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Abstracts of a Selected Number of Dr. Livingston's Published Papers Perceived Control, Specific At-Risk and General Fear of AIDS: Intraracial Variation Among African American College Students [Livingston, I.L. & T.E. Maxwell Johnson: The Urban League Review, 15(1):53-70, 1991]. Acquired Immune Deficiency Syndrome (AIDS) is a fatal disease of epidemic proportions. Approximately 270,000 cases of AIDS exist in the United States. Given that African Americans are disproportionately afflicted with AIDS and because heightened sexual activity in adolescence and young adulthood begins in college, it is reasoned that African American college population is an important target group to assess: (a) intraracial variation of being in control, (b) specific at-risk and general fear of AIDS and (c) the inverse relationship between perceived control and fear of AIDS. Using a sample of 375, it was seen that African Americans had relatively variable responses on being in control and fearful of AIDS. Being in control (b= -.180, p<.001) and females (b= -.914, p<.001) were related to lower levels of specific fear of AIDS. Being in control (b= -.176, p<.001) and knowledgeable about how AIDS is transmitted (b= -.273, p<.001) were related to lower levels of general fear of AIDS. _____________________________________________________________________________ HIV/AIDS Control in Africa: The Importance of Epidemiological and Health Promotion Approaches [I.L. Livingston: Health Promotion International, 8(3):189-198, 1993]. HIV infection and AIDS are disproportionately afflicting Third World countries, especially the countries of Africa, where substantial adult communities and villages are literally being annihilated. Because there is no known cure for HIV/AIDS, and because of the high costs of current antiviral therapy (e.g., AZT), it is a cost-effective use of health resources for the economically poor countries of Africa to use health promotion/education to intervenes and control the incidence of HIV infection and AIDS. Crucial to any effective health promotion effort is a thorough knowledge about the epidemiological specifics and distribution of HIV/AIDS in Africa, the known at-risk segments of the population, and the known at.-risk conditions (e.g., male-female relationships, stress) and behaviors (e.g., peer and other pressures to engage in unprotected sex) for HIV infection. For health promotion to be successful it has to be unrelentingly applied to all at-risk groups in African societies, region-specific and culturally sensitive, and it has to acquire active cooperation from all members of the community of African nations. ______________________________________________________________________________ Perceived Control, Knowledge and Fear of AIDS Among College Students: An Exploratory Study [I.L. Livingston: Journal of Health & Social Policy, 2(2):47-65, 1990]. It is reasoned that fear of AIDS can be an inhibiting factors for students’ adopting protective health behavior against acquiring AIDS. The study examined (a) how knowledgeable students are about AIDS and being in control of their life situation and (b) the relationship between knowledge of AIDS, perceived control and other selected factors on students’ fear of AIDS. Using a sample of N=597, drawn from two east coast universities, it was seen that, although some misconceptions still persist, students were both knowledgeable and fearful about AIDS. Foreign students reported more fear of AIDS. Having less knowledge as to how AIDS is acquired and a perceived lack of control were two dominant factors shown to be statistically (p<.05) related to a fear of AIDS. Some policy implications were discussed. ______________________________________________________________________________ Co-Factors, Host Susceptibility, and AIDS: An Argument For Stress [I. L. Livingston: Journal of the National Medical Association, 80(1):49- , 1988]. Acquired immune deficiency syndrome (AIDS) is perhaps the most serious communicable public health disease of modern society. The human and social devastation associated with this disease is tremendous. To date, a retro virus (HTLV-III) has been implicated in the etiology of AIDS> There remains several critical questions, however, that only a more eclectic approach, certainly with a social science input, can more adequately address. Such questions have to deal with, for example, why are there differential outcomes regarding initiation, progress, and severity of AIDS? Realizing this need, this paper argues for the possible co-factor contribution of stress to host immune suppression and, ultimately, host susceptibility to the AIDS virus and its associated outcomes. A conceptual sociopsychophysiologic model of the entire stress process, i.e., from onset, reaction up to and including effect, is presented and discussed. Within the context of the model, stress is viewed as a physiologic reaction and stressors are viewed as initiators of the stress process. The possible stress-AIDS experience is discussed using the model as a conceptual guiding tool. The paper concludes with the need for health educators to educate the general public, at-risk groups, and the medical and associated professions about the nature of stress, or in short, how best to cope with and manage stress within the context of available resources. __________________________________________________________________________ AIDS/HIV Crisis in Developing Countries: The Need For Greater Understanding and Innovative Health Promotion Approaches [I. L. Livingston: Journal of the National Medical Association, 84(9)755-770, 1992]. Epidemiological data on morbidity and mortality have shown that the acquired immune deficiency syndrome/human immunodeficiency virus (AIDS/HIV) epidemic is relatively widespread in developing countries of the world, especially in the already economically deprived regions of Sub-Saharan Africa. Africa is estimated to have approximately 5 million seropositive individuals, and by the year 2000, this number is expected to include 10 million HIV-infected children. Improved control over this epidemic can only come through a greater understanding of the specifics of the disease and, eventually, the introduction of more effective and innovative health promotion campaigns targeted at medical personnel, traditional healers, families, and persons with AIDS. Comprehensive health promotion campaigns, carefully using mass media strategies, in addition to more community-based programs, all operating under "decentralized" AIDS control programs, are reasoned to be the most efficacious approach that African and other countries can use to successfully contain the AIDS? HIV epidemic. Given the reality of the following factors: Pattern II (i.e., transmission of AIDS via heterosexual sexual activity) is the main mode of HIV transmission in Africa, the traditional dominant roles males have in sexual relations, and the positive relationship between sexually transmitted diseases and AIDS, health promotion campaigns must focus specifically on addressing at-risk culturally related sexual values and behaviors in African communities. Failure to address these and other related factors will certainly lead to an escalation of the AIDS/HIV epidemic in Africa and, therefore, concomitant devastation in the human and societal realms of the region. ______________________________________________________________________________ Blacks, Lifestyle and Hypertension: The Importance of Health Education [I.L. Livingston: Humboldt Journal of Social Relations, 14(1&2):195-213, 1986]. When compared with their white counterparts, it is an undisputed fact that black Americans have twice the prevalence and severity of hypertension and its related sequellae. More fruitful answers to this race-related hypertension issue can be more realistically obtained by a more thorough examination of the dynamics associated with the daily lifestyle experiences of black Americans. Blood pressure studies conducted in the United States, as well as abroad involving black populations, provide support for this lifestyle position, i.e., versus the often talked about" genetic" position. These studies underscore that race by itself is not as important a determinant on blood pressure elevation as is its predisposing influence on how black Americans interact with and are influenced by their socio-psycho-cultural environment. Lifestyle is viewed to mean both conscious discretionary and unconscious non-discretionary daily experiences of black Americans. Stressful life experiences are viewed as perhaps the most important such experiences and, possibly, as having a direct effect on elevated BP. Another group of life-style factors, discussed under the heading behavioral (e.g., alcohol consumption)/nutritional (e.g., dietary consumption) factors, are reported to have more of a synergistic effect on BP elevation. Finally, given that most of these life-style factors are potentially "modifiable," it is reasoned that constructive efforts to intervene in addressing the black American-hypertension problem, i.e., thereby preventing and/or reducing elevated BP, should, of necessity, encompass instructional and educational information. And, depending on the segmentation of the black American population, i.e., into primary and secondary audiences, based on their life-style and at-risk status, this aforementioned information can be successfully delivered under the "umbrella" of health education. _____________________________________________________________________________ Social Integration and Black Intraracial Variation in Blood Pressure [I..L. Livingston, D. M. Levine and R.D.. Moore: Ethnicity and Disease, 1:135-149, 1991]. An evaluation is made of the inverse role social integration plays in explaining variation in blood pressure among a sample of 1420 black Americans. This sample is part of a larger representative sample of 6717 adults (18 years and older) who were interviewed in the 1981-82 Maryland Statewide Hypertension Control Program. Social integration is operationalized in terms of five submeasures: employment, marriage, church affiliation, group affiliation, and having someone to talk to when needed. Separate multiple regression analyses were conducted for males (n - 587) and females (n = 833), and selected covariates (e.g., age, education, body mass index, physical exercise, current use of anti hypertension medication, cigarette smoking) were entered to assess more adequately the hypothesized inverse relationship between social integration and systolic and diastolic blood pressure. Only church affiliation appears inversely associated with systolic (males: b = -4.898; 95% CI = -10.385 to 0.589; females: b = -4.005; 95% CI = -8.341 to 0.331) and diastolic (males: b = -6.511; 95% CI = -10.038 to -2.985; females: b = -5.318; 95% CI = -8.329 to -2.307) blood pressure. These results indicate that several pathways can influence how social integration, especially affiliation with a church, contributes to lower levels of blood pressure. The possibility that biological as well as psychosocial pathways operate is discussed. Given the dominant and inverse association of church affiliation to blood pressure, health education is discussed as a public health strategy to disseminate information regarding the possible health importance of social integration for black Americans. The adherence to sound preventive health practices (e.g., exercising, lower weight-to-height body ratio) should also be part of the health education strategy to reduce elevated blood pressure in black Americans. _____________________________________________________________________ Cardiac Reactivity and Elevated Blood Pressure Level Among Young African Americans: The Importance of Stress. I.L. Livingston and R.J. Marshall: In D.J. Jones (ed.), Prescriptions and Policies: The Social Well-Being of African Americans in the 1990s. Transaction Publishers, New Brunswick, 1991. Compared with White Americans, African Americans are afflicted twice as much by high blood pressure (HBP) or hypertension and its devastating health-related outcomes. Interracial differences in HBP begin to show their insidious presence very early in the life cycle, especially around the adolescent period. There is no known etiology for (essential) hypertension. Thus, the major focus of this paper is to show that stress (operationalized from a sociopsychophysiological perspective, leading over time, to cardiac reactivity in the body) is a salient contributing factor to the etiology and, possibly, exacerbation of elevated arterial blood pressure (BP) in the African American adolescent. A sociopsychophysiological model of the stress process is used as a frame work in which to (1) understand how young African Americans are predisposed to view their life experiences as stressful, (2) see how their bodily systems react to stress, and (3) see how it is possible, over time, for certain effects, such as hypertension, to manifest themselves if stress is not abated. Preventive strategies are discussed and policy-oriented recommendations are made that could reduce the severity of the morbidity and mortality related to hypertension, especially in the at-risk African American adolescent population.
Stress, Hypertension and Renal Disease in Black Americans: A Review With Implications [I. L. Livingston: National Journal of Sociology, 5(2):143-181, 1991]. Various factors contribute to Black Americans suffering a disproportionate incidence of chronic and acute health conditions and, as a result, trail white Americans by approximately six years in life expectancy. This paper, however, focuses on three sequential health conditions which, it is reasoned, are unfortunately "endemic" to large portions of the Black American population. The conditions are: (1) chronic stress, (2) elevated arterial blood pressure or hypertension and (3) kidney disease or end-stage renal disease (ESRD). Using a sociopsychophysiological conceptual model of the stress process (Figure 1, p. 157), which has the Filter Resource Capability System as its "core," the paper discusses how various race and poverty-related stressors can be initially perceived by Black Americans and, over time, lead to stress, hypertension and indirectly to ESRD. It is reasoned and illustrated in the model, that in terms of health promotion efforts to prevent and control these and other health outcomes in the black community, great emphasis has to be placed on increasing the structural and functional strength and resiliency of Black American’s Filter Resource Capability Systems. The paper discusses a variety of implications for the stress-hypertension-ESRD relationship in blacks and concludes with certain suggestions for improving the health, especially of at-risk, low income Black Americans. ______________________________________________________________________________ Renal Disease and Black Americans: Selected Issues [I. L. Livingston: Social Science and Medicine, 37(5):613-621, 1993]. Black Americans compared with their white counterparts are disproportionately hypertensive and have a greater incidence of end-stage renal disease (ESRD). Renal disease is a frequent end point of accelerated hypertension. The reasons why Black Americans have a higher incidence of ESRD relative to white Americans are explored. As transplantation is a preferred mode of treatment for chronically ill ESRD patients, the paper examines some of the reasons why blacks are more reluctant than whites to donate their organs (e.g., kidneys) for transplantation. Although various reasons affect organ donation, altruism is explored as a possible factor that may influence the willingness of black to donate their organs. _____________________________________________________________________________ Hypertension, End-Stage Renal Disease and Rehabilitation: A Look at Black Americans [I. L. Livingston and A. Ackah: The Western Journal of Black Studies, 16(2):103- 112, 1992]. It has been reported that as many as 58 million people in the United States have elevated blood pressure (i.e., systolic blood pressure (SBP) greater than or equal to 140 mm Hg and/or diastolic blood pressure (DBP) greater than or equal to 90 mm Hg) or are taking antihypertensive medication. The prevalence of hypertension increase with age and is approximately twice as high in Blacks compared with Whites (Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, 1988). Of particular importance to this paper is the fact that empirical studies have documented that chronic elevations in blood pressure (BP) contribute to irreversible end-organ damage. The targeted end of interest in this paper is the kidney and the subsequent related diseases are referred to collectively as end-stage renal disease or ESRD. According to Van der Werff (1984), each year thousands of people between the ages of 5 and 55 years fall victim to fatal kidney disease. Currently, death from kidney or renal disease is, to a large extent, preventable. This fact is due mainly to the two established medical procedures for treating patients with renal failure - renal dialysis and kidney transplant. Because of restorative attempts associated with these two procedures that are referred to collectively as "rehabilitative" procedures. Although there is some arguments as to which of the two procedures is the preferred choice, it has been said (Van der Werff, 1984) that kidney transplant is not a direct alternative to dialysis; for many people it is the only way to survive. This paper will focus primarily on kidney transplantation as an elected form of rehabilitation to correct or restore some form of ESRD in the Black American population _____________________________________________________________________________ Alcohol Consumption and Hypertension: A Review With Suggested Implications [I. L. Livingston: Journal of the National Medical Association, 77(2)129- , 1985]. Alcohol abuse and hypertension are two important health concerns for the US population. A review of the literature indicates, however, that Black Americans are at greater risk of experiencing primary and secondary health and behavioral problems associated with these two concerns. Empirical evidence exists suggesting a relationship between alcohol consumption and hypertension and its related sequellae. Although the correlation is not of a dose-effect nature, the results of numerous longitudinal and other studies have suggested a positive relationship. Various implications exist in the treatment, control, and prevention of hypertension for high-risk groups. For example, existing health-care protocols may be modified for regular screening and monitoring of "excessive" alcohol consumption patterns, especially of hypertensive and borderline hypertensive patients. Whenever possible, health-care counseling and education should be a necessary adjunct to treatment and prevention efforts to better control hypertension in the Black community. ______________________________________________________________________________ Stress and Health Dysfunctions: The Importance of Health Education [I. L. Livingston: Stress and Medicine, 4:155-161, 1988]. Stress, especially of a chronic nature, poses problems for the health of people in contemporary societies. In consequence, there is an increasing need for emphasis on health education as a means of controlling and reducing stress in everyday life. To accomplish this, the importance of predisposing and mediating factors must be considered and a number of stress intervention programs are possible. Amongst there are various means to modify life style and knowledge of various social and environmental factors can contribute to this. As complete avoidance from stress is not possible, the public and particularly the high at-risk segment of the population, should have the means to obtain education concerning stress and health dysfunction. _______________________________________________________________________________ Stress and Violence in Developing Countries [I.L. Livingston and R.Brown Jr.: International Third World Studies Journal Review, 8:79-86]. According to the Director General of the World Health Organization (WHO), approximately three and a half million people in the world die as a result of injuries caused by accidental or intentional violence (Nakajima, 1993). Violence is increasing and it has reached epidemic proportions in our modern-day societies, especially those found in relatively poorer Third World Countries (TWCs), and there needs to be a concerted epidemiological effort to address the multifaceted etiology of violence. Of necessity such efforts must be guided by theoretical approaches that, while general in nature, are sufficiently flexible to address the specific needs and contexts of particular countries, for example, TWCs. Additionally, theoretically-driven studies involving the etiology of violence must address the possible interaction of contributing factors at both the macro or societal (e.g., poverty) and micro or individual (e.g., stress) levels. The discussion in this paper represents such an integrated effort. The greatest cause of morbidity and mortality in the world is listed at the end of the International Classification of Diseases. It is given the code Z59.5 - extreme poverty. Based on the poverty-stress argument that be subsequently presented in this paper, it is important to note that in addition to mental illness, suicide, family disintegration and substance abuse, poverty is an important contributor to stress (The State of World Health, 1995). This relationship is very important for TWCs, because of various contributing conditions (e.g., high balance of payments, overpopulation), they are disproportionately poor. An estimated 30 - 70 percent of urban populations in developing countries are living in conditions of extreme material deprivation as reflected in: inadequate environmental services including water, sanitation and waste disposal, as well as poor quality shelter and limited access to social services, including health and education (Bradley et al., 1992). It is argued in this paper that poverty, which is later referred to as a "stressor," has the potential to put individuals at risk both to engage in and be a recipient of a variety negative experiences, such as violence. One area that reflects the upsurge and epidemic nature of violence, and one that is increasingly recognized and publicized, is gender-based violence. In September 1992 the United Nations Commission on the Status of Women drafted a declaration on violence against women. This declaration was subsequently adopted by the General Assembly in the fall of 1993. According to Article 1 of the declaration, violence against women includes any act of gender-based violence that results in or is likely to result in, physical, sexual and/or psychological harm or suffering to women (Economic and Social Council, 1992). Sexual abuse is by far the most serious act of gender-based violence and it has been aptly documented in various TWCs (e.g., Bosnia, Cambodia, Liberia, Somalia and Uganda, Swiss and Giller, 1993). When the term violence is used in this paper it is referring primarily to interpersonal violence (IPV), such as homicides, robberies, and rape. To a lesser degree when violence is used it will be referring to collective violence (CV), such as political violence involving mass (ethnic) killings and rape. IPV covers a wide range of subjects involving injury or threat to the physical and/or psychological well-being of the individual, family, or group (Pynoos, et al 1993). In selectively addressing the multidimensional nature of IPV, and elucidating the pervasiveness of violence in TWCs, the paper will discuss issues relating to the offender, the system, and the victim. Notwithstanding the complex issues surrounding the etiology of violence in the context of TWCs, the belief is that it can be prevented and/or controlled through the application of selected intervention (e.g., health education) strategies. This latter point is very much related to the view that "The prevention of violence is feasible inasmuch as it is an expression of human behavior, attitudes, and lifestyles, all of which can be modified through activities aimed at health promotion" (PAHO, 1993, p. 1). The main purpose of the paper is to: 1) present a selected discussion of violence as a public health problem, especially in TWCs; (2) use a sociopsychophysiologic model of the stress process to discuss the reciprocal relationship between stress and violence, i.e., how stress contributes to violence via macro antecedent conditions (e.g poverty), and how violence, in turn, can exacerbate these antecedent conditions and stress; and (3) discuss ways of intervening, both on the macro and micro levels, to prevent and/or control the epidemic of violence in TWCs.
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