Health Disparities

Does Selective Migration Explain the Latino Paradox?: A Comparative Analysis of Mexicans in the U.S. and Mexico

by Georgiana Bostean

Published 5/23/2012 (OnlineFirst) in Journal of Immigrant and Minority Health

Latino immigrants, particularly Mexican, have some health advantages over U.S.-born Mexicans and Whites. Because of... more Latino immigrants, particularly Mexican, have some health advantages over U.S.-born Mexicans and Whites. Because of their lower socioeconomic status, this phenomenon has been called the epidemiologic “Hispanic Paradox.” While cultural theories have dominated explanations for the Paradox, the role of selective migration has been inadequately addressed. This study is among the few to combine Mexican and U.S. data to examine health selectivity in activity limitation, self-rated health, and chronic conditions among Mexican immigrants, ages 18 and over. Drawing on theories of selective migration, this study tested the “healthy migrant” and “salmon-bias” hypotheses by comparing the health of Mexican immigrants in the U.S. to non-migrants in Mexico, and to return migrants in Mexico. Results suggest that there are both healthy migrant and salmon-bias effects in activity limitation, but not other health aspects. In fact, consistent with prior research, immigrants are negatively selected on self-rated health. Future research should consider the complexities of migrants’ health profiles and examine selection mechanisms alongside other factors such as acculturation.

Patient Centred Care: A Response to Racial and Religious Health Disparities in the GTA

by Kristianne C. Anor

Final Research Project for ANTH 3110 - Acquiring Research Skills

This paper examines the symbiotic nature of culture and science, under the scope of medicine. Specifically, this... more This paper examines the symbiotic nature of culture and science, under the scope of medicine. Specifically, this research project explores the specific ways in which health care professionals tailor their medical approach to better fit the needs of each of their patients - in other words, this paper analyzes the UHN's Patient Centred Care model of medicine and how it seeks to minimize the rising racial and religious health disparities in the GTA.

Perceived Discrimination and Smoking Among Rural-to-Urban Migrant Women in China

by Sanghyuk Shin

Published online first in the Journal of Immigrant and Minority Health, March 3, 2012

Smoking may be a coping mechanism for psychosocial stress caused by discrimination. We conducted a cross-sectional... more Smoking may be a coping mechanism for psychosocial stress caused by discrimination. We conducted a cross-sectional survey of rural-to-urban migrant women working as restaurant/hotel workers (RHWs) and those working as sex workers (FSWs) in 10 Chinese cities to investigate whether perceived discrimination is associated with smoking. We interviewed RHWs at medical examination clinics and FSWs at entertainment venues. Modified Poisson regression was used to estimate prevalence ratios. Of the 1,696 RHWs and 532 FSWs enrolled, 155 (9.1%) and 63 (11.8%) reported perceived discrimination, respectively. Perceived discrimination was independently associated with ever tried smoking (prevalence ratio [PR], 1.71; 95% confidence interval [CI], 1.31–2.23) and current smoking (PR, 2.52; 95% CI, 1.32–4.79) among RHWs and ever tried smoking (PR, 1.36; 95% CI, 1.16–1.61) and current smoking (PR, 1.63; 95% CI, 1.28–2.06) among FSWs. Perceived discrimination is associated with higher prevalence of smoking among rural-to-urban migrant women in China.

Racial discrimination and depressive symptoms among African American men: The mediating and moderating roles of masculine self-reliance and John Henryism

by Derrick Matthews

Matthews, D. D., Hammond, W. P., Nuru-Jeter, A., Cole-Lewis, Y., & Melvin, T. (In press). Racial discrimination and depressive symptoms among African American men: The mediating and moderating roles of masculine self-reliance and John Henryism. Psychology of Men & Masculinity.

Despite well-documented associations between everyday racial discrimination and depression, mechanisms underlying this... more Despite well-documented associations between everyday racial discrimination and depression, mechanisms underlying this association among African American men are poorly understood. Guided by the Transactional Model of Stress and Coping, we frame masculine self-reliance and John Henryism as appraisal mechanisms that influence the relationship between racial discrimination, a source of significant psychosocial stress, and depressive symptoms among African American men. We also investigate whether the proposed relationships vary by reported discrimination-specific coping responses. Participants were 478 African American men recruited primarily from barbershops in the West and South regions of the United States. Multiple linear regression and Sobel-Goodman mediation analyses were used to examine direct and mediated associations between our study variables. Racial discrimination and masculine self-reliance were positively associated with depressive symptoms, though the latter only among active responders. John Henryism was negatively associated with depressive symptoms, mediated the masculine self-reliance-depressive symptom relationship, and among active responders moderated the racial discrimination-depressive symptoms relationship. Though structural interventions are essential, clinical interventions designed to mitigate the mental health consequences of racial discrimination among African American men should leverage masculine self-reliance and active coping mechanisms.

Access to Health Care for Latinos in Massachusetts: Findings and Policy Implications

by Gonzalo Bacigalupe

The Mauricio Gaston Institute, Winter, 2001

Opportunity in Complexity: Applied Whole Systems Design in Healthcare Innovation

by Renee Davis

Written as a final synthesis paper for the Whole Systems Design program of the Center for Creative Change at Antioch University Seattle.

We currently face what's known as a wicked mess of healthcare problems. A Whole Systems Design approach can lead the... more We currently face what's known as a wicked mess of healthcare problems. A Whole Systems Design approach can lead the way for the development of a system that's effective, sustainable and accessible. This paper is an exploration of such an approach and how it might be applied to healthcare innovation today.

Intergroup relations and health disparities: A social psychological perspective

by Wendy Berry Mendes

Destigmatizing Hepatitis B in the Asian American Community: Lessons Learned from the San Francisco Hep B Free Campaign

by Wei Ming Dariotis

Pandemic (H1N1) 2009 Surveillance In Marginalized Populations, Tijuana, Mexico

by Angela M Robertson

Rodwell TC, Robertson AM, Aguirre N, Vera A, Anderson CM, Lozada R, Chait L, Schooley RT, Zhang XQ, Strathdee SA. Emerg Infect Dis. 2010 Aug;16(8):1292-5.

To detect early cases of pandemic (H1N1) 2009 infection, in 2009 we surveyed 303 persons from marginalized populations... more To detect early cases of pandemic (H1N1) 2009 infection, in 2009 we surveyed 303 persons from marginalized populations of drug users, sex workers, and homeless persons in Tijuana, Mexico. Six confirmed cases of pandemic (H1N1) 2009 were detected, and the use of rapid, mobile influenza testing was demonstrated.

Who gets the best sleep? Ethnic and socioeconomic factors related to sleep disturbance

by Michael Grandner

Objectives: Lower socioeconomic status is associated with short or long sleep duration and sleep disturbance (e.g.,... more Objectives: Lower socioeconomic status is associated with short or long sleep duration and sleep disturbance (e.g., sleep apnea), which are all related to increased mortality risk. General sleep complaints, however, which may better approximate symptoms as they are experienced, have not been examined in a large population sample. Methods: Sample consisted of n = 159,856 participants from the Behavioral Risk Factor Surveillance System, representing 36 states/regions across the US. Sleep complaints were measured with a telephone survey item that assessed ‘‘trouble falling asleep,” ‘‘staying asleep” or ‘‘sleeping too much.” Data analysis utilized hierarchical logistic regression and Rao-Schott v2. Results: Asian respondents reported the least complaints, and Hispanic/Latino and Black/African-American individuals reported fewer complaints than Whites. Lower income and educational attainment was associated with more sleep complaints. Employment was associated with less sleep complaints and unemployment with more. Married individuals reported the least sleep complaints. Significant interactions with race/ethnicity indicate that the relationship between sleep complaints and marital status, income and employment differs among groups for men, and the relationship with education differs among groups for women. Conclusions: Rates of sleep complaints in African-American, Hispanic/Latino and Asian/Other groups were similar to Whites. Lower socioeconomic status was associated with higher rates of sleep complaint.

"Sleep disparity" in the population: poor sleep quality is strongly associated with poverty and ethnicity

by Michael Grandner

BACKGROUND: Little is known about the social determinants of sleep attainment. This study examines the relationship of... more BACKGROUND: Little is known about the social determinants of sleep attainment. This study examines the relationship of race/ethnicity, socio-economic status (SES) and other factors upon sleep quality. METHODS: A cross-sectional survey of 9,714 randomly selected subjects was used to explore sleep quality obtained by self-report, in relation to socioeconomic factors including poverty, employment status, and education level. The primary outcome was poor sleep quality. Data were collected by the Philadelphia Health Management Corporation. RESULTS: Significant differences were observed in the outcome for race/ethnicity (African-American and Latino versus White: unadjusted OR=1.59, 95% CI 1.24-2.05 and OR=1.65, 95% CI 1.37-1.98, respectively) and income (below poverty threshold, unadjusted OR=2.84, 95%CI 2.41-3.35). In multivariable modeling, health indicators significantly influenced sleep quality most prominently in poor individuals. After adjusting for socioeconomic factors (education, employment) and health indicators, the association of income and poor sleep quality diminished, but still persisted in poor Whites while it was no longer significant in poor African-Americans (adjusted OR=1.95, 95% CI 1.47-2.58 versus OR=1.16, 95% CI 0.87-1.54, respectively). Post-college education (adjusted OR=0.47, 95% CI 0.31-0.71) protected against poor sleep. CONCLUSIONS: A "sleep disparity" exists in the study population: poor sleep quality is strongly associated with poverty and race. Factors such as employment, education and health status, amongst others, significantly mediated this effect only in poor subjects, suggesting a differential vulnerability to these factors in poor relative to non-poor individuals in the context of sleep quality. Consideration of this could help optimize targeted interventions in certain groups and subsequently reduce the adverse societal effects of poor sleep.

Ethics and Health Inequalities: Are Preferences of Those Who Finance Health Expenditure Collectively Taken Into Account?

by Jordan Panayotov

Presented at 136th APHA Annual Meeting, San Diego, USA, October 2008

WHO states that all people have the right to the highest attainable health. The declared ethics is that all people are... more WHO states that all people have the right to the highest attainable health. The declared ethics is that all people are of equal value, irrespective of their personal characteristics. However, choices are inevitable, since resources are limited and less than the needs, i.e. always some claims are declined. The question is: “Which claims will be declined?” and more importantly: “On what basis some claims will be declined?” In different points of time and in different societies claims are declined on different basis. Today health expenditure is predominantly public in most countries. According to Pareto Optimality concept allocation of resources is efficient, if it is not possible to increase someone's benefit without at the same time decreasing another person's benefit. However, allocating limited resources based only on individual preferences of recipients means de facto acknowledging greater right to health for the recipients. Focusing on particular individual's health maximization effectively deprives resources from another individual. Does this mean that the right to highest attainable health of the former is greater than the same right of the later? Do people value one person more than the other? Health inequalities, being measurable differences in health status between people which are avoidable and unfair, are illustration for both: unethical and inefficient allocation of limited public resources. If preferences of tax-payers are properly taken into account, when by allocating limited resources some claims are declined, than the right of an individual to the highest attainable health should not be achieved by denying this right to others.

Addressing health inequities

by Carmel Martin

CHANGE IN CHILD HEALTH AND SOCIOECONOMIC STATUS: EXAMINING THE MODERATING EFFECTS OF DIFFERENTIAL PARENTING

by Dillon T. Browne

The Family Standpoint of Investigation: Examining the Correlates and Costs of Parental Stress in a Sample of Families Involved With Ontario Child Welfare

by Dillon T. Browne

Where is Community Health?: Racism, the Clinic, and the Biopolitical State

by Jenna Loyd

(2010). In Patton, Cindy, ed. Rebirth of the Clinic: Places and Agents in Contemporary Health Care. University of Minnesota Press.

Calculating expected years of life lost for assessing local ethnic disparities in causes of premature death

by Tomás Aragón

BMC Public Health. 2008 Apr 10;8:116. PubMed PMID: 18402698; PubMed Central PMCID: PMC2386472.

Biological memories of past environments: Epigenetic pathways to health disparities

by Zaneta Thayer

Human health tends to mirror gradients in social standing
related to class, ethnicity and race. Past research in... more Human health tends to mirror gradients in social standing
related to class, ethnicity and race. Past research in the social
sciences suggests that environmental experiences related to
social status contribute to these disparities, but the underlying
biological mechanisms are only partially understood. Here, we
review research related to three domains of environmental
exposure that point to epigenetic contributions to health
disparities: nutrition, psychosocial stress and environmental
toxicant exposure. Each exposure has effects that may persist
across the life course and in some instances may be transmitted
to offspring via epigenetic inheritance. Since epigenetic
markings provide a “memory” of past experiences, minimizing
future disparities in health will be partially contingent upon
our ability to address inequality in the current environment.
We suggest that future research in environmental epigenetics
focus on establishing the reversibility of stress-induced
epigenetic modifications, and also on identifying positive
epigenetic effects of environmental enrichment.

Equity Aspects of Canadian Immunization Programs: Differences within and between countries

by Mirella Veras

Gender issues in health care utilization

by Dawn Howerton

Travis, C.B., Meltzer, A.L., Howerton, D.M. (2010). Gender issues in health care utilization. In J.C. Chrisler & D.R. McCreary (Eds.), Handbook of Gender Research in Psychology (pp. 517-540). New York: Springer