Racial/Ethnic Disparities in Mental Health Service Use for Older Foster Youth and Foster Care Alumni

Studies have shown that foster care alumni have disproportionally high rates of poor mental health outcomes compared to the general population. The purpose of this study was to examine differences in mental health service use for Latino, African American, and White youth while in foster care and upon exit from the foster care system. Secondary data were used to identify youth 1 year prior to exiting the foster care system (N?=?934) and 1 year after exit from the foster care system (N?=?433). Racial/ethnic disparities in mental health service use upon exit from the foster care system were found, with Latino youth using the least amount of services after foster care exit. Racial/ethnic service disparities in type of services used were also found. Findings suggest that a lack of support (e.g., mandatory or voluntary) may be significant in overcoming challenges in the continuation or disruption of services.     

Women's Health Care

No abstract available for this article.     

Racial/Ethnic Disparities in Health: The Role of Lifestyle,Education, Income,and Wealth

Abstract

This article addresses the persistent relationship between race/ethnicity, SES, health-related lifestyle behaviors, and self-reported health using data from the 1995 National Health Interview Survey and its topical supplements. Through a series of models, we found that both SES (education, income, home ownership, and house and business monetary value) and health-related lifestyle behaviors (physical activity, nutrition awareness, and smoking) contribute to racial/ethnic disparities in self-reported health. Further, the impact of education on smoking behavior and self-reported health differs by race/ethnicity, with non-Hispanic whites receiving greater health benefits from education than African Americans and Hispanics. Although SES and lifestyle behaviors are indirect paths through which race/ethnicity affects health, the relationship between SES and health also is shaped by racial/ethnic status.     

Risk Assessment Tools and Racial/Ethnic Disparities in the Juvenile Justice System

This paper addresses the possible consequences for racial and ethnic disparities of the growing reliance on risk assessment tools for sentencing in juvenile justice systems. These tools consider both legal factors (i.e. criminal history) and personal background factors (e.g. household composition, parents’ arrest history, the youth’s mental health, attitudes, school status, and current employment status) to predict the likelihood of recidivism, which then informs punishment decisions. Because they decontextualize race, the associations between race and risk factors linked to race could possibly create higher risk scores and harsher punishments for minority youth.     

Racial/Ethnic Differences in Court Referred Pathways to Mental Health Services for Children in Foster Care

Racial/Ethnic disparity in placement patterns and service utilization among children in foster care has been documented in a variety of studies. This study examined the role of the court process in referring children in foster care to mental health services and tested for racial/ethnic differences in the patterns of referral and service use. Court records for 142 children ages 2–16, representing Caucasian, African American, and Hispanic racial/ethnic groups were reviewed. Results indicate that the court process does play a significant role in referring children to services. Significant differences by race and ethnicity in mental health service utilization prior to the child's protective placement, as well as service orders, and post-placement service use were identified. Caucasian youth were more likely to receive orders for psychotherapy and to have documented use of psychotherapy than were African American and Hispanic youth, even when the possible confounding effects of age and type of maltreatment were controlled. Implications for the effective delivery of supportive services to those children most in need are discussed.     

College Women's Gynecological Health Care Practices and Preferences

Abstract

Panic disorder is characterized by recurrent, sudden, often unprovoked attacks of intense, diffuse autonomic discharge accompanied by severe anxiety as distinguished from ordinary generalized anxiety. Recent research indicates a biochemical abnormality that predisposes some individuals to the disorder, which generally begins in young adulthood and affects women twice as frequently as men. Untreated panic disorder follows a chronic, fluctuating course. Complications include hypochondriasis, anticipatory anxiety, phobic avoidance and agoraphobia, abuse of alcohol and sedative drugs, and depression.

Diagnosis is complicated by patients' complaints of physical rather than emotional symptoms. Workups can be avoided if the physician considers the diagnosis in apparently healthy young adults who present with episodic cardiac, gastrointestinal, neurologic, and/or respiratory symptoms. The physician needs to be able to distinguish the symptoms of panic disorder from those of ordinary anxiety and also to rule out medical conditions that mimic panic disorder.

Neither conventional benzodiazepines nor psychotherapy alone is very effective in stopping panic attacks, but alprazolam, imipramine, and phenelzine are all highly effective. Alprazolam has fewer troublesome side effects, but patience and perseverance are necessary to reach therapeutic levels with all three drugs. Inadequate dosage is the most common cause of treatment failure. Most patients do well once their attacks are controlled and do not require close follow-up. Patient education is an important part of long-term management because relapses are common.     

Women's Status,Fertility Decline,and Women's Health in Developing Countries: Direct and Indirect Influences of Social Status on Health

Abstract In the present three‐wave study of 72 developing countries, we use growth curves to examine how changes in fertility and level of fertility mediate the effect of women's social status on women's health as measured by infant mortality, maternal mortality, and female life expectancy. We find that level of female education, average age at marriage, and the percentage of married women using contraceptives influence attained level of fertility, with controls for economic growth and dependency status. Change in fertility, however, is predicted only by average age at marriage and by level of education. Change in fertility, in turn, predicts improvement in all three women's health indicators, while the level of fertility predicts improvement in maternal mortality and infant mortality. In addition to the mediating effects of fertility, both age at marriage and education contribute directly to reduced level of infant mortality; level of primary education contributes directly to reduced levels of maternal mortality; and use of contraceptives contributes directly to improvement in female life expectancy. These findings provide strong evidence that women's social status makes direct contributions to women's health which cannot be attributed to economic growth, dependency status, and/or the mediating effects of level and change in fertility. The policy implication for developing countries is that greater gains can be made in women's health, particularly maternal health, by improving women's social status, especially in rural areas.     

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.     

Disparities in Access to Health Care Among Middle-Aged and Older Adults with Disabilities

Disability is increasing among middle-aged adults and, reversing earlier trends, increasing among older adults as well. Disability is experienced disproportionately by Black and lower socioeconomic status (SES) individuals. We used Medical Expenditure Panel Survey data to examine health care disparities in access to health care for middle-aged (31 to 64 years of age) and older (65+ years of age) adults with disabilities by race and ethnicity, education, and income (n = 13,174). Using logistic regression, we examined three measures of potential (e.g., usual source of care), and three measures of realized (e.g., counseling related to smoking) access. Middle-aged and older minority individuals with disabilities had lower relative risks of having usual sources of care and higher relative risks of having suboptimal usual sources of care (e.g., a place rather than a person) than White adults with disabilities. There were SES effects observed for middle-aged adults with disabilities across most measures that were, for certain measures, more pronounced than SES effects among older adults with disabilities. These findings are important, since health resources (e.g., a usual source of care) may mediate relations among disability, morbidity, and mortality. Policy actions that may mitigate the disparities we observed include financial incentives to support access to an optimal usual source of care and mechanisms to foster behavioral interventions related to smoking and exercise. Ensuring that these actions address the specific concerns of individuals with disabilities, such as physical accessibility and provider cultural competency, is essential.     

Racial and Ethnic Determinants of Interracial and Ethnic Trust

The purpose of this cross-sectional study was to discern which individual factors are associated with interracial/ethnic trust among a national probability sample of African Americans, Latinos, and non-Hispanic whites. Using national data from the 2000 Community Benchmark Survey, the multiple regression results indicate that, even after controlling for education and income, African Americans and Latinos reported significantly lower levels of interracial/ethnic trust than did non-Hispanic whites. Additionally, separate regression equations indicate that predictors associated with interracial/ethnic trust varied by racial and ethnic group. Implications and future research are discussed.     

Racial and Ethnic Residential Patterns in Canada

The aim of this study is to understand how city factors explain racial and ethnic residential patterns in contemporary multiethnic cities. We examined residential patterns among 17 groups in 12 Canadian cities. The results suggest that we should be cautious in taking factors derived from literature based largely on European experiences at the beginning of the last century and applying them uniformly to different groups in Canadian multiethnic cities. Our results show that the residential segregation of different racial and ethnic groups is affected by different sets of city factors. In addition, most factors suggested in that literature do not relate to the segregation patterns among visible minority groups.     

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.     

The Impact of Comedy on Racial and Ethnic Discourse

An overwhelming facet of race literature suggests that American society has entered an era of colorblindness; where instead of perpetuating racist ideology through blatant discriminatory legislation, racial differences are either understated or ignored entirely. These new racial processes are reflected in the policies of major social institutions, but also within popular culture. Yet, as made evident by the success of comedians such as Chris Rock and Dave Chappelle, stand‐up comedy challenges acceptable racial discourse, placing race in the forefront. Comedy persists as a facet of popular culture where racial difference is made apparent, yet ironically the art of comedy is usually overlooked by sociologists. What is lacking in the humor research is an understanding of how comedy creates an environment where race can be spoken about directly, and often times harshly. Through the analysis of focus groups, this study finds evidence to suggest that racial and ethnic comedy serves to both reinforce and wane racial and ethnic stereotypes, similarities, and differences. After watching stand‐up comedy clips of popular comedians, black and white respondents show both agreement and disagreement on the following: (1) the offensiveness of ethnic comedy, (2) stereotypes and perceived truths, and (3) the utility of ethnic comedy in everyday interactions. These findings are helpful in understanding how comedy serves as one of the few openly racialized facets of popular culture as well as uncovering some of the ways in which race works within the culture of a self‐proclaimed colorblind society.     

Racial and Ethnic Differences in Family Caregiving in California

Abstract

Family caregivers are the main source of long-term care for older persons in the United States. At the same time, cultural values and beliefs shape decisions surrounding who provides care and whether families use formal support interventions to assist the caregiver. The current article examines how the family caregiving experience differs among racial and ethnic groups in terms of caregiver characteristics, service utilization, caregiver strain, and coping mechanisms. Telephone interviews were conducted in English and Spanish with a random sample of 1,643 respondents in California who provide care to someone age 50 or over. Bivariate analyses showed evidence of ethnic differences in the demographic characteristics of caregivers, intensity of care provided, caregiver health, level of financial strain, religious service attendance, formal service utilization and barriers to formal services. Odds ratios showed that White and African American caregivers were about two times as likely to use formal caregiver services as were Asian/Native Hawaiian/Pacific Islander and Latina American caregivers. Implied by these findings is the need for further understanding of caregiver service needs among diverse racial and ethnic groups.     

Marriage and Women's Health in Japan

In this study, we evaluate alternative hypotheses about the potentially harmful or beneficial effects of marriage on women's health and examine the factors underlying observed relationships between marriage and health. Using data from the Japanese Panel Survey of Consumers, an annual survey of a nationally representative sample of Japanese women (N = 1,610), our study advances current scholarship on marriage and health by focusing on a context characterized by a high degree of gender inequality. Results from models employing different approaches to the potential role of health‐related selection into marriage consistently indicate that marriage is associated with better mental and physical health and that the lower levels of employment among married women play an important role in explaining this relationship. Our findings highlight the importance of considering how the specific pathways linking marriage and health may vary across societies with different gender and institutional contexts.     

Racial and Ethnic Differences in Problem Gambling among College Students

The college years are a formative period where the risk for development of problematic gambling is high. Research examining racial and ethnic differences in gambling behaviors has been limited and inconsistent. The aims of this study were to examine racial and ethnic differences in problem gambling among a large sample of college students. Undergraduates (N = 3058) from a large southern university completed an online screening questionnaire which included demographics, gambling frequency, gambling expenditure (i.e. money lost) in the previous 6 months, and the South Oaks Gambling Screen (SOGS). Negative binomial regression results indicated that Asian participants gambled less frequently than participants who were Caucasian or Hispanic/Latino(a), but spent more money than participants who were African-American (AA)/Black or Hispanic/Latino(a). A significantly larger proportion of Asian students met probable pathological gambling criteria (SOGS 5+; 7.8 %) and at-risk gambling criteria (SOGS 3+; 16.3 %)) than Caucasian (5.2; 10.1 %), AA/Black (3.9; 10.2 %), or Hispanic/Latino(a) (3.6; 9.4 %) students. Additionally, a significantly larger proportion of Asian students endorsed problematic gambling indicators such as lying about losses, feeling guilty about gambling, feeling like they had a gambling problem, being criticized for their gambling, feeling like they couldn’t stop gambling, losing time from school or work due to gambling, having a family history of problem gambling, and arguing with close others about their gambling than Caucasian, AA/Black or Hispanic/Latino(a) students. Results suggest that Asian students may be a high-risk sub-group of college gamblers, and that there is a critical need for targeted interventions for this population.     

[Mis]Placing Race in Biomedical Clinical Context: Racial Categories,Medical Research,and the Reproduction of Health Disparities

Notions of racial categories as biologically significant remain persistently salient to oppressive hegemonic ideas about race, despite scientific evidence to the contrary. Biomedical and epidemiological researchers are both professionally socialized and institutionally mandated to utilize racial categories in their research design, implementation, and interpretation processes, under the premise that doing so can facilitate the development of measures to combat racial disparities in health outcomes and care. However, when aggregate data intended to illustrate racial disparities are inappropriately extrapolated to the individualized context of biomedical clinical practice, essentialist notions of racial difference are reified. This paper integrates interdisciplinary perspectives from the fields of sociology, medicine, public health, epidemiology, evolutionary biology, and biological anthropology to explore the ideological, historical, and structural contexts through which the conflation of racial categories as indicators of group‐level inequities in health outcomes and care experiences with essentialized notions of biological differences between racial groups may inform disparate care at the level of individual patient encounter in biomedical clinical practice.     

Program Knowledge and Racial Disparities in Savings Outcomes in a Child Development Account Experiment

This study investigated whether participants’ program knowledge was associated with savings outcomes in Child Development Accounts and whether differences in program knowledge explained racial and ethnic disparities in savings outcomes. We used data collected from White, Black, American Indian, and Hispanic treatment participants in the SEED for Oklahoma Kids (SEED OK) experiment (N?=?1126). Analysis results indicated that knowledge of SEED OK program features was low, especially among members of minority groups. Logit and Tobit regressions showed that program knowledge was positively related to the likelihood of holding a SEED OK account and to individual savings amounts. Gaps in program knowledge were associated with racial disparities in savings outcomes. If Whites and minorities had the same levels of program knowledge, gaps in savings outcomes would have significantly narrowed. The findings call for the development of policy designs and communication tools to enhance knowledge of program features among households with Child Development Accounts, especially racial- and ethnic-minority households.