|2002 Abstracts, presentation slides, and handouts|
Raynard Kington, MD, PhD
Racial and Ethnic Disparities in Health: An Overview of National Data and NIH Future Directions in Behavioral and Social Causal Factors
In spite of the great improvements in the health of the American people over the past hundred years, there remain persistent and large differences in health status across racial and ethnic populations. This presentation will briefly review data from the National Center for Health Statistics on the patterns of health status for the largest racial and ethnic populations in the US. One important theme to be highlighted is the substantial heterogeneity within any of the populations, including differences across Hispanic and Asian sub-populations as well as differences between native and foreign-born persons of African descent. The presentation will then provide a brief overview of the proposes causal pathways accounting for the patterns described. Finally, there will be an overview of current priority areas for the National Institutes of Health in the behavioral and social sciences with a focus on how they relate to the challenge of addressing racial and ethnic health disparities.
Oscar A. Barbarin, III, PhD
SES, Ethnicity, Culture: Toward Understanding the Sources Of Disparity in Academic and Mental Health Outcomes
This presentation reviews data on the role of SES (socioeconomic status), Ethnicity and Culture as underpinnings of the disparities in the wellbeing of children and adolescents. It begins with a summary of the status of American children with respect to early development, with an emphasis on mental health and academic outcomes. Much attention has focused on SES as the principal factor in producing and maintaining ethnic disparities. However, the data suggest a much more complex picture. The role of family and the social environment prove to be especially important. How individuals come to see themselves and how they are responded to by others must also be considered. In that light, the role of stigma and ethnic stereotypes emerge as important mediators of wellbeing.
The Emperor's New Clothes: Biomedical Research and the Social Construction of Race
Throughout American history the biological mortality of minority populations have been higher than those of the Euro-American majority. Biomedical research has assumed that this condition is a natural consequence of racial difference. Yet are these patterns of mortality truly justified by genetic differences? Biomedical research has confused the social with the biological concept of race. Therefore it has focused on innate or genetic explanations for these disparities. Ironically, the program to identify racial difference has proceeded without proper adherence to genetic theory and experimental design. A correct definition of biological race illustrates that anatomically modern humans do not show such divisions. Once this is realized a genetic theory explaining the disease mortality differential becomes even more problematic. Thus, well-intentioned researchers who insist on examining race as a variable in health need to be clear on exactly which definition, the biological or the social one, their research design is targeting. The remedies we design from the socially constructed theory of race are radically different, than from those we would suggest if we believe the biological theory. The latter, blames the victim for their illness, locating their malady as an aspect of their race. The former asks what does our society do that contributes differentially to the genetic predisposition of individuals.
Perinatal Health Of Mexican American/Latino Women: Implications For Research and Health Service Delivery
This presentation will provide an overview of the different factors that need to be considered for adequately addressing perinatal health needs of Mexican American/Latino women. The overview will incorporate an examination of a variety of research and health service delivery paradigms that need further development to help explain gaps in knowledge about perinatal health outcomes of interest and delivery of health services among Mexican American women and their infants. These research and service delivery paradigms include both: the need for better survey research and data collection tools as well as new ways to identify research protocols that include: a) an examination of the phenomenon of cultural transformation in the context of immigration, and b) the interplay of forces including acculturation, economic factors, social and environmental stressors including racism/discrimination, family and community resources and health systems factors. Perinatal health outcomes such as prenatal care, low birthweight, preterm delivery, intrauterine growth retardation, and other neonatal outcomes will be used as examples to illustrate the need for new research and health service delivery paradigms
Betzabe Butron-Riveros, MD, MSc, PHDC
Robert Agans, PhD
The Hispanic Paradox and Measurement Error: Recall of Last Menstrual Period and Estimation of Gestational Age Among Mexican Immigrants
Since the mid-80's, researchers in the U.S. have found that the proportion of Hispanic infants with low birth weight is similar to, or lower than, the proportion of non-Hispanic infants with low birth weight, despite the fact that Hispanic mothers tend to have less prenatal care due to their lower socioeconomic status (ergo-the paradox). A review of 32 studies published from 1982 to 1996 showed that approximately 5.7% of white infants, 6.2% of Hispanic infants, and 12.8% of African Americans infants are born with low birth weight (LBW). Some researchers have suggested that the surprisingly low rate of LBW among Latinos might be due to measurement error in terms of inaccurate recall of last menstrual period (LMP) and, consequently, miscalculation of gestational age (GA). Such errors, for example, might contribute to the underreporting of pre-term births (i.e., births < 37 weeks of gestational age). In this presentation, we examine if the low rate of LBW among Mexican infants is attributable to GA misclassification due to inaccurate recall of LMP. Through focus groups, we explored how women from Mexico determined LMP and identified factors that made recall more or less difficult. For example, regular menstruation, family planning, and desire to get pregnant were all important determinants of LMP recall. In addition, we explored how women from Mexico calculated GA. In sum, all of the women interviewed used LMP to calculate GA, and nearly all of them considered the normal length of gestation to be nine months. In conclusion, our findings indicate that the way Mexican immigrant women recall their date of LMP or estimate gestational age do not seem to be a large source of measurement error that contributes to the misclassification of Hispanic births. Recommendations for soliciting accurate LMP in Mexican populations as well as suggestions for future research will be made.
Cliff Akiyama, MA
Assessing the Health of Asian American Youth: A Multidisciplinary Approach
As the population of Asian and Pacific Islander Americans (API) continues to rise in the United States, so do their healthcare needs. Unfortunately, not all Asian Americans are as uniformly educated, acculturated, and financially stable, as the myth of the "model minority" would have us suggest. Although adults from many nationality groups between American Asian and Pacific Islanders have adapted well to life in the United States, serious problems have emerged among Asian American youth. In particular, youth gang violence in the Asian and Pacific Islander community has increased dramatically in the last few years. In Los Angeles County alone, there are currently 151 Asian youth gangs, with a total gang membership of over 6,000. Other surrounding counties in California and the cities of Philadelphia, Fairfax Virginia, and Portland Oregon have seen similar trends in the rise of Asian youth gangs. Gang members have an average age of 15, with a range of 8-22 years. Suicide is another problem not often addressed in the Asian community, who account for 11% of all suicides reported. Asian women have the highest suicide rate among those 15 to 24 years of age. Teenage pregnancy is also on the rise among Asian Americans, though subgroup rates illustrate the wide diversity across nationality groups. Teen births account for only 1% of all births to Chinese American women, but 19% of all births to Laotian women. However, when computed using a "single" API classification, the percentage of births to teenage mothers is 5.6%, far below the percentage among whites (12%), Hispanics (16%) and blacks (18%). On the surface then, it would appear that births to Asian teenage mothers are not a problem, but clearly that is not the case in Southeast Asian and Pacific Islander communities. As other ethnic communities, Asian Americans need health and social services for their children's overall well being. Many of the Asian youths in these communities lack "access" to targeted healthcare prevention/intervention programs and most of all, the community as a whole, lacks "education" on these very sensitive issues of gang violence, suicide, teen pregnancy, and drug/alcohol abuse, as they are often viewed as "taboo" in the community. The purpose of this lecture is to present timely data on selected Asian and Pacific Islander youth health issues and to offer strategies for controlling these epidemics. The first step in solving a problem is to recognize it. We must take that first step.
Felicia Schanche Hodge, DrPH
Tobacco Control in American Indian Communities
American Indian and Alaska Natives have some of the highest cigarette smoking rates in the nation. Alaska Natives adult smoking rates are reported as high as 80% among the Rosebud Sioux tribe of South Dakota. This is more that four times the national average. Alaska Natives youth consistency have extremely high smoking rates (40-60%) - they start smoking at a young age and continue throughout adulthood. This session provides information on patterns of tobacco use and abuse, highlight tribal tobacco policies, tobacco sales and successful approaches to tobacco control.
Health Equity & Social Justice: Community Models, National Priorities
The United States has never, in its 226-year history, been a nation where access to health and health care has been the rule for all. History is replete with examples of medical pseudoscience serving as the basis for Jim Crow legislation, enslaved Africans being used as subjects for human experimentation, forced sterilization on women of color, segregation in health care facilities and more recently, the findings of the Institute of Medicine report attesting to the fact that discrimination in health and health care is a reality and does affect access to care and subsequently, health outcomes. The recent upsurge in interest in health care disparities and their elimination has brought a new energy to a long-standing problem. Public health as a discipline recognizes the primary importance of social determinants of health and the importance of a multidisciplinary approach to a complex problem. As such, this presentation focuses on what I perceive as a basic change in the health disparities paradigm. This focus addresses the presence of significant and severe inequities in American society. These inequities include, income, wealth possession, the distribution of power, the long term effects of racism and discrimination as well as provider attitudes and institutional racial attitudes that propagate blacked access to services. The focus must be one of creating health equity through social justice. This is a focus that addresses the issues of equity, rights and the interactions of the many societal forces on the health of individuals and communities. National models such the Minnesota model need exploration as well as a national approach that by definition is comprehensive, collaborative and seeks to create a society marked by social health, and social justice.
|Last updated April 16, 2012|