Is neighborhood racial/ethnic composition associated with depressive symptoms? The multi-ethnic study of atherosclerosis

The racial/ethnic composition of a neighborhood may be related to residents’ depressive symptoms through differential levels of neighborhood social support and/or stressors. We used the Multi-Ethnic Study of Atherosclerosis to investigate cross-sectional associations of neighborhood racial/ethnic composition with the Center for Epidemiologic Studies-Depression (CES-D) scale in adults aged 45–84. The key exposure was a census-derived measure of the percentage of residents of the same racial/ethnic background in each participant’s census tract. Two-level multilevel models were used to estimate associations of neighborhood racial/ethnic composition with CES-D scores after controlling for age, income, marital status, education and nativity. We found that living in a neighborhood with a higher percentage of residents of the same race/ethnicity was associated with increased CES-D scores in African American men (p < 0.05), and decreased CES-D scores in Hispanic men and women and Chinese women, although these differences were not statistically significant. Models were further adjusted for neighborhood-level covariates (social cohesion, safety, problems, aesthetic quality and socioeconomic factors) derived from survey responses and census data. Adjusting for other neighborhood characteristics strengthened protective associations amongst Hispanics, but did not change the significant associations in African American men. These results demonstrate heterogeneity in the associations of race/ethnic composition with mental health and the need for further exploration of which aspects of neighborhood environments may contribute to these associations.     

A multi-group path analysis of the relationship between perceived racial discrimination and self-rated stress: how does it vary across racial/ethnic groups?

Objective: The objective of this study was to answer three questions: (1) Is perceived discrimination adversely related to self-rated stress via the social capital and health care system distrust pathways? (2) Does the relationship between perceived discrimination and self-rated stress vary across race/ethnicity groups? and (3) Do the two pathways differ by one’s race/ethnicity background?

Design: Using the Philadelphia Health Management Corporation’s Southeastern Pennsylvania Household Survey, we classified 9831 respondents into 4 race/ethnicity groups: non-Hispanic White (n?=?6621), non-Hispanic Black (n?=?2359), Hispanic (n?=?505), and non-Hispanic other races (n?=?346). Structural equation modeling was employed to simultaneously estimate five sets of equations, including the confirmatory factor analysis for both social capital and health care distrust and both direct and indirect effects from perceived discrimination to self-rated stress.

Results: The key findings drawn from the analysis include the following: (1) in general, people who experienced racial discrimination have higher distrust and weaker social capital than those without perceived discrimination and both distrust and social capital are ultimately related to self-rated stress. (2) The direct relationship between perceived discrimination and self-rated stress is found for all race/ethnicity groups (except non-Hispanic other races) and it does not vary across groups. (3) The two pathways can be applied to non-Hispanic White and Black, but for Hispanic and non-Hispanic other races, we found little evidence for the social capital pathway.

Conclusions: For non-Hispanic White, non-Hispanic Black, and Hispanic, perceived discrimination is negatively related to self-rated stress. This finding highlights the importance of reducing interpersonal discriminatory behavior even for non-Hispanic White. The health care system distrust pathway can be used to address the racial health disparity in stress as it holds true for all four race/ethnicity groups. On the other hand, the social capital pathway seems to better help non-Hispanic White and Black to mediate the adverse effect of perceived discrimination on stress.     

Active school transport and fast food intake: Are there racial and ethnic differences?

ObjectivesTo investigate whether active school transport was associated with fast food consumption, and to examine differences across racial/ethnic groups.MethodsAdolescent data (n = 3194) from the 2009 California Health Interview Survey were analyzed with logistic regression models to examine the association between active school transport (AST) and fast food intake across racial/ethnic groups.ResultsIn the overall sample, AST during 1–2 days in the past week was associated with greater likelihood of fast food intake (OR: 1.58; 95% CI: 1.03–2.43), compared with zero days of AST, controlling for demographic and other factors. The association between AST and fast food intake differed significantly by race/ethnicity (p < 0.01). Among Latino adolescents, greater frequency of AST was significantly associated with greater likelihood of fast food intake (1–2 days OR, 2.37, 95%CI: 1.05–5.35; 3–4 days OR, 2.78, 95% CI: 1.04–7.43; 5 days OR, 2.20, 95%CI: 1.23–3.93). Among White and Asian adolescents, there was a curvilinear pattern: relative to adolescents who reported zero days of AST, those who did AST 1–2 days/week had greater likelihood of fast food intake, but AST of 3–4 days and 5 days/week was associated respectively, with higher and lower likelihood of fast food intake among both groups.ConclusionsAST appears to be a risk factor for fast food intake, and may expose some ethnic groups more than others to increased opportunity to purchase and consume fast food. Programs and policies to promote AST among adolescents should incorporate efforts to encourage healthy eating and discourage concentration of fast food outlets near schools.     

When does a difference become a disparity? Conceptualizing racial and ethnic disparities in health

Definitions of racial and ethnic disparities fall along a continuum from differences with little connotation of being unjust to those that result from overt discrimination. Where along this continuum one decides that a racial difference becomes a disparity is subjective, but the magnitude of the injustice is generally proportional to how much control a person is perceived to have over the cause of the difference in health. The degree to which one sees environmental factors and social context as shaping choices has important implications for the measurement of disparities and ultimately for directing efforts to eliminate them.     

Is menopausal status related to women’s attitudes toward menopause and aging?

The objective of this study was to explore the relationship between menopausal status and attitudes toward menopause and aging. We identified 1,400 Bengali Hindu women aged 40–55 years (early perimenopausal n = 445; late perimenopausal n = 240; early postmenopausal n = 285; late postmenopausal n = 430) from West Bengal, India. Information on attitudes toward menopause and aging was collected from March 2009 to July 2012 using ten agree/disagree statements, of which three were positive, four were negative, and the rest were neutral. We used only the positive and negative statements in the analyses. The participants were given three response options for each statement: (1) agreed, (2) disagreed, and (3) felt neutral. Agreement with positive statements and disagreement with negative statements were scored as 3. The converse responses were scored as 1. Neutral responses were not scored. Thus, the total attitude score for each participant ranged from 7 to 21. Additionally, data on sociodemographic and reproductive variables, menopausal symptoms, and perceptions toward menopause were also collected. Multivariable analyses (ANCOVA) showed that postmenopausal women had more positive attitudes toward menopause and aging than perimenopausal women. Providing balanced information about menopause and aging might help to foster positive attitudes toward menopause.     

Is there a contradiction between telemedicine and business?

Is there a contradiction between telemedicine and business? The driving forces in the telemedicine market are: competition within the health-care industry, newly developed cheap information technology (especially the Internet) and 21st-century health-care consumers, with their expectations of free choice and a high level of health-care. The market has four segments (citizens, patients, professionals and employees) and the boundaries between these segments are blurred. The telemedicine market is obviously growing, but it is still unstructured, fractured and disorganized. The telemedicine market needs a meeting place where the status of telemedicine and telecare can be reviewed. This would be a place in which to explore new ways to improve the efficiency of health-care services and a forum in which to draw a roadmap for future developments. One such place is the International Trade Event and Conference for eHealth, Telemedicine and Health ICT, Med-e-Tel. At the 2004 event, there were 32 exhibitors from 23 countries and over 400 industry and medical participants. A survey of participants showed that the event was judged to be a success. There is no conflict between telemedicine and business. On the contrary, telemedicine is a promising area of business development.     

Are state patterns of smoking different for different racial/ethnic groups? an application of multilevel analysis

OBJECTIVES: Tobacco use research has often assumed "average" effects across place, race, and socioeconomic position. We explored and mapped the variation in smoking prevalence for racial/ethnic groups by gender and state after adjusting for demographic factors. METHODS: We executed a cross-sectional, weighted, two-level multilevel multiple regression analysis (individuals in states), with current smoking as the outcome, using the 1995-1996 Current Population Survey Tobacco Use Supplement, for non-Hispanic (NH) whites, NH blacks, and Hispanics. We also calculated adjusted smoking prevalence, 95% confidence intervals, Spearman correlations, and state residual-based maps to examine state patterns. RESULTS: We found different smoking patterns for each racial group. Black women's smoking rates were markedly lower than the national subgroup rate in six clustered states in the deep South. Smoking rates for whites were higher than the subgroup national rate in several Great Lakes states, Texas, Nevada, and North Carolina. For white women, several rural Midwest states displayed lower-than-expected smoking rates (Idaho, Utah, South Dakota, and Nebraska). We documented positive correlations for smoking prevalence between men and women within each racial group, but not between racial groups, indicating a race-specific pattern of smoking. We found that state tobacco variables (taxation and agriculture) did not account for remaining state smoking variance after inclusion of demographic variables. CONCLUSION: Multilevel modeling may enhance surveillance of tobacco use patterns. Focusing on race-specific state smoking patterns may illuminate why racial/ethnic minority groups exhibit lower smoking prevalence compared to their white counterparts, by examining context of smoking that may be race-specific.     

Is there a hard-to-reach audience?

The "hard-to-reach" label has been applied to many different audiences. Persons who have a low socioeconomic status (SES), members of ethnic minorities, and persons who have a low level of literacy often are tagged as "hard-to-reach." The authors identify reasons why these groups have been labelled "hard-to-reach," discuss preconceptions associated with the "hard-to-reach" label, propose alternative conceptualizations of these audiences, and present implications of such conceptualizations for health communication campaigns. Pejorative labels and preconceptions about various groups may lead to depicting these audiences as powerless, apathetic, and isolated. The authors discuss alternative conceptualizations, which highlight the strengths of different audience segments and encourage innovative approaches to the communication process. These alternative conceptualizations emphasize interactive communication, a view of society in which individuals are seen as members of equivalent--albeit different--cultures, and a shift of responsibility for health problems from individuals to social systems. Recommendations for incorporating these alternative concepts into health campaigns include formative research techniques that create a dialogue among participants, more sophisticated segmentation techniques to capture audience diversity, and new roles for mass media that are more interactive and responsive to individual needs.     

Is there a Mediterranean bioethics?

Is there a special Mediterranean approach to Bioethics and if so what are the roots of this approach? And why not a Bosphorus, or a ??lake Michigan?? bioethics? The answer to such a question depends on the focus one takes on defining ??Mediterranean??? On the one hand one can refer to the Mediterranean region which includes the surrounding coasts, having Europe on its northern coast line, northern Africa on its southern coast line (and these will include the north and South West coasts), and in the Eastern region countries which border with Middle-Eastern countries. This approach is the approach currently being taken by European Parliamentarians when they speak about the Mediterranean, namely including countries like France, Italy and Libya. On the other hand there is the look upon the Mediterranean as ??Southern Europe??; this is a more ??traditional?? way on how westerners view the Mediterranean. This common approach is often recognized when, for example, we speak of ??Mediterranean diet??, or, ??Mediterranean Temperament??. It would include Eastern countries like Greece and Cyprus. This article focuses on these two approaches to Mediterranean ethics after discussing issues pertaining to the region which are important to define in this context. It then analyses the need for having a Mediterranean approach to bioethical issues.     

Is there a perfectionist in each of us? An experimental study on perfectionism and eating disorder symptoms

Previous studies have shown consistent associations between perfectionism and eating disorder (ED) symptoms. However, to date, only one study (Shafran et al., 2006) used an experimental design to examine in a non-clinical sample the causal relationship between perfectionism and ED symptoms. The current experimental study aimed to build on that study by examining the role of trait perfectionism in the effects of an experimental induction of perfectionism and by adopting a multidimensional approach to perfectionism. University students (N=100; Mage=20.6years; SD=2.24) were randomly assigned to one of three experimental conditions, that is, a high Personal Standards condition, a condition combining Personal Standards perfectionism and Evaluative Concerns perfectionism, and a non-perfectionist condition. Compared to the non-perfectionist condition, participants in the two perfectionist conditions reported higher levels of state perfectionism during the next 24h and this effect occurred irrespective of trait perfectionism levels. Further, participants in the perfectionist conditions, compared to those in the non-perfectionist condition, reported significantly higher levels of restraint and binging during the 24h after manipulation. Together, the results suggest that perfectionism can be induced in people irrespective of their levels of trait perfectionism and that perfectionism represents a causal risk factor for ED pathology.     

Is there a future for a Staphylococcus aureus vaccine?

Multiple attempts to develop a vaccine to prevent Staphylococcus aureus infections have failed. To date, all have been based upon the development of opsonic antibodies. New information suggests that cell mediated immunity may be critical for protection against S. aureus infections. The arm of the immune system that provides the protection contains the Th17/IL-17 axis. Th17 cells release IL-17, which are important for mobilization and activation of neutrophils. Naturally, antibodies aid the neutrophils in the uptake and killing of staphylococci, but immune globulin does not seem to be sufficient to afford protection. New approaches that focus on Th17/IL-17 may allow for the development of a successful S. aureus vaccine.     

How much of racial/ethnic disparities in dietary intakes, exercise, and weight status can be explained by nutrition- and health-related psychosocial factors and socioeconomic status among US adults?

Large disparities exist in obesity and other chronic diseases across racial/ethnic and socioeconomic status (SES) groups in the United States. This study examined how much of racial/ethnic differences in diet, exercise, and weight status could be explained by nutrition- and health-related psychosocial factors (NHRPF) and SES among US adults. Nationally representative data of 4,356 US adults from the 1994-1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey were used. NHRPF were assessed using 24 questions and related index scores. Dietary intakes were assessed using two nonconsecutive 24-hour dietary recalls. The US Department of Agriculture 2005 Healthy Eating Index was applied to evaluate diet quality. Body mass index was calculated based on self-reported weight and height. SES was assessed using education and household income. Americans with higher SES had better NHRPF and Healthy Eating Index scores. There were some small racial/ethnic differences in NHRPF, including making food choices and awareness of nutrition-related health risks. Multivariable linear and logistic regression models revealed some racial/ethnic differences in diet, exercise, and body mass index, but few of these disparities was explained by NHRPF, whereas SES explained some. The odds ratio of body mass index ≥25 for non-Hispanic blacks compared with whites decreased by 38% after SES was adjusted for. For exercise, we found a smaller change (9.5%) in the racial/ethnic differences when controlling for SES. In conclusion, NHRPF may explain very few, but SES may contribute some of the racial/ethnic disparities in diet, exercise, and weight status in the United States.     

Micronutrient challenges across the age spectrum: Is there a role for red meat?

In recent years, there has been controversy about the healthiness of red meat, prompting suggestions that people should limit their consumption. However, national dietary surveys indicate that UK diets can be low in nutrients typically found in red meat, e.g. vitamin B₂, vitamin D, iron, magnesium, zinc, selenium and potassium, particularly among low‐income groups, teenagers and females. This article examines the nutritional challenges from infanthood to old age and considers whether there is still a role for red meat in helping people to achieve their dietary requirements. The fossil record indicates that early man evolved as an omnivore, with meat representing a significant source of protein and nutrients in the prehistoric diet. Modern diets offer substantially more variation in protein sources yet the range of nutrients supplied by red meat and their high bioavailability may make meat particularly suitable for human diets. Studies suggest that low intakes of red meat are a marker for iron insufficiency, while inclusion of red meat in the diet is associated with higher mineral intakes. Moderate amounts of lean red meat provide a wide range of important nutrients, without substantially increasing intakes of energy and saturated fatty acids. While concerns have been raised about the potential impact of red meat on the risk of chronic disease, the data are mostly observational and may be confounded by cooking methods or other dietary factors. In conclusion, integrating red meat into diets across the age spectrum, from infanthood to old age, may help to narrow the present gap between micronutrient intakes and recommendations.