Browsing by Author "LaVeist, Thomas A."

Now showing 1 - 9 of 9
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    A methodological note on modeling the effects of race: the case of psychological distress
    (2008) Nuru-Jeter, Amani; Williams, Chyvette T.; LaVeist, Thomas A.
    Psychological distress is an important indicator of the mental well-being of the population. Findings regarding racial differences in distress are inconclusive but may represent an important pathway through which disparities exist across a number of physical health outcomes. We used data from the 1994 Minority Health Survey, a nationally representative multiracial/ethnic sample of adults in US households, to examine racial/ethnic differences in psychological distress (n = 3623). Our primary study aim was to examine differences between additive and multiplicative models in assessing the influence of income and gender on the race/distress relationship. We hypothesized that additive models do not suffi ciently account for potential interactions of race with income and gender, and may therefore mask important differences in distress between racial groups. The results suggest that our hypotheses were supported. After adjusting for income, there were no statistically signifi cant differences in distress levels between racial groups. However, significant differences emerge when multiplicative models are used demonstrating the complexities of the intersection of race, income and gender in predicting psychological distress. Black men and women of higher income status represent a particularly vulnerable group, whereas Hispanic men are especially hardy. We discuss the implications of our fi ndings for future work on racial health disparities.
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    Attitudes about Racism, Medical Mistrust, and Satisfaction with Care among African American and White Cardiac Patients
    (2000) LaVeist, Thomas A.; Nickerson, Kim J.; Bowie, Janice V.
    The authors examine determinants of satisfaction with medical care among 1,784 (781 African American and 1,003 white) cardiac patients. Patient satisfaction was modeled as a function of predisposing factors (gender, age, medical mistrust, and perception of racism) and enabling factors (medical insurance). African Americans reported less satisfaction with care. Although both black and white patients tended not to endorse the existence of racism in the medical care system, African American patients were more likely to perceive racism. African American patients were significantly more likely to report mistrust. Multivariate analysis found that the perception of racism and mistrust of the medical care system led to less satisfaction with care. When perceived racism and medical mistrust were controlled, race was no longer a significant predictor of satisfaction.
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    Environmental and Socio-Economic Factors as Contributors to Racial Disparities in Diabetes Prevalence
    (2009) LaVeist, Thomas A.; Thorpe, Roland J.; Galarraga, Jessica E.; Bower, Kelly M.; Gary-Webb, Tiffany L.
    BACKGROUND We deployed a study design that attempts to account for racial differences in socioeconomic and environmental risk exposures to determine if the diabetes race disparity reported in national data is similar when black and white Americans live under similar social conditions. DESIGN & METHODS We compared data from the 2003 National Health Interview Survey (NHIS) with the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) Study, which was conducted in a racially-integrated urban community without race differences in socioeconomic status. RESULTS In the NHIS, African Americans had greater adjusted odds of having diabetes compared to whites (OR: 1.61, 95% CI: 1.26−2.04); whereas, in EHDIC-SWB white and African Americans had similar odds of having diabetes (OR: 1.07, 95% CI: 0.71−1.58). Diabetes prevalence for African Americans was similar in NHIS and EHDIC-SWB (10.4%, 95%CI: 9.5−11.4 and 10.5%, 95%CI: 8.5−12.5, respectively). Diabetes prevalence among whites differed for NHIS (6.6%, 95%CI: 6.2−6.9%) and EHDIC-SWB (10.1%, 95%CI: 7.6−12.5%). CONCLUSIONS Race disparities in diabetes may stem from differences in the health risk environments that African Americans and whites live. When African Americans and whites live in similar risk environments, their health outcomes are more similar.
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    Mistrust of Health Care Organizations Is Associated with Underutilization of Health Services
    (2009) LaVeist, Thomas A.; Isaac, Lydia A.; Williams, Karen Patricia
    PURPOSE: We report the validation of an instrument to measure mistrust of health care organizations and examine the relationship between mistrust and health care service underutilization. METHODS: We conducted a telephone survey of a random sample of households in Baltimore City, MD. We surveyed 401 persons and followed up with 327 persons (81.5 percent) 3 weeks after the baseline interview. We conducted tests of the validity and reliability of the Medical Mistrust Index (MMI) and then conducted multivariate modeling to examine the relationship between mistrust and five measures of underutilization of health services. RESULTS: Using principle components analysis, we reduced the 17-item MMI to 7 items with a single dimension. Test-retest reliability was moderately strong, ranging from Pearson correlation of 0.346-0.697. In multivariate modeling, the MMI was predictive of four of five measures of underutilization of health services: failure to take medical advice (b=1.56, p<.01), failure to keep a follow-up appointment (b=1.11, p=.01), postponing receiving needed care (b=0.939, p=.01), and failure to fill a prescription (b=1.48, p=.002). MMI was not significantly associated with failure to get needed medical care (b=0.815, p=.06). CONCLUSIONS: The MMI is a robust predictor of underutilization of health services. Greater attention should be devoted to building greater trust among patients.
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    Perceived Discrimination and Adherence to Medical Care in a Racially Integrated Community
    (2007) Casagrande, Sarah Stark; Gary, Tiffany L.; LaVeist, Thomas A.; Gaskin, Darrell J.; Cooper, Lisa A.
    Background Past research indicates that access to health care and utilization of services varies by sociodemographic characteristics, but little is known about racial differences in health care utilization within racially integrated communities. Objective To determine whether perceived discrimination was associated with delays in seeking medical care and adherence to medical care recommendations among African Americans and whites living in a socioeconomically homogenous and racially integrated community. Design A cross-sectional analysis from the Exploring Health Disparities in Integrated Communities Study. Participants Study participants include 1,408 African-American (59.3%) and white (40.7%) adults (≥18 years) in Baltimore, Md. Measurements An interviewer-administered questionnaire was used to assess the associations of perceived discrimination with help-seeking behavior for and adherence to medical care. Results For both African Americans and whites, a report of 1–2 and >2 discrimination experiences in one’s lifetime were associated with more medical care delays and nonadherence compared to those with no experiences after adjustment for need, enabling, and predisposing factors (odds ratio [OR]=1.8, 2.6; OR=2.2, 3.3, respectively; all P<.05). Results were similar for perceived discrimination occurring in the past year. Conclusions Experiences with discrimination were associated with delays in seeking medical care and poor adherence to medical care recommendations INDEPENDENT OF NEED, ENABLING, AND PREDISPOSING FACTORS, INCLUDING MEDICAL MISTRUST; however, a prospective study is needed. Further research in this area should include exploration of other potential mechanisms for the association between perceived discrimination and health service utilization.
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    Race and Trust in the Health Care System
    (2003) Boulware, L. Ebony; Cooper, Lisa A.; Ratner, Lloyd E.; LaVeist, Thomas A.; Powe, Neil R.
    Objective. A legacy of racial discrimination in medical research and the health care system has been linked to a low level of trust in medical research and medical care among African Americans. While racial differences in trust in physicians have been demonstrated, little is known about racial variation in trust of health insurance plans and hospitals. For the present study, the authors analyzed responses to a cross sectional telephone survey to assess the independent relationship of self-reported race (non-Hispanic black or non-Hispanic white) with trust in physicians, hospitals, and health insurance plans. Methods. Respondents ages 18–75 years were asked to rate their level of trust in physicians, health insurance plans, and hospitals. Items from the Medical Mistrust Index were used to assess fear and suspicion of hospitals. Results. Responses were analyzed for 49 (42%) non-Hispanic black and 69 (58%) non-Hispanic white respondents (N=118; 94% of total survey population). A majority of respondents trusted physicians (71%) and hospitals (70%), but fewer trusted their health insurance plans (28%). After adjustment for potential confounders, non-Hispanic black respondents were less likely to trust their physicians than non-Hispanic white respondents (adjusted absolute difference 37%; p=0.01) and more likely to trust their health insurance plans (adjusted absolute difference 28%; p=0.04). The difference in trust of hospitals (adjusted absolute difference 13%) was not statistically significant. Non-Hispanic black respondents were more likely than non-Hispanic white respondents to be concerned about personal privacy and the potential for harmful experimentation in hospitals. Conclusions. Patterns of trust in components of our health care system differ by race. Differences in trust may reflect divergent cultural experiences of blacks and whites as well as differences in expectations for care. Improved understanding of these factors is needed if efforts to enhance patient access to and satisfaction with care are to be effective.
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    Race/Ethnicity and Hypertension: The Role of Social Support
    (2010) Bell, Caryn N.; Thorpe, Roland J.; LaVeist, Thomas A.
    Abstract available at publisher's web site.
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    THE ECONOMIC BURDEN OF HEALTH INEQUALITIES IN THE UNITED STATES
    (2009) LaVeist, Thomas A.; Gaskin, Darrell J.; Richard, Patrick
    We estimated the economic burden of health disparities in the United States using three measures: (1) direct medical costs of health inequalities, (2) indirect costs of health inequalities, and (3) costs of premature death. Our analysis found: • Between 2003 and 2006 thecombined costs of health inequalitiesand premature death in the United States were $1.24 trillion. • Eliminating health disparities for minorities would havereduced direct medicalcareexpenditures by $229.4 billion for the years 2003-2006. • Between 2003 and 2006, 30.6% of direct medicalcareexpenditures for African Americans, Asians,and Hispanics were excess costs due to health inequalities. • Eliminating health inequalities for minorities would havereduced indirectcostsassociated with illnessand premature death by morethan onetrillion dollars between 2003 and 2006.
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    The Sociobiologic Integrative Model (SBIM): Enhancing the Integration of Sociobehavioral, Environmental, and Biomolecular Knowledge in Urban Health and Disparities Research
    (2007) Gibbons, M. Chris; Brock, Malcolm; Alberg, Anthony J.; Glass, Thomas; LaVeist, Thomas A.; Baylin, Stephen; Levine, David; Fox, C. Earl
    Disentangling the myriad determinants of disease, within the context of urban health or health disparities, requires a transdisciplinary approach. Transdisciplinary approaches draw on concepts from multiple scientific disciplines to develop a novel, integrated perspective from which to conduct scientific investigation. Most historic and contemporary conceptual models of health were derived either from the sociobehavioral sciences or the biomolecular sciences. Those models deriving from the sociobehavioral sciences generally lack detail on involved biological mechanisms whereas those derived from the biomolecular sciences largely do not consider socioenvironmental determinants. As such, advances in transdisciplinary characterizations of health in complex systems like the urban environment or health disparities may be impeded. This paper suggests a sociobiologic organizing model that encourages a multilevel, integrative perspective in the study of urban health and health disparities.