National Trends in Ethnic Disparities in Mental Health Care
Medical Care. 45(11):1012-1019, November 2007.
Blanco, Carlos MD, PhD; Patel, Sapana R. PhD; Liu, Linxu PhD; Jiang, Huiping PhD; Lewis-Fernandez, Roberto MD; Schmidt, Andrew B. Lcsw; Liebowitz, Michael R. MD; Olfson, Mark MD, MPH
Corresponding author: Carlos Blanco
Email: Cblanco@nyspi.epmc.columbia.edu
Anxiety Orders Clinic
New York State Psychiatric Institute/Columbia University
OJECTIVE: To compare trends in office-based treatment of mental disorders between Hispanics and non-Hispanics.
DESIGN, SETTING AND PARTICIPANTS: Analysis of a nationally representative sample of visits to office-based physicians conducted between 1993 and 2002 (N = 251,905). Visits were grouped into 3 discrete time periods, 1993-1996, 1997-1999 and 2000-2002.
MAIN OUTCOME MEASURES: Rate of diagnosis, type of mental health visit, type of treatment received (medication or psychotherapy), rate of psychotropic medications prescription, and specialty of the treating physician.
RESULTS: From 1993-1996 to 2000-2002, the proportion of office visits in which mental health care was provided decreased for Hispanics from 12.2% to 11.7% while it increased from 13.1% to 15.7% for non-Hispanics (P < 0.05). Visits with a diagnosis of mental disorder decreased from 5.2% to 5.1% in Hispanics but increased from 6.0% to 8.8% in non-Hispanics (P < 0.05). Visits resulting in prescription of a psychotropic medication decreased from 10.2% to 9.3% in Hispanics, while they increased from 10.2% to 12.5% in non-Hispanics (P < 0.05). Psychotherapy visits decreased from 2.4% to 1.3% in Hispanics (P < 0.05), whereas they remained constant (2.5%) in non-Hispanics. Visits to a psychiatrist decreased from 2.5% to 1.3% in Hispanics (P < 0.05), while they increased (nonsignificantly) from 3.1% to 3.5% for non-Hispanics. Most differences persisted after adjusting for age and insurance status.
CONCLUSIONS: From 1993 to 2002, there was an increase in mental health care disparities between Hispanics and non-Hispanics treated by office-based physicians. Improvement of the mental health care for Hispanics continues to be an important public health priority, with clear opportunities and challenges for health care policy-makers and practitioners.
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November 2007
The Effect of Migration to the United States on Substance Use Disorders Among Returned Mexican Migrants and Families of Migrant
Am J Public Health. 2007 Oct;97(10) 1847-1851
Borges G, Medina-Mora ME, Breslau J, Aguilar-Gaxiola S.
Corresponding author: Guilherme Borges
Email: guibor@imp.edu.mx
National Institute of Psychiatry
Metropolitan Autonomous University
Mexico City, Mexico
OBJECTIVES: We examined the association between substance use disorders and migration to the United States in a nationally representative sample of the Mexican population.
METHODS: We used the World Mental Health version of the Composite International Diagnostic Interview to conduct structured, computer-assisted, face-to-face interviews with a cross-sectional sample of household residents aged 18 to 65 years who lived in Mexico in cities with a population of at least 2500 people in 2001 and 2002. The response rate was 76.6%, with 5826 respondents interviewed.
RESULTS: Respondents who had migrated to the United States and respondents who had family members in the United States were more likely to have used alcohol, marijuana, or cocaine at least once in their lifetime; to develop a substance use disorder; and to have a current (in the past 12 months) substance use disorder than were other Mexicans.
CONCLUSIONS: International migration appears to play a large role in transforming substance use norms and pathology in Mexico. Future studies should examine how networks extending over international boundaries influence substance use.
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October 2007
Cigarette Prices, Smoking, and the Poor: Implications of Recent Trends
Am J Public Health. 2007 Oct;97(10): 1873-1877.
Franks P, Jerant AF, Leigh JP, Lee D, Chiem A, Lewis I, Lee S.
Corresponding author: Peter Franks, pfranks@ucdavis.edu
Center for Health Services Research in Primary Care
Department of Family and Community Medicine
University of California, Davis, School of Medicine
OBJECTIVE: We examined the relationship between smoking participation and cigarette pack price by income group and time period to determine role of cigarette prices in income-related disparities in smoking in the United States.
METHODS: We used data from the 1984-2004 Behavioral Risk Factor Surveillance System surveys linked to information on cigarette prices to examine the adjusted prevalence of smoking participation and smoking participation-cigarette pack price elasticity (change in percentage of persons smoking relative to a 1% change in cigarette price) by income group (<25th percentile [lower] vs >/=25th percentile [higher]) and time period (before vs after the MSA).
RESULTS: An increasing real cigarette-pack price over time was associated with a marked decline in smoking among higher-income but not among lower-income persons. Although the pre-MSA association between cigarette pack price and smoking revealed a larger elasticity in the lower- versus higher-income persons (-0.45 vs -0.22), the post-MSA association was not statistically significant (P>.2) for either income group.
CONCLUSIONS: Despite cigarette price increases after the MSA, income-related smoking disparities have increased. Increasing cigarette prices may no longer be an effective policy tool and may impose a disproportionate burden on poor smokers.
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September 2007
The impact of the built environment on children's school conduct grades: the role of diversity of use in a Hispanic neighborhood
Am J Community Psychol. 2006 Dec;38(3-4):299-310.
Szapocznik J, Lombard J, Martinez F, Mason CA, Gorman-Smith D, Plater-Zyberk E, Brown SC, Spokane A
Corresponding author: JSzapocz@med.miami.edu
University of Miami School of Medicine
Center for Family Studies
Miami, FL
ABSTRACT: A population-based study examined the relationship between diversity of use of the built environment and teacher reports of children's grades. Diversity of use of the built environment (i.e., proportion of a block that is residential, institutional, commercial and vacant) was assessed for all 403 city blocks in East Little Havana, Miami-a Hispanic neighborhood. Cluster analysis identified three block-types, based on diversity of use: Residential, Mixed-Use, and Commercial. Cross-classified hierarchical linear modeling was used to examine the impact of diversity of use, school, gender, and year-in-school on academic and conduct grades for 2857 public school children who lived in these blocks. Contrary to popular belief, mixed-use blocks were associated with optimal outcomes. Specifically, follow-up analyses found that a youth living on a residential block had a 74% greater odds of being in the lowest 10% of conduct grades (conduct GPA <2.17) than a youth living on a mixed-use block. In fact, an analysis of the population attributable fraction suggests that if the risk associated with residential blocks could be reduced to the level of risk associated with mixed-use blocks, a 38% reduction in Conduct GPAs <2.17 could be achieved in the total population. These findings suggest that public policy targeting the built environment may be a mechanism for community-based interventions to enhance children's classroom conduct, and potentially related sequelae.
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August 2007
The Real Contribution of Added Sugars and Fats to Obesity
Epidemiol Rev. 2007;29:160-71. Epub 2007 Jun 24.
Adam Drewnowski (adamdrew@u.washington.edu)
University of Washington, Seattle, WA
ABSTRACT: Obesity rates in the United States are a function of socioeconomic status. Higher rates are found among groups with lower educational and income levels, among racial and ethnic minorities, and in high-poverty areas. Yet, the relation between obesity, nutrition, and diet continues to be viewed in biologic terms, with the search for likely causes focused on consumption of specific macronutrients, foods, or food groups. Epidemiologic evidence linking diet composition and body weight has mostly relied on ecologic comparisons, time trends, and analyses of cross-sectional studies. Plausible physiologic mechanisms have included the metabolic effects of dietary components, mostly sugars and fats, on regulation of food intake and deposition of body fat. However, the evidence could not have been convincing since the blame for rising obesity rates seems to shift regularly, every 10 years or so, from fats to sugars and then back again. This review demonstrates that much of past epidemiologic research is consistent with a single parsimonious explanation: obesity has been linked repeatedly to consumption of low-cost foods. Refined grains, added sugars, and added fats are inexpensive, good tasting, and convenient. The fact that energy-dense foods (megajoules/kilogram) cost less per megajoule than do nutrient-dense foods means that energy-dense diets are not only cheaper but may be preferentially selected by the lower-income consumer. In other words, the low cost of dietary energy (dollars/megajoule), rather than specific food, beverage, or macronutrient choices, may be the main predictor of population weight gain. Examining past studies of the contribution of added sugars and fats to obesity rates through the prism of food prices and diet costs is the purpose of this review.
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July 2007
Ten Largest Racial and Ethnic Health Disparities in the United States based on Healthy People 2010 Objectives.
American Journal of Epidemiology. 2007 Jul 1;166(1):97-103. Epub 2007 Apr 26
Keppel KG
Corresponding author: KKeppel@cdc.gov
National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.
ABSTRACT: A consistent framework has been developed for measuring health disparities and making comparisons across indicators with regard to the public health goals of Healthy People 2010. Disparities are measured as the percent difference from the best group rate, with all indicators being expressed in terms of adverse events. The 10 largest health disparities for each of five US racial and ethnic groups are identified here. There are both similarities and differences in the largest health disparities. New cases of tuberculosis and drug-induced death rates are among the largest health disparities for four of the five racial and ethnic groups. However, drug-induced death is the only indicator among the 10 largest disparities that is shared by both Black and White non-Hispanic populations.
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June 2007
Diabetes self-management: Perspectives of Latino patients and their health care providers.
Patient Educ Couns. 2007 May;66(2):202-10. Epub 2007 Feb 27.
Carbone ET*, Rosal MC, Torres MI, Goins KV, Bermudez OI.
*Corresponding author: ecarbone@nutrition.umass.edu
Department of Nutrition, Chenoweth Laboratory, 100 Holdsworth Way, University of Massachusetts, Amherst, MA 01003-9282, United States.
OVERVIEW: Lifestyle modification programs tailored to experience, culture, psychosocial characteristics, and world-view can improve knowledge, self-care behaviors, and glucose control among Latinos with diabetes. Few data exist, however, on improving diabetes self-management among Latinos. In addition, views and practices of practitioners caring for these patients have received little attention.
OBJECTIVE: This study describes findings from qualitative research to inform the refinement of self-management interventions tailored to Latino patients with type 2 diabetes.
METHODS: Two practitioner focus groups assessed perceptions of patients' knowledge, attitudes, and behaviors. Four patient focus groups examined knowledge, beliefs, practices, barriers, and facilitators. Data were transcribed and subjected to content analysis.
RESULTS: Thirty-seven patients seeking care at a community clinic participated, along with 15 health care practitioners. Important knowledge gaps regarding diabetes causation and self-management were identified. Negative attitudes towards self-management were common among patients. Key facilitators included strong religious faith and support of medical practitioners. Families both facilitated and prevented adoption of self-management practices.
CONCLUSION: This study provides unique insights into the knowledge, attitudes, practices, and perceived barriers facing Latino patients and their providers regarding diabetes self-management.
PRACTICE IMPLICATIONS: Study findings underscore the need to develop tailored programs for this population and to train practitioners on their implementation.
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May 2007
Cervical cancer: a qualitative study on subjectivity, family, gender and health services
Reproductive Health 2007, 4:2 doi:10.1186/1742-4755-4-2
Blanca E Pelcastre-Villafuerte1 , Laura L Tirado-Gómez2 , Alejandro Mohar-Betancourt3 and Malaquías López-Cervantes4
1 Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Secretaría de Salud, México, Av, Universidad 655, Santa María Ahuacatitlán, C.P. 62508, Cuernavaca, Morelos, México
2 Departamento de Epidemiología, Instituto Nacional de Cancerología de México, Av. San Fernando No. 22; 2°, Piso de investigación, Col. Sección XVI., Del Tlalpan, C.P. 01480, México, D.F., México
3 Dirección General, Instituto Nacional de Cancerología de México, Av. San Fernando No. 22; 3er, Piso de edificio de quimioterapia, Col. Sección XVI., Del Tlalpan, C.P. 01480, México, D.F., México
4 Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Edificio B 3er. Piso, Del Coyoacan C.P. 04510, México, D.F., México
BACKGROUND: In 2002, cervical cancer was one of the leading causes of death in Mexico. Quantitative techniques allowed for the identification of socioeconomic, behavioral and biological characteristics that are part of its etiology.
However such characteristics, are inadequate to explain sufficiently the role that emotions, family networks and socially-constructed categories such as gender play in the demand and utilization of health services for cervical cancer diagnosis and treatment and neither the timely undertaking of preventive actions, such as getting a PAP smear or seeking adequate and continuons treatment.
METHODS: A qualitative study was carried out to analyze the role of different social and cultural factors in the timely detection of cervical cancer. As part of a multi-level, multi-method research effort, this particular study was based on individual interviews with women diagnosed with cervical cancer (identified as the "cases"), their female friends and relatives (identified as the "controls") and the cases' husbands.
RESULTS: The results showed that both: denial and fear are two important components that regulate the behavior of both the women and their partners. Women with a small support network may have limited opportunities for taking action in favor of their own health and wellbeing.
CONCLUSION: Women tend not to worry about their health, in general and neither about cervical cancer in particular, as a consequence of their conceptualizations regarding their body and feminine identify – both of which are socially determined. Furthermore, it is necessary to improve the quality of information provided in health services.
This article can be downloaded here.
April 2007
The Role of Acculturation in Nutrition, Lifestyle, and Incidence of Type 2 Diabetes among Latinos.
Perez-Escamilla R, Putnik P.
J Nutr. 2007 Apr;137(4):860-70.
Rafael Pérez-Escamilla* and Predrag Putnik
Department of Nutritional Sciences, Center for Eliminating Health Disparities among Latinos, University of Connecticut, Storrs, CT 06269-4017
* To whom correspondence should be addressed: E-mail: rafael.perez-escamilla@uconn.edu.
ABSTRACT: Latinos have become the largest ethnic minority group in the U.S. and will become 25% of the population by 2050. The purpose of this critical review is to examine the influence of acculturation on type 2 diabetes and corresponding risk factors, including 1) dietary intake, 2) physical activity patterns, 3) smoking and alcohol consumption, and 4) obesity. Among Latinos, acculturation has been associated with obesity risk, suboptimal dietary choices including lack of breast-feeding, low intake of fruits and vegetables, a higher consumption of fats and artificial drinks containing high levels of refined sugar, smoking, and alcohol consumption. In contrast, acculturation has been positively associated with physical activity and a lower likelihood of type 2 diabetes among Latinos. However, findings have been inconsistent across acculturation indicators and appear to be strongly modified by Latino subethnicity and gender. It is important to improve existing acculturation measures available. Mexican Americans have been the target group in the majority of studies. Research in this group must continue but it is important to conduct additional research with other Latino subgroups that have been left out of most of the acculturation, lifestyles, and health outcomes research. Differences between acculturation and health-related outcomes may be confounded by socio-economic status, age, and movement from urban to rural areas. Longitudinal multivariate acculturation research is essential to disentangle these relations and to develop sound behavioral change theories that adequately predict behavioral change among Latinos.
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The same issue includes the following excellent commentary on this article:
Acculturation and biomarkers for type 2 diabetes in Latinos.
Fernandez ML. J Nutr. 2007 Apr;137(4):871-2.
Article can be viewed here (subscription may be required)
Address correspondence to: MARIA-LUZ.FERNANDEZ@uconn.edu
March 2007
Pathologies of power: rethinking health and human rights.
Am J Public Health. 1999 Oct;89(10):1486-96.
Farmer P.
Department of Social Medicine, Harvard Medical School, Boston, Mass. 02115, USA.
ABSTRACT: The field of health and human rights has grown quickly, but its boundaries have yet to be traced. Fifty-one years after the Universal Declaration of Human Rights, consensus regarding the most promising directions for the future is lacking; however, outcome-oriented assessments lead us to question approaches that rely solely on recourse to formal legal and civil rights. Similarly unpromising are approaches that rely overmuch on appeals to governments: careful study reveals that state power has been responsible for most human rights violations and that most violations are embedded in "structural violence"--social and economic inequities that determine who will be at risk for assaults and who will be shielded. This article advances an agenda for research and action grounded in the struggle for social and economic rights, an agenda suited to public health and medicine, whose central contributions to future progress in human rights will be linked to the equitable distribution of the fruits of scientific advancement. Such an approach is in keeping with the Universal Declaration but runs counter to several of the reigning ideologies of public health, including those favoring efficacy over equity.
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February 2007
The influence of maternal weight and glucose tolerance on infant birthweight in Latino mother-infant pairs
Kieffer EC, Tabaei BP, Carman WJ, Nolan GH, Guzman JR, Herman WH.
Am J Public Health. 2006 Dec;96(12):2201-8. Epub 2006 Oct 31.
At the time of this study, Edith C. Kieffer and Wendy J. Carman were with the Department of Health Behavior and Health Education, University of Michigan, Ann Arbor. Bahman P. Tabaei and William H. Herman were with the Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor. George H. Nolan was with the Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, Mich. J. Ricardo Guzman was with Community Health and Social Services, Inc, Detroit.
OBJECTIVES: We assessed the influence of maternal anthropometric and metabolic variables, including glucose tolerance, on infant birthweight.
METHODS: In our prospective, population-based cohort study of 1041 Latino mother-infant pairs, we used standardized interviews, anthropometry, metabolic assays, and medical record reviews. We assessed relationships among maternal sociodemographic, prenatal care, anthropometric, and metabolic characteristics and birthweight with analysis of variance and bivariate and multivariate linear regression analyses.
RESULTS: Forty-two percent of women in this study entered pregnancy overweight or obese; at least 36% exceeded weight-gain recommendations. Twenty-seven percent of the women had at least some degree of glucose abnormality, including 6.8% who had gestational diabetes. Maternal multiparity, height, weight, weight gain, and 1-hour screening glucose levels were significant independent predictors of infant birthweight after adjustment for gestational age.
CONCLUSION: Studies of birthweight should account for maternal glucose level. Given the increased risk of adverse maternal and infant outcomes associated with excessive maternal weight, weight gain, and glucose intolerance, and the high prevalence of these conditions and type 2 diabetes among Latinas, public health professionals have unique opportunities for prevention through prenatal and postpartum interventions.
Correspondence: Requests for reprints should be sent to Edith C. Kieffer, University of Michigan School of Social Work, South University, Room 3770, Ann Arbor, MI 48109-1106 (e-mail: ekieffer@umich.edu ).
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January 2007
Race, Race-Based Discrimination, and Health Outcomes Among African Americans
Vickie M. Mays,1,3,4 - Susan D. Cochran,2,3 - Namdi W. Barnes,3,4
Departments of 1Health Services and 2Epidemiology, University of California, Los Angeles, School of Public Health; 3UCLA Center for Research, Education, Training and Strategic Communication on Minority Health Disparities; and 4Department of Psychology, UCLA, Los Angeles, California 90095-1563; email: mays@ucla.edu, cochran@ucla.edu, nbarnesn@ucla.edu
Annual Review of Psychology
Vol. 58: 201-225 (Volume publication date January 2007)
(doi:10.1146/annurev.psych.57.102904.190212)
First published online as a Review in Advance on September 5, 2006
ABSTRACT: Persistent and vexing health disadvantages accrue to African Americans despite decades of work to erase the effects of race discrimination in this country. Participating in these efforts, psychologists and other social scientists have hypothesized that African Americans' continuing experiences with racism and discrimination may lie at the root of the many well-documented race-based physical health disparities that affect this population. With newly emerging methodologies in both measurement of contextual factors and functional neuroscience, an opportunity now exists to cleave together a comprehensive understanding of the ways in which discrimination has harmful effects on health. In this article, we review emerging work that locates the cause of race-based health disparities in the external effects of the contextual social space on the internal world of brain functioning and physiologic response. These approaches reflect the growing interdisciplinary nature of psychology in general, and the field of race relations in particular.
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