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Background African American race and uninsurance are associated with undertreatment and poor survival in solid tumor cancers. This relationship has not been examined in acute myeloid leukemia (AML) where absence of treatment or treatment delays can result in death within weeks or months. Induction followed by consolidation treatment, in contrast, has a high probability for remission or cure. We examined the relationship between race and health insurance and inpatient chemotherapy and survival in AML patients between the ages of 21 and 64 years. We also examined inpatient costs associated with inpatient treatment. Methods We used population-based data from the Virginia Cancer Registry and the Virginia Health Information discharge data for patients diagnosed with AML between 1999 and 2006 (n = 523). Adjusted logistic regression was used to measure the relationship between the independent variables and chemotherapy. We used the Cox proportional hazards method to estimate survival. Results Uninsured patients were more likely to be untreated than their privately insured counterparts (odds ratio, 4.40; 95% confidence interval, 1.85-10.49) and had a higher likelihood of death (hazard ratio, 1.29; 95% confidence interval, 1.02-1.84). Once treatment was adjusted in the survival analyses, differences between insurance groups were not statistically significant. The median 1-year cost of inpatient care following diagnosis for patients who received chemotherapy exceeded $100,000. Conclusion This study addressed the urgency for health insurance that affords access to care. Without treatment, the outcome of AML is death within only a few months; with treatment, the chance for long-term remission or even cure exists.

Indian state of Kerala, and Sri Lanka have a special place in global health discourses, although there has been a relatively little systematic analysis of women's health in these societies. Moreover, there are a number of dimensions of women's health that have been underappreciated by public health researchers and development experts due to systematic gender biases in health research. This article seeks to provide a more complete picture of women's health in Kerala and Sri Lanka by explicitly addressing three key gender biases: inattention to health issues that particularly affect women, incomplete approaches to understanding the health of women and insufficient attention paid to the interactions between gender and other social stratification, such as class, ethnicity or caste.

In population health research, it is important to consider socioecological perspectives that include cultural attitudes and beliefs which permeate all levels (intrapersonal, interpersonal, institut...

Minority populations have remained in relatively poor health compared to the majority population and continue to be underserved by the health care system. Racial and ethnic health disparities are not new phenomena. Understanding the causes of these disparities continues to evolve. Within the past decade researchers have looked more toward social determinants of health to explain the differences. The Institute of Medicine (IOM) report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care provided documentation to shift the discussion from patient behaviors to the contributions of health care systems, including health care providers, that contribute to health disparities. The report was the first comprehensive study that documented racial and ethnic inequities within the US health care delivery system (ie, differential treatment on the basis of race and ethnicity). The authors of the IOM report indicated that they found some evidence to suggest that bias, prejudice, and stereotyping by providers may contribute to differences in care. It is possible that food and nutrition practitioners have the same biases and are presented with the same systems challenges as the health care providers referenced in the IOM report. It is, therefore, also possible that food and nutrition practitioners may be at risk of contributing to health disparities. This article provides an in-depth look at the recommendations put forth by the IOM, offers discipline-specific recommendations consistent with those outlined in the IOM model, and introduces other models that may be of use as food and nutrition practitioners move forward with developing strategies to eliminate racial and ethnic health disparities.

An increasing body of public health literature links patterns of racial/ethnic residential segregation to health status and health disparities. Despite substantial new empirical work, meaningful understanding of the pathways through which segregation operates to influence health remains elusive. The literature on segregation and health was appraised with an emphasis on select conceptual, methodological, and analytical issues. Recommendations for advancing the next generation of racial/ethnic residential segregation and health research will require closer attention to sharpening the methodology of measuring segregation, testing mediating pathways and effect modification, incorporating stronger test of causality, exploring factors of resilience in segregated areas, applying a life-course perspective, broadening the scope of the investigation of segregation to include nativity status in blacks and other racial/ethnic groups, and linking segregation measures with biological data.

Gender, the complex of social relations and practices attached to biological sex, is one of the most important socio-cultural factors influencing health and health-related behavior. Although a large body of health research suggests that men with similar social disadvantages as women experience poorer health outcomes in relation to disability, chronic illness, injury rates and mortality, men's health is rarely deconstructed through the lens of gender. The purpose of this article is to increase understanding of the ways in which masculinities intersect with other social determinants of health creating health disparities among men, and to provide direction for masculine affirming health interventions aimed specifically at men. With the goal of promoting the health of men and decreasing health disparities, the authors have developed, within the Canadian context, an innovative theoretical framework for men's health, Health, Illness, Men and Masculinities (HIMM), based on the influence of masculinity throughout the lifecourse. We discuss three main phases of men's lifecourse showing how masculinity intersects with other social determinants of health differently during youth, middle-age and the older years. The HIMM Framework points to the need for research and theory development that moves us beyond a limited focus on any one individual man to consider men's health and illness practices in the larger social context within which masculinity is defined and produced. It can thus advance men's health research and theory development, and provide direction for policy, education, health care delivery and health promotion initiatives aimed specifically at men in many locales, contexts and countries.

The role of health care organizations in reducing inequalities in health has recently drawn considerable interest from researchers and policy makers (McKee 2002; Smedley, Stith, and Nelson 2003;). It is clearly acknowledged that disparities in health are a result of interrelated factors external to the health care realm, such as socioeconomic status (SES), ethnicity, geography, and education (Chin et al. 2007; Starfield and Birn 2007; Benyamini et al. 2008; Riva et al. 2009;), yet health care organizations have an important role in reducing health disparities caused by these social factors, as well as by unequal access to quality medical care (Aaron and Clancy 2003). To address this need, the National Health Plan Collaborative was formed in 2004, aimed at reducing racial and ethnic disparities and improving the overall quality of care in the U.S. health care system. Early reports indicate that the plans have made significant headway in achieving coordination of disparities activities across the organization (Lurie et al. 2008). Yet data on programs' structures and the processes put in place, as well as achievements in disparity reduction, have not been reported to date. The means by which health care organizations can effectively achieve disparity reductions are yet to be unveiled (Fiscella 2007). Israeli society has a diverse demographic profile in terms of its ethnic, religious, immigrant, and socioeconomic makeup. Recent reports show widening inequalities in economic status, as attested by the higher Gini coefficient (a marker of income variance) in Israel than in all OECD countries (Shmueli and Gross 2001). Recent studies report considerable differences in the health status of the Israeli population (Epstein and Horev 2007): differences in life expectancy according to geographical areas, minority status (mainly between the largest minority of Arab Muslims and the general Israeli Jewish population), and level of education (Shuval 1990; Chernichovsky and Anson 2005; Israeli Bureau of Statistics 2009;); large differences in infant mortality rates according to geographical area and minority status (Tarabeia et al. 2004); and disparities in the prevalence of chronic diseases according to minority status and education level in a variety of conditions, including osteoporosis (Nitzan-Kaluski et al. 2003), obesity (Keinan-Boker et al. 2005), and coronary artery disease (Salameh et al. 2008). In Israel, all citizens, by law, are members of one of four health funds that serve as insurers and health care providers. Clalit Health Services is the largest health fund with over 3.8 million enrollees (53 percent market share), with

This study examines disparities in health status, health care utilization, insurance coverage and satisfaction in US low-income parents of infants and toddlers with disabilities compared to low-income parents of children without disabilities. The Early Head Start Research and Evaluation Project is a longitudinal study involving 2087 families in 17 communities across the United States. Families completed interviews at enrollment and at 7, 16, and 28 months after enrollment. Descriptive analyses were conducted to characterize children’s status in terms of health, health care use, and insurance coverage. Children with disabilities were more likely to experience poor health and to use more health care services. Parents of children with disabilities were more likely to report that medical care was inadequate. Hispanic children were less likely to experience excellent health. Hispanic parents were less likely to have health insurance or to report that their medical care was adequate. Low-income parents of young children with disabilities perceived their children as less healthy, more vulnerable and needing more health services. This study demonstrates the importance of providing accessible, culturally-competent services to this vulnerable population.

Lower socioeconomic status is commonly related to worse health. If poor access to health care were the only explanation, universal access to care should eliminate the association. We studied 14,800 patients with access to Canada's universal health care system who were initially free of cardiac disease, tracking them for at least ten years and seven months. We found that socially disadvantaged patients used health care services more than did their counterparts with higher incomes and education. We also found that service use by people with lower incomes and less education had little impact on their poorer health outcomes, particularly mortality. Countries contemplating national health insurance cannot rely on universal health care to eliminate historical disparities in outcomes suffered by disadvantaged groups. Universal access can only reduce these disparities. Our findings suggest the need to introduce large-scale preventive strategies early in patients' lives to help change unhealthy behavior.

How do self-identified multiracial adults fit into documented patterns of racial health disparities? We assess whether the health status of adults who view themselves as multiracial is distinctive from that of adults who maintain a single-race identity, by using a seven-year (2001–2007) pooled sample of the Behavioral Risk Factor Surveillance System (BRFSS). We explore racial differences in self-rated health between whites and several single and multiracial adults with binary logistic regression analyses and investigate whether placing these groups into a self-reported “best race” category alters patterns of health disparities. We propose four hypotheses that predict how the self-rated health status of specific multiracial groups compares with their respective component single-race counterparts, and we find substantial complexity in that no one explanatory model applies to all multiracial combinations. We also find that placing multiracial groups into a single “best race” category likely obscures the pattern of health disparities for selected groups because some multiracial adults (e.g., American Indians) tend to identify with single-race groups whose health experience they do not share.

Objectives. We conducted the first empirical examination of disparities in H1N1 exposure, susceptibility to H1N1 complications, and access to health care during the H1N1 influenza pandemic. Methods. We conducted a nationally representative survey among a sample drawn from more than 60 000 US households. We analyzed responses from 1479 adults, including significant numbers of Blacks and Hispanics. The survey asked respondents about their ability to impose social distance in response to public health recommendations, their chronic health conditions, and their access to health care. Results. Risk of exposure to H1N1 was significantly related to race and ethnicity. Spanish-speaking Hispanics were at greatest risk of exposure but were less susceptible to complications from H1N1. Disparities in access to health care remained significant for Spanish-speaking Hispanics after controlling for other demographic factors. We used measures based on prevalence of chronic conditions to determine that Blacks were the most susceptible to complications from H1N1. Conclusions. We found significant race/ethnicity-related disparities in potential risk from H1N1 flu. Disparities in the risks of exposure, susceptibility (particularly to severe disease), and access to health care may interact to exacerbate existing health inequalities and contribute to increased morbidity and mortality in these populations.

The purpose of the study was to evaluate the development of self-rated health among boys and girls during adolescence.Longitudinal cohort study, involving 1,046 Swedish adolescents from the seventh (12-13 years old) to the ninth grade. Self-rated health (well-being) and health-related empowerment were measured using a questionnaire.In the seventh as well as in the ninth grade, the proportion of adolescents reporting a good health was lower in girls than in boys. In general, girls showed lower health-related empowerment as compared with boys and this difference remained between both the grades. In boys and girls belonging to both grades, a high empowerment score was related to a high self-rated health. For both boys and girls, self-rated health declined between the seventh and ninth grade. In girls, the proportion rating their health as "very good" declined from 47 % to 30%, and in boys the same proportion declined from 56% to 46%, indicating an increasing gender difference. Only a minor proportion of adolescents (16% of the boys and 13% of the girls) reported an improvement. A high self-rated health in grade nine was, in girls, predicted by positive school experiences in seventh grade and, in boys, by a good mood in the family.During adolescence, girls reported lower self-rated health than boys and this gender difference increased over the years. High empowerment is related to high self-rated health, and positive school experiences and a good mood in the family seem to be important predictors of a positive development of self-rated health.

William Edward Burghardt Du Bois is considered one of the most prolific and brilliant scholars of our time. While his contributions to civil rights, sociology, history, African American studies, and urban studies are universally recognized, his legacy in the public health and epidemiology discourses is not as widely acknowledged by contemporary health researchers. His seminal work The Philadelphia Negro: A Social Study (1899) and his report “The Health and Physique of the Negro American” (1906) may be considered early harbingers in general of public health—and more specifically, social epidemiology—research. During the late nineteenth and early twentieth centuries, Black and White differences in mortality and morbidity were largely attributed to notions of biological racial inferiority. Efforts by Du Bois to challenge these predominant notions resulted in the systematic empirical investigation of social factors contributing to Black health risk and health disparities. More than one hundred years after Du Bois's pioneering scholarship, racial/ethnic and social disparities remain a central challenge for public health and medical professionals. Given the persistence of health disparities and the increasing focus on neighborhood social and physical environments as fundamental factors contributing to health inequalities, this paper seeks to historically situate Du Bois's scholarship, describe the methodological and conceptual significance of his seminal studies, and articulate the importance of incorporating Du Bois's legacy to advance the next generation of racial/ethnic health inequality research.

Despite the widespread assumption that racial differences in stress exist and that stress is a key mediator linking racial status to poor health, relatively few studies have explicitly examined this premise. We examine the distribution of stress across racial groups and the role of stress vulnerability and exposure in explaining racial differences in health in a community sample of Black, Hispanic, and White adults, employing a modeling strategy that accounts for the correlation between types of stressors and the accumulation of stressors in the prediction of health outcomes. We find significant racial differences in overall and cumulative exposure to eight stress domains. Blacks exhibit a higher prevalence and greater clustering of high stress scores than Whites. American-born Hispanics show prevalence rates and patterns of accumulation of stressors comparable to Blacks, while foreign-born Hispanics have stress profiles similar to Whites. Multiple stressors correlate with poor physical and mental health, with financial and relationship stressors exhibiting the largest and most consistent effects. Though we find no support for the stress-vulnerability hypothesis, the stress-exposure hypothesis does account for some racial health disparities. We discuss implications for future research and policy.

Although thriving in many respects, racial health disparities research suffers from a lack of historical analysis and may be in danger of reaching a saturation point. This article examines how renewed attention to history can enhance the explanatory power of such research. First, it surveys a body of writing on what history can contribute to contemporary social science and policy debates. Next, it compares current racial health disparities research to the analytical impasse encountered by urban poverty researchers of the late 1980s and early 1990s. It contrasts that work with two classic post-Second World War urban histories, and identifies qualities of the latter lacking in conventional social science. The essay then surveys historically oriented works on race and health, pointing out their usefulness to racial health disparities research while discussing promising future research directions. It concludes with a brief reflection on changes in the academic institutional context necessary for fruitful synergy between public health researchers and historians.

Studies have linked the experience of child abuse or adversity to mental health problems in adulthood, and researchers have long documented ethnic/race disproportionality in foster care. Yet, the adult mental health outcomes of maltreated children placed in foster care have not been sufficiently examined across diverse ethnic groups. Although information on transitioning youth and young adults has emerged, the impact of ethnicity on adult mental health outcomes has been studied infrequently. Given the overrepresentation of ethnic minority children in foster care in certain communities, this study examined the relationship between ethnicity and mental health outcomes for Hispanic, African American, and White adults who experienced family foster care as children. Logistic regression models indicated that ethnicity was not a significant predictor of adult mental health ( p > .05). However, gender, age of entrance into child welfare, maternal mental health, maltreatment while in care, number of placements, and degree of preparation for leaving care were associated significantly with the adult's mental health outcomes.

There is ample research showing that there are health disparities for minorities with respect to seeking mental health services in the United States. Although there are general barriers for minorities in seeking service health, minority women are more vulnerable due to their negative experiences and lower satisfaction in receiving health care, compared to men. This study utilized the National Latino and Asian American Study (NLAAS) data set, which is the first population-based mental health study on Latino and Asian Americans, to give a full description of Latina and Asian American women's experience in mental health service seeking and identifies the opportunities in increasing their satisfaction levels. The results showed that perceived discrimination attributed to gender or race/ethnicity is negatively predicting levels of satisfaction of mental health service seeking. Older age, higher education levels, longer duration in the United States, and better mental health, are positively related to satisfaction levels for Latina and Asian American women.

In the United States, African Americans face stark inequalities in health. The life course perspective offers a unique viewpoint through which racial disparities in morbidity and mortality may be understood as the result of repeated exposures to risk factors during both childhood and adulthood. However, the utility of this approach is limited by its failure to investigate the degree to which racial/ethnic minorities are able to translate gains in socioeconomic status into favorable health outcomes, both for themselves and for their children. In order to adequately reflect the realities of marginalized groups, life course models must explore the interactive nature of linkages across lifecourse stages, pay particular attention to the unique processes that create and maintain health disparities over time, and consider the specific contexts in which these processes occur. To this end, I examine the ways in which exclusionary forces and discriminatory conditions are likely to prevent African American women and their children from reaping the health benefits typically associated with upward socioeconomic mobility.

As genetic and genomic research has progressed since the sequencing of the human genome, scientists have continued to struggle to understand the role of genetic and socio-cultural factors in racial and ethnic health disparities. Recognition that race and ethnicity correlate imperfectly with differences in allele frequency, environmental exposures, and significant health outcomes has made framing the relationship between genetic variation, race, ethnicity, and disease one of the most heated debates of the genome era. Because racial and ethnic identities reflect a complicated mix of social and genetic factors, critics have argued that use of racial and ethnic categories as analytical variables in biomedical research lacks rigor, leads to potentially dangerous stereotyping in medical practice, and sends harmful messages of innate racial difference to the broader public.Concerns over the current lack of diversity in human genetic and genomic studies have developed in parallel to discussions of the appropriate use of racial and ethnic categories during the research process.

Although racial disparities in health have been documented both historically and in more contemporary contexts, the frameworks used to explain these patterns have varied, ranging from earlier theories regarding innate racial differences in biological vulnerability, to more recent theories focusing on the impact of social inequalities. However, despite increasing evidence for the lack of a genetic definition of race, biological explanations for the association between race and health continue in public health and medical discourse. Indeed, there is considerable debate between those adopting a “social determinants” perspective of race and health and those focusing on more individual-level psychological, behavioral, and biologic risk factors. While there are a number of scientifically plausible and evolving reasons for the association between race and health, ranging from broader social forces to factors at the cellular level, in this essay we argue for the need for more transdisciplinary approaches that specify determinants at multiple ecological levels of analysis. We posit that contrasting ways of examining race and health are not necessarily incompatible, and that more productive discussions should explicitly differentiate between determinants of individual health from those of population health; and between inquiries addressing racial patterns in health from those seeking to explain racial disparities in health. Specifically, we advance a socio-psychobiological framework, which is both historically grounded and evidence-based. This model asserts that psychological and biological factors, while playing a central role in determining individual risk for poor health, are relatively less consequential for understanding racial disparities in health at the population level. Such a framework emphasizes the etiologic role of social inequities in generating and perpetuating racial disparities in health and highlights their impact on psychological, behavioral, and biological disease processes.

Media messages directed to African American women are more likely to have health content that emphasizes negative outcomes or sexual stereotypes. This paper critiques the use of health messages that focus on high mortality and morbidity rates, yet have not reduced health disparities, but have instead reduced Black women's bodies to carriers of disease. I introduce an ethic of resistance that privileges the authority and wholeness of Black women rather than disease and fragmentation. An ethic of resistance helps Black women connect to their spiritual health, move from passive receiver to active resister of negative messages, and break the generational silence to demystify sexuality and integrate it into a lifestyle of wholeness. My hope is to improve the health outcomes of African American women by improving the message.

Health-related quality of life instruments (HRQoL) are widely used to produce measures that summarize population health and to inform decision-making and health policy. Although the literature about the relationship between health and race in the United States is quite extensive, there is a lack of studies that comprehensively examine the relationship between race and preference-based HRQoL. Given the widespread use of these measures, it becomes important to understand the extent of the race differences in HRQoL scores and factors associated with any such differences.We examined the differences in HRQoL, between blacks and whites and associated factors, using the summary scores of the SF-6D, EQ-5D, QWB-SA, HUI2, HUI3, administered by telephone to a nationally representative sample of 3,578 black and white US adults between the ages of 35 and 89 in the National Health Measurement Study (NHMS).Black women had substantially lower HRQoL than white women. The difference was largely explained by sociodemographic and socioeconomic variables. Black men did not differ significantly from white men, except for the EQ-5D. HRQoL among black men was higher at higher income levels, while the HRQoL of black women was especially low compared to other groups at high income levels.

While disparities in health and health care between vulnerable (e.g., minorities, low-income) and majority populations are well documented, less is known about disparities within these special populations that are large and diverse. Such knowledge is essential to determine the neediest within these generally needy populations, and to plan interventions to reduce their health and health care disparities. With data from 1,331 women residing in Los Angeles County California, in one of the largest, most comprehensive studies of the health of homeless women to date, this study examined the health and health care disparities among homeless African American, Latina, and white women. This study further explored if race/ethnicity and other factors that predispose homeless women to poor health, or enable them to obtain better health care, were associated with their unmet need for medical care. The study found that white, non-Latina women were more likely to report unmet need than African Americans and Latinas, and women suffering from drug abuse, violence, or depression were most in need of care. These findings should be considered in targeting and addressing the special needs of homeless women of different racial/ethnic groups. © Taylor & Francis Group, LLC.

Self-rated health status provides insights into the health beliefs of a population. This will be important for framing public health messages in the context of the need to 'close the gap' for Australian Indigenous people. Our primary objectives were to describe the self-rated health status of Indigenous people attending the Inala Indigenous Health service, identify associations with positive and negative self-rated health status and identify targets for public health awareness raising activity.Using a convenience sample, we approached all Indigenous patients attending the Inala Indigenous Health Service for an Indigenous adult health check between June 2007 and July 2008. From Indigenous adult health check data we analysed self-rated health status and chronic disease risk factors.Out of a possible 509, 413 patients were recruited (response rate 81%). The number of participants who rated their health as fair or poor was 47%. The association of greatest magnitude and statistical significance with Indigenous patients' self rated health status (negative versus positive) was waist circumference followed by smoking, depression and age. Chronic disease risk factors not associated with self-rated health status included systolic blood pressure, harmful alcohol use, marijuana use, presence of diabetes and lack of exercise.High rates of negative self-rated health status were found. Public health awareness-raising for Indigenous audiences should consider targeting chronic disease risk factors such as systolic blood pressure, harmful alcohol use, marijuana use, presence of diabetes and lack of exercise.

In the second edition of The New Public Health, authors Tulchinsky and Varavikova present a comprehensive overview of the evolution of public health and health issues. Their book succeeds in introducing the broad areas of this expanding field as they seek to balance traditional concerns for populations with more modern concerns for individuals and human rights. One of the main strengths of this text is the authors‟ coverage of many contemporary public health topics, such as specialized communities, which include the mentally ill, homosexual men and women, immigrants, and Native Americans. However, the authors provide very limited criticism of prior mishaps in public health and little emphasis on health promotion, a major component of current approaches. Instead, there is an overemphasis on an epidemiological perspective of many public health topics. Admission of failures to address certain issues adequately, a more robust presentation of the premises of health promotion, and more attention to ecological models of disease prevention would have strengthened the second edition of The New Public Health. Perhaps the authors will include these dimensions of the 21st century in subsequent editions of their valuable book.

Hmong Americans are a minority population with a hypertensive health problem that is often undiagnosed and not medically managed. Vulnerable populations, such as ethnic minorities, are susceptible to poor health because of their unique perception of disease and treatment. Healthy People 2010 has goals that include promoting quality of life and eliminating health disparities. The Health Belief Model recognizes an individual’s perceived susceptibility to disease, perceived severity of disease, perceived benefits of certain behaviors in reducing disease, and perceived barriers, such as cost, to preventive action. Nurses and other health care professionals are in a unique position to promote health in these vulnerable populations by using the Health Belief Model. Health promotion includes identifying barriers, empowering individuals through knowledge, as well as encouraging and educating positive health behaviors.

Numerous studies acknowledge that the well-being of our nation hinges on the health of its people. There is specific concern about children because they represent the future. Ignoring children's health needs can compromise their educational preparedness, occupational pursuits, productivity, and longevity. Current science demonstrates that developmental, emotional, or behavioral limitations experienced during the early years of life and over the life course are associated with poor adult health outcomes. Poverty, restricted access to health insurance and health care services, cultural and linguistic barriers, neighborhood conditions, and racial and class inequalities exacerbate poor health outcomes and contribute to child health inequality. To respond to the complexities and threats of child health inequality, social workers must be sensitized to the physical and material constraints that support them and join forces with other disciplines in comprehensive approaches to reduce and prevent them. This article focuses on current knowledge about child health inequality and recommends how social workers can effect change in this area through practice, policy, and research that adheres to the profession's ethical principles and standards and promotes the public health.

This commentary provides an in-depth and comprehensive contextual understanding of key issues influencing health in Asian American communities. It is a valuable resource addressing health disparities through ecological lenses and multilevel analyses and is congruent with the current movement toward a better understanding of the social determinants of health. The chapters are groundbreaking work of more than 40 leading researchers and community advocates. The book’s emphasis on understanding the social, cultural, and political context of the health of Asian Americans is relevant for a wide range of health professionals, social scientists, community advocates, and policy makers. It is also an excellent resource for faculty members and students interested not only in Asian American—related issues but also broader issues in vulnerable populations, public health, and social justice.

U.S. immigrants are a physically healthy population, but we do not understand the explanatory factors responsible for their physical health status, particularly those related to social network support. Using data from the 2001 wave of the National Health Interview Survey, we examine multiple measures of immigrant adaptation, investigating their influence on measures of physical health. In particular, we examine how well indicators of social support and integration explain the immigrant health advantage. Results show clear evidence of an immigrant paradox in physical health, but that measures of support and integration explain almost none of the immigration effect on physical health.

Physical health problems become more common as people age and are associated with a great deal of disability. Although racial and ethnic disparities have been reported in physical health, little is known about whether these disparities remain in the latest part of older adulthood. Accordingly, the current study sought to examine racial and ethnic differences in the physical health status of three age groups of older adults, using the 2005 and 2007 California Health Interview Survey. The sample for the current study included 40,631 individuals aged 55 and older: 33,488 non-Hispanic whites, 1,858 blacks, 2,872 Asians and Pacific Islanders, and 2,412 Latinos. Respondents were compared with regard to three indicators of physical health: four chronic health conditions, difficulties with activities of daily living, and self-rated health. Analyses were conducted with and without adjustment for sex, marital status, education, English-language proficiency, nativity, and insurance status. Results revealed that, in general, racial and ethnic disparities existed for physical health in late adulthood, with differences less pronounced for Asians and Pacific Islanders and Latinos aged 75 and older after multivariable adjustment. Disparities between blacks and non-Hispanic whites and disparities across all racial and ethnic minorities in self-rated health still existed. These findings suggest that, to reduce racial and ethnic disparities, clinicians need to address specific sociodemographic and lifestyle factors related to racial and ethnic differences in health before these conditions are manifested in late adulthood.

Hispanics are the largest minority group in United States and at a great risk for poor health outcomes linked to poor access to health care. Their large geographic distribution makes it critical that the underlying factors resulting in health care disparities among documented and undocumented Hispanics be addressed at local, state, and national levels. Health care systems should establish community partnership for effective strategies to address these disparities. This article presents factors identified in the literature that contribute to health care disparities among Hispanics and provides strategies for improving access to health care for health promotion.

Questions about the design of the new US Medicare prescription drug benefit were raised even before its passage, where one of the most heated issues has been the number of plans offered to beneficiaries. Whether beneficiaries believe that there should be extensive or limited choice is still an open question. To study this issue, we analyzed data from the Kaiser Family Foundation/Harvard School of Public Health Survey, which included 718 individuals aged 65 years and above. The survey asked these older adults (i) whether they prefer having dozens of plans or for Medicare to offer a restricted number of plans and (ii) whether they think there are too many, too few or the right amount of plans. Our findings show that the majority of beneficiaries (69%) preferred that Medicare offer a limited number of options while only 29% wanted to see dozens of plans on the market. We also examine the effect of education level, income, political affiliation, race and health status on the desire for more or fewer plans. One surprising finding is that seniors with higher education appear to prefer fewer, not more, plan choices. Overall, our results question the merit of offering so many prescription drugs plan choices to Medicare beneficiaries.

Asthma affects almost 23 million people in the United States and ranks as a leading cause of health disparities among minority and low socioeconomic groups, with the largest impact on minority children. This article will examine how fragmented health care in the United States contributes to asthma care disparities in minority populations and will discuss how health care reform may help overcome these disparities. Causes of asthma care disparities are marked by the socioeconomic relationship of the disease including, but not limited to, underprescribing and underuse of preventative medication, low primary care follow-up after acute exacerbations, and the limited availability of pharmacy resources in urban communities. Furthermore, the importance of health care coverage cannot be overemphasized. With the recent passage of the Patient Protection and Affordable Care Act, health care reform offers significant opportunities to reduce or eliminate disparities in minorities. For health care reform to succeed, it must address the specific needs of minorities and support the development of a wide range of community-based interventions and programs with an emphasis on prevention, primary care, chronic care management, and care coordination. In addition, policies that promote cultural competence and improve access and continuity of care are needed, as they serve as predictors of higher-quality asthma care in minorities. Current asthma initiatives targeting minorities need better coordination and increased funding. Solutions to improve adherence to evidence-based clinical practice guidelines may be a potentially powerful tool for reducing or eliminating disparities in asthma care. For asthma care interventions and policies to be effective in targeting asthma care disparities, they must be implemented in a variety of health care settings.

Despite extensive research on the relationship between social capital and health, the specific pathways through which social capital is related to health have not been fully elucidated. Moreover, research has generally been cross-sectional, particularly in Canada, and hence not clearly attentive to the causal relationship between social capital and health. In this study we have examined the importance of multiple forms of individual social capital for the functional health status of adult Canadians, employing the Canadian National Population Health Survey (NPHS). We examine changes in health between 1996 and 2000, using individual level variables from 1996 as predictors. In our final model, the key aspect of social capital affecting changes in health status is being loved by someone. This is predicted by being married, frequency of family contacts, religious service attendance and being born in Canada. Insecurity about food also has a direct effect on changes in health status. The latter is affected by income, daily smoking and age. The results suggest that policies to support family stability and family unification, for example through immigration, and efforts to minimize the disruptions of divorce could contribute to the health of Canadians.

Purpose To quantify socioeconomic status and ethnic differences in risk for coronary heart disease (CHD) accrued from major risk factors in the United States. Methods Data came from the National Health and Nutrition Examination Survey 2001–2006. Outcomes examined were (a) 10-year risk for CHD events as predicted by the National Cholesterol Education Program Adult Treatment Panel III 2004 Updated Guidelines; and (b) the prevalence of the metabolic syndrome and overt diabetes mellitus (a CHD risk-equivalent). Results Strong inverse socioeconomic gradients with risk were present in all race/ethnicity groups except foreign-born Mexican American men, and were attenuated by controls for physical activity, smoking, and abdominal obesity. In contrast, race/ethnicity disparities were seen in some but not all socioeconomic strata, with some non-Hispanic Blacks and US-born Mexican Americans having higher risk and some foreign-born Mexican Americans having lower risk. Conclusions Disparities in cardiovascular risk in the United States are primarily related to socioeconomic status and less to race/ethnicity. Socioeconomically disadvantaged individuals should be targeted for lifestyle counseling and early screening for risk factors, regardless of race/ethnicity, to reduce social disparities in cardiovascular outcomes.

Limited research in health valuation analyzes samples with high proportions of racial/ethnic minorities within the United States. The primary objective was to explore patterns of health valuation across race/ethnicity using the Collaborative Psychiatric Epidemiology Surveys. A secondary objective was to analyze whether mental health disorder and immigrant status were associated with these estimates.Health valuation questions using different metrics (time and money) were analyzed. Ordered logit models stratified across poor and moderate health tested differences by race/ethnicity, with mental health disorder and immigrant status as covariates.Asians in moderate health and Latinos were willing to pay more for health than non-Latino whites. Asians in moderate health were willing to trade more time for health. Latinos in poor health were less willing to trade time and gave disproportionate zero-trade responses. Lifetime history of anxiety disorder was positively associated with both metrics. Immigrant status confounded money valuation for Asians in moderate health, and time valuation for Latinos in poor health.Health valuation estimates vary across race/ethnicity depending upon the metric. Time valuation scenarios appear less feasible for Latinos in poor health. More research is necessary to understand these differences and the role of immigrant status in health valuation.

Currently, the life expectancy of black Americans is about five years shorter than that of white Americans when factoring for gender. Poor patient compliance is often used as an explanation for why black people have worse health outcomes. The proof, however, is anecdotal and relies primarily on discourses about black people's general dysfunction. Black patients often respond in kind to problems they experience with health care access. They often conclude that the medical professionals they work with are racist. In most cases, neither of these explanations is correct. This paper argues that behavioral explanations for health care disparities shift attention away from structural issues, namely health care rationing and the limits of therapeutic medicine. The lack of an open discussion about the structural issues is part of the reason the goal initiated by the Clinton administration to end racial disparities by 2010, Healthy People 2010, largely failed.

We examine if commonly used distress measures, rates of psychiatric disorders, and chronic health conditions are affected by alternate measures of race-ethnicity for African Americans and Caribbean blacks. We examined two alternative self-identification measures to investigate if their influence might differ. A study on national household probability sample of non-institutionalized African Americans (n = 3,570) and blacks from Caribbean countries, who now live in the United States (n = 1,621), was conducted between February 2001 and June 2003, using a slightly modified version of the Composite International Diagnostic Interview. The method used to measure black race and ethnicity has influence on physical and mental health outcomes. The distributions of depressive symptoms are not affected, while the distributions of DSM IV disorders and chronic health conditions vary by race and ethnic self-identifications among the African American and Caribbean black populations. There are serious implications of using alternate measures of race-ethnicity on the distribution of physical and mental health morbidity among African Americans and Caribbean blacks. The conceptualization and assessment of race-ethnicity should be carefully considered when studying mental and physical health statuses and service needs in the American black population.

Culturally sensitive health interventions have proven to be vitally important for the elimination of the health disparities that Black Americans face. The purpose of this study was to illuminate the role and importance of health behavior racial typicality and racial identification in how Black Americans view and engage in health behaviors. Black Americans completed racial identity measures and rated a variety of both health-promoting and health-compromising behaviors on whether they were more typical of Blacks or Whites (i.e., racial typicality), personal importance, and frequency of engagement. Results indicated the extent to which health behaviors were viewed as relatively more descriptive of Blacks (rather than Whites) was associated with higher perceived importance and greater frequency of engagement, particularly among those reporting higher levels of nationalist racial identification. Finally, health behavior importance mediated the relationship between racial typicality of the behavior and engagement in the behavior. The results of the study are discussed in terms of their implications for providing empirical support for the necessity of culturally tailored interventions in eliminating Black American health disparities.

According to many reports, time in the United States negatively affects the health of Hispanic immigrants. However, little is known about the role of traditional health beliefs and practices in immigrants' underutilization of the US health care system. This descriptive, qualitative study utilized narrative interviews with 20 foreign-born Hispanic women of childbearing age to gain a better understanding of their existing health beliefs, health promotion practices, past health care experiences, and transition into a new society and health care system. Demographic data and scores on the short acculturation scale for Hispanics were also analyzed. Results highlight the importance of female social support for Hispanic women in making health care decisions; their dual use of US medical intervention and home and herbal remedies; and perceived racial discrimination on their health-care seeking behaviors and adherence to treatment modalities. Recommendations are included for professionals who provide health care to immigrant Hispanic women and their families.

This study was designed to compare the health perceptions of adults based on race (African American and Caucasian) and gender in the southern United States to determine if health perception contributed to health disparity between African Americans and Caucasians.A between-groups design was used in this study where African Americans and Caucasians completed an extensive health questionnaire and were compared for health perceptions and self-reported health status differences.Fewer African Americans (p.05; males, 55.8%; females, 68%) perceived their health to be good to excellent compared with Caucasians (males, 76.6%; females, 77.1%) and more had been diagnosed with 1 or more chronic diseases. Yet, more than three-quarters of all groups thought that their health care provider shared with them good to excellent information about their health, and 75.0% of the African American males and 71.5% of the Caucasian males and more than 62.0% of the African American and Caucasian females stated that medication cost was not a reason they did not take prescribed medications.Health perceptions of African Americans are often not consistent with their actual health, and this is especially true for African American males. Their perceptions appear to influence the value they place on health behaviors which may result in a reduced health status.

Background: Immigration has been and remains an important force shaping Canadian demography and identity. Health characteristics associated with the movement of large numbers of people have current and future implications for migrants, health practitioners and health systems. We aimed to identify demographics and health status data for migrant populations in Canada. Methods: We systematically searched Ovid MEDLINE (1996–2009) and other relevant web-based databases to examine immigrant selection processes, demographic statistics, health status from population studies and health service implications associated with migration to Canada. Studies and data were selected based on relevance, use of recent data and quality. Results: Currently, immigration represents two-thirds of Canada’s population growth, and immigrants make up more than 20% of the nation’s population. Both of these metrics are expected to increase. In general, newly arriving immigrants are healthier than the Canadian population, but over time there is a decline in this healthy immigrant effect. Immigrants and children born to new immigrants represent growing cohorts; in some metropolitan regions of Canada, they represent the majority of the patient population. Access to health services and health conditions of some migrant populations differ from patterns among Canadian-born patients, and these disparities have implications for preventive care and provision of health services. Interpretation: Because the health characteristics of some migrant populations vary according to their origin and experience, improved understanding of the scope and nature of the immigration process will help practitioners who will be increasingly involved in the care of immigrant populations, including prevention, early detection of disease and treatment.

Self-rated general health has been used widely in health surveys as a single-item measurement of health-rated quality of life. Heterogeneity in self-evaluation of health has been well documented, yet the causes of this heterogeneity are poorly understood. This study evaluated the moderating effects of age, aging, gender, race, education and income on the relationship between physical functioning and self-rated general health using social comparison theory as a guiding framework. A longitudinal mixed-effects regression model was used to analyze a cohort enrolled into the Health and Retirement Study in 1993 that was interviewed at baseline and during four subsequent waves. The results revealed that the association between physical functioning and self-rated general health is weaker among subgroups that tend to have lower health status; i.e., older individuals, non-Caucasians and less educated individuals. These findings suggest the usefulness of social comparison theory in explaining self-rated general health and provide the basis for future research.

Background Consumers with a mental illness have a significantly higher risk of physical health problems than the general population. The role of health behaviour beliefs and their part in the health of consumers with a mental illness has been poorly explored in the literature. Objectives To understand the relationship between physical health risk factors and health behaviour beliefs in consumers with schizophrenia. Design A cross-sectional survey study design using the European Health and Behaviour Survey and assessing ( n =99) consumer's blood pressure, waist circumference, body mass index, smoking history, exercise levels, demographics, family history of diabetes and cardiovascular disease was used. Settings The study was conducted in a 76-bed psychiatric facility located within a 550-bed metropolitan generalist hospital in Sydney, Australia. Participants Patients attending an outpatient clozapine clinic at the mental health service were asked to participate in the survey by a nurse working in the clinic during the study period. Results Of the 163 consumers asked to be involved in the study, n =99 agreed to participate. Mean waist circumference and body mass index for both males and females were significantly above normal population limits. Overall, consumer's beliefs toward their health on the European Health and Behaviour Survey were positive, having statistically significantly more positive attitudes to the statements ‘avoiding too much sugar', ‘drinking no alcohol' and ‘yearly blood pressure checks' than a previously published non-mental health consumer sample. Whilst having positive attitude toward their healthcare, consumers' physical health risk parameters were higher than general population norms. Conclusions Consumers with a mental illness have a significantly higher risk for serious physical health problems, yet possess high positive attitudes toward their physical health care. Models of care need to explore this contradiction within mental health services to improve patient outcomes.

As in other countries, public heath in the United States continues to evolve to ensure healthy families and communities as well as individuals. Great achievements in the control of infectious and chronic disease and injuries will need to be sustained while we face new challenges, including providing universal access to high quality healthcare as well as addressing the underlying behavioral risk factors and the social, physical and environmental determinants of health. Meeting these challenges will require strengthening the governmental and non-governmental public health systems and working closely with other sectors.

In many ways, lives of men and women have become more similar over recent years, as more and more women have entered the labour market. Despite this, differences remain. These, in turn, affect both patients' experiences of health and disease and the health services required.

Background National data do not account for race differences in health risks resulting from racial segregation or the correlation between race and socioeconomic status. Therefore, these data may inaccurately attribute differences in obesity to race rather than differing social context. The goal of this study was to investigate whether race disparities in obesity among women persist in a community of black people and white people living in the same social context with similar income. Methods Race disparities in obesity were examined among black women and white women living in the same social context with similar income, using the data from the Exploring Health Disparities in Integrated Communities-SWB (EHDIC-SWB) study, and these estimates were compared to national data (National Health Interview Survey) to determine if race disparities in obesity were attenuated among women in EHDIC-SWB. Obesity was based on participants9 self-reported height and weight. Logistic regression was used to examine the association between race and obesity. Results In the national sample, black women exhibited greater odds of being obese (OR 1.99, 95% CI 1.71 to 2.32) than white women after controlling for covariates. In the EHDIC-SWB sample, black women had similar odds of being obese (OR 1.25, 95% CI 0.90 to 1.75) as compared to white women, after adjusting for covariates. Conclusions There are no race disparities in obesity among poor, urban women sharing the same social context. Developing policies that focus on modifying social aspects of the environment may reduce disparities in obesity among low-income women living in urban communities.

As part of a women’s health center project, we reviewed 16 years of research to examine health disparities between women with and without disabilities. We reviewed MEDLINE-indexed articles between 1990 and 2005 with data on women with and without physical, sensory, intellectual, developmental, or psychiatric disabilities. Our review found few articles examining health disparities in chronic disease, cancer, mental health and substance abuse, preventive screening, health-promoting behaviors, and health services utilization. Results reflect apparent health disparities between women with and without disabilities. Challenges for the field exist in standardizing disability definitions and determining a future course for health disparity research and policy.