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Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities

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A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (30 November 2017) | Viewed by 92832

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Special Issue Editor

Prof. Dr. Shervin Assari

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Guest Editor

Department of Psychiatry and School of Public Health, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5295, USA
Interests: depression; race; gender; sex; class
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Race, gender, class, and place shape the physical and mental health of populations in multiple ways. Differential exposure and differential vulnerability are two main hypotheses that have explained how race, gender, class, and place get under people’s skin. According to the differential exposure hypothesis, these fundamental factors determine exposure to a wide range of risk and protective factors that have health implications. In this view, distribution of risk and protective factors are not random but follows a social gradient. According to this hypothesis, differential exposure mediates the group differences in health based on these fundamental factors. According to the differential vulnerability hypothesis, our race, gender, class, and place shape the vulnerability and resilience of populations to a certain or combination of risk or protective factors. Based on this hypothesis, the effects of risk factors are not universal but specific to social groups.

However, the story is more complex. For some outcomes, class interacts with race and gender, and for some others, class explains the effect of race and gender on health. The meanings and implications of race and gender also change across populations and settings including cohorts. Furthermore, countries differ in the role of gender, race, and class in peoples’ lives. For instance, in the United States income may be the most salient social determinant of health and the same could be said about education in Western Europe. Education may not have the same effect in rural and urban areas, and race is more salient in Southern parts of the United States. The intersection of race, gender, class, and place have effects which are different from algebraic sums of their effects. For instance, in the United States, the experiences of Black men are very different from Black women. Finally, race-, class-, and gender- lines may compete with each other in shaping some health behaviors and outcomes.

The findings have major clinical, public health, and policy implications. Results are expected to extend the field of health disparities by discovering new mechanisms behind health disparities. Some findings may advocate for local rather than universal policies, programs, and interventions. They may suggest that tailored interventions and programs that are targeted to the specific needs of socio-demographic groups (e.g., based on race, gender, and class) may have higher acceptability and efficacy than programs that ignore the between- and within-group heterogeneities in the mechanisms that shape health and illness.

The Special Issue “Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities” invites state-of-the-art original and review articles on the above-mentioned topics. Potential papers of interest include: 1) studies testing differential exposure or differential vulnerability; 2) studies testing additive and multiplicative effects; 3) studies that compare countries or locations within countries; 4) studies that report mediators or moderators of disparities; 5) studies on tailored interventions for sub-populations; 6) studies using a national sample, or using longitudinal design; 7) studies using an intersectionality approach; and 8) studies on measurement and methodology issues.

Dr. Shervin Assari
Guest Editor

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed Open Access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) has been waived for publication in this Special Issue.

Keywords

race
ethnicity
gender
place
cross-country comparisons
health disparities

Published Papers (12 papers)

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Research

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15 pages, 226 KiB

Open AccessArticle

Chronicity and Mental Health Service Utilization for Anxiety, Mood, and Substance Use Disorders among Black Men in the United States; Ethnicity and Nativity Differences

by Vickie M. Mays, Audrey L. Jones, Susan D. Cochran, Robert Joseph Taylor, Jane Rafferty and James S. Jackson

Healthcare 2018, 6(2), 53; https://doi.org/10.3390/healthcare6020053 - 23 May 2018

Cited by 19 | Viewed by 6771

Abstract

This study investigated ethnic and nativity differences in the chronicity and treatment of psychiatric disorders of African American and Caribbean Black men in the U.S. Data were analyzed from the National Survey of American Life, a population-based study which included 1859 self-identified Black men (1222 African American, 176 Caribbean Black men born within the U.S., and 461 Caribbean Black men born outside the U.S.). Lifetime and twelve-month prevalence of DSM-IV mood, anxiety, and substance use disorders (including Bipolar I and Dysthmia), disorder chronicity, and rate of mental health services use among those meeting criteria for a lifetime psychiatric disorder were examined. Logistic regression models were employed to determine ethnic differences in chronicity, and treatment utilization for disorders. While rates of DSM-IV disorders were generally low in this community sample of Black men, their disorders were chronic and remained untreated. Caribbean Black men born in the U.S. had higher prevalence of Post-Traumatic Stress Disorder, Major Depressive Disorder, and Alcohol Abuse Disorder compared with African American men. Foreign born Caribbean Black men experienced greater chronicity in Social Phobia and Generalized Anxiety Disorder compared to other Black Men. Utilization of mental health service was low for all groups of Black Men, but lowest for the foreign born Caribbean Black men. Results underscore the large unmet needs of both African American and Caribbean Black men in the United States. Results also highlight the role of ethnicity and nativity in mental disorder chronicity and mental health service utilization patterns of Black men. Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

17 pages, 284 KiB

Open AccessFeature PaperArticle

Racial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010–2015

by Audrey L. Jones, Susan D. Cochran, Arleen Leibowitz, Kenneth B. Wells, Gerald Kominski and Vickie M. Mays

Healthcare 2018, 6(2), 29; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare6020029 - 22 Mar 2018

Cited by 23 | Viewed by 6570

Abstract

Background. Black and Latino minorities have traditionally had poorer access to primary care than non-Latino Whites, but these patterns could change with the Affordable Care Act (ACA). To guide post-ACA efforts to address mental health service disparities, we used a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care. Methods. Data were obtained from the Medical Expenditures Panel Survey (MEPS), a two-year panel study of healthcare use, satisfaction with care, and costs of services in the United States (US). We pooled data from six waves (14–19) of participants with serious psychological distress to examine racial, ethnic, and nativity disparities in medical and mental health visits to primary care (PC) and specialty mental health (SMH) providers around the time of ACA reforms, 2010–2015. Results. Of the 2747 respondents with serious psychological distress, 1316 were non-Latino White, 632 non-Latino Black, 532 identified as Latino with Mexican, Central American, or South American (MCS) origins, and 267 as Latino with Caribbean island origins; 525 were foreign/island born. All racial/ethnic groups were less likely than non-Latino Whites to have any PC visit. Of those who used PC, non-Latino Blacks were less likely than Whites to have a PC mental health visit, while foreign born MCS Latinos were less likely to visit an SMH provider. Conditional on any mental health visit, Latinos from the Caribbean were more likely than non-Latino Whites to visit SMH providers versus PC providers only, while non-Latino Blacks and US born MCS Latinos received fewer PC mental health visits than non-Latino Whites. Conclusion. Racial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services. Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

14 pages, 215 KiB

Open AccessArticle

Correlates of Objective Social Isolation from Family and Friends among Older Adults

by Linda M. Chatters, Harry Owen Taylor, Emily J. Nicklett and Robert Joseph Taylor

Healthcare 2018, 6(1), 24; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare6010024 - 03 Mar 2018

Cited by 45 | Viewed by 11158

Abstract

This study examined the correlates of objective social isolation from extended family members and friends among older adults. The analysis is based on the older adult sub-sample of the National Survey of American Life (n = 1321). Multinomial logistic regression analyses examined race/ethnicity, demographics, functional health and family and friend network factors as correlates of objective isolation from family and friends. Only 4.47% of respondents were objectively isolated from both their extended family and friends, 10.82% were isolated from their friends, and 7.43% were isolated from their family members. Men were more likely to be objectively isolated from both family and friends and older adults who live with others were significantly more likely to be objectively isolated from their friends. When controlling for subjective social isolation, the two measures of functional health were significantly associated with objective social isolation. In particular, higher levels of self-care impairment decreased the risk of being objectively isolated from friends only, whereas higher mobility impairment was associated with an increased likelihood of being objectively isolated from friends only. Subjective evaluations of social isolation from family and friends were consistently associated with being objectively isolated from family and friends. There were no significant differences between African-Americans, Black Caribbeans and non-Hispanic Whites in objective isolation. These and other findings are discussed in detail. Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

10 pages, 1075 KiB

Open AccessArticle

Examining Differential Resilience Mechanisms by Comparing ‘Tipping Points’ of the Effects of Neighborhood Conditions on Anxiety by Race/Ethnicity

by Emil Nicolae Coman and Helen Zhao Wu

Healthcare 2018, 6(1), 18; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare6010018 - 20 Feb 2018

Cited by 6 | Viewed by 5147

Abstract

Exposure to adverse environmental and social conditions affects physical and mental health through complex mechanisms. Different racial/ethnic (R/E) groups may be more or less vulnerable to the same conditions, and the resilience mechanisms that can protect them likely operate differently in each population. We investigate how adverse neighborhood conditions (neighborhood disorder, NDis) differentially impact mental health (anxiety, Anx) in a sample of white and Black (African American) young women from Southeast Texas, USA. We illustrate a simple yet underutilized segmented regression model where linearity is relaxed to allow for a shift in the strength of the effect with the levels of the predictor. We compare how these effects change within R/E groups with the level of the predictor, but also how the “tipping points,” where the effects change in strength, may differ by R/E. We find with classic linear regression that neighborhood disorder adversely affects Black women’s anxiety, while in white women the effect seems negligible. Segmented regressions show that the Ndis → Anx effects in both groups of women appear to shift at similar levels, about one-fifth of a standard deviation below the mean of NDis, but the effect for Black women appears to start out as negative, then shifts in sign, i.e., to increase anxiety, while for white women, the opposite pattern emerges. Our findings can aid in devising better strategies for reducing health disparities that take into account different coping or resilience mechanisms operating differentially at distinct levels of adversity. We recommend that researchers investigate when adversity becomes exceedingly harmful and whether this happens differentially in distinct populations, so that intervention policies can be planned to reverse conditions that are more amenable to change, in effect pushing back the overall social risk factors below such tipping points. Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

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9 pages, 351 KiB

Open AccessArticle

Moderating Effect of Residential History on the Effects of a Fatherhood Program on Parenting Skills Satisfaction among Nonresident African American Fathers

by Yiqing Qian, E. Hill De Loney and Cleopatra Howard Caldwell

Healthcare 2018, 6(1), 13; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare6010013 - 09 Feb 2018

Cited by 4 | Viewed by 5067

Abstract

Nonresident African American (AA) fathers sometimes face challenges to achieving satisfaction with their parenting skills, which may inhibit their motivations for parenting. Studies have found that residential history of fathers is associated with parental involvement; however, current fatherhood programs rarely consider the influence of different residential history on fathering. In the current study, we examined whether nonresident AA fathers’ residential history with their sons moderated their parenting skills satisfaction after participating in the Fathers and Sons Program. Our results indicated that after controlling for fathers’ pretest parenting skills satisfaction, age, education, marital status, employment, and ever lived with their son’s mother; there was a moderating effect of residential history on the intervention’s effects on posttest parenting skills satisfaction. The regression analyses showed that fathers in the intervention group who had lived with their son increased their parenting skills satisfaction more at posttest compared with fathers who had never lived with their sons. However, fathers in the comparison group who had lived with their sons had lower posttest parenting skills satisfaction. Future fatherhood programs for nonresident AA fathers should develop more nuanced group-specific interventions that consider residential history as a critical factor to enhance their parenting skills satisfaction as a strategy for improving father involvement. Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

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19 pages, 269 KiB

Open AccessArticle

How Neighborhood Effects Vary: Childbearing and Fathering among Latino and African American Adolescents

by Jessica L. Lucero, Anna Maria Santiago and George C. Galster

Healthcare 2018, 6(1), 7; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare6010007 - 18 Jan 2018

Cited by 2 | Viewed by 4542

Abstract

This study examines what neighborhood conditions experienced at age 15 and after are associated with teen childbearing and fathering among Latino and African American youth and whether these neighborhood effects vary by gender and/or ethnicity. Administrative and survey data from a natural experiment are used for a sample of 517 Latino and African American youth whose families were quasi-randomly assigned to public housing operated by the Denver (CO) Housing Authority (DHA). Characteristics of the neighborhood initially assigned by DHA to wait list applicants are utilized as identifying instruments for the neighborhood contexts experienced during adolescence. Cox Proportional Hazards (PH) models reveal that neighborhoods having higher percentages of foreign-born residents but lower levels of social capital robustly predict reduced odds of teen parenting though the magnitude of these effects was contingent on gender and ethnicity. Specifically, the presence of foreign-born neighbors on the risk of teen parenting produced a stronger dampening effect for African American youth when compared to Latino youth. Additionally, the effects of social capital on teen parenting were stronger for males than females. Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

11 pages, 407 KiB

Open AccessArticle

Age and Gender Differences in Psychological Distress among African Americans and Whites: Findings from the 2016 National Health Interview Survey

by Daphne C. Watkins and Natasha C. Johnson

Healthcare 2018, 6(1), 6; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare6010006 - 17 Jan 2018

Cited by 25 | Viewed by 7154

Abstract

Previous studies report a race and mental health paradox: Whites score higher on measures of major depression compared to African Americans, but the opposite is true for psychological distress (i.e., African Americans score higher on distress measures compared to Whites). Independently, race, age, and gender outcomes for psychological distress are well documented in the literature. However, there is relatively little research on how psychological distress interferes with the lives of African Americans and Whites at the intersection of their various race, age, and gender identities. This study uses data from the 2016 National Health Interview Survey to examine age and gender differences in psychological distress and how much psychological distress interferes with the lives of African Americans and Whites. Our study findings are contrary to the paradox such that young White women (M = 3.36, SD = 1.14) and middle-aged White men (M = 2.55, SD = 3.97) experienced higher psychological distress than all other race, age, and gender groups. Psychological distress interference was relatively high among the high distress groups, except for older African American men (M = 1.73, SD = 1.05) and young African American women (M = 1.93, SD = 0.95). Implications for studies that consider cultural experiences of psychological distress, and how it impacts different demographic groups are discussed. Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

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11 pages, 217 KiB

Open AccessArticle

The Benefits of Higher Income in Protecting against Chronic Medical Conditions Are Smaller for African Americans than Whites

by Shervin Assari

Healthcare 2018, 6(1), 2; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare6010002 - 09 Jan 2018

Cited by 68 | Viewed by 13473

Abstract

Background: Blacks’ diminished return is defined as smaller protective effects of socioeconomic status (SES) on health of African Americans compared to Whites. Aim: Using a nationally representative sample, the current study aimed to examine if the protective effect of income on chronic medical conditions (CMC) differs for African Americans compared to Whites. Methods: With a cross-sectional design, the National Survey of American Life (NSAL), 2003, included 3570 non-Hispanic African Americans and 891 non-Hispanic Whites. The dependent variable was CMC, treated as a continuous measure. The independent variable was income. Race was the focal moderator. Age, education, and marital status were covariates. Linear regressions were used to test if the protective effect of income against CMC varies by race. Results: High income was associated with a lower number of CMC in the pooled sample. We found a significant interaction between race and income, suggesting that income has a smaller protective effect against CMC for African Americans than it does for Whites. Conclusion: Blacks’ diminished return also holds for the effects of income on CMC. Blacks’ diminished return is a contributing mechanism to the racial disparities in health in the United States that is often overlooked. More research is needed on the role of diminished health return of SES resources among other minority groups. Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

235 KiB

Open AccessArticle

Socioeconomic Status and Glycemic Control in Type 2 Diabetes; Race by Gender Differences

by Shervin Assari, Maryam Moghani Lankarani, John D. Piette and James E. Aikens

Healthcare 2017, 5(4), 83; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare5040083 - 01 Nov 2017

Cited by 23 | Viewed by 8391

Abstract

Background: This study aimed to investigate differences in the association between socioeconomic status (SES) and glycemic control in type 2 diabetes mellitus (DM) across race by gender groups. Methods: Using a convenient sampling strategy, participants were 112 patients with type 2 DM who were prescribed insulin (ns = 38 Black women, 34 Black men, 14 White women, and 26 White men, respectively). Linear regression was used to test the associations between sociodemographic variables (race, gender, SES, governmental insurance) and Hemoglobin A1c (HbA1c) in the pooled sample and within subgroups defined by race and gender. Results: In the pooled sample, neither SES nor governmental insurance were associated with HbA1c. However, the race by gender interaction approached statistical significance (B = 0.34, 95% CI = −0.24–3.00, p =0.094), suggesting higher HbA1c in Black women, compared to other race by gender groups. In stratified models, SES (B = −0.33, 95% CI = −0.10–0.00, p = 0.050), and governmental insurance (B = 0.35, 95% CI = 0.05–2.42, p = 0.042) were associated with HbA1c for Black men, but not for any of the other race by gender subgroups. Conclusion: Socioeconomic factors may relate to health outcomes differently across race by gender subgroups. In particular, SES may be uniquely important for glycemic control of Black men. Due to lack of generalizability of the findings, additional research is needed. Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

736 KiB

Open AccessArticle

Reference Intervals for Non-Fasting CVD Lipids and Inflammation Markers in Pregnant Indigenous Australian Women

by Tracy L. Schumacher, Christopher Oldmeadow, Don Clausen, Loretta Weatherall, Lyniece Keogh, Kirsty G. Pringle and Kym M. Rae

Healthcare 2017, 5(4), 72; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare5040072 - 14 Oct 2017

Cited by 1 | Viewed by 6072

Abstract

Indigenous Australians experience high rates of cardiovascular disease (CVD). The origins of CVD may commence during pregnancy, yet few serum reference values for CVD biomarkers exist specific to the pregnancy period. The Gomeroi gaaynggal research project is a program that undertakes research and provides some health services to pregnant Indigenous women. Three hundred and ninety-nine non-fasting samples provided by the study participants (206 pregnancies and 175 women) have been used to construct reference intervals for CVD biomarkers during this critical time. A pragmatic design was used, in that women were not excluded for the presence of chronic or acute health states. Percentile bands for non-linear relationships were constructed according to the methods of Wright and Royston (2008), using the xriml package in StataIC 13.1. Serum cholesterol, triglycerides, cystatin-C and alkaline phosphatase increased as gestational age progressed, with little change seen in high-sensitivity C-Reactive Protein and γ glutamyl transferase. Values provided in the reference intervals are consistent with findings from other research projects. These reference intervals will form a basis with which future CVD biomarkers for pregnant Indigenous Australian women can be compared. Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

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Review

Jump to: Research

11 pages, 188 KiB

Open AccessReview

A Novel Approach to Transforming Smoking Cessation Practice for Pregnant Aboriginal Women and Girls Living in the Pilbara

by Paula Wyndow, Roz Walker and Tracy Reibel

Healthcare 2018, 6(1), 10; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare6010010 - 23 Jan 2018

Cited by 11 | Viewed by 6522

Abstract

Tobacco smoking during pregnancy contributes to a range of adverse perinatal outcomes; but is a potentially modifiable behavior. In Australia Aboriginal and Torres Strait Islander women face a range of barriers that hinder; rather than support smoking cessation. Few smoking cessation programs consider the broader social determinants of women’s lives; the gendered nature of these or the complexities which impinge on behavior change in the presence of social and economic disadvantage and substantial individual and intergenerational trauma. Drawing on the salient gender and trauma-informed literature this paper describes the rationale underpinning formative research which will inform the design of a localized, culturally meaningful smoking cessation program for Aboriginal women living in the Hedland and Western Desert communities of the remote Pilbara region of Western Australia. We contend that a women-centered, trauma-informed approach to smoking cessation has much to offer those seeking to address this critical public health issue Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

443 KiB

Open AccessReview

Cross-National Differences in Psychosocial Factors of Perinatal Depression: A Systematic Review of India and Japan

by Mizuki Takegata, Yukiko Ohashi, Anisha Lazarus and Toshinori Kitamura

Healthcare 2017, 5(4), 91; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare5040091 - 04 Dec 2017

Cited by 19 | Viewed by 8482

Abstract

Perinatal depression is prevalent worldwide. However, there are few available studies that discuss the different cultural factors affecting perinatal depression within Asian countries. This study aims to compare the literature regarding related factors relating to perinatal depression in India and Japan, and to synthesize the evidence common to both countries in addition to the country-specific evidence. We conducted a systematic review using several databases (CINAHL, MEDLINE, Pubmed, Ovid, SCOPUS, IndMED, and ICHUSI). Keywords were “antenatal depression” or “postpartum depression”, and “India” or “Japan”. Both Japanese and English language papers were reviewed. The identified evidence was compared between the two countries, as well as with non-Asian countries based on previous reports. In total, 15 articles on India and 35 on Japan were reviewed. Although several factors were shared between the two countries as well as with other non-Asian countries (vulnerable personality, being abused, age, marital conflict, and lower socio-demographic status), some differing factors were identified between India and Japan and non-Asian countries; India: poor socioeconomic status, living only with the husband, pregnancy not welcomed by the husband, a female baby, and poor relationship with in-laws; Japan: infertility treatment, conflict with work–life balance, poor relationships with biological mother or in-laws, and concerns about social relations with the other mother’s friends. To conclude, involving the family and community may be important for implementing both global standardized and culture-specific interventions. In India, treatment involving the in-laws may be effective because large family structure is a significant predictor of perinatal depression. In Japan, a family/community approach involving not only the mother’s family of origin but also the working environment is essential. Full article

(This article belongs to the Special Issue Health Effects of Race, Gender, Class, and Place: Complexities and Heterogeneities)

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