Leslie R. M. Hausmann

Perceived Discrimination in Health Care and Health Status in a Racially Diverse Sample

Background:Despite the surge of recent research on the association between perceived discrimination and health-related outcomes, few studies have focused on race-based discrimination encountered in health care settings. This study examined the prevalence of such discrimination, and its association with health status, for the 3 largest race/ethnic groups in the United States. Methods:Data were drawn from the 2004 Behavioral Risk Factor Surveillance System survey. The primary variables were perceived racial discrimination in health care and self-reported health status. Multivariable logistic regression was used to compare the prevalence of perceived discrimination for whites, African Americans, and Hispanics, and to examine the association between perceived discrimination and health status, controlling for sex, age, income, education, health care coverage, affordability of medical care, racial salience, and state. Results:Perceived discrimination was reported by 2%, 5.2%, and 10.9% of whites, Hispanics, and African Americans, respectively. Only the difference between African Americans and whites remained significant in adjusted analyses [odds ratio (OR) = 3.22, 95% confidence interval (CI) = 2.46–4.21]. Racial/ethnic differences in perceived discrimination depended on income, education, health care coverage, and affordability of medical care. Perceived discrimination was associated with worse health status for the overall sample (OR = 1.71, 95% CI = 1.35–2.16). Stratified analyses revealed that this relationship was significant for whites (OR = 2.00, 95% CI = 1.45–2.77) and African Americans (OR = 1.95, 95% CI = 1.39–2.73), but not for Hispanics (OR = 0.55, 95% CI = 0.24–1.22). Conclusions:Perceived racial discrimination in health care is much more prevalent for African Americans than for whites or Hispanics. Furthermore, such discrimination is associated with worse health both for African Americans and for whites.

Dimensions of perceived racism and self-reported health: examination of racial/ethnic differences and potential mediators.

BackgroundMany details of the negative relationship between perceived racial/ethnic discrimination and health are poorly understood.PurposeThe purpose of this study was to examine racial/ethnic differences in the relationship between perceived discrimination and self-reported health, identify dimensions of discrimination that drive this relationship, and explore psychological mediators.MethodsAsian, Black, and Latino(a) adults (N = 734) completed measures of perceived racial/ethnic discrimination, self-reported health, depression, anxiety, and cynical hostility.ResultsThe association between perceived discrimination and poor self-reported health was significant and did not differ across racial/ethnic subgroups. Race-related social exclusion and threat/harassment uniquely contributed to poor health for all groups. Depression, anxiety, and cynical hostility fully mediated the effect of social exclusion on health, but did not fully explain the effect of threat.ConclusionsOur results suggest that noxious effects of race-related exclusion and threat transcend between-group differences in discriminatory experiences. The effects of race-related exclusion and threat on health, however, may operate through different mechanisms.

Perceived Discrimination in Health Care and Use of Preventive Health Services

ObjectiveTo examine the relationship between perceived discrimination and preventive health care utilization.Design and ParticipantsCross-sectional analysis using the 2004 Behavioral Risk Factor Surveillance System “Reactions to Race” module (N = 28,839).MeasurementsOutcomes were self-reported utilization of seven preventive health services. Predictors included perceived negative and positive racial discrimination (vs. none) while seeking health care in the past year. Multivariable models adjusted for additional patient characteristics.Main ResultsIn unadjusted models, negative discrimination was significantly associated with less utilization of mammogram, pap test, PSA test, blood stool test, and sigmoidoscopy/colonoscopy (ORs = 0.53–0.73, p < .05), but not flu or pneumococcal vaccines (ORs = 0.76 and 0.84). Positive discrimination was significantly associated with more utilization of all services (ORs = 1.29–1.58, p < .05) except pap test (OR = 0.94). In adjusted models, neither negative nor positive discrimination was predictive of utilization, except for PSA test (positive discrimination OR = 1.33, p < .05).ConclusionsPerceived racial discrimination in health care does not independently predict preventive health care utilization.

Effects of External and Internal Motivation to Control Prejudice on Implicit Prejudice: The Mediating Role of Efforts to Control Prejudiced Responses

We examined the effects of internal and external motivation to control prejudice on implicit prejudice, focusing on identifying a mediator of the relation between external motivation and implicit prejudice. White participants completed internal and external motivation to control prejudice measures several weeks before completing the Implicit Association Test (IAT). Participants who were more internally motivated showed less implicit prejudice, whereas those who were more externally motivated displayed more implicit prejudice. Consistent with an ironic processes explanation, the effect of external motivation on increased implicit prejudice was mediated by efforts to control prejudiced responses.

Racial disparities in the monitoring of patients on chronic opioid therapy.

TOC summary Racial differences were observed in the use of several recommended monitoring and follow‐up treatment practices among patients taking opioids for long‐term pain management. Abstract Despite well‐documented racial disparities in prescribing opioid medications for pain, little is known about whether there are disparities in the monitoring and follow‐up treatment of patients who are prescribed opioid medications. We conducted a retrospective cohort study to examine whether there are racial differences in the use of recommended opioid monitoring and follow‐up treatment practices. Our sample included 1646 white and 253 black patients who filled opioid prescriptions for noncancer pain for ⩾90 consecutive days at the Veterans Affairs Pittsburgh Healthcare System pharmacy in fiscal years 2007 and 2008. Several opioid monitoring and follow‐up treatment practices were extracted from electronic health records for a 12‐month follow‐up period. Findings indicated that 26.3% of patients had opioid agreements on file, pain was documented in 71.7% of primary care follow‐up visits, urine drug tests were administered to 49.3% of patients, and 21.2% and 4.2% of patients were referred to pain and substance abuse specialists, respectively. Racial differences were observed in several of these practices. In adjusted comparisons, pain was documented less frequently for black patients than for white patients. Among those who had at least 1 urine drug test, black patients were subjected to more tests, especially if they were on higher doses of opioids. Compared with white patients, black patients were less likely to be referred to a pain specialist and more likely to be referred for substance abuse assessment. Addressing disparities in opioid monitoring and follow‐up treatment practices may be a previously neglected route to reducing racial disparities in pain management.

Intergroup friendships on campus: Predicting close and casual friendships between White and African American first-year college students

Intergroup friendships have been linked to important outcomes such as reduced prejudice, increased empathy for outgroups, and lower intergroup anxiety. However, little is known about the factors facilitating such friendships. This longitudinal study therefore examined factors associated with the development of friendships between White and African American freshmen at a predominantly White university. African American (vs. White) and male (vs. female) students had more intergroup friendships at the end of freshman year. Friendships between African American and White freshmen were also associated with more direct and indirect intergroup contact during high school, less prejudice upon entering college, having an outgroup roommate (White or African American), having any roommate, and having more contact with outgroup members during the academic year.

Racial differences in diabetes-related psychosocial factors and glycemic control in patients with type 2 diabetes

Background: We examined whether diabetes-related psychosocial factors differ between African American and white patients with type 2 diabetes. We also tested whether racial differences in glycemic control are independent of such factors. Methods: Baseline glycosylated hemoglobin (HbA1c) and survey measures from 79 African American and 203 white adult participants in a diabetes self-management clinical trial were analyzed. Results: Several psychosocial characteristics varied by race. Perceived interference of diabetes with daily life, perceived diabetes severity, and diabetes-related emotional distress were higher for African Americans than for whites, as were access to illness-management resources and social support. Mean HbA1c levels were higher among African Americans than whites (8.14 vs 7.40, beta = 0.17). This difference persisted after adjusting for demographic, clinical, and diabetes-related psychosocial characteristics that differed by race (beta = 0.18). Less access to illness-management resources (beta = −0.25) and greater perceived severity of diabetes (beta = 0.21) also predicted higher HbA1c. Discussion: Although racial differences in diabetes-related psychosocial factors were observed, African Americans continued to have poorer glycemic control than whites even after such differences were taken into account. Interventions that target psychosocial factors related to diabetes management, particularly illness-management resources, may be a promising way to improve glycemic control for all patients.

Racial and Ethnic Disparities in Pneumonia Treatment and Mortality

Background:The extent to which racial/ethnic disparities in pneumonia care occur within or between hospitals is unclear. Objective:Examine within and between-hospital racial/ethnic disparities in quality indicators and mortality for patients hospitalized for pneumonia. Research Design:Retrospective cohort study. Subjects:A total of 1,183,753 non-Hispanic white, African American, and Hispanic adults hospitalized for pneumonia between January 2005 and June 2006. Measures:Eight pneumonia care quality indicators and in-hospital mortality. Results:Performance rates for the 8 quality indicators ranged from 99.4% (oxygenation assessment within 24 hours) to 60.2% (influenza vaccination). Overall hospital mortality was 4.1%. African American and Hispanic patients were less likely to receive pneumococcal and influenza vaccinations, smoking cessation counseling, and first dose of antibiotic within 4 hours than white patients at the same hospital (ORs = 0.65–0.95). Patients at hospitals with the racial composition of those attended by average African Americans and Hispanics were less likely to receive all indicators except blood culture within 24 hours than patients at hospitals with the racial composition of those attended by average whites. Hospital mortality was higher for African Americans (OR = 1.05; 95% CI = 1.02, 1.09) and lower for Hispanics (OR = 0.85; 95% CI = 0.81, 0.89) than for whites within the same hospital. Mortality for patients at hospitals with the racial composition of those attended by average African Americans (OR = 1.21; 95% CI = 1.18, 1.25) or Hispanics (OR = 1.18; 95% CI = 1.14, 1.23) was higher than for patients at hospitals with the racial composition of those attended by average whites. Conclusions:Racial/ethnic disparities in pneumonia treatment and mortality are larger and more consistent between hospitals than within hospitals.

School desegregation and social science research.

Research on the effects of school desegregation, once quite common in psychology and related fields, has declined considerably since the mid-1980s. Factors contributing to changes in the quantity and focus of such research since the Brown v. Board of Education (1954) decision are discussed, with an emphasis on those related to the decline of this research in the last 2 decades. These factors include the nations retreat from the policy of school desegregation and the associated decline in research funding. Changing perspectives regarding desegregation, the outcomes of desegregation that merit study, and the desirable composition of research teams studying desegregation have also played a role. Demographic changes in our society and its schools that have made salient other research topics and the development of effective research paradigms for studying intergroup relations in the laboratory have also contributed to this decline. ((c) 2004 APA, all rights reserved)

Understanding racial and ethnic differences in patient experiences with outpatient health care in Veterans Affairs Medical Centers.

Background:Racial and ethnic differences in patient health care experiences have not been well examined in the Veterans Affairs (VA) Healthcare System. Objectives:To examine racial/ethnic differences in outpatient health care experiences within and between VA medical facilities. Research Design:We assessed within-facility and between-facility racial/ethnic differences in responses to the 2010 VA Survey of Healthcare Experiences of Patients using mixed-effects multinomial regression. Subjects:A total of 211,459 respondents (53.2%) to a random survey of outpatients from 910 VA medical facilities (71.9% non-Hispanic white, 15.1% non-Hispanic black, 6.4% Hispanic, and 6.7% Other race/ethnicity). Measures:Negative and positive patient-reported experiences in 8 domains of health care. Results:Between-facility effects for black race were higher for 7 domains of negative experiences [risk differences (RDs): 0.37% to 1.64%] and lower for 6 domains of positive experiences (RDs: −0.69% to −2.54%). Between-facility effects for Hispanic ethnicity were higher for 5 domains of negative experiences (RDs: 0.60%–1.34%) and lower for 5 domains of positive experiences (RDs: −1.00% to −1.88%). Hispanic ethnicity was also associated with higher within-facility rates of positive experiences for 5 domains of care (RDs: 2.97%–4.08%). Other race/ethnicity was associated with significantly higher within-facility rates of negative experiences (RDs: 2.04%–3.95%) and lower rates of positive experiences for all 8 domains (RDs: −2.05% to −4.70%). Conclusions:In a national random sample of Veterans managed in the VA Healthcare System, we demonstrated significant within-facility and between-facility racial and ethnic differences in outpatient health care experiences, with differing patterns for each minority group.