Paler Is Not Prettier: Little Evidence of Colorism Among Asian American Speed-Daters

Background and Aims: Hispanics have experienced the greatest increase in hepatocellular carcinoma (HCC) incidence and mortality among ethnic/racial groups during the last two decades in the US. Chronic liver disease (CLD) is a major cause of morbidity and mortality in Hispanics. HCC risk in US-born Hispanics is reportedly higher than that in foreign-born Hispanics. Few studies, however, have examined the extent to which detailed individual risk factors for HCC could account for the observed risk disparity by nativity. The objective of the present study was to evaluate the difference in risk of HCC and CLD, respectively, by nativity in Hispanics, and to assess the extent to which risk factors can account for the risk differences. Methods: A prospective analysis was conducted among 36,864 Hispanics who participated in the Multiethnic Cohort (MEC). Nativity was categorized into US-born (N=18,485) and foreign-born (N=18,379; 74% Mexican-born, 26% Central/South American-born). Demographic and potential risk factors were assessed at baseline using self-administered questionnaire. Hepatitis B and C viral (HBV/HCV) status were determined using the Medicare claim files in a subset of participants (N=16,436). Incident HCC cases were identified through linkages to the SEER registries and CLD deaths were determined through linkages to state death certificate files in California and Hawaii and the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) for HCC incidence and CLD deaths associated with nativity were calculated using Cox proportional hazard models adjusted for age, risk factors and potential confounders. Results: During a median follow up of 19.6 years, 189 Hispanics (118 US-born, 71 foreign-born) were diagnosed with HCC and 298 Hispanics (194 US-born, 104 foreign-born) died of CLD. The age-adjusted HCC incidence rate (per 100,000) was almost twice as high in US-born as in foreign-born Hispanic men (44.7 vs. 23.1), but comparable for US- and foreign-born Hispanic women (14.5 vs. 13.4). US-born Hispanic men and women had an 89% to 114% higher CLD mortality rate compared to their foreign-born counterparts, respectively. HBV/HCV and diabetes were the strongest risk factors for HCC in both US- and foreign-born Hispanics. Heavy alcohol consumption, current smoking status, diabetes, and HBV/HCV were associated with risk of CLD deaths in US- and foreign-born men. HBV/HCV, diabetes and body mass index (BMI) were associated with risk of CLD death in US- and foreign-born women. After adjustment for age, level of education, BMI, alcohol intake, smoking status, and history of diabetes, the HRs (95% CIs) of HCC incidence and CLD death were 1.77 (1.21, 2.59) and 1.78 (1.29, 2.43), respectively for US-born compared to foreign-born Hispanic men. The corresponding figures were 1.01 (0.60, 1.70) and 1.89 (1.27, 2.81) for women. The results were similar in the subgroup of Medicare study participants with further adjustment for HBV/HCV infection status. Conclusions: US-born Hispanic men are at greater risk of developing HCC and CLD than their foreign-born counterparts. In Hispanic women, while the risk of developing HCC is similar between the nativity groups, the risk of CLD death is much greater in US-born than in foreign-born women. Overall known difference in demographic and risk factors do not account for the observed disparities in HCC and CLD risk between US- and foreign-born Hispanics. Future studies are warranted to identify factors that contribute to the elevated risk of HCC and CLD in US-born Hispanics. Citation Format: Veronica Wendy Setiawan, Pengxiao C. Wei, Brenda Y. Hernandez, Shelly C. Lu, Kristine R. Monroe, Loic Le Marchand, Jian Min Yuan. Disparity in liver cancer incidence and chronic liver disease mortality by US nativity in Hispanics: The Multiethnic Cohort. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C70.

Over 43 million immigrants live in the United States (U.S.). Foreign-born populations experience multiple disparities related to human papillomavirus (HPV), including higher cervical cancer mortality rates, yet little research has examined the prevalence of genital HPV infection among this population. We used data from 1,822 women and 1,622 men ages 20–59 in the U.S. who participated in the 2013–2014 National Health and Nutrition Examination Survey (NHANES). Participants reported their nativity status (foreign- vs. U.S.-born) and provided biospecimens for HPV testing. We assessed nativity differences in the prevalence of three HPV infection outcomes (any HPV type, high-risk HPV type, and vaccine-preventable HPV type) using weighted logistic regression. Overall, 40% of women and 46% of men tested positive for any type of HPV. Compared to women born in the U.S., foreign-born women had a lower prevalence of infection with any HPV type (32% vs. 42%, p < .01). Compared to men born in the U.S., foreign-born men had a lower prevalence of all HPV infection outcomes (any type: 39% vs. 48%; high-risk: 22% vs. 34%; vaccine-preventable: 12% vs. 16%; all p < .05). Multivariable models attenuated several of these differences, though foreign-born men had lower odds of infection with a high-risk HPV type (OR = 0.75; 95% CI: 0.60–0.93, p < .01) after adjusting for covariates. Although lower than among their U.S.-born counterparts, HPV infection is prevalent among foreign-born women and men in the U.S. Findings can help inform strategic communication campaigns and targeted HPV vaccination and cervical cancer screening efforts for immigrant populations.

Nativity Disparities in Human Papillomavirus Vaccination Among U.S. Adults

Michigan’s Proposal 2 and California’s Proposition 209 explicitly prohibit their state governments from discriminating or granting “preferential treatment ... on the basis of race.” Proponents of both ballot initiatives specifically employed this language to eliminate state promulgated race-based affirmative action programs. For advocates of Proposal 2 and Proposition 209, affirmative action is the quintessential example of a preference on the basis on race. They reasoned that the policy benefits blacks and Latinos and burdens whites and, in some formulations, Asian Americans. This Article neither defends affirmative action nor critiques anti-affirmative action initiatives. Instead, we take Proposition 209 and Proposal 2 seriously by engaging in something of a thought experiment: what concretely does it mean to make institutional processes colorblind or race neutral? We believe it particularly productive to explore this question in the context of school admissions policies, where selection procedures have been highly scrutinized and debated. Our more particular focus is on the personal statement, which remains an important but under-examined part of the admission process. While it is clear that post-affirmative action admissions criteria exclude or omit race from consideration, what that means for evaluating the personal statement is decidedly less than clear. Surprisingly, this issue has received little scholarly attention. Most commentators have focused on the demographic consequences of eliminating race from consideration, and not the mechanisms college and university admissions employ to attempt to purge race from the admissions process. The assumption seems to be that implementing the colorblind imperative of Proposition 209 and Proposal 2 is easy institutional business. But this is not so. Focusing on the personal statement, we will demonstrate that eliminating race from admissions is far from simple. Indeed, so long as the personal statement is part of the admissions process, it might not even be possible. Nor does prohibiting explicit references to race in the context of admissions make admissions processes race neutral. As we will show, again drawing on the personal statement, formally eliminating race from admissions decisionmaking installs a new racial preference. The new racial preference is not a preference for a racial category per se. Nor is this preference “on the basis of skin color,” which is how opponents of affirmative characterize the policy. The new racial preference gives a priority or advantage to applicants who choose to suppress their racial identity over those who do not so choose. More specifically, this racial preference benefits applicants who (a) view their racial identity as irrelevant or inessential and (b) make no express mention of it in the application process. These applicants are advantaged vis-a-vis applicants for whom race is a fundamental part of their sense of self. One might think of this preference as a kind of racial viewpoint discrimination—analogous to the viewpoint distinction or preference that the First Amendment prohibits. Race is the “content” and colorblindness and racial consciousness are competing “viewpoints.” Just as the government’s regulation of speech must be content neutral and cannot be based upon the viewpoint expressed, a university’s regulation of admissions should be content neutral and † Professors of Law, UCLA School of Law. For discussions about or feedback on this Article, we thank Kimberle Crenshaw, Carole Goldberg, Jerry Kang, Mitu Gulati, Luke Harris, and Russell Robinson, and Michael Schill. Laura Wirth, Emily Wood, Jordan Blair Woods, Nina Farnia, and Hentyle Yapp provided invaluable research assistance. We are indebted to as always to the research staff of the law library, including Cheryl Kelly Fischer. For their insight into the Cantrell litigation, we thank Mark Rosenbaum and Catherine Lhamon from the ACLU of Southern California, and Anurima Bhargawa of the NAACP-LDF. We also thank Angela Onwuachi-Willig for inviting us to participate in this symposium. Finally, we thank the editors of the California Law Review for their patience and for the care with which they engaged our ideas.

ABSTRACTUsing a sample of up to 1,208 Asian Americans, we examine the effects of skin tone on perceived commonality with African Americans, Latinos, and whites. Overall, we find that Asian Americans are more likely to identify with whites than with African Americans or Latinos. When we account for skin tone, we find that Asian Americans with a medium skin tone experience increased odds of perceiving a commonality with African Americans and Latinos. While we expected the relationship between skin tone and perceived commonality to be mediated by experiences of discrimination, this was not the case. We conclude that Asian Americans occupy a position toward the top of the black-white binary and the oppressive racial hierarchy that exists within the United States. Like previous scholars, we suggest that Asian Americans can use their relative standing to disrupt the oppressive racial hierarchy. However, we recognize that whites, holding a position at the top of the racial hierarchy, must also be responsible for dismantling it.

BackgroundThere are no nationwide studies on mortality after coronary artery bypass grafting (CABG) among foreign-born populations that include detailed information about country of birth and information about socioeconomic position. The objective was to investigate the risk of mortality after CABG considering socioeconomic position, sex and country of birth.Material and MethodsWe included all 72 333 patients undergoing a first isolated CABG in Sweden, during 1995 - 2007 of whom 12.7% were foreign-born. The patients were classified according to educational level, sex, and country of birth and were followed up to December 2007. We estimated the risk of short and long term mortality after CABG in a multivariable model adjusted for age, calendar year of surgery, diabetes, educational level, and waiting time for surgery. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated based on the Cox proportional hazard model.FindingsThere were 15,284 deaths during the follow-up, 10.4% of whom were foreign-born. The foreign-born patients were 3 to 4 years younger than Sweden-born patients at the time of CABG surgery. There were no significant differences in overall early or late mortality between foreign-born and Sweden-born men and women after CABG. All-cause mortality differed in between regions and was highest in foreign-born men from Eastern Africa (HR 3.80, 95% CI 1.58–9.17), China (HR 3.61, 95% CI 1.50–8.69), and in Chile (HR 2.12, 95% CI 1.01–4.47). Patients with low level of education had worse survival compared to those with longer than 12 years of education irrespective of sex and country of birth. This difference was more pronounced among foreign-born women (HR 1.50, 95% CI 1.00–2.33).ConclusionThis national study showed higher CABG mortality in patients from lower socioeconomic position. Early and late mortality did not differ after isolated CABG in foreign-born and Sweden-born patients.

Teaching and Learning Guide for: The Persistent Problem of Colorism: Skin Tone, Status, and Inequality

Guest Editors' Introduction

Improving cultural competency and practicing cultural humility in dermatologic training: Skin of color education and board certification

Honoring Asian diversity by collecting Asian subpopulation data in health research.

Skin of color representation in medical education: An analysis of National Board of Medical Examiners' self-assessments and popular question banks

We examined patterns of body mass index (BMI) and obesity among a nationally representative sample of first-, second-, and third-generation Latinos and Asian Americans to reveal associations with nativity or country of origin. We used data from the National Latino and Asian American Survey (2002-2003) to generate nationally representative estimates of mean BMI and obesity prevalence and explored changes in the distribution of BMI by generational status. Analyses tested the association between generational status and BMI and examined whether this association varied by ethnicity, education, or gender. We found substantial heterogeneity in BMI and obesity by country of origin and an increase in BMI in later generations among most subgroups. The data suggest different patterns for Latinos and Asian Americans in the nature and degree of distributional changes in BMI with generational status in the United States. Generational status is associated with increased BMI and obesity among Latinos and Asian Americans. Aggregate estimates not accounting for nativity and country of origin may mask significant heterogeneity in the prevalence of obesity and patterns of distributional change, with implications for prevention strategies.

Mental health outcomes and their association to race and ethnicity in acne patients: A population-based study

In 2009, President Obama signed an Executive Order calling for strategies to improve the health of Asian Americans and to seek data on the health disparities in Asian American subgroups.1 Data on Asian American subgroups are scarce and many health disparities remain unknown. The purpose of this Advisory is to highlight the gaps in existing research on cardiovascular disease (CVD) among Asian Americans, and to serve as a call to action on behalf of the American Heart Association to address these areas of need. Asian Americans are the fastest growing racial/ethnic group in the United States, representing 25% of all foreign-born people in the United States.2 They are projected to reach nearly 34 million by 2050.3 Several major Federal surveys (eg, the American Community Survey, the National Health Interview Survey, and the Behavioral Risk Factor Surveillance Survey) only recently started to classify Asian Americans into 7 subgroups: Asian Indian, Chinese, Filipino, Korean, Japanese, Vietnamese, and Other Asian. The first six of these subgroups together constitute >90% of Asian Americans in the United States.4 Although some data are available on Asian subgroups from these major federal surveys, in general, these data are not available for public use because of the privacy concerns resulting from the small sample sizes within subgroups. This situation limits their utility for health-related research. Because health surveys and questionnaires almost universally combine persons of Asian ancestry into a single group, the heterogeneity within this classification is masked. Socioeconomic and cultural factors have been found to be associated with CVD and its risk factors, which is why it is important to understand these differences among Asian subgroups. The Table shows the number of persons in each group based on the most recent US Census data available (American Community Survey, 2008), with the recognition that …

Dear Dr. Dermatoethics: Why is diversity in clinical trials important?