Racial differences in Norplant use in the United States

The introduction of the contraceptive implant Norplant has focused attention on how social factors may affect contraceptive use. In the United States, race is a central category of social organization which may impact Norplant use. I use data from the 1995 National Survey of Family Growth to answer three main questions. (1) Are women of color more likely to use Norplant? (2) To what extent can racial differences in Norplant use be explained by a structural bias in the provision of medical care? (3) To what extent can racial differences in Norplant use be explained by life circumstances which may affect individual women's contraceptive decisions? I find that African American and Native American women are more likely than white or Asian American women to be recent Norplant users. There are no differences in recent use by Hispanic origin. Both a structural bias in the provision of care and differences in life circumstances account for the disparity in Norplant use between African Americans and whites. However, none of the factors examined here explain Native American women's high rate of use. Concerns about health risks for Norplant use are also discussed. These findings point out the importance of examining structural, individual and health status factors in studies of the use of health services.Norplant Race Contraception United States

Racial differences in satisfaction with health care providers: An evaluation of three explanations.

African Americans are less likely than whites to be satisfied with their health care. In my dissertation I consider the multiple mechanisms by which race affects experiences in the health care system. I test three potential sources of the gap in satisfaction: (1) racial differences in health status, (2) structural level race differences in access to and source of care, and (3) individual level race differences in how health care providers treat patients. To assess these hypotheses I analyze focus group data collected for my dissertation and secondary quantitative data from the 1995 Detroit Area Study. The quantitative dependent variables that measure satisfaction are an evaluation of the health care provider on treatment with dignity and respect, and spending enough time in the examination. First, I find that although self-reported health and psychological distress generally have a negative relationship to race and satisfaction, African Americans' worse average health status does not account for lower satisfaction with health care providers. Second, the quantitative data do not indicate that access to or source of care explain much of the racial gap in satisfaction with care. However, nearly every focus group explained that patients with Blue Cross/Blue Shield receive better care than those with a health maintenance organization or public insurance. The degree to which this accounts for African Americans lower average satisfaction with health care providers cannot be clearly determined from these data. Third, individual level factors explain more of the statistical variation than the other factors. Whites reduced social distance from their health care provider, that is their greater likelihood of having a same-race health care provider and of having a higher income like their health care provider, explains much of the racial variation in satisfaction. Focus group data support the importance of having a health care provider with whom they have a personal connection. Finally, there is a debate about usefulness of expectations in understanding satisfaction with health care. The qualitative data suggest that expectations are useful for analyzing differences between groups with disparate life experiences. Specifically, race, education, and income seem to influence expectations for care.Ph.D.Black studiesEthnic studiesHealth and Environmental SciencesHealth care managementSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/132828/2/9990931.pd

African-American preference for same-race healthcare providers: the role of healthcare discrimination.

The results suggest that while knowledge of unfair treatment historically and perceptions of current racial inequity do not affect preferences, personal experiences of unfair treatment may have a significant effect on African-American patients' preferences regarding health care. Findings suggest that rather than focusing on how historical mistreatment and current inequities in medical treatment affect individual patients, research should focus on individual experiences

The effects of Obama's political success on the self-rated health of Blacks, Hispanics, and Whites

Stress in the social environment can affect individual health. Election of the first Black President of the United States provides an opportunity to assess how a positive change in the macro-political climate impacts the health of Americans. Past research suggests that race-related political events influence the health of non-dominant racial groups. Yet many questions remain, including the types of events that affect health, the timing and durability of health effects, and whether effects are similar for Blacks and Hispanics in the United States. The present study uses data from the Ohio Family Health Survey, which was in the field from August 6, 2008 until January 24, 2009, to assess whether immediate changes in average self-rated health occurred after key events in the election of President Barack Obama. We find better average health ratings among Blacks and Hispanics immediately following Obama’s nomination by the Democratic Party. Similar effects did not occur after the election or inauguration, and Whites showed no effect of any of the events. We discuss the implications of these findings in terms of the theoretical links between macro-level social conditions, race/ethnicity, and health.African and African American Studie

Physicians’ Perceptions of Patients’ Social and Behavioral Characteristics and Race Disparities in Treatment Recommendations for Men With Coronary Artery Disease

Objectives. A growing body of evidence suggests that provider decisionmaking contributes to racial/ethnic disparities in care. We examined the factors mediating the relationship between patient race/ethnicity and provider recommendations for coronary artery bypass graft surgery. Methods. Analyses were conducted with a data set that included medical record, angiogram, and provider survey data on postangiogram encounters with patients who were categorized as appropriate candidates for coronary artery bypass graft surgery. Results. Race significantly influenced physician recommendations among male, but not female, patients. Physicians’ perceptions of patients’ education and physical activity preferences were significant predictors of their recommendations, independent of clinical factors, appropriateness, payer, and physician characteristics. Furthermore, these variables mediated the effects of patient race on provider recommendations. Conclusions. Our findings point to the importance of research and intervention strategies addressing the ways in which providers’ beliefs about patients mediate disparities in treatment. In addition, they highlight the need for discourse and consensus development on the role of social factors in clinical decisionmaking