Date on Master's Thesis/Doctoral Dissertation

5-2024

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Health Promotion and Behavioral Sciences

Degree Program

Public Health Sciences with a specialization in Health Promotion, PhD

Committee Chair

Wendel, Monica

Committee Member

Kerr, Jelani

Committee Member

Williams, Kim

Committee Member

Karimi, Seyed

Author's Keywords

Cardiovascular disease; racism in medicine; medical mistrust; structural racism; Black Americans; United States

Abstract

Cardiovascular disease (CVD) persists as the leading preventable cause of death and disability among Black Americans in the United States. Structural and psychosocial factors such as racism have been highlighted as a fundamental cause of persistent cardiovascular health disparities in the U.S. This study examined the associations between racism in medicine, medical mistrust and CVD among Black Americans using the Minority Stress Theory as a theoretical framework. This study evaluates the sociodemographic differences in the quality of care received among Black Americans. Data from the Health Information National Trends Survey, 2022 and the Consumer Assessment of Healthcare Provider and Systems Survey, 2019 were used to test the hypothesis that experiences of racism in medicine and mistrust of health care providers and health care systems will be associated with increased odds of CVD among Black Americans. Adjusted logistic regression and ordinal logistic regression models were performed. This dissertation follows a traditional format and includes five chapters, covering the introduction, literature review, method, results, and discussion. Chapter 1 provides an overview of CVD disparities and racism as a structural determinant. Chapter 2 synthesizes the literature on racism and CVD, racism in medicine, medical mistrust, and introduces the Minority Stress Theory as the theoretical framework guiding the study. Chapter 3 describes the methodological approaches for the study. Chapter 4 details the results. Chapter 5 summarizes and discusses the study findings, strengths and limitations, public health implications, and recommendations for future research. Racism in medicine and mistrust of health care providers were found to be significantly associated with higher odds of CVD among Black American adults. Mistrust of the health care system was associated with lower odds of CVD among Black Americans. This study is unique and contributes to the current science as it is the first to examine the association between racism in medicine, medical mistrust and CVD among Black Americans using the Minority Stress Theory. Results of this study could guide CVD prevention strategies for Black Americans with a focus on health care provider culturally sensitive interventions and equitable health care policies to mitigate the deleterious effects of racism on CVD.

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