Graduation Year

2007

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Aging Studies

Major Professor

Jennifer R. Salmon, Ph.D.

Co-Major Professor

David A. Chiriboga, Ph.D.

Keywords

Ethnic disparities, Neighborhood, Geographic information systems, Health, Depression

Abstract

African Americans, Hispanics, and other minorities in the U.S. continue to face conditions of residential and educational segregation, lower socioeconomic status, and higher rates of mortality than whites. Better theory-based research that uses community and individual level factors to explain how health disparities are created and perpetuated is needed. The Community Context and Health Disparities Model, which extends the work of Schulz and Northridge (2004) with elements described by Williams and Collins (2001), is described. This framework identifies the pathways by which characteristics of the physical, built, social, economic, and healthcare environments impact health and are mediated by individual traits. Two measures of the healthcare environment, physician density and emergency room hospital accessibility, are created using Geographic Information Systems (GIS), compared to traditional measures of these concepts, and contrasted across racial and ethnic populations. The Community Context and Health Disparities Model is implemented to understand physical and mental health disparities among a sample of older adults in Miami-Dade County who were participants in the Survey of Older Floridians using hierarchical linear modeling (HLM). Exogenous measures of each community domain, including the healthcare measures created, are used as community-level predictors of self-rated health and number of depressive symptoms. The results show that community poverty rate predicts self-rated health, but is no longer significant after individual attributes are controlled. There is a significant interaction between Hispanic ethnicity and community poverty associated with self-rated health. Hispanics are negatively impacted by community poverty but other ethnic groups are not. Depressive symptoms are found to be primarily explained by individual characteristics. Future research, practice recommendations and policy implications of these findings are described.

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