Neighborhood racial composition, racial discrimination, and depressive symptoms in African Americans

Examining the integrated model of the interpersonal-psychological theory of suicide and intersectionality theory among Black male adolescents

INTRODUCTION

Guided by Opara et al.'s (2022), Integrated Model of the Interpersonal Psychological Theory of Suicide and Intersectionality Theory, the current study examined contextual stressors experienced disparately by Black youth (racial discrimination, poverty, and community violence) as moderators of the association between individual motivating factors for suicidal thoughts and behaviors (perceived burdensomeness, thwarted belongingness, and hopelessness) and active suicidal ideation.

METHOD

Participants were 457 Black adolescent boys (mean age = 15.31, SD = 1.26) who completed self-report surveys.

RESULTS

As predicted, the association between perceived burdensomeness and active suicidal ideation was significantly moderated by economic stress. In addition, the association between peer belongingness and suicidal ideation was significantly moderated by racial discrimination, but there were no moderating effects for school belongingness. Finally, the association between hopelessness and suicidal ideation was significantly moderated by both racial discrimination and witnessing community violence.

CONCLUSION

These findings highlight the need for research, interventions, and policy work devoted to using integrated approaches of individual and socioeconomically relevant patterns of suicidal thoughts and behaviors to support Black youth exposed to various forms of structural oppression.

Racial Trauma and Black Mothers' Mental Health: Does Cognitive Flexibility Buffer the Effects of Racialized Stress?

Racialized stress disproportionately impacts Black individuals and confers increased risk for psychological distress and executive dysfunction. However, there is little evidence on psychological distress' association with cognitive flexibility (CF), an executive function theorized to be a neurocognitive resilience factor, as it is shown to reflect the ability to adapt thoughts/behaviors to changing environmental stimuli. As such, we aimed to examine the relation between racialized stress and psychological distress and the potential buffering effects of CF. Data were drawn from The Family Life Project and included 372 Black mothers from rural households experiencing poverty. Mothers completed a battery of questionnaires to assess sociodemographics, experiences with racialized stress (RRSE), psychological distress (CES-D), and their cognitive flexibility (WCST-64). Results evidenced a significant association between psychological distress and racialized stress, such that mothers who reported higher racialized stress reported higher psychological distress; this relation remained significant after controlling for a host of sociodemographic risk factors. CF did not emerge as a significant moderator of the relation between psychological distress and racialized stress. Findings highlight the potential deleterious effects of racialized stress on psychological distress. There may be unique facets of racialized stress that differentially impact the risk for psychological distress, and CF potentially buffers this relation. Further investigations are needed to understand the underlying mechanisms that may confer resilience to psychological distress amongst Black mothers.

Neighborhood ethnic composition and social identity threat: the mediating role of perceived discrimination

Ethnic proportions of neighborhoods are a "macro" measure of intergroup contact and can buffer or expose people of color to discrimination. Simultaneously, perceived discrimination can sensitize students of color to social identity threat in environments in which they are numerically underrepresented and negatively stereotyped. In the current research, we integrate these two lines of research to examine whether neighborhood ethnic composition - the percentage of Latinx residents in one's home community - predicts social identity threat for Latinx students attending college at a predominately White institution (PWI). In two studies, Latinx college students attending a PWI provided their 5-digit zip code and completed measures assessing their perceived discrimination and social identity threat. Across both studies, neighborhood ethnic composition (greater percentage of Latinx residents) was associated with greater social identity threat and this association was mediated by greater perceived discrimination. These studies advance research on neighborhood ethnic composition and social identity threat.

Does ethnic concentration buffer effects of neighborhood deprivation on early childhood growth?

BACKGROUND

Neighborhood socioeconomic marginalization and racial residential segregation are associated with differential health outcomes in adulthood and pregnancy, but the intergenerational effects of these exposures on early childhood growth are underexplored. Our objective was to investigate racial and ethnic differences in the association between neighborhood deprivation and early childhood growth trajectories, with modification by neighborhood racial concentration.

METHODS

Using longitudinal clinical data among 58,860 children receiving care in community-based clinics in the ADVANCE Clinical Data Research Network, we identified four early childhood (0-24 months) body mass index (BMI) trajectories using group-based trajectory modeling: Low, Catch-Up, Moderate, and High. In race- and ethnicity-stratified multinomial logistic regression analyses, trajectory group membership was modeled as a function of neighborhood deprivation, neighborhood racial concentration, neighborhood deprivation*racial concentration interactions, and confounders.

RESULTS

Greater neighborhood deprivation was marginally associated with greater odds of Catch-Up trajectory for most racial and ethnic groups, with a null association observed among Assimilated Hispanic children. Conversely, neighborhood deprivation was not associated with Low trajectory for non-Hispanic Black or White children; however, in Less Assimilated Hispanic children, higher neighborhood deprivation was marginally associated with higher odds of Low trajectory, most strongly in neighborhoods with higher vs. lower Hispanic concentration. Associations between neighborhood deprivation and High trajectories varied substantially by race and ethnicity, ranging from inverse among Less Assimilated Hispanic children to a positive association among non-Hispanic White children that was attenuated in neighborhoods with higher White concentration.

CONCLUSION

Greater neighborhood deprivation was generally associated with greater or similar odds of each alternative growth trajectory, most consistently for non-Hispanic White and Black children. Associations were largely similar across levels of neighborhood racial concentration. Further research is needed to understand contextual or behavioral factors that contribute to the observed racial and ethnic differences in the association between neighborhood deprivation and early childhood growth.

Racial Residential Segregation and Mental Health During Pregnancy

Importance

Research suggests the social, physical, and socioeconomic contexts of residing in segregated neighborhoods may negatively affect mental health.

Objective

To assess the association between racial residential segregation and prenatal mental health among Asian, Black, Hispanic, and White individuals.

Design, Setting, and Participants

This population-based cross-sectional study was conducted in Kaiser Permanente Northern California (KPNC), an integrated health care delivery system. Participants included self-identified Asian, Black, Hispanic, and White pregnant individuals who attended at least 1 prenatal care visit at KPNC between January 1, 2014, and December 31, 2019. Data were analyzed from January 14, 2023, to August 15, 2024.

Exposures

Racial residential segregation, defined by the local Getis-Ord Gi* statistic, was calculated in each racial and ethnic group and categorized as low (<0), medium (0-1.96), or high (>1.96). A positive Gi* statistic indicates overrepresentation (greater clustering or segregation) of the racial and ethnic group in an index census tract and neighboring tracts compared with the larger surrounding geographic area.

Main Outcomes and Measures

Prenatal depression and anxiety defined by diagnoses codes documented in the electronic health record between the first day of the last menstrual period and the day prior to birth.

Results

Among the 201 115 participants included in the analysis (mean [SD] age, 30.8 [5.3] years; 26.8% Asian, 6.6% Black, 28.0% Hispanic, and 38.6% White), prenatal depression and anxiety were highest in Black individuals (18.3% and 18.4%, respectively), followed by White (16.0% and 18.2%, respectively), Hispanic (13.0% and 14.4%, respectively), and Asian (5.7% and 6.4%, respectively) individuals. Asian (40.8% vs 31.1%) and Black (43.3% vs 22.6%) individuals were more likely to live in neighborhoods with high vs low segregation, while Hispanic individuals were equally likely (34.3% vs 34.7%). High compared with low segregation was associated with greater odds of prenatal depression (adjusted odds ratio [AOR], 1.25 [95% CI, 1.10-1.42]) and anxiety (AOR, 1.14 [95% CI, 1.00-1.29]) among Black individuals. High segregation was associated with lower odds of prenatal depression among Asian (AOR, 0.75 [95% CI, 0.69-0.82]), Hispanic (AOR, 0.88 [95% CI, 0.82-0.94]), and White (AOR, 0.91 [95% CI, 0.86-0.96]) individuals. Similar associations were found for anxiety among Asian (AOR, 0.80 [95% CI, 0.73-0.87]) and Hispanic (AOR, 0.88 [95% CI, 0.82-0.93]) but not White (AOR, 0.95 [95% CI, 0.90-1.00]) individuals.

Conclusions and Relevance

In this cross-sectional study, racial and ethnic residential segregation was associated with worse prenatal mental health for Black individuals but better mental health for Asian, Hispanic, and White individuals. Policies reducing segregation and its impact may improve mental health outcomes in pregnant Black individuals.

Mental Health across the Early Life Course at the Intersection of Race, Skin Tone, and School Racial Context

Prior research documents higher levels of depressive symptoms among Black Americans relative to Whites. Yet, we know less about the role of other dimensions of stratification (e.g., skin tone) in shaping mental health inequality between Black and White adults, and whether mental health trajectories by race and skin tone among Black adults are contingent upon social contexts in childhood and adolescence. To address these gaps, this study asks: 1) to what extent do self-identified race and interviewer-rated skin tone among Black respondents shape inequalities in depressive symptoms between Black and White Americans across ages 12-42? 2) Are trajectories of depressive symptoms by race and skin tone among Black respondents contingent on school racial contexts (e.g., school racial composition)? Using five waves of data from the National Longitudinal Study of Adolescent to Adult Health and growth curve models, results suggest trajectories of depressive symptoms across ages 12-42 vary by race, school racial context, and skin tone among Black respondents. Specifically, Black students rated as having very dark, dark, and medium brown skin who attended high proportion Black schools in adolescence experienced lower levels of depressive symptoms than their White and light-skinned Black counterparts, particularly across the teen years and early 20s. Conversely, attending higher proportion White schools led to increases in depressive symptoms across earlier ages for Black students, particularly those who fell within the middle of the skin color continuum. Findings highlight competing advantages and disadvantages of navigating racialized spaces in childhood/adolescence for Black Americans of different skin tones.

Fear of a Black Neighborhood: Anti-Black Racism and the Health of White Americans

Does anti-Black racism harm White Americans? We advance hypotheses that address this question within the neighborhood context. Hypotheses are tested with neighborhood and survey data from a probability sample of White residents of Nashville, Tennessee. We find that regardless of neighborhood crime rates or socioeconomic compositions, Whites report heightened perceptions of crime and danger in their neighborhoods as the proportion of Black residents increases. Perceived neighborhood danger, in turn, predicts increased symptoms of psychophysiological distress. When stratified by socioeconomic status (SES), however, low-SES Whites also report perceptions of higher status when living near more Black neighbors, which entirely offsets their distress. We conclude that although anti-Black racism can ironically harm the health of White Americans, compensatory racist ideologies can also offset these harms, particularly for lower-status Whites. We situate our findings within broader discussions of anti-Black racism, residential segregation, and psychiatric disorders commonly observed among White Americans.

Neighborhood racial composition and experiences of racial discrimination: Associations with cytokines during pregnancy among African American women

Background

Preterm birth rates are consistently higher in African American (AA) pregnancies compared to White pregnancies in the United States. Neighborhood racial composition, experiences of racial discrimination, and systemic inflammation are factors that have been associated with preterm birth and other adverse pregnancy outcomes that may account for these disparities. Here, we investigated whether perceived neighborhood racial composition and experiences of discrimination were predictive of cytokine levels during pregnancy among AA individuals.

Methods

545 AA individuals completed surveys and had blood samples collected at prenatal clinics in the Midwest at three timepoints (8-18,19-29, and 30-36 weeks gestation) throughout pregnancy. Pro-inflammatory [interferon (IFN)-γ, interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, macrophage migration inhibitory factor (MIF)] and anti-inflammatory cytokines (IL-10) were quantified. Multivariate and multilevel models were used to examine associations of perceived neighborhood racial composition and experiences of racial discrimination with cytokine levels, controlling for relevant covariates.

Results

Perceived neighborhood racial composition was significantly associated with MIF at 30-36 weeks gestation in multivariate regression (p < 0.001). Living in neighborhoods with more compared to fewer White people was predictive of higher levels of MIF (b = 0.599, SE = 0.12, p < 0.001). Experiences of discrimination were also associated with higher levels of MIF (β = 0.141, SE = 0.07, p = 0.036). Neither predictor was associated with other cytokines. Follow-up analyses revealed that neighborhood racial composition was also predictive of higher MIF levels at 8-18 weeks gestation (p = 0.02) and at 19-29 weeks gestation (p = 0.04).

Conclusions

Living in neighborhoods with more White individuals and having more lifetime experiences of racial discrimination were positively related to levels of the pro-inflammatory cytokine, MIF, among pregnant AA individuals. MIF's known positive relationships with chronic stress and preterm birth suggest that these elevations in MIF may have negative health consequences. Future studies should explore whether MIF serves as a pathway between neighborhood racial composition or experiences of racial discrimination and preterm birth risk among AA individuals.

Racial disparities in Death rates and Death incidences in Xinjiang: A study of multilevel ecological mechanisms

Health disparities based on racial status are well-researched by social scientists, but this field of knowledge has rarely been investigated beyond the Western context. As the largest province in China, Xinjiang has over 50% non-Han populace-and this group is subjected to various forms of inequalities. The current study is the first to quantitatively demonstrate the disparity in mortality between the Han majority and Turkic minority in Xinjiang. We have developed a theory-driven framework to approach race as a fundamental cause of mortality disparity through both individual and context-level pathways that trigger the proximate determinants of death. We compiled the 2015 China Microcensus with the Sixth Decennial Census (2010) and web-extracted point-of-interest information for data at different ecological levels. The results reveal that the mortality rate is significantly pronounced for Turks at the county-level and Turks' death incidence is elevated at the household level. The inclusion of variables at the individual- and context-level explains about 38% of the mortality disparity between Han and Turks, but the significant disparity remains strong after considering the covariates, the "healthy migrant" scenario, geographical clustering, and exposure risk. We cautiously suggest the remaining unexplained portion of the mortality disparity may be due to unobserved racial inequity and urge the academic community to further investigate this underexplored subject.

Perceived Neighborhood Racial Composition and Depressive Symptoms Among Black Americans Across Adulthood: Evaluating the Role of Psychosocial Risks and Resources

Objectives: To evaluate the relationships between perceived neighborhood racial composition (PNRC), psychosocial risks and resources, and depressive symptoms among young (ages 22-35), middle-aged (ages 36-49), and older (ages 50+) Black Americans. Methods: Full sample and age-stratified linear regression models estimated the PNRC-depressive symptoms association and the extent to which it persisted after accounting for psychosocial risks (i.e., neighborhood disorder, other social stressors) and resources (i.e., mastery, social support, racial identity) among 627 Black Americans in the Nashville Stress and Health Study. Results: Living in racially integrated and predominately White neighborhoods was associated with elevated depressive symptoms. While psychosocial risks and resources explained a substantial portion of these associations, patterns varied across age groups. Discussion: PNRC impacts depressive symptoms among Black Americans by shaping psychosocial risks and resources. Findings underscore interconnections between contextual and psychosocial factors, as well as the distinct mental health significance of these processes across stages of adulthood.

Structural Racism and Adolescent Mental Health Disparities in Northern California

Importance

Understanding how structural racism is associated with adolescent mental health is critical to advance health equity.

Objective

To assess associations between neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE) and adolescent depressive symptoms, suicidality, and related racial and ethnic disparities.

Design, Setting, and Participants

This was a retrospective cohort study using electronic health records of adolescents aged 12 to 16 years who attended well-teen visits between 2017 and 2021. Kaiser Permanente Northern California is an integrated health care delivery system serving 4.6 million members. The cohort included 34 252 individuals born singleton at an affiliated facility from January 1, 2005, to December 31, 2009, and who had completed at least 1 mental health screener during a well-teen visit by November 23, 2021.

Exposures

American Community Survey 2016 to 2021 5-year estimates were used to calculate ICE scores for adolescents' residential census tract at ages 10 to 11. Three ICE measures were used as proxies of structural racism: racial privilege (ICE-race and ethnicity; hereinafter ICE-race), economic privilege (ICE-income), and combined economic and racial privilege (ICE-income plus race and ethnicity; herinafter ICE-income plus race). ICE scores were categorized into quintiles based on California statewide distributions.

Main Outcomes and Measures

Depressive symptoms and suicidality were assessed through self-report screeners during well-teen visits. Depressive symptoms were considered to be present if patients had a score on the Patient Health Questionnaire-2 of 3 or higher (the tool uses a Likert scale to determine the frequency [0 = not at all; 3 = nearly every day] that they had depressed mood and lack of pleasure in usual activities in the past 2 weeks; responses were summed and dichotomized).

Results

Analyses included 34 252 adolescents (12-16 years of age; mean [SD] age, 13.7 [0.8] years; 17 557 [51.3%] male, 7284 [21.3%] Asian or Pacific Islander, 2587 [7.6%] Black], 9061 [26.5%] Hispanic, 75 [0.2%] American Indian or Indigenous, 12 176 [35.5%] White, and 3069 [9%] other or unknown). Risks of depressive symptoms and suicidality generally increased with each level of declining neighborhood privilege. Adjusted risk ratios comparing adolescents from neighborhoods with the least to most racial and economic privilege were 1.37 (95% CI, 1.20-1.55) for depressive symptoms and 1.59 (95% CI, 1.23-2.05) for suicidality. Racial disparities between Black and White youth and Hispanic and White youth decreased after adjusting for each ICE measure, and became nonsignificant in models adjusting for ICE-race and ICE-income plus race.

Conclusions and Relevance

In this cohort study, lower neighborhood privilege was associated with greater risks of adolescent depressive symptoms and suicidality. Furthermore, adjusting for neighborhood privilege reduced mental health disparities affecting Black and Hispanic adolescents. These findings suggest that efforts to promote equity in adolescent mental health should extend beyond the clinical setting and consider the inequitable neighborhood contexts that are shaped by structural racism.

Effects of Perceived Discrimination on Behavioral Health Outcomes in People Aging With Traumatic Brain Injury

OBJECTIVE

To evaluate major and everyday experiences of discrimination (MED and EED, respectively) in relation to behavioral health outcomes in people with traumatic brain injury (PwTBI).

SETTING

Outpatient research laboratory.

PARTICIPANTS

Adults, 50 years or older, with a chronic (1+ year) history of moderate or severe TBI ( N = 118).

DESIGN

Cross-sectional observational study.

MAIN MEASURES

MED and EED (primary measures of interest) and behavioral health outcomes: global cognition, psychological symptoms, neurobehavioral symptoms, societal participation, and health-related quality of life (HRQoL). In participants with available geodata ( N = 28), neighborhood socioeconomic deprivation (ND) was examined as a potential contributor to MED, EED, and measured outcomes.

RESULTS

EED and MED were significantly associated with psychological symptoms, neurobehavioral symptoms, and HRQoL after correction for multiple comparisons. Counter to expectations, EED were related to higher societal participation. MED and EED were unrelated to cognition. When MED and EED were entered together in hierarchical regressions, only EED made significant contributions beyond demographic and injury-related covariates to each outcome. Sensitivity analyses revealed that most of these relationships were not solely accounted for by disability-related discrimination. ND showed negligible associations with discrimination but moderate effect sizes for cognition and participation. Race was not significantly related to discrimination and was not a significant predictor in regression models but was strongly associated with ND.

CONCLUSION

The current data provide preliminary support for perceived discrimination as an important factor in neurobehavioral and psychosocial health, but not cognitive performance, after TBI. These relationships appear to be driven by daily experiences of discriminatory treatment versus single major instances of injustice. Measured outcomes may also reflect socioeconomic challenges and structural discrimination faced by diverse PwTBI, although more work in this area is urgently needed. Multiple sources of marginalization and disenfranchisement and their functional effects should be considered in TBI rehabilitation and outcome monitoring.

Socioeconomic Stability Buffers Racial Discrimination Effect on Depression in a Marginalized Community

Depression disproportionately burdens poverty-affected minority communities. Racism and racial discrimination are well-known determinants of depression among members of marginalized minority communities. Less is known about potential buffers of the discrimination effects on depression, particularly those that could serve as targets for efficient community-based policies and interventions. Our secondary analysis of data from a community needs assessment survey (N = 677) in an urban minority neighborhood of low socio-economic status revealed that high school completion and current employment significantly weakened the association between discrimination and depression. Our findings frame community-level efforts to foster high school completion and employment as potential strategies to reduce the footprint of racism on the mental health of marginalized community members. Implications for future research and policy are discussed.

Racial Discrimination as a Cumulative Risk Factor Affecting Parental Stress on the Psychological Distress of Korean Americans (Both US- and Foreign-Born) amid COVID-19: Structural Equation Modeling

This study examined the relationships of parental stress and racial discrimination to the psychological distress of Korean Americans (both US- and foreign-born) during the COVID-19 pandemic. It also explored whether racial discrimination moderated the effect of parental stress on psychological distress. Using primary data collected between May 24, 2020, and June 14, 2020, via an online questionnaire, confirmatory factor analysis and structural equation models were conducted on 339 Korean American parents. Results indicated that parental stress and racial discrimination were associated with parental psychological distress. However, when the sample was divided by parental sex, racial discrimination played as a moderator, the interaction of discrimination, and parenting stress was associated with more psychological distress only for mothers. Based on the study results, we recommended that policymakers should consider policies and programs that can reduce racism to make up for the public health crisis associated with COVID-19; clinical practitioners also need to provide appropriate virtual mental/physical health services and interventions that can decrease parental stress and psychological distress amid COVID-19.

Psychosocial Predictors of Chronic Musculoskeletal Pain Outcomes and their Contextual Determinants Among Black Individuals: A Narrative Review

Black communities are disproportionally affected by Chronic Musculoskeletal Pain (CMP), but little is known about the psychological predictors of CMP outcomes and their contextual determinants among Black individuals. To address this gap, we conducted a narrative review of extant literature to (1) report the major conceptual models mentioned in prior work explaining the link between contextual determinants and psychological responses to pain among Black individuals with CMP; and (2) describe psychological factors related to CMP outcomes in this population that are highlighted in the literature. We searched 4 databases (APA PsycNet, PubMed/MEDLINE, Scopus, and Google Scholar) using the following search terms: musculoskeletal pain, chronic pain, mental health, psychological, coping, health disparities, contextual factors, conceptual models, psychosocial, Black, African American, pain, disability, and outcomes. We illustrate 3 relevant conceptual models - socioecological, cumulative stress, and biopsychosocial - related to contextual determinants and several psychological factors that influence CMP outcomes among Black individuals: (1) disproportionate burden of mental health and psychiatric diagnoses, (2) distinct coping strategies, (3) pain-related perceived injustice and perceived racial/ethnic discrimination, and (4) preferences and expectations related to seeking and receiving pain care. The detailed clinical and research implications could serve as a blueprint for the providers and clinical researchers to address health disparities and improve care for Black individuals with CMP. PERSPECTIVE: This narrative review illustrates conceptual models explaining the link between contextual determinants and psychological responses to pain among Black individuals with chronic musculoskeletal pain. We discuss 3 relevant conceptual models - socioecological, cumulative stress, biopsychosocial -, and 4 psychological factors: disproportionate burden of mental health, distinct coping strategies, perceived injustice/discrimination, preferences/expectations.

Discrimination in Context: Examining Neighborhood-Level Variation in the Incidence and Adverse Effects of Perceived Racial and Ethnic Discrimination Among Chicago Youth

A growing body of research links interpersonal racial and ethnic discrimination to adverse youth outcomes. Yet, studies examining the relevance of neighborhood context for discrimination are sparse. This study examines neighborhood-level variation in the incidence and impact of perceived racial and ethnic discrimination on depressive symptoms, suicidal behavior, violent behavior, and substance use. Hierarchical regression models on a sample of 1333 African American and Hispanic youth (52.44% female; x̄ = 13.03 years, SD = 3.25 at wave 1) residing in 238 Chicago neighborhoods from the Project on Human Development in Chicago Neighborhoods indicated little to no neighborhood-level variation in the incidence and impact of discrimination. Findings suggest that the experience of discrimination among youth of color is ubiquitous.

Perception of Racial and Intersectional Discrimination in the Workplace Is High Among Black Orthopaedic Surgeons: Results of a Survey of 274 Black Orthopaedic Surgeons in Practice

INTRODUCTION

There are approximately 573 practicing Black orthopaedic surgeons in the United States, which represents 1.9% overall. The purpose of this study was to describe this underrepresented cohort within the field of orthopaedic surgery and to report their perception of occupational opportunity and workplace discrimination.

METHODS

An anonymous survey was administered to 455 practicing orthopaedic surgeons who self-identify as Black. The 38-question electronic survey requested demographic and practice information and solicited perspectives on race and racial discrimination in current orthopaedic practices and general views regarding occupational opportunity and discrimination.

RESULTS

The survey was completed by 274 Black orthopaedic surgeons (60%). Over 97% of respondents believe that Black orthopaedic surgeons in the United States face workplace discrimination. Most Black orthopaedic surgeons (94%) agreed that racial discrimination in the workplace is a problem but less than 20% agreed that the leaders of national orthopaedic organizations are trying sincerely to end it. Black female orthopaedic surgeons reported lower occupational opportunity and higher discrimination than Black male orthopaedic surgeons across all survey items.

DISCUSSION

This study is the first to report on the workplace environment and the extent of discrimination experienced by Black surgeons, specifically Black orthopaedic surgeons in the United States. Most respondents, particularly female respondents, agreed that racial discrimination and diminished occupational opportunity are pervasive in the workplace and reported experiencing various racial microaggressions in practice.

Pathways linking census tract typologies with subjective neighborhood disorder and depressive symptoms in the Black Women's Experiences Living with Lupus (BeWELL) Study

Depression is a common comorbidity among Black women with systemic lupus erythematosus (SLE), an understudied autoimmune disease characterized by major racial and gender inequities. Research is needed that examines how area-level factors influence risk of depression in this population. Latent profile analysis revealed four neighborhood typologies among metropolitan Atlanta, Georgia census tracts that participants (n=438) in the Black Women's Experiences Living with Lupus (BeWELL) Study were living in: Integrated/High-SES, Moderately Segregated/Mid-SES, Highly Segregated/Mid-SES, and Highly Segregated/Low-SES. Structural equation models indicated that highly segregated census tracts were associated with the greatest levels of depression via increased subjective assessments of neighborhood disorder. Policies that invest in segregated areas and address physical and social aspects of the environment that contribute to neighborhood disorder may promote mental health among Black women with SLE.

Neighborhood Ethnic Composition and Self-rated Health Among Chinese and Vietnamese American Immigrants

Immigrants tend to live in areas with higher co-ethnic density, and the effect of neighborhood ethnic composition could be particularly salient for health. This study explored associations between neighborhood ethnic composition and self-rated health among Asian immigrants. We analyzed data collected at baseline from 670 Chinese and Vietnamese immigrants enrolled in a lifestyle intervention trial. Residential addresses were geocoded and combined with neighborhood socio-demographic profiles based on census data. We used generalized estimating equations to examine neighborhood ethnic composition and self-rated health. Independent of individual-level factors, living in neighborhoods more densely populated by whites was associated with poor/fair self-rated health. Neighborhood household income and density of participants' own ethnic group were not associated with poor/fair self-rated health. More research is warranted to disentangle reasons why Chinese and Vietnamese immigrants living in white-concentrated neighborhoods reported poorer self-rated health, including investigating effects of discrimination, relative deprivation, and availability of social resources.

Race and other sociodemographic categories are differentially linked to multiple dimensions of interpersonal-level discrimination: Implications for intersectional, health research

Objectives

To examine whether intersections of race with other key sociodemographic categories contribute to variations in multiple dimensions of race- and non-race-related, interpersonal-level discrimination and burden in urban-dwelling African Americans and Whites.

Methods

Data from 2,958 participants aged 30–64 in the population-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to estimate up to four-way interactions of race, age, gender, and poverty status with reports of racial and everyday discrimination, discrimination across multiple social statuses, and related lifetime discrimination burden in multiple regression models.

Results

We observed that: 1) African Americans experienced all forms of discrimination more frequently than Whites, but this finding was qualified by interactions of race with age, gender, and/or poverty status; 2) older African Americans, particularly African American men, and African American men living in poverty reported the greatest lifetime discrimination burden; 3) older African Americans reported greater racial discrimination and greater frequency of multiple social status-based discrimination than younger African Americans; 4) African American men reported greater racial and everyday discrimination and a greater frequency of social status discrimination than African American women; and, 5) White women reported greater frequency of discrimination than White men. All p’s < .05.

Conclusions

Within African Americans, older, male individuals with lower SES experienced greater racial, lifetime, and multiple social status-based discrimination, but this pattern was not observed in Whites. Among Whites, women reported greater frequency of discrimination across multiple social statuses and other factors (i.e., gender, income, appearance, and health status) than men. Efforts to reduce discrimination-related health disparities should concurrently assess dimensions of interpersonal-level discrimination across multiple sociodemographic categories, while simultaneously considering the broader socioecological context shaping these factors.

Vicarious racial discrimination, racial identity, and alcohol-related outcomes among Black young adults: An experimental approach

Objective: Racial discrimination is a known risk factor for alcohol-related outcomes among young Black American adults. However, vicarious racial discrimination's associations with alcohol-related outcomes and the role of racial identity in these associations remain unknown. This within-subject experiment study tested whether associations of vicarious racial discrimination with alcohol craving and attentional bias differed by three components of racial identity (centrality, private regard, and public regard). Method: Black young adult, at-risk drinkers (N = 51; Mage = 21 [SD = 3.02]; 60% female) completed two vicarious racial discrimination conditions (manipulated by video) followed by alcohol craving and attentional bias tasks. Results: Associations of vicarious discrimination with alcohol craving were exacerbated by high centrality and buffered by high private regard, but did not differ by public regard. No associations of vicarious discrimination with alcohol attention bias were found. Conclusion: Findings highlight the important role of Black racial identity in within-group differences in the impact of vicarious racial discrimination on select implicit indicators of alcohol risk among Black young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Chronic Stress-Related Neural Activity Associates With Subclinical Cardiovascular Disease in a Community-Based Cohort: Data From the Washington, D.C. Cardiovascular Health and Needs Assessment

Background: Psychosocial stress correlates with cardiovascular (CV) events; however, associations between physiologic measures of stressors and CVD remain incompletely understood, especially in racial/ethnic minority populations in resource-limited neighborhoods. We examined associations between chronic stress-related neural activity, measured by amygdalar ¹⁸Fluorodeoxyglucose (¹⁸FDG) uptake, and aortic vascular FDG uptake (arterial inflammation measure) in a community-based cohort.

Methods: Forty participants from the Washington, DC CV Health and Needs Assessment (DC-CHNA), a study of a predominantly African-American population in resource-limited urban areas and 25 healthy volunteers underwent detailed phenotyping, including ¹⁸FDG PET/CT for assessing amygdalar activity (AmygA), vascular FDG uptake, and hematopoietic (leukopoietic) tissue activity. Mediation analysis was used to test whether the link between AmygA and vascular FDG uptake was mediated by hematopoietic activity.

Results: AmygA (1.11 ± 0.09 vs. 1.05 ± 0.09, p = 0.004) and vascular FDG uptake (1.63 ± 0.22 vs. 1.55 ± 0.17, p = 0.05) were greater in the DC-CHNA cohort compared to volunteers. Within the DC-CHNA cohort, AmygA associated with vascular FDG uptake after adjustment for Framingham score and body mass index (β = 0.41, p = 0.015). The AmygA and aortic vascular FDG uptake relationship was in part mediated by splenic (20.2%) and bone marrow (11.8%) activity.

Conclusions: AmygA, or chronic stress-related neural activity, associates with subclinical CVD risk in a community-based cohort. This may in part be mediated by the hematopoietic system. Our findings of this hypothesis-generating study are suggestive of a potential relationship between chronic stress-related neural activity and subclinical CVD in an African American community-based population. Taken together, these findings suggest a potential mechanism by which chronic psychosocial stress, such as stressors that can be experienced in adverse social conditions, promotes greater cardiovascular risk amongst resource-limited, community-based populations most impacted by cardiovascular health disparities. However, larger prospective studies examining these findings in other racially and ethnically diverse populations are necessary to confirm and extend these findings.

The Mediating role of perceived discrimination and stress in the associations between neighborhood social environment and TV Viewing among Jackson Heart Study participants

Objectives

The aim of this study was to test the mediating role of perceived discrimination and stress on associations between perceived neighborhood social environment (PNSE) and TV viewing.

Methods

Baseline data were used for 4716 participants (mean age = 55.1 y; 63.4% female) in the Jackson Heart Study (JHS), a large prospective cohort study of African Americans in Jackson, Mississippi. One binary TV viewing outcome was created: ≥4 h/day versus <4 h/day. PNSE variables included neighborhood violence, problems (higher value = more violence/problems), and social cohesion (higher value = more cohesion). Mediators included perceived lifetime discrimination, daily discrimination, and chronic stress (higher value = greater discrimination/stress). Multivariable regression was used with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation adjusting for demographics, health-related and psychosocial factors, and population density.

Results

Neighborhood violence, problems, and social cohesion were indirectly associated with TV viewing through lifetime discrimination (OR = 1.03, 95%BC CI = 1.00, 1.07; OR = 1.03, 95%BC CI = 0.99, 1.06 [marginal]; OR = 0.98, 95%BC CI = 0.94, 0.99, respectively) and chronic stress (OR = 0.95, 95%BC CI = 0.90, 0.99; OR = 0.96, 95%BC CI = 0.92, 0.99; OR = 1.05, 95%BC CI = 1.01, 1.10, respectively). Daily discrimination was neither directly nor indirectly associated with TV viewing.

Conclusions

Each PNSE variable was indirectly associated with TV viewing via lifetime discrimination and perceived stress, but not with daily discrimination among JHS participants. Unexpected directionality of mediating effects of lifetime discrimination and chronic stress should be replicated in future studies. Further research is also needed to pinpoint effective community efforts and physical environmental policies (e.g., installing bright street lights, community policing) to reduce adverse neighborhood conditions and psychosocial factors, and decrease TV viewing and subsequent cardiovascular disease risk.

Education, perceived discrimination and risk for depression in a southern black cohort

Objectives: Assess whether education moderates associations between discrimination and depression risk within a southern Black/African American cohort in a labor market shifting from manufacturing and farming to education-intensive industries, such as health care and technology.Methods: Data are from the Pitt County (NC) Study (n = 1154) collected in 2001. Depression risk was assessed with the Center for Epidemiologic Study-Depression (CES-D) scale. Discrimination was measured using a subset from the Everyday Discrimination Scale. Education was categorized as completion of less than high school (HS), HS/GED (General Educational Development), or any college.Results: Completing any college mitigated the association between discrimination and CES-D among men (b = -1.33, 95% CI = -2.56, -0.09) but not women (b = -0.19, 95% CI = -1.36, 0.98).Conclusions: Education is protective for depression risk related to discrimination for men but not women. Recent macroeconomic changes placed a premium on higher levels of education in 2018, as in the 1990s. Because racial discrimination remains a stressor in the everyday lives of African Americans regardless of education level, the health benefits of higher education for working-aged African Americans in shifting labor markets warrants further investigation.

Intersectionality, racial discrimination and oral health in Australia

BACKGROUND

There is a dearth of studies on the extent to which perceived racial discrimination shapes oral health. Following an intersectional perspective, we estimated the prevalence of perceived racial discrimination in Australia, its association with oral health impairment, and examined whether this association was more severe among low socioeconomic status (SES) groups.

METHODS

Data came from the 2013 National Dental Telephone Interview Survey (N = 2798), a population-based study of Australian adults. Multivariable Poisson regression models were estimated to test the relationship between perceived racial discrimination and self-reported oral health impairment, as well as to investigate whether the magnitude of this association was greater among low-SES respondents. Relative Excess Risks due to Interaction (RERI) were used to indicate the presence of potentially large discrimination effects within low-SES strata.

RESULTS

Racial discrimination in the past 12 months was reported by 11.5% of all participants. Australians reporting racial discrimination had 1.4 (95% CI 1.1, 1.7) times the prevalence of impaired oral health. The association between perceived racial discrimination and oral health impairment was stronger among low-SES groups. The RERI was 0.55, indicating a super-additive Effect Measure Modification (EMM) by income on the additive scale. Similar results were observed with the EMM analyses by educational attainment.

CONCLUSION

Our findings indicate that perceived racial discrimination, as a specific form of widespread inequality, is associated with higher frequencies of oral health impairment among Australian adults. We also suggest that socially marginalized groups bear a greater burden of the oral health effects of racial discrimination.

Perceived Discrimination Trajectories and Depressive Symptoms Among Middle-Aged and Older Black Adults

BACKGROUND AND OBJECTIVES

Perceived discrimination is a risk factor for poor mental health. However, most studies measure discrimination at one time point, which does not account for heterogeneity in the cumulative patterning of exposure to discrimination. To address this gap, we examine the association between discrimination trajectories and depressive symptoms among black middle-aged and older adults.

RESEARCH DESIGN AND METHODS

Data were analyzed from a subsample of black Health and Retirement Study respondents (2006-2018, N = 2926, older than 50 years). General discrimination and racial discrimination trajectories were constructed based on the Everyday Discrimination Scale using repeated measures latent profile analyses. We examined the extent to which the association between discrimination trajectories are differentially associated with depressive symptoms (8-item Center for Epidemiological Studies-Depression scale) using negative binomial regression models adjusted for potential confounders. Effect modification by age and gender was tested.

RESULTS

Individuals in the persistently high (incident rate ratio [IRR]: 1.70; 95% confidence interval [CI]: 1.49-1.95) and moderate general discrimination trajectories (IRR: 1.19; 95% CI: 1.06-1.33) were more likely to have elevated depressive symptoms in comparison to those in the persistently low trajectory. This relationship was strongest among older adults aged older than 65 years. Respondents in the persistently high racial discrimination trajectory (IRR: 1.50; 95% CI: 1.29-1.73) had a higher risk of elevated depressive symptoms in comparison to respondents in the persistently low trajectory. Sensitivity analyses indicated that there was an independent association between persistently high racial discrimination trajectory class and elevated depressive symptoms, after adjusting for racial discrimination measured at a single time point.

DISCUSSION AND IMPLICATIONS

Characterizing longitudinal patterns of perceived discrimination may facilitate the stratification of mental health risk and vulnerability among black middle-aged and older adults. Trajectories of racial discrimination may inform risk of worse depressive symptoms more accurately than a single assessment of discrimination.

Maternal Age Patterns of Preterm Birth: Exploring the Moderating Roles of Chronic Stress and Race/Ethnicity

BACKGROUND

Despite the suggested contribution of cumulative chronic stress to the racial/ethnic disparities in preterm birth (PTB), it is unclear how chronic stress, maternal age, and race/ethnicity are linked underlying PTB.

PURPOSE

We investigated the moderating effect of chronic stress on the maternal age-PTB association among non-Hispanic (N-H) White, N-H Black, Hispanic, and Asian women.

METHODS

We analyzed the Washington State's Pregnancy Risk Assessment Monitoring System data linked with birth certificates. The sample included women aged 18 years or older who birthed the first, singleton baby without birth defects. Chronic stress was measured by race/ethnicity-specific chronic stress indices. A maternal age-chronic stress interaction was modeled to predict PTB by logistic regression stratified by race/ethnicity. In subanalysis, the moderating role of racism was investigated in the maternal age-chronic stress interaction among three minority groups combined.

RESULTS

Women's maternal age trajectory of PTB varied by their race/ethnicity and chronic stress level. N-H White and N-H Black women showed a steeper maternal age-related increase in PTB (weathering) under higher chronic stress, indicating a chronic stress' cumulative effect with maternal age. Besides, the extent of weathering was amplified by racism on top of chronic stress, particularly among N-H Black women.

CONCLUSIONS

These results show that both chronic stress and racism may develop accelerated PTB risk among minority women. Future research should use more objective and accurate chronic stress measures to ascertain the complex relationships among chronic stress, racial discrimination, and maternal age underlying the racial/ethnic differentials in PTB.

Social Support, Everyday Discrimination, and Depressive Symptoms Among Older African Americans: A Longitudinal Study

Background and Objectives

The purpose of the study was to explore the long-term effects of everyday discrimination on depressive symptoms among older African Americans, as well as the moderating role of social support in this association.

Research Design and Methods

Mixed-effects negative binomial regression analyses were performed on data selected from 6 waves of the Health and Retirement Study (2006-2016; baseline N = 1,144). The number of depressive symptoms was calculated based on an 8-item Center for Epidemiologic Studies Depression measure. Everyday discrimination was measured using a 6-item scale. Contact with and perceived support from extended family and friends were assessed.

Results

Older African Americans who experienced more frequent perceived discrimination had more depressive symptoms over time. Significant interactions between discrimination and perceived support from extended family and friends were found, indicating that among older African Americans who reported higher support from extended family and friends, perceived discrimination was positively associated with depressive symptoms over time. However, perceived discrimination and depressive symptoms were not longitudinally related among those who reported lower levels of perceived support.

Discussion and Implications

This is one of the few studies to examine the effects of discrimination on depressive symptoms over time and the first longitudinal study to test the role of social support in coping with discrimination in older African Americans. This study extends cross-sectional works on discrimination and mental health, indicating that experiences of discrimination can result in worse mental health over time. The significant interactions are consistent with the resource mobilization framework, which suggests that individuals who are more negatively affected by discrimination (more depressive symptoms) are more likely to reach out to friends and family to cope with discrimination.

The Role of Neighborhood Experiences in Psychological Distress among African American and White Smokers

Residential area characteristics and discrimination have been associated with psychological distress. Differences in these relationships across racial groups are not well understood. We examined the relative role of perceived discrimination, neighborhood problems and neighborhood cohesion/trust in explaining differences in psychological distress (indicated by anxiety and depressive symptoms) between 224 African American and 225 White smokers (income ≤ 400% federal poverty level) in a smoking cessation intervention study. Surveys were linked to US census-tract data. We conducted random intercept Poisson multi-level regression models and examined interactions between race and neighborhood experiences. African Americans had greater risk of anxiety and depressive symptoms and greater individual and neighborhood disadvantage than Whites. Controlling for objective neighborhood characteristics, when perceived discrimination and perceived neighborhood characteristics were added to the regression models the association between anxiety symptoms and race were no longer statistically significant; the association between depressive symptoms and race decreased but remained statistically significant. Lower neighborhood social cohesion/trust and greater neighborhood problems increased depressive symptoms for African Americans, but not for Whites. Perceived discrimination and neighborhood social cohesion/trust outweighed the importance of race in explaining anxiety symptoms. These findings underscore the need for multi-level interventions addressing social and environmental contexts.

Racial discrimination trajectories predicting psychological well-being: From emerging adulthood to adulthood

Perceived racial discrimination (PRD) has been documented as a risk factor for worse psychological well-being among African Americans. Yet, most researchers have not examined how trajectories of PRD during emerging adulthood shape psychological well-being in adulthood. Moreover, less is known about whether demographic factors and components of racial identity shape PRD over time. We identified trajectories of PRD among 605 African American emerging adults and examined whether PRD trajectories were associated with depressive symptoms, anxiety symptoms, and perceived lack of control in adulthood. Four trajectories of PRD were identified (i.e., high-stable, moderate-declining, low-rising, and low-stable), and demographic factors and racial identity indicators influenced the likelihood of trajectory classification. In addition, members of the moderate-declining trajectory exhibited higher levels of depressive symptoms, anxiety symptoms, and perceived lack of control than members in the low-stable trajectory. Our findings suggest that changes in PRD in emerging adulthood can extend our understanding of psychological well-being in adulthood. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Trajectories of Depressive Symptoms and Neighborhood Changes from Adolescence to Adulthood: Latent Class Growth Analysis and Multilevel Growth Curve Models

The role of neighborhood socioeconomic status (SES) and racial/ethnic composition on depression has received considerable attention in the United States. This study examines associations between trajectory patterns of neighborhood changes and depressive symptoms using data from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health. We used latent class growth analysis to determine the number and distribution of person-centered trajectories for neighborhood characteristics, and multilevel growth curve models to examine how belonging to each class impacted depression trajectories from ages 13 to 32 among non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), Hispanics, and non-Hispanic Others (NHO). The distribution of neighborhood SES classes across racial/ethnic groups suggests significant levels of economic inequality, but had no effect on depressive symptoms. A more complex picture emerged on the number and distribution of racial/ethnic composition latent class trajectories. Compared to NHB peers who lived in predominantly NHW neighborhoods from adolescence to adulthood, NHBs in more diverse neighborhoods had lower risk for depressive symptoms. Conversely, Hispanics living in neighborhoods with fewer NHWs had higher risk for depressive symptoms. Among NHOs, living in neighborhoods with a critical mass of other NHOs had a protective effect against depressive symptoms.

The Psychological Cost of Racial Discrimination: What is the Role of Residential Segregation?

Racial discrimination is known to harm health, but to what extent the health burden of racial discrimination is contingent on residential contexts is understudied. This study examines the moderating role of racial residential segregation in the relationship between racial discrimination and psychological distress. Nationally representative data from the 2002-2003 National Latino and Asian American Study were merged with metropolitan-level data from the U.S. Census. Logistic regression models were used to test the independent and joint contributions of racial discrimination and residential segregation to psychological distress among Asians and Latinxs, stratified by nativity status. Higher residential segregation (measured by the interaction index) is associated with lower odds of distress among U.S.-born Asians but not among other groups. As for the moderating effect, residential segregation exacerbates the positive association between discrimination and distress among foreign-born Asians (measured by the dissimilarity index) and foreign-born Latinxs (measured by the interaction index), but not among their respective U.S.-born counterparts. Taken together, the present study highlights that strategies to mitigate the psychological burden of racial discrimination need to move beyond individual-level efforts to incorporate neighborhood-based approaches. In particular, results provide empirical support for efforts to reduce residential segregation, particularly among immigrants who are discriminated against.

Interactive Relations Across Dimensions of Interpersonal-Level Discrimination and Depressive Symptoms to Carotid Intimal-Medial Thickening in African Americans

OBJECTIVE

This study aimed to examine within-race interactions of multiple dimensions of self-reported discrimination with depressive symptoms in relation to carotid intimal-medial thickness (IMT), a subclinical marker of atherosclerosis prospectively implicated in stroke incidence, in middle-aged to older African American and white adults.

METHODS

Participants were a socioeconomically diverse group of 1941 African Americans (56.5%) and whites from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (30-64 years old, 47% men, 45.2% with household income <125% federal poverty threshold) who underwent carotid IMT measurement. Discrimination was assessed across four dimensions (everyday, frequency across various social statuses, racial, and lifetime burden). The Center for Epidemiologic Studies Depression scale was used to assess depressive symptoms.

RESULTS

In cross-sectional hierarchical regression analyses, two interactions were observed in African Americans: more frequent discrimination across various social statuses (b < 0.001, p = .006) and a higher lifetime discrimination burden (b < 0.001, p = .02) were each related to thicker carotid IMT in those with greater depressive symptoms. No significant findings were observed within whites.

CONCLUSIONS

Among African Americans, those reporting high levels of discrimination and depressive symptoms have increased carotid atherosclerosis and may be at greater risk for clinical end points compared with those reporting one or neither of these risk factors. Findings suggest that assessment of interactive relationships among social and psychological factors may elucidate novel pathways for cardiovascular disease, including stroke, among African Americans.

Cultural stressors experienced by young Latinas with depressive symptoms living in a tumultuous sociopolitical climate in the United States

The purpose of this study is to describe the cultural stressors experienced by Latina young women with depressive symptoms from 2016 to 2018 in the United States. Twenty-four Latina young women (mean age = 16.7 years) participated in this qualitative descriptive study. Content analysis of interviews revealed four cultural stressors: Parental oversight, pressure to succeed, being treated differently, and fears of deportation. Experiences with cultural stressors varied across generational status. Clinicians should provide Latina young women with a safe space for discussing cultural stressors, assess how they are managing their stress, and advocate for policies that will benefit the well-being of Latina young women.

Black-White Marriages: The Moderating Role of Openness on Experience of Couple Discrimination and Marital Satisfaction

This study examined how open communication between spouses may buffer against discrimination experienced by Black-White couples. Results from 178 couples analyzed using a combination of common-fate and actor-partner interdependence models, indicated that for Black partners, marital satisfaction was not contingent on the level of openness when experiences of couple discrimination were low. When experiences of couple discrimination were high, levels of marital satisfaction were maintained among partners who reported high openness and reduced among partners who reported low openness. Moderation effects were not found for White partners. The results suggest that because Black partners are more aware of and sensitized to discrimination, White partners' abilities to attune to their partners' needs for support could help enhance their relationships.

Relative deprivation in context: How contextual status homogeneity shapes the relationship between disadvantaged social status and health

We examine the relationship between disadvantaged social status and adverse health outcomes within a context-contingent thesis of relative deprivation. We argue that the health effect of low relative status depends on contextual status homogeneity, which is measured as income inequality and group diversity. Applying mixed-effect modeling to the pooled 2011-2013 Chinese General Social Survey and exploring the cross-level interactions, we found that 1) people in the bottom socioeconomic quartile report significantly better health when contextual income inequality is lower; 2) racial-ethnic minorities report significantly better health when contextual ethnic diversity is higher; and 3) religious minorities also report significantly better health when contextual religious diversity is higher. Ethnic minorities and Muslims even report better health than the majorities in highly diverse contexts. Thus, contextual status homogeneity can modify or even eliminate the health disparities caused by relative deprivation. The context-level moderation of relative deprivation may be explained by the processes of social comparison, institutional resources, and social capital formation. Our findings suggest that health disparities are an interactive product of contextual homogeneity and individual's relative deprivation, and underscore the importance of the nature of the social environment where relative deprivation occurs. In this way, we contribute to knowledge about reducing health disparities along the social gradient.

Racial discrimination and alcohol use and negative drinking consequences among Black Americans: a meta-analytical review

BACKGROUND AND AIMS

Findings of the association between racial discrimination and alcohol use and related consequences are inconsistent, and the role of potential moderators in the association is largely unknown. This meta-analysis aimed to synthesize the discrimination-alcohol literature among Black Americans, estimate the magnitude of associations and explore differences as a function of sample characteristics.

METHODS

Empirical studies reporting the association of racial discrimination with alcohol-related behaviors in an all-black sample were identified via systematic literature search. A random-effects meta-analysis was conducted using 33 effect sizes extracted from 27 studies, all of which used US samples (n = 26 894).

RESULTS

Significant positive associations were found for racial discrimination with alcohol consumption [k = 9, confidence interval (CI) = 0.08, 0.17, I²  = 49%, r = 0.12], heavy/binge drinking (k = 12, CI = 0.02, 0.10), I²  = 27%, r = 0.06), at-risk drinking (k = 4, CI = 0.06, 0.23, I²  = 0%, r = 0.14) and negative drinking consequences (k = 5, CI = 0.09, 0.25, I²  = 94%, r = 0.25), but not with alcohol use disorder (k = 3, CI = -0.01, 0.20, I²  = 90%, r = 0.10). Only alcohol consumption and negative drinking consequences showed significant between-study heterogeneity and had a sufficient quantity of studies for moderation analysis (i.e., 4 or more studies). The positive association of racial discrimination with negative drinking consequences was stronger among younger samples; the association with alcohol consumption did not differ by age or proportion of men.

CONCLUSIONS

Experiences of racial discrimination are associated with diverse alcohol-related behaviors among Black Americans, with a stronger association with problematic alcohol use, particularly among younger individuals.

Racial discrimination, John Henryism coping, and behavioral health conditions among predominantly poor, urban African Americans: Implications for community-level opioid problems and mental health services

The current study examined the relationship between John Henryism Active Coping (JHAC), experiences of racial discrimination, and behavioral health outcomes in a community sample of 319 Black adults. Assessments included primary health care screenings as well as self-reported survey questions to assess JHAC, experiences of discrimination, and self-reported behavioral health. Logistic regression models, adjusted for control variables, found a significant relationship between JHAC and having an opioid problem (odds ratio [OR] = 0.95, p = 0.003) and needing mental health services (OR = 0.95, p < 0.001), such that higher levels of coping were associated with lower odds of reporting an opioid problem and needing mental health services. Notably, racial discrimination was not significantly independently associated with behavioral health. Implications for interventions and community programming are discussed.

Neighborhood Ethnic Composition and Perceived Discrimination Among Young Adult Latina/os: The Mediating Role of Ethnic Centrality

This study examines whether neighborhood ethnic composition (i.e., percentage of Latina/os residing in a given residential community) predicts greater perceived experiences of ethnic discrimination and whether this direct effect is mediated by ethnic centrality (i.e., perceived importance of ethnicity for one’s identity). In a cross-sectional study, 237 self-identified young adult Latina/os reported their five-digit zip codes and sociodemographic information and completed measures of ethnic centrality and perceived ethnic discrimination. A mediation analysis revealed that neighborhood ethnic composition indirectly predicted perceived ethnic discrimination through its effect on ethnic centrality even when accounting for known sociodemographic predictors of perceived discrimination, b = 0.28, SE = .18, 95% confidence interval (CI) = [0.03, 0.71]. These results provide initial evidence that where young adult Latina/os live and grow up impacts the extent to which they find their ethnicity to be an essential part of their identity and, consequently, their perceived frequency of experiencing ethnic discrimination.

Factor Structure for Chronic Stress Before and During Pregnancy by Racial/Ethnic Group

This study aimed to explore race/ethnicity-specific dimensionalities of chronic stress before and during pregnancy for non-Hispanic (N-H) White, N-H Black, Hispanic, and Asian women in the United States. This study analyzed the data among 6,850 women from the New York City and Washington State Pregnancy Risk Assessment Monitoring System (2004-2007) linked with birth certificates. Separate exploratory factor analysis was conducted by race/ethnicity using a maximum-likelihood extraction method with 26 chronic stress items before and during pregnancy. Correlations and internal consistency reliabilities among items and latent factors determined race/ethnicity-specific factor structures of chronic stress. Chronic stress was race/ethnicity-distinctive and multidimensional with low correlations among the factors ( r = .07-.28, p < .05). Despite financial hardship, perceived isolation, and physical violence underlying chronic stress among the racial/ethnic groups, intergroup variations existed under each group's cultural or sociopolitical contexts. This study could help develop targeted strategies to intervene with women's chronic stressors before childbirth.

Effects of Neighborhood Discrimination Towards Mainland Immigrants on Mental Health in Hong Kong

Using data from a representative sample of Chinese adults who were surveyed in the Hong Kong Panel Study of Social Dynamics (HKPSSD), we estimate the effects of neighborhood discrimination towards immigrants from Mainland China on the mental health of Chinese residents in Hong Kong. Contrary to our expectations, discrimination towards immigrants from Mainland China measured at the neighborhood level is not associated with the poor mental health of post-1997 immigrants; instead, a higher level of immigrant discrimination is associated with a lower level of psychological distress for both post-1997 Mainland immigrants and other Chinese residents in Hong Kong. A functional family also appears to be a consistent predictor of better mental health for both groups. Our findings, therefore, suggest that immigrant discrimination can signify a prejudice that leads to social distance or avoidance and that the post-1997 Mainland immigrants do not have extensive contact with other local residents in Hong Kong. Although local residents’ discriminatory attitudes may not result in aggressive behaviors that have a negative impact on newcomers’ mental health, the social distance between the immigrants and the local residents is still an issue that requires further research and practical attention.

Longitudinal Associations of Neighborhood-level Racial Residential Segregation with Obesity Among Blacks

BACKGROUND

Despite 50 years since the passage of the Fair Housing Act of 1968, the majority of black Americans continue to live in highly segregated communities. Differing exposure to obesogenic environments in segregated neighborhoods may contribute to racial disparities in obesity prevalence.

METHODS

We used prospective data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to examine associations between levels of neighborhood-level racial residential segregation and incident obesity in black men and women. Obesity, determined by measured anthropometry, and residential segregation, measured using the local Gi*statistic, were recorded at baseline and follow-up at years 7, 10, 15, 20, and 25. We used marginal structural survival models to account for time-dependent confounding and for loss to follow-up.

RESULTS

Black women living in highly segregated neighborhoods at the prior exam were 30% more likely to become obese during the follow-up period as compared with women living in neighborhoods with low levels of segregation after adjustment for sociodemographic and cardiovascular risk covariates (hazard ratio = 1.3 [95% confidence interval = 1.0, 1.7]). Cumulatively high exposure to segregation averaged across time points was associated with 50% higher hazard of obesity (hazard ratio = 1.5 [95% confidence interval = 1.0, 2.3]) among women. We observed few differences in obesity incidence among men by segregation levels.

CONCLUSIONS

Fewer health-promoting resources, stressful neighborhood context, and social norms that are less stigmatizing of obesity may contribute to these findings, but more research on specific pathways leading from segregation to obesity is needed to understand differing patterns between men and women.

Mentalizing, Epistemic Trust and the Phenomenology of Psychotherapy

This paper seeks to elucidate the phenomenological experience of psychotherapy in the context of the theory of mentalizing and epistemic trust. We describe two related phenomenological experiences that are the domain of psychotherapeutic work. The first is the patient's direct experience of their own personal narrative being recognized, marked and reflected back to them by the therapist. Secondly, this intersubjective recognition makes possible the regulation and alignment of the patient's imaginative capacity in relation to phenomenological experiences. In describing three aspects of the communication process that unfold in effective psychotherapeutic interventions - (1) the epistemic match, (2) improving mentalizing and (3) the re-emergence of social learning - the way in which any effective treatment is embedded in metacognitive processes about the self in relation to perceptual social reality is explained. In particular, attention is drawn to wider social determinants of psychopathology. We discuss the possible mechanism for the relationship between the socioeconomic environment and psychopathology, and the implications of this for psychotherapeutic treatment.

Neighborhood racial discrimination and the development of major depression

This study examined the impact of neighborhood racial discrimination on the development of major depressive disorder (MDD) in a sample of African American women. Participants were 499 women from Georgia and Iowa with no history of MDD who were followed for 9 to 11 years. Several neighborhood characteristics (community social disorder, community cohesion, and community racism) and individual characteristics (negative life events, financial strain, personal outlook, religious involvement, relationship quality, negative affectivity, and individual experiences of racism) were employed as predictors of whether or not the women met criteria for MDD during this period of time. In a multilevel logistic regression analysis, neighborhood-level discrimination as well as individual-level variables including the number of negative life events, financial strain, and negative affectivity were found to be significant predictors of developing MDD. Analyses of cross-level interactions indicated that the effects of neighborhood-level discrimination were moderated by the quality of individuals' relationships, such that better relationships with others served to lessen the effect of neighborhood discrimination on depression. Implications of these findings for understanding the negative effects of racial discrimination are discussed. (PsycINFO Database Record

The Effects of Multiple Dimensions of Risk and Protective Factors on Depressive Symptoms Among Nonresident African American Fathers

Compared to other groups, African American men experience proportionately greater adverse social and economic circumstances, which have been linked to poor mental health. A growing body of literature has begun to examine depressive symptoms among African American men; however, limited literature has examined the concurrent contributions of risk and protective factors among nonresident African American fathers. This study examined the relative contribution of perceived financial strain, perceived neighborhood characteristics, and interpersonal stress on depressive symptoms among 347 nonresident African American fathers. Social support was examined as a protective factor for depressive symptoms. Results from hierarchical regression analyses indicated interpersonal stress was associated with depressive symptoms even after controlling for perceived financial strain, perceived neighborhood characteristics, and specific sociodemographic factors. Additionally, among fathers with high interpersonal stress, having more social support buffered the negative effect of interpersonal stress on depressive symptoms. Findings suggest experiencing strain from multiple dimensions can increase the risk of depressive symptoms among nonresident African American fathers. We also found that interpersonal stress was especially harmful for mental health. Family service providers and mental health professionals should incorporate stress management techniques to reduce stressful interpersonal relationships as a way to lower depressive symptoms among nonresident African American fathers.

Racial discrimination and cortisol in African American emerging adults: The role of neighborhood racial composition

OBJECTIVES

African American (AA) emerging adults may become more vulnerable to the consequences of racial discrimination (discrimination) as many begin to occupy racially mixed contexts. Little is known, however, about whether the effect of discrimination on cortisol concentration varies by neighborhood racial composition. We evaluated whether the percentage of White neighbors qualified the association between discrimination and overall cortisol concentration.

METHOD

We used self-report data from the Flint Adolescent Study and block-level census data linked to the participant's home address. Our sample consisted of 241 AA emerging adults (56.8% Female; 19-22 year olds). We used multilevel regression analyses to evaluate whether the percentage of White neighbors modified the association between discrimination and overall cortisol concentration.

RESULTS

Discrimination experienced in the past year, but not chronic discrimination was linked to lower cortisol concentrations among AA emerging adults living in neighborhoods with a high concentration of White neighbors. Specifically, past year discrimination was negatively associated among AAs residing in neighborhoods with 46.9% of White residents or higher.

CONCLUSIONS

Our results lay the foundation for future research on racial health disparities by suggesting that contextual factors such as neighborhood racial composition can shape the influence race-based discrimination has on health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Ethnic density effects for adult mental health: systematic review and meta-analysis of international studies

BACKGROUND

Despite increased ethnic diversity in more economically developed countries it is unclear whether residential concentration of ethnic minority people (ethnic density) is detrimental or protective for mental health. This is the first systematic review and meta-analysis covering the international literature, assessing ethnic density associations with mental health outcomes.

METHODS

We systematically searched Medline, PsychINFO, Sociological Abstracts, Web of Science from inception to 31 March 2016. We obtained additional data from study authors. We conducted random-effects meta-analysis taking into account clustering of estimates within datasets. Meta-regression assessed heterogeneity in studies due to ethnicity, country, generation, and area-level deprivation. Our main exposure was ethnic density, defined as the residential concentration of own racial/ethnic minority group. Outcomes included depression, anxiety and the common mental disorders (CMD), suicide, suicidality, psychotic experiences, and psychosis.

RESULTS

We included 41 studies in the review, with meta-analysis of 12 studies. In the meta-analyses, we found a large reduction in relative odds of psychotic experiences [odds ratio (OR) 0.82 (95% confidence interval (CI) 0.76-0.89)] and suicidal ideation [OR 0.88 (95% CI 0.79-0.98)] for each 10 percentage-point increase in own ethnic density. For CMD, depression, and anxiety, associations were indicative of protective effects of own ethnic density; however, results were not statistically significant. Findings from narrative review were consistent with those of the meta-analysis.

CONCLUSIONS

The findings support consistent protective ethnic density associations across countries and racial/ethnic minority populations as well as mental health outcomes. This may suggest the importance of the social environment in patterning detrimental mental health outcomes in marginalized and excluded population groups.

Characterizing Blunt Use Among Twitter Users: Racial/Ethnic Differences in Use Patterns and Characteristics

BACKGROUND

Young adult Twitter users are exposed to and often participate in tweets that promote risky behaviors, such as blunt use. Blunts are hollowed out cigars or cigarillos that are filled with marijuana.

OBJECTIVES

The current study was designed to determine the use patterns and characteristics of African American, Hispanic and White young adult Twitter users who reported past month blunt use.

METHODS

Young adults (N = 753, 74% male) who reported past month blunt use were recruited via Twitter to participate in a brief anonymous online survey about their blunt use.

RESULTS

Findings revealed that African American young adults initiated blunt smoking at an earlier age (14.8 years), reported more days of blunt smoking in the past month (23.2 days) and smoked more blunts in the past month (27.2 blunts) than their Hispanic (16.5 years, 19.7 days, and 15.4 blunts) and White (18.1 years, 15.8 days, and 22.2 blunts) counterparts, p <.01. African American young adults were more likely than their White counterparts to report physical craving as an obstacle to quitting blunt smoking. Several racial/ethnic differences were also found on attitudes about blunt use and reasons for initiating and continuing to smoke blunts.

CONCLUSIONS

Findings suggest that blunt use patterns and attitudes about blunt use vary by race/ethnicity. Understanding racial/ethnic differences in blunt use patterns and characteristics offers opportunities to tailor future interventions and enhance outcomes among African American, Hispanic and White young adults.