BBH 302 Exam 1

As stated in the movie, after living in the U.S. for _____ or more years, Latino immigrants are 1.5 times more likely to have high blood pressure than when they first arrived.

5

Heckler report 1985

60k excess deaths in minority populations.

African American women have babies born small at twice rate of white women- why

African Americans collectively have lower SES but even when you correct for that the gap doesn't go away- actually widened as SES improved. Due to unequal treatment of African Americans- racism takes a heavy toll of AA children even before leaving the womb. Weathering

who has highest rates of chronic liver disease and cirrhosis>

American Indians

Collerectal cancer

American Indians highest rates but not much different than blacks. Scanning between blacks and white not much different

Which race has the highest rates of unintentional injuries (accidents)?

American Indians/Alaskan Natives- associated with alcoholism

In the Singh and Miller (2004) article on immigration, the "Immigrant Paradox" was consistently present in all but a few sub-groups from which population? Hispanics, Asians, blacks, American Indiands

Asians

tuberculosis

Crowded environment=spread of infectious diseases like TB. Most people with TB will never become sick, 9 million do become sick (usually in places of poverty, malnourished). Also airborne so spreads rapidly. To treat need 4 drugs a day every day for 6 months. If failed to treat first time can come back in drug resistant form

Although this is would be an intervention that would be impossible to fund, Dr. Warne mentioned that he would like to prescribe affluence as a treatment for diabetes. In ONE sentence, describe what he meant by that.

Dr. Warne is referring to how in regards to diabetes, affluence could be a treatment because it would decrease the stress of poverty that causes increased stress hormones (which when constantly high triggers the constant release of glucose that leads to diabetes) and also provide healthy food and access to exercise facilities that would decrease diabetes risk.

social determinants of health

Economic/social policies such as access to healthcare or education, SES, housing, employment, differential access to services/opportunities of society by race

H pylori and the Asian Enigma

H pylori high in Asia but not equal rates of stomach cancer

Dr. Iton stated that the relationship between health and wealth is relatively loose for new immigrants. What did he mean by this?

He means that new latino immigrants, even if they are from low SES have better health that wealthy people from US.However the health-wealth relationship becomes tighter as the years pass

Cervical cancer

Hispanic Latino women have highest incidence rates, highest death rates in black women

Positive Immigrant Selectivity refers to the idea that

Immigrants may be healthier than those who could not migrate

Thrifty gene hypothesis

Indians were here before industrialization- gene always there but not turned on until in area with fast food, etc. Gene's help them hold onto fat because used to live in a situation where food was scarce. Also applied to Blacks that survived slavery.

History of pacific islands:

Japanese took over, then US, then independent. 1946-48 nuclear devices detonated near/around island. 1954- BRAVO- hydrogen bomb, radioactive fallout onto two islands- resettled but broke down community and caused stress/contamination. One island is under US control (army base) and has wealthy resources- indigenous not allowed to live there. People who were once there were resettled. Small island can absorb all of them. Contrast between islands- health of Americans living on army base is similar to middle class neighborhood in America. Lifespan, infant mortality rate, diabetes (30% in islands), and TB disparities. No access to vaccines for hep B

Movie Hidden America Children of the Mountains

Kentucky and West Virginia- ½ million live in extreme poverty. Coal companies have taken billions from the mountains. Families have an average annual income less than the price of a new car. Availability of government resources- cannot pick up trash. Lack of transportation. Only 1/10 have college degree. Dealing prescription drugs- in 2007 Purdue pharma deliberately misled people about addictiveness of drug, also Xanax and oxi- institutionalized racism. Oxicotten is the prize- $120. Central Appalachia #1 for toothlessness- mountain dew. Secondary prevention- safety net program- dental clinical in a truck. Many are miners- dangerous, black lung, 60k per year. Why don't they leave? "Once Appalachia in is your blood it's in your blood forever".

Stress and subordination/macock study

More control less stress. Poverty is a chronic stressor that constantly wear and tears your body even at cellular level

What is the Healthy Immigrant Effect?

People who are healthier may have the ability to migrate more than those not as healthy. Also bring their healthier diet with them, many social ties because immigrants tend to move to places where they know people (instant community that reduces barriers with healthcare system)

What is the "Life-course perspective" in regard to African American women's high amount of pre-term birth weights?

The idea that birth outcomes are the product of the entire life course of the mother and are heavily influenced by the chronic stress of racism.

What is the name of the U.S. agency that was responsible for conducting a majority of the health inspections of immigrants upon entry to the U.S. in the early 1900s?

U.S. Public Health Service

links between stress and health****

When we feel threatened or don't have control stress response kicks in and signals adrenal glands to release cortisol which flood bloodstream with glucose, increase HR, raise BP. Prolonged activation impairs immune function, inhibits immunity- inc. risk diabetes and heart diseases. heightened stress response/health behaviors impacted by social support, stigma identification, coping style- can be negative

Public planners, urban planners and local government officials make plans about land use in ways that benefit some and disadvantage others. If you think about the "cliff diagram" that Dr. Francis covered in class, is this considered a social determinant of health that, if improved, could move high-risk populations away from the edge of the cliff?

Yes, it is a social determinant of health

internalized racism

acceptance by members of the stigmatized races of negative messages about their own abilities and intrinsic worth. Not believing in others who look like them and themselves, accepting limitations to own humanity, embracing "whiteness", self-devaluation, resignation, helplessness, hopelessness. "white man's ice is colder"

Singh and Miller

acculturation process, positive immigrant selectivity, suicide and homicide higher in immigrants, life expectancy higher in immigrants

Which of the following new modes of travel in the early/mid 1900s raised concerns about the medical inspections process, and the likelihood that immigrants would spread diseases and infections to the American public?

air travel

In the late 1800s and early 1900s, which group was almost exclusively banned from entering the U.S., a group labeled as "parasite-ridden?"

asians

lung cancer

black men have highest rates even though cigarette smoking between blacks and whites about the same

septicemia

blood infection- anyone who has dealt with severe forms of disease such as cancer/HIV- anything that would compromise immune system, diseases you need intense care for, long term illnesses for a long amount of time increases risk of- tied to not getting health care you need, not going in to get diagnoses of time because of fear of public charge

Syphilis Study at Tuskeegee

by the US public Health Service between 1932 and 1972. Symptoms of syphilis include tumors, heart disease, paralysis, blindness and insanity. Black physicians involved.

Causes of disparities in blacks

cancer disparities- access to care, later stage diagnoses, centuries of institutional racism, lack of knowledge to care for blacks, genetic fatalism (your parents had it so there's no way you can avoid getting it), urbanization and poverty, distrust or medical system or mistrust (history of dishonesty, etc.)

hispanics/latinos leading causes of death

cancer leading cause of death (not heart disease), then disease of heart, unintentional injuries, cerebrovascular disease, diabetes, chronic liver disease and cirrhosis, Alzheimer's, Chronic lower respiratory diseases, influenza/pneumonia, nephritis.

weathering

carrying a burden, blacks seem to be developing chronic diseases at earlier ages than other populations. Incidence rate might be the same between races however if blacks are developing these diseases at 20s instead of 40s the prevalence is higher. Explains differences in life expectancy because if you get a disease at a younger age the wear and tear on your system is far greater than if you develop the disease at an older age

In an attempt to combat the hunger that followed after the dam was built, the U.S. Government began to supply commodity foods to the population, which had a direct impact on diabetes rates. This is an example of an act of ______________.

commission

Safety net organization

community based local health organizations devoted to improving health or decreasing disparity. Catch people who might fall through the cracks- uninsured, lack transportation to clinic/hospital, etc. Fill in gap

The damming of the Gila River was discussed as one of the major events in history that changed the face of health for the Tohono O'odham tribe in Arizona. Apart from loss of income and food access because of reduced agriculture, what was also discussed as a major determinant of health disparities in this population?

cultural loss

What is the Immigrant Health Paradox?

despite being at lower income/education, immigrant populations tend to be healthier than US born counterparts. But the longer you have been here you see these benefits less (except for mental health- because you have community you see much less in immigrant population). Consistency present in all but a few sub-groups from Asian populations

Institutionalized racism

differential access to the goods, services, and opportunities of society by race. Normative, sometimes legalized, and often manifests as inherited disadvantage. Structural- in custom, practice and law so no perpetrator. Material conditions (access to education, housing, employment, medical facilities, clean environment) and access to power (access to information including one's own history, resources, voice). Flower pots: initial historical insult of separating seed into 2 different soils; the contemporary structural factors of the flower boxes which keep the soil separate and the act of omission in not addressing the differences in soils over the years. Normative aspects- initial preference of red over pink

Blacks/African Americans leading causes of death

disease of heart, malignant neoplasms, cerebrovascular disease, unintentional injuries (these 4 have not changed since 1980), diabetes, chronic lower respiratory diseases (asthma, bronchitis-smoking), nephritis, homicide, Alzheimer's, septicemia

American Indians and Alaskan natives leading causes of death

diseases of heart (#1), unintentional injuries, malignant neoplasms (cancer), chronic liver diseases (alcoholism) and cirrhosis. Suicide in top 10.

Native Hawaiians and Pacific Islanders leading causes of death

diseases of heart, malignant neoplasms, diabetes

Leading causes of death in non hispanic whites

diseases of the heart, malignant neoplasms, chronic lower respiratory diseases, unintentional injuries, suicide

differences vs. disparities

disparities are unethical (people who have more money are healthier than those with less). Differences are those such as prostate cancer is higher in men than women due to their biology.

True or false: Suicide and homicide were lower in immigrants.

false

true or false: Regardless of seating (i.e., first class, second class, etc.), immigrants arriving to the country on ships and trains were subject to equally harsh health inspections and medical examinations.

false

true or false: Being on guard all the time (hypervigilance), having little control at work, living in an unsafe neighborhood, being uncertain about where food will come from, and worrying about one's children are all considered to be acute stressors.

false, chronic

Immigrants social determinants of health

fear of public charge (scared they will be deported because they will be seen as burden on healthcare system), cultural ignorance (language, customs)

health disparities in non hispanic whites

highest levels of death from suicide (especially white men, however Hispanics highest rates of ideation), highest incidence of breast cancer in white women, highest uterine cancer, ovarian second highest incidence, prostate and lung cancer 2nd highest incidence in men, highest rates of oral and bladder cancer (chewing tobacco), highest lymphoma and leukemia, high cigarette smoking (25-44 years), highest suicide, alcohol use (highest heavy use in native Americans) and illicit drugs, highest death rates of death from drug poisoning

hispanics/latinos health disparities

highest teenage child bearing, no or late prenatal care, HIV/AIDS, higher diabetes, higher obesity, higher asthma, higher TB, cancer for all sites (incidence)- cervical cancer highest (but Vietnamese women highest rates of all groups), highest number of health care visits (chronic disease), lower health care coverage

genetic fatalism

if your family member has a disease you believe no matter what you will get it so you do nothing to prevent. In regards to race- American Indians are prone to have diabetes

inequalities vs. inequities

inequality is a difference, inequity is like a disparity and is unethical. An inequality would be the higher prevalence of lung cancer in smokers. An inequity would be that resource poor individuals are often enrolled in health insurance programs that have higher premiums and deductibles

Not having interpreters in areas in which there is a large prevalence of immigrants from China is an example of what type of racism?

institutionalized

Terrel Dew Johnson (the photographer) took the viewers through a tour of the reservation he used to live on, and showed the one source of water for the entire reservation. Based on the reading by Jones on levels of racism, this is an example of which "ism."

institutionalized

Which type of racism is the most fundamental, and is viewed as the starting place for change?

institutionalized

Patients of color not following a physician's guidance because of beliefs that the physician does not have their best interest in mind is an example of which type of racism?

internalized

major barriers to health and quality health care in immigrants

lack of access to health services (tend to have lower income), lack of health insurance (fear of public charge), language barriers (many children who have parents who do not speak English navigate the health care world for them- may be chronic stressor), cultural ignorance

hispanic/latino social determinants of health

language barriers, disconnect between modern medicine and traditional beliefs, urbanization and poverty, represent a large proportion of immigrant pop

asians barriers to culturally-appropriate care

language barriers, traditional vs. modern medicine, beliefs about causes of illness, limited access in the working poor (very poor health, working conditions, crowding, uninsured and under-insured, fear of public charge). Huge stigma against mental illnesses

prostate cancer

leading cancer death for black men, leading incidence and death rates. Sustained over time. Rates of incidence spiked due to measurement error or public health push to get people to go in for more screenings.

What major health disparity in Asian/pacific islander populations is associated with the high incidence of hep B?

liver cancer- mother to child

Blacks/African Americans health disparities

low levels of life expectancy (lowest in black men), highest rates of infant mortality, highest days spent in hospital, high obesity and diabetes (mortality highest in blacks-beta blockers not effective to treat hypertension in blacks), stroke and coronary heart disease (in general biology of arteries are thinner- originally thought blacks doing well so underestimated), highest rates of prostate cancer, highest death rates of HIV/AIDS, high Lupus, TB (US-born not all blacks actually asians, due to poverty/HIV), sickle cell anemia (genetics- west Africa)

asians leading causes of death

malignant neoplasms, diseases of heart, cerebrovascular disease, unintentional injuries, diabetes, influenza, chronic lower respiratory disease, Alzheimer's, nephritis, suicide

Incidence vs. prevalence

more whites than minorities. When we think about any specific disease, overall prevalence is higher in minorities compared to whites but overall incidence rate higher in whites (because higher number of whites have disease). Prevalence is percentage, incidence is the number of new cases.

Hispanic/Latino health paradox

most Hispanics in the US have better health than the average population despite higher poverty rates, less education and poorer access to health care compared to non-Hispanic whites. What we see in immigrant health paradox mostly due to Hispanic/Latino paradox. Much lower general mental health problems BUT Hispanic female teens suicide ideation higher. Networks and support that buffer effects of mental health problems.

Dislocation

moving to unfamiliar area=stress

What is race?

not based on biology but is an idea with ascribe to biology. American racial classification is totally cultural. Being black just means looking dark enough.

Native Hawaiians and Pacific Islanders health disparities

obesity, hypertension, diabetes (highest out of all races in 2007), smoking, alcohol consumption, hepatitis B (mother to child), HIV/AIDS, TB (23X that of US- living conditions), Stomach and Liver Cancer, asthma (living conditions, twice the rate in regards to ever having asthma), illicit drug use-heroin, current cocaine use, attempted suicide

Omission vs commission

omission is when you don't provide service that's necessary- making assumption someone can't afford diagnostic test so don't recommend- would be that a physician is unaware of patient's cultural background - did not know patient had to pray about it before going through with treatment so didn't go through with it. Commission providing wrong treatment- beta blockers don't work well in blacks- recommend to someone without knowing they're black, over diagnosing kids into special education

asians health disparities

one of the healthiest groups in the US. High rates of hepatitis B and TB, lower rates of death for heart disease and cancers overall (but highest rates of all population of cervical cancer in Vietnamese women), higher stomach and liver ca incidence (compared to all racial groups-highest rate of stomach cancer in Korean men)

Physicians not referring patients of color for diagnostic tests because of assumptions about the patient's medical adherence is an example of which type of racism?

personally-mediated

personally- mediated racism

prejudice (differential assumptions about abilities, motives, and intentions) and discrimination (differential actions). Lack of respect, suspicion, devaluation, scapegoating, dehumanization. Intentional and unintentional- commission (providing wrong treatment- beta blockers don't work well in blacks- recommend to someone without knowing they're black, over diagnosing kids into special education) and omission (don't provide service that's necessary- making assumption someone can't afford diagnostic test so don't recommend)

An epidemiologist in the movie stated that __________ increases the risk of cardiovascular disease, infectious diseases, diabetes, strokes and cancer.

social isolation

how does stress induce labor and cause preterm birth/low birthweight in blacks?

stress may induce labor and cause preterm birth/low birthweight- constricts blood flow to the placenta which decreases fetal growth (low birth weight baby), increases inflammation in uterus which reduces the amount of room the baby has, cortisol can cause early contractions

American Indians and Alaskan natives health disparities

sudden infant death syndrome (SIDS), infant mortality, chronic liver diseases/cirrhosis mortality, diabetes mortality (no genetic explanation), unintentional injuries, suicide, smoking during pregnancy, prenatal care. Also fetal alcohol syndrome, domestic violence, alcoholism and substance abuse, homicide (2nd highest), tuberculosis (bronchitis, crowding, poor resources, co-morbid with HIV), obesity, mental health problems

Who is the gardener? (levels of racism- Jones)

the government

What role does acculturation play in immigrants' health?

the longer you have been here you start to adopt practices of US. An increased risk of disease with increasing length of being here

Acculturation Process

the longer you have been here you start to adopt practices of US. An increased risk of disease with increasing length of being here. Acculturation you still retain parts of your culture, assimilation you lose your culture.

true or false: Immigrants suffering from disease (considered loathsome or contagious) were banned from entering the U.S. as a part of the Immigration Act of 1891.

true

true or false: In general, life expectancy was higher in immigrants.

true

hispanics/latinos causes of diaprities

underinsured are working and often have multiple part time jobs so don't have reliable health care coverage provided by employer. OR have but copays to high. Immigrants- fear of public charge. Also language barriers, disconnect between modern medicine and traditional beliefs, urbanization and poverty, represent a large proportion of immigrant population

What major health intervention has virtually eradicated hep B in other parts of the world?

vaccines

working poor social determinants of health

very poor health, working conditions, crowding, uninsured and under-insured, fear of public charge)

asthma

waste treatment plants often built in places where over crowding, residential segregation, bus depots built here so leads to air pollution. Blacks/african americans have very high rates.

cliff diagram- explain

we have populations that are high risk, cliff represents disease. There should be tertiary care at bottom of cliff to catch you when you fall. Even better would be primary prevention- fence at cliff (seat belts, no smoking laws, brushing teeth, healthy diet, physical activity). There should also be secondary prevention (net right after cliff- safety net programs- screenings, education classes, etc.). Best would be moving them away from cliff= social determinants of health- policies and institutions that keep people low risk

Social gradients in health (health-wealth gradient)

wealth/health social gradient in health. With higher income comes decrease in excess death and better health at every single level of wealth. Stair step relationship/correlation. the more control you have the less likely you will be affected by life stressors. Job insecurity, being poor- increases risk of illness. Poverty is a chronic stressor that constantly wear and tears your body even at cellular level

most of the poor in america are what race?

white

Life expectancy

white females highest, if you can make it to 65, there is something different about that population so that there is very little differences between life expectancies between races and genders vs. life expectancy at birth. Social determinants matter less at 65 than those when born (what neighborhood born into, family, etc.)

Breast cancer

white women highest incidence, black women highest deaths. Later stage diagnoses for black women- less preventative screenings. Tumors larger and more aggressive in blacks (easier to treat may be?)