Youths of Mexican Descent of the Southwest: Exploring Differences in Ethnic Labels

Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort

BACKGROUND

Initiation of anti-osteoporosis medications after hip fracture lowers the risk of subsequent fragility fractures. Historical biases of targeting secondary fracture prevention towards certain groups may result in treatment disparities. We examined associations of patient age, sex and race with anti-osteoporosis medication prescription following hip fracture.

METHODS

A cohort of patients with a hip fracture between 2016-2018 was assembled from the American College of Surgeons National Surgical Quality Improvement Program registry. Patients on anti-osteoporosis medications prior to admission were excluded. Multivariable logistic regression was used to determine adjusted associations between patient age, sex and race and their interactions with prescription of anti-osteoporosis medications within 30 days of surgery.

RESULTS

In total, 12,249 patients with a hip fracture were identified with a median age of 82 years (IQR: 73-87), and 67% were female (n = 8,218). Thirty days postoperatively, 26% (n = 3146) of patients had been prescribed anti-osteoporosis medication. A significant interaction between age and sex with medication prescription was observed (p = 0.04). Male patients in their 50s (OR:0.75, 95%CI:0.60-0.92), 60s (OR:0.81, 95%CI:0.70-0.94) and 70s (OR:0.89, 95%CI:0.81-0.97) were less likely to be prescribed anti-osteoporosis medication compared to female patients of the same age. Patients who belonged to minority racial groups were not less likely to receive anti-osteoporosis medications than patients of white race.

INTERPRETATION

Only 26% of patients were prescribed anti-osteoporosis medications following hip fracture, despite consensus guidelines urging early initiation of secondary prevention treatments. Given that prescription varied by age and sex, strategies to prevent disparities in secondary fracture prevention are warranted.

Associations between ethnic labels and substance use among Hispanic/Latino adolescents in Los Angeles

Self-identification with ethnic-specific labels may indicate successful ethnic identity formation, which could protect against substance use. Alternatively, it might indicate affiliation with oppositional subcultures, a potential risk factor. This study examined longitudinal associations between ethnic labels and substance use among 1,575 Hispanic adolescents in Los Angeles. Adolescents who identified as Cholo or La Raza in 9th grade were at increased risk of past-month substance use in 11th grade. Associations were similar across gender and were not confounded by socioeconomic status, ethnic identity development, acculturation, or language use. Targeted prevention interventions for adolescents who identify with these subcultures may be warranted.

Ethnic Identity and Substance Use Among Mexican-Heritage Preadolescents: Moderator Effects of Gender and Time in the United States

This study examined interactive relationships among ethnic identity, gender, time in the US, and changes in substance use outcomes among a school-based sample of 1,731 Mexican-heritage preadolescents (ages 9-13). Residual change multilevel models adjusting for school clustering and using multiply imputed data assessed changes from beginning to end of fifth grade in use of alcohol, cigarettes, marijuana and inhalants, and four substance use antecedents. Effects of ethnic identity were conditional on time in the US, and in opposite directions by gender. Among males living longer in the US, stronger ethnic identity predicted desirable changes in all but one outcome (substance offers). Among females living longer in the US, stronger ethnic identity predicted undesirable changes in alcohol use, pro-drug norms, and peer substance use. Interpretations focus on differential exposure to substance use opportunities and the erosion of traditional gender role socialization among Mexican-heritage youth having lived longer in the US.

Ethnic Identity and Substance Use Among Mexican-Heritage Preadolescents: Moderator Effects of Gender and Time in the United States

This study examined interactive relationships among ethnic identity, gender, time in the US, and changes in substance use outcomes among a school-based sample of 1,731 Mexican-heritage preadolescents (ages 9-13). Residual change multilevel models adjusting for school clustering and using multiply imputed data assessed changes from beginning to end of fifth grade in use of alcohol, cigarettes, marijuana and inhalants, and four substance use antecedents. Effects of ethnic identity were conditional on time in the US, and in opposite directions by gender. Among males living longer in the US, stronger ethnic identity predicted desirable changes in all but one outcome (substance offers). Among females living longer in the US, stronger ethnic identity predicted undesirable changes in alcohol use, pro-drug norms, and peer substance use. Interpretations focus on differential exposure to substance use opportunities and the erosion of traditional gender role socialization among Mexican-heritage youth having lived longer in the US.

Issues in the Assessment of "Race" among Latinos: Implications for Research and Policy

Measurement of race and ethnicity is integral to assessing and addressing health disparities experienced by minorities. However, the unique experiences of Latinos related to race and the discordance between understandings of race among Latinos and the predominant U.S. conceptualizations of this construct impact how Latinos respond to measurement approaches. As a result, data collection methodologies often yield ambiguous responses that reveal little about this population. This paper examines Latinos' racial responding, and how this relates to their experiences and understanding of their racial identity. We recommend the use of a combined race and ethnicity question and open-ended race and ethnicity questions, when feasible, which will likely yield more meaningful data that can be used to address this populations' health needs.

THE MODERATING EFFECTS OF ETHNIC IDENTIFICATION ON THE RELATIONSHIP BETWEEN PARENTAL MONITORING AND SUBSTANCE USE IN MEXICAN HERITAGE ADOLESCENTS IN THE SOUTHWEST UNITED STATES

The purpose of this study was to assess the combined effects of ethnic identification and perceived parental monitoring on the substance use of a sample of 162 male and 192 female Mexican heritage seventh grade adolescents. Parental monitoring predicted lower risk for substance use. An interaction of ethnic identification by parental monitoring was observed with parental monitoring exhibiting stronger effects in decreasing use of alcohol use among boys who scored low on ethnic identification. For girls, decreased substance use was predicted by stronger parental monitoring coupled with high ethnic identification. Results are discussed in terms of how the youth's ethnic identification is a distinct process from acculturation, and how ethnic identification may operate as an added protective factor in conjunction with parental monitoring, as protective factors against adolescent substance abuse.

Ethnic label use in adolescents from traditional and non-traditional immigrant communities

Understanding adolescents’ use of ethnic labels is a key developmental issue, particularly given the practical significance of identity and self-definition in adolescents’ lives. Ethnic labeling was examined among adolescents in the traditional immigrant receiving area of Los Angeles (Asian n = 258, Latino n = 279) and the non-traditional immigrant receiving area of North Carolina (Asian n = 165, Latino n = 239). Logistic regressions showed that adolescents from different geographic settings use different ethnic labels, with youth from NC preferring heritage and panethnic labels and youth from LA preferring hyphenated American labels. Second generation youth were more likely than first generation youth to use hyphenated American labels, and less likely to use heritage or panethnic labels. Greater ethnic centrality increased the odds of heritage label use, and greater English proficiency increased the odds of heritage-American label use. These associations significantly mediated the initial effects of setting. Further results examine ethnic differences as well as links between labels and self-esteem. The discussion highlights implications of ethnic labeling and context.