The pathways from perceived discrimination to self-rated health: an investigation of the roles of distrust, social capital, and health behaviors.
The pathways from perceived discrimination to self-rated health: an investigation of the roles of distrust, social capital, and health behaviors.
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DOI：
10.1016/j.socscimed.2013.12.021
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发表时间：
2014-03
影响因子：
5.4
通讯作者：
Yang, Tse-Chuan
中科院分区：
文献类型：
--
作者：
Chen, Danhong;Yang, Tse-Chuan
关键词：
尽管已经对感知到的歧视对健康的不利影响进行了广泛的研究，但尚不清楚感知到的歧视是如何潜移默化的。本文建立了一个综合的结构方程模型，既考虑了感知歧视对自测健康(SRH)的直接影响，也包含了感知歧视通过卫生保健系统不信任、邻里社会资本、健康行为和健康状况对SRH的间接影响。运用结构方程模型对2008年宾夕法尼亚州东南部家庭健康调查中的9880名成年人(年龄在18岁至100岁之间)，我们不仅证实了歧视与贫穷或公平的SRH之间的正向和直接关联，而且还验证了两个潜在的机制：1)感知到的歧视与较低的邻里社会资本相关，这进一步导致了较差或公平的SRH；以及2)感知到的歧视与导致健康状况恶化的危险行为(例如，身体活动和睡眠质量降低，以及吸烟加剧)有关，从而导致较差或公平的SRH。此外，我们发现，感知到的歧视与医疗保健系统的不信任负相关，但不信任与贫穷或公平的SRH之间没有显著关系。
Although there has been extensive research on the adverse impacts of perceived discrimination on health, it remains unclear how perceived discrimination gets under the skin. This paper develops a comprehensive structural equation model (SEM) by incorporating both the direct effects of perceived discrimination on self-rated health (SRH), a powerful predictor for many health outcomes, and the indirect effects of perceived discrimination on SRH through health care system distrust, neighborhood social capital, and health behaviors and health conditions. Applying SEM to 9,880 adults (aged between 18 and 100) in the 2008 Southeastern Pennsylvania Household Health Survey, we not only confirmed the positive and direct association between discrimination and poor or fair SRH, but also verified two underlying mechanisms: 1) perceived discrimination is associated with lower neighborhood social capital, which further contributes to poor or fair SRH; and 2) perceived discrimination is related to risky behaviors (e.g., reduced physical activity and sleep quality, and intensified smoking) that lead to worse health conditions, and then result in poor or fair SRH. Moreover, we found that perceived discrimination is negatively associated with health care system distrust, but did not find a significant relationship between distrust and poor or fair SRH.
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