Gender and ethnic differences in the co-occurrence of adolescent risk behaviors

Design

Results

Conclusion

We consider gender and ethnic differences in the co-occurrence of adolescent behaviors related to health and well-being.

Using a nationally representative sample of adolescents in the National Longitudinal Survey of Youth (1997–2000), we examine behavior among students as well as school drop-outs. We use latent class models (LCMs) to identify subpopulations of adolescents with similar patterns of co-occurring behaviors. The generalizability of the findings for African American adolescents in the 1970s is considered using a sample of inner-city youth from the Pathways to Adulthood Survey.

For all ethnic groups, we find a subpopulation with ‘problem behavior’ characteristics (in which early sexual initiation, alcohol use, smoking, marijuana use, and truancy are all highly prevalent). This cluster is most common among European American adolescents and among young men. A subpopulation characterized by behaviors often leading to poor social outcomes (e.g. truancy, early sexual initiation and fighting) is most common for African American adolescents, especially young African American men.

Our findings suggest that multi-factorial interventions which address the interrelationships between all of the behaviors are relevant regardless of gender or ethnicity. However, the ethnic and gender differences in the likelihood of specific patterns of interrelationships highlight the importance of considering the ethnic and gender composition of a population when developing future research and interventions.     

Social environment and substance misuse: A study of ethnic variations among inner London adolescents

Objectives. To explore ethnic variations in drug, tobacco and alcohol use and their correlation with other factors which operate through peer, familial and religious influences.

Design. Semi‐structured interviews with 132 12–13‐year‐old young people from four ethnic groups attending secondary schools in two inner London boroughs and a follow‐up interview completed approximately 17 months later.

Results. The data was analysed using chi‐square and McNemar tests. Familial, religious and peer influence closely correlated with ethnicity. Bangladeshi young people showed lower levels of peer and higher levels of religious and familial involvement and lower levels of substance use. White young people reported higher levels of peer, lower levels of religious and familial involvement, and a higher level of substance use. Black African and Black Caribbean young people lay between the two extremes.

Conclusion. The findings suggest that young people with lower levels of familial and religious influence, or higher levels of peer influence, have higher levels of substance consumption than other young people. Health education initiatives need to promote personal decision‐making skills within the context of the young people's individual culture. Cultural diversity should be recognised within local health education needs assessment.     

Attitudes to deceased organ donation and registration as a donor among minority ethnic groups in North America and the UK: a synthesis of quantitative and qualitative research

Objectives. A systematic review and synthesis of quantitative and qualitative research were undertaken to examine attitudes to deceased donation and registration as an organ donor among ethnic minorities in the UK and North America.

Design. A systematic search and assessments of relevance and quality were conducted. Parallel syntheses were then undertaken of 14 quantitative and 12 qualitative papers followed by their integration. The synthesis was organised around five barriers that emerged as key issues: (1) knowledge regarding deceased donation and registration as a donor; (2) discussion of donation/registration with family members; (3) faith and cultural beliefs; (4) bodily concerns including disfigurement and intactness; and (5) trust in doctors and the health care system.

Results. In all countries, knowledge of organ donation and registration remained low despite public campaigns, with African-Americans and Black African and Black Caribbean populations in the UK often regarding organ donation as a ‘white’ issue. Each of the four attitudinal barriers was also more prevalent among ethnic minorities compared with the majority population. However, the significance of trust and uncertainties regarding religion/faith differed between groups, reflecting salient aspects of ethnic identity and experiences. Differences were also identified within ethnic groups associated with age and generation, although respect for the views of elders often influenced younger peoples' willingness to donate.

Conclusion. There is a need for a more nuanced understanding of ethnicity and of variations in attitudes associated with country of origin, age/generation, socio-economic status and area of residence, to inform public campaigns and promote sensitive discussions with bereaved ethnic minority families. The traditional focus on knowledge and attitudes also requires to be complemented by a greater emphasis on organisational and service-related barriers and changes required to enhance ethnic minorities' access to registration as a donor and consent to deceased donation.     

Ethnicity, genetics, and breast cancer: media portrayal of disease identities

Design

Results

Conclusions

To describe, compare, and analyze how the risk of breast cancer is framed in newspapers directed towards an ethnic minority population (Jewish) with higher risk of inherited breast cancer compared with newspaper coverage for the general population (Anglo-Canadian) without this risk.

This investigation utilized a mixed methods (quantitative and qualitative) approach. The design emphasized a content analysis conducted on ethnically specific and non-ethnic newspaper articles.

It is noteworthy that the ‘Jewish’ newspapers devote a substantially larger proportion of articles on breast cancer to genetic risk as the key risk factor for this disease. Articles in the Jewish newspapers tend to link being a Jewish woman with being at risk for a diagnosis of breast cancer. This ethnic ‘identity’ is reinforced through the repeated association of Jewish heritage and genetic breast cancer risk at the exclusion of other known risk factors. This isolated genetic link to breast cancer is not a message that is replicated within the provincial newsprint articles.

These findings assist in the facilitation of prevention and treatment of those with or at risk of breast cancer. The health policy implications of this portrayal as well as suggestions for change are considered.     

Patient ethnicity: a key predictor of cancer care satisfaction

Introduction. Research in cancer care satisfaction itself is scarce; investigation of the role of ethnicity in care satisfaction is even rarer.

Objective. The present study examined relationships between ethnicity and satisfaction with care in a sample of 759 patients diagnosed with three different types of cancer (lung, head and neck, or gynecologic) from a large tertiary cancer hospital.

Method. Respondents filled out an assessment package that consisted of demographics, the Ware Patient Satisfaction Questionnaire-III (PSQ-III), 17 additional items constructed by the research team to examine other specific areas of satisfaction, and the Psychological Screen for Cancer (PSSCAN) Part C, to measure anxiety and depression.

Results. In a multivariate analysis, being non-White emerged as the primary predictor variable (beyond patient age, gender, marital status, education, cancer site, duration of illness, and presence or absence of metastases) of several of the PSQ-III satisfaction subscales.

Conclusion. Health care systems must consider how to become more responsive to the needs of all individuals, regardless of their ethnic background and levels of acculturation.     

The dragon and the snake: health practices among Chinese in the UK from an inter-disciplinary perspective

Objectives. This paper explores how ethnicity has been represented in research on the health practices of Chinese populations in the UK and suggests ways in which such research might be enriched by adopting an interdisciplinary approach.

Design. A systematic literature review of studies was conducted on research with ‘Chinese’ in the UK.

Results. The review highlighted that research with Chinese populations is frequently grounded in assumptions about the homogeneity of Chinese ethnic and cultural identities, and health practices, which undermines the generalizability of findings and conclusions.

Conclusions. There was a lack of clarity surrounding the term ‘Chinese’ as an ethnic and national label that can lead to racialised constructions of ethnicity. An interdisciplinary approach is a valuable tool for enriching understandings of culturally-specific accounts of health and illness, and to address ways in which Chinese populations negotiate different health care systems and models of health.     

Ethnicity and HIV risk behaviour,testing and knowledge in Guatemala

Objectives. To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes.

Design. Data on 16,205 women aged 15–49 and 6822 men aged 15–59 from the 2008–2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only).

Results. The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage.

Conclusions. The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes.     

Racial discrimination,racial/ethnic segregation,and health behaviors in the CARDIA study

Objective

Racial discrimination has been associated with unhealthy behaviors, but the mechanisms responsible for these associations are not understood and may be related to residential racial segregation. We investigated associations between self-reported racial discrimination and health behaviors before and after controlling for individual- and neighborhood-level characteristics; and potential effect modification of these associations by segregation.

Design

We used data from the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) study for 1169 African-Americans and 1322 whites. To assess racial discrimination, we used a four category variable to capture the extent and persistence of self-reported discrimination between examination at years 7 (1992–1993) and 15 (2000–2001). We assessed smoking status, alcohol consumption, and physical activity at year 20 (2005–2006). Segregation was examined as the racial/ethnic composition at the Census tract level.

Results

Discrimination was more common in African-Americans (89.1%) than in whites (40.0%). Living in areas with high percentage of blacks was associated with less reports of discrimination in African-Americans but more reports in whites. After adjustment for selected characteristics including individual- and neighborhood-level socioeconomic conditions and segregation, we found significant positive associations of discrimination with smoking and alcohol consumption in African-Americans and with smoking in whites. African-Americans experiencing moderate or high discrimination were more physically active than those reporting no discrimination. Whites reporting some discrimination were also more physically active than those reporting no discrimination. We observed no interactions between discrimination and segregation measures in African-Americans or whites for any of the three health behaviors.

Conclusions

Racial discrimination may impact individuals' adoption of healthy and unhealthy behaviors independent of racial/ethnic segregation. These behaviors may help individuals buffer or reduce the stress of discrimination.     

Concepts of race and ethnicity among health researchers: patterns and implications

Objectives. This study adds to the discussion of appropriate categories of analysis in health research. We contribute data based on actual interviews about the concepts of race and ethnicity, conducted among a broad range of US health researchers.

Design. In-person qualitative interviews were conducted with 73 scientists at two health research institutions, one that focused on public health research, and one that focused on research about a specific disease. This represents a larger and more interdisciplinary sample of health researchers than has been previously interviewed about these topics.

Results. We identify a core model of how race and ethnicity are understood. The respondents were confused about the concepts of race and ethnicity and their link to genetic differences between populations; many treated these concepts as interchangeable and genetically based. Although ethnicity was considered somewhat more socially constructed, it was often felt to cause unhealthy behavior. In addition, the situation is not improving; the younger health researchers tended to put a stronger emphasis on the genetic aspects of race than did the older health researchers.

Conclusion. Unlike reviews of how these concepts are used in scientific publications in which race and ethnicity are often undefined, our face-to-face interviews with these researchers allowed an understanding of their concepts of race and ethnicity. Building on their actual perspectives, these data suggest alternative approaches to formal and continuing educational training for health researchers. We recommend beginning with discussions of human diversity, and then moving on to what race and ethnicity are – and are not.     

Exploring differences in self-rated health among Blacks,Whites, Mexicans,and Puerto Ricans

Objectives. Self-rated health (SRH) is a robust predictor of subsequent health and mortality. Although age, gender, and race differences in SRH have been explored, less work has examined ethnic differences, particularly in the US.

Design. The current study uses representative data from six Chicago communities to compare levels and determinants of fair–poor health for Blacks, Whites, Mexicans, and Puerto Ricans (n=1311).

Results. Mexicans and Puerto Ricans were at least three times more likely to report fair or poor health than Whites, while African-Americans were over twice as likely. In adjusted logistic regression models, only Mexicans remain significantly more likely to report fair–poor health than Whites (OR = 4.3, CI = 1.8–9.8). However, this effect disappears when controlling for acculturation. No variable predicted poor subjective health for all groups, though depression was associated with poor health for most.

Conclusion. Together, these analyses suggest that the single item measure of SRH might not be appropriate for comparing health status across members of different race/ethnic groups. More research is needed to understand what factors influence how an individual perceives his or her health.     

Reproductive and maternity health care services in Finland: perceptions and experiences of Somali-born immigrant women

Objective. To explore immigrant Somali women's experiences of reproductive and maternity health care services (RMHCS) and their perceptions about the service providers.

Design. Five focus group discussions were conducted from April 1999 to June 2000 using a purposeful sampling strategy in order to reach multiparous female Somali-born Immigrants with experiences from the maternity health care in Finland.

Participants. A total of 70 married Somali women aged 18–50 and mother of 2–10 children were studied. Among them, 18 came from Kenya, 32 from Mogadishu and 20 from Hargeysa.

Settings. Of the participants, 45 were living in the city of Vantaa, 22 in the city of Helsinki and 13 in the city of Turku.

Results. Participants were satisfied with the RMHCS they received in Finland. Despite their satisfaction, the health care providers' social attitudes towards them were perceived as unfriendly, and communication as poor.

Conclusions. The women's experiences revealed that they have access to good quality RMHCS in Finland. While their experiences are significant, their perceptions are important for physicians, nurses and midwives in order to achieve culturally competent care.     

Ethnicity in Dutch health research: situating scientific practice

Objective: A growing body of work is examining the role health research itself plays in the construction of ‘ethnicity.’ We discuss the results of our investigation as to how the political, social, and institutional dynamics of the context in which health research takes place affect the manner in which knowledge about ethnicity and health is produced.

Design: Qualitative content analysis of academic publications, interviews with biomedical and health researchers, and participant observation at various conferences and scientific events.

Results: We identified four aspects related to the context in which Dutch research takes place that we have found relevant to biomedical and health-research practices. Firstly, the ‘diversity’ and ‘inclusion’ policies of the major funding institution; secondly, the official Dutch national ethnic registration system; a third factor was the size of the Netherlands and the problem of small sample sizes; and lastly, the need for researchers to use meaningful ethnic categories when publishing in English-language journals.

Conclusions: Our analysis facilitates the understanding of how specific ethnicities are constructed in this field and provides fruitful insight into the socio-scientific co-production of ethnicity, and specifically into the manner in which common-sense ethnic categories and hierarchies are granted scientific validity through academic publication and, are subsequently, used in clinical guidelines and policy.     

Variations in health behaviours among inner city 12‐year‐olds from four ethnic groups

Objectives. To describe factors that contribute to variations in health‐related behaviours and attitudes among inner city 12‐year‐olds. To see if there was an identifiable patterning by ethnic group.

Design. Semi‐structured interviews with a stratified sample of 12‐year‐old students and their parents from four ethnic groups, attending state secondary schools in two inner London boroughs.

Results. Bangladeshi young people were significantly more likely to receive school meals. There was no variation in reported snacking between the groups. Girls and Bangladeshi students were less likely to report exercising outside school (33% of Bangladeshi boys reported not exercising outside school compared to 5% of boys from all other groups). Bangladeshi boys and their parents were more likely to report that bullying or worries about racial violence prevented them from going out after school. White young people were more likely to report experimenting with and the regular use of cigarettes and alcohol. Use of alcohol and cigarettes was also associated with gender, religion and strength of religious observance. White parents were the least likely to report restricting their child's social activities as a way of influencing behaviour and expressed more concerns about their child's potential for health‐damaging behaviour than parents in all other groups.

Conclusion. This study shows that ethnicity alone is insufficient and inadequate in explaining variations in health behaviours among inner city teenagers. A complex mix of personal, cultural and social factors including ethnicity shape the behaviours and attitudes of these young people.     

‘Black like Beckham’? Moving beyond definitions of ethnicity based on skin colour and ancestry

Objectives. The definitions of ethnic status currently employed in, particularly, epidemiological research, tend to focus on skin colour or on perceived historical or ancestral links with certain geographical locations. Neither of these classificatory systems stem from any widely supported theoretical standpoint and their usefulness in terms of explaining any ethnic variation is therefore questionable. In order to enable more informative exploration of ethnicity and its relationship with health and other indicators, a clearer understanding of the processes involved in ethnic identification is required. This paper sets out to explore underlying dimensions which could constitute an ethnic identity across different ethnic groups in England.

Design. Principal components factor analyses on the different ethnic groups included in the Ethnic Minority Psychiatric Illness Rates in the Community study: Bangladeshi, Caribbean, Indian, Irish and Pakistani people and a ‘white majority’ group.

Results. In each ethnically specific model, three dimensions of ethnic identity were determined; related to multiculturalism, or the sustenance of ethnic difference, racialisation and community participation. In the ethnic minority group models the ‘multiculturalism’ dimension formed two factors: one related to the presentation of oneself as a member of a particular ethnic group and one exploring attitudes towards cultural assimilation. The findings suggested that the processes of ethnic identification are similar across the different ethnic (minority and majority) groups explored, but that there may be important differences within any particular group.

Conclusion. The recognition of these dimensions of ethnic affiliation provide us with an opportunity to improve our indicators of ethnic status. Each of these dimensions would appear to be important to the lives of people from different ethnic groups in England. These findings also highlight the important role that external attitudes play in the understanding of what it means to be a member of any ethnic group. This aspect of ethnic affiliation has been ignored by current definitions of ethnicity and this imbalance should be redressed.     

Breaking down the barriers: a qualitative study to understand child oral health in refugee and migrant communities in Australia

Objective. Australia is an increasingly multicultural nation. Never before has the dental workforce been exposed to such language, cultural, religious and ethnic diversity. There is evidence that refugee and migrant children experience significantly poorer oral health than the nonmigrant population. However, little is known about the oral health knowledge, practices and beliefs of parents with young children from refugee and migrant backgrounds. The aim of this study was to identify the sociocultural influences on child oral health in these communities.

Design. Participatory and qualitative research methods were utilised. Partnerships were established with community agencies representing migrants from Iraq, Lebanon and Pakistan. Focus group discussions and semi-structured interviews were conducted with community members. Qualitative data were analysed thematically, combining focus group and interview data.

Results. Over 100 women participated in focus groups (n = 11) and semi-structured interviews (n = 7). Key findings included the knowledge, beliefs and practices concerning: caries risk factors, oral health practices and oral health literacy. Despite mothers' knowledge of the major causes of poor oral health – dietary changes, confusion about child oral hygiene practices and limited oral health literacy all influenced child oral health outcomes.

Conclusion. This culturally competent qualitative study explores the sociocultural factors influencing child oral health in refugee and migrant communities. Understanding and acknowledging these factors are a prerequisite to determining where and how to intervene to improve oral health. Furthermore, it has implications for both dental and non-dental health professionals working to reduce health inequalities within such communities.     

Differential survival in blacks and Hispanics with AIDS

Objective. The object of this study was to investigate whether there are differences in survival by ethnicity in people with AIDS.

Design. The CDC Public Access Dataset was analysed. To estimate survival more accurately, a cohort of individuals diagnosed in 1987 was chosen from the dataset. Using this analysis, probabilities of survival were estimated.

Results. There were significant differences in survival in blacks and Hispanics as compared to whites diagnosed in 1987. Although there are differences in survival by transmission category, survival differences by ethnicity persisted when analysed within specific transmission categories. A model where the frequency distributions of survival were log‐transformed suggests that disease progression per se may not be the most important factor, but time of diagnosis may be. In addition, in looking at median survival by year of diagnosis, it is clear that blacks and Hispanics have not shown the same magnitude of improvement in survival time, and lag behind whites.

Conclusions. This study clearly shows differences in survival with AIDS by ethnicity. Differential access to health care may underlie such ethnic differences in survival.     

The influence of ethnicity and length of time since immigration on physical activity

Design/setting/participants

Main results

Conclusions

This study investigates whether ethnicity and length of time since immigration influence levels of leisure-time physical activity in Sweden.

This cross-sectional study analyses data from the Swedish Survey of Living Conditions from the years 1996, 1997 and 1999, which is conducted annually and is a simple, random sample drawn from the register of the total population in Sweden. The total sample was 14,485 men and women aged 20–74 years, who were categorised according to country of origin: born in Sweden, Western Europe, Finland, Southern Europe, Eastern Europe or all other countries. The multivariate analysis was performed using a logistic regression model in order to investigate the effects of possible confounding factors on physical activity.

The risk of reporting low levels of physical activity was significantly higher for men born in Finland, Southern Europe and in the category ‘all other countries’, and also for women born in Southern Europe, Eastern Europe and ‘all other countries’, compared with men and women born in Sweden. After the inclusion of the variables education, smoking, body mass index and longstanding illness or disability into the model, the relationship between ethnicity and low levels of physical activity decreased to non-significance for men born in Finland and Southern Europe, but remained significant for men born in the category ‘all other countries’. The differences in risk for women observed in the crude model remained significant even after inclusion of all other variables in the multivariate model. A positive gradient was observed between the length of time since immigration to Sweden and low levels of physical activity in women but no relationship was observed in men.

There are significant differences in levels of leisure-time physical activity between different ethnic groups living in Sweden, which could not all be explained by the confounding factors age, education, smoking, body mass index or long-term illness or disability. In women, but not in men, levels of leisure-time physical activity increased with increasing time since immigration to Sweden.     

The potential for measuring ethnicity and health in a multicultural milieu – the case of type 2 diabetes in Australia

Objective. Ethnicity influences health in many ways. For example, type 2 diabetes (T2DM) is disproportionately prevalent among certain ethnic groups. Assessing ethnicity is difficult, and numerous proxy measures are used to capture its various components. Australian guidelines specify a set of variables for measuring ethnicity, and how such parameters should be categorised. Using T2DM data collections as an illustrative example, this study sought to examine how ethnicity is measured in Australian health databases and, by comparing current practice with Australia's existing benchmark recommendations, to identify potential areas for improvement of the health data landscape.

Design. We identified databases containing information from which ethnic group-specific estimates of T2DM burden may be gleaned. For each database, details regarding ethnicity variables were extracted, and compared with the Australian guidelines.

Results. Data collection instruments for 32 relevant databases were reviewed. Birthplace was recorded in 27 databases (84%), but mode of birthplace assessment varied. Indigenous status was commonly recorded (78%, n=25), but only nine databases recorded other aspects of self-perceived race/ethnicity. Of 28 survey/audit databases, 14 accommodated linguistic preferences other than English, and 11 either excluded non-English speakers or those for whom a translator was not available, or only offered questionnaires in English.

Conclusions. Considerable variation exists in the measurement of ethnicity in Australian health data-sets. While various markers of ethnicity provide complementary information about the ethnic profile within a data-set, non-uniform measurement renders comparison between data-sets difficult. A standardised approach is necessary, and identifying the ethnicity variables that are particularly relevant to the health sector is warranted. Including self-identified ethnicity in Australia's set of recommended indicators and as a core component of the national census should be considered. Globalisation and increasing migration mean that these findings have implications internationally, including for multi-ethnic countries throughout North America and Europe.     

Racial and ethnic health disparities: evidence of discrimination's effects across the SEP spectrum

Objectives. Perceived discrimination is a psychosocial stressor that plays a role in explaining racial/ethnic disparities in self-reported physical and mental health. The purpose of this paper is: (1) to investigate the association between perceived discrimination in receiving healthcare and racial/ethnic disparities in self-rated health status, physical, and emotional functional limitations among a diverse sample of California adults; (2) to assess whether discrimination effects vary by racial/ethnic group and gender; and (3) to evaluate how the effects of discrimination on health are manifest across the socioeconomic position (SEP) spectrum.

Design. Data were drawn from the 2001 California Health Interview Survey adult file (n=55,428). The analytic approach employed multivariate linear and logistic regressions. Discrimination is qualitatively identified into two types: (1) discrimination due to race/ethnicity, language, or accent, and (2) other discrimination.

Results. Findings show that both types of discrimination negatively influenced self-rated health, and were associated with a two to three-fold odds of limitations in physical and emotional health. Further, these effects varied by racial/ethnic group and gender, and the effects were mixed. Most notably, for emotional health, racial/ethnic discrimination penalized Latinas more than non-Latina Whites, but for physical health, other discrimination was less detrimental to Latinas than it was to non-Latina Whites. At higher levels of SEP, the effects of racial/ethnic discrimination on self-rated health and other discriminations' effects on physical health were attenuated.

Discussion. Higher SEP may serve as an important mitigator, particularly when comparing the medium to the low SEP categories. It is also possible that SEP effects cannot be extracted from the relationships of interest in that SEP is an expression of social discrimination. In fact, negative health effects associated with discrimination are evident across the SEP spectrum. This study highlights the complexity of the relationships between discrimination and racial/ethnic identity, gender, and SEP.