Annie Ro

Racial Discrimination and Health Among Asian Americans: Evidence, Assessment, and Directions for Future Research

Research shows that racial discrimination is related to illness among diverse racial and ethnic populations. Studies of racial discrimination and health among Asian Americans, however, remain underdeveloped. In this paper, the authors review evidence on racial discrimination and health among Asian Americans, identify gaps in the literature, and provide suggestions for future research. They identified 62 empirical articles assessing the relation between discrimination and health among Asian Americans. The majority of articles focused on mental health problems, followed by physical and behavioral problems. Most studies find that discrimination was associated with poorer health, although the most consistent findings were for mental health problems. This review suggests that future studies should continue to investigate the following: 1) the measurement of discrimination among Asian Americans, whose experiences may be qualitatively different from those of other racial minority groups; 2) the heterogeneity among Asian Americans, including those factors that are particularly salient in this population, such as ethnic ancestry and immigration history; and 3) the health implications of discrimination at multiple ecologic levels, ranging from the individual level to the structural level.

Disentangling the Effects of Racial and Weight Discrimination on Body Mass Index and Obesity Among Asian Americans

OBJECTIVES We examined whether racial discrimination is associated with increased body mass index (BMI) and obesity among Asian Americans. Further, we explored whether this association strengthens with increasing time in the United States. METHODS We analyzed data from the 2002 to 2003 National Latino and Asian American Study (n=1956). Regression models tested whether reports of racial discrimination were associated with BMI and obesity, after accounting for weight discrimination, age, gender, marital status, ethnicity, generation, employment, health status, and social desirability bias (the tendency to seek approval by providing the most socially desirable response to a question). RESULTS We found that (1) racial discrimination was associated with increased BMI and obesity after we controlled for weight discrimination, social desirability bias, and other factors and (2) the association between racial discrimination and BMI strengthened with increasing time in the United States. CONCLUSIONS Racial discrimination may be an important factor related to weight gain among ethnic minorities.

Educational Attainment in the Context of Social Inequality New Directions for Research on Education and Health

A large literature documents a strong and consistent educational gradient in health: more-educated persons enjoy lower rates of morbidity and mortality. This literature has generally focused on the amount of schooling one completes but has yet to comprehensively examine other facets of education, such as educational quality or school segregation. More importantly, the literature has generally conceptualized education at the level of individual persons and has yet to fully study the structural dimensions of education and the production of educational inequities. The goal of this article is to identify several areas of educational inequity beyond personal educational attainment. These include (a) population differences in the strength of the educational gradient in health, (b) educational quality, (c) school segregation, and (d) the role of place of education among immigrants. We also discuss some emerging issues, such as student debt and pathways to education. Accordingly, there is much work to be done to further our knowledge regarding the relationship between education and health.

Social Status Correlates of Reporting Gender Discrimination and Racial Discrimination Among Racially Diverse Women

The growing body of research on discrimination and health indicates a deleterious effect of discrimination on various health outcomes. However, less is known about the sociodemographic correlates of reporting racial discrimination and gender discrimination among racially diverse women. We examined the associations of social status characteristics with lifetime experiences of racial discrimination and gender discrimination using a racially-diverse sample of 754 women attending family planning clinics in North California (11.4% African American, 16.8% Latina, 10.1% Asian and 61.7% Caucasian). A multivariate analysis revealed that race, financial difficulty and marital status were significantly correlated with higher reports of racial discrimination, while race, education, financial difficulty and nativity were significantly correlated with gender discrimination scores. Our findings suggest that the social patterning of perceiving racial discrimination is somewhat different from that of gender discrimination. This has implications in the realm of discrimination research and applied interventions, as different forms of discrimination may have unique covariates that should be accounted for in research analysis or program design.

The longer you stay, the worse your health? A critical review of the negative acculturation theory among Asian immigrants.

Researchers have become increasingly interested in the health patterns of immigrants with longer residence in the United States, as this reveals the health consequences of integration processes. The negative acculturation effect has been the dominant interpretation of duration patterns, despite empirical and theoretical uncertainties about this assumption. This theory assumes that immigrant health declines with longer residence in the United States because of poorer health behaviors and health risks that reflect Americanized lifestyles. This paper reviews the empirical support for the negative acculturation theory among Asian immigrants to determine if and when it is an appropriate interpretation for duration patterns. I conclude that empirical inconsistencies and methodological issues limit the negative acculturation theory as the primary interpretation for duration patterns. First, there is no consistent evidence that health behaviors decline with time. There is also substantial group heterogeneity in duration patterns as well as heterogeneity across health outcomes. The literature has not adequately addressed methodological shortcomings, such as confounding by cohort effects or non-linear duration patterns. Length of residence in the United States is still an important aspect of Asian immigrant health, but the mechanisms of this relationship are still understudied. I propose alternative frameworks between duration and health that consider environmental influences and end with future research directions to explore research gaps.

Effects of gender discrimination and reported stress on drug use among racially/ethnically diverse women in Northern California.

PURPOSE Gender discrimination has been associated with worse health outcomes for U.S. women. Using the stress and coping process framework, we examined whether lifetime gender discrimination was associated with maladaptive coping behaviors, namely, lifetime and recent hard drug use. We also considered whether reported stress from gender discrimination mediated this relationship and whether this process differed across racial/ethnic groups. METHODS We used data from a racially/ethnically diverse convenience sample of 754 women attending family planning clinics in Northern California (11% African American, 17% Latina, 10% Asian, and 62% Caucasian). To test our hypotheses, we conducted logistic regression models, controlling for sociodemographic characteristics. MAIN FINDINGS Gender discrimination was positively associated with both lifetime and recent hard drug use. We did not find support for the mediation hypothesis, because stress was not associated with either lifetime or recent hard drug use. There was evidence of some race moderation for the Latina sample. Among these respondents, gender discrimination was associated with higher odds of lifetime drug use, whereas stress was associated with lower odds. CONCLUSION These results suggest that experiences of gender discrimination may still activate negative coping strategies involving drug use, regardless of the stress they cause. For Latina respondents, more research is needed to better understand the stress and coping process related to gender discrimination.

Residential Mobility Across Local Areas in the United States and the Geographic Distribution of the Healthy Population

Determining whether population dynamics provide competing explanations to place effects for observed geographic patterns of population health is critical for understanding health inequality. We focus on the working-age population—the period of adulthood when health disparities are greatest—and analyze detailed data on residential mobility collected for the first time in the 2000 U.S. census. Residential mobility over a five-year period is frequent and selective, with some variation by race and gender. Even so, we found little evidence that mobility biases cross-sectional snapshots of local population health. Areas undergoing large or rapid population growth or decline may be exceptions. Overall, place of residence is an important health indicator; yet, the frequency of residential mobility raises questions of interpretation from etiological or policy perspectives, complicating simple understandings that residential exposures alone explain the association between place and health. Psychosocial stressors related to contingencies of social identity associated with being black, urban, or poor in the United States may also have adverse health impacts that track with structural location even with movement across residential areas.

Duration of U.S. stay and body mass index among Latino and Asian immigrants: A test of theoretical pathways

Studies find that longer-term immigrants have higher body mass index (BMI) than their more recently arrived counterparts. Most interpretations of these health patterns by duration of U.S. residence rely on theories of immigrant integration; they posit that with increasing time in the United States, immigrants incorporate economically, socially, and culturally into aspects of U.S. society, and that these changes impact health. Few studies empirically examine whether these aspects of integration are indeed mediators of the association between duration of U.S. stay and BMI, and if their patterns differ across immigrant subgroups. This study examines data from the National Latino and Asian American Survey, using path analytic methods to simultaneously test six hypothesized mediators between duration and BMI: household income, English language ability, ethnic identity, family cohesion, acculturative stress and discrimination for both Latino and Asian immigrants, stratified by gender. We find little evidence for an association between duration and BMI for either Latino or Asian men. For women, duration and BMI have a significant and positive relationship, although the pathways differ between the two ethnic groups. For Latina women, household income and acculturative stress are significant indirect pathways, although they work in opposing directions. For Asian women, English proficiency and discrimination are significant indirect pathways. Our findings reveal complex pathways between duration and BMI that vary by ethnicity and gender and highlight limitations in the negative acculturation theory, which suggests that exposure to the United States should have a net negative impact on health. In contrast, our findings suggest that not all groups show declining health with longer duration, as measured by BMI, and that integration processes do not always translate into health differences in the expected directions. Future research on duration patterns may need to consider alternative explanations beyond incorporation-based processes, such as cross-national health theories or age, period, cohort effects.

Dimensions of racism and their impact on partner selection among men of colour who have sex with men: understanding pathways to sexual risk

While many studies have established the relationship between experiences of racism and sexual risk among men of colour who have sex with men, the pathways by which this occurs are underdeveloped. To address this gap, we must better investigate the lived realities of racism in the gay community. In this study, we had the unique opportunity to examine experiences of racism among African American, Asian/Pacific Islander and Latino men who have sex with men living in Los Angeles through focus groups and individual in-depth interviews. We found three themes of racism: exclusion from West Hollywood and the mainstream gay community, sexual rejection based on race/ethnicity and sexual stereotypes. There were differences across the three racial groups in the experiences of each theme, however. We then considered how racism impacted partner selection and found that race played a salient role in determining power differentials within mixed-race partnerships. Finally, we discussed several future areas for research that can better establish pathways between racism and sexual risk.

Changes in health selection of obesity among Mexican immigrants: a binational examination.

Health selection is often measured by comparing the health of more recent immigrants to the native born of their new host country. However, this comparison fails to take into account two important factors: (1) that changes in the health profile of sending countries may impact the health of immigrants over time, and (2) that the best comparison group for health selection would be people who remain in the country of origin. Obesity represents an important health outcome that may be best understood by taking into account these two factors. Using nationally-representative datasets from Mexico and the US, we examined differences in obesity-related health selection, by gender, in 2000 and 2012. We calculated prevalence ratios from log-binomial models to compare the risk of obesity among recent immigrants to the US to Mexican nationals with varying likelihood of migration, in order to determine changes in health selection over time. Among men in 2000, we found little difference in obesity status between recent immigrants to the US and Mexican non-migrants. However, in 2012, Mexican men who were the least likely to migrate had higher obesity prevalence than recent immigrants, which may reflect emerging health selection. The trends for women, however, indicated differences in obesity status between recent Mexican immigrants and non-migrants at both time points. In both 2000 and 2012, Mexican national women had significantly higher obesity prevalence than recent immigrant women, with the biggest difference between recent immigrants and Mexican women who were least likely to migrate. There was also indication that selection increased with time for women, as the differences between Mexican nationals and recent immigrants to the US grew from 2000 to 2012. Our study is among the first to use a binational dataset to examine the impact of health selectivity, over time, on obesity.