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African Americans' Perceived Sociocultural Determinants of Suicide: Afrocentric Implications for Public Health Inequalities a

Valerie Borum a

Department of Social Work, Metropolitan State University of Denver, Denver, Colorado, USA Published online: 28 Oct 2014.

Click for updates To cite this article: Valerie Borum (2014) African Americans' Perceived Sociocultural Determinants of Suicide: Afrocentric Implications for Public Health Inequalities, Social Work in Public Health, 29:7, 656-670, DOI: 10.1080/19371918.2013.776339 To link to this article: http://dx.doi.org/10.1080/19371918.2013.776339

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Social Work in Public Health, 29:656–670, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1937-1918 print/1937-190X online DOI: 10.1080/19371918.2013.776339

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African Americans’ Perceived Sociocultural Determinants of Suicide: Afrocentric Implications for Public Health Inequalities Valerie Borum Department of Social Work, Metropolitan State University of Denver, Denver, Colorado, USA

The cultural values of African Americans have not been adequately incorporated as a theoretical base to develop new public health models. The major objectives of this study were to explore, with a purposive sample, via seven focus groups, 40 African American college students, the following: How do (a) ethnic culture and (b) a “minoritized” status influence perceptions of sociocultural determinants in explaining increases in the incidence of suicide among African Americans? Thematic results of focus group discussions including the following: (a) racism, discrimination, and stereotyping; (b) U.S. individualism; (c) integration and cultural assimilation; and, (d) the prison industrial complex. Keywords: African American, culture, suicide, public health, ethnicity, Afrocentricity, heal inequalities

Suicide has been declared an important public health issue. According to the Centers for Disease Control and Prevention ([CDC, 2008) approximately 89 people in the United States complete suicide every day. A recent assessment of suicide rates shows a rate of 12/100,000 for Whites and one half that rate, 5 to 6/100,000, for African Americans (American Association of Suicidology [AAS], 2008). Although mortality rates historically and currently show lower rates of suicide among African Americans in comparison to Whites, the rate of suicide among African Americans has increased, particularly among adolescent and young adult African American males (AAS, 2008; CDC, 2008). Suicide is now the third leading cause of death among 15- to 24-year-old African Americans, after homicides and accidents (AAS, 2008; CDC, 2008). Suicide rates for African American adolescents and young adults between ages 15 and 24 increased by 200% between 1975 and 1995. Among African Americans age 10 to 14 the rate increase was more than 230% (CDC, 2000; U.S. Suicide Statistics, 2005). African American males accounted for 84% of completed suicides among African Americans, a gender difference found in all U.S. racial/ethnic groups (Maris, Berman, & Silverman, 2000). African American women, on the other hand, have the lowest rate of suicide in the United States among all racial and ethnic groups, males and females (i.e., 1.7 per 100,000 for African American women and 5.0 per 100,000 for White women; AAS, 2008; U.S. Suicide Statistics, 2005). Address correspondence to Valerie Borum, PhD, MSW, Assistant Professor and BSW Director, Metropolitan State University of Denver, Department of Social Work, Denver, CO 80237, USA. E-mail: [email protected]

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Explanations for the increase in suicide among African Americans, particularly among African American adolescents and African American males, have included sociocultural factors such as racism and the assimilation experience—the internalization of the dominant group’s worldview, beliefs, values, and behaviors. It is hypothesized that assimilation into the dominant group’s, in this case, White Americans, cultural milieu can have negative mental health outcomes for African Americans, including increases in suicidal behavior (Gibbs, 1997; Prudhomme, 1938; Walker, 2007). For example, there is growing evidence of the association between assimilation and mental health related variables, such as exposure to stressful events, family functioning, availability of protective formal and informal resources, help-seeking behavior, and suicide (Gibbs, 1997; Walker, 2007). Other modifiable psychosocial risk factors that have been identified in explaining suicide among African Americans include substance abuse (Marion & Range, 2003; Murphy, 2000). Depression (Adcock & Nagy, 1991; Lester, 1999), family dysfunction (e.g., violence; Summerville et al., 1996), and interpersonal and marital discord (Willis et al., 2003; CDC, 2000) have been identified as psychosocial risk factors. In addition, death or loss of a parent or close family member (CDC, 2000), a history of delinquency (Corneau & Lanctot, 2004; Thompson et al., 2006), a history of psychiatric disorders and HIV diagnosis (Kenagy, 2005; Summerville et al., 1996), availability of lethal means, such as guns (Willis et al., 2003), and exposure to racial inequality (Burr, Hartman, & Matteson, 1999) have been identified as risk factors. Suicide and Culture A supplement to the surgeon general’s report, Mental Health: Culture, Race, and Ethnicity, called for an in-depth understanding and appreciation of how culture influences the nature of mental illness, including self-destructive and suicidal behavior, among ethnically diverse groups (U.S. Department of Health and Human Services, 2001). However, much of the research investigating suicidal behavior has been conducted within the general population of persons of European descent (i.e., persons classified as White). There is a dearth of literature on suicidal behavior among African Americans, male and females. When African Americans are included in research studies focusing on suicide, their numbers are usually small and are oftentimes compared to White, middle-class participants in assessing suicidal risk and protection (Joe & Kaplan, 2001; Poussaint & Alexander, 2000). In these comparisons, assumptions, values, and methodologies used for interpreting and explaining White, middle-class participants’ behaviors are then applied to African American participants without much attention to differences in culture, worldview, histories, and sociocultural realities. For example, Kershaw (1998) states that “The descriptions and analysis of Black life experiences have been formulated on the models set forth by White life experiences. The problem with this practice is the obvious one: Black and White life experiences are not the same” (p. 27). Furthermore, Kiev (1979) states that “culture determines the nature of the precipitating factors which trigger off suicidal behavior” (p. 220). Culture also influences culture-specific choices of method and lethality (e.g., gun, overdose, hanging, etc.) in suicide (Kiev, 1979; Maris et al., 2000). Culture determines the parameters of suicide according to the psychological orientation and behavioral manifestations of a particular ethnic group (Azibo, 1998; Gibbs, 1997). Therefore, asking why some individuals engage in suicidal behavior is a very different question than asking why some ethnic populations (i.e., African Americans) engage in suicidal behaviors. The first question, in which the individual is the unit of analysis, seeks to understand the causes of individual cases among a collective people. However, the second question seeks to understand the causes of incidence in suicide in an ethnic population (Kiev, 1979; Rose, 1985). In other words, researchers can find explanations regarding the variations in risk and protective factors among individuals and still miss the question relevant to public health: Why is suicide less

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common among African Americans in comparison to Whites (and other U.S. racial and ethnic groups)? Or why is there an increase in the incidence of suicide among African Americans? The responses to these questions require a different theoretical orientation and framework, such as Afrocentricity, because the questions are more relevant to an understanding of the sociocultural determinants of suicide in a population (i.e., ethnic group), not the risk and protective factors of individual cases (Aschengrau & Seage, 2008; Rose, 1985).

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Purpose of Study There is a dearth of research examining suicide and ethnic culture, specifically among African Americans, from a theoretical perspective. To comprehend the nature and incidence of contemporary suicide among African Americans, researchers must first examine the historical, sociocultural, and political features found in African American experiences. There is a need to understand what has changed to create the growing incidence of suicide in the African American population. One way to do this is to explore, in the form of an Afro-lay/folk theory, via focus groups, the following questions: (a) How does ethnic culture influence perceptions of sociocultural determinants in explaining increases in the incidence of suicide among African Americans? (b) How does a “minoritized” status influence perceptions of sociocultural determinants in explaining an increase in the incidence of suicide among African Americans? and (c) What new insights can an Afrocentric theoretical framework provide in understanding the increase in incidence of suicidal behavior among African Americans? Kershaw (1998) states that greater attention should be placed on generating knowledge that stems from research participants’ understanding of constructs/concepts before testing theoretical relationships. A THEORY OF AFROCENTRICITY: A CONCEPTUAL OVERVIEW To provide a theoretical framework that is inclusive and allows for African American cultural and historical significance when dealing with contemporary increases in the incidence of suicide among African Americans, a sociocultural framework, such as Afrocentricity, is required (Asante, 1990; Azibo, 1998; Schiele, 2000). Afrocentricity recognizes culture and history as the centerpiece of any analysis of people of African descent. Asante (1990) explains that Afrocentricity affirms the dynamic and active manner in which people of African descent are primary and central agents in the shaping of their histories. Human agency, as a guiding principle, provides the filter in describing the existence and strivings of persons of African descent in United States and throughout the diaspora. Afrocentricity, as a conceptual and theoretical framework, attempts such human agency, definition, and identity (Asante, 1990). Afrocentricity can also be viewed as a “philosophical ideology” (ways of being, thinking, and knowing), which centralizes African American history, culture, and African heritage; or more concisely, Asante (1990, p. 28) describes Afrocentricity as a “philosophical outlook determined by history” consisting of the following premises: The cosmological aspects (e.g., worldview) entail viewing reality from the diunital (both/and) perspective of interdependency where all elements of the universe are interconnected. Its ontological aspects (e.g., view of human nature) assume all elements of the universe (e.g., people, animals, etc.) are spiritual—all elements are created from this universal, spiritual substance. Epistemologically, a great deal of emphasis is placed on an affective way of knowing and obtaining information while its axiological significance underscores interpersonal relationships as the highest value (Asante, 1990; Schiele, 2000). The emphasis on interpersonal relationships helps to foster a human-centered orientation toward life. As a result, material/object acquisition would not supersede the maintenance and strength of interpersonal ties (Asante, 1990; Nobles, 2004).

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Core African American Cultural Characteristics Afrocentric researchers and scholars have reached a consensus on the following core characteristics found in African American culture: (a) centrality of the collective community, (b) emphasis on the oral tradition, (c) spiritual and ethical essence of human beings and life, (d) harmony with nature, (e) the extended self-hood, (f) reverence of ancestors and elderly, (g) the interconnectedness of all life-spiritual and nonmaterial, (h) rhythm and time orientation, and (i) the unity of being (Akbar, 1984; Asante, 1990; Azibo, 1998; Meyers, 1988). Not surprisingly, these identified core African American cultural characteristics have also been found to provide protection in moderating suicide risk among African Americans. For example, modifiable psychosocial protective factors among African Americans have included spirituality and religious involvement (Anglin, Gabriel, & Kaslow, 2005; Early & Akers, 1993; Walker et al., 2007). Spirituality has been positively associated with psychological and physiological well-being (e.g., Early & Akers, 1993). Spirituality and faith tradition are vital components of African American culture (Lincoln & Mamiya, 1990). Family cohesiveness (Gibbs, 1997), extended family and kinship networks (Stack, 1998; Nobles 2004), fraternal and social organizations, social support networks (Nisbet, 1996), and Black consciousness (Azibo, 1998; Kirk & Zucker, 1979) have also been found to provide African Americans protection in moderating suicide risk. Although several cultural protective factors that provide African Americans buffer against suicide risk have been identified, it remains unclear exactly how culture interacts with suicide protection and/or risk. In other words, research must go beyond identifying individual risk and protective factors and move toward developing theories that can be empirically tested to explain how and why these cultural protective factors act as moderators in suicide risk in the African American population. It is at this juncture that Afrocentricity, an overarching theoretical and conceptual framework, is incorporated as a public health pathway in understanding the role of ethnic culture in explaining the nature and incidence of suicide among African Americans. In light of the above description of Afrocentricity as a theoretical and conceptual organizing framework in this study for elucidating the role of ethnic culture, it is important to note that there is no conflict in using qualitative approaches in an inductive and deductive manner. As Berg (2001) notes, “Central to misconception are the notions that grounded theory is an entirely inductive process, that it does not verify findings, and that it somehow molds the data to the theory rather than the reverse” (p. 244). Categories used by researchers utilizing qualitative, interpretive approaches can be decided inductively, deductively, as well as a combination of both (Glaser & Strauss, 1999). Inductive reasoning and deductive reasoning are not independent of interactions between theoretical interests (e.g., Afrocentricity) and empirical observations (qualitative, interpretive approaches; Barker, 1957; Berg, 2001).

METHOD A qualitative, exploratory research study consisting of focus groups with 40 African American female students was reviewed and approved by the Institutional Review Board at the site of the study (Northeast U.S. university setting). A qualitative, exploratory design was incorporated to ascertain perceptions of sociocultural determinants of suicide among African Americans. Rubin and Babbie (2010) have indicated that if there is a dearth of information regarding a particular research area, an exploratory approach is an empirically appropriate vehicle to conduct a study. Furthermore, there is a dearth of research and theoretical perspectives on suicide and ethnic culture among African Americans; therefore, the employment of an exploratory research design based on a qualitative research approach (i.e., focus groups) is most appropriate for this study (Ibrahim & Arrendondo, 1986; Marshall & Rossman, 1999).

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Furthermore, an Afrocentric theoretical premise consists of conducting research inquiries in a manner that provides interaction (i.e., spiritual and oral tradition) between the researchers and participants (Kershaw, 1998; Schiele, 2000). Kershaw (1998, p. 35) states that the researcher should not be bound, methodologically speaking, by positivist limitations that separate self and subject. In other words, when researchers are alienated from research participants, paradoxically, participants are not subjects, but objects (Friere, 1999). Qualitative research aims to place research participants’ experiences and perceived/identified needs at the center of knowledge development and validation (Kershaw, 1998). Knowledge generated from this method can facilitate the development of theoretical relationships and public health policy initiatives based in an interpretive framework of the participants’ understanding of issues relevant to them.

Sample and Selection A purposive sample was recruited for this study. Eligible participants were 40 African American female college students enrolled at a historically, predominantly White university, located in a Northeastern U.S. state during the 2007 to 2008 academic year. The mean age of the sample was 26, with ages ranging from 18 to 39. Existing literature suggests that the nonrandom sampling method is acceptable until a database can be developed that can more adequately assess a population (Bernard, 1995; Kershaw, 1998). To capture the role of ethnic culture only African American students were recruited. The study’s focus did not include “race” as a pan-ethnic construct; therefore, Nigerian American, Jamaican American, or South African American students, for example, were excluded. By recruiting African American students specifically the investigator could more readily ascertain unique cultural and historical experiences among a “relatively homogenous” ethnic sample consisting of inherent diversity. Furthermore, as Berg (2001) notes the main reason for incorporating purposive sampling is to ensure that participants possess specific attributes that fit the study criteria.

Data Collection The primary data collection technique employed in this study was focus groups. Focus groups feature informal, structured discussions rather than formal, closed-ended ones. The researcher explores a few general topics to help uncover the participants’ perspective but otherwise takes note of how the participants frame and structure the responses (Bernard, 1995; Marshall & Rossman, 1999; Rubin & Babbie, 2010). In addition, focus groups can serve as a vehicle to explore and validate African Americans’ sociocultural experiences and their collective, cultural survival/resistance strategies (Kershaw, 1998). Focus group questions were established prior to the focus group discussions in an effort to guide the process. Focus questions or general directions included questions, such as “How do you explain suicidal behavior among African Americans? How do you explain the increase in suicide among African Americans? What might make African Americans attempt suicide? What might prevent African Americans from committing suicide? What else should I know to understand perceptions of suicide among African Americans?” After written consent, all focus group discussions were tape-recorded for transcription purposes. Reflexive journaling was used to foster maximum validity of research findings. Additionally, at the end of each focus group session, as a means to further increase the validity of findings, the researcher/facilitator employed a member-checking strategy (Berg, 2001) by summarizing focus group discussions and asking participants to respond to the summaries in terms of their accuracy. Participants were compensated $45 each for their participation.

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Data Analysis This study, a grounded theory approach, entailed a content analysis (Glaser & Strauss, 1999). The focus group interviews were transcribed verbatim. Following transcription, focus group discussions were analyzed by identifying and coding topical schema (i.e., meaning units) in the form of themes and concepts in the transcript data. Coding schemes were derived theoretically according to the study’s framework with regard to sociocultural determinants of suicide among African Americans. Inductive codes were categorized into meaningful clusters within the theoretical framework. Concurrently, in efforts of developing theoretical relationships, Afrocentricity is incorporated as an overarching framework in deductively organizing emerging, inductive themes stemming from focus group discussions as a preliminary explanatory model. As noted earlier by Berg (2001) in this document, “Central to misconception are the notions that grounded theory is an entirely inductive process, that it does not verify findings, and that it somehow molds the data to the theory rather than the reverse” (p. 244).

RESULTS The results of the inductive and emergent themes stemming from the focus group discussions are discussed below, highlighting some of the Afrocentric theoretical premises and underlying assumptions germane to a sociocultural perspective. Emergent themes related to increases in the incidence of suicide among African Americans included the following perceived sociocultural determinants: (a) racism, discrimination, and stereotyping; (b) U.S. individualism; (c) integration and cultural assimilation; and (d) the prison industrial complex. At least two to three representative and independent statements from focus groups have been included whenever possible (Berg, 2001). A discussion of the findings is presented along with each of the four above resulting focus group themes to further illustrate the Afrocentric theoretical underpinnings and emerging theoretical relationships. Berg (2001) noted that “with regard to qualitative research reports, several options are available for writing about the findings (data) and results (interpretation of the data)” (p. 277).

Theme 1: Racism, Discrimination, and Stereotyping Essed (1990), in her qualitative study of daily experiences of racism and discrimination by African Americans (i.e., racial profiling, workplace discrimination, etc.), described the chronic nature of stress that is associated with racism, discrimination, and stereotyping as a way of everyday life by stating: “To live with the threat of racism means planning, almost everyday of one’s life, how to avoid or defend oneself against discrimination” (p. 260). The impact of racism and its daily assault on the psyche of African Americas has been shown to have negative effects on their psychological functioning (Azibo, 1998; Schiele, 2000). For example, when asked, “What might make African Americans attempt suicide?” participants from each and every focus group responded by sharing the following thematic responses: Definitely external like racism is always there. I don’t know maybe racism, like I don’t know, I just feel like everything is—it’s a set up. Just comparing African Americans against privileged races, just the expectation of—just very negative connotations about yourself and your peer group and your race, then ultimately—like in a big scheme of things you don’t have anything to look forward to : : : then there are no options. Racism, that’s always a factor [Agreement].

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Color-blind and high-risk individual approaches to public health tend to treat all ethnic groups similarly without regard to their specific and differential experiences related to structural and institutional power (Zuberi & Bonilla-Silva, 2008). In other words, color-blind approaches to public health tend to decontexualize the experiences of African Americans and erroneously disconnect them from the U.S. context in which they live (i.e., racism, discrimination, stereotypes; McMahon & Allen-Meares, 1992). However, an Afrocentric approach to public health does not view institutional racism, oppression, and discrimination as remote pathologies in an otherwise healthy society; instead, the societal context of racism must be addressed within an Afrocentric public health framework. As Zuberi and Bonilla-Silva (2008) state regarding racially oppressed or “minoritized” groups: “they are thrown into a world of preexisting meanings as [people]” (p. 18). It is the cultural, hegemonic social construction of race (read: phenotype) that attributes social value, rewards, risks, dehumanization, and oppression among different groups and functions as a means of creating disparities and inequalities. Therefore, the responses to sociocultural forces (and determinants) will vary among groups as the impact of these forces will also vary—African Americans as a group, for example, do not benefit from racism; however, Whites do (i.e., white privilege). In this sense, institutional racism refers to the systematic, structural practices that exclude groups based on race from access to resources and perpetuate their “minoritized” status in economic, political, and social life (Grant & Ladson-Billings, 1997, p. 231). As a result, an Afrocentric approach to public health recognizes racism, and its subsequent ideology, as a societal problem rather than a population-specific problem. African Americans, an ethnic population, are oftentimes projected as “the problem,” when African Americans are actually the bearers of the “the problem”: racism. Racism and its effects on African Americans (and other ethnic groups of color) can include what Miller (2009, p. 41) refers to as “race-based traumatic stress.” Race-based traumatic stress, due to its persistence and ubiquity, can include feelings of rage, anger, fear, worthlessness, humiliation, degradation, etc., which can have an impact on African Americans as a group. However, the target for change— public health crisis—in this instance is the eradication of racism and its pathological effects on both those who are victimized by it as well as those who perpetuate it. Carter & Forsyth (2009) de-emphasize the pathology (e.g., individual cases of suicidal behavior) of African Americans and other ethnic groups as a result of racism by stating the following: “: : : it might be more clinically effective to consider the effects of racism as a type of psychological injury rather than as mental disorder, since the effects of racism arise from environmental stressors rather than from an abnormality of the target” (p. 37). A public health modification that focuses on population-based approaches instead of focusing on individual cases would emphasize and explicate the effects of racism as a stressor on the affected population.

Theme 2: U.S. Individualism One way to understand contemporary increases in the incidence of suicide among African Americans is by looking at how culture and societal behavioral norms and beliefs affect ethnic and racial groups. In other words, a method of understanding the incidence of suicide would be to investigate the potential relationship and effects of traditional “American” values on African American life chances. For example, an investigation of the U.S. emphasis and value in individualism and its impact on African Americans as an ethnic group would be important in understanding some of the underlying sociocultural determinants of suicidal behavior. Beliefs and values in individualism manifest as a conceptual view of the individual as the primary motivator and explanatory model for human behavior (Schiele, 2000; Shiang, 1998). The individual, as the primary unit of analysis, is then held as solely responsible for his or her life chances. For example, according to the participants:

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America as an institution isn’t created for Black people, you know, but still being individualistic, that’s the type of environment that it is, so but as far as like family and collectivism, and church, and school, and community, then that doesn’t match up because within our collective society or culture you’re not supposed to be individualistic.

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I think there’s a strong sense of community, and the whole theory of “It Takes a Village to Raise a Child,” and you know just a lot of people take that seriously. [Agreement: “That’s true, that is so true!”] It could be physiological, physical, like actual makeup of that person, what’s in their genes. We all react to things differently, and I think that’s where community comes in. I think there’s more of a stronger value in African American communities. Well, African Americans as a whole are a collectivist society, and Western European, whatever, they value individualism.

Afrocentric scholars have argued that an Afrocentric cultural orientation of the “self” emphasizes interdependence, collectivity, and shared responsibility; thus, the most appropriate framework for conceptualizing the concept of “self” among African Americans (Asante, 1990; Baldwin, 1981; Schiele, 2000). Afrocentrically, the conception of “self” is understood and defined within the context of the group, which includes one’s people and the survival of peoplehood—an “extendedself” (Nobles, 2004). The self is not treated as separate from the ethnic group and represents a diuntial (both/and) or appositional relationship between the self and the group. In other words, the concept of self can be better understood by the familiar African proverb, “I am because we are, and because we are therefore I am” (Mbiti, 1970, p. 141). In fact, from an Afrocentric worldview standpoint, because the self is extended to include one’s peoplehood, suicide in the African American community would be classified as homicide—the killing of the extended self, not the separate, autonomous self. In other words, the concept of the self is not viewed as separate and isolated from ones people, community, or group, and thus the self is unable to commit suicide against an isolated or separated self. As one participant noted: “: : : like the collective thing, I know that within my experience, suicide is associated with selfishness, and to take your life is a selfish thing to do, you know, ‘Why would you do this to me?”’ Another participant noted: I think what would be considered suicide in the white community is completely different from what’s considered suicide in the Black community, because we don’t necessarily commit more suicide, I think we just kill each other more. We kill each other instead of killing ourselves, so in a sense it is killing ourselves.

In the dominant Euro-American culture, however, the conception of self is paradoxical to African American culture. Josefowitz (1985, p. 77) explains regarding white culture, “We believe in rugged individualism. The individual is the primary unit of analysis.” Several researchers and scholars have proposed a cultural worldview among African Americans from which they interpret reality and view the world (e.g., Asante, 1990; Nobles, 2004; Schiele, 2000). Within this worldview the “individual” and the group are collapsed, and the person and the community merge and are interdependently defined in terms of each other (Ani, 1994). The person does not exist outside the context of the larger, ethnic community because of the emotional, spiritual, and physical impetus for human interaction—a necessity for the manifestation of humanity. In essence, the ethnic community is “created by the spiritual communion or joining of persons” (Ani, 1994, p. 352). If people are spiritually connected, then there is no perceptual disjointing between and among its ethnic group members, and identity is, therefore, collective (Schiele, 2000). Personal identity is then simply a unique manifestation of the common, cultural ethos of the group (Ani, 1994; Schiele, 2000).

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An Afrocentric theoretical approach to public health gives preeminence to the group and complements the ultimate focus of public health as a field of study (i.e., population approaches). For example, the well-being and life chances of the group (African Americans) take precedence over the well-being and life chances of the individual. An Afrocentric public health perspective is based on a collective orientation where public health needs and interests of African Americans as a collective, ethnic group supersede the needs and interests of African Americans as individuals— collective survival is paramount (Asante, 1990; Baldwin, 1981; Schiele, 2000). Individual risk and protective factors may be a way to understand what is happening regarding suicide among individuals; however, these same data tell us very little about why it happens in a population such as African Americans. As noted by one of the participants in the focus group: Don’t look at it as separate, look at it as Black people as a whole, and White people as a whole, because if you look at it separate, there’s gonna be individual differences in everything. [Agreement] : : : And, it may not be like a bad thing that like—it may not necessarily—it’s just that that’s their culture.

Theme 3: Integration and Cultural Assimilation Cultural worldviews also have an impact on suicidal behavior and responses to profound despair as well as coping and managing difficult circumstances (Shiang, 1998; Sue & Sue, 1999). For example, Prudhomme (1938) hypothesized that a rise in the incidence of suicide among African Americans would take place “as the [African American] environment approximates that of the majority” (p. 391). Prudhomme and Walker (2007) propose that the more acculturated African Americans become to the majority culture, the more likely they would consider suicide and the less likely they would embrace an African American cultural worldview (i.e., religiosity/spirituality, extended family networks, collective identity), which provides protection against suicide. Focus group participants noted in reference to the increase in incidence of suicidal behavior among African Americans the following related to integration and cultural assimilation/acculturation: I think it’s again the “watering down of our culture,” and wanting to assimilate to the masses, the society norm, the European culture, and so these are the practices and behavior that I do, and this is how I begin to think, this is how I begin to feel, and this is how I begin to act. I definitely think assimilation comes with a different mind-set about. I mean this setting is just very different when we talk about culture. I think it’s the pressure to assimilate, because of this newly achieved status. I think that like going back to our own level of [acculturation] like the more we infuse ourselves with them, like white culture, and lose our own identity as Black culture. We talk about pre-like-integration, this whole idea of community—we’re integrated and stuff and I don’t know, I think the values have changed.

Prior to the Civil Rights Act of 1964, the suicide rate for African Americans was one fourth of that of Whites. However, by the late 1970s and early 1980s African Americans were committing suicide at half the rate of Whites (Joe, 2006; Joe & Kaplan, 2001). Walker (2007) explains the increase in suicide among African Americans since the 1960s as a result of cultural changes (read: acculturation) in the African American community. In this instance, assimilation and/or acculturation on the part of African Americans refer to the extent in which they “participate in the cultural traditions, values, beliefs, and practices of their own culture versus those of the dominant ’White’ society” (Landrine & Klonoff, 1996, p. 1).

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The Euro-American culture is the dominant culture in the U.S., and Nobles (2004) explains that power is the ability of one group to superimpose their definition of reality and then convince other groups that it is their description of reality. This form of ethnocentrism and the superimposition of White culture is the widespread belief in the superiority of White culture—its cultural values, norms, and behaviors (Young, 1990). Young (1990) explains that cultural oppression is “the universalization of a dominant group’s experience and culture, and its establishment as the norm” (p. 59). Its achievement in positioning itself as the norm and standard for which all other groups are measured and compared is done so in a manner that marginalizes and devalues salient aspects of other groups’ cultures (i.e., communal/collective and spiritual values). Instead, EuroAmerican values such as individualism, materialism, objectification, and inordinate competition are highlighted and encouraged (Schiele, 2000). Chinweizu (1978) describes this so-called civilizing process of persons of African descent: It was a miseducation process which, by encouraging me to glorify all things European, and by teaching me a low esteem for and negative attitudes towards things African, sought to cultivate in me that kind of inferiority complex which drives a perfectly fine right foot to strive to mutilate itself into a left foot. It was a miseducation : : : it sought thereby to indoctrinate me with the colonizers’ ideology; it sought to internalize in my consciousness the values of the colonizers. (p. xiv)

A prevailing misconception about African American culture is the assumption that the “new world” experience eradicated all vestiges of African cultural traditions as result of U.S. enslavement of Africans. In fact, what is striking is the role of hundreds years of enslavement followed by enforced segregation and exclusion from larger society has played in the retention of African traditions by African Americans (Ani, 1994; Asante, 1990; Azibo, 1998). Arguably, then, the challenge for African Americans now is related to their ability to comfortably negotiate between at least two cultural worldviews—Afrocentric and Eurocentric. As Robinson and Hamilton (1994) state, “an Afrocentric paradigm is the worldview that inherently has the greatest historical and cultural meaning for African Americans—a worldview that allows for optimal spiritual strength and identity development” (p. 331). Theme 4: Prison Industrial Complex Ideology represents a cultural worldview that is replicated and validated in the daily lives of people (Ani, 1994; Fields, 1990). Societal ideology is perpetuated by those who own and control the vast majority of social, educational, and media institutions. This ideology created must then be viewed as valid in some limited means by oppressed peoples, such as African Americans, for the ideology to affect another group’s worldview and outlook on life (Ani, 1994; Fields, 1990). For example, the media as well as other United States (and international) institutions have portrayed young African American males as criminals, thus perpetuating an ideology about the criminality of young Black males. This imagery then, repeated over and over again, begins to take hold in the public’s mind. The fear of African American males “is the most important racially manipulated emotion that has held white people captive to the white supremacy system since the colonial era” (Anderson & Collins, 1992, p. 400). For example, a White woman may fear African American men even though she faces greater danger from White men in the home (Ani, 1994; Fields, 1990). The impact of the prison industrial complex has been experienced by African Americans as an ethnic population, not simply as individuals. African Americans, as an ethnic group, constitute almost 14% of the U.S. population and approximately 13% of drug users, for example, and yet African Americans comprise nearly 57% of those incarcerated in U.S. state prisons for drug crimes (U.S. Census Bureau, 2010; Western & Wildeman, 2009). White, non-Hispanic Americans, on the other hand, make up nearly 64% of the U.S. population and 68% of drug users but only constitute

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23% of those incarcerated in U.S. state prisons for drug crimes (U.S. Census Bureau, 2010; Western & Wildeman, 2009). In relation to explaining the increase in suicide among African Americans, and African American men in particular, the participants responded by stating the following:

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Because of unemployment rates and the prison system, and just the numbers there, that it’s definitely different, and the risks are, I think the risks are—or the impetus is different, because I mean marginally there aren’t as many Caucasian males in prison or unemployed, you know it’s a different situation for African Americans. I definitely think it’s like, ‘What do I do now?’ I’m gonna go to jail anyway, I might as well be, you know, something—just like a crazy thought process behind it, and then it’s just [snaps fingers] snap, like bam, out. Yeah, I’m not sure because two weeks ago on the front page of The Times was—you know, “Plight Deepens for a Black Male.”

The process of ethnic destabilization via the prison industrial complex, a means of social control, has copious, negative-related impacts on African Americans as a population. For one, the incarceration rates of African Americans men limit the number of available partners in African American relationships/marriages, families, and neighborhood communities. This prison industry also manufactures a large pool of primarily young African American men with little to no marketable skills, social stigma, and limited to no access to sustainable employment, public housing, or the ability to participate in the political process (e.g., right to vote) based on a felony conviction (Western, 2002; Western & Wildeman, 2009). This industry further limits the possibilities of a critical, ethnic mass to challenge the disparities and inequities in society via social movements or radical upset. When all the impacts of massive incarceration are intertwined, it produces what Western and Wildeman (2009) explain as essentially a perpetual, second-class, “minoritized,” ethnic population. Alexander (2010) further discusses the impact of this societal ideology regarding African Americans, and African American males in particular, and the burgeoning mass incarceration in her recent book, The New Jim Crow: Mass Incarceration in the Age of colorblindness. Alexander explains how in 1982 the Reagan administrations’ War on Drugs public policies had a devastating impact on African American families and communities. In less than 30 years, the U.S. prison population rose from approximately 300,000 to more than two million, with the majority of drug convictions accounting for the increase (Stemen & Rengifo, 2011). The United States imprisons a larger percentage (5 times greater) of its African American population (particularly males) than did South Africa did at the peak of apartheid (Alexander, 2010; Beckett, 1999). Beginning in the mid to late 1980s there was a dramatic increase in African American suicide rates, especially among adolescent and young adult African American males (Joe & Kaplan, 2001; Utsey, Hook, & Standard, 2007). From 1981 to 1994, the rate of suicide among African American males age 15 to 24 increased 83% (and a 10% increase for African American females; AAS, 2004; Joe & Kaplan, 2001). Barnes and Bell (2003) have noted that there was an even more dramatic increase in the incidence of suicide among African American males between age 10 to 19 (114% increase) and 10 to 14 (233% increase) during this same time period. The entire process of removing and disconnecting large segments of an ethnic population from key life communal areas via mass incarceration generates the aforementioned perceived sociocultural determinants in explaining the increase in the incidence of suicide and suicidal behavior among African Americans and the subsequent communal instability (Western, 2002; Western & Wildeman, 2009). For example, to really understand the devastating impact of this particular set of public policies (i.e., War on Drugs) on the health and well-being of African Americans as a population is to recognize that there are more African American males in prison,

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jail, and/or on probation/parole than were enslaved in 1850, prior to the Civil War (Alexander, 2010, p. 25). The prison industrial complex—“slave ships that don’t move”—represents the reenslavement and capture of African Americans, particularly young Black males (Borum, 2007). In fact, when enslaved Africans did commit suicide (although rarely), it was generally done so as a form of resistance (e.g., escape capture, avoid brutal punishment, or sale; Genovese, 1974). Understanding “police-precipitated suicide” among African American men from an Afrocentric approach to public health is to also understand how African Americans negotiate their Afrocentric life chances within the sociocultural context (history, culture, heritage, etc.) in which they live. As one participant noted: I’m remembering someone I went to school with and there’s still speculation about how he died. Some say that the cops shot him, and then some people say that he just turned the gun on himself. He was troubled. He had been to jail several times. According to a friend, he said that would kill himself before he’d go back to jail. So the night of his death he was robbing a CVS Pharmacy, and the cops were about to arrest him, a battle occurred, and supposedly, he turned the gun on himself, because he didn’t want to go back to jail. So for him, death was the answer instead of having to go back to jail. So maybe this is how some Black males feel.

CONCLUSION This qualitative study was guided and organized by an Afrocentric theoretical framework in efforts of building a preliminary public health model that incorporates African American cultural values as its foundation. Perceptions of socio-cultural determinants of suicide were explored with a sample of 40 African American students enrolled in a northeaster, predominantly white university located in a city with a high level of racial and ethnic diversity. Within this setting and in response to focus questions about the increase in incidence of suicide among African Americans the following four perceived socio-cultural determinants emerged from focus group discussions: 1) racism, discrimination, and stereotyping; 2) U.S. individualism; 3) integration and cultural assimilation; and, 4) the prison industrial complex. First, when discussing and responding to focus questions regarding increases in the incidence of suicide among African Americans, a major theme of focus group discussions was the effects of racism, discrimination, and stereotyping on the African American psyche. The persistence and ubiquity of racism was perceived as a socio-determinant in explaining an increase in suicide ˚ among African Americans. As one participant stated, “Definitely externalUlike racism is always there.” Second, the superimposition of the dominant group’s cultural worldview and value in U.S. individualism was viewed as a socio-cultural determinant in explaining suicide among African Americans. For example, one participant stated, “Well, African Americans as a whole are a collectivist society, and Western European, whatever, they value individualism.” In order to commit suicide, one has to view oneself as a separate, autonomous being. In African American culture, the self is extended to include one’s people (read: collective worldview); therefore, suicide would entail the extended self (e.g., homicide), because there is no isolated, separate self. Third, participants described the pressure to assimilate into the dominant, Euro-American culture as another socio-cultural determinant in explaining an increase in suicide among African Americans. Participants stated the following, for example: “I definitely think assimilation comes with a different mindset. I mean this setting is just very different when we talk about culture” and “I think that like going back to our own level of [acculturation] like the more we infuse ourselves with them, like white culture, and lose our own identity as Black culture.” Fourth, participants described the prison industrial complex as a socio-cultural determinant of suicide among African Americans, particularly African American youth and adult males. As one

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participant stated, “Because of unemployment rates and the prison system, and just the numbers there, that it’s definitely different, and the risks are, I think the risks are–or the impetus is different : : : I think that adds to despair, hopelessness in the African American community.”

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AFROCENTRIC IMPLICATIONS FOR PUBLIC HEALTH The present study underscores the importance of integrating ethnic culture in research studies designed to examine public health inequities (e.g., increase in the incidence in suicide among African Americans). An Afrocentric theoretical approach to public health affords researchers a pathway to understanding the role of ethnic culture and suicidal behavior among African Americans by identifying the deep structure of cultural worldviews. An Afrocentric approach to public health stresses the importance of understanding the precipitating, socio-cultural determinants of suicide among African Americans within the context of African American history, heritage, culture, and lived experiences. An Afrocentric population-based approach also allows for a robust analysis of how a “minoritized” status limits health and well being among African Americans as an ethnic population by creating and maintaining health inequalities and disparities despite their cultural protection (e.g., spirituality, extended family, collectivism).

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