Background and Objectives: Among the multiple factors posited to drive the health inequities that black men experience, the fundamental role of stress in the production of poor health is a key component. Allostatic load (AL) is considered to be a byproduct of stressors related to cumulative disadvantage. Exposure to chronic stress is associated with poorer mental health including depressive symptoms. Few studies have investigated how AL contributes to depressive symptoms among black men. The purpose of the cross-sectional study was to examine the association between AL and depressive symptoms among middle- to old age black men.Research Design and Methods: This project used the 2010 and 2012 wave of the Health and Retirement Study enhanced face-to-face interview that included a biomarker assessment and psychosocial questionnaire. Depressive symptoms, assessed by the endorsement of 3 or more symptoms on the Center for Epidemiological Studies—Depression 8-item scale, was the outcome variable. The main independent variable, AL, score was calculated by summing the number values that were in the high range for that particular biomarker value scores ranging from 0 to 7. black men whose AL score was 3 or greater were considered to be in the high AL group. Modified Poisson regression was used to estimate prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs).Results: There was a larger proportion of black men in the high AL group who reported depressive symptoms (30.0% vs. 20.0%) compared with black men in the low AL group. After adjusting for age, education, income, drinking, and smoking status, the prevalence of reporting 3 or more depressive symptoms was statistically significant among black men in the high AL group (PR = 1.61 [95% CI: 1.20–2.17]) than black men in the low AL group.Discussion and Implications: Exposure to chronic stress is related to reporting 3 or more depressive symptoms among black men after controlling for potential confounders. Improving the social and economic conditions for which black men work, play, and pray is key to reducing stress, thereby potentially leading to the reporting of fewer depressive symptoms.

African Americans (AAs) are 20% more likely to develop serious psychological distress compared to Whites but are less likely to use mental health services. The study objective was to evaluate the effectiveness of recruitment strategies to engage AA fathers in a mental health intervention. Using the community-based participatory research (CBPR) approach, a community-academic partnership (CAP) developed and implemented direct and indirect referral strategies to engage AA fathers in a mental health intervention. Direct referral strategies focused on community partner identification of potentially eligible participants, providing information about the study (i.e., study flyer), and referring potential participants to the study. Indirect referrals included posting flyers in local businesses frequented by AA men, radio advertisements, and social media posts from community organizations. From January to October 2019, 50 direct and 1388 indirect referrals were documented, yielding 24 participants screened and 15 enrolled. Of all participants screened, 58% were referred through indirect referral, 38% were referred directly by community partners, and 4% of the participants were referred through both direct and indirect referrals. Twenty percent of those exposed to the direct referral methods and 1% of those exposed to the indirect referral methods were enrolled. The indirect referrals accounted for 60% of enrollment, whereas the direct referrals accounted for 33.3% of enrollment. Collaborating with the community partners to engage hard-to-reach populations in mental health studies allowed for broad dissemination of recruitment methods, but still resulted in low participant accrual. Additional focus on increasing direct referral methods appears to be a fruitful area of CBPR.

Background: Maternal and infant health disparities remain a persistent public health issue in the United States, disproportionately affecting systematically marginalized communities. While doulas have been shown to improve birth outcomes and reduce inequities, their integration into maternity care systems remains limited. Objectives: This study aimed to explore the roles and challenges of different doula models, identify systemic barriers to their integration, and propose strategies for sustainable implementation. Design: A qualitative study using a phenomenological approach that adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines. Methods: Using purposive and snowball sampling, 20 stakeholders, including doulas, healthcare providers, Medicaid specialists, and public health professionals, were recruited from Omaha, Nebraska, and Nashville, Tennessee. Semi-structured interviews were conducted in person and via Zoom, lasting between 30 and 90 min. Thematic analysis, supported by Dedoose software, was used to identify key themes related to doula integration, systemic barriers, and policy recommendations. Data credibility was reinforced through member-checking and an audit trail documenting coding decisions. Results: Three primary themes emerged: (1) Doula Types and Their Impact, private practice doulas offer individualized care but face financial barriers; hospital-based doulas improve communication but encounter institutional constraints; community-based doulas provide culturally competent care but struggle with sustainability. (2) Strategies for Sustainable Integration, hybrid models enhance continuity of care, public health partnerships support funding and advocacy, and advisory boards foster interdisciplinary collaboration. (3) Policy Recommendations, expanding Medicaid coverage, increasing equitable reimbursement rates, and establishing standardized doula training and certification to improve accessibility and professional recognition. Conclusion: Implementing policy reforms and fostering collaborative models can help optimize doula services and improve perinatal outcomes, particularly for systematically marginalized populations. Sustainable funding, standardized certification, and public health partnerships are essential for improving accessibility to doula care.