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Chicago Ridge, IL, United States

Discrimination is detrimental to health behaviors and outcomes, but little is known about which measures of discrimination are most strongly related to health, if relationships with health outcomes vary by race/ethnicity, and if coping responses moderate these associations. To explore these issues, the current study assessed race/ethnic differences in five measures of race/ethnic discrimination, as well as emotional and behavioral coping responses, within a population-based sample of Whites, African Americans, Mexicans, and Puerto Ricans (n = 1,699). Stratified adjusted logistic regression models were run to examine associations between the discrimination measures and mental, physical, and health behavior outcomes and to test the role of coping. Overall, 86 % of the sample reported discrimination. Puerto Ricans were more likely than Mexicans and Whites to report most types of discrimination but less likely than Blacks. Discrimination was most strongly related to depression and was less consistently (or not) associated with physical health and health behaviors. Differences by measure of discrimination and respondent race/ethnicity were apparent. No support was found to suggest that coping responses moderate the association between discrimination and health. More work is needed to understand the health effects of this widespread social problem. In addition, interventions attempting to reduce health disparities need to take into account the influence of discrimination. © 2013 The New York Academy of Medicine. Source


Whitman S.,Sinai Urban Health Institute | Orsi J.,Metropolitan Chicago Breast Cancer Task Force | Hurlbert M.,Avon Foundation Breast Cancer Crusade
Cancer Epidemiology | Year: 2012

Introduction: Although the racial disparity in breast cancer mortality is widely discussed there are no studies that analyze this phenomenon at the city level. Methods: We used national death files, abstracting those cases for which the cause was malignant neoplasm of the breast (ICD-10. =. C50) for the numerators and American Community Survey data for the denominators. The 25 largest cities in the US were the units of analysis. Non-Hispanic Black:non-Hispanic White rate ratios (RRs) were calculated, along with their confidence intervals, as measures of the racial disparity. Seven ecological (city-level) variables were examined as possible correlates. Results: Almost all the NHB rates were greater than almost all the NHW rates. All but 3 of the RRs (range 0.78-2.09; median. =. 1.44) were >1, 13 of them significantly so. None of the RRs. <. 1 were significant. From among the 7 potential correlates, only median household income (. r=. -0.43, p=. 0.037) and a measure of segregation (. r=. 0.42, r=. 0.039) were significantly related to the RR. Conclusion: This is the first study that we have been able to locate which examines city-level racial disparities in breast cancer mortality. The results are of concern for several cities and for the field in general. A strategy for reducing this disparity in Chicago is in place and may serve as a model for other cities wanting to initiate a similar process. Clearly it is time to take action. © 2011. Source


BACKGROUND: Race/ethnic discrimination is associated with poorer mental and physical health, worse health behaviors, and increased mortality, in addition to overall race/ethnic disparities in health. More specifically, it has been suggested as a possible determinant of the significant race/ethnic differences in the quantity and quality of medical care received by individuals in the United States. OBJECTIVES: The current study examines the association between 3 measures of racial/ethnic discrimination (Experiences of Discrimination, Everyday Discrimination Scale and discrimination in health care) and 6 types of preventive services (mammogram, clinical breast examination, Pap smear, colonoscopy/sigmoidoscopy, blood pressure screening, and diabetes screening). RESEARCH DESIGN: Frequencies and correlations are run within a population-based sample of 1699 respondents from Chicago that includes whites, African Americans, Mexicans, and Puerto Ricans. Adjusted logistic regression models are run separately by race/ethnicity. RESULTS: Findings show that levels of perceived discrimination vary between all race/ethnic groups, with blacks consistently reporting the highest levels and whites the lowest. Discrimination is only inconsistently related to obtaining screenings for cancer, hypertension, and diabetes. The few significant relationships found differed both by measure of discrimination and the respondents' race and ethnicity. CONCLUSIONS: Given the growing diversity in the United States and the prevalence of discrimination, more research regarding its impact on health care utilization is needed. Only when all the factors influencing patient behaviors are better understood will policies and interventions designed to improve them be successful. These are important steps that will help attain our national goals of eliminating race/ethnic disparities in health. Copyright © 2012 by Lippincott Williams & Wilkins. Source


Hunt B.R.,Sinai Urban Health Institute | Whitman S.,Sinai Urban Health Institute | Hurlbert M.S.,Avon Foundation Breast Cancer Crusade
Cancer Epidemiology | Year: 2014

Introduction: This paper presents race-specific breast cancer mortality rates and the corresponding rate ratios for the 50 largest U.S. cities for each of the 5-year intervals between 1990 and 2009. Methods: The 50 largest cities in the U.S. were the units of analysis. Numerator data were abstracted from national death files where the cause was malignant neoplasm of the breast (ICD-9. = 174 and ICD-10. = C50) for women. Population-based denominators were obtained from the U.S. Census Bureau for 1990, 2000, and 2010. To measure the racial disparity, we calculated non-Hispanic Black:non-Hispanic White rate ratios (RRs) and confidence intervals for each 5-year period. Results: At the final time point (2005-2009), two RRs were less than 1, but neither significantly so, while 39 RRs were >1, 23 of them significantly so. Of the 41 cities included in the analysis, 35 saw an increase in the Black:White RR between 1990-1994 and 2005-2009. In many of the cities, the increase in the disparity occurred because White rates improved substantially over the 20-year study period, while Black rates did not. There were 1710 excess Black deaths annually due to this disparity in breast cancer mortality, for an average of about 5 each day. Conclusion: This analysis revealed large and growing disparities in Black:White breast cancer mortality in the U.S. and many of its largest cities during the period 1990-2009. Much work remains to achieve equality in breast cancer mortality outcomes. © 2013 Elsevier Ltd. Source


Benjamins M.R.,Sinai Urban Health Institute | Whitman S.,Sinai Urban Health Institute
Journal of Behavioral Medicine | Year: 2014

Discrimination has been found to be detrimental to health, but less is known about the influence of discrimination in health care. To address this, the current study (1) compared levels of racial/ethnic discrimination in health care among four race/ethnic groups; (2) determined associations between this type of discrimination and health care outcomes; and (3) assessed potential mediators and moderators as suggested by previous studies. Multivariate logistic regression models were used within a population-based sample of 1,699 White, African American, Mexican, and Puerto Rican respondents. Overall, 23 % of the sample reported discrimination in health care, with levels varying substantially by race/ethnicity. In adjusted models, this type of discrimination was associated with an increased likelihood of having unmet health care needs (OR = 2.48, CI = 1.57-3.90) and lower odds of perceiving excellent quality of care (OR = 0.43, CI = 0.28-0.66), but not with the use of a physician when not sick or use of alternative medicine. The mediating role of mental health factors was inconsistently observed and the relationships were not moderated by race/ethnicity. These findings expand the literature and provide preliminary evidence that can eventually inform the development of interventions and the training of health care providers. © 2013 Springer Science+Business Media New York. Source

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