presentation
Transcript of presentation
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“More research (and action) is needed”
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“Hispanic paradox”
• Higher poverty, less formal education, less healthcare
• Better health; lower mortality rates
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“Hispanic paradox”
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Heartdisease
Stroke Cancer
Hispanic Male
Non-HispanicWhite MaleAfricanAmerican Male
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Hispanic paradox
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Heart disease Stroke Cancer
Hispanic Female
Non-Hispanic WhiteFemaleAfrican AmericanFemale
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“Hispanic paradox”
• “Healthy migrant” hypothesis
• Barrio effect?
• “Salmon bias”?
• Acculturation risk?
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Not the end of story
• Higher disability rates? • Higher diagnosed Type II diabetes over
age 20 and mortality (Mexican Americans)
• Higher obesity (Mexican Americans)• More stomach, liver, gallbladder and
cervical cancers• Worse asthma (Puerto Ricans)• Less asthma (Mexican Americans)
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Hispanic paradox
• Kyriakos S. Markides, University of Texas Medical Branch, Galveston
• Jeanne Ruiz, Ph.D., R.N., assistant professor at The University of Texas Health Science Center at San Antonio (UTHSCSA)
• Smith and Bradshaw, University of Texas School of Public Health
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Why are Latinos with diabetes twice as likely to die from it as
non-Hispanic whites?
• Genetics?• Culture?• Environment?• Less access to care?• Racism?
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Which Latinos?
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Which Latinos?
• Mexican, Puerto Rican, Venezuelan, Cuban?
• Immigrant or second-generation?
• Wealthy or poor?
• Urban or rural?
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Which Latinos?
• Who decides?
• Researchers don’t all agree
• Self-ID can change
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Whose genes?
• Studies to define “genetic ancestry”
• Body composition (NY Puerto Ricans)
• Asthma (SF Mexican-Americans, NY Puerto Ricans)
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Environment
• NIEHS environmental genome project
- environmental conditions, plus
- genetic susceptibility
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Psychosocial factors
• Work environment (job stress, shift work);
• personality and negative emotions (anger, hostility, anxiety, and depression);
• protective effects of social networks and support.
• Hope and curiosity
(Ichiro Kawachi on heart disease)
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Social determinants
• Income inequality
• Social cohesion and mutual trust
• Inequalities in political participation, civic engagement
• Residential segregation
(Kawachi, Harvard University)
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Racism
Unequal treatment
-- Studies on unconscious decision-making
Racialized living
-- Allostatic load (stress response)
-- Social rank
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“More research is needed”
• Countries of origin
• Regional differences (multi-center studies)
• Lengths of U.S. residence
• Research in countries of origin
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Ichiro KawachiThomas A. LaVeist
Brian Smedley, ed.
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Leading causes of death among Latinos (2003)
1) Diseases of heart 28,2982) Malignant neoplasms 24,0703) Unintentional injuries h 10,4184) Cerebrovascular diseases 6,6585) Diabetes mellitus 6,1796) Chronic liver disease and cirrhosis 3,3827) Homicide 3,3558) Chronic lower respiratory diseases 3,1749) Influenza and pneumonia 2,94810)Certain conditions originating in the perinatal
period 2,628
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Asthma
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Worst air pollution
SHORT-TERM PARTICULATES
(soot)• Los Angeles-Long
Beach-Riverside• Bakersfield• Fresno-Madera
OZONE (smog)• Bakersfield,CA • Los Angeles-Long
Beach-Riverside• Visalia-
Porterville,CA
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Community stories
• Community organizers
• City and county health officers
• Community food assessment (PolicyLink)
• Center on Alcohol Marketing and Youth
• Community Action to Fight Asthma
(regional project info)
http://www.calasthma.org/
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Asthma
• Who is being counted?
• Access to medications in school
• School air safety
• Air pollution regulations
• Corporate responsibility
• Land use laws
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AIDS/HIV
• 14 percent of the population; 20 percent of AIDS diagnoses
• 32 percent U.S. born; 18 percent Puerto Rican; 17 percent Mexican
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AIDS – issues
• Transmission patterns
• Education
• Access to care
• Community concern
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AIDS -resources
• Kaiser Family Foundation
• GLAAD (http://www.glaad.org/publications/resource_doc_detail.php?id=3101)
• Bienestar(http://www.bienestar.org)
• Proyecto Contra SIDA Por Vida
• San Francisco AIDS Foundation(http://www.sfaf.org/beta/2005_win/mortality.html)
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How to find stories
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Evaluating stories
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Consider the source
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Evaluating a study
• Who are the participants (subjects)
• Number of participants (sample size)
• Institution
• P value
• Standard deviation (SD)
• Mean, median
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Examples
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SPJ Rainbow Sourcebook
and Diversity Toolbox