WITHDRAWN: The Intersectionality of Social Determinants of Health and Transportation Inequities: Investigating Health Outcomes Among Women in the United States

Background and Purpose

The purpose of this investigation was to examine the numerous factors leading to health disparities in relation to transportation barriers among women in the US. In 2010, The World Health Organization (WHO) published the Social Determinants of Health (SDH) Framework outlining the multifaceted approach to understanding health inequities (Solar & Irwin, 2010). Although research and public awareness of health disparities across the U.S. has gained increasing awareness, the intersection of women’s health, racial/ethnic minority status, and transportation barriers has yet to be investigated within the SDH framework (Cho, Crenshaw, and McCall 2013; Crenshaw 1989).

Among SDH’s complex web of factors, transportation barriers have been identified as predictors of health disparities (Syed, Gerber, & Sharp, 2013). Moreover, data suggest that the longer life expectancies for females compared to males makes transportation dependence a greater issue for longer in their lives (Choi, Mezuk, Lohman, Edwards, & Rebok, 2012). Also, we know that minority women are more at-risk for transportation deficiency (Kim, 2011) and poor health outcomes (Beckie, 2012; Wang & Beydoun, 2007; Ward et al., 2004). As individuals age, an increase in transportation barriers complicate opportunities for self-management and healthcare visits (Adorno, Fields, Cronley, Parekh, & Magruder, 2016).

Methods

Adult females (18 and over) who live in the U.S. were recruited through online methods for three months with no financial incentives. The Perceived Wellness Survey (PWS) was utilized to test the perceived health of female participants (Adams, Bezner, Garner, & Woodruff, 1998). Various factors within the SDH framework were analyzed to test for the impact of transportation barriers through a moderated mediation model.

Results

Through a dynamic online survey, the researcher collected a nationally representative sample of 1031 women. The average age of the sample was 33.22 years (SD=10.97), with a range between 18 and 84 years (N=1031). The majority (84.2%) of the respondents were White non-Hispanic (n=868). The majority of the sample (84.9%, n=873) traveled using their personal automobile. There was not a significant association between racial categories (White, Black, and Latina) and car ownership (Χ²(2)=2.87, p=0.238). Women who use their own vehicle had significantly higher levels of perceived wellness (M=13.20, SD=3.12) than those who did not (M=11.58, SD=3.27, t(1026)=-5.92, p<0.001). Women who did not drive their own vehicle reported significantly poorer quality of housing (t(182.51)=4.69, p<0.001), living in less safe neighborhoods (t(1008)=2.89, p=0.004), worse neighborhood conditions (t(1006)=3.23, p=0.001), and reported higher levels of neighborhood litter (t(1008)=2.76, p=0.006). The moderated mediation among SDH factors and car ownership accounted for 14% of the variance in perceived wellness among women.

Conclusion and Implications

This study evaluates the complexities of transportation barriers and the impact on health and living situation for women in the US. The impact of these barriers can be seen through the dynamic Perceived Wellness Survey as well as women’s living environments. Future studies would benefit from a more diverse sample to better capture the experience with transportation difficulties among minority women.