Healthcare stereotype threat, health disparities, and minority aging

项目总结 年迈的非洲裔美国人和拉美裔美国人之间的健康差距是巨大的，而且持续存在。1个大的 这些人口中生活在贫困中的部分人、医疗保健可获得性和质量是其 疾病、残疾和死亡的不成比例的负担。然而，非洲裔美国人和拉丁裔人晚年健康 即使在更高的社会经济背景下，差距仍然存在。这表明，除了经济上的 障碍，有心理社会障碍的医疗保健资源的使用，或利用，因此，健康 在老龄化的少数族裔中。拟议的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护理心理社会障碍来理解晚年健康差异 在老龄少数群体中，即医疗保健刻板印象威胁(HCST)，3-9岁，以及如何改善这一问题。 刻板印象威胁是指个人被降低为群体刻板印象的威胁，10-13可以导致 避免与刻板印象相关的领域。例如，女性已被证明可以避免STEM 领域、领导角色和其他刻板印象的男性领域，以避免刻板印象的自卑和他们的 负面的社会和心理后果。我的中心假设是刻板印象 在医疗保健环境中，不健康的生活方式、地位低下和智力低下是老年少数民族的突出问题 并影响医疗资源的使用和健康结果。这是此类研究中的第一项，拟议的研究将 调查关于HCST是否以及如何导致医疗保健差异的研究问题 与白人相比，老年非裔美国人和拉丁裔人的资源使用和健康状况。方法是 受到刻板印象威胁理论3、9、10、16、17和我的文化和社会认同健康理论的启发。18个特定 目标有三个：(1)记录基于族裔/种族和基于年龄的HCST之间的联系，以交叉- 非裔、拉丁裔和非裔美国人的部分和纵向医疗资源使用和健康结果 白人老年人；(2)使用随机对照试验(RCT)检查经济和其他调节因素 HCST和对医疗环境的感知之间的联系，包括医疗资源质量； 以及(3)使用随机对照试验检查匹配的患者和医生在种族/民族和/或年龄方面的影响 HCST与医疗资源质量感知之间的关联。拟议的研究 设计包括三项研究，采用调查和实验相结合的方法，涉及 包括一次数据收集和二次数据分析。一位老年学助理教授和 在南加州大学，我(候选人：Abdou)拥有跨学科的专业知识 心理学、社会流行病学、人口健康、寿命和代际健康差距。这 NIA K01将提供独特的机会，通过卫生经济学培训来增强我目前的专业知识， 保健服务研究，以及关于陈规定型威胁以及统计和研究方法的高级培训(即， 纵向数据，RCT)。与我强大的跨学科指导团队一起，我将获得必要的 支持和培训我朝着建立独立研究的长期职业目标努力 计划，包括开发成功的NIH R01，以减少晚年健康差距并改善 通过降低Hcst而导致的少数群体老龄化及其社会文化和心理生物学后果。

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.