more research (and action) is needed. hispanic paradox higher poverty, less formal education, less...
TRANSCRIPT
“More research (and action) is needed”
“Hispanic paradox”
• Higher poverty, less formal education, less healthcare
• Better health; lower mortality rates
“Hispanic paradox”
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Heartdisease
Stroke Cancer
Hispanic Male
Non-HispanicWhite MaleAfricanAmerican Male
Hispanic paradox
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Heart disease Stroke Cancer
Hispanic Female
Non-Hispanic WhiteFemaleAfrican AmericanFemale
“Hispanic paradox”
• “Healthy migrant” hypothesis
• Barrio effect?
• “Salmon bias”?
• Acculturation risk?
Not the end of story
• Higher disability rates? • Higher diagnosed Type II diabetes over
age 20 and mortality (Mexican Americans)
• Higher obesity (Mexican Americans)• More stomach, liver, gallbladder and
cervical cancers• Worse asthma (Puerto Ricans)• Less asthma (Mexican Americans)
Hispanic paradox
• Kyriakos S. Markides, University of Texas Medical Branch, Galveston
• Jeanne Ruiz, Ph.D., R.N., assistant professor at The University of Texas Health Science Center at San Antonio (UTHSCSA)
• Smith and Bradshaw, University of Texas School of Public Health
Why are Latinos with diabetes twice as likely to die from it as
non-Hispanic whites?
• Genetics?• Culture?• Environment?• Less access to care?• Racism?
Which Latinos?
Which Latinos?
• Mexican, Puerto Rican, Venezuelan, Cuban?
• Immigrant or second-generation?
• Wealthy or poor?
• Urban or rural?
Which Latinos?
• Who decides?
• Researchers don’t all agree
• Self-ID can change
Whose genes?
• Studies to define “genetic ancestry”
• Body composition (NY Puerto Ricans)
• Asthma (SF Mexican-Americans, NY Puerto Ricans)
Environment
• NIEHS environmental genome project
- environmental conditions, plus
- genetic susceptibility
Psychosocial factors
• Work environment (job stress, shift work);
• personality and negative emotions (anger, hostility, anxiety, and depression);
• protective effects of social networks and support.
• Hope and curiosity
(Ichiro Kawachi on heart disease)
Social determinants
• Income inequality
• Social cohesion and mutual trust
• Inequalities in political participation, civic engagement
• Residential segregation
(Kawachi, Harvard University)
Racism
Unequal treatment
-- Studies on unconscious decision-making
Racialized living
-- Allostatic load (stress response)
-- Social rank
“More research is needed”
• Countries of origin
• Regional differences (multi-center studies)
• Lengths of U.S. residence
• Research in countries of origin
Ichiro KawachiThomas A. LaVeist
Brian Smedley, ed.
Leading causes of death among Latinos (2003)
1) Diseases of heart 28,2982) Malignant neoplasms 24,0703) Unintentional injuries h 10,4184) Cerebrovascular diseases 6,6585) Diabetes mellitus 6,1796) Chronic liver disease and cirrhosis 3,3827) Homicide 3,3558) Chronic lower respiratory diseases 3,1749) Influenza and pneumonia 2,94810)Certain conditions originating in the perinatal
period 2,628
Asthma
Worst air pollution
SHORT-TERM PARTICULATES
(soot)• Los Angeles-Long
Beach-Riverside• Bakersfield• Fresno-Madera
OZONE (smog)• Bakersfield,CA • Los Angeles-Long
Beach-Riverside• Visalia-
Porterville,CA
Community stories
• Community organizers
• City and county health officers
• Community food assessment (PolicyLink)
• Center on Alcohol Marketing and Youth
• Community Action to Fight Asthma
(regional project info)
http://www.calasthma.org/
Asthma
• Who is being counted?
• Access to medications in school
• School air safety
• Air pollution regulations
• Corporate responsibility
• Land use laws
AIDS/HIV
• 14 percent of the population; 20 percent of AIDS diagnoses
• 32 percent U.S. born; 18 percent Puerto Rican; 17 percent Mexican
AIDS – issues
• Transmission patterns
• Education
• Access to care
• Community concern
AIDS -resources
• Kaiser Family Foundation
• GLAAD (http://www.glaad.org/publications/resource_doc_detail.php?id=3101)
• Bienestar(http://www.bienestar.org)
• Proyecto Contra SIDA Por Vida
• San Francisco AIDS Foundation(http://www.sfaf.org/beta/2005_win/mortality.html)
How to find stories
Evaluating stories
Consider the source
Evaluating a study
• Who are the participants (subjects)
• Number of participants (sample size)
• Institution
• P value
• Standard deviation (SD)
• Mean, median
Examples
SPJ Rainbow Sourcebook
and Diversity Toolbox