Relationships between discrimination in health care and health care outcomes among four race/ethnic groups.

Discrimination has been found to be detrimental to health, but less is known about the influence of discrimination in health care. To address this, the current study (1) compared levels of racial/ethnic discrimination in health care among four race/ethnic groups; (2) determined associations between this type of discrimination and health care outcomes; and (3) assessed potential mediators and moderators as suggested by previous studies. Multivariate logistic regression models were used within a population-based sample of 1,699 White, African American, Mexican, and Puerto Rican respondents. Overall, 23% of the sample reported discrimination in health care, with levels varying substantially by race/ethnicity. In adjusted models, this type of discrimination was associated with an increased likelihood of having unmet health care needs (OR = 2.48, CI = 1.57-3.90) and lower odds of perceiving excellent quality of care (OR = 0.43, CI = 0.28-0.66), but not with the use of a physician when not sick or use of alternative medicine. The mediating role of mental health factors was inconsistently observed and the relationships were not moderated by race/ethnicity. These findings expand the literature and provide preliminary evidence that can eventually inform the development of interventions and the training of health care providers.

Race/ethnic discrimination and preventive service utilization in a sample of whites, blacks, Mexicans, and Puerto Ricans.

BACKGROUND: Race/ethnic discrimination is associated with poorer mental and physical health, worse health behaviors, and increased mortality, in addition to overall race/ethnic disparities in health. More specifically, it has been suggested as a possible determinant of the significant race/ethnic differences in the quantity and quality of medical care received by individuals in the United States. OBJECTIVES: The current study examines the association between 3 measures of racial/ethnic discrimination (Experiences of Discrimination, Everyday Discrimination Scale and discrimination in health care) and 6 types of preventive services (mammogram, clinical breast examination, Pap smear, colonoscopy/sigmoidoscopy, blood pressure screening, and diabetes screening). RESEARCH DESIGN: Frequencies and correlations are run within a population-based sample of 1699 respondents from Chicago that includes whites, African Americans, Mexicans, and Puerto Ricans. Adjusted logistic regression models are run separately by race/ethnicity. RESULTS: Findings show that levels of perceived discrimination vary between all race/ethnic groups, with blacks consistently reporting the highest levels and whites the lowest. Discrimination is only inconsistently related to obtaining screenings for cancer, hypertension, and diabetes. The few significant relationships found differed both by measure of discrimination and the respondents' race and ethnicity. CONCLUSIONS: Given the growing diversity in the United States and the prevalence of discrimination, more research regarding its impact on health care utilization is needed. Only when all the factors influencing patient behaviors are better understood will policies and interventions designed to improve them be successful. These are important steps that will help attain our national goals of eliminating race/ethnic disparities in health.

Exploring differences in self-rated health among Blacks, Whites, Mexicans, and Puerto Ricans.

OBJECTIVES: Self-rated health (SRH) is a robust predictor of subsequent health and mortality. Although age, gender, and race differences in SRH have been explored, less work has examined ethnic differences, particularly in the US. DESIGN: The current study uses representative data from six Chicago communities to compare levels and determinants of fair-poor health for Blacks, Whites, Mexicans, and Puerto Ricans (n=1311). RESULTS: Mexicans and Puerto Ricans were at least three times more likely to report fair or poor health than Whites, while African-Americans were over twice as likely. In adjusted logistic regression models, only Mexicans remain significantly more likely to report fair-poor health than Whites (OR = 4.3, CI = 1.8-9.8). However, this effect disappears when controlling for acculturation. No variable predicted poor subjective health for all groups, though depression was associated with poor health for most. CONCLUSION: Together, these analyses suggest that the single item measure of SRH might not be appropriate for comparing health status across members of different race/ethnic groups. More research is needed to understand what factors influence how an individual perceives his or her health.

Religion: a sociocultural predictor of health behaviors in Mexico.

OBJECTIVE: Tobacco, alcohol, and physical inactivity are now among the top 10 risk factors for mortality in the Americas region. Subsequently, a more complete understanding of the various cultural factors that influence health behaviors such as these is needed. METHOD: This study investigates how religion influences the use of alcohol and cigarettes within a large, nationally representative sample of older adults in Mexico (Mexican Health and Aging Study, N = 10,399). RESULTS: Religious salience and participation in religious activities are both significantly associated with smoking status, but not alcohol use. DISCUSSION: This is one of the first studies to examine these associations in a developing country. Despite cultural differences, the negative relationship between religion and smoking in Mexico corresponds to associations seen in the United States and other Western countries. This type of information may be useful to health researchers, providers, and policy makers attempting to reduce deaths due to preventable causes.

Predictors of preventive health care use among middle-aged and older adults in Mexico: the role of religion.

Research has shown that religion is associated with a wide range of health behaviors among adults of all ages. Although there is strong support for religion's influence on behaviors such as drinking and smoking, less is known about the possible relationship between religion and the use of preventive health services. This relationship may be particularly important in Mexico, a country with high levels of religiousness and low levels of preventive service utilization. The current study uses a nationally representative sample of middle-aged and older adults in Mexico (n = 9,890) to test the association between three facets of religion and three preventive services aimed at detecting chronic conditions or underlying risk factors. The findings show that religious salience is significantly related to the use of blood pressure and cholesterol screenings, even after controlling for a variety of social, demographic, and health-related factors. In addition, attending religious services and participating in religious activities are both positively associated with blood pressure and diabetes screening. This type of research adds to our knowledge of the determinants of preventive service utilization, as well as to the burgeoning literature on religion and health. Furthermore, because the vast majority of research in this field takes place in more developed and Westernized countries, such as the US and Western Europe, analyzing this relationship in a sample of older Mexicans is critical for providing the field with a more comparative orientation.