Limited access to healthcare, along with food insecurity and healthcare professional (HCP) bias, have had a chilling impact on Black communities. Black people continue to live fewer years on average than White or Latino people, are more likely to die from treatable conditions and are at risk for many chronic health conditions, including diabetes and hypertension.^1-3  Evidence also shows that Black patients face racial bias in healthcare settings and have disproportionately longer waits for specialty care.⁴

 “We expanded insurance coverage, produced more research and increased awareness, but none of it has translated into reduced health disparities or better outcomes for Black Americans,” says Kevin Griffith, PhD, assistant professor in the Department of Health Policy at Vanderbilt University Medical Center in Nashville. Below, experts discuss the common challenges Black patients often face when navigating the healthcare system and strategies for closing the disparity gap.   

Challenge: Lack of trust

Systemic racism and perceived bias within the healthcare system have caused many to believe that HCPs favor White patients or treat Black patients unfairly. Events like the 1932 Tuskegee Syphilis Study, for example, in which Black men with syphilis were observed without consent and left untreated, fueled mistrust of doctors and healthcare in general. The study lasted 40 years, and because the men didn’t receive treatment, some of their female partners contracted syphilis.⁵ “There’s a lot of research on how physicians, nurses and others in the health system don’t provide culturally sensitive care to Black patients and they often interpret their pain as perhaps being overestimated,” Griffith says.

Solution: Listen and document

“It’s important that clinicians understand the historical contexts of the Black community and medicine in America and not take Black patients’ hesitation personally,” says Brandi Addison, DO, FACE, DABOM, an endocrinologist at South Texas Endocrinology & Metabolism Center in Corpus Christi, TX. She adds, “Black patients often feel unheard and that their concerns are dismissed. Before I jump into any health topic, I check to see how the patient is doing overall. By doing that small check-in on social well-being, I get a better idea of the mental space my patient is in and how I should approach their health concerns that day.”

Karriem Watson, DHSc, MS, MPH, chief executive officer for the UI Health Mile Square Health Center in Chicago, notes that many healthcare systems use medical scribes to assist clinicians in documenting patient encounters, so they can better engage with patients during short visits. “This allows the provider to have more of a connection with the patient and to be more present for what they’re communicating to them,” Watson says.

Challenge: Shortage of Black physicians

Research shows that when Black patients are treated by Black doctors, they often experience better health outcomes, engagement and satisfaction. Improvements in preventive care and chronic disease management are due, in part, to better communication, trust and reduced racial bias.⁶ “There is strong evidence that this bias and this stigma is not just a frustration but has real-world implications for health and mortality,” says Watson. He recommends referring patients who are treatment-hesitant to Black physicians. “That doesn’t mean that only a Black provider can take care of a Black patient,” Watson continues, “but representation matters and, across the board, we know that when you have diverse voices at the table with diverse experiences, you have improved outcomes.”   

Unfortunately, there is a shortage of Black physicians, who make up only 5.7% of doctors in the United States even though Black Americans account for 14.4% of the population.^7,8 “We have this really leaky pipeline of Black physicians, all the way from med school to residency, to practicing to moving into leadership positions within the health system,” says Griffith. “They leave at higher rates than White students or physicians at every step of that process.”

In an effort to create a more diverse physician workforce, the American Medical Association’s (AMA) Minority Affairs Consortium (MAC) started the Doctors Back to School program to encourage underrepresented students to pursue medical careers.⁹ Similarly, the AMA also launched the Community Health Impact Lab Micro Grants Program, which awards $50,000 to physicians who break down the healthcare barriers they see in their communities.¹⁰ For information on applying for this AMA micro grant program, go to: ama-assn.org.

Solution:

Clinicians can refer patients to Black physicians in their area through the Find a Black Doctor website (findablackdoctor.com), an online directory of U.S.-based Black physicians in active clinical practice.   

 “There is strong evidence that this bias and this stigma is not just a frustration but has real-world implications for health and mortality.”

—Kevin Griffith, PhD

Challenge: Racial bias

In a survey conducted by the Commonwealth Fund, healthcare workers said they witnessed racial bias, with a significant percentage reporting they’ve seen racial discrimination against patients in their facilities.¹¹ The survey concluded that discrimination against patients based on race is a serious problem that impacts care delivery and workforce morale.¹¹ Other studies have shown widespread racial bias when seeking treatment, and also that Black patients are less likely than White patients to receive opioids for acute pain in emergency departments.¹² “It’s not just that Black patients are not treated as well when they go to a hospital—they also tend to seek care from hospitals and facilities that have worse outcomes,” says Griffith.

Solution:

Experts say that healthcare workers should be trained to identify and respond to racism whenever it occurs. Griffith recommends that physicians engage in interactive and repeated implicit bias training. “One-time implicit bias trainings check a box, but they don’t change behavior,” he says. “What actually works is sustained, interactive training that helps clinicians recognize bias and actively work against it over time.”

 

Challenge: Insurance cutbacks

New federal work requirements now require many able-bodied adults (ages 18-64) receiving federally funded Medicaid to work, and those receiving Supplemental Nutrition Assistance Program (SNAP) benefits to volunteer or train 80 hours a month, with exceptions for disability, caregiving or other hardship. According to a 2025 JAMA study, over 40% of the 5 million people who are at risk of losing Medicaid coverage have at least three chronic health conditions, including diabetes, obesity and hypertension.¹³ Additionally, there was a 15% increase in premiums for Affordable Care Act (ACA) recipients in 2026—the biggest hike in 8 years.¹⁴

Watson notes that these policy changes will impact access to primary care doctors and specialists needed for comprehensive diabetes care for many of his patients of color. “Think about patients with uncontrolled diabetes who need to have access to an endocrinologist or a podiatrist to address some of the inequities that we see in amputation rates due to untreated peripheral artery disease,” Watson says.

Solution:

Experts say clinicians should refer patients with limited insurance coverage to nonprofit programs and community clinics for support. They should also advise them to contact their state insurance department or to reach out to social workers and financial assistance departments at a local hospital to get the diabetes care they need. HCPs can direct them to a clinic in their area by visiting the National Association of Free & Charitable Clinics.

 

Challenge: Food insecurity

A recent study published in The Science of Diabetes Self-Management and Care found high rates of diabetes-related distress and low rates of nutrition education in Black and Hispanic adults.¹⁵ The authors concluded that increased nutrition and self-management education is critical to improving diabetes outcomes and health equity. Nigel Walters, MD, an internist at Endeavor Health in Arlington Heights, IL, notes that lack of access to affordable, nutritious food like fresh produce in lower-income areas forces residents to rely on fast food or convenience stores with unhealthy options—adding to a surge in obesity and diabetes. “It is important to delve into food accessibility with all patients since we do know that food deserts exist,” he says.

Solution:

For pa­tients struggling with food insecurity, financial assistance may be available through SNAP. Experts also recommend keeping a list of local resources that are highly accessible, such as food banks, communi­ty gardens and farmers mar­kets, and having office staff update it regularly. In addition, you can refer patients to county health departments for potential resources such as local nutrition classes.

 

Challenge: The digital divide 

A large-scale analysis of telehealth use among Medicare beneficiaries found that Black, Hispanic and Asian patients consistently had lower rates of telehealth use compared to White beneficiaries.¹⁶ “The rise of telehealth led to high expectations for improving access to care and allowing all folks to be able to hop on the computer and get the timely care that they can’t receive in their community,” says Griffith. “But we’ve seen the opposite to be the case for many in the Black community, where there is a digital divide that has exacerbated longstanding disparities.” This disparity is even greater in specialty care telehealth visits, as Black and Hispanic patients were significantly less likely to access virtual specialist consultations for diabetes management.¹⁶

Solution:

Griffith stresses the importance of supporting patients who don’t have technology at home by referring them to programs such as the Digital Divide Consult offered by the U.S. Department of Veterans Affairs, which lends video-enabled tablets at no cost to veterans who need them so they can activate telehealth. The National Digital Inclusion Alliance also offers programs for subsidized internet access and devices to people living in urban and rural areas, including navigators who help individuals get connected and improve their digital skills. “This kind of support is critical to closing that digital divide so that all these great technical advancements don’t actually make disparities worse,” Griffith says.

—by Cathy Cassata

While quitting smoking can be difficult for anyone, research shows it’s particularly challenging for Black adults, who make more quit attempts than their White counterparts but are often less successful.¹ Experts pin the problem on several issues. “The first is physiological: African Americans have a slower rate of smoke metabolism, so they absorb more nicotine with each cigarette,” explains Jennifer Folkenroth, senior director of Nationwide Tobacco Programs at the American Lung Association (ALA) in Chicago. As a result, she says, Black smokers are more likely to become addicted and to experience more intense cravings.² 

Societal and cultural factors also come into play. “African Americans are more likely to turn to smoking to help them cope with stress from racism and discrimination,” says Sophia Allen, PhD, MBA, assistant professor at the Center for Research on Tobacco and Health at Penn State College of Medicine in Hershey, PA. She adds that the tobacco industry also markets heavily to Black Americans. “They advertise in Black-focused magazines and place ads in corner stores in Black neighborhoods,” Allen explains. “They also heavily promote menthol cigarettes, which are more addictive and harder to quit.”³

Despite these hurdles, Black smokers are highly motivated to break the habit, Allen stresses. “When you remove structural barriers and offer evidence-based care, their outcomes dramatically improve,” she says. Here are some culturally tailored cessation strategies that are proven to work.

Be direct

It’s important to bring up quitting, even if patients don’t broach the topic themselves. Evidence shows that only around half of Black adults who smoke were advised by their doctor to stop.⁴ While many practitioners use motivational interviewing to encourage patients to make behavior changes, research suggests this is less effective in Black patients when it comes to quitting,⁵ notes Ken Resnicow, PhD, a smoking-cessation researcher at the University of Minnesota School of Public Health in Minneapolis. “We’ve found that Black patients respond better to a more directed approach,” he explains. Experts recommend using the “Five A’s” behavioral counseling model (Ask, Advise, Assess, Assist, Arrange) when encouraging your patients to quit.⁶

1. Ask about their cigarette use (e.g., how often do they smoke and how many packs a day).
2. Advise patients to quit for better health, especially when it comes to diabetes management. For example, educate them on how the high levels of nicotine in cigarettes make the body less responsive to insulin, which raises blood sugar levels.
3. Assess how willing they are to stop. Ask them to rate how important it is for them to stop smoking on a scale of 1 to 10. If they are serious about quitting, encourage patients to discuss their intention to quit with family and friends. If they belong to a church, that may also be a source of support and guidance, as many offer weekly support groups and counseling for members, notes Allen.
4. Assist by helping them set a date, providing them with self-help materials and prescribing medications such as varenicline for nonmenthol smokers and nicotine replacement therapy (NRT) such as nicotine patches, lozenges and gum. Also, make patients aware of nicotine withdrawal symptoms so they know what to expect, Resnicow advises.
5. Arrange follow-up visits, whether it’s virtual or in-person.

Use culturally tailored interventions

“When guiding patients to smoking-cessation programs, it’s important to find ones that focus on issues that are unique to African American smokers,” stresses Resnicow. Culturally tailored interventions can also help push back against the aggressive marketing techniques of tobacco companies. Stores in predominantly Black neighborhoods, for example, are up to 10 times more likely to display tobacco ads than stores with fewer Black residents, according to the American Lung Association.

Experts also say cognitive behavior therapy (CBT) is a crucial part of any cessation plan, particularly for this population. One study showed that Black patients who had eight sessions of CBT were almost twice as likely to quit after a year compared to those who just got general health education about smoking cessation.⁷ “CBT can help Black patients cope better with some of the stressors that drive them to smoke, like discrimination they may face daily,” explains Allen.

In a 2023 study co-authored by Resnicow and published in the American Journal of Preventive Medicine, Black adults enrolled in a state quitline were significantly more successful after six months when they were given culturally tailored smoking-cessation interventions.⁸ In this study, participants watched “Pathways to Freedom,” a 60-minute video designed to help Black Americans quit smoking by explaining the history of tobacco within the Black community, its ties to slavery and its impact today. “It’s important that patients be able to identify with the people they see in print and video materials,” stresses Resnicow. “It helps to see other Black smokers and physicians, and to recognize cigarettes with the telltale green stripe, which means they contain menthol.” The video is available on most state-sponsored quitlines, including 802quits.org.

The American Lung Association has also launched a new Freedom From Smoking program tailored to Black communities called “My Glory. My Journey. Living a Tobacco-Free Life.” The ALA notes that an initial pilot study found that 85% of participants were able to successfully quit after completing the program.⁹ Patients can call 1-800-LUNG-USA to find a program in their area, says Folkenroth.

Offer pharmacotherapy

Research shows that Black Americans are less likely to use prescription smoking-cessation medications than White smokers, despite the efficacy of such medications.¹⁰ This is due in part to these medications not being offered to them by doctors—or, if they are, patients assume they won’t be covered by insurance, explains Allen. But when combined with counseling, medication such as varenicline and NRTs can dramatically increase quit rates. Black daily smokers who were given varenicline while getting counseling had significantly greater quit rates than those who got a placebo, according to a 2022 study published in JAMA.¹¹ 

“Don’t be afraid to be proactive,” advises Resnicow. “You can say toward the end of a visit, ‘I know we’ve talked about quitting smoking, and you’re not quite ready, but I’ve called in a prescription for smoking-cessation medication, and we checked that your insurance covers it,’” he says. In general, experts recommend a combination of long- and short-acting NRT, such as the nicotine patch combined with nicotine gum or lozenges.

Another barrier to treatment stems from insurance coverage, notes Allen. While all smoking-cessation medications are required to be covered under both Medicare and Medicaid, private insurance plans can vary, with some covering these meds for only 90 days. When access is an issue, experts suggest referring patients to quitlines that offer free nicotine-replacement products. Patients can find free NRTs by calling their state’s tobacco quitline, 1-800-QUIT-NOW, or going to 802Quits.org and the CDC’s Smokefree site (smokefree.gov). You can also refer patients to patient-assistance programs for free or discounted medications (e.g., NeedyMeds, RxAssist) or manufacturer websites for varenicline.

In addition to free NRTs, quitlines typically offer telephone or text-based counseling. “Quitlines are convenient, especially if patients don’t have access to a car and can’t drive to a group or individual therapy session,” says Allen. “They also provide some anonymity.” Younger patients often prefer personalized text messages and emails, while adults over the age of 60 might be more comfortable with telephone counseling and printed materials, adds Allen: “If they’re at work and get a craving, or are at home and their partner is smoking, a motivational call or text can make all the difference.”

Schedule frequent follow-ups

Before your patient leaves your office, schedule a follow-up visit, ideally within a week or two of their quit date, advises Allen. “It’s a way to offer moral support, as well as address nicotine withdrawal symptoms and any other challenges they may encounter,” she explains. “If they haven’t been successful, encourage them to try again. And remind them that most people need to make several attempts before they quit smoking for good.”

—by Hallie Levine

“African Americans
are more likely to turn to smoking to help them cope with stress from racism and discrimination.”

—Sophia Allen, PhD, MBA

While the U.S. has one of the highest rates of diabetes in the world, the disease does not affect everyone equally. According to the Office of Minority Health in the U.S. Department of Health and Human Services, Black adults are twice as likely to die from diabetes and three times more likely to be hospitalized for related complications due to nonadherence.¹ One reason for this disparity stems from deep-seated misconceptions about the disease, and as a result those who buy into them can suffer serious health consequences, including morbidity and mortality.²

“Health knowledge among African Americans is traditionally passed along through generations, by word of mouth, and within communities,” says Leon N. Rock, M.Ed, co-founder and chief executive officer of the African American Diabetes Association (AADA) in Beltsville, MD. “People find themselves holding onto beliefs about the causes and treatment of diabetes that are mythical and not scientifically accurate.” 

Experts note that racism, mistrust and socioeconomic factors contribute significantly to the development of these misunderstandings.³ (See “Bridging the care gap in Black communities”) “It’s essential for clinicians to account for these disadvantages when designing diabetes interventions for African American patients,” says Rachel L. Amdur, MD, an internist at Northwestern Medicine and assistant professor at Northwestern University’s Feinberg School of Medicine in Chicago. “Clinicians need to practice awareness and ask patients to explain their cultural beliefs and perspectives about diabetes as part of a patient-centered care plan,” Dr. Amdur adds. “The goal is holistic—to treat the whole person.”

Below, experts discuss five common diabetes myths and ways to debunk them.

MYTH #1:
“Diabetes is known as ‘the sugar’ because that’s what causes it.”

REALITY:
“Eating sugar is not the only thing that can raise your blood sugar.”

Dr. Amdur tells patients that “Eating sugar is not the only thing that can raise your blood sugar,” although high blood glucose (sugar) levels are a key part of the disease. She also explains that obesity and lack of physical activity can increase diabetes risk. That said, overconsumption of sugar remains a problem for many Black Americans, who consume 20% more sugar-sweetened beverages and added sugars daily compared with their non-Hispanic and White counterparts.⁴ Additionally, sugary drinks like sweet tea and “red drink” (a sweet red punch with West African hibiscus), and desserts like sweet potato pie are soul food staples.

“Black Americans often live in ‘food deserts,’ where healthier food items are less accessible, and where there is targeted marketing for foods and beverages with high sugar content,” Dr. Amdur says. Studies also suggest these environmental factors contribute to higher rates of obesity and diabetes in these communities.^5,6

For those reasons, Dr. Amdur says it’s important to create nutrition plans that include healthier traditional foods that contain less or no sugar. “Many people connect to their culture through the foods they eat, so it’s important to know they don’t have to give up favorite foods but instead eat smaller portions or modify preparation,” she says. “We specifically discuss sweetened beverages, for example, and I often point out that sweet tea can have as much sugar as soda pop, and they should look for flavored beverage options without sugar.”

MYTH #2:
“Diabetes runs in my family, so I was doomed.”

REALITY:
“Anyone can develop diabetes.”

Dr. Amdur starts by saying, “Anyone can develop diabetes, and while genetics plays a role, it’s not the only cause.” She notes that fear-based beliefs like these often arise when a patient has witnessed advanced complications among close family or friends. “I’ve had some patients catastrophize a diabetes diagnosis from the get-go,” Dr. Amdur says. “I tell them that back when Grandma was diagnosed, we let prior generations have uncontrolled diabetes way too long, so bad things happened. Today, we have better tools.”

Dr. Amdur reassures patients who feel “doomed” that with proper adherence to medication, dietary and lifestyle modifications, and strategies like glucose monitoring, people with diabetes can live a full life.

Tip: Make addressing diabetes a family affair. “Involving family members in adopting healthier lifestyle habits can be a bonding experience for patients and even protect future generations from diabetes onset,” Dr. Amdur says.

Health knowledge among African Americans is traditionally passed along through generations, by word of mouth, and within communities.”

—Leon N. Rock, M.Ed

MYTH #3:
“Natural remedies can cure my diabetes.”

REALITY:
“There is no cure for diabetes.”

Experts say patients often bring up apple cider vinegar, cinnamon and vitamin D, which are widely promoted on the internet and in social media platforms as “natural” cures for diabetes.

Additionally, Rock points out that “home remedies have been passed down through generations.” He notes that in many Black families, these cures come directly from the women they trust most—mothers, grandmothers and great-aunts. “When your healthcare has always been rooted in family wisdom, it’s not always easy to trade that history for a doctor’s prescription,” he says.

This is one reason why Estelle M. Everett, MD, MHS, an endocrinologist, health services researcher and assistant professor at the Geffen School of Medicine at the University of California Los Angeles, takes a direct approach: “I tell my patients there is no cure for diabetes,” she says. “We discuss how diabetes is a serious disease and, once developed, it remains a lifelong condition that requires diligent monitoring and management.”

Experts also recommend introducing facts with referrals to evidence-based information, such as the American Diabetes Association and the African American Diabetes Association. “I’ll acknowledge there’s a real science around cinnamon, and that a small amount might help,” Dr. Amdur says. She adds, “I never say it won’t work, but that we’re going to need more than that to treat your diabetes. I don’t want them to give up on the treatment routine we’ve established.” 

A bigger concern, experts say, is when patients come in with bottles of unregulated supplements advertised online that don’t disclose ingredients on their labels. “I tell them that we have no idea what these supplements contain and that it could be something harmful,” Dr. Everett says. “I would never recommend these products.” She also explains that supplements are not regulated by the FDA, and that companies are facing legal action over claims that their products cure, treat or prevent diabetes.⁷

MYTH #4:
“I’m not going on insulin because it’s addictive.”

REALITY:
“Insulin is neither addictive nor habit-forming, but something our bodies produce naturally.”

Black patients often have reservations about starting insulin because it is perceived as worsening diabetes, and producing severe complications, including death.⁸ “The impression is if you go on insulin, you’re really done for,” says Dr. Everett. “And it’s going to cause blindness, kidney disease, amputation or worse—because that’s been ingrained from family or community experiences.” Rock adds that Black patients have an historic distrust of medications. “The thinking is physicians and the pharmaceutical industry are pushing insulin on the African American community to create chemical dependence,” he says.

Dr. Everett counters these misconceptions by saying that insulin is neither addictive nor habit-forming, but something our bodies produce naturally. She recommends reframing the need for manufactured insulin as a protective tool to achieve better glucose control and to lower risk of poor outcomes. “I’ve found that when I emphasize that insulin is something their bodies are already making and that the medication is supplementing what their body can no longer produce effectively, it becomes less frightening.”

MYTH #5:
“I won’t use diabetes technology because it can track me.”

REALITY:
“Only people directly involved in your care are going to have access to your data.”

Several technologies have emerged for diabetes management, including smart insulin pens and continuous glucose monitoring (CGM) devices that can be connected to cellphones and the internet. And while an estimated 1 in 5 diabetes patients use these devices today, adoption by Black Americans has been significantly less prevalent.⁹ “This population has more challenges managing their diabetes and a higher risk of complications, so they may actually gain the most benefit from diabetes technology,” Dr. Everett says. But the issue, Rock notes, is once again mistrust of the healthcare system. “They think device makers are just doing research,” he says. “There’s a stigma around attaching something to their bodies or sticking something into their arms daily—they believe it could be a tracking device.”

Dr. Everett recommends saying the following: “Patients tell me they’re afraid someone is going to use their information or data against them, but I assure them that device makers do a lot to keep your information confidential and, from our end, only people directly involved in your care are going to have access to your data.” Dr. Everett also chooses marketing materials or videos by manufacturers where Black people are represented, or refers them to messages by Black diabetes influencers on YouTube and social media platforms. “I do my best to connect patients with images and content that will resonate with them,” she says.  

—by Linda Keslar

“Clinicians need to practice awareness and ask patients to explain their cultural beliefs and perspectives about diabetes as part of a patient-centered care plan.”

—Rachel L. Amdur, MD

Special thanks to our medical reviewer:

E. Elizabeth Obialo, MD, MBA, FACE
Lead Physician, Garland Health Center, The University of Texas Southwestern Medical School, Dallas, TX

Content reviewed by:

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