185671 Detrimental health effects of discrimination: Does health care setting matter?

Tuesday, October 28, 2008

Laura Hoyt D'Anna, DrPH , Center for Health Care Innovation, California State University, Long Beach, Long Beach, CA
Kevin Malotte, DrPH , Center for Health Care Innovation, California State University, Long Beach, Long Beach, CA
Gregory D. Stevens, PhD , Center for Community Health Studies, University of Southern California, Alhambra, CA
Kai Ya Tsai, MSPH , Center for Community Health Studies, University of Southern California, Alhambra, CA
Discrimination is a powerful predictor of poorer health outcomes at the individual and population levels. This study seeks to understand how the perception of discrimination may vary depending on the type of medical care setting used by California adults. The specific aims are: (1) To investigate the associations between the type of medical care setting adults utilize most often and perceived experiences of both general and medical care-related discrimination; (2) To determine whether relationships vary by race/ethnicity, gender, socioeconomic position, and acculturation level. Data are drawn from the 2005 California Health Interview Survey (CHIS 2005). CHIS is a population-based random digit dial telephone survey of California residents conducted every two years to monitor health related indicators and relative changes. Interviews for CHIS 2005 were conducted in five languages. Adult CHIS 2005 participants (N=43,020) were interviewed between July 2005 and April 2006. The sample is comprised of Latinos (18.7%), Asians/Native Hawaiians/Pacific-Islanders (9.3%), African-Americans (4.2%), American-Indian/Alaska Natives (<1%), and Non-Latino Whites (64%). Preliminary results suggest that medical care setting is not an important predictor for general discrimination. However, those seeking medical care in community-based settings were 1.5 times more likely than those accessing services in HMO settings to report medical care-related discrimination (OR=1.55; CI: 1.17, 2.04). Further, differential effects were detected by race/ethnicity, gender, and income level. Acculturation effects will be explored in the final analysis. This study will enhance understanding of the complexity of discrimination, and will support public policy efforts toward equity and social justice within California's healthcare delivery system.

Learning Objectives:
1. Analyze how the experiences of general and medical care-related discrimination are affected by a variety of factors including type of healthcare setting, gender, race/ethnicity, socioeconomic position, and acculturation level. 2. Articulate several challenges in defining and measuring discrimination.

Keywords: Health Disparities, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: In the process of earning my doctorate degree from the UCLA School of Public Health, I completed a dissertation focusing on detrimental health impacts of discrimination among California adults. I have served at executive and programmatic management levels for public and community health not-for-profit organizations for over 15 years. In addition to my current research endeavors, I currently conduct private consulting for community-based organizations in the areas of research, evaluation, strategic planning, and program development, with a particular focus in the area of health disparities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.