Skip to main content

Advertisement

Log in

Racial/Ethnic Differences in the Use of Primary Care Providers and Preventive Health Services at a Midwestern University

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Many universities seek to improve the health and wellbeing of their faculty and staff through employer wellness programs but racial/ethnic disparities in health care use may still persist. The purpose of this research was to identify racial/ethnic disparities in the use of preventive health services at a Midwestern university. A record review was conducted of self-reported health data from University employees, examining the use of primary care and common screening procedures collected in a Personal Health Assessment conducted by the University’s wellness program. Results show that there were significant racial/ethnic differences in the use of primary care and participation in screening. Notably, Asian employees in this sample were less likely to have a primary care provider and participate in routine cancer screenings. The observed racial/ethnic differences in screening behavior were mediated by the use of primary care. Together, these data show that despite equal access to care, racial and ethnic disparities in screening persist and that having a primary care provider is an important predictor of screening behavior. Results suggest that health communications designed to increase screening among specific racial/ethnic minority groups should target primary care use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Milem JF, Clayton-Pedersen AR, Hurtado S, Allen WR. Enhancing campus climates for racial/ethnic diversity: Educational policy and practice. Rev High Educ. 1998;21(3):279–302. doi:10.1353/rhe.1998.0003.

    Article  Google Scholar 

  2. Gebhardt DL, Crump CE. Employee fitness and wellness programs in the workplace. Am Psychol. 1990;45(2):262–72. doi:10.1037//0003-066x.45.2.262.

    Article  CAS  PubMed  Google Scholar 

  3. Anderko L, Roffenbender JS, Goetzel RZ, Millard F, Wildenhaus K, DeSantis C, et al. Promoting prevention through the Affordable Care Act: Workplace wellness. Prev Chronic Dis. 2012;9:120092. doi:10.5888/pcd9.120092.

  4. Goldstein F, Noyce J. Well-designed employer-sponsored wellness programs can lead to a healthier workforce. Popul Health Manag. 2013;16(3):214–5. doi:10.1089/pop.2013.1631.

    Article  PubMed  Google Scholar 

  5. Liu H, Harris KM, Weinberger S, Serxner S, Mattke S, Exum E. Effect of an employer-sponsored health and wellness program on medical cost and utilization. Popul Health Manag. 2013;16(1):1–6. doi:10.1089/pop.2011.0108.

    Article  CAS  PubMed  Google Scholar 

  6. Baicker K, Cutler D, Song Z. Workplace wellness programs can generate savings. Health Aff. 2010;29(2):304–11. doi:10.1377/hlthaff.2009.0626.

    Article  Google Scholar 

  7. Corporate Health & Wellness Association. A Failure to Communicate: How Cultural Incompetence Leaves Many Wellness Programs Incomplete. Corporate Wellness Magazine. 2015. Retrieved from: http://www.corporatewellnessmagazine.com/worksite-wellness/a-failure-to-communicate/.

  8. James J. Workplace Wellness Programs. Health Policy Briefs, Health Affairs. 2013. Retrieved from: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=93.

  9. Thompson SE, Smith BA, Bybee RF. Factors influencing participation in worksite wellness programs among minority and underserved populations. Fam Commun Health. 2005;28(3):267–73.

    Article  Google Scholar 

  10. Association of State and Territorial Health Officials, 2015. The Economic Case for Health Equity. 2015. Retrieved from: http://www.astho.org/Programs/Health-Equity/Economic-Case-Issue-Brief/.

  11. Agency for Healthcare Research and Quality. National Healthcare Disparities Report, 2014. U.S. Department of Health and Human Services. 2014. Retrieved from: http://www.ahrq.gov/research/findings/nhqrdr/nhqdr14/index.html.

  12. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2011 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. 2014. Retrieved from: http://nccd.cdc.gov/uscs/.

  13. Horner MJ, Altekruse SF, Zou Z, Wideroff L, Katki HA, Stinchcomb DG. US geographic distribution of prevaccine era cervical cancer screening, incidence, stage, and mortality. Cancer Epidemiol Biomarkers. 2011;20(4):591–9. doi:10.1158/1055-9965.epi-10-1183.

    Article  Google Scholar 

  14. Ollberding NJ, Nomura AM, Wilkens LR, Henderson BE, Kolonel LN. Racial/ethnic differences in colorectal cancer risk: the multiethnic cohort study. Int J Cancer. 2011;129(8):1899–906. doi:10.1002/ijc.25822.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Cheng I, Witte JS, McClure LA, Shema SJ, Cockburn MG, John EM, et al. Socioeconomic status and prostate cancer incidence and mortality rates among the diverse population of California. Cancer Causes Control. 2009;20(8):1431–40. doi:10.1007/s10552-009-9369-0.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Williams H, Powell IJ. Epidemiology, pathology, and genetics of prostate cancer among African Americans compared with other ethnicities. Methods Mol Biol. 2009;472:439–53. doi:10.1007/978-1-60327-492-0_21.

    Article  PubMed  Google Scholar 

  17. Raymundo EM, Rice KR, Chen Y, Zhao J, Brassell SA. Prostate cancer in Asian Americans: incidence, management and outcomes in an equal access healthcare system. BJU Int. 2011;107:1216–22. doi:10.1111/j.1464-410x.2010.09685.x.

    Article  PubMed  Google Scholar 

  18. American Urological Association. Early Detection of Prostate Cancer: AUA Guideline. 2013. Retrieved from: http://www.auanet.org/education/guidelines/prostate-cancerdetection.cfm.

  19. U.S. Preventive Services Task Force. Final Recommendation Statement Prostate Cancer: Screening. 2012. Retrieved from: http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening

  20. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR). 2012;61(03):41–45. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6103a1.htm.

  21. Grant R, Greene D. The health care home model: primary health care meeting public health goals. Am J Public Health. 2012;102(6):1096–103. doi:10.2105/ajph.2011.300397.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Browne AJ, Varcoe CM, Wong ST, Smye VL, Lavoie J, Littlejohn D, et al. Closing the health equity gap: evidence-based strategies for primary health care organizations. Int J Equity Health. 2012;11(1):59. doi:10.1186/1475-9276-11-59.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Mosquera PA, Hernández J, Vega R, Martínez J, Labonte R, Sanders D, et al. The impact of primary healthcare in reducing inequalities in child health outcomes, Bogota-Colombia: an ecological analysis. Int J Equity Health. 2012;11(66). doi:10.1186/1475-9276-11-66.

  24. Homayoon B, Shahidi NC, Cheung WY. Impact of Asian ethnicity on colorectal cancer screening: a population-based analysis. Am J Clin Oncol. 2013;36(2):167–73. doi:10.1097/coc.0b013e3182439068.

    Article  PubMed  Google Scholar 

  25. World Health Organization. The World Health Report 2008: Primary health care (now more than ever). 2014. Retrieved from: http://www.who.int/whr/2008/whr08_en.pdf.

  26. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879–91. doi:10.3758/brm.40.3.879.

    Article  PubMed  Google Scholar 

  27. Chen M. Cancer health disparities among Asian Americans: what we do and what we need to do. Cancer. 2005;104(12):2895–902. doi:10.1002/cncr.21501.

    Article  PubMed  Google Scholar 

  28. Ma G, Shive S, MinQi W, Yin T. Cancer screening behaviors and barriers in Asian Americans. Am J Health Behav. 2009;33(6):650–60. doi:10.5993/ajhb.33.6.3.

    Article  PubMed  Google Scholar 

  29. Lee HY, Eunsu J, Der Pa V, Lundquist M. Breast and cervical cancer screening among Asian American women and Latinas: does race/ethnicity matter? J Women's Health. 2010;19(10):1877–84. doi:10.1089/jwh.2009.1783.

    Article  Google Scholar 

  30. Jung-Won L. Linguistic and ethnic disparities in breast and cervical cancer screening and health risk behaviors among Latina and Asian American Women. J Women's Health. 2010;19(6):1097–107. doi:10.1089/jwh.2009.1614.

    Article  Google Scholar 

  31. Jun J, Oh KM. Asian and Hispanic Americans' cancer fatalism and colon cancer screening. Am J Health Behav. 2013;37(2):145–54. doi:10.5993/ajhb.37.2.1.

    Article  PubMed  Google Scholar 

  32. Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. Psychosoc Med. 2012;Doc11.

  33. Bodle EE, Islam N, Kwon SC, Zojwalla N, Ahsan H, Senie RT. Cancer screening practices of Asian American physicians in New York City. J Immigr Minor Health. 2008;10(3):239–46.

  34. Lee MM, Lee F, Stewart S, McPhee S. Cancer screening practices among primary care physicians serving Chinese Americans in San Francisco. West J Med. 1999;170(3):148–55.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Shokar NK, Nguyen-Oghalai T, Wu H. Factors associated with a physician’s recommendation for colorectal cancer testing in a diverse population. Fam Med. 2009;41(6):427–33.

    PubMed  Google Scholar 

  36. Ngo‐Metzger Q, Legedza AT, Phillips RS. Asian Americans’ reports of their health care experiences. J Gen Intern Med. 2004;19(2):111–9.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Carney PA, Lee‐Lin F, Mongoue‐Tchokote S, Mori M, Leung H, Lau C, et al. Improving colorectal cancer screening in Asian Americans: results of a randomized intervention study. Cancer. 2014;120(11):1702–12.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Wang JHY, Liang W, Ma GX, Gehan E, Wang HE, Ji CS, et al. Promoting Chinese-speaking primary care physicians' communication with immigrant patients about colorectal cancer screening: a cluster randomized trial design. J Health Care Poor Undeserved. 2014;25(3):1079–100.

    Article  Google Scholar 

  39. Lu M, Moritz S, Lorenzetti D, Sykes L, Straus S, Quan H. A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women. BMC Public Health. 2012;12(1):413.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kwon HT, Ma GX, Gold RS, Atkinson NL, Wang MQ. Primary care physicians’ cancer screening recommendation practices and perceptions of cancer risk of Asian Americans. Asian Pac J Cancer Prev. 2013;14(3):1999–2004.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Chin MH, Clarke AR, Nocon RS, Casey AA, Goddu AP, Keesecker NM, et al. A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care. J Gen Intern Med. 2012;27(8):992–1000.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Islam NS, Khan S, Kwon S, Jang D, Ro M, Trinh-Shevrin C. Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: historical challenges and potential solutions. J Health Care Poor Underserved. 2010;21(4):1354–81.

    PubMed  PubMed Central  Google Scholar 

Download references

Compliance with Ethical Standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all participants for being included in the study. All authors, Elizabeth S. Focella, Victoria A. Shaffer, Erin A. Dannecker, Mary J. Clark, and Laura H. Schopp, declare that they have no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elizabeth S. Focella.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Focella, E.S., Shaffer, V.A., Dannecker, E.A. et al. Racial/Ethnic Differences in the Use of Primary Care Providers and Preventive Health Services at a Midwestern University. J. Racial and Ethnic Health Disparities 3, 309–319 (2016). https://doi.org/10.1007/s40615-015-0148-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-015-0148-1

Keywords

Navigation