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Kim Y, Son I, Wie D, Muntaner C, Kim H, Kim SS. Don't ask for fair treatment? A gender analysis of ethnic discrimination, response to discrimination, and self-rated health among marriage migrants in South Korea. Int J Equity Health 2016; 15:112. [PMID: 27430432 PMCID: PMC4949882 DOI: 10.1186/s12939-016-0396-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Ethnic discrimination is increasingly common nowadays in South Korea with the influx of migrants. Despite the growing body of evidences suggests that ethnic discrimination negatively impacts health, only few researches have been conducted on the association between ethnic discrimination and health outcomes among marriage migrants in Korea. This study sought to examine how ethnic discrimination and response to the discrimination are related to self-rated health and whether the association differs by victim’s gender. Methods We conducted two-step analysis using cross-sectional dataset from the ‘National Survey of Multicultural Families 2012’. First, we examined the association between perceived ethnic discrimination and self-rated health among 14,406 marriage migrants in Korea. Second, among the marriage migrants who experienced ethnic discrimination (n=5,880), we examined how response to discrimination (i.e., whether or not asking for fair treatment) is related to poor self-rated health. All analyses were conducted after being stratified by the migrant’s gender. Results This research found the significant association between ethnic discrimination and poor self-rated health among female marriage migrants (OR: 1.53, 95 % CI: 1.32, 1.76), but not among male marriage migrants (OR: 1.16, 95 % CI: 0.81, 1.66). In the restricted analysis with marriage migrants who experienced ethnic discrimination, compared to the group who did not ask for fair treatment, female marriage migrants who asked for fair treatment were more likely to report poor self-rated health (OR: 1.21, 95 % CI: 0.98, 1.50); however, male marriage migrants who asked for fair treatment were less likely to report poor self-rated health (OR: 0.65, 95 % CI: 0.36, 1.04) although both were not statistically significant. Conclusions This is the first study to investigate gender difference in the association between response to ethnic discrimination and self-rated health in South Korea. We discussed that gender may play an important role in the association between response to discrimination and self-rated health among marriage migrants in Korea. In order to prevent discrimination which could endanger the health of ethnic minorities including marriage migrants, relevant policies are needed. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0396-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yugyun Kim
- Department of Public Health Sciences, Graduate School of Korea University, Anam-ro, Seongbuk-gu, Seoul, South Korea
| | - Inseo Son
- Asiatic Research Institute, Korea University, Anam-ro, Seongbuk-gu, Seoul, South Korea
| | - Dainn Wie
- National Graduate Institute for Policy Studies, 7-22-1, Roppongi, Minato-ku, Tokyo, Japan
| | - Carles Muntaner
- Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hyunwoo Kim
- Department of Public Health Sciences, Graduate School of Korea University, Anam-ro, Seongbuk-gu, Seoul, South Korea
| | - Seung-Sup Kim
- Department of Public Health Sciences, Graduate School of Korea University, Anam-ro, Seongbuk-gu, Seoul, South Korea. .,Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Department of Environmental and Occupational Health, Milken Institute School of Public Health at George Washington University, Washington, DC, USA.
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152
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Powell W, Adams LB, Cole-Lewis Y, Agyemang A, Upton RD. Masculinity and Race-Related Factors as Barriers to Health Help-Seeking Among African American Men. Behav Med 2016; 42:150-63. [PMID: 27337619 PMCID: PMC4979354 DOI: 10.1080/08964289.2016.1165174] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Men's tendency to delay health help-seeking is largely attributed to masculinity, but findings scarcely focus on African American men who face additional race-related, help-seeking barriers. Building principally on reactance theory, we test a hypothesized model situating racial discrimination, masculinity norms salience (MNS), everyday racism (ERD), racial identity, sense of control (SOC), and depressive symptomatology as key barriers to African American men's health help-seeking. A total of 458 African American men were recruited primarily from US barbershops in the Western and Southern regions. The primary outcome was Barriers to Help-Seeking Scale (BHSS) scores. The hypothesized model was investigated with confirmatory factor and path analysis with tests for measurement invariance. Our model fit was excellent [Formula: see text] CFI = 0.99; TLI = 1.00; RMSEA = 0.00, and 90% CI [0.00, 0.07] and operated equivalently across different age, income, and education strata. Frequent ERD and higher MNS contributed to higher BHHS scores. The relationship between ERD exposure and BHHS scores was partially mediated by diminished SOC and greater depressive symptomatology. Interventions aimed at addressing African American men's health help-seeking should not only address masculinity norms but also threats to sense of control, and negative psychological sequelae induced by everyday racism.
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153
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Molina KM, James D. Discrimination, internalized racism, and depression: A comparative study of African American and Afro-Caribbean adults in the US. GROUP PROCESSES & INTERGROUP RELATIONS 2016; 19:439-461. [PMID: 28405176 PMCID: PMC5386401 DOI: 10.1177/1368430216641304] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Emerging research suggests that both perceptions of discrimination and internalized racism (i.e., endorsement of negative stereotypes of one's racial group) are associated with poor mental health. Yet, no studies to date have examined their effects on mental health with racial/ethnic minorities in the US in a single study. The present study examined: (a) the direct effects of everyday discrimination and internalized racism on risk of DSM-IV criteria of past-year major depressive disorder (MDD); (b) the interactive effects of everyday discrimination and internalized racism on risk of past-year MDD; and (c) the indirect effect of everyday discrimination on risk of past-year MDD via internalized racism. Further, we examined whether these associations differed by ethnic group membership. We utilized nationally representative data of Afro-Caribbean (N = 1,418) and African American (N = 3,570) adults from the National Survey of American Life. Results revealed that experiencing discrimination was associated with increased odds of past-year MDD among the total sample. Moreover, for Afro-Caribbeans, but not African Americans, internalized racism was associated with decreased odds of meeting criteria for past-year MDD. We did not find an interaction effect for everyday discrimination by internalized racism, nor an indirect effect of discrimination on risk of past-year MDD through internalized racism. Collectively, our findings suggest a need to investigate other potential mechanisms by which discrimination impacts mental health, and examine further the underlying factors of internalized racism as a potential self-protective strategy. Lastly, our findings point to the need for research that draws attention to the heterogeneity within the U.S. Black population.
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154
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Adebiyi AO, Fagbola MA, Olakehinde O, Ogunniyi A. Enacted and implied stigma for dementia in a community in south-west Nigeria. Psychogeriatrics 2016; 16:268-73. [PMID: 26551624 DOI: 10.1111/psyg.12156] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 07/30/2015] [Accepted: 08/12/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia is a chronic progressive disease that mostly affects the elderly. There is often a stigma surrounding dementia patients because of poor awareness about the disease. In Nigeria, this stigma and related attitudes have not been fully explored. In this study, we assessed the attitude of people towards demented individuals in a transitional community in Nigeria. METHODS The study used a mixed methods approach. Focused group discussions exploring the concept of dementia were conducted among six community groups, and quantitative data was obtained from an interviewer-administered questionnaire. A total of 313 respondents were selected with a cluster sampling technique. RESULTS Only 212 respondents (67.7%) were aware of dementia. 'Memory loss disease', 'ageing disease', 'disease of insanity', 'brain disorder', 'disease of forgetfulness', and 'dull brain' are the common names used to describe dementia in the community. Enacted stigma was evident as 36% of respondents felt dementia was associated with shame and embarrassment in the community. Implied stigma was evident in another third that opined that demented individuals would prefer not to know or let others know that they have the disease. Also, 28% were of the opinion that people do not take those with dementia seriously. Of the 22 (10.4%) that reported having received structured information about dementia, 16 (72.7%) got the information from health facilities. Qualitative data revealed the presence of enacted stigma in the community as some referred to affected individuals by derogatory names such as 'madman'. Some statements from the focus group discussion participants also gave useful insights into the scorn with which demented individuals are sometimes treated. CONCLUSION The presence of enacted and implied stigma related to dementia within the community calls for concern. More research efforts are needed to unravel the burden of stigma within communities and best practice for stigma-reducing interventions.
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Affiliation(s)
- Akindele O Adebiyi
- Department of Preventive Medicine and Primary Care, University of Ibadan, Ibadan, Nigeria
| | - Motunrayo A Fagbola
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Olaide Olakehinde
- IDEA Project, Institute of Advanced Medical Research, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Internal Medicine, University of Ibadan, Ibadan, Nigeria
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155
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Racial discrimination predicts greater systemic inflammation in pregnant African American women. Appl Nurs Res 2016; 32:98-103. [PMID: 27969060 DOI: 10.1016/j.apnr.2016.06.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/18/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE Chronic exposure to racial discrimination by pregnant African American women may lead to allostatic overload; thereby, predisposing women to systemic inflammation. Thus, the goal of this study was to examine if experiences of racial discrimination are related to systemic inflammation in pregnant African Americans. METHODS A sample of 96 African American women from Chicago completed questionnaires and had blood drawn during the second trimester of pregnancy (19.7±2.5 weeks). RESULTS Experiences of racial discrimination were associated with higher cytokine levels of interleukin (IL)-4 (B=2.161, 95% CI = 1.02-3.30, p<.001) and IL-6 (B=1.859, 95% CI=.61-3.11, p=.004) when controlling for covariates. CONCLUSION These findings suggest that experiences of racial discrimination may cause physiological wear and tear on the body leading to alteration of immune functions. Nurses should inquire about women's experiences of racial discrimination and make referrals for community or church support groups for women who report racial discrimination.
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156
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Miller CT, Solomon SE, Varni SE, Hodge JJ, Knapp FA, Bunn JY. A transactional approach to relationships over time between perceived HIV stigma and the psychological and physical well-being of people with HIV. Soc Sci Med 2016; 162:97-105. [PMID: 27348608 DOI: 10.1016/j.socscimed.2016.06.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 06/12/2016] [Accepted: 06/14/2016] [Indexed: 11/18/2022]
Abstract
RATIONALE Cross-sectional studies demonstrate that perceived discrimination is related to the psychological and physical well-being of stigmatized people. The theoretical and empirical foci of most of this research in on how racial discrimination undermines well-being. The present study takes a transactional approach to examine people with HIV, a potentially concealable stigma. HYPOTHESIS The transactional approach posits that even as discrimination adversely affects the psychological well-being of people with HIV, psychological distress also makes them more sensitive to perceiving that they may be or have been stigmatized, and may increase the chances that other people actually do stigmatize them. METHODS This hypothesis was tested in a longitudinal study in which 216 New England residents with HIV were recruited to complete measures of perceived HIV stigma and well-being across three time points, approximately 90 days apart. This study also expanded on past research by assessing anticipated and internalized stigma as well as perceived discrimination. RESULTS Results indicated that all of these aspects of HIV stigma prospectively predicted psychological distress, thriving, and physical well-being. Equally important, psychological distress and thriving also prospectively predicted all three aspects of HIV stigma, but physical well-being did not. CONCLUSION These findings suggest that people with HIV are ensnared in a cycle in which experiences of stigma and reduced psychological well-being mutually reinforce each other.
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Affiliation(s)
- Carol T Miller
- Department of Psychological Science, University of Vermont, Burlington, VT, 05405, USA.
| | | | - Susan E Varni
- Vermont Child Health Improvement Program, University of Vermont, Burlington, VT, 05405, USA
| | - James J Hodge
- Department of Psychological Science, University of Vermont, Burlington, VT, 05405, USA
| | - F Andrew Knapp
- Finger Lakes Community College, FLCC Canandaigua Campus, 3325 Marvin Sands Drive, Canandaigua, NY, 14424, USA
| | - Janice Y Bunn
- Biostatistics Unit, University of Vermont, Burlington, VT, 05405, USA
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157
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Fortuna LR, Álvarez K, Ramos Ortiz Z, Wang Y, Mozo Alegría X, Cook BL, Alegría M. Mental health, migration stressors and suicidal ideation among Latino immigrants in Spain and the United States. Eur Psychiatry 2016; 36:15-22. [PMID: 27311103 DOI: 10.1016/j.eurpsy.2016.03.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/12/2016] [Accepted: 03/08/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Immigration stress appears to augment the risk for suicide behaviors for Latinos. Yet, specific risk factors that contribute to suicidal ideation (SI) among diverse Latino immigrant populations are not well established. METHODS Data were collected in Boston, Madrid and Barcelona using a screening battery assessing mental health, substance abuse risk, trauma exposure, demographics, and sociocultural factors. Prevalence rates of lifetime and 30-day SI were compared across sites. Logistic regression modeling was used to identify sociodemographic, clinical, and sociocultural-contextual factors associated with 30-day SI. RESULTS Five hundred and sixty-seven Latino patients from primary care, behavioral health and HIV clinics and community agencies participated. Rates of lifetime SI ranged from 29-35%; rates for 30-day SI were 21-23%. Rates of SI were not statistically different between sites. Factors associated with SI included exposure to discrimination, lower ethnic identity, elevated family conflict, and low sense of belonging (P<0.01). In the adjusted model, higher scores on depression, posttraumatic stress disorder, and trauma exposure were significantly associated with 30-day SI (OR=1.14, 1.04, and 7.76, respectively). Greater number of years living in the host country was significantly associated with increased odds of having SI (OR=2.22) while having citizenship status was associated with lower odds (OR=0.45). CONCLUSION Latinos suffering depression, trauma exposure, and immigration stressors are more likely to experience SI. Despite differences in country of origin, education, and other demographic factors between countries, rates of SI did not differ. Recommendations for prevention and clinical practice for addressing suicidal ideation risk among Latino immigrants are discussed.
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Affiliation(s)
- L R Fortuna
- Boston University Medical School, Boston Medical Center, Child and Adolescent Psychiatry, 850, Harrison Avenue, Dowling Building, 7th Floor, Boston, MA 02118 USA; Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50, Staniford Street, Suite 830 Boston, MA 02114 USA
| | - K Álvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50, Staniford Street, Suite 830 Boston, MA 02114 USA
| | - Z Ramos Ortiz
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50, Staniford Street, Suite 830 Boston, MA 02114 USA
| | - Y Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50, Staniford Street, Suite 830 Boston, MA 02114 USA
| | - X Mozo Alegría
- Hospital Universitari Vall d'Hebron, Paseo de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - B L Cook
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, 1035, Cambridge Street, Cambridge MA 02141 USA
| | - M Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50, Staniford Street, Suite 830 Boston, MA 02114 USA.
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158
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Hudson DL, Neighbors HW, Geronimus AT, Jackson JS. Racial Discrimination, John Henryism, and Depression Among African Americans. JOURNAL OF BLACK PSYCHOLOGY 2016. [PMID: 27529626 DOI: 10.1177/00957984145677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Evidence from previous studies indicates that racial discrimination is significantly associated with depression and that African Americans with higher levels of socioeconomic status (SES) report greater exposure to racial discrimination compared to those with lower SES levels. Coping strategies could alter the relationship between racial discrimination and depression among African Americans. This study first examined whether greater levels of SES were associated with increased reports of racial discrimination and ratings of John Henryism, a measure of high-effort coping, among African Americans. Second, we examined whether high-effort coping moderated the relationship between racial discrimination and depression. Data were drawn from the National Survey of American Life Reinterview (n = 2,137). Analyses indicated that greater levels of education were positively associated with racial discrimination (p < .001) and increased levels of racial discrimination were positively related to depression (p < .001), controlling for all sociodemographic factors. Greater levels of John Henryism were associated with increased odds of depression but there was no evidence to suggest that the relationship between discrimination and depression was altered by the effects of John Henryism.
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159
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Hudson DL, Neighbors HW, Geronimus AT, Jackson JS. Racial Discrimination, John Henryism, and Depression Among African Americans. JOURNAL OF BLACK PSYCHOLOGY 2016; 42:221-243. [PMID: 27529626 DOI: 10.1177/0095798414567757] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Evidence from previous studies indicates that racial discrimination is significantly associated with depression and that African Americans with higher levels of socioeconomic status (SES) report greater exposure to racial discrimination compared to those with lower SES levels. Coping strategies could alter the relationship between racial discrimination and depression among African Americans. This study first examined whether greater levels of SES were associated with increased reports of racial discrimination and ratings of John Henryism, a measure of high-effort coping, among African Americans. Second, we examined whether high-effort coping moderated the relationship between racial discrimination and depression. Data were drawn from the National Survey of American Life Reinterview (n = 2,137). Analyses indicated that greater levels of education were positively associated with racial discrimination (p < .001) and increased levels of racial discrimination were positively related to depression (p < .001), controlling for all sociodemographic factors. Greater levels of John Henryism were associated with increased odds of depression but there was no evidence to suggest that the relationship between discrimination and depression was altered by the effects of John Henryism.
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160
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Wallace S, Nazroo J, Bécares L. Cumulative Effect of Racial Discrimination on the Mental Health of Ethnic Minorities in the United Kingdom. Am J Public Health 2016; 106:1294-300. [PMID: 27077347 DOI: 10.2105/ajph.2016.303121] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the longitudinal association between cumulative exposure to racial discrimination and changes in the mental health of ethnic minority people. METHODS We used data from 4 waves (2009-2013) of the UK Household Longitudinal Study, a longitudinal household panel survey of approximately 40 000 households, including an ethnic minority boost sample of approximately 4000 households. RESULTS Ethnic minority people who reported exposure to racial discrimination at 1 time point had 12-Item Short Form Health Survey (SF-12) mental component scores 1.93 (95% confidence interval [CI] = -3.31, -0.56) points lower than did those who reported no exposure to racial discrimination, whereas those who had been exposed to 2 or more domains of racial discrimination, at 2 different time points, had SF-12 mental component scores 8.26 (95% CI = -13.33, -3.18) points lower than did those who reported no experiences of racial discrimination. Controlling for racial discrimination and other socioeconomic factors reduced ethnic inequalities in mental health. CONCLUSIONS Cumulative exposure to racial discrimination has incremental negative long-term effects on the mental health of ethnic minority people in the United Kingdom. Studies that examine exposure to racial discrimination at 1 point in time may underestimate the contribution of racism to poor health.
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Affiliation(s)
- Stephanie Wallace
- All of the authors are with Centre on Dynamics of Ethnicity, University of Manchester, Manchester, Lancashire, UK
| | - James Nazroo
- All of the authors are with Centre on Dynamics of Ethnicity, University of Manchester, Manchester, Lancashire, UK
| | - Laia Bécares
- All of the authors are with Centre on Dynamics of Ethnicity, University of Manchester, Manchester, Lancashire, UK
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161
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Nollen NL, Ahluwalia JS, Lei Y, Yu Q, Scheuermann TS, Mayo MS. Adult Cigarette Smokers at Highest Risk for Concurrent Alternative Tobacco Product Use Among a Racially/Ethnically and Socioeconomically Diverse Sample. Nicotine Tob Res 2016; 18:386-94. [PMID: 25999383 PMCID: PMC6220834 DOI: 10.1093/ntr/ntv110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 05/12/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Rates of alternative tobacco product use (ATPs; eg, cigars, cigarillos, pipes) among cigarette smokers are on the rise but little is known about the subgroups at highest risk. This study explored interactions between demographic, tobacco, and psychosocial factors to identify cigarette smokers at highest risk for ATP use from a racially/ethnically and socioeconomically diverse sample of adult smokers across the full smoking spectrum (nondaily, daily light, daily heavy). METHODS Two-thousand three-hundred seventy-six adult cigarette smokers participated in an online cross-sectional survey. Quotas ensured equal recruitment of African American (AA), white (W), Hispanic/Latino (H) as well as daily and nondaily smokers. Classification and Regression Tree modeling was used to identify subgroups of cigarette smokers at highest risk for ATP use. RESULTS 51.3% were Cig+ATP smokers. Alcohol for men and age, race/ethnicity, and discrimination for women increased the probability of ATP use. Strikingly, 73.5% of men screening positive for moderate to heavy drinking and 62.2% of younger (≤45 years) African American/Hispanic/Latino women who experienced regular discrimination were Cig+ATP smokers. CONCLUSIONS Screening for concurrent ATP use is necessary for the continued success of tobacco cessation efforts especially among male alcohol users and racial/ethnic minority women who are at greatest risk for ATP use.
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Affiliation(s)
- Nicole L Nollen
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS;
| | - Jasjit S Ahluwalia
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Yang Lei
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS
| | - Qing Yu
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS
| | - Taneisha S Scheuermann
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS
| | - Matthew S Mayo
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, KS
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162
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Reid AE, Rosenthal L, Earnshaw VA, Lewis TT, Lewis JB, Stasko EC, Tobin JN, Ickovics JR. Discrimination and excessive weight gain during pregnancy among Black and Latina young women. Soc Sci Med 2016; 156:134-41. [PMID: 27038321 DOI: 10.1016/j.socscimed.2016.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 02/26/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
RATIONALE Excessive weight gain during pregnancy is a major determinant of later life obesity among both Black and Latina women and their offspring. However, psychosocial determinants of this risk, including everyday discrimination, and potential moderators of such effects remain unexplored. OBJECTIVE We examined the influence of discrimination, a culturally relevant stressor, on odds of gaining weight beyond Institute of Medicine recommendations during pregnancy. Whether the effect was moderated by race/ethnicity, age, or depressive symptoms was also examined. METHOD Participants were 413 Black and Latina pregnant young women, ages 14-21 years. Experience with discrimination and all moderators were assessed in the second trimester. Last weight recorded in the third trimester was abstracted from medical records and used to determine excessive weight gain. RESULTS Ever experiencing discrimination was associated with a 71% increase in the odds of excessive weight gain. The effect of discrimination was primarily present among women who attributed this treatment to membership in a historically oppressed group (e.g., ethnic minority, female) or to membership in other stigmatized groups (e.g., overweight). The effect of ever experiencing discrimination was not moderated by race/ethnicity or age but was moderated by depressive symptoms. Supporting the perspective of the environmental affordances model, discrimination strongly predicted excessive weight gain when women were low in depressive symptoms but had no effect when women were high in depressive symptoms. The moderating role of depressive symptoms was equivalent for Black and Latina women. CONCLUSION Results highlight the role of discrimination in perpetuating weight-related health disparities and suggest opportunities for improving health outcomes among young pregnant women.
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Affiliation(s)
- Allecia E Reid
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States; Colby College, Psychology Department, United States.
| | - Lisa Rosenthal
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States; Pace University, Psychology Department, United States
| | - Valerie A Earnshaw
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States; Harvard Medical School, Department of Pediatrics, United States; Boston Children's Hospital, Department of Medicine, United States
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, United States
| | - Jessica B Lewis
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States
| | - Emily C Stasko
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States
| | | | - Jeannette R Ickovics
- Yale University, Center for Interdisciplinary Research on AIDS, School of Public Health, United States
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163
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Van Dyke ME, Vaccarino V, Quyyumi AA, Lewis TT. Socioeconomic status discrimination is associated with poor sleep in African-Americans, but not Whites. Soc Sci Med 2016; 153:141-7. [PMID: 26896878 DOI: 10.1016/j.socscimed.2016.02.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/18/2016] [Accepted: 02/08/2016] [Indexed: 01/05/2023]
Abstract
RATIONALE Research on self-reported experiences of discrimination and health has grown in recent decades, but has largely focused on racial discrimination or overall mistreatment. Less is known about reports of discrimination on the basis of socioeconomic status (SES), despite the fact that SES is one of the most powerful social determinants of health. OBJECTIVE We sought to examine the cross-sectional association between self-reported SES discrimination and subjective sleep quality, an emerging risk factor for disease. We further examined whether associations differed by race or SES. METHODS We used logistic and linear regression to analyze data from a population-based cohort of 425 African-American and White middle-aged adults (67.5% female) in the Southeastern United States. SES discrimination was assessed with a modified Experiences of Discrimination Scale and poor subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index. RESULTS In logistic regression models adjusted for age, gender, and education, reports of SES discrimination were associated with poor sleep quality among African-Americans (OR = 2.39 95%, CI = 1.35, 4.24), but not Whites (OR = 1.03, 95% CI = 0.57, 1.87), and the race × SES discrimination interaction was significant at p = 0.04. After additional adjustments for reports of racial and gender discrimination, other psychosocial stressors, body mass index and depressive symptoms, SES discrimination remained a significant predictor of poor sleep among African-Americans, but not Whites. In contrast to findings by race, SES discrimination and sleep associations did not significantly differ by SES. CONCLUSION Findings suggest that reports of SES discrimination may be an important risk factor for subjective sleep quality among African-Americans and support the need to consider the health impact of SES-related stressors in the context of race.
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Affiliation(s)
- Miriam E Van Dyke
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA.
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA.
| | - Arshed A Quyyumi
- Division of Cardiology, School of Medicine, Emory University, 1462 Clifton Road, NE, Suite 507, Atlanta, GA 30322, USA.
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, NE, Atlanta, GA 30322, USA.
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Trajectories of perceived discrimination from adolescence to emerging adulthood and substance use among Hispanic youth in Los Angeles. Addict Behav 2016; 53:108-12. [PMID: 26477013 DOI: 10.1016/j.addbeh.2015.10.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 09/21/2015] [Accepted: 10/04/2015] [Indexed: 11/23/2022]
Abstract
Previous studies have documented associations between perceptions of racial/ethnic discrimination and adverse health outcomes among Hispanics and other minority groups. However, these studies have not examined change in perceived discrimination over the lifecourse and whether trajectories of perceived discrimination affect outcomes differently. This study of 2722 Hispanic students identified trajectories of perceived discrimination from 9th grade through emerging adulthood (approximately ages 14-23), and compared these trajectory groups on substance use outcomes. Four distinct trajectory groups were identified: (1) low and stable discrimination, (2) increasing discrimination, (3) initially high but decreasing discrimination, and (4) high and stable discrimination. Compared with the low and stable discrimination group, the groups that experienced higher levels of discrimination were at higher risk of cigarette, alcohol, marijuana, and hard drug use. Specifically, the group with increasing discrimination (group 2) had a higher risk of alcohol, marijuana, and hard drug use; the group with initially high but decreasing discrimination (group 3) had a higher risk of cigarette smoking and alcohol use; and the group with high and stable discrimination (group 4) had a higher risk of alcohol, marijuana, and hard drug use. Results indicate that experiencing discrimination during adolescence, emerging adulthood, or both, regardless of whether the discrimination increases or decreases, could place Hispanic youth at risk for substance use. Health education programs are needed to help Hispanic youth learn effective skills to cope with discrimination without resorting to substance use.
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165
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Britt-Spells AM, Slebodnik M, Sands LP, Rollock D. Effects of Perceived Discrimination on Depressive Symptoms Among Black Men Residing in the United States: A Meta-Analysis. Am J Mens Health 2016; 12:52-63. [PMID: 26742988 DOI: 10.1177/1557988315624509] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Research reports that perceived discrimination is positively associated with depressive symptoms. The literature is limited when examining this relationship among Black men. This meta-analysis systematically examines the current literature and investigates the relationship of perceived discrimination on depressive symptoms among Black men residing in the United States. Using a random-effects model, study findings indicate a positive association between perceived discrimination and depressive symptoms among Black men ( r = .29). Several potential moderators were also examined in this study; however, there were no significant moderation effects detected. Recommendations and implications for future research and practice are discussed.
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166
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Kolarcik P, Geckova AM, Reijneveld SA, Van Dijk JP. The mediating effect of discrimination, social support and hopelessness on self-rated health of Roma adolescents in Slovakia. Int J Equity Health 2015; 14:137. [PMID: 26584612 PMCID: PMC4653892 DOI: 10.1186/s12939-015-0270-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 11/10/2015] [Indexed: 11/16/2022] Open
Abstract
Background According to the EU-MIDIS report on discrimination, Roma are the most discriminated against group in Europe. Research suggests that experiencing discrimination may itself be detrimental to health. The aim of this paper is to investigate whether discrimination, hopelessness and social support mediate differences in self-rated health (SRH) between Roma and non-Roma adolescents. Methods We conducted a cross-sectional study among Roma from separated and segregated settlements in the eastern part of Slovakia (N = 330; mean age = 14.50; interview) and non-Roma adolescents (N = 722; mean age = 14.86; questionnaire); only non-missing data were used for analyses (n = 759). The effect of perceived discrimination, mother and father social support, and hopelessness on SRH was analysed as crude and adjusted for ethnicity, age, gender, parental education and social desirability. Mediating effects were separately assessed using the Sobel test and structural equation modelling. Results Roma adolescents reported poorer SRH and more discrimination, mother and father social support, hopelessness and social desirability. Roma ethnicity (Odds ratio/95 %-Confidence interval 3.27/2.40–4.47), discrimination (2.66/1.82–3.88), hopelessness (1.35/1.20–1.51) and mother (0.92/0.88–0.97) and father social support (0.96/0.93 – 0.997) were statistically significant predictors of poor SRH. Perceived discrimination, social support and hopelessness mediated the ethnicity-health association, with adjustment for social support increasing its strength and the other two variables decreasing it. Conclusions Perceived discrimination, social support and hopelessness mediate a part of the association between Roma ethnicity and poor SRH, with discrimination and hopelessness being risk factors and social support a protective factor.
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Affiliation(s)
- Peter Kolarcik
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Košice, Slovakia. .,Department of Health Psychology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Košice, Slovakia. .,Olomouc University Social Health Institute, Sts Cyril and Methodius Faculty of Theology, Palacky University Olomouc, Univerzitní 22, 771 11, Olomouc, Czech Republic.
| | - Andrea Madarasova Geckova
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Košice, Slovakia. .,Department of Health Psychology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Košice, Slovakia. .,Olomouc University Social Health Institute, Sts Cyril and Methodius Faculty of Theology, Palacky University Olomouc, Univerzitní 22, 771 11, Olomouc, Czech Republic.
| | - Sijmen A Reijneveld
- Department of Social Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
| | - Jitse P Van Dijk
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 11, Košice, Slovakia. .,Department of Social Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
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167
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Bastos JL, Celeste RK, Silva DAS, Priest N, Paradies YC. Assessing mediators between discrimination, health behaviours and physical health outcomes: a representative cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1731-42. [PMID: 26264154 DOI: 10.1007/s00127-015-1108-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Discrimination is a social determinant of health; however, the pathways linking discrimination to ill-health are under-researched. This study investigated the mediators through which discrimination affects health behaviours and physical health outcomes, as well as assessed whether sex moderated these mechanisms. METHODS Data from a representative survey (n = 1023) of undergraduate students enrolled in a Brazilian university in 2012 were used. Structural equation models were applied to assess the following mediation mechanisms--(1) discrimination influences self-rated health and body mass index via anxiety/depression; (2) discrimination affects behaviours (alcohol consumption, problem drinking, smoking, fruit/vegetable consumption, and physical activity) through discomfort associated with discriminatory experiences. The potential of sex to act as an effect-modifying variable was also explored in each of the postulated pathways. RESULTS The effect of discrimination on self-rated poor health was totally (100.0%) mediated by anxiety/depression, while body mass index was not correlated with discrimination. Self-reported discrimination was associated with some behaviours via discomfort. Particularly, discomfort partially mediated the positive association between discrimination, leisure time physical activity (43.3%), and fruit/vegetable consumption (52.2%). Sex modified the association between discrimination, discomfort and physical activity in that such mechanism (more discrimination → more discomfort → more physical activity) was statistically significant in the entire sample and among females, but not among males. CONCLUSIONS This is one of the first studies to demonstrate that discrimination is associated with physical health outcomes and behaviours via distinct pathways. Future investigations should further explicate the mediational pathways between discrimination and key health outcomes.
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Affiliation(s)
- João Luiz Bastos
- Post-graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Santa Catarina, 88040-970, Brazil.
| | - Roger Keller Celeste
- Post-graduate Program in Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil.
| | - Diego Augusto Santos Silva
- Post-graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Santa Catarina, 88040-970, Brazil.
- Post-graduate Program in Physical Education, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, SC, 88040-970, Brazil.
| | - Naomi Priest
- Australian Centre for Applied Social Research Methods, Australian National University, Acton ACT, Canberra, NSW, 0200, Australia.
| | - Yin Carl Paradies
- Faculty of Arts and Education, Alfred Deakin Research Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC, 3125, Australia.
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168
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Lacey KK, Parnell R, Mouzon DM, Matusko N, Head D, Abelson JM, Jackson JS. The mental health of US Black women: the roles of social context and severe intimate partner violence. BMJ Open 2015; 5:e008415. [PMID: 26482770 PMCID: PMC4611204 DOI: 10.1136/bmjopen-2015-008415] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Black women continue to have rates of mental health conditions that can be negative for their well-being. This study examined the contribution of social and contextual factors and severe physical intimate partner violence on the mental health of US Black women (African-American and Caribbean Black). SETTING Data were largely collected via in-person community interviews at participants' homes. PARTICIPANTS We studied 3277 African-American and Black Caribbean women from the 2001-2003 National Survey of American Life (NSAL), the largest and most complete sample of Blacks residing in the USA. PRIMARY AND SECONDARY OUTCOMES Key outcomes included an array of psychiatric disorders based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). RESULTS Bivariate results revealed noticeably high rates of any anxiety disorder, post-traumatic stress disorder, any substance disorder, alcohol abuse disorder, suicide ideation and attempts, and any overall mental disorder among African-American women relative to Caribbean Black women. Multiple social and contextual factors were associated with various mental disorders among both sets of Black women in multivariate models, with the most consistent associations found for severe physical intimate partner violence. Everyday discrimination was associated with anxiety disorders (95% AOR=2.08 CI 1.23 to 3.51), eating disorders (95% AOR=2.69 CI 1.38 to 5.22), and any disorder (95% AOR=2.18 CI 1.40 to 3.40), while neighbourhood drug problems contributed to mood (95% AOR=1.19 CI 1.04 to 1.36), substance disorders (95% AOR=1.37 CI 1.11 to 1.69) and any disorder (95% AOR=1.18 CI 1.03 to 1.34). CONCLUSIONS Severe physical intimate partner violence, discrimination, and to a lesser extent, neighbourhood problems are important predictors of Black women's health, findings that inform intervention and clinical services tailored to meet the needs of Black women from diverse ethnic and cultural backgrounds.
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Affiliation(s)
- Krim K Lacey
- University of Michigan, Institute for Social Research, Program for Research on Black Americans, Ann Arbor, Michigan, USA
| | - Regina Parnell
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Dawne M Mouzon
- Rutgers, The State University of New Jersey, Edward J. Bloustein School of Planning and Public Policy & Institute for Health, Health Care Policy & Aging Research, New Brunswick, New Jersey, USA
| | - Niki Matusko
- University of Michigan, Institute for Social Research, Ann Arbor, Michigan, USA
| | - Doreen Head
- College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Jamie M Abelson
- University of Michigan, Institute for Social Research, Ann Arbor, Michigan, USA
| | - James S Jackson
- University of Michigan, Institute for Social Research, Ann Arbor, Michigan, USA
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169
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Bécares L, Nazroo J, Kelly Y. A longitudinal examination of maternal, family, and area-level experiences of racism on children's socioemotional development: Patterns and possible explanations. Soc Sci Med 2015; 142:128-35. [PMID: 26301485 DOI: 10.1016/j.socscimed.2015.08.025] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
The association between experienced racial discrimination and poor health is now well documented, particularly among adult populations. However, longitudinal studies of the association between racism and child health are limited, and evidence on how racial discrimination experienced by members of children's immediate environment impact on child development, and the mechanisms by which this occurs, is scarce. We examined the longitudinal association between maternal, family, and area-level experiences of racial discrimination, and children's socioemotional development. We proposed that exposure to racial discrimination would be detrimental to children's socioemotional development via two mother-centred stress pathways: a worsening in maternal mental health, and an increase in harsh parenting practices. Data on ethnic minority mothers and their children were drawn from waves 3 to 5 (2006-2012) of the UK Millennium Cohort Study. Results of longitudinal path analyses show a strong association between maternal and family experiences of racial discrimination in wave 3, and a worsening in mother's mental health in wave 4. Maternal and family experiences of racial discrimination at wave 3 had an indirect effect on children's socioemotional development at wave 5. This occurred mainly via a worsening in mother's mental health, although some events of racial discrimination experienced by the mother and other family members also impacted negatively on children's socioemotional development via an increase in harsh parenting practices. We found a direct effect of maternal and family experiences of racial discrimination on children's socioemotional development. Our findings document the harm of growing up in a racist environment on the socioemotional development of children, and provide some evidence for the role of mother-centred stress mechanisms in linking vicarious exposure to racial discrimination to children's socioemotional development.
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Affiliation(s)
- Laia Bécares
- Centre on Dynamics of Ethnicity, University of Manchester, Oxford Road, M13 9PL, UK.
| | - James Nazroo
- Centre on Dynamics of Ethnicity, University of Manchester, Oxford Road, M13 9PL, UK
| | - Yvonne Kelly
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
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170
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Nadimpalli SB, James BD, Yu L, Cothran F, Barnes LL. The association between discrimination and depressive symptoms among older African Americans: the role of psychological and social factors. Exp Aging Res 2015; 41:1-24. [PMID: 25494668 DOI: 10.1080/0361073x.2015.978201] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED BACKGROUND/STUDY CONTEXT: Several studies have demonstrated a link between perceived discrimination and depression in ethnic minority groups, yet most have focused on younger or middle-aged African Americans and little is known about factors that may moderate the relationship. METHODS Participants were 487 older African Americans (60-98 years old) enrolled in the Minority Aging Research Study. Discrimination, depressive symptoms, and psychological and social resources were assessed via interview using validated measures. Ordinal logistic regression models were used to assess (1) the main relationship between discrimination and depression and (2) resilience, purpose in life, social isolation, and social networks as potential moderators of this relationship. RESULTS In models adjusted for age, sex, education, and income, perceived discrimination was positively associated with depressive symptoms (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.10-1.31; p < .001). However, there was no evidence of effect modification by resilience, purpose in life, social isolation, or social networks (all ps ≤ .05). CONCLUSION Findings provide support for accumulating evidence on the adverse mental health effects of discrimination among older African Americans. Because the association was not modified by psychological or social factors, these findings do not support a role for a buffering effect of resources on discrimination and depressive symptoms. Further studies are needed to examine a wider range of coping resources among older adults.
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171
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Johnson AM, Kirk R, Muzik M. Overcoming Workplace Barriers: A Focus Group Study Exploring African American Mothers' Needs for Workplace Breastfeeding Support. J Hum Lact 2015; 31:425-33. [PMID: 25714345 PMCID: PMC4506723 DOI: 10.1177/0890334415573001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 01/21/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Persistent racial disparities in breastfeeding show that African American women breastfeed at the lowest rates. Return to work is a critical breastfeeding barrier for African American women who return to work sooner than other ethnic groups and more often encounter unsupportive work environments. They also face psychosocial burdens that make breastfeeding at work uniquely challenging. Participants share personal struggles with combining paid employment and breastfeeding and suggest workplace and personal support strategies that they believe will help continue breastfeeding after a return to work. OBJECTIVE To explore current perspectives on ways to support African American mothers' workplace breastfeeding behavior. METHODS Pregnant African American women (n = 8), African American mothers of infants (n = 21), and lactation support providers (n = 9) participated in 1 of 6 focus groups in the Greater Detroit area. Each focus group audiotape was transcribed verbatim. Thematic analysis was used to inductively analyze focus group transcripts and field notes. Focus groups explored thoughts, perceptions, and behavior on interventions to support African American women's breastfeeding. RESULTS Participants indicate that they generally believed breastfeeding was a healthy option for the baby; however, paid employment is a critical barrier to successful breastfeeding for which mothers receive little help. Participants felt breastfeeding interventions that support working African American mothers should include education and training for health care professionals, regulation and enforcement of workplace breastfeeding support policies, and support from peers who act as breastfeeding role models. CONCLUSION Culturally appropriate interventions are needed to support breastfeeding among working African American women.
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Affiliation(s)
- Angela Marie Johnson
- Department of Psychiatry and Program for Multicultural Health, University of Michigan Health System, Ann Arbor, MI, USA
| | - Rosalind Kirk
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
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172
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Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study. J Racial Ethn Health Disparities 2015; 3:250-8. [PMID: 27271066 DOI: 10.1007/s40615-015-0136-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/29/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Diversification of the physician workforce continues to be a national priority; however, a paucity of knowledge about the medical school experience for African American medical students limits our ability to achieve this goal. Previous studies document that African American medical students are at greater risk for depression and anxiety. This study moves beyond these findings to explore the role of racial identity (the extent to which a person normatively defines her/himself with regard to race) and its relationship to well-being for African American medical students in their first year of training. METHODS This study used baseline data from the Medical Student Cognitive Habits and Growth Evaluation (CHANGE) Study; a large national longitudinal cohort study of 4732 medical students at 49 medical schools in the US racial identity for African American students (n = 301) was assessed using the centrality sub-scale of the Multidimensional Inventory of Black Identity. Generalized linear regression models with a Poisson regression family distribution were used to estimate the relative risks of depression, anxiety, and perceived stress. RESULTS First year African American medical students who had lower levels of racial identity were less likely to experience depressive and anxiety symptoms in their first year of medical school. After controlling for other important social predictors of poor mental health (gender and SES), this finding remained significant. CONCLUSIONS Results increase knowledge about the role of race as a core part of an individual's self-concept. These findings provide new insight into the relationship between racial identity and psychological distress, particularly with respect to a group of high-achieving young adults.
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173
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Denton EGD, Shaffer JA, Alcantara C, Clemow L, Brondolo E. Hispanic residential ethnic density and depression in post-acute coronary syndrome patients: Re-thinking the role of social support. Int J Soc Psychiatry 2015; 61:225-35. [PMID: 24985313 PMCID: PMC4281507 DOI: 10.1177/0020764014540148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The ethnic density hypothesis suggests that ethnic density confers greater social support and consequently protects against depressive symptoms in ethnic minority individuals. However, the potential benefits of ethnic density have not been examined in individuals who are facing a specific and salient life stressor. AIMS We examined the degree to which the effects of Hispanic ethnic density on depressive symptoms are explained by socioeconomic resources and social support. METHODS Patients with acute coronary syndrome (ACS, N = 472) completed the Beck Depression Inventory (BDI) and measures of demographics, ACS clinical factors and perceived social support. Neighborhood characteristics, including median income, number of single parent households and Hispanic ethnic density, were extracted from the American Community Survey Census (2005-2009) for each patient using his or her geocoded address. RESULTS In a linear regression analysis adjusted for demographic and clinical factors, Hispanic ethnic density was positively associated with depressive symptoms (β = .09, standard error (SE) = .04, p = .03). However, Hispanic density was no longer a significant predictor of depressive symptoms when neighborhood characteristics were controlled. The relationship of Hispanic density on depressive symptoms was moderated by nativity status. Among US-born patients with ACS, there was a significant positive relationship between Hispanic density and depressive symptoms and social support significantly mediated this effect. There was no observed effect of Hispanic density to depressive symptoms for foreign-born ACS patients. CONCLUSION Although previous research suggests that ethnic density may be protective against depression, our data suggest that among patients with ACS, living in a community with a high concentration of Hispanic individuals is associated with constrained social and economic resources that are themselves associated with greater depressive symptoms. These data add to a growing body of literature on the effects of racial or ethnic segregation on health outcomes.
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Affiliation(s)
- Ellen-Ge D Denton
- Department of Psychology, College of Staten Island, The City University of New York, Staten Island, NY, USA
| | - Jonathan A Shaffer
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Carmela Alcantara
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Lynn Clemow
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
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175
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Kwate NOA, Goodman MS. Cross-sectional and longitudinal effects of racism on mental health among residents of Black neighborhoods in New York City. Am J Public Health 2015; 105:711-8. [PMID: 25521873 PMCID: PMC4358177 DOI: 10.2105/ajph.2014.302243] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated the impact of reported racism on the mental health of African Americans at cross-sectional time points and longitudinally, over the course of 1 year. METHODS The Black Linking Inequality, Feelings, and the Environment (LIFE) Study recruited Black residents (n = 144) from a probability sample of 2 predominantly Black New York City neighborhoods during December 2011 to June 2013. Respondents completed self-report surveys, including multiple measures of racism. We conducted assessments at baseline, 2-month follow-up, and 1-year follow-up. Weighted multivariate linear regression models assessed changes in racism and health over time. RESULTS Cross-sectional results varied by time point and by outcome, with only some measures associated with distress, and effects were stronger for poor mental health days than for depression. Individuals who denied thinking about their race fared worst. Longitudinally, increasing frequencies of racism predicted worse mental health across all 3 outcomes. CONCLUSIONS These results support theories of racism as a health-defeating stressor and are among the few that show temporal associations with health.
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Affiliation(s)
- Naa Oyo A Kwate
- Naa Oyo A. Kwate is with the Departments of Human Ecology and Africana Studies, Rutgers University, New Brunswick, NJ. Melody S. Goodman is with the Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO
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176
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Rosenthal L, Earnshaw VA, Lewis TT, Reid AE, Lewis JB, Stasko EC, Tobin JN, Ickovics JR. Changes in experiences with discrimination across pregnancy and postpartum: age differences and consequences for mental health. Am J Public Health 2015; 105:686-93. [PMID: 24922166 PMCID: PMC4264991 DOI: 10.2105/ajph.2014.301906] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We aimed to contribute to growing research and theory suggesting the importance of examining patterns of change over time and critical life periods to fully understand the effects of discrimination on health, with a focus on the period of pregnancy and postpartum and mental health outcomes. METHODS We used hierarchical linear modeling to examine changes across pregnancy and postpartum in everyday discrimination and the resulting consequences for mental health among predominantly Black and Latina, socioeconomically disadvantaged young women who were receiving prenatal care in New York City. RESULTS Patterns of change in experiences with discrimination varied according to age. Among the youngest participants, discrimination increased from the second to third trimesters and then decreased to lower than the baseline level by 1 year postpartum; among the oldest participants, discrimination decreased from the second trimester to 6 months postpartum and then returned to the baseline level by 1 year postpartum. Within-subjects changes in discrimination over time predicted changes in depressive and anxiety symptoms at subsequent points. Discrimination more strongly predicted anxiety symptoms among participants reporting food insecurity. CONCLUSIONS Our results support a life course approach to understanding the impact of experiences with discrimination on health and when to intervene.
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Affiliation(s)
- Lisa Rosenthal
- Lisa Rosenthal is with the Psychology Department, Pace University, New York, NY. Valerie A. Earnshaw, Jessica B. Lewis, and Jeannette R. Ickovics are with the Yale School of Public Health and the Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT. Tené T. Lewis is with the Rollins School of Public Health, Emory University, Atlanta, GA. Allecia E. Reid is with the Psychology Department, Colby College, Waterville, ME. Emily C. Stasko is with the Department of Psychology, Drexel University, Philadelphia, PA. Jonathan N. Tobin is with the Clinical Directors Network, New York, NY
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177
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Rosenthal L, Earnshaw VA, Carroll-Scott A, Henderson KE, Peters SM, McCaslin C, Ickovics JR. Weight- and race-based bullying: health associations among urban adolescents. J Health Psychol 2015; 20:401-12. [PMID: 24155192 PMCID: PMC3995896 DOI: 10.1177/1359105313502567] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Stigma-based bullying is associated with negative mental and physical health outcomes. In a longitudinal study, surveys and physical assessments were conducted with mostly Black and Latino, socioeconomically disadvantaged, urban students. As hypothesized, greater weight- and race-based bullying each was significantly indirectly associated with increased blood pressure and body mass index, as well as decreased overall self-rated health across 2 years, through the mechanism of more negative emotional symptoms. Results support important avenues for future research on mechanisms and longitudinal associations of stigma-based bullying with health. Interventions are needed to reduce stigma-based bullying and buffer adolescents from adverse health effects.
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Affiliation(s)
- Lisa Rosenthal
- Yale School of Public Health, CARE: Community Alliance for Research and Engagement, USA
| | - Valerie A Earnshaw
- Yale School of Public Health, CARE: Community Alliance for Research and Engagement, USA
| | - Amy Carroll-Scott
- Yale School of Public Health, CARE: Community Alliance for Research and Engagement, USA
| | | | - Susan M Peters
- Yale School of Public Health, CARE: Community Alliance for Research and Engagement, USA
| | | | - Jeannette R Ickovics
- Yale School of Public Health, CARE: Community Alliance for Research and Engagement, USA
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178
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Van Sluytman L, Spikes P, Nandi V, Van Tieu H, Frye V, Patterson J, Koblin B. Ties that bind: community attachment and the experience of discrimination among Black men who have sex with men. CULTURE, HEALTH & SEXUALITY 2015; 17:859-72. [PMID: 25647586 PMCID: PMC4629835 DOI: 10.1080/13691058.2015.1004762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In the USA, the impact of psychological distress may be greater for Black men who have sex with men given that they may experience both racial discrimination in society at large and discrimination due to sexual orientation within Black communities. Attachments to community members may play a role in addressing psychological distress for members of this vulnerable population. This analysis is based on 312 Black men who have sex with men recruited for a behavioural intervention trial in New York City. Analyses were conducted using bivariate and multivariable logistic regression to examine the relationship of discrimination and community attachment to psychological distress. Most participants (63%) reported exposure to both discrimination due to race and sexual orientation. However, a majority of participants (89%) also reported racial and/or sexual orientation community attachment. Psychological distress was significant and negatively associated with older age (40 years and above), being a high school graduate and having racial and/or sexual orientation community attachments. Psychological distress was significantly and positively associated with being HIV-positive and experiencing both racial and sexual orientation discrimination. Similar results were found in the multivariable model. Susceptibility to disparate psychological distress outcomes must be understood in relation to social membership, including its particular norms, structures and ecological milieu.
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Affiliation(s)
| | - Pilgrim Spikes
- Division of HIV/AIDS Prevention, US Centers for Disease Control, Atlanta, USA
| | | | | | | | - Jocelyn Patterson
- Division of HIV/AIDS Prevention, US Centers for Disease Control, Atlanta, USA
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179
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Race Attribution Modifies the Association Between Daily Discrimination and Major Depressive Disorder Among Blacks: the Role of Gender and Ethnicity. J Racial Ethn Health Disparities 2015; 2:200-10. [PMID: 26863338 DOI: 10.1007/s40615-014-0064-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 09/10/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Although the association between discrimination and depression among Blacks is well-known, we do not know if this effect is influenced by race attribution. In this current study, we investigated the effect modification of race attribution on the association between everyday discrimination and major depressive disorder (MDD) among Blacks in the United States, and whether this effect modification is influenced by the intersection of ethnicity and gender. METHODS With a cross-sectional design, this study used data from the National Survey of American Life (NSAL), 2001-2003. The study included a nationally representative sample of Blacks (n = 5,008), composed of 3,570 African Americans and 1,438 Caribbean Blacks. Everyday discrimination, two single-item measures of race attribution (race as the major barrier against upward social mobility, and race as the main cause for being discriminated against) and 12-month MDD were measured. In the first step, we fit logistic regressions to the pooled sample. In the next step, we ran regressions specific to the intersections of ethnicity and gender. Interaction between race attribution and discrimination were also entered into the models. RESULTS Among Caribbean Black men, the belief that race is a major barrier against one's own upward social mobility modified the association between exposure to daily discrimination and MDD. In this group, the association between discrimination and MDD was weaker among those who believed that race is a major barrier against one's own upward social mobility. Race attribution did not modify the association between discrimination and MDD among African American men, African American women, and Caribbean Black women. The other measure of race attribution (race as the main cause of being discriminated against) did not modify the association between discrimination and MDD in any ethnicity by gender subgroups. CONCLUSIONS Among Caribbean Black men, the link between everyday discrimination and depression may depend on seeing race as the main barrier against upward social mobility. Among African American men and women, however, the link between discrimination and MDD does not depend on race attribution. Our results suggest that ethnicity, gender, and race attribution may alter the association between discrimination and risk of MDD among Blacks.
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180
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Bostwick WB, Boyd CJ, Hughes TL, West BT, McCabe SE. Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2015; 84:35-45. [PMID: 24826824 DOI: 10.1037/h0098851] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Health disparities among sexual minority groups, particularly mental health disparities, are well-documented. Numerous studies have demonstrated heightened prevalence of depressive and anxiety disorders among lesbian, gay, and bisexual groups as compared with heterosexuals. Some authors posit that these disparities are the result of the stress that prejudice and perceived discrimination can cause. The current study extends previous research by examining the associations between multiple types of discrimination, based on race or ethnicity, gender, and sexual orientation, and past-year mental health disorders in a national sample of self-identified lesbian, gay, and bisexual women and men (n = 577). Findings suggest that different types of discrimination may be differentially associated with past-year mental health disorders. Notably, sexual orientation discrimination was associated with higher odds of a past-year disorder only in combination with other types of discrimination. These findings point to the complexity of the relationship between discrimination experiences and mental health, and suggest that further work is needed to better explicate the interplay among multiple marginalized identities, discrimination, and mental health.
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Affiliation(s)
- Wendy B Bostwick
- Public Health and Health Education Programs, Northern Illinois University
| | | | | | - Brady T West
- Survey Research Center, Institute for Social Research, University of Michigan
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181
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Thayer ZM, Kuzawa CW. Ethnic discrimination predicts poor self-rated health and cortisol in pregnancy: insights from New Zealand. Soc Sci Med 2015; 128:36-42. [PMID: 25589034 DOI: 10.1016/j.socscimed.2015.01.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite growing research emphasis on understanding the health effects of ethnic discrimination, little work has focused on how such exposures may influence a woman's biology and health during pregnancy. Understanding such effects is important given evidence that maternal stress experience in pregnancy can have long term effects on offspring health. Here we present data evaluating the relationship between perceived discrimination, self-rated health, and the stress hormone cortisol measured in late pregnancy among a diverse sample of women living in Auckland, New Zealand (N = 55). We also evaluated possible intergenerational impacts of maternal discrimination on stress reactivity in a subset of offspring (N = 19). Pregnant women were recruited from two antenatal care clinics in Auckland. Women were met in their homes between 34 and 36 weeks gestation, during which time a prenatal stress questionnaire was administered and saliva samples (morning and evening from two days) were obtained. Offspring cortisol reactivity was assessed at the standard six week postnatal vaccination visit. We found that 34% of women reported having experienced ethnic discrimination, with minority and immigrant women being more likely to report being angry or upset in response to discrimination experience compared with NZ-born women of European descent. Women reporting discrimination experience had worse self-rated health, higher evening cortisol and gave birth to infants with higher cortisol reactivity, all independent of ethnicity and material deprivation. These findings suggest that discrimination experience can have biological impacts in pregnancy and across generations, potentially contributing to the ethnic gradient in health.
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Affiliation(s)
- Zaneta M Thayer
- Department of Anthropology, University of Colorado Denver, Denver, CO, USA.
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182
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Lewis TT, Cogburn CD, Williams DR. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol 2015; 11:407-40. [PMID: 25581238 DOI: 10.1146/annurev-clinpsy-032814-112728] [Citation(s) in RCA: 608] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Over the past two decades, research examining the impact of self-reported experiences of discrimination on mental and physical health has increased dramatically. Studies have found consistent associations between exposure to discrimination and a wide range of Diagnostic and Statistical Manual of Mental Disorders (DSM)-diagnosed mental disorders as well as objective physical health outcomes. Associations are seen in cross-sectional as well as longitudinal studies and persist even after adjustment for confounding variables, including personality characteristics and other threats to validity. However, controversies remain, particularly around the best approach to measuring experiences of discrimination, the significance of racial/ethnic discrimination versus overall mistreatment, the need to account for "intersectionalities," and the importance of comprehensive assessments. These issues are discussed in detail, along with emerging areas of emphasis including cyber discrimination, anticipatory stress or vigilance around discrimination, and interventions with potential to reduce the negative effects of discrimination on health. We also discuss priorities for future research and implications for interventions and policy.
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Affiliation(s)
- Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322;
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183
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Johnson A, Kirk R, Rosenblum KL, Muzik M. Enhancing breastfeeding rates among African American women: a systematic review of current psychosocial interventions. Breastfeed Med 2015; 10:45-62. [PMID: 25423601 PMCID: PMC4307211 DOI: 10.1089/bfm.2014.0023] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The goals of this article are to provide a review of key interventions and strategies that impact initiation and duration of breastfeeding with particular focus on low-income African American mothers' maternal psychological vulnerabilities during the early postpartum period using a social ecological perspective as a guiding framework. Although modest gains have been achieved in breastfeeding initiation rates in the United States, a projected gap remains between infant feeding practices and national Healthy People breastfeeding goals set for 2020, particularly among African Americans. These disparities raise concerns that socially disadvantaged mothers and babies may be at increased risk for poor postnatal outcomes because of poorer mental health and increased vulnerability to chronic health conditions. Breastfeeding can be a protective factor, strengthening the relationship between mother and baby and increasing infant health and resilience. Evidence suggests that no single intervention can sufficiently address the multiple breastfeeding barriers faced by mothers. Effective intervention strategies require a multilevel approach. A social ecological perspective highlights that individual knowledge, behavior, and attitudes are shaped by interactions between the individual woman, her friends and family, and her wider historical, social, political, economic, institutional, and community contexts, and therefore effective breastfeeding interventions must reflect all these aspects. Current breastfeeding interventions are disjointed and inadequately meet all African American women's social and psychological breastfeeding needs. Poor outcomes indicate a need for an integrative approach to address the complexity of interrelated breastfeeding barriers mothers' experience across layers of the social ecological system.
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Affiliation(s)
- Angela Johnson
- Department of Psychiatry, University of Michigan , Ann Arbor, Michigan
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184
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Everyday discrimination and mood and substance use disorders: a latent profile analysis with African Americans and Caribbean Blacks. Addict Behav 2015; 40:119-25. [PMID: 25254321 DOI: 10.1016/j.addbeh.2014.08.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/24/2014] [Accepted: 08/11/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Perceived discrimination is a major source of health-related stress. The purpose of this study was to model the heterogeneity of everyday-discrimination experiences among African American and Caribbean Blacks and to identify differences in the prevalence of mood and substance use outcomes, including generalized anxiety disorder, major depressive disorder, alcohol-use disorder, and illicit drug-use disorder among the identified subgroups. METHOD The study uses data from the National Survey of American Life obtained from a sample of African American and Caribbean Black respondents (N=4,462) between 18 and 65 years. RESULTS We used latent profile analysis and multinomial regression analyses to identify and validate latent subgroups and test hypotheses, yielding 4 classes of perceived everyday discrimination: Low Discrimination, Disrespect and Condescension, General Discrimination, and Chronic Discrimination. Findings show significant differences exist between the Low Discrimination and General Discrimination classes for major depressive disorder, alcohol-use disorder, and illicit drug-use disorder. Moreover, we find significant differences exist between the Low Discrimination and Chronic Discrimination classes for the four disorders examined. Compared with the Chronic Discrimination class, members of the other classes were significantly less likely to meet criteria for generalized anxiety disorder, major depressive disorder, alcohol-use disorder, and illicit drug-use disorder. CONCLUSIONS Findings suggest elevated levels of discrimination increase risk for mood and substance-use disorders. Importantly, results suggest the prevalence of mood and substance-use disorders is a function of the type and frequency of discrimination that individuals experience.
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185
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Calabrese SK, Meyer IH, Overstreet NM, Haile R, Hansen NB. Exploring Discrimination and Mental Health Disparities Faced By Black Sexual Minority Women Using a Minority Stress Framework. PSYCHOLOGY OF WOMEN QUARTERLY 2014; 39:287-304. [PMID: 26424904 DOI: 10.1177/0361684314560730] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Black sexual minority women are triply marginalized due to their race, gender, and sexual orientation. We compared three dimensions of discrimination-frequency (regularity of occurrences), scope (number of types of discriminatory acts experienced), and number of bases (number of social statuses to which discrimination was attributed)-and self-reported mental health (depressive symptoms, psychological well-being, and social well-being) between 64 Black sexual minority women and each of two groups sharing two of three marginalized statuses: (a) 67 White sexual minority women and (b) 67 Black sexual minority men. Black sexual minority women reported greater discrimination frequency, scope, and number of bases and poorer psychological and social well-being than White sexual minority women and more discrimination bases, a higher level of depressive symptoms, and poorer social well-being than Black sexual minority men. We then tested and contrasted dimensions of discrimination as mediators between social status (race or gender) and mental health outcomes. Discrimination frequency and scope mediated the association between race and mental health, with a stronger effect via frequency among sexual minority women. Number of discrimination bases mediated the association between gender and mental health among Black sexual minorities. Future research and clinical practice would benefit from considering Black sexual minority women's mental health in a multidimensional minority stress context.
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Affiliation(s)
- Sarah K Calabrese
- Yale School of Public Health/Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Ilan H Meyer
- The Williams Institute UCLA School of Law, University of California, Los Angeles, CA, USA
| | | | - Rahwa Haile
- Public Health Department, State University of New York at Old Westbury, Old Westbury, NY, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
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186
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Boynton MH, O'Hara RE, Covault J, Scott D, Tennen H. A mediational model of racial discrimination and alcohol-related problems among african american college students. J Stud Alcohol Drugs 2014; 75:228-34. [PMID: 24650816 DOI: 10.15288/jsad.2014.75.228] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Racial discrimination has been identified as an important predictor of alcohol-related outcomes for African Americans. The goal of the current study was to extend previously found links between lifetime discrimination, alcohol use, and alcohol problems as well as to elucidate the affective mechanisms underlying these associations, as moderated by gender. METHOD A multiple-groups structural equation model was computed using survey data collected from 619 students from a historically Black college/university. RESULTS The final model provided excellent fit to the data, explaining 6% of the variance in alcohol consumption and 37% of the variance in alcohol problems. Discrimination was a significant predictor of alcohol-related problems but not, by and large, level of use. For men, anger-but not discrimination-specific anger-was a significant partial mediator of the link between discrimination and both alcohol use and alcohol problems. Depression partially mediated the link between discrimination and alcohol problems for both men and women. CONCLUSIONS The results suggest that, for African Americans whose drinking leads to drinking-related problems, discrimination and poor affective self-regulation are highly relevant and predictive factors, especially for men.
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Affiliation(s)
- Marcella H Boynton
- Alcohol Research Center, University of Connecticut School of Medicine, Farmington, Connecticut, Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Ross E O'Hara
- Alcohol Research Center, University of Connecticut School of Medicine, Farmington, Connecticut, Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jonathan Covault
- Alcohol Research Center, University of Connecticut School of Medicine, Farmington, Connecticut, Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Denise Scott
- Collaborative Alcohol Research Center, Howard University, Washington, DC
| | - Howard Tennen
- Alcohol Research Center, University of Connecticut School of Medicine, Farmington, Connecticut, Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, Connecticut
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187
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Ikram UZ, Snijder MB, Fassaert TJ, Schene AH, Kunst AE, Stronks K. The contribution of perceived ethnic discrimination to the prevalence of depression. Eur J Public Health 2014; 25:243-8. [DOI: 10.1093/eurpub/cku180] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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188
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Himmelstein MS, Young DM, Sanchez DT, Jackson JS. Vigilance in the discrimination-stress model for Black Americans. Psychol Health 2014; 30:253-67. [PMID: 25247925 DOI: 10.1080/08870446.2014.966104] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Daily events of discrimination are important factors in understanding health disparities. Vigilant coping, or protecting against anticipated discrimination by monitoring and modifying behaviour, is an understudied mechanism that may link discrimination and health outcomes. This study investigates how responding to everyday discrimination with anticipatory vigilance relates to the health of Black men and women. METHODS Black adults (N = 221) from the Detroit area completed measures of discrimination, adverse life events, vigilance coping, stress, depressive symptoms and self-reported health. RESULTS Vigilance coping strategies mediated the relationship between discrimination and stress. Multi-group path analysis revealed that stress in turn was associated with increased depression in men and women. Self-reported health consequences of stress differed between men and women. CONCLUSIONS Vigilance coping mediates the link between discrimination and stress, and stress has consequences for health outcomes resulting from discrimination. More research is needed to understand other underlying contributors to discrimination, stress and poor health outcomes as well as to create potential interventions to ameliorate health outcomes in the face of discrimination-related stress.
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189
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Krieger N. Discrimination and Health Inequities. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2014; 44:643-710. [DOI: 10.2190/hs.44.4.b] [Citation(s) in RCA: 429] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In 1999, only 20 studies in the public health literature employed instruments to measure self-reported experiences of discrimination. Fifteen years later, the number of empirical investigations on discrimination and health easily exceeds 500, with these studies increasingly global in scope and focused on major types of discrimination variously involving race/ethnicity, indigenous status, immigrant status, gender, sexuality, disability, and age, separately and in combination. And yet, as I also document, even as the number of investigations has dramatically expanded, the scope remains narrow: studies remain focused primarily on interpersonal discrimination, and scant research investigates the health impacts of structural discrimination, a gap consonant with the limited epidemiologic research on political systems and population health. Accordingly, to help advance the state of the field, this updated review article: ( a) briefly reviews definitions of discrimination, illustrated with examples from the United States; ( b) discusses theoretical insights useful for conceptualizing how discrimination can become embodied and produce health inequities, including via distortion of scientific knowledge; ( c) concisely summarizes extant evidence—both robust and inconsistent—linking discrimination and health; and ( d) addresses several key methodological controversies and challenges, including the need for careful attention to domains, pathways, level, and spatiotemporal scale, in historical context.
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190
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Bastos JL, Barros AJD, Celeste RK, Paradies Y, Faerstein E. Age, class and race discrimination: their interactions and associations with mental health among Brazilian university students. CAD SAUDE PUBLICA 2014; 30:175-86. [PMID: 24627024 DOI: 10.1590/0102-311x00163812] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 08/01/2013] [Indexed: 11/22/2022] Open
Abstract
Although research on discrimination and health has progressed significantly, it has tended to focus on racial discrimination and US populations. This study explored different types of discrimination, their interactions and associations with common mental disorders among Brazilian university students, in Rio de Janeiro in 2010. Associations between discrimination and common mental disorders were examined using multiple logistic regression models, adjusted for confounders. Interactions between discrimination and socio-demographics were tested. Discrimination attributed to age, class and skin color/race were the most frequently reported. In a fully adjusted model, discrimination attributed to skin color/race and class were both independently associated with increased odds of common mental disorders. The simultaneous reporting of skin color/race, class and age discrimination was associated with the highest odds ratio. No significant interactions were found. Skin color/race and class discrimination were important, but their simultaneous reporting, in conjunction with age discrimination, were associated with the highest occurrence of common mental disorders.
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191
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Sadiq S, Bashir A. Relationship between perceived discrimination and loneliness among transgender: Mediating role of coping mechanism. ACTA ACUST UNITED AC 2014. [DOI: 10.5861/ijrsp.2014.940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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192
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Nakhaie R, Wijesingha R. Discrimination and Health of Male and Female Canadian Immigrant. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2014. [DOI: 10.1007/s12134-014-0392-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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193
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Womack VY, Ning H, Lewis CE, Loucks EB, Puterman E, Reis J, Siddique J, Sternfeld B, Van Horn L, Carnethon MR. Relationship between perceived discrimination and sedentary behavior in adults. Am J Health Behav 2014; 38:641-9. [PMID: 24933133 PMCID: PMC4229242 DOI: 10.5993/ajhb.38.5.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To identify psychosocial factors associated with sedentary behavior, we tested whether perceived discrimination is associated with sedentary behavior. METHODS Black and white men and women (N = 3270) from the Coronary Artery Risk Development in Young Adults (CARDIA) Study reported experiences of discrimination and time engaged in total and screen time sedentary behaviors in 2010-11. RESULTS There were no associations of discriminatory experiences with total sedentary behavior time. However, discriminatory experiences were positively associated with screen time for black men (OR 1.81, 95% CI: 1.14, 2.86) and white women (OR 1.51, 95% CI: 1.14, 2.00) after adjusting for demographic and traditional cardiovascular disease risk factors. CONCLUSION Among black men and white women, discriminatory experiences were correlated with more screen time sedentary behavior.
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Affiliation(s)
- Veronica Y Womack
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cora E Lewis
- Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Eric B Loucks
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Eli Puterman
- Psychiatry Department, University of California-San Francisco, San Francisco, CA, USA
| | - Jared Reis
- Division of Prevention and Population Sciences, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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194
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Schunck R, Reiss K, Razum O. Pathways between perceived discrimination and health among immigrants: evidence from a large national panel survey in Germany. ETHNICITY & HEALTH 2014; 20:493-510. [PMID: 24992379 DOI: 10.1080/13557858.2014.932756] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Discrimination is an important determinant of health, and its experience may contribute to the emergence of health inequalities between immigrants and nonimmigrants. We examine pathways between perceived discrimination and health among immigrants in Germany: (1) whether perceptions of discrimination predict self-reported mental and physical health (SF-12), or (2) whether poor mental and physical health predict perceptions of discrimination, and (3) whether discrimination affects physical health via mental health. DESIGN Data on immigrants come from the German Socio-Economic Panel (SOEP) from the years 2002 to 2010 (N = 8,307), a large national panel survey. Random and fixed effects regression models have been estimated. RESULTS Perceptions of discrimination affect mental and physical health. The effect of perceived discrimination on physical health is mediated by its effect on mental health. Our analyses do not support the notion that mental and physical health predict the subsequent reporting of discrimination. Different immigrant groups are differentially exposed to perceived discrimination. CONCLUSION In spite of anti-discrimination laws, the health of immigrants in Germany is negatively affected by perceived discrimination. Differential exposure to perceived discrimination may be seen as a mechanism contributing to the emergence of health inequalities in Germany.
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Affiliation(s)
- Reinhard Schunck
- a Department of Sociology , Bielefeld University , Bielefeld , Germany
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195
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Sellers SL, Cherepanov D, Hanmer J, Fryback DG, Palta M. Erratum to: Interpersonal discrimination and health-related quality of life among black and white men and women in the United States. Qual Life Res 2014; 22:1313-8. [PMID: 23306666 DOI: 10.1007/s11136-012-0278-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We assessed associations between discrimination and health-related quality of life among black and white men and women in the United States. METHODS We examined data from the National Health Measurement Study, a nationally representative sample of 3,648 adults aged 35-89 in the non-institutionalized US population. These data include self-reported lifetime and everyday discrimination as well as several health utility indexes (EQ-5D, HUI3, and SF-6D). Multiple regression was used to compute mean health utility scores adjusted for age, income, education, and chronic diseases for each race-by-gender subgroup. RESULTS Black men and women reported more discrimination than white men and women. Health utility tended to be worse as reported discrimination increased. With a few exceptions, differences between mean health utility scores in the lowest and highest discrimination groups exceeded the 0.03 difference generally considered to be a clinically significant difference. CONCLUSIONS Persons who experienced discrimination tended to score lower on health utility measures. The study also revealed a complex relationship between experiences of discrimination and race and gender. Because of these differential social and demographic relationships caution is urged when interpreting self-rated health measures in research, clinical, and policy settings.
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196
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Thayer ZM. The vitamin D hypothesis revisited: race-based disparities in birth outcomes in the United States and ultraviolet light availability. Am J Epidemiol 2014; 179:947-55. [PMID: 24618066 DOI: 10.1093/aje/kwu023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Skin color has been proposed to contribute to race-based health disparities in the United States because of differences in ultraviolet (UV) light-induced vitamin D synthesis. The prediction of this hypothesis, herein named the UVD hypothesis, is that racial disparities in health outcomes are correlated with UV light availability. This paper investigates whether UV light availability is associated with disparities in the rates of low birth weight (LBW) and preterm birth (PTB) between whites and blacks, because these outcomes are thought to be influenced by vitamin D status and to shape disease risk in later life. Data on LBW and PTB from 2007 (n = 2,825,620 births) were compared with data on UV light exposure across the United States. Contrary to the predictions of the UVD hypothesis, LBW and PTB rate disparities were greatest in states with the highest UV light exposure. Notably, income inequality was positively and significantly related to LBW and PTB disparities, even after controlling for UV light availability. The results of this analysis demonstrate that there is a significant environmental gradient in racial disparities in birth outcomes in the United States, but other social or environmental factors associated with living in the southern United States are likely stronger contributors to disparities in birth outcomes than UV light-induced vitamin D status.
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Dutton GR, Lewis TT, Durant N, Halanych J, Kiefe CI, Sidney S, Kim Y, Lewis CE. Perceived weight discrimination in the CARDIA study: differences by race, sex, and weight status. Obesity (Silver Spring) 2014; 22:530-6. [PMID: 23512948 PMCID: PMC3695009 DOI: 10.1002/oby.20438] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/21/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine self-reported weight discrimination and differences based on race, sex, and BMI in a biracial cohort of community-based middle-aged adults. DESIGN AND METHODS Participants (3,466, mean age = 50 years, mean BMI = 30 kg/m²) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study who completed the 25-year examination of this epidemiological investigation in 2010-2011 were reported. The sample included normal weight, overweight, and obese participants. CARDIA participants are distributed into four race-sex groups, with about half being African-American and half White. Participants completed a self-reported measure of weight discrimination. RESULTS Among overweight/obese participants, weight discrimination was lowest for White men (12.0%) and highest for White women (30.2%). The adjusted odds ratio (95% CI) for weight discrimination in those with class 2/3 obesity (BMI ≥ 35 kg/m²) versus the normal-weight was most pronounced: African American men, 4.59 (1.71-12.34); African American women, 7.82 (3.57-17.13); White men, 6.99 (2.27-21.49); and White women, 18.60 (8.97-38.54). Being overweight (BMI = 25-29.9 kg/m²) vs. normal weight was associated with increased discrimination in White women only: 2.10 (1.11-3.96). CONCLUSIONS Novel evidence for a race-sex interaction on perceived weight discrimination, with White women more likely to report discrimination at all levels of overweight and obesity was provided. Pychosocial mechanisms responsible for these differences deserve exploration.
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Affiliation(s)
- Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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198
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Bryant K, Wicks MN, Willis N. Recruitment of older African American males for depression research: lessons learned. Arch Psychiatr Nurs 2014; 28:17-20. [PMID: 24506982 PMCID: PMC4259097 DOI: 10.1016/j.apnu.2013.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 09/19/2013] [Indexed: 11/29/2022]
Abstract
Depression is projected to become the leading cause of disability and the second leading contributor to the global burden of disease in approximately 10years. Few studies have explored the signs and symptoms of depression experienced by older African American men. Therefore, a pilot study was developed with the goal of addressing this gap in knowledge. Despite a variety of recruitment strategies, the study yielded no participants after 9months of effort. Lessons learned from the recruitment efforts and other researchers' successful techniques and strategies are discussed.
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Affiliation(s)
- Keneshia Bryant
- Translational Research Institute KL2 Scholar, College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Mona Newsome Wicks
- The University of Tennessee Health Science Center, College of Nursing, Memphis, TN.
| | - Nathaniel Willis
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR.
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199
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Abstract
Researchers have long speculated that exposure to discrimination may increase cardiovascular disease (CVD) risk but compared to other psychosocial risk factors, large-scale epidemiologic and community based studies examining associations between reports of discrimination and CVD risk have only emerged fairly recently. This review summarizes findings from studies of self-reported experiences of discrimination and CVD risk published between 2011-2013. We document the innovative advances in recent work, the notable heterogeneity in these studies, and the considerable need for additional work with objective clinical endpoints other than blood pressure. Implications for the study of racial disparities in CVD and clinical practice are also discussed.
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200
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Nadal KL, Griffin KE, Wong Y, Hamit S, Rasmus M. The Impact of Racial Microaggressions on Mental Health: Counseling Implications for Clients of Color. JOURNAL OF COUNSELING AND DEVELOPMENT 2014. [DOI: 10.1002/j.1556-6676.2014.00130.x] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kevin L. Nadal
- Department of Psychology, John Jay College of Criminal Justice, City University of New York
| | - Katie E. Griffin
- Department of Psychology, John Jay College of Criminal Justice, City University of New York
| | - Yinglee Wong
- Department of Psychology, John Jay College of Criminal Justice, City University of New York
| | - Sahran Hamit
- Department of Psychology, John Jay College of Criminal Justice, City University of New York
| | - Morgan Rasmus
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University
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