Relying on panel data from the first-wave Disability Study, an adult community sample living in Miami-Dade County in 2004, this dissertation examines the influence of women's race, ethnicity, culture, and structure on their health care utilization, quality of care, and institutional barriers to that care. Few studies go beyond the black-white dichotomy in describing disparities in health care, and these analyses are unique in investigating differences between white, African American, Cuban, and non-Cuban Hispanic subpopulations. Part One describes how health care utilization patterns differ by race and ethnicity and explores the influence of culture and structure. Findings indicate that ethnicity is strongly associated with whether women saw a health care provider in the past year, with Hispanics less likely than whites to report having accessed care. Race and ethnicity both are associated with frequency of use, with minority women in general reporting lower rates of medical visits than white women. I examined the effects of five cultural factors (language, exercise, obesity, religiosity, and tobacco use) and four structural factors (neighborhood safety, discrimination, insurance status, and social isolation). Health care use was associated with having a preference for the English language and with being insured, religious, and obese. Higher utilization rates were typical for women who do not exercise regularly, use tobacco, live in unsafe neighborhoods, and report higher levels of daily discrimination. Part Two examines racial and ethnic, cultural, and structural variation in women's perceptions of the quality of their non-routine health care and of institutional barriers to that care. Findings fail to suggest racial, ethnic, or language effects, but they do indicate that women who are insured and those who report low levels of daily discrimination report higher quality of care. This dissertation makes a number of contributions with important implications. Results underscore the multidimensionality of health care uptake and quality, with the implication that comprehensive measures of these outcomes should be considered in racial and ethnic disparity studies. Results also highlight the value of including cultural and structural explanatory factors in studies of health care.
