Ashiabi Godwin S
Department of Human Development, California State University, Hayward, CA, USA.
Ethn Health. 2008 Nov 1;13(5):375-98. doi: 10.1080/13557850801900364.
Three questions were examined: does a structural equation model (SEM) of the links among family resources (socioeconomic status, SES), sociocultural (perception of quality of care), structural (health insurance coverage and health care utilization), parental psychological resources (parental depression and perception of quality of parenting), and child health apply similarly across blacks and whites? Do the items used to indicate the factors exhibit differences across groups? Is race/ethnicity associated with differences in structural paths?
Data on 18,092 black and white children (ages 0-11) from the 2002 National Survey of American Families data set was used. A two-stage, eight-step multigroup SEM was used to examine the associations among family resources, sociocultural, structural, parental psychological resources and child health status.
First, the patterning of the structural model applied similarly to black and whites. Second, there were some differences in factor loadings across groups. Third, although sociocultural, structural, and parental psychological resources mediated the link between SES and health status, the effects of SES on these mediators differed between blacks and whites; but there was no difference between groups in the effects of SES on health status. Fourth, perception of quality of care and health care use mediated the effects of health insurance on health and the effects of parental depression and quality of parenting on health status, respectively. Fifth, health care use mediated the effects of perception of quality of care on health status. Finally, health insurance was linked with a greater increase in health care use among blacks than whites; and perception of quality of care was strongly associated with better health for blacks than for whites.
When sociocultural, structural, and parental psychological constructs are adjusted for, there are no significant differences in SES effects on health status between groups. Perception of quality of care is an important determinant of health care utilization, given health insurance coverage and SES. Finally, parental depression and behaviors also determine perception of care and health care utilization decisions.
研究了三个问题：家庭资源（社会经济地位，SES）、社会文化（对医疗质量的认知）、结构因素（医疗保险覆盖范围和医疗保健利用情况）、父母心理资源（父母抑郁和对育儿质量的认知）与儿童健康之间联系的结构方程模型（SEM）在黑人和白人中是否具有相似的适用性？用于表示这些因素的项目在不同群体之间是否存在差异？种族/族裔与结构路径的差异是否相关？
使用了来自2002年美国家庭全国调查数据集的18,092名黑人和白人儿童（0至11岁）的数据。采用两阶段、八步骤多组结构方程模型来研究家庭资源、社会文化、结构因素、父母心理资源与儿童健康状况之间的关联。
第一，结构模型的模式在黑人和白人中具有相似的适用性。第二，不同群体之间的因子载荷存在一些差异。第三，尽管社会文化、结构和父母心理资源介导了SES与健康状况之间的联系，但SES对这些中介因素的影响在黑人和白人之间有所不同；但SES对健康状况的影响在不同群体之间没有差异。第四，对医疗质量的认知和医疗保健利用分别介导了医疗保险对健康的影响以及父母抑郁和育儿质量对健康状况的影响。第五，医疗保健利用介导了对医疗质量的认知对健康状况的影响。最后，医疗保险与黑人医疗保健利用的增加幅度大于白人相关；并且对医疗质量的认知与黑人健康状况优于白人密切相关。
在对社会文化、结构和父母心理结构进行调整后，不同群体之间SES对健康状况的影响没有显著差异。在有医疗保险覆盖和SES的情况下，对医疗质量的认知是医疗保健利用的重要决定因素。最后，父母的抑郁和行为也决定了对医疗的认知和医疗保健利用决策。
