Underserved and Socially Disadvantaged Groups and Linkages with Health and Health Care Differentials: Volume 37

This chapter provides an introduction to the volume along with a very brief review of literature on underserved and socially disadvantaged groups and health and health care differentials.

This chapter uses the approach of a literature review.

The chapter argues for the importance of greater examination of underserved and socially disadvantaged groups in consideration of health and health care differentials.

The author reviews the issues of underserved and socially disadvantaged groups in consideration of health and health care differentials and previews this book.

The purpose of this study was to examine whether girls of color (GOC) had more or less social support than their peers and whether that affected their likelihood of experiencing the symptoms of anxiety and depression.

The National Comorbidity Survey – Adolescent Supplement (n = 10,123) is a nationally representative study of mental disorder in US adolescents. GOC made up roughly 10% of the sample (n = 1,016). Structural equation models were used to analyze the relationship between family support and psychological distress for the entire sample and then analyzed for GOC, boys of color, White girls and boys, and Latino girls and boys to compare across groups. Because of the inextricable relationship between socioeconomic status and race, three-way interactions between class, race, and gender were used to examine class differences within groups.

Path analysis revealed the following: (1) among adolescents with both low and high socioeconomic status, GOC had significantly less family support than their peers; (2) surprisingly, despite the fact that GOC had significantly less family support than their peers, they were not more likely to experience symptoms of anxiety and depression.

Research limitations include cross-sectional data and limited measures. However, this study adds to the understanding of adolescent mental health and mental health of vulnerable adolescent populations. This is important because mental disorders, particularly anxiety and depression, are increasing in prevalence among American youth, and youth with multiple social disadvantages may be more likely to experience them.

GOC, regardless of their socioeconomic backgrounds, were at a marked disadvantage regarding their perceptions of social support, a known buffer of anxiety and depression. Yet despite this disadvantage, GOC were no more likely to experience a mood disorder than their peers. These findings suggest the following: (1) family support may have less of a protective effect on the mental health of GOC than their peers; (2) GOC may be using other resources to protect their mental health; and (3) as mental health patients, GOC require unique interventions.

Drawing from theories of modernization and socioemotional selectivity, this study investigates the effect of familial support on the relationship between immigrant generation and mental health service use for Asian American and Latinx older adults.

Using the data from the National Latino and Asian American Study (NLAAS) 2002–2003, nested logistic regressions (N = 810) were used to test the effects of familial support (parent–child relationship quality) on the relationship between immigrant generation and the use of mental health services. Differences in familial support between older adults and their younger counterparts were also accounted for.

The results indicate that familial support partially attenuates the relationship between immigrant generation and mental health service use, but only for Latinx groups. Familial support was not significantly different for older adults than that of those younger in age.

Findings suggest the need for a better understanding of familial support as it relates to mental health service use for these groups. Approaches to improving the access to, and the overall use of, mental health services should be sensitive to ethnic variation. Immigrant groups may also endure stressors associated with legal and citizenship status. Future research should consider the effect of these political identities on mental health. Studies on parent–child relationship quality should also be longitudinal in order to better understand the dynamic nature of familial support across the life course.

This chapter addresses gaps in the literature as Asian Americans are relatively understudied group with regard to mental health. Previous studies showed that US-born Asian American and Latinx populations are more likely to use mental health services than their foreign-born counterparts, but the effects of generation status and familial support for older adults are unclear.

To investigate the association between subjective dimensions of socioeconomic status and psychological distress, paying particular attention to Latino subgroup differences.

We used data from the Latino sample (N = 2,554) of the National Latino and Asian American Study (NLAAS). For our main analyses, we conducted a series of weighted multivariable linear regressions.

The results showed that subjective social status was associated with reduced psychological distress.

There are several key study limitations that warrant consideration. Chiefly, data utilized were cross-sectional; thus, it is unclear whether subjective socioeconomic status (SES) precedes or follows psychological distress.

Overall, our study makes several contributions to the sociological study of mental health differentials among Latinos. We show the importance of the association between subjective SES indicators and psychological distress. We also demonstrate how the associations analyzed in this study varied by Latino subethnicity, which we argue is an important step to fully understand the different social processes associated with the mental health of different Latina/o groups.

Although established theoretical models suggest that race differences in physical health are partially explained by exposures to environmental toxins, there is little empirical evidence to support these processes. We build on previous research by formally testing whether black–white differences in self-rated physical health are mediated by the embodiment of environmental toxins.

Using cross-sectional data from the National Health and Nutrition Examination Surveys (2007–2008), we employ ordinary least squares regression to model environmental toxins (from urine specimens) and overall self-rated health as a function of race and ethnicity. We employ the Sobel test of indirect effects to formally assess mediation.

Our results show that non-Hispanic black respondents tend to exhibit higher levels of total toxins, lead, and cadmium in their urine and poorer physical health than non-Hispanic whites, even with adjustments for age, gender, and socioeconomic status (SES). Our mediation analyses suggest that blacks may exhibit poorer physical health than whites because they tend to embody higher levels of cadmium.

Research limitations include cross-sectional data and restricted indicators of SES.

This study contributes to previous work by bridging the fields of social epidemiology and environmental inequality and by formally testing established theoretical models.

This study illuminates the experiences of adults diagnosed with autism spectrum disorders (ASDs) and intellectual disabilities (IDs) and their challenges and successes in receiving quality healthcare services. Individuals with developmental disabilities often experience health issues associated with aging at earlier ages and at higher rates than the general population. This population has a higher incidence of chronic health conditions that require regular medical attention.

The intent of this project was to learn directly from adults and their caregivers how well healthcare providers understand autism, explore their experience with how well their care is coordinated between primary healthcare and other specialty services, and identify factors which could impact access to care and to discover what other barriers which may potentially influence health outcomes for ASD adult.

A qualitative study conducted with semi-structured interviews with 12 adults diagnosed with ASD and/or their guardians/caregivers.

Some of the adults interviewed experienced negative health outcomes and suboptimal relationships with healthcare providers; others seemed to have positive relationships. Clinical and communications accommodations were necessary to make healthcare provision more comfortable. Barriers to accessing healthcare services existed in many forms.

The healthcare needs of the growing population adults diagnosed with ASD/ID are anticipated to be significant. This challenge is further exacerbated given there are few trained healthcare providers who are prepared or dedicated to serve this population. Continuing to build awareness of the health needs of the ASD/ID adult population is critical.

This project is highly innovative as it is the first attempt to understand how the adult autism population accesses care and perceives their healthcare interactions. This study serves as a starting point to suggest new opportunities for further research for this growing population.

This study aims to better understand the key factors that affect the quality of care that patients with Hepatitis C are likely to receive in rural communities and to consider how to build a more effective health support system for the rural residents.

This qualitative study with a grounded theory approach allowed us to draw a conceptual map of the occurrence while informants had the opportunity to contemplate and share their thoughts on the issues, which led into new understandings of the subject matter.

The local leaders held a romanticized view toward rural life while the disadvantaged reported a sense of powerlessness to bring about the needed changes to help them battle Hepatitis C.

Although describing a single social setting provides in-depth description, generalizability to other settings is always a limitation. If one wishes to start a support group, he/she may have to start asking the clergy of different churches to be the cofounders of the support group organization.

Churches may have the most potential to bring about the needed changes in rural settings by fostering a supportive heath care environment in their communities.

The purpose of this study is to explore rural children’s own perspectives on health, well-being, and nutrition to better understand how they approach, navigate, and make sense of these topics.

This study uses a qualitative ethnographic research design theoretically informed by the “new” Sociology of Childhood and methodologically informed by constructivist grounded theory. This ongoing study with fifth-grade students in an elementary school in a small rural school district in central Illinois consists of ethnographic observations conducted at the school, in-depth interviews with students, and participatory tools that seek to involve students more fully in the process of data collection.

Preliminary findings of this pilot study suggest that many aspects often discussed in the context of childhood obesity, especially in rural settings, including knowledge or education about healthy eating, increasing physical activity levels, or access to healthy foods, are complex and multifaceted and do not easily lend themselves to standard interventions. Findings also indicate that children’s ideas about healthy eating deviate from their own eating practices.

Conceptualized as a grounded theory study, the research is not intended to be generalizable or reproducible. Instead, the study seeks to develop hypotheses directly from the field and study participants’ views and voices. These perspectives will inform a more in-depth study of childhood obesity in rural settings planned for 2019.

Findings from this pilot study will inform innovative, informed interventions that are guided by children’s own experiences and perspectives. Study findings will also be of benefit to practicing pediatricians and other child health professionals as they understand how to better think about and address challenges of health and weight management of patients and their families.

This research chapter focuses on gender issues and women’s health concerns relevant to leprosy disease and their implications for leprosy control program in Southeast Nigeria. Four research questions guided the study, two of which were to ascertain the ways in which gender affect both awareness of leprosy and community support and post-treatment reintegration of persons affected by leprosy (PAL) into their communities.

A sample size of 1,116 adults drawn through cluster and random sampling methods were the study participants from whom quantitative data were collected via questionnaire. Qualitative data were generated through focus group discussion (FGD) among PAL, and in-depth interview (IDI) of both leprosy control staff, and other stakeholders purposively drawn from the area. The Statistical Package for the Social Sciences (SPSS) software was employed to process data, while frequency tables, bar charts, and chi-square were used to present, analyze, and test the hypothesis.

The study found that level of awareness about leprosy (which has several local names in the area) was relatively high (89.6%). However, significant differences exist in levels of awareness on leprosy between males and females. Also, men were perceived as less likely to comply with treatment instructions due to their gender roles of family economic upkeep. Males affected by leprosy were also found to encounter severest forms of social discrimination and post-treatment reintegration challenges.

The study scope was limited to the examination of public perception of gender issues and women’s healthcare concerns related to leprosy and their implications for leprosy control program in Southeast Nigeria. Only PAL registered with Nigeria’s Leprosy Control Programme participated with other non-patient respondents. The study focused on social aspects of leprosy (other than its biophysical component).

The implication of the research outcome includes need for deliberate strategy by leprosy control team to improve the level of awareness/knowledge as well as treatment compliance across gender. Similarly, differential mode of social reaction (to male and female gender) affected by leprosy should be addressed. Above all, aggressive public enlightenment through public, private, and local media and prohibition of sociocultural practices that promote spread of leprosy were stressed as measures to enhance leprosy control in the area.

The study fills the knowledge gap with respect to gender issues and women’s healthcare concerns related to leprosy and their implications for leprosy control program in Southeast Nigeria. Findings from the concluded research set it apart and differed with earlier and similar studies elsewhere. For instance, men affected by leprosy in the area encounter severest forms of negative social reaction; are less compliant to treatment plans and less aware of leprosy when compared with females. All these affirm the position of the chapter that gender issues relevant to leprosy differ according to cultural setting, time, and place of inquiry and do not align to any universal scheme.

Scientific reductionism has made sure that the biological phenomena were abstracted from the social and cultural contexts in which they occur. As a result, institutions of medicine and patient care processes have not taken into account the social and cultural determinants of the illness, therefore concealing a Western and masculine norm. Only recently, gender studies have managed to claim importance of the gender in the process of medical practices capable of dealing with diverse health cultures.

This chapter proposes further reflections on gender inequalities in health policy for the care and management of thalassemia, taking into account of the differences in health needs, and gendered experience and meanings of illness. It will analyze the medicalization of the female body in the thalassemia experience.

Qualitative data for this study came from the biographical narratives of 10 thalassemic women in the care of the Polyclinic of Messina (Italy).

The analysis will highlight an inequality between men and women not only in the degree and modes of medicalization of the bodies but also in the incorporation of an imagination that encages the woman in the necessary role of wife and mother, making the illness an experience particularly dolorous.

These findings can help shape health policies in the cure of thalassemia, which take into account gender differences as an indispensable element in the compliance with the therapeutic process.

They report on the urgency to deconstruct the social imagination according to which a woman is a “real” woman only if she is also a mother.

To shed light on how gender norms are reproduced in medical training and practice through an exploration of representations of the problem of “work–life balance.” Women physicians and women physician-researchers (WPs/WPRs) in Canada and in the United States experience social and health inequities when compared to their men colleagues. Despite current medical school acceptance parity, upon entering the medical workforce, women work harder than men to succeed within the historically male-dominated structures and value system of the medical profession.

We performed a critical discourse analysis of articles retrieved from academic databases and leading Anglo-American journals that discussed “work–life balance,” to investigate how the discourse contributed to, or challenged, the reproduction of gender norms in medicine.

While the medical literature acknowledges that the social and health inequities experienced by WP/WPR result from discriminatory norms and practices, it neglects to challenge built-in gendered inequities in benchmarks for success in the profession. Instead, proposed solutions require that WP/WPR themselves learn to cope and make better lifestyle choices, including downloading domestic responsibilities on socially disadvantaged – racialized and poor – women. Authors’ gender appears to make no difference.

Our search was limited to the Anglo-American literature, often retrieved articles inaccessible via our university library, excluded informal venues (e.g., blogs), and did not include cases of same-sex couples or interviews of WP/WPR. All these may have challenged components of our argument by revealing more nuanced debates, occurring under different political, cultural, and economic contexts.

While individual choices of WP/WPR are important to the protagonists, to successfully address the very real problem of work–life balance experienced by WP/WPR, patriarchal norms should be challenged, failure to comply with these norms should be rejected as explanations for work–life balance challenges, and norms themselves should become the focus of analysis and intervention.

The medical language used by physicians of both genders normalizes gendered inequities, favoring the success of medical men over women, and reproducing the professional and personal disadvantages experienced by the latter, further burdening socially disadvantaged women.

This chapter explores variation in direct care workers’ health risks within institutional and home-based settings, according to the demographic composition of workers and the gendered, raced, and citizenship-based expressions of their work roles.

This quantitative intersectional study draws on two nationwide datasets from the US National Center for Long-term Care Statistics, a division of the Centers for Disease Control and Prevention, the National Nursing Assistant Study (NNAS), and National Home Health Aide Survey (NHHAS).

Workplace context was the strongest predictor of workers’ health risks and working conditions. Physical injuries affected more than half of facility-based workers annually compared to less than 10% of home-based workers. Facility-based workers are more likely to report insufficient time for tasks, lower job satisfaction, and less respect and appreciation from patients. Home-based workers may be more likely to experience emotional distress, be offered fewer benefits, but experience fewer injuries, due to the better relative health of their patients and having more time for client care. Women reported more injuries and more time pressure than men across racial and citizenship groups within the same work setting.

There are limitations to the NHHAS and NNAS public-release data file data. We are unable to fully capture citizenship, some racial/ethnic categories, workers over age 65, supervisory workers, facilities with fewer than three residents, and facilities not certified with Medicare or Medicaid. The exclusion of these questions, workers, and contexts is a weakness of the present study.

Analyses draw on data from the first nationally representative sample surveys of home health aides and nursing assistants in the United States. Direct care workers are an important population to capture through intersectional research since care work is done predominantly by multiracial women and immigrants. This research also underscores the importance of workplace contexts in shaping the labor performed and the workers’ experiences.

The aim of this chapter was to analyze of the most hazardous aspects of home care work in Italy.

The chapter is based on a multi-method analysis conducted in Italy, including a survey on a sample of 867 home care assistants, and four focus groups organized with home care assistants.

The data collected show that: (1) there is a strong correlation between the physical and emotional complexity of the work and the workers’ malaise; (2) the live-in formula is not clearly linked with high levels of psychophysical malaise, while isolation is associated much more strongly with a high index of malaise; and (3) violence in the workplace is clearly one of the main risks to which home care assistants are exposed.

The findings may suffer from limitations due to the type of data collected. First, it was a convenience survey, so the results are not generalizable and they may be negatively influenced by bias relating to sample self-selection. Second, the empirical research was not designed to investigate occupational health alone, so accurate information on symptoms, causes of ill-health, experiences of violence, and the meaning of respondents’ malaise and of the episodes of violence were not available. Third, with the help of an epidemiologist, we could have included some diagnostic tests to better ascertain the workers’ state of health.

The chapter offers an original contribution to sociological research on the occupational health hazards from a gender-specific perspective. First, it investigates workers’ health risks in an understudied and highly feminized and racialized occupational sector. It also analyzes the implications of both the emotional and the body work on the workers’ health. It deals with the correlation between cohabitation and health problems. Finally, it looks into the impact of workplace violence on workers’ health, which is a strongly gendered issue, and rooted in social processes that stigmatize and racialize migrant women employed as home care assistants.