Gender, Ethnicity, and Health Research

196 Pages·2002·3.565 MB·English

by  Sana Loue (auth.)

Gender, Ethnicity,
and Health Research
Gender, Ethnicity,
and Health Research
Sana Loue
Case Western Reserve University
Cleveland, Ohio
KLUWER ACADEMIC PUBLISHERS
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Preface
Health researchers routinely evaluate health and illness across subgroupsdefined by their sex,
gender, ethnicity, and race. All too often, these classifications are proffered as an explanation
for any differences that may be detected, for example, in access to care, frequency of disease,
or response to treatment. Relatively few researchers, however, have examined what these
classifications mean on a theoretical level or in the context of their own research.
Assume, for example, that a researcher concludes from his or her data that African-
Americans utilize certain surgical procedures less frequently than whites. This conclusion may
mean little without an examination of the various underlying issues. Is there such a construct as
race at all? How were whites and African-Americans classified as such? Does this finding
reflect inappropriate overutilization of the specific procedures among whites or inappropriate
underutilization among African-Americans? To what extent are socioeconomic status and
method of payment related to the less frequent use? Are there differences in the manner in
which health care providers present the various treatment options to whites and to African-
Americans that could account for these differences in utilization? Are there differences in
health care-seeking and health care preferences between the two groups that would explain
the difference in utilization? Is the racial classification a surrogate measure for another variable
that has remained unidentified and unmeasured? All too often, unfortunately, such issues are
ignored or lightly dismissed with an entreaty for additional research.
This text represents an effort to address these and other issues. The text uses a multi-
disciplinary approach, integrating concepts from a variety of disciplines including anthropol-
ogy, epidemiology, ethics, history, law, public health, and sociology. The text is designed to
encouragecriticalthinking about the meaning of these constructs; our past, current, and future
use of these concepts; and the implications and consequences of such use. Consequently, the
text does not set forth answers to these issues, but rather focuses on a process of inquiry that
can be used to find answers. This approach is critical because how we resolve such issues is
likely to vary over time, place, and population.
v
Acknowledgments
Several people deserve special mention for their thoughtful and critical review of earlier drafts
of this text. Linda Lloyd of Alliance Healthcare Foundation and Beth Quill of the University of
Texas at Houston, School of Public Health, provided me with invaluable feedback. Two former
students who had taken my course on Gender, Ethnicity, and Health Research, Lynn Sivinski
and Siran Karoukian, provided me with insightful comments from the viewpoint of graduate
students utilizing the text as a text. Jill Korbin and Atwood Gaines, both of Case Western
Reserve University, are to be thanked for our many discussions relating to issues examined in
this text.
Hal Morgenstern of the University of California at Los Angeles, School of Public Health,
kindly granted permission for the use of diagrams pertaining to study design and confounding,
which have been incorporated intoChapter 2. Southern Illinois UniversityPress also granted
permission for portions of Chapter 2, which appear as Chapter 3 in Forensic Epidemiology,
Southern Illinois University Press (1998).
Fatoumata Traore, Jay F. Fiedler, and Sandra M. Ferber provided me with invaluable
research assistance. Mariclaire Cloutier of Kluwer Academic / Plenum Publishers deserves
accolades, as always, for her editorial support and encouragement.
vii
Contents
Prologue: Understanding Social Constructs 1
Part I. Foundations
Chapter 1. Ethical Principles Governing Research Involving Human Participants 13
Historical Foundations 13
Governing Principles 15
Respect for Persons 15
Justice and Fairness 20
Beneficence and Nonmaleficence 20
The Role of the Institutional Review Board 21
Exercises 22
References 23
Chapter 2. Principles of Research Design 27
Causation and Causal Inference 27
Research Design 29
Types of Research 29
Clinical Trials 30
Observational Designs 31
Interpreting the Results 35
Statistical Significance and Confidence Intervals 35
Internal and External Validity 36
Sampling and Sample Size 41
Sampling Techniques 41
Sample Size and Power 43
Exercises 44
References 45
ix
x Contents
Chapter 3. Race and Ethnicity 47
Race 47
Ethnicity 50
The Use of Race and Ethnicity in Health Research 51
Exercises 54
References 55
Chapter 4. Sex, Gender, and Sexual Orientation 59
Introduction 59
Biological Sex 59
Gender Identity and Gender Role 60
Sexual Orientation 61
Transsexuality and Transgenderism 63
Transsexuality 63
Transgenderism 63
Exercises 64
References 64
Chapter 5. Health Care Utilization and Access 67
Utilization in the Context of a Health System Model 67
Categorical Models 67
Health Systems Models 68
Characteristics of the Population at Risk 69
The Health Care-Seeking Process 69
Determinants of Health Care-Seeking Behavior 72
The Role of Beliefs and Behavior: Models of Behavior Change 77
Health Belief Model 77
Social Cognitive Theory 77
Theory of Reasoned Action 78
Diffusion Theory 78
Exercises 79
References 80
Part II. The Health of Communities
Chapter 6. African-American Health 87
Introduction 87
Historical and Cultural Context 88
African-American Health during Slavery 88
African-American Health during Reconstruction 90
African-American Health during the 20th Century 90
Health Status 93
Infectious Disease 93
Chronic Disease 93
IntentionalInjury 95
Contents xi
Exercises 95
References 96
Chapter 7. Asian and Pacific Islander Health 101
Introduction 101
Cultural and Historical Context 102
Language and Acculturation 102
Explanatory Models of Health and Illness 102
Historical Context 104
Health Status 107
Infectious Disease 107
Chronic Disease 108
Mental Health and Illness 110
Exercises 111
References 112
Chapter 8. Hispanic Health 117
Introduction 117
Cultural and Historical Context 118
Language and Acculturation 118
Explanatory Models of Health 118
Historical Context 123
Health Status 125
Infectious Disease 125
Chronic Disease 125
Mental Health and Illness 127
Exercises 128
References 128
Chapter 9. The Health of Native Americans 133
Introduction 133
Origin and Culture Areas 133
Current Demographics 134
Cultural and Historical Context 134
Language 134
Traditional Lifestyles 135
Explanatory Models of Health and Illness 135
Historical Context 136
Native American Health Status 138
Overview 138
Infectious Disease 138
Chronic Disease 139
Mental Health and Illness 141
Exercises 142
References 143
xii Contents
Chapter 10. Women and Health 147
Background 147
Cultural and Historical Context: Sex and Gender 148
Health Status 150
Human Immunodeficiency Virus 150
Chronic Disease 150
Reproductive Health 151
IntentionalInjury 153
Exercises 154
References 154
Chapter 11. Sexual Orientation and Health 159
Introduction 159
Cultural and Historical Context 160
Access to Health Care 161
Cancer 162
Sexually Transmitted Diseases 163
Mental Health and Psychosocial Issues 163
“Coming Out” 163
Substance Use 164
Suicide 164
Physical and Sexual Abuse 165
Exercises 165
References 166
Part III. Case Studies of Disease
Chapter 12. Case Study One: Human Immunodeficiency Virus (HIV) and
the Acquired Immunodeficiency Syndrome (AIDS) 173
Background 173
A Biomedical Perspective of HIV/AIDS 174
Virus Transmission 174
Clinical Progression of Disease 174
Current Trends in the Epidemiology of HIV/AIDS in the United States 175
The Cultural Construction ofHIV/AIDS 176
Exercises 178
References 179
Chapter 13. Case Study Two: Diabetes Mellitus 185
Background 185
The Epidemiology of Diabetes 185
Incidence and Prevalence 185
Risk Factors 187
Protective Factors 187
Contents xiii
Cultural Factors in Diabetes Care 188
Exercises 188
References 188
Index 193