Individuals who experience repeated stressful events are at risk for developing physical and psychological illnesses. African Americans are an ethnic group that is exposed to a range of stressors over time, including racism which leads to discrimination. African Americans also suffer disproportionately from hypertension, cardiac disease, obesity, and drug and alcohol abuse--all illnesses that have been linked to stress. This paper describes a model to guide nursing practice, research, and education about the influence of racism on the cognitive appraisal, stress, and coping of African Americans. Lazarus and Folkman's (1984) phenomenological approach to cognitive appraisal, stress, and coping is the theoretical framework on which the model is based.

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A Center for Substance Abuse Treatment Knowledge Application Program based on cognitive-behavioral and self-management treatment approaches and targeted to older adults with substance abuse was provided through a community behavioral health center. A sample of 199 adults aged 50 and above participated in the 18-session program. Observations were made at intake and 6 months after intake. Program completers versus noncompleters differed significantly over time, favoring completers with regard to decreased use of nonmedical prescription drugs, improved cognitive functioning, improved mental health, increased vitality, and lack of bodily pain. Significant time effects were noted in participants' decreased use of alcohol and binge drinking, reduced stress, fewer emotional problems, a decrease in having to reduce important activities, and increased prescription of medication for psychological problems. Participants also reported significant improvement in their social functioning, and their physical health and emotional problems had less impact on what they were able to do.

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BACKGROUND: HIV risk perceptions have been unreliable in predicting behavioral change, suggesting that significantfactors which may contribute to HIV risk perception remain unknown. OBJECTIVE: The purpose of this research was to describe HIV risk perceptions of two discordant samples and theorize about possible antecedents to their HIV risk perception. STUDY DESIGN: The multiethnic samples consist of female college students (n = 286) and female HIV seronegative injecting drug users (n = 101). Secondary analysis of two data sets was conductedfor this comparative descriptive study. RESULTS: Approximately 90% of college students and 60.4% of injecting drug users appraised their HIV risk as nil or small Injecting drug users were 3.1 times more likely than college students to perceive some risk of HIV infection and 28.8 times more likely to perceive a large or great risk. CONCLUSION: Both samples minimized their HIV risk. HIV risk perception appears to be based on cognitive antecedents in addition to risky HIV-related sexual and drug-use behavior. It is theorized that both samples used the cognitive coping strategies of denial; distancing, and downward comparison to minimize their HIV risk perception.