Racism triggers smoking in British ethnic minority adolescents: evidence from the determinants of young adult social wellbeing and health (DASH) longitudinal study

OBJECTIVE: Racism may have a negative impact on the health behaviours in adolescence, however there were few longitudinal studies. We examined the impact of perceived racism on smoking in an ethnically diverse sample of adolescents in the UK, and potential modifying factors. DESIGN AND METHODS: In 2002/03, 6643 11-13 year olds in London, ~80% ethnic minorities, participated in the baseline survey. In 2005/06 4,782 were followed-up. In 2012-14 665 took part in a pilot follow-up aged 21-23y, including 42 qualitative interviews. Measures of socio- economic and psychosocial factors and health were collected. RESULTS: Ethnic minority adolescents were more likely to report racism compared with White British, but smoking was generally lower. Reported racism in adolescence was associated with having ever smoked (e.g. males Odds Ratio 2.20, 95% CI 1.59-3.02), and with smoking initiation (males 4.09, 2.45-6.83). Smoking initiation was greatest among Black Caribbeans. Attendance to a place of worship, being a Muslim and a good parent-child relationship were independent protective factors. Qualitative interviews supported evidence for reported racism as well as protective factors including increasing ethnic diversity, a sense of identity and belonging, supportive parenting, high aspirations, and religious faith. CONCLUSIONS: This is the first UK study to show the negative impact of racism on smoking in adolescence, regardless of ethnic origin. Religious involvement and parenting may provide social support and reinforce cultural and religious values which may prevent the uptake of harmful health behaviours such as smoking. This has implications for health promotion among young people of all ethnicities.

Evaluation of a pilot study for breast and cervical cancer screening with Bradford's minority ethnic women; a community development approach, 1991-93

The objectives were to provide information about breast and cervical cancer and related screening services to minority ethnic women, to enable them to make well informed decisions and choices; to adopt a health education strategy based on a community development approach, augmented by a local publicity campaign; and to evaluate both the direct and indirect effects of this project. To this end a community development intervention study was made over 18 months from October 1991 to March 1993 in Bradford, a multicultural city with 87,000 residents from minority ethnic groups. The subjects of the study were 1,628 women from minority ethnic groups in three geographical areas of Bradford. A stratified sample of 1,000 women (670 South Asian, 163 African-Caribbean, 96 Eastern European and 71 other) was interviewed at the beginning of the project and six months after the health promotion intervention. Two specifically trained Health Promotion Facilitators from minority ethnic groups undertook community development work within three neighbourhoods in Bradford with the largest minority ethnic populations. There were group sessions in both formal and informal settings, which included the health education about breast and cervical cancer and the associated screening programmes. These sessions were in the women's preferred languages and audio-visual material and a specially designed teaching pack were used. There were significant differences in the baseline levels of knowledge about cervical cancer and breast cancer and breast across the different minority ethnic groups. The South Asian women had the lowest levels of knowledge and also showed the most significant improvements. Significant increases in attendance for cervical smear and breastcancer screening were self-reported. These were confirmed by anecdotal views of local health professionals. In addition, a local self-help group for South Asian women was established; also the contacts with other related organisations and professionals has help to raise the issues of ethnically sensitive services within the voluntary and statutory sectors. A community development approach to health promotion is particularly valuable in communities with low levels of knowledge about a disease/s or health service provision. Community development approaches often produce outcomes that had not been predicted. (AU)

Cancer in minority ethnic populations: priorities from epidemiology data

The aim of this paper is to review the literature on the frequency of cancers to develop priorities for cancer policy, prevention, services and research for black and minority ethnic populations in Britain. Data on populations originating in the Indian sub-continent, and Caribbean and African Commonwealth were extracted from published works. Cancers were ranked (top seven) on the basis of the number of cases, actual frequency, and also on relative frequency (SMR, SRR, PMR). Cancer was found to be a common cause of death. For example, during 1979-83 the proportion of death resulting from neoplasms in immigrants living in England and Wales was 11 percent for Indian and African men aged 20-49, and 19 percent for Caribbeans. The corresponding proportions were higher among women. The pattern of cancer depended on the method used to assess rankings. On the basis of the number of cases the top 3 ranking cancers for adults were breast, lung and neoplasms of the lymphatic system. Based on SMR's cancer of the gall bladder, liver and oral cavity ranked amongst the top 3 for adults. For children the top ranking cancers were acute lymphoblastic leukaemia, central nervous system tumours and neuroblastoma. Variations by ethnic groups were more evident in the rankings of relative frequency than in rankings based on numbers of cases. In conclusion, the most common and preventable cancers among minority ethnic populations were the same as those for the general population. The different cancer pattern based on SMRs highlight additional needs and provide potential models for research into understanding the causes of these cancers. Health services policy and practice should ensure that the common and preventable cancers take priority over rare cancers and those for which there is no effective treatment or prevention. Priorities for policy, prevention, clinical care and research should be set separately, for they differ. (AU)

The Rastafarian community and the "gateway" theory: lessons to be learned

The findings presented in this paper are drawn from a national ethnographic study conducted in six Jamaican populations, one of which was composed of members of the Rastafarian religion recruited from Kingston and south coast villages. Ninety-one members of the Rastafarian sect were formally interviewed and observed. The ethnographic study purposely over-sampled the Rastafarian community (1) because it was not sufficiently represented in the 1987 survey and (2) in order to examine the relationship between use of ganja and crack/cocaine. If ganja is, in fact, a "gateway" drug to cocaine, we would anticipate a high prevalence of crack/cocaine in this population. The data revealed that, as a group, members of the Rastafarian community were the most vigorous in shaping the definition of the term "drug". Cocaine is considered a drug but ganja, despite its illegal status, is considered a "natural" substance with health rendering properties and ritual functions. Not surprisingly, 0.4 percent of the Rastafarians surveyed believed that ganja should be legalized. Of all the populations investigated, Rastafarians were most likely to report that crack/cocaine was easy to obtain and to rank crack and cocaine as the most commonly used drugs. As a group, they are, in many ways, the most at risk for crack/cocaine use and addiction; compared with the rest of the sample, they have more urban, tourist and overseas experience as well as high potential for exposure to crack/cocaine. Yet the Rastafarian doctrine and design for living frequently were cited as the justification for preventing and/or for relinquishing the use of crack/cocaine. In its exception to the gateway theory, the Rastafarians community suggests protective mechanisms that inhibit the shift toward crack/cocaine use in high risk populations. (AU)

Crack: new directions in drug research. Part 1. Differences between the marijuana economy and the cocaine/crack economy

Crack use and trafficking in low-income, minority communities in New York City have pushed into prominence many aspects of drug use/misuse and distribution which had formerly received inadequate attention. For example, the generation and reinvestment of drug incomes are important determinants of how various drugs are experienced. While in retrospect marijuana trafficking appears to have been an almost benign affair, crack trafficking is fast-paced, ruthless, steeped in violence, and improvishes everyone who becomes engaged in it. In this part the differences between rates, volumes, and methods of income generation related to the use and distribution of marijuana and cocaine are elaborated. The contrast raises a question: Do economies like drug distribution follow a particular rhythmic pattern (capital accumulation during the benign marijuana passage followed by capital depletion in the overheated crack era), and how is it related to the changing demands of the regional economy? Viewed from this perspective, drug distributors and users appear not so much as "deviant" or "alienated" or as a "reserve pool of labor," but rather as a type of labor force which does indispensable work for the whole society. (AU)

From Ganja to crack: Caribbean participation in the underground economy in Brooklyn, 1976-1986. Part 2. Establishment of the cocaine (and crack) economy

Shortages in the supply of marijuana, which became acute around 1981, caused Rastafari marijuana distributors very reluctantly to disregard religious injunctions against the use of any psychoactive substance except marijuana, and to experiment with the use and distribution of cocaine hydrochloride powder for intranasal administration and, later, for smoking (freebase and crack). This experimentation became ruinous, and many were retired ignominiously from drug distribution. In the crack era they have been succeeded by completely new social, cultural, and economic arrangements. (AU)

From Ganja to crack: Caribbean participation in the underground economy in Brooklyn, 1976-1986. Part 1. Establishment of the marijuana economy

The involvement of Caribbean youth in drug distribution (marijuana from the mid-1960s to 1981; cocaine hydrochloride powder and crack from 1981 to 1987, the time of writing) throughout the Circum-Caribbean area and in North America is described. Social, economic, and cultural outcomes of these engagements are highlighted, and the relationship between the underground economy of drugs and the corporate, capitalist economy is explored. Responding to high rates of unemployment and to other problems of migrant adaptation, young Caribbean African males established a mutlimillion dollar marijuana (ganja) trading network which linked cultivators on the islands with exporters/importers and street-level distributors in North American cities. By 1976, its participants had become Rastafarians, or followers of an ideology of self-reliance and indigenous development. Following its precepts, they reinvested marijuana revenues to revive cottage industry and agriculture. In Caribbean or minority neighbourhoods, therefore, marijuana was a "positive vibration" and its distribution were lionized.(AU)

A comparitive study of self-esteem among minority group adolescents in Britain

This paper challenges the fundamental assumptions and empirical evidence upon which earlier conventional views of the nature and meaning of black self-esteem are based. Review of the literature reveals that a number of these assumptions and conclusions have been drawn from poor, incomplete and inadequate empirical data. Results of more recent rigorous investigations suggest alternative conclusions and interpretations regarding the meaning, level and quality of black self-esteem (AU)

Mental illness in immigrant minorities in London

An epidemiological study has been made of rates of mental illness in a number of ethnic minorities who are immigrants to Britian, and have settled in a defined area of South London. Of the groups considered, those from Africa, the Old Commonwealth, India and Pakistan have the highest rates. The lowest rates were found in those from Cyprus and Malta, native Britons, and those from the Caribbean. After controlling for the effects of age, sex and social class it was found that the pattern of illness in a number of the immigrant groups differed from the pattern found in the native born. Those from Africa, the Caribbean anmd India and Pakistan manifested an excess of schizophrenia, while those from Eire manifested a dearth of such illness when compared with matched, native-born controls. The combination of the following factors was used to try to predict the rank order of illness rated among the ethnic groups considered: community integration; status isolation; status striving in a climate of limited opportunity; and selective migration. (Summary)

Ethnicity and attitudes to deceased kidney donation: a survey in Barbados and comparison with Black Caribbean people in the United Kingdom

Background: Black minority ethnic groups in the UK have relatively low rates of deceased donation and report a higher prevalence of beliefs that are regarded as barriers to donation. However there is little data from migrants' countries of origin. This paper examines community attitudes to deceased kidney donation in Barbados and compares the findings with a survey conducted in a disadvantaged multi-ethnic area of south London. Methods: Questionnaires were administered at four public health centres in Barbados and at three private general practices. Adjusted odds ratios were calculated to compare attitudinal responses with a prior survey of 328 Caribbean and 808 White respondents in south London. Results: Questionnaires were completed by 327 respondents in Barbados (93% response); 42% men and 58% women, with a mean age of 40.4 years (SD 12.6). The main religious groups were Anglican (29%) and Pentecostal (24%). Educational levels ranged from 18% not completing 5th form to 12% with university education. Attitudes to the notion of organ donation were favourable, with 73% willing to donate their kidneys after their death and only 5% definitely against this. Most preferred an opt-in system of donation. Responses to nine attitudinal questions identified 18% as having no concerns and 9% as having 4 or more concerns. The highest level of concern (43%) was for lack of confidence that medical teams would try as hard to save the life of a person who has agreed to donate organs. There was no significant association between age, gender, education or religion and attitudinal barriers, but greater knowledge of donation had some positive effect on attitudes. Comparison of attitudes to donation in south London and Barbados (adjusting for gender, age, level of education, employment status) indicated that a significantly higher proportion of the south London Caribbean respondents identified attitudinal barriers to donation. Community attitudes in Barbados are favourable to deceased donation based on a system of informed consent. Comparison with south London data supports the hypothesis that the relatively high prevalence of negative attitudes to deceased donation among disadvantaged ethnic minorities in high income countries may reflect feelings of marginalisation and lack of belonging.