title: Reported racial discrimination, trust in physicians, and medication adherence among inner-city African Americans with hypertension.
abstract: OBJECTIVE
  We sought to determine if reported racial discrimination was associated with medication nonadherence among African Americans with hypertension and if distrust of physicians was a contributing factor.
  
  
  METHODS
  Data were obtained from the TRUST project conducted in Birmingham, Alabama, 2006 to 2008. All participants were African Americans diagnosed with hypertension and receiving care at an inner city, safety net setting. Three categories of increasing adherence were defined based on the Morisky Medication Adherence Scale. Trust in physicians was measured with the Hall General Trust Scale, and discrimination was measured with the Experiences of Discrimination Scale. Associations were quantified by ordinal logistic regression, adjusting for gender, age, education, and income.
  
  
  RESULTS
  The analytic sample consisted of 227 African American men and 553 African American women, with a mean age of 53.7 ± 9.9 years. Mean discrimination scores decreased monotonically across increasing category of medication adherence (4.1, 3.6, 2.9; P = .025), though the opposite was found for trust scores (36.5, 38.5, 40.8; P < .001). Trust mediated 39% (95% confidence interval = 17%, 100%) of the association between discrimination and medication adherence.
  
  
  CONCLUSIONS
  Within our sample of inner city African Americans with hypertension, racial discrimination was associated with lower medication adherence, and this association was partially mediated by trust in physicians. Patient, physician and system approaches to increase "earned" trust may enhance existing interventions for promoting medication adherence.
authors.affiliation: Yendelela L. Cuffee and Antoinette Schoenthaler are with the Department of Population Health, Langone Medical Center, New York University, New York, NY. J. Lee Hargraves is with the Division of Family Medicine, Milagros Rosal is with the Department of Preventive Behavioral Medicine, Becky A. Briesacher is with the Division of Geriatric Medicine, and Sharina Person and Jeroan Allison are with the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Sandral Hullett is with Cooper Green Mercy Hospital, Birmingham, AL.
authors.forename: Yendelela L
authors.initials: YL
authors.lastname: Cuffee
authors.forename: J Lee
authors.initials: JL
authors.lastname: Hargraves
authors.forename: Milagros
authors.initials: M
authors.lastname: Rosal
authors.forename: Becky A
authors.initials: BA
authors.lastname: Briesacher
authors.forename: Antoinette
authors.initials: A
authors.lastname: Schoenthaler
authors.forename: Sharina
authors.initials: S
authors.lastname: Person
authors.forename: Sandral
authors.initials: S
authors.lastname: Hullett
authors.forename: Jeroan
authors.initials: J
authors.lastname: Allison
mesh_terms: D000328:Adult; D001741:Black or African American; D000407:Alabama; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010817:Physician-Patient Relations; D063505:Racism; D057566:Self Report; D012680:Sensitivity and Specificity; D035502:Trust; D014505:Urban Population
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