Special Social Groups, Social Factors and Disparities in Health and Health Care: Volume 34

This chapter provides both an introduction to the volume and a brief review of literature on special social groups and social factors as linked to disparities in health and health care services.

This chapter takes the form of a literature review.

The chapter argues for the importance of greater examination of special social groups and other social factors in understanding disparities in health and health care services.

Reviews the issues of special social groups and other social factors and previews this volume.

This chapter explores military women’s fear of sexual assault, especially while deployed overseas, the strategies they use to manage those fears, and the health consequences of both their fears and their strategies for reducing them.

Data come from 25 in-depth, semi-structured qualitative interviews conducted in 2012 and 2013 with women veterans and military members. All participants were under age 45 and had deployed to Iraq or Afghanistan at some point.

Surprisingly, 44% reported neither concern about sexual assault nor any special strategies taken to prevent it. In contrast, another 44% reported both concern about sexual assault and special strategies taken to prevent it. Finally, 12% reported no special concerns about sexual assault due to the strategies they took to prevent it. For these latter two groups, rape-preventions strategies and the fears that led to them could contribute to lack of exercise, sleep difficulties, anxiety, depression, or post-traumatic stress disorder.

This research is based on a small and non-random sample which over-represents southwestern residents, whites, Army members, and commissioned officers, and under-represents African Americans, Navy members, noncommissioned officers, and enlisted personnel. As a result, it cannot be used to extrapolate to the population more generally. It also focuses solely on women’s experiences, due to their greater risk of assault, although men’s experiences with sexual trauma certainly deserve further study. Finally, the research relied on only one coder, which may have reduced reliability. However, it is less likely to have reduced validity compared to studies utilizing multiple coders, since such studies typically use coders who either share or have been trained to use the main authors’ intellectual perspectives.

Previous research has looked at the effect of sexual assault on female military members. This chapter extends that research by exploring how fear of rape can affect female military members even if they are not themselves assaulted, with a special focus on its health effects. In addition, previous research on fear of rape in the general population has focused on its social effects. This chapter suggests the need for further research on potential health effects of fear of rape in the general population.

This study aims to provide a better understanding of Native American women veterans’ experiences with Veteran Administration and Indian Health Services. Eighteen interviews were conducted with special attention to the quality and quantity of health and mental health care services veterans accessed, the barriers and local contextual factors in accessing and utilizing services, and potential solutions to service gaps for women veterans from two Montana reservations, the Northern Cheyenne Reservation and the Confederated Salish and Kootenai Tribes of the Flathead Reservation.

We examine the barriers and needs of Native American veterans in both reservations using qualitative methods. The research analyzed 18 interviews with women veterans from the Northern Cheyenne and Flathead reservations.

Native American women veterans identified a number of barriers to accessing care, some of which include lack of information regarding eligibility and the types of services available. Women often found the application process to be confusing and difficult. Other barriers included distance, cost of travel, and conflicts with their work schedule.

This exploratory case study served to clarify the challenges and obstacles Native American women veterans experience with accessing health and mental health services. This research revealed several patterns and themes in the experience of Native American women veterans in both reservation communities when attempting to access and seek care at Veterans Administration (VA) facilities and Indian Health Services (IHS). This research calls for policy changes and research to clarify how resources can be more efficiently and effectively distributed to rural veterans.

Little research has addressed the needs of Native American veterans. American Indians and Alaska Natives serve at a higher rate in the U.S. military than any other population. This research provides important information about Native American veterans who are often underrepresented in survey research, yet a rapidly growing segment of the United States military and veteran population.

Research on Asian Americans’ health behavior has often cited socioeconomic status, race, language, cultural beliefs, acculturation, etc. as barriers to seeking health care services. Less is known about Southeast Asians refugees’ help-seeking process. In this exploratory study, we examine the illness experiences of Southeast Asian refugees with a Type 2 diabetes diagnosis, and consider the factors that contribute to their understanding and management of diabetes.

We used Pescosolido’s network episode model to frame our understanding of the ways in which Southeast Asians maneuver through their social support networks, face barriers in accessing health care services, and manage their diabetes. We interviewed a convenience sample of 16 adults. All interviews were digitally recorded, transcribed, and coded. Analysis was guided by the grounded theory approach.

Our findings revealed that Southeast Asians’ definition, acceptance, and management of their diabetes was largely influenced by various factors including: trauma and PTSD from their refugee experience, challenges of acculturation, illness experience, mental health, and access and barriers to health care services. The network episode model provides a blueprint for understanding the social and cultural challenges that Southeast Asian refugees face with regards to their diabetes.

Research limitations include the small and convenience sample used for the study, which does not contribute to generalizability. However, our findings contribute to the limited but growing studies on Southeast Asian refugees in the United States, and emphasize the need for health care providers to consider the illness experience, health beliefs, and the social context of Southeast Asian refugees with diabetes. Although the adults in this study were not recent immigrants, their immigrant history and experiences influenced their understanding and management of their diabetes.

Few qualitative studies focus on the health of Southeast Asians in the United States (Hmong, Laotian, Cambodian, and Vietnamese). This study has potential value for clinicians, social workers, and community providers serving ethnic minority populations, specifically Southeast Asians. In this study, older immigrant adults faced generational challenges that impacted their chronic illness (Type 2 diabetes).

This systematic review will attempt to begin the fusion of Aboriginal health and Aboriginal education to show the need for strategic research and policy development that brings these two important fields together for the benefit of improving the lives of Aboriginal people regardless of residency or socioeconomic conditions.

A search of published and gray literature that examined Aboriginal health and Aboriginal education was conducted. Through computerized database (PubMed, PsycInfo, ERIC, Google Scholar, and Google) searches were performed in November 2014 to find abstracts, articles, gray literature, and reports pertaining to Aboriginal health and Aboriginal education in Canada.

Inadequate datasets impede the ability to look at Aboriginal health and education in Canada as there are no national datasets that adequately provide data to do more than cross-sectional analysis. By conducting research in a pan-Aboriginal manner negates that there is traditional worldviews that individuals, families, and communities embrace and embody in their daily lives. It is necessary for the Canadian government and society to work with Aboriginal people to change the fundamental ways in which the macro-level systems work together in order for true social change to occur which will lead to increased self-determination specifically in Aboriginal health and education.

The chapter reveals that Aboriginal health and education are key determinants to the health and well-being of Aboriginal people. Identity, self-determination, and Aboriginal worldviews need to be a part of research studies in order to have “two-eyed seeing” of the intertwined and interconnectedness of health and education.

To determine gendered patterns of preventive medical care (physical and dental/optical) use among pan-ethnic U.S. Asian and Latino adults.

Using National Latino and Asian American Study (2004) data, we apply Andersen’s (1995) Behavioral Model of Health Services Use to assess how preventive care use among Asian and Latino men and women varies as a function of predisposing, enabling, and need-based characteristics. We explore whether adjustment for these factors mediates gender disparities in both physical and dental/optical check-ups, and test whether certain factors operate differently among men versus women.

A higher proportion of women reported a routine care visit last year, especially among Latinos. Adjusting for predisposing, enabling, and need-based factors explained the gender difference in reporting a dental/optician check-up, but not a physical check-up, among both Asian and Latino adults.

Our findings illustrate how gender patterns in routine care use differ by race/ethnicity, and highlight the fundamental importance of enabling characteristics (especially health insurance and having a regular doctor) for shaping routine care use between men and women, both Asian and Latino. Limitations of this chapter are that the data are cross-sectional and were collected before the implementation of the Affordable Care Act, and measures are self-reported.

This chapter focuses on Asian and Latinos because they represent the fastest growing minority populations in the United States, yet few studies have evaluated gender differences in preventative health care use among these groups.

This study is to examine factors contributing to the variability in chronic obstructive pulmonary disorder (COPD) and asthma hospitalization rates when the influence of patient characteristics is being simultaneously considered by applying a risk adjustment method.

A longitudinal analysis of COPD and asthma hospitalization of rural Medicare beneficiaries in 427 rural health clinics (RHCs) was conducted utilizing administrative data and inpatient and outpatient claims from Region 4. The repeated measures of risk-adjusted COPD and asthma admission rate were analyzed by growth curve modeling. A generalized estimating equation (GEE) method was used to identify the relevance of selected predictors in accounting for the variability in risk-adjusted admission rates for COPD and asthma.

Both adjusted and unadjusted rates of COPD admission showed a slight decline from 2010 to 2013. The growth curve modeling showed the annual rates of change were gradually accentuated through time. GEE revealed that a moderate amount of variance (marginal R ² = 0.66) in the risk-adjusted hospital admission rates for COPD and asthma was accounted for by contextual, ecological, and organizational variables.

The contextual, ecological, and organizational factors are those associated with RHCs, not hospitals. We cannot infer how the variability in hospital practices in RHC service areas may have contributed to the disparities in admissions. Identification of RHCs with substantially higher rates than an average rate can portray the need for further enhancement of needed ambulatory or primary care services for the specific groups of RHCs. Because the risk-adjusted rates of hospitalization do not vary by classification of rural area, future research should address the variation in a specific COPD and asthma condition of RHC patients.

Risk-adjusted admission rates for COPD and asthma are influenced by the synergism of multiple contextual, ecological, and organizational factors instead of a single factor.

This chapter examines the associations between gender, social support, and health outcomes for individuals living with HIV disease. We include social integration and social isolation as structural measures of social support as well as perceived social support and social conflict as functional measures of social support. We include both mental health and physical health outcomes, which are too often studied in isolation of each other.

Data are from the Coping with HIV/AIDS in the Southeast (CHASE) study; this study reports on baseline data from 611 participants collected from 2001 to 2002. We first examined differences by gender and race, and then used blocked linear regression to determine the additive effects of the social support variables on both mental and physical health outcomes while controlling for potential confounders.

There were notable differences in the significance and strength of social support variables in health outcome models for men and women. Unlike men, social conflict was the strongest predictor of greater psychological distress and poorer physical health-related quality of life among women.

While the results from this study contribute to a greater understanding of gender differences in the relationships between social support and health outcomes, the data used for this study are limited to those living with HIV/AIDS in the Southeast.

Our findings suggest that social conflict may be more detrimental for the health of women than men.

This chapter examines how people weigh and discuss opportunities for collective action to improve community health. Drawing from research on civic and social movement engagement, it focuses specifically on how cultural logics of pragmatism, activism, and cynicism are invoked in such debates.

Qualitative data come from four focus group discussions of strategies for reducing tobacco use in Atlanta’s lesbian, gay, bisexual, and transgender (LGBT) communities. Participants included 36 self-identified community members.

Pragmatic logics were used most often in evaluating the tobacco control strategies, with activist logics second and cynicism a distant third. This echoes prior research, but our participants used these logics in unexpected ways: they combined pragmatism and activism, downplaying the former’s emphasis on individual self-interest and the latter’s emphasis on contentious confrontation. In addition, use of the logics varied by focus group and strategy, but not with individual speaker’s identities.

Though limited by a narrow demographic focus and small convenience sample, our study suggests that public support for community health initiatives will likely depend on how they are framed and on the interactional dynamics and shared identities of the groups they are presented to.

Logics of pragmatism, activism, and cynicism inform debate over community health initiatives, as with other forms of civic action. However, use of these logics is not uniform but varies with the groups and issues at hand. Our study participants’ mutual LGBT identification gave them a sense of shared community and a familiarity with the politicization of personal life that led them to combine pragmatist and activist logics in novel ways.

The primary aim of this chapter is to explore stigmatization, stress, and coping among adolescent mothers and to identify positive coping mechanisms that not only resist stigmatization but also generate positive affect.

Fifty-two pregnant and parenting adolescents in an urban county in the Midwestern United States were recruited to participate. A journaling tool was developed and used to allow participants to express their thoughts and concerns in a real-time, reflexive manner. Data were coded at different “nodes” or themes. Concepts, such as stigma, stress, strength, and empowerment were operationalized into key words and “themes” based on previous published literature. Key phrases were used to code the journaling data.

Adolescent mothers used positive reappraisal of life circumstances to create a positive self-image and resist the stress of stigma and parenting. Overcoming stereotypes and success in parenting were reappraised as “strength,” which allowed the young women to feel empowered in their caregiving role.

The chapter also contributes to the sociological literature on positive coping responses to stigma and stress. Indeed, very few studies have employed the sociological imagination of pregnant and parenting adolescents by describing not only their lives but also seeking their understanding and explaining their lives sociologically. This chapter also has direct implications for several health care providers, including nurses and social workers. For example, nurses and social workers are a vital part of the healthcare team for pregnant and parenting adolescents, and they often serve as the link between the adolescent, her family and significant others, and healthcare and social service agencies.

This chapter described the mechanisms that adolescent mothers use to cope with stress with a focus on how caregiving generates positive affect through the voices of these young mothers themselves. This chapter contributed to the sociological literature on stress and coping. In particular, our findings were also in line with the work of sociologist Antonovsky’s Sense of Coherence concept. SOC is a global measure that indicates the availability of, and willingness to use, adaptive coping resources as a key variable in maintaining health.

This chapter focuses on health information-seeking (HIS) which reflects people’s search of information about health issues via the use of mass media resources. Several empirical studies report that consumption of such resources is not randomly distributed across demographic groups and countries. We aim to explain differences in HIS using the perspectives of sociological theories which state that individuals are rational beings who strive to reach their goals by means of available resources. Based on these theories, we hypothesize that variation in the extensiveness of social security policies explains cross-national differences in HIS and in relationship between education and HIS.

Our results are obtained using hierarchical multilevel analysis of the data from the Eurobarometer 58.2, in a sample of 14,835 respondents from 15 European countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, the Netherlands, Luxembourg, Portugal, Spain, Sweden, and the United Kingdom.

We found that social security policies matter for the relationship between education and health information-seeking. The results indicate that in Southern European countries, the better educated use more mass media for getting health information than the less educated. However, in Central, Northern and Western European countries, the negative impact of low education is absent. This might suggest that social security policies in these countries have a favorable impact on health information-seeking behavior of the low educated.

Further research is needed to find which specific social security policies are more effective in reduction of the negative impact of low education on HIS. The findings of this chapter offer suggestions for social policy initiatives to reduce educational differences in HIS or to keep the reduction reached stable over time.

In this chapter, we have used a more sophisticated method of multilevel analysis to examine the combined impact of social security policies and individual education on the use of mass media resources for search of health information. This has not yet been studied in the previous research.

Despite mixed evidence, researchers often suggest that married adults tend to live generally healthier lifestyles than their unmarried counterparts. In this chapter, we propose and test a reconceptualization of the health lifestyle that distinguishes between “homebody” risks and “hedonic” risks that may help to make sense of previous findings concerning marriage and health-related behavior.

Using data from the 2004 Survey of Adults (n = 1,385), we employ ordinary least squares regression to model indices of normative and conventional homebody risks (greater body mass, infrequent exercise, poorer diet, and abstinence from alcohol) and unconventional and potentially dangerous hedonic risks (smoking, heavy drinking, going out to bars, eating out, inadequate sleep, and driving without seatbelts) as a function of marital status.

Our key findings indicate that married adults tend to score higher on homebody risks and lower on hedonic risks than never married adults, net of controls for age, gender, race/ethnicity, citizenship, interview language, education, employment status, household income, and religious involvement.

Research limitations include cross-sectional data, restricted indicators of health-related behavior, and narrow external validity.

Contrary to previous research, we conclude that the lifestyle of married adults is not uniformly healthy.

The “Social Determinants of Health” construct is well-entrenched in the way that both health care providers and researchers think about the effects of social conditions on health. Although there are a number of theories that fall under this rubric for the social production of health and illness, the core of this construct is the idea that social stratification leads to health disparity. In this chapter we show how such a mechanism might work for relating social stratification and job stress.

We used the pooled 2002, 2006, 2010 Quality of Work Life modules of the General Social Survey to test a model of the relationships between gender, age, education, and nativity with “bad jobs” and indicators of health status.

Findings show that social status is positively associated with job quality and with health in turn. Lower social status characteristics are related to bad jobs and poorer health.

Health disparities are thus “explained” by the consequences of social status for occupation and job quality, thereby depicting exactly how health disparities arise in normal social life. The theory and results underscore the importance of explicitly modeling social status factors in explanations of health disparities.

It is common to relate health disparities to social status but it is not common to show the mechanisms whereby social status actually produces health disparities. Addressing health disparities means addressing the consequences of social inequalities for normal activities of social life such as work. Improving job quality would be a health “treatment” that addresses health disparities.

This chapter demonstrates the value of explicitly tracing the consequences of status differences on differences in social context such as work conditions and then health. In the study of health disparities this is not often done. In this chapter we show how social inequality leads to occupational and job quality differences that, in turn, lead to health differences.