RACE ETHNICITY & HEALTH
RACE ETHNICITY & HEALTH HLTH 236
Popular in Course
Popular in Health Sciences
This 17 page Class Notes was uploaded by Gus Braun on Wednesday October 21, 2015. The Class Notes belongs to HLTH 236 at Texas A&M University taught by Susan Ward in Fall. Since its upload, it has received 31 views. For similar materials see /class/225859/hlth-236-texas-a-m-university in Health Sciences at Texas A&M University.
Reviews for RACE ETHNICITY & HEALTH
Report this Material
What is Karma?
Karma is the currency of StudySoup.
Date Created: 10/21/15
Exam 1 HLTH 236 Readings Socioeconomic Disparities in Health Interaction of Race and Gender Tuskegee Syphilis Study Classi cation of Races in Europe and North America Understanding Racialethnic disparities in health 0 Diminishing returns 0 Differences between raceethnicities Racial residential segregation Population Pro ling and public health risk 0 South African national Blood Service Overview of race and Hispanic origin Census Briefs 0 De nitions of Race Categories 9 The in uence of RaceEthnicity amp SES on Endoflife care in the ICU Socioeconomic Disparities in Health in the US Race Socioeconomic status and health Specifying raceethnic differences in risk for psychiatric disorders in the US Racial disparities in awareness of the Human papillomavirus The relationships among body size biological sex ethnicity amp health lifestyles in Adolescents Racial differences in the use of cardiac catheterization after acute myocardial infarction RacialEthnic Disparities in Stroke Care U39 eENN gt19quot 9 t It Ib Ip Il It It I G kIIJALNNt IO Motion Charts Census Data Motion Chart Infant Mortality Motion Chart Immigration Data Motion Chart SES Data Motion Chart Leading Causes of Death Motion Chart Health Care Utilization Motion Chart Power Point Review Introduction to Race Ethnicity and Health 0 Race Social Category Physical appearance due to particular historical social and political forces Focused on physical characteristics Ethnicity Social category Shared Cultural identity with distinct behavioral characteristics Focused on Common cultural traits Nationality Membership to a Nation or sovereign state citizenship place of residency sense of national identity Health Disparities incidence prevalence mortality and burden of disease within a population Health Care disparities differences in the presence of illness health outcomes or access to care within a population Inequality in Health differences in both health experience and health status between countries regions states and socioeconomic groups Inequity in Health systematic unfair or unjust yet potentially avoidable differences in access to health services across defined population groups Determinants of health Factors which directly cause illness and disease or are risk factors that affect the health of a population community or individual 0 Socioenvironmental factors 0 Physical Environmental factors 0 Individual factors 0 Access to Health services Mortality Number of deaths Within a population 0 Crude Mortality Rate total number within a time period 0 Causespecific attributed to a particular causedisease illness 0 Agespecific specific age group 0 Infant mortality rate infants under the age of 1 Life EXpectancy average years a person can expect to live a healthyproductive lifestyle that is determined at a particular age Morbidity Number of individuals with a disease illness injuries and disabilities within a population 0 Incidence number of persons contractingnew cases of a disease 0 Prevalence number of persons who haveall cases a particular diseasecondition Socioeconomic Status measure of social and economic characteristics that typically include measures of 0 Income Poverty level Wealth Education Work status occupation Place of residence OOOOO Historical Background 0 The Plessy v Ferguson decision 1896 endorsed the development of state and local Jim Crow laws requiring the separation of the races These laws applied not only schools and other public accommodations but also health care Jim Crow Period Black Code regulated racial and ethnic minorities to second class citizenship As early as 1899 W E B Du Bois one ofthe most in uential African American intellectuals of the 20Lh century published The Philadelphia Negro where he used social science methods to describe social and economic conditions that shaped the quality of life and health status of African Americans Booker T Washington was the founder and president of Tuskegee Institute in Alabama Washington made a direct link between the economic progress of Blacks and the negative impact being caused by premature death from disease With leadership from Booker T Washington the Negro Health Improvement Week was launched in 1915 The program grew into a yearround campaign across the nation and became so successful that around 1932 it was adopted by the US Public Health Service as part of the new federal Office of Negro Health Works In 1951 however the Office of Negro Health Works was decommissioned in the name of integration and thus brought to an end the longest sustained minority health campaign in US history African Americans arrived in 1619 slavery lasted 244 years Tuskegee 193219727Carried out in Macon County Alabama involved 600 black men 399 with Syphilis and 201 without disease The US public health service in trying to learn more about syphilis and justify treatment programs for blacks withheld adequate treatment from a group of poor black men who had the disease Researchers told the men they were being treated for bad Blood They did not receive the proper treatment needed to cure their illness In exchange the men received free medical exams free meals and burial insurance It was originally projected to last 6 months but actually went on for 40 years Summer of 1973 a classaction lawsuit filed by the national Association for the Advancement of Colored People NAACP ended in a settlement that gave more than 9 million to the study participants and the US government promised to give free medical and burial services to all living participants The Tuskegee Health Benefit Program was established to provide these services It also gave health services for wives widows and children who had been infected because of the study Margaret Heckler Secretary of USDepartment of Health and Human Services released the Secretary 3 Task Force Report on Black anal Minority Health The 10 volume landmark report documented excess deaths from seven disease conditions cancer cardiovascular diseases chemical dependency diabetes homicide unintentional injuriesand infant mortality experienced by African Americans Hispanics Native Americans and Asian andor Paci c Islander and Alaskan Native populations Black people got inferior care because of their race Amendments Directive 15 Emancipation Proclamation After more than 240 years of slavery President Abraham Lincoln issued the Emancipation Proclamation on January 1 1863 announcing quotthat all persons held as slavesquot within the rebellious areas quotare and henceforward shall be free 13111 Amendment rati ed in 1865 outlawed slavery in the US and all territories 14th Amendment The 143911 amendment paved the way equal educational opportunities with the Supreme Court s declaration in Brown v Board of Education that racially segregated schools violate the equal protection of the laws guaranteed by the Fourteenth Amendment 15111 Ammendment Male Voting rights however a plethora of insidious methodologies for preventing African Americans from exercising their voting rights were successfully implemented by racist whites who dominated the corridors leading to the voting booths Voter qualifying tests eg literacy tests discriminatory enforcement of registration rules poll taxes and outright racial gerrymandering were just some of the devices standing between African Americans and their constitutionally guaranteed right to both register to vote and vote Civil rights act of 1964 o Prohibited discrimination in public accommodations such as mass transportation restaurants and hotels on the basis of race color religion or national origin shifted government policy away from the support of racially discriminatory social norms Voting Rights Act 1965 o Eliminated discriminatory election practices and suspended literacy tests and provided for the appointment of federal examiners this and the CRA dismantled the most limiting components of the Jim Crow Laws and ful lled the constitutional guarantees contained in the 14Lh and 15th amendments 19111 Amendment The 19th amendment guaranteed all American women the right to vote Of ce of Management and Budget OMB issued in 1977 the quotRace and Ethnic Standards for Federal Statistics and Administrative Reportingquot contained in Statistical Policy Directive No 15 Directive 15 is an attempt to standardize data collection so that comparisons of races could be made by creating categories to classify individuals Importance of Studying Minority Health The public cost of disparitiesA disproportionate burden of disease among racial and ethnic minorities results in greater health care expenditures not only for these groups but for the rest of society This shared risk begs the question What would the cost savings be for society as a whole if disease rates for all racial and ethnic groups were the same as those for non Hispanic whites The costs of health disparities to business According to the Us Bureau of Labor Statistics by 2015 racial and ethnic minorities will comprise 415 percent of the work force A recent report by the National Business Group on Health found that there are two major nancial incentives to motivate businesses to care about reducing health disparities rst the possibility of reducing direct health care costs and second the advantage of reducing the indirect costs that result from poor health and illness Direct Costs Direct health care costs are those dollars companies spend to treat an employee s health condition illness or disease the bulk of these costs are insurance premiums While employerbased health insurance is an expected bene t in whitecollar professional jobs the cost of providing this bene t continues to grow exponentially each year Given that the labor force is becoming more ethnically diverse providing mp1 J r A health r quot programs to reduce health disparities would result in signi cant savings in health care expenditures Rather than spending dollars on interventions to treat existing are 39 to it is more cost effective to diseases many r promote health and prevent disease Not only does this bene t the employee in terms of better quality of life it bene ts the employer by reducing the direct costs of treatment for preventable diseases and health conditions Indirect Costs The indirect costs of health disparities are equally disruptive and costly to productivity Indirect health costs include compromised onthejob productivity due to poor health or illness as well as total loss of productivity due to absenteeism One employee in poor health impacts the entire organization by creating stress on other employees as they attempt to ll the void disrupting the work environment through disability leave and levying the extra costs of hiring and training new employees as replacements National Center on Minority Health and Health Disparities N CMHD In 2000 Congress established the NCMHD to lead coordinate support and assess the NIH effort to eliminate health disparities One of the signi cant outcomes of the legislation was a Strategic Plan and Budget for Eliminating Health Disparities to enhance NIH efforts in I research 2 research infrastructure and 3 public information and community outreach Two demographic Trends 0 An aging society combined with increasing proportions of minorities that place an increasing demand on a health care system that seems ill prepared to handle it thus it s important for minority health to be a central feature of training programs in public health medicine nursing social work pharmaceutical science and other disciplines that relate to health 0 Why health disparities exist 0 Group identity by appearance culture nationality etc 0 Provide adequate health services for all minorities 0 Prepare for the next generation of health professionals to work with and in minority populations 0 Minorities will eventually make up 50 percent of the population Mortality Rate 0 Infant Mortality Rate Probability of dying between birth and exactly one year of age expressed per 1000 live births o NeoNatal Mortality RateNumber of deaths during the first 28 completed days of life per 1000 live births in a given year or other period 0 Post NeoNatal Mortality Rate rate of newborns dying between 28 and 364 days of age Socio economical Model 0 Intrapersonal o Interpersonal 0 Organizational 0 Community 0 Public Policy Epidemiology 0 Incidence and Prevalence 0 Incidence Rates The rate a disease develops in a group of people over a certain period of time Number of new cases Divide the number of new cases by the number of people at risk and multiply 0 Prevalence RatesNumber of existing cases of a disease in a population at some designated timeDivide number of cases by total number in population at a given time 0 Mortality and Morbidity 0 Mortality Number of deaths in a population at a given time o Morbidity Number of ill individuals among a group of people at risk for the illness at a given time 0 Infant Mortality Number of infant deaths among infants 0365 days at a given period of time divided by the population size at midpoint times of multiplier generally 1000 0 Neonatal Mortality The same as infant mortality except involves infants from 028 days 0 Speci c Rates Stratified rates 0 Adjusted RatesStatistical procedures applied to make crude rates more comparable 0 Mortality Crossover Mortality rates that illustrate two groups of individuals vary in one way for younger versus older individuals 0 Comparative Mortality Crude mortality rates can not be compared Age adjusted and specific mortality rates can be compared more accurately 0 Acute Short term 0 Chronic Long term 0 Birth Rates 0 Number of live births at a given time 0 Divide the of live births in selected time by the population size at midpoint of a selected time period then multiply 0 Years of Potential Life Lost 0 YPLL o The number of years that are lost due to untimely death Based upon average life expectancy Does not include quality of life in the calculation Socioeconomic Status 0 Raceethnicity shown to determine a person s SES 0 Discrimination may be foundation of SES inequalities o Minorities are more likely to 0 Live in poverty 0 Receive highcost mortgages 0 Be unemployed o 25 American women of South Asian descent did not have a Pap smear in past 3 years 0 Avoidable procedures hospitalizations and untreated disease 0 Low birth weight and negative child health outcomes 0 Minority children in highpoverty areas are more likely to be exposed to alcohol and tobacco advertisements 0 Research indicates there is a strong relationship between SES and an increased risk of being affected by health disparities 0 Income 0 Education 0 Occupation status 3 Determinants of Health 0 Behavior amp Lifestyle 0 Tobacco use poor nutrition 0 Environmental Exposure 0 Poor communities residential crowding violence pollution 0 Social environment 0 Risk and prevalence of chronic and infectious disease 0 Healthcare 0 Access lack of preventive and primary health services Low SES and Health 0 Increased morbidity and mortality 0 More likely to suffer from mental disorder 0 Martial distress and disrupted parenting 0 Children with depression substance abuse behavior problems 0 Barriers 0 Health care child care transportation etc Closing the Gap 0n SES Disparities 0 Providing health coverage 0 Improving economic conditions 0 Increasing educational opportunities 0 Introducing culturally sensitive health promotion efforts Future Directions using SES 0 Lifestyles 0 Health related behaviors highrisk behaviors 0 Mental health 0 Coping resources cognitive abilities 0 Access to healthcare 0 Use of healthcare 0 Social network and support 0 Exposure to psychosocial physical chemical stressors o SES and disability prevalence o Acculturation Health behaviorshealth beliefs 0 De nition Mosby s Medical Dictionary 8th edition 2009 Elsevier 0 An action taken by a person to maintain attain or regain good health and to prevent illness 0 Health behavior re ects a person s health beliefs 0 Implicit amp explicit 0 Examples 0 Exercise levels none some daily too much 0 Eating behaviors balanced diet high fat diet vegan diet 0 Vaccinations none or all 0 Smoking not or daily 0 TypesClassifications 0 Health enhancing Have health bene ts to the person practicing the behavior aka Preventive Behaviors Illness Behaviors 0 Health impairing Have harmful effects on the health of the person engaged in the behaviors aka Risk Behaviors Implicit vs Explicit o Implicit Implied or understood though not directly expressed Contained in the nature of something though not readily apparent o Explicit Clearly developed or formulated Fully and clearly expressed or demonstrated Culture and Implicit health attitudes 0 Cultural traditions and beliefs shape our attitudes o Attitudes and contexts shape our behaviors 0 Therefore health behaviors not always motivated by health but by other factors 0 Smoking rates among women 0 22 in developed countries 0 9 in developingunderdeveloped countries Preventative behaviors and types of prevention 0 Primary 0 Strategies used to avoid diseases 0 ExamplesVaccinations 0 Secondary 0 Early diagnosis and treatment of existing disease andor health condition in order to avoid further debilitative effects 0 Examples Screenings Self BE for amp pap smears for cervical cancer 0 Aim Catch it early to avoid advancement o Tertiary 0 Fighting the disease andor health condition when signs symptoms present to minimize complications 0 Examples Medication therapy adherence changing dietexercise regimen o Quaternary o Avoidance of overtreatment Illness behaviors and types of prevention 0 Behaviors people engage in with the aim of relieving effects of illness 0 Examples Seeing a therapist for psychological symptoms taking pain killer for arthritis pain 0 Closest to Secondary Prevention 0 Illness behaviors strongly linked to sociodemographic factors such as 0 Gender Utilization of medical services higher in women than men 0 Ethnicity Utilization of medical services lower among Hispanics amp Blacks compared to Whites amp Asians Education 0 0 Social classincome Utilization of medical services greater among higher SES than lower 0 Family structure Risk behaviors 0 Any behavior that puts an individual at risk for negative consequences 0 Behaviors which are associated with increased risldsusceptibility to adverse health consequences eg illness injury 0 Examples Illicit drug use nonadherence to prescribed medical regime not using seatbelts 0 Gray area for Health Risk behaviors 0 Good behaviors gone bad 0 Examples Drug Use Exercise Sexual Activity Determinants of health 0 Healthy People 2020 is exploring these questions by developing objectives that address the relationship between health status and biology individual behavior health services social factors and policies and emphasizing an ecological approach to disease prevention and health promotion An ecological approach focuses on both individuallevel and populationlevel determinants of health and interventions o Determinants of health fall under five broad categories 0 Policymaking Policies at the local State and Federal level affect individual and population health Increasing taxes on tobacco sales for example can improve population health by reducing the number of people using tobacco products 0 Social Factors Social determinants of health re ect social factors and the physical conditions in the environment in which people are born live learn play work and age Also known as social and physical determinants of health they impact a wide range of health functioning and quality of life outcomes Poor health outcomes are often made worse by the interaction between individuals and their social and physical environment Health services Both access to health services and the quality of health services can impact health Healthy People 2020 directly addresses access to health services as a topic area and incorporates quality of health services throughout a number of topic areas Lack of access or limited access to health services greatly impacts an individual s health status For example when individuals do not have health insurance they are less likely to participate in preventive care and are more likely to delay medical treatment 0 0 Individual behavior Individual behavior also plays a role in health outcomes For example if an individual quits smoking his or her risk of developing heart disease is greatly reduced Biology and Genetics Some biological and genetic factors affect specific populations more than others For example older adults are biologically prone to being in poorer health than adolescents due to the physical and cognitive effects of aging O Disparity those differences that are indicative of injustice or unfairness Dissimilarities differences that are not attributed to injustice or unfairness Health disparities o a particular type of health difference that is closely linked with social economic andor environmental disadvantage Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group religion socioeconomic status gender age mental health cognitive sensory or physical disability sexual orientation or gender identity geographic location or other characteristics historically linked to discrimination or exclusion Health care disparities 0 refers to differences specifically within the healthcare system access to health care quality of health care and utilization of health care services that are a result of injustice Health care dissimilarities 0 refers to theses same differences within the health care system access to health care quality of health care and utilization of health care services that are NOT a result of injustice Health equity attainment of the highest level of health for all people Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities historical and contemporary injustices and the elimination of health and health care disparities Health Care Utilization o Enabling factors are resources that either facilitate or inhibit someone seeking health care services For example having a car is a facilitating factor because it provides transportation a useful resources for physically traveling to a health care provider Having no health insurance would be an inhibiting factor because it often deters one from seeking health care services 0 Predisposing Factors 7 are an individual s inclination to use health services most notably one s attitudes toward using health care These attitudes may be facilitating or inhibiting and are largely in uences by cultural beliefs and prior experiences For example if someone distrusts the medical establishment or has had negative experiences with the medical establishment heshe may be less likely to seek health care services Conversely is one has a great relationship with a medical provider heshe is more likely to continue visiting this provider in the future 0 Perceived Need for Health Care Service 7 is one s belief that heshe does or does NOT need to utilize health care services for health issues If one does not perceive a need for an action including health behaviors he she is much less likely to engage in that behavior Leading causes of death 0 heart disease 0 malignant neoplasms tumors 0 For whites blacks American Indians Alaskan Natives and Latinos heart disease is the leading cause of death and malignant tumors cancer is the second leading cause of death 0 For Asians and Paci c Islanders malignant tumors is the leading cause of death while heart disease is the close second Theories of health disparities o Socio Environmental Theories 0 Risk exposure 0 Resource Deprivation 0 Risk exposure 0 First there is risk exposure theory Risk exposure theory says that high prevalence of social or environmental health risks in predominantly minority communities lead to a higher prevalence of disease and death Because the United States is a highly racial segregated country different rates of health risk in different communities place different populations at different levels of risk in those communities 0 Resource Deprivation 0 Resource deprivation says that racial ethnic disparities in health status exist because minorities are more likely than whites to live in communities that are lacking in the necessary infrastructure to support a healthy lifestyle Infrastructure includes road ways food sources safety and health care services to name a few 0 Psychosocialbehavioral theories 0 Among the psychosocialbehavioral theories these theories relate to aspects of the culture or behavior specific racial ethnic groups that in uence the behavior of individuals 0 Weathering Hypothesis 0 The Weathering Hypothesis seeks to explain the differences between AfricanAmericans and Whites in pregnancy outcomes The Weathering Hypothesis proposes that social stress in the community in the environment and the society affects African Americans and other minorities negatively Specifically these populations are said to actually weather or age at accelerated rates because of increased exposure to stress We know that excess stress has numerous health implications including premature aging and associated conditions 0 John Henryism o The John Henryism theory was developed by Sherman James a psychologist who was trying to understand why African Americans have such high rates of hypertension The John Henryism hypothesis assumes that lower SES individuals in general and AfricanAmericans in particular are routinely exposed to psychosocial stressors eg chronic financial strain job insecurity and subtle or not so subtle social insults linked to race or social class that require them to use considerable energy each day to manage the psychological stress generated by these conditions p 167 The hypothesis further assumes that individuals exposed to excess psychosocial stressors will respond differently with varying degrees of success The John Henry Hypothesis predicts that individuals in lower SES categories who utilize active coping skills related to the excess stressors are more likely to suffer from hypertension due to their effort 0 Physiological Theories 0 Genetic differences among racialethnic populations Someone Else s Studv Guide I found Online De nition of Race and the Race concept 0 Race biological term used to describe ethnic groups on the basis of physical characteristics Blumenbach s classi cation of race Caucasian white Mongolian yellow Malayan brown Negro black American red Problems with the race concept Concept has not been clearly defined nor consistently appliediraces are classi ed differently depending on the country There is no consensus definition of race Race is often confounded with other relate concepts such as ethnicity and nationality The existence of races has little support from biological or genetic research Two people with the same genetic makeup can receive a different designation depending on the society they are born The same person can have different status depending on when they were born before 1985 in Japan or after 1989 in the US The terms race ethnicity and nationality are not interchangeable o Often concepts such as ethnicity skin color and nationality are captured together in one inclusive term and this results in some degree of measurement error and leaves a great deal of room for erroneous interpretation of research ndings as well as other consequences Demography and minority Health Demography study of population Characteristics that affect minority health behavioral environmental cultural Racialethnic com position of the U S 300 million people total US population Racialethnic composition of US by percent 0 Whites 751 percent 0 Blacks 123 percent 0 American Indian Alaskan Native 09 percent 0 Asian 36 percent 0 Hispanic Latino 125 percent US Census every ten years official record of the population 0 Data from the first census in 1790 was only categorized into four groups free white males free white females all other free persons and slaves o The second census added a clarification that Indians not taxed were to be excluded in the tabulation of free persons 0 The 1910 census was the first to use the term other 0 The twentieth century also saw the inclusion of additional nationalities including Filipino Mexican and Korean 0 Beginning in the 2000 census it became more permissible for individuals to select as many racialethnicnationality groups as they desired Known Statistics on Child Bearing 0 Highest iPuerto Ricans 0 Lowest Japanese Chinese and AsianPaci c Islander Fertility Minority Health 0 Number of Births per thousand females of childbearing age 1544 0 Fertility number of offspring produced by a population 0 Hispanics Highest 0 Whites and American Indians Lowest Epidemiology in Minority Health 0 Epidemiology The study of the distribution and determinants of mortality death and morbidity disease in human populations 0 Difference between age adjusted crude and other rates 0 Ageadjusted must be adjusted for age which minimizes the effects of differing age distributions when comparing different populations 0 Unadjusted are limited because they do not account for the differences in age distribution of the comparison population 0 Crude Everything 0 What is infant mortality used as a marker of general health status of a population calculated as a total number of infant deaths divided by the total number of live births times 1000 o Lifeexpectancy Number of years a given individual can expect to live assuming that mortality conditions at the person s birth remain the same Survival Curve 0 Shows the population of a birth cohort group projected to be alive as the population ages The curve begins at 100 percent and the percent living declines as the population ages Mortality crossover in Minority Health 0 After a certain age 80 blacks live longer compared to the white population Leading cause ofDeath 0 Heart disease cancer stroke asthma and injuries USPHS Syphilis Study at Tuskegee o 19321972 0 Aim of study was to see if blacks reacted differently were untreated and told they had Bad Blood Mental Health Mental Health the successful performance of mental function resulting in productive activities fulfilling relationships with other people and the ability to adapt to change and to cope with adversity Mental health problems signs and symptoms of insuf cient intensity or duration to meet the criteria for any mental disorder Mental Illness the term that refers collectively to all mental disorders which are health conditions characterized by alterations in thinking mood or behavior associated with distress andor impaired functioning Stress how immigrants adapted to a new location Asians had a lower rate of mental illness because of social support families Black population women are more susceptible to mental illness that men Mood disorders or Depressive disorder a combination of symptoms that interfere with one s ability to work study sleep eat and enjoy pleasurable activities Dysthymic Disorder long term chronic symptoms that do not disable but keep one from functioning well or from feeling good Bipolar disorder cycling mood changes that include one or more manic episodes and one or more major depressive episodes Suicidal disorder organized attempts to harm or kill oneself Psychotic Disorders Schizophrenia brain disorder characterized by delusions hallucinations disorganized speech and behavior and so onimore prevalent in men but women get it at the same rate but men have more severe effects and are less responsive to medications Anxiety Disorders Panic Disorders panic attacks or discrete of intense terror or discomfort in the absence of real threat or danger ObsessiveCompulsive disorder OCD intrusive anxious thoughts and impulses and engagement in ritualized or repetitive behaviors Posttraumatic stress disorder intense fear hopelessness and horror following an extreme traumatic event Social Phobias intense and persistent fear of objects and situations that pose little or no actual danger Generalized Anxiety disorder chronic persistent and exaggerated worry and tension that are difficult to control Eating disorders Anorexia Nervosa the restriction of food and the refusal to maintain a normal body weight Bulimia Nervosa recurrent episodes of binge eating excessive eating and purging Childhood disorders 0 AttentionDeficitHyperactivity Disorder developmental disorder of selfcontrol characterized by a pattern of inattention hyperactivity and impulsivity o Autistic disorder developmental disorder that affects a person s ability to communicate form relationships and respond appropriately to the environment Cognitive disorders 0 Alzheimer s Disease agerelated irreversible brain disorder manifested by memory loss decline in thinking and personality changes Health Care disparities 0 De nitions 0 Differences in quality of care that are not due to clinically appropriate treatment decisions or patient preferencesitreatment equality and quality of care 0 Health status disparities differences among racial or ethnic groups in health status including morbidity mortality and differences in statistics of mortality morbidity disability etc 0 Health Care dissimilarities issues that are not caused by underlying inequities differences are by patient cultural preferences or patient choiceinatural differences that just happen because people are different and people s cultures are different patient preference 0 Role of Institute of Medicine 198920027maj or research arm of federal government that looks at policy and programming regarding health care disparities o Racial and Ethnic variations and access and use of health care insurance trust of system and mistrust location transportation know where to get it and how to get it Knowledge 0 Constructs of the Behavioral Model 0 Enabling factors relate to structural or material resources that can be barriers or facilitators in seeking care EX having health insurance the ability to take sick time off from work having access to transportation or having preexisting relationship with a health care provider 0 Predisposing factors measure the patient s inclination to use health services this includes the patient s attitudes toward using care which are influenced by cultural beliefs prior experiences and perceptions 0 Need for health care refers to the patient s perceived need for health care services this includes the individual s health status and the severity and duration of their symptoms 0 Population and situations relating to cultural competence roles of health related and cultural values disease in most cases racial and ethnic minorities aren t seen by providers who aren t the same race as them