Faith-based Social Capital, Racial Trust, Community Support of Immigrants' Rights and Risk of Tuberculosis in Selected Metropolitan Statistical Areas, 2000 and 2006. Público

Abstract

Abstract

Faith-based Social Capital, Racial Trust, Community Support of Immigrants' Rights and
Risk of Tuberculosis in Selected Metropolitan Statistical Areas, 2000 and 2006.

By Christine E. Miner

Purpose: Since 2002, Foreign-born individuals represent the majority of Tuberculosis
(TB) cases in the United States. Risk factors associated with the U.S. and Foreign-born
populations include living conditions, occupation, socioeconomic status, biological risk
factors and country of origin, for the Foreign-born population alone. However, few
studies have examined the association between other social determinants of health and
TB, especially in the Foreign-born population. This study will provide information on the
association between TB case rates in Metropolitan Statistical Area's (MSA's) and MSA-
specific faith-based social capital, racial trust and support of immigrants' rights.

Methods: Two public use datasets were used in this analysis. First, the Online
Tuberculosis Information System (OTIS) contains data on all verified cases in the United States

and Pacific Islands from 1993. Only two demographic variables could be
stratified for at a time due to suppression of cross-classified surveillance data. The Social
Capital Community Benchmark Survey, containing data from a random sample of
citizens in 42 communities, was used to create a contextual measure of the
degree of social capital in each MSA. Analyses performed included descriptive statistics
and Poisson regression of correlated data.

Results: A 1-standard deviation increase in MSA-specific faith-based social capital was
associated with a 1.54 increase in rate for diagnosis of TB in selected MSAs after
adjusting for race, sex and year (p=0.03). This finding was similar in three models that
adjusted for U.S./Foreign-born status and year (RR: 2.01, p=0.06), U.S./Foreign-born
status, race and year (RR: 1.63, p=0.01), and U.S/Foreign-born status, sex and year (RR:
3.81, p=0.01). Decreased support of immigrants' rights was also associated with
increased TB case rates, in two models that adjusted for sex (RR: 2.21, p=0.02), and age
and sex (RR: 1.91, p=0.06).

Conclusion: MSA-level decreased support of immigrants' rights and faith-based social
capital were associated with increased TB rates. More studies should be conducted to
replicate these findings, and if replicated, interventions could be designed to further
decrease TB case rates in the U.S.

Table of Contents

Table of Contents
Introduction ..............................................................................................................1
Background and Literature Review .......................................................................3

Overview ........................................................................................................3

Biology of Tuberculosis .................................................................................3
Risk
Factors
...................................................................................................4
Biological
Determinants
....................................................................4
Social
Determinants
...........................................................................6

Importance of Study .......................................................................................13
Research Questions ..................................................................................................15
Methods ............................................................................................................16

Data Sources ..................................................................................................16


Social Capital Community Benchmark Survey .................................16


Online Tuberculosis Information System (OTIS) ..............................19
Combining
Data
Sources
...................................................................21
Data
Analysis
.................................................................................................22
Descriptive
Statistics
..........................................................................22


Poisson Regression of Correlated Data..............................................23
Results ............................................................................................................27

Descriptive Statistics ......................................................................................27

Poisson Regression of Correlated Data..........................................................34
Discussion ............................................................................................................42

Summary of Findings .....................................................................................42

Comparison to Literature ...............................................................................43
Strengths
and
Limitations
..............................................................................45

Public Health Implications .............................................................................46
Future
Directions
...........................................................................................48
Conclusion
.....................................................................................................49
References ............................................................................................................51
Tables
............................................................................................................57
Appendix ............................................................................................................66

IRB Approval .................................................................................................66

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Palavra-chave	Tuberculosis Social Capital Racial Trust Immigrants Support of Immigrants' Rights
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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