1016/S0277-9536(9900390-1) [DOI] [PubMed] [Google Scholar]
  12. DeCuir-Gunby JT, Marshall PL, McCulloch AW. Developing and using a codebook for the analysis of interview data: An example from a professional development research. Field Methods. 2010 Dec 27;23:136–155. Advance Online Publication. [Google Scholar]
  13. Denby R, Alford K. Understanding African American discipline styles: Suggestions for effective social work intervention. Journal of Multicultural Social Work. 1996;4(3):81–98. [Google Scholar]
  14. Doyle O, Pecukonis EV, Lindsey M. Correlates and consequences of father nurturance in an African American college sample. Journal of Family Issues. 2013 Sep 6; Advance online publication. [Google Scholar]
  15. Edin K, Tach L, Mincy R. Claiming fatherhood: Race and the dynamics of paternal involvement among unmarried men. The Annals of the American Academy of Political and Social Science. 2009;621(1):149–177. doi: 10.1177/0002716208325548. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Genuchi MC, Valdez JN. The role of anger as a component of a masculine variation of depression. Psychology of Men & Masculinity. 2014 Apr 7; Advance online publication. http://dx.doi.org/10.1037/a0036155. [Google Scholar]
  17. Gross D, Garvey C, Julion W, Fogg L. Preventive parent training with low-income, ethnic minority families of preschoolers. In: Briesmeister JM, Schaefer CE, editors. Handbook of parent training: Helping parents prevent and solve problem behaviors. 3rd ed. NY: John Wiley & Sons; 2007. pp. 5–24. [Google Scholar]
  18. Hammond WP. Taking it like a man: Masculine role norms as moderators of the racial discrimination-depressive symptoms association among African American men. American Journal of Public Health. 2012;102(S2):S232–S241. doi: 10.2105/AJPH.2011.300485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hammond WP, Mattis JS. Being a man about it: Manhood meaning among African American men. Psychology of Men & Masculinity. 2005;6(2):114–126. [Google Scholar]
  20. Hawkins AJ, Dollahite DC. Generative fathering: Beyond deficit perspectives. Thousand Oaks, CA: Sage; 1997. [Google Scholar]
  21. Hoeve M, Dubas JS, Eichelsheim VI, van der Laan PH, Smeenk W, Gerris JR. The relationship between parenting and delinquency: A meta-analysis. Journal of abnormal child psychology. 2009;37(6):749–775. doi: 10.1007/s10802-009-9310-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Horn IB, Joseph JG, Cheng TL. Nonabusive physical punishment and child behavior among African-American children: A systematic review. Journal of the National Medical Association. 2004;96(9):1162–1168. [PMC free article] [PubMed] [Google Scholar]
  23. Hunter AG, Davis JE. Constructing gender: An exploration of Afro-American men's conceptualization of manhood. Gender & Society. 1992;6(3):464–479. [Google Scholar]
  24. Jacobson KC, Crockett LJ. Parental monitoring and adolescent adjustment: An ecological perspective. Journal of Research on Adolescence. 2000;10:65–97. [Google Scholar]
  25. Jarrett RL, Roy KM, Burton LM. Fathers in the “hood”: Insights from qualitative research on low-income African-American men. Handbook of father involvement: Multidisciplinary perspectives. 2002:211–248. [Google Scholar]
  26. Jones J, Mosher WD. Fathers’ involvement with their children: United States, 2006–2010. National health statistics reports. 2013;(71):1. [PubMed] [Google Scholar]
  27. Julion WA, Breitenstein SM, Waddell D. Fatherhood intervention development in collaboration with African American non-resident fathers. Research in nursing & health. 2012;35(5):490–506. doi: 10.1002/nur.21492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. King V. Variation in the consequences of nonresident father involvement for children’s wellbeing. Journal of Marriage and the Family. 1994;56:963–972. [Google Scholar]
  29. King V, Harris KM, Heard HE. Racial and ethnic diversity in nonresident father involvement. Journal of Marriage and Family. 2004;66:1–21. [Google Scholar]
  30. Lamb ME, Tamis-LeMonda C. The role of the father: An Introduction. In: Lamb Michael., editor. The role of the father in child development. 4th ed. Hoboken: John Wiley & Sons, Inc; 2004. [Google Scholar]
  31. Lemay CA, Cashman SB, Elfenbein DS, Felice ME. A qualitative study of the meaning of fatherhood among young urban fathers. Public Health Nursing. 2010;27(3):221–231. doi: 10.1111/j.1525-1446.2010.00847.x. [DOI] [PubMed] [Google Scholar]
  32. Letiecq BL, Koblinsky SA. Parenting in violent neighborhoods: African American fathers share strategies for keeping children safe. Journal of Family Issues. 2004;25(6):715–734. [Google Scholar]
  33. Mandara J, Murray CB, Joyner TN. The impact of fathers' absence on African American adolescents' gender role development. Sex Roles. 2005;53(3/4):207–220. [Google Scholar]
  34. Martin LA, Neighbors HW, Griffith DM. The experience of symptoms of depression in men vs women: Analysis of the National Comorbidity Survey Replication. Journal of the American Medical Association. 2013;70(10):1100–1106. doi: 10.1001/jamapsychiatry.2013.1985. [DOI] [PubMed] [Google Scholar]
  35. McAdoo HP. Transgenerational patterns of upward mobility in African American families. In: McAdoo HP, editor. Black families. Newbury Park, CA: Sage; 1988. [Google Scholar]
  36. McLoyd VC, Smith J. Physical discipline and behavior problems in African American, European American, and Hispanic children: Emotional support as a moderator. Journal of Marriage and Family. 2002;64(1):40–53. [Google Scholar]
  37. Nebbitt VE, Lombe M, Doyle O, Vaughn MG. Modeling variation in paternal encouragement and monitoring among African American adolescents living in urban public housing: A latent profile analytic approach. Journal of African American Studies. 2013;17:253–274. [Google Scholar]
  38. Nelson TJ, Clampet-Lundquist S, Edin K. Sustaining fragile fatherhood: Father involvement among low-income, noncustodial African American fathers in Philadelphia. In: Tamis-LeMonda CS, Cabrera N, editors. Handbook of father involvement: Multidisciplinary perspectives. Mahwah, NJ: Lawrence Erlbaum Associates; 2002. pp. 525–553. [Google Scholar]
  39. Padgett D. Qualitative methods in social work research: Challenges and rewards. Thousand Oaks, California: Sage Publications; 1998. [Google Scholar]
  40. Plunkett SW, Henry CS, Robinson LC, Behnke A, Falcon PC., III Adolescent perceptions of parental behaviors, adolescent self-esteem, and adolescent depressed mood. Journal of Child and Family Studies. 2007;16(6):760–772. [Google Scholar]
  41. QSR. NVivo qualitative data analysis software (Version 8): QSR International Pty Ltd. 2008 [Google Scholar]
  42. Reingle JM, Jennings WG, Lynne-Landsman SD, Cottler LB, Maldonado-Molina Mildre M. Toward an understanding of risk and protective factors for violence among adolescent boys and men: A longitudinal analysis. Journal of adolescent health. 2013;52(4):493–498. doi: 10.1016/j.jadohealth.2012.08.006. doi: http://dx.doi.org/10.1016/j.jadohealth.2012.08.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Robbins SP, Chatterjee P, Canda ER. Contemporary human behavior theory: A critical perspective for social work. Needham Heights, MA: Allyn & Bacon; 1998. [Google Scholar]
  44. Roberts RE, Roberts CR, Chen RY. Ethnocultural differences in prevalence of adolescent depression. American Journal of Community Psychology. 1997;25(1):95–110. doi: 10.1023/a:1024649925737. [DOI] [PubMed] [Google Scholar]
  45. Roberts-Douglass K, Curtis-Boles H. Exploring positive masculinity development in African American men: A retrospective study. Psychology of Men & Masculinity. 2013;14(1):7–15. [Google Scholar]
  46. Rohner RP, Khaleque A, editors. Handbook for the study of parental acceptance and rejection. 4 ed. Storrs, CT: Rohner Research Publications; 2005. [Google Scholar]
  47. Roopnarine JL. African American and African Caribbean fathers: Levels, quality, and meaning of involvement. In: Lamb ME, editor. The role of the father in child development. 4th ed. New York: Wiley & Sons; 2004. pp. 58–97. [Google Scholar]
  48. Rounsaville BJ, Carroll KM, Onken LS. A stage model of behavioral therapies research: Getting started and moving on from stage I. Clinical Psychology: Science & Practice. 2001;8(2):133–142. [Google Scholar]
  49. Ryan GW, Bernard HR. Techniques to identify themes. Field Methods. 2003;15:85–109. [Google Scholar]
  50. Sanders CB, Cuneo CJ. Social reliability in qualitative team research. Sociology. 2010;44(2):325–343. [Google Scholar]
  51. Schutt RK. Investigating the social world: The process and practice of research. (7th Ed.) 2012:320–357. Retrieved from http://www.sagepub.com/upm-data/43454_10.pdf. [Google Scholar]
  52. Schwartz SJ, Finley GE. Fathering in intact and divorced families: Ethnic differences in retrospective reports. Journal of Marriage and Family. 2005;67(1):207–215. [Google Scholar]
  53. Seltzer JA. Relationships between fathers and children who live apart: The father’s role after separation. Journal of Marriage and the Family. 1991;53:79–101. [Google Scholar]
  54. Staples R, Johnson LB. Black families at the crossroads: Challenges and prospects. Jossey-Bass; 1993. [Google Scholar]
  55. Strauss A, Corbin J. Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, California: Sage Publications; 1998. [Google Scholar]
  56. Thomas KA, Dettlaff AJ. African American families and the role of physical discipline: Witnessing the past in the present. Journal of Human Behavior in the Social Environment. 2011;21(8):963–977. [Google Scholar]
  57. Toth JF, Xu X. Ethnic and cultural diversity in father’s involvement: A racial/ethnic comparison of African American, Hispanic, and White fathers. Youth & Society. 1999;31(1):76–99. [Google Scholar]
  58. Tuckett AG. Qualitative research sampling: The very real complexities. Nurse Researcher. 2004;12(1):47–61. doi: 10.7748/nr2004.07.12.1.47.c5930. [DOI] [PubMed] [Google Scholar]
  59. Zimmerman MA, Ramirez-Valles J, Zapert KM, Maton KI. A longitudinal study of stress-buffering effects for urban African-American male adolescent problem behaviors and mental health. Journal of Community Psychology. 2000;28(1):17–33. [Google Scholar]
  60. Zimmerman MA, Salem DA. Family structure and psychosocial correlates among urban African-American adolescent males. Child Development. 1995;66(6):1598–1613. [PubMed] [Google Scholar]

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