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African American and non-Hispanic white children's health: integrating alternative explanations

Objectives. 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? Design. 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. Results. 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. Conclusions. 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.