Understanding the effect of ethnic density on mental health: multi-level investigation of survey data from England.

OBJECTIVES: To determine if living in areas where higher proportions of people of the same ethnicity reside is protective for common mental disorders, and associated with a reduced exposure to discrimination and improved social support. Finally, to determine if any protective ethnic density effects are mediated by reduced exposure to racism and improved social support. DESIGN: Multi-level logistic regression analysis of national survey data, with area-level, own-group ethnic density modelled as the main exposure. Participants and setting 4281 participants of Irish, black Caribbean, Indian, Pakistani, Bangladeshi, and white British ethnicity, aged 16-74 years, randomly sampled from 892 "middle layer super output areas" in England. MAIN OUTCOME MEASURES: Common mental disorders (assessed via structured interviews); discrimination (assessed via structured questionnaire); and social support and social networks (assessed via structured questionnaire). RESULTS: Although the most ethnically dense areas were also the poorest, for each 10 percentage point increase in own-group ethnic density, there was evidence of a decreased risk of common mental disorders, for the full ethnic minority sample (odds ratio 0.94 (95% confidence interval 0.89 to 0.99); P=0.02, trend), for the Irish group (odds ratio 0.21 (0.06 to 0.74); P=0.01, trend), and for the Bangladeshi group (odds ratio 0.75 (0.62 to 0.91); P=0.005, trend), after adjusting for a priori confounders. For some groups, living in areas of higher own-group density was associated with a reduction in the reporting of discrimination and with improved social support and improved social networks. However, none of these factors mediated ethnic density effects. CONCLUSIONS: A protective effect of living in areas of higher own-group ethnic density was present for common mental disorders for some minority groups. People living in areas of higher own-group density may report improved social support and less discrimination, but these associations did not fully account for density effects.

Investigating variations in infant mortality in England and Wales by mother's country of birth, 1983-2001.

The aim of this study was to investigate variations in infant mortality from 1983 to 2001 by birthweight, registration status, father's social class, age of mother at birth and cause of death, among babies of mothers born in countries that represent the largest ethnic minority groups in England and Wales. A total of 70,208 infant death registration records linked to their corresponding birth registration records were used. The study focused on infant deaths of babies of mothers born in the UK, Republic of Ireland, Caribbean, West Africa, East Africa, India, Pakistan and Bangladesh. From 1983 to 2001 infant mortality rates decreased overall, and this was also apparent in the rates by mother's country of birth. Overall, babies of mothers born in Pakistan consistently had the highest infant mortality rates. Low-birthweight babies of mothers born in West Africa had the highest infant, neonatal and postneonatal death rates. Differences were also seen by registration status, mother's age and between manual and non-manual occupations for all countries from 1983 to 2001. For babies of mothers born in the UK, Caribbean and West Africa, immaturity-related conditions were the most common cause of infant deaths. The leading cause of infant death among babies of mothers born in Pakistan and Bangladesh was congenital anomalies.

Alcohol use by young people from different ethnic groups: consumption, intoxication and negative consequences.

OBJECTIVE: To investigate alcohol consumption among mid-adolescents from different ethnic groups and explore overall and gender variations in drinking behaviours. METHODS: A survey of alcohol use by 609 14-16 year olds recruited from three schools in an ethnically diverse area of London. Approximately 70% of the sample was of white English, white Irish, black Caribbean or black African ethnic origin. Self-report information was collected via a researcher-administered structured interview. RESULTS: There was a significantly lower prevalence of lifetime alcohol use among black African respondents than among the other three ethnic groups. Black African males and males and females from the two white ethnic groups reported drinking above levels recommended by the English Department of Health. Among the recent drinkers, over half of the white Irish and white English groups and over a quarter of black Caribbean and black African groups had been intoxicated in the 90 days before interview. Approximately three quarters of the white English and white Irish recent drinkers, but only a half of black Caribbean and black African recent drinkers had experienced a negative drinking-related consequence during the last year. CONCLUSIONS: The survey findings suggest that while young people of white English or white Irish ethnic origin from the populations studied are more likely to drink excessively and experience negative consequences from their drinking than black African and black Caribbean youth, a substantial minority of black African and black Caribbean youth also experience alcohol-related problems.

Socioeconomic and ethnic group differences in self reported health status and use of health services by children and young people in England: cross sectional study.

OBJECTIVES: To examine whether self reported health status and use of health services varies in children of different social class and ethnic group. DESIGN: Cross sectional study from the 1999 health survey for England. SUBJECTS: 6648 children and young adults aged 2-20 years. SETTING: Private households in England. MAIN OUTCOME MEASURES: Proportion of children (or their parents) reporting episodes of acute illness in the preceding fortnight and prevalence of self reported longstanding illness. Proportion reporting specific illnesses. Proportion reporting that they had consulted a general practitioner in the preceding fortnight, attended hospital outpatient departments in the three preceding months, or been admitted to hospital in the preceding year. RESULTS: Large socioeconomic differences were observed between ethnic subgroups; a higher proportion of Afro-Caribbean, Indian, Pakistani, and Bangladeshi children belonged to lower social classes than the general population. The proportion of children and young adults reporting acute illnesses in the preceding two weeks was lower in Bangladeshi and Chinese subgroups (odds ratio 0.41, 95% confidence interval 0.27 to 0.61 and 0.46, 0.28 to 0.77, respectively) than in the general population. Longstanding illnesses was less common in Bangladeshi and Pakistani children (0.52, 0.40 to 0.67 and 0.57, 0.46 to 0.70) than in the general population. Irish and Afro-Caribbean children reported the highest prevalence of asthma (19.5% and 17.7%) and Bangladeshi children the lowest (8.2%). A higher proportion of Afro-Caribbean children reported major injuries than the general population (11.0% v 10.0%), and children from all Asian subgroups reported fewer major and minor injuries than the general population. Indian and Pakistani children were more likely to have consulted their general practitioner in the preceding fortnight than the general population (1.86, 1.35 to 2.57 and 1.51, 1.13 to 2.01, respectively). Indian, Pakistani, Bangladeshi, and Chinese children were less likely to have attended outpatient departments in the preceding three months. No significant differences were found between ethnic groups in the admission of inpatients to hospitals. Acute and chronic illness were the best predictors of children's use of health services. Social classes did not differ in self reported prevalence of treated infections, major injuries, or minor injuries, and no socioeconomic differences were seen in the use of primary and secondary healthcare services. CONCLUSIONS: Children's use of health services reflected health status rather than ethnic group or socioeconomic status, implying that equity of access has been partly achieved, although reasons why children from ethnic minority groups are able to access primary care but receive less secondary care need to be investigated.

The moderating effects of gender and ethnicity on the relationship between effect expectancies and alcohol problems.

OBJECTIVE: Research has demonstrated that alcohol outcome expectancies moderate the relationship between psychological states such as stress and negative affect and alcohol use. This study examined whether the relationship between expectancies and alcohol problems would be moderated by gender and ethnicity. METHOD: Using a household survey format, personal interviews were conducted with Puerto Rican and Irish American men and women. The final sample consisted of 412 (231 male) Puerto Ricans and 476 (252 male) Irish Americans. Alcohol expectancies were measured with the Effects of Drinking Alcohol Scale. All subjects resided in the New York metropolitan area. The original study was designed to compare the drinking behaviors and alcohol-related beliefs of groups with varied drinking practices and distinct drinking beliefs. RESULTS: Both gender and ethnicity moderated the links between aggressive and self-control expectancies and drinking problems. For example, anticipated loss of control from drinking was more negatively related to Puerto Rican and female alcohol problems than it was to Irish and male problems. CONCLUSIONS: The present findings suggest that whether an outcome expectancy is associated with more alcohol problems depends upon the particular meaning of the outcome. This meaning, in turn, depends upon an individual's particular sociocultural perspective which is associated with such personal characteristics as gender and ethnicity.

The relationship between ethnicity, gender and alcohol consumption: a strategy for testing competing models.

AIM: This study tested mediator, moderator and main effects models to determine the pattern of relationships between ethnicity, gender, temperament, and alcohol use. DESIGN: A large-scale survey was employed. Respondents were interviewed in their homes. Participants were 523 Puerto Rican and 490 Irish American adults residing in the New York metropolitan area. MEASURES: Quantity and frequency of alcohol consumption were assessed with standard measures, and recent drinking problems with the substance abuse module of the Composite International Diagnostic Instrument. FINDINGS: Rather than supporting a complex, nested model, the findings supported a main effects model and indicated that each of the three predictors was related to one or more drinking measure. While gender strongly influenced each drinking behavior, ethnicity only influenced frequency, and temperament only influenced recent drinking problems. CONCLUSIONS: The results support previous studies indicating consistent male-female drinking differences while highlighting a statistical strategy for comparing competing models of ethnic drinking behavior.

Ethnic differences in substance use and alcohol-use-related mortality among first generation migrants to England and Wales

Epidemiological studies among migrant ethnic groups are potentially important as a way to provide insight into the relative importance of genetic, cultural, and socioeconomic factors in the etiology of substance use disorders. This paper summarizes prior United Kingdom studies of the prevalence of substance-use-associated problems in different ethnic groups before analyzing trends in recent mortality data by country of birth. On this evidence, rates of alcohol-related mortality may be marginally higher for those born in the Caribbean than for the native British, but are substantially raised for those born in Ireland and the Indian subcontinent. There is some indication that rates for the Caribbean and possibly the Irish groups have risen more rapidly than for the national population over a 12-year period. These difference in mortality rates seem to have arisen for complex reasons.(AU)

Cross sectional analysis of mortality by country of birth in England and Wales, 1970-92.

OBJECTIVE: To compare mortalities for selected groups of immigrants with the national average. DESIGN: Analysis of mortality for adults aged 20-69 in 1970-2 and 1989-92 using population data from 1971 and 1991 censuses. Mortality of Scottish and Irish immigrants aged 25-74 was also compared with mortality in Scotland and Ireland for 1991. SETTING: England and Wales. MAIN OUTCOME MEASURES: Standardised mortality ratios for deaths from all causes, ischaemic heart disease, cerebrovascular disease, lung cancer, and breast cancer. RESULTS: In 1989-92 mortality from all causes was higher than the national average for Scottish immigrants, by 32% for men and 36% for women; for Irish immigrants it was higher by 39% for men and 20% for women; and for Caribbean born men it was lower by 23%. Ischaemic heart disease and lung cancer accounted for 30-40% of the excess mortality in Scottish and Irish immigrants. For south Asians, excess mortality from circulatory disease was balanced by lower mortality from cancer. Standardised mortality ratios for cerebrovascular disease in 1989-92 were highest for west African immigrants (271 for men and 181 for women). CONCLUSIONS: Widening differences in mortality ratios for migrants compared with the general population were not simply due to socioeconomic inequalities. The low mortality from all causes for Caribbean immigrants could largely be attributed to low mortality from ischaemic heart disease, which is unexplained. The excess mortality from cerebrovascular and hypertensive diseases in migrants from both west Africa and the Caribbean suggests that genetic factors underlie the susceptibility to hypertension in people of black African descent.

Alcohol-use-related problems in Puerto Rican and Irish-American males.

This study compared the alcohol-use-related problems of Puerto Rican and Irish-American men: groups sometimes considered at "high risk" for the development of such problems. It was found that Irish-American men had higher lifetime prevalence rates in the following areas: excessive intake, tolerance and/or dependence, physical or psychological problems associated with alcohol misuse, and social and/or occupational problems associated with alcohol misuse. Results are discussed in terms of Puerto Rican and Irish-American risk status and the importance of appropriate comparisons in studies focused on culture/ethnicity and alcohol consumption.

Birth prevalence of malformations in members of different ethnic groups and in the offspring of matings between them, in Birmingham, England.

STUDY OBJECTIVES: The aims were: (1) to compare the birth prevalence of malformations in different ethnic groups and (2) to explore the reasons for the ethnic variations found by examining birth prevalence in the offspring of matings between ethnic groups. DESIGN: Analysis of data from a register of malformations and register of births. SETTING: Birmingham, England. SUBJECTS: A total of 432,778 infants (including stillbirths) born in 1960-84. MAIN RESULTS: Significant differences (p < 0.01) between ethnic groups were exhibited by the birth prevalence of neural tube defects (NTD), cleft palate, cleft lip, oesophageal atresia/fistula, hypospadias, hip dislocation, clubfoot, polydactyly, and syndactyly. In the offspring of matings between parents of European and Caribbean origin, the birth prevalence of NTD, cleft lip, hypospadias, hip dislocation, polydactyly, and syndactyly seemed more likely to be influenced by the ethnicity of both parents than by that of the mother alone. The reverse was true for the birth prevalence of NTD in subjects with one parent of Irish origin and on of British. CONCLUSIONS: Genetic differences may be responsible for Europeans being at lower risk of polydactyly and at higher risk of NTD, cleft lip, hypospadias, hip dislocation, and syndactyly than Caribbeans. Variations in the intrauterine environment are more likely to account for NTD being more common in Irish than in British subjects.

The value of ethnographic alcohol studies: a psychologist's perspective.

Drinking behavior has been studied by scientists from a variety of social science disciplines including anthropology, economics, sociology, and psychology. The very nature of their narrow, discipline-based training and work, however, has often prevented these scientists from appreciating each other's different methodologies and from conducting cooperative, interdisciplinary studies. In this paper, I discuss how my own experience with ethnographic alcohol studies influenced my research on drinking behavior. I then outline a research strategy that could be used to foster interdisciplinary alcohol studies.

A greater than 200 kb deletion removing the entire beta-like globin gene cluster in a family of Irish descent.

We describe a new deletional form of gamma delta beta-thalassemia segregating in two generations of a family of Irish descent. Affected family members present with a beta-thalassemia minor phenotype, normal Hb A2 and Hb F levels. Genomic blotting analyses on DNA from affected family members show heterozygosity for a large deletion beginning at least 15 kb upstream of the 5' endpoint of the gamma delta beta-thalassemia-1 deletion, extending through the entire beta-like globin gene cluster, and continuing for at least 10 kb beyond the 3' endpoint of the deletion associated with the Spanish form of delta beta 0-thalassemia. This deletion is among the largest described so far, and removes at least 205 kb encompassing the entire beta-like globin gene cluster on chromosome 11.

The use of inpatient psychiatric care by immigrants in a London Borough.

The prevalence of admission to psychiatric inpatient care in the major immigrant groups in the London Borough of Newham in 1982 is surveyed and results discussed with reference to relevant published literature. High admission rates were found among young West Indian men and older West Indian women, Pakistani men, older Indian women, Irish women and women from the West African new commonwealth. Women from the East African new commonwealth had a low admission rate. The diagnostic mixture found in patients from the various groups is discussed.

The use of inpatient psychiatric care by immigrants in a London Borough

The prevalence of admission to psychiatric inpatient care in the major immigrant groups in the London Borough of Newham in 1982 is surveyed and results discussed with reference to relevant published literature. High admission rates were found among young West Indian men and older West Indian women, Pakistani men, older Indian women, Irish women and women from the West African new commonwealth. Women from the East African new commonwealth had a low admission rate. The diagnostic mixture found in patients from the various groups is discussed. (AU)

Ethnic differences in consultation rates in urban general practice.

OBJECTIVE: To determine the patterns of consultations with the general practitioner among different ethnic groups and the outcome of these consultations. DESIGN: Retrospective analysis of data from one urban group general practice collected during 1979-81 as part of a research project in seven practices. SETTING: Group general practice in the London borough of Brent with a list size of 10,877 patients in July 1980. SUBJECTS: Patients registered with the practice during the 23 months to April 1981 who accounted for 67,197 consultations. MAIN OUTCOME MEASURES: Ethnic state, sex and social class distribution, and diagnosis of patients consulting and frequency of consultations analysed as standardised consultation ratios and standardised patient consultation ratios. RESULTS: Compared with other ethnic groups male Asians (that is, including those born in Britain and those originating from the Indian subcontinent and east Africa) had a substantially increased standardised patient consultation ratio. Consultation rates for mental disorders--in particular, anxiety and depression--were reduced in all groups of immigrant descent. West Indians consulted more frequently for hypertension and asthma, and their children less frequently with otitis media. Asians consulted more frequently with upper respiratory tract infections and non-specific symptoms. Native British patients were more likely to leave the surgery with a follow up appointment, prescription, or certificate. CONCLUSION: Notwithstanding the limitations of this study, ethnic differences in consultation rates were apparent. These differences require further investigation if the needs of minority ethnic groups are not to be overlooked.

Sarcoidosis in a racially mixed community.

Over a 23-year period 497 patients with sarcoidosis were seen at Willesden Chest Clinic, of whom 151 were British, 105 Irish, 165 West Indian, and 35 Asian. The estimated annual incidence was: British 4/100,000, Irish 21/100,000, West Indian 58/100,000 and Asian 14/100,000. There was a marked female preponderance in the Irish (65 per cent) and West Indians (57 per cent). The female mean age was 35 years, the male mean age 32 years. Asian and West Indian patients were older (mean 37 and 38 years) and Irish patients younger (mean 29 years). West Indian patients more frequently had involvement of the less common extrathoracic sites. In 402 patients the outcome was known: 64 per cent of patients recovered within five years but proportionally fewer West Indians (55 per cent) and Asians (48 per cent) recovered. The greater morbidity in the West Indian and Asian patients was particularly associated with extrathoracic disease in which the results were poor.

Lessons from the study of immigrant mortality.

PIP: This paper reports the results of a systematic review of mortality among immigrant groups in England and Wales. Mortality rates in 1970-72 were compared with rates both in the countries of origin and in England and Wales. All-cause male mortality was lower in immigrants from italy, the Caribbean, and Poland than in the countries of origin, suggesting a selection effect among migrants. The opposite patttern was noted for imigrants from Ireland, however, indicating social and health disadvantages may be a stimulus to migration. The high mortality from tuberculosis in immigrants from the indian subcontinent and Ireland, low mortality from ischemic heart disease and high mortality from cerebrovascular disease in Caribbean men, and low mortality from cancer of the lung and intestine in all but Irish men reflect the influence of the migrants' original country. A possible influence of the host country on determining disease rates is seen in adaptation of immigrant mortality ratios toward the England and Wales average. For example, immigrants from several countries analyzed had ischemic heart disease mortalty ratios intermediate between those for the original country and for England and Wales. In addition, British people born in the Indian subcontinent showed a mortality pattern intermediate between that of the Indians and the England and Wales average, supporting the argument that environmental rather than genetic determinants may be involved in the principal chronic diseases. Particularly high mortality from complications of pregnancy and childbirthwas noted in indian and Caribbean immigrants, indicating that there may be social and cultural barriers to the receipt of adequate medical care. Finally, social class differences did not account for mortality differences among immigrant groups. Mortality was higher for the Irish than the English or Welsh in each social class group, which suggests there are cultural influences on mortality that act independently of social class influences.^ieng

Ethnicity and the pain experience.

The first objective of this investigation was to examine interethnic differences and similarities in the reported pain experience of Black, Irish, Italian, Jewish and Puerto Rican facial pain patients. Responses, attitudes and descriptions were found to be relatively similar after controlling for most variables shown by previous studies to influence reported pain experience. These variables include symptom history, signs elicited on physical, radiographic and laboratory examination, as well as social, cultural and psychological data. A thirty-five item scale was employed to measure patients' pain experience. Using analysis of variance and covariance, no significant interethnic differences were found for twenty-three (65.7%) of the items. The majority of the twelve items for which interethnic differences were found concerned the patients' emotionality (stoicism vs expressiveness) in response to pain, and interference in daily functioning attributed to pain. The pain experiences reported by the Black, Italian and Jewish patients were found most similar as measured by the twelve items. Irish and Puerto Rican patients appeared relatively distinct from the other groups as well as from each other. The second objective of this study was to identify particular variables that influence intraethnic variation in the pain experience. These were determined by multiple regression analysis of two summary indices previously derived by factor analysis of the thirty-five items. The specific variables which were most influential differed according to ethnicity, as follows: degree of medical acculturation for Black patients; degree of social assimilation for Irish patients; duration of pain for Italian patients; and level of psychological distress for Jewish and Puerto Rican patients. Thus, it appears that, in our study population, interethnic homogeneity is present for most aspects of the pain experience, while intraethnic heterogeneity exists for factors that may influence that experience. That is, the five ethnic groups were generally found to be similar in their reported responses to pain. Yet, each group was quite different with regard to factors which influence the responses.

Some social and phenomenological characteristics of psychotic immigrants.

Various studies have shown: (i) increased rates of psychoses in immigrants to Britain, and a particularly high rate of schizophrenia in the West Indian- and West African-born; and (ii) a greater proportion of atypical psychoses in immigrants. A retrospective study of psychotic inpatients from a London psychiatric unit demonstrated increased rates of schizophrenia in patients from the Caribbean and West Africa. These patients included a high proportion of those with paranoid and religious phenomenology, those with frequent changes of diagnosis, formal admissions, and married women. The West Indian-born had been in Britain for nearly 10 years before first seeing a psychiatrist and, if they had an illness with religious symptomatology, were likely to have been in hospital for only 3 weeks. Rates of schizophrenia without paranoid phenomenology were similar in each ethnic group. It is suggested that the increase in the diagnosis of schizophrenia in the West Indian-born, and possibly in the West African-born, may be due in part to the occurrence of acute psychotic reactions which are diagnosed as schizophrenia.