The authors tested hypotheses regarding the influence of race on prescription drug use following Anderson's framework (Anderson R. A Behavioral Model of Families Use of Health Services. Research Series 25. Chicago: Center for Health Administration Studies, University of Chicago), which posits that the decision to seek care is influenced by predisposing, enabling, and need factors. They also incorporated the finding that the number of physician visits has been shown to be related to rates of prescription medication.

Data for this study were derived from the Household Component of the 1987 National Medical Expenditure Survey, which was a nationally representative interview survey. The sample for this study included preschool children (ages 1 to 5 years) and school age children (6 to 17 years).

Results showed that, among children with at least one physician visit, black and Hispanic children averaged one fewer visits than white children. Also, about 75% of preschool black and Hispanic children received a prescription medication versus 63% of white preschool children. About 50% of school aged black and Hispanic children received prescription medication versus 66% of white school aged children. There were no race differences in activity reduction or bed days, except Hispanic school age children reported more bed days. Additionally, more Hispanic mothers rated their preschool child's health as poor compared with the other groups, and more Hispanic and black mothers rated their school aged child's health as poor compared with white mothers.

After predisposing and enabling variables were taken into consideration, black preschool children were shown to be half as likely to receive prescription medication compared with white preschool children (partially adjusted odds ratio (OR) for black versus white children=0.532, p<0.001). No such association for Hispanic versus white preschool children was found. Health- related (need) variables did not change this relationship. Adding the number of physician visits (which was lower for blacks than whites) substantially reduced the association between race and prescription drug use, indicating that blacks’ use of fewer prescription medications was partially due to their having less access to care (fully adjusted OR for black versus white children=0.697, n.s.). In school aged children, both black and Hispanic children were less likely to receive prescription medication after taking into account all factors, including the number of physician visits (fully adjusted OR for black versus white children=0.601, p<0.001; and fully adjusted OR for Hispanic versus white children=0.697, p<0.01).

The number of prescription medications was also significantly lower for black preschool children after adjusting for all factors, including the number of physician visits. These patterns were not statistically significant among preschool Hispanic children or among school aged children.

The authors suggest these finding may be due in part to a possible propensity of white children, compared with minority children, for visiting providers who prescribe a larger number of medications during one visit instead of one medication, over-the-counter preparations, or injections. They also suggested this finding may be due to compliance differences between minority and white families in their use of prescription drugs. Specifically, they suggested cultural or language issues influencing the use of prescribed medications might explain these findings rather than physician prescribing behaviors.

The authors concluded that "the results of this study suggest that clinicians should recognize population differences and focus on the links that they influence: that of prescribing and compliance. Promoting patients (and in this case, parent) education regarding the importance of filling the prescription and taking it as directed is a first step in closing the utilization gap." They also concluded that research on racial disparities in access to care issued should target prescription drug use specifically.

The limitations of this study include its inability to differentiate patterns due to compliance versus physician behavior. Thus the authors’ conclusions regarding the importance of considering compliance in reducing the utilization gap might be overstated based on these data.