African Americans of the Mental health
IN GENERAL, HEALTH status in the United States has continually improved throughout the last century. However, tremendous disparities in health status exist across various segments of the population [Sebastian 1999, Wallace 1999 and Williams et al 1997]. African Americans have higher rates of death, disease, and disability than Caucasians, including higher rates for 13 of the 15 leading causes of death in the U.S. [Williams et al 1997].
Results from studies comparing mental health status of African Americans and Caucasians vary. Some researchers found that African Americans have higher levels of psychological distress [Fiscella and Franks 1997, Snowden 2003, Thompson 2002 and Vega et al 1997]. However, results from the Epidemiological Catchment Area Study [Robins and Regier 1991. L.N. Robins and D.A. Regier. Psychiatric disorders in America: The Epidimiologic Catchment Area Study, Free Press, New York (1991).Robins and Regier 1991] and the National Comorbidity Study [Kessler et al 2002] found that African Americans have lower or equivalent rates of psychiatric disorder. On the other hand, when gender was examined in the ECA study, African American women had higher rates of anxiety disorders than Caucasian women [Robins and Regier 1991]. The purpose of this manuscript is to compare rural African American and Caucasian women on alcohol and other drug use (AOD), comorbid Axis I psychiatric disorders, and experiences with violence.
Review of the literature
Researchers have shown that race is not the primary contributor to health disparities, but socioeconomic status (SES) [Sebastian 1999 and Williams et al 1997]. Compared with Caucasians, African Americans have a median income that is 63% less and are more than twice as likely to be unemployed, three times more likely to be poor, and twice as likely not to have graduated from college [Williams et al 1997]. Also contributing to disparities in SES, African American families are more likely to be headed by a single parent, to lack health insurance, and to live in segregated, impoverished housing [Wallace 1999]. More than one-third of all African American women live in poverty, placing them at a tremendous disadvantage [Davis 1997]. Disparities in health care may exist because people with higher SES status have more resources (money, education, prestige, power, social support and social connections) that can be used to prevent risk and to promote health. [Buka 2002 and Galea and Vlahov 2002]. Studies of racial differences in health that control for SES often find that racial disparities are reduced and sometimes eliminated [Williams et al 1997]. However, importantly, race is often a determinant of SES in that many African Americans face economic discrimination [Williams et al 1997].
Rural women are at particular risk for health disparities. Rural women often live in poverty, are unemployed, lack health insurance, and face environmental and geographic constraints that limit access to what limited health care exists [Gaston 2001]. Lack of personal transportation and unreliable public transportation compounds geographic separation and further limits access to health care for rural women. Many rural areas are characterized by conditions that plague poor, inner-city neighborhoods such as poverty, high crime rates, alcohol and other drug (AOD) use, domestic violence, and few opportunities for entertainment that are not centered around AOD use [Boyd and Mackey 2000, National Institute on Drug Abuse [NIDA] 1997 and Rural Women’s Work Group 2000]. In addition to increasing risk for AOD use and relapse after treatment, these conditions are associated with increased risk for stress-related mental disorders such as anxiety disorders and major depression.
Prevalence rates for use of illicit drugs vary across studies and according to time frame (i.e., lifetime, 1 month, 1 year). According to the latest National Household Survey on Drug Abuse [Substance Abuse and Mental Health Services Administration [SAMSA] 2002], for persons 12 years old or older, more Caucasians use illicit drugs than do African Americans for lifetime use (44.5% vs. 38.6%) and past year use (12.9 vs. 12.2). Past month use of illicit drugs was slightly higher for African Americans (7.4%) than for Caucasians (7.2%). In the age range of 12 to 17, which is the only age range reported by race and gender, more Caucasian women used illicit drugs than African American women for lifetime use (28.5% vs. 27.5%), past year use (21.4% vs. 18.0%), and past month use (10.8% vs. 8.7%).
Similarly, more Caucasians (aged 12 or older) used alcohol than African Americans in three types of alcohol use categories: any use (52.7% vs. 35.1%); binge alcohol use (21.5% vs. 16.8%); and heavy alcohol use (6.4% vs. 4.1%). In the only age range reported by race and gender (12–17 year old), Caucasian women reported higher use than African American women: Any use (19.7% vs. 11.2%) binge alcohol use (11.5% vs. 5.9%); and heavy alcohol use (2.4% vs. .5%) [Substance Abuse and Mental Health Services Administration [SAMSA] 2002]. Earlier studies of alcohol use found that more African American women abstain from alcohol use than do Caucasians (64% vs. 48%) [Jones-Webb 1998].
Although AOD use among African Americans is lower than or equal to that of Caucasians, African Americans disproportionately experience negative health and social consequences of AOD use [D’Avanzo et al 2000, John et al 1997 and Rouse et al 1995]. African Americans have higher incidences of alcohol related illness such as cirrhosis, cancer, pulmonary disease, malnutrition, and birth defects than do Caucasians [D’Avanzo et al 2000 and Jones-Webb 1998]. African Americans suffer disproportionately from many AOD related adverse effects: unemployment, substandard housing, homelessness, poor educational outcome, and inadequate health care [Woods 1998]. However, these same conditions are risk factors for AOD disorders, thus creating a vicious circle [Galea and Vlahov 2002]. African Americans also are at greater risk of being victims of alcohol or illicit drug-related homicides, being arrested for drunkenness or possession of a controlled substance, and being sent to prison rather than to treatment [D’Avanzo et al 2000].
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