Browsing by Subject "Health disparities"
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Item Modeling lesbian, gay, and bisexual patient disclosures : an exploration of the role of memorable messages, past experiences, perceived visibility, screening behaviors, and efficacy(2015-08) Brown, Laura Elizabeth, Ph. D.; Donovan-Kicken, Erin E.; Dailey, Rene; Vangelisti , Anita; McGlone, Matt; Whittaker , TiffanyLesbian, gay, and bisexual (LGB) people in the United States face unique challenges such as the denial of civil and human rights, discrimination, and societal stigma (HealthyPeople.gov). These challenges facilitate additive minority stress, as evidenced by significantly poorer physical and mental health outcomes for LGBs as compared to heterosexuals. One root of these health disparities is a disclosure-based dilemma in the patient-provider context. Summarized, this dilemma is: "Should I reveal my sexual orientation to my doctor and risk discrimination or stigmatization, or should I conceal my sexual orientation and risk not receiving quality medical care that is tailored to my needs as a patient?" This study investigated competing, predictive models, all of which are grounded in existing research regarding interpersonal health communication and LGB health. The models hypothesized that the following variables predict likelihood of disclosure of sexual orientation: Memorable messages about sexual orientation and receiving care, past disclosure experiences in the patient-provider context, self-perceived visibility of sexual orientation, and patients' pre-screening behaviors of providers. Disclosure efficacy and target efficacy were predicted to mediate these relationships. LGB individuals (N = 209) completed an online questionnaire about receiving health care. Results revealed that disclosure efficacy mediated the predictive relationship between positivity of a past disclosure experience and likelihood of future disclosure. Significance of a past disclosure experience directly, negatively predicted likelihood of future disclosure. Some evidence indicated that self-perceived visibility of sexual minority status positively predicted likelihood of future disclosure. Results failed to support the predictive power of memorable messages and patients' pre-screening behaviors of providers. Theoretical contributions to interpersonal communication models of disclosure are offered, as are practical contributions meant to address patient-provider interactions and, more broadly, the reduction of health disparities for LGB individuals.Item Suicidality among Latina adolescents : the relative effects of psychosocial risk factors and psychological symptoms(2014-08) Alvarez, Kiara; Carlson, Cindy I., 1949-In national surveys of adolescents, Latina females have been found to have higher rates of suicidal ideation and attempts when compared to Latino males and to non-Latino White and Black males and females (Centers for Disease Control [CDC], 2014). The reasons for these gender and racial disparities in suicidal behavior have not been definitively established. Prior research indicates that suicidal behavior among adolescents is influenced by both individual-level psychological symptoms and by psychosocial risk factors (Bridge, Goldstein, & Brent, 2006; King & Merchant, 2008; Prinstein, Boergers, Spirito, Little, & Grapentine, 2000). Among Latina adolescents in particular, the interplay between cultural processes and family relationships has been identified as a key influence on suicidal behavior (Zayas, 2011). The purpose of this study was to build upon Zayas’s (2011) model of suicidality among adolescent Latinas by evaluating the relative effects of individual, family, and peer factors on suicidal ideation, plans, and attempts. A latent variable structural equation model (SEM) was developed and tested using a sample that included 946 Latinas aged 13 to 18 who were interviewed for a national psychiatric epidemiological survey, the National Comorbidity Survey – Adolescent Supplement (NCS-A; Kessler, 2013). The SEM model measured the direct and indirect effects of the latent variables of generation status, peer support, negative peer influence, family relationships, and depression on suicidality. Results of the study indicated that higher levels of depression, poorer family relationships, and higher levels of negative peer influence resulted in higher levels of suicidality. The influence of family relationships and negative peer influence on suicidality were partially mediated by depression; however, negative peer influence also had a substantial direct effect on suicidality. Results of this study support a clinical focus on multisystemic interventions for Latina adolescents that address functioning at individual, family, and peer levels, as well as further investigation into the pathways by which negative peer influence impacts suicidality in this population.Item Three essays on the social and temporal dimensions of cardiovascular health among the Mexican-origin population in the United States(2014-08) Dondero, Molly; Hummer, Robert A.The size of the Mexican-origin population in the United States means that its health patterns have important implications for the country’s overall population health. Understanding how this population is woven into the country’s complex social patterning of health is critical to understanding current social disparities in health. Drawing on a health disparities perspective and nationally representative datasets, this dissertation addresses key gaps in the social demographic literature on the health of the Mexican-origin population through three empirical chapters that examine how multiple measures of cardiovascular health are distributed across diverse social status and temporal configurations. I first examine how the obesity epidemic has unfolded across multiple temporal (age, period, and cohort) and social dimensions (gender, nativity, and race) for the Mexican-origin population. I find that period rather than cohort forces have shaped the rise in obesity among the Mexican-origin population. Furthermore, the pronounced group differences in obesity prevalence have remained stable across periods and cohorts, with the exception of a growing nativity gap among Mexican-origin women, among whom obesity has increased faster for U.S.-born individuals compared with foreign-born individuals. I next address the intersection of two additional temporal and social determinants of health: duration of residence in the United States and educational attainment. Building on research documenting a weak relationship between education and health for Mexican immigrants, I assess whether duration of U.S. residence strengthens this association. The patterns vary by outcome, but generally indicate that negative education gradients in health are more pronounced for long-term Mexican immigrants than for recent Mexican immigrants and that the education gradients of long-term Mexican immigrants resemble those of U.S.-born Whites. I then engage the literature linking acculturation to poor health among Mexican immigrants. Acculturation models of immigrant health have come under critique for ignoring the structural determinants of health. I engage in this debate by using segmented assimilation theory—which emphasizes the role of structural factors—to examine whether education conditions the association between acculturation and health. I find support for the idea that the detrimental influence of acculturation on cardiovascular health is concentrated among Mexican immigrant adults with low levels of education.