American Journal of Speech-Language Pathology Vol.21 181-182 August 2012. doi:10.1044/1058-0360(2012/ed-03)
© American Speech-Language-Hearing Association
Do Demographic and Cultural Differences Exist in Adulthood?
Carol Scheffner Hammer, Editor
As Editor, I have been struck by how few studies submitted to the American Journal of Speech-Language Pathology
attend to the cultural, racial/ethnic, and socioeconomic diversity that exists within the adult population. Information is infrequently provided about the cultural, racial, and/or ethnic backgrounds of the participants. To be fair, many studies do report the educational status of participants, which can be viewed as a proxy for socioeconomic status (SES); however, the role of SES typically is not central to the research questions, nor is it considered in the analyses. As a result, the field of speech-language pathology has little information about differences that occur among adult populations with various speech and language disorders. However, there are reasons to hypothesize that differences do exist
in the speech and language abilities of adults from diverse backgrounds who have various diagnoses and that individuals from diverse backgrounds may respond differently to intervention. We cannot assume that there are no differences without having conducted studies that investigate such factors.
For decades, statistics have shown that individuals from diverse backgrounds have poorer health than those from the White, middle-class mainstream population. Although the overall health of Americans has improved, and individuals are living longer, minorities, which constitute 25% of the population, experience dramatic health disparities. These disparities include shorter life expectancy and poorer overall health as well as higher rates of diabetes, cancer, heart disease, and stroke. A complex interaction of biological, environmental, and behavioral factors is thought to contribute to these disparities (National Institute on Minority Health and Health Disparities, 2012; U.S. Centers for Disease Control and Prevention, 2011). In addition to higher rates of impairment, differences in the outcomes of individuals with these disorders have also been found. For example, a number of studies have demonstrated that racial/ethnic minorities who experience strokes have more severe strokes, greater levels of initial impairment, and poorer long-term outcomes than White, middle-class adults (see review by Ellis, 2009).
Additionally, government studies have consistently demonstrated that individuals from minority backgrounds and with low incomes have lower quality health care experiences. Specifically, the 2010 National Health Care Disparities Report (Agency for Healthcare Research and Quality, 2011) showed significant disparities in health care access and health care quality among racial, ethnic, and SES groups. Using six core measures of health care, this report found that Blacks had worse access to care than Whites on four of the six core measures, and Hispanics had worse access to care than non-Hispanics on five of the six measures. Low-income individuals had the worst access to care on all six core measures. Similar findings were found for the quality of health care received, with Blacks, Hispanics, and low-income individuals receiving poorer quality health care than non-Hispanic Whites with higher incomes. It is reasonable to expect that reduced access to health care and receipt of lower quality health care lead to poorer health outcomes. It is also reasonable to hypothesize that the poorer health outcomes include medical conditions that fall under the purview of speech-language pathologists, and thus, should receive our attention.
In addition, there is a large body of evidence from research on children that shows that differences exist among cultural, racial/ethnic, and SES groups. Evidence abounds demonstrating cultural and racial/ethnic variations in the language and communicative behaviors that are valued, dialects spoken, parenting beliefs and practices, and a host of other key aspects of life (cf. Heath, 1983; Rogoff, 2003; van Kleeck, 1994; Washington & Craig, 2002). Studies that consider the role of SES also show differences in the speech and language abilities and language environments of children from low-income and middle-income families (cf. Hart & Risley, 1995). Given that differences among these groups exist in childhood, it seems reasonable to expect that these differences do not disappear in adulthood. Yet, relatively few studies on the adult population consider the cultural, racial/ethnic, and SES characteristics of the participants.
I strongly encourage researchers who focus on adult populations to investigate the role that culture, race/ethnicity, and SES may play in their area of study. Differences may be seen in the incidence and prevalence of various disorders, the mechanisms that cause the disorders being studied, and the severity and short- and long-term outcomes of individuals with these disorders. Additionally, differences may be observed in the quality of services provided and in individuals' access to speech-language services, desire to seek and remain in services, and outcomes as a result of treatment. It cannot be assumed that all interventions work equally well for all individuals. Differences in outcomes may occur due to a host of factors. As a result, culture, race/ethnicity, and SES need to assume a larger role in investigations of adults with speech and language disorders.
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- Agency for Healthcare Research and Quality. (2011). 2010 National healthcare disparities report. Washington, DC: U.S. Department of Health and Human Services.
- Ellis, C. (2009). Does race/ethnicity really matter in adult neuro-genics? American Journal of Speech-Language Pathology, 18, 310–314.[Abstract/Free Full Text]
- Hart, B., & Risley, T. (1995). Meaningful differences. Baltimore, MD: Brookes.
- Heath, S. B. (1983). Ways with words. New York, NY: Cambridge University Press.
- Rogoff, B. (2003). The cultural nature of human development. New York, NY: Oxford University Press.
- National Institute on Minority Health and Health Disparities. (2012). Health disparities: Closing the gap. Retrieved from www.nimhd.nih.gov.hdFactSheet_gap.asp
- U.S. Centers for Disease Control and Prevention. (2011). CDC health disparities and inequalities report—United States, 2011. Morbidity and Mortality Weekly Report, 60(Suppl), 1–160.
- van Kleeck, A. (1994). Potential cultural bias in training parents as conversational partners with their children who have delays in language development. American Journal of Speech-Language Pathology, 3, 67–78.[Abstract/Free Full Text]
- Washington, J. A., & Craig, H. K. (2002). Morphosyntactic forms of African American English used by young children and their caregivers. Applied Psycholinguistics, 23(2), 209–231.[Web of Science]