Are measures of discrimination associated with the health status and behavior of Black males?
Abstract
Black males have higher morbidity and mortality rates of many chronic health conditions compared to White males. Many have suggested that lack of engagement with the health care system, and other social factors are associated with poor health. For example, discrimination, the differential treatment of a person due to race, has been cited as a factor that influences the health of Black males. The study, which aims to add to the discrimination and health literature, used data from the Indiana Black Men's Health Study, a community-based needs assessment on the social determinants that influence the health of Black males in Indiana. This dissertation consists of three studies. The first explored the association between measures of discrimination and current cigarette and alcohol use. The results from study 1 determined that males' with emotional and physical symptoms in response to discrimination had an increased likelihood of current cigarette use (OR: 2.12, p < 0.01; OR: 2.48, p <0.01, respectively). Findings suggest that smoking may be a means by which Black males cope with unfair treatment. The second study examined the correlates of health care discrimination and explored associations with chronic health conditions. The results demonstrated that frequent race thoughts (OR: 2.02, p < 0.05), not having health insurance (OR: 1.93, p < 0.05), and increased depressive symptomology (OR: 1.07,p < 0.01) were correlates of healthcare discrimination. Additionally, results from the analyses suggest that frequent race thoughts were marginally (p < 0.10) associated with having a chronic health condition (IRR: 1.18, 95% CI: 0.97-1.44), but not discrimination in the health care setting. Interestingly, the likelihood of experiencing health care discrimination decreased with age. The third and final study explored the association between discrimination and Black males' preference for informal versus formal sources of and places to receive health information. Additional aims of the study examined differences in health outcomes and healthy behaviors based on these preferences. The study examined knowledge about prostate screening and receiving prostate-specific antigen (PSA) tests among males 40 years or older. The results suggested that having some college education, being married, experiencing financial barrier to health care services, and earning more than $35,000 were predictive of using a formal source for health information. Older age, having a college degree, increased social support and higher self-rated health were significantly associated with using a formal place for health information. There were no statistically significant differences in health outcomes or prostate screening behavior based on formal versus informal sources of and places to receive health information. In the 40-year or older subset, having health insurance and higher income were positively associated with receiving a PSA test (OR: 2.09, p < 0.10; OR: 4.07, p < 0.01, respectively). Discrimination was not a statistically significant predictor of any of the outcomes of interest. A general hypothesis among all the studies was that discrimination is adversely associated with the health and health behavior of Black males. While the results do support the hypothesis that discrimination adversely influences Black males' health, they also suggest that resources to seek and engage with the health care system (e.g. health insurance) also have an influence. In some cases, the influences of resources had a more significant effect on Black males' health outcomes than discrimination. Findings contribute to the existing literature by demonstrating that both discrimination and having access to health promoting services are associated with Black males' health, a group that is often under studied in the broader literature. The results highlight a need to identify further barriers to men's health. These efforts can be used to develop targeted interventions and other health campaigns to abate poor health outcomes. Further, more research is needed to determine ways to promote healthy lifestyle behaviors and coping mechanism among Black males.
Degree
Ph.D.
Advisors
Hyner, Purdue University.
Subject Area
African American Studies|Public health|Gender studies
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