The Grand Challenge of Reducing Gender and Racial/Ethnic Disparities in Service Access and Needs Among Adults with Alcohol Misuse

This study examined the impact of the Affordable Care Act (ACA) on gender and racial and ethnic disparities in accessing and using behavioral health services among a national sample of adults who reported heavy or binge alcohol use (n = 52,496) and those with alcohol use disorder (AUD; n = 22,966). Difference-in-differences models estimated service-related disparities before (2008–2009) and after (2011–2014) health care reform. A subanalysis was conducted before (2011–2013) and after (2014) full implementation of the ACA. Asian subgroups among respondents with heavy or binge drinking were excluded from substance use disorder (SUD) treatment and unmet need outcome models due to insufficient cell size. Among heavy or binge drinkers, unmet SUD treatment need decreased among Black women and increased among Black men. Mental health (MH) treatment decreased among Asian men, whereas unmet MH treatment need decreased among Hispanic men. MH treatment increased among Hispanic women with AUD. Although there were improvements in service use and access among Black and Hispanic women and Hispanic men, there were setbacks among Black and Asian men. Implications for social workers are discussed.     

Socioeconomic Correlates of Current and Regular Smoking Among College Students in Rhode Island

Objective: The objective of this study was to determine how sociodemographic variables, in particular socioeconomic status, correlate with current and regular smoking among college students in Rhode Island. Participants and Methods: Over a 4-year period (academic year 2000-2001 to 2003-2004), the authors examined sociodemographic correlates of cigarette use among 3,984 students aged 17 to 24 years from 10 colleges and universities in Rhode Island. Results: One-third of participants (32.0%) had smoked a cigarette in the 30 days preceding the questionnaire. Findings from a pair of logistic regression models indicated that participants from upper-income families were more likely to be current smokers—although not regular smokers—suggesting that the effect of socioeconomic status on smoking is partly dependent on the level of addiction. In addition, freshmen were more likely to be current and regular smokers than were upperclassmen, and white students were most likely to be regular smokers. Conclusions: The frequency of college students who reported that they first tried smoking and first smoked regularly while in college increased from freshman to senior year, indicating that the college years are a vulnerable period for smoking initiation and habituation.     

Examining Outpatient Health Care Utilization Among Adults with Severe or Profound Intellectual Disabilities Living in an Urban Setting

Abstract

The present study examined the health status and outpatient health care utilization among 52 adults with severe or profound intellectual disabilities (IDs) living with their families or in group homes in New York City. Bivariate and regression analyses among demographic variables, medical conditions, health care utilization, and type of living situation were conducted. Findings indicate that demographic factors andhealth statuses were similar regardless of living situation, except for ageand the presence of Down Syndrome, that is, younger people and people with Down Syndrome were more likely to live with family than in group homes. The results indicated that regardless of where they lived, individuals had high rates (70%) of overweight/obesity. The mean number of internal medicine, specialty medicine, nursing, and total clinic visits were significantly higher for those living in group homes compared to those living with their families. The findings and their implications are discussed with respect to social work policy and practice.     

Labor Market Disparities Between African Americans and Afro Caribbeans: Reexamining the Role of Immigrant Selectivity

Black immigrants from the Caribbean have long attained greater labor market success than African Americans. The most recent studies show that Afro Caribbeans have earnings that are approximately 16% greater than African Americans and that Afro Caribbeans are as much as 21% more likely to be employed than African Americans. The most prominent explanation for greater Afro Caribbean success is that, because they have chosen to migrate, Afro Caribbeans are positively self‐selected on characteristics that are key for success in the U.S. labor market. Proponents of immigrant selectivity argue that migrants have greater levels of both hard and soft skills than nonmigrants. Using data from the National Survey of American Life—the first social survey to provide a nationally representative sample of both African Americans and Afro Caribbeans—this study finds that Afro Caribbeans have greater hard skills than African Americans but split the difference on two measures of soft skills: African Americans and Afro Caribbeans are matched on John Henryism, but African Americans have greater personal mastery than Afro Caribbeans. Contrary to expectations, controlling for differences in hard and soft skills does not provide for a meaningful reduction in labor market disparities between African Americans and Afro Caribbeans.     

Prospects for Examining Perceived Choice and Control Among Older Adults Living With Family

This review aims to advance the field of aging research by examining coresidence with family, race, and other characteristics as potential determinants of choice and control in older adults. Living with family likely impacts perceived choice and control, as household members often work together to make decisions about care. Race may also influence choice and control, as an accumulation of challenges and opportunities create unique life experiences. This review considers human agency in its examination of choice and control. Suggestions for future research will be discussed.     

Depression and Religiosity in African American and White Community-Dwelling Older Adults

SUMMARY

This research examined the extent to which religiosity was predictive of level of depression, even after controlling for race, gender, social support, income sufficiency, and physical health. Data were collected using in-home interviews conducted from 1999 to 2001 with 1,000 adults age 65 to 106. Subjects were recruited from a stratified, random sample of Medicare beneficiaries age 65 and older in five central Alabama counties (three rural and two urban). The sample was stratified by county, race, and sex and included balanced numbers of African American males and females and White males and females. Highly religious persons had lower levels of depression, even when controlling for other known covariates, β = -.16, t(972) p < .001. Females reported higher levels of depression, β = .07, t(972) p < .05. Although race was unrelated to depression in the model including gender and religiosity only, African Americans reported fewer symptoms of depression than did Whites when social support, income sufficiency, and physical health were added to the model, β= -.08, t(972) p < .01. Results suggest the importance of health and social service professionals' drawing upon older adults' positive spirituality in professional interventions to prevent and treat depression.     

Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Young African American Males: Barriers to Access to Health Care

African American males continue to experience an unacceptable and disproportionate number of health disparities when compared with other racial and ethnic groups. Young African American males can expect to live the least amount of time when compared to any other ethnic minority or racial sub-group. Understanding the obstacles and barriers that impede access to health care and wellness services among young African American males is essential to begin the process of decreasing health disparities. The goal of this qualitative study was to explore and identify the barriers experienced by young African American males in accessing health care services while also creating a rare opportunity to give voice to young African American males. The study results indicate that young African American males have multiple perceptions of barriers to health care services. Their perceptions fell into three categories: the negative impact of environment or community, lack of finances or no insurance, and distrust of medical practices associated with race history resulting in accessing healthcare as a last resort. Additional research is needed to craft community-based programs to: a) educate young African American males on the importance of preventative strategies to maintain wellness; and b) ensure that the appropriate medical and wellness services are available and reaching young African American males in need.     

Health Status and Health Care Services Among Older Persons in India

Summary

India is characterized by significant rural-based living, population heterogeneity, financial constraints, and reverse sex ratio. Traditions of joint families, life-long physical activity, vegetarianism, and social and spiritual enrichment, all known to promote healthy aging, are widely prevalent. With the increasing pace of population aging, the health of older persons in India has been the focus of recent attention. Existing data indicate a significant morbidity among the aged, much of which may remain subclinical. Considerable variations in morbidity exist with respect to gender, place of residence (rural vs. urban), and socioeconomic status. Rapid demographic transition without a concomitant epidemiological transition is responsible for the dual load of infections and degenerative diseases in older persons, these being common causes of death. Most age-related morbidity is preventable. Health promotion and cost-effective interventions based on the primary health care approach over a lifelong course, especially at the village level, will greatly help towards achieving the goal of healthy aging. The rapidly changing socioeconomic scenario in India also calls for appropriate policy actions to achieve this goal.     

The Association Between the New Rural Cooperative Medical System and Health Care Seeking Behavior Among Middle-Aged and Older Chinese

The new rural cooperative medical system (NCMS) is the primary form of social insurance in rural China. This study aims to explore how the NCMS influences the health care seeking behaviors of middle-aged and older Chinese, considering the family and community contexts. A series of multi-level (three-level) models using data from the first wave of the China Health and Retirement Longitudinal Study (CHARLS) are used. We find that the presence of NCMS coverage has a statistically significant association with seeking inpatient and outpatient care but not physical checkups among middle-aged and older rural Chinese: Rural residents insured by NCMS were more likely to seek inpatient and outpatient care than people who were not insured. Other factors at the individual level (such as self-perceived health and number of doctor-diagnosed chronic diseases), the family level (such as living arrangements and household expenditures), and the community level (such as the presence of township hospitals within the community) are also significant predictors of health care seeking behaviors.     

An Analysis of Health Care Disparities and Subsequent Public Policy Initiatives

Racial and ethnic health disparities are a major clinical, public health, and societal problem in the United States. This article provides a historical analysis of the identification and progression of health disparities between Whites and minorities from 1989 to 2011. Key causes of health disparities are addressed, including the lack of culturally competent care, health insurance, and medical homes. Federal legislation that mandated federal health agencies to implement a plan to eliminate disparities is discussed.     

Student Nurse Education in a University Health Center

Abstract

Objective: This study assessed the association between ethnicity and family socioeconomic status (SES) as it relates to the prevalence of vaginal douching among female undergraduates in a university community. Participants and Methods: This was a cross-sectional survey conducted between September 2011 and February 2012 among 1,535 female undergraduates using a semistructured behavioral questionnaire adapted by the authors from previous research related to vaginal douching practice. Results: The overall prevalence of vaginal douching was 79.35% and the practice was significantly associated with the mother's age, ethnicity, low SES (educational level, occupation, and monthly income), and area of residence. The father's age and SES were statistically nonsignificant. Conclusion: Ethnicity and low SES of mothers were significantly associated with a higher prevalence of douching in daughters. These factors should be considered among others in any intervention to discourage vaginal douching among college women.     

Socioeconomic Status and Health Disparity in the United States

Abstract

Low socioeconomic status (SES) has been associated with high rates of many chronic diseases. This study was a cluster analysis of data from 9,830 adults in the 1994-96 Continuing Survey of Food Intakes by the Individuals (1994-96 CSFII) in order to characterize more fully the biologic and social factors that might be associated with chronic diseases. The study employed cluster analysis to define three SES groups (low, middle, and high) based on income, education, age, gender, and race. A significant increase was found in self-reported diabetes, hypertension, heart disease, obesity, and stroke across these groups, being highest in the lowest SES group. Results revealed that health disparity in the U.S. may be substantial, with some population groups bearing a disproportionate burden of chronic diseases.     

Group Images and Possible Selves Among Adolescents: Linking Stereotypes to Expectations by Race and Ethnicity

The study is motivated by the differential alignment of educational achievement and aspirations along race and ethnic lines. Specifically, black and Hispanic students have comparable educational aspirations relative towhites, yet earn much lower grades and test scores. On the other hand, compared to white students, Asian youth overperform in their grades and test scores given their aspirations. Focus groups and interviews of high school students reveal prevalent stereotypes that link ethnic group membership to academic ability as well as other skills. Specifically, Asian youth are believed to be especially gifted in their academic abilities, while blacks are seen as less successful in academic endeavors. Stereotypes about Hispanics focused less on their academic performance and more on their occupational concentration in manual labor. These images form the reference point for the construction of success among ethnic youth; specifically, blacks speak of academic goals in terms of avoiding failure, Hispanic youth aim primarily to avoid factory or manual labor, and Asians focus on keeping up with high expectations of their academic pursuits. Hence, I argue that adolescents define their goals primarily in terms of the stereotypical images attached to their ethnic group. Specifically, minority youth focused on avoiding failure defined by prevalent group stereotypes. Moreover, these images maintain racially and ethnically segregated extracurricular activities that reinforce segregated peer groups. Finally, socialization with same-race peers promote comparable conceptions of success within racial groups.     

Caregiving and Care Receiving Among Older Lesbian,Gay, and Bisexual Adults

Abstract

A survey research design was used to examine caregiving, care receiving, and the willingness to provide caregiving among lesbian, gay, and bisexual (LGB) older adults recruited from community groups. More than one-third reported receiving care from people other than healthcare providers in the last five years; more than two thirds provided care to other LGB adults. Those who had given care were more likely than non-caregivers to give care in the future. The gender and sexual orientation of recipients of future help affected participants' willingness to provide care, as did their education level and style of coping. Participants willing to provide care to older LGB adults perceived such experiences to be less burdensome and more personally rewarding than those who were un-willing to provide care.     

Racial/Ethnic Patterns of Kindergarten School Enrollment in the United States

Enrollment into unequal schools at the start of formal education is an important mechanism for the reproduction of racial/ethnic educational inequalities. We examine whether there are racial/ethnic differences in school enrollment options at kindergarten, the start of schooling. We use nationally representative data from the Early Childhood Longitudinal Study‐Birth Cohort (ECLS‐B) to model whether parents seek information about their child's school before enrolling, whether parents move to a location so that a child can attend a certain school, or whether parents enroll their child in a school other than the assigned public school. Results indicate that enrollment patterns differ greatly across race/ethnicity. Whereas Black families are the most likely to seek information on a school's performance, White families are the most likely to use the elite option of choosing their residential location to access a particular school. These differences persist when controlling for socioeconomic status and sociogeographic location. Kindergarten enrollment patterns preserve the advantages of White families, perpetuating racial/ethnic disparities through multiple institutions and contributing to intergenerational processes of social stratification. Research should continue to examine specific educational consequences of housing inequities and residential segregation.     

Depression and Mental-Health Service Utilization Among Women in WIC

Abstract

This exploratory 2003 study of 261 women in WIC addresses depression and mental-health service utilization in six race/ethnic-immigrant/migrant groups and factors amenable to change. Using the PrimeMD-PHQ, island-born Puerto Rican women had the highest prevalence of subthreshold depressive syndrome (27.8%); African American women had the highest prevalence of major depressive syndrome (21.3%); proportionately more White women used mental-health services (41.9%). The odds for major depressive syndrome among those with no one to help with childcare were almost four times greater than those with help. The odds of mental-health service use among those with indirect exposure to mental-health care were four times greater than those without such exposure. Implications for intervention and further research are discussed.     

Inequitable Access to Health Services for Older Adults with Diabetes: Potential Solutions on a State Level

Diabetes is a serious global public health challenge. The cost for health services for diabetes care has increased 41% over the past 5 years. Despite escalating health expenditure, the United States continues to have higher rates of diabetes than many other developed countries. There is a need for health care reform in the United States not only in reducing health care costs but also in improving the quality of preventative care. This study presents the testing of a multilevel model investigating variables on the individual and state levels to develop a better understanding of the most important contextual pathways that can lead to providing older adults (50+) with type 2 diabetes with the recommended preventative quality care they require. The model was tested using a three-level repeated cross-sectional design with data from various existing data sources, using a national sample of 181,870 individuals aged 50 years and older. Results showed that differences in state health care systems contributed to inequitable access. Specifically, in a state where there was a higher percentage of adults 65 and older coupled with a shortage of health care professionals, the likelihood of receiving the recommended preventative quality care decreased. Also, older adults living in states with a higher percentage of people with diagnosed diabetes but with a lower-than-average annual per capita health care expenditure fared worse in receiving quality preventative care. Last, older adults in wealthy states with higher percentages of uninsured people had the lowest odds of receiving quality preventative care. Health care reform, similar to what is currently promoted by the Patient Protection and Affordable Care Act of 2010, is recommended to improve the performance of all health care systems in all states.     

Health‐Related Parenting Among U.S. Families and Young Children's Physical Health

Parenting is a constellation of behaviors, yet investigations of the link between parenting and children's health typically focus on singular behaviors. Thus, patterns of health‐related parenting among U.S. families, associations between patterns and children's physical health, and the prevalence of such patterns among different sociodemographic groups remain unknown. Applying latent class analysis to the Early Childhood Longitudinal Study–Birth Cohort (2001; N = 8,550) revealed 6 parenting patterns. The pattern characterized by high levels of television watching was associated with the worst overall health; the pattern characterized by the highest consumption of food and amount of outdoor play was linked to the highest odds of obesity. Children of less‐educated mothers and Black mothers were more likely to experience both of these patterns than the patterns associated with the best child health, but these patterns did not differ for Hispanics (vs. Whites). Income differences only appeared for patterns associated with children's general health.