Health Care Access and Utilization Among US-Born and Foreign-Born Asian Americans

Despite efforts to eliminate inequality in health and health care, disparities in health care access and utilization persist in the United States. The purpose of this study was to compare the access to care and use of health care services of US-born and foreign-born Asian Americans. We used aggregated data from the National Health Interview Survey (NHIS) from 2003 to 2005, including 2,500 participants who identified themselves as Asian. Associations between country of birth and reported access and utilization of care in the previous 12 months were examined. After controlling for covariates, being foreign-born was negatively related to indicators of access to care, including health insurance (OR = 0.29, 95%CI = 0.18-0.48), routine care access (OR = 0.52, 95%CI = 0.36-0.75), and sick care access [OR = 0.67, 95%CI = 0.47-0.96)]. Being foreign-born was also negatively related to all indicators of health care utilization (office visit: OR = 0.58, 95%CI = 0.41-0.81; seen/talked to a general doctor: OR = 0.69, 95%CI = 0.52-0.90; seen/talked to a specialist: OR = 0.42, 95%CI = 0.28-0.63) but ER visit (OR = 0.84, 95%CI = 0.59-1.20). There are substantial differences by country of birth in health care access and utilization among Asian Americans. Our findings emphasize the need for developing culturally sensitive health services and intervention programs for Asian communities.     

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.     

Ethnic and Nativity Differences in the Social Support-Physical Health Association Among Black Americans

Despite an abundant literature on social support and health, relatively less is known about how support and its impact on physical health vary within the Black population. Using the National Survey of American Life (NSAL), this paper examines which sources and types of support are associated with physical health among African Americans, U.S.-born Caribbean Blacks and foreign-born Caribbean Blacks. The results showed that for U.S.-born Caribbean Blacks, being married was especially beneficial to health. Closeness to family was associated with better health while negative interactions with family members was associated with worse health for African Americans and foreign-born Caribbean Blacks. Different sources of instrumental support affected all three groups. Overall, the findings reveal that, among Black Americans, the association between social support and physical health is contingent upon ethnicity, nativity, and the ways in which social support and health are operationalized.     

Associations Between Stressful Events and Self-Reported Mental Health Problems Among Non-Western Immigrants in Denmark

The aim of the present paper is to investigate the relationships of stressful events with self-reported mental health problems in the general population, comparing non-western immigrants with Danish nationals. 11.500 individuals aged 18–64 years from eight ethnic groups were invited to participate in a bilingual telephone survey on health among ethnic minorities in Denmark in 2007. Overall response rate is 52.1%. 3.997 individuals were selected for the present study. Self-reported mental health problems is twice as high among immigrants from Ex-Yugoslavia (24.6%), Iraq (30.2%) Iran (20.5%), Lebanon (27.2%) and Pakistan (19.9%), as among Danish nationals (9.7%) χ² (7, n = 3.997) = 21.57, P > 0.00. Non-western immigrants report twelve out of thirteen types of stressful events more frequently compared to Danish nationals. The most frequently reported stressful event among non-western immigrants is ‘personal disease’. Immigrants perceive the perils of daily life as more stressful in comparison with host nationals probably because of the additional challenges of adjusting to a new environment.     

Disparities in Self-Reported Diabetes Mellitus among Arab, Chaldean, and Black Americans in Southeast Michigan

Diabetes mellitus is an important public health problem that disproportionately affects minorities. Using a cross sectional, convenience sample, we estimated the prevalence of self-reported diabetes for Whites (n = 212), Arabs (n = 1,303), Chaldeans (n = 828), and Blacks (n = 789) in southeast Michigan. In addition, using a logistic regression model, we estimated odds ratios and 95% confidence intervals for the association between ethnicity and diabetes before and after adjusting for demographic, socioeconomic status, health care, chronic conditions, and health behavior variables. The overall age- and sex-adjusted prevalence of diabetes was 7.0%. Estimates were highest for Blacks (8.0%) followed by Arabs and Whites (7.0% for each group) and Chaldeans (6.0%). In the fully adjusted model, the association between ethnicity and diabetes was not statistically significant. Future studies should collect more detailed socioeconomic status, acculturation and health behavior information, which are factors that may affect the relationship between race/ethnicity and diabetes.     

Self-Reported Discrimination and Health-Related Quality of Life Among Whites, Blacks, Mexicans and Central Americans

This study investigates whether self-reported racial discrimination is related to poor health-related quality of life (HRQoL). Analyses focused on Whites (n = 52,571), Blacks (n = 4,343), Mexicans (n = 12,336), Central Americans (n = 1,504), Multi-ethnic Latinos (n = 1,102), and Other Latinos (n = 1,828) who participated in the 2003 and 2005 California Health Interview survey. Logistic and negative binomial regression was used to examine the association between HRQoL (assessed with the CDC unhealthy days measures) and self-reported racial discrimination. Discrimination was reported by 10% of Whites, 57% of Blacks, and 24–31% of the Latino groups. These reports were associated with increased number of unhealthy days, disability days, and poor self-rated health, even after, controlling for education and other factors. This association did not consistently vary by race/ethnicity. Racial discrimination may be a risk factor for poor HRQoL among diverse groups. Future research should examine the factors that may reduce potential exposure to racial discrimination.     

综合性医院医师心理健康状况的性别差异

目的了解综合性医院医师心理健康状况,并探讨其心理健康状况的性别差异。方法采用症状自评量表(SCL-90)对2所医院765名男医师及451名女医师的心理健康状况进行测定,比较其性别差异。结果女医师的SCL-90总分及躯体化、焦虑、抑郁、敌对、人际关系敏感5个因子上的得分明显高于男医师;男/女医师SCL-90总分的差异在初级和中级职称中显著,在高级职称人群中不显著。结论综合性医院女医师的心理健康状况较男医师差,可能与其对性别角色的认知差异有关。     

Mental Illness Stigma,Help Seeking,and Public Health Programs

Globally, more than 70% of people with mental illness receive no treatment from health care staff. Evidence suggests that factors increasing the likelihood of treatment avoidance or delay before presenting for care include (1) lack of knowledge to identify features of mental illnesses, (2) ignorance about how to access treatment, (3) prejudice against people who have mental illness, and (4) expectation of discrimination against people diagnosed with mental illness. In this article, we reviewed the evidence on whether large-scale anti-stigma campaigns could lead to increased levels of help seeking.INCREASING EVIDENCE SUGgests that significantly greater barriers exist to receipt of mental health care in comparison with physical health care. Worldwide, more than 70% of young people and adults with mental illness do not receive any mental health treatment from health care staff.1 The difference between true prevalence and treated prevalence can be called the treatment gap.2 This article describes the roles that stigma and discrimination contribute to the treatment gap3,4 and assesses the evidence that public health approaches to stigma and discrimination can facilitate access to mental health care. We present new data from the evaluation of Time to Change, England’s largest ever program to reduce mental illness stigma and discrimination.5     

Racial, Ethnic, and Sex Differences in the Associations Between Violence and Self-Reported Health Among US High School Students

BACKGROUND:  Involvement in interpersonal violence or suicidal behaviors can have a significant impact on an adolescent's physical health. Similarly, previous research has suggested that lived experiences, more than the presence or absence of physical ailments, can significantly influence self-assessed health status among adolescents. The purpose of this study was to examine the cross-sectional associations between involvement in violence and poor or fair self-reported health among US high school students.
METHODS:  Data were obtained from the 2005 national Youth Risk Behavior Survey (n = 13,953). Logistic regression analyses were conducted to determine the associations between violence-related measures and self-reported health while controlling for demographic characteristics and potential confounders. Analyses are presented for students overall and stratified by sex and race/ethnicity.
RESULTS:  Overall, 7.2% of students reported fair or poor self-rated health. Having been in a physical fight, having been injured in a physical fight, having attempted suicide, and having not gone to school because of safety concerns were significantly associated with fair or poor self-rated health after controlling for demographic characteristics and other potential confounders. Differences associated with race/ethnicity and sex are identified.
CONCLUSIONS:  Four of the 5 violence-related measures included in these analyses were significantly associated with fair or poor self-rated health. Future studies should consider the impact of involvement in violent behaviors and perceptions of both physical and mental well-being.     

Perceived Racial Discrimination and Mental Health in Diverse Groups of Asian Americans: The Differing Impacts by Age,Education, and Ethnicity

Journal of Immigrant and Minority Health - The aim of this study was to examine how perceived racial discrimination is associated with mental distress among diverse Asian Americans and to explore...     

Latina Self-Reported Mental Health and Delay in Health Care in a New Latino Destination

Understanding how depression and/or anxiety affects use of health care among Latinas in rapidly growing new Latino destinations, population where the growth rate of the Latino population exceeds the national average, may enhance community engagement efforts. Using community-based participatory research, a questionnaire assessing health care use was administered to 289 Latinas. Most (70%) reported delaying healthcare, and self-reported depression/anxiety was associated with a 3.1 fold (95% CI: 1.6–5.9) increase in delay, after adjusting for current health status, acculturation, age, education, and place of birth. Mental health disparities exist among Latinas, which are related to delays in use of health care. A gap exists regarding health education interventions for Latinas. More research is needed to identify successful models, especially in new Latino destinations as they may be particularly vulnerable to delay care.     

2008年绵阳市男男性行为者家庭及朋友歧视与个体行为和心理健康的关系

[目的]了解男男性行为者(MSM)家庭及朋友歧视经历现状及对个体行为和心理健康的关系。[方法]采用应答者趋动招募抽样法(RDS)对MSM人群常见的家庭及朋友歧视经历情况进行招募和自填式匿名调查。[结果]共调查201人,报告在最近6个月因同性恋被家人训斥、被朋友训斥、被家庭拒绝接纳、朋友断绝交往、失去住处依次分别为19.4%、17.4%、10.5%、11.9%和4.0%,因同性恋被家人训斥与年龄,因同性恋朋友断绝交往、失去住处与文化程度相关性显著(P0.05)。因同性恋被朋友训斥等相应歧视经历与是否常与MSM朋友进餐/喝茶、去公共浴室、去MSM活动公园,是否接受过性病诊疗服务、做过艾滋病咨询服务,因同性恋朋友断绝交往与近1周抑郁症状检出,因同性恋被家人训斥、被朋友训斥、失去住处等与近6月自杀意念、自杀计划、自杀未遂报告率相关联(P0.05),相关歧视经历多,到相应社会活动场所、接受过性病诊疗服务、接受过艾滋病咨询服务、抑郁症状检出和自自杀行为报告率较高。[结论]MSM面临家庭、朋友的普遍歧视,对人群健康及艾滋病流行带来影响。如何减少家庭及朋友歧视,更有效面对MSM人群的健康威胁和艾滋病的挑战,值得高度关注和探索。     

Changes in Experiences With Discrimination Across Pregnancy and Postpartum: Age Differences and Consequences for Mental Health

Objectives. We aimed to contribute to growing research and theory suggesting the importance of examining patterns of change over time and critical life periods to fully understand the effects of discrimination on health, with a focus on the period of pregnancy and postpartum and mental health outcomes.Methods. We used hierarchical linear modeling to examine changes across pregnancy and postpartum in everyday discrimination and the resulting consequences for mental health among predominantly Black and Latina, socioeconomically disadvantaged young women who were receiving prenatal care in New York City.Results. Patterns of change in experiences with discrimination varied according to age. Among the youngest participants, discrimination increased from the second to third trimesters and then decreased to lower than the baseline level by 1 year postpartum; among the oldest participants, discrimination decreased from the second trimester to 6 months postpartum and then returned to the baseline level by 1 year postpartum. Within-subjects changes in discrimination over time predicted changes in depressive and anxiety symptoms at subsequent points. Discrimination more strongly predicted anxiety symptoms among participants reporting food insecurity.Conclusions. Our results support a life course approach to understanding the impact of experiences with discrimination on health and when to intervene.A large and ever-growing body of research has shown that experiences with discrimination are associated with a wide range of adverse mental and physical health outcomes and may help explain socioeconomic and racial/ethnic health disparities in the United States.1,2 Although the majority of this research has been cross-sectional, an increasing number of longitudinal studies have shown that discrimination predicts poorer health.3,4 Some studies have gone further to examine within-person changes over time in discrimination and the resulting health implications.5–7Recently, Gee et al.8 proposed a life course perspective, calling for more research on changes in experiences with discrimination during critical periods to fully understand discrimination’s health effects and inform interventions. We examined changes across pregnancy and 1 year postpartum in experiences with everyday discrimination and consequences in terms of subsequent changes in depressive and anxiety symptoms among predominantly Black and Latina, socioeconomically disadvantaged young women residing in New York City. In their recent theoretical article, Gee et al. asserted:

Exposure to racism can change in nature, importance, and intensity. Similarly, health and the factors that produce health can change. A growing body of research shows that health is not merely the result of risks that occur sporadically at one point in time. Failure to attend to these temporal changes not only shortchanges our knowledge base, but also can lead to missed opportunities for intervention.8^(p967)

Cross-sectional (or even longitudinal) studies examining between-subjects associations of discrimination with health outcomes cannot assess changes in discrimination over time. To advance understanding of the health effects of discrimination, taking a life course perspective and examining changes in discrimination over time are crucial. Gee et al.8 highlighted potential age-patterned exposures to discrimination, with certain critical periods during which changes are more drastic. Some research supports this perspective, with evidence that racial discrimination increases across adolescence5 among African American youths and increases over time6 among African American, Latino, and Asian American youths. Although Gee et al. focused on racism, we suggest that their framework applies to all forms of discrimination.Pregnancy and postpartum may be a critical period to study changes in discrimination, given that women’s experiences with discrimination during pregnancy increase their likelihood of adverse maternal and infant health outcomes such as having a low birth weight infant9,10 and contracting a sexually transmitted infection.11 Also, women experience changes in their bodies, social relationships, and emotions12 during pregnancy and postpartum and come into contact with a variety of new social institutions, including those related to obstetrics and child care; thus, as a result of these life changes, women may experience changes in exposure to discrimination during this time period.8Changes in experiences with discrimination may also vary according to factors such as age, race/ethnicity, nativity, and socioeconomic status. Socioeconomically disadvantaged women, women of color, and women born outside of the United States who may have experienced discrimination regularly throughout their lives might feel that they are treated better or face less discrimination during pregnancy and the postpartum period, when people may extend them courtesies (e.g., giving up a seat on a bus) and institutions may offer added support (e.g., ensuring prenatal and infant care).By contrast, some theories suggest that Black and Latina women in the United States may experience heightened discrimination during pregnancy and postpartum because of group stereotypes related to sexuality and motherhood (e.g., sexual promiscuity, single parenthood) and the societal devaluation of motherhood in women of color.13,14 Some of these negative stereotypes specifically target Black and Latina adolescents and young women14 and so may be particularly relevant for younger age groups. Thus, experiences with discrimination can increase or decrease during pregnancy and postpartum, and the pattern of change may vary on the basis of characteristics such as age, race/ethnicity, nativity, and socioeconomic status. It is therefore important to assess these characteristics as potential moderators of changes in discrimination during this period.Discrimination is an important determinant of mental health across different social groups.1,2 The majority of research on discrimination and mental health is cross sectional; as noted, however, an increasing amount of research has explored this association longitudinally. For example, individual differences in Black Americans’ experiences with racial discrimination have been found to predict depressive and anxiety symptoms at a later time point, but differences in depressive and anxiety symptoms have not been found to predict racial discrimination at a later point.4,15Studies have begun to explore whether experiences with discrimination change over time and whether these changes are associated with changes in mental health. Schulz et al.7 found that changes over 2 time points (spaced 5 years apart) in Black American women’s experiences with discrimination were positively associated with simultaneous changes in depressive symptoms and negatively associated with changes in self-rated health.Greene et al.6 found that changes in experiences with discrimination across 5 time points (over 3 years) were negatively associated with simultaneous changes in self-esteem and positively associated with changes in depressive symptoms among Black, Latino, and Asian American high school students. Similarly, Brody et al.5 found that changes in experiences with racial discrimination across 3 time points (over 5 years) were positively associated with simultaneous changes in conduct problems and depressive symptoms among Black adolescents. To the best of our knowledge, despite this existing research on discrimination and depressive symptoms, no work has examined associations between changes in discrimination and changes in anxiety or assessed these associations during pregnancy.Yet, pregnancy and postpartum may be a particularly important period during which to examine associations of discrimination with depressive and anxiety symptoms. During pregnancy, these symptoms have adverse consequences for birth outcomes (e.g., preterm birth and low birth weight) and infant development (e.g., cognitive and motor development).16 In the postpartum period, these symptoms have adverse consequences with respect to parenting behaviors (e.g., playing with and talking to the infant) and the health of both the mother and the child.17 In addition, although past research suggests that discrimination has adverse mental health consequences across diverse groups, much of this research has focused on specific groups (e.g., Black Americans), and thus it is important to examine whether these associations vary according to factors such as age, race/ethnicity, nativity, and socioeconomic status.The first aim of our study was to examine changes in experiences with discrimination across pregnancy and 1 year postpartum and assess whether age, race/ethnicity, nativity, or socioeconomic status moderated the pattern of change. Our second aim was to explore whether changes in experiences with discrimination over time predicted changes in depressive and anxiety symptoms at subsequent points and whether the sociodemographic factors just described moderated these associations.Given the competing theories described earlier, we did not have a specific expected pattern of change; rather, we hypothesized that experiences with discrimination would change across pregnancy and the postpartum period and that age, race/ethnicity, nativity, or socioeconomic status of participant might moderate that pattern. Also, consistent with past work showing associations between discrimination and mental health across diverse groups, we hypothesized that changes in experiences with discrimination across pregnancy and postpartum would significantly positively predict changes in depressive and anxiety symptoms at subsequent time points and that participants’ age, race/ethnicity, nativity, and socioeconomic status would not moderate those associations.     

Differences In Nutritional And Physical Health Indicators Among Older African Americans,European Americans,And Hispanic Americans

Abstract

Inadequate protein intake contributes to poor nutritional status, reduced muscle mass, strength and function, and increased mortality. Evaluating differences in protein intake and related health indicators among racial/ethnic groups enables the development of targeted interventions. This study’s purpose was to determine differences in protein intake, nutritional status, and muscle strength/function among 273 older African, European, and Hispanic Americans. Protein intake, nutritional status, grip strength, timed-up-and-go (TUG), and chair stand assessments were conducted. Protein intake was significantly greater among Hispanic Americans (0.96?g/kg body weight) followed by European Americans (0.83?g/kg body weight), and African Americans (0.64?g/kg body weight). Intakes by all groups were below recommendations. Low nutritional status, grip strength, chair rise, and TUG scores were observed in African Americans and European American females and were consistent with lower protein intakes. Results show significant differences among the groups and the need for interventions to improve diet and physical health.     

同性恋歧视及其心理健康问题

人们对同性恋现象的态度已从以前的“罪恶”、“变态”逐渐转变为今天的“宽容”、“一种不同的生活方式”。但就像黑种人之于白种人,少数民族之于多数民族,在一个少数服从多数的环境下,在一个强势群体往往是数量占绝对优势的群体,同性恋仍为社会所不容。同性恋群体所受到的不公正待遇,所承受的社会压力,以及心理健康状况,已是一个不容忽视的问题。本文分析了国内外的同性恋歧视现象及其心理健康问题,并提出了一些相关的建议。即应加强童年、青少年的性教育,充分利用传媒优势在全社会形成一种健康的性文化。另外,我们的社会应给同性恋者提供一个宽容的社会环境。