Racial and ethnic health disparities: evidence of discrimination's effects across the SEP spectrum.

OBJECTIVES: Perceived discrimination is a psychosocial stressor that plays a role in explaining racial/ethnic disparities in self-reported physical and mental health. The purpose of this paper is: (1) to investigate the association between perceived discrimination in receiving healthcare and racial/ethnic disparities in self-rated health status, physical, and emotional functional limitations among a diverse sample of California adults; (2) to assess whether discrimination effects vary by racial/ethnic group and gender; and (3) to evaluate how the effects of discrimination on health are manifest across the socioeconomic position (SEP) spectrum. DESIGN: Data were drawn from the 2001 California Health Interview Survey adult file (n=55,428). The analytic approach employed multivariate linear and logistic regressions. Discrimination is qualitatively identified into two types: (1) discrimination due to race/ethnicity, language, or accent, and (2) other discrimination. RESULTS: Findings show that both types of discrimination negatively influenced self-rated health, and were associated with a two to three-fold odds of limitations in physical and emotional health. Further, these effects varied by racial/ethnic group and gender, and the effects were mixed. Most notably, for emotional health, racial/ethnic discrimination penalized Latinas more than non-Latina Whites, but for physical health, other discrimination was less detrimental to Latinas than it was to non-Latina Whites. At higher levels of SEP, the effects of racial/ethnic discrimination on self-rated health and other discriminations' effects on physical health were attenuated. DISCUSSION: Higher SEP may serve as an important mitigator, particularly when comparing the medium to the low SEP categories. It is also possible that SEP effects cannot be extracted from the relationships of interest in that SEP is an expression of social discrimination. In fact, negative health effects associated with discrimination are evident across the SEP spectrum. This study highlights the complexity of the relationships between discrimination and racial/ethnic identity, gender, and SEP.

A worksite obesity intervention: results from a group-randomized trial.

OBJECTIVES: We used a participatory process to develop an obesity intervention appropriate for elementary school personnel. METHODS: A randomized controlled trial included 16 school worksites (8 intervention, 8 control). Intervention schools formed committees to develop and implement health promotion activities for employees. Anthropometric and self-report data were collected at baseline and postintervention (2 years later). The primary outcome measures were body mass index (BMI), waist-hip ratio, physical activity, and fruit and vegetable consumption. RESULTS: After adjustment for age, ethnicity, and job classification, employees in intervention schools reduced their BMI by an average of 0.04 kg/m2, and those in control schools increased their BMI by an average of 0.37 kg/m2. Comparisons for waist-hip ratio, weekly physical activity minutes, and fruit and vegetable consumption were not significant. CONCLUSIONS: The participatory process appeared to be an effective means for stimulating change. The intervention may have slowed and perhaps reversed the tendency of adults to gain weight progressively with age.

Correlation of obesity with elevated blood pressure among racial/ethnic minority children in two Los Angeles middle schools.

INTRODUCTION: To identify anthropometric and fitness correlates of elevated blood pressure, serum cholesterol, and glycated hemoglobin, we examined anthropometric and physiologic biomarkers among racial/ethnic minority children aged 11 to 13 years in two urban Los Angeles middle schools. We explored the potential for using obesity or fitness level as screening variables for cardiovascular disease risk factors in these students. METHODS: During regularly scheduled physical education classes, we collected data on demographic characteristics, height, weight, blood pressure, nonfasting total serum cholesterol, glycated hemoglobin, time to run/walk 1 mile, and a range of self-reported behaviors. A total of 199 sixth-graders (121 Latinos, 78 African Americans) participated in the study. RESULTS: Bivariate analyses indicated that 48.6% of sixth-graders were of desirable weight, 17.5% were overweight, 29.9% were at risk for overweight, and 4.0% were underweight. Higher weight was associated with higher levels of serum cholesterol, systolic blood pressure, and diastolic blood pressure (P values for all associations <.02) but not with glycated hemoglobin. Multivariate analyses maintained the findings with regard to blood pressure but not serum cholesterol. CONCLUSION: Overweight status could be a screening variable for identifying youth at risk for high blood pressure. Obesity prevention and intervention programs and policies need to target low-income racial/ethnic minority children. Assessment of hypertension status also seems warranted in low-income racial/ethnic minority sixth-graders, as does early intervention for children at high risk.

Fighting cancer with fitness: dietary outcomes of a randomized, controlled lifestyle change intervention in healthy African-American women.

OBJECTIVES: This study tested the efficacy of an 8-week, culturally targeted community-based nutrition and physical activity promotion intervention, Fight Cancer with Fitness! (FCF). METHODS: A randomized, controlled trial was conducted in a black-owned commercial gym in a sample of 366 predominantly overweight or obese, healthy African-American women. RESULTS: Dietary quality as indexed by fruit and vegetable intake improved significantly in the intervention group compared to the control group at 12-month follow-up, and proportion of calories consumed as fat decreased in both groups. CONCLUSIONS: This individually targeted cancer prevention intervention produced beneficial effects on dietary quality that were sustained for at least 12 months.

Challenges in improving fitness: results of a community-based, randomized, controlled lifestyle change intervention.

OBJECTIVE: This study tested the efficacy of an 8-week culturally targeted nutrition and physical activity intervention on body composition. METHODS: A randomized, attention-controlled, two-group trial was conducted in a blackowned commercial gym with a sample of 366 predominantly healthy, obese African American women. A free 1-year membership to the study site gym was provided to participants in both groups. Data were collected at baseline, 2, 6, and 12 months. RESULTS: Sample retention at 1 year was 71%. Between-group longitudinal analysis including only participants with complete data revealed a trend toward weight stability in the intervention group at 2 months compared with controls (+0.05 kg/m(2), p = 0.75; +0.32 kg/m(2), p = 0.08, respectively), disappearing at 12 months (+1.37 kg/m(2), p = 0.0001; +1.02 kg/m(2), p = 0.001, respectively). Within-group analysis demonstrated that intervention and control participants' fitness (1-mile run-walk) improved by 1.9 minutes (p = 0.0001) and 2.3 minutes (p = 0.0001), respectively, at 12 months. Mixed model regression analyses demonstrated a significant main effect of the intervention on fitness (p = 0.0185) and a marginally significant effect on body mass index (BMI) (p = 0.057), at 2 months, disappearing by 6 months. By 12 months, however, the controls exhibited a significant advantage in waist circumference stability compared with intervention participants (+1.1 cm, p = 0.2763; +2.1 cm, p = 0.0002, respectively). CONCLUSIONS: The intervention produced modest short-term improvements in body composition, but the economic incentive of a free 1-year gym membership provided to all participants was a more potent intervention than the education and social support intervention tested. However, longer-term fitness enhancement remains elusive and demands research and policy attention. These findings have policy implications in that employer-/insurer-subsidized gym memberships may require interventions targeting other levels of change (e.g., physical or social/environmental) to foster sustainable fitness improvements.

First-aid training and capabilities of the lay public: a potential alternative source of emergency medical assistance following a natural disaster.

Basic first-aid skills can be useful in treating minor injuries that commonly result from natural disasters in the United States. Yet there has been insufficient research on training and competence in first-aid skills among community residents. This study utilises panel data for 414 adults in Los Angeles, California, who were interviewed within three years of the 1994 Northridge earthquake and re-interviewed in 1999 after the El Ninõ winter of 1997-98. Descriptive, bivariate and multivariate analyses were performed. Results showed that 24 percent of the members of the sample had received first-aid training since their Northridge earthquake interview. First-aid training, particularly recent training, was associated with greater perceived first-aid skills, as well as with increased expected and actual employment of those skills. With the appropriate training and skill retention, lay members of the public can potentially contribute to a post-disaster medical response.

Psychological distress following urban earthquakes in California.

During and following a disaster caused by a natural event, human populations are thought to be at greater risk of psychological morbidity and mortality directly attributable to increased, disaster-induced stress. Drawing both on the research of others and that conducted at the Center for Public Health and Disaster Relief of the University of California-Los Angeles (UCLA) following California earthquakes, this paper examines the extent to which research evidence supports these assumptions. Following a brief history of disaster research in the United States, the response of persons at the time of an earthquake was examined with particular attention to psychological morbidity; the number of deaths that can be attributed to cardiovascular events and suicides; and the extent to which and by whom, health services are used following an earthquake. The implications of research findings for practitioners in the field are discussed.

Role models, ethnic identity, and health-risk behaviors in urban adolescents.

BACKGROUND: The assumption that role models or mentors constructively influence adolescent psychological functioning has prompted societal investment in mentoring programs. However, there has been little empirical evaluation of the relationship between role model or mentor characteristics and health behaviors. OBJECTIVES: To describe role model selection in urban adolescents and examine the relationships between role model characteristics, psychosocial functioning, and health-risk behaviors. DESIGN: Cross-sectional survey. PARTICIPANTS: A population-based, multiethnic sample of Los Angeles County adolescents aged 12 to 17 years was generated from a 3-stage, area-probability sampling frame. Of 877 adolescents identified, 749 are included in this analysis. METHODS: In-person, in-home interviews were conducted. MAIN OUTCOME MEASURES: Substance use, academic performance, and self-perception (measures of ethnic identify and self-esteem). Ethnic identity was measured by an adaptation of a scale developed by Phinney (J Adolesc Res. 1992;7:156-176) to assess commonalities across ethnic groups. RESULTS: Fifty-six percent of adolescents identified a role model. Higher levels of ethnic identity were associated with moving from identifying no role model to identifying a figure primarily available through the media to identifying a known individual, familial or nonfamilial (P<.001). Having a role model, particularly an individual known to the adolescent, was also associated with higher self-esteem (P<.001) and higher grades (P<.05). For white males without custodial fathers, having a role model was associated with decreased substance use (P<.05). CONCLUSION: Role model selection is associated with protective psychosocial characteristics.

Victimization after a natural disaster : Social disorganization or community cohesion?

The data were collected from three independent community samples, beginning seven months after the 1994 Northridge, California earthquake and following in one year intervals for the two subsequent samples. Exposure to traumatic stress (Norris 1990)-including criminal victimization-in the 12 months prior to the interview was assessed in each sample. For all traumatic stress/victimization and for each of seven individual events, rates remain flat over time (3 data points), suggesting that neither social disorganization nor social cohesion occurred after the earthquake. In the first sample respondents only reporton pre-disaster events, for them post-earthquake rates of traumatic stress and victimization were compared with pre-earthquake rates. In contrast to the trend data, reduction in rates of robbery and, to a lesser extent, major life changes suggest that an altruistic community (social cohesion) may have risen. A third set of analyses show that the severity of exposure to the earthquake does not make a contribution to traumatic stress or victimization beyond that explained by the demographic variables repeatedly found to predict vulnerability to victimization. There is no indication that social disorganization follows a natural disaster, and there is minor support for the emergence of an altruistic community (AU)

The Multidimensional Anger Inventory.

Previous research suggests that anger has important social and health consequences, particularly cardiovascular health. The pathogenic aspects of anger have not been identified, however, in part because of a reliance on unidimensional measures of anger. The present article describes psychometric data for an inventory that is sensitive to the multidimensional nature of the anger construct. It was hypothesized that the newly developed Multidimensional Anger Inventory (MAI) would include scales reflective of the following dimensions of anger: frequency, duration, magnitude, mode of expression, hostile outlook, and range of anger-eliciting situations. The mode of expression dimension was expected to contain separate anger-in, anger-out, guilt, brood, and anger-discuss measures. The inventory was administered to two populations: male and female college students and male factory workers. Factor analyses of the MAI within the two samples showed that the frequency, duration, and magnitude dimensions clustered together to form an anger-arousal factor that accounted for 64% and 71% of the variance in the two samples, respectively. The range of anger-eliciting situations and hostile outlook emerged as separate dimensions, as hypothesized. Mode of anger expression was best described by two dimensions labeled anger-in and anger-out. Psychometric analyses of the scale showed that it possessed adequate test-retest reliability (r = 0.75) and high internal consistency (alpha = .84 and .89 for the two samples). The validity of the scale was supported by the expected pattern of relations with other inventories designed to assess anger or hostility. Comparisons of MAI scores between (college versus factory) and within (male versus female) populations were made.