An Empirical Analysis of White Privilege, Social Position and Health

Accumulated evidence has demonstrated that social position matters for health. Those with greater socioeconomic resources and greater perceived standing in the social hierarchy have better health than those with fewer resources and lower perceived standing. Race is another salient axis by which health is stratified in the U.S., but few studies have examined the benefit of White privilege. 

In this paper, we investigated how perceptions of inequality and subjective and objective social status affected the health and well-being of N = 630 White residents in three Boston neighborhoods lying on a social gradient differentiated by race, ethnicity, income and prestige. Outcomes were self-rated health, dental health, and happiness. Results suggested that: neighborhood residence was not associated with health after controlling for individual level factors (e.g., positive ratings of the neighborhood, education level); objective measures of socioeconomic status were associated with better self-reported and dental health, but subjective assessments of social position were more strongly associated; and White residents living in the two wealthiest neighborhoods, and who perceived Black families as welcome in their neighborhoods enjoyed better health than those who believed them to be less welcome. However, those who lived in the least wealthy and most diverse neighborhood fared worse when reporting Black families to be welcome. 

These results suggest that White privilege and relative social position interact to shape health outcomes.

Below:  Relationship between perceived neighborhood welcome to Black families and health outcomes (self-rated health, dental health, and happiness). Values for self-rated health ranged from 1 to 4; dental health from 1 to 5; and happiness from 0 to 2. For both self-rated health and dental health, lower scores are better.

Full article at:   http://goo.gl/V2gSZ3

By:  Kwate NO1, Goodman MS2.

• 1Departments of Human Ecology and Africana Studies, Rutgers, The State University of New Jersey, 55 Dudley Rd, Cook Office Building, New Brunswick, NJ 08901-8520, USA. Electronic address: nokwate@rci.rutgers.edu.
• 2Division of Public Health Sciences Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO 63110, USA. 
• Soc Sci Med. 2014 Sep;116:150-60. doi: 10.1016/j.socscimed.2014.05.041. Epub 2014 Jun 13.

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Health Risk Behaviors in a Representative Sample of Bisexual and Heterosexual Female High School Students in Massachusetts

BACKGROUND:

Differences in sexual health-related outcomes by sexual behavior and identity remain underinvestigated among bisexual female adolescents.

METHODS:

Data from girls (N = 875) who participated in the Massachusetts Youth Risk Behavior Surveillance survey were analyzed. Weighted logistic regression models were fit to examine sexual and psychosocial health by lifetime sexual behavior (behaviorally bisexual vs behaviorally heterosexual) and sexual identity (bisexual vs heterosexual) adjusting for grade and race/ethnicity.

RESULTS:

Overall, 10.5% of girls reported lifetime bisexual behavior and 8.1% reported a bisexual identity. Behavior and identity were discordant for bisexual young women as 53.2% of behaviorally bisexual students had a bisexual identity and 46.8% had a heterosexual identity. Bisexual identity and behavior were associated with unprotected intercourse at last sexual encounter, early sexual debut, 4 or more lifetime partners, history of forced/unwanted sex, sexually transmitted infection testing history, past-year depression, and past-month drug use.

CONCLUSION:

Bisexuality, whether defined by identity or behavior, is associated with adverse sexual and psychosocial health outcomes in adolescent girls. Studies that explore wellness across the life span, and are designed to recognize developmental differences burgeoning in adolescence, may provide insights into the differential sexual risk outcomes observed among bisexual girls.

Purchase full article at:   http://goo.gl/2g4sZM

By:   White Hughto JM1,2, Biello KB3,4, Reisner SL5,6,7, Perez-Brumer A8, Heflin KJ9, Mimiaga MJ10,11,12.

• 1The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215. Jwhite@fenwayhealth.org.
• 2Department of Chronic Disease Epidemiology, Yale School of Public Health. Jwhite@fenwayhealth.org.
• 3The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215. Kbiello@fenwayhealth.org.
• 4Departments of Behavioral & Social Sciences and Epidemiology, Institute for Community Health Promotion, Brown University School of Public Health. Kbiello@fenwayhealth.org.
• 5The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215. SReisner@fenwayhealth.org.
• 6Division of General Pediatrics, Boston Children's Hospital/Harvard Medical School. SReisner@fenwayhealth.org.
• 7Department of Epidemiology, Harvard T.H. Chan School of Public Health. SReisner@fenwayhealth.org.
• 8Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032. Agp2133@columbia.edu.
• 9Center for Health Care Strategies, 200 American Metro Blvd., Hamilton, New Jersey 08619. Kheflin@chcs.org.
• 10The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215. Mmimiaga@fenwayhealth.org.
• 11Institute for Community Health Promotion, Brown University School of Public Health. Mmimiaga@fenwayhealth.org.
• 12Harvard T.H. Chan School of Public Health. Mmimiaga@fenwayhealth.org. 

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“They See Us As Machines:” The Experience of Recent Immigrant Women in the Low Wage Informal Labor Sector

This study explores the organization of work and occupational health risk as elicited from recently immigrated women (n = 8) who have been in the US for less than three years and employed in informal work sectors such as cleaning and factory work in the greater Boston area in Massachusetts. Additional interviews (n = 8) with Community Key Informants with knowledge of this sector and representatives of temporary employment agencies in the area provides further context to the interviews conducted with recent immigrant women. 

These results were also compared with our immigrant occupational health survey, a large project that spawned this study. Responses from the study participants suggest health outcomes consistent with being a day-laborer scholarship, new immigrant women are especially at higher risk within these low wage informal work sectors. A difference in health experiences based on ethnicity and occupation was also observed. 

Low skilled temporary jobs are fashioned around meeting the job performance expectations of the employer; the worker’s needs are hardly addressed, resulting in low work standards, little worker protection and poor health outcomes. The rising prevalence of non-standard employment or informal labor sector requires that policies or labor market legislation be revised to meet the needs presented by these marginalized workers.

Below:  Framework of coding structures, which reflect the work-related experiences and health of immigrant women in informal work sectors

Full article at:  http://goo.gl/PLiZ9m

By:   

Bindu Panikkar

Rubenstein School of Environment and Natural Resources, University of Vermont, Burlington, VT, United States of America

Doug Brugge, Raymond R. Hyatt

Department of Public Health and Community Medicine, Tufts University, Boston, MA, United States of America

David M. Gute

Department of Civil and Environmental Engineering, Tufts University, Medford, MA, United States of America

 

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Sexual Risk Behaviors & Psychosocial Health Concerns of Female-To-Male Transgender Men Screening for STDs at an Urban Community Health Center

The sexual health of female-to-male (FTM) transgender men remains understudied. De-identified electronic medical records of 23 FTMs (mean age = 32, 48% racial/ethnic minority) who screened for sexually transmitted diseases (STDs) between July and December 2007 at a Boston, Massachusetts area health center were analyzed. 

Almost half (48%) were on testosterone and 39% had undergone chest surgery; none had undergone genital reconstruction. The majority (57%) were bisexual, and 30% reported sex with nontransgender males only in the prior three months. One individual was HIV-infected (4.3%) and two (8.7%) had a history of STDs (all laboratory-confirmed). Overall, 26% engaged in sexual risk behavior in the prior three months (i.e., unprotected sex with a nontransgender male, condom breakage, or anonymous sex). 

The majority (61%) had a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) diagnosis (52% depression, 52% anxiety, and 26% adjustment disorder), and regular alcohol use was common (65%). Alcohol use, psychosocial distress histories, and sex with males only (versus with males and females) were associated with sexual risk in the past three months. 

Transgender men have concomitant psychosocial health vulnerabilities which may contribute to sexual risk behaviors. Future research is needed to understand the myriad social, behavioral, and biological factors that contribute to HIV and STD vulnerability for FTMs.

Full article at: http://goo.gl/CDtiZy

By: Sari L. Reisner,a,b,* Jaclyn M. White,a Kenneth H. Mayer,a,c and Matthew J. Mimiagaa,d,e

^aThe Fenway Institute, Fenway Health, Boston, MA, USA

^bDepartment of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA

^cDepartment of Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA

^dDepartment of Epidemiology, Harvard School of Public Health, Boston, MA, USA

^eDepartment of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA

^*Corresponding author. Email: gro.htlaehyawnef@rensiers

  

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Post-Traumatic Stress Symptoms & Their Association with Smoking Outcome Expectancies among Homeless Smokers in Boston

Cigarette smoking and traumatic life experiences are each common among homeless adults, but the prevalence and correlates of post-traumatic stress disorder (PTSD) symptoms among homeless smokers are not known. We assessed symptoms of PTSD and their association with smoking outcome expectancies in a sample of homeless smokers in Boston.

We used time-location sampling to conduct an in-person survey of homeless adult smokers using Boston Health Care for the Homeless Program clinical services. We assessed symptoms of PTSD with the PTSD Checklist - Civilian version and considered scores ≥14 as positive. We used the Smoking Effects Questionnaire to assess positive and negative smoking outcome expectancies. We modeled the associations between PTSD screening status and smoking expectancies using design-adjusted linear regression.

Eighty-six percent of eligible individuals participated (N=306). Sixty-eight percent of participants screened positive for PTSD. Screen-positive respondents were younger, more likely to report fair/poor health, chronic obstructive pulmonary disease, and past-month hallucinations, and had greater drug and alcohol use severity and cigarette dependence. In analyses controlling for these confounders, PTSD screen-positive participants more strongly endorsed smoking to reduce negative affect, smoking for social benefits, and smoking for weight control. Exploratory analyses suggested that these associations were driven by avoidance/numbing and re-experiencing symptoms.

Symptoms of post-traumatic stress are common among homeless smokers and strongly associated with positive smoking outcome expectancies. Tobacco cessation programs for this population should consider screening for PTSD and fostering a trauma-sensitive treatment environment.

Purchase full article at: http://goo.gl/wHL34Q

By: Baggett TP1, Campbell EG2, Chang Y3, Magid LM4, Rigotti NA5.

• 1Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA Boston Health Care for the Homeless Program, Boston, MA tbaggett@mgh.harvard.edu.
• 2Department of Medicine, Harvard Medical School, Boston, MA Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.
• 3Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA.
• 4Boston University, College of Health and Rehabilitation Sciences and School of Public Health, Boston, MA.
• 5Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.  

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Differences in Attitudes About HIV Pre-Exposure Prophylaxis Use among Stimulant Versus Alcohol Using Men Who Have Sex with Men

Alcohol and stimulant use are independently associated with increased HIV acquisition among men who have sex with men (MSM). We assessed differences in acceptability and perceived barriers to uptake of pre-exposure prophylaxis (PrEP) among stimulant and alcohol-using MSM in Boston. 

From September 2012-2013, a quantitative assessment was conducted with 254 MSM respondents who reported recent condomless sex in the context of concurrent stimulant (crack/cocaine and crystal methamphetamine; n = 132) or alcohol use (n = 122). Thirteen (5.1  %) reported previous PrEP use. In multivariable models, stimulant users were more likely to be concerned that substance use would affect PrEP adherence, and were less concerned about HIV stigma as a barrier to PrEP uptake compared to alcohol users. 

Barriers to PrEP uptake and adherence differ by type of substance used. Different strategies may be required for PrEP implementation among MSM who use stimulants and alcohol.

Purchase full article at: http://goo.gl/FCuNcy

By: Oldenburg CE1,2, Mitty JA1,3, Biello KB1,4, Closson EF1, Safren SA5, Mayer KH1,3,6, Mimiaga MJ7,8,9.

• 1The Fenway Institute, Fenway Community Health, Boston, MA, USA.
• 2Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
• 3Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
• 4Departments of Behavioral and Social Sciences and Epidemiology, and the Institute for Community Health Promotion, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA.
• 5Department of Psychology, University of Miami, Miami, FL, USA.
• 6Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
• 7The Fenway Institute, Fenway Community Health, Boston, MA, USA. matthew_mimiaga@brown.edu.
• 8Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. matthew_mimiaga@brown.edu.
• 9Departments of Behavioral and Social Sciences and Epidemiology, and the Institute for Community Health Promotion, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA. matthew_mimiaga@brown.edu.

  

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Awareness of Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP) Is Low but Interest Is High Among Men Engaging in Condomless Anal Sex with Men in Boston, Pittsburgh, and San Juan

This study examines awareness of and experiences with post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) among 228 men recruited in Boston, Pittsburgh, and San Juan between 12/2010 and 6/2012. 

All of them reported having condomless anal sex with a man in the prior year. Overall, 41% had heard of PEP, ranging from 16% in San Juan to 64% in Boston. Only 21% had heard of PrEP, ranging from 8% in San Juan to 36% in Boston. Three had used PEP, and none had used PrEP. 

After the methods were described to participants, interest in both was high, with intentions to use PEP and PrEP respectively at 9.1 and 7.7 (10-point scale). Increased public education is needed to raise awareness of these HIV prevention methods, especially among MSM who acknowledge potential risk behavior. It also seems likely that many such men would use these methods once they become aware of them.

Via:   http://ht.ly/QTjq8 HT @Columbia