conferences.jbsinternational.com

James S. Jackson James S. Jackson

Program for Research on Black AmericansProgram for Research on Black AmericansInstitute for Social ResearchInstitute for Social Research

University of MichiganUniversity of Michigan

Appreciation to the staff and faculty of PRBA. Funding for the projects discussed in this talk provided by Appreciation to the staff and faculty of PRBA. Funding for the projects discussed in this talk provided by NIA, NIDA, OBSSR, NSF, and NIMH. NIA, NIDA, OBSSR, NSF, and NIMH. Talk presented at Center for Substance Abuse Treatment Talk presented at Center for Substance Abuse Treatment

Satellite Session Linking Research to Practice: Addressing Racial and Ethnic Health Disparities in Satellite Session Linking Research to Practice: Addressing Racial and Ethnic Health Disparities in Substance Abuse Treatment and HIV/AIDS. San Juan, Puerto Rico, June 14, 2008Substance Abuse Treatment and HIV/AIDS. San Juan, Puerto Rico, June 14, 2008

Race, Ethnicity and National Origin in Race, Ethnicity and National Origin in Conducting Mental Health Research in Conducting Mental Health Research in

Black PopulationsBlack Populations

R.I.C.E.R.I.C.E.

RRaceace

IImmigrationmmigration

CCultureulture

EEthnicity (and Gender, Age, and SES)thnicity (and Gender, Age, and SES)

Race Matters

Even if we don’t know what “IT” isEven if we don’t know what “IT” is

Nature of Race in United Nature of Race in United StatesStates

One Drop RuleOne Drop Rule Association with Intelligence and Character Association with Intelligence and Character Real Discrimination in housing, schooling, Real Discrimination in housing, schooling,

occupation, and related areas of lifeoccupation, and related areas of life

Biological and Social Biological and Social Perspectives on RacePerspectives on Race

Self–reported (or other reported) race/ethnicity Self–reported (or other reported) race/ethnicity most often used categorization in both most often used categorization in both biological and social researchbiological and social research

Why should we observe such large and both Why should we observe such large and both consistent (African Americans), and consistent (African Americans), and inconsistent (Caribbeans, Latinos, Asians, etc), inconsistent (Caribbeans, Latinos, Asians, etc), disparities among race/ethnic groupsdisparities among race/ethnic groups

However we construe race (ethnicity, etc) there However we construe race (ethnicity, etc) there are two processes operativeare two processes operative

BiologicalBiological Social – Self & OtherSocial – Self & Other

Far-fetched to think that biological process alone Far-fetched to think that biological process alone could account for observed group differences in could account for observed group differences in health in U.S. as I have reviewed herehealth in U.S. as I have reviewed here

Social processes must play a major roleSocial processes must play a major role

Yes BlackYes Black Not BlackNot Black

YesYes

BlackBlack African African AmericanAmerican

HispanicHispanic

Afro CaribbeanAfro Caribbean

NotNot

BlackBlack HispanicHispanic

Afro Afro CaribbeanCaribbean

Non-Hispanic Non-Hispanic WhiteWhite

Self and Other Race Perceptions

Self

Other

Non-Minority

Minority

Difference

Clinical Appropriateness and Need

Patient Preferences

The Operation of Healthcare Systems and the Legal and Regulatory Climate

Discrimination: Biases andPrejudice, Stereotyping, andUncertainty

UNKNOWN

Disparity

Qua

li ty

o f H

e al th

Car

e /H

e alth

Figure 1: Differences and Disparities: Populations with Equal Access to Health Care

Populations with Equal Access to Health Care

Law of Small Effects in Race Related Outcomes (Jackson, 2004)

There is no one single factor that produces observed physical health disparities among race/ethnic groups in U.S.

Group of small differences that accumulate over the life-course to produce observed differences in adulthood and older ages among different race/ethnic groups

Some Candidates

Gene/gene and gene/environment interactionsGene/gene and gene/environment interactions Discrimination and perceived racism (stress Discrimination and perceived racism (stress

process)process) Accumulated stress (weathering, allostatic load, Accumulated stress (weathering, allostatic load,

etc.)etc.) Life course selection Life course selection Cultural factorsCultural factors Behavioral differencesBehavioral differences SES and institutional arrangementSES and institutional arrangement

Disparities in Demographic, Economic, and Social Resources: Structural Inequalities

Blacks disproportionately in comparison to Blacks disproportionately in comparison to Non-Hispanic Whites remain materially Non-Hispanic Whites remain materially disadvantaged and geographically segregated, disadvantaged and geographically segregated, especially in poor, core urban areasespecially in poor, core urban areas

There are large disparities in living There are large disparities in living arrangements favoring non-Hispanic Whitesarrangements favoring non-Hispanic Whites

Disparities in Health Status, Health Services and Mental Health: Physical and Psychological Inequalities

Large disparities in all cause and specific cause Large disparities in all cause and specific cause death rates exist among ethnic and racial groups death rates exist among ethnic and racial groups – these differences are not due in any simple – these differences are not due in any simple way to socioeconomic statusway to socioeconomic status

Infant mortality rates have declined but large Infant mortality rates have declined but large difference exist between African Americans and difference exist between African Americans and whiteswhites

There are large disparities in health care There are large disparities in health care utilization between blacks and whites in this utilization between blacks and whites in this countrycountry

Health Disparities by Age, Aging and the Life-Course

There are links from childhood (infancy, neonatal, There are links from childhood (infancy, neonatal, pregnancy, etc.) social conditions to race/ethnic pregnancy, etc.) social conditions to race/ethnic disparities in adulthood and older age (e.g. Warner & disparities in adulthood and older age (e.g. Warner & Hayward, 2003)Hayward, 2003)

Over the life course blacks more than any other group Over the life course blacks more than any other group live the fewest years and a high proportion of these years live the fewest years and a high proportion of these years is in poor health (e.g. Hayward & Heron, 2002)is in poor health (e.g. Hayward & Heron, 2002)

Health, race, ethnicity and mobility (SES) are linked in Health, race, ethnicity and mobility (SES) are linked in complex ways across childhood, adolescence, adulthood, complex ways across childhood, adolescence, adulthood, and old age (e.g. Hayward et al, 2003; Whitfield & and old age (e.g. Hayward et al, 2003; Whitfield & Hayward, 2003; Crimmins et al, 2000; Crimmins & Hayward, 2003; Crimmins et al, 2000; Crimmins & Saito, 2001)Saito, 2001)

National Survey of American Life

Feb 2001-Present

NSAL Sampling Areas

Sample DesignSample Design 6,082 Adult face-to-face interviews6,082 Adult face-to-face interviews

3,570 African Americans [70.7%]3,570 African Americans [70.7%] 1,621 Afro-Caribbeans [77.3%]1,621 Afro-Caribbeans [77.3%] 891 Non-Hispanic Whites* [69.7%]891 Non-Hispanic Whites* [69.7%]

1170 African American and Afro-Caribbean 1170 African American and Afro-Caribbean Adolescent face-to-face interviews [80.4%]Adolescent face-to-face interviews [80.4%]

Parents/Guardians self-administered interviewsParents/Guardians self-administered interviews Age 18 and older Age 18 and older English Speaking only English Speaking only * Includes 891 Whites living in predominantly African American neighborhoods, and 115 whites living * Includes 891 Whites living in predominantly African American neighborhoods, and 115 whites living

in areas with an African American population of less than 10%.in areas with an African American population of less than 10%.

Areas CoveredAreas Covered

DisordersDisorders Risk FactorsRisk Factors

SocialSocial PsychologicalPsychological MaterialMaterial

Study Specific FociStudy Specific Foci

Areas CoveredAreas Covered NeighborhoodNeighborhood Religion Religion Cognitive FunctioningCognitive Functioning Psychological ResourcesPsychological Resources Health ProblemsHealth Problems EmploymentEmployment Family and FriendsFamily and Friends Mental Health (CIDI and Other Mental Health)Mental Health (CIDI and Other Mental Health)

Areas Covered (cont.)Areas Covered (cont.)

Use of Help ResourcesUse of Help Resources Group and Personal IdentityGroup and Personal Identity DiscriminationDiscrimination Demographics (Including ancestry)Demographics (Including ancestry) Immigration Immigration PoliticsPolitics DetentionDetention Technology and 3-Generation EligibilityTechnology and 3-Generation Eligibility

Mental Health SectionsMental Health Sections

Screening Questions for DisordersScreening Questions for Disorders DepressionDepression Mania Mania Panic Disorder Panic Disorder Social PhobiaSocial Phobia AgoraphobiaAgoraphobia Generalized Anxiety DisorderGeneralized Anxiety Disorder SuicidalitySuicidality Substance UseSubstance Use Pharmaco EpidemiologyPharmaco Epidemiology PersonalityPersonality Post-Traumatic Stress DisorderPost-Traumatic Stress Disorder

Mental Health Sections Mental Health Sections (cont.)(cont.)

30-Day Symptoms (CES-D)30-Day Symptoms (CES-D) Tobacco UseTobacco Use Eating DisordersEating Disorders Premenstrual SyndromePremenstrual Syndrome Obsessive Compulsive DisorderObsessive Compulsive Disorder Psychosis ScreenPsychosis Screen Gambling ScreenGambling Screen Family HistoryFamily History Attention Deficit/Hyperactivity <45Attention Deficit/Hyperactivity <45 Oppositional Defiant Disorder <45Oppositional Defiant Disorder <45 Conduct Disorder <45Conduct Disorder <45 Separation Anxiety Disorder Separation Anxiety Disorder Services UsedServices Used

Immigration Status Immigration Status and Ancestry Matter and Ancestry Matter for Afro-Caribbeansfor Afro-Caribbeans

Lifetime Any Disorder**Lifetime Any Disorder** (in percentages) (in percentages)

47.6

23.0 22.0

12.915.3

0

10

20

30

40

50

R & ParentsU.S. Born

R U.S. Born, 1+ Parents

Not

R Came to U.S. >20 Yrs

Ago

R Came to U.S. 11-20 Yrs

Ago


Ago

White*

African American

Caribbean

Source: NSAL, National Survey of American Life, 2004.Note: Adjusted for age.F-Statistics significant, p < .001*NSAL Whites living in areas with Black population of 10% or more.**Includes 7 disorders asked of all races: Major Depression, Dysthymia, Mania, Panic Disorder, Social Phobia, Generalized Anxiety Disorder, and Agoraphobia

31.5

20.822.6

0

10

20

30

40

50

Total

12-Month Any Disorder**12-Month Any Disorder** (in percentages) (in percentages)

27.7

13.3

14.7

8.29.5

0

5

10

15

20

25

30



Not


Ago


Ago


Ago

White*

African American

Caribbean

Source: NSAL, National Survey of American Life, 2004.Note: Adjusted for age.First graph: F-Statistic significant, p < .05. Second graph: F-Statistic significant, p < .001.*NSAL Whites living in areas with Black population of 10% or more.**Includes 7 disorders asked of all races: Major Depression, Dysthymia, Mania, Panic Disorder, Social Phobia, Generalized Anxiety Disorder, and Agoraphobia

15.5

11.9

13.9

0

5

10

15

20

25

30

Total

Age, Ancestry, and Timing of Age, Ancestry, and Timing of Immigration Matter for Black Immigration Matter for Black

CaribbeansCaribbeans

Lifetime Any Disorder for Black Lifetime Any Disorder for Black Caribbeans Over 55 Years of AgeCaribbeans Over 55 Years of Age

50.6

7.7

11.58.8

43.3

0

10

20

30

40

50



Not


Ago


Ago


Ago

Source: NSAL, National Survey of American Life, 2004.F-Statistics significant, p < .001*NSAL Whites living in areas with Black population of 10% or more.**Includes 7 disorders asked of all races: Major Depression, Dysthymia, Mania, Panic Disorder, Social Phobia, Generalized Anxiety Disorder, and Agoraphobia

31.5

20.822.6

0

10

20

30

40

50

Total

White

African American

Caribbean

Over 55 Years of Age at Time of Interview

Lifetime Any Disorder for Black Lifetime Any Disorder for Black

Caribbeans 35 to 54 Years of AgeCaribbeans 35 to 54 Years of Age

60.7

42.1

30.5

9.9

18.4

0

10

20

30

40

50



Not


Ago


Ago


Ago


31.5

20.822.6

0

10

20

30

40

50

Total

White

African American

Caribbean

35 to 54 Year Years of Age at Time of Interview

Lifetime Any Disorder for Black Lifetime Any Disorder for Black

Caribbeans 18 to 34 Years of AgeCaribbeans 18 to 34 Years of Age

65.6 52.9

27.1

36.538.8

0

10

20

30

40

50



Not


Ago


Ago


Ago


31.5

20.822.6

0

10

20

30

40

50

Total

White

African American

Caribbean

18 to 34 Years of Age at Time of Interview

Never Arrested, Never Detained

Arrested, Never Detained

Reform, Detention Ctr Only

Jail, Prison

Substance Disorder:

Black 3.7% 18.9% 24.7% 32.8% N 81 122 19 164

Caribbean 3.7 13.0 51.4 42.1 N 42 28 18 67

White ****** ****** ****** ****** N ****** ****** ****** ******

Any Disorder:

Black 27.7% 36.2% 54.5% 51.0% N 601 233 42 255

Caribbean 24.7 40.1 57.1 60.4 N 282 87 20 96

White 27.1 37.3 50.0 43.8 N 184 31 4 42

(in percentages)Detention Status

(Black N = 3570; Caribbean N = 1623; White N = 891)

1 time 2 times 3+ times

Substance Disorder:Black 24.1% 40.7% 45.7%

N 68 33 63

Caribbean 19.0 67.3 43.9

N 12 37 18

White ****** ****** ****** N ****** ****** ******

Any Disorder:Black 42.8% 57.5% 63.8%

N 121 46 88

Caribbean 34.4 87.3 65.9

N 22 48 27

White 47.2 42.9 36.4

N 25 9 8

(Black N = 3570; Caribbean N = 1623; White N = 891)

# of Times Jailed or imprisoned(in percentages)

Less than 6 mos 6+ Mos

Substance Disorder:Black 28.0% 41.2%

N 89 75

Caribbean 44.6 40.0

N 33 34

White ****** ****** N ****** ******

Any Disorder:Black 45.6% 60.4%

N 145 110

Caribbean 56.2 64.7

N 41 55

White 44.0 42.9

N 33 9

(in percentages)(Black N = 3570; Caribbean N = 1623; White N = 891)

# of Months Spent in Jail or Prison

Summary from NSAL Cross-Section Summary from NSAL Cross-Section StudyStudy

Serious mental health problems manifest in different ways Serious mental health problems manifest in different ways among race and ethnic groups in the united statesamong race and ethnic groups in the united states

Black ethnicity is an important source of these differencesBlack ethnicity is an important source of these differences Among Afro-Caribbeans, immigrant and ancestry status Among Afro-Caribbeans, immigrant and ancestry status

make important differencesmake important differences First generation health protection is not an adequate First generation health protection is not an adequate

explanation for differences among Afro-Caribbeans, whites explanation for differences among Afro-Caribbeans, whites and African Americansand African Americans

Mental health disparities are not reducible in any simplistic Mental health disparities are not reducible in any simplistic way to differences in social and economic statuses among way to differences in social and economic statuses among groupsgroups

Complex, multi-faceted, and life-course influencedComplex, multi-faceted, and life-course influenced

Family Connections Across Generations and Nations

International Multi-Generational Survey:

Multi-Generation StudyMulti-Generation Study

Funded by National Institute on Aging and Funded by National Institute on Aging and National Institute on Drug AbuseNational Institute on Drug Abuse

Goal: Interview three Goal: Interview three consecutiveconsecutive family family generation members in an effort to better generation members in an effort to better understand how they interact, how they understand how they interact, how they cope, and what similarities and differences cope, and what similarities and differences they sharethey share

Caribbean

U.S. UK Canada

Black Caribbean Diaspora

Focal and Family Focal and Family RespondentsRespondents

Focal respondents obtained from NSAL (~ Focal respondents obtained from NSAL (~ 1,612)1,612)

Family members living in U.S. (~1,803), Family members living in U.S. (~1,803), Caribbean, Europe or Africa (~1,000)Caribbean, Europe or Africa (~1,000) Sampling method will maximize family Sampling method will maximize family

members living internationallymembers living internationally

Diagram OrganizationDiagram OrganizationGrandparents G1

Parents G2

Respondent G3

Children G4

Grandchildren G5

P1A P1B P2A P2B

P1

R

P2

C1 C2

C1A C1B C2A C2B

Select Caribbean Countries Select Caribbean Countries IncludedIncluded

AnegadaAnegada Bahamas Bahamas Barbados Barbados British Virgin Islands British Virgin Islands Dominican Republic Dominican Republic Grenada Grenada Guyana Guyana Jamaica Jamaica Puerto Rico Puerto Rico Saint Croix Saint Croix Saint John Saint John Saint Thomas Saint Thomas Saint Vincent and The Grenadines Saint Vincent and The Grenadines Tortola Tortola Trinidad and Tobago Trinidad and Tobago U.S. Virgin IslandsU.S. Virgin Islands Virgin GordaVirgin Gorda

Countries included based on distribution of focal respondents in NSAL, and ease of travel and data collection in the countries.

International Multi-Generational International Multi-Generational Survey: United States BaseSurvey: United States Base

Core Multi-Generational Respondent

Caribbean American/European American/African American/Asian American

Hispanic American

Selected Multi-Generational Family Members

United States Africa Europe Asia Caribbean

NSAL Three-Generation and Caribbean Cross-NSAL Three-Generation and Caribbean Cross-Section Field period 2005-2006Section Field period 2005-2006

U.S. Interviews = 2303 (Apr – Dec, 2005)U.S. Interviews = 2303 (Apr – Dec, 2005) Focal R = 1068, Family R = 1235Focal R = 1068, Family R = 1235 African Americans = 854; African Americans = 854; Afro Caribbeans = 655; Afro Caribbeans = 655; Non-Hispanic Whites = 761Non-Hispanic Whites = 761 388 Triads, 447 Dyads, 234 Single Interviews388 Triads, 447 Dyads, 234 Single Interviews

Jamaica Cross-section = 1218 (Aug – Dec)Jamaica Cross-section = 1218 (Aug – Dec) Guyana Cross-section = 2068 (July – Aug)Guyana Cross-section = 2068 (July – Aug)

Average Age by Generation Cohort by Average Age by Generation Cohort by EthnicityEthnicity

69.371.5 72.8

47.4 47.4

53.0

26.6 22.627.5

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Oldest Middle Youngest

African American Caribbean White

Average Years of Education by Average Years of Education by Generation Cohort by EthnicityGeneration Cohort by Ethnicity

11.1 10.8

12.512.8 13.2

13.5

12.3 12.213.0

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0



Average Family Income (2004) Average Family Income (2004) Before Taxes by Generation Before Taxes by Generation

Cohort by EthnicityCohort by Ethnicity

0

10000

20000

30000

40000

50000

60000

70000

Oldes t M iddle Y ounges t


Socio-demographics by Generation Socio-demographics by Generation Cohort by Ethnicity - OldestCohort by Ethnicity - Oldest

African African AmericanAmerican

CaribbeanCaribbean WhiteWhite

FemaleFemale 69.8%69.8% 53.1%53.1% 63.2%63.2%EmployedEmployed 32.6%32.6% 14.6%14.6% 18.4%18.4%Home OwnershipHome Ownership 68.2%68.2% 54.7%54.7% 84.2%84.2%Married or Living w/ Married or Living w/ PartnerPartner 37.5%37.5% 41.3%41.3% 50.2%50.2%U.S. BornU.S. Born 100.0%100.0% 61.8%61.8% 98.4%98.4%

Socio-demographics by Generation Socio-demographics by Generation Cohort by Ethnicity - MiddleCohort by Ethnicity - Middle




Socio-demographics by Generation Socio-demographics by Generation Cohort by Ethnicity - YoungestCohort by Ethnicity - Youngest




Made Changes in Behaviors Made Changes in Behaviors by Ever Been Testedby Ever Been Tested

71.6

38.4

28.4

61.6

0

10

20

30

40

50

60

70

80

Yes No

Yes

No

H54. Ever Been Tested for HIV/AIDS?

H55. Made Changes in Behaviors?

Chances of Getting HIV/AIDS Chances of Getting HIV/AIDS by Ever Been Testedby Ever Been Tested

42.2

7.63.1

35

24.9

53.4

69.8

0

10

20

30

40

50

60

70

High Medium Low None

Yes

No

H54. Ever Been

Tested for HIV/AIDS?

H56. Your Chances of Getting HIV/AIDS?

Chances of Getting HIV/AIDS by Chances of Getting HIV/AIDS by Made Changes in BehaviorsMade Changes in Behaviors

5.21.9

8.9

3.5

40

24.6

45.9

69.9

0

10

20

30

40

50

60

70

High Medium Low None

Yes

No

H55. Made Changes in

Your Sexual or Other

Behaviors due to HIV/AIDS?

H56. Your Chances of Getting HIV/AIDS?

Percent Changed Sexual Behavior Due to Percent Changed Sexual Behavior Due to AIDS/HIV by Generation Cohort by AIDS/HIV by Generation Cohort by

EthnicityEthnicity

25.2 26.0

11.6

49.6

60.8

13.7

59.9

46.8

30.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0



Chances of Getting HIV Virus by Chances of Getting HIV Virus by Ethnicity - OldestEthnicity - Oldest

0.9

11.4

1.84.5

0.7 1.4

16.3 12.5 12.5

78.275.3

83.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

High Medium Low None at All


Chances of Getting HIV Virus by Chances of Getting HIV Virus by Ethnicity - MiddleEthnicity - Middle

3.2 1.2 0.54.9

13.8

2.3

31.4 27.3 28.6

60.5 57.7

68.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0



Chances of Getting HIV Virus by Chances of Getting HIV Virus by Ethnicity - YoungestEthnicity - Youngest

8.4 7.6

0.9

8.25.8

10.6

30.6

42.7

38.3

52.2

43.9

50

0.0

10.0

20.0

30.0

40.0

50.0

60.0



Prevalence of Lifetime Major Prevalence of Lifetime Major Depressive Disorder by Generation Depressive Disorder by Generation

Cohort by RaceCohort by Race

5.4

9.9

15.0

12.1

20.4

18.0

13.011.2

16.3

0.0

5.0

10.0

15.0

20.0

25.0



Prevalence of 12-Month Major Prevalence of 12-Month Major Depressive Disorder by Generation Depressive Disorder by Generation

Cohort by RaceCohort by Race

1.4

0.2

3.8

5.0

13.1

8.7

3.74.0

6.3

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0



Prevalence of Lifetime Bipolar* Prevalence of Lifetime Bipolar* Disorder by Generation Cohort by RaceDisorder by Generation Cohort by Race

2.8

0.3 0.6

7.5

11.2

0.8

6.7

10.8

2.7

0.0

2.0

4.0

6.0

8.0

10.0

12.0



*Combination of Bipolar I, Bipolar II, Subthreshold

Prevalence of Lifetime Alcohol Abuse or Prevalence of Lifetime Alcohol Abuse or Dependence by Generation Cohort by Dependence by Generation Cohort by

EthnicityEthnicity

8.2

15.6

4.0

8.0

12.6

13.9

3.84.0

11.8

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0



Prevalence of Lifetime Drug Abuse or Prevalence of Lifetime Drug Abuse or Dependence by Generation Cohort by Dependence by Generation Cohort by

EthnicityEthnicity

2.6

8.3

1.6

6.7

8.8 9.1

4.3

4.9

14.8

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0



Black Caribbean and African Black Caribbean and African Immigrant 5 City Diaspora StudyImmigrant 5 City Diaspora Study

Toronto ~ 1,500 + Multi-Gen*Toronto ~ 1,500 + Multi-Gen* London ~ 1,500 + Multi-Gen*London ~ 1,500 + Multi-Gen* Jamaica Jamaica 1,500 + Multi-Gen**1,500 + Multi-Gen** Guyana Guyana 2,066 + Multi-Gen**2,066 + Multi-Gen** Miami (Washington DC, Los Angeles) ~ 1,500 + Miami (Washington DC, Los Angeles) ~ 1,500 +

Multi-Gen*Multi-Gen*

*Pending*Pending

**Completed**Completed

Socio-demographics of U.S Born and Socio-demographics of U.S Born and Foreign Born Caribbean, Guyanese and Foreign Born Caribbean, Guyanese and

JamaicanJamaican

US Born US Born CaribbeanCaribbean

Foreign Foreign Born Born

CaribbeanCaribbean

GuyaneseGuyanese JamaicanJamaican

Avg. Age Avg. Age (years)(years)

34.834.8 43.443.4 40.140.1 36.936.9

Avg. Years Avg. Years of Educationof Education

13.413.4 12.912.9 10.8810.88 11.9411.94

FemaleFemale 60.0%60.0% 60.5%60.5% 61.1%61.1% 70.1%70.1%

WorkingWorking 70.7%70.7% 73.8%73.8% 56.2%56.2% 54.4%54.4%

MarriedMarried 35.2%35.2% 45.7%45.7% 49.5%49.5% 33.1%33.1%

Own HomeOwn Home 34.3%34.3% 41.3%41.3% 55.6%55.6% 46.9%46.9%

Percent of Respondents “Screened Into” Percent of Respondents “Screened Into” Lifetime Major Depressive Disorder, Lifetime Major Depressive Disorder,

Mania, Substance Abuse or DependenceMania, Substance Abuse or Dependence

US Born US Born CaribbeanCaribbean

Foreign Foreign Born Born

CaribbeanCaribbean

GuyaneseGuyanese JamaicanJamaican

DepressionDepression 60.9%60.9% 46.0%46.0% 61.9%61.9% 65.3%65.3%

ManiaMania 27.1%27.1% 14.7%14.7% 22.7%22.7% 23.0%23.0%Substance Substance Abuse or Abuse or DependenceDependence

13.6%13.6% 4.8%4.8% 7.7%7.7% 4.1%4.1%

Conclusions on Intra-Generational Conclusions on Intra-Generational Family and Cross-National ComparisonsFamily and Cross-National Comparisons

Life-Course PerspectiveLife-Course Perspective Aging and Multi-GenerationalAging and Multi-Generational Cross-National ComparisonsCross-National Comparisons Tremendous resource for new investigators Tremendous resource for new investigators

interested in R.I.C.E. in the context of aging interested in R.I.C.E. in the context of aging and human developmentand human development

International Multi-Generational International Multi-Generational Survey: Caribbean BaseSurvey: Caribbean Base

Core Multi-Generational Respondent

Jamaica/Guyana

Selected Multi-Generational Family Members

Caribbean/United States/England/Canada/

NSAL Panel Study NSAL Panel Study

Two Wave Face-to-Face Follow-up Two Wave Face-to-Face Follow-up of NSALof NSAL

BiomarkersBiomarkers GenotypingGenotyping Better PhenotypingBetter Phenotyping MD Incidence AssessmentMD Incidence Assessment Longitudinal Social, Psychological Longitudinal Social, Psychological

and Contextual Factorsand Contextual Factors

Outcomes of the NSALOutcomes of the NSAL

In-depth data on important American Black, In-depth data on important American Black, Afro-Caribbean, and Latino, Asian, and Afro-Caribbean, and Latino, Asian, and Non-Hispanic White populations at the Non-Hispanic White populations at the beginning of the new century.beginning of the new century.

International ComparisonsInternational Comparisons

Data that go beyond demographic and Data that go beyond demographic and economic descriptions.economic descriptions.

Outcomes of the Outcomes of the NSALNSAL

Important social, health, mental health, Important social, health, mental health, political, and attitudinal data for new political, and attitudinal data for new scientific discoveries and public policy scientific discoveries and public policy relevant decision-making.relevant decision-making.

Large enough samples to investigate within Large enough samples to investigate within group differences and similarities – group differences and similarities – especially environmental influences.especially environmental influences.

Thank You

Websites for NSAL and CPES Information:

http://rcgd.isr.umich.edu/prba/nsal.htm

http://www.icpsr.umich.edu/sumprog/courses/2007-03-44.html

http://www.icpsr.umich.edu/training/index.html



http://www.icpsr.umich.edu/training/index.html

conferences.jbsinternational.com

Health & Medicine

ethnic health disparities

physical health disparities

health status

poor health

health services

health care populations

raceethnic disparities

health care utilization