Health Psych: Culture and Health

HIV

- Blacks, Latinos, American Indian/Alaska Natives more likely to have HIV than Whites - Prevalence of HIV is highest among MSM

SES Differences in Health: Elderly Health

- Greater disability - More limitations in daily living - More frequent and rapid cognitive decline

Drug Use

- In 2010, Whites accounted for 82% of all (approx. 40K) drug-induced death - Rates of drug-induced deaths highest among Whites and American Indian/Alaska Native

SES Differences in Health: Adult Health

- Life expectancy (6 yrs between someone with a college education and someone with less than a high school education) - Premature chronic morbidity and disability of • Hypertension • Diabetes • Cardiovascular disease • Obesity • Osteoarthritis • Depression • Oral pathology • Many cancers

SES Differences in Health: Adolescent health

- Pregnancy - STD's - Depression - Obesity - Suicide - More likely to be sexually abused - Drop out of high school - Be killed - Lower satisfaction with health - Less family involvement - Worse problem-solving - Less physical activity

Tobacco Use

- Smoking is lowest among Black and Asian youth - Smoking is highest among American Indian/Alaska Native

Alcohol Use

- The prevalence (average number of episodes) of binge drinking is highest among Whites and people with a higher income - The intensity of binge drinking (amount of drinks consumed during episode) is highest among American Indian/Alaska Natives

Problems with looking across culture

1. Mixing up SES with ethnicity/race and geography. 2. Categories are broad and heterogeneous e.g., Latino includes Dominicans and Mexicans e.g., Asian includes Chinese, Japanese, Korean, Vietnamese, Hmong 3. Groups differ in the degree of exposure to and identification with mainstream American culture 4. Cultural differences in measurement (i.e., depression)

Cardiovascular Health

Blacks have highest rates of coronary heart disease, hypertension, and blood pressure than other racial/ethnic groups.

Health Insurance

Chronically ill patients without insurance are more likely than those with coverage - To not have visited a health-care professional - To not have a standard site for care or to identify their standard site of care as the emergency room - Lack of health insurance is also associated with reduced use of preventative services, especially among racial/ethnic minorities • In 2008, 2/5 Hispanics and 1/5 African Americans were uninsured • Between 2004 and 2008, up to 39% of people at or below the Federal Poverty Line were also uninsured

Culture

Culture can be defined as a dynamic, yet stable, set of goals, beliefs, and attitudes shared by a group of people

How do we know so much about racial/ethnic health disparities? Other contributors

David Williams (Harvard, formerly at Univ. of Michigan) - James Jackson (Univ. of Michigan)

SES Differences in Health: Child Care

Greater risks of death from infectious disease - Sudden infant death - Accidents - Child Abuse - Exposure to lead poisoning and household smoke - Asthma - Developmental delay and learning disabilities - Conduct disturbances - Avoidable hospitalizations - Exposure to marital conflict and intimate partner violence - Overcrowding - Lower health status and more risk behaviors as a preteen

What is race?

Once thought to be a biological construct • Now more commonly accepted to be a "social construct" based on phenotypic characteristics such as skin color, facial features, hair texture. • For the most part, we operationalize race as self-identified race.

What is Socioeconomic status (SES)?

SES is a composite measure of economic, social, and work status.

Suicides

Whites and American Indian/Alaska Native have the highest rates of suicide - Although some researchers suggest that the rates we know are underestimates for AI/AN • Males are four times more likely than females to commit suicide • Individuals with a 12 yrs of education are more likely than those with more education and more likely than those with less education to commit suicide • Blacks and Whites are more likely to use a firearm • Hispanics and AI/AN are more likely to suffocate themselves

Williams and Jackson Contributions

Williams Everyday Discrimination Scale • Studies - 'National Survey of American Life' which compared Whites and Blacks in US on mental health disorders - 'National Survey of Black Americans' which surveyed Black Americans, African Americans, and Caribbean Americans • Paper entitled "Race, Socioeconomic Status, and Health The Added Effects of Racism and Discrimination" (Williams, 1999) which discussed mechanisms.

Why is culture important to health and health psychology?

we are all products of our culture People from certain cultures are at greater/lesser risk of certain illnesses or conditions. • This known as a health disparity

Acculturation and Health

• Acculturation is the process of cultural exchange resulting from intercultural contact. • The more acculturation to US: - More smoking - More alcohol consumption - More other substance use - Less cancer screening - More premature births and low birthweight - More hypertension - More obesity - More HIV/AIDS

Mental Health

• All subgroups of minorities (except Puerto Ricans) exhibit lower rates of lifetime mental disorders than Whites • American Indians/Alaska Natives are at greater risk of PTSD and alcohol dependence, but lower risk for depression

Accidents

• American Indian/Alaska Native have the highest rates of death from motor-vehicle. Why? • Males have higher death rates than females • Latino workers and foreign workers are more likely to die from a work-related injury - Blacks and Latinos are more likely to work in occupations that are high-risk for injury/illness/fatality

Food Desert

• An area where affordable, healthy food is unavailable

Maternal/Child Health

• Black women have the highest rates of preterm birth and infant mortality in the United States. • Black and Latina women have higher rates of adolescent pregnancy than members of other racial/ethnic groups.

What happened in 1954?

• Brown vs. Board of Education • Does anybody know what happened in this case?

Chronic Illnesses

• Colorectal Cancer - Blacks are more likely to have & die from colorectal cancer than Whites. - Latinos are less likely to have and die from colorectal cancer than Whites. • Obesity and Diabetes - Blacks and Latinos are more likely to have diabetes than Whites - Mexican men born in US more likely to be obese than Mexican men born in Mexico

How do we know so much about racial/ethnic health disparities?

• Dr. Kenneth Clark and Dr. Mamie Phipps Clark

How do we know so much about SES and health?

• Dr. Sir Michael Marmot and the Whitehall Studies • Dr. Nancy Adler and Pathways of SES-Health

SES Differences in Health

• Fetal and Neonatal Health - Unplanned pregnancy - Unwanted pregnancy - Single and/or adolescent pregnancy - Smoking during pregnancy - Urogenital tract infections - Chronic illness in the mother - Inadequate prenatal care - Preterm birth - Low Birth Weight

SES

• In the United States, Blacks, Latinos, American Indian/Alaskan Natives tend to have lower income and lower educational attainment - As we just went over, there are CLEARLY SES differences in health • However, that doesn't explain it all. • A lot of studies statistically control for SES, but there are still racial/ethnic differences

How is SES measured?

• Income • Education • Parental Education • Zip Code • SES Ladder

Latino Paradox

• Latinos in the United States paradoxically have better health (for some health behaviors) than their White counterparts although they generally have lower average income and less education. • Explanations - Barrio Advantage - Healthy Migrant Effect - Salmon Bias • Acculturation

Racial/Ethnic Disparities

• Maternal and Child Health • Chronic Illnesses • Alcohol, Tobacco, and Drug Use • Homicides, Suicides, Work-Related Injuries, Motor-Related Accidents • Mental Health

Nancy Adler

• Nancy Adler (UCSF) has built on the work of Michael Marmot and applied it to the United States • Wrote a paper entitled "Socioeconomic status and health: The challenge of the gradient" (1994). • Discussed SES disparities, but also MECHANISMS for these disparities • Why would people with less money have more health problems?

Plessy vs. Ferguson Decision 7-1

• Plessy's rights were NOT violated, it is ok if things are separate, as long as they are equal Segregation was OK, as long as things were "equal"

Pathways

• SES • Health Insurance • Latino Paradox • Acculturation • Food Deserts • Distrust of medical professionals

What is culture?

• Skin color • Ethnic Background • Language • Customs and Traditions • Socioeconomic Status • Religious Beliefs

Behavioral Pathways

• Smoking • Physical Activity and Community Resources • Diet

Nancy Adler's Three Reasons

• Spurious associations or Third variable - Conclusion: Plausible, not probable • Drift hypothesis - Conclusion: Part of it, but doesn't explain everything SES may interact with health through different pathways - Conclusion: Big part of it

1954: Brown vs Board of Education

• States were permitted to have segregated schools • Oliver Brown, pastor in Topeka, Kansas had a daughter in third grade • She had to walk 6 blocks to catch a bus to attend a Black school further away • She had a White school 7 blocks away • Brown sent his daughter's application to the school, they rejected it • Joined a class-action with other parents in the community

Kenneth Clark and Mamie Clark's role in Brown vs Board of edication

• Supreme Court wanted to know in which ways Blacks are affected by separate schools - Quality of the education - Busing - Psychological Effects • Kenneth Clark and Mamie Clark used psychological research to show the negative effects of segregation (racism) on the mental health of Black children -Doll Experiment

SES and Health Overview

• There are SES disparities all across the lifespan • Michael Marmot and Nancy Adler are pioneers in this field • There are behavioral pathways through - smoking, - physical activity and community resources, - diet

Whitehall Study I

• This is a FOUNDATIONAL study in health psychology • We understand now that SES is important in health, but this was not always understood as a fact • The Whitehall Studies demonstrated that social factors impact health

Distrust of Medical Professionals

• Tuskegee Syphilis Study • Mississippi and North Carolina sterilization program • For 70 years, California sterilized 20,000 (mostly Asian and Latino) men and women starting in 1909 • Only in 2014 (2014!) did Gov. Jerry Brown sign a law prohibiting sterilization in prisons