Perceived racism and blood pressure: a review of the literature and conceptual and methodological critique

Perceived racial discrimination and mental health in low-income, urban-dwelling whites

This study examined the relationship between perceived racial discrimination and the presence of anxiety and depression in a sample of low-income, urban-dwelling whites. Data were analyzed from a cross-sectional survey of low-income whites living in an inner-city neighborhood in the mid-Atlantic United States. Perceived racial discrimination was reported by 39 percent of participants. Rates of depression in the population exceed prevalence rates in the general U.S. population. Those who perceived racial discrimination and were bothered by it experienced significantly greater odds of being depressed (OR = 2.78, 95% CI 1.60-4.82) and had higher anxiety scores (b = 2.02, SE 0.55, p = 0.000) than those who did not perceive racial discrimination. Low-income, urban white populations have been largely ignored in public health research. This study demonstrates that perceived racial discrimination is common in poor urban whites. Further, exposure to discrimination that is perceived as a stressor is associated with mental illness.

Experiencing discrimination increases risk taking

Prior research has revealed racial disparities in health outcomes and health-compromising behaviors, such as smoking and drug abuse. It has been suggested that discrimination contributes to such disparities, but the mechanisms through which this might occur are not well understood. In the research reported here, we examined whether the experience of discrimination affects acute physiological stress responses and increases risk-taking behavior. Black and White participants each received rejecting feedback from partners who were either of their own race (in-group rejection) or of a different race (out-group rejection, which could be interpreted as discrimination). Physiological (cardiovascular and neuroendocrine) changes, cognition (memory and attentional bias), affect, and risk-taking behavior were assessed. Significant participant race × partner race interactions were observed. Cross-race rejection, compared with same-race rejection, was associated with lower levels of cortisol, increased cardiac output, decreased vascular resistance, greater anger, increased attentional bias, and more risk-taking behavior. These data suggest that perceived discrimination is associated with distinct profiles of physiological reactivity, affect, cognitive processing, and risk taking, implicating direct and indirect pathways to health disparities.

Implicit racial bias as a moderator of the association between racial discrimination and hypertension: a study of Midlife African American men

OBJECTIVES

Empirical findings on racial discrimination and hypertension risk have been inconsistent. Some studies have found no association between self-reported experiences of discrimination and cardiovascular health outcomes, whereas others have found moderated or curvilinear relationships. The current cross-sectional study examined whether the association between racial discrimination and hypertension is moderated by implicit racial bias among African American midlife men.

METHODS

This study examined the data on 91 African American men between 30 and 50 years of age. Primary variables were self-reported experiences of racial discrimination and unconscious racial bias as measured by the Black-White Implicit Association Test. Modified Poisson regression models were specified, examining hypertension, defined as a mean resting systolic level of at least 140 mm Hg or diastolic level of at least 90 mm Hg, or self-reported history of cardiovascular medication use with a physician diagnosis of hypertension.

RESULTS

No main effects for discrimination or implicit racial bias were found, but the interaction of the two variables was significantly related to hypertension (χ(2)(1) = 4.89, p < .05). Among participants with an implicit antiblack bias, more frequent reports of discrimination were associated with a higher probability of hypertension, whereas among those with an implicit problack bias, it was associated with lower risk.

CONCLUSIONS

The combination of experiencing racial discrimination and holding an antiblack bias may have particularly detrimental consequences on hypertension among African American midlife men, whereas holding an implicit problack bias may buffer the effects of racial discrimination. Efforts to address both internalized racial bias and racial discrimination may lower cardiovascular risk in this population.

Expressed racial identity and hypertension in a telephone survey sample from Toronto and Vancouver, Canada: do socioeconomic status, perceived discrimination and psychosocial stress explain the relatively high risk of hypertension for Black Canadians?

INTRODUCTION

Canadian research on racial health inequalities that foregrounds socially constructed racial identities and social factors which can explain consequent racial health inequalities is rare. This paper adopts a social typology of salient racial identities in contemporary Canada, empirically documents consequent racial inequalities in hypertension in an original survey dataset from Toronto and Vancouver, Canada, and then attempts to explain the inequalities in hypertension with information on socioeconomic status, perceived experiences with institutionalized and interpersonal discrimination, and psychosocial stress.

METHODS

Telephone interviews were conducted in 2009 with 706 randomly selected adults living in the City of Toronto and 838 randomly selected adults living in the Vancouver Census Metropolitan Area. Bivariate analyses and logistic regression modeling were used to examine relationships between racial identity, hypertension, socio-demographic factors, socioeconomic status, perceived discrimination and psychosocial stress.

RESULTS

The Black Canadians in the sample were the most likely to report major and routine discriminatory experiences and were the least educated and the poorest. Black respondents were significantly more likely than Asian, South Asian and White respondents to report hypertension controlling for age, immigrant status and city of residence. Of the explanatory factors examined in this study, only educational attainment explained some of the relative risk of hypertension for Black respondents. Most of the risk remained unexplained in the models.

CONCLUSIONS

Consistent with previous Canadian research, socioeconomic status explained a small portion of the relatively high risk of hypertension documented for the Black respondents. Perceived experiences of discrimination both major and routine and self-reported psychosocial stress did not explain these racial inequalities in hypertension. Conducting subgroup analyses by gender, discerning between real and perceived experiences of discrimination and considering potentially moderating factors such as coping strategy and internalization of racial stereotypes are important issues to address in future Canadian racial inequalities research of this kind.

Toward understanding ethnic and cultural factors in the interviewing process

The clinical interview is critical in the diagnostic assessment undertaking in clinical settings, and cultural/ethnic influences have been shown to influence the outcome of this process. Specifically, a number of studies have reported that proportionally far more ethnic minorities than Caucasians are likely to be misdiagnosed when assessed for psychiatric disorders. This particularly is the case when open clinical interviews are used. Semistructured interviews, on the other hand, result in an increase in diagnostic accuracy with ethnic minorities. Parameters associated with bias in the clinical interview of ethnic minorities and its impact on assessment, diagnosis, and treatment decisions are examined. Although the current discussion focuses primarily on African Americans, many examples are provided that pertain to other ethnic groups. Strategies for addressing these issues are explored and recommendations for increasing cultural competence are made. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Racial/ethnic and gender differences in the association between self-reported experiences of racial/ethnic discrimination and inflammation in the CARDIA cohort of 4 US communities

Inflammation is etiologically implicated in cardiometabolic diseases for which there are known racial/ethnic disparities. Prior studies suggest there may be an association between self-reported experiences of racial/ethnic discrimination and inflammation, particularly C-reactive protein (CRP). It is not known whether that association is influenced by race/ethnicity and gender. In separate hierarchical linear models with time-varying covariates, we examined that association among 901 Black women, 614 Black men, 958 White women, and 863 White men in the Coronary Artery Risk Development in Young Adults (CARDIA) study in four US communities. Self-reported experiences of racial/ethnic discrimination were ascertained in 1992-93 and 2000-01. Inflammation was measured as log-transformed CRP in those years and 2005-06. All analyses were adjusted for blood pressure, plasma total cholesterol, triglycerides, homeostatic model assessment for insulin resistance (HOMA-IR), age, education, and community. Our findings extend prior research by suggesting that, broadly speaking, self-reported experiences of racial/ethnic discrimination are associated with inflammation; however, this association is complex and varies for Black and White women and men. Black women reporting 1 or 2 experiences of discrimination had higher levels of CRP compared to Black women reporting no experiences of discrimination (β = 0.141, SE = 0.062, P < 0.05). This association was not statistically significant among Black women reporting 3 or more experiences of discrimination and not independent of modifiable risks (smoking and obesity) in the final model. White women reporting 3 or more experiences of discrimination had significantly higher levels of CRP compared to White women reporting no experiences of discrimination independent of modifiable risks in the final model (β = 0.300, SE = 0.113, P < 0.01). The association between self-reported experiences of racial/ethnic discrimination and CRP was not statistically significant among Black and White men reporting 1 or 2 experiences of discrimination. Further research in other populations is needed.

Conceptual and methodological aspects of relations between discrimination and health in epidemiological studies

This article addresses conceptual and methodological aspects of the relations between discrimination and health from an epidemiological perspective. Definitions of discrimination and related constructs are reviewed, and the main theories underlying their association with health are presented. Scales developed to assess discrimination are discussed, in conjunction with a new instrument, devised to operationalize the concept in Brazilian epidemiological surveys. As a relatively unpredictable and uncontrollable source of psychosocial stress, discrimination has been consistently associated with adverse health outcomes and behaviors, particularly mental disorders, smoking, and alcohol use. However, progress in the area depends partly on dealing with aspects related to the assessment of the phenomenon, such as the definition of a construct map and simultaneous measurement of different types of discrimination. Research involving these aspects will enhance our understanding of discrimination and its health consequences, thus increasing our ability to reduce its social occurrence.

Physiological reactivity to psychological stress in human pregnancy: current knowledge and future directions

Cardiovascular and neuroendocrine reactivity to acute stress are important predictors of health outcomes in non-pregnant populations. Greater magnitude and duration of physiological responses have been associated with increased risk of hypertensive disorders and diabetes, greater susceptibility to infectious illnesses, suppression of cell-mediated immunity as well as risk for depression and anxiety disorders. Stress reactivity during pregnancy has unique implications for maternal health, birth outcomes, and fetal development. However, as compared to the larger literature, our understanding of the predictors and consequences of exaggerated stress reactivity in pregnancy is limited. This paper reviews the current state of this literature with an emphasis on gaps in knowledge and future directions.

Maternal experiences of racial discrimination and child weight status in the first 3 years of life

Among US racial/ethnic minority women, we examined associations between maternal experiences of racial discrimination and child growth in the first 3 years of life. We analyzed data from Project Viva, a pre-birth cohort study. We restricted analyses to 539 mother–infant pairs; 294 were Black, 127 Hispanic, 110 Asian and 8 from additional racial/ethnic groups. During pregnancy, mothers completed the Experiences of Discrimination survey that measured lifetime experiences of racial discrimination in diverse domains. We categorized responses as 0, 1–2 or ⩾3 domains. Main outcomes were birth weight for gestational age z-score; weight for age (WFA) z-score at 6 months of age; and at 3 years of age, body mass index (BMI) z-score. In multivariable analyses, we adjusted for maternal race/ethnicity, nativity, education, age, pre-pregnancy BMI, household income and child sex and age. Among this cohort of mostly (58.2%) US-born and economically non-impoverished mothers, 33% reported 0 domains of discrimination, 33% reported discrimination in 1–2 domains and 35% reported discrimination in ⩾3 domains. Compared with children whose mothers reported no discrimination, those whose mothers reported ⩾3 domains had lower birth weight for gestational age z-score (β −0.25; 95% CI: −0.45, −0.04), lower 6 month WFA z-score (β −0.34; 95% CI: −0.65, −0.03) and lower 3-year BMI z-score (β −0.33; 95% CI: −0.66, 0.00). In conclusion, we found that among this cohort of US racial/ethnic minority women, mothers’ report of experiencing lifetime discrimination in ⩾ 3 domains was associated with lower fetal growth, weight at 6 months and 3-year BMI among their offspring.

Perceived discrimination and hypertension among African Americans in the Jackson Heart Study

OBJECTIVES

Using Jackson Heart Study data, we examined whether perceived discrimination was associated with prevalent hypertension in African Americans.

METHODS

Everyday discrimination, lifetime discrimination, burden of discrimination, and stress from discrimination were examined among 4939 participants aged 35 to 84 years (women = 3123; men = 1816). We estimated prevalence ratios of hypertension by discrimination, and adjusted for age, gender, socioeconomic status, and risk factors.

RESULTS

The prevalence of hypertension was 64.0% in women and 59.7% in men. After adjustment for age, gender, and socioeconomic status, lifetime discrimination and burden of discrimination were associated with greater hypertension prevalence (prevalence ratios for highest vs lowest quartile were 1.08 [95% confidence interval (CI) = 1.02, 1.15] and 1.09 [95% CI = 1.02,1.16] for lifetime discrimination and burden of discrimination, respectively). Associations were slightly weakened after adjustment for body mass index and behavioral factors. No associations were observed for everyday discrimination.

CONCLUSIONS

Further understanding the role of perceived discrimination in the etiology of hypertension may be beneficial in eliminating hypertension disparities.

Discrimination and the stress response: psychological and physiological consequences of anticipating prejudice in interethnic interactions

OBJECTIVES

We sought to demonstrate that individuals who anticipate interacting with a prejudiced cross-race/ethnicity partner show an exacerbated stress response, as measured through both self-report and hemodynamic and vascular responses, compared with individuals anticipating interacting with a nonprejudiced cross-race/ethnicity partner.

METHODS

Through a questionnaire exchange with a White interaction partner (a confederate) Latina participants learned that their partner had racial/ethnic biased or egalitarian attitudes. Latina participants reported their cognitive and emotional states, and cardiovascular responses were measured while participants prepared and delivered a speech to the White confederate.

RESULTS

Participants who believed that their interaction partner held prejudiced attitudes reported greater concern and more threat emotions before the interaction, and more stress after the interaction, and showed greater cardiovascular response than did participants who believed that their partner had egalitarian attitudes.

CONCLUSIONS

This study shows that merely anticipating prejudice leads to both psychological and cardiovascular stress responses. These results are consistent with the conceptualization of anticipated discrimination as a stressor and suggest that vigilance for prejudice may be a contributing factor to racial/ethnic health disparities in the United States.

Questioning the General Self-Esteem Vaccine: General Self-Esteem, Racial Discrimination, and Standardised Achievement Across Indigenous and Non-Indigenous Students

Psychological research and the popular media culture have repeatedly noted that self-esteem positively contributes to life satisfaction and performance indicators across a large variety of domains. However, while varying measures of self-esteem may be argued to have a positive influence on outcome measures, increasing evidence suggests that perceptions of racial discrimination may also have a negative impact across a wide variety of outcomes. The current investigation used structural equation modelling techniques to examine the potential impact of Indigenous and non-Indigenous Australian students' General Self-Esteem and their perceptions of racial discrimination on spelling and maths achievement. Results indicated that General Self-Esteem displayed little or no significant relations with the performance measures, yet perceived racial discrimination significantly and negatively predicted both spelling and maths achievement for the Indigenous and non-Indigenous students. In addition, no significant latent interaction between General Self-Esteem and perceived discrimination was identified, raising questions for the self-protective properties of General Self-Esteem, at least for achievement outcomes.

Psychoneuroimmunology in pregnancy: immune pathways linking stress with maternal health, adverse birth outcomes, and fetal development

It is well-established that psychological stress promotes immune dysregulation in nonpregnant humans and animals. Stress promotes inflammation, impairs antibody responses to vaccination, slows wound healing, and suppresses cell-mediated immune function. Importantly, the immune system changes substantially to support healthy pregnancy, with attenuation of inflammatory responses and impairment of cell-mediated immunity. This adaptation is postulated to protect the fetus from rejection by the maternal immune system. Thus, stress-induced immune dysregulation during pregnancy has unique implications for both maternal and fetal health, particularly preterm birth. However, very limited research has examined stress-immune relationships in pregnancy. The application of psychoneuroimmunology research models to the perinatal period holds great promise for elucidating biological pathways by which stress may affect adverse pregnancy outcomes, maternal health, and fetal development.

Differential effects of perceived discrimination on the diurnal cortisol rhythm of African Americans and Whites

The current study considered the influence of perceived discrimination on the diurnal cortisol rhythm of 50 African American older adults and a matched comparison groups of 100 Whites (M(age)=56.6; 58% female). The role of socioeconomic status (SES) as a moderator of the effects of discrimination on the diurnal decline was also considered for each group. In support of the idea that perceptions of unfair treatment take on a unique meaning for stigmatized minority groups, results suggest that perceived discrimination is associated with a flatter (less healthy) diurnal slope among Whites but a steeper (more healthy) diurnal slope among African Americans. Perceived discrimination was also found to be more strongly associated with a steepening of the diurnal slope among lower SES African Americans than higher SES African Americans.

Racial discrimination, mood disorders, and cardiovascular disease among black americans

PURPOSE

To examine associations between racial discrimination, mood disorders, and cardiovascular disease (CVD) among Black Americans.

METHODS

Weighted logistic regression analyses were performed on a nationally representative sample of Black Americans (n = 5022) in the National Survey of American Life (NSAL; 2001-2003). Racial discrimination and CVD were assessed via self-report. Mood disorder was measured with the World Health Organization Composite International Diagnostic Interview.

RESULTS

Model-adjusted risk ratios (RRs) revealed that participants with a history of mood disorder had greater risk of CVD (RR, 1.28; 95% confidence interval (CI), 1.12-1.45). This relationship was found specifically among those younger than 50 years of age (RR, 1.56; 95% CI, 1.27-1.91). There was a significant interaction between racial discrimination and mood disorder in predicting CVD in the total (F = 2.86, 3 df, p = .047) and younger sample (F = 2.98, 3 df, p = .047). Participants with a history of mood disorder who reported high levels of racial discrimination had the greatest risk of CVD.

CONCLUSIONS

The association between racial discrimination and CVD is moderated by history of mood disorder. Future studies may examine pathways through which racial discrimination and mood disorders impact CVD risk among Black Americans.

Responding to racism: insights on how racism can damage health from an urban study of Australian Aboriginal people

This paper examines responses to racism and the pathways through which racism can affect health and wellbeing for Aboriginal people living in an urban environment. Face-to-face interviews were conducted in 2006/07 with 153 Aboriginal people living in Adelaide, Australia. Participants were asked about their experience of, and responses to, racism, and the impact of these experiences on their health. Racism was regularly experienced by 93% of participants. Almost two thirds of people felt that racism affected their health. Using a thematic analysis with a particular focus on how agency and structure interacted, a number of key reactions and responses to racism were identified. These included: emotional and physiological reactions; and responses such as gaining support from social networks; confronting the person/situation; ignoring it; avoiding situations where they might experience racism; 'minimising' the significance or severity of racism or questioning whether incidents were racist; and consuming alcohol, tobacco and other drugs. A further theme was a conscious decision to not 'allow' racism to affect health. Our study found that most people used more than one of these coping strategies, and that strategies were selected with an awareness of positive and negative health impacts. While individuals demonstrated substantial agency in their responses, there were clear structural constraints on how they reacted and responded. We found that not only was racism potentially detrimental to health, but so too were some responses. However, while some strategies appeared 'healthier' than others, most strategies entailed costs and benefits, and these depended on the meanings of responses for individuals. This paper concludes that initiatives to promote health-protective responses to racism need to consider structural constraints and the overarching goal of reducing systemic racism.

The impact of weight stigma on caloric consumption

The present study assessed the influence of exposure to weight stigma on energy intake in both overweight and normal-weight adult women. Seventy-three women (mean age: 31.71 ± 12.72 years), both overweight (n = 34) and normal weight (n = 39), were randomly assigned to view one of two videos depicting either weight stigmatizing material or neutral material, after which they consumed snacks ad libitum. Pre- and post-video measures included blood pressure, attitudes toward overweight individuals, and positive and negative affect. Participants' body weight was measured, as was the number of kilocalories consumed following video exposure. Overweight women who watched the stigmatizing video ate more than three times as many kilocalories as overweight women who watched the neutral video (302.82 vs. 89.00 kcal), and significantly more calories than the normal-weight individuals who watched either the stigmatizing or the neutral video. A two-by-two analysis of covariance revealed that even after adjusting for relevant covariates, there was a significant interaction between video type and weight status in that when overweight, individuals consumed significantly more calories if they were in the stigmatizing condition vs. the neutral condition (F(1,65) = 4.37, P = 0.04, η(2) = 0.03). These findings suggest that among overweight women, exposure to weight stigmatizing material may lead to increased caloric consumption. This directly challenges the notion that pressure to lose weight in the form of weight stigma will have a positive, motivating effect on overweight individuals.

Is discrimination an equal opportunity risk?: racial experiences, socioeconomic status, and health status among black and white adults

Using the 2004 Behavioral Risk Factor Surveillance System, we explore the relationship between racial awareness, perceived discrimination, and self-rated health among black (n = 5,902) and white (n = 28,451) adults. We find that adjusting for group differences in racial awareness and discrimination, in addition to socioeconomic status, explains the black-white gap in self-rated health. However, logistic regression models also find evidence for differential vulnerability among black and whites adults, based on socioeconomic status. While both groups are equally harmed by emotional and/or physical reactions to race-based treatment, the negative consequences of discriminatory experiences for black adults are exacerbated by their poorer socioeconomic standing. In contrast, the association between racial awareness and self-rated health is more sensitive to socioeconomic standing among whites. Poorer health is more likely to occur among whites when they reflect at least daily on their own racial status-but only when it happens in tandem with mid-range educational achievement, or among homemakers.

Beliefs about racism and health among African American women with diabetes: a qualitative study

Exposure to racism has been linked to poor health outcomes. Little is known about the impact of racism on diabetes outcomes. This study explored African American women's beliefs about how racism interacts with their diabetes self-management and control. Four focus groups were conducted with a convenience sample of 28 adult African American women with type 2 diabetes who were recruited from a larger quantitative study on racism and diabetes. The focus group discussions were transcribed verbatim and analyzed by the authors. Women reported that exposure to racism was a common phenomenon, and their beliefs did in fact link racism to poor health. Specifically, women reported that exposure to racism caused physiological arousal including cardiovascular and metabolic perturbations. There was consensus that physiological arousal was generally detrimental to health. Women also described limited, and in some cases maladaptive, strategies to cope with racist events, including eating unhealthy food choices and portions. There was consensus that the subjective nature of perceiving racism and accompanying social prohibitions often made it impossible to address racism directly. Many women described anger in such situations and the tendency to internalize anger and other negative emotions, only to find that the negative emotions would be reactivated repeatedly with exposure to novel racial stressors, even long after the original racist event remitted. African American women in this study believed that racism affects their diabetes self-management and control. Health beliefs can exert powerful effects on health behaviors and may provide an opportunity for health promotion interventions in diabetes.

The influence of coping with perceived racism and stress on lipid levels in African Americans

BACKGROUND

Lipid dysregulation is a major contributor to cardiovascular disease (CVD) risk and is attributed to numerous biological, psychosocial, and behavioral risk factors. Psychological stress has been examined as a predictor of lipid dysregulation; however, the role of coping with perceived racism, a stressor unique to the African American experience, has not been addressed. The current study sought to determine the impact of behavioral coping responses to perceived racism and perceived daily stress on lipid levels in African Americans.

METHODS

The sample consisted of 122 African American participants who resided in the Washington, DC, metropolitan area. Data were collected as part of an ongoing study entitled Stress and Psychoneuroimmunological Factors in Renal Health and Disease at Howard University Hospital.

RESULTS

Through canonical analysis, distinct profiles of African American lipid function emerged with body mass index, age, and behavioral coping responses to perceived racism being associated with high-density lipoprotein cholesterol (HDL-C), triglycerides, and low-density lipoprotein cholesterol (LDL-C), respectively. Results from linear regression analyses showed that greater endorsement of behavioral coping responses to perceived racism items predicted higher levels of LDL (B = .24, p < .05). This relationship was not mediated by pathophysiological mechanisms associated with the stress response system such as cortisol, norepinephrine, epinephrine, and IL-6.

CONCLUSION

The relationship between elevated levels of LDL and behavioral coping responses to perceived racism suggests that African Americans may be at increased risk for CVD due to the unique stress encountered by racism in our culture. Behavioral pathways used to counteract the negative effects of perceived discrimination may better explain this relationship. Further research is necessary to determine other biobehavioral and pathophysiological mechanisms that explain this relationship.

Racism and hypertension: a review of the empirical evidence and implications for clinical practice

BACKGROUND

Despite improved hypertension (HTN) awareness and treatment, racial disparities in HTN prevalence persist. An understanding of the biopsychosocial determinants of HTN is necessary to address racial disparities in the prevalence of HTN. This review examines the evidence directly and indirectly linking multiple levels of racism to HTN.

METHODS

Published empirical research in EBSCO databases investigating the relationships of three levels of racism (individual/interpersonal, internalized, and institutional racism) to HTN was reviewed.

RESULTS

Direct evidence linking individual/interpersonal racism to HTN diagnosis is weak. However, the relationship of individual/interpersonal racism to ambulatory blood pressure (ABP) is more consistent, with all published studies reporting a positive relationship of interpersonal racism to ABP. There is no direct evidence linking internalized racism to BP. Population-based studies provide some evidence linking institutional racism, in the forms of residential racial segregation (RRS) and incarceration, to HTN incidence. Racism shows associations to stress exposure and reactivity as well as associations to established HTN-related risk factors including obesity, low levels of physical activity and alcohol use. The effects vary by level of racism.

CONCLUSIONS

Overall the findings suggest that racism may increase risk for HTN; these effects emerge more clearly for institutional racism than for individual level racism. All levels of racism may influence the prevalence of HTN via stress exposure and reactivity and by fostering conditions that undermine health behaviors, raising the barriers to lifestyle change.

Multiple Pathways Linking Racism to Health Outcomes

This commentary discusses advances in the conceptual understanding of racism and selected research findings in the social neurosciences. The traditional stress and coping model holds that racism constitutes a source of aversive experiences that, when perceived by the individual, eventually lead to poor health outcomes. Current evidence points to additional psychophysiological pathways linking facets of racist environments with physiological reactions that contribute to disease. The alternative pathways emphasize prenatal experiences, subcortical emotional neural circuits, conscious and preconscious emotion regulation, perseverative cognitions, and negative affective states stemming from racist cognitive schemata. Recognition of these pathways challenges change agents to use an array of cognitive and self-controlling interventions in mitigating racism's impact. Additionally, it charges policy makers to develop strategies that eliminate deep-seated structural aspects of racism in society.

The association of race, cultural factors, and health-related quality of life in persons with spinal cord injury

OBJECTIVE

To examine the association of race and cultural factors with quality-of-life factors (participation, life satisfaction, perceived health status) in people with spinal cord injury (SCI).

DESIGN

Cross-sectional multisite study using structured questionnaires.

SETTING

Six National SCI Model Systems centers.

PARTICIPANTS

People with SCI (N=275; age ≥16y; SCI with discernable neurologic impairments; used power or manual wheelchair for >1y as primary means of mobility; nonambulatory except for exercise purposes).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Participation (Craig Handicap Assessment and Reporting Technique Short Form); satisfaction (Satisfaction With Life Scale); and perceived health status (2 items from 36-Item Short Form Health Survey).

RESULTS

African American (n=96) with SCI reported more experiences of discrimination in health care, greater perceived racism, more health care system distrust, and lower health literacy than whites (n=156; P range, <.001-<.05). Participants who reported experiencing more discrimination in health care reported better occupational functioning (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.07-2.09; P<.05). Those who perceived more racism in health care settings reported better occupational functioning (OR, 1.65; 95% CI, 1.12-2.43; P<.05) and greater perceived health (β=.36; 95% CI, .05-.68; P<.05). Those who reported more distrust in the health care system reported better current health compared with 1 year ago (β=.38; 95% CI, .06-.69; P<.05). Those who reported better communication with their health care provider reported higher levels of mobility (OR, 1.5; 95% CI, 1.05-2.13; P<.05) and better general health (β=.27; 95% CI, .01-.53; P<.05).

CONCLUSIONS

In this cross-sectional study of people with SCI, higher levels of perceived discrimination and racism and better communication with health care providers were associated with an increase in participation and functioning and improvements in perceptions of well-being. These associations are different from those reported in other study populations and warrant confirmation in future prospective studies.

Perceived weight discrimination amplifies the link between central adiposity and nondiabetic glycemic control (HbA1c)

BACKGROUND

While the preclinical development of type 2 diabetes is partly explained by obesity and central adiposity, psychosocial research has shown that chronic stressors such as discrimination have health consequences as well.

PURPOSE

We investigated the extent to which the well-established effects of obesity and central adiposity on nondiabetic glycemic control (indexed by HbA(1c)) were moderated by a targeted psychosocial stressor linked to weight: perceived weight discrimination.

METHODS

The data came from the nondiabetic subsample (n = 938) of the Midlife in the United States (MIDUS II) survey.

RESULTS

Body mass index (BMI), waist-to-hip ratio, and waist circumference were linked to significantly higher HbA(1c) (p < 0.001). Multivariate-adjusted models showed that weight discrimination exacerbated the effects of waist-to-hip ratio on HbA(1c) ( p < 0.05), such that people who had higher waist-to-hip ratios and reported weight discrimination had the highest HbA(1c) levels.

CONCLUSION

Understanding how biological and psychosocial factors interact at nondiabetic levels to increase vulnerability could have important implications for public health and education strategies. Effective strategies may include targeting sources of discrimination rather than solely targeting the health behaviors and practices of overweight and obese persons.

Racial Discrimination and Asian Mental Health: A Meta-Analysis

Although research on racial discrimination and mental health has proliferated, findings are varied and dispersed. This study explored the critical question of how Asians, in particular, deal with discrimination and how this relates to Asian mental health. With 99 correlations from 23 independent studies, the overall relationship between racial discrimination and mental health was statistically significant ( r = .23). Individual resources (i.e., personal constructs and strengths, social support, cultural identity, and coping strategies) were also found to be significantly related to racial discrimination ( r = -.19, -.15, -.10, .22, respectively) and to mental health with the exception of coping strategies ( r = -.48, -.27, -.21, respectively). Recommendations regarding future research and clinical implications of these findings are discussed.

Neighborhood stressors and race/ethnic differences in hypertension prevalence (the Multi-Ethnic Study of Atherosclerosis)

BACKGROUND

The reasons for racial/ethnic disparities in hypertension (HTN) prevalence in the United States are poorly understood.

METHODS

Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated whether individual- and neighborhood-level chronic stressors contribute to these disparities in cross-sectional analyses. The sample consisted of 2,679 MESA participants (45-84 years) residing in Baltimore, New York, and North Carolina. HTN was defined as systolic or diastolic blood pressure ≥140 or 90 mm Hg, or taking antihypertensive medications. Individual-level chronic stress was measured by self-reported chronic burden and perceived major and everyday discrimination. A measure of neighborhood (census tract) chronic stressors (i.e., physical disorder, violence) was developed using data from a telephone survey conducted with other residents of MESA neighborhoods. Binomial regression was used to estimate associations between HTN and race/ethnicity before and after adjustment for individual and neighborhood stressors.

RESULTS

The prevalence of HTN was 59.5% in African Americans (AAs), 43.9% in Hispanics, and 42.0% in whites. Age- and sex-adjusted relative prevalences of HTN (compared to whites) were 1.30 (95% confidence interval (CI): 1.22-1.38) for AA and 1.16 (95% CI: 1.04-1.31) for Hispanics. Adjustment for neighborhood stressors reduced these to 1.17 (95% CI: 1.11-1.22) and 1.09 (95% CI: 1.00-1.18), respectively. Additional adjustment for individual-level stressors, acculturation, income, education, and other neighborhood features only slightly reduced these associations.

CONCLUSION

Neighborhood chronic stressors may contribute to race/ethnic differences in HTN prevalence in the United States.

Racism, health status, and birth outcomes: results of a participatory community-based intervention and health survey

Many community-based participatory research (CBPR) partnerships address social determinants of health as a central consideration. However, research studies that explicitly address racism are scarce in the CBPR literature, and there is a dearth of available community-generated data to empirically examine how racism influences health disparities at the local level. In this paper, we provide results of a cross-sectional, population-based health survey conducted in the urban areas of Genesee and Saginaw Counties in Michigan to assess how a sustained community intervention to reduce racism and infant mortality influenced knowledge, beliefs, and experiences of racism and to explore how perceived racism is associated with self-rated health and birth outcomes. We used ANOVA and regression models to compare the responses of intervention participants and non-participants as well as African Americans and European Americans (N = 629). We found that intervention participants reported greater acknowledgment of the enduring and differential impact of racism in comparison to the non-intervention participants. Moreover, survey analyses revealed that racism was associated with health in the following ways: (1) experiences of racial discrimination predicted self-rated physical health, mental health, and smoking status; (2) perceived racism against one's racial group predicted lower self-rated physical health; and (3) emotional responses to racism-related experiences were marginally associated with lower birth-weight births in the study sample. Our study bolsters the published findings on perceived racism and health outcomes and highlights the usefulness of CBPR and community surveys to empirically investigate racism as a social determinant of health.

Longitudinal relationships between antiretroviral treatment adherence and discrimination due to HIV-serostatus, race, and sexual orientation among African-American men with HIV

African-Americans show worse HIV disease outcomes compared to Whites. Health disparities may be aggravated by discrimination, which is associated with worse health and maladaptive health behaviors. We examined longitudinal effects of discrimination on antiretroviral treatment adherence among 152 HIV-positive Black men who have sex with men. We measured adherence and discrimination due to HIV-serostatus, race/ethnicity, and sexual orientation at baseline and monthly for 6 months. Hierarchical repeated-measures models tested longitudinal effects of each discrimination type on adherence. Over 6 months, participants took 60% of prescribed medications on average; substantial percentages experienced discrimination (HIV-serostatus, 38%; race/ethnicity, 40%; and sexual orientation, 33%). Greater discrimination due to all three characteristics was significantly bivariately associated with lower adherence (all p's < 0.05). In the multivariate model, only racial discrimination was significant (p < 0.05). Efforts to improve HIV treatment adherence should consider the context of multiple stigmas, especially racism.

The Role of Sensory Gating in the Racism/Blood Pressure Relationship

African Americans bear a disproportionate burden of hypertension with racism postulated as a unique stressor contributing to the noted disparities. Epidemiological studies have found differences in the prevalence of hypertension among African Americans based on the amount of perceived racism reported, and experimental studies have shown increased cardiovascular reactivity to racially-aversive stressors. A difference in individual response to racial stressors may create subgroups of African Americans at highest risk for hypertension and its complications. Although sensory gating is the brain’s capacity to selectively regulate its sensitivity to environmental sensory stimuli, scant research has been done regarding the role of sensory gating in the stress response, and no research has explored sensory gating with racial stressors. To address this gap, we examined whether P50 sensory gating was associated with cardiovascular and central nervous system responses to an experimentally-induced racial stressor among 15 African Americans. A paired-click paradigm was administered prior to the experimental condition, which involved exposure to a neutral and then a racially-aversive photo stimulus. Participants with weak gating showed a significant within-subjects decrease in alpha-band activity when viewing the racially aversive stimulus and had significantly decreased alpha activity when viewing the aversive stimuli compared to participants with strong gating. Increased cardiovascular reactivity occurred with the aversive stimulus, and gender differences were noted. A gating effect on cardiovascular reactivity could not be determined given the small sample size and the fact that few men qualified as having ‘good’ gating. Although subjects reported no conscious awareness of distress when viewing the racially-aversive stimulus, both cardiovascular and central nervous system reactions occurred, with the responses varying based on the level of sensory gating. These results suggest sensory gating as a potential physiologic factor that may influence the relationship between perceived racial stressors and health outcomes.

Family Adaptability and Cohesion and High Blood Pressure among Urban African American women

African American women are at greater risk for complications related to high blood pressure. This study examined relationships between high blood pressure, pulse pressure, body mass index, family adaptability, family cohesion and social support among 146 Urban African American women. Significant relationships were found between family adaptability and systolic blood pressure (p = .03) and between adaptability and pulse pressure (p ≤ .01). Based on study results, practitioners should routinely assess family functioning, specifically family adaptability, in African American women who are at risk for high blood pressure or diagnosed with high blood pressure to minimize complications associated with hypertension.

Perceived discrimination, psychological distress and health

Racism and discrimination can have significant implications for health, through complex biopsychosocial interactions. Latino groups, and particularly Puerto Ricans, are an understudied population in the United States in terms of the prevalence of discrimination and its relevance to health. Participants in our study were 45- to 75-year-old (N = 1122) Puerto Ricans. The measures were perceived discrimination, depressive symptomatology (CES-D), perceived stress (PSS), self-rated health, medical conditions, blood pressure, smoking and drinking behaviours, demographics. Our findings show that 36.9 per cent of participants had at some time experienced discrimination, with men, those with more years of education, currently employed and with higher incomes being more likely to report it. Experiences of discrimination were associated with increased levels of depressive symptoms and perceived stress. When controlling for covariates, perceived discrimination was predictive of the number of medical conditions, of ever having smoked and having been a drinker, and having higher values of diastolic pressure. Depressive symptoms are a mediator of the effect of perceived discrimination on medical conditions, confirmed by the Sobel test: z = 3.57, p < 0.001. Mediating roles of perceived stress, smoking and drinking behaviours were not confirmed. Increased depressive symptoms might be the main pathway through which perceived discrimination is associated with a greater number of medical diagnoses.

Socioeconomic Status and Coronary Heart Disease Risk: The Role of Social Cognitive Factors

The aim of this study is to examine existing research on social cognitive factors that may, in part, mediate the relationship between socioeconomic status (SES) and coronary heart disease (CHD). We focus on how social status is 'carried' in the mental systems of individuals, and how these systems differentially affect CHD risk and associated behaviors. To this end, literatures documenting the association of various social cognitive factors (e.g., social comparison, perceived discrimination, and self-efficacy) with cardiovascular disease are reviewed as are literatures regarding the relationship of these factors to SES. Possible mechanisms through which social cognitions may affect health are addressed. In addition, directions for future research are discussed, and a model identifying the possible associations between social cognitive factors, SES, and coronary disease is provided.

Chronic psychosocial stress and hypertension

Genetic and behavioral factors do not fully explain the development of hypertension, and there is increasing evidence suggesting that psychosocial factors may also play an important role. Exposure to chronic stress has been hypothesized as a risk factor for hypertension, and occupational stress, stressful aspects of the social environment, and low socioeconomic status have each been studied extensively. The study of discrimination is a more recent and rapidly growing area of investigation and may also help to explain the well-known racial disparities in hypertension. Research regarding mechanisms underlying stress effects on hypertension has largely focused on cardiovascular reactivity, but delayed recovery to the pre-stress level is increasingly being evaluated as another possible pathway. Recent findings in each of these areas are reviewed, and directions for future research are discussed.

Do experiences of racial discrimination predict cardiovascular disease among African American men? The moderating role of internalized negative racial group attitudes

Studies examining associations between racial discrimination and cardiovascular health outcomes have been inconsistent, with some studies finding the highest risk of hypertension among African Americans who report no discrimination. A potential explanation of the latter is that hypertension and other cardiovascular problems are fostered by internalization and denial of racial discrimination. To explore this hypothesis, the current study examines the role of internalized negative racial group attitudes in linking experiences of racial discrimination and history of cardiovascular disease among African American men. We predicted a significant interaction between reported discrimination and internalized negative racial group attitudes in predicting cardiovascular disease. Weighted logistic regression analyses were conducted among 1216 African American men from the National Survey of American Life (NSAL; 2001-2003). We found no main effect of racial discrimination in predicting history of cardiovascular disease. However, agreeing with negative beliefs about Blacks was positively associated with cardiovascular disease history, and also moderated the effect of racial discrimination. Reporting racial discrimination was associated with higher risk of cardiovascular disease among African American men who disagreed with negative beliefs about Blacks. However, among African American men who endorsed negative beliefs about Blacks, the risk of cardiovascular disease was greatest among those reporting no discrimination. Findings suggest that racial discrimination and the internalization of negative racial group attitudes are both risk factors for cardiovascular disease among African American men. Furthermore, the combination of internalizing negative beliefs about Blacks and the absence of reported racial discrimination appear to be associated with particularly poor cardiovascular health. Steps to address racial discrimination as well as programs aimed at developing a positive racial group identity may help to improve cardiovascular health among African American men.

Perceptions of race/ethnic discrimination in relation to mortality among Black women: results from the Black Women's Health Study

BACKGROUND

Because racial discrimination is a form of chronic psychological stress that might unfavorably affect health, we examined whether perceived experiences of racism among black women are associated with mortality.

METHODS

We followed 48 924 participants in the Black Women's Health Study (mean age, 40.5 years) for 8 years to assess the risk of all-cause mortality associated with perceived experiences of racism. Subanalyses of cancer and cardiovascular mortality were also conducted. Perceived racism was evaluated by 8 questions about institutionalized racism (unfair treatment on the job, in housing, or by the police) and everyday experiences of racism (eg, others acting as if the woman was not intelligent). We estimated the relative risk of death with Cox proportional hazard models, adjusting for traditional and socioenvironmental risk factors.

RESULTS

During 412 224 person years of follow-up from 1997 to 2005, there were 920 deaths, including 277 due to cancer and 195 due to cardiovascular causes. All-cause mortality was not associated with institutionalized racism (relative risk, 1.0; 95% confidence interval, 0.8-1.2) for the highest category vs the lowest or with everyday racism (relative risk, 0.9; 95% confidence interval, 0.8-1.2) for the highest quartile compared with the lowest. Risk estimates for the highest categories of perceived racism relative to the lowest were greater than 1.0 for cancer deaths and less than 1.0 for cardiovascular disease death but were not statistically significant.

CONCLUSIONS

In this large prospective study of black women, reported experiences of racism were not significantly related to mortality. Longer follow-up of this relatively young cohort and further work is warranted in this complex area of research because continued race/ethnic disparities in mortality are not entirely explained by traditional risk factors.

Medication adherence beliefs of community-dwelling hypertensive African Americans

BACKGROUND AND OBJECTIVE

Medication adherence is low among hypertensive patients regardless of ethnic background. However, the prevalence of nonadherence is higher among African Americans when compared with their white American counterparts. Recognizing African American perspectives about their adherence to antihypertensive medications is necessary for the development of successful interventions aimed at improving adherence to prescribed regimens. The purpose of this qualitative study was to explore community-dwelling hypertensive African American behavioral, normative, and control beliefs regarding their adherence to antihypertensive medications.

SUBJECTS AND METHODS

A community and academic partnership was formed to conduct 3 audio-taped focus groups with 40 hypertensive and low-income African American adults aged 18 years and older. Interview questions were based on the theory of planned behavior. All transcripts from the tapes were analyzed using thematic analysis.

RESULTS AND CONCLUSIONS

Behavioral beliefs associated with medication adherence identified both positive and negative outcomes. Family, friends, neighbors, and God were associated with normative beliefs. Limited financial resources, neighborhood violence, and distrust of healthcare professionals were key control beliefs. Although these results cannot be generalized, they do provide significant insight into the contextual factors associated with the lives of community-dwelling hypertensive African Americans who fit a similar demographic profile. These findings are important because they can be used to tailor interventions to increase their medication adherence.

Widening the aim of health promotion to include the most disadvantaged: vulnerable adolescents and the social determinants of health

Growing numbers of adolescents are marginalized by social factors beyond their control, leading to poor health outcomes for their families and future generations. Although the role of the social determinants of health has been recognized for many years, there is a gap in our knowledge about the strategies needed to address these factors in health promotion. Drawing on a review of literature on health promotion for marginalized and out-of-school adolescents, this paper highlights some urgent areas of focus for researchers and policy makers addressing adolescent health. Social determinants of health affecting marginalized adolescents identified by the review were education, gender, identity, homelessness, poverty, family structure, culture, religion and perceived racism, yet there is little solid evidence as to how to best address these factors. More systematic research, evaluation and global debate about long-term solutions to chronic poverty, lack of education and social marginalization are needed to break the cycle of ill health among vulnerable adolescents.

Perceived discrimination and health-related quality of life among Arabs and Jews in Israel: a population-based survey

Background

Studies have shown that perceived discrimination may be associated with impaired health. The aim of this study was to assess the levels of perceived discrimination on the basis of origin and ethnicity and measure the association with health in three population groups in Israel: non-immigrant Jews, immigrants from the former Soviet Union, and Arabs.

Methods

A cross sectional random telephone survey was performed in 2006 covering 1,004 Israelis aged 35-65; of these, 404 were non-immigrant Jews, 200 were immigrants from the former Soviet Union and 400 were Arabs, the final number for regression analysis was 952. Respondents were asked about their perceived experiences with discrimination in seven different areas. Quality of life, both physical and mental were measured by the Short Form 12.

Results

Perceived discrimination on the basis of origin was highest among immigrants. About 30% of immigrants and 20% of Arabs reported feeling discriminated against in areas such as education and employment. After adjusting for socioeconomic variables, discrimination was associated with poor physical health among non-immigrant Jews (OR = 0.42, CI = 0.19, 0.91) and immigrants (OR = 0.51, CI = 0.27, 0.94), but not among Arabs. Poor mental health was significantly associated with discrimination only among non-immigrant Jews (OR = 0.42, CI = 0.18, 0.96).

Conclusions

Perceived discrimination seemed high in both minority populations in Israel (Arabs and immigrants) and needs to be addressed as such. However, discrimination was associated with physical health only among Jews (non-immigrants and immigrants), and not among Arabs. These results may be due to measurement artifacts or may be a true phenomenon, further research is needed to ascertain the results.

Racial discrimination and health: a systematic review of scales with a focus on their psychometric properties

The literature addressing the use of the race variable to study causes of racial inequities in health is characterized by a dense discussion on the pitfalls in interpreting statistical associations as causal relationships. In contrast, fewer studies have addressed the use of racial discrimination scales to estimate discrimination effects on health, and none of them provided a thorough assessment of the scales' psychometric properties. Our aim was to systematically review self-reported racial discrimination scales to describe their development processes and to provide a synthesis of their psychometric properties. A computer-based search in PubMed, LILACS, PsycInfo, Scielo, Scopus and Web of Science was conducted without any type of restriction, using search queries containing free and controlled vocabulary. After initially identifying 3060 references, 24 scales were included in the review. Despite the fact that discrimination stands as topic of international relevance, 23 (96%) scales were developed within the United States. Most studies (67%, N = 16) were published in the last 12 years, documenting initial attempts at scale development, with a dearth of investigations on scale refinements or cross-cultural adaptations. Psychometric properties were acceptable; sixteen of all scales presented reliability scores above 0.7, 19 out of 20 instruments confirmed at least 75% of all previously stated hypotheses regarding the constructs under consideration, and conceptual dimensional structure was supported by means of any type of factor analysis in 17 of 21 scales. However, independent researchers, apart from the original scale developers, have rarely examined such scales. The use of racial terminology and how it may influence self-reported experiences of discrimination has not yet been thoroughly examined. The need to consider other types of unfair treatment as concurrently important health-damaging exposures, and the idea of a universal instrument which would permit cross-cultural adaptations, should be discussed among researchers in this emerging field of inquiry.

Racial discrimination and health among Asian Americans: evidence, assessment, and directions for future research

Research shows that racial discrimination is related to illness among diverse racial and ethnic populations. Studies of racial discrimination and health among Asian Americans, however, remain underdeveloped. In this paper, the authors review evidence on racial discrimination and health among Asian Americans, identify gaps in the literature, and provide suggestions for future research. They identified 62 empirical articles assessing the relation between discrimination and health among Asian Americans. The majority of articles focused on mental health problems, followed by physical and behavioral problems. Most studies find that discrimination was associated with poorer health, although the most consistent findings were for mental health problems. This review suggests that future studies should continue to investigate the following: 1) the measurement of discrimination among Asian Americans, whose experiences may be qualitatively different from those of other racial minority groups; 2) the heterogeneity among Asian Americans, including those factors that are particularly salient in this population, such as ethnic ancestry and immigration history; and 3) the health implications of discrimination at multiple ecologic levels, ranging from the individual level to the structural level.

Unfair treatment and trait anger in relation to nighttime ambulatory blood pressure in African American and white adolescents

OBJECTIVE

To determine if ambulatory blood pressure (ABP) at night relative to day ABP among adolescents is influenced by unfair treatment and trait anger, and whether these associations are stronger in African Americans and adolescents from lower socioeconomic status (SES) families and neighborhoods.

METHODS

A total of 189 healthy white and African American adolescents (ages = 14-16 years, standard deviation = 0.62, 50% female) completed 2 days and 1 night of ABP monitoring and unfair treatment and trait anger questionnaires. SES was measured using 1) parental education and 2) a composite neighborhood SES score based on U.S. Census tract data for neighborhood poverty and education. The night/day ABP ratio was calculated by dividing the night ABP mean (readings from the self-reported bedtime of each participant through 5 AM) by the day ABP mean (8:30 AM until self-reported bedtime).

RESULTS

Higher trait anger was associated with a higher night/day diastolic blood pressure (DBP) ratio in the full sample, B = 0.003, SE = 0.001, t = 2.20, p = .03. A significant interaction effect for Race x Unfair Treatment on the night/day DBP ratio, B = 0.01, SE = 0.003, t = 3.17, p = .002, followed by post hoc tests indicated that greater unfair treatment was associated with a higher night/day DBP ratio among African Americans, B = 0.006, SE = 0.002, t = 2.56, p = .01. Further, among African American adolescents living in lower SES neighborhoods, greater unfair treatment predicted a higher night/day DBP ratio, B = 0.008, SE = 0.003, t = 3.15, p = .002, and higher trait anger scores predicted a higher night/day DBP ratio, B = 0.008, SE = 0.002, t = 3.19, p = .002.

CONCLUSIONS

Trait anger may be a factor leading to elevated nighttime DBP in both African Americans and whites. Unfair treatment and trait anger are important predictors of elevated night/day ABP ratios among African American adolescents living in lower SES neighborhoods. These factors may contribute to the onset of hypertension in African Americans at a younger age.

Resiliency in the face of disadvantage: do Hispanic cultural characteristics protect health outcomes?

Hispanics living in the United States may face substantial adversity, given stresses of immigration and acculturation, low incomes, poor educational and occupational opportunities, inadequate access to health care, and exposure to discrimination. Despite these disadvantages, the Hispanic population often shows equal or better health outcomes when compared to non-Hispanic Whites, a trend that has puzzled researchers and has been referred to as the "Hispanic Paradox." Hispanics with non-U.S. nativity also tend to show better health than those born in the United States, although this advantage dissipates with increasing time spent in the United States. The current article discusses the Reserve Capacity Model (L.C. Gallo & K. A. Matthews, 2003) as a potential framework for understanding how psychosocial risk and resilient factors may contribute to health disparities associated with broad sociocultural factors, such as low socioeconomic status or minority ethnicity. In addition, we examine theory concerning features of the Hispanic culture that may enhance resilience (e.g., social resources, familism, religiousness; G. Marin & B. V. Marin, 1991) in the face of adverse circumstances. We summarize some of our recent work that has empirically tested effects of risk and resilient factors in Hispanic health in the contexts of prostate cancer and cardiovascular disease. We conclude by discussing future directions and opportunities for researchers interested in culture-specific resiliency factors in relation to health outcomes.

Genetic ancestry, social classification, and racial inequalities in blood pressure in Southeastern Puerto Rico

BACKGROUND

The role of race in human genetics and biomedical research is among the most contested issues in science. Much debate centers on the relative importance of genetic versus sociocultural factors in explaining racial inequalities in health. However, few studies integrate genetic and sociocultural data to test competing explanations directly.

METHODOLOGY/PRINCIPAL FINDINGS

We draw on ethnographic, epidemiologic, and genetic data collected in Southeastern Puerto Rico to isolate two distinct variables for which race is often used as a proxy: genetic ancestry versus social classification. We show that color, an aspect of social classification based on the culturally defined meaning of race in Puerto Rico, better predicts blood pressure than does a genetic-based estimate of continental ancestry. We also find that incorporating sociocultural variables reveals a new and significant association between a candidate gene polymorphism for hypertension (alpha(2C) adrenergic receptor deletion) and blood pressure.

CONCLUSIONS/SIGNIFICANCE

This study addresses the recognized need to measure both genetic and sociocultural factors in research on racial inequalities in health. Our preliminary results provide the most direct evidence to date that previously reported associations between genetic ancestry and health may be attributable to sociocultural factors related to race and racism, rather than to functional genetic differences between racially defined groups. Our results also imply that including sociocultural variables in future research may improve our ability to detect significant allele-phenotype associations. Thus, measuring sociocultural factors related to race may both empower future genetic association studies and help to clarify the biological consequences of social inequalities.

The effects of ethnic discrimination and socioeconomic status on endothelin-1 among blacks and whites

BACKGROUND

Ethnic disparities in cardiovascular disease (CVD) may partially reflect differences in chronic stress burden that vary by social class and exposure to ethnic discrimination. Stress is associated with increased endothelin-1 (ET-1). This study examined the relationship of ET-1 to socioeconomic status (SES) and to perceived ethnic discrimination among black (n = 51) and white (n = 65) adults (mean age 36.5).

METHODS

The Perceived Discrimination subscale of the Scale of Ethnic Experience measured exposure to discrimination and the Hollingshead Two-Factor Index of Social Position assessed SES. Plasma ET-1 was sampled upon awakening after an overnight admission.

RESULTS

SES and ET-1 levels were similar across ethnic groups, but mean discrimination scores were higher among blacks than whites (P < 0.001). Multiple regressions found that the SES x ethnicity interaction was associated with ET-1 (P < 0.05), after adjustment for gender, resting mean arterial pressure (MAP), body mass index (BMI), and exercise frequency. Regressions stratified by ethnicity revealed that lower SES correlated with higher ET-1 in whites (P < 0.001), but not blacks, and accounted for 21% of the variance. Another series of regressions revealed an interaction effect of ethnicity by discrimination on ET-1 (P < 0.05). Increased discrimination correlated with increased ET-1 among blacks (P < 0.05), but not whites, and explained 11% of the variance after adjustment for SES, gender, exercise frequency, and socially desirable response bias.

CONCLUSIONS

Thus, ET-1 levels increased in association with different psychosocial burdens in blacks and whites. Plasma ET-1 was higher among whites with lower SES and among blacks with higher levels of perceived ethnic discrimination, regardless of SES.

The association between perceived discrimination and obesity in a population-based multiracial and multiethnic adult sample

OBJECTIVES

We examined whether perceived chronic discrimination was related to excess body fat accumulation in a random, multiethnic, population-based sample of US adults.

METHODS

We used multivariate multinomial logistic regression and logistic regression analyses to examine the relationship between interpersonal experiences of perceived chronic discrimination and body mass index and high-risk waist circumference.

RESULTS

Consistent with other studies, our analyses showed that perceived unfair treatment was associated with increased abdominal obesity. Compared with Irish, Jewish, Polish, and Italian Whites who did not experience perceived chronic discrimination, Irish, Jewish, Polish, and Italian Whites who perceived chronic discrimination were 2 to 6 times more likely to have a high-risk waist circumference. No significant relationship between perceived discrimination and the obesity measures was found among the other Whites, Blacks, or Hispanics.

CONCLUSIONS

These findings are not completely unsupported. White ethnic groups including Polish, Italians, Jews, and Irish have historically been discriminated against in the United States, and other recent research suggests that they experience higher levels of perceived discrimination than do other Whites and that these experiences adversely affect their health.

Racism and child health: a review of the literature and future directions

OBJECTIVE

Racism is a mechanism through which racial/ethnic disparities occur in child health. To assess the present state of research into the effects of racism on child health, a review of the literature was undertaken.

METHODS

A MEDLINE review of the literature was conducted between October and November 2007. Studies reporting on empirical research relating to racism or racial discrimination as a predictor or contributor to a child health outcome were included in this review. The definition of "child health" was broad and included behavioral, mental, and physical health.

RESULTS

Forty articles describing empirical research on racism and child health were found. Most studies (65%) reported on research performed on behavioral and mental health outcomes. Other areas studied included birth outcomes, cardiovascular and metabolic diseases, and satisfaction with care. Most research has been conducted on African-American samples (70%), on adolescents and on older children, and without a uniformly standardized approach to measuring racism. Furthermore, many studies used measures that were created for adult populations.

CONCLUSIONS

There are a limited number of studies evaluating the relationship between racism and child health. Most studies, to date, show relationships between perceived racism and behavioral and mental health. Future studies need to include more ethnically diverse minority groups and needs to consider studying the effects of racism in younger children. Instruments need to be developed that measure perceptions of racism in children and youth that take into account the unique contexts and developmental levels of children, as well as differences in the perception of racism in different ethnocultural groups. Furthermore, studies incorporating racism as a specific psychosocial stressor that can potentially have biophysiologic sequelae need to be conducted to understand the processes and mechanisms through which racism may contribute to child health disparities.