The role of marriage in explaining racial and ethnic disparities in access to health care for men in the US

Reducing disparities in access to health care is a long-standing objective of the federal government. Building on research showing that marriage can provide important resources for obtaining needed health care, we suggest that racial and ethnic differences in marriage could explain persistent disparities in access. Using data from MEPS and NLSY we investigate the association between marriage and access to health care among men, and estimate the extent to which racial and ethnic differences in both the returns to marriage and marital rates explain differences in access and preventive service use. We find that marriage accounts for up to 24 % of racial and ethnic differences in access and preventive use. The returns to marriage for whites and blacks, however, are greater than that for Hispanics. We suggest that differences in spousal characteristics such as education and income could explain why whites and blacks benefit from marriage more than Hispanics. We find support for this hypothesis: differences in spousal characteristics account for up to 37 % of the gap in access and preventive use among married adults.     

Asian Americans and Mental Health Services

Abstract

Research in the 1970s and 1980s revealed that Asian Americans, compared with other ethnic groups, tended to under-utilize mental health services. This article is aimed at adding new information to the literature by examining data from the 1990s. The raw data comprised 97,212 total admissions representing 45,774 total individuals utilizing mental health services during a four-year period in San Diego County, California. By comparing our findings with previous research cases on utilization patterns of mental health services, new evidence is found about Asian Americans in terms of their (1) underrepresentation in mental health services, (2) presentation of more severe symptoms than those of other racial/ethnic groups when first seen at clinics, (3) lower dropout rates and higher average lengths of stay than other racial/ethnic groups, and (4) higher percentages of using day treatment and outpatient programs but lower percentage of using inpatient programs.     

Income inequality, race, and child well-being: an aggregate analysis in the 50 United States

Interest in income inequality as a predictor of health has exploded since the mid-1990s. Recent analyses suggest, however, that the effect of income inequality on population health is not robust to a control for the racial composition of the population. That observation raises two interpretational questions. First, does income inequality have an independent effect on population health? Second, what does the effect of racial composition on population health mean? We use data from the Urban Institute's Assessing the New Federalism project and the Kids Count Databook to evaluate the aggregate effects of income inequality on diverse measures of child well-being (e.g., infant mortality, high school drop-out rates) in the 50 U.S. states. We replicate the finding that, net of the racial/ethnic composition of the population, the effects of income inequality are not significant. Moreover, the effects of racial composition on child well-being appear to be compositional (i.e., they reflect the less positive outcomes observed among racial/ethnic minorities) rather than contextual (i.e., representing the independent influence of social context). Whereas cross-level effects are still possible, our results cast doubt on the health relevance of these aggregate characteristics of the population.     

Infant health, race/ethnicity, and early educational outcomes using the ECLS-B

Using data from the "Early Childhood Longitudinal Study—Birth Cohort," this article emphasizes the central role of poor infant health as a mechanism in the formation of early educational disparities. Results indicate that the varying prevalence of poor infant health across racial/ethnic groups explains a significant portion of the black disadvantage and a moderate portion of the Asian advantage relative to whites in math and reading skills at age four. Results also demonstrate that infant health is an equal opportunity offender across social groups as children with poor health are equally disadvantaged in terms of early cognitive development, regardless of racial/ethnic status. Overall, results indicate that health at birth has important consequences for individual educational achievement and racial/ethnic disparities in cognitive development and school readiness.     

Adolescent cigarette smoking in U.S. racial/ethnic subgroups: findings from the National Education Longitudinal Study

Using nationally representative data for 16,454 8th graders and 13,840 10th graders, we explore racial/ethnic differences in "daily cigarette initiation," beginning to smoke on a daily basis between baseline interviews and reinterviews conducted two years later. In both samples, the initiation rate among whites is more than double the rate among blacks and higher than rates among Asian/Pacific Islanders and Hispanics. Risk factors at the individual, family, and peer-group levels of analysis do not explain most racial/ethnic differences. We develop alternative hypotheses by extending theories of cigarette use to the school level, and we test them using multilevel models: Consistent with social learning theory, cigarette risk among blacks and Hispanics decreases as the percentage of racial/ethnic minority students in the school increases. Consistent with strain theory, cigarette risk increases with the academic competitiveness of the school--especially among females--after controlling for the adolescent's academic performance.     

Resurgent Ethnicity among Asian Americans: Ethnic Neighborhood Context and Health

In this study I investigate the associations of neighborhood socioeconomic and social environments with the health of Asian Americans living in both Asian ethnic neighborhoods and non-Asian neighborhoods. I use a sample of 1962 Asian Americans from the National Latino and Asian American Study (NLAAS, 2003-04). Three key findings emerge. First, absolute levels of socioeconomic and social resources do not differ greatly between the Asian ethnic neighborhoods and non-Asian neighborhoods in which Asian Americans live. Second, the ethnic neighborhood context conditions the effects of neighborhood education on health so that higher neighborhood education is related to better self-rated health among Asian Americans only when they live in Asian ethnic neighborhoods. Finally, the social environment, measured by everyday discrimination and social cohesion, does not differ in its health effects for individuals living in Asian ethnic and non-Asian neighborhoods. Together, these findings illuminate the complex ways that racial and ethnic neighborhood concentration impacts health.     

Intermarriage,Ethnic Identity,and Perceived Social Standing Among Asian Women in the United States

This study investigates the consequences of Asian women's intermarriage—whether it is associated with higher social standing and lower ethnic identity, using data on Asian women (N = 589) from the National Latino and Asian American Survey (NLAAS). The socioeconomic status of partners of women who intermarried and partners of women who married men of the same ethnicity are compared. The potential associations between intermarriage and two subjective measures—ethnic identity and perceived social standing—are explored. The study rejects the hypothesis based on the conventional belief that Asian women in the United States find “better” partners with higher socioeconomic status from other racial or ethnic groups. The findings support the view that marital assimilation leads to identificational assimilation and demonstrate that intermarriage is not associated with higher perceived social standing. The results suggest that educational and occupational endogamy plays a larger role in Asian women's intermarriage than social exchange.     

Diversity Within Diversity

Summary

Asian American elderly form a heterogeneous group with respect to immigration history, ethnic/cultural background, socioeconomic position, and health and mental health status. This paper provides an overview of the internal heterogeneity within the Asian American elderly population and identifies those who experience multiple stressors affecting their quality of life. Then it discusses barriers to formal service utilization as well as strengths and deficits of informal support systems. To better serve Asian American elders with their multiple needs for health, mental health, and social services, increased funding is recommended for research on this group, diversification of social service programs in coethnic communities, and increased cultural competence in non-Asian social service agencies.     

Rethinking a universal framework in the psychiatric symptom-disorder relationship

Research on disparities in health and services should include a critical examination of how social, cultural, and contextual factors affect the connection between symptoms and psychiatric disorders. Systematic differences in this connection by these factors will mean that clinicians using a universalist approach to disorders may make more diagnostic errors for certain patients (e.g., ethnic minorities, the poor). Based on the literature on normative clinical decision-making, this study tests for whether the effect of specific psychiatric disorders on key symptoms is the same for certain groups of the population. The data come from the National Comorbidity Survey. Conditional probabilities of disorders and symptoms, the elements feeding into clinical decision-making, are calculated and tested for equivalence across various racial/ethnic, educational, income, and gender groups. We find some significant differences in the relation of key symptoms to disorders across groups. These findings should encourage testing relativistic frameworks in diagnostic nosology as a step to improve clinical decision-making and reduce diagnostic and treatment disparities in mental health services.     

Racial differences in depression trajectories among older women: socioeconomic, family, and health influences

Despite recent increases in life course research on mental illness, important questions remain about the social patterning of, and explanations for, depression trajectories among women in later life. The authors investigate competing theoretical frameworks for the age patterning of depressive symptoms and the physical health, socioeconomic, and family mechanisms differentiating black and white women. Using data from the National Longitudinal Survey of Mature Women, the authors use linear mixed (growth curve) models to estimate trajectories of distress for women aged 52 to 81 years (N = 3,182). The results demonstrate that: (1) there are persistently higher levels of depressive symptoms among black women relative to white women throughout later life; (2) physical health and socioeconomic status account for much of the racial gap in depressive symptoms; and (3) marital status moderates race differences in distress. The findings highlight the importance of physical health, family, and socioeconomic status in racial disparities in mental health.     

Health-related quality of life in older adults: Testing the double jeopardy hypothesis

The double jeopardy hypothesis posits that racial minority elderly suffer a double disadvantage to health due to the interactive effects of age and race. Empirical examinations have found mixed support for the proposition that the aging process heightens the health disadvantage for racial minorities compared to whites. Race-by-age differences are tested using a health-related quality of life measure that has been largely overlooked in previous double jeopardy analyses. The outcome, number of days in poor physical health during the past month, quantifies day-to-day physical well-being in a way not available to standard measures of morbidity and mortality. The data are from the 2003 California Health Interview Survey (CHIS) and were analyzed using negative binomial regression. Results show that the magnitude of differences in the number of physically unhealthy days for African Americans and Hispanics compared to their white counterparts is much larger in the elderly strata than that observed between younger groups. Additionally, social characteristics do not fully explain why racial differences in poor physical health days are greater at older ages. A life course perspective is proposed as one possible explanation for the double jeopardy finding. The results indicate a need to consider health-related quality of life outcomes when examining racial/ethnic health disparities among the elderly population. The appendix presents cross-validation of the 2003 CHIS results with the 2005 CHIS and the findings are replicated.     

Are pregnant women happier? Racial and ethnic differences in the relationship between pregnancy and life satisfaction in the United States

This paper examines the relationship between pregnancy and life satisfaction for US women of childbearing age using a large sample from the 2005 to 2009 waves of the Behavioral Risk Factor Surveillance System. The results show strong differences by race and ethnicity. Pregnancy has a significant positive correlation with happiness for Whites and Hispanics, but no relationship for Blacks. This differential in the marginal effect of pregnancy is in addition to a general decrease in satisfaction for Black women, independent of being pregnant. The results cannot be explained by differences in other demographics such age, income, education, or physical health status. Within each racial/ethnic group, the results are consistent across different categories for all these characteristics. Racial and ethnic differences in the effects of pregnancy on support from others can partly explain this result. For Whites and Hispanic women, pregnancy increases their feelings of social and emotional support from others, while pregnant Black women report lower levels of social and emotional support than non-pregnant Black women.     

Man Up,Man Down: Race–Ethnicity and the Hierarchy of Men in Female‐Dominated Work

Scholars have largely overlooked the significance of race and socioeconomic status in determining which men traverse gender boundaries into female‐dominated, typically devalued, work. Examining the gender composition of the jobs that racial minority men occupy provides critical insights into mechanisms of broader racial disparities in the labor market—in addition to stalled occupational desegregation trends between men and women. Using nationally representative data from the three‐year American Community Survey (2010–2012), we examine racial/ethnic and educational differences in which men occupy gender‐typed jobs. We find that racial minority men are more likely than white men to occupy female‐dominated jobs at all levels of education—except highly educated Asian/Pacific Islander men—and that these patterns are more pronounced at lower levels of education. These findings have implications for broader occupational inequality patterns among men as well as between men and women.     

THEORIES OF ETHNIC SOCIAL DISTANCE: COMPARATIVE EMPIRICAL TESTS FOR THREE DISTINCT ETHNIC GROUPS

Social science theories of ethnic division and antipathy are tested empirically using survey and zip code data for representative samples of whites, African Americans, and Mexican Americans in Texas. Ordered logistic regression tests estimate the effects of theoretically relevant variables on probabilities of racial and ethnic out-group social distance. Competing social science theories of ethnic and racial social distance are tested for multiple groups. Statistical support is found for group attachment/identity theories and realistic group conflict theories in explaining variance in out-group social closeness. The socioeconomic theory was not found to be an important predictor of out-group social closeness.     

Rethinking empirical approaches to racial segregation

Within empirical approaches to racial residential segregation, there has been a tendency to draw on the work of or influenced by Robert E. Park and his ecological hypothesis to explore social and spatial relations between members of different ethnic and racial groups, thus framing research within a race relations paradigm. This has promoted an analysis which naturalizes racial differences but which also sidelines structural considerations. In turn this approach has also fed into political discourses on segregation, at times supporting more reactionary positions. This paper seeks to address this debate by considering whether emphasis on minority ethnic concentration sidelines the more pertinent issue of concentration in deprived areas, suggesting that neighbourhood deprivation as a measure can be more easily aligned with structural conditions which have influenced the settlement and historical experience of many ethnic minority communities. Specifically, I consider the extent to which a measure of neighbourhood deprivation is more important than the ethnic composition of an area for thinking about the distribution of inequalities in unemployment (as one example of socio‐economic inequality). Using multilevel logistic regression I find neighbourhood income deprivation to be more important than levels of co‐ethnic concentration for explaining ethnic differences in unemployment. The findings imply that neighbourhood deprivation is significantly more important for considering inequalities in unemployment for ethnic minorities than the ethnic composition of an area.     

Patients' race, ethnicity, language, and trust in a physician

We examine whether racial/ethnic/language-based variation in measured levels of patients' trust in a physician depends on the survey items used to measure that trust. Survey items include: (1) a direct measure of patients' trust that the doctor will put the patient's medical needs above all other considerations, and (2) three indirect measures of trust asking about expectations for specific physician behaviors, including referring to a specialist, being influenced by insurance rules, and performing unnecessary tests. Using a national survey, we find lower scores on indirect measures of trust in a physician among minority users of health care services than among non-Hispanic white users. In contrast, the direct measure of trust does not differ among non-Hispanic whites and nonwhites once we control for potential confounding factors. The results indicate that racial/ethnic/language-based differences exist primarily in those aspects of patients' trust in a physician that reflect specific physician behaviors.     

Racial/ethnic disparities in prior mental health service use among incarcerated adolescents

Research on racial and ethnic disparities in mental health and substance abuse service use among incarcerated youth in the U.S. is inconclusive. This cross-sectional study adds to our understanding of racial and ethnic disparities by examining the prior use of mental health and substance abuse services among incarcerated juveniles. Guided by Andersen's behavioral model of health service utilization, a series of logistic regression analyses were conducted on a non-probability sample of 13–19 year-old youth in two residential facilities for juvenile offenders in Western Pennsylvania (N = 181). Black and Hispanic youth were less likely than White youth to have used mental health and substance abuse services, even when controlling for predisposing, enabling, and need factors. Additional analyses revealed that these differences did not hold across all service types, specifically with regards to outpatient service use. Significant differences did exist, however, in the prior use of inpatient mental health and substance abuse services. This suggests that White youth are often funneled into the mental health system, while youth of color enter the justice system. Implications for racial/ethnic disproportionality in service use and justice system involvement are discussed.     

Well‐being among adolescent boys

Most studies on mental health in the adult population have found a significant relationship between mental health and social class. No study has thoroughly examined this relationship in the adolescent population. This article, based on the Bachman, O'Malley, and Johnston “Youth in Transition” data set, tests the social class/mental state relationship among adolescents. Three separate measures—well‐being, psychiatric symptoms, and depression—are used to indicate mental state. Social class is based on a composite measure of socioeconomic level that exists within the “Youth in Transition” data set. Surprisingly, no relationship was found. These results persisted even when more traditional measures of social class based on parents’ education and the Duncan ranking of the fathers’ occupations were substituted for socioeconomic level. An alternative explanation supporting social stress is discussed in light of Thornberry's developmental hypothesis.     

On and Off the Reservation: A Discussion of the Social,Physical, and Mental Health Indicators of Suicide in the Native American Community

This article reviews explanations for the heightened rates of suicide among the US Native American population. Particular attention is afforded to the social, historical, physical, and mental health stressors that may contribute to such high rates. A great deal of scientific research has centered on determining and analyzing the many socio‐demographic indicators of suicide. Studies at the intersection of race/ethnicity and suicide have drawn attention to the fact that certain groups have higher suicide rates than others. At the pinnacle of groups most susceptible to suicide are Native Americans, followed closely by White non‐Hispanics, and then all other racial/ethnic groups ( Sederer 1994 ). As of 2008, Native Americans were more than twice as likely to commit suicide as Blacks, Hispanics, or Asian‐Americans. The analysis begins with an exploration of potential explanations behind the alarming rates of suicide within the Native American community, followed by critiques of the various theories.     

Race/Ethnicity,Attitudes, and Living With Parents During Young Adulthood

Non‐White young adults are more likely to live with their parents throughout their 20s, more likely to return home after going away to college, and less likely to leave again after returning. Scholars have speculated that subcultural differences in attitudes toward marriage and family play a key role in generating racial/ethnic differences in rates of coresidence with parents among young adults. Data from the National Education Longitudinal Survey of 1988 (N = 11,228) were analyzed in order to test this hypothesis. Attitudes toward marriage and family were significantly associated with coresidence, especially among young men, but did not substantially account for racial/ethnic differences in living arrangements. Among young non‐White women and young Black men, higher rates of coresidence were related to differences from Whites in socioeconomic or marital status (and sometimes both) that were largely independent of differences in attitudes toward marriage and family.