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Discrimination and the Health of Asian Americans. 13 th Annual Summer Public Health Research Videoconference on Minority Health. Gilbert C. Gee, Ph.D. University of Michigan Health Behavior & Health Education June 25, 2007. Explanations for Health Disparities. Genetics Culture

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Discrimination and the health of asian americans l.jpg

Discrimination and the Health of Asian Americans

13th Annual Summer Public Health Research Videoconference on Minority Health

Gilbert C. Gee, Ph.D.

University of Michigan

Health Behavior & Health Education

June 25, 2007


Explanations for health disparities l.jpg
Explanations for Health Disparities

  • Genetics

  • Culture

  • Health care

  • Socioeconomic position

  • Discrimination


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Growing interest

  • U.S. Surgeon General

    • Mental Health, Culture, Race & Ethnicity, 2001

  • World Health Organization

    • Mental Health: New Understanding, New Hope, 2001

  • Institute of Medicine

    • Unequal Treatment, 2003

    • Eliminating Health Disparities, 2004

  • National Academies of Science

    • Measuring Racial Discrimination, 2004


Potential pathways between discrimination health l.jpg

Socioeconomic & other opportunities

Hazardous exposures

Historical trauma, soul wound

Hate crimes

Helpseeking & health services

Chronic & acute stress

Potential pathways between discrimination & health


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Model Minority

Asian Invasion


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2002 GSS: (n=2685)

  • How warm do you feel towards (1=warm...9=very cool)?

    • Asian Americans 3.7

    • Hispanics 3.6

    • African Americans 3.4

    • Caucasians 2.9


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  • MSNBC, 1998:

    • “American Beats Out Kwan”

  • Seattle Times, 2002:

    • “American outshines Kwan, Slutskaya in skating surprise.”


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  • “Asian and Pacific Islander homebuyers experience consistent adverse treatment 20.4%of the time, with systematic discrimination occurring in housing availability, inspections, financing assistance, and agent encouragement. This level of discrimination is comparable to the level experienced by African American homebuyers…”

Turner et al., 2003. Discrimination in Metropolitan Housing Markets: Phase 2. Urban Institute.


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National Latino & Asian American Study (NLAAS) consistent adverse treatment 20.4%


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National Latino & Asian American Study (NLAAS) consistent adverse treatment 20.4%

  • Household survey, 2002-2003

  • Languages:

    • Cantonese, English, Mandarin, Spanish, Tagalog, Vietnamese

  • Response rate: 69% & 74%

  • n=2095

  • Weighted

  • PI: David Takeuchi


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Select sample characteristics consistent adverse treatment 20.4%

  • Foreign born 77%

  • Female 52%

  • Married 65%

  • Age 41

  • Per capita income $40K

  • West coast 68%


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Research Questions consistent adverse treatment 20.4%

  • Is self-reported discrimination associated with increased:

    • Chronic conditions

    • Mental disorders


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Everyday Discrimination scale consistent adverse treatment 20.4%

  • Developed from qualitative research

  • Theoretical focus with chronic stressors

  • 9 items total

    • Less courtesy

    • Poorer service in restaurants

    • Called names, insulted

  • Cronbach’s alpha = 0.91

  • Williams, et al., 1997. Racial differences in physical and mental health. Socioeconomic status, stress and discrimination. J Health Psychol. 2: 335-351.


    Chronic health conditions l.jpg
    Chronic Health Conditions consistent adverse treatment 20.4%

    • World mental health composite international diagnostic interview (WHM-CIDI)

    • Intended for cross-cultural epidemiologic studies internationally

    World Health Organization. Disability Assessment Schedule II (WHO-DAS II). 1998. Geneva, World Health Organization.


    Health conditions l.jpg

    Cardiovascular consistent adverse treatment 20.4%

    Heart attack

    Stroke

    Heart disease

    High blood pressure

    Pain

    Chronic back/neck problems

    Headaches

    Other chronic pain

    Respiratory

    Hay fever

    Asthma

    Tuberculosis

    Other chronic lung diseases

    Other

    Diabetes

    HIV/AIDS

    Cancer

    Epilepsy/Seizures

    Health Conditions


    Measures l.jpg

    Outcomes consistent adverse treatment 20.4%

    Chronic conditions

    Mental health disorders

    Discrimination

    Reporting factors

    Social desirability(Crowne & Marlowe, 1960)

    Other stressors

    Poverty

    Family cohesion

    Acculturative stress

    Sociodemographics

    Age

    Gender

    SES

    Nativity, language, generation

    Region

    Marital status

    Measures


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    Discrimination and Chronic Health Conditions, Negative Binomial Regression

    Bivariate Model 1 Model 2

    b b b

    Discrimination 0.13** 0.25*** 0.25***

    Social Desirability 0.02 ----- 0.00

    Models 1 & 2 control for age, same household, gender, poverty, education, ethnicity, employment, marital status, region, nativity, family cohesion

    n=2095

    Gee, et al., in press. Am J Public Health


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    Discrimination & Individual Outcomes (Odds Ratios) Binomial Regression

    Cardio . Respirat. Pain Other

    Discrimination 1.69 ** 1.37 *** 1.71 *** 0.89

    Social Desirability 1.02 1.00 0.98 0.98

    Adjusted for other covariates

    n=2095


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    DSM-IV Criteria Binomial Regression

    World Health Organization Composite International Diagnostic Interview (WHM-CIDI)

    Depressive

    Major depressive disorder

    Dysthymia

    Anxiety

    Panic disorder

    Agoraphobia w/o panic

    Social phobia

    GAD

    PTSD

    Substance Use

    12-Month Mental Health Disorders


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    Discrimination & 12 Month DSM-IV Disorders (bivariate) Binomial Regression

    Discrimination Any disorder Depressive Anxiety

    Q1 Least 3.9% 1.3 3.2

    Q2 6.4 1.6 4.8

    Q3 8.3 5.0 4.3

    Q4 Most 18.1 10.9 10.8

    Gee GC, et al. 2007. The Association between Self-Reported Discrimination and 12-month DSM-IV Mental Disorders among Asian Americans Nationwide. Soc Sci & Med 64(10):1984-1996.


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    Adjusted for other covariates. Binomial Regression


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    Immigrant analysis (n=1593) Binomial Regression

    12 Month DSM-IV Disorder Health

    Any Depressive Anxiety Conditions

    OR OR OR beta

    Acculturative stress 1.09 1.18 1.02 0.07**

    Discrimination 1.98** 2.17** 1.88** 0.27***

    Adjusted for other covariates

    DSM-IV disorders analyses use logit models

    Health conditions analysis uses negative binomial models


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    Discrimination Binomial RegressionPyramid

    Overt

    Inter-personal

    Covert

    Interpersonal

    Structural


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    Multiple Levels of Discrimination: Segregation & Redlining Binomial Regression

    Gee, 2002. A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. Am J Public Health, 92: 615-623


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    Resistance Binomial Regression


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    • “I was in a car accident … needed prescriptions filled …. I dropped over to the city welfare and this woman treated me like I was scamming something from her. And I’m also on depression medication and I said, “Well, look, forget about the painkillers if this is how you’re going to be. Just give me my depression medication. Yeah, it would be great to have it, because I’m in pain – that’s why it was prescribed to me. But if you’re going to make a big ordeal about it, then see ya’.”


    Resources buffers l.jpg
    Resources & Buffers …. I dropped over to the city welfare and this woman treated me like I was scamming something from her. And I’m also on depression medication and I said, “Well, look, forget about the painkillers if this is how you’re going to be. Just give me my depression medication. Yeah, it would be great to have it, because I’m

    • Social activism

    • Social support

    • Active avoidance

    • Ethnic identity

    • Ethnic enclaves


    Summary l.jpg
    Summary …. I dropped over to the city welfare and this woman treated me like I was scamming something from her. And I’m also on depression medication and I said, “Well, look, forget about the painkillers if this is how you’re going to be. Just give me my depression medication. Yeah, it would be great to have it, because I’m

    • Racial discrimination is associated with

      • 12-Month DSM-IV mental disorders

      • Physical health conditions

    • Robust to social desirability, other stressors, and demographics

    • Moderated by resources


    Further research l.jpg
    Further Research …. I dropped over to the city welfare and this woman treated me like I was scamming something from her. And I’m also on depression medication and I said, “Well, look, forget about the painkillers if this is how you’re going to be. Just give me my depression medication. Yeah, it would be great to have it, because I’m

    • Additional studies

      • Japanese Brazilians

      • Workplace

      • Multilevel

      • CBPR Detroit

    • Methodological development

      • Objective measures

      • CHIS

      • Age discrimination


    Acknowledgements l.jpg
    Acknowledgements …. I dropped over to the city welfare and this woman treated me like I was scamming something from her. And I’m also on depression medication and I said, “Well, look, forget about the painkillers if this is how you’re going to be. Just give me my depression medication. Yeah, it would be great to have it, because I’m

    • NIMH (U01 MH62209, U01MH62207); PI David Takeuchi & Margarita Alegria

    • University of Michigan Rackham Faculty Fellowship & Grant

    • Juan Chen, Michael Spencer, Tiffany Yip & other members of the NLAAS team


    Thank you l.jpg

    Thank You …. I dropped over to the city welfare and this woman treated me like I was scamming something from her. And I’m also on depression medication and I said, “Well, look, forget about the painkillers if this is how you’re going to be. Just give me my depression medication. Yeah, it would be great to have it, because I’m


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