Dissertation Title："Understanding Latino Health Policy and Barriers to Care"

Little is known about how cultural changes influence the Latino experience in healthcare. Issues such as generational status, nativity, English proficiency and age of arrival at immigration may have a profound effect on the rate at which Latinos experience barriers to medical care, perceive discrimination and support health policy issues.

Paper 1 investigates how variation in the components of acculturation and experiences of discrimination could explain differences in the report of four barriers to care and also assesses the role of cultural factors as potential predictors of discrimination. For Latinos, traditional measures of acculturation were associated with increased barriers including being in the US longer, speaking English and having an American identity. I conclude that as Latinos become more acculturated they have higher expectations of the healthcare system and report more barriers to care.

Paper 2 examines the prevalence of discrimination among Latinos and the correlates of perceived discrimination including SES and cultural factors. Cubans are less likely to perceive discrimination compared to other Latino subgroups even after controlling for SES and cultural factors. English proficient and fourth generation Latinos are more likely to perceive discrimination compared to Spanish proficient and earlier generation Latinos. I conclude assimilation is associated with more discrimination and that the benefit of isolated ethnic enclaves might explain Cuban rates of reporting discrimination.

Paper 3 assesses the rates of non-Hispanic white/Latino and non-immigrant/immigrant differences in three measures of support for healthcare: (a) Identifying health and healthcare as a priority for government action; (b) viewing healthcare as a policy-oriented priority; and (c) identifying healthcare as a determinant of candidate voting. I conclude that for US Latinos healthcare voting is associated with indicators of assimilation and that as Latinos become more integrated into mainstream American culture they also approximate majority views on healthcare.