Healthcare stereotype threat, health disparities, and minority aging

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PROJECT SUMMARY Health disparities among aging African Americans and Latinos are substantial and persistent. 1 With large segments of these populations living in poverty, healthcare access and quality are major contributors to their disproportionate burdens of disease, disability, and death. Yet, African American and Latino later life health disparities persist even in higher socioeconomic contexts. 2 This suggests that, in addition to economic barriers, there are psychosocial barriers to healthcare resource use, or utilization, and, thus, good health among aging minorities. The purpose of the proposed career development and research is to provide new understanding of later life health disparities by examining a previously overlooked psychosocial barrier to care among aging minorities, namely healthcare stereotype threat (HCST), 3-9 and how it can be ameliorated. Stereotype threat is the threat of being personally reduced to a group stereotype, 10-13 which can lead individuals to avoid stereotype-relevant domains. 10-12 For example, females have been shown to avoid STEM fields, leadership roles, and other stereotypically male domains to avoid stereotypes of inferiority and their negative social and psychological consequences. 14,15 My central hypothesis is that stereotypes regarding unhealthy lifestyles, low status, and inferior intelligence are salient for aging minorities in healthcare settings and influence healthcare resource use and health outcomes. The first of its kind, the proposed research will investigate the research questions of whether and how HCST contributes to disparities in healthcare resource use and health in aging African Americans and Latinos as compared to Whites. The approach is informed by Stereotype Threat Theory3,9,10,16,17 and my Culture and Social Identity Health Theory. 18 Specific Aims are threefold: (1) To document the association of ethnicity/race-based and age-based HCST to cross- sectional and longitudinal healthcare resource use and health outcomes among African American, Latino, and White older adults; (2) To use randomized controlled trial (RCT) to examine economic and other moderators of the link between HCST and perceptions of the healthcare environment, including healthcare resource quality; and (3) To use RCT to examine how matching patients and physicians on race/ethnicity and/or age impacts the association between HCST and perceptions of healthcare resource quality. The proposed research design consists of three studies, employs a combination of survey and experimental methods, and involves both primary data collection and secondary data analysis. An assistant professor of Gerontology and Psychology at the University of Southern California, I (Candidate: Abdou) possess interdisciplinary expertise in psychology, social epidemiology, population health, and lifespan and intergenerational health disparities. This NIA K01 will provide the unique opportunity to augment my current expertise with training in health economics, health services research, and advanced training in stereotype threat and statistical and research methods (i.e., longitudinal data, RCT). Alongside my strong interdisciplinary mentorship team, I will receive the necessary support and training to work toward my long-term career goal of establishing an independent research program, including development of a successful NIH R01, to reduce later life health disparities and improve minority aging through the reduction of HCST and its sociocultural and psychobiological consequences.