Is doctor-patient race concordance associated with greater satisfaction with care?

We examined a national sample of African American, white, Hispanic, and Asian American respondents to test the hypothesis that doctor-patient race concordance is predictive of patient satisfaction. Our analysis examined racial/ethnic differences in patient satisfaction among patients in multiple combinations of doctor-patient race/ethnicity pairs. Additionally, we outline the determinants of doctor-patient race concordance. The analysis used the 1994 Commonwealth Fund Minority Health Survey to construct a series of multivariate models. We found that for respondents in each race/ethnic group, patients who had a choice in the selection of their physician were more likely to be race concordant. Whites were more likely to be race concordant with their physician compared to African American, Hispanic, and Asian American respondents. Among each race/ethnic group, respondents who were race concordant reported greater satisfaction with their physician compared with respondents who were not race concordant. These findings suggest support for the continuation of efforts to increase the number of minority physicians, while placing greater emphasis on improving the ability of physicians to interact with patients who are not of their own race.     

Social isolation from extended family members and friends among African Americans: Findings from a national survey

This study investigated the correlates of objective social isolation from extended family members and friends among a national sample of African Americans. The analysis is based upon the African American subsample (n = 3,570) of the National Survey of American Life. The dependent variable examines four categories of respondents: 1) socially isolated from both family and friends, 2) socially isolated from friends only, 3) socially isolated from family only, and 4) not socially isolated. Overall, 23% of respondents indicated some degree of objective social isolation from family, friends or both groups, while the complementary 77% of the sample were not isolated from family or friends. Only 4% of respondents indicated being isolated from both family and friends. Multinomial logistic regression analysis revealed several gender, education, marital status and region differences. In particular, African American women were less likely to be socially isolated from family members than African American men. This finding was sustained even when controlling for differences in subjective isolation from family members, underscoring the protective effect of female gender. Study findings are discussed in relation to previous research on social isolation, as well as prior research on African American social support networks.     

Examining the impact of gender, race/ethnicity, and family factors on mental health issues in a sample of court-involved youth

Faced with anywhere between one half and two thirds of its youth having a diagnosable mental illness, the identification and treatment of mental health concerns is a critically important endeavor for professionals working with youth who have contact with the juvenile justice system. In addition, the literature suggests that factors related to both the family and to the gender of the adolescent must be incorporated into any approach to assessment and intervention within this special population. Further, prior work that has documented the interaction of gender and family issues with adolescent race/ethnicity warrants further empirical attention, as does the intermediary role that the family may play in the development of both internalizing and externalizing behaviors. The present study extends this literature by examining factors related to gender, race/ethnicity, family factors, and mental health issues in a sample of 2,549 Caucasian and African American youth coming to the attention of juvenile courts. Multivariate analysis of variance results indicated significant main effects for gender and race/ethnicity, as well as a significant gender x race/ethnicity interaction for the family and externalizing variables. A multiple group structural equation modeling procedure was employed in order to test the hypothesis that family environment mediates the relationship between gender and mental health problems, as well as to test for potential differences in these relationships as a function of race/ethnicity. Results indicated support for the mediation model in the sample of African American youth but not in the sample of Caucasian youth.     

African American and Black Caribbean feelings of closeness to Africans

African American and Black Caribbean relations dominate research on interactions across black ethnic divides. Using National Survey of American Life data, we explore a different aspect of black interethnic attitudes: how close these groups feel towards Africans. African Americans and Black Caribbeans were largely similar in their feelings of closeness to Africans. For Black Caribbeans, younger and male respondents, those reporting higher levels of financial strain, living in the northeast and persons who immigrated to the US at least 11 years ago, report feeling especially close to Africans. Being male was the only significant correlate among African Americans. The findings are discussed in relation to how race, ethnicity and national origin shape personal identities within the US and their significance for intergroup perceptions. These broader issues warrant further consideration in light of assertions that race as a defining feature of American life and intergroup relations is obsolete.     

Self-Perceived Physical Attractiveness,Self-Esteem,Race, and Gender

Abstract

African American self-perceptions of physical attractiveness are found to be higher than white self-perceptions, while there is no difference by race in the correlation between self-perceived attractiveness and self-esteem. Controlling for self-perceived attractiveness, African Americans have lower self-esteem than whites, suggesting that African American perceptions of physical attractiveness, mirrored in the slogan “Black is Beautiful,” may have contributed to the disappearance over the past forty years of the gap between African American and white self-esteem. Self-esteem is more strongly related to self-perceived physical attractiveness for females than males, particularly among whites.     

Disentangling substantiation: The influence of race, income, and risk on the substantiation decision in child welfare

Understanding the source of disparities found at decision-making points along the child welfare pathway is essential to understanding and addressing the overrepresentation of African American children. Although research has documented the existence of disparities, it has been less successful in identifying the explanatory factors behind them. Critiques of research examining these disparities have suggested that poverty is likely a stronger explanatory factor than race, yet analyses that include measures of poverty using data from child welfare systems have largely not been conducted. This study uses data from the Texas child welfare system to identify the factors contributing to disparities at the substantiation decision. Given the relationship between poverty and child maltreatment, the analyses control for the effect of family income, as well as other factors related to maltreatment, to better understand the effect of race on this decision-making point. Findings indicate that when family income is controlled, race is not a significant factor in the substantiation decision. However, when also controlling for caseworker perceptions of risk, race emerges as the stronger explanatory factor. This suggests not only an important relationship between race, income, and risk assessment, but also that disproportionality in the child welfare system is a complex phenomenon that cannot be explained by a single factor. These results further demonstrate that the effect of racial bias on decision-making remains an important consideration in understanding the overrepresentation of African American children.     

Parenting in Context: Impact of Neighborhood Poverty,Residential Stability,Public Services,Social Networks,and Danger on Parental Behaviors

This prospective longitudinal study examined the unique and combined effects of neighborhood characteristics on parental behaviors in the context of more distal and more proximal influences. With a sample of 368 mothers from high‐risk communities in 4 parts of the United States, this study examined relations between race (African American or European American), locality (urban or rural), neighborhood characteristics, family context, and child problem behaviors, and parental warmth, appropriate and consistent discipline, and harsh interactions. Analyses testing increasingly proximal influences on parenting revealed that initial race differences in warmth and consistent discipline disappeared when neighborhood influences were considered. Although generally culture and context did not moderate other relations found between neighborhood characteristics, family context, and child behaviors, the few interactions found highlight the complex influences on parenting.     

And Some of Us Are Braver: Stress and Coping Among African American Women

African American women fulfill many roles within their family and community. Most notably, these women are often defined by their “strength” and rarely seen as “vulnerable.” Many African American women demonstrate strength as they struggle to maintain employment, raise children, and nurture spouses and extended family, but these same women are at risk for a higher rate of health and emotional problems. In this article, the authors use relational cultural, stress and coping, and lifespan theories, along with Black feminist thought to discuss the interlocking effects of race, gender, and class regarding the psychological well-being of African American women 18 to 55 years old. We conclude with a discussion of research, practice, and teaching implications.     

Untangling Inequalities: Gender,Race, and Socioeconomic Differences in Depression1

In their important paper, Link and Phelan (1995) argue that socioeconomic status is a fundamental cause of variation in well‐being and that the social resources associated with socioeconomic status constitute the fundamental cause of variation in well‐being. In this article, I elaborate on the fundamental cause perspective in three respects: by suggesting an expansion of the definition of resources, by examining how race and gender influence variation in the relationship between resources and mental health, and by developing a model of the relationship between social class, race, and gender that takes account of the potential asymmetry in the influence of resources across race and gender. Using the 2003 National Health Interview Survey and ordinary least squares regression, I find that black and white men are significantly less depressed than black and white women. However, women accrue greater mental health advantage from marriage, home ownership, and education. African‐American men experience less depression as a result of being unmarried and non‐Hispanic white women experience less benefit from full‐time employment, relative to African‐American women and men. Results are discussed in terms of implications for future research on race, class, and gender differences in health.     

Racial Differences in Sexual and Fertility Attitudes in an Urban Setting

Using data from the Project on Human Development in Chicago Neighborhoods (neighborhood N= 77; individual N= 951), we consider the extent to which African American youth maintain sexual and fertility‐related norms that support early sexual activity and childbearing and examine the robustness of racial differences in sexual attitudes to controls for neighborhood, family, and individual characteristics. At a minimum, neighborhood economic disadvantage accounts for 26% of the baseline increased likelihood of holding attitudes that encourage early sexual activity among African American youth when compared with Whites. Neighborhood‐, family‐, and individual‐level factors account for 67% of the race difference in sexual attitudes. Implications for contextual and race‐based theories of sexual and fertility norms are discussed.     

Adolescent Depression as a Contributing Factor to the Development of Substance Use Disorders

An exploratory investigation of the variables linking adolescent substance abuse and depression was conducted using the “grounded theory” qualitative research approach. A convenience sample was drawn from African American adolescents, aged 12 to 18 years, who reside in a public housing community in Baltimore, Maryland. The results revealed approximately 5% of the sample openly admitted to using drugs because they are sad, feel like a failure, lack energy and because they have family problems. Moreover, 26% of the respondents reported drinking alcoholic beverages; 26% of the population reported smoking marijuana and 16% of the respondents reported they smoke cigarettes. Additionally, life stressors (i.e. an absent parent from the home, childhood illnesses, family discord, living in kinship or foster care environments, living in single-parent households and unemployment) are adversely impacting the lives of African American adolescents residing in a public housing community.     

Marital Processes and Parental Socialization in Families of Color: A Decade Review of Research

Research published during the past decade on African American, Latino, and Asian American families is reviewed. Emphasis is given to selected issues within the broad domains of marriage and parenting. The first section highlights demographic trends in family formation and family structure and factors that contributed to secular changes in family structure among African Americans. In the second section, new conceptualizations of marital relations within Latino families are discussed, along with research documenting the complexities in African American men's conceptions of manhood. Studies examining within‐group variation in marital conflict and racial and ethnic differences in division of household labor, marital relations, and children's adjustment to marital and family conflict also are reviewed. The third section gives attention to research on (a) paternal involvement among fathers of color; (b) the relation of parenting behavior to race and ethnicity, grandmother involvement, neighborhood and peer characteristics, and immigration; and (c) racial and ethnic socialization. The article concludes with an overview of recent advances in the study of families of color and important challenges and issues that represent research opportunities for the new decade.     

Developmental Precursors of Number of Sexual Partners From Ages 16 to 22

This study examines family and child characteristics, parent and peer relationships, and early adolescent behavior as statistical predictors of trajectories of number of sexual partners from midadolescence through early adulthood using data from 527 participants in the Child Development Project. Early adolescent developmental antecedents accounted for modest variance in number of sexual partners. Latent growth models revealed that African American race, more advanced pubertal development, lower parental monitoring knowledge, association with more deviant peers, and lower grade point average in early adolescence each predicted having more sexual partners at age 16. In addition, non‐African American race, lower child IQ, higher parental monitoring knowledge, and lower early adolescent internalizing problems each was associated with a higher rate of growth in number of sexual partners over time at the ages following 16. Latent growth mixture modeling identified subgroups with distinct trajectories of involvement with sexual partners that were associated with family and child characteristics, parent and peer relationships, and behavior in early adolescence.     

Gender,Race/Ethnicity,and Deviant Drinking: A Longitudinal Application of Social Structure and Social Learning Theory

Aker's (1998) theory of social structure and social learning (SSSL) argues that structural variations in deviant behavior, such as gender or race/ethnic differences in underage or heavy drinking, are mediated by social learning variables. However, longitudinal analyses of deviant drinking in an urban sample of white, black, and Hispanic adolescents fail to support the SSSL mediation hypothesis. Significant gender and race/ethnic differences persist after controls for social learning variables as well as for social bonding variables. Interaction effects involving two social bonding variables—family attachment and moral belief—point to theoretically important conditions that maintain a gender gap in underage drinking and relatively low levels of deviant drinking among African American adolescents.     

Self-Esteem,Locus of Control,and Suicide Risk

Abstract

Past research suggests that African American clients in need of mental health services are less likely to be properly diagnosed and receive appropriate treatment compared to White Americans. It has been further suggested that this may be even a greater problem for those who are both African American and female. In the current study, 2 groups of hospitalized clinically depressed females (92 African American females; 99 White females) were administered the Self-Esteem Rating Scale, Internal Control Index, and Suicide Risk Scale. Results indicated more similarities than differences between the two groups. For instance, there were no differences in locus of control or suicide risk between groups. In addition, although there were differences in self-esteem between groups, self-esteem was the best predictor of suicide risk within groups (White, R² =42%; African American, R² = 19%). African American females possessed higher self-esteem than White females (p = .05). For African American females age and self-esteem were positively correlated (r = .27, p =.01). Clinically depressed females could benefit from treatment focusing on improving self-esteem within a context of multicultural sensitivity.     

Race,Class, and Support for the Welfare State*

Two competing approaches to the study of African Americans—the race and class perspectives—have dominated attempts to explain their views on contemporary issues. To examine the race versus class debate, this study uses African Americans' views on government spending for five social welfare concerns: (1) improving and protecting the nation's health, (2) solving the problems of big cities, (3) halting rising crime rates, (4) dealing with drug addiction, and (5) improving the nation's education system. Data from the 1972–1990 General Social Surveys are used to compare middle-class blacks with both working-class blacks and whites and middle-class whites in terms of their support for government spending for those five social welfare issues. Examining group means, we found no significant difference between the two black classes but a significant difference between the black middle class and the white middle class on support for government spending in all areas except halting the rising crime rates (where there were no significant differences among the four groups). Similarly, using logistic regression analysis we found that race continued to have a significant effect on support for spending even after controlling for class, year, age, gender, education, income, and occupational prestige. In respect to social welfare spending, the results indicate support for the race, as opposed to the class, perspective; that is, race is better than class for predicting African American attitudes on government spending.     

Religiosity as a Moderator of Family Conflict and Depressive Symptoms among African American and White Young Grandmothers

ABSTRACT

This study examined the association between religiosity, conflict in the mother-daughter relationship, and depressive symptoms among 83 African American and white grandmothers. Interviews were conducted during the early stages of adaptation to grandparenthood due to the birth of a baby to a teenage daughter. The results of this study suggest that religiosity is associated with less depressive symptoms. In addition, religiosity moderates the relationship between conflict and depressive symptoms for African American grandmothers. Specifically, highly religious African American grandmothers experiencing low conflict with their daughters reported lower depressive symptoms than those who were less religious. These findings were not evident for white grandmothers. The implications of these findings for grandmothers in families with teenage mothers are discussed within the context of race, religiosity, family relationships, and psychological well-being.     

The Sexual Debut of Girls in Early Adolescence: The Intersection of Race,Pubertal Timing,and Friendship Group Characteristics

Scholars who have studied the effects of early pubertal timing on girls' sexual debut contend that this association may result from the company they keep. Although this basic biosocial model of adolescent behavior has been applied to various outcomes with diverse samples of adolescent girls, less work has contextualized this microlevel developmental phenomenon within the larger macrolevel structures of race and ethnicity. Using a sample of White, African American, and Latina girls (N=1,299) drawn from the National Longitudinal Study of Adolescent Health, this study conducted within‐group multivariate analyses and found important differences in the linkages that make up this biosocial model by race and ethnicity, with the linkages strongest for Whites, followed by Latina, and African American girls. These differences in association may reflect differences in the social construction of girlhood across race and ethnicity.     

Shifting Perceptions of Race and Incarceration as Adolescents Age: Addressing Disproportionate Minority Contact by Understanding How Social Environment Informs Racial Attitudes

African American youth disproportionately experience incarceration in the United States and a number of programs have been created to address disproportionate minority contact (DMC) with the juvenile justice system. Thus, we aim to understand the ways in which race and incarceration are conceptualized differently by younger and older youth. Within these age categories we explore how perceptions of incarceration and crime inform racial attitudes among African American adolescents. We also investigate how a program grounded in an operating framework that extols an achievement ideology and designed to decrease DMC among African American adolescent males shapes participants’ attitudes about race and incarceration and their perceived future trajectories Our findings suggest the older participants were less likely to embrace achievement ideology and more likely to be aware of the structural barriers related to race. Thus, a more culturally responsive, critically engaged intervention may be more appropriate for African American youth.