Risk and protective factors associated with depression among racial and ethnic mothers of adolescents

The central paradigm linking disadvantaged social status and mental health has been the social stress model (Horwitz, 1999), the assumption being that individuals residing in lower social status groups are subjected to greater levels of stress not experienced by individuals from higher status groups. A further assumption is that such individuals have fewer resources to cope with stress, in turn leading to higher levels of psychological disorder, including depression (Pearlin, 1989). Despite these key assumptions, there is a dearth of literature comparing the social patterning of stress exposure (Hatch & Dohrenwend, 2007; Meyer, Schwartz, & Frost, 2008; Kessler, Mickelson, & Williams, 1999; Turner & Avison, 2003; Turner & Lloyd, 1999; Turner, Wheaton, & Lloyd, 1995), and the distribution and contribution of protective factors, posited to play a role in the low rates of depression found among African- and Latino-Americans (Alegria et al., 2007; Breslau, Aguilar-Gaxiola, Kendler, Su, Williams, & Kessler, 2006; Breslau, Borges, Hagar, Tancredi, Gilman, 2009; Gavin, Walton, Chae, Alegria, Jackson, & Takeuchi, 2010; Williams, & Neighbors, 2006). Thus, this study sought to describe both the distribution and contribution of risk and protective factors in relation to depression among a sample of African-, European-, and Latina-American mothers of adolescents, including testing a hypothesized mechanism through which social support, an important protective factor specific to women and depression, operates. ^ Despite the finding that the levels of depression were not statistically different across all three groups of women, surprising results were found in describing the distribution of both risk and protective factors, in that results reported among all women who were mothers when analyzed masked differences within each ethnic group when SES was assessed, a point made explicit by Williams (2002) regarding racial and ethnic variations in women's health. In the final analysis, while perceived social support was found to partially mediate the effect of social isolation on depression, among African-Americans, the direct effect of social isolation and depression was lower among this group of women, as was the indirect effect of social isolation and perceived social support when compared to European- and Latina-American mothers. Or, put differently, higher levels of social isolation were not found to be as associated with more depression or lower social support among African-American mothers when compared to their European- and Latina-American counterparts. ^ Women in American society occupy a number of roles, i.e., that of being female, married or single, mother, homemaker or employee. In addition, to these roles, ethnicity and SES also come into play, such that the intersection of all these roles and the social contexts that they occupy are equally important and must be taken into consideration when making predictions drawn from the social stress model. Based on these findings, it appears that the assumptions of the social stress model need to be revisited to include the variety of roles that intersect among individuals from differing social groups. More specifically, among women who are mothers and occupy a myriad of other roles, i.e., that of being female, married or single, African- or Latina-American, mother, homemaker or employee, the intersection of all the roles and the social contexts that women occupy are equally important and must be taken into consideration when looking at both the types and distribution of stressors across women. Predictions based on simple, mutually exclusive categories of social groups may lead to erroneous assumptions and misleading results.^

Childhood ethnic differences in ametropia and ocular biometry:the Aston Eye Study

Purpose: To describe the methodology, sampling strategy and preliminary results for the Aston Eye Study (AES), a cross-sectional study to determine the prevalence of refractive error and its associated ocular biometry in a large multi-racial sample of school children from the metropolitan area of Birmingham, England. Methods: A target sample of 1700 children aged 6–7 years and 1200 aged 12–13 years is being selected from Birmingham schools selected randomly with stratification by area deprivation index (a measure of socio-economic status). Schools with pupils predominantly (>70%) from a single race are excluded. Sample size calculations account for the likely participation rate and the clustering of individuals within schools. Procedures involve standardised protocols to allow for comparison with international population-based data. Visual acuity, non-contact ocular biometry (axial length, corneal radius of curvature and anterior chamber depth) and cycloplegic autorefraction are measured in both eyes. Distance and near oculomotor balance, height and weight are also assessed. Questionnaires for parents and older children will allow the influence of environmental factors on refractive error to be examined. Results: Recruitment and data collection are ongoing (currently N = 655). Preliminary cross-sectional data on 213 South Asian, 44 black African Caribbean and 70 white European children aged 6–7 years and 114 South Asian, 40 black African Caribbean and 115 white European children aged 12–13 years found myopia prevalence of 9.4% and 29.4% for the two age groups respectively. A more negative mean spherical equivalent refraction (SER) was observed in older children (-0.21 D vs +0.87 D). Ethnic differences in myopia prevalence are emerging with South Asian children having higher levels than white European children 36.8% vs 18.6% (for the older children). Axial length, corneal radius of curvature and anterior chamber depth were normally distributed, while SER was leptokurtic (p < 0.001) with a slight negative skew. Conclusions: The AES will allow ethnic differences in the ocular characteristics of children from a large metropolitan area of the UK to be examined. The findings to date indicate the emergence of higher levels of myopia by early adolescence in second and third generation British South Asians, compared to white European children. The continuation of the AES will allow the early determinants of these ethnic differences to be studied.

Black and minority ethnic graduate entrepreneurs: motivations, characteristics and access to finance

This paper draws upon four case studies to examine characteristics, entrepreneurial motivations and access to finance of black and minority ethnic (BME) graduates in the UK. We find that BME graduates starting a business are motivated by a desire to “do better”, and rely heavily on personal savings and family sources for start-up capital. In addition: • There is no conclusive evidence that suggests in this study that BME graduates entered entrepreneurship because of unemployment; with the exception of a few, all had jobs prior to entering self employment. • “Glass ceilings” were often cited by participants of the case studies as a kind of barrier, but there was reluctance to specify exactly what that meant. • Also, lack of satisfaction from working for others is considered to be a strong motivator for entering self-employment but other reasons, to be one’s own boss and the prospect of higher earnings, are also strong motivators. There is, therefore, a need for support agencies and universities to recognise the distinctive nature of BME graduate enterprise in order to provide effective solutions for different groups. This might include a) work experience, b) advice on an adequate capital structure at start up, c) adequate funding and training, and d) appropriate training for all graduates in basic business education.

Enhanced diabetes care to patients of south Asian ethnic origin (the United Kingdom Asian Diabetes Study):a cluster randomised controlled trial

Background - Delivery of high-quality, evidence-based health care to deprived sectors of the community is a major goal for society. We investigated the effectiveness of a culturally sensitive, enhanced care package in UK general practices for improvement of cardiovascular risk factors in patients of south Asian origin with type 2 diabetes. Methods - In this cluster randomised controlled trial, 21 inner-city practices in the UK were assigned by simple randomisation to intervention (enhanced care including additional time with practice nurse and support from a link worker and diabetes-specialist nurse [nine practices; n=868]) or control (standard care [12 practices; n=618]) groups. All adult patients of south Asian origin with type 2 diabetes were eligible. Prescribing algorithms with clearly defined targets were provided for all practices. Primary outcomes were changes in blood pressure, total cholesterol, and glycaemic control (haemoglobin A1c) after 2 years. Analysis was by intention to treat. This trial is registered, number ISRCTN 38297969. Findings - We recorded significant differences between treatment groups in diastolic blood pressure (1·91 [95% CI -2·88 to -0·94] mm?Hg, p=0·0001) and mean arterial pressure (1·36 [-2·49 to -0·23] mm?Hg, p=0·0180), after adjustment for confounders and clustering. We noted no significant differences between groups for total cholesterol (0·03 [-0·04 to 0·11] mmol/L), systolic blood pressure (-0·33 [-2·41 to 1·75] mm?Hg), or HbA1c (-0·15% [-0·33 to 0·03]). Economic analysis suggests that the nurse-led intervention was not cost effective (incremental cost-effectiveness ratio £28?933 per QALY gained). Across the whole study population over the 2 years of the trial, systolic blood pressure, diastolic blood pressure, and cholesterol decreased significantly by 4·9 (95% CI 4·0–5·9) mm?Hg, 3·8 (3·2–4·4) mm?Hg, and 0·45 (0·40–0·51) mmol/L, respectively, and we recorded a small and non-significant increase for haemoglobin A1c (0·04% [-0·04 to 0·13]), p=0·290). Interpretation - We recorded additional, although small, benefits from our culturally tailored care package that were greater than the secular changes achieved in the UK in recent years. Stricter targets in general practice and further measures to motivate patients are needed to achieve best possible health-care outcomes in south Asian patients with diabetes. Funding - Pfizer, Sanofi-Aventis, Servier Laboratories UK, Merck Sharp & Dohme/Schering-Plough, Takeda UK, Roche, Merck Pharma, Daiichi-Sankyo UK, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Bristol-Myers Squibb, Solvay Health Care, and Assurance Medical Society UK.

Comparative risk of microalbuminuria and proteinuria in UK residents of south Asian and white European ethnic background with type 2 diabetes:a report from UKADS

Objective - This study investigated and compared the prevalence of microalbuminuria and overt proteinuria and their determinants in a cohort of UK resident patients of white European or south Asian ethnicity with type 2 diabetes mellitus. Research design and methods - A total of 1978 patients, comprising 1486 of south Asian and 492 of white European ethnicity, in 25 general practices in Coventry and Birmingham inner city areas in England were studied in a cross-sectional study. Demographic and risk factor data were collected and presence of microalbuminuria and overt proteinuria assessed. Main outcome measures - Prevalences of microalbuminuria and overt proteinuria. Results - Urinary albumin:creatinine measurements were available for 1852 (94%) patients. The south Asian group had a lower prevalence of microalbuminuria, 19% vs. 23% and a higher prevalence of overt proteinuria, 8% vs. 3%, X2?=?15.85, 2df, P?=?0.0004. In multiple logistic regression models, adjusted for confounding factors, significantly increased risk for the south Asian vs. white European patients for overt proteinuria was shown; OR (95% CI) 2.17 (1.05, 4.49), P?=?0.0365. For microalbuminuria, an interaction effect for ethnicity and duration of diabetes suggested that risk for south Asian patients was lower in early years following diagnosis; OR for SA vs. WH at durations 0 and 1 year were 0.56 (0.37, 0.86) and 0.59 (0.39, 0.89) respectively. After 20 years’ duration, OR?=?1.40 (0.63, 3.08). Limitations - Comparability of ethnicity defined groups; statistical methods controlled for differences between groups, but residual confounding may remain. Analyses are based on a single measure of albumin:creatinine ratio. Conclusions - There were significant differences between ethnicity groups in risk factor profiles and microalbuminuria and overt proteinuria outcomes. Whilst south Asian patients had no excess risk of microalbuminuria, the risk of overt proteinuria was elevated significantly, which might be explained by faster progression of renal dysfunction in patients of south Asian ethnicity.

Ethnic differences in health related quality of life for patients with type 2 diabetes

Background - The objective of this study was to investigate the association between ethnicity and health related quality of life (HRQoL) in patients with type 2 diabetes. Methods - The EuroQol EQ-5D measure was administered to 1,978 patients with type 2 diabetes in the UK Asian Diabetes Study (UKADS): 1,486 of south Asian origin (Indian, Pakistani, Bangladeshi or other south Asian) and 492 of white European origin. Multivariate regression using ordinary least square (OLS), Tobit, fractional logit and Censored Least Absolutes Deviations estimators was used to estimate the impact of ethnicity on both visual analogue scale (VAS) and utility scores for the EuroQol EQ-5D. Results - Mean EQ-5D VAS and utility scores were lower among south Asians with diabetes compared to the white European population; the unadjusted effect on the mean EQ-5D VAS score was −7.82 (Standard error [SE] = 1.06, p < 0.01) and on the EQ-5D utility score was −0.06 (SE = 0.02, p < 0.01) (OLS estimator). After controlling for socio-demographic and clinical confounders, the adjusted effect on the EQ-5D VAS score was −9.35 (SE = 2.46, p < 0.01) and on the EQ-5D utility score was 0.06 (SE = 0.04), although the latter was not statistically significant. Conclusions - There was a large and statistically significant association between south Asian ethnicity and lower EQ-5D VAS scores. In contrast, there was no significant difference in EQ-5D utility scores between the south Asian and white European sub-groups. Further research is needed to explain the differences in effects on subjective EQ-5D VAS scores and population-weighted EQ-5D utility scores in this context.

Latin Americans in London:language, integration and ethnic identity

This thesis studies the links between language, migration and integration in the context of the 'new migrant' group of Latin Americans in London. It reviews the many ways in which language impacts the integration processes of migrants by influencing people's access to jobs, services, social contacts and information. By focusing on migrants' experiences this research also investigates the ways in which language and identity articulate, as well as the affective variables that are at play in the acquisition of the local language. With a large sector trapped in a cycle of poor command of English and labour market disadvantage, many Latin Americans experience exclusion and poverty. In reaction to this, a sector of the community is campaigning for ethnic minority recognition. This work reviews the debates for recognition and the strategy of organising around ethnicity, paying special attention to the role language plays in the process. The study is based on over two and half years of qualitative research, which included interviews, surveys, and long-term participant observation within a community organisation and a recognition campaign. Its interdisciplinary perspective allows the recognition of both the intimate links between language and identity, as well as the social and structural forces that influence migrants' linguistic integration. It unveils the practical and symbolic value that the mother tongue has for Latin American migrants and provides a broader account of their experiences. This research calls attention to the need for a more comprehensive approach to the study of language and migration in order to acknowledge the affective and social factors involved in the linguistic practices of migrants. By studying the community's struggles for recognition, this work evidences both the importance of visibility for minority groups in London and the intrinsic methodological limitations of monitoring through ethnic categorisation.

Religion & ethnic identity among Mexican youths in Homestead, Florida

Immigrant youth are the fastest growing component of the U.S. population and Mexicans are the largest immigrant group in the U.S. The manner in which they integrate into U.S. society and the ways that they become civically engaged, will greatly determine the nature of civil society in the United States over the next few decades. Moreover, religion is increasingly recognized as an important factor in immigrant adaptation. Based upon fieldwork of participant observation and interviews in Homestead, Florida, this thesis examined the relationship among Mexican youths' identity, religion and civic engagement. I found that if these youths are active in religious practices they will be more likely to identify themselves as part of the dominant group, in this case American society. Religious groups are powerful tools that can help these youth reach the greater community.

The Political Economy of Ethnic Empowerment in India

This dissertation consists of three papers, which together examine whether policies meant to address inequality, succeed in mitigating the impact of traditional institutions such as caste and enable ethnic minorities to claim their rights. Using experimental and quasi-experimental methods with data from a variety of primary and secondary sources, this dissertation analyzes whether policies meant to empower vulnerable groups in India have succeeded in doing so. The findings suggest that while legislations in the form of mandated political representation or freedom of information laws are necessary in terms of increasing the accountability of government towards citizens, they may not be sufficient in ensuring adequate and uniform delivery of public services, especially to citizens belonging to marginalized groups. Further, empowering citizens – especially those belonging to groups that have faced historic discrimination – to actively participate in civic and political life may require more active and intensive policy and programmatic interventions.

Dealing with the Legacy of Ethnic Conflict: Confronting ‘Othering’ through Transformative Adult Education—A Northern Ireland Case Study

Despite its peace process, Northern Ireland remains a deeply divided society. The legacy of a 30-year conflict has ensured that the state continues to be prone to outbreaks of violence over contentious issues such as Orange Order parading and the flying of national flags. This paper argues that in order to address this legacy, there is a need to confront the Othering processes that have helped to generate and sustain division. It will argue that programmes of adult education can play an important role in helping the conflicting groups to reimagine their ‘exclusive’ notions of the nation to one capable of incorporating the Other.

ETHNIC MINORITIES AND HUMAN RIGHTS VIOLATIONS THE AFRO-COLOMBIAN CASE1

ResumenLa discriminación racial, la pobreza y la exclusión social son problemas estructurales que han afectadoa las minorías étnicas colombianas por décadas. De los grupos minoritarios del país, los(as)afrocolombianos(as) experimentan el más alto nivel de pobreza, hecho que se demuestra en sulimitado acceso a las políticas de educación, salud, empleo y demás servicios públicos y programassociales. De hecho, las regiones con fuerte presencia afrocolombiana presentan los peores indicadoressocio-económicos y la mayor parte de las víctimas (directas) del conflicto armado internoque afecta a la nación son las comunidades afrocolombianas. Las violaciones de derechos humanos contra los(as) afrocolombianos(as) han sido cometidas tanto por instituciones del Estado comopor actores no-estatales. Dichas violaciones son prohibidas por la Constitución Nacional y por lostratados de derechos humanos ratificados por el Estado colombiano. Sin embargo, los efectos de lasmismas siguen sin ser analizados a profundidad. En este texto se estudia en detalle las normas dederechos humanos que buscan proteger a la población afrocolombiana como grupo étnico minoritario.También se estudian las principales consecuencias de las prácticas racistas contra las comunidadesafrocolombianas y los retos de éstas en el marco del conflicto armado interno. El artículo se convierteen una de las pocas investigaciones que explica la compleja situación de derechos humanos de lascomunidades afrocolombianas en la historia reciente del país.Palabras clave: Afrocolombianos(as), minorías, derechos y discriminación. AbstractRacial discrimination, poverty and social exclusion are structural problems that have affected the Colombianethnic minorities for decades. Among these minority groups, Afro-Colombians experience the highest levelof poverty, which is demonstrated by their limited access to education, health, employment, and other socialprograms and services. In fact, most regions with Afro-Colombian presence endure the worst socio-economicindicators, and the main victims of the internal armed conflict are the Afro-Colombian communities. Humanrights violations against Afro-Colombians have been committed by both state and non-state actors.These violations are prohibited by the new Colombian Constitution (approved in 1991) and human rightstreaties ratified by the Colombian state. However, their effects on Afro-Colombians have not been extensivelyexplored. This paper analyzes in depth the domestic human rights framework that seeks the protectionof Afro-Colombians as an ethnic minority. Also, it studies in detail the consequences of racist practicestowards the Afro-Colombian communities and the challenges of their struggle for human rights in the frameof the internal armed conflict. The text represents one of the few works of its kind that explains the mainaspects of the complex human rights situation of Afro-Colombians throughout the nation’s recent history.Keywords: Afro-Colombians, minorities, rights and discrimination.