Trends in alcohol-related mortality among New Mexico's American Indians, Hispanics, and non-Hispanic whites

Reduction of alcohol-related mortality is a national goal for health promotion and disease prevention. We conducted this analysis to determine whether trends in New Mexico's Hispanics, non-Hispanic Whites, and American Indians were consistent with national trends in alcohol-related mortality, and whether differences in drinking patterns could account for racial and ethnic differences in rates. Age-adjusted, race-specific, and ethnic-specific alcohol-related mortality rates and 95% confidence intervals were calculated for 5-year periods for 1958-1991 using New Mexico vital statistics data. We estimated the prevalence of acute and chronic at-risk drinking behaviors and abstinence from data collected by the Behavioral Risk Factor Surveillance System (BRFSS) for the period 1986-1992. We found that alcohol-related mortality rates varied substantially by race, ethnicity, sex, age, and calendar period. American Indians had the highest rates for both sexes. Rates increased sharply from the period 1958-1962 until the late 1970s and the early 1980s, and then began to decrease rapidly. However, during the most recent decade, the rates have followed contrasting trends in the three ethnic and racial groups. Although rates have continued to decline among non-Hispanic Whites, rates for Hispanics and American Indians have not declined, and still remain substantially higher than rates during the 1958-1962 period. Differences in at-risk drinking behaviors reported to the BRFSS do not explain the contrast in race-specific and ethnic-specific mortality rates. Although progress has been made in reducing national per capita alcohol consumption and alcohol-related mortality, certain high-risk racial and ethnic groups may not be sharing in the progress.     

The role of diabetes mellitus in the higher prevalence of tuberculosis among Hispanics

OBJECTIVES: This research studied the relative contribution of diabetes mellitus to the increased prevalence of tuberculosis in Hispanics. METHODS: A case-control study was conducted involving all 5290 discharges from civilian hospitals in California during 1991 who had a diagnosis of tuberculosis, and 37,366 control subjects who had a primary discharge diagnosis of deep venous thrombosis, pulmonary embolism, or acute appendicitis. Risk of tuberculosis was estimated as the odds ratio (OR) across race/ethnicity, with adjustment for other factors. RESULTS: Diabetes mellitus was found to be an independent risk factor for tuberculosis. The association of diabetes and tuberculosis was higher among Hispanics (adjusted OR [ORadj] = 2.95: 95% confidence interval [CI] = 2.61, 3.33) than among non-Hispanic Whites (ORadj = 1.31: 95% CI = 1.19. 1.45): among non-Hispanic Blacks, diabetes was not found to be associated with tuberculosis (ORadj = 0.93: 95% CI = 0.78, 1.09). Among Hispanics aged 25 to 54, the estimated risk of tuberculosis attributable to diabetes (25.2%) was equivalent to that attributable to HIV infection (25.5%). CONCLUSIONS: Diabetes mellitus remains a significant risk factor for tuberculosis in the United States. The association is especially notable in middle-aged Hispanics.     

Changes in drinking problems among whites, blacks, and Hispanics: 1984-1992

This paper reports changes in drinking problems among Whites, Blacks, and Hispanics between 1984 and 1992. A probability sample including 1,777 Whites. 1,947 Blacks, and 1,453 Hispanics in the United States adult household population was interviewed in 1984. In 1992 a subsample consisting of 788 Whites, 723 Blacks, and 703 Hispanics was reinterviewed. Results show a decrease in problem prevalence among Whites, stability among Blacks, and an increase among Hispanics. Problem incidence was higher among Hispanics than among Whites and Blacks, put problem remission was higher among Whites. Women had a lower problem incidence but a higher problem remission than men, independent of ethnicity. The two best predictors of problem status in 1992 were reporting a problem in 1984 and reporting a high level of consumption in 1984.     

Age-related differences in risks of drinking and driving in gender and ethnic groups

We examine the extent to which empirically observed age-related differences in rates of drinking and driving can be explained by concurrent differences in drinking patterns. Building on previous research showing significant age differences in drinking patterns between men and women and among three ethnic groups, Whites, Blacks, and Hispanics, our study considers whether there are unique gender and ethnic group differences in patterns of drinking and driving. Data were from 4395 respondents 12 to 80 years old in a general population survey of 20 urban areas in the United States. During the month preceding the interview, 1130 (25.7%) of all respondents had driven after having one or more drinks. Drinking pattern measures included drinking frequency, average drinking quantity, and the variance in the number of drinks consumed per occasion. To assess the relationships of drinking patterns to drinking and driving across age groups, two sets of analyses were conducted, one set in which age differences in drinking patterns were statistically controlled and one set in which they were not. Although the statistical control for drinking patterns reduced age differences between gender and ethnic groups, it did not eliminate them. The reduction demonstrated that part of observed group differences in driving after drinking over age among gender and ethnic groups is due to age-related differences in drinking patterns. However, despite controlling drinking patterns young respondents remained more likely to drink and drive. A supplementary analysis of self-reported incidents of driving while intoxicated (i.e., driving after having five or more drinks) further indicated that, controlling for drinking patterns, young respondents are most at risk.     

Motor vehicle occupant deaths among Hispanic and black children and teenagers

OBJECTIVE: To determine the risk of motor vehicle occupant deaths per unit of travel for Hispanic, non-Hispanic black, and non-Hispanic white children (aged 5-12 years) and teenagers (aged 13-19 years). DESIGN: Comparison of 1989 to 1993 motor vehicle occupant death rates of children and teenagers by race, ethnicity, and sex by using data on mortality from the National Center for Health Statistics, travel data from the 1990 Nationwide Personal Transportation Survey, and 1990 US census data. RESULTS: Among children 5 to 12 years old, race/ ethnicity differences per 100000 persons were unremarkable, but per billion vehicle-miles of travel, the rates were 14 for non-Hispanic blacks, 8 for Hispanics, and 5 for non-Hispanic whites. Among teenagers aged 13 to 19, the rates per 100000 persons were highest for non-Hispanic whites; however, the rates per billion vehicle-miles were 45 for Hispanics, 34 for non-Hispanic blacks, and 30 for non-Hispanic whites. Black and Hispanic male teenagers had substantially higher death rates per billion vehicle-miles of travel than either white male teenagers or female teenagers in any racial/ethnic group. CONCLUSIONS: Black and Hispanic children and teenagers are at higher risk of dying in motor vehicle crashes when they travel. Greater public health attention is needed to address these increased risks.     

Ethnic differences in posttraumatic distress: Hispanics’ symptoms differ in kind and degree.

This longitudinal study of physical injury survivors examined the degree to which Hispanic and non-Hispanic Caucasians reported similar posttraumatic stress disorder (PTSD) symptoms. Adult physical trauma survivors (N = 677) provided information regarding posttraumatic distress by completing an interview-administered version of the PTSD Symptom Checklist (Civilian version) at 3 time points: within days of trauma exposure and again at 6 and 12 months posttrauma. Structural equation modeling with propensity weights was used in analyzing data. Results replicated prior research indicating that Hispanics report greater overall PTSD symptom severity. However, the size of this effect varied significantly across the 17 individual PTSD symptoms, and several symptoms were not reported more highly by Hispanics. Relative to non-Hispanic Caucasians, Hispanics tended to report higher levels of symptoms that could be regarded as exaggerated or intensified cognitive and sensory perceptions (e.g., hypervigilance, flashbacks). In contrast, few differences were observed for symptoms characteristic of impaired psychological functioning (e.g., difficulty concentrating, sleep disturbance). Findings suggest that the pattern of PTSD symptoms experienced most prominently by Hispanics differs in kind and not merely in degree. Results have implications for theory aimed at explaining this ethnic disparity in posttraumatic psychological distress as well as for clinical intervention with trauma-exposed Hispanics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Race and self-esteem: Meta-analyses comparing Whites, Blacks, Hispanics, Asians, and American Indians and comment on Gray-Little and Hafdahl (2000).

These meta-analyses examine race differences in self-esteem among 712 datapoints. Blacks scored higher than Whites on self-esteem measures (d=0.19), but Whites scored higher than other racial minority groups, including Hispanics (d=-0.09), Asians (d=-0.30), and American Indians (d=-0.21). Most of these differences were smallest in childhood and grew larger with age. Blacks' self-esteem increased over time relative to Whites', with the Black advantage not appearing until the 1980s. Black and Hispanic samples scored higher on measures without an academic self-esteem subscale. Relative to Whites, minority males had lower self-esteem than did minority females, and Black and Hispanic self-esteem was higher in groups with high socioeconomic status. The results are most consistent with a cultural interpretation of racial differences in self-esteem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between ethnicity and advance directives in a frail older population

OBJECTIVE: To assess the relationship between ethnicity and Health Care wishes, including Advance Directives, in a group of frail older persons in PACE (Program For All Inclusive Care Of The Elderly). DESIGN: Retrospective chart review of 1193 participants in the PACE program. SETTING: Program of All Inclusive Care Of The Elderly (PACE), a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation. PARTICIPANTS: A total of 1193 older adults, all of whom met state criteria for nursing home level of care. There were 385 non-Hispanic whites, 364 blacks, 156 Hispanics, and 288 Asians. MEASUREMENTS: Presence or absence of advance directives, type of health care wishes selected including living will, durable power of attorney, and health care proxy. RESULTS: Frail older white, black, Hispanic and Asian Americans differ significantly in their health care wishes and how they choose to express them. Blacks were significantly more likely to select aggressive interventions and less likely than non-Hispanic whites and Hispanics to utilize a written instrument for expressing health care wishes. Whites were significantly more likely to utilize written documents for advance directives, whereas Asians were more likely to select less aggressive interventions but were unlikely to use written advance directives. CONCLUSIONS: In this population, we found significant ethnic variations in choice of health care wishes. Although health care wishes are an individual decision, an awareness of cross cultural patterns can assist practitioners in addressing the concerns of their patients, as well as assisting Health Care Policy Development.     

Prevalence of weight reducing and weight gaining in adolescent girls and boys.

Surveyed the prevalence of weight reducing and weight gaining in 1,373 high school students. 63% of the girls and 16.2% of the boys reported being on weight-reducing regimens; 9.1% of the girls and 28.4% of the boys were trying to gain weight. Most female reducers and male gainers were already normal weight. Whites and Hispanics were more likely to be reducing, whereas Blacks were more likely to be gaining. Exercise and moderate caloric reduction were most popular for weight reducing, and a small but significant number were regularly using fasting, vomiting, laxatives, and appetite suppressants. The rate of weight reducing in female high school adolescents has increased significantly since similar surveys of American youths 20 yrs ago. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Race-ethnic differences in stroke risk factors among hospitalized patients with cerebral infarction: the Northern Manhattan Stroke Study

African-Americans have an unexplained increased incidence and mortality from stroke compared with whites, and little is known about stroke in Hispanics. To investigate cross-sectional differences in sociodemographic and stroke risk factors, we prospectively evaluated 430 patients hospitalized for acute ischemic stroke (black 35%. Hispanic 46%, white 19%) over the age of 39 from Northern Manhattan. Blacks and Hispanics were younger than whites (mean ages, blacks 70, Hispanics 67, whites 80; p < 0.001) and were more likely to have less than 12 years of education than whites. Hypertension was more prevalent in blacks and Hispanics with stroke than whites (blacks 76%, Hispanics 79%, whites 63%; p < 0.05) and was often untreated in blacks. Left ventricular hypertrophy by ECG was more frequent in blacks (blacks 20%, whites 9%; p = 0.02). History of cardiac disease (atrial fibrillation, myocardial infarction, angina, and congestive heart failure) was less prevalent in both blacks and Hispanics. Black women were significantly more obese than white women (mean Quetelet Index percent, blacks 3.9%, whites 3.6%; p < 0.05). Heavy alcohol use was more often reported by blacks and Hispanics; cigarette smoking was increased only in blacks. Moreover, blacks were less likely to have visited a physician 1 year after their stroke (blacks 85%, whites 98%; p < 0.05), and Hispanics less often lived alone compared with whites. These cross-sectional differences suggest that the burden of stroke risk factors is increased in both blacks and Hispanics with stroke. Further studies controlling for stroke risk factors are needed to establish whether race-ethnicity is an independent determinant of stroke risk.     

Agreement between self-reported early cancer detection practices and medical audits among Hispanic and non-Hispanic white health plan members in northern California

BACKGROUND: Using the medical records of a large, prepaid health plan, our purpose was to assess the accuracy of self-reported data on cancer detection practices and to evaluate any differences in accuracy between Hispanics and non-Hispanic whites. METHODS: Data were collected on six procedures: mammography, clinical breast examination, Pap smear, sigmoidoscopy, fecal occult blood tests, and digital rectal examination. We audited the medical records of 815 randomly selected Hispanic and 483 non-Hispanic white members of the Kaiser Permanente Medical Care Program in Northern California. All responded to a telephone survey. Using a standardized form, we recorded any of the six target examinations that had been performed within 5 years of the telephone interview. We then compared the times of the most recent screening tests as reported in the telephone survey with those in the medical record. RESULTS: For the 2 years before the telephone interview, self-reports for screening tests overestimated the actual rates at which these tests were performed as documented in the medical records. Lack of agreement between self-report and medical record audits was substantial for all screening procedures except sigmoidoscopy. Hispanic members had fewer procedures done for most tests, but the differences were not statistically significant. Overestimates in self-reported screening rates did not differ substantially between Hispanics and non-Hispanic whites. CONCLUSIONS: Self-reported data on early cancer detection procedures can substantially overestimate their occurrence among both non-Hispanic white and Hispanic populations. These findings confirm earlier findings for Pap smear and affect decisions on cancer prevention procedures that rely on the accuracy of self-reported data.     

Physical disability and mental health: An epidemiology of psychiatric and substance disorders.

Objective: To estimate the lifetime and 1-year prevalence of psychiatric and substance disorders as they vary by the presence of physical disability and across gender, race- ethnicity, and age. Study Design: Community screening provided a sampling frame from which stratified random samples were drawn. Participants: Half were men, half were screened as having activity limitation, and African Americans, non-Hispanic Whites, persons of Cuban heritage, and other Hispanics each composed 25% of the sample. Interviews were completed with 1,986 individuals using the Composite International Diagnostic Interview. Outcome Measures: The authors provide the lifetime and past-year occurrence of both psychiatric and substance disorders. Results: A compelling relationship is observed between physical disability and risk for the lifetime occurrence of both psychiatric and substance disorders and for the past-year occurrence of psychiatric disorders. Elevations in risk are greater for men than for women, for the young than for the old, and for persons of Hispanic heritage compared with African Americans and non- Hispanic Whites. Conclusions: Physical disability appears to represent a dimension of stress that increases risk for the occurrence of psychiatric or substance disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Archetypal patterns, mental representations, and replicative processes in infancy

This study was designed to identify the expectancies held by Mexican Americans toward the drinking of alcoholic beverages as well as toward excessive drinking. Random samples of 534 Mexican American and 616 non-Hispanic White residents of San José, California and of San Antonio, Texas were interviewed over the telephone. Mexican Americans were found to have unique expectancies toward drinking of alcoholic beverages and toward excessive drinking that differed from those held by non-Hispanic Whites. In addition, Mexican Americans expected the various outcomes in greater proportion than non-Hispanic Whites and the Mexican American respondents classified as high in acculturation tended to respond in a manner similar to that of non-Hispanic White respondents. Multivariate analyses of variance with common (across ethnic groups) factor scales with ethnicity, gender, and drinking status as independent variables showed main effects for drinking status and for ethnicity. The group differences in expectancies identified here support the need for culturally appropriate interventions that target group-specific beliefs.     

Self-esteem development from age 14 to 30 years: A longitudinal study.

We examined the development of self-esteem in adolescence and young adulthood. Data came from the Young Adults section of the National Longitudinal Survey of Youth, which includes 8 assessments across a 14-year period of a national probability sample of 7,100 individuals age 14 to 30 years. Latent growth curve analyses indicated that self-esteem increases during adolescence and continues to increase more slowly in young adulthood. Women and men did not differ in their self-esteem trajectories. In adolescence, Hispanics had lower self-esteem than Blacks and Whites, but the self-esteem of Hispanics subsequently increased more strongly, so that at age 30 Blacks and Hispanics had higher self-esteem than Whites. At each age, emotionally stable, extraverted, and conscientious individuals experienced higher self-esteem than emotionally unstable, introverted, and less conscientious individuals. Moreover, at each age, high sense of mastery, low risk taking, and better health predicted higher self-esteem. Finally, the results suggest that normative increase in sense of mastery accounts for a large proportion of the normative increase in self-esteem. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cultural Differences in Young Children's Vulnerability to Injuries: A Risk and Protection Perspective.

Interview data from 100 lower income Hispanic and 50 White mothers from a nutritional service clinic extended prior research on cultural differences in the risk for unintentional pediatric injuries. Group differences were expected in reported injury incidence and in the prevalence and impact of contributing factors. As predicted, White mothers reported more injuries for a young child, and among Hispanic mothers, English language preference and use were associated with more reported injuries. Hierarchical regression analysis revealed that risky behaviors, mother's judgment about child compliance, and stressful life events were better predictors of injuries than housing quality, but among Hispanics, the impact of certain factors (e.g.. child temperament) was qualified by mother's acculturation level. Stress and child temperament explained injury differences between more- and less-acculturated Hispanic families but only partially accounted for differences between White mothers and less-acculturated Hispanics. Pediatric injury risk and protective factors seemed to operate in concert with cultural processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Photodynamic therapy (PDT) and photodiagnosis (PD) using endogenous photosensitization induced by 5-aminolevulinic acid (ALA): current clinical and development status

Although low levels of social support have been related to mortality from coronary heart disease, little is known about the role of social support among Mexican Americans. The authors therefore examined the relationship between social support and long-term survival in the Corpus Christi Heart Project. They developed a social support scale that used data collected during in-hospital interviews of 292 Mexican Americans and 304 non-Hispanic Whites who survived a myocardial infarction for more than 28 days. The scale incorporated three measures: marital status; if not married, whether living alone; and whether advised to seek help. During an average follow-up period of 43 months, 115 participants died. Survival following myocardial infarction was greater for those with high or medium social support than for those with low social support. With age, gender, ethnicity, education, employment, smoking, diabetes, hypertension, and hypercholesterolemia included in a proportional hazards regression model, the relative risk of mortality was 1.89 (95% CI, 1.20-2.97) for those with low social support. But when the two ethnic groups were analyzed separately, low social support was no longer a significant predictor of mortality for non-Hispanic Whites, whereas for Mexican Americans, the relative risk of mortality was 3.38 (95% CI, 1.73-6.62) for those with low social support.     

Incidence of surgically treated uveal melanoma by race and ethnicity

OBJECTIVE: The purpose of the study was to determine the race- and ethnicity-specific incidence of histologically confirmed uveal melanoma. DESIGN: The study design was a retrospective study of histologically confirmed cases of primary uveal melanoma submitted to the Florida Cancer Data System (FCDS). MAIN OUTCOME MEASURES: Race-, gender-, and Hispanic-specific incidence rates of uveal melanoma were measured. Calculations are based on Florida census data and Hispanic population estimates from the University of Florida Bureau of Economic and Business Research. RESULTS: From 1981 through 1993, 873 histologically confirmed uveal melanomas were reported to the FCDS. Four melanomas occurred in black non-Hispanics, 47 in white Hispanics, and none in black Hispanics. The relative risk of uveal melanoma for blacks compared to non-Hispanic whites was 0.03 (95% confidence interval, 0.01-0.08). Non-Hispanic white men had 72 times the risk of uveal melanoma compared to black men; non-Hispanic white women experienced a 22-fold risk compared to black women. White Hispanics were less likely to develop uveal melanoma than white non-Hispanics (relative risk, 0.36; 95% confidence interval, 0.27-0.48). CONCLUSION: The risk of uveal melanoma in blacks is exceptionally low. The reason for lower risk of uveal melanoma in white Hispanics than in white non-Hispanics is not known but could be related to the protective effects associated with dark skin pigmentation or may be because of unknown cultural-environmental exposures or socioeconomic factors.     

Race-ethnic inequality and psychological distress: Depressive symptoms from adolescence to young adulthood.

Social inequality is well established in the mental health of race-ethnic groups, but little is known about this disparity from adolescence to young adulthood. This study examined differences in trajectories of depressive symptoms across 4 race-ethnic groups (Whites, Blacks, Hispanics, and Asians) using 3 waves of the National Longitudinal Study of Adolescent Health. Latent trajectory analyses showed race-ethnic variations among both females and males. Stressors were significantly related to depressive symptoms for all study members, but they accounted for symptom trajectories only among Black males and minority females. Persistent differences in trajectories for Blacks and Whites showed parallel slopes that did not converge over time. Neither background characteristics nor social resources (i.e., social support) altered this gap. However, social support represents a potential equalizer of these race-ethnic differences, owing to the ubiquitous nature of its protective effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)