Assessing Race, Ethnicity and Gender in Health

166 Pages·2006·1.974 MB·English

by  Sana Loue (auth.)

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Assessing Race, Ethnicity and
Gender in Health
Assessing Race, Ethnicity
and Gender in Health
Sana Loue
CaseWesternReserveUniversity
Cleveland,Ohio
SanaLoue
CaseWesternReserveUniversity
Cleveland,OH44106–4945
USA
Coverillustration(cid:2)C 2006Superstock
LibraryofCongressControlNumber:2006920917
ISBN10:0-387-32461-5 e-ISBN0-387-32462-3
ISBN13:978-0387-32461-6
Printedonacid-freepaper.
(cid:2)C 2006SpringerScience+BusinessMedia,Inc.
Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewritten
permissionofthepublisher(SpringerScience+BusinessMedia,Inc.,233SpringStreet,NewYork,
NY10013,USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis.Use
in connection with any form of information storage and retrieval, electronic adaptation, computer
software,orbysimilarordissimilarmethodologynowknownorhereafterdevelopedisforbidden.
Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,evenifthey
arenotidentifiedassuch,isnottobetakenasanexpressionofopinionastowhetherornottheyare
subjecttoproprietaryrights.
PrintedintheUnitedStatesofAmerica. (TB/MVY)
9 8 7 6 5 4 3 2 1
springer.com
Acknowledgments
Thisbookwouldnothavebeenpossiblewithoutthevisionofmyformereditor,
Mariclaire Cloutier, and my current editor, Bill Tucker. Appreciation is due to
a number of individuals for their assistance with the research. Gary Edmunds,
Nancy Mendez, Ingrid Vargas, and Jenice Contreras deserve recognition for the
manyhoursthattheyspenttrackingdownreferences.
I owe special thanks to members of the communities with which I work, too
numeroustonameindividually,fortheircontributionstomyeducationandtothe
evolutionofmyunderstandingofidentities.
v
List of Tables
1. Comparison of categories and definitions for race and ethnicity
developedbyFederalOfficeofManagementandBudget............ 27
2. Comparisonofthreeapproachestocolorclassificationin
Nicaragua...................................................................... 28
3. Diagnosticcriteriaandsymptomsforgenderidentity
disorders........................................................................ 68
4. Classificationsystemsofbisexuality...................................... 74
5. Selectedstudiesindicatingprevalenceofsexualbehaviorin
comparisonwithsexualidentity........................................... 76
6. EstimatedAIDScasesbyrace/ethnicity.................................. 91
7. Summarytableofselectedmeasuresofethnicandracial
identityandidentification................................................... 121
8. Summarytableofselectedmeasuresofimmigrationstatus.......... 124
9. Characteristicsofselectedmeasuresofacculturation.................. 128
10. Summarytableofselectedtoolstoassessgenderrole................. 138
11. Summarytableofsuggesteddimensionsofassessmentfor
sexualorientation............................................................. 146
vii
Contents
Prologue xi
PARTI FOUNDATIONS
1. ConstructingCategories:ContextandConsequences .................. 3
2. MethodologicalConsiderations.............................................. 11
PARTII CONSTRUCTS:THEIRDEFINITIONANDUSE
3. DefiningRace,EthnicityandRelatedConstructs........................ 25
4. DefiningSex,Gender,andSexualOrientationConstructs............. 54
5. Race,Ethnicity,andSexualOrientationinHealth....................... 86
PARTIII ASSESSING GENDER, ETHNICITY, AND RELATED
CONSTRUCTS
6. MeasuresofEthnicity,EthnicIdentification,Acculturation,
andImmigrationStatus........................................................ 119
7. MeasuresofSex,Gender,GenderRole,andSexualOrientation...... 136
Index 153
ix
Prologue
AmericanstudiesarefivetimesmorelikelythanEuropeantrialstoreportinpub-
licationstheraceorethnicityofthestudyparticipants(Sheikh,Netuveli,Kai,and
Panesar,2004).Inareviewoffull-lengtharticlesappearinginthreemajorpedi-
atricjournals,forinstance,itwasfoundthatoverone-halfofthepublishedreports
contained data on participants’ race and/or ethnicity (Walsh and Ross, 2003).
Nearly 80% of hospitals in the United States collect data on race and ethnicity
(Runy, 2004). Despite the relatively high prevalence of collecting and reporting
race/ethnicity information, however, significant debate continues regarding the
wisdomofthispractice.Thefollowingobjectionshavebeenvoicedwithregard
tothecollectionanduseofdatarelatingtoraceandethnicity.
(cid:2)
The categories once used are inadequate and categories change too frequently
tomakethecollectionofthedataworthwhile.Asanexample,duringtheperiod
from1990to2003,hospitalsinRhodeIslandutilizedthreedifferentclassification
systems for the collection and recording of race and ethnicity data (Buechner,
2004).
(cid:2)
Categories that we construct may not be valid due to intermarriage. The most
recentcensusdataindicatesthatover2%oftheAmericanpopulation,ormore
than7millionpersons,nowacknowledgeamultiracialidentity(Ahmann,2005).
Childrenweremorelikelytoberecordedashavingamultiracialidentitythan
adults,whichsuggestsanincreaseininterracialcoupling.
(cid:2)
Data collection based on self-reports is not valid because individuals change
theirself-identificationdependinguponthecontextinwhichtheyareaskedto
sodesignate(KaplanandBennett,2003).
(cid:2)
Individualsgroupedintothesamecategorydemonstratesignificantgeneticdi-
versity,sothattheconstructionofthecategoriesisquestionable(Erickson,2003;
Schultz,2003).Therearenogenevariantsthatarepresentinallindividualsof
onepopulationandthatareabsentintheindividualsofanotherpopulationgroup
(Bonham,Warshauer-Baker,andCollins,2005).Forinstance,Wilsonandcol-
leagues(2001)foundinastudyofdrug-metabolizingenzymesandgenotyping
ineightpopulationsaroundtheworldthatgenotypesclusteredintofourgroups,
xi
xii Prologue
butthefourgroupsdidnotcorrespondtothepopulationsfromwhichtheyhad
beendrawn.
(cid:2)
Categorizationsaretoobroadtohaveanydefinitivemedicalmeaning(Schultz,
2003)andmayobscureheterogeneitywithingroups(Kaufman,1999;Williams,
2001). Gatrad and Sheikh (2000) have cautioned health care providers to re-
frainfrommakingassumptionsaboutpatients’willingnessorunwillingnessto
undergo particular screening tests or elective procedures on the basis of their
ethnicity.
(cid:2)
Sociallydeterminedcategoriescannotbeappliedtobiologicalscience(Schultz,
2003).
(cid:2)
Classifying individuals on the basis of socially constructed categories of race
and ethnicity serves to reinforce racial and ethnic divisions that already exist
(Azuonye,1996;BogueandEdwards,1971;Fullilove,1998;Stolley,1999).
(cid:2)
Thecategoriesdevelopedforraceandethnicityareoftenusedtocomparemi-
noritygroupstothemajoritypopulationandthesecomparisonsoftenfocuson
thenegativeaspectsofthehealthandlivesofminoritygroupmembers(Lo´pez,
2003).
(cid:2)
Afocusonethnicorracialgroupsmayleadresearcherstobelieveorencourage
them to disregard relevant social or cultural processes that are shared across
groupboundaries(Garro,2001).
Additionalconcernshavebeenvoicedwithregardtotheassessmentofaccul-
turationlevelandimmigrationstatus,twoconstructsthatarerelevanttoraceand
ethnicity.
(cid:2)
Categoriesofimmigrationstatuschangetoofrequentlytobeusefulovertime.As
anexample,attemptstoassessimmigrants’utilizationofpubliclyfundedhealth
careforspecificservicesmustbecognizantofthefluctuationsinparticipants’
eligibilityforbenefitsasaresultofchangesintheirimmigrationstatusand/or
changesintherelevantlegislation(Loue,Cooper,andLloyd,2005).
(cid:2)
Self-reportsofimmigrationstatuswillbeinaccurate,iftheyareprovided,due
tofearsofdeportation.
(cid:2)
Questions relating to immigration status will result in poor recruitment and
retentionduetofearsoftheconsequencesthatmightensuefollowingdisclosure.
Similar objections have been raised to the collection of data relating to sexual
orientationandsexualidentity:
(cid:2)
Sexualorientationand/orsexualidentityarefluidoveralifetimeandassessment
atonepointintimemaybeinaccurate.
(cid:2)
Howanindividualchoosestoidentifyhim-orherselfmaynotbereflectiveof
his or her true orientation because of concern about the consequences of self-
disclosureand,accordingly,collectionofthisinformationisnotvaluable.
(cid:2)
Assessmentofsexualorientationtendstocomparehomosexualsandheterosex-
uals,withtheresultinginferencethathomosexualityissomehow“lessthan”or
“worsethan”orundesirable.
Prologue xiii
Indeed,withrespecttoanyorallofthesevariables,thereislittleconsensusamong
researchersastohowcategoriesshouldbedefinedorwhoshouldbeassignedto
them.And,inviewofsuchvociferousdispleasurewiththecollectionandrecording
ofthesevariablesinthecontextofhealthcareandresearch,onemustnecessarily
questionwhyitisdone.
Hospitalshavebeenfoundtocollectthesedatainordertomeettherequirements
ofalaworregulation,toimprovethequalityofcare,toensuretheavailabilityof
interpreterservices,toimproveormaintaincommunityrelations,toassistintar-
getingmarketingefforts,and/orbecauseitisperceivedasbeneficial(Runy,2004).
Pediatric researchers have reported collecting and reporting race and ethnicity
databecauseitwasrequiredbytheinstitutionalreviewboardoftheirinstitution,
theNationalInstitutesofHealth,and/orthepeer-reviewedjournalinwhichthey
wishedtopublish;toconformtoatraditionofreportingraceandethnicitydata;
to better describe the study population; and/or because they believed that it was
relevant(WalshandRoss,2003).
Scholarshavesuggestedotherreasonsunderlyingthenecessityforthecollection
of data relating to race and ethnicity (Mays, Ponce, Washington, and Cochran,
2003).Thesereasonsarerelevant,aswell,todataregardingsexualorientation.
(1) To describe vital and health statistics. These data provide information that
canbeutilizedbypublichealthprogrammingandplanningtodevelopprograms
targeting specific health issues of concern in a manner that is appropriate to the
affectedcommunities.
(2) To identify risk indicators for specific health outcomes. It has been argued
that ethnicity itself constitutes a risk factor for specific diseases, such as Tay-
Sachs, which occurs predominantly in individuals of Eastern European Jewish
descent(Greenidge,2004).Allelesassociatedwithsicklecellanemiaarenotevenly
distributedacrossracial/ethnicgroups,butarefoundmorefrequentlyinAfrican-
American populations (Collins, 2004). The risk factor profile for breast cancer
among African-American women has been found to differ from that of white
women,althoughtheunderlyingmechanismsofthesedifferencesrequirefurther
investigation(Bernstein,Teal,Joslyn,andWilson,2003).
(3) Toimprovethedeliveryofhealthcareservices(Hasnaian-WyniaandPierce,
2005).Nonwhitepatientshavebeenfoundtoratethequalityofandtheirsatisfac-
tion with their health care lower than do whites (Haviland, Morales, Reise, and
Hays,2003).Tosomeextent,thisdifferencemaybeattributabletodisparatetreat-
mentbyhealthcareprovidersassociatedwithdifferencesinpatientself-identified
or perceived race or ethnicity (Bach, Pham, Schrag, Tate, and Hargraves, 2004;
vanRynandBurke,2000).
(4) To identify markers of unmeasured biological differences. Researchers have
reportedslowermetabolismofsomedrugsinpersonsofAsianethnicity,compared
towhiteandblacks(Meadows,2003).Ithasbeenhypothesizedthatthisdifference
maybeattributable,inpart,togeneticfactorsthathavenotyetbeenidentified.
(5) Toidentifyproxyvariablesforunmeasuredsocialfactors.Race,ethnicity,sex,
andsexualorientationmayserveasmarkersforothervariablesthatweareunable