BBH 302 Exam 2

Acculturation

- "Cultural modification of an individual, group, or people by adapting to or borrowing traits from another culture."

health disparities

- "differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific populations in the United States"

Safety Net Program:

- A secondary prevention approach to providing goods or services (e.g., health care, food, education, etc., often for free) to individuals or communities who may have limited access to these goods and services.

Suicide mortality rates were highest in which YOUNG ADULTS?

- AI/AN; second highest in White

Health Disparities in Asians, Native Hawaiians, and Pacific Islanders (ANHPI): Cardiovascular Disease (CVD) and Hypertension

- APIs had the lowest rates of CVD mortality - NHPIs had the second highest rates of hypertension, highly linked to CVD and diabetes.

Health disparities in blacks: Asthma

- Black children bore the greatest burden of asthma - Black adults had the second highest rate of current asthma - Blacks' burden of poverty may partially explain the increased rates of asthma in this group.

Health disparities in blacks: Tuberculosis (TB)

- Blacks accounted for majority of cases in U.S.-born populations - TB risk factors include poor housing conditions, crowding, and HIV infection. The disproportionately high rates of TB infection in Blacks can be partially explained by increased exposure to these risk factors

Unique Challenges to health in blacks

- Blacks are over-represented in low-income and unemployed groups - Blacks had a lower rate of high school/bachelor completion, unemployed at twice the rate of Whites. Blacks are also known to live in segregated neighborhoods, with fewer amenities (parks, health clinics), lower access to fresh fruits/vegetables, greater violence, greater exposure to environmental toxins, and more targeted marketing of fast food, alcohol, and tobacco products.

L07 Health disparites in Blacks summary:

- Blacks in the U.S. are disproportionately impacted by a number of chronic diseases, including certain cancers (prostate, breast, and colon), diabetes, hypertension, stroke, and asthma. - We also learned about the disproportionately high rates of infant mortality and negative birth outcomes in the population. The major take-home messages from this lesson include: - Racism has real impacts on the health of Black populations - The Tuskegee Syphilis Study is an example of institutionalized racism that continues to impact Blacks' perceptions of the trustworthiness of the medical community Diseases and conditions to remember include: -Septicemia and its causes (leading cause of death only for this racial group) -Hypertension -Prostate cancer -Breast cancer mortality -HIV -Tuberculosis (highest in U.S.-born populations) -Infant mortality -Homicide (leading cause of death only for this racial group)

Health disparities in blacks: Mental health problems

- Blacks living in poverty were 2-3 times more likely to report serious psychological distress than those who were not in poverty. Chronic stress. - Blacks had lower levels of mental health treatment, despite these disparities.

Health disparities in blacks: Homicide

- Blacks, particularly Black men, bear the greatest burden for homicide. - Black males were most likely to die from firearm-related injuries

Which of the following were the 4 main barriers to participation in clinical research among African Americans?

- Communication - Trust - Experimentation - Logistics of the Research Process

Unique challenges for white populations?

- Generally healthy and high life expectancy. - Poor are often ignored. - Unique exposures due to skin tone. - Unique exposures due to social norms. - Unique exposures in rural populations.

Health disparities in blacks: HIV

- HIV rates were highest in Black populations; this is one disease for which the disparities are extreme and sobering. The rates were 4-20 times greater in Blacks - Tremendous public health efforts are targeted towards increasing HIV testing and promoting safe sexual practices in Black populations. Given that HIV weakens the immune system, and the fact that HIV is comorbid with TB, these health burdens increase the risk of developing septicemia.

Health disparities in whites: Cardiovascular Disease (CVD), Hypertension, and Stroke

- Heart disease prevalence was second highest in Whites - Stroke prevalence rates were highest in Blacks, but similar between Whites

Suicide ideation (suicidal thoughts) were highest in what YOUTH?

- Hispanic female youth (Puerto Rican)

Latina Birth Outcomes Paradox

- Hispanic/Latina women have similar birth outcomes as women of higher socioeconomic status and those with better healthcare access.

Health disparities in whites: Tuberculosis (TB)

- In U.S.-born populations Whites had the second highest rates (31%). A striking disparity for Whites. - The disproportionately high rates of TB infection in Whites can be partially explained by an increased exposure to many of the same risk factors identified for other populations, including substandard housing and other factors related to poverty. Substance abuse is also a significant risk factor

Health disparities in blacks: Infant Mortality

- Infant mortality is a major disparity in Blacks, 26% of Black women received late or no prenatal care. This is not enough to explain these disparities in Blacks. Racism and Chronic stress

The Tuskegee syphilis study was an example of which form of racism?

- Institutionalized, structural racism. Blacks in the U.S. were subject to centuries of discrimination, which is a chronic, ever-present stressor that has multiple, negative impacts on health. - This set the ground for pervasive medical mistrust in Blacks and was the cause for a restructuring of human subjects protections in research.

Health Disparities in American Indians and Alaskan Natives (AI/AN): Obesity

- More likely to be overweight/obese compared to Whites.

Health Disparities in American Indians and Alaskan Natives (AI/AN): Cancer

- Prevalence of cancer in all sites was second highest - AI/AN males had the second highest incidence rate of colon and rectum cancer - For females, the colon and rectum cancer incidence rate was highest among AIs/ANs. - Colorectal screening rates, colonoscopy rates, mammography screenings, and Pap smear testing were the lowest. - Cervical cancer incidence rates were highest among AI/AN females - Breast cancer incidence rates were lowest among AI/AN women - Stomach cancer incidence rates were highest among AI/AN males and females

Health disparities in blacks: Diabetes

- Prevalence of diabetes was second highest among Blacks, Blacks had the highest mortality rate from diabetes; rate 2 times higher than the rate for Whites

In what ways does chronic stress impact pregnancy and birth outcomes?

- Racism experienced by black mothers is causing premature birth/low birth weight infants (accounting for very bad birth outcomes in the U.S.). Experiencing racism is a true form of chronic stress: 1. By triggering labor 2. Constricting blood flow to the placenta 3. Inflammation in the uterus

The mobile dental office and Eula's community clinic that were highlighted in the "A Hidden America: Children of the Mountains" film are examples of:

- Safety net programs

Thinking of all of the racial and ethnic groups we have discussed thus far, which of the following ONLY appear in the top 10 leading causes of death for Blacks?

- Septicemia and homicide

Health disparities in whites: Tobacco and Other Substance Use

- Smoking prevalence rates in adults were third highest in White males - With regards to drinking, Whites ages 18 and older reported the highest rates of alcohol use - Regarding the use of illicit drugs and marijuana, Whites ages 12+ reported the third highest prevalence rates. White males and females had the highest drug poisoning death rates involving opioids and heroin.

Which of the following is a MAJOR health disparity in White populations?

- Suicide

Syphilis Study at Tuskegee University, conducted by the U.S. Public Health Service

- Tarnished the Black community. The goal was to study the natural course of syphilis; participants were told they were being treated for "bad blood." They received free medical exams, free meals, and burial insurance; no syphilis treatments were given. - This study became a shameful blemish in U.S. history because the men were not provided with informed consent; they did not know/fully understand what their participation entailed.

Health disparities in whites: Cancer

- The prevalence of cancer was highest in Whites - Whites had the highest incidence rates of certain cancers, specifically breast, ovarian, oral (men), urinary bladder, lymphoma, and leukemia. - Although the incidence rate of some cancers was higher in Whites, survival rates for several cancers were better/higher in Whites compared to Blacks - Whites developed many of these cancers at a faster rate than Blacks, Blacks died from these cancers at a higher rate than Whites. - White women had the second highest mortality rates from breast cancer. Whites consistently had the second highest mortality rates over time, thus, this is considered a major health disparity compared to all other races, other than Blacks

Health disparities in blacks: Tobacco and Other Substance Use

- The prevalence of current smoking in adults was third highest in Blacks - Second-highest rates of alcohol use - Regarding the use of illicit drugs and marijuana, Blacks reported the second-highest rates of use

Health disparities in whites: Mental Health Problems

- While Whites often had the second or third lowest rates of many mental health indicators, they had the highest suicide death rates. Whites males bore the greatest burden of suicide. - Suicide is the third leading cause of death for youth ages 10-14, and the second leading cause of death for individuals ages 15-34 years. Suicide death is also more prevalent in males, although females have twice the reported suicide attempts as males. - Whites report the highest rates of receipt of medications for mental health treatment or counseling in the past year, as well as receipt of treatment following a major depressive episode.

Suicide mortality rates were highest in which ADULTS?

- White males

L08 Health disparities in Whites Summary:

- Whites in the U.S. are disproportionately impacted by a number of chronic diseases, including certain cancers (oral, ovarian, lymphoma, leukemia), suicide, binge drinking, and drug poisoning. The major take-home messages from this lesson include: - Poor White populations are often ignored - Suicide is a major health disparity, particularly for older White men - Opioid drug poisoning is a particular concern for rural, poor Whites - Heart disease rates were 2nd highest in Whites - Tuberculosis rates were 2nd highest in U.S.-born Whites

Additional Disparities in AI/AN populations:

- teenage pregnancy - domestic violence - liver disease - hepatitis (risk factor for liver disease) - asthma - tuberculosis

Health Disparities in Hispanics/Latinos: Diabetes

-3rd highest rates. -Mortality rates from diabetes are significantly higher in Hispanics/Latinos than in non-Hispanic Whites.

Health Disparities in Hispanics/Latinos: Liver Disease

-Alcohol use and viral hepatitis are usual causes of liver disease in Hispanics/Latinos; fatty liver disease also contribute. -The reasons for the disparities are perplexing, particularly given the lower rates of alcohol use in this population. Liver disease increases the risk of liver cancer, and Hispanics/Latinos carry a higher incidence and higher burden of death from liver cancer than other populations.

Health Disparities in Hispanics/Latinos: Cardiovascular Disease (CVD)

-Lower prevalence of several CVDs, however, many of the risk factors are higher, including hypertension, diabetes, and obesity.

Top ten causes of death in whites

1. Diseases of the heart 2. Malignant neoplasms 3. Chronic lower respiratory diseases (smoking) 4. Unintentional injuries 5. Cerebrovascular diseases 6. Alzheimer's Disease 7. Diabetes 8. Influenza and pneumonia 9. Suicide 10. Nephritis, nephrotic syndrome and nephrosis

Which of the following describes a paradox for AI/AN health disparities?

AI/AN drinking rates are lower than some other groups, but alcohol-related deaths are higher.

Number 1 cause of death in Hispanics/Latinos?

Malignant Neoplasms (cancer)

Number one cause of death in Asians, Native Hawaiians, and Pacific Islanders (APIs)

Malignant neoplasms (cancer)

Health Disparities in (AI/AN): Disability

- AI/AN adults had the highest disability prevalence rates, they also reported the highest rates of headaches or migraines, lower back pain, and neck pain - AIs/ANs were most likely to report having 4 or more of 10 selected chronic conditions. The 10 conditions included hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, hepatitis, weak or failing kidneys, chronic obstructive pulmonary disease, or current asthma.

Health Disparities in (AI/AN): Tobacco and Other Substance Use

- AI/AN females reported the highest prevalence of current smoking, AI/AN males reported the second highest smoking rates - Overall alcohol use was lower in AIs/ANs than other populations. This is a bit of a paradox, since alcohol-related deaths were higher for AI/AN populations - Major causes of alcohol-related deaths included motor vehicle accidents, poisoning, homicide, suicide, liver disease, alcoholic dependence, and cirrhosis. - The prevalence of illicit drug and marijuana use was also highest in AIs/ANs. The rates of death by drug poisoning involving opioids and heroin were second highest in AIs/ANs

Drs. Collins and David described a research study that they conducted which showed that unfavorable birth outcomes in African-American women were NOT due to genetics. What finding led them to this conclusion?

- African women had birth outcomes similar to Whites

Indian Health Service (IHS):

- An agency in the Department of Health and Human Services that provides comprehensive health care and services to native populations from federally-recognized tribes.

"Isms":

- Any kind of discrimination against another person because of a particular characteristic. This may be discrimination due to race or ethnicity, sex, sexual orientation, gender identity, age, or any other characteristic. (Sexism, heterosexism, ageism)

Native Hawaiians and Other Pacific Islanders (NH/PI) definition:

- Anyone having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

healthy immigrant effect

- Better health, healthier lifestyles or behaviors

Comission

- Providing the wrong treatment

Difference

- Something that can be attributed to simple differences in biology. - Ex: prevalence of breast cancer is higher in women than in men

Health Disparities in American Indians and Alaskan Natives (AI/AN): Chronic Liver Disease and Cirrohosis

- Strikingly high rate.

Social Determinants of Health:

- Structures and policies in society that can serve to promote or impede health. - Ex: discrimination, housing policies, income/wealth, educational opportunities, or community resources.

Positive Immigrant Selectivity:

- The hypothesis that there is a selection effect that explains better health in immigrants; people who immigrate to the U.S. may be healthier, in general, than those who do not immigrate. Social position

Incidence

- The number of new cases of disease during a specified time interval.

Suicide ideation was highest in which ADULTS?

- White adults

Leading cause of death in whites

Diseases of the heart

Number One cause of death in American Indians and Alaskan Natives?

Diseases of the heart

Number one cause of death in blacks

Diseases of the heart

Lesson 6

Health Disparities in Asian, Native Hawaiian, and Pacific Islander Populations

Lesson 7

Health Disparities in Black Populations

Lesson 4

Health Disparities in Hispanic/Latino Populations

Lesson 8

Health Disparities in White Populations

Review Terms

L01-L03

What major health disparity in Asian/Native Hawaiian/Pacific Islander populations is associated with the high incidence of Hepatitis B?

Liver cancer

Which of the following problems is MOST prevalent in American Indian/Native Alaskan populations?

Motor vehicle-related deaths

Hispanics/Latinos have greater life expectancy than Non-Hispanic Whites and Blacks. TRUE OR FALSE?

TRUE. Hispanics/Latinos have greater life expectancy than non-Hispanic Whites and Blacks despite this group having lower socioeconomic status (SES) and education than Whites.

Suicide rates are disproportionately high in American Indian/Alaskan Native populations, compared to other minority groups. TRUE OR FALSE

True; the rates of death from suicide are second highest in AI/AN groups; the highest rates are found in Whites.

Overall, Jones concludes that racial and ethnic health disparities may be due to:

(1) a differential quality of health care (2) differential access to care (3) differential life opportunities that impact health and disease.

Health Disparities in (AI/AN): Unintentional Injuries

- 3rd leading cause of death - The greatest disparity was seen for motor vehicle-related injuries, with the death rate for AIs/ANs almost 50% higher than the rate for non-Hispanic Whites. -Seat belt use was lower among AIs/ANs

Amenable Deaths:

- Avoidable deaths that could be prevented if individuals received adequate and timely health care.

Inequalities:

- Similar to health disparities

omission

- Withholding or not providing treatment.

Health Disparities in Hispanics/Latinos: Mental Health Problems

-Lower rates of mental health problems -Hispanic high school students report higher rates of suicide ideation/planning and suicide attempts than Black, and White students. -Second lowest rate of mental health service use/treatment than any other racial/ethnics group -Mental illnesses may be underreported in this population

Top 10 causes of death in blacks

1. Diseases of the heart 2. Malignant neoplasms 3. Cerebrovascular diseases 4. Unintentional injuries 5. Diabetes 6. Chronic lower respiratory diseases 7. Nephritis, nephrotic syndrome, and nephrosis 8. Homicide 9. Alzheimer's 10. Septicemia (blood poisoning or infection)

What disease do Hispanics/Latinos have better outcomes for, compared to non-Hispanic, Whites?

Cardiovascular disease (CVD) and cancer mortality was lower in Hispanic/Latino populations, although the rates for certain CVD risk factors (obesity and hypertension) and certain cancers (prostate) were higher in Hispanics/Latinos.

Health disparities in native populations summary:

- AIs/ANs in the U.S. are disproportionately impacted by a number of chronic diseases, including diabetes, obesity, cardiovascular disease, and cancer. - Several health behaviors increase disease risk, including smoking and substance use. - The major take-home messages from this lesson include: Cultural loss, land loss, and discrimination played a major role in increasing health disparities in native populations. Diabetes and obesity were "side effects" of a commodity program designed to end hunger - Several diseases/health outcomes are highest in native populations, including: Diabetes Motor vehicle-related deaths Alcohol-related injuries and diseases, such as chronic liver disease and cirrhosis of the liver, fetal alcohol syndrome, and Sudden Infant Death Syndrome Mental health problems (2nd highest suicide mortality)

L06 Health Disparities in Asian, Native Hawaiian, and Pacific Islander Populations Summary:

- ANHPIs in the U.S. are disproportionately impacted by a number of chronic diseases, including certain cancers, tuberculosis, and asthma. The major take-home messages from this lesson include: - Asians, Native Hawaiians, and Pacific Islanders are diverse; it is important to examine individual group health disparities and risk factors - The Model Minority perception disadvantages Asian populations who may be at high risk for disease, including those living in poverty Asians have unique health disparities: - Stomach cancer in Korean men (highest) - Cervical cancer in Vietnamese and Cambodian women (highest) - Tuberculosis in foreign-born Asians (highest) - Hepatitis B infection, increasing the risk of liver cancer - H. pylori infection, increasing the risk of stomach cancer Native Hawaiians have high rates of obesity and mental health problems Native Hawaiians and Pacific Islanders are burdened by obesity, diabetes, asthma, and poverty

The Model Minority

- APIs are referred to as the "Model Minority" given their higher income and (generally) better health than other racial/ethnic groups. However, this perception creates barriers to health and optimal health care, as it 1. ignores the great diversity in ANHPI populations 2. ignores the many ANHPIs who live in poverty, as well as those who are disproportionately burdened by certain conditions and diseases that should be targeted for prevention and early intervention.

Health Disparities in Hispanics/Latinos: Obesity

- Adults/youth have extremely high rates - Puerto Rican females were shown to have very high rates of obesity -Acculturation

Unique Challenges to Health in Asians, Native Hawaiians, and Pacific Islanders: Osteoporosis

- Asian American women are reported to consume lower levels of calcium and are more likely to be lactose intolerant. Increasing risk of osteoporosis.

Genetic Fatalism

- Belief that an individual is destined to develop a disease due to a family history of the disease. There is also a belief that no intervention (lifestyle or medical) is likely to change this destiny.

Health disparities in blacks: Obesity

- Black adults and children have a disproportionately high prevalence of obesity, which is a major risk factor for diabetes, CVD, and other negative health outcomes. - Black children 2-19 had second highest rate of obesity

Health disparities in blacks: cancer

- Cancer incidence rates, in all sites was second highest - Blacks carry a disproportionately high burden of specific cancers. Lung, colon/rectum, prostate, cervix, stomach, and pancreas cancer. -Blacks had low survival rates and more likely to die. - Black men appear to develop more aggressive forms of prostate cancer, and at earlier ages than other populations. _ Black women have the highest rates of pap smears but cervical cancer is high. - Black women had the highest mortality rates from breast cancer, despite high rates of mammograms - Black reports the second highest rates of colorectal tests or procedures, but they have the highest rates of colon and rectum cancer

Health Disparities in Asians, Native Hawaiians, and Pacific Islanders (ANHPI): Obesity

- Data on obesity in ANHPI populations are limited. - Asian adults had the lowest prevalence of obesity for all groups - However, NHPI adults had the second highest rates of obesity

Tertiary prevention

- Efforts are focused on treatment and rehabilitation. - This includes medication, surgery and other treatments for current problems, as well as efforts to prevent further problems associated with the disease/injury.

secondary prevention

- Efforts to aid in the early detection or identification of disease or injury, or treatment to prevent further problems. - Ex: A mammography to detect breast cancer.

primary prevention

- Efforts to reduce or control disease/injury before any symptoms exist. The assumption is that the individual does not have a disease/injury, so the focus is on reducing risk and keeping the individual disease/injury free. - Ex: use of seatbelts to prevent injuries or death from motor vehicle accidents, or brushing your teeth to prevent cavities.

Immigrant Paradox:

- Foreign-born populations tend to be healthier than their U.S.-born counterparts, despite the fact that immigrants tend to have a lower socioeconomic status (income and education).

mortality

- Frequency of the occurrence of death in a defined population during a specified interval of time - (e.g., breast cancer mortality rate in 2010).

Unique Challenges to Health in Asians, Native Hawaiians, and Pacific Islanders: Stomach Cancer

- H.pylori bacterial infections are endemic to many parts of Asia and these infections are the greatest risk factor for stomach cancer. - This phenomenon is known as the Asian Enigma. Additional risk factors for stomach cancer include dietary habits such as food storage and preservation techniques (sodium nitrate) and low levels of fresh fruit/vegetable consumption in ANHPI populations

Health Disparities in American Indians and Alaskan Natives (AI/AN): Cardiovascular Disease (CVD)

- Highest prevalence of heart disease - Reported the lowest levels of leisure-time physical activity. Also had a higher prevalence of hypertension

Health Disparities in (AI/AN): Mental Health Problems

- Highest prevalence of reported psychological distress - Second highest rate of mortality from suicide

Health disaprites in Hispanic/Latinos Summary:

- Hispanics/Latinos in the U.S. have a higher life expectancy and better chronic disease morbidity (cancer and cardiovascular disease) than Whites. - Cancer is the leading cause of death - Additional health disparities specific to this group include: Obesity Diabetes Cervical cancer Infant mortality in Puerto Ricans Liver Disease Suicide ideation in female teens - Foreign-born Hispanics/Latinos report better health than U.S.-born Hispanics/Latinos, although this health advantage decreases with a longer duration of stay in the U.S. (acculturation hypothesis).

The Whitehall Study

- Landmark study that showed that there was a social gradient in health

What is the Latino paradox?

- Latinos that were immigrants (stressful conditions of adaptation, lower income) were found to have better health than even the wealthiest populations in America who were not dealing with these situations. - Strong family ties, aka lots of social support, that help to protect against the negative impacts of American culture leading to health problems.

Health Disparities in Asians, Native Hawaiians, and Pacific Islanders (ANHPI): Mental health problems

- Lowest rates of psychological distress was reported in Asians in the Health, however, NHPI reported the second highest rates - NHPI reported the highest rates of depressive disorders. There is a great deal of stigma around mental health in ANHPI populations. Asian Americans believed it is shameful to seek help for mental health problems, and that these problems are due to a lack of willpower. - Mental health problems are grossly under-reported in ANHPI populations, highlighting the need for interventions in this area. Mental health care and treatment is likely underutilized.

Health Disparities in Asians, Native Hawaiians, and Pacific Islanders (ANHPI): Cancer

- Lung, liver, and colorectal cancer were the leading causes of cancer death in API men, and lung, breast, and colorectal cancers were the leading causes for API women. - Stomach cancer is a particular concern for ANHPI populations. Death rates from stomach cancer were almost twice as high for ANHPIs than for Whites. The highest stomach cancer rates in the world are seen in Korean men and women. - Cambodian and Vietnamese women have been shown to have the highest cervical cancer incidence and mortality rates of all racial/ethnic groups, low pap smear rates - Colon/rectum/anus cancer mortality rates in 2013 were lowest in API groups, as were breast cancer mortality rates, despite Asian adults reporting lower use of mammography and colorectal testing over time compared to other racial/ethnic groups - Liver cancer incidence rates were twice as high in ANHPIs as they were in non-Hispanic Whites, high rates of hepatitis

Heckler Report

- One of the first governmental reports to acknowledge that there were unexplainable differences in death rates between Whites and minority populations in the U.S.

Health disparities in blacks: Cardiovascular Disease (CVD), Hypertension, and Stroke

- Prevalence of CVD Blacks was lower but the mortality rates for Black males was higher - This is another example of a disparity in prevalence (with Whites having the highest rates of CVD, but Blacks having a higher mortality rate)

Health Disparities in Asians, Native Hawaiians, and Pacific Islanders (ANHPI): Infant Mortality

- Rates were lowest in APIs, the rates for all Pacific Islanders were higher than the rate for Whites. - Prenatal care was lower in certain API groups

Inequities:

- Refer to differences in the distribution or allocation of resources between groups

Morbidity

- Referring to any departure from, subjective or objective, a state of physiological or psychological well-being.

Health Disparities in (AI/AN): Infant Mortality

- Second highest infant mortality rates - Sudden Infant Death Syndrome and Fetal Alcohol Syndrome are disproportionately high in AIs/ANs

Health Disparities in American Indians and Alaskan Natives (AI/AN): Diabetes

- Second highest mortality rate from diabetes - The mortality rates for AIs/ANs were almost twice as high as the rates for Whites

What is septicemia most highly associated with?

- Septicemia (blood poisoning/infection) is most highly associated with serious, typically long-term, diseases such as cancer and HIV infection, as well as long stays in intensive care units.

Latino Health Paradox or Hispanic Mortality Paradox:

- Similar to the Immigrant Paradox. Despite generally being lower income and having lower education, Hispanics/Latinos in the U.S. tend to be healthier than other ethnic groups.

Disempowerment

- Similar to the term marginalization, efforts "to deprive of power, authority, or influence: make weak, ineffectual, or unimportant."

American Indians and Alaskan Natives are usually lumped into the "Other" racial/ethnic category in large, population-based health surveys, making it difficult to make any meaningful conclusions about health or changes in health in this population over time. TRUE OR FALSE

- TRUE. They represented less than 1% (0.9%) of the U.S. population in 2010.

Health Disparities in Asians, Native Hawaiians, and Pacific Islanders (ANHPI): Tuberculosis (TB)

- The majority of TB cases (46%) were in foreign-born Asians. This suggests that the risk factors differ for foreign-born Asian populations. Poverty, poor housing conditions, crowding, and HIV infection are all risk factors for TB.

Health Disparities in American Indians and Alaskan Natives (AI/AN): All-Cause Mortality

- The mortality rate was 50% greater than the mortality rate for Whites - Cancer/cardiovascular disease were the 2 leading causes of death for AI/AN men during this time period, followed by unintentional injury, diabetes, and chronic liver disease. - For AI/AN females, the 2 leading causes of death were cancer and cardiovascular disease, followed by unintentional injuries, diabetes, and stroke.

Prevalence

- The number of total cases (new and pre existing) at a specific point in time. Usually expressed as a percentage during a specific year.

Asian Enigma:

- The paradox in low rates of gastric (stomach) cancer in certain parts of Asia, despite high rates of Helicobacter Pylori infection, which increases the risk of gastric cancer.

Model Minority:

- The perception that Asian/Pacific Islander populations are the healthiest and wealthiest of all racial/ethnic minorities.

Health Disparities in Asians, Native Hawaiians, and Pacific Islanders (ANHPI): Asthma

- The prevalence of current asthma was highest in NHPI adults, the prevalence was second highest in NHPI children - Several risk factors include exposure to secondhand smoke (a serious risk for children), exposure to environmental toxins (e.g., living near bus depots or waste treatment plants), and poor living conditions with exposures to triggers, such as cockroaches, dust mites, mold, and outdoor air pollutants.

Health Disparities in Asians, Native Hawaiians, and Pacific Islanders (ANHPI): Tobacco and Other Substance Use

- The prevalence of smoking was second highest in NHPI adults and lowest in Asians. Overall alcohol use, binge drinking, heavy alcohol use and drug use was lower in ANHPIs than in Whites

Excess Death:

- The rate of death in a specified population above the expected rate for other populations.

Health Disparities in Asians, Native Hawaiians, and Pacific Islanders (ANHPI): Diabetes

- The rates for Asians were almost half the rate of NHPIs

Marginalized Populations:

- They are historically disadvantaged groups in the U.S. that have been placed in the margins of society due to skin color, language, income, education, sexual orientation, gender identity, disability status, and/or other characteristics.

Unique Challenges to Health in Asians, Native Hawaiians, and Pacific Islanders: HIV

- Third highest in NHPI

Public charge

- U.S. policy that threatens deportation for immigrants who do not contribute to society, or are considered a burden on society - (e.g., those who do not hold jobs and rely on public welfare for support).

Disparities:

- Usually have some ethical issues at its source. - Ex: uninsured populations report lower rates of preventive screenings and wellness visits than well-insured populations

Unique Health Risks for Hispanics/Latinos: Gender-Based Risks

- Women had lower wages and educational attainment, also at higher risk for abuse, including intimate partner violence.

Health Disparities in Hispanics/Latinos: Unintentional Injuries

-3rd leading cause of death -Most deaths were due to car accidents and accidental poisoning

Health Disparities in Hispanics/Latinos: Cancer

-Although cancer was the leading cause of death in Hispanics, cancer mortality rates are lower than the rates for Whites. -Cervical cancer rates are higher in Hispanic/Latino women than Whites/Blacks. -Other infection-related cancers (gastric and hepatic) are higher in Hispanics/Latinos. The main causes of cancer death in Hispanic/Latino men is lung, liver, and colorectal cancer. For women, it is breast, lung, and colorectal cancer. Cancer is one disease that applies to the Latino Health Paradox. -Despite Hispanics/Latinos reporting lower rates of mammography use and colorectal screenings than Blacks, and Whites over time, their incidence and mortality rates from breast and colorectal cancer are lower than other populations

Influences on Health Protection in Hispanics/Latinos:

-Familism: places the family at the center, and prioritizes family over individual needs or desires. Provide strong familial/social support -Healthy Immigrant Effect: Those who migrate for seasonal farm work are healthier to begin with. -Latina Birth Outcomes Paradox: Although the reasons are largely unknown, Hispanics/Latinas have birth outcomes similar to higher SES women and women with better access to health care, despite having the highest birth rates.

Unique Health Risks for Hispanics/Latinos: Environmental Risks

-Majority live in urban areas, increasing the risk of certain respiratory diseases (like asthma), cardiovascular disease, and pregnancy/birth complications, given the proximity to highways, bus depots, train yards and other environmental hazards. -Likely to live in areas exposed to environmental toxins, such as those emitted from waste treatment plants and pollution from factories. Water quality was also found to be low (containing toxins)

Unique Health Risks for Hispanics/Latinos: Occupational Risks

-More likely to be working in unskilled, high-risk jobs (e.g., construction, agricultural work, custodial, or factory work). These exposures increase risks for injury/death from occupational hazards. -Hispanic/Latino agricultural and construction workers had a higher risk of heat stroke and exposure to carbon monoxide and pesticides, injuries, respiratory illnesses, food insecurity, and mental health problems, such as depression. Many agricultural workers are undocumented, most do not have employer-provided insurance

Health Disparities in Hispanics/Latinos: Tobacco Use

-While a lower percentage of Hispanic/Latino adults reported using tobacco products, tobacco companies targeted Hispanic/Latino communities with tobacco marketing. -Puerto Ricans have very high rates of smoking. Given tobacco's links with a number of other diseases, including cancers and CVD, efforts to reduce tobacco use in this population are crucial.

Top ten causes of death in AI/AN populations:

1. Diseases of the heart 2. Malignant neoplasms 3. Unintentional injuries 4. Diabetes mellitus 5. Chronic liver disease and cirrhosis 6. Chronic lower respiratory diseases 7. Cerebrovascular disease 8. Suicide 9. Nephritis, Nephrotic Syndrome, Nephrosis 10. Influenza and pneumonia

Top ten causes of death in APIs

1. Malignant neoplasms 2. Diseases of the heart 3. Cerebrovascular diseases 4. Unintentional injuries 5. Diabetes 6. Alzheimer's 7. Influenza and pneumonia 8. Chronic lower respiratory diseases 9. Nephritis, nephrotic syndrome, and nephrosis 10. Suicide

Top 10 causes of death in Hispanics/Latinos:

1. Malignant neoplasms (cancer) 2. Diseases of the heart 3. Unintentional injuries (accidents) 4. Cerebrovascular disease (stroke) 5. Diabetes mellitus 6. Alzheimer's Disease 7. Chronic liver disease and cirrhosis 8. Chronic lower respiratory diseases 9. Nephritis, Nephrotic Syndrome, Nephrosis (kidney diseases, highly linked to diabetes) 10. Influenza and pneumonia

Lesson 5

Health Disparities in Native Populations