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Objectives. We investigated whether racial/ethnic health disparities exist in Canada and whether socioeconomic or behavioral differences between racial/ ethnic minorities and nonminorities account for such disparities. Methods. We used data from the National Population Health Survey, conducted by Statistics Canada in 1996 and 1997. We used regression models to examine differences in functional and self-reported health. Results. Our study found no association between socioeconomic or behavioral differences and racial/ethnic health disparities. There was no clear pattern between racial/ethnic minority status and health. Conclusions. The state can play an important role in health outcomes, and public commitment to accessible health care may explain why socioeconomic status and health behaviors are weak indicators of racial/ethnic health variation in Canada.

Research indicates that race plays a role in the identification of eating disorders. Studies involving 160 undergraduate students of various ethnicities who read passages describing adolescent girls with eating disorder symptoms. The students identified eating disorders more readily when the passage described a Caucasian girl rather than an African American or Hispanic girl. Implications for public awareness and clinical practice are discussed.

Mean levels of three characteristics--verbal IQ, number of sexual partners, and birth weight--were examined in African American, White (European-descent) Americans, and Black/White mixed race American adolescents. The sample came from Wave 1 of the National Longitudinal Study of Adolescent Health. The mean age was 16 years. According to their interviewers, the mixed race children had an African American physical appearance. The African American adolescents had a lower birth weight, a lower verbal IQ, and a higher number of sexual partners than did White adolescents. For each characteristic, the mixed race mean fell between the means of the two parental populations. Design extensions were proposed that include: (1) directly genotyping for individual racial admixture, (2) including parents of the mixed race children, and (3) including their cousins. KEY WORDS: race differences; IQ; Add Health; birth weight; sexual partners; African American.

Diabetics are either more or less likely to develop certain complications of diabetes depending on their ethnic background even when they all receive the same health care. In a study of 62,432 diabetics enrolled in an HMO, blacks, Asians, and Hispanics were more likely than whites to develop end-stage kidney failure, but less likely to develop cardiovascular disease., Context: Higher rates of microvascular complications have been reported for minorities. Disparate access to quality health care is a common explanation for ethnic disparities in diabetic complication rates in the US population. Examining an ethnically diverse population with uniform health care coverage may be useful. Objective: To assess ethnic disparities in the incidence of diabetic complications within a nonprofit prepaid health care organization. Design and Setting: Longitudinal observational study conducted January 1 1995, through December 31, 1998, at Kaiser Permanente Medical Care Program in northern California. Participants: A total of 62 432 diabetic patients, including Asians (12%), blacks (14%), Latinos (10%), and whites (64%). Main Outcome Measures: Incident myocardial infarction (MI), stroke, congestive heart failure (CHF), and nontraumatic lower extremity amputation (LEA), defined by primary hospitalization discharge diagnosis, procedures, or underlying cause of death; and end-stage renal disease (ESRD), defined as renal insufficiency requiring renal replacement therapy or transplantation for survival or by underlying cause of death. Results: Patterns of ethnic differences were not consistent across complications and frequently persisted despite adjustment for a wide range of demographic, socioeconomic, behavioral, and clinical factors. Adjusted hazard ratios (relative to that of whites) were 0.56, 0.68, and 0.68 for blacks, Asians, and Latinos, respectively (P Conclusions: This study confirms previous reports of elevated incidence of ESRD among ethnic minorities, despite uniform medical care coverage, and provides new evidence that rates of other complications are similar or lower relative to those of whites. The persistence of ethnic disparities after adjustment suggests a possible genetic origin, the contribution of unmeasured environmental factors, or a combination of these factors.

Research indicates that body image disturbance after weight loss remains high for individuals with early onset of obesity, which may be linked to a persistent self-image of themselves from their adolescent years. Caucasians exhibited a higher disturbance score prior to weight loss than other ethnic groups, possibly due to greater social pressure to be slender.

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.

A. R. Hafdahl and B. Gray-Little (2002) raised several issues of study inclusion and statistical reporting, none of which challenged the overall results or took issue with the theoretical conclusions of J. M. Twenge and J. Crocker (2002). Excluding the few studies whose inclusion Hafdahl and Gray-Little questioned would not change the results. Twenge and Crocker's inclusion of twice as many data sources is the more likely cause of differences between the 2 meta-analyses. The authors argue that including standardized regression coefficients is essential for reader understanding and reiterate the position that academic self-esteem scales should not be included in an analysis focusing on general self-esteem. Examining the specific domains of self-esteem would entail another meta-analysis, preferably one including other specific domains as well.

A recent research synthesis by the authors (B. Gray-Little & A. R. Hafdahl, 2000) reported a self-esteem advantage for African American relative to White children and adolescents. In their partial replication, comment, and extension, J. M. Twenge and J. Crocker (2002) explained some differences between the 2 reviews by emphasizing their larger sample size. In this reply, the authors note important differences not only in sample size, but also in sampling strategy and statistical analyses. Different standards were used for judging the quality of data for calculating an effect size and for determining relevance of the samples to the hypotheses. Furthermore, the authors question certain of Twenge and Crocker's statistical procedures, particularly their regression and correlation analyses relating moderator variables to effect size.

Black cancer patients have the same outcome as white cancer patients provided they receive the same treatments, according to researchers who analyzed 54 studies covering 189,877 white patients and 32,004 black patients with 14 different cancers. This supports the idea that black cancer patients have higher mortality rates because they do not receive adequate treatment, not because there is some biological difference between the races., Context in recent years a theory that cancer biology is different in blacks and whites has gained prominence in reaction to epidemiologic observations that blacks have poorer survival than whites, even when diagnosed with cancer of similar severity. Yet, few studies have evaluated whether lower-quality treatment and shorter overall life expectancy due to a greater burden of other illnesses may explain the survival discrepancy. Objective To estimate the magnitude of overall and cancer-specific survival differences between blacks and whites who receive comparable treatment for similar-stage cancer. Data Sources We searched MEDLINE for English-language articles published from 1966 to January 2002 that reported on overall survival for black and white patients treated similarly for cancer. Study Selection The abstracts or titles for 891 citations were independently examined by 2 authors. The full text was retrieved if the abstract mentioned both black and white patients, made some comment regarding either similarity of treatment received or presented an analysis based on the treatment received, and commented on survival. Studies were included if they included data for at least 10 black and 10 white patients; specified the cohort ascertainment method and what measures were undertaken to minimize loss to follow-up; summarized survival of both blacks and whites using actuarial measures; presented outcomes within stage, adjusted for stage, or based on cohorts with balanced stage distributions; and specified that blacks and whites in the study received similar treatment. We identified 89 unique cohorts in 54 articles that met our inclusion criteria. Data Extraction Overall survival rates and hazard ratios (HRs) for death for blacks relative to whites were calculated. These were subsequently adjusted for rates of death due to causes other than the cancer under study to determine cancer-specific survival and cancer-specific HRs. Data Synthesis Results represent 189877 white and 32004 black patients with 14 different cancers. Compared with whites, blacks had an overall excess risk of death (HR, 1.16; 95% confidence interval [Cl], 1.12-1.20). After correction for deaths due to other causes, the cancer-specific HR was 1.07 (95% Cl, 1.02-1.13). Of the 14 cancers, blacks were at a significantly higher risk of cancer-specific death only for cancer of the breast, uterus, or bladder. Conclusions Only modest cancer-specific survival differences are evident for blacks and whites treated comparably for similar-stage cancer. Therefore, differences in cancer biology between racial groups are unlikely to be responsible for a substantial portion of the survival discrepancy. Differences in treatment, stage at presentation, and mortality from other diseases should represent the primary targets of research and interventions designed to reduce disparities in cancer outcomes.

Much of the research on women's health has not deepened our understanding of health issues affecting Latinas. Yet integration of research on Latinas into the women's health agenda is important for at least 2 reasons. First, critical public health issues facing Latinas must be better understood if effective interventions designed to eliminate racial and ethnic disparities in health are to be developed and implemented. Second, studies on the health of Latinas represent unique opportunities to advance scientific understandings of underlying processes relevant to the health of other populations. Such research can further our knowledge of the processes underlying cultural adaptation and negotiation of changing sex roles and how these issues affect the health of women. Critical research and empirical approaches that help us to understand how race, ethnicity, sex, and class shape the health of Latinas will inform broader public health issues.

Little is known about the health of Asian American and Pacific Islander (AAPI) women, a rapidly growing population marked by diverse sociodemographic characteristics, health needs, and access to and use of health services. This commentary provides broad recommendations for research, program development, and policy development based on the first-ever White House Initiative report on AAPIs. These recommendations address the issues of data, access, civil rights, community capacity, and the need to recognize ethnic subgroups among the AAPI population. Reflecting on the events of the past year, the recommendations provide direction for public health to address the health and well-being of AAPI women.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was applied to 1,558 Caucasian and 229 African American psychiatric inpatients, and the results were examined for ethnic differences and test bias. Although some MMPI-2 scales exhibited bias in underpredicting psychopathology in the African American patients, in the majority of applications the differences were minor and clinically insignificant.

Background. The purpose of this analysis was to examine the association of sociodemographic variables and health-related conditions with 5-year declines in cognitive function among Mexican American elderly persons. Methods. The cognitive function of 1759 participants was assessed by using the Mini-Mental State Examination (MMSE) in 1993/1994 and again in 1998/1999. Cognitive decline was defined by two sets of criteria: (1) a drop to 17 or below on the MMSE at follow-up, and (2) a decline of at least three points, the mean change in MMSE scores among respondents who obtained scores at or above the 5th percentile distribution at baseline. Results. Cognitive decline was significantly associated with sociodemographic variables including age, education, marital status, and household composition. In addition, respondents with reported vision impairment, stroke, and diabetes were at increased risk for cognitive decline after controlling for multiple potential confounders. Conclusion. Although age and education have been reported as the more salient predictors of cognitive deterioration, other sociodemographic and several medical conditions including stroke and diabetes should be considered as part of cognitive aging studies among Mexican American elders.

The authors report preliminary findings supporting the utility of the self-concordance model (K. M. Sheldon & A. J. Elliot, 1999) as an alternative approach to studying depression among Vietnamese American (N = 121) and European American (N = 155) college students. The participants completed measures of personal goals, goal self-concordance, and depression. Compared with the European American participants, the Vietnamese American participants reported higher levels of depression and lower levels of goal self-concordance. According to mediational analyses, ethnicity no longer accounted for significant variance in depression after the authors statistically controlled for goal self-concordance. Key words: depression, European American college students, goal self-concordance, mediation, Vietnamese American college students, ********** A GROWING BODY OF EVIDENCE suggests that Vietnamese immigrants experience multiple problems in adapting to life in the United States, including downward occupational mobility, intergenerational conflict, and increased rates [...]

Objective: To identify sociodemographic differences in the incidence of the subtypes of first ever stroke in a multiethnic population. Methods: A prospective community stroke register (1995-8) was developed using multiple [...]

First-degree relatives of African-Americans with Alzheimer's disease have a higher risk of developing the disease than first-degree relative of whites but the reasons for this are not clear. Female sex and the presence of the apolipoprotein E epsilon 4 gene also increased the risk in both whites and African-Americans., Context Evidence exists that the incidence of Alzheimer disease (AD), as well as risk attributable to specific genetic factors such as apolipoprotein E(APOE) genotype, may vary considerably among ethnic groups. Family studies of probands with AD offer an opportunity to evaluate lifetime risk of dementia among relatives of these probands. Objective To compare lifetime dementia risk estimates among relatives of white and African American probands with probable or definite AD. Design and Setting Risk analysis using data collected by questionnaire and supplemental records between May 1991 and March 2001 at 17 medical centers contributing to the Multi-Institutional Research in Alzheimer's Genetic Epidemiology Study. Participants A total of 17639 first-degree biological relatives and 2474 spouses of 2339 white AD probands, and 2281 first-degree biological relatives and 257 spouses of 255 African American AD probands. Main Outcome Measures Cumulative risk of dementia by age 85 years, stratified by ethnicity and sex of relatives and by APOE genotype of probands. Results Cumulative risk of dementia in first-degree biological relatives of African American AD probands by age 85 years was 43.7% (SE, 3.1%), and the corresponding risk in first-degree biological relatives of white AD probands was 26.9% (SE, 0.8%), yielding a relative risk (RR) of 1.6(95% confidence interval [Cl], 1.4-1.9; P Conclusion First-degree relatives of African Americans with AD have a higher cumulative risk of dementia than do those of whites with AD. However, in this study, the additional risk of dementia conferred by being a first-degree relative, by being female, or by the probability of having an APOE [epsilon]4 allele appeared similar in African American and white families. These data provide estimates of dementia risk that can be used to offer counseling to family members of patients with AD.

This article investigates the relationship between ethnicity, racism, and health in London. An analysis of cultural lifestyles, social structure, self-presentation is presented.

Racial inequity in the provision of healthcare is widely recognized. In this paper, I assess the role of social distance from healthcare providers in accounting for whites' higher rating of healthcare providers. Using data from the Detroit Area Study, I test whether having higher socioeconomic status, like most healthcare providers, and racial concordance with healthcare provider account for the gap in satisfaction between whites and African Americans. I find that socioeconomic status and racial concordance variables account for a portion of whites' higher rating of the respect shown by their healthcare provider. Racial differences in evaluation of time spent with healthcare provider are accounted for by socioeconomic status, but not racial concordance. As researchers explore the causes of and remedies for the racial disparity in use and evaluation of healthcare, the subtle and indirect effects of race on the patient-healthcare provider relationship must be considered.

This study investigated internalizing and externalizing symptoms as potential mediators of the relationship between perceived discrimination and early substance abuse among 195 American Indian 5 through 8 graders from three reservations that share a common culture (e.g., language, spiritual beliefs, and traditional practices) in the upper Midwest. The findings indicated that, although perceived discrimination contributed significantly to internalizing symptoms among the adolescents, internalizing symptoms were unrelated to early substance abuse. Rather, the effects of perceived discrimination on early substance abuse were mediated by adolescent anger and delinquent behaviors. The results are discussed in terms of the consequences of perceived discrimination on the development of American Indian early adolescents.

It is generally recognized that the health of populations is determined primarily by the structure and organization of a society, including the level of scientific knowledge and technological capacity as […]

This article discusses the relationship between race discrimination, high blood pressure, and cardiovascular health.

This article tests the claim that public water companies provided black communities with better service than did private water companies. It draws from three sources: typhoid fever rates in 1911 and 1921, waterborne disease rates in fourteen North Carolina towns between 1889 and 1908, and investment patterns in cities with public and private water companies. A study of New Orleans, which municipalized its water system in 1908, complements the evidence that public ownership reduced white disease rates only slightly, but reduced black disease rates sharply. These surprising results have implications for contemporary policy debates and for understanding American history.

Black heart attack patients who are treated by a black doctor are no more likely to have cardiac catheterization then black patients treated by a white doctor. Black heart attack patients as a group are less likely to have cardiac catheterization than whites, but a study of 35,676 white patients and 4,039 black patients found this was not caused by the race of the doctor.

Both black and white patients with heart failure appear to benefit from the beta blocker carvedilol, according to a study of 217 black and 877 white patients. Black patients with heart failure generally have a worse outcome than whites and may not respond to medications in the same way as whites.

Black patients with heart failure may not respond to treatment with ACE inhibitors. This was the conclusion of a study of 1,196 white patients and 800 black patients with heart failure who all took the ACE inhibitor enalapril.

Urban Aboriginal people could be expected to achieve positive health outcomes owing to their close proximity to mainstream health care services. The available data indicate that this is not the case, although people generally self-report as being in 'good to excellent' health. Research indicates that Aboriginal people may not be benefiting from mainstream services owing to the emphasis placed on biomedical models of health that conflict with more culturally-based, ethnomedical models. This paper looks at achieving an interface between the two models as a means of pursuing more positive health outcomes in urban settings.

Women and ethnic minorities may have different responses to the AIDS virus, and doctors should take this into account when treating them. In a study of 1,256 female and 1,603 male HIV patients, women had more rapid decreases in CD4+ T cell counts than men and non-whites had slower decreases than whites.

This paper explores how social class and race affect the public health policy-making process in an urban area. Ethnographic methods were used to collect and analyze information about HIV/AIDS and tuberculosis policy-making by the Washington, DC Commission of Public Health. Kingdon's conceptual model of policy making was used to analyze and understand the process. The problems of HIV/AIDS and tuberculosis in the district have important social class dimensions that were not always made explicit, but were instead defined in terms of 'race' and 'place'. Social class considerations and racial politics shaped what policies were developed or not developed and implemented successfully or failed. This study, which has national and international implications, concludes that there is a need to improve our understanding of the complex social dimensions of public health problems; there needs to be more consideration of the politics of strategy formulation and how issues of social class and race affect this process; and public health needs to strengthen its constituency in order to build support for the successful development and implementation of policy. Keywords: Social class; Race; Urban health; Health policy; HIV/AIDS; Tuberculosis

A study, using the Symptoms Check List 90R, of the association between the psychiatric symptoms and the race, sex, and age factors in opium addicts undergoing detoxication revealed considerable influence due to race differences. The finding emphasizes the importance for treatment planning. Afro American substance abusers experienced substantially lower psychiatric symptoms on a majority of the scales than did their white counterparts.

Black children and white, Hispanic, and Asian children with cancer who have equal access to contemporary therapy appear to have similar survival rates. Researchers compared the survival rates in 798 black children with various forms of cancer with the rates in 4,507 white, Hispanic, and Asian children with various cancers. The patients were treated between January, 1962 and June, 1992 regardless of their families' ability to pay. Among the children who received care before the advent of major treatment advances, the overall 10-year cancer survival rate was 37% in black children and 50% in the other children. Among the children who were treated after the advent of major therapeutic advances, the 10-year survival rate was 67% in blacks and 66% in the others. The improved treatment outcome observed in black children is largely due to a higher survival rate in those with acute lymphoblastic leukemia., Objective.--To determine whether there is a racial difference in prognosis among childhood cancers. Design.--An overall (30-year) survival analysis by race was followed by separate studies for "early" and "recent" treatment eras, defined by time points at which significantly improved outcome was demonstrated for specific tumor types. Stratified analyses were performed to adjust for recognized prognostic features. Setting.--Pediatric oncology research and treatment center. Patients.--The study included 798 black and 4507 white children with newly diagnosed malignancies treated from January 1962 through June 1992. These patients were accepted for treatment regardless of their financial status and were enrolled on disease-specific protocols. Results.--Across the 30-year study period, black children had a significantly poorer rate of survival than white children (P

This article discusses the relationship between race, education, health status, and employment. Topics include work limitation, disability status, and functional ability.

Many studies demonstrating an association between race and the use of medical services have used hospital discharge abstract data. The quality of the measures of race in such data sources has heretofore been unexplored Hospital discharge abstract data from New York State were used to identify 767 cardiac patients who had been admitted to a hospital twice. Racial classifications during the two admissions were concordant 93.7% of the time. Kappa was .89 for Blacks, .72 for Whites, and .43 for all other racial groups. Evidence suggests that the misclassification of race in hospital discharge abstract data is nondifferential; racial discrepancies in access to medical services are thus probably even greater than those previously reported. (Am J Public Health. 1994;84: 1018-1021), Information on race is often drawn from hospital discharge data, but racial classification for those who are neither black nor white may have a high degree of unreliability. Race is often assigned by hospital clerks upon admission, and in emergency cases or because of sensitivity issues, the classification is often made by observation rather than questioning. Researchers analyzed data from the medical records of 2487 people who had a first hospital admission for heart attack and were readmitted to a hospital within six months. Racial classifications were compared for the 767 people admitted to a different hospital versus those readmitted to the same hospital. Agreement between the two separate classifications was highest for blacks, followed by whites. There was substantial disagreement between the two classifications for people of other races, including Asian and American Indian. Misclassification can skew results of studies that compare medical care based on race.

Black and white American men have similar death rates from coronary heart disease is the same for black and white Americans. A 30-year study of 2,181 people conducted in the southeastern United States surveyed blood pressure, blood cholesterol, level of education, diabetes status, and whether or not participants were smokers. Causes of death were coded according to the International Classification of Diseases manual. No women, white or black, were recorded as dying from heart disease between the ages of 35 and 44. When age was taken into account and all causes of death were evaluated, black women had a higher mortality rate than white women, but black men did not have a higher rate than white men. Variables associated with death from causes other than coronary heart disease were high cholesterol levels, high systolic blood pressure, diabetes and smoking. These variables were significant for all groups.

Objectives. This study sought to examine racial differences in the use of medical procedures and diagnostic tests by elderly Americans. Methods. We used 1986 physician claims data for a 5% national sample of Medicare enrollees aged 65 years and older to study 32 procedures and tests. For each service, we calculated the age-and sex-adjusted rate of use by race and the corresponding White-Black relative risk. Results. Whites were more likely than Blacks to receive 23 services, and for many of these services, the differences in use were substantial. In contrast, Blacks were more likely than Whites to receive seven services. White had a particular advantage in access to higher-technology or newer services. Racial differences in use persisted among elders who had Medicaid in addition to Medicare coverage and increased among rural elders. Conclusions. There are pervasive racial differences in the use of medical services by elderly Americans that cannot be explained by differences in the prevalence of specific clinical conditions. Financial barriers to care do not fully account for these findings. Race may exacerbate the impact of other barriers to access. (Am J Public Health. 1993;83:948-954), Almost all elderly Americans get health insurance through Medicare, and despite some gaps in coverage, it has expanded access to formerly underserved populations. To examine racial differences in the use of medical procedures and diagnostic tests by the elderly, data from 1986 physician claims were used for a 5% sample of Medicare enrollees 65 years of age and older to study 32 procedures and tests. Whites were found to be much more likely than Blacks to receive 23 services, and Blacks were more likely than Whites to receive seven. Whites had better access to high-tech or newer services. Even among blacks who had Medicaid as well as Medicare, the racial difference persisted and was most marked among elderly rural blacks. Although differences in the prevalence of specific clinical conditions alone cannot explain the racial differences in the use of medical services by the elderly, it may be that race exacerbates the effect of other barriers to access.