TY - JOUR
T1 - Individual health care system distrust and neighborhood social environment
T2 - How are they jointly associated with self-rated health?
AU - Yang, Tse Chuan
AU - Matthews, Stephen A.
AU - Shoff, Carla
N1 - Funding Information:
We acknowledge the support of the SSRI at the Pennsylvania State University for providing funding to secure the data licensing agreement with the Philadelphia Health Management Corporation and continued support of the leading author’s position. Additional support was provided to the GIA Core through the PRI, which receives core funding from the National Institutes of Child Health and Human Development (R24-HD41025).
PY - 2011/10
Y1 - 2011/10
N2 - Americans' distrust in the health care system has increased in the past decades; however, little research has explored the impact of distrust on self-rated health and even less is known about whether neighborhood social environment plays a role in understanding the relationship between distrust and self-rated health. This study fills these gaps by investigating both the direct and moderating associations of neighborhood social environment with self-rated health. Our analysis is based on the 2008 Philadelphia Health Management Corporation's household survey and neighborhood-level data. Findings from multilevel logistic regression show that after controlling for individual- and neighborhood-level covariates, distrust is directly and adversely related to self-rated health, and that neighborhood social affluence and stability are directly and negatively associated with the odds of reporting poor/fair health. Neighborhood disadvantage and crime rates are not directly related to self-rated health, but increase the odds of having poor/fair health via distrust. Overall, our results suggest that macro-level actions can alter individual's perception of residential environment and lead to improved health. To improve the public health in an urban setting, rebuilding confidence in the health care system is integral, and the policies that help establish safe and cohesive neighborhoods may reduce the adverse effect of distrust on self-rated health.
AB - Americans' distrust in the health care system has increased in the past decades; however, little research has explored the impact of distrust on self-rated health and even less is known about whether neighborhood social environment plays a role in understanding the relationship between distrust and self-rated health. This study fills these gaps by investigating both the direct and moderating associations of neighborhood social environment with self-rated health. Our analysis is based on the 2008 Philadelphia Health Management Corporation's household survey and neighborhood-level data. Findings from multilevel logistic regression show that after controlling for individual- and neighborhood-level covariates, distrust is directly and adversely related to self-rated health, and that neighborhood social affluence and stability are directly and negatively associated with the odds of reporting poor/fair health. Neighborhood disadvantage and crime rates are not directly related to self-rated health, but increase the odds of having poor/fair health via distrust. Overall, our results suggest that macro-level actions can alter individual's perception of residential environment and lead to improved health. To improve the public health in an urban setting, rebuilding confidence in the health care system is integral, and the policies that help establish safe and cohesive neighborhoods may reduce the adverse effect of distrust on self-rated health.
KW - Health care system distrust
KW - Multilevel modeling
KW - Neighborhood social environment
KW - Philadelphia
KW - Self-rated health
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U2 - 10.1007/s11524-011-9561-x
DO - 10.1007/s11524-011-9561-x
M3 - Article
C2 - 21455831
AN - SCOPUS:84855337654
SN - 1099-3460
VL - 88
SP - 945
EP - 958
JO - Journal of Urban Health
JF - Journal of Urban Health
IS - 5
ER -