Healthcare stereotype threat, health disparities, and minority aging

医疗保健刻板印象威胁、健康差异和少数族裔老龄化

• 批准号: 9904318
• 负责人: Cleopatra Miriam Abdou
• 金额: $ 12.95万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2021-02-26
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9904318
• 关键词: Accounting; Address; African American; Age; Aging; Anxiety; Area; California; Cessation of life; Communities; Data; Data Analyses; Data Collection; Development; Diabetes Mellitus; Economics; Education; Elderly; Environment; Ethnic Origin; Female; Fright; Gerontology; Goals; Health; Health Insurance; Health Services; Health Services Research; Healthcare; Healthcare Systems; Healthy People 2020; Income; Individual; Inequality; Inferior; Institutional Policy; Insurance Coverage; Intelligence; Intervention; K-Series Research Career Programs; Knowledge; Latino; Lead; Leadership; Life; Link; Longevity; Measures; Medical Education; Medicare claim; Mentorship; Methods; Minority; Mission; Modification; Outcome; Patients; Perception; Physicians; Policy Maker; Population; Poverty; Prevention; Process; Provider; Psychology; Public Health; Public Policy; Quality of life; Race; Randomized Controlled Trials; Reporting; Research; Research Design; Research Methodology; Research Training; Resources; Risk Behaviors; Role; STEM field; Social Identification; Statistical Methods; Stereotyping; Surveys; Time; Training; United States National Institutes of Health; Universities; Work; barrier to care; base; burden of illness; career; career development; community based participatory research; cost; disability; disorder prevention; ethnic identity; health care availability; health care disparity; health care quality; health care service utilization; health care settings; health disparity; health economics; health equity; health inequalities; healthspan; improved; innovation; insight; intergenerational; male; novel; population health; professor; programs; psychobiologic; psychologic; psychosocial; racial and ethnic; racial minority; research and development; social; social culture; social epidemiology; socioeconomics; theories; trial design; unhealthy lifestyle

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.

项目摘要 老年非裔美国人和拉丁美洲人之间的健康差距是巨大和持久的。1、大 生活在贫困中的这些人口的部分，医疗保健的获得和质量是他们的主要贡献者。 不成比例的疾病、残疾和死亡负担。然而，非裔美国人和拉丁美洲人晚年的健康状况 即使在较高的社会经济背景下，差距也依然存在。2.这表明，除了经济 障碍，医疗保健资源的使用或利用存在心理社会障碍，从而影响健康 在少数民族中。拟议职业发展和研究的目的是提供新的 通过检查以前被忽视的社会心理障碍来了解晚年健康差异 在老年少数群体中，即医疗保健刻板印象威胁（HCST），3-9以及如何改善。 刻板印象威胁是个人被降低到群体刻板印象的威胁，10-13这可能导致 个人避免刻板印象相关领域。10-12例如，女性已被证明避免STEM 妇女在性别、领导作用和其他陈规定型的男性领域中的作用，以避免低人一等的陈规定型观念， 负面的社会和心理后果。14，15我的中心假设是， 不健康的生活方式、低地位和低智力是医疗机构中老年少数群体的突出问题 并影响医疗资源的使用和健康结果。这是同类研究中的第一次，拟议的研究将 调查HCST是否以及如何导致医疗保健差异的研究问题 资源使用和健康在老龄化非洲裔美国人和拉丁美洲人相比，白人。该方法是 由刻板印象威胁理论3，9，10，16，17和我的文化和社会认同健康理论提供信息。18特异性 目的有三个：（1）记录基于种族/种族和基于年龄的HCST与跨 非裔美国人、拉丁美洲人和 白色老年人;（2）使用随机对照试验（RCT）检查经济和其他调节因素， HCST与医疗环境感知之间的联系，包括医疗资源质量; 和（3）使用RCT来检查患者和医生在种族/民族和/或年龄方面的匹配如何影响 HCST和医疗资源质量感知之间的关联。拟议研究 设计包括三个研究，采用调查和实验相结合的方法，并涉及 主要数据收集和次要数据分析。老年学助理教授， 心理学在南加州大学，我（候选人：阿卜杜）拥有跨学科的专业知识，在 心理学、社会流行病学、人口健康以及寿命和代际健康差异。这 NIA K 01将提供一个独特的机会，通过卫生经济学培训来增强我目前的专业知识， 卫生服务研究，以及定型观念威胁和统计及研究方法方面的高级培训（即， 纵向数据（RCT）。除了我强大的跨学科导师团队，我将获得必要的 支持和培训，以实现我建立独立研究的长期职业目标 计划，包括开发成功的NIH R 01，以减少晚年健康差异， 通过减少HCST及其社会文化和心理生物学后果来减少少数群体老龄化。