Latino populations: a unique opportunity for epidemiological research of asthma

Asthma is a significant health problem among Latinos, the largest minority population in the US. Asthma prevalence, morbidity and mortality are highest in Puerto Ricans, intermediate in Dominicans and Cubans, and lowest in Mexicans and Central Americans. From a cultural and social perspective, Latinos represent a wide variety of national origins and ethnic and cultural groups, with a full spectrum of social class. From a genetic perspective, Latinos have descended from Native American, European and African populations. Here, we review results from recent genetic and clinical studies to illustrate the unique opportunity Latino groups offer for studying the interaction between racial, genetic and environmental contributions to asthma and drug responsiveness.     

Untangling the associations among distrust, race, and neighborhood social environment: a social disorganization perspective

Over the past decade, interest in exploring how health care system distrust is associated with individual health outcomes and behaviors has grown substantially, and the racial difference in distrust has been well documented, with African Americans demonstrating higher distrust than whites. However, relatively little is known about whether the individual-level determinants of distrust differ by various dimensions of distrust, and even less is understood regarding whether the race-distrust association could be moderated by the neighborhood social environment. This study used a dual-dimensional distrust scale (values and competence distrust), and applied social disorganization theory to address these gaps. We combined the 2008 Philadelphia Health Management Corporation's household survey (N = 3746 adult respondents, 51% of which are of African American race) with neighborhood-level data (N = 45 neighborhoods) maintained by the 2000 U.S. Census and the Philadelphia Police Department. Using multilevel modeling, we found that first, after controlling for individual- and neighborhood-level covariates, African American residents have greater values distrust than whites, but no racial difference was found in competence distrust; second, competence distrust is more likely to be determined by personal health status and access to health care services than is values distrust; and third, ceteris paribus, the association between race and values distrust was weakened by the increasing level of neighborhood stability. These results not only indicate that different aspects of distrust may be determined via different mechanisms, but also suggest that establishing a stable neighborhood may ameliorate the level of distrust in the health care system among African Americans. As distrust has been identified as a barrier to medical research, the insight provided by this study can be applied to develop a health care system that is trusted, which will, in turn, improve population health.     

Person/environment construct: positivist versus naturalist, dilemma or opportunity for health social work research and practice?

The purpose of this paper is to indicate that there is nothing fundamentally wrong with the social work purpose of simultaneous attention to persons in their contexts. In fact, the productive pull of both perspectives is what separates social work from other helping professions. Indeed, it is what separates health social work from other health professions. What has created difficulty, however, has been the predominant lens through which person and environment have been investigated, understood and manipulated. This paper compares two major models of knowledge building in an attempt to identify the consequences for research and practice in social work. Examples are provided from both research and practice that derive from these differing perspectives in an effort to clarify the choices social worker health professionals make when encountering a person-in situation.     

Human genetics, environment, and communities of color: ethical and social implications

A conference titled "Human Genetics, Environment, and Communities of Color: Ethical and Social Implications" and a workshop symposium titled "Human Genetics and Environmental Justice" were held by West Harlem Environmental Action, Inc., with cosponsorship by the National Institute of Environmental Health Sciences (NIEHS), the Community Outreach and Education Program of the NIEHS P30 Center for Environmental Health at the Mailman School of Public Health at Columbia University, New York, and the U.S. Environmental Protection Agency. The conference and symposium took place at Columbia University in New York City on 4-5 February 2002. Expert panels composed of public health practitioners, genetic researchers, ethicists, lawyers, social scientists, and community organizations were assembled to explore how genetic research will affect communities of color, specifically in environmental health research. The goal of the conference was to educate participants on the science and ethics of genetic research and to explore the potential benefits and pitfalls of genetic research vis-à-vis new trends in environmental health research, specifically with reference to communities of color. The goal of the symposium was to discuss the major perceptions and concerns for community-based environmental justice advocates and other communities of color regarding environmental health genetic research. The conference and symposium drew more than 300 participants and articulated important perspectives on the opportunities and challenges for environmental justice advocates and other communities of color posed by rapid advances in environmental health genetic research and toxicogenomics.     

Modern cancer epidemiological research: genetic polymorphisms and environment

Individual cancer susceptibility seems to be related to factors such as changes in oncogenes and tumor suppressor genes expression, and differences in the action of metabolic enzymes and DNA repair regulated by specific genes. Epidemiological studies on genetic polymorphisms of human xenobiotics metabolizing enzymes and cancer have revealed low relative risks. Research considering genetic polymorphisms prevalence jointly with environmental exposures could be relevant for a better understanding of cancer etiology and the mechanisms of carcinogenesis and also for new insights on cancer prognosis. This study reviews the approaches of molecular epidemiology in cancer research, stressing case-control and cohort designs involving genetic polymorphisms, and factors that could introduce bias and confounding in these studies. Similarly to classical epidemiological research, genetic polymorphisms requires considering aspects of precision and accuracy in the study design.     

Pharmacy: a unique opportunity to participate in education

Health education and health maintenance are part of the traditional role of the pharmacist, particularly for those engaged in general practice (retail) pharmacy, writes J. W. Barnett, APhO Hereford and Worcester AHA, in the last of our series. Pharmaceutical officers have many opportunities to exercise this professional role themselves either by direct contact with the public, or indirectly by helping and advising others. Although this generally involves educating the public on medicines, wider issues are also involved -- for example, fluoridation and the risk of poisoning from household chemicals.     

Reducing income inequity and boosting social capital: new responsibilities in social epidemiological research

This paper focuses on the fact that there are not only large inequalities in health between but also within countries. The question is raised as to whether these two types of health inequalities are caused by similar processes, and whether understanding these processes could lead to new strategies for reducing such differences. Many studies in Germany have demonstrated that mortality and morbidity are much higher for low-status as compared to high-status population groups. These health inequalities are usually explained by differences in working and living conditions, in health behaviour and in health services utilisation. For some years there has been an extensive discussion in the international Public Health community on health inequalities between countries and on how they can be explained by income inequalities, with the term "social capital" becoming a central issue. This debate has been largely neglected in Germany, but such groundwork now offers an important opportunity for a more comprehensive discussion in this country as well.     

Immigrant Latino men in rural communities in the Northwest: social environment and HIV/STI risk

This study explored how migration-related socio-cultural and environmental factors interact to render immigrant Latino men residing in rural Oregon at increased risk for HIV/STI. More specifically, the paper describes the socio-demographic characteristics and sexual risk profile of immigrant Latino men and characterises the physical and socio-cultural contexts in which they reside. In-depth interviews were conducted with 49 men who newly immigrated to the USA and had recently engaged in sexual intercourse with women. Content analysis indicated that job instability and seasonal/industry restrictions resulted in frequent changes in employment and living situations, and one-third of respondents reported having no one to turn to when in need. Over two-fifths had ever had sex with a sex worker, with almost a quarter reporting sex with a sex worker in the past three months. In addition, over half of the men reported that they never, or inconsistently, used condoms. Although respect for wives/girlfriends was valued, loneliness, sexual experimentation and inherent sexual needs were cited as reasons that men have sex outside their primary relationships. Our data support the convergence of risky environments and migration-driven factors in exacerbating STI prevalence and the HIV epidemic among Latino immigrant men residing in the Northwest.     

Immigrant Latino men in rural communities in the Northwest: social environment and HIV/STI risk

This study explored how migration-related socio-cultural and environmental factors interact to render immigrant Latino men residing in rural Oregon at increased risk for HIV/STI. More specifically, the paper describes the socio-demographic characteristics and sexual risk profile of immigrant Latino men and characterises the physical and socio-cultural contexts in which they reside. In-depth interviews were conducted with 49 men who newly immigrated to the USA and had recently engaged in sexual intercourse with women. Content analysis indicated that job instability and seasonal/industry restrictions resulted in frequent changes in employment and living situations, and one-third of respondents reported having no one to turn to when in need. Over two-fifths had ever had sex with a sex worker, with almost a quarter reporting sex with a sex worker in the past three months. In addition, over half of the men reported that they never, or inconsistently, used condoms. Although respect for wives/girlfriends was valued, loneliness, sexual experimentation and inherent sexual needs were cited as reasons that men have sex outside their primary relationships. Our data support the convergence of risky environments and migration-driven factors in exacerbating STI prevalence and the HIV epidemic among Latino immigrant men residing in the Northwest.     

Participation rates in a case-control study: the impact of age, race, and race of interviewer

PURPOSE: Despite concerns about declining participation rates in epidemiologic studies in recent years, relatively few papers have discussed obstacles to recruiting study participants or strategies for optimizing response rates. This report describes factors associated with nonparticipation in a population-based, case-control study of breast cancer and discusses ways to overcome barriers to participation. METHODS: Contact and cooperation rates were calculated for participants in the Carolina Breast Cancer Study (CBCS), stratified by case status, age, race, and race of interviewer. Demographic and breast cancer risk factor characteristics of partial and full responders also were compared. RESULTS: Contact rates and cooperation rates varied by case/control status and demographic characteristics. Contact rates were lower among controls, younger women, and black women. Cooperation rates were lower among controls, older women, and black cases. Cooperation rates were higher among both black and nonblack women when participants and interviewers were concordant on race. CONCLUSIONS: Obstacles to recruitment seem to differ among race and age subgroups, suggesting that recruitment strategies may need to be tailored to potential participants based upon demographic characteristics. Strategies have been implemented to improve response rates in this and other epidemiologic studies; however, additional research and innovation in this area are needed.     

Assessing the health perspectives of unique populations of adolescents: a focus group study

Few articles report on youth's perceptions about health-related issues and needs and even fewer have given voice to youth with disabilities, chronic health conditions, or youth in therapeutic foster care. The purpose of this study was to explore perceptions of health issues from the perspectives of youth placed in therapeutic foster care, youth with chronic medical conditions, and youth with disabilities. Twelve focus groups with 67 youth aged 13-20 were conducted in rural, suburban, and urban communities in the Commonwealth of Virginia. Data analysis revealed both within unique group themes and themes that cut across unique groups. Youth in therapeutic foster care with chronic health conditions or with disabilities perceive themselves as being different from their peers. Participants in each group expressed concerns about the unique issues that they confront daily and how these challenges differentiate them from youth who do not share their life experiences. They expressed the desire for other youth to understand them better and to not treat them differently. Discussion and implications focus on the need to create programs to support the unique needs of these youth.     

Reifying human difference: the debate on genetics, race, and health.

The causes of racial and ethnic inequalities in health and the most appropriate categories to use to address health inequality have been the subject of heated debate in recent years. At the same time, genetic explanations for racial disparities have figured prominently in the scientific and popular press since the announcement of the sequencing of the human genome. To understand how such explanations assumed prominence, this essay analyzes the circulation of ideas about race and genetics and the rhetorical strategies used by authors of key texts to shape the debate. The authority of genetic accounts for racial and ethnic difference in disease, the author argues, is rooted in a broad cultural faith in the promise of genetics to solve problems of human disease and the inner truth of human beings that is intertwined with historical meanings attached to race. Such accounts are problematic for a variety of reasons. Importantly, they produce, reify, and naturalize notions of racial difference, provide a scientific rationale for racially targeted medical care, and distract attention from research that probes the complex ways in which political, economic, social, and biological factors, especially those of inequality and racism, cause health disparities.     

Nutrition communication for a Latino community: formative research foundations

Formative research techniques were used to develop a tailored health communication nutrition intervention for Latinas and their families. Members of the target community were recruited to participate in focus groups, depth interviews, and participant observations. Women, in particular, were observed preparing meals in their homes and purchasing groceries. The objective was to identify variables that could be used for targeting, segmenting, and tailoring the intervention. Results from these efforts were used to develop a theory-based intervention, which is described at the conclusion of the article.     

A measurement of social support in epidemiological research: the social experiences checklist tested in a general population in The Netherlands.

STUDY OBJECTIVE--This study aimed to examine in a general population the psychometric qualities of an instrument designed to measure positive and negative social experiences that had been developed in a clinical setting. DESIGN--The Netherlands monitoring project on cardiovascular disease risk factors, a large scale population based study (comprising 36,588 men and women aged 20 to 59 years) carried out in three Dutch towns (Amsterdam, Doetinchem, and Maastricht) offered the possibility of testing the strength of this instrument cross sectionally. MEASUREMENTS AND MAIN RESULTS--The social experiences checklist (SEC) which resulted from a research project on the quality of life of cancer patients was used. The independence of positive and negative experiences was confirmed. The reliability of both the positive and negative experiences dimension was good (Cronbach's alpha = 0.82 and 0.72 respectively). In accordance with the results of a study on cancer patients, the theoretically derived four dimensions in the experience of social support did not seem to be independent. The validity of the SEC was confirmed by Pearson correlations with neuroticism and coping styles. Neuroticism seemed to be negatively correlated with positive social experiences and was positively correlated with negative social experiences. The coping style of seeking information and direct action was positively correlated with positive social experiences. Coping by withdrawal was negatively correlated with negative social experiences. Women and highly educated people seemed to have more positive and fewer negative social experiences than men and people with less education. Younger people had more positive social experiences than older people. The oldest group in the study, those aged 50 to 59, reported fewer negative social experiences than any other age group. CONCLUSIONS--Similar results were found in a study of cancer patients. This underlines the usefulness of the instrument not only for cancer patients but also in survey research in a general population.     

Middle ear effusion in children and the indoor environment: an epidemiological study

A prospective study of 337 children was carried out during a 3-month period. The purpose of the study was to evaluate the importance of indoor environmental factors in homes and day-care institutions for the incidence of middle ear effusion (MEE). The indoor environmental factors measured in institutions were carbon dioxide, temperature, and relative humidity. Conditions in the homes were assessed by a questionnaire. Middle ear effusion was measured by tympanometry. No relationship was found between indoor environmental factors and MEE, with the exception of parental smoking at home, which increased the frequency of MEE in children.