Racial and Ethnic Differences in Health Status, Obesity, Smoking, and
Physical Activity
Executive
Summary
submitted
by
Federation
for Community Planning
Cleveland,
Ohio
Joseph
G. Ahern
research
associate
George
D. Weiner, PhD
principal
investigator
June
29, 2001
Racial
and ethnic variations in insurance status and access to care have been
well documented in the medical and social science literatures, with poorer
health consequences shown for the uninsured and those having barriers to
care. However, the relationships between race/ethnicity, insurance, access
to care, and ultimately health outcomes are potentially confounded by a
host of other variables related to race/ethnicity (e.g., socioeconomic
status, education, health risk behaviors, environmental and other
contextual social factors).
To get a fair and honest picture, we must first identify the key
contributing factors associated with racial and ethnic variations in
health status, and then adjusted for these confounding variables.
The 1998 Ohio Family Health Survey (OFHS) provides a detailed data
set with a wide variety of demographic, socioeconomic, insurance, health
behavior, health status, and geographic identifiers that allow us to do
this.
The
Gallup Organization conducted the 1998 Ohio Family Health Survey under
contract with the Ohio Department of Health (ODH).
They completed interviews with one adult in each of 16,261 Ohio
households. In
addition, they collected information about 5,788 children from interviews
with adult family members.
Each record was weighted to reflect the age, gender and racial
distribution in each county.
Survey
questions were modeled after several well-known national survey
instruments, including the National Health Interview Survey, Behavioral
Risk Factor Surveillance System, Current Population Survey and SF12
Physical and Mental Health Summary Scores.
Our
descriptive analyses of survey data found that black Ohioans were in
significantly poorer physical health (SF12 scores) than adult Ohioans in
general. They
were also more likely to rate their overall health as ?poor-fair,?
although we found no statistically significant difference in their mental
health scores or prevalence of chronic conditions.
Blacks were also more likely to be categorized as obese based on
their body mass indexes (BMIs) and were less likely to report regular
exercise in the prior 12 months.
Racial
minorities, however, differed significantly from the adult population in
general for a number of predisposing (demographic and sociocultural) and enabling
(socioeconomic and access) characteristics.
For example, black educational attainment was lower, as was their
income, and availability of health insurance.
Asians, in contrast, were younger, better educated, had higher
incomes, and were more likely to have health insurance.
When we controlled for these and other confounding factors,
physical health of blacks (as measured by the SF12 questions) became
indistinguishable from the overall adult population, as did the exercise
rate. The
higher proportion rating ?poor-fair? health persisted, however, as did
the propensity towards obesity.
On the other hand, all significant differences for Asians, except
for the low smoking prevalence, disappeared.
Difference for other minorities persisted.
Our
findings are mixed.
Controlling for confounding predisposing
and enabling factors dampened
some disparities for minorities that we found in our simple descriptive
analyses, but some disparities still persisted.
While the direct affect of race on health may be lessened
after we control for other variables, race still manifests itself indirectly
on health status through poorer education and lower socioeconomic status.
While no less pernicious, these are issues that might be remedied
through public health and public policy initiatives.
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