Start Date

18-6-2019 9:00 AM

End Date

18-6-2019 10:30 AM

Description

Multiracial Health Behaviors and Disparities:

An Integrated Literature Review

Elsa Chiyo Iwai

Faculty Sponsor: Elizabeth P. Anderson RN, PhD

Background: The year 2000 was a pivotal year for multiracial individuals. Changes to the U.S. Census Bureau included acknowledging multiracial individuals. However, where multiracial individuals and healthcare intersect, the research is relatively new and limited. Multiracial individuals confound many assumptions about race. Uncertainty exists between socially constructed racial categories and populations that have evolved genetic patterns independently over time but fail to fit perfectly within categorical lines. Although social changes has raised awareness on mixed race and multiracial individuals, a deeper exploration of the meaning of race and its relevance to health is needed.

Objectives: To explore to what extent multiracial individuals align with established monoracial health behaviors and disparities.

Method: An integrated literature review was conducted to explore existing literature on multiracial health behaviors and disparities. After the data collection process, the sources were synthesized and analyzed as outlined in the Burns, Groves, and Gray (2013) text. A data review matrix was utilized and literature was categorized. A total of seven research studies from 2000 to 2019 were selected and analyzed.

Results: Four Themes emerged after analysis on age groups were not specific and inclusive: 1) Landmark study (a) on sexual behavior of young adults: African American with White persons had higher sexual behavior risks (one night stands (p=0.05), ever paid or was paid for sex (p<0.01). Landmark study (a) multiracial (was not specific on mixture), Pacific Islander, Native American, Asian adults were found to have significantly higher HBV vaccination (p< 0.01). 2) Health Behavior Risks: multiracial (white, Black, Asian; confusing on mixture) adolescents were found to have higher risks in general health, negative school experience, and participation in smoking and drinking (p< 0.05). 3) Health Maintenance: multiracial Black/White and black/Native American young adults were less likely to report primary care service and less likely to have a routine physical exam (p<0.001). 4) Mental Health: multiracial (not specific on mixture)adolescents were found to have higher levels of depression and anxiety (p<0.001). Malleability racial identity multiracial (Asian/White, Black/White, Black/Latino/Native American) predicted lower mental health (p<0.001). Forced choice dilemmas (Asian/White, Latino/White, Native American/White, Black/White, Black Native American multiracial mixture) associated with devaluation in society predicted greater depressive symptoms (p<0.01).

Conclusion: Major limitations of the half of the studies lacked a theoretical/conceptual framework and representativeness (no Hispanics in 5 studies, older adults none, limited geographical area in 2 studies). Older adult age groups >62 years (older adults) have high risk of vulnerability and may adopt different health behaviors and experience health disparities not faced by multiracial individuals of other age group. Six studies were self-reported survey and questionnaire which may be at risk for responder bias. Future research recommendations are to utilize a theoretical/conceptual framework, the Ecological Framework for Understanding Identify Development (Root, 2003). The framework covers all facets of identify formation for multiracial individuals. In utilization of this framework for ILR this researcher found the health component was ranked low as a fifth element out of 6 of which should be revised to the first level. Incorporation of more specific multi-racial subgroups including Hispanics with delineation of ages reflective of adolescents, young adult, middle-aged and older adults.

The purpose of this ILR was to use existing research to explore multiracial health. The focus was on examining the health patterns and health disparities of multiracial population in comparison to their monoracial components. Failure to rethink the constricted paradigm of monorace health in regards to multiracial health is misleading. The lack of research and inapplicable monoracial health standards mask multiracial health disparities for many multiracial subgroups. A key factor in understanding multiracial health behaviors and experienced health disparities is removing the over generalization and invisibility of multiracial realities in healthcare. Through the lens of the Ecological Framework of Identity Development, this ILR study expressed the dynamics of multiracial identity and how all their lived experiences directly and indirectly influenced their health behaviors and risks.

Key terms: multiracial health, mixed race health

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Jun 18th, 9:00 AM Jun 18th, 10:30 AM

Multiracial Health Behaviors and Disparities: An Integrated Literature Review

Multiracial Health Behaviors and Disparities:

An Integrated Literature Review

Elsa Chiyo Iwai

Faculty Sponsor: Elizabeth P. Anderson RN, PhD

Background: The year 2000 was a pivotal year for multiracial individuals. Changes to the U.S. Census Bureau included acknowledging multiracial individuals. However, where multiracial individuals and healthcare intersect, the research is relatively new and limited. Multiracial individuals confound many assumptions about race. Uncertainty exists between socially constructed racial categories and populations that have evolved genetic patterns independently over time but fail to fit perfectly within categorical lines. Although social changes has raised awareness on mixed race and multiracial individuals, a deeper exploration of the meaning of race and its relevance to health is needed.

Objectives: To explore to what extent multiracial individuals align with established monoracial health behaviors and disparities.

Method: An integrated literature review was conducted to explore existing literature on multiracial health behaviors and disparities. After the data collection process, the sources were synthesized and analyzed as outlined in the Burns, Groves, and Gray (2013) text. A data review matrix was utilized and literature was categorized. A total of seven research studies from 2000 to 2019 were selected and analyzed.

Results: Four Themes emerged after analysis on age groups were not specific and inclusive: 1) Landmark study (a) on sexual behavior of young adults: African American with White persons had higher sexual behavior risks (one night stands (p=0.05), ever paid or was paid for sex (p<0.01). Landmark study (a) multiracial (was not specific on mixture), Pacific Islander, Native American, Asian adults were found to have significantly higher HBV vaccination (p< 0.01). 2) Health Behavior Risks: multiracial (white, Black, Asian; confusing on mixture) adolescents were found to have higher risks in general health, negative school experience, and participation in smoking and drinking (p< 0.05). 3) Health Maintenance: multiracial Black/White and black/Native American young adults were less likely to report primary care service and less likely to have a routine physical exam (p<0.001). 4) Mental Health: multiracial (not specific on mixture)adolescents were found to have higher levels of depression and anxiety (p<0.001). Malleability racial identity multiracial (Asian/White, Black/White, Black/Latino/Native American) predicted lower mental health (p<0.001). Forced choice dilemmas (Asian/White, Latino/White, Native American/White, Black/White, Black Native American multiracial mixture) associated with devaluation in society predicted greater depressive symptoms (p<0.01).

Conclusion: Major limitations of the half of the studies lacked a theoretical/conceptual framework and representativeness (no Hispanics in 5 studies, older adults none, limited geographical area in 2 studies). Older adult age groups >62 years (older adults) have high risk of vulnerability and may adopt different health behaviors and experience health disparities not faced by multiracial individuals of other age group. Six studies were self-reported survey and questionnaire which may be at risk for responder bias. Future research recommendations are to utilize a theoretical/conceptual framework, the Ecological Framework for Understanding Identify Development (Root, 2003). The framework covers all facets of identify formation for multiracial individuals. In utilization of this framework for ILR this researcher found the health component was ranked low as a fifth element out of 6 of which should be revised to the first level. Incorporation of more specific multi-racial subgroups including Hispanics with delineation of ages reflective of adolescents, young adult, middle-aged and older adults.

The purpose of this ILR was to use existing research to explore multiracial health. The focus was on examining the health patterns and health disparities of multiracial population in comparison to their monoracial components. Failure to rethink the constricted paradigm of monorace health in regards to multiracial health is misleading. The lack of research and inapplicable monoracial health standards mask multiracial health disparities for many multiracial subgroups. A key factor in understanding multiracial health behaviors and experienced health disparities is removing the over generalization and invisibility of multiracial realities in healthcare. Through the lens of the Ecological Framework of Identity Development, this ILR study expressed the dynamics of multiracial identity and how all their lived experiences directly and indirectly influenced their health behaviors and risks.

Key terms: multiracial health, mixed race health