The Legacy of Tuskegee and Trust in Medical Care: METHODS

Study Design and Population

During July and August of 2003, participants were surveyed as part of a cross-sectional study designed to assess mistrust of the healthcare system. We conducted a telephone survey of a random sam­pie of residents of Baltimore City, MD. The data were collected as part of a larger study that focused on mistrust of the healthcare system among minorities at three sites: Washington, DC; New York City; and Baltimore. The Baltimore site focused on African Americans. This was in part due to the fact that the city has a long-standing, economically diverse, yet relatively segregated black population. This characteristic of Baltimore made sampling an economically diverse black population feasible without oversampling. In addition, each study location conducted a site-specific substudy. Baltimore was selected as the site for the Tuskegee substudy because of its large African-American population.

Data were collected using the sampling method described by Waksberg. We sampled households and selected the household member age >18 who had the most recent birthday. Baltimore City has 167 telephone exchanges (first three numbers of a telephone number) within two area codes (410 and 443). The 45 exchanges that were associated exclusively with cellular phones were excluded. Another 23 exchanges were excluded because they are exclusively owned by large businesses or institutions, such as universities, large corporations, or city and state government.
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We selected a 1% random sample (9,899) of the remaining 99 exchanges with all possible combinations of the last four digits (0001-9999). Trained interviewers called each number, documenting those that were disconnected or not in service, those who did not speak English, those who refused and those who agreed to participate in the interview. For the telephone numbers answered by an answering machine, a message was left, and the number was called back a minimum of two times. The interviewers made contact (actually talked with an eligible respondent) with 783 people—401 completed the interview (51.2%) and 382 refused. The interviewers obtained oral consent. Respondents were compensated $20 for their participation.


Knowledge of the Tuskegee study was assessed by six items. The first five items were multiple-choice, with one correct response for each item. These survey items assessed factual information about the Tuskegee study. The final item asked if a similar study was possible today.

Medical mistrust was assessed using the seven-item Medical Mistrust Index (MMI). The scale employs Likert-type response codes ranging from “strongly disagree” to “strongly agree.” Examples of items included in the mistrust scale are: “Patients have sometimes been deceived or misled by healthcare organizations” and “Healthcare organizations put the patient’s health first.” The MMI shows good reliability (Chronbach’s a = 0.76). nexium 20 mg

Other measures used in the study were race, age, sex, education, income and insurance status. Age, education and income were analyzed as continuous variables. Race and sex were analyzed as binary variables. Insurance status categories were private, Medicaid, Medicare and uninsured. For analysis, three dummy variables were created for insurance status with private insurance as the reference group.