Racism and health: the relationship between experience of racial discrimination and health in New Zealand

Accumulating research suggests that racism may be a major determinant of health. Here we report associations between self-reported experience of racial discrimination and health in New Zealand. Data from the 2002/2003 New Zealand Health Survey, a cross-sectional survey involving face-to-face interviews with 12,500 people, were analysed. Five items were included to capture racial discrimination in two dimensions: experience of ethnically motivated attack (physical or verbal), or unfair treatment because of ethnicity (by a health professional, in work or when gaining housing). Ethnicity was classified using self-identification to one of four ethnic groups: Māori, Pacific, Asian and European/Other peoples. Logistic regression, accounting for the survey design, age, sex, ethnicity and deprivation, was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Māori reported the highest prevalence of "ever" experiencing any of the forms of racial discrimination (34%), followed by similar levels among Asian (28%) and Pacific peoples (25%). Māori were almost 10 times more likely to experience multiple types of discrimination compared to European/Others (4.5% vs. 0.5%). Reported experience of racial discrimination was associated with each of the measures of health examined. Experience of any one of the five types of discrimination was significantly associated with poor or fair self-rated health; lower physical functioning; lower mental health; smoking; and cardiovascular disease. There was strong evidence of a dose-response relationship between the number of reported types of discrimination and each health measure. These results highlight the need for racism to be considered in efforts to eliminate ethnic inequalities in health.     

A challenge to the cross-cultural validity of the SF-36 health survey: factor structure in Maori, Pacific and New Zealand European ethnic groups

This paper reports on a principal component factor analysis of the SF-36 health status questionnaire in the three major ethnic groups in New Zealand (New Zealand Europeans, Maori and Pacific). The SF-36 is hypothesised to have a two-dimensional structure with distinct (weakly correlated) mental and physical health components, and support for this structural model has generally been found cross-nationally. However, in Maori and Pacific models of health mental and physical dimensions are not generally seen as separable, or independently functioning. This raises the possibility that the questionnaire's hypothesised structural model would not be supported among Maori and Pacific ethnic groups. This study evaluated that possibility. The results of the analysis showed a similar factor structure among New Zealand Europeans, and younger Maori (<45 years) to that reported by Ware et al. for Western European countries. Among Pacific people and older Maori (45 years and over), however, the factor structure did not clearly differentiate physical and mental health components. Implications are discussed both specific to the SF-36 (and in particular the use of principal component summary scores), and more generally for the cross-cultural validity of self-reported health status measures.     

Comparing Measures of Racial/Ethnic Discrimination, Coping, and Associations with Health-Related Outcomes in a Diverse Sample

Discrimination is detrimental to health behaviors and outcomes, but little is known about which measures of discrimination are most strongly related to health, if relationships with health outcomes vary by race/ethnicity, and if coping responses moderate these associations. To explore these issues, the current study assessed race/ethnic differences in five measures of race/ethnic discrimination, as well as emotional and behavioral coping responses, within a population-based sample of Whites, African Americans, Mexicans, and Puerto Ricans (n = 1,699). Stratified adjusted logistic regression models were run to examine associations between the discrimination measures and mental, physical, and health behavior outcomes and to test the role of coping. Overall, 86 % of the sample reported discrimination. Puerto Ricans were more likely than Mexicans and Whites to report most types of discrimination but less likely than Blacks. Discrimination was most strongly related to depression and was less consistently (or not) associated with physical health and health behaviors. Differences by measure of discrimination and respondent race/ethnicity were apparent. No support was found to suggest that coping responses moderate the association between discrimination and health. More work is needed to understand the health effects of this widespread social problem. In addition, interventions attempting to reduce health disparities need to take into account the influence of discrimination.     

Mental-physical comorbidity in an ethnically diverse population

The relationship between mental disorders and chronic physical conditions is well established, but the possibility of ethnic group differences in mental-physical associations has seldom been investigated. This study investigated ethnic differences in associations between four physical conditions (chronic pain, cardiovascular disease, diabetes, and respiratory disease) and 12-month mood and anxiety disorders. A nationally representative face-to-face household survey was carried out in New Zealand from 2003 to 2004 with 12,992 participants aged 16 and older, achieving a response rate of 73.3%. The current study is of the subsample of 7,435 participants who were assessed for chronic physical conditions (via a standard checklist), and compares Maori, Pacific and Other New Zealanders. DSM-IV mental disorders were measured with the Composite International Diagnostic Interview (CIDI 3.0). The ethnic groups differed significantly in prevalences of both physical and mental disorders, but almost no ethnic differences in mental-physical associations were found. Independent of ethnicity, associations were observed between chronic pain and mood and anxiety disorders, cardiovascular disease and anxiety disorders, respiratory disease and mood and anxiety disorders. Despite differences in mental and physical health status between ethnic groups in New Zealand, mental-physical disorder associations occur with considerable consistency across the groups. These results suggest that whatever factors are conducive to the development of a mental disorder from a physical disorder (or vice versa), they are either unaffected by the cultural differences manifest in these ethnic groups, or, any cultural factors operating serve to both increase and decrease comorbidity such that they cancel each other out.     

Self-Reported Racial Discrimination and Substance Use Among Asian Americans in Arizona

We examined associations between different forms of self-reported racial discrimination and current substance use (i.e., smoking, alcohol use, and controlled substance use) among Asian Americans living in Arizona. The data are from 271 Asian American adults participating in the 2008 Asian Pacific Arizona Inititative (APAZI) Survey, which is part of a larger collaboration between community members, organizational leaders, and researchers. Asian Americans treated like they were not American because of their race were at increased risk of tobacco use, after controlling for covariates, including age, gender, education, family income, health insurance, nativity status, and language, and other types of racial discrimination. Also, individuals treated differently because of their race were at increased risk of alcohol use and controlled substance use, after controlling for covariates and other types of racial discrimination. The results indicate that Asian Americans experience a wide range of racial discrimination types and some forms of racial discrimination may have greater associations with tobacco, alcohol, and controlled substance use than others.     

A systematic review of studies examining the relationship between reported racism and health and wellbeing for children and young people

Racial discrimination is increasingly recognised as a determinant of racial and ethnic health inequalities, with growing evidence of strong associations between racial discrimination and adult health outcomes. There is a growing body of literature that considers the effects of racial discrimination on child and youth health. The aim of this paper is to provide a systematic review of studies that examine relationships between reported racial discrimination and child and youth health. We describe the characteristics of 121 studies identified by a comprehensive search strategy, including definitions and measurements of racial discrimination and the nature of reported associations. Most studies were published in the last seven years, used cross-sectional designs and were conducted in the United States with young people aged 12–18 years. African American, Latino/a, and Asian populations were most frequently included in these studies. Of the 461 associations examined in these studies, mental health outcomes (e.g. depression, anxiety) were most commonly reported, with statistically significant associations with racial discrimination found in 76% of outcomes examined. Statistically significant associations were also found for over 50% of associations between racial discrimination and positive mental health (e.g. self esteem, resilience), behaviour problems, wellbeing, and pregnancy/birth outcomes. The field is currently limited by a lack of longitudinal studies, limited psychometrically validated exposure instruments and poor conceptualisation and definition of racial discrimination. There is also a need to investigate the complex and varying pathways by which reported racial discrimination affect child and youth health. Ensuring study quality in this field will allow future research to reveal the complex role that racial discrimination plays as a determinant of child and youth health.     

Ethnic density and area deprivation: Neighbourhood effects on Māori health and racial discrimination in Aotearoa/New Zealand

Some studies suggest that ethnic minority people are healthier when they live in areas with a higher concentration of people from their own ethnic group, a so-called ethnic density effect. To date, no studies have examined the ethnic density effect among indigenous peoples, for whom connections to land, patterns of settlement, and drivers of residential location may differ from ethnic minority populations.The present study analysed the Māori sample from the 2006/07 New Zealand Health Survey to examine the association between increased Māori ethnic density, area deprivation, health, and experiences of racial discrimination. Results of multilevel regressions showed that an increase in Māori ethnic density was associated with decreased odds of reporting poor self-rated health, doctor-diagnosed common mental disorders, and experienced racial discrimination. These associations were strengthened after adjusting for area deprivation, which was consistently associated with increased odds of reporting poor health and reports of racial discrimination. Our findings show that whereas ethnic density is protective of the health and exposure to racial discrimination of Māori, this effect is concealed by the detrimental effect of area deprivation, signalling that the benefits of ethnic density must be interpreted within the current socio-political context. This includes the institutional structures and racist practices that have created existing health and socioeconomic inequities in the first place, and maintain the unequal distribution of concentrated poverty in areas of high Māori density. Addressing poverty and the inequitable distribution of socioeconomic resources by ethnicity and place in New Zealand is vital to improving health and reducing inequalities. Given the racialised nature of access to goods, services, and opportunities within New Zealand society, this also requires a strong commitment to eliminating racism. Such commitment and action will allow the benefits potentially flowing from strong communities to be fully realised.     

The association between self-reported racial discrimination and 12-month DSM-IV mental disorders among Asian Americans nationwide

Growing research finds that reports of discrimination are associated with mental health. However, many US studies are focused on regional samples and do not control for important confounders such as other stressors and response factors. The present study examines the association between self-reported racial discrimination and DSM-IV defined mental disorders among Asian respondents to the 2002-2003 US National Latino and Asian American Study (n=2047). Logistic regression analyses indicated that self-reported racial discrimination was associated with greater odds of having any DSM-IV disorder, depressive disorder, or anxiety disorder within the past 12 months-controlling for sociodemographic characteristics, acculturative stress, family cohesion, poverty, self-rated health, chronic physical conditions, and social desirability. Further, multinomial logistic regression found that individuals who reported discrimination were at a twofold greater risk of having one disorder within the past 12 months, and a threefold greater risk of having two or more disorders. Thus, self-reported discrimination was associated with increased risk of mental disorders among Asian Americans across the United States and this relationship was not explained by social desirability, physical health, other stressors, and sociodemographic factors. Should these associations ultimately be shown enduring and causal, they suggest that policies designed to reduce discrimination may help improve mental health.     

Self-Reported Experience of Racial Discrimination and Health Care Use in New Zealand: Results From the 2006/07 New Zealand Health Survey

Objectives. We investigated whether reported experience of racial discrimination in health care and in other domains was associated with cancer screening and negative health care experiences.Methods. We used 2006/07 New Zealand Health Survey data (n = 12 488 adults). We used logistic regression to examine the relationship of reported experience of racial discrimination in health care (unfair treatment by a health professional) and in other domains (personal attack, unfair treatment in work and when gaining housing) to breast and cervical cancer screening and negative patient experiences adjusted for other variables.Results. Racial discrimination by a health professional was associated with lower odds of breast (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.14, 0.996) and cervical cancer (OR = 0.51; 95% CI = 0.30, 0.87) screening among Maori women. Racial discrimination by a health professional (OR = 1.57; 95% CI = 1.15, 2.14) and racial discrimination more widely (OR = 1.55; 95% CI = 1.35, 1.79) were associated with negative patient experiences for all participants.Conclusions. Experience of racial discrimination in both health care and other settings may influence health care use and experiences of care and is a potential pathway to poor health.Racism is increasingly recognized as an important determinant of health and driver of ethnic health inequalities.1 Regardless of its health effects, racism breaches fundamental human rights and is morally wrong. It is important to understand how racism operates as a health risk to develop interventions that reduce ethnic inequalities in health within a context of eliminating racism.2Racism is an organized system that categorizes racial/ethnic groups and structures opportunity, leading to inequities in societal goods and resources and a racialized social order.3–5 Racism operates via institutional and individual practices (racial discrimination) and varies in form and type.6,7 The pathways whereby racism leads to poor health are also multiple, with direct and indirect mechanisms such as race-based assaults and violence, physiological and psychological stress mechanisms, differential exposures to health risk factors, differential access to and experiences of health care, and differential access to goods, resources, and power in society.6,8–10Research on racism and health, particularly self-reported racism, has increased. Self-reported experience of racism has been linked to multiple health measures (including mental and physical health outcomes and health risk factors) across a variety of countries and for different ethnic groups.10–12 Research on how self-reported experience of racism may negatively affect health has largely focused on racism as a stressor with mental and physical health consequences.10,13 Comparatively less evidence is available on how experience of racism may influence health service use,10 although this is another potentially important pathway to poor health.14,15Studies on the association between self-reported racism and health care experience and use have included racism experienced within the health care system, outside of the health care system, or both.16–19 Health care measures have included use of specific services such as cancer screening19–24 and receipt of optimal care,20,25 measures of unmet need,16,26 measures of adherence to care,17,27,28 and measures of satisfaction and experiences with care.18,29–31Various mechanisms have been suggested to explain how the experience of racism may negatively affect health care use, experiences of health care, and subsequent poor health. Experiences of racism within the health care system may influence health by shaping decision making of both providers and patients and influencing future health behaviors, including future health care use behaviors and potential disengagement from the health care system.14,18,26 Experiences of racism in wider society also may lead to general mistrust and avoidance of dominant culture institutions, including health care systems.15,30 This is supported by evidence that both experiences of racism and general discrimination within and outside of health care have been associated with negative health care use measures.15,16,19,22New Zealand has a population of approximately 4.4 million people, with the major ethnic groupings being Maori (indigenous peoples, 15% of the population), European (77%), Pacific (7%), and Asian (10%).32 Ethnic inequalities in health and socioeconomic status persist, with racism a potentially important contributor to these inequalities.33 Previous research in New Zealand has shown reported experience of racial discrimination by a health professional to be higher among non-European ethnic groups with experiences of racial discrimination in different settings associated with multiple health outcomes and risk factors.34In this study, we focused on the relationship between racial discrimination and health service use and experience, an area not previously examined in New Zealand. We provide important information on how racial discrimination may affect health care use as a possible pathway to poor health outcomes and ethnic health inequalities in New Zealand. In addition, our study contributes to the limited evidence on racial discrimination and health care internationally.Primary health care in New Zealand is available to all residents and is usually provided at general practices. Costs of visits are universally subsidized by government to enable lower patient copayments with additional limited provision for extra funding based on high need.35 Currently, 2 publicly funded national cancer screening programs are available.36 Breast cancer screening is free to all eligible women through BreastScreen Aotearoa. Cervical cancer screening usually incurs a fee and is available through patients’ usual primary care provider or specific cervical cancer screening providers.We specifically examined the association between self-reported experience of racial discrimination and the use of health care in 2 domains—cancer screening and negative patient perceptions of health care encounters. We hypothesized that experience of racial discrimination both within and outside the health care system may negatively affect how individuals use and experience health care.     

Exploring reasons for ethnic disparities in diet- and lifestyle-related chronic disease for Asian sub-groups in New Zealand: a scoping exercise

Objectives: The current study aimed to explore if the impact of various risk factors for chronic disease differed for people of Chinese, Indian and New Zealand European and Other (NZEO) ethnicities.

Design: Data analysed for this paper was extracted from the 2003–04 and the 2006–07 NZ Health surveys for adults aged 25–70 which used a cross-sectional survey design. Data from both the survey waves were combined and all statistical analysis was done using SAS version 9.2 or 9.3. Ethnicity of participants was coded using a priority-based classification system as (1) Indian, (2) Chinese, (3) Other Asian, (4) NZEO, (5) Maori and (6) Pacific. Only data for Indians, Chinese and NZEO were used for the current study. Prevalence estimates and 95% confidence intervals for chronic disease and the associated risk factors were generated to describe the sample. Logistic regression analysis was used to examine whether the difference in the change in risk of chronic disease with different exposures was different according to ethnicity.

Results: Higher deprivation resulted in increased risk of chronic disease in Indian and Chinese males but not in NZEO males (p =?.03). There was a weak evidence for a differing effect of physical activity (p?=?.10) on chronic disease with the protective effect not seen in Indian or Chinese participants.

Conclusion: The results of the current study indicate that some factors such as socio-economic deprivation and physical activity may impact differently on the prevalence of chronic disease according to ethnicity. The authors recommend further investigation of these factors using improved and innovative methodology and high-quality ethnicity data to better understand the factors underpinning ethnic disparities in disease prevalence among Asian sub-groups.     

How much does health care contribute to health inequality in New Zealand?

OBJECTIVE: To quantify the contribution of health care to ethnic and socio-economic inequalities in health in New Zealand in 2000-02, using the concept of 'amenable' mortality (deaths at ages 0-74 years from causes responsive to health care). DATA SOURCES AND METHODS: Mortality data for 2000-02 were provided by the New Zealand Health Information Service and 2001 Census population data were provided by Statistics New Zealand. The classification of ICD-10 codes as amenable or non-amenable used in the Australian and New Zealand Atlas of Avoidable Mortality (2006) was adopted. Ethnicity was categorised as Maori, Pacific or European/Other. Socio-economic position was measured using a Census-based small area deprivation index, the NZDep2001. Mortality rates were standardised for age by the direct method for the ethnic group comparisons, and for both age and ethnicity for the deprivation group comparisons. The contribution of health care to health inequality was then quantified as the ratio of the difference in standardised amenable mortality rates to the difference in standardised total mortality rates (in the age group 0-74 years) between relevant groups. RESULTS: Amenable causes of death were estimated to account for 27%, 34%, 33% and 44% of the total mortality disparity (0-74 years) for Maori males, Maori females, Pacific males and Pacific females respectively, relative to their European/ Other counterparts (adjusting for age). The corresponding proportions for the 'deprived' population relative to the 'non-deprived' population were 26% (males) and 30% (females), adjusting for age and ethnicity. CONCLUSIONS: Amenable causes of death made a substantial contribution to differences in mortality in the 0-74 year age range between ethnic and socio-economic groups in New Zealand in 2000-02, ranging from 26-44% depending on the group.     

Discrimination and health in an English study

In this study we examine the relationship between education, racial discrimination and health among white (n=227), African Caribbean (n=213) and Indian and Pakistani (n=233) adults aged between 18 and 59 years living in Leeds, England, as measured in a stratified population survey. Measures of discrimination included any physical attack, verbal abuse and a combined variable, any discrimination due to race, colour, ethnicity or sex. Analyses were conducted examining the relationship between education and discrimination, discrimination and health, and discrimination and health controlling for education. People educated above secondary level were more likely than people educated to secondary level or below to report being physically attacked, verbally abused and exposed to discrimination. People from minority ethnic groups (African Caribbean and Indian Pakistani) were more likely to be verbally abused and exposed to discrimination than the white group. Ethnicity and education interacted for African Caribbeans, such that respondents with post-school qualifications were more likely to report verbal abuse or any discrimination. There was no association between having been exposed to any kind of discrimination and having fair or poor health. Physical attack and any discrimination were associated with anxiety, worry and depression. The results remained unchanged when ethnicity and education were included in the models. Education and ethnicity were associated with differences in exposure to discrimination. In turn, exposure to discrimination was associated with higher levels of anxiety, worry or depression although there was no association between discrimination and health. The results support the contention that racial discrimination may play an important role in modifying the relationship between ethnicity, socioeconomic position and health. The counter-intuitive relationship between education and levels of reported discrimination in non-minority ethnic groups highlights the value of explicitly modeling discrimination to gain a better understanding of the social determinants of health.     

Experiences of Discrimination and Their Impact on the Mental Health Among African American,Asian and Pacific Islander,and Latino Men Who Have Sex With Men

Objectives. We examined the associations between specific types and sources of discrimination and mental health outcomes among US racial/ethnic minority men who have sex with men (MSM) and how these associations varied by race/ethnicity.Methods. A chain-referral sample of 403 African American, 393 Asian and Pacific Islander (API), and 400 Latino MSM recruited in Los Angeles County, California completed a standardized questionnaire. Data were obtained from the Ethnic Minority Men’s Health Study from May 2008 to October 2009.Results. Past-year experiences of racism within the general community and perceived homophobia among heterosexual friends were positively associated with depression and anxiety. Past-year homophobia experienced within the general community was also positively associated with anxiety. These statistically significant associations did not vary across racial/ethnic groups. The positive association of perceived racism within the gay community with anxiety differed by race/ethnicity, and was statistically significant only for APIs. Perceived homophobia within the family was not associated with either depression or anxiety.Conclusions. Higher levels of experiences of discrimination were associated with psychological distress among MSM of color. However, specific types and sources of discrimination were differentially linked to negative mental health outcomes among African American, API, and Latino MSM.Accumulating data indicate that mental health problems are more prevalent among sexual minorities than among heterosexuals.1,2 A recent meta-analysis of 25 epidemiological studies revealed that the lifetime prevalence of depression and anxiety disorders was at least 1.5 times higher among lesbians, gays, and bisexuals, whereas the lifetime risk for suicide attempts was 2.47 times greater in sexual minority groups.2 Research linked a wide range of mental health outcomes among sexual minorities—including depression,3–10 anxiety,6,9,10 panic disorder,6 psychological distress,11–16 suicide attempts,11 and suicidal ideation11,17—to the effects of discrimination. Furthermore, studies showed widespread experiences of discrimination among sexual minorities.6,8,16,18,19 One population-based survey of US adults found that more than three quarters (76%) of gay or bisexual respondents reported a lifetime experience of discrimination.6 In another population-based survey of US adults, close to one quarter (21.4%) of lesbian, gay, or bisexual respondents reported experiencing discrimination in the past year.18Although the disproportionate prevalence of mental health difficulties and experiences of social discrimination among lesbian, gay, and bisexual people are well documented, the association between discrimination and mental health outcomes is not well understood. Among the gaps in our understanding are the following 2 points. First, it is unclear which types and sources of discrimination have an adverse effect on mental health among sexual minorities. Three of the 15 existing studies on the impact of discrimination on mental health outcomes utilized composite measures of overall perceived discrimination that combined various forms of discrimination experiences.6,10,15 Eleven studies examined specific types of discrimination, such as antigay violence,5,9,11,12,14,17 racism,8,16 and homophobia,3,4,8,12,13,16 but made no specific references to their sources (e.g., family, heterosexual friends, a mainstream gay community, a larger general community). One study specified only a single source (i.e., White gay men) for one particular form of discrimination (i.e., perceived devaluation of Asian gay men7).Second, it remains unknown whether previous study findings on the association between discrimination and poor mental health outcomes among sexual minorities are generalizable across racial/ethnic groups, because few studies of sexual minorities have directly compared the effects of discrimination on mental health outcomes among various racial/ethnic minority groups. Studies of discrimination and mental health among sexual minorities have either aggregated multiple racial and ethnic groups,3–6,9,11–14,17 or been limited to 1 (i.e., African Americans,10 Asians,8 Latinos16) or 2 groups (i.e., Asians and Latinos15).The present study addressed these gaps in the literature by examining the associations of specific types and sources of discrimination with mental health outcomes in a sample of African American, Asian or Pacific Islander (API), and Latino men who have sex with men (MSM). First, we examined the prevalence of discrimination based on race/ethnicity and sexual orientation. Second, we determined which types and sources of discrimination were associated with mental health outcomes. Finally, we assessed whether these associations varied by race/ethnicity.     

R-rated film viewing and adolescent smoking

OBJECTIVES: As smoking is very common in R-rated films, we sought to determine if viewing R-rated films is associated with adolescent smoking. METHODS: Three annual cross-sectional surveys conducted of 88,505 Year 10 students of largely European, Maori, Asian or Pacific Islander ethnicity in secondary schools in New Zealand between 2002 and 2004. Outcomes of interest were: intention to smoke among never smokers; past experimentation with smoking among current non-smokers; current smoking status; and current frequency of smoking. RESULTS: Dose-response relationships were observed between the frequency of viewing R-rated films and all outcome measures controlling for age, gender, ethnicity, peer smoking, parental smoking, socioeconomic status, pocket money and household smoking rules. Compared to never viewing R-rated films, viewing at least weekly nearly tripled the relative risk (2.81; 95% confidence interval 2.57, 3.09) of never smokers being susceptible to smoking, and more than doubled the risk of both past experimentation (2.28; 95% CI 2.12, 2.45) and smoking>/=monthly (2.31; 95% CI 2.10, 2.54). Each of these risks was seen across all ethnic groups. CONCLUSIONS: Our results extend the association that has been demonstrated between viewing R-rated films and current smoking in American youth by demonstrating the same association in youth of different ethnic and cultural backgrounds in New Zealand.     

Perceived racial/ethnic discrimination,problem behaviors,and mental health among minority urban youth

Objectives. We examined perceived frequency and intensity of racial/ethnic discrimination and associations with high-risk behaviors/conditions among adolescents.

Design. With surveys from 2490 racial/ethnic minority adolescents primarily with low socioeconomic status, we used regression analysis to examine associations between racial/ethnic discrimination and behavioral health outcomes (alcohol use, marijuana use, physical aggression, delinquency, victimization, depression, suicidal ideation, and sexual behaviors).

Results. Most adolescents (73%) experienced racial/ethnic discrimination and 42% of experiences were ‘somewhat-’ or ‘very disturbing.’ Adolescents reporting frequent and disturbing racial/ethnic discrimination were at increased risk of all measured behaviors, except alcohol and marijuana use. Adolescents who experienced any racial/ethnic discrimination were at increased risk for victimization and depression. Regardless of intensity, adolescents who experienced racial/ethnic discrimination at least occasionally were more likely to report greater physical aggression, delinquency, suicidal ideation, younger age at first oral sex, unprotected sex during last intercourse, and more lifetime sexual partners.

Conclusion. Most adolescents had experienced racial/ethnic discrimination due to their race/ethnicity. Even occasional experiences of racial/ethnic discrimination likely contribute to maladaptive behavioral and mental health outcomes among adolescents. Prevention and coping strategies are important targets for intervention.     

Asthma in Pacificans in New Zealand and in the South Pacific

Asthma morbidity is a major public health problem in New Zealand. While considerable research has been done on asthma prevalence and access to asthma care among European and Maori, currently available information on the prevalence and severity of asthma in Pacific people in New Zealand is sparse. Furthermore, there have been only a few surveys on asthma prevalence in Pacific countries and these have used a variety of methodologies. We have therefore reviewed research on asthma prevalence and access to asthma health care in New Zealand and the Pacific nations, which had included information on Pacific people. The available evidence indicates several key features of asthma in Pacific people. In New Zealand, asthma prevalence in Pacific children is similar to, or lower than, that in non-Polynesian children, whereas in adults the prevalence is higher in both Pacific and Maori people. Asthma is more severe in Pacific people and Maori with a higher frequency of hospitalizations. The available evidence also indicates that the greater severity, and the greater adult prevalence, in Pacific people may be partly or wholly due to problems of access to culturally appropriate asthma health care and asthma education. However, this is an area that needs further research. There is some evidence that prevalence of asthma may be higher in Pacific children in New Zealand than in the Pacific, however little else is known about the prevalence patterns of asthma throughout the Pacific. Systematic standardised prevalence studies, including participation in Phase III of the ISAAC study, would clearly be of value in assessing the patterns and extent of asthma morbidity throughout the Pacific.     

Mismatched racial identities, colourism, and health in Toronto and Vancouver

Using original telephone survey data collected from adult residents of Toronto (n = 685) and Vancouver (n = 814) in 2009, I investigate associations between mental and physical health and variously conceived racial identities. An 'expressed racial identity' is a self-identification with a racial grouping that a person will readily express to others when asked to fit into official racial classifications presented by Census forms, survey researchers, insurance forms, and the like. Distinguishing between Asian, Black, South Asian, and White expressed racial identities, I find that survey respondents expressing Black identity are the most likely to report high blood pressure or hypertension, a risk that is slightly attenuated by socioeconomic status, and that respondents expressing Asian identity are the most likely to report poorer self-rated mental health and self-rated overall health, risks that are not explained by socioeconomic status. I also find that darker-skinned Black respondents are more likely than lighter-skinned Black respondents to report poor health outcomes, indicating that colourism, processes of discrimination which privilege lighter-skinned people of colour over their darker-skinned counterparts, exists and has implications for well-being in Canada as it does in the United States. Finally, 'reflected racial identity' refers to the racial identity that a person believes that others tend to perceive him or her to be. I find that expressed and reflected racial identities differ from one another for large proportions of self-expressed Black and South Asian respondents and relatively few self-expressed White and Asian respondents. I also find that mismatched racial identities correspond with relatively high risks of various poor health outcomes, especially for respondents who consider themselves White but believe that others tend to think they are something else. I conclude by presenting a framework for conceptualizing multifaceted suites of racial identities and relating their various components and inconsistencies between them to health outcomes.     

Racial and Gender Discrimination,Early Life Factors,and Chronic Physical Health Conditions in Midlife

PurposeMost studies of perceived discrimination have been cross-sectional and focused primarily on mental rather than physical health conditions. We examined the associations of perceived racial and gender discrimination reported in adulthood with early life factors and self-reported physician diagnosis of chronic physical health conditions.MethodsWe used data from a racially diverse birth cohort of U.S. women (n = 168; average age, 41 years) with prospectively collected early life data (e.g., parental socioeconomic factors) and adult reported data on perceived discrimination, physical health conditions, and relevant risk factors. We performed modified robust Poisson regression owing to the high prevalence of the outcomes.ResultsFifty percent of participants reported racial and 39% reported gender discrimination. Early life factors did not have strong associations with perceived discrimination. In adjusted regression models, participants reporting at least three experiences of gender or racial discrimination had a 38% increased risk of having at least one physical health condition (relative risk, 1.38; 95% confidence interval, 1.01–1.87). Using standardized regression coefficients, the magnitude of the association of having physical health condition(s) was larger for perceived discrimination than for being overweight or obese.ConclusionOur results suggest a substantial chronic disease burden associated with perceived discrimination, which may exceed the impact of established risk factors for poor physical health.     

Do all ethnic groups in New Zealand exhibit socio‐economic mortality gradients?

OBJECTIVES: First, to establish whether a deprivation gradient in all-cause mortality exists for all ethnic groups within New Zealand; second, if such gradients do exist, whether their absolute slopes are the same; and third, if such gradients exist, what impact the unequal deprivation distributions of the different ethnic groups have on the observed ethnic inequalities in life expectancy at birth. METHOD: Abridged lifetables for the period 1999-2003 were constructed using standard demographic methods for each of four ethnic groups (Asian, Pacific, Maori and European) by NZDep2001 quintile and sex. Gradients were estimated by fitting generalised linear models to the quintile-specific life expectancy estimates for each ethnic group (by sex). The contribution of variation in deprivation distributions to inter-ethnic inequalities in life expectancy was estimated by re-weighting the quintile-specific mortality rates for each ethnic group using weights derived from the European deprivation distribution and recalculating the lifetable. RESULTS: All four ethnic groups exhibit deprivation gradients in all-cause mortality (life expectancy). Maori show the steepest gradients, with slopes approximately 25% steeper than those of Europeans for both males and females. By contrast, gradients among Asian and Pacific peoples are shallower than those of their European counterparts. CONCLUSION: While socio-economic gradients in health exist among all ethnic groups, they are relatively shallow among Pacific and (especially) Asian peoples. For these ethnic groups, caution should be exercised in applying deprivation or other socio-economic measures as proxy indicators of need for health services.     

Hepatitis B carriage explains the excess rate of hepatocellular carcinoma for Maori, Pacific Island and Asian people compared to Europeans in New Zealand.

BACKGROUND: The aim of this research was to determine the hepatitis B surface antigen (HBsAg) carrier prevalence among cases of hepatocellular carcinoma (HCC), and the population attributable risk of HBsAg carriage for HCC, by ethnicity in New Zealand. METHODS: The hospital notes of HCC cases registered with the New Zealand Cancer Registry, for the years 1987-1994 inclusive, were viewed to determine the HBsAg status. Results The HBsAg status was determined for 193 cases of HCC. The HBsAg carrier prevalence for non-Europeans with HCC was markedly higher than that for Europeans, being 76.7% for Maori, 80.0% for Pacific Island people, and 88.5% for Asians, compared to 6.0% for Europeans. In addition to the effect of ethnicity, HCC cases aged <60 years were more likely to be HBsAg carriers than those aged > or = 60 years. The estimated population attributable risk of HBsAg for HCC, within each ethnic group, was only marginally less than the HBsAg prevalence due to the high relative risk of HBsAg carriage for HCC. The standardized incidence rate ratios of HCC for Maori, Pacific Island people and Asians compared to Europeans were 9.6, 20.4, and 22.3, respectively. Hepatocellular carcinoma attributable to HBsAg carriage explained 79%, 83%, and 92% of the excess standardized rate of HCC, compared to Europeans, for Maori, Pacific Island people, and Asians, respectively. Conclusions The HBsAg carrier prevalence in non-European cases of HCC in New Zealand is between 75% and 90%. HBsAg carriage explains the majority of the excess rate of HCC in non-Europeans compared to Europeans in New Zealand.