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1.
JAMA Netw Open ; 3(1): e1918745, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31913496

RESUMO

Importance: The 2016 US presidential election brought national visibility to prominent economic issues affecting rural America, yet little has been done to examine serious health or economic problems in rural communities from the perspectives of rural US adults themselves. Objective: To examine views on the most serious health and economic concerns and potential solutions in rural communities. Design, Setting, and Participants: This survey study used 2 cross-sectional probability-based telephone (cellular and landline) surveys of adults living in the rural United States. The first survey was conducted June 6 to August 4, 2018, and the second survey was conducted January 31 to March 2, 2019. All results were weighted to be nationally representative of rural US adults. Data analysis was conducted in April 2019. Main Outcomes and Measures: The primary study outcomes were the prevalence of rural adults reporting their biggest community problems, problems with health care access and costs, ratings of the local economy, views on opioid addiction, and views on solving major community issues. Results: The 2018 survey included 1300 respondents (response rate, 12%; completion rate, 70%), and the 2019 survey included 1405 respondents (response rate, 8%; completion rate, 76%). Rural adults primarily identified as non-Hispanic white (78%), and more than half of respondents were 50 years or older (survey 1: 55%, survey 2: 53%). Rural adults identified opioid or other drug addiction or abuse (25%; 95% CI, 22%-28%) and economic concerns (21%; 95% CI, 19%-24%) as the most serious problems facing their local communities. Opioid or other drug addiction or abuse was reported as a serious problem in their local community by 57% (95% CI, 53%-60%) of rural adults, while 49% (95% CI, 46%-53%) of rural adults said they personally know someone who has had opioid addiction. Problems paying medical bills were reported by 32% (95% CI, 29%-36%) of rural adults, and recent issues with accessing health care were reported by 26% (95% CI, 23%-30%) of rural adults. Regarding financial and economic issues, 55% (95% CI, 52%-59%) of rural adults rated their local economy as only fair or poor, and 49% (95% CI, 44%-54%) of rural adults said they would have difficulty paying off an unexpected $1000 expense. On solving major community problems, 58% (95% CI, 54%-62%) of rural adults saw a need for outside help to solve major community problems, and among those who reported needing outside help, 61% (95% CI, 57%-66%) identified a major role for government. Conclusions and Relevance: These findings suggest that in today's economically stretched rural United States, opioid or other drug addiction or abuse has emerged as an equal problem with economic concerns. One in 3 rural adults still have problems paying their medical bills even after the passage and implementation of the Patient Protection and Affordable Care Act. Although rural communities have traditionally been self-reliant, more than half of rural adults are open to outside help to solve serious problems facing their communities, including major help from government.

2.
Health Serv Res ; 54 Suppl 2: 1409-1418, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31667831

RESUMO

OBJECTIVE: To examine experiences of racial/ethnic discrimination among Latinos in the United States, which broadly contribute to their poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 803 Latinos and a comparison group of 902 non-Hispanic white US adults, conducted January-April 2017. METHODS: We calculated the percent of Latinos reporting discrimination in several domains, including health care. We used logistic regression to compare the Latino-white difference in odds of discrimination, and among Latinos only to examine variation by socioeconomic status and country of birth. PRINCIPAL FINDINGS: One in five Latinos (20 percent) reported experiencing discrimination in clinical encounters, while 17 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Latinos also reported experiencing discrimination with employment (33 percent applying for jobs; 32 percent obtaining equal pay/promotions), housing (31 percent), and police interactions (27 percent). In adjusted models, Latinos had significantly higher odds than whites for reporting discrimination in health care visits (OR: 3.18, 95% CI: 1.61, 6.26) and across several other domains. Latinos with college degrees had significantly higher odds of reporting discrimination in multiple domains than those without college degrees, with few differences between foreign-born and US-born Latinos. CONCLUSIONS: Latinos in the United States report experiencing widespread discrimination in health care and other areas of their lives, at significantly higher levels than whites. Being born in the United States and earning a college degree are not protective against discrimination, suggesting that further health and social policy efforts to eliminate discrimination are needed.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Racismo/psicologia , Inquéritos e Questionários , Telefone , Estados Unidos
3.
Health Serv Res ; 54 Suppl 2: 1454-1466, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31659745

RESUMO

OBJECTIVE: To examine reported experiences of discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the United States, which broadly contribute to poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data came from a national, probability-based telephone survey of US adults, including 489 LGBTQ adults (282 non-Hispanic whites and 201 racial/ethnic minorities), conducted January-April 2017. METHODS: We calculated the percentages of LGBTQ adults reporting experiences of discrimination in health care and several other domains related to their sexual orientation and, for transgender adults, gender identity. We report these results overall, by race/ethnicity, and among transgender adults only. We used multivariable models to estimate adjusted odds of discrimination between racial/ethnic minority and white LGBTQ respondents. PRINCIPAL FINDINGS: Experiences of interpersonal discrimination were common for LGBTQ adults, including slurs (57 percent), microaggressions (53 percent), sexual harassment (51 percent), violence (51 percent), and harassment regarding bathroom use (34 percent). More than one in six LGBTQ adults also reported avoiding health care due to anticipated discrimination (18 percent), including 22 percent of transgender adults, while 16 percent of LGBTQ adults reported discrimination in health care encounters. LGBTQ racial/ethnic minorities had statistically significantly higher odds than whites in reporting discrimination based on their LGBTQ identity when applying for jobs, when trying to vote or participate in politics, and interacting with the legal system CONCLUSIONS: Discrimination is widely experienced by LGBTQ adults across health care and other domains, especially among racial/ethnic minorities. Policy and programmatic efforts are needed to reduce these negative experiences and their health impact on sexual and/or gender minority adults, particularly those who experience compounded forms of discrimination.


Assuntos
Disparidades em Assistência à Saúde , Assédio Sexual , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adolescente , Adulto , Feminino , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Habitação , Humanos , Masculino , Assédio Sexual/etnologia , Assédio Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Inquéritos e Questionários , Telefone , Estados Unidos , Adulto Jovem
4.
Health Serv Res ; 54 Suppl 2: 1442-1453, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31663120

RESUMO

OBJECTIVE: To examine reported experiences of gender discrimination and harassment among US women. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey of 1596 women, conducted January-April 2017. METHODS: We calculated the percentages of women reporting gender discrimination and harassment in several domains, including health care. We used logistic regression to examine variation in experiences among women by race/ethnicity and sexual orientation/gender identity. PRINCIPAL FINDINGS: Sizable fractions of women experience discrimination and harassment, including discrimination in health care (18 percent), equal pay/promotions (41 percent), and higher education (20 percent). In adjusted models, Native American, black, and Latina women had higher odds than white women of reporting gender discrimination in several domains, including health care. Latinas' odds of health care avoidance versus whites was (OR [95% CI]) 3.69 (1.59, 8.58), while blacks' odds of discrimination in health care visits versus whites was 2.00 [1.06, 3.74]. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) women had higher odds of reporting sexual harassment (2.16 [1.06, 4.40]) and violence (2.71 [1.43, 5.16]) against themselves or female family members than non-LGBTQ women. CONCLUSIONS: Results suggest that discrimination and harassment are widely experienced by women across multiple domains of their lives, particularly those who are a racial/ethnic minority or LGBTQ. Further policy and programmatic efforts beyond current legal protections for women are needed to meaningfully reduce these negative experiences, as they impact women's health care and their lives overall.


Assuntos
Disparidades em Assistência à Saúde , Sexismo , Assédio Sexual , Minorias Sexuais e de Gênero/estatística & dados numéricos , Saúde da Mulher , Adolescente , Adulto , Idoso , Emprego , Feminino , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Sexismo/etnologia , Sexismo/estatística & dados numéricos , Assédio Sexual/etnologia , Assédio Sexual/estatística & dados numéricos , Inquéritos e Questionários , Telefone , Estados Unidos
5.
Health Serv Res ; 54 Suppl 2: 1399-1408, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31663124

RESUMO

OBJECTIVE: To examine experiences of racial discrimination among black adults in the United States, which broadly contribute to their poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 802 non-Hispanic black and a comparison group of 902 non-Hispanic white US adults, conducted January-April 2017. METHODS: We calculated the percent of blacks reporting discrimination in several domains, including health care. We used logistic regression to compare the black-white difference in odds of discrimination, and among blacks only to examine variation by socioeconomic status, gender, and neighborhood racial composition. PRINCIPAL FINDINGS: About one-third of blacks (32 percent) reported experiencing discrimination in clinical encounters, while 22 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A majority of black adults reported experiencing discrimination in employment (57 percent in obtaining equal pay/promotions; 56 percent in applying for jobs), police interactions (60 percent reported being stopped/unfairly treated by police), and hearing microaggressions (52 percent) and racial slurs (51 percent). In adjusted models, blacks had significantly higher odds than whites of reporting discrimination in every domain. Among blacks, having a college degree was associated with higher odds of experiencing overall institutional discrimination. CONCLUSIONS: The extent of reported discrimination across several areas of life suggests a broad pattern of discrimination against blacks in America, beyond isolated experiences. Black-white disparities exist on nearly all dimensions of experiences with public and private institutions, including health care and the police. Evidence of systemic discrimination suggests a need for more active institutional interventions to address racism in policy and practice.


Assuntos
Afro-Americanos/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adolescente , Adulto , Afro-Americanos/psicologia , Idoso , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Racismo/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone , Estados Unidos
6.
Health Serv Res ; 54 Suppl 2: 1431-1441, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31657013

RESUMO

OBJECTIVE: To examine reported racial discrimination and harassment against Native Americans, which broadly contribute to poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 342 Native American and 902 white US adults, conducted January-April 2017. METHODS: We calculated the percent of Native Americans reporting discrimination in several domains, including health care. We used logistic regression to compare the Native American-white difference in odds of discrimination and conducted exploratory analyses among Native Americans only to examine variation by socioeconomic and geographic/neighborhood characteristics. PRINCIPAL FINDINGS: More than one in five Native Americans (23 percent) reported experiencing discrimination in clinical encounters, while 15 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Native Americans also reported they or family members have experienced violence (38 percent) or have been threatened or harassed (34 percent). In adjusted models, Native Americans had higher odds than whites of reporting discrimination across several domains, including health care and interactions with the police/courts. In exploratory analyses, the association between geographic/neighborhood characteristics and discrimination among Native Americans was mixed. CONCLUSIONS: Discrimination and harassment are widely reported by Native Americans across multiple domains of their lives, regardless of geographic or neighborhood context. Native Americans report major disparities compared to whites in fair treatment by institutions, particularly with health care and police/courts. Results suggest modern forms of discrimination and harassment against Native Americans are systemic and untreated problems.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Índios Norte-Americanos/estatística & dados numéricos , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Índios Norte-Americanos/psicologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Racismo/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone , Estados Unidos
7.
Health Serv Res ; 54 Suppl 2: 1419-1430, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31657465

RESUMO

OBJECTIVE: To examine experiences of racial discrimination among Asian Americans, which broadly contribute to poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey, including 500 Asian and a comparison group of 902 white US adults, conducted January to April 2017. METHODS: We calculated the percent of Asian Americans reporting discrimination in several domains, including health care. We used logistic regression to compare the Asian-white difference in odds of discrimination, and among Asians only to examine variation by geographic heritage group (South Asian versus East Asian) and gender. PRINCIPAL FINDINGS: 13 percent of Asians reported discrimination in healthcare encounters. At least one in four adults reported experiencing discrimination in employment (27 percent job applications, 25 percent equal pay/promotions); housing (25 percent); and interpersonal interactions (35 percent microaggressions, 32 percent racial slurs). In unadjusted models, East and South Asians were more likely than whites to report experiences of institutional discrimination, and South Asians were more likely than whites to report microaggressions. In adjusted models, Asians had higher odds than whites of reporting avoiding health care due to discrimination concerns and also when obtaining housing. CONCLUSIONS: Asians in the United States experience discrimination interpersonally and across many institutional settings, including housing and health care. South Asians may be especially vulnerable to forms of institutional discrimination and microaggressions. These results illustrate a need for greater investigation into the unique experiences of Asian subgroups and greater protections for groups at higher risk of discrimination, within health care and beyond.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adolescente , Adulto , Americanos Asiáticos/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Racismo/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone
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