Despite having similar Medicare health insurance coverage, elderly utilization and IHD mortality rates differ markedly not only between whites and minorities, but within minority groups themselves. A large, nationally representative survey of physicians and patients is needed to distinguish between systemwide "failures to refer" and patient "aversions to surgery" as explanations for lower black rates of surgical interventions.

Objective. The purposes of this study were to describe physical activity habits of individuals with type 2 diabetes participating in a selfmanagement initiative conducted in real-world settings that was sponsored by the Robert Wood Johnson Foundation (RWJF); to assess changes in physical activity over time; and to identify factors associated with physical activity levels.Research design and methods. Clinical and community-based programs participating in the RWJF-funded Diabetes Initiative implemented comprehensive models for self-management, including supports to increase physical activity. A cohort of 622 largely lower-income and ethnic minority program participants (72% female, 85% overweight or obese) completed telephone surveys assessing self-reported physical activity levels at two times that were about 8 months apart.