Colorectal cancer mortality among Hispanics in California: differences by neighborhood socioeconomic status and nativity

BACKGROUND

Socioeconomic status (SES) plays an important role in colorectal cancer (CRC) mortality, although the independent and joint effects with nativity and neighborhood factors have yet to be evaluated.

METHODS

With nearly one-third of all US Hispanics residing in California, the authors obtained information from the California Cancer Registry to examine the associations between neighborhood SES and mortality in all 33,146 Hispanic individuals diagnosed with CRC from 1988 through 2010, with a particular focus on associations among US-born and foreign-born Hispanics. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CI) for overall and CRC-specific mortality.

RESULTS

Hispanics residing in lower SES neighborhoods demonstrated a higher rate of overall and CRC-specific mortality than those residing in high SES neighborhoods (SES quintile 1[low] vs quintile 5 [high]: HR, 1.15 [95% CI, 1.05-1.26] and HR, 1.16 [95% CI, 1.03-1.30], respectively). Nativity modified the associations between SES and mortality (P for interaction, .02 for overall and P for interaction, .01 for CRC-specific mortality) such that the SES associations were observed only among US-born (P for trend < .01 for overall and CRC-specific mortality) but not among foreign-born Hispanics.

CONCLUSIONS

Neighborhood SES demonstrates significant differential effects on overall and CRC-specific mortality between US-born and foreign-born Hispanics. Future efforts should investigate the underlying contextual and individual-level factors that could account for these differential associations by nativity.

Social identity complexity, cross-ethnic friendships, and intergroup attitudes in urban middle schools

This study investigated contextual antecedents (i.e., cross-ethnic peers and friends) and correlates (i.e., intergroup attitudes) of social identity complexity in seventh grade. Social identity complexity refers to the perceived overlap among social groups with which youth identify. Identifying mostly with out-of-school sports, religious affiliations, and peer crowds, the ethnically diverse sample (N = 622; Mage in seventh grade = 12.56) showed moderately high complexity. Social identity complexity mediated the link between cross-ethnic friendships and ethnic intergroup attitudes, but only when adolescents had a high proportion of cross-ethnic peers at school. Results are discussed in terms of how school diversity can promote complex social identities and positive intergroup attitudes.

Heterosexual anal intercourse among men in Long Beach, California

Anal intercourse poses a greater risk for human immunodeficiency virus (HIV) transmission than vaginal intercourse, and in recent years there has been a growing understanding that heterosexual anal intercourse (HAI) is not uncommon. However, the majority of the anal intercourse literature has focused on men who have sex with men. The little research on HAI has mostly looked at women, with limited work among men. This analysis examined the association between HAI and high-risk behaviors (N = 1,622) and sexual sensation seeking (N = 239) in a sample of men recruited from 2001 to 2012 in Long Beach, California. Almost half of the sample was non-Hispanic Black. The median age was 42 years, 42% were homeless, and 20% reported recent HAI. Men who reported HAI were likely to be Hispanic, were likely to be homeless, had a male partner, engaged in sex exchange, and used cocaine or amphetamines during sex. Men who reported HAI scored higher on the Sexual Sensation Seeking scale. This research supports other work showing the relationship between HAI and high-risk behaviors. More important, it contributes new knowledge by demonstrating the association between HAI and sexual sensation seeking. This research highlights the importance of personality traits when trying to understand sexual behavior and when developing HIV prevention interventions.

Ductal carcinoma in situ: knowledge of associated risks and prognosis among Latina and non-Latina white women

While not itself life-threatening, ductal carcinoma in situ (DCIS) can progress to invasive disease if untreated, and confers an increased risk of future breast cancer. We investigated knowledge of DCIS among a cohort of English- and Spanish-speaking Latina and English-speaking non-Latina white women previously treated for DCIS. We examined knowledge of DCIS with four true/false statements about risk of invasive disease, breast cancer recurrence, and prognosis. For each knowledge statement, we modeled the odds of a correct answer by language-ethnicity (English-speaking Latinas, Spanish-speaking Latinas, and English-speaking whites) adjusting for demographics, health history, and treatment factors. Of 710 participants, 52 % were English-speaking whites, 21 % English-speaking Latinas, and 27 % Spanish-speaking Latinas. Less than half (41 %) of participants were aware that DCIS is not life-threatening and only 32 % knew that surgical treatment choice does not impact mortality; whereas two-thirds (67 %) understood that DCIS confers increased risk of future breast cancer, and almost all (92 %) knew that DCIS, if untreated, could become invasive. Only three Spanish-speakers used professional interpreters during discussions with their physicians. In adjusted analyses, compared to English-speaking whites, both English- and Spanish-speaking Latinas had significantly lower odds of knowing that DCIS was not life-threatening (OR, 95 % CI 0.6, 0.4-0.9 and 0.5, 0.3-0.9, respectively). In contrast, Spanish-speaking Latinas had a twofold higher odds of knowing that DCIS increases risk of future breast cancer (OR, 95 % CI 2.6, 1.6-4.4), but English-speaking Latinas were no different from English-speaking whites. Our data suggest that physicians are more successful at conveying the risks conferred by DCIS than the nuances of DCIS as a non-life-threatening diagnosis. This uneven communication is most marked for Spanish-speaking Latinas. In addition to the use of professional interpreters, efforts to create culturally and linguistically standardized information could improve knowledge and engagement in informed decision making for all DCIS patients.

Health disparities in cost of care in patients with Alzheimer's disease: an analysis across 4 state Medicaid populations

OBJECTIVES

To investigate health disparities with respect to cost of care across 4 state Medicaid populations.

METHODS

Data were obtained from Centers for Medicare and Medicaid Services (CMS) for this retrospective study. Patients were enrolled in a California, Florida, New Jersey, or New York Medicaid programs during 2004, with a diagnosis of Alzheimer's disease (International Classification of Diseases, Ninth Revision 331.0). Outcome of interest was cost of care. Decomposition of cost to calculate disparities was estimated using the Oaxaca-Blinder model. An a priori α level of .01 was used.

RESULTS

Approximately 158 974 individuals qualified for this study. Disparities were found to exist between blacks and whites (with blacks having higher costs; P < .0001), whites and others (with whites having higher costs; P < .0001), blacks and Hispanics (with blacks having higher costs; P < .0001), blacks and others (with blacks having higher costs; P < .0001), and Hispanics and others (with Hispanics having higher costs; P < .0001).

CONCLUSIONS

Disparities in cost among minority-to-minority populations were just as prevalent, if not higher, than minority-white disparities.

Bullying victimization as a mediator of associations between cultural/familial variables, substance use, and depressive symptoms among Hispanic youth

OBJECTIVES

This article examines the antecedents and consequences of bullying victimization among a sample of Hispanic high school students. Although cultural and familial variables have been examined as potential risk or protective factors for substance use and depression, previous studies have not examined the role of peer victimization in these processes. We evaluated a conceptual model in which cultural and familial factors influenced the risk of victimization, which in turn influenced the risk of substance use and depression.

DESIGN

Data were collected as part of a longitudinal survey study of 9th and 10th grade Hispanic/Latino students in Southern California (n = 1167). The student bodies were at least 70% Hispanic/Latino with a range of socioeconomic characteristics represented. We used linear and logistic regression models to test hypothesized relationships between cultural and familial factors and depression and substance use. We used a mediational model to assess whether bullying victimization mediated these associations.

RESULTS

Acculturative stress and family cohesion were significantly associated with bullying victimization. Family cohesion was associate d with depression and substance use. Social support was associated with alcohol use. Acculturative stress was associated with higher depression. The associations between acculturative stress and depression, family cohesion and depression, and family cohesion and cigarette use were mediated by bullying victimization.

CONCLUSION

These findings provide valuable information to the growing, but still limited, literature about the cultural barriers and strengths that are intrinsic to the transition from adolescence to emerging adulthood among Hispanic youth. Our findings are consistent with a mediational model in which cultural/familial factors influence the risk of peer victimization, which in turn influences depressive symptoms and smoking, suggesting the potential positive benefits of school-based programs that facilitate the development of coping skills for students experiencing cultural and familial stressors.

Income gains and very low-weight birth among low-income black mothers in California

We test the hypothesis suggested in the literature that an acute income gain in the form of the earned income tax credit reduces the odds of a very low-weight birth among low-income non-Hispanic black mothers. We apply ecological time series and supplemental individual-level logistic regression methods to monthly birth data from California between 1989 and 1997. Contrary to our hypothesis, the odds of very low-weight birth increases above its expected value two months after mothers typically receive the credit. We discuss our findings in relation to the epidemiologic literature concerned with ambient events during pregnancy and recommend further investigation.

Decomposing associations between acculturation and drinking in Mexican Americans

BACKGROUND

Acculturation to life in the United States is a known predictor of Hispanic drinking behavior. We compare the ability of 2 theoretical models of this effect-sociocultural theory and general stress theory-to account for associations between acculturation and drinking in a sample of Mexican Americans. Limitations of previous evaluations of these theoretical models are addressed using a broader range of hypothesized cognitive mediators and a more direct measure of acculturative stress. In addition, we explore nonlinearities as possible underpinnings of attenuated acculturation effects among men.

METHODS

Respondents (N = 2,595, current drinker N = 1,351) were interviewed as part of 2 recent multistage probability samples in a study of drinking behavior among Mexican Americans in the United States. The ability of norms, drinking motives, alcohol expectancies, and acculturation stress to account for relations between acculturation and drinking outcomes (volume and heavy drinking days) were assessed with a hierarchical linear regression strategy. Nonlinear trends were assessed by modeling quadratic effects of acculturation and acculturation stress on cognitive mediators and drinking outcomes.

RESULTS

Consistent with previous findings, acculturation effects on drinking outcomes were stronger for women than men. Among women, only drinking motives explained acculturation associations with volume or heavy drinking days. Among men, acculturation was linked to increases in norms, and norms were positive predictors of drinking outcomes. However, adjusted effects of acculturation were nonexistent or trending in a negative direction, which counteracted this indirect normative influence. Acculturation stress did not explain the positive associations between acculturation and drinking.

CONCLUSIONS

Stress and alcohol outcome expectancies play little role in the positive linear association between acculturation and drinking outcomes, but drinking motives appear to at least partially account for this effect. Consistent with recent reports, these results challenge stress models of linear acculturation effects on drinking outcomes and provide (partial) support for sociocultural models. Inconsistent mediation patterns-rather than nonlinearities-represented a more plausible statistical description of why acculturation-drinking associations are weakened among men.

Vitamin D levels in Hispanics with multiple sclerosis

Vitamin D has been associated with multiple sclerosis (MS) and several markers of disease state in whites. There are limited reports of vitamin D's influence in MS in ethnic groups, such as in Hispanics. In this study, we compared vitamin D levels in Hispanics and whites with MS and tried to determine whether season or increasing disability influence hypovitaminosis D in Hispanics with MS. Serum 25-hydroxyvitamin D [25(OH)D] levels and clinical characteristics were compared in a cross-sectional sample of Hispanics (n = 80) and whites (n = 80) with MS recruited from the University of Southern California. Serum 25(OH)D levels were significantly lower in Hispanics than whites with MS (mean and standard deviation 25.1 ± 9.4 and 37.3 ± 19.8 ng/ml, respectively; p < 0.001). Hispanics were significantly more likely than whites to be vitamin D insufficient (≤ 30 ng/ml; 70 vs. 41 %, respectively; p < 0.001) and deficient (≤ 20 ng/ml; 40 vs. 14 %, respectively, p < 0.001). In Hispanics, serum 25(OH)D levels were not influenced by season (p = 0.8) or higher physical disability (EDSS ≥ 6, p = 0.7). We found that the relationship between vitamin D and MS differs by Hispanic ethnicity. Hypovitaminosis D was significantly more common among Hispanics than among whites with MS, and the majority of Hispanics were vitamin D insufficient. Interestingly, there was no association between vitamin D levels and season or increasing disability in the Hispanics. Our findings imply that factors influencing vitamin D levels and possibly vitamin D requirements may vary by ethnicity in patients with MS. These results should be confirmed in larger, prospective multi-ethnic cohort studies.

Association between limited English proficiency and understanding prescription labels among five ethnic groups in California

OBJECTIVE

Misunderstanding of prescription labels results in adverse drug events and non-adherence. We assessed the effect of limited English and other factors on prescription understanding among five ethnic groups in a controlled analysis.

DESIGN

Subjects were respondents to California's 2007 Health Interview Survey who received a prescription in the past year. In separate logistic regressions, limited English's effect on self-reported prescription understanding - controlling for bilingual doctor, education level, medications for chronic conditions, disability, years in USA, citizenship and socio-demographics - was estimated for Mexicans, Central Americans, Chinese, Koreans, and Vietnamese.

RESULTS

Unweighted sample size was 48,968. Approximately 14% had limited English and 8% had difficulty in understanding prescriptions. In multivariate analysis, limited English increased odds of difficulty in understanding prescriptions by three times for Mexicans, Central Americans, and Koreans, and four times for Chinese; it was insignificant for Vietnamese. Generally, having a bilingual doctor reduced odds of difficulty while disability, low education, low income or recent immigration increased odds of difficulty. Effects varied according to the ethnic group. In controlled analysis, Chinese and Korean ethnicity increased odds of difficulty compared to Mexican or Central American ethnicity; Vietnamese ethnicity reduced odds of difficulty compared to others.

CONCLUSIONS

Limited English blocked prescription understanding for all groups except Vietnamese. Translated prescription labels and interpreted in-person pharmacy consultations are indicated. Education and ethnicity affected prescription understanding; prescription instructions must be compatible with patients' educational level and culture. Bilingual/bicultural providers and interpreters can help bridge linguistic/cultural gaps but efforts should be made to ensure that they are truly culturally and linguistically concordant. Linguistic, cultural or educational needs should be noted in the patient's record or on the prescription to alert pharmacy staff. Sub-populations needing extra support include chronically ill, disabled, recent immigrants, low-income or rural inhabitants. Community outreach workers may provide an effective strategy for assisting these sub-populations with prescriptions.

Genetic variations in nitric oxide synthase and arginase influence exhaled nitric oxide levels in children

BACKGROUND

Exhaled nitric oxide (FeNO) is a biomarker of airway inflammation. In the nitric oxide (NO) synthesis pathway, nitric oxide synthases (encoded by NOS1, NOS2A, and NOS3) and arginases (encoded by ARG1 and ARG2) compete for L-arginine. Although FeNO levels are higher in children with asthma/allergy, influence of these conditions on the relationships between variations in these genes and FeNO remains unknown. The aims of the study were to evaluate the role of genetic variations in nitric oxide synthases and arginases on FeNO in children and to assess the influence of asthma and respiratory allergy on these genetic associations.

METHODS

Among children (6-11 years) who participated in the southern California Children's Health Study, variations in these five genetic loci were characterized by tagSNPs. FeNO was measured in two consecutive years (N = 2298 and 2515 in Years 1 and 2, respectively). Repeated measures analysis of variance was used to evaluate the associations between these genetic variants and FeNO.

RESULTS

Sequence variations in the NOS2A and ARG2 loci were globally associated with FeNO (P = 0.0002 and 0.01, respectively). The ARG2 association was tagged by intronic variant rs3742879 with stronger association with FeNO in asthmatic children (P-interaction = 0.01). The association of a NOS2A promoter haplotype with FeNO varied significantly by rs3742879 genotypes and by asthma.

CONCLUSION

Variants in the NO synthesis pathway genes jointly contribute to differences in FeNO concentrations. Some of these genetic influences were stronger in children with asthma. Further studies are required to confirm our findings.

Between black and brown: blaxican (black-Mexican) multiracial identity in California

This article explores the racial/ethnic identities of multiracial Black-Mexicans or “Blaxicans.” In-depth interviews with 12 Blaxican individuals in California reveal how they negotiate distinct cultural systems to accomplish multiracial identities. I argue that choosing, accomplishing, and asserting a Blaxican identity challenges the dominant monoracial discourse in the United States, in particular among African American and Chicana/o communities. That is, Blaxican respondents are held accountable by African Americans and Chicanas/os/Mexicans to monoracial notions of “authenticity.” The process whereby Blaxicans move between these monoracial spaces to create multiracial identities illustrates crucial aspects of the social construction of race/ethnicity in the United States and the influence of social interactions in shaping how Blaxicans develop their multiracial identities.

Relation of race, ethnicity and cardiac surgeons to operative mortality rates in primary coronary artery bypass grafting in California

The aim of this study was to evaluate whether African American, Hispanic, and Asian patients in California were more likely to undergo coronary artery bypass grafting (CABG) by cardiac surgeons with higher risk-adjusted mortality rates (RAMRs). Clinical data from the California CABG Outcomes Reporting Program were analyzed for all patients who underwent isolated CABG from 2003 to 2006 by surgeons who performed ≥ 10 operations. Surgeons were divided into quintiles on the basis of their RAMRs, with the top-performing surgeons in the first quintile and the lowest performing surgeons in the fifth quintile. There were 72,845 isolated CABG procedures performed by 303 surgeons, including 49,886 in white, 9,380 in Hispanic, 6,867 in Asian, and 2,750 in African American patients. African American and Asian patients underwent CABG by surgeons with higher mean RAMRs (2.90% and 2.99%, respectively) compared with the state average of 2.65% (p <0.001). Compared to white patients, Asian and Hispanic patients were more likely to be treated by surgeons in the lowest quintile (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.11 to 1.3, and OR 1.38, 95% CI 1.30 to 1.48, respectively). African Americans and Hispanics were less likely to be operated on by surgeons in the top quintile compared to white patients (OR 0.80, 95% CI 0.71 to 0.90, and OR 0.81, 95% CI 0.76 to 0.87, respectively). Hispanics were less likely to be treated by surgeons in the top quintile than by surgeons in the lowest quintile (OR 0.65, 95% CI 0.60 to 0.75). In conclusion, racial and ethnic minority patients who undergo isolated CABG in California may be more likely to be operated on by cardiac surgeons with higher RAMRs.

“Because being fat means being sick”: children at risk of type 2 diabetes

This study addresses the social and cultural underpinnings that shape children’s risk of type 2 diabetes, as identified by a racially and economically diverse group of parents and their children living in Anaheim, California. Based on in-depth interviews with 28 adults and 17 children, we explored how they understood what constitutes “good health” in children and the aspects of their neighborhoods and communities that acted as resources or impediments to their children’s well-being. We found that parents and children employed a language of food that reflected a fear-based, medicalized orientation to food consumption. Although nearly all agreed that children should stay active, densely populated neighborhoods, apartment complexes with rigid outdoor rules, high crime rates, police surveillance, and diminished access to public parks and recreational facilities posed challenges. Similarly problematic were deficits in school lunch programs and the limited sometimes demeaning, conversations with healthcare professionals about diabetes risk and prevention. Together, these narratives identify key structural processes attendant to type 2 diabetes risk in children and call for a more politicized conversation regarding prevention strategies and public healthcare practices.

Jean-Louis Vignes: California's forgotten winemaker

This article represents a first step in the process of restoring the legacy of pioneer California winemaker Jean-Louis Vignes (1780–1862). Vignes was a native of France who established and operated a commercial winery (El Aliso) in Los Angeles for 22 years (1833–1855). The article includes the first known photograph of Vignes discovered by the author. While prominent twentieth-century American wine historians have acknowledged Vignes, the author emphasizes a key distinction made by French historian Leonce Jore. Vignes left France to go to the Sandwich Islands as part of a commercial enterprise that traveled with Catholic missionaries (Picpus Fathers). Only after five years of frustration did Vignes move to Los Angeles and establish a winery. The author uses the remembrances of well-known nineteenth-century commentator William Heath Davis [Seventy-Five Years in California (San Francisco, 1929)] to give some personal insights into Vignes as a winemaker. Davis visited him at El Aliso three times as a young man and lived long enough (1909) to validate Vignes’s vision for the potential of winemaking in California. The article also includes the first known full citation for Vignes’s gravesite at Evergreen Cemetery in Los Angeles.

The impact of transit-oriented development on housing prices in San Diego, CA

This research measures the influence of transit-oriented development (TOD) on the San Diego, CA, condominium market. Many view TOD as a key element in creating a less auto dependent and more sustainable transport system. Price premiums indicate a potential for a market-driven expansion of TOD inventory. A hedonic price model is estimated to isolate statistically the effect of TOD. This includes interaction terms between station distance and various measures of pedestrian orientation. The resulting model shows that station proximity has a significantly stronger impact when coupled with a pedestrian-oriented environment. Conversely, station area condominiums in more auto-oriented environments may sell at a discount. This indicates that TOD has a synergistic value greater than the sum of its parts. It also implies a healthy demand for more TOD housing in San Diego.

Organophosphate pesticide exposure and attention in young Mexican-American children: the CHAMACOS study

BACKGROUND

Exposure to organophosphate (OP) pesticides, well-known neurotoxicants, has been associated with neurobehavioral deficits in children.

OBJECTIVES

We investigated whether OP exposure, as measured by urinary dialkyl phosphate (DAP) metabolites in pregnant women and their children, was associated with attention-related outcomes among Mexican-American children living in an agricultural region of California.

METHODS

Children were assessed at ages 3.5 years (n = 331) and 5 years (n = 323). Mothers completed the Child Behavior Checklist (CBCL). We administered the NEPSY-II visual attention subtest to children at 3.5 years and Conners' Kiddie Continuous Performance Test (K-CPT) at 5 years. The K-CPT yielded a standardized attention deficit/hyperactivity disorder (ADHD) Confidence Index score. Psychometricians scored behavior of the 5-year-olds during testing using the Hillside Behavior Rating Scale.

RESULTS

Prenatal DAPs (nanomoles per liter) were nonsignificantly associated with maternal report of attention problems and ADHD at age 3.5 years but were significantly related at age 5 years [CBCL attention problems: β = 0.7 points; 95% confidence interval (CI), 0.2-1.2; ADHD: β = 1.3; 95% CI, 0.4-2.1]. Prenatal DAPs were associated with scores on the K-CPT ADHD Confidence Index > 70th percentile [odds ratio (OR) = 5.1; 95% CI, 1.7-15.7] and with a composite ADHD indicator of the various measures (OR = 3.5; 95% CI, 1.1-10.7). Some outcomes exhibited evidence of effect modification by sex, with associations found only among boys. There was also limited evidence of associations between child DAPs and attention.

CONCLUSIONS

In utero DAPs and, to a lesser extent, postnatal DAPs were associated adversely with attention as assessed by maternal report, psychometrician observation, and direct assessment. These associations were somewhat stronger at 5 years than at 3.5 years and were stronger in boys.

PON1 and neurodevelopment in children from the CHAMACOS study exposed to organophosphate pesticides in utero

BACKGROUND

Paraoxonase 1 (PON1) detoxifies oxon derivatives of some organophosphate (OP) pesticides, and its genetic polymorphisms influence enzyme activity and quantity. We previously reported that maternal urinary concentrations of dialkyl phosphate (DAP) metabolites, a marker of OP pesticide exposure, were related to poorer mental development and maternally reported symptoms consistent with pervasive developmental disorder (PDD) in 2-year-olds participating in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) study.

OBJECTIVE

We determined whether PON1 genotypes and enzyme measurements were associated with child neurobehavioral development and whether PON1 modified the association of in utero exposure to OPs (as assessed by maternal DAPs) and neurobehavior.

METHODS

We measured DAP concentrations in maternal urine during pregnancy, PON1₁₉₂ and PON1₋₁₀₈ genotypes in mothers and children, and arylesterase (ARYase) and paraoxonase (POase) in maternal, cord, and 2-year-olds' blood. We assessed 353 2-year-olds on the Mental Development Index (MDI) and Psychomotor Development Index (PDI) of the Bayley Scales of Infant Development and queried their mothers on the Child Behavior Checklist to obtain a score for PDD.

RESULTS

Children with the PON1(-108T) allele had poorer MDI scores and somewhat poorer PDI scores. Children were less likely to display PDD when they or their mothers had higher ARYase activity and when their mothers had higher POase activity. The association between DAPs and MDI scores was strongest in children with PON1(-108T) allele, but this and other interactions between DAPs and PON1 polymorphisms or enzymes were not significant.

CONCLUSION

PON1 was associated with child neurobehavioral development, but additional research is needed to confirm whether it modifies the relation with in utero OP exposure.

Effect of race and ethnicity classification on survey estimates: Anomaly of the weighted totals of American Indians and Alaska Natives

Racial classification is a paramount concern in data collection and analysis for American Indians and Alaska Natives (AI/ANs) and has far-reaching implications in health research. We examine how different racial classifications affect survey weights and consequently change health-related indicators for the AI/AN population in California. Using a very large random population-based sample of AI/ANs, we compared the impact of three weighting strategies on counts and rates of selected health indicators. We found that different weights examined in this study did not change the percentage estimates of health-related variables for AI/ANs, but did influence the population total estimates dramatically. In survey data, different racial classifications and tabulations of AI/ANs could yield discrepancies in weighted estimates for the AI/AN population. Policy makers need to be aware that the choice of racial classification schemes for this racial-political group can generally influence the data they use for decision making.

Disparities in hepatocellular carcinoma survival among Californians of Asian ancestry, 1988 to 2007

BACKGROUND

Hepatocellular carcinoma (HCC) represents a significant health disparity affecting Asian Americans, a population comprised of distinct ethnic groups. The purpose of this article is to analyze Californians of Asian ancestry with HCC with respect to socioeconomic status, demographic factors, stage of disease, treatment received, and survival.

METHODS

To investigate ethnic differences in survival, we analyzed ethnically disaggregated data from 6,068 Californians of Asian ancestry with HCC diagnosed in 1988 to 2007 and reported to the California Cancer Registry.

RESULTS

Compared with the average of all ethnic groups, cause-specific mortality was significantly higher among Laotian/Hmong [hazard ratio, 2.08; 95% confidence interval (95% CI), 1.78-2.44] and Cambodian patients (hazard ratio, 1.26; 95% CI, 1.06-1.51), groups with higher proportions of their populations at low levels of socioeconomic status; in addition, Laotian/Hmong patients disproportionately presented at later stages of disease, with only 3% receiving local surgical treatment, resection, or liver transplantation. After adjustment for time of diagnosis, age at diagnosis, gender, geographic region, stage at diagnosis, type of surgery, and socioeconomic status, survival disparities remained for both groups (Laotian/Hmong hazard ratio, 1.51; 95% CI, 1.28-1.79; Cambodian hazard ratio, 1.24; 95% CI, 1.03-1.48).

CONCLUSIONS

Our hypothesis that survival outcomes would differ by ethnicity was verified.

IMPACT

Research is needed not only to develop more effective treatments for HCC but also to develop community-based interventions to recruit Asian Americans, particularly Laotian/Hmong and Cambodians, for hepatitis B screening and into medical management to prevent or detect this tumor at an early stage.

Can religion help prevent obesity? Religious messages and the prevalence of being overweight or obese among Korean women in California

This research examines the influence of messages from religious leaders and congregants on whether Korean women are overweight or obese. Data were drawn from telephone interviews with a probability sample (N = 591) of women of Korean descent living in California. Overweight or obese prevalence was measured using World Health Organization standards for Asians (BMI > 23). Respondents reported the frequency of messages discouraging “excessive eating” or encouraging “exercise” from religious leaders and congregants during a typical month. When conditioned on leaders’ messages, the frequency of congregants’ messages was associated with a significantly lower probability of being overweight or obese, although messages from either in the absence of the other were unassociated with being overweight or obese. At least for Korean women, religion may help prevent obesity via religious-based social mechanisms.

Oranges or "lemons"? Family farming and product quality in the Spanish orange industry, 1870-1960

In the early twentieth century California became a big exporter of some agricultural products that, until then, had only been grown on a large scale in the mediterranean basin. As a result, exports of those products diminished or stagnated in Mediterranean countries, with important repercussions on their economies. The Spanish orange industry, however, continued to expand, despite the fact that a substantial percentage of Spanish oranges came from farms owned by (often illiterate) small peasants who, in comparison to the California growers, used a great deal of labor, small amounts of capital, and little science. This paper shows that Spanish farmers were in fact capable of growing high-quality oranges at prices that were more competitive than those in California, although interested they often preferred to satisfy the strong demand for middling fruit from Great Britain because it was a more profitable business. This, combined with a deficient use of brand names, gave the Spanish citrus industry serious reputation problems by the 1930s, from which, however, it recovered quickly.

The agriburb: recalling the suburban side of Ontario, California's agricultural colonization

This essay spotlights the development of Ontario, California, in the last decades of the nineteenth century. It demonstrates that many agricultural communities in California, particularly so-called agricultural colonies, represent a unique rural suburban type labeled here as "agriburbs." Agriburbs, such as Ontario, were communities consciously planned, developed, and promoted based on the drive for profit in emerging agricultural markets. Advertised as the perfect mix of rural and urban, they promised a superior middle-class lifestyle. On the one hand, agriburbs evoked the myths of agrarian security and virtue, a life on a farm in an environment that was good for both soil and soul. On the other hand, agriburbs were ideally urbane but not urban because of their many amenities that represented cultural symbols of modernity, refinement, and progress. An understanding of California's agriburbs deepens an appreciation for both the growth and development of California at the turn of the twentieth century and the diversity of suburban types across the American landscape.

The effects of racial/ethnic segregation on Latino and Black homicide

Racial/ethnic residential segregation has been shown to contribute to violence and have harmful consequences for minority groups. However, research examining the segregation–crime relationship has focused almost exclusively on blacks and whites while largely ignoring Latinos and other race/ethnic groups and has rarely considered potential mediators (e.g., concentrated disadvantage) in segregation–violence relationships. This study uses year 2000 arrest data for California and New York census places to extend segregation–crime research by comparing the effects of racial/ethnic residential segregation from whites on black and Latino homicide. Results indicate that (1) racial/ethnic segregation contributes to both Latino and black homicide, and (2) the effects for both groups are mediated by concentrated disadvantage. Implications for segregation–violence relationships, the racial-invariance position, and the Latino paradox are discussed.