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C Pope, J Klein, University of Rochester
Recent studies
of cardiologic health services report differential treatment for
Black and White patients, but cannot explain how racial disparities
occur in the process of care. Because the AMA/CDC Guidelines for
Adolescent Preventive Services (GAPS) address preventive cardiology
risk behaviors, interventions in this age group offer an opportunity
to examine naturally occurring racial disparities in communication.
We first studied racial differences in health promotion advice among
436 teens between 15-18 years old, especially for physical activity
(p < .001), diet/obesity (p < .001), and smoking (p < .001).
Using Communication Accommodation Theory, covert sources of discrimination
were identified in talk with White physicians.
Secondary analysis of health encounters were completed for seven
randomly selected, matched pairs of privately insured Black and
White teens of the same gender and age. Audiotaped interviews were
transcribed using conversation analysis transcription and categorized
using taxonomy from linguistic anthropology. Though all teens received
less screening, counseling, and health promotion than recommended
by the AMA/CDC Guidelines, Black teens received less preventive
advice than White teens in both the larger cohort and qualitative
sample, with less positive affect, time, and participation. Black
teens received more selective attention, missed cues, and threats.
Differences in the use of ethnic vernacular were not associated
with differences in care. Statistically significant differences
in topics (p < .047), power-oriented interruptions (p <.02),
and uses of positive (p <.002) and negative (p <.0003) humor
suggest that monoracial and interracial habits of speaking behavior
contribute to disparities in care.
The use of social theory and linguistic methodology can reveal the
complexity and subtlety of racial disparities in the content and
quality of preventive cardiology advice, with implications for other
cardiology services and older patients. The racial disparities identified
require critical reflection and an awareness of communication quality
for physicians concerned with more equitable care for all patients.
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