Skip to main content
SpringerLink
Log in

A Trajectory Model for Understanding and Assessing Health Disparities in Immigrant/Refugee Communities

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

While numerous factors contributing to racial/ethnic health disparities have been identified, the clustering and interaction of these factors as a syndemic or trajectory has not been well-studied (Starfield in Soc Sci Med 64:1355–1362, 2007; Singer in Soc Sci Med 39(7):931–948, 1994). More importantly, for immigrant/refugee populations, the interaction of contributing factors is not documented adequately enough to provide a solid framework for planning, implementation and evaluation of interventions aimed at reducing disparities. In this paper, the authors draw from the literatures on health disparities and immigrant/refugee health, as well as direct program and research experience, to propose an approach for assessment of the diachronic interaction of ecological factors (a trajectory, or “diachronic ecology”) contributing to health disparities among immigrant/refugee populations. It is our hope that this approach will contribute to the important effort to collect data supporting the development of interventions and policies that effectively address the dynamic processes through which health disparities are created, maintained, and changed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. Though the current emphasis on racial/ethnic health disparities was foreshadowed much earlier in separate efforts by W. E. B. DuBois and Booker T. Washington to address African-American health issues (DuBois 1906/2003; Quinn and Thomas 1996; Thomas et al. 2006).

  2. Though exercise and health “fads” have existed for some time, and of course, it has always been a part of life for athletes. We are referring to the popularization of exercise as part of a modern lifestyle, where it has become a significant commercial enterprise and consumer choice (fitness centers, gyms, running paths, sports apparel, etc.).

  3. As a syndemic. See, for example, [1].

References

  1. Singer M. AIDS and the health crisis of the urban poor: the perspective of critical medical anthropology. Soc Sci Med. 1994;39(7):931–48.

    Article  PubMed  CAS  Google Scholar 

  2. Starfield B. Pathways of influence on equity in health. Soc Sci Med. 2007;64:1355–62.

    Article  PubMed  Google Scholar 

  3. US Department of Health and Human Services (DHHS). Healthy people 2010. Rockville Md: US DHHS; 2000.

    Google Scholar 

  4. El Nasser H. The USA’s soaring population: 299,976,463 and counting… USA Today July 4; 2006.

  5. Singh GK, Miller BA. Health, life expectancy, and mortality patterns among immigrant populations in the United States. Can J Public Health. 2004;95(3):I14–21.

    PubMed  Google Scholar 

  6. US Department of Health and Human Services (DHHS). Report of the US department of health and human services secretary’s task force on black and minority health, volume 1, executive summary. Washington, DC: US DHHS; 1995.

    Google Scholar 

  7. Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care; 2003.

    Google Scholar 

  8. Lillie–Blanton M, Lewis CB. Issue brief: policy challenges and opportunities in closing the racial/ethnic divide in health care. Menlo Park: The Henry J. Kaiser Family Foundation; 2005.

    Google Scholar 

  9. Lillie–Blanton M, Rushing EO, Ruiz R, Mayberry R, Boone L. Racial/ethnic differences in cardiac care: the weight of the evidence. Menlo Park: The Henry J. Kaiser Family Foundation; 2002.

    Google Scholar 

  10. SteelFisher GK. Issue brief—addressing unequal treatment: disparities in health care. New York: The Commonwealth Fund; 2004.

    Google Scholar 

  11. Agency for Healthcare Research, Quality. Third national healthcare disparities report. Rockville: AHRQ, DHHS; 2005.

    Google Scholar 

  12. Agency for Healthcare Research, Quality. Program brief: AHRQ activities to reduce racial and ethnic disparities in health care. Rockville: AHRQ, DHHS; 2007.

    Google Scholar 

  13. Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health. 2006;27:167–94.

    Article  PubMed  Google Scholar 

  14. Hernandez DJ, Charney E, editors. From generation to generation: the health and well-being of children in immigrant families. Washington, DC: National Academy Press; 1998.

    Google Scholar 

  15. Landale NS, Oropesa RS, Gorman BK. Immigration and infant health: birth outcomes of immigrant and native-born women. In: Hernandez DJ, editor. Children of immigrants: health, adjustment and public assistance. Washington, DC: National Academy Press; 1999.

    Google Scholar 

  16. Guendelman S, Gould JB, Hudes M, Eskenazi B. Generational differences in perinatal health among the Mexican American population: findings from the NHANES 1982–1984. Amer J Pub H. 1990;80:61–5.

    Article  Google Scholar 

  17. Guendelman S. Sociocultural factors in hispanic pregnancy outcomes. In: Morton CJ, Hirsch RG, editors. Developing public health social work programs to prevent low birthweight and infant mortality: high risk populations and outreach. Berkeley: University of California Press; 1998.

    Google Scholar 

  18. Ackerman LK. Health problems of refugees. J Am Board Fam Pract. 1997;10(5):337–48.

    PubMed  CAS  Google Scholar 

  19. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.

    Article  PubMed  CAS  Google Scholar 

  20. Mensah GA, Mokdad AH, Ford ES, Greenlund KJ, Croft JB. State of disparities in cardiovascular health in the United States. Circulation. 2005;111(10):1233–41.

    Article  PubMed  Google Scholar 

  21. Jasso G, Massey DS, Rosenzweig MR, Smith JP. Immigrant health: selectivity and acculturation. Paper prepared for the national academy of sciences conference on racial and ethnic disparities in health; no date.

  22. Jasso G, Massey DS, Rosenzweig MR, Smith JP. The new immigrant pilot survey (NIS): overview and findings about U.S. Immigrants at Admission. Demography. 2000;37(1):127–38.

    Article  PubMed  CAS  Google Scholar 

  23. Portes A, Rumbaut RG. Immigrant America: a portrait. Berkeley: University of California Press; 2006.

    Google Scholar 

  24. Rumbaut RG, Portes A. Introduction—ethogenesis: coming of age in immigrant America. In: Rumbaut RG, Portes A, editors. Ethnicities: children of immigrants in America. Berkeley: University of California Press; 2001.

    Google Scholar 

  25. Rumbaut RG, Portes A, editors. Legacies: the story of the immigrant second generation. Berkeley: University of California Press; 2001.

    Google Scholar 

  26. Kaiser Family Foundation. Mexican immigrants’ health status worsens after living in the U.S., Study Finds. Daily health policy report. San Francisco: Kaiser Family Foundation; 2005.

    Google Scholar 

  27. Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J. Culturally competent healthcare systems: a systematic review. Amer J Prev Med. 2003;24(3S):68–79.

    Article  Google Scholar 

  28. Corbie-Smith G. The continuing legacy of the tuskegee syphilis study: considerations for clinical investigation. Am J Med Sci. 1999;317(1):5–8.

    Article  PubMed  CAS  Google Scholar 

  29. Geiger HJ. Racial stereotyping and medicine: the need for cultural competence. CMAJ. 2001;164(12):16–9.

    Google Scholar 

  30. Kawachi I, Kennedy BP, Wilkinson RG. Society and population health reader, volume i: income inequality and health. New York: The New Press; 1999.

    Google Scholar 

  31. LaVeist TA, John MW. Health risk and the inequitable distribution of liquor stores in African-American neighborhoods. Soc Sci Med. 2000;51:613–7.

    Article  PubMed  CAS  Google Scholar 

  32. Morland K, Wing S, Diez–Roux A, Poole C. Neighborhood characteristics associated with location of food stores and food service places. Am J Prev Med. 2002;22:23–9.

    Article  PubMed  Google Scholar 

  33. Richards CF, Lowe RA. Researching racial and ethnic disparities in health. Acad Emerg Med. 2003;10(11):1169–75.

    Article  PubMed  Google Scholar 

  34. Shihadeh ES, Flynn N. Segregation and crime: the effect of black isolation on the rates of black urban violence. Sociol Forces. 1996;74:1325–52.

    Article  Google Scholar 

  35. Thomas SB, Quinn SC. The tuskegee syphilis study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community. Amer J Pub H. 1991;81:1498–505.

    Article  CAS  Google Scholar 

  36. Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404–16.

    PubMed  CAS  Google Scholar 

  37. Greenberg M, Rahmanou H. Looking to the future: a commentary on children of immigrant families. Los Altos: David & Lucile Packard Foundation; 2004.

    Google Scholar 

  38. Capps R. Hardship among children of immigrants: findings from the national survey of American families. Number B-29 in a series of reports entitled new federalism: national survey of American families. Washington, DC: Urban Institute; 1999.

    Google Scholar 

  39. Hagan J, Rodríguez N, Capps R. Effects of the 1996 immigration and welfare reform acts on communities in Texas and Mexico. Houston: University of Houston center for immigration research, working paper WPS; 1999. p. 99–110.

    Google Scholar 

  40. Aday LA. At risk in America: the health and health care needs of vulnerable populations in the United States. San Francisco: Jossey–Bass; 1993.

    Google Scholar 

  41. Flaskerud JH, Betty JW. Conceptualizing vulnerable populations health-related research. Nurs Res. 1998;47(2):69–78.

    Article  PubMed  CAS  Google Scholar 

  42. Sebastian JG. Definitions and theory underlying vulnerability. In: Sebastian JG, Bushy A, editors. Special populations in the community: advances in reducing health disparities. Gaithersburg: Aspen Publications; 1999.

    Google Scholar 

  43. Sebastian JG. Vulnerability and vulnerable populations. In: Stanhope M, Lancaster J, editors. Community health nursing: promoting the health of individuals, aggregates and communities. 4th ed. St. Louis: Mosby; 1996.

    Google Scholar 

  44. Dressler WW, Oths KS, Gravlee CC. Race and ethnicity in public health research: models to explain health disparities. Annu Rev Anthropol. 2005;34:231–52.

    Article  Google Scholar 

  45. Carasquillo O, Ferry DH, Edwards J, Glied S. Eligibility for government Insurance if immigrant provisions of welfare reform are repealed. Am J Pub Health. 2003;93(10):1680–2.

    Article  Google Scholar 

  46. Mohanty SA, Woolhandler S, Himmelstein DU, Pati S, Carrasquillo O, Bor DH. Health care expenditures of immigrants in the United States: a nationally representative analysis. Amer J Pub H. 2005;95(8):1431–8.

    Article  Google Scholar 

  47. Gornick ME. the association of race/socioeconomic status and use of medicare services; a little known failure in access to care. Ann NY Acad Sci. 1999;896:497–500.

    Article  PubMed  CAS  Google Scholar 

  48. Weissman JS, Betancourt J, Campbell EG, et al. Resident physician’s preparedness to provide cross-cultural care. JAMA. 2005;294(9):1058–67.

    Article  PubMed  CAS  Google Scholar 

  49. Brown P, editor. Understanding and applying medical anthropology. Mountain View, Calif: Mayfield Publishing Company; 1998.

    Google Scholar 

  50. Fadiman A. The spirit catches you and you fall down: a hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus and Giroux; 1997.

    Google Scholar 

  51. Puschel K, Thompson B, Coronado GD, Lopez L, Kimball AM. Factors related to cancer screening in hispanics: a comparison of the perceptions of hispanic community members, healthcare providers, and representatives of organizations that serve hispanics. Health Educ Behav. 2001;28:573–90.

    Article  PubMed  CAS  Google Scholar 

  52. Edberg M, Wong F, Park R, Corey K. Preliminary qualitative results from an ongoing study of HIV Risk in Three Southeast Asian Communities. In: Proceedings of the XIV international AIDS conference, Barcelona, Spain: World Health Organization, UNAIDS, Centers for Disease Control and other sponsors; July 2002.

  53. Hsu E, Davies CA, Hansen DJ. Understanding mental health needs of Southeast Asian refugees: historical, cultural and contextual challenges. Clín Psychol Rev. 2004;24:193–213.

    Article  PubMed  Google Scholar 

  54. Min PG. Changes in Korean immigrants’ gender role and social status, and their marital conflicts. Sociol Forum. 2001;16(2):301–20.

    Article  Google Scholar 

  55. Schweitzer R, Melville F, Steel Z, Lacherez P. Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled sudanese refugees. Aust N Z J Psychiatr. 2006;40(2):179–88.

    Google Scholar 

  56. Thomas TN. Acculturative stress in the adjustment of immigrant families. J Soc Distress Homeless. 1995;4(2):131–42.

    Article  Google Scholar 

  57. Brown ER, Ojeda VD, Wyn R, Levan R. Racial and ethnic disparities in access to health insurance and health care. Los Angeles: UCLA Center for Health Policy Research and Henry J. Kaiser Family Foundation; 2000.

    Google Scholar 

  58. Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Pub H. 2003;93(2):200–8.

    Article  Google Scholar 

  59. Mossakowski KN. Coping with perceived discrimination: does ethnic identity protect mental health? J Health Soc Behav. 2003;44(3, Special Issue—Race, Ethnicity and Mental Health):318–33.

    Article  PubMed  Google Scholar 

  60. Sampson RJ. The neighborhood context of well-being. Perspect Biol Med. 2003;46(3, Supplement):S53–64.

    PubMed  Google Scholar 

  61. Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277(5328):918–24.

    Article  PubMed  CAS  Google Scholar 

  62. Agency for Healthcare Research and Quality. Addressing racial and ethnic barriers to effective health care: the need for better data. Washington, DC: AHRQ; 2002.

    Google Scholar 

  63. Minnesota Immigrant Health Task Force. Immigrant health: a call to action. Minneapolis: Minnesota State Department of Health; 2005.

    Google Scholar 

  64. Bramscombe NR, Schmitt MT, Harvey R. Perceiving pervasive discrimination among African-Americans: Implications for group identification and well-being. J Pers Soc Psychol. 1999;77:135–49.

    Article  Google Scholar 

  65. Crocker J, Major B, Steele C, Gilbert D, Fiske S, editors. The handbook of social psychology, vol. 2. 4th ed. Boston: McGraw-Hill; 1998. p. 504–53.

    Google Scholar 

  66. Spencer-Rodgers J, Collins NL. Risk and resilience: dual effects of perceptions of group disadvantage among Latinos. J Exp Soc Psychol. 2006;42(6):729–37.

    Article  Google Scholar 

  67. Clauss-Ehlers CS. Sociocultural factors, resilience, and coping: support for a culturally sensitive measure of resilience. J Appl Dev Psych. 2008;29(3):197–212.

    Article  Google Scholar 

  68. Chng CL, Wong FY, Park RJ, Edberg M, Lai DS. A model for understanding sexual health among Asian American/Pacific Islander men who have sex with men (MSM) in the United States. AIDS Educ Prev. 2003;15(Supplement A):21–38.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, 2175K Street, NW, Suite 700, Washington, DC, 20037, USA

    Mark Edberg & Amita Vyas

  2. Department of Epidemiology and Biostatistics, George Washington University School of Public Health and Health Services, Washington, DC, USA

    Sean Cleary

Authors
  1. Mark Edberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sean Cleary
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amita Vyas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark Edberg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Edberg, M., Cleary, S. & Vyas, A. A Trajectory Model for Understanding and Assessing Health Disparities in Immigrant/Refugee Communities. J Immigrant Minority Health 13, 576–584 (2011). https://doi.org/10.1007/s10903-010-9337-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-010-9337-5

Keywords

Search

Navigation