Monday, June 17, 2002
Racial and Ethnic Disparities in Health: An Overview of National Data and NIH Future Directions in Behavioral and Social Causal Factors
Raynard Kington, M.D., Ph.D.

Abstract:

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.

Learning Objectives:

1. Understand the broad patterns of health status among the large racial and ethnic populations in the US
2. Understand the extent to which there is masked heterogeneity in health status within most populations, including minority populations in the US
3. Understand the broad categories of potential causal factors that might account for racial and ethnic disparities in health
4. Identify important future directions of research on the behavioral and social factors related to health

Online References:

1. Health, United States
2. Office of Minority Health, DHHS data and statistic webpage
3. America's Children, Key National Indicators of Well Being
4. Older Americans, Key Indicators of Well Being
5. Addressing Health Disparities: The NIH Program of Action
6. Office of Behavioral and Social Sciences Research (OBSSR)

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SES, Ethnicity, Culture: Toward Understanding the Sources Of Disparity in Academic and Mental Health Outcomes
Oscar A. Barbarin, III, Ph.D.

Abstract:

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.

Bibliographic Citations:

1. Barbarin, O. and Richter, L. (2001).. Mandela's Children: Child Development in Post-Apartheid South Africa. NY: Routledge.
2. Bempechat, J. (1998). Against the Odds: How 'At-Risk' Children Exceed Expectations. San Francisco: Jossey-Bass Publishers
3. Clark, R. (1983). Family Life and School Achievement: Why Poor Children Succeed and Fail. Chicago: University of Chicago Press.
4. Pinderhughes, Elaine (1989) Race, Ethnicity and Power New York: Free Press
5. Reyna, C. (2000).Lazy, Dumb, or Industrious: When stereotypes convey attribution information in the classroom. Educational Psychology Review, 12, 85-110.
6. Barrera, M., Jr., Castro, F. G., & Biglan, A. (1999).Ethnicity, substance use, and development:Exemplars for exploring group differences and similarities.Development and Psychopathology, 11, 805-822.

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Tuesday, June 18, 2002
The Emperor's New Clothes: Biomedical Research and the Social Construction of Race.
Joseph L. Graves, Jr., Ph.D.

Abstract:

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.

Bibliographic Citations:

1. Weiss, K., Genetic Variation and Human Disease: Principles and Evolutionary Approaches, (Cambridge: Cambridge University Press, 1995.)
2. Cavalli-Sfroza, L.L., P. Menozzi, and A. Piazza, The History and Geography of Human Genes, (Princeton: Princeton University Press, 1994.)
3. Graves, J.L., The Emperor's New Clothes: Biological Theories of Race at the Millennium, (New Brunswick, NJ.: Rutgers University Press, 2001.)
4. Templeton, A.R., The Genetic and Evolutionary Significance of Human Races, in Understanding Race and Intelligence: Separating Science from Myth, J. Fish, Ed. (Mahwah, NJ: Lawrence Erlbaum Press, 2002, pp. 31-56.)
5. Graves, J.L., The Misuse of Life History Theory: J.P. Rushton and the Pseudoscience of Racial Hierarchy, in Understanding Race and Intelligence: Separating Science from Myth, J. Fish, Ed. (Mahwah, NJ: Lawrence Erlbaum Press, 2002, pp. 57-94.)

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Recent developments in improving racial & ethnic data
Olivia D. Carter-Pokras, M.H.S., Ph.D.

Bibliographic Citations:

1. American Journal of Public Health 2000 No;90(11):1687-9 contains several articles regarding implications of the new Federal standards.

2. Atkinson JO, MacDorman MF, Parker JD. Trends in births to parents of two different races in the United States: 1971-995. Ethn Dis 2001 Spring-Summer;11(2):273-85.

3. Bierman AS, Lurie N, Collins KS, Eisenberg JM. Addressing racial and ethnic barriers to effective health care: the need for better data. Health Affairs 2002 May-Jun;21(3):91-102.

4. Carter-Pokras O, Montgomery LE. Social epidemiology (book review), public health reports. March-April 2001 Vol 116:173-175.
   
   

5. Department of Health and Human Services. Policy on the Inclusion of Racial and Ethnic Categories in HHS Funded and Sponsored Data Collection and Reporting Systems. http://aspe.hhs.gov/datacncl/inclusn.htm 1997.

6. Health Systems Research Inc. Performance Measurement in Managed Care and its Role in Eliminating Racial and Ethnic Disparities in Health: Meeting Summary. Prepared for U.S. Department of Health and Human Services and The Commonwealth Fund.

7. Heck KE, Parker JD, McKendry CJ, Schoendorf KC. Multiple-race mothers on the California birth certificate, 2000. Ethn Dis 2001 Fall;11(4):626-32.

8. HHS Data Council. Improving the Collection and Use of Racial and Ethnic Data in HHS: Joint Report of the HHS Data Council Working Group on Racial and Ethnic Data and the Data Work Group of the HHS Initiative to Eliminate Racial and Ethnic Disparities in Health. http://aspe.hhs.gov/datacncl/racerpt/index.htm December 1999.

9. HHS Data Council. HHS Directory of Health and Human Services Data Resources. http://aspe.os.dhhs.gov/datacncl/datadir

10. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. 2002.

11. Lee, Sharon. Using the New Racial Categories in the 2000 Census. Prepared for the Anne E. Casey Foundation. March 2001.

12. National Health Law Project. Assessment of State Laws, Regulations and Practices Affecting the Collection and Reporting of Racial and Ethnic Data by Health Insurers and Managed Care Plans. Prepared for the HHS Office of Minority Health. 2001.

13. National Institutes of Health. Policy on Reporting Race and Ethnicity Data: Subjects in Clinical Research. August 8, 2001. http://grants.nih.gov/grants/guide/notice-files/NOT-OD-01-053.html

14. Office of Management and Budget. Federal Data on Race and Ethnicity. Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. http://www.whitehouse.gov/omb/fedreg/ombdir15.html October 30, 1997.

15. Parker JD, Makuc DM. Methodologic implications of allocating multiple-race data to single-race categories. Health Serv Res 2002 Feb; 37(1):203-15.

16. Parker JD, Lucas JB. Multiple race reporting for children in a national health survey. Ethn Dis 2000 Spring-Summer;10(2):263-74.

17. Parker JD. Birth weight trends among interracial black and white infants. Epidemiology 2000 May;11(3):237-9.

18. Perot RT, Youdelman M. Racial, Ethnic and Primary Language Data Collection in the Health Care System: An Assessment of Federal Policies and Practices. The Commonwealth Fund. http://www.cmwf.org/programs/minority/perot racial ethnic 492.pdf September 2001

19. Public Health Foundation. A Primer on Collaborating with Medicaid Agencies and Using Medicaid Data in Efforts to Eliminate Racial and Ethnic Disparities in Health. Prepared with funding from the HHS Office of Minority Health. January 2001.

20. Zambrana RE, Carter-Pokras O. Health Data Issues for Hispanics: Implications for Public Health Research. Journal of Health Care for the Poor and Underserved. Vol 12, No. 1. 2001.

Wednesday, June 19, 2002
Perinatal Health Of Mexican American/Latino Women: Implications For Research, and Health Service Delivery
Hector Balcazar, Ph.D.

Abstract:

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

Learning Objectives:

1. Identify at least three gaps in knowledge about perinatal health outcomes among Mexican American/Latino women
2. Identify at least three gaps in knowledge about health service delivery in the area of perinatal health of Mexican Americans
3. List at least two survey research and data collection tools needed to better address perinatal health among Mexican Americans
4. Describe new research protocols in perinatal health of Mexican Americans that include concepts such as acculturation, social/environmental stressors including racism/discrimination, family and community resources and health system factors

Bibliographic Citations:

1. Zambrana, R., and Logie, L. Latino child health: need for inclusion in the US national discourse. American Journal of Public Health 2000; Vol. 90: No. 12, 1827-1833.
2. Fuentes-Afflick E, Lurie, P. Low birthweight and Latino ethnicity. Examining the epidemiological paradox. Archives of Pediatrics and Adolescent Medicine 1997; 151:665-674
3. Scribner, R. Paradox as paradigm- the health outcomes of Mexican Americans. American Journal of Public Health 1996; 86:303-305
4. Franzini L, Ribbie J, Keddie A. Understanding the Hispanic Paradox. Ethnicity and Disease 2001; 11:496-518
5. Frisbie P, Forbes D. and Pullum, S. Compromised birth outcomes and infant mortality among racial and ethnic groups. Demography 1996; 33:469-481.
6. Balcazar, H. and Krull, J. Determinants of birthweight outcomes among Mexican American women: examining conflicting results about acculturation. Ethnicity and Disease 1999; 9:410-422
7. Balcazar, H., Coonrod, D., Moore, P., Bay, C., and Russ. Use of perinatal, infant and chioldhood health services among high-risk Hispanics in Arizona. The Medicare, Medicaid, and SCHIP Agency. Research Monograph. Hispanic Grant Program. April, 2002. Washington DC.

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The Hispanic Paradox and Measurement Error: Recall of Last Menstrual Period and Estimation of Gestational Age Among Mexican Immigrants.
Natalia Deeb-Sossa, M.A., Betzabe Butron-Riveros, M.D., M.Sc., P.H.D.C. and Robert Agans, Ph.D.

Abstract:

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.

Learning Objectives:

1. List potential sources of measurement error in the calculation of GA.
2. Identify some factors that make LMP recall by Mexican immigrant women more or less difficult.
3. Understand how to overcome difficulties in designing and conducting focus groups with Mexican immigrant populations.
4. Describes ways that healthcare providers might minimize errors in recalling LMP with Mexican immigrants.
5. Recognize implications for future research.

Bibliographic Citations:

1. Buekens P., Notzon, F., Kotelchuck, N., & Wilcox, A. (2000). Why do mexican americans give birth to few low birth weight infants? American Journal of Epidemiology, 152, 347-351.
2. Franzini, L., Ribbie, J., & Keddie, A. (2001). Understanding the hispanic paradox. Ethnicity and Disease, 11, 496-518.
3. Hines, A. M. (1993). Linking qualitative and quantitative methods in cross-cultural survey research: Techniques from cognitive science. American Journal of Community Psychology, 21(6), 729-746.
4. Marín, G., & Marín. B. V. (1991). Research With Hispanic Populations. Newbury Park: Sage.
5. Palloni, A., & Morenoff, J. (2001). Interpreting the paradoxical in the hispanic paradox: Demographic and epidemiologic approach. Annals of The New York Academy of Sciences, 954, 140-174.

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Thursday, June 20, 2002
Assessing the Health of Asian American Youth: A Multidisciplinary Approach
Cliff Akiyama, M.A.

Abstract:

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.

Learning Objectives:

1. Be aware of data on health issues pertaining to the Asian community, in particular, Asian youth.
2. Have greater ability to understand and work with the Asian community, which unfortunately is so often "closed" to outsiders.
3. Appreciate that in order for any prevention/intervention program to work in the Asian community, we must both realize that there is a problem and use a multidisciplinary approach that includes the public health, medical, legal, and sometimes the law enforcement communities.

Bibliographic Citations:

1. Akiyama, Cliff and Kawasaki, Ron: Southeast Asian Youth Gangs: A Rising Epidemic. Mind and Human Interaction, Vol. 10, Number 4 (pages 247-255), 2000
2. Gall, Susan and Natividad, Irene (eds): The Asian American Almanac. Gale Research. Detroit, MI, 1995
3. Lim, Ji Hyun: Teen Pregnancy A Tradition. Asian Week (March 2-8, 2001)
4. Ma, Grace Xueqin: The Culture of Health: Asian Communities in the United States. Bergin and Garvey. Westport, CT, 1999
5. Ng, Kit S.: Counseling Asian Families from a Systems Perspective. American Counseling Assn., Alexandria, VA, 1998
6. Zhan, Lin: Asian Voices: Asian and Asian American Health Educators Speak Out. Jones and Bartlett. Sudbury, MA, 1998

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Friday, June 21, 2002
Tobacco Control in American Indian communities
Felicia Schanche Hodge, Dr.P.H

Abstract:

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.

Learning Objectives:

1. To identify the smoking rates among American Indians as compared to the general population.
2. To understand the cultural constructs of cultural tobacco use.
3. To gain an understanding of intervention strategies that work, and why they work.

Bibliographic Citations:

1. Hodge, F. American Indian and Alaska Native Teen Cigarette Smoking: A Review. In: David Burns (Ed.) Changing Adolescent Smoking Prevalence, National Cancer Institute Monograph, 2002.
2. Hodge, F., Casken, J. Characteristics of American Indian Women Cigarette Smokers: Prevalence and Cessation Status, Health Care for Women International, 20:455-469, 1999.
3. Hodge, F., Toms, F., Guillermo, T. Achieving Cultural Competency and Responsive Health Care Delivery Cancer (supplement), Vol. 83, No. 8, pp. 1714-16, 1998.
4. Hodge, F. Tobacco Control Leadership in Indian Communities. Tobacco and Health, Plenum Pub Co NY 1995.
5. Hodge, F., Fredericks, L., Kipnis, P. Patient and Smoking Patterns in Northern California American Indian Clinics; Urban Rural Contrasts, Cancer, October 1, 1996.

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Health Equity & Social Justice: Community Models, National Priorities
Adewale Troutman, M.D., M.P.H., F.S.C.S.P.P., F.W.H.O/E.U.C.C.

Abstract:

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.

Learning Objectives:

At the end of this presentation, the participant will:

1. Gain an understanding of the relationship between social determinants of health and health outcomes
2. Discuss the significance of a human rights focus on the process of eliminating health disparities
3. Outline the importance of shifting the current paradigm of the elimination of health disparities to one of empowerment and universality by creating health equity through social justice
4. Explore the issues of social justice and socioeconomic equity as it relates to the publics health

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Links: 
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