Issues in Health and Health Care Related to Race/Ethnicity, Immigration, SES and Gender: Volume 30

This chapter will initially review some health care system issues with a focus on the US health care system. It will then review some of the sociological literature about race/ethnicity, immigration, socioeconomic status (SES) and gender and how these factors link to health and health care. In addition, the chapter will serve as an introduction to the volume and will briefly review the contents of the other sections and chapters in this volume.

Using the data from a unique sample of Mexican-American adults from the U.S.-Mexico border area, this chapter offers explanations for Mexican-American obesity, with the special focus on immigrant generation status, income, and gender. On a theoretical plane, this study attempts to apply the nutrition transition theory to the study of immigrant assimilation in a regional context. Considered are the most important structural dimensions of immigrant assimilation – country of birth (the United States vs. Mexico) and age of arrival. Of the two aforementioned factors, age of arrival is found to be a stronger predictor of obesity that country of birth. As Mexican-American immigrants’ length of residence increases, so does their Body Mass Index (BMI) that reflects the adoption of less diverse diet and sedentary lifestyles. Through the use of multilevel hierarchical modeling, I also found sizeable variation in obesity by income, gender, and family history of obesity. The analyses suggest that the interventions aimed at reducing overweight and obesity among Mexican-Americans in the U.S.-Mexico border region should be better targeted by focusing on women and low-income households.

Purpose – One-third of the world's population is infected with tuberculosis (TB) and there are two million TB-related deaths worldwide every year. Along the U.S.-Mexico border, migration patterns, and reduced access to health care contribute to high rates of TB. Delayed diagnosis of TB, the focus of this chapter, increases the likelihood that a patient will progress to more advanced stages of the disease and heightens the risk of TB transmission to others as patients are contagious for longer periods of time.

Approach – Despite the seriousness of these consequences, few sociological studies have examined delayed diagnosis of TB and why people affected by TB symptoms delay care. Because of this, we take a health narratives approach to understanding the experiences of 15 TB patients of Mexican descent in a high-risk border community (e.g., El Paso, Texas) in order to discover why delayed diagnoses happen and how they impact patients.

Findings – Fourteen of the fifteen patients experienced delayed diagnosis. Analysis of these fourteen narratives revealed two broad themes: (1) provider lack of awareness, including repeated misdiagnosis and TB test errors, and (2) patient disadvantage, including fear of U.S. immigration authorities and few economic resources for care.

Implications – Findings from this study suggest that prompt diagnosis of TB could be achieved if providers were more cognizant of TB and its symptoms and public health policies increased access to health care regardless of immigration status or socioeconomic status.

Scholars have explained how people in Japan feel ashamed when elderly members of the family are cared for by formal services such as day care or government/commercial-based nursing homes due to the cultural norms of the consciousness of social appearance. However, this consciousness of social appearance plays a minimum role when it comes to elderly Japanese immigrant women's preference to utilize formal care services in the United States. They see receiving family based care as a burden on their middle-aged children (or grandchildren) and they prefer purchasing formal long-term care services when they can no longer feel confident about maintaining their independent lives. Elderly Japanese immigrant women hold rather positive views on formal care in the United States, including nursing homes. This chapter suggests that elderly Japanese immigrant women may not consider it shameful to utilize formal care as many previous scholars have suggested.

In this chapter we examine how micro- and macro-level issues including access to child-only or family public health insurance shape low-income immigrant families’ health care experiences in two policy contexts in the Washington, DC metropolitan area.

This qualitative study includes 40 in-depth interviews with first-generation, low-income immigrant Latin American and African mothers in DC and Northern Virginia.

The majority of families living in Virginia had child-only health insurance, whereas most of the families living in Washington, DC, had family health insurance. Regardless of these insurance differences, all mothers had access to free health care for prenatal care. Pregnancy, for most, was their entry into the U.S. health care system. Families’ ongoing health care experiences differed in relation to insurance access, and culture, including parents’ previous experiences with health care in their countries of origin.

Future research should consider the experiences of other immigrant groups, mental health experiences of immigrants, and fathers’ experiences with health care.

Future initiatives to address health care should focus on providing family health care to low-income immigrant families across the country, improving access to mental health services for immigrant families, and creating more culturally and linguistically appropriate health care services.

This study points to the importance of family health care for immigrant families, as well as care that is culturally and linguistically competent.

This study illustrates the need for public family health insurance for low-income immigrant families, and the importance of culturally competent health care for immigrants.

Research is needed that uses large enough samples to facilitate disaggregation of users by specific types of complementary/alternative medical (CAM) practices and by ethnicity in order to examine possible patterns in the use of CAM therapies not accorded efficacy by family physicians. The objective of this study is too use data from a large population health survey to determine the relationship ethnicity, measured with multiple indicators, has with the use of CAM therapies classified as “accepted” or “rejected” by family physicians in terms of efficacy. Using data from the Canadian Community Health Survey (CCHS) Cycle 1.1, logistic regression models estimate the factors influencing the use of the two binary categories of CAM therapy. Measures of ethnicity available in the CCHS are used to focus on ethnic origin, comparing North American and Foreign born, and on ethnic identification, comparing Whites with Asians, South Asians, Blacks, Latin Americans, Aboriginals, and others. Whites and North American born had higher odds of using “accepted” therapies, whereas immigrant visible minorities and those with Asian ethnic identities were more likely to use “rejected” therapies. This research confirms that ethnicity constitutes a cultural resource upon which users of CAM draw as they make their health-care decisions, sometimes despite the recommendations of family physicians.

A developing body of research has demonstrated the impact of racial residential segregation on a variety of negative health outcomes. However, little is known about the effect of residential segregation on access to health care.

This study utilizes multilevel binary logit models based on individual-level health data from the 2008 Behavioral Risk Factor Surveillance System linked to metropolitan-area level data to examine the association between Black-White segregation in 136 metropolitan statistical areas in the United States and health-care coverage.

Overall, an increase in Black-White segregation is related to a decrease in the likelihood of having health insurance for Black residents and an increase in the Black-White gap in health-care coverage. These effects are substantial even when controlling for the effects of educational, social, and economic factors.

This study is the first to examine the impact of segregation on an individual's ability to access health-care coverage, which is an essential starting point for accessing health care in the United States.

This chapter explores how direct-to-consumer advertisements (DTCA) for major depression and anxiety disorders use contemporary gender scripts to sell medications and disease definitions to consumers, and in the process reflect and reinforce those scripts for both men and women. Between 1997 and 2006, antidepressant DTCA in popular magazines overwhelmingly depicted depression as a (white) female disorder, as did anti-anxiety DTCA, although not to such an extreme extent. In addition, DTCA often alerted men to the benefits they might reap if the women in their lives sought treatment, while suggesting that women had a responsibility to seek such treatment for the sake of their loved ones. Moreover, DTCA disproportionately encouraged women to monitor their emotions while encouraging men to monitor their physical sensations. Finally, DTCA suggested that medication would yield benefits for women primarily in their close relationships and for men primarily in their work lives, thus reinforcing the binary sex divisions implicit in hegemonic masculinity and emphasized femininity. At a broader level, DTCA studied for this article suggest to both women and men that individuals should monitor themselves and others for a wide variety of common emotions, behaviors, and physical sensations, thus individualizing social problems and encouraging the expansion of medical authority over everyday life.

The discovery of the BRCA1 and BRCA2 genes has facilitated the construction of a new group of women referred to as “previvors” – individuals who are survivors of a predisposition to cancer but who are not presently ill. These “previvors” constitute the first generation of women faced with the option to make preventative health choices based on this kind of genetic information. Therefore, this research examines how young BRCA positive women negotiate the medicalization of their bodies based on their new “potentially ill” status. Analyzing the posts in an online forum specifically for “young previvors,” the findings indicate that the majority share an “anything's better than cancer” mantra, suggesting that fear of death largely outweighs all other fears or concerns. Consequently, asserting control by taking preventative action is considered a mechanism for quelling the fear, uncertainty, and stress associated with being a BRCA gene carrier. Constructed as a medical diagnosis, carrying the BRCA mutation is consequently perceived as requiring a corresponding medical treatment. As such, despite the connection these women describe feeling with the “parts that make them a woman,” they appear to believe that they must undergo prophylactic surgery and disassociate from their bodies in order to save their lives. Ultimately, they convince themselves to view their breasts and ovaries simply as nonessential organs, rather than as core components of their feminine, sexual, and reproductive identities.

Although competence to live alone is typically associated with measures of activities of daily living, such measures fail to capture problematic situations that older people face in daily life. In particular, little is known about how older homebound women handle potentially harmful incidents. During a descriptive phenomenological study of the experience of reaching help quickly (RHQ) with 40 older homebound women, 33 women spontaneously reported 139 incidents (falls, “tight spots,” near-falls, health problems, and unwanted visitors) that they managed alone. The purpose of this secondary phenomenological analysis of RHQ project data was to describe the experience of those women with handling “close-calls.” Data yielded a typology of close-call incidents and five components of the phenomenon, managing a close-call. In addition to self-directed intentions to lessen the impact of each incident, there were four component phenomena relative to help-seeking, ranging from no mention of need for help (70% of incidents) to managing without desired or solicited help (6% of incidents). Contextual factors, including availability of potential helpers and access to help-seeking devices, influenced intentions in close-calls. Findings are springboards for further research and stimuli for new approaches to practice. Researchers should broaden the focus of competence assessment to take in empirical situations. Further work should be done to explore how older people appraise their status following close-calls and how they move from self-management to consideration of help-seeking and in some cases, on to active help-seeking. Because few close-calls were reported, practitioners could use our typology as an assessment protocol during routine visits. Practitioners can elicit self-management intentions relative to a particular close-call and build dialogue around those intentions, thereby bolstering ability of older women to manage close-calls effectively.

We examine the influences of African-American and female legislators on the supportiveness of states toward elders. Previous research shows complementary supportiveness among women and minority legislators on education policy and a range of social policies affecting families. Women legislators extend this support to various dimensions of “state age friendliness.” We examine here whether African-American legislators extend their support similarly. We draw on a cross-sectional data set for the 50 American states around the year 2000 in conjunction with regression. We find that, controlling for the most prominent alternative factors generally shaping state orientations and policies, women legislators are selectively supportive of dimensions of state elderly friendliness, but African-American legislators do not share this support. We attribute the discrepancy in the support of this area of social policy to women and minority legislators having specific divergent priorities with regard to elders as well as to how these priorities are conditioned by women and black legislators being concentrated in different states having distinctive cultures.

As the population ages in the United States and globally, health-care demands are rising and varied, including the growth of home health care. Small, regional, qualitative studies indicate both satisfaction and exploitation in home health-care work. These intimate, caring relationships with clients may be especially challenging for minorities due to client prejudice and structural marginalization. This study broadens the scope of current research by addressing issues facing home health-care workers using large-scale, nationwide data.

Using nationally representative data of home health aides in the US, the National Home Health Aide Survey (NHHAS), we evaluate which features of work are related to overall satisfaction. The prevalence and sources of discrimination and working conditions are examined according to workers’ intersectional gender, race, ethnicity, and class identities.

Satisfaction was highest for those who were extremely satisfied with challenging work, learning new skills, and were most supported in their caring labor. Salary was the area with the most frequent dissatisfaction. Support for reproductive and caring labor was often inadequate. Black women and men reported the highest levels of discrimination (about 28.0%), followed by Hispanic women and men (16.5% and 10%, respectively). The largest source of discrimination was patients (80.4%). There were differences in job outcomes according to intersectional identities of race, class, and gender.

Discrimination, low wages, and not having enough support for both reproductive and caring labor are problems for home health aides. Improving home health aide work is also likely to improve patient outcomes.