Racial and Ethnic Disparities in the Lifetime Prevalence of Homelessness in the United States

Homelessness in the United States is often examined using cross-sectional, point-in-time samples. Any experience of homelessness is a risk factor for adverse outcomes, so it is also useful to understand the incidence of homelessness over longer periods. We estimate the lifetime prevalence of homelessness among members of the Baby Boom cohort (n = 6,545) using the 2012 and 2014 waves of the Health and Retirement Study (HRS), a nationally representative survey of older Americans. Our analysis indicates that 6.2 % of respondents had a period of homelessness at some point in their lives. We also identify dramatic disparities in lifetime incidence of homelessness by racial and ethnic subgroups. Rates of homelessness were higher for non-Hispanic blacks (16.8 %) or Hispanics of any race (8.1 %) than for non-Hispanic whites (4.8 %; all differences significant with p < .05). The black-white gap, but not the Hispanic-white gap, remained significant after adjustment for covariates such as education, veteran status, and geographic region.     

HIV seroprevalence and risk behaviors among clients attending tuberculosis clinics in Miami-Dade County,Florida, 1989–1996

Miami-Dade County is a major HIV epicenter and a port of entry for immigrants from nations with high endemic rates of tuberculosis (TB). We analyzed data from an unlinked (blinded) serosurvey of clients attending four Miami TB clinics to elucidate the dynamic HIV seroprevalence patterns in relation to demographics and risk behaviors. Data were analyzed from 3,107 consecutive TB patients at four TB treatment clinics over eight years. Overall HIV seroprevalence was 23.6% with a significantly higher infection rate for men (26.6%) compared to women (17.3%) (p < 0.0001). In rank order, the HIV infection rates were 30.3% for black non-Hispanics, 24.7% for white non-Hispanics and 14.2% for Hispanics. U.S.-born clients had significantly higher HIV rates compared with foreign-born clients (32.4% vs. 18.5%, p < 0.0001). HIV rates declined over six years from (32.5% to 15.9%, p < 0.0001) with significant trends observed for men and women; and for blacks, whites and Hispanics. Seroprevalence was 15.7% for clients identifying heterosexual contact as their only risk. Highly significant increases in seroprevalence above this heterosexual-contact-only `baseline', were found for clients disclosing the following high-risk behaviors: male-to-male sex, drug injection, smoking crack cocaine, receiving or giving money/drugs for sex, and sexual contact with a drug injector or HIV-infected partner. While highly significant elevations in HIV seroprevalence were associated with each of these definitive risk behaviors, even the baseline HIV infection rate of 15.7% in heterosexual-contact-only clients was markedly higher than that of the general population. These findings underscore the need to obtain routine HIV serology on all TB patients.     

The Effects of Allostatic Load on Racial/Ethnic Mortality Differences in the United States

This study expands on previous findings of racial/ethnic and allostatic load (AL) associations with mortality by addressing whether differential AL levels by race/ethnicity may explain all-cause mortality differences. This study used data from the third National Health and Nutrition Survey public-use file, gathered between 1988 and 1994, with up to 18 years of mortality follow-up (n = 11,733). AL scores were calculated using a 10-biomarker algorithm based on clinically determined thresholds. Results of discrete-time hazard models suggest that AL is associated with increased mortality risks, independent of other factors, including race/ethnicity and SES. The results also suggest that the AL–mortality association is stronger for non-Hispanic blacks than for non-Hispanic whites, and that at low levels of AL observed mortality differences between non-Hispanic blacks and non-Hispanic whites are non-significant. These findings suggest that mortality differences between non-Hispanic blacks and non-Hispanic whites may be the result of how early life exposure causes premature aging and increased mortality risks. More attention to resource allocation and local environments is needed to understand why non-Hispanic blacks experience premature aging that leads to differential mortality risks compared to non-Hispanic whites.     

HIV seroprevalence and risk behaviors among clients attending a clinic for the homeless in Miami/Dade County,Florida, 1990–1996

In the early 1990s, HIV seroprevalence was highest at the Miami homeless clinic among 16 homeless sites participating in a nationwide sentinel survey. To examine dynamic seroprevalence patterns in Miami's homeless clients in relation to demographics and risk behaviors over six years, we analyzed data from an unlinked (blinded) serosurvey of clients attending the principal primary care clinic serving Miami's homeless. Data were from 3,797 medical encounters with homeless persons who, on their initial clinic visit within an annual survey period, received routine serologic testing and a risk behavior survey. Overall HIV seroprevalence was 15.9% and infection rates for men (16.4%) and women (14.5%) did not differ. Seroprevalence for blacks (19.9%) was significantly higher than for Hispanics (9.1%) or whites (8.3%) (p < 0.0001). Seroprevalence was 12.6% (35 times the national rate) for clients reporting heterosexual contact as their only risk. Significant increases in seroprevalence, above this heterosexual-contact-only 'baseline', were found for clients disclosing high-risk behaviors: male-to-male sex, drug injection, receiving or giving money/drugs for sex, and sexual contact with a drug injector or HIV-infected partner (p < 0.0001). Seroprevalence declined over six years from 23.2 to 7.2% (p < 0.0001). Significant downward trends were observed for men and women, blacks and Hispanics, men who have sex with men, and clients reporting heterosexual contact. The proportion of clients reporting high-risk behaviors decreased sharply (p < 0.0001). Elevated HIV seroprevalence in Miami's homeless clients was strongly associated with high-risk behaviors. Expansion of HIV prevention and HIV/drug treatment services for homeless persons is strongly recommended.     

Contraception,attitude-practice,and fertility differentials among US Hispanic,African–American and white women

Hispanic fertility (primarily among nationals from Mexico, Central and South America in the US) is higher today than it is in Mexico and the other nations of origin (Frank and Heuveline 2005). It persists into the second and third generations, with only moderate signs of declining to replacement. Meanwhile, the fertility rates of African–Americans, American Indians Cubans, and Puerto Ricans have all declined to replacement, only slightly above the non-Hispanic white population. This study attempts to clarify the question why African–American fertility has declined to replacement, but Hispanic fertility has not. The data used are from Cycle 6 of the National Survey of Family Growth (NSFG) of 2002. Differences in physiological or marital-status factors are found not to explain these fertility differences; however, there are significant differences in the practice of contraception during early childbearing years. Slightly less effective methods if contraception is used, and less recourse to abortion if a pregnancy is undesired, all imply higher fertility for Hispanic women. Underlying contraceptive behaviour are sets of attitudes and motives that favour, permit, or seek childbearing. A much higher percentage of Hispanic than African–American women report that they wanted their last birth and intend to have another in the future. Hispanic women of all socio-economic statuses are considerably more pronatal in their attitudes, particularly with respect to the births of first and second children.     

Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage Over the Life-Course

Health insurance coverage varies substantially between racial and ethnic groups in the United States. Compared to non-Hispanic whites, African Americans and people of Hispanic origin had persistently lower insurance coverage rates at all ages. This article describes age- and group-specific dynamics of insurance gain and loss that contribute to inequalities found in traditional cross-sectional studies. It uses the longitudinal 2008 Panel of the Survey of Income and Program Participation (N = 114,345) to describe age-specific patterns of disparity prior to the Affordable Care Act (ACA). A formal decomposition on increment–decrement life tables of insurance gain and loss shows that coverage disparities are predominately driven by minority groups’ greater propensity to lose the insurance that they already have. Uninsured African Americans were faster to gain insurance compared to non-Hispanic whites, but their high rates of insurance loss more than negated this advantage. Disparities from greater rates of loss among minority groups emerge rapidly at the end of childhood and persist throughout adulthood. This is especially true for African Americans and Hispanics, and their relative disadvantages again heighten in their 40s and 50s.     

Interracial Marriage and Self-Reported Health of Whites and Blacks in the United States

This study examines the self-reported health of 180,291 married non-Hispanic blacks and whites in interracial versus endogamous marriages. Data are from the National Health Interview Survey pooled over the period 1997–2013. The results from ordinal logistic regressions show that non-Hispanic whites intermarried with non-Hispanic blacks, non-Hispanic whites intermarried with non-Hispanic other races, and non-Hispanic white women with Hispanic husbands report significantly poorer health than their endogamous counterparts. Furthermore, non-Hispanic whites with non-Hispanic black spouses also fare worse than their interracially married peers with Hispanic spouses. In contrast, the self-reported health of married non-Hispanic blacks shows no significant difference between the interracially and the endogamously married. Our findings highlight the theoretical significance of spousal characteristics and couple-level contexts in the household production of health.     

Neighborhood Concentrated Disadvantage and Adult Mortality: Insights for Racial and Ethnic Differences

While racial and ethnic differences in mortality are pervasive and well documented, less is known about how mortality risk varies by neighborhood socioeconomic status across racial and ethnic identity. We conducted a prospective analysis on a sample of adults living at or below 300% poverty with 8 years of the National Health Interview Survey (N = 159,400) linked to 11,600 deaths to examine the association between neighborhood disadvantage and mortality for non-Hispanic whites, non-Hispanic blacks, and U.S.- and foreign-born Hispanics. Using multilevel logistic regression, we find that the probability of death from any cause for lower-income adults is higher in more-disadvantaged neighborhoods, compared to less-disadvantaged neighborhoods, but only for whites. The adjusted likelihood of death for blacks and foreign-born Hispanics is not associated with neighborhood disadvantage, and the likelihood of death for U.S.-born Hispanics is lower in more-disadvantaged neighborhoods. While future research and policy should focus on improving health-promoting resources in all communities, care should be given to better understanding why race/ethnic groups have differential mortality returns with respect to area-specific socioeconomic conditions.     

The Persistence of Racial Disadvantage: The Socioeconomic Attainments of Single-Race and Multi-Race Native Americans

Using data from the 2000 U.S. Census, we investigate the schooling and earnings of single-race and multi-race Native Americans. Our analysis distinguishes between Single-Race Native Americans, biracial White Native Americans, biracial Hispanic-White Native Americans, and biracial Black Native Americans. Further differentiating by gender, the results indicate significant variation in socioeconomic attainments across these different Native American groups although almost all of them are in some way disadvantaged relative to non-Hispanic, non-Native American whites. The most disadvantaged group tends to be Single-Race Native Americans who have the lowest levels of schooling as well as lower earnings relative to non-Hispanic, non-Native American whites who are comparable in terms of schooling, age, and other basic demographic characteristics. The results demonstrate notable differentials by the racial/ethnic type of Native American group as well as by gender. In the case of men, all of the Native American groups have clear socioeconomic disadvantages. One contrast is that migration slightly increases the earnings of men but it slightly decreases the earnings of women. We interpret these findings as underscoring how measured socioeconomic differentials between demographic groups are significantly affected by the categorization of race/ethnicity in surveys and by how persons choose to be enumerated in terms of those categories.     

Metropolitan Structure and Neighborhood Attainment: Exploring Intermetropolitan Variation in Racial Residential Segregation

Using data from the 1981, 1991, and 2001 waves of the Panel Study of Income Dynamics and several decennial censuses, we examine how characteristics of metropolitan areas are associated with black and white households’ neighborhood racial composition. Results from hierarchical linear models show that about 20% to 40% of the variation in the percentage of households’ tract population that is non-Hispanic white or non-Hispanic black exists across metropolitan areas. Over time, white households’ exposure to non-Hispanic white neighbors has declined, and their exposure to non-Hispanic black neighbors has increased; the reverse trends are observed for blacks. These trends cannot be attributed to changes in the ecological structure of metropolitan areas. Blacks have fewer white neighbors in large metropolitan areas containing sizable minority populations, and blacks have more white neighbors in metropolitan areas with high government employment. Whites have more black neighbors in metropolitan areas with high levels of government employment and ample new housing; whites have fewer black neighbors in metropolitan areas with a high level of municipal fragmentation. The association between metropolitan-area percentage black and tract percentage black is weaker among whites than among blacks, suggesting that whites are especially motivated to self-segregate in metropolitan areas with large black populations.     

Migration Selection, Protection, and Acculturation in Health: A Binational Perspective on Older Adults

In this article, we test for four potential explanations of the Hispanic Health Paradox (HHP): the “salmon bias,” emigration selection, and sociocultural protection originating in either destination or sending country. To reduce biases related to attrition by return migration typical of most U.S.-based surveys, we combine data from the Mexican Health and Aging Study in Mexico and the U.S. National Health Interview Survey to compare self-reported diabetes, hypertension, current smoking, obesity, and self-rated health among Mexican-born men ages 50 and older according to their previous U.S. migration experience, and U.S.-born Mexican Americans and non-Hispanic whites. We also use height, a measure of health during childhood, to bolster some of our tests. We find an immigrant advantage relative to non-Hispanic whites in hypertension and, to a lesser extent, obesity. We find evidence consistent with emigration selection and the salmon bias in height, hypertension, and self-rated health among immigrants with less than 15 years of experience in the United States; we do not find conclusive evidence consistent with sociocultural protection mechanisms. Finally, we illustrate that although ignoring return migrants when testing for the HHP and its mechanisms, as well as for the association between U.S. experience and health, exaggerates these associations, they are not fully driven by return migration-related attrition.     

Thailand population statistics

A few statistics on population for Thailand are reported for April 1, 1993. Total population is determined to be 58,113,000 of which 29,039,000 are males and 29,074,000 are females. The urban population was 17,852,000 and the rural population was 40,261,000. Regional distribution showed population in the north to be 9,443,000, in the northeast to be 19,590,000, in the south to be 7,107,000, and in the center excluding Bangkok to be 14,517,000. The population of Bangkok Metropolitan area was 7.5 million. Age distribution was 16.7 million under the age of 15 years, 19.4 million 6-21 years, 37.1 million 15-59 years, 4.2 million 60 years and older, and 35.3 million 20 years and older. There were 15,002,000 women in the reproductive ages of 15-44 years. The crude birth rate was 17.4/1000 population. The crude death rate was 5.9/1000 population. Infant mortality was 35.5/1000 live births. The natural growth rate was 1.15%. Life expectancy at birth was 66.4 years for males and 71.8 years for females. Life expectancy at 60 years was 17.9 years for males and 21.2 years for females. The total fertility rate was 2.2/woman. Contraceptive prevalence was 75.0%. Estimated population in the year 2012 is expected to be 71,310,000. A graph provides the projected number of living children per 1000 aged 12 years or younger who would be born to mothers with HIV infection and the number who would be orphans between 1990 and 2000. 350,000 children 12 years and under are expected to be born to HIV-infected mothers in the year 2000.     

Racial/Ethnic and Nativity Patterns of U.S. Adolescent and Young Adult Smoking

We document racial/ethnic and nativity differences in U.S. smoking patterns among adolescents and young adults using the 2006 Tobacco Use Supplement to the Current Population Survey (n = 44,202). Stratifying the sample by nativity status within five racial/ethnic groups (Asian American, Mexican–American, other Hispanic, non-Hispanic black, and non-Hispanic white), and further by sex and age, we compare self-reports of lifetime smoking across groups. U.S.-born non-Hispanic whites, particularly men, report smoking more than individuals in other racial/ethnic/nativity groups. Some groups of young women (e.g., foreign-born and U.S.-born Asian Americans, foreign-born and U.S.-born Mexican–Americans, and foreign-born blacks) report extremely low levels of smoking. Foreign-born females in all of the 25–34 year old racial/ethnic groups exhibit greater proportions of never smoking than their U.S.-born counterparts. Heavy/moderate and light/intermittent smoking is generally higher in the older age group among U.S.-born males and females, whereas smoking among the foreign-born of both sexes is low at younger ages and remains low at older ages. Taken together, these findings highlight the importance of considering both race/ethnicity and nativity in assessments of smoking patterns and in strategies to reduce overall U.S. smoking prevalence and smoking-attributable health disparities.     

Paradox Revisited: A Further Investigation of Racial/Ethnic Differences in Infant Mortality by Maternal Age

I reexamine the epidemiological paradox of lower overall infant mortality rates in the Mexican-origin population relative to U.S.-born non-Hispanic whites using the 1995–2002 U.S. NCHS linked cohort birth-infant death files. A comparison of infant mortality rates among U.S.-born non-Hispanic white and Mexican-origin mothers by maternal age reveals an infant survival advantage at younger maternal ages when compared with non-Hispanic whites, which is consistent with the Hispanic infant mortality paradox. However, this is accompanied by higher infant mortality at older ages for Mexican-origin women, which is consistent with the weathering framework. These patterns vary by nativity of the mother and do not change when rates are adjusted for risk factors. The relative infant survival disadvantage among Mexican-origin infants born to older mothers may be attributed to differences in the socioeconomic attributes of U.S.-born non-Hispanic white and Mexican-origin women.     

Erosion of Advantage: Decomposing Differences in Infant Mortality Rates Among Older Non-Hispanic White and Mexican-Origin Mothers

We build on findings from recent research showing an erosion of infant survival advantage in the Mexican-origin population relative to non-Hispanic whites at older maternal ages, with patterns that differ by nativity. This runs counter to the well-documented Hispanic infant mortality paradox and suggests that weathering and/or other negative health selection mechanisms may contribute to increasing disadvantage at older maternal ages. Using the National Center for Health Statistics (NCHS) cohort-linked birth and infant death files, we decompose the difference in Mexican-origin non-Hispanic white infant mortality at older maternal ages to better understand the contribution of selected medical and social risk factors to components of the difference. We find differences in the distribution and effects of risk factors across the three populations of interest. The infant mortality rate (IMR) gap between Mexican-origin women and non-Hispanic whites can be attributed to numerous offsetting factors, with inadequate prenatal care standing out as a major contributor to the IMR difference. Equalizing access to and utilization of prenatal care may provide one possible route to closing the IMR gap at older maternal ages.     

Gender comparisons of injection drug use practices in shooting galleries

Previous research studies and anecdotal evidence portray shooting galleries as locales that place injection drug users at great risk for HIV infection, drug use and violence. Collectively, these studies highlight the need to intervene with injectors who frequent shooting galleries. However, few researchers have studied an often-forgotten risk group – women injecting drug users who frequent shooting galleries – and compared their risk behaviors to their male counterparts. To address this gap in the research literature and to evaluate the functionality of the shooting gallery as a setting for HIV prevention, we collected data on risk practices from 201 injectors (101 men and 100 women) who were recruited from eight shooting galleries in Miami, Florida. Results indicate that, compared with men, women injectors engaged in a similar variety and frequency of injection risk behaviors and had more shooting companions. While only minor gender differences were apparent, relatively few injectors – male or female – adhered to current recommendations for needle hygiene practices. Needle hygiene practices existed equally among injectors of both sexes, however very few adhered to current recommendations. Furthermore, contrary to common images of shooting galleries, use of other drugs was infrequently reported, episodes of violence or victimization were uncommon, and sexual contact almost never occurred. Operators of shooting galleries, both men and women, indicated their willingness to participate in HIV prevention efforts. Implications of these findings for HIV intervention indicate that (1) there is a great need to intervene with both men and women IDUs who frequent shooting galleries and that (2) shooting galleries can be an optimal setting for HIV prevention.     

HIV Risk Behaviors in the U.S. Transgender Population: Prevalence and Predictors in a Large Internet Sample

To study the influence of gender on HIV risk, a sample of the U.S. transgender population (N = 1,229) was recruited via the Internet. HIV risk and prevalence were lower than reported in prior studies of localized, urban samples but higher than the overall U.S. population. Findings suggest that gender nonconformity alone does not itself result in markedly higher HIV risk. Sex with nontransgender men emerged as the strongest independent predictor of unsafe sex for both male-to-female (MtF) and female-to-male (FtM) participants. These sexual relationships constitute a process that may either affirm or problematize gender identity and sexual orientation, with different emphases for MtFs and FtMs, respectively.     

Race,wages, and assimilation among Cuban immigrants

This study uses data from the 1980 and 1990 Census and the 1994–2000 Current Population Survey to examine the determinants of earnings among male Cuban immigrants in the U.S. by race. Nonwhite Cuban immigrants earn about 15 percent less than whites, on average. Much of the racial wage gap is due to differences in educational attainment, age at migration, and years in the U.S., but the gap remains at almost 4 percent after controlling for such factors. Nonwhite Cuban immigrants also have lower returns to education than whites. A comparison to white, non-Hispanic U.S. natives indicates that nonwhite Cubans not only earn less initially than white Cubans on arrival in the U.S., but also do not significantly close the racial earnings gap over time.