Ethnic and Gender Differences in Psychosocial Risk,Protection, and Adolescent Alcohol Use

Theoretical models suggest that many diverse psychosocial factors contribute to the etiology of substance use among youth. It has been suggested that substance use is a function of the total number of etiologic factors, rather than a specific type or set of factors. This study examined whether cumulative psychosocial risk and protection measured in the 7th grade predicted alcohol use in the 9th grade across ethnically diverse samples of adolescents. Participants consisted of black (n = 775) and Hispanic (n = 467) inner-city youth and white suburban youth (n = 708). Prevalence rates for alcohol use and risk/protection varied more widely based on ethnic group compared to gender. Black youth reported the fewest risk factors and lowest levels of alcohol use, white youth reported the most risk factors and highest levels of alcohol use, and Hispanic youth reported the fewest protective factors and intermediate levels of alcohol use. Despite these differences, structural equation modeling indicated that a latent factor consisting of cumulative risk, protection, and their interaction significantly predicted later alcohol use for the combined sample as well as for each ethnic/gender subgroup. However, the proportion of variance explained in alcohol use varied across subgroups, and moderator analyses indicated that protection significantly buffered the effects of risk differentially across subgroups. The strongest protective effects were observed among black inner-city youth. Findings suggest that prevention approaches should focus on enhancing protection in addition to reducing risk, particularly among youth with lower levels of psychosocial protection.     

Patterns of Alcohol Use Among Ethnically Diverse Black and Hispanic Urban Youth

Adolescent alcohol use remains a pressing problem. Identifying which groups are at greater risk of alcohol use helps in understanding the etiology of drinking and the development of alcohol prevention programs. Little epidemiologic information regarding alcohol use among inner-city minority adolescents is available. This study examined the relationship between patterns of alcohol use and ethnic group, a black group consisting primarily of African-Americans and Caribbean/West Indians and a Hispanic group of predominantly Puerto Ricans and Dominicans, among urban youth. Hispanic youth reported greater experience with alcohol than black youth. Dominican adolescents drank more frequently, drank more per drinking occasion, and planned to drink more in the future than Puerto Rican adolescents. Similarly, Caribbean/West Indian youth drank more frequently, became drunk more often, drank more per drinking occasion, and planned to drink more in the future relative to African-American youth. In general, gender did not moderate the relationship with alcohol. This study indicates that only considering ethnic group membership is not sufficient because there were important subgroup differences in patterns of alcohol use for both Hispanics and Blacks. Implications for prevention are discussed.     

Differences in patient perceptions of integrated care among black,hispanic, and white Medicare beneficiaries

ObjectiveThis study sought to identify potential disparities among racial/ethnic groups in patient perceptions of integrated care (PPIC) and to explore how methodological differences may influence measured disparities.Data SourceData from Medicare beneficiaries who completed the 2015 Medicare Current Beneficiary Survey (MCBS) and were enrolled in Part A benefits for an entire year.Study DesignWe used 4‐point measures of eight dimensions of PPIC and assessed differences in dimensions among racial/ethnic groups. To estimate differences, we applied a “rank and replace” method using multiple regression models in three steps, balancing differences in health status among racial groups and adjusting for differences in socioeconomic status. We reran all analyses with additional SES controls and using standard multiple variable regression.Data Collection/Extraction MethodsNot applicable.Principal FindingsWe found several significant differences in perceived integrated care between Black versus White (three of eight measures) and Hispanic versus White (one of eight) Medicare beneficiaries. On average, Black beneficiaries perceived more integrated support for self‐care than did White beneficiaries (mean difference = 0.14, SE = 0.06, P =.02). Black beneficiaries perceived more integrated specialists’ knowledge of past medical history than did White beneficiaries (mean difference = 0.12, SE = 0.06, P =.01). Black and Hispanic beneficiaries also each reported, on average, 0.18 more integrated medication and home health management than did White beneficiaries (P <.01 and P <.01). These findings were robust to sensitivity analyses and model specifications.ConclusionsThere exist some aspects of care for which Black and Hispanic beneficiaries may perceive greater integrated care than non‐Hispanic White beneficiaries. Further studies should test theories explaining why racial/ethnic groups perceive differences in integrated care.     

The effects of race/ethnicity, income, and family structure on adolescent risk behaviors

OBJECTIVES: The study examined the unique and combined contributions of race/ethnicity, income, and family structure to adolescent cigarette smoking, alcohol use, involvement with violence, suicidal thoughts or attempts, and sexual intercourse. METHODS: Analyses were based on the National Longitudinal Study of Adolescent Health. A nationally representative sample of 7th to 12th graders participated in in-home interviews, as did a resident parent for 85.6% of the adolescent subjects. The final sample included 10,803 White, Black, and Hispanic 7th to 12th graders. RESULTS: White adolescents were more likely to smoke cigarettes, drink alcohol, and attempt suicide in the younger years than were Black and Hispanic youths. Black youths were more likely to have had sexual intercourse; both Black and Hispanic youths were more likely than White teens to engage in violence. Controlling for gender, race/ethnicity, income, and family structure together explained no more than 10% of the variance in each of the 5 risk behaviors among younger adolescents and no more than 7% among older youths. CONCLUSIONS: Findings suggest that when taken together, race/ethnicity, income, and family structure provide only limited understanding of adolescent risk behaviors.     

Racial/ethnic disparities in preschool immunizations: United States, 1996-2001

OBJECTIVES: We examined current racial/ethnic differences in immunization coverage rates among US preschool children. METHODS: Using National Immunization Survey data from 1996 through 2001, we compared vaccination coverage rates between non-Hispanic White, non-Hispanic Black, Hispanic, and Asian preschool children. RESULTS: During the 6-year study period, the immunization coverage gap between White and Black children widened by an average of 1.1% each year, and the gap between White and Hispanic children widened by an average of 0.5% each year. The gap between White and Asian children narrowed by an average of 0.8% each year. CONCLUSIONS: Racial/ethnic disparities in preschool immunization coverage rates have increased significantly among some groups; critical improvements in identifying, understanding, and addressing race/ethnicity-specific health care differences are needed to achieve the Healthy People 2010 goal of eliminating disparities.     

Alcohol use by young people from different ethnic groups: consumption, intoxication and negative consequences

Objective. To investigate alcohol consumption among mid‐adolescents from different ethnic groups and explore overall and gender variations in drinking behaviours.

Methods. A survey of alcohol use by 609 14–16 year olds recruited from three schools in an ethnically diverse area of London. Approximately 70% of the sample was of White English, White Irish, Black Caribbean or Black African ethnic origin. Self‐report information was collected via a researcher‐administered structured interview.

Results. There was a significantly lower prevalence of lifetime alcohol use among Black African respondents than among the other three ethnic groups. Black African males and males and females from the two White ethnic groups reported drinking above levels recommended by the English Department of Health. Among the recent drinkers, over half of the White Irish and White English groups and over a quarter of Black Caribbean and Black African groups had been intoxicated in the 90 days before interview. Approximately three quarters of the White English and White Irish recent drinkers, but only a half of Black Caribbean and Black African recent drinkers had experienced a negative drinking‐related consequence during the last year.

Conclusions. The survey findings suggest that while young people of White English or White Irish ethnic origin from the populations studied are more likely to drink excessively and experience negative consequences from their drinking than Black African and Black Caribbean youth, a substantial minority of Black African and Black Caribbean youth also experience alcohol‐related problems.     

Racial/Ethnic differences in smoking, drinking, and illicit drug use among American high school seniors, 1976-89.

BACKGROUND. This paper reports racial/ethnic differences in the use of licit and illicit drugs by high school seniors in the United States. METHODS. The study uses questionnaire data from annual, nationally representative surveys of seniors from 1976 through 1989. Combined sample sizes were 57,620 for 1976-79; 75,772 for 1980-84; and 73,527 for 1985-89. RESULTS. Native American had the highest prevalence rates for cigarettes, alcohol, and most illicit drugs; White students had the next highest rates for most drugs. Asian Americans had the lowest prevalence rates, and Black students had levels nearly as low except for marijuana. Prevalence rates for the Hispanic groups were mostly in the intermediate ranges except for relatively high cocaine use among the males. Trend patterns for most forms of drug use were similar across subgroups, although cigarette use declined more sharply for Black than White seniors, resulting in greater Black-White differences in recent years. CONCLUSIONS. This study, other school-based studies, and general population surveys all show relatively low levels of drug use by most non-White youth, especially Black Americans and Asian Americans. Multivariate analyses indicate that such subgroup differences in high school seniors' drug use are not primarily attributable to family composition, parents' education, region, or urban-rural distinctions.     

Ethnic and gender differences in farm tasks and safety practices among rural California farm youth

Agricultural work is hazardous and is common among rural youth, especially those living on farms or ranches. Previous work has shown differences in farm work and injury patterns between boys and girls, but little data exist addressing ethnic differences. This study examined ethnic and gender differences in farm tasks, safety attitudes, and use of protective measures among rural California youth working on farms or ranches. The University of California, Davis Youth Agricultural Injury Study is a longitudinal study focusing on agricultural work experience among youth enrolled in an agricultural sciences curriculum in 10 public high schools in California's Central Valley during the 2001-2005 school years. Using cross-sectional data from the initial entrance survey, we studied 946 participants who reported farm work in the previous year. Median annual hours of farm work varied significantly between boys and girls (p < 0.001) and between ethnic groups (p < 0.05) (Hispanic boys: 624 hr; Hispanic girls: 189 hr; White/Other boys: 832 hr; White/Other girls: 468 hr). Girls and Hispanic students were less likely than boys and White/Other students, respectively, to perform hazardous tasks involving tractors, machinery, and chemicals. Median age for initiating work on selected hazardous tasks was up to 3 years later for Hispanic students. Use of task-appropriate safety measures was low in all groups for most hazardous tasks. Boys were more likely than girls to use task-appropriate safety measures, with the exception of seatbelt use when in a car or truck. Hispanic students were more likely than White/Other students to employ safety measures. Girls and Hispanic youth worked fewer farm hours and had reduced exposure to selected hazardous tasks. Use of task-appropriate safety measures was low for all groups but increased for Hispanic students. Further study should explore reasons for low use of safety measures and develop educational efforts to bring about social norm changes promoting their use.     

ETHNICITY AND DRINKING IN NORTHERN CALIFORNIA: A COMPARISON AMONG WHITES, BLACKS AND HISPANICS

This research reports the drinking patterns and alcohol problemsin three ethnic groups of the U.S. population: Whites, Blacksand Hispanics. Respondents were sampled randomly from the generalpopulation of three counties of the San Francisco Bay Area,in northern California. Both Black and Hispanic females havehigher rates of abstention than White females, but at the aggregatelevel male's drinking patterns are similar across ethnic groups.However, among males the patterning of drinking and the prevalenceof alcohol problems by age change dramatically according toethnicity. Among White males drinking and problems decreaseabruptly from the twenties to the thirties, as has been traditionallyfound in the U.S. general population. Among Black males thetrend is exactly the opposite of that for Whites, while amongHispanic males there also is a decrease but not quite so largeas that for Whites, and the frequency of heavy drinking andproblems is always higher than for the other two groups. Thetypes of problem reported by respondents do not vary by ethnicitybut the sociodemographic correlates of both number of drinksconsumed per month and number of alcohol problems do differamong the ethnic groups. Both Hispanics and Blacks have moreliberal attitudes toward alcohol use than Whites. These resultssuggest that Whites, Blacks and Hispanics each have a characteristicway of using alcoholic beverages. The less restrictive viewstowards alcohol use in the Black and Hispanic culture, as wellas the different patterning of drinking and problems by age,are of importance for prevention: Whites, Blacks and Hispanicshave different groups of people at risk for developing alcoholproblems and prevention should be planned accordingly.     

Racial Disparities in Pregnancy-Related Drinking Reduction

Objective The purpose of this study was to investigate the likelihood that women of different racial and ethnic groups would reduce their alcohol consumption during pregnancy. Methods Data came from 22 states participating in the Pregnancy Risk Assessment Monitoring System from 2001 to 2005. After stratifying the sample by preconception drinking level, logistic regressions were used to predict drinking reduction and cessation by the third trimester by race, controlling for age, education, marital status, Medicaid status, pregnancy intention, smoking status, and state. Results Overall, Black, Asian/Pacific Islander and Hispanic women were all significantly less likely than White women to reduce their heavy drinking after becoming pregnant. American Indian/Alaskan Native women who were moderate drinkers before conception were over 2 times more likely than White women to reduce drinking after becoming pregnant (OR 2.19, CI 0.71, 6.76), although this difference was non-significant (P = .17). Among those who binge drank in the months before pregnancy, compared to White women, Black (OR 0.26, CI 0.17–0.39), Hispanic (OR 0.19, CI 0.12–0.29), American Indian/Alaskan Native (OR 0.44 CI 0.20, 0.96), and Asian/Pacific Islander women (OR 0.11, CI 0.06–0.22) were all less likely to quit binge drinking while pregnant. Conclusion Significant racial differences in pregnancy-related drinking reduction are evident, and may help explain racial disparities in FAS. Results suggest that more targeted efforts are needed to meet the national goals of preventing alcohol-exposed pregnancies.     

Decreased incidence of hip fracture in Hispanics, Asians, and blacks: California Hospital Discharge Data.

We examined the incidence of hip fracture in Non-Hispanic White, Hispanic, Black, and Asian Americans for the years 1983 and 1984 using a data base which contains a summary of all hospitalizations for the State of California. We found a consistently lower risk for hip fracture after age 60 in Hispanic, Black, and Asian American females than in White females who were not Hispanic. Overall age-adjusted hip fracture rates in Hispanic, Black, and Asian females were 49.7, 57.3, and 85.4, respectively, and 140.7/100,000 in White females who were not Hispanic. These differences were not found in males, although Whites (not Hispanic) had the highest incidence of hip fractures among males.     

Ethnic differences in midwife-attended US births.

This study examined US ethnic differences in midwifery care from 1982 through 1989. After adjustment for maternal characteristics, Native American mothers were most likely, and White and Asian mothers were least likely, to obtain midwifery care. For these three groups, midwifery use increased rapidly in the period from 1982 through 1989. Compared with White mothers, Black and Hispanic mothers were more likely to be attended by a midwife; however, their use of midwives increased more slowly. Though the local availability of obstetricians and midwives may determine a woman's choice of care provider, these data suggest that cultural factors also play a role.     

Differences in the Portrayal of Health Risk Behaviors by Black and White Characters in Popular Films

Adolescent exposure to risk in film has been associated with behavior. We coded Black and White character involvement in sex, violence, alcohol use, and tobacco use, and combinations of those behaviors in popular mainstream and Black-oriented films (film n = 63, character n = 426). Health risk portrayals were common, with the majority of characters portraying at least one. Black characters were more likely than Whites to portray sex and alcohol use, while White characters were more likely to portray violence. Within-segment combinations of sex and alcohol were more prevalent for Black characters, while violence and alcohol were more prevalent for Whites. Throughout a film, Black characters were more likely than White characters to portray sex and alcohol, sex and tobacco, and alcohol and tobacco. Risky behaviors are prevalent, but types portrayed differ between Black and White characters. This may have implications for health disparities in Black and White adolescents.     

Ethnic differences in the growth of low-birthweight infants

Differences in growth were investigated among ethnic groups in low-birthweight babies (<2500 g or <32 weeks gestation) at birth and at 2–3 years. This prospective study was based on data for all 3091 low-birthweight live births in the South East Thames Region, UK, over a 1-year period, surviving to discharge from hospital. Weights were recorded at birth and at 2–3 years for 998 babies, and head circumferences for 859. These were compared with the UK 1990 reference standards. Ethnic differences were adjusted for parity, multiple birth, smoking and alcohol during pregnancy, mother's height, weight and age, marital status, partner's support and social class. At 2–3 years, there was substantial average catch-up growth only for the weight of infants of 32 weeks' gestation. Babies <32 weeks gestation had fallen behind. Head circumferences had failed to keep up or had fallen behind for both groups. The ethnic groups had similar birthweight standard deviation scores (SDS). At 2–3 years, Black babies of <32 weeks' gestation had gained in weight and head circumference compared with White babies (adjusted difference in weight SDS: 0.71, [95% CI 0.28, 1.13]). Asian babies of at least 32 weeks' gestation had smaller heads than White, a difference that increased with time. It was concluded that ethnic differences in the growth of low-birthweight infants are related to gestational age. Although most of the babies born at <28 weeks' gestation were close to their birthweight reference standards, only the Black infants had maintained their position at 2–3 years. Black infants, particularly when born preterm, tend to put on more weight than White.     

Universal Screening for Alcohol and Drug Use and Racial Disparities in Child Protective Services Reporting

This study examines racial disparities in Child Protective Services (CPS) reporting at delivery in a county with universal screening for alcohol/drug use in prenatal care. It also explores two mechanisms through which universal screening could reduce reporting disparities: Equitable Surveillance and Effective Treatment. Equitable Surveillance is premised on the assumptions that identification of drug use through screening in prenatal care leads to CPS reporting at delivery and that Black women are screened more than White women, which leads to disproportionate reporting of Black newborns. Universal screening would correct this by ensuring that prenatal providers screen and therefore also report White women to CPS, thereby reducing disparities. Effective Treatment is premised on the idea that identification of drug use through screening in prenatal care leads women to receive treatment during pregnancy, which thereby reduces CPS reporting at delivery. Universal screening would lead to prenatal providers screening more Black women and thereby to more Black women receiving treatment prenatally. The increase in treatment receipt during pregnancy would then decrease the number of Black newborns reported to CPS at delivery, thereby reducing disparities. County data were used to compare the racial/ethnic distribution of women and newborns in three points in the system (identification in prenatal care, treatment entry during pregnancy, and reporting to CPS at delivery related to maternal alcohol/drug use) and explore pathways to treatment. Despite Black women having alcohol/drug use identified by prenatal care providers at similar rates to White women and entering treatment more than expected, Black newborns were four times more likely than White newborns to be reported to CPS at delivery. This contradicts the premise of Effective Treatment. By default, findings were more consistent with Equitable Surveillance than Effective Treatment. Providers and policy makers should not assume that universal screening in prenatal care reduces CPS reporting disparities.     

Racial and ethnic differences in risk factors associated with suicidal behavior among young adults in the USA

Objective. The objectives of this study are to examine racial and ethnic differences in suicidal behaviour, its main risk factors, and the effect of the risk factors on suicidal behaviour in young adults in the United States.

Design. Using nationally representative data (n = 10,585) from Add Health, we calculate the prevalence of suicidal behavior and associated risk factors for non-Hispanic White, non-Hispanic Black, and Hispanic youth (aged 18–26) using logistic regression models of suicidal ideation stratified by race.

Results. Non-Hispanic White and Hispanic young adults have higher rates of suicidal ideation than their non-Hispanic Black counterparts, but racial/ethnic differences in attempts are not statistically significant. Non-Hispanic Whites and Hispanic young adults are more likely to possess key risk factors for suicide. With the exception of substance use variables (i.e. alcohol and marijuana use) which appear to be more conducive to suicidal ideation in non-Hispanic Black than in non-Hispanic White young adults, the effects of risk factors appear to be similar across race/ethnicity.

Conclusion. The higher prevalence of suicidal ideation in non-Hispanic White and Hispanic young adults may be driven by their greater exposure to risk factors, as opposed to differences in the effects of these risk factors. More research is needed to uncover why non-Hispanic White and Hispanic young adults have higher rates of suicidal ideation than their non-Hispanic Black counterparts; yet, rates of suicide attempts are comparable and non-Hispanic White young adults have the highest rate of completed suicides.     

A closer look at disparities in earnings between white and minoritized dentists

Objective

To examine the factors that account for differences in dentist earnings between White and minoritized dentists.

Data Sources

We used data from the American Dental Association's Survey of dental practice, which includes information on 2001–2018 dentist net income, practice ZIP code, patient mix between private and public insurance, and dentist gender, age, and year of dental school graduation. We merged the data on dentist race and ethnicity and school of graduation from the American Dental Association masterfile. Based on practice ZIP code, we also merged the data on local area racial and ethnic composition from the American Community Survey.

Study Design

We used a linear Blinder-Oaxaca decomposition to assess observable characteristics that explain the gap in earnings between White and minoritized dentists. To assess differences in earnings between White and minoritized dentists at different points of the income distribution, we used a re-centered influence function and estimated an unconditional quantile Blinder-Oaxaca decomposition.

Data Extraction Methods

We extracted data for 22,086 dentists ages 25–85 who worked at least 8 weeks per year and 20 hours per week.

Principal Findings

Observable characteristics accounted for 58% of the earnings gap between White and Asian dentists, 55% of the gap between White and Hispanic dentists, and 31% of the gap between White and Black dentists. The gap in earnings between White and Asian dentists narrowed at higher quantiles of the income distribution.

Conclusions

Compared to other minoritized dentists, Black dentists have the largest earnings disparities relative to White dentists. While the level of the explained component of the disparity for Black dentists is comparable to the explained part of the disparities for other minoritized dentists, the excess percentage of the unexplained component for Black dentists accounts for the additional amount of disparity that Black dentists experienced. Persistent income disparities could discourage minoritized dentists from entering the profession.     

Explaining Racial/Ethnic Differences in Adolescent Substance Abuse Treatment Completion in the United States: A Decomposition Analysis

PurposeTo identify contributors to racial/ethnic differences in completion of alcohol and marijuana treatment among adolescents at publicly funded providers.MethodsThe 2007 Treatment Episode Data Set provided substance use history, treatment setting, and treatment outcomes for youth aged 12–17 years from five racial/ethnic groups (N = 67,060). Individual-level records were linked to variables measuring the social context and service system characteristics of the metropolitan area. We implemented nonlinear regression decomposition to identify variables that explained minority-white differences.ResultsBlack and Hispanic youth were significantly less likely than whites to complete treatment for both alcohol and marijuana. Completion rates were similar for whites, Native Americans, and Asian-Americans, however. Differences in predictor variables explained 12.7% of the black-white alcohol treatment gap and 7.6% of the marijuana treatment gap. In contrast, predictors explained 57.4% of the Hispanic-white alcohol treatment gap and 19.8% of the marijuana treatment gap. While differences in the distribution of individual-level variables explained little of the completion gaps, metropolitan-level variables substantially contributed to Hispanic-white gaps. For example, racial/ethnic composition of the metropolitan area explained 41.0% of the Hispanic-white alcohol completion gap and 23.2% of the marijuana completion gap. Regional differences in addiction treatment financing (particularly use of Medicaid funding) explained 13.7% of the Hispanic-white alcohol completion gap and 9.8% of the Hispanic-white marijuana treatment completion gap.ConclusionsFactors related to social context are likely to be important contributors to white-minority differences in addiction treatment completion, particularly for Hispanic youth. Increased Medicaid funding, coupled with culturally tailored services, could be particularly beneficial.