Possible Effects on Differences

Health promotion could have different effects for various racial and ethnic groups. We illustrate possible reasons for this, though the research on each is not conclusive.

First, racial and ethnic groups may differ initially on the behavior that one seeks to influence. As discussed above, some unhealthy behaviors are more characteristic of older whites—smoking, less frequent Pap tests and mammogram screening—and others are more characteristic of older blacks and Hispanics—less physical activity and obesity (Winkleby and Cubbin, 2004). The relative physical inactivity of blacks and Mexican Americans cannot be explained by the socioeconomic status of individuals (Crespo et al., 2000). Also, even at similar socioeconomic levels, Mexican American women have more body fat than white women of similar body mass (Casas et al., 2001). (There is more limited information on these behaviors for Asians and American Indians and Alaska Natives.) It is reasonable to expect that health promotion interventions targeted at specific behaviors should have differential effects across groups, but whether those with more or less healthy behavioral profiles would be more affected is undetermined.

Second, some interventions may affect socioeconomic groups differently, with some being more responsive to them because of differences in education or income. Some interventions, such as smoking cessation, have been more successful among more educated people, but others, such as cholesterol screening, appear to affect socioeconomic groups equally (Cutler, 2004). Since racial and ethnic groups differ in socioeconomic status, interventions with disproportionate influence on higher status groups could affect differences, increasing the black disadvantage but reducing the Asian advantage (and the Hispanic advantage for mortality) relative to whites. Particularly if such effects are temporary, this difference is not necessarily a reason for avoiding such interventions.

Third, the social situation for members of some racial or ethnic groups may favor a stronger or weaker response to a specific intervention. The social environment plays a large role in the health of older persons, with younger family members involved in caregiving to maintain the health of older persons and keep them in their home environment. Extended caregiving networks are reported to be more active among some racial and ethnic minorities than others (Navaie-Waliser et al., 2001; Roth et al., 2001; Williams and Dilworth-Anderson, 2002). Eyler et al. (1999) found that, in comparison with black and American Indian women, Hispanic women were more likely to have high levels of social support, which promoted physical activity. The amount of social support, including also support from the wider community, may determine whether health promotion



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