The present study identifies risk factors for intimate partner violence (IPV) initiation and persistence over three years in a high psychosocial risk Asian American and Pacific Islander (AAPI) sample of women with children living in Hawaii.
378 women in a 3-year relationship with the same partner reported IPV experiences at baseline and three years later. Baseline risk factors included characteristics of each woman, her partner, and their relationship. Bivariate and multivariate regression models were conducted to assess the influence of risk factors on the likelihood of experiencing IPV initiation and persistence.
Of women who experienced no physical violence at baseline, 43% reported IPV initiation. Of women who did experience physical violence at baseline, 57% reported IPV persistence. Being unemployed and reporting poor mental health at baseline are important risk factors for experiencing IPV initiation. Reporting frequent physical violence at baseline increases the likelihood of experiencing IPV persistence. Asian women were significantly less likely to report IPV persistence than other groups of women.
Our study indicates that among a high psychosocial risk sample of AAPI women there are different risk factors for IPV initiation and persistence. Future prevention and screening efforts may need to focus on these risk factors.
Despite reports of increasing non-medical prescription drug use, relatively few studies have systematically evaluated the prevalence and correlates of non-medical prescription drug use, particularly in populations that might be especially vulnerable (e.g., injection drug users [IDUs]). We examined factors associated with non-medical prescription drug use among a community-based cohort of current and former IDUs in Baltimore (The ALIVE Study). We conducted a cross-sectional analysis of data from cohort participants that responded to a survey that included questions on non-medical prescription drug use between 2005–06 (n=1320). Non-medical prescription drug use was considered to be use of any of the following: Opiates (Oxycontin, Percocet), Benzodiazepines or Clonidine, purchased on the street and taken orally within the last six months. Data on other covariates of interest (e.g., demographics, substance use, general health) was obtained through a standardized interview. The median age was 46 years; 66% were male, 85% were African-American. Twenty one percent reported any non-medical prescription drug use; 12% reported using more than one drug. Non-medical use of opiates was most common (17%). In multivariate analysis, non-medical prescription drug use was significantly associated with Caucasian race (prevalence ratio [PR]: 1.79), self-reported bodily pain (PR: 1.58), hazardous alcohol use (PR: 1.47), marijuana use (PR: 1.65), non-injection cocaine/heroin use (PR: 1.70), diverted use of buprenorphine (PR: 1.51) or methadone (PR: 2.51), and active injection drug use (PR: 3.50; p<0.05 for all). The association between bodily pain and non-medical prescription drug use was stronger among persons that were not using substances (marijuana, injecting drugs, snorting/smoking heroin, cocaine, using crack) as compared to those using these substances. The high prevalence of non-medical prescription drug use among this population warrants further research and action. Information on the risks of nonmedical prescription drug use especially overdose, should be incorporated into interventions targeted at IDUs.
non-medical prescription drug use; poly-drug use; injection drug users; substance abuse; Baltimore
We examined developmental trajectories of marijuana use among a cohort of urban African Americans followed from first grade to mid adulthood. We compared risk factors in childhood and adolescence and consequences in mid adulthood across trajectory groups.
Using semiparametric group-based mixture modeling, five marijuana trajectories for men (n=455) and four trajectories for women (n=495) were identified extending from adolescence to young adulthood (age 32). We labeled the four trajectory groups similar for men and women “abstainers,” “adolescent only users,” “early adulthood decliners,” and “persistent users.” We named the unique fifth group for men “late starters.”
Multivariate multinomial logistic regressions show that childhood problem behaviors, adolescent family involvement, and dropping out of high school differentiated trajectory membership. Analyses comparing the trajectory groups on behavioral, social, and health outcomes at age 42 revealed that for both men and women, those in the persistent trajectory had the most problems, and those in the early adult decliner group also had specific problems. Male late starters also had poor outcomes.
The findings point to the value of identifying specific patterns of substance use over the life course and understanding the differences in their correlates and consequences. The implications of these findings are discussed.
African Americans; marijuana use trajectories; semiparametric group-based approach; prospective study; antecedents; consequences
The objective of this study is to obtain and discuss in-depth information on mental health problems, including the status, barriers, and potential solutions in 1.5 and 2nd generation Asian American young adults. As a part of the Health Needs Assessment project, the researchers conducted two focus groups with 17 young adults (mainly 1.5 or 2nd generation) from eight Asian American communities (Asian Indian, Cambodian, Chinese, Indonesian, Korean, Taiwanese, Thai, and Vietnamese) in Montgomery County, Maryland. We developed a moderator's guide with open-ended questions and used it to collect qualitative data. Using a software, we organized and identified emergent themes by major categories. Participants reported a several common sources of stress that affect the mental health of Asian American young adults including: pressure to meet parental expectations of high academic achievement and live up to the “model minority” stereotype; difficulty of balancing two different cultures and communicating with parents; family obligations based on the strong family values; and discrimination or isolation due to racial or cultural background. Young Asian Americans tend not to seek professional help for their mental health problems; instead they use personal support networks—close friends, significant others, and religious community. Participants suggested that Asian cultural norms that do not consider mental problems important, and associated stigma of seeking professional care might undermine their mental health help seeking behavior. Our findings support a need for delivering culturally appropriate programs to raise awareness of mental health and cultural training for health providers to deliver culturally appropriate care.
Mental health; Asian American; Young adults; Immigrant health; 1.5 generation; 2nd generation
Research indicates that engagement in community organizations is positively associated with health, particularly among aging populations, yet few studies have examined in detail the influence of community engagement (CE) on later health among African Americans. This study provides a longitudinal assessment of the effects of CE over a 22-year period on physical and mental health among a population of urban African American women.
Data were from the Woodlawn Study, a prospective study of children and their families from an African American community in Chicago. Mothers who were assessed in 1975 and in 1997 reported involvement in religious and secular organizations. These reports were combined to create a five-category construct: no CE, early CE only, late CE only, persistent CE (either type at both assessments), and diverse and persistent CE (both types at both assessments). Multivariate regression analyses with multiple imputation (for N=680) estimated the impact of CE on four measures of physical and mental health: SF-36 physical functioning, self-rated health, anxious mood, and depressed mood.
Women with late-only, persistent, and diverse and persistent CE reported significantly better health compared to non-involved women. Persistently engaged women were less likely to report anxious or depressed mood than those with early CE only. Persistent and diverse CE was more highly associated with better physical functioning than was persistent CE. Results highlight the strong positive link between health and concurrent, persistent, and diverse CE among African American women.
USA; social integration; community engagement; physical health; mental health; African American; aging; longitudinal; women; ethnicity
Although there has been much discussion about the persistence of poverty and welfare receipt among child-rearing women in the US, little is known about long-term patterns of poverty and welfare receipt or what differentiates those who remain on welfare from those who do not. Furthermore, are there distinctions between child-rearing women who are poor but not on welfare from those who do receive welfare? This study examined trajectories of welfare receipt and poverty among African-American women (n = 680) followed from 1966 to 1997. A semiparametric group-based approach revealed four trajectories of welfare receipt: no welfare (64.2%), early leavers (12.7%), late leavers (10.1%), and persistent welfare recipients (10.1%). The “no welfare” group was further divided into a poverty group and a not poverty group to distinguish predictors of welfare from predictors of poverty. Multivariate analyses revealed differences in predictors of trajectory groups in terms of education, physical and psychological health, and social integration. In addition, earlier chronic illness and social integration were important predictors to differentiate between long-term users (i.e., late leavers, persistent recipients) and short-term users (i.e., early leavers). Trajectories did not differ in teenage motherhood, substance use, or family history of welfare receipt. Implications for public policy are discussed.
Welfare trajectory; Semiparametric growth mixture model; African-American women; Social integration; Psychological distress; Social roles
Low-income urban whites in the United States have largely gone unexamined in health disparities research. In this study, we explored cancer prevention behaviors in this population. We compared data on whites with low socioeconomic status (SES) from the 2003 Exploring Health Disparities in Integrated Communities Study in Southwest Baltimore, Maryland (EHDIC-SWB) with nationally representative data for low SES white respondents from the 2003 National Health Interview Survey (NHIS). Rates for health behaviors and health indicators for whites from the EHDIC-SWB study as compared to NHIS prevalence estimates were as follows: current cigarette smoking, 59% (31% nationally); current regular drinking, 5% (5% nationally); overweight, 26% (32% nationally); obesity, 30% (22% nationally); mammography in the past 2 years, 50% (57% nationally); Pap smear in the past 2 years, 64% (68% nationally); screening for colon cancer in the past 2 years, 41% (30% nationally); and fair or poor self-reported health, 37% (22% nationally). Several cancer prevention behaviors and health indicators for white EHDIC-SWB respondents were far from the Healthy People 2010 objectives. This study provides rare estimates of cancer-related health and health care measures in an understudied population in the United States. Findings illustrate the need for further examination of health behaviors in low SES white urban populations who may share health risks with their poor minority urban counterparts.
Urban health; Socioeconomic status; Preventive health; Health disparities; White
Using longitudinal data from the Woodlawn Project (N=680), this study examined how patterns of living arrangements among a community cohort of African American mothers were associated with later physical and emotional health. We identified eight patterns of stability and transition in living arrangements during the childrearing years. Health outcomes include SF-36 Physical Functioning, SF-36 Bodily Pain, depressed mood, and anxious mood. Specific patterns of living arrangements were related to later health, controlling for age, earlier health, education, and poverty. Poverty explained many, but not all, of the relationships between living arrangements and health. Findings underscored the benefits of social support and social integration and highlighted the negative effects of marital dissolution on health.
African Americans; family structure; health and illness; longitudinal; poverty; social support
We compare life course characteristics of a cohort of African American women (N=457) by their smoking status at age 42: never smoker (34.1%), former smoker (27.8%), or current smoker (38.1%). The Woodlawn population from which our sample is drawn has been followed from first grade (1966–67) to mid adulthood (2002–3) and is a cohort of children from a disadvantaged Chicago community.
Examination of the effects of cumulative disadvantage on smoking behavior showed that nearly half of women who first lived in poverty as children, dropped out of school, became teen mothers, and were poor as young adults currently smoked; less than 22% of women with none of these difficulties were current smokers. Regression analyses focusing on smoking and evidence of social disadvantage in childhood, adolescence, and young adulthood showed that women with more education were much less likely to be current smokers. Women reporting low parental supervision in adolescence and less frequent church attendance in young adulthood and those whose mothers’ reported regular smoking were significantly more likely to be current smokers. Poverty and marital status in young adulthood varied significantly among smoking categories in bivariate relationships, but not in final multivariate regression models.
Few other studies have examined smoking careers with data from age 6 to 42, comparing social disadvantage characteristics over the life course. While marital status, church involvement and parental supervision are not usually included as measures of socioeconomic status, they represent advantages in terms of social capital and should be considered mechanisms for transmitting disparities.
African Americans; smoking; life course; longitudinal study; SES; social disadvantage
Social connectedness has been shown to be related to health and well-being, yet there is little knowledge about its developmental and intergenerational origins. We examine the childhood, family, and neighbourhood origins of social connectedness in young adulthood in a cohort of African American children (N=1242) from Chicago followed since 1966. The five measures of social connections are: political involvement, organizational membership, church involvement, family ties, and friend ties. In multivariate analyses, predictors of social connectedness were found across the life course: first grade social adaptation to school, childhood family resources, family social participation, adult neighbourhood characteristics, social class, and marital status. We conclude that adult social connections have roots in childhood behaviour and social involvement, family resources and family social connections as well as one’s own resources and the neighbourhood where one lives.
Life Course Study; Longitudinal Research; Social Connections; African American; Intergenerational; multi-Level; Neighbourhood; Social Class; Family; Social Adaptation
The purpose of this study was to investigate the cumulative effects of poverty and family stressors to the later life functional status of African American women.
We used longitudinal data covering a 30-year period for a cohort of 553 African American women with common life experiences. Interviews were conducted with these women as young mothers, as mothers of adolescents, and in early old age (two thirds aged 60+). We classified women as high, usual, or low functioning by using physical and mental health indicators. We examined both timing and duration of poverty and family stressors.
Initially these women were largely healthy, but health declines were steeper and occurred earlier for those who were low functioning in later life. Persistent poverty was detrimental to functioning at older ages, as was persistent family stress. Women who left poverty early did not differ in later life functioning from women who were never poor.
Despite similar earlier life circumstances and health, there was substantial heterogeneity in functioning in early old age. Long-term poverty and family stress were strongly associated with being low functioning. Early poverty and transient family problems did not have lasting health effects, underscoring the plasticity of human development and the importance of interventions that can alter life course trajectories.
Poverty; Functional status; Family stress; African American women
This study examines pathways to adult marijuana and cocaine use in a cohort of African Americans from Woodlawn, an inner city community in Chicago. Assessments were conducted in first grade (age 6), adolescence (age 16), early adulthood (age 32), and in mid adulthood (age 42). The Social Adaptation Life Course Framework guided the focus on social adaptation, social bonds, and economic resources as predictors of adult drug use. Results indicate that more frequent substance use in adolescence and lower income and less frequent church attendance in early adulthood increase the risk of midlife drug use. Shyness in first grade related inversely to later cocaine use and marijuana use (marginally significant). Indirect pathways to drug use also were identified. Gender differences were not significant. The findings show continuities in social maladaptation over time and the importance of social integration and economic resources in the early adult years.
Liver cancer is one of most commonly diagnosed cancers among Koreans. Chronic hepatitis B virus (HBV) infection is a major risk factor for liver cancer. HBV infection can be prevented by effective screening and vaccination programs. The purpose of this study is to examine the status of HBV infection and the predictors associated with HBV vaccination.
The study population was derived from the 2005 Korea National Cancer Screening Survey (KNCSS). The KNCSS is an annual cross-sectional survey that uses a nationally-representative random sampling to investigate cancer screening rates. A total of 1,786 Koreans over 40 years of age participated in this study.
Of all the participants, 5.9% reported HBV positive (HBsAg+, HBsAb-), 41.8% were HBV negative but protected (HBsAg-, HBsAb+), and 52.3% were unprotected (HBsAg-, HBsAb-). Among unprotected individuals (n = 934), 23.1% reported to have received the vaccination. About half of those who had vaccinations completed the 3-shot vaccine series. In multiple analyses, education, having private cancer insurance, alcohol use, having regular check-up, and doing regular exercise were associated with completed HBV vaccination.
This study result suggests that we need a liver cancer education program to increase HBV awareness and to increase the liver cancer prevention message among low educated populations.
Few longitudinal studies have examined the effects of education on drug use disorders among community populations of African Americans. This study explores the impact of multiple early education indicators on later problem drug use in an African American population followed for more than 35 years. The initial cohort comprised all 1st graders (N = 1242, 51% female) living in the Woodlawn community of Chicago in 1966. Follow-up assessments were conducted in adolescence (1975–76), early adulthood (1992–93), and mid adulthood (2002–3). One or both adult interviews were completed by 1053 individuals providing information for identifying lifetime drug use disorders. Logistic regression with multiple imputation revealed several important relationships between early education indicators and DSM-III-R/DSM-IV drug use disorders. Specifically, the risk for adult problem drug use was related to: underachievement in 1st grade; low 7th and 8th grade standardized math scores; both suspension from and skipping school in adolescence; not having a high school diploma (compared to having a college degree), and having a diploma or GED (compared to having a college degree). Also, 1st graders characterized as shy by their teachers were less likely to develop problem drug use in adulthood. Results indicate potential opportunities for targeted intervention at multiple life stages.
Drug use disorders; educational attainment; classroom behaviors; school performance; African Americans; longitudinal study
Little has been published about racial/ethnic differences in the prevalence of overweight among adolescents that accounts in detail for socioeconomic status, acculturation, and behavioral and environmental factors. Increased understanding of factors associated with overweight can provide a rational basis for developing interventions to address the obesity epidemic in the United States.
Using a cross-sectional analysis of data from adolescents who participated in the California Health Interview Survey 2003, we estimated the prevalence of overweight and at risk of overweight, combined as a single measure (AROW, body mass index ≥85th percentile). We used logistic regression models to examine associations between AROW and risk factors.
Twenty-nine percent of California adolescents were AROW. The prevalence of AROW differed significantly by sex and race. Boys were more likely than girls to be AROW (33% vs 25%). American Indians/Pacific Islanders/others (39%) were at highest risk, followed by Hispanics (37%), blacks (35%), whites (23%), and Asians (15%). For boys, older age, Hispanic or American Indian/Pacific Islander/other race/ethnicity, lower education of parents, and longer residence in the United States were significantly associated with AROW. For girls, Hispanic or black race/ethnicity, lower education of parents, and poor dietary habits were significantly associated with AROW.
The high prevalence of AROW among California adolescents in most racial/ethnic groups indicates the need for culturally specific and appropriate interventions to prevent and treat overweight.
The purpose of this study was to determine if disparities exist in lifetime utilization of mental health/substance abuse services among Asian, Native Hawaiian/Other Pacific Islander (NHOPI) and white mothers. The study sample was comprised of mothers assessed to be at-risk (n=491) and not at-risk (n=218) for child maltreatment in the Hawaii Healthy Start Program study. Multiple logistic regression models were used to test the effects of predisposing, need, and enabling factors on utilization of services. Results revealed that, among mothers with depressive symptoms, compared with whites, Asians and NHOPI were significantly less likely to have received services. There were no significant racial differences in use of mental health/substance use services by other factors. These results suggest that racial disparities exist in utilization of mental health/substance abuse services among mothers with depressive symptoms. Future research is needed to identify barriers and facilitators to accessing needed services for Asian and NHOPI women.
Perceived racial discrimination is one factor which may discourage ethnic minorities from using healthcare. However, existing research only partially explains why some persons do accept health promotion messages and use preventive care, while others do not. This analysis explores 1) the psychosocial characteristics of those, within disadvantaged groups, who identify their previous experiences as racially discriminatory, 2) the extent to which perceived racism is associated with broader perspectives on societal racism and powerlessness, and 3) how these views relate to disadvantaged groups' expectation of mistreatment in healthcare, feelings of mistrust, and motivation to use care.
Using survey data from 576 African-American women, we explored the prevalence and predictors of beliefs and experiences related to social disengagement, racial discrimination, desired and actual racial concordance with medical providers, and fear of medical research. We then used both sociodemographic characteristics, and experiences and attitudes about disadvantage, to model respondents' scores on an index of personal motivation to receive breast cancer screening, measuring screening knowledge, rejection of fatalistic explanatory models of cancer, and belief in early detection, and in collaborative models of patient-provider responsibility.
Age was associated with lower motivation to screen, as were depressive symptoms, anomie, and fear of medical research. Motivation was low among those more comfortable with African-American providers, regardless of current provider race. However, greater awareness of societal racism positively predicted motivation, as did talking to others when experiencing discrimination. Talking was most useful for women with depressive symptoms.
Supporting the Durkheimian concepts of both anomic and altruistic suicide, both disengagement (depression, anomie, vulnerability to victimization, and discomfort with non-Black physicians) as well as over-acceptance (low awareness of discrimination in society) predict poor health maintenance attitudes in disadvantaged women. Women who recognize their connection to other African-American women, and who talk about negative experiences, appear most motivated to protect their health.
OBJECTIVES: Several Asian-American groups are at a higher risk of dying of liver diseases attributable to hepatitis-B infection. This culturally diverse community should be well informed of and protected against liver diseases. The present study assesses the knowledge of hepatitis B before and after a hepatitis-B educational program and determines the infection status of an Asian community. METHODS: Nine Asian communities of Montgomery County, MD, enrolled in the hepatitis-B prevention program between 2005 and 2006. They attended culturally tailored lectures on prevention, completed self-administered pre- and posttests, and received blood screening for the disease. RESULTS: More than 800 Asian Americans participated in the study. Knowledge of prevention was improved after educational delivery. The average infection rate was 4.5%, with Cambodian, Thai, Vietnamese, Chinese and Korean groups having higher infection rates. The age group of 36-45 had the highest percentage of carriers (9.1%). CONCLUSION: Many Asian groups, particularly those of a southeast Asian decent, were subject to a higher probability of hepatitis-B infection. At an increased risk are first-generation Asian immigrants, groups with low immunization rates and those aged 36-45. The findings provide potential directions for focusing preventive interventions on at-risk Asian communities to reduce liver cancer disparities.
Hispanics are the fastest growing demographic group in the United States; however, "Hispanic" is a broad term that describes people who are from or whose ancestors are from multiple countries of origin. This study examines, separately, the social, cultural, and behavioral factors associated with overweight and obesity among Mexican American adults and among Central American adults.
To estimate the prevalence of overweight and obesity among Mexican and Central Americans living in California, we conducted a cross-sectional analysis of data from the 2001 California Health Interview Survey using SUDAAN software to account for the survey's multistage sampling design.
Of the 8304 Mexican Americans participating in the survey, 36.8% were overweight and 26.2% were obese. Of the 1019 Central Americans, 39.2% were overweight and 22.2% were obese. Among Mexican American men, age and marital status were associated with overweight and obesity; and education, acculturation, health insurance status, health status, and use of vitamins were associated with obesity only. Among Mexican American women, age, education, number of children, health status, and health behavior were associated with overweight and obesity. Among Central American men, age, education, and access to health care were associated with overweight, whereas marital status, acculturation, health care, and binge drinking were associated with obesity. Among Central American women, number of children was associated with overweight and obesity; and age and education were associated with obesity only.
Our findings of high rates of overweight and obesity among Mexican and Central Americans in California indicate the need for a wide variety of effective weight-loss interventions targeting these populations, and the differences we found in the factors associated with overweight and obesity may suggest the need for unique intervention strategies for different Hispanic subgroups.
Although it is known that at comparable body mass index (BMI) levels Asian Americans have a higher prevalence of high blood pressure, heart disease, and type 2 diabetes than whites, little is known about the social, behavioral, and cultural factors associated with obesity risk in this population.
A cross-sectional analysis of the 2003 California Health Interview Survey was performed to estimate overweight and obesity prevalence among Korean Americans using BMI criteria suggested by the World Health Organization for Asian populations worldwide. In addition, associations between demographics, social, behavioral, and cultural factors and the risk of being overweight and obese were examined.
Of 492 Korean American respondents, 38% were overweight and 8% were obese according to World Health Organization body mass index criteria for Asians. In a multivariate analysis, sex, marital status, poverty, and length of residence in the United States were associated with BMI. Men were more likely to be overweight or obese than women, and length of residence in the United States was strongly associated with higher body mass index.
Like other ethnic groups, Korean Americans have a sociodemographic profile that is identified with an increased risk of becoming obese. Considering these factors in developing early diet and physical activity interventions could be an important opportunity to prevent weight gain and diminish disease caused by obesity. This study also suggests how meaningful BMI criteria tailored for Asian Americans could be used to more accurately measure risk of obesity within a heterogeneous population such as the U.S. population.
This study, informed by ecological frameworks, compared the prevalence, predictors, and association of home smoking restrictions with secondhand smoke exposure (SHSe) between Koreans in Seoul, South Korea, and Korean Americans in California, United States.
A cross-sectional survey was drawn from telephone interviews with Korean adults in Seoul (N = 500) and California (N = 2,830) during 2001–02. Multivariable regressions were used for analyses.
Koreans, compared with Korean Americans, had significantly fewer complete home smoking bans, 19% (95% CI: 16–23) versus 66% (95% CI: 64–68), and were more likely to not have a home smoking restriction, 64% (95% CI: 60–69) versus 5% (95% CI: 4–6). Home smoking restrictions were associated with lower home SHSe; however, the impact was consistently larger among Korean Americans. Households with more SHSe sources were less likely to have the strongest home smoking restrictions, where the difference in complete bans among Korean Americans versus Koreans was largely among those at low risk of SHSe, 82% (95% CI: 76–86) versus 36% (95% CI: 17–57), while high-risk Korean American and Koreans had similar low probabilities, 10% (95% CI: 7–13) versus 7% (95% CI: 3–13).
Consistent with ecological frameworks, exposure to California’s antismoking policy and culture was associated with stronger home smoking restrictions and improved effectiveness. Interventions tailored to Korean and Korean American SHSe profiles are needed. Behavioral interventions specifically for high-risk Korean Americans and stronger policy controls for Koreans may be effective at rapidly expanding home smoking restrictions.