For women within ethnic minority communities, social determinants of health such as chronic poverty, unemployment, trauma, domestic violence, and mental health and substance abuse problems can be exacerbated by lack of health insurance (Gonzales & Ortiz, 2015); limited to access to quality health care services (Butkus et al., 2020); and discrimination and oppression. In particular, Black and Latinx women demonstrate rates of depression as high as 30 to 45 percent (Price, Coles, & Wingold, 2017) and are more likely to receive Medicare and/or Medicaid (Butkus et al., 2020). Thus, this study strove to: (1) examine psychosocial risks factors (i.e. smoking, substance use, suicidal ideation, and depression) in a national sample of Black and Latinx women and (2) identify the multiple dimensions of social determinants of health that Black and Latinx women are experiencing compared to White women.
Using the 2018 National Survey on Drug Use and Health, the current study included Black, Latinx, and White women 18 years of age and older (n=20622). Demographic, mental health, and substance usage variables were examined for their association with overall health. Bivariate and multivariate comparisons examined the associations among individual behavioral health risks experienced by all women. Ordinal logistic regression examined whether depression, suicidal ideation, cigarette usage, drug & alcohol usage, geographic location, and recipient of Medicaid along with demographic variables predicted self-reported overall health (1=Excellent, 2=Very Good, 3=Good, 4=Fair/Poor). Regression models were run for each group of women separately, with a fourth model including all participants.
Those experiencing any lifetime depression were 1.39 (Black, p=0.004), 1.22 (Latinx, p=0.02), and 1.21 (White, p<0.001) times more likely to be in the next worse health category compared to those who had not experienced lifetime depression. While suicidal ideation was not a significant predictor, experiencing psychological distress in the past month was (Black, p<0.001; Latinx, p<0.001; White, p<0.001). For not using cigarettes, Black (p<0.001), Latinx (p<0.001), and White (p<0.001) women were 36%, 30%, and 42% less likely to be in the next worse health category compared to those who used cigarettes. Finally, for the inclusive model, Black women were 1.33 (p < 0.001) and Latinx women were 1.52 (p < 0.001) times more likely to report being in the next worse health category compared to White women.
Findings from this study demonstrate that the relationship between overall health and social determinants of health exists and women are experiencing them across racial lines. Future research and data collection should ensure that when inquiring about an individual’s overall health, it is imperative to explore if they are factoring in social, mental, and physical well-being indicators, or perhaps just one or two isolated factors.