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The chapter is devoted to analysis of the structure of regional identity. Topicality of this issue is caused by the processes of social differentiation of regions. The purpose of the research is to describe the factors of regional identity. Regional identity is predetermined by natural, geographical, socio-cultural, ethnic, and socio-political factors. Regional identity is viewed as a complex dynamic structure. It is analyzed on the basis of application of concepts of constructivism and symbolic capital. The authors come to the conclusion that dynamics of regional identity are determined by individuals’ evaluation of the conditions of the territory for satisfying the needs and implementation of life plans. This aspect is analyzed from the positions of the concept of constructivism. It is also concluded that dynamics of regional identity depends on attractive image of the territory and realization of its uniqueness. This aspect of regional identity is viewed as a symbolic capital, which stimulates the development of territory.

This study investigated disparities in dual diagnosis (comorbid substance use and depressive/anxiety disorders) among US adults by nativity and racial–ethnic origin and socioeconomic, cultural, and psychosocial factors that may account for the observed disparities.

The study drew on data from two waves of the National Epidemiological Survey on Alcohol and Related Conditions. Racial–ethnic categories included African, Asian/Pacific Islander, European, Mexican, Puerto Rican, and other Hispanic/Latino. Substance use and depressive/anxiety disorders were assessed per DSM-IV. A four-category measure of comorbidity was constructed: no substance use or psychiatric disorder; substance use disorder only; depressive/anxiety disorder only; and dual diagnosis. The data were analyzed using multinomial logistic regression.

The prevalence of dual diagnosis was low but varied by nativity, with the highest rates among Europeans and Puerto Ricans born in US states, and the lowest among Mexicans and Asians/Pacific Islanders. The nativity and racial–ethnic effects on likelihood of having dual diagnosis remained significant after all adjustments.

The limitations included measures of immigrant status, race–ethnicity, and stress and potential misdiagnosis of mental disorder among ethnic minorities.

This new knowledge will help to guide public health and health care interventions addressing immigrant mental and behavioral health gaps.

This study addressed the research gap in regard to the prevalence and correlates of dual diagnosis among immigrants and racial–ethnic minorities. The study used the most current and comprehensive data addressing psychiatric conditions among US adults and examined factors rarely captured in epidemiologic surveys (e.g., acculturation).

Racial and ethnic minorities utilize less healthcare than their similarly situated white counterparts in the United States, resulting in speculation that these actions may stem in part from less desire for care. In order to adequately understand the role of care-seeking for racial and ethnic disparities in healthcare, we must fully and systematically consider the complex set of social factors that influence healthcare seeking and use.

Data for this study come from a 2005 national survey of community-dwelling Medicare beneficiaries (N = 2,138). We examine racial and ethnic variation in intentions to seek care, grounding our analyses in the behavioral model of healthcare utilization. Our analysis consists of a series of nested multivariate logistic regression models that follow the sequencing of the behavioral model while including additional social factors.

We find that Latino, Black, and Native American older adults express greater preferences for seeking healthcare compared to whites. Worrying about one’s health, having skepticism toward doctors in general, and living in a small city rather than a Metropolitan Area, but not health need, socioeconomic status, or healthcare system characteristics, explain some of the racial and ethnic variation in care-seeking preferences. Overall, we show that even after comprehensively accounting for factors known to influence disparities in utilization, elderly racial and ethnic minorities express greater desire to seek care than whites.

We suggest that future research examine social factors such as unmeasured wealth differences, cultural frameworks, and role identities in healthcare interactions in order to understand differences in care-seeking and, importantly, the relationship between care-seeking and disparities in utilization.

This study represents a systematic analysis of the ways individual, social, and structural context may account for racial and ethnic differences in seeking medical care. We build on healthcare seeking literature by including more comprehensive measures of social relationships, healthcare and system-level characteristics, and exploring a wide variety of health beliefs and expectations. Further, our study investigates care seeking among multiple understudied racial and ethnic groups. We find that racial and ethnic minorities are more likely to say they would seek healthcare than whites, suggesting that guidelines promoting the elicitation and understanding of patient preferences in the context of the clinical interaction is an important step toward reducing utilization disparities. These findings also underscore the notion that health policy should go further to address the broader social factors relating to care-seeking in the first place.

Purpose – This chapter frames the horizon of inquiry intended by this conference on the Hispanic Presence in the Washington region. It presents social theory related to the formation of new types of community substance in immigrant receiving countries called ethnicities, especially in American metropolitan regions.

Findings – This synthesis of approaches to intergroup relations and account of changes in the collection of data regarding urban ethnicity frame a new research agenda.

Practical implications – This chapter proposes new horizons for regional studies and ethnicities. It addresses metropolitan governance, especially relationships among persons, groups, and cultures in regions that lack representation and institutions for political development. The web-based data sets and recommended readings provide sources that quantitatively and qualitatively deepen insight into the Hispanic presence in the country and in various metropolitan regions. Along with another forthcoming collection on the history, politics, and architecture of Washington, DC, this work catalyzes research to enable teaching and service related to the metropolitan region surrounding the federal district.

Social implications – This chapter includes models of action-oriented research that engage ethnic groups in coalition building and that test the viability of Hispanicity as a social-cultural development model.

Originality/value of chapter – This chapter blends social theory with community-based practices. It broaches substantive questions about appropriate scales of social analysis and ethnicity as interrelated dimensions of research and practice the government created data sets and places called metropolitan regions. It elaborates a new, fundamentally regional model that is unlike, but not opposed to, the country-wide focus of ethnic group advocacy and interest groups.

Based on the aforementioned data, the risk index (RI) identifies the percentage of all students of a given racial/ethnic group in a given disability category. The RI is calculated by dividing the number of students in a given racial/ethnic group served in a given disability category (e.g. LD) by the total enrollment for that racial/ethnic group in the school population. The 1998 OCR data revealed risk indices for all racial/ethnic groups that were higher for LD than those found for MR. The NRC (2002) report stated that, “Asian/Pacific Islander have placement rates of 2.23%. Rates for all other racial/ethnic groups exceed 6%, and for American Indian/Alaskan Natives, the rate reached 7.45%” (p. 47). The second index, odds ratio, provides a comparative index of risk and is calculated by dividing the risk index on one racial/ethnic group by the risk index of another racial/ethnic group. In the OCR and OSEP databases, the odds ratios are reported relative to White students. If the risk index is identical for a particular minority group and White students, the odds ratio will equal 1.0. Odds ratios greater than 1.0 indicate that minority group students are at a greater risk of identification, while odds ratios of less than 1.0 indicate that they are less at risk. Using the 1998 OCR placement rates, the LD odds ratio for American Indian/Alaskan Natives is 1.24, showing that they have a 24% greater likelihood of being assigned to the LD category than White students. Odds ratios for Asian/Pacific Islander are low (0.37). For both Black and Hispanic students, the odds ratios are close to 1.0. The third index, composition index (CI), shows the proportion of all children served under a given disability category who are members of a given racial/ethnic group and is calculated by dividing the number of students of a given racial or ethnic group enrolled in a particular disability category. Two underlying assumptions of the CI are that the sum of composition indices for the five racial/ethnic groups will total 100%, and baseline enrollment of a given racial/ethnic group is not controlled. More specifically, the CI may be calculated using the percent of 6- through 21-year old population with the racial/ethnic composition of IDEA and U.S. census population statistics. For example, if 64% of the U.S. population is White, 15% is Black, 16% is Hispanic, 4% is Asian, and 1% is American Indian these data not interpretable without knowing the percentage of the racial/ethnic composition with IDEA. Hypothetically, IDEA data may show that of the 6–21 year olds served under IDEA, 63% are White, 20% are Black, 14% are Hispanic, 2% are Asian, and 1% is American Indian. To calculate disproportionality, a benchmark (e.g. 10%) against which to measure the difference between these percentages must be used. If the difference between the two percentages and the difference represented as a proportion of the group’s percent of population exceeds +10, then the racial/ethnic group is overrepresented. Conversely, if the difference between the two percentages and the difference represented as a proportion of the group’s percent of the population is larger than −10, then, the racial/ethnic group is underrepresented.

Discrimination has been identified as a major stressor and influence on immigrant health. This study examined the role of perceived discrimination in relation to other factors, in particular, acculturation, in physical and mental health of immigrants and refugees. Data for US adults (18 +  years) were derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Mental and physical health was assessed with SF-12. Acculturation and perceived discrimination were assessed with multidimensional measures. Structural equation models were used to estimate the effects of acculturation, stressful life effects, perceived discrimination, and social support on health among immigrants and refugees. Among first-generation immigrants, discrimination in health care had a negative association with physical health while discrimination in general had a negative association with mental health. Social support had positive associations with physical and mental health and mediated the association of discrimination to health. There were no significant associations between discrimination and health among refugees, but the direction and magnitude of associations were similar to those for first-generation immigrants. Efforts aiming at reducing discrimination and enhancing integration/social support for immigrants are likely to help with maintaining and protecting immigrants’ health and well-being. Further research using larger samples of refugees and testing moderating effects of key social/psychosocial variables on immigrant health outcomes is warranted. This study used multidimensional measures of health, perceived discrimination, and acculturation to examine the pathways between key social/psychosocial factors in health of immigrants and refugees at the national level. This study included possibly the largest national sample of refugees.

Depressive symptoms are higher among racial and ethnic minorities in the United States. Many studies have evidenced associations between school disconnectedness and depressive symptoms by race and ethnicity in adolescence (Joyce & Early, 2014; Walsemann, Bell, & Maitra, 2011). Given that adolescents spend most of their time at home when they are not at school (Larson & Richards, 2001), it is important to understand how mother-child relationships may moderate school disconnectedness, and how mother–child relationships may serve as a protective buffer for depressive symptoms in the transition to adulthood. I use data from Waves II and III of the National Longitudinal Study of Adolescent to Adult Health (Add Health) from 1995 to 2002 (n = 9,766) and OLS regression analysis to examine how school disconnectedness in adolescence is associated with depressive symptoms in the transition to adulthood, and how mother–child relationships in adolescence moderate these associations in the United States. I examine differences in these relationships across racial and ethnic groups. I find that school disconnectedness in adolescence is associated with increased depressive symptoms in the transition to adulthood, and that maternal warmth and communication moderates the association between school disconnectedness and depressive symptoms. Maternal relationship quality in adolescence serves as an important protective factor for mental health in the transition to adulthood.

To investigate ethnic group differences in the utilization of preventive medical care services among U.S. Asian and Latino immigrant adults.

Using data from the 2002–2003 National Latino and Asian American Study, we examined whether differences exist in the reporting of any preventive physical care or dental/optician visit during the last year across Asian and Latino immigrant groups. Following, we applied Andersen’s (1995) Behavioral Model of Health Services Use to assess how ethnic disparities in preventive care use are a function of predisposing, enabling/impeding, and need-based factors.

Descriptive results showed that among Latinos, a much lower proportion of Mexican immigrants reported a preventive medical care visit during the last year than either Cuban or Puerto Rican immigrants. Asian immigrants show less variation in use, but significant differences still exist with Filipino immigrants reporting the highest level of use, followed by Vietnamese and then Chinese immigrants. Logistic regression models also indicated that predisposing characteristics, especially aspects of acculturation status, contribute strongly to ethnic group differences in preventive care use, while enabling/disabling and need-based characteristics are less important.

While studies of medical care use often treat Asians and Latinos as homogeneous groups, our findings illustrate the need for a more detailed view of the foreign-born population. Findings also highlight the role of acculturation status in shaping group differences in preventive medical care use – and as such, the importance of considering these differences when promoting the use of timely preventive care services among immigrant populations.