Erratum to: Interpersonal discrimination and health-related quality of life among black and white men and women in the United States

Impact of Racial/Ethnic Discrimination on Quality of Life Among Breast Cancer Survivors

Although racial/ethnic disparities in health-care access, treatment, and cancer outcomes are well documented, the impact of racial/ethnic discrimination on cancer survivorship is unclear. We examined associations between quality of life (QoL) and self-reported discrimination among 3,991 women with breast cancer recruited during 2006-2013 from the Pathways Study in the Kaiser Permanente Northern California integrated health-care system, using linear regression models. Overall, 31% of women reported experiencing racial/ethnic discrimination, with differences by race/ethnicity (82% among non-Hispanic Black women vs. 19% among non-Hispanic White women) and nativity (40% among foreign-born Hispanic women vs. 76% among US-born Asian-American women). Experiencing racial/ethnic discrimination was associated with lower QoL in fully adjusted models. The mean QoL score was 119.6 (95% confidence interval (CI): 102.0, 137.1) for women who did not report discrimination, 115.5 (95% CI: 98.0, 133.0) for those who reported some discrimination/less than the median level, and 110.2 (95% CI: 92.7, 127.7) for those who reported more discrimination/greater than or equal to the median level. Discrimination was associated with lower QoL among women who used passive coping strategies or lived in neighborhoods with high neighborhood socioeconomic status, neighborhoods with high levels of segregation, or non-ethnic enclaves. Among breast cancer survivors, clinically meaningful differences in QoL scores were associated with racial/ethnic discrimination. Additional studies are needed to understand potential pathways through which these social factors affect survivorship outcomes.

Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use

Objective

The American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults.

Methods

We analyzed baseline self-report data from 254 Native adults ages 18-55 years with recent binge substance use who were enrolled in an evaluation of "EMPWR," a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers.

Results

A little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38).

Conclusion

Our findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.

Racial Discrimination and Health-Related Quality of Life: An Examination Among Asian American Immigrants

OBJECTIVES

We aimed to examine the relationship between everyday and major racial discrimination with health-related quality of life (HRQOL), which consists of self-rated health, days of poor physical health, mental health, and activity limitation.

DESIGN

In a cross-sectional analytic sample of 524 foreign-born Asian adults, aged 18 years and older, we conducted multivariable logistic regression and multivariable negative binomial regression to examine associations between discrimination and HRQOL. Furthermore, potential effect modification was tested by gender, ethnicity, and social support.

RESULTS

Associations were found between everyday racial discrimination and days of poor physical health (incidence rate ratio, IRR = 1.05), mental health (IRR = 1.03), and activity limitation (IRR = 1.05). Stronger significant associations were observed between major racial discrimination and days of poor physical health (IRR = 1.21), mental health (IRR = 1.16), and activity limitation (IRR = 1.53), adjusting for all covariates. Racial discrimination was not associated with poor self-rated health. In addition, gender significantly modified the relationship between continuous racial discrimination and activity limitation days with associations of greater magnitude among men, while social support significantly modified the association between categorized major racial discrimination and physically unhealthy days. When stratified, the association was only significant among those with low social support (IRR = 3.04; 95% CI: 1.60, 5.79) as opposed to high social support.

CONCLUSIONS

This study supports the association between racial discrimination and worse HRQOL among Asian Americans, which can inform future interventions, especially among men and those with low social support, aimed at improving the quality of life in this population.

Discrimination and Sleep among Asians and Pacific Islanders Adults

STUDY OBJECTIVES

To examine the association between discrimination and sleep duration and difficulty among Asians and Pacific Islanders (APIs) in the United States, and to test nativity and ethnic identity (EI) as effect modifiers.

METHODS

This cross-sectional study of 1,765 adults from the National Epidemiology Study of Alcohol and Related Conditions III, assessed discrimination using the Experiences of Discrimination scale. Discrimimation was classified as low, moderate, and high. Regression models were used to examine self-reported sleep duration and difficulty.

RESULTS

In bivariate analyses, individuals with high discrimination had the shortest sleep and reported sleep difficulty most often. Using linear models adjusted for sociodemographic and health characteristics, moderate and high discrimination were associated with 9 minutes (standard error [SE]: 4.8, p <0.10) and 14.4 minutes (SE: 6.0, p <0.05) less sleep, respectively, relative to low discrimination. Individuals with moderate and high discrimination had higher prevalence of sleep difficulty compared to those with low discrimination (prevalence ratio [PR]: 1.51, 95% confidence interval [CI]: 1.14-1.99 and PR: 1.73, 95% CI: 1.33-2.24, respectively). Interaction effect was observed in sleep difficulty by nativity and EI, but not duration. The association between discrimination and sleep difficulty was stronger among US-born relative to foreign-born participants. Among participants with low EI, moderate and high discrimination were associated with sleep difficulty, whereas among those with high EI, only high discrimination displayed this association.

CONCLUSIONS

Discrimination is associated with sleep duration and difficulty, and varies by nativity and EI. Research is needed to improve sleep among APIs that experience discrimination.[.

Cross-sectional validation of the PROMIS-Preference scoring system by its association with social determinants of health

PURPOSE

PROMIS-Preference (PROPr) is a generic, societal, preference-based summary score that uses seven domains from the Patient-Reported Outcomes Measurement Information System (PROMIS). This report evaluates construct validity of PROPr by its association with social determinants of health (SDoH).

METHODS

An online panel survey of the US adult population included PROPr, SDoH, demographics, chronic conditions, and four other scores: the EuroQol-5D-5L (EQ-5D-5L), Health Utilities Index (HUI) Mark 2 and Mark 3, and the Short Form-6D (SF-6D). Each score was regressed on age, gender, health conditions, and a single SDoH. The SDoH coefficient represents the strength of its association to PROPr and was used to assess known-groups validity. Convergent validity was evaluated using Pearson correlations between different summary scores and Spearman correlations between SDoH coefficients from different summary scores.

RESULTS

From 4142 participants, all summary scores had statistically significant differences for variables related to education, income, food and financial insecurity, and social interactions. Of the 42 SDoH variables tested, the number of statistically significant variables was 27 for EQ-5D-5L, 17 for HUI Mark 2, 23 for HUI Mark 3, 27 for PROPr, and 27 for SF-6D. The average SDoH coefficients were - 0.086 for EQ-5D-5L, - 0.039 for HUI Mark 2, - 0.063 for HUI Mark 3, - 0.064 for PROPr, and - 0.037 for SF-6D. Despite the difference in magnitude across the measures, Pearson correlations were 0.60 to 0.76 and Spearman correlations were 0.74 to 0.87.

CONCLUSIONS

These results provide evidence of construct validity supporting the use of PROPr monitor population health in the general US population.

Longitudinal associations between self-reported experiences of discrimination and depressive symptoms in young women and men post- myocardial infarction

Objectives

Research suggests that following a myocardial infarction (MI), women under the age of 60 have more elevated depressive symptoms and adverse outcomes than similarly aged men. Identifying risk factors that contribute to gender differences in depressive symptoms among this group may be critical to the development of psychosocial interventions. Experiences of discrimination may be an important correlate of depressive symptoms in this group; however, studies of this relationship have largely been cross-sectional and focused on healthy populations. This study examines longitudinal associations among gender, discrimination, and depressive symptoms in a young post-MI cohort.

Methods

Participants were 313 adults from the Myocardial Infarction and Mental Stress Ischemia Study 2 of young (≤60 yrs) post-MI patients. At baseline and 6 month follow-up, depressive symptoms were measured with the Beck Depression Inventory-II and discrimination was assessed with the 10-item version Everyday Discrimination scale. Linear regression models were used to assess the longitudinal association between reports of discrimination and depressive symptoms adjusted for sociodemographic characteristics, psychosocial factors and health status indicators and tested for gender differences.

Results

The mean age was 51.2, 49.6% were women, and 69.5% were African-American. Although the discrimination-by-gender interaction was marginally significant (p=.09) in the fully adjusted model, findings suggest that the association between changes in reports of discrimination and depressive symptoms over time may be more pronounced for women (β=.61, standard error=.15, p<.001) than men (β=.27, standard error=.13, p=.033).

Conclusion

Our findings suggest that discrimination is a risk factor for depressive symptoms in young post-MI populations over time.

Prevalence of workplace discrimination and mistreatment in a national sample of older U.S. workers: The REGARDS cohort study

Although workplace discrimination and mistreatment (WDM) has recently drawn widespread media attention, our understanding of the prevalence of these phenomena remains limited. In the current study, we generated national prevalence estimates of WDM from a community-based cohort of employed black and white men and women aged ≥48 years. Measures of WDM in the current job were obtained by computer-assisted telephone interview (2011-2013) involving dichotomous responses (yes or no) to five questions and deriving a composite measure of discrimination (yes to at least one). Prevalence estimates and age- and region-adjusted prevalence ratios were derived with use of SUDAAN software to account for the complex sample design. Analyses were stratified by race and sex subgroups. This sample represents over 40 million U.S. workers aged ≥48 years. The prevalence of workplace discrimination ranged from a high of 25% for black women to a low of 11% for white men. Blacks reported a 60% higher rate of discrimination compared to whites; women reported a 53% higher prevalence of discrimination, compared with men. The prevalence of workplace mistreatment ranged from 13% for black women to 8% for white men. Women reported a 52% higher prevalence of mistreatment compared to men, while differences by race were not significant. Mistreatment was 4-8 times more prevalent among those reporting discrimination than among those reporting none. Subgroup differences in mistreatment were confined to the wage-employed. Findings suggest that middle age and older wage-employed blacks and women experience the highest prevalence of WDM; moreover, discrimination is strongly associated with mistreatment. This study contributes to our understanding of at-risk segments of the U.S. labor market and the need for targeted interventions to reduce WDM.

Type 2 Diabetes Self-Management in Non-Hispanic Black Men: a Current State of the Literature

PURPOSE OF REVIEW

This article discusses the state of type 2 diabetes (T2D) self-management research on non-Hispanic Black men with a focus on their knowledge of diabetes, factors that impact T2D self-management and intervention research that specifically targets non-Hispanic Black men with T2D.

RECENT FINDINGS

Studies on T2D knowledge and barriers and facilitators to T2D self-management in non-Hispanic Black men are limited to small qualitative focus group and in-depth interviews. To date, few T2D interventions for non-Hispanic Black men have been developed and tested. Research shows that non-Hispanic Black men's knowledge of T2D may be less than optimal compared to non-Hispanic white men. Factors that influence T2D self-management in non-Hispanic Black men include gender-related values and beliefs, and a range of other psychosocial (e.g., social support) and structural (e.g., access to health care) factors. Interventions with gender-specific programming may show promise. More studies with larger sample sizes and longitudinal designs are needed to develop programming to effectively target this at-risk population.

It's a Matter of Trust: Older African Americans Speak About Their Health Care Encounters

PURPOSE

To examine perceptions of older African Americans' encounters with health care providers and ways to enhance trust.

METHOD

Transcribed semi-structured interviews with African American senior center members were analyzed, using Pattern Coding method.

RESULTS

Four themes emerged: "Added Insult of Ageism," "Alternative Remedies," "Good Providers in a 'Broken' System," and "The Foundation of Trust Is Person Recognition." Provider behaviors leading to mistrust included erroneously assuming stereotypical preferences and competence, spending inadequate time listening to patients, disregarding patient preferences, and insufficiently explaining treatments.

DISCUSSION

Of importance to improving trust among older African American patients is valuing individual histories and preferences by reallocating scarce time to person-centered listening, individualizing treatments, more completely explaining interventions, and assuring that patients understand and agree with treatment plans.