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Ronald L. Braithwaite, PhD, is a professor in the Department of Community Health and Preventive Medicine, director of research in the Department of Family Medicine, and a professor in the Department of Psychiatry at Morehouse School of Medicine, Atlanta. He is the coeditor of Prisons and AIDS from Jossey-Bass.
Sandra E. Taylor, PhD, is a professor and chair in the Department of Aociology and Criminal Justice at Clark Atlanta University, Atlanta. Taylor and Braithwaite are coeditors of the first and second editions of Health Issues in the Black Community from Josse-Bass.
Henrie M. Tredwell, PhD, is a professor in the Department of Health and Preventive Medicine and director of Community Voices and the Men's and Reentry Health Initiative at the National Center for Primary Care at the Morehouse school of Medicine, Atlanta. Dr. Treadwell served for 16 years as program director at the W.K. Kellogg Foundation.
"...a detailed look at how health risks affect the black community...covers such topics as AIDS, chemical dependency, cancer, violence, sickle-cell anemia, infant mortality, and lead poisoning."
Approximately 2.7 million children and adolescents in this country have asthma (Gergen & Evans, 1988). In addition to being the leading chronic disease among youths, asthma is responsible for the majority of days lost from school (Fowler, Davenport, & Garg, 1992) and contributes significantly to the number of emergency room visits and hospitalizations. Data from the 1987 National Medical Expenditure Survey reveal that annually children with asthma obtain 3.1 times as many prescriptions, make 1.9 times as many ambulatory provider visits, have 2.2 times as many emergency room visits, and are hospitalized 3.5 times as often as children without asthma. On average, children with asthma incur about $1,129 in annual health care costs as compared to $468 for children without asthma (Lozano, Sullivan, Smith, & Weiss, 1999).
Minority children, particularly those who are poor and living in urban environments, are disproportionately affected by asthma. African Americans and Hispanics have five times more hospitalizations than whites and are four to five times more likely to die from asthma (Gergen & Weiss, 1990; Weiss, Gergen, & Crain, 1992).
Exposure to indoor allergens and pollutants such as dust mites, tobacco smoke, and cockroaches (Malveaux & Fletcher-Vincent, 1995) may contribute to the exacerbation of asthma. A study of 611 asthmatic children from eight cities found that 85 percent of them lived in homes with detectable cockroach antigen (Rosenstreich, Eggleston, & Kattan, 1997). Cockroach populations are highest in crowded urban areas (Sarpong, Wood, & Eggleston, 1996). African American race is an independent predictor of cockroach exposure and sensitization (Sarpong et al., 1996), suggesting either that African Americans are likely to have been exposed to a particularly potent cockroach antigen or that they have a specific genetic predisposition to sensitization that may initiate an immunological cascade resulting in asthma (Miller, 1999).
Although indoor allergens and pollutants are significant, the presence of external environmental toxins is also important to mention. Compared to nonurban children, children living in urban areas may be greatly exposed to higher levels of air pollution, in part fueled by the exhausts of cars, buses, trucks, and factories (Northridge et al., 1999).
National Health and Nutrition Examination Survey (NHANES) III data reveal that 4.4 percent (or 930,000) of the children in the United States between the ages of one and five have elevated lead levels (> 10 ug/dl). Children one to two years old have the highest rates of lead poisoning (5.9 percent). Poor children are eight times more likely than affluent children to have elevated lead levels. African American children are five times more likely than white children to have elevated lead levels. A primary reason for this disparity is the clustering of poor families, often African American, into substandard housing, where water damage-and moisture often cause deterioration of the walls leading to peeling and cracking of paint. About 64 million homes still contain lead paint, and about 15 percent of homes have lead in pipes, faucets, or well pumps (Spake & Couzin, 1999). Younger children may ingest lead directly by drinking water contaminated by lead in the pipes or by eating paint chips or indirectly by playing with toys contaminated by lead dust particles (CDC, 1997).
Ingested lead from any source can affect the developing brain, leading to hyperactivity, attention-deficit disorder, and aggressive behaviors. It is estimated that 20 to 30 percent of children in special education have been affected by significant lead exposure. Children with elevated lead levels are six times more likely than others to have learning disabilities and seven times more likely to drop out of school (Spake & Couzin, 1999). Aggressive children may grow up to become bullying adolescents and to engage in antisocial activities such as vandalism, arson, and shoplifting.
The 1997 Youth Risk Behavior Survey (YRBS) indicates an 11 percent decrease in the number of teenagers who are sexually active by the age of nineteen. Although African American teenagers are more likely than white teenagers to be sexually experienced, similar declines in sexual activity have also been noted among African American teenagers (from 81 percent to 73 percent).
Although there has been significant improvement overall in the use of contraception, much of that gain has been due to use of condoms. Use of condoms increased 23 percent overall from 1991 to 1997. The percentage of African American adolescents using condoms at last intercourse (64 percent) exceeded that of whites (56 percent) and Hispanics (48 percent) (CDC, 1998b).
It is important to note, however, that the rates of use of other contraceptive methods have fallen. The use of oral contraceptive pills (OCPs), for example, decreased by 4 percent between 1982 and 1995, with the largest decline noted among young African American women less than twenty-five years of age (Abma, Chandra, Mosher, Peterson, & Piccinino, 1997). The percentage of teenagers using OCPs fell by 15 percent (from 59 percent to 44 percent) between 1988 and 1995. Among young women aged twenty to twenty-four, the percentage dropped from 68 percent to 52 percent during the same time period. Over the same period, OCP use decreased by 60 percent among African American teenagers and decreased by 36 percent among young women aged twenty to twenty-four (CDC, 1998c).
Gonorrhea and chlamydia are two sexually transmitted diseases (STDs) that disproportionately affect African Americans. Although both can be easily treated with a short course of antibiotics, there are serious, long-term consequences for both males and females if these infections go undetected and untreated. Complications for females include pelvic inflammatory disease, ectopic pregnancy, and sterility, and males are at risk for orchitis and sterility. These potential dangers underscore the need for widespread screening for these diseases, particularly among adolescents of color, who suffer the highest rates of infection (Neinsten, 1996).
Although pregnancy rates have also decreased (CDC, 1998a), about one million teenagers become pregnant annually (Moore, 1996). Forty percent of adolescent females of color will become pregnant at least once before age nineteen, as compared to 21 percent of white females (Henshaw, 1997). Almost 90 percent of all teen pregnancies are unintended (Moore, 1996). In general, about 51 percent of teen pregnancies end in live births, 35 percent in induced abortions, and 14 percent in miscarriages or stillbirths (Moore, 1996).
Between 1992 and 1995, birthrates dropped for teens fifteen to nineteen, with the largest percentage decline (24 percent) noted among African American teens, compared to 17 percent for white teens (Ventura, Martin, Curtin, & Mathews, 1999). Rates have stayed constant for younger teens (Moore, 1996). The U.S. teen birthrate in 1997 (52.3 per 1,000) is still higher than the rate in 1980 (50 per 1,000) and is higher than in any other industrialized nation. Rates for African American adolescents (90.8 per 1,000), although lower than the rates for Hispanic adolescents (97.4 per 1,000), are about twice that of white adolescents (36 per 1,000) (Ventura et al., 1999).
Once a teen is pregnant, she is at increased risk for a subsequent pregnancy. Twenty-two percent of births to teens are not first births (Moore, Papillo, Williams, Jager, & Jones, 1999), although the live birthrate has declined by 16 percent since 1991 (Ventura et al., 1999).
Eighty-three percent of teens who give birth and 61 percent who have abortions are from poor and low-income families. One-third are products of teen pregnancies themselves. Between 50 and 60 percent of teens who become pregnant have a history of physical or sexual abuse (Alan Guttmacher Institute, 1994)...
|Foreword: Another Call to Action|
|Pt. 1||Health Status Across the Life Span||1|
|1||African American Health: An Overview||3|
|2||The Health Status of Children and Adolescents||13|
|3||The Health Status of Black Women||44|
|4||The Health Status of Black Men||62|
|5||Health and the Elderly||81|
|Pt. 2||Social, Mental, Environmental Challenges||97|
|6||The Epidemiology of Mental Disorder: 1985-2000||99|
|7||The Role of Black Faith Communities in Fostering Health||129|
|8||The Epidemic of Homicide and Violence||151|
|9||The Dilemma of Organ and Tissue Transplantation||167|
|Pt. 3||Chronic Diseases||187|
|10||Hypertension and Other Risk Factors for Stroke||189|
|13||Sickle Cell Anemia||242|
|15||Pediatric Asthma in African American Children||282|
|Pt. 4||Lifestyle Behaviors||307|
|17||Tobacco: From Slavery to Addiction||347|
|19||Alcohol Use and Misuse||403|
|Pt. 5||Ethical, Political, and Ecological Issues||469|
|22||The Quest for Environmental Justice||471|
|23||Research and Ethics: A Legacy of Distrust||489|
|24||Health Policy Challenges||503|
|25||Cultural Sensitivity in Public Health||516|
|26||Closing the Gap: Eliminating Health Disparities||543|