Jennifer Malat

Psychosocial factors in medical and psychological treatment avoidance: the role of the doctor-patient relationship.

A community sample of 1106 adults was examined to assess the impact of the doctor–patient relationship on participants’ avoidance of treatment for a recognized medical or psychological problem. Of five aspects of participants’ previous experience with their physicians, all but waiting time predicted participants’ self-reported treatment avoidance. In two logistic regression models participants who felt their physicians listened more to their concerns were less likely to avoid treatment for both medical and psychological problems during the previous 12 months. These findings suggest that patients’ perceptions of how they are treated by physicians may help explain why many people delay or avoid healthcare treatment, even when faced with a significant health problem.

Poverty Experience, Race, and Child Health

Objectives. Studies that examine childrens poverty and health at one point in time do not account for some children experiencing poverty briefly and others living in poverty for much of their lives. The objective of this study was to determine how duration of poverty and child race are related to child health. Methods. To assess these relationships, we analyzed data from the Panel Study of Income Dynamics and its Child Development Supplement. Ordinary least squares regression was used to estimate bivariate and multivariate models predicting caregiver-rated child health. The regression models assessed the statistical effect of the proportion of childhood in poverty and child race on child health, controlling for child sex, age, parental education, whether the household includes two parents, and family poverty in the last year. Results. Increasing proportion of childhood in poverty is associated with worse health status. In addition, African American children are more likely than white children to have lower-rated health status. The analysis does not support the hypothesis that poverty more strongly affects the health of African American children. Conclusions. Increasing exposure to family poverty negatively affects child health. Future research would benefit from more studies that utilize longitudinal measures of childhood poverty. We suggest that public policies to reduce childhood poverty exposure would improve child health.

Expanding research on the racial disparity in medical treatment with ideas from sociology

While hundreds of studies document racial differences in the use of medical procedures in the United States, by comparison little is known about the causes of these differences. This gap in knowledge should serve as a call to sociologists who, drawing on their disciplinary tradition of studying inequality, could improve understanding of the disparity. This article offers suggestions about how medical sociologists in the USA might bring sociology to the study of racial disparities in medical treatment. The article begins by reviewing the existing approaches to understanding the racial disparity in medical treatment. After considering the extant research and its limits, the article goes on to describe how a few specific concepts from sociology - cultural capital, social networks, self-presentation and social distance, all framed in a race critical framework - and more diverse methodological approaches can advance studies of the racial disparity in medical treatment

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 womens 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 womens 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.

White doctors and nurses on racial inequality in health care in the USA: whiteness and colour-blind racial ideology

Abstract In this paper we report on an interdisciplinary project interviewing doctors and nurses about racial inequality in health care in the USA. We analysed data from interviews with twenty-two white doctors and nurses in which they were asked to offer explanations for racial inequality in health care. Results provide insight into how whiteness operates to provide white patients more often with appropriate health care and how colour-blind ideology can be adapted to accommodate naming white advantage and potential racial discrimination. However, even when naming mechanisms of white advantage in accessing resources, the white respondents avoided acknowledging how they are implicated in racial inequality in health care. We discuss the implications for understanding whiteness and colour-blind ideology.

Reproductive Life Plan Counseling and Effective Contraceptive Use among Urban Women Utilizing Title X Services

BACKGROUND Although the Centers for Disease Control and Prevention and the U.S. Office of Population Affairs recommend inclusion of reproductive life plan counseling (RLPC) in all well-woman health care visits, no studies have examined the effect of RLPC sessions on the decision to use effective contraception at publicly funded family planning sites. RLPC could be a particularly impactful intervention for disadvantaged social groups who are less likely to use the most effective contraceptive methods. METHODS Using data from 771 nonpregnant, non-pregnancy-seeking women receiving gynecological services in the Cincinnati-Hamilton County Reproductive Health and Wellness Program, multinomial logistic regression models compared users of nonmedical/no method with users of 1) the pill, patch, or ring, 2) depot medroxyprogesterone acetate, and 3) long-acting reversible contraception (LARC). The effect of RLPC on the use of each form of contraception, and whether it mediated the effect of race/ethnicity and education on contraceptive use, was examined while controlling for age, insurance status, and birth history. The interaction between RLPC and race/ethnicity and the interaction between RLPC and educational attainment was also assessed. FINDINGS RLPC was not associated with contraceptive use. The data suggested that RLPC may increase LARC use over nonmedical/no method use. RLPC did not mediate or moderate the effect of race/ethnicity or educational attainment on contraceptive use in any comparison. CONCLUSIONS In this system of publicly funded family planning clinics, RLPC seems not to encourage effective method use, providing no support for the efficacy of the RLPC intervention. The results suggest that this intervention requires further development and evaluation.

Measuring lifetime stress exposure and protective factors in life course research on racial inequality and birth outcomes

Abstract There has been a long-standing interest in better understanding how social factors contribute to racial disparities in health, including birth outcomes. A recent emphasis in this context has been on identifying the effects of stress exposure and protective factors experienced over the entire lifetime. Yet despite repeated calls for a life course approach to research on this topic, very few studies have actually assessed how stressors and protective factors occurring over women’s lives relate to birth outcomes. We discuss this issue here by describing how challenges in the measurement of lifetime stress exposure and protective factors have prevented researchers from developing an empirically-based life course perspective on health. First, we summarize prevailing views on racial inequality and birth outcomes; second, we discuss measurement challenges that exist in this context; and finally, we describe both new tools and needed tools for assessing lifetime stress exposure and suggest opportunities for integrating information on stress exposure and psychosocial protective factors. We conclude that more studies are needed that integrate information about lifetime stress exposures and the protective factors that promote resilience against such exposures to inform policy and practice recommendations to reduce racial disparities in birth outcomes.

The Appeal and Problems of a Cultural Competence Approach to Reducing Racial Disparities

Eliminating racial disparities in health care is a high priority goal for health care organizations. Disparities have been observed across a wide range of treatments and health conditions, from treatment of pain due to bone fracture to the treatment of HIV/AIDS. Inequalities between whites and blacks have been documented most frequently, but other non-white groups are disadvantaged as well. Research suggests that access to treatment and provider recommendations tend to account for the inequality.1

The Effect of Age and Childhood Social Class on Preference for New Healthcare Practices

ABSTRACT Bourdieu theorized that habitus structures and is structured by experiences in the social world, with childhood experiences having the strongest influence. Habitus can yield rewards in specific fields through dispositions to enact certain practices. Healthcare provides an opportunity to assess how age and childhood social class interact to produce preferences in a changing field. Are people who developed their habitus in higher social classes as children more likely to report preferences that reflect new practices? Is there greater inequality at older ages? We find that parents’ educational attainment and occupational prestige does not have a direct effect on respondents’ preferences to be involved in their healthcare decisions. However, there is a significant interaction with age, with larger gaps by childhood social class among older respondents. Results suggest that when valued practices change, socially advantaged groups can most quickly adapt. The findings have implications for the replication of class inequality.