Jacques Yzet Nazroo

Cumulative Effect of Racial Discrimination on the Mental Health of Ethnic Minorities in the United Kingdom

OBJECTIVES To examine the longitudinal association between cumulative exposure to racial discrimination and changes in the mental health of ethnic minority people. METHODS We used data from 4 waves (2009-2013) of the UK Household Longitudinal Study, a longitudinal household panel survey of approximately 40 000 households, including an ethnic minority boost sample of approximately 4000 households. RESULTS Ethnic minority people who reported exposure to racial discrimination at 1 time point had 12-Item Short Form Health Survey (SF-12) mental component scores 1.93 (95% confidence interval [CI] = -3.31, -0.56) points lower than did those who reported no exposure to racial discrimination, whereas those who had been exposed to 2 or more domains of racial discrimination, at 2 different time points, had SF-12 mental component scores 8.26 (95% CI = -13.33, -3.18) points lower than did those who reported no experiences of racial discrimination. Controlling for racial discrimination and other socioeconomic factors reduced ethnic inequalities in mental health. CONCLUSIONS Cumulative exposure to racial discrimination has incremental negative long-term effects on the mental health of ethnic minority people in the United Kingdom. Studies that examine exposure to racial discrimination at 1 point in time may underestimate the contribution of racism to poor health.

Social capital, ethnic density and mental health among ethnic minority people in England: a mixed-methods study

Objectives Ethnic minority people have been suggested to be healthier when living in areas with a higher concentration of people from their own ethnic group, a so-called ethnic density effect. Explanations behind the ethnic density effect propose that positive health outcomes are partially attributed to the protective and buffering effects of increased social capital on health. In fact, a parallel literature has reported increased levels of social capital in areas of greater ethnic residential diversity, but to date, no study in England has explored whether increased social capital mediates the relationship between protective effects attributed to the residential concentration of ethnic minority groups and health. Design We employ a mixed-methods approach to examine the association between ethnicity, social capital and mental health. We analyse geocoded data from the 2004 Health Survey for England to examine the association between (1) ethnic residential concentration and health; (2) ethnic residential concentration and social capital; (3) social capital and health; and (4) the mediating effect of social capital on the association between the residential concentration of ethnic groups and health. To further add to our understanding of the processes involved, data from a qualitative study of quality older ethnic minority people were be used to examine accounts of the significance of place of residence to quality of life. Results The association between ethnic density and social capital varies depending on the level of measurement of social capital and differed across ethnic minority groups. Social capital was not found to mediate the association between ethnic density and health. Structural differences in the characteristics of the neighbourhoods where different ethnic groups reside are reflected in the accounts of their daily experiences, and we observed different narratives of neighbourhood experiences between Indian and Caribbean respondents. The use of mixed methods provides an important contribution to the study of ethnic minority peoples experience of their neighbourhood, as this approach has allowed us to gain important insights that cannot be inferred from quantitative or qualitative data alone.

Life Course Pathways to Later Life Wellbeing: A Comparative Study of the Role of Socio-Economic Position in England and the U.S.

The influence of early life, accumulation and social mobility on wellbeing in later life in the U.S. and England is investigated. Using cross-sectional data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), we estimate multivariate regressions of hedonic and eudemonic measures of wellbeing on these life course mechanisms, controlling for age, gender, ethnic background, partnership status, health and wealth. On the level of the life course mechanisms, there is mixed evidence regarding the critical impact of early life, strong evidence for an association between accumulation and eudemonic wellbeing and a moderate negative effect of downward social mobility. While the relation between hedonic wellbeing and life course mechanisms is unclear or in a different direction than anticipated, eudemonic wellbeing is clearly related to accumulation and mobility in both countries and to early life in the U.S. On the societal level, the major observation is that the life course has a larger influence in the U.S. than in England.

Life-history data.

Life-history data are quantitative, retrospective and autobiographical data collected through event-history calendars. By mimicking the structure of our memories, these instruments can gather reliable information on different dimensions of the lifecourse. Life-history data enable the duration, timing and ordering of events to be brought to the foreground of analysis. Extending the scope of lifecourse research, life-history data make it possible to examine the long-term effects of past policies with more precision and detail.

Longitudinal relationships between hearing aid use and cognitive function in older Americans

To test whether hearing aid use alters cognitive trajectories in older adults.

Socioemotional wellbeing of mixed race/ethnicity children in the UK and US: Patterns and mechanisms

Existing literature suggests that mixed race/ethnicity children are more likely to experience poor socioemotional wellbeing in both the US and the UK, although the evidence is stronger in the US. It is suggested that this inequality may be a consequence of struggles with identity formation, more limited connections with racial/ethnic/cultural heritage, and increased risk of exposure to racism. Using data from the UK Millennium Cohort Study (n = 13,734) and the US Early Childhood Longitudinal Study-Birth Cohort (n ~ 6250), we examine differences in the socioemotional wellbeing of mixed and non-mixed 5/6 year old children in the UK and US and explore heterogeneity in outcomes across different mixed groups in both locations. We estimate a series of linear regressions to examine the contribution of factors that may explain any observed differences, including socio-economic and cultural factors, and examine the extent to which these processes vary across the two nations. We find no evidence of greater risk for poor socioemotional wellbeing for mixed race/ethnicity children in both national contexts. We find that mixed race/ethnicity children experience socio-economic advantage compared to their non-mixed minority counterparts and that socio-economic advantage is protective for socioemotional wellbeing. Cultural factors do not contribute to differences in socioemotional wellbeing across mixed and non-mixed groups. Our evidence suggests then that at age 5/6 there is no evidence of poorer socioemotional wellbeing for mixed race/ethnicity children in either the UK or the US. The contrast between our findings and some previous literature, which reports that mixed race/ethnicity children have poorer socioemotional wellbeing, may reflect changes in the meaning of mixed identities across periods and/or the developmental stage of the children we studied.

Dementia across local districts in England 2014 to 2015

The number of older people needing dementia care is projected to rise rapidly, and local districts are now charged with responding to this need. But evidence on local area factors of dementia is scarce. We studied the odds of dementia prevalence and its individual risk factors enriched with area factors.

Ethnic differences in women’s use of mental health services: do social networks play a role? Findings from a national survey

ABSTRACT Objectives: The reasons for ethnic differences in women’s mental health service use in England remain unclear. The aims of this study were to ascertain: ethnic differences in women’s usage of mental health services, if social networks are independently associated with service use, and if the association between women’s social networks and service use varies between ethnic groups. Design: Logistic regression modelling of nationally representative data from the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) survey conducted in England. The analytic sample (2260 women, aged 16–74 years) was drawn from the representative subsample of 2340 women in EMPIRIC for whom data on mental health services, and social networks were available. Results: Pakistani and Bangladeshi women were less likely than White women to have used mental health services (Pakistani OR = 0.23, CI = 0.08–0.65, p = .005; Bangladeshi OR = 0.25, CI = 0.07–0.86, p = .027). Frequent contact with relatives reduced mental health service use (OR = 0.45, CI = 0.23–0.89, p = .023). An increase in perceived inadequate support in women’s close networks was associated with increased odds of using mental health services (OR = 1.91, CI = 1.11–3.27, p = .019). The influence of social networks on mental health service use did not differ between ethnic groups. Conclusions: The differential treatment of women from Pakistani and Bangladeshi ethnic groups in primary care settings could be a possible reason for the observed differences in mental health service use.

An econometric analysis of cognitive impairment and healthcare utilization in the ageing population

ABSTRACT The ageing population is a major concern for policy makers, with the ever-increasing strains placed on health budgets. One overlooked area of research is the impact that cognitive impairment (an early marker of potential dementia onset) has on the healthcare utilization of an ageing population. Based on the theoretical micro-economic foundations of healthcare demand, we study the relationship between cognitive functioning and impairment, measured by word recall and changes thereof, and healthcare utilization among over 50s in nine European countries. The contribution of this article is to produce estimates for cognitive functioning and impairment, as opposed to full dementia, in the context of healthcare utilization. We apply regression models to healthcare utilization data from Waves 1, 2 and 4 of the Survey of Health, Ageing and Retirement in Europe and find that recalling one additional word is associated with a reduction in visits to a medical doctor of 0.32, per year (p<0.01). Even after controlling for self-assessed health, this association is strong at just over 0.1 visits – this is the additional impact, over and above the average number of visits for similar individuals without cognitive impairment.

Visual and hearing impairments are associated with cognitive decline in older people

INTRODUCTION highly prevalagent hearing and vision sensory impairments among older people may contribute to the risk of cognitive decline and pathological impairments including dementia.This study aims to determine whether single and dual sensory impairment (hearing and/or vision) are independently associated with cognitive decline among older adults and to describe cognitive trajectories according to their impairment pattern. MATERIAL AND METHODS we used data from totals of 13,123, 11,417 and 21,265 respondents aged 50+ at baseline from the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE), respectively. We performed growth curve analysis to identify cognitive trajectories, and a joint model was used to deal with attrition problems in longitudinal ageing surveys. RESULTS respondents with a single sensory impairment had lower episodic memory score than those without sensory impairment in HRS (β = -0.15, P < 0.001), ELSA (β = -0.14, P < 0.001) and SHARE (β = -0.26, P < 0.001). The analysis further shows that older adults with dual sensory impairment in HRS (β = -0.25, P < 0.001), ELSA (β = -0.35, P < 0.001) and SHARE (β = -0.68, P < 0.001) remembered fewer words compared with those with no sensory impairment. The stronger associations between sensory impairment and lower episodic memory levels were found in the joint model which accounted for attrition. CONCLUSIONS hearing and/or vision impairments are a marker for the risk of cognitive decline that could inform preventative interventions to maximise cognitive health and longevity. Further studies are needed to investigate how sensory markers could inform strategies to improve cognitive ageing.