Deck 8: Culture and Health

Question 1

_________ is defined as a complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity, according to the World Health Organization (1948).

A) Health
B) Fitness
C) Mental illness
D) Sanity

Answer 1

A

Question 2

The Department of Health and Human Services (2011) defines ___________ as "differences in health outcomes that are closely linked with social, economic, and environmental disadvantage . . . often driven by the social conditions in which individuals live, learn, work, and play."

A) deficiencies
B) disparities
C) impartialities
D) insufficiencies

Answer 2

B

Question 3

Health disparities cannot be fully understood without considering both health and

A) age.
B) gender.
C) funding.
D) health care.

Answer 3

D

Question 4

One the following is an example of a health disparity.

A) A research study conducted with only European American participants.
B) A medical office that provides office signs, consent forms, and other documents only in English.
C) Systemically higher rates of HIV infection in lesbian, gay, and transgender youth.
D) A cisgender male doctor who routinely calls his cisgender female patients "honey".

Question 5

One of the following is an example of health care disparity

A) Systematically higher death rates from heart disease among Blacks compared to European Americans.
B) Systematic differential quality of treatment to low income patients in relation to their higher income counterparts (e.g., providers give more information about preventive services to high income patients).
C) Systematic differences across healthcare facilities in the number of providers of color.
D) Systematic difference in the preference of patients of color for a particular clinic over others.

Question 6

Which group tends to practice better health habits?

A) Younger, more affluent, better-educated people under low levels of stress
B) Younger, less affluent, moderately educated people, under low levels of stress
C) Generally, people from lower socioeconomic classes
D) Generally, older, better-educated people under moderate levels of stress

Question 7

According to the ________________, an individual's behavior is affected by their perception of a personal health threat.

A) Health belief model
B) Health and Human Services
C) Health threat theory
D) Health perception model

Question 8

According to the health belief model, an individual's health behavior is affected by their

A) perception of their susceptibility to an illness.
B) perception of a personal religious belief.
C) model of health belief.
D) consistency between his/her behaviors and beliefs.

Question 9

The health belief model says that how people behave or seek to maintain or improve their health is influenced by

A) genetics.
B) their thoughts about health.
C) their friends and family members.
D) the environment.

Question 10

Health behaviors differ according to demographic factors such as

A) education, social status, economic status, and stress levels.
B) mostly social status and economic status.
C) mostly education and stress levels.
D) social status alone.

Question 11

An individual's perception of health threat is influenced by all of the following factors except

A) specific beliefs about vulnerability to a particular disorder.
B) beliefs about the consequences of the disorder.
C) health behaviors.
D) general health values.

Question 12

Which of the following accurate summarizes the Common-Sense Model of health behaviors?

A) Perceptions of illness predict emotional response. Emotional response predicts the evaluation of distress. Evaluation of distress predicts how individuals revise their perceptions of illness and future emotional response.
B) Emotional responses predict coping. Coping predicts the evaluation of coping. Evaluation of coping predicts how individuals revise their emotional responses and future coping.
C) Perceptions of discrimination predict coping. Coping predicts the evaluation of coping. Evaluation of coping predicts how individuals revise their perceptions of discrimination and future coping.
D) Perceptions of illness predict coping. Coping predicts the evaluation of coping. Evaluation of coping predicts how individuals revise their perceptions of illness and future coping.

Question 13

Research conducted using the Common-Sense Model has shown

A) Nothing. There is little research to support the Common-Sense Model.
B) All the variables are important but the order in which they happen is not.
C) People's perceptions of their illness explain their emergency room visits.
D) The model primarily predicts behaviors related to physical illness, and may relate to mental health outcomes.

Question 14

European American physicians have been known to misdiagnose Black patients' symptoms of heart attacks at _______________ than identical symptoms of European American patients.

A) a higher rate
B) a lower rate
C) about the same rate
D) a lower frequency

Question 15

Which ethnic groups are most likely than European Americans to delay or forgo care because of costs?

A) Blacks and Latinxs
B) Blacks and American Indians/Alaska Natives
C) American Indian/Alaska Natives, Blacks, and Latinxs
D) American Indian/Alaska Natives and Latinxs

Question 16

In regards to mammograms and Pap smears, which of the following groups had the highest rates of preventive screenings?

A) European American women
B) Latinx women
C) American Indian/Alaska Native women
D) Black women

Question 17

A Kaiser Family Foundation report provided ratings across ethnic groups on 29 measures of health status and outcomes. Which of the following groups had better indicators than European Americans?

A) European Americans
B) Asian Americans
C) American Indian/Alaska Native women
D) Black women

Question 18

Which of the following statements in FALSE regarding major health disparities?

A) People of color account for a disproportionate share of new AIDS cases.
B) People of color have more cancer deaths compared to European Americans.
C) The use of physical restraints in nursing homes is lower for Hispanics than European Americans.
D) Diabetes has reached epidemic proportions among people of color.

Question 19

Which of the following statements is FALSE regarding gender differences and health disparities?

A) African American women were less likely to receive a flu vaccine than European American women.
B) Women of color were less likely to be diagnosed with late-stage breast cancer than European American women.
C) Asian/Pacific Islander women were less likely than European American women to enroll in substance use treatment within 14 days of their diagnosis.
D) Providers for Black and Latinx women with chronic renal failure failed to meet the standard of not prescribing potentially harmful medications more often than with European American women.

Question 20

An individual's perception of a health threat is influenced by all of the followings except

A) specific beliefs about vulnerability to a particular disorder.
B) general health values.
C) beliefs about the consequences of the disorder.
D) specific symptoms of the disorder.

Question 21

What are the MAIN causes of health disparities?

A) Unfeeling health care professionals
B) Racism, poverty, and structural barriers to accessing health care
C) Increasing diversity in the United States
D) Laziness on the part of ethnic minorities

Question 22

Which of the following is NOT a cause of health disparities

A) Structural inequities
B) Being Black
C) Racism
D) Stress

Question 23

The underutilization of healthcare services on the part of people of color is partly due to

A) A long history of abuses by physicians, including inflicting intentional infections and not using sufficient analgesia during surgeries.
B) Their unwarranted paranoia against medical providers, especially European American men.
C) Recent cases in popular press that reflect poor treatment of people of color.
D) Low levels of education on the part of people of color who don't know when to seek services.

Question 24

Throughout the chapter, ___________ is stressed as a fundamental, underlying cause of health and health care disparities.

A) sexism
B) ageism
C) discrimination
D) racism

Question 25

Priscilla, an immigrant from the Philippines, noticed that the doctor did not take time to answer her father's questions, but did with a European American male patient. This story illustrates the influence of __________ on mental health professionals.

A) financing for health care
B) prejudice
C) age
D) ethnic group membership

Question 26

Higher death rates among African Americans due to AIDS, cancer, and heart disease can be attributed to

A) differential treatment by health care professionals.
B) greater participation in health behaviors by this group.
C) the genetic superiority of European Americans.
D) the greater physical vulnerability of people of color to these diseases.

Question 27

Exposure to chronic stress causes physiological consequences such as high blood pressure, increased heart rate, and elevated blood sugar and cortisol levels. This is known as:

A) a health care disparity.
B) a health disparity.
C) allostatic load.
D) racism.

Question 28

One of the following is NOT a barrier to people of color for accessing health care services

A) Access to desktop computers.
B) Access to a smartphone.
C) Access to providers of their ethnic group.
D) Language.

Question 29

Maria, a European American woman, was shocked and upset when she heard a nurse and doctor in the hospital emergency room discussing how they would not give an African American man needed treatment because he did not have insurance and the procedure he needed was too expensive. This incident is an example of differences in _______________ that lead to health disparities.

A) health status
B) health behaviors
C) health care
D) health beliefs

Question 30

Adrian tells the story of a Black woman and a European American woman who came to the emergency room at the same time, reporting the same symptom of abdominal pain. The European American woman was seen immediately, but the Black woman waited seven hours. This is an example of the effects of _______________ on health disparities.

A) structural barriers
B) poverty
C) racism
D) language

Question 31

Some individuals who are not as familiar with behaviors and beliefs of people of color continue to question the need to improve health care disparities when they observe these individuals

A) behave in risky manners.
B) seem to lack motivation to seek health care.
C) behave in certain ways that are not consistent to Western conceptions of a healthy lifestyle.
D) seem to lack opportunities to receive appropriate health care in a capitalist society.

Question 32

For most minority group members, particularly those in remote, rural locations, it is easier to

A) gain access to quality health care.
B) stay within their own community and just "deal" with their ailments.
C) learn to practice medicine for their own family and community.
D) "sell out" by gaining relations with more affluent members of society.

Question 33

Among the different factors affecting access to health care, which is the most important factor to be considered?

A) Patients' perceptions
B) Entry into the health care system
C) Structural barriers
D) Utilization of care

Question 34

Patients' ____________ seem(s) to be most important in considering access to health care because we can assume that most individuals would have to be comfortable with the persons providing health care.

A) race
B) perceptions
C) socioeconomic status
D) health

Question 35

Patients of color generally trust health professionals _____________ European American patients.

A) as much as
B) less than
C) much more than
D) slightly more than

Question 36

O'Brien et al. (2010) measured what was important to patients in their interactions with their physicians. Which of the following statements is FALSE concerning the findings of this research?

A) All of the cultural groups in the study expressed exactly the same concerns.
B) All of the cultural groups emphasized the importance of the physician's genuine concern for patients.
C) African American women often cited frustration with physician's invalidating their perspective.
D) Latinxs emphasized the importance of technical competence.

Question 37

Brondolo, Gallo, and Myers (2009) state that racism has led to inequitable access to social, educational, and material resources. These resources affect health status through access to things such as healthy diets and appropriate medical care. These are examples of the ___________ effects of racism on health status.

A) unbelievable
B) direct
C) indirect
D) None of the above. Racism does not affect health status.

Question 38

Paradies and colleagues (2015) studied racism and health and found:

A) The largest impact of racism on positive mental health outcomes
B) The largest impact of racism on negative mental health outcomes
C) The largest impact of racism on general physical health outcomes
D) The largest impact of racism on specific physical health outcomes

Question 39

Allostatic load refers to the

A) effects of racism on health status.
B) physiological costs of chronic stress.
C) economic costs of health care.
D) identification with a cultural group that is not your own.

Question 40

How do people gain entry into the health care system?

A) Telephone
B) Internet
C) Referrals from others
D) All of the above

Question 41

Which of the following is NOT an example of a structural barrier to health care?

A) The distrust of medical professionals
B) Having a health care provider with evening and weekend hours
C) Having a health care provider who can be easily reached by telephone
D) The lack of health care providers in a particular geographical area

Question 42

In the 2017 AHRQ report, National Healthcare Quality and Disparities Report, a general conclusion was that

A) Indicators of health disparities have improved over time but only for Latinxs.
B) Most indicators of health disparities have improved over time.
C) Some indicators of health disparities have not improved over time, but some have.
D) Most indicators of health disparities have not improved over time.

Question 43

Beatrice's story about how difficult it was to translate when taking her mother and grandmother to the doctor illustrates disparities in

A) access to health care
B) treatment strategies
C) diagnosis
D) racial bias

Question 44

Kim was told she needed a "card" to get medical help but she didn't know what that was. This story illustrates the effects of __________ on health care disparities.

A) racism
B) language
C) structural barriers
D) age

Question 45

The fact that rural populations are at risk for receiving poorer-quality health care illustrates the effect of ______________ on health disparities.

A) race
B) geography
C) gender
D) language

Question 46

Lack of insurance, transportation, and language skills are all examples of ________ that influence access to health care.

A) racism
B) age
C) multicultural competencies
D) structural barriers

Question 47

Language brokers can bridge the divide for patients needing services by providing much needed language support. Language brokers are:

A) Trained interpreters that work in medical settings.
B) People who support translation or interpretation without any formal training.
C) Untrained translators hired by medical facilities.
D) Bilingual staff at medical facilities that are identified to provide translations when needed.

Question 48

Providing trained interpreters is

A) a legal requirement that medical facilities often meet.
B) a professional requirement that medical facilities often meet.
C) a legal requirement that medical facilities often fail to meet.
D) a professional requirement that medical facilities often fail to meet.

Question 49

A medical provider believes she is providing equal care to all her patients and values her patients regardless of race or ethnic background. However, outcome data show that she prescribes medications differently to her European American patients compared to her Asian American patients. She most likely:

A) holds implicit biases, which are not in conscious awareness.
B) holds explicit biases, which are in conscious awareness.
C) is in denial about her racism.
D) is lying about her value for equal care.

Question 50

In studies documenting the relationship between implicit bias and healthcare outcomes, Maina and colleagues (2018) found

A) Across studies trainees, but not licensed medical providers, exhibite significant pro-European American bias.
B) Some studies showed provider bias and other did not. On average, the bias on the part of medical providers was negligible. Providers perceived that people of color received worse care than European Americans.
C) Across studies, medical provides exhibited bias against people of color, and medical providers perceived that people of color received worse care than European Americans.
D) Across studies, medical provides exhibited bias against people of color, but medical providers perceived that people of color received better care than European Americans.

Question 51

Domenech Rodríguez (2018) coined the term ___________ to refer to the "passive and pervasive ways in which individuals are shaped by their environments and that result in our unchecked implicit attitudes and biases".

A) cultural racism
B) cultural programming
C) implicit associations
D) unconscious bias

Question 52

In the _______________ African American men from rural Alabama were allowed to go untreated for syphilis.

A) Tuskegee experiment
B) Alabama experiment
C) Black Syphilis Study
D) Guatemala syphilis study

Question 53

Information about the abuses against Black research participants in the Tuskegee Experiment was exposed due to the

A) Equal Opportunity Act.
B) Freedom of Information Act.
C) Voting Rights Act.
D) Civil Rights Act.

Question 54

What has been the impact of the discovery of information regarding things like the Tuskegee Experiment, sterilization experiments, and the use of slaves as involuntary medical research subjects?

A) The increased cultural competence of health care providers
B) The increased trust of medical professionals by people of color
C) Mistrust toward medical professionals by people of color
D) Increased access to health care for people of color

Question 55

Between 1946 and 1948 the U.S. government conducted experiments in which they intentionally tried to infect Guatemalan prisoners with syphilis and gonorrhea to study the effects of these diseases. Why were these experiments stopped?

A) Because the medical professionals felt it was unethical to conduct such experiments
B) Because of the public outrage when the experiments were discovered
C) Because the researchers found it was too difficult to infect the prisoners with the viruses
D) Because too many prisoners ended up dying from the infections

Question 56

What is one way to decrease health care disparities for people of color?

A) Increase the number of people of color in the health care field
B) Increase health care costs
C) Increase the number of health care clinics in suburban areas
D) Decrease the number of bilingual health care workers

Question 57

Harriett Washington (2006) documents the long history of mistreatment of Blacks since colonial times. Among the atrocities, she writes of:

A) grave robbing for the purposes of training medical students.
B) experimental surgeries for the purpose of perfecting procedures before using them on European Americans.
C) reduced use of pain killers because Blacks were thought to feel less pain than European Americans.
D) all the above answers are correct.

Question 58

When President Clinton signed the Health Disparities Research and Education Act (PL-106-525) into law in 2000, he intended to eliminate health disparities in:

A) by 2010
B) by 2020
C) by 2050
D) he did not specify.

Question 59

According to the Department of Health and Human Services report, which of these is NOT one of the many factors mentioned that leads to differences in health care?

A) Differing cultural beliefs
B) Health values
C) Local environmental conditions
D) Lifestyle choices

Question 60

The Health Revitalization Act of 1993 made an important shift to attempt to address health disparities in the US. That policy shift was:

A) require the inclusion of women and people of color in research, especially clinical trials.
B) to develop the decennial reports Health People.
C) require demographic data collection at all federally funded medical facilities.
D) require IRB approval for all research involving people of color.

Question 61

As researchers struggle with how to best address health disparities, research methods have shifted to be more inclusive. A specific method that federal agencies are calling for is community based participatory research. In this method:

A) community partners take the lead in research with support from academic researchers.
B) academic researchers take the lead in research but always with consultation and support from community partners.
C) community and academic partners are on equal footing at every phase of research.
D) community and academic researchers take turns leading different phases of research.

Question 62

One of the following is an example of community based participatory research:

A) Academic researchers ensuring they have IRB approval from community agencies.
B) Academic researchers teaching community partners how to run their own statistics.
C) Community partners giving access to academic researchers to study their patients.
D) Shared authorship between academic researchers and community partners on presentations and publications.

Question 63

The Affordable Care Act attempts to address health disparities in two ways:
Increasing diversification of the workforce and supporting the development of cultural competence in all healthcare providers. Which of the following is true:

A) In the past 5 years we have made significant strides in workforce representation.
B) The workforce shows significant lopsidedness with Black, Latinx, and American Indian providers underrepresented relative.
C) We know very well how to train medical providers in cultural competence but we don't seem to have enough educators to provide the training.
D) The cultural competence evaluation data shows very poor results. We need new training programs.

Question 64

One of the examples below is NOT an example of cultural competence.

A) Using patients' preferred pronouns.
B) Using a patient's preferred language.
C) Asking the patient how they understand their illness.
D) Recognizing a cultural misfit and referring a patient to another provider.

Question 65

The "culture" in cultural competence refers to:

A) national origin
B) race/ethnicity but also age, gender identity, sexual orientation, disability, religion, income level, education, geography, and profession
C) race/ethnicity but also age, nationality, religion, income level, and socialization
D) race/ethnicity

Question 66

When discussing health disparities, little information was provided on lesbian, gay, bisexual, transgender and other groups marginalized on the basis of their sexual orientation and/or gender identity. The reason for this is

A) It is difficult to pack some much information into one chapter.
B) The health disparities associated with these marginalized identities are radically different than those for people of color.
C) There is little information for people with these marginalized identities much more data is needed to understand which disparities exist.
D) People of color may also be lesbian, gay, bisexual, transgender, etc. The information provided her already includes them.

Question 67

Based on American values, the best health care should be provded for whom?

A) Everyone
B) The wealthy, because they deserve it
C) The middle class, because they keep America going
D) Poor college students

Question 68

An important problem that will occur if health care disparities persist is

A) the cost of health care will become so high that our economy will not be able to pay.
B) European American doctors will dominate hospital staff.
C) people of color will become almost extinct.
D) people of color will have to have their own hospital facilities to be treated properly.

Question 69

There are notable differences in health care coverage across ethnic groups. Which ethnic group had the highest rates of uninsured people, in a 2013 Kaiser Family Foundation report?

A) Latinxs
B) African Americans
C) Asian Americans
D) European American Americans