Discrimination and the Health of Asian Americans Gilbert C. Gee, Ph.D. University of Michigan Health...
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Discrimination and the Health of Asian Americans
Gilbert C. Gee, Ph.D.
University of Michigan
Health Behavior & Health Education
June 25, 2007
13th Annual Summer Public Health Research Videoconference on Minority Health
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Explanations for Health Disparities
Genetics
Culture
Health care
Socioeconomic position
Discrimination
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Growing interest
U.S. Surgeon GeneralMental Health, Culture, Race & Ethnicity, 2001
World Health OrganizationMental Health: New Understanding, New Hope, 2001
Institute of MedicineUnequal Treatment, 2003Eliminating Health Disparities, 2004
National Academies of ScienceMeasuring Racial Discrimination, 2004
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Potential pathways between discrimination & health
Socioeconomic & other opportunities
Hazardous exposures
Historical trauma, soul wound
Hate crimes
Helpseeking & health services
Chronic & acute stress
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Model Minority
Asian Invasion
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2002 GSS: (n=2685)
How warm do you feel towards (1=warm...9=very cool)?
Asian Americans 3.7
Hispanics 3.6
African Americans 3.4
Caucasians 2.9
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2004 GSS: Which group do you have the least in common with? (n=45,112)
0 10 20 30 40
Whites
Blacks
Jews
Hispanics
Asians
Equal with all
None
%
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2004 GSS: Which group do you feel the most in common with? (n=45,112)
0 5 10 15 20 25
White
Blacks
Jews
Hispanics
Asians
Equal with all
None
%
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MSNBC, 1998: “American Beats Out Kwan”
Seattle Times, 2002:“American outshines Kwan, Slutskaya in skating surprise.”
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“Asian and Pacific Islander homebuyers experience consistent adverse treatment 20.4% of the time, with systematic discrimination occurring in housing availability, inspections, financing assistance, and agent encouragement. This level of discrimination is comparable to the level experienced by African American homebuyers…”
Turner et al., 2003. Discrimination in Metropolitan Housing Markets: Phase 2. Urban Institute.
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National Latino & Asian American Study (NLAAS)
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National Latino & Asian American Study (NLAAS)
Household survey, 2002-2003
Languages:
Cantonese, English, Mandarin, Spanish, Tagalog, Vietnamese
Response rate: 69% & 74%
n=2095
Weighted
PI: David Takeuchi
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Select sample characteristics
Foreign born 77%
Female 52%
Married 65%
Age 41
Per capita income $40K
West coast 68%
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Research Questions
Is self-reported discrimination associated with increased:
Chronic conditions
Mental disorders
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Everyday Discrimination scale
Developed from qualitative research
Theoretical focus with chronic stressors
9 items total1. Less courtesy
2. Poorer service in restaurants
3. Called names, insulted
Cronbach’s alpha = 0.91
Williams, et al., 1997. Racial differences in physical and mental health. Socioeconomic status, stress and discrimination. J Health Psychol. 2: 335-351.
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Chronic Health Conditions
World mental health composite international diagnostic interview (WHM-CIDI)
Intended for cross-cultural epidemiologic studies internationally
World Health Organization. Disability Assessment Schedule II (WHO-DAS II). 1998. Geneva, World Health Organization.
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Health Conditions
CardiovascularHeart attackStrokeHeart diseaseHigh blood pressure
PainChronic back/neck problemsHeadachesOther chronic pain
RespiratoryHay feverAsthmaTuberculosisOther chronic lung diseases
OtherDiabetesHIV/AIDSCancerEpilepsy/Seizures
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Measures
OutcomesChronic conditions
Mental health disorders
Discrimination
Reporting factorsSocial desirability (Crowne & Marlowe, 1960)
Other stressorsPovertyFamily cohesionAcculturative stress
SociodemographicsAgeGenderSESNativity, language, generation
RegionMarital status
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Discrimination and Chronic Health Conditions, Negative Binomial Regression
Bivariate Model 1 Model 2
b b b
Discrimination 0.13** 0.25***0.25***
Social Desirability 0.02 ----- 0.00
Models 1 & 2 control for age, same household, gender, poverty, education, ethnicity, employment, marital status, region, nativity, family cohesion
n=2095 Gee, et al., in press. Am J Public Health
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Discrimination & Individual Outcomes (Odds Ratios)
Cardio. Respirat. Pain Other
Discrimination 1.69 ** 1.37 *** 1.71 *** 0.89
Social Desirability 1.02 1.00 0.98 0.98
Adjusted for other covariatesn=2095
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12-Month Mental Health Disorders
DSM-IV Criteria
World Health Organization Composite International Diagnostic Interview (WHM-CIDI)
DepressiveMajor depressive disorderDysthymia
AnxietyPanic disorderAgoraphobia w/o panicSocial phobiaGADPTSD
Substance Use
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Discrimination & 12 Month DSM-IV Disorders (bivariate)
Discrimination Any disorder Depressive Anxiety
Q1 Least 3.9% 1.3 3.2
Q2 6.4 1.6 4.8
Q3 8.3 5.0 4.3
Q4 Most 18.1 10.9 10.8
Gee GC, et al. 2007. The Association between Self-Reported Discrimination and 12-month DSM-IV Mental Disorders among Asian Americans Nationwide. Soc Sci & Med 64(10):1984-1996.
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Adjusted for other covariates.
Figure 2. Predicted Probabilities of 12-month DSM IV Disorders, by Self-Reported Discrimination (Adjusted)*
National Latino & Asian American Study (n=2,095)
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
Any DSMDisorder
Any DepressiveDisorder
Any AnxietyDisorder
Pre
dic
ted
Pro
ba
bili
ty o
f D
iso
rde
r
Discrimination
25th percentile
50th percentile
75th percentile
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12 Month DSM-IV Disorder Health Any Depressive Anxiety
Conditions
OR OR OR beta
Acculturative stress 1.09 1.18 1.02 0.07**
Discrimination 1.98** 2.17** 1.88** 0.27***
Adjusted for other covariates
DSM-IV disorders analyses use logit models Health conditions analysis uses negative binomial models
Immigrant analysis (n=1593)
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OvertInter-
personal
Discrimination Pyramid
Covert
Interpersonal
Structural
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Gee, 2002. A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. Am J Public Health, 92: 615-623
Multiple Levels of Discrimination: Segregation & Redlining
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Resistance
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“I was in a car accident … needed prescriptions filled …. I dropped over to the city welfare and this woman treated me like I was scamming something from her. And I’m also on depression medication and I said, “Well, look, forget about the painkillers if this is how you’re going to be. Just give me my depression medication. Yeah, it would be great to have it, because I’m in pain – that’s why it was prescribed to me. But if you’re going to make a big ordeal about it, then see ya’.”
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Resources & Buffers
Social activism
Social support
Active avoidance
Ethnic identity
Ethnic enclaves
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Summary
Racial discrimination is associated with12-Month DSM-IV mental disorders
Physical health conditions
Robust to social desirability, other stressors, and demographics
Moderated by resources
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Further Research
Additional studiesJapanese Brazilians
Workplace
Multilevel
CBPR Detroit
Methodological developmentObjective measures
CHIS
Age discrimination
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Acknowledgements
NIMH (U01 MH62209, U01MH62207); PI David Takeuchi & Margarita Alegria
University of Michigan Rackham Faculty Fellowship & Grant
Juan Chen, Michael Spencer, Tiffany Yip & other members of the NLAAS team
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Thank You
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