BACKGROUND Black race, inadequate health literacy, and poor perceived control are predictors of increased cardiovascular disease (CVD) risk. The purpose of this study was to explore the relationships among race, health literacy, perceived control, and CVD risk while controlling for known risk factors in incarcerated men. METHODS We included data from 349 incarcerated men to examine race and CVD risk (Framingham Risk Score) using a serial mediation model with health literacy and perceived control using 95% confidence intervals (CIs) from 5000 bootstrap samples. RESULTS Of the participants (age, 36 ± 10; education, 12 ± 2; body mass index, 28.3 ± 5.0), 64.2% were White and 35.8% were Black. Black incarcerated men were younger (P = .047) with lower levels of health literacy (P < .001). All 3 indirect effects of race on CVD were significant, whereas the direct effect of race was not. Black incarcerated men had higher levels of CVD risk through health literacy (a1b1 = 0.3571; 95% CI, 0.0948-0.7162) and lower levels of CVD risk through perceived control (a2b2 = -0.1855; 95% CI, -0.4388 to -0.0077). Black incarcerated men had higher levels of CVD risk through health literacy influenced by perceived control (a1b2d21 = 0.0627; 95% CI, 0.0028-0.1409), indicating that despite the protective effect of higher levels of perceived control in Black incarcerated men, CVD risk remained higher compared with their White counterparts. CONCLUSION Future CVD risk reduction interventions in incarcerated men, specifically Black incarcerated men, should include goals of improving health literacy and perceived control as modifiable risk factors.

中文翻译：

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健康素养和感知控制：美国被监禁男性种族与心血管疾病风险之间关系的中介因素。

背景黑人种族、健康素养不足和感知控制能力差是心血管疾病（CVD）风险增加的预测因素。本研究的目的是探讨种族、健康素养、感知控制和心血管疾病风险之间的关系，同时控制被监禁男性的已知风险因素。方法 我们纳入了 349 名被监禁男子的数据，使用具有健康素养和感知控制的系列中介模型，使用来自 5000 个引导样本的 95% 置信区间 (CI) 来检查种族和 CVD 风险（弗雷明汉风险评分）。结果 参与者（年龄，36 ± 10；教育程度，12 ± 2；体重指数，28.3 ± 5.0）中，64.2% 是白人，35.8% 是黑人。黑人被监禁男性更年轻 (P = .047)，健康素养水平较低 (P < .001)。种族对 CVD 的所有 3 种间接影响都很显着，而种族的直接影响则不然。黑人被监禁男性通过健康素养获得较高水平的 CVD 风险（a1b1 = 0.3571；95% CI，0.0948-0.7162），通过感知控制获得较低水平的 CVD 风险（a2b2 = -0.1855；95% CI，-0.4388 至 -0.0077） 。黑人被监禁男性因受感知控制影响的健康素养而具有较高水平的 CVD 风险（a1b2d21 = 0.0627；95% CI，0.0028-0.1409），这表明尽管黑人被监禁男性较高水平的感知控制具有保护作用，但 CVD 风险仍然存在与白人同行相比更高。结论 未来对被监禁男性（特别是黑人被监禁男性）的 CVD 风险降低干预措施应包括提高健康素养和将控制感视为可改变的风险因素的目标。