The impact of cumulative trauma on health service utilization practices of Black immigrant women.

Abstract

Background: Factors that influence health service utilization among Black immigrant women with experiences of trauma are not well understood. An improved understanding of the impact of cumulative trauma on Black immigrant women's health care utilization is critical to increase access to health services for this population.

Methods: Using baseline data of 147 Black immigrant women from an existing NICHD-funded study, hierarchical multiple linear regression was used to assess the impact of length of stay in the US, education, cumulative trauma frequency, everyday discrimination, and the interaction of discrimination and cumulative trauma on health service utilization. A model-building approach was used to determine covariates to include in the final model.

Results: Cumulative trauma frequency was positively associated with health service usage (b = 0.02; p = 0.026). Compared to Black immigrant women who had lived in the US for longer than 10 years, those who had lived in the US between 1 and 4 years were less likely to use health services (b = -0.89; CI: -1.67, -0.11). Black immigrant women with bachelor's degrees were less likely to use health services compared to Black immigrant women with post-graduate degrees (b = -0.85; CI: -1.61, -0.09). The interaction of cumulative trauma and discrimination was also significantly associated with the behavior of utilizing health services (b = 0.002; CI: 0.0003, 0.004). Those who experienced higher perceived levels of discrimination and high cumulative trauma levels were more likely to use health services compared to those with lower levels of discrimination and high levels of cumulative trauma.

Conclusion: Cumulative trauma experiences were positively correlated with health service utilization, and discrimination strengthened this relationship. Future work must examine long-term data for patterns of seeking health services over time, explore specific types of health services associated with cumulative trauma experiences, and study associations between health service usage and health outcomes.