Comparing measures of racial/ethnic discrimination, coping, and associations with health-related outcomes in a diverse sample

Maternal Experiences of Racial Discrimination, Child Indicators of Toxic Stress, and the Minding the Baby Early Home Visiting Intervention

BACKGROUND

Racism is a significant source of toxic stress and a root cause of health inequities. Emerging evidence suggests that exposure to vicarious racism (i.e., racism experienced by a caregiver) is associated with poor child health and development, but associations with biological indicators of toxic stress have not been well studied. It is also unknown whether two-generation interventions, such as early home visiting programs, may help to mitigate the harmful effects of vicarious racism.

OBJECTIVE

The purpose of this study was to examine associations between maternal experiences of racial discrimination and child indicators of toxic stress and to test whether relationships are moderated by prior participation in Minding the Baby (MTB), an attachment-based early home visiting intervention.

METHODS

Ninety-seven maternal-child dyads (n = 43 intervention dyads, n = 54 control dyads) enrolled in the MTB Early School Age follow-up study. Mothers reported on racial discrimination using the Experiences of Discrimination Scale. Child indicators of toxic stress included salivary biomarkers of inflammation (e.g., C-reactive protein, panel of pro-inflammatory cytokines), body mass index, and maternally reported child behavioral problems. We used linear regression to examine associations between maternal experiences of racial discrimination and child indicators of toxic stress and included an interaction term between experiences of discrimination and MTB group assignment (intervention vs. control) to test moderating effects of the MTB intervention.

RESULTS

Mothers identified as Black/African American (33%) and Hispanic/Latina (64%). In adjusted models, maternal experiences of racial discrimination were associated with elevated salivary interleukin-6 and tumor necrosis factor-α levels in children, but not child body mass index or behavior. Prior participation in the MTB intervention moderated the relationship between maternal experiences of discrimination and child interleukin-6 levels.

DISCUSSION

Results of this study suggest that racism may contribute to the biological embedding of early adversity through influences on inflammation, but additional research with serum markers is needed to better understand this relationship. Improved understanding of the relationships among vicarious racism, protective factors, and childhood toxic stress is necessary to inform family and systemic-level intervention.

Racism, stress and health in Asian Americans: A structural equation analysis of mediation and social support group differences

The buffering effect of social support on the negative effects of racism exposure on health outcomes has been mixed in prior studies regarding Asian Americans. Based on the stress-coping framework and using structural equation modelling (SEM) methods, we tested a theoretical model portraying simultaneous mediational paths from racism exposure to general physical and mental health through racism-related stress. Bootstrap analysis was used to test the indirect effects present in the model. Additionally, multi-group SEM analysis was conducted to investigate the moderation effect of social support from family and friends on the paths in the model. The sample consisted of 310 Asian American adults who completed an online survey. The results from the two-step SEM analysis and bootstrap analysis supported the theoretical model-racism exposure can simultaneously have a negative indirect effect on Asian Americans' physical and mental health via racism-related stress. Multi-group SEM analysis showed that there were no differences in model path coefficients based on having varying levels of social support from friends or family.

Coping with Discrimination from Peers and Adults: Implications for Adolescents' School Belonging

School belonging is a key indicator of students' academic well-being that is threatened by adults' and peers' transgressions of discrimination. Moreover, the hierarchical power structure at school enables adults and peers to enact ethnic-racial discrimination differently, which is also more or less salient among Black, Asian American, and Latinx youth. Therefore, this study aimed to disentangle the links between adult and peer-perpetrated racial discrimination at school, five distinct coping strategies, and school belonging across ethnic-racial groups. Participants were 1686 students in grades 9-12. These results indicated that adolescents who reported peer discrimination also reported greater proactive and aggressive coping. Black youth who reported more adult discrimination also reported more proactive coping, whereas Asian and Latinx youth who reported more peer discrimination reported more proactive coping. Peer discrimination was indirectly associated with greater school belonging via proactive coping, whereas adult discrimination was directly and negatively related to belonging. These findings suggest that adolescents may be selecting to proactively cope when faced with the discrimination source they most often navigate.

Association between racial discrimination and health-related quality of life and the impact of social relationships

PURPOSE

Interpersonal racial discrimination is associated with poor health. Social relationships may moderate the impact of discrimination and represent modifiable behaviors that can be targeted by public health interventions. We described citywide associations between self-reported racial discrimination and health-related quality of life among the overall New York City (NYC) adult residential population and by four main race/ethnicity groups and explored whether social relationships moderated health effects of discrimination.

METHODS

We analyzed cross-sectional survey data from 2335 adults weighted to be representative of the NYC population. We measured exposures to lifetime interpersonal racial discrimination in nine domains using a modified version of the Experiences of Discrimination scale. We performed unadjusted and adjusted regression analyses on four self-rated health-related quality of life outcomes including general health, physical health, mental health, and limitations from physical or mental health.

RESULTS

Overall, 47% [95% CI 44.5, 50.3] of respondents reported having experienced racial discrimination in at least one domain. In the overall population, significant associations with racial discrimination were noted in adjusted models for poor physical health, poor mental health, and limitations by poor physical and mental health. Among those exposed to racial discrimination, the risk of experiencing poor mental health was lower among those who had contact with family or friends outside their household at least once a week, compared with those who had less frequent social contact.

CONCLUSION

This study provides evidence that social relationships may moderate the impact of racial discrimination on mental health and should be integrated into health promotion efforts.

Effect of Perceived Discrimination on Depressive Symptoms in 1st- and 2nd-Generation Afghan-Americans

While it is well established that Afghan refugees are disproportionately affected by mental health problems, limited evidence exists concerning the psychosocial needs of their children who are transitioning to adulthood in the United States; that is, of 1st- and 2nd-generation Afghan-Americans. The purpose of this study was to examine the effect of perceived discrimination on depressive symptoms in this population, and to determine whether discrimination is buffered by ethnic identity and social support. A convenience sample of 133 1st- and 2nd-generation Afghan-Americans participated in this study by completing a brief survey. We used OLS regression methods to control for covariates, and to sequentially test study hypotheses. The results show that perceived discrimination was significantly associated with high levels of depression. Furthermore, the effect of discrimination on depression was not buffered by ethnic identity or social support. We found that perceived discrimination was a significant source of stress and a risk-factor for negative mental health outcomes among 1st- and 2nd-generation Afghan-Americans. Future research should examine additional pre-dispositional and protective factors for discriminatory experiences and associated health outcomes.

Immigrants’ Experiences of Everyday Discrimination in Canada: Unpacking the Contributions of Assimilation, Race, and Early Socialization

We examined perceptions of everyday discrimination among immigrants in Canada and in comparison to native-born Canadians using data from the 2013 Canadian Community Health Survey. We find that recent immigrants report less discrimination than native-born Canadians, ceteris paribus. Recent immigrants also report less discrimination than their fellow immigrants who had been residing in Canada for much longer durations. There were trivial differences in perceptions of everyday discrimination between native-born Canadians and midway and established immigrants, all else being equal. Additional analysis suggests that differences in age at arrival and associated early socialization experiences might explain variations in immigrants’ perceived discrimination.

Binge drinking and perceived ethnic discrimination among Hispanics/Latinos: Results from the Hispanic community health study/study of Latinos sociocultural ancillary study

The study assessed whether overall perceived ethnic discrimination and four unique discrimination types were associated with binge drinking in participants from the Hispanic Community Health Study/Study of Latinos who also completed the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (n = 5,313). In unadjusted analyses that were weighted for sampling strategy and design, each unit increase in discrimination type was associated with a 12-63% increase in odds of binge drinking; however, after adjusting for important demographic variables including age, sex, heritage group, language, and duration of U.S. residence, there was no longer an association between discrimination and binge drinking. Further research still needs to identify the salient factors that contribute to increased risk for binge drinking among Hispanics/Latinos.

Perceived discrimination and cancer screening behaviors in US Hispanics: the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

PURPOSE

Perceived discrimination has been associated with lower adherence to cancer screening guidelines. We examined whether perceived discrimination was associated with adherence to breast, cervical, colorectal, and prostate cancer screening guidelines in US Hispanic/Latino adults.

METHODS

Data were obtained from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study, including 5,313 Hispanic adults aged 18–74 from Bronx, NY, Chicago, IL, Miami, FL, and San Diego, CA, and those who were within appropriate age ranges for specific screening tests were included in the analysis. Cancer screening behaviors were assessed via self-report. Perceived discrimination was measured using the Perceived Ethnic Discrimination Questionnaire. Confounder-adjusted multivariable polytomous logistic regression models assessed the association between perceived discrimination and adherence to cancer screening guidelines.

RESULTS

Among women eligible for screening, 72.1 % were adherent to cervical cancer screening guidelines and 71.3 %were adherent to breast cancer screening guidelines. In participants aged 50–74, 24.6 % of women and 27.0 % of men were adherent to fecal occult blood test guidelines; 43.5 % of women and 34.8 % of men were adherent to colonoscopy/sigmoidoscopy guidelines; 41.0 % of men were adherent to prostate-specific antigen screening guidelines. Health insurance coverage, rather than perceived ethnic discrimination,was the variable most associated with receiving breast, cervical,colorectal, or prostate cancer screening.

CONCLUSIONS

The influence of discrimination as a barrier to cancer screening may be modest among Hispanics/Latinos in urban US regions. Having health insurance facilitates cancer screening in this population. Efforts to increase cancer screening in Hispanics/Latinos should focus on increasing access to these services, especially among the uninsured.

Racism as a Determinant of Health: A Systematic Review and Meta-Analysis

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.

Discrimination and common mental disorders of undergraduate students of the Universidade Federal de Santa Catarina

INTRODUCTION

The pathogenic and consistent effect of discrimination on mental health has been largely documented in the literature. However, there are few studies measuring multiple types of discrimination, evaluating the existence of a dose-response relationship or investigating possible effect modifiers of such an association.

OBJECTIVE

To investigate the association between experiences of discrimination attributed to multiple reasons and common mental disorders, including the adjustment for potential confounders, assessment of dose-response relations, and examination of effect modifiers in undergraduate students from southern Brazil.

METHODS

In the first semester of 2012, 1,023 students from the Universidade Federal de Santa Catarina answered a self-administered questionnaire on socio-demographic characteristics, undergraduate course, experiences of discrimination and common mental disorders. Associations were analyzed through logistic regression models, estimation of Odds Ratios and 95% confidence intervals (95%CI).

RESULTS

The study results showed that students reporting discrimination at high frequency and intensity were 4.4 (95%CI 1.6 - 12.4) times more likely to present common mental disorders. However, the relationship between discrimination and common mental disorders was protective among Electrical Engineering students, when compared to Accounting Sciences students who did not report discrimination.

CONCLUSION

The findings suggest that the dose-response relationship between experiences of discrimination and common mental disorders reinforces the hypothetical causal nature of this association. Nevertheless, the modification of effect caused by the undergraduate course should be considered in future studies for a better understanding and measurement of both phenomena.

Stress and Coping among Black Women Employed in Non-professional Service and Professional Occupations in Florida and Georgia

Culture enhances the ability to address the stressors related to ethnicity/race, employment, and lifestyle. From this interaction, two coping patterns emerge: individualist-oriented or collectivist-oriented, of which women prefer the latter. However, there is limited knowledge about the impact of ethnicity/race on the coping strategies of Black working women in the USA. Therefore, the purpose of this cross-sectional survey was to examine the coping strategies of two groups of Black women, those who work in non-professional service-related jobs and those employed as professionals. We explored Black women from two southern states, Florida and Georgia, in their use of coping strategies for everyday stressors. A modified version of Lazarus and Folkman's Transactional Model was used as the framework of this study. The sample for this cross-sectional survey consisted of 313 Black women employed in non-professional service jobs and 343 in professional roles. The thoughts and actions related to coping in everyday stressors were measured with The Ways of Coping Questionnaire.

Muddling Through the Health System: Experiences of Three Groups of Black Women in Three Regions

Health-care disparities are a well-documented concern among patients and providers who care for minority groups in the United States. In this study, focus groups were created from an original sample of 606 Black women representing three regions in the United States: the South, the Midwest, and the Virgin Islands. Composed of 10 randomly selected members each (n = 30), the focus groups provided insights into the nature of these disparities, with some suggestions for viable solutions. Participants voiced concerns regarding cultural taboos about discussing menopause, financial concerns, and negative experiences with healthcare leading to distrust in medical systems. The primary solution proposed was an increase in Black health-care professionals who would have increased rapport with, empathy for, and understanding of the concerns of Black women.

Racial and non-racial discrimination and smoking status among South African adults 10 years after apartheid

BACKGROUND

Despite a long history of discrimination and persisting racial disparities in smoking prevalence, little research exists on the relationship between discrimination and smoking in South Africa.

METHODS

This analysis examined chronic (day-to-day) and acute (lifetime) experiences of racial and non-racial (eg, age, gender or physical appearance) discrimination and smoking status among respondents to the South Africa Stress and Health study. Logistic regression models were constructed using SAS-Callable SUDAAN.

RESULTS

Both chronic racial discrimination (RR=1.45, 95% CI 1.14 to 1.85) and chronic non-racial discrimination (RR=1.69, 95% CI 1.37 to 2.08) predicted a higher risk of smoking, but neither type of acute discrimination did. Total (sum of racial and non-racial) chronic discrimination (RR=1.46, 95% CI 1.20 to 1.78) and total acute discrimination (RR=1.28, 95% CI 1.01 to 1.60) predicted a higher risk of current smoking.

CONCLUSIONS

Racial and non-racial discrimination may be related to South African adults' smoking behaviour, but this relationship likely varies by the timing and frequency of these experiences. Future research should use longitudinal data to identify the temporal ordering of the relationships studied, include areas outside of South Africa to increase generalisability and consider the implications of these findings for smoking cessation approaches in South Africa.

Longitudinal determinants of substance use disorders

Substance use and substance use disorders (SUDs) have been linked with marital discord. Relatively little is known, however, about the antecedents of SUDs, the mediators of these factors over time, or their associations with the spousal/partner relationship among urban adults. A better understanding of the longitudinal pathways to marital conflict and to SUDs should help prevention and intervention programs target their precursors within the developmental period in which they occur. The present study, therefore, examined the longitudinal predictors of an unsupportive spousal/partner relationship and SUDs among a community sample of urban African American and Puerto Rican adults from East Harlem, NY. Participants (N = 816) completed structured questionnaires at five time waves, from adolescence to adulthood (mean ages = 14, 19, 24, 29, and 32 years). Structural equation modeling examined the effects of earlier environmental and social stressors and intrapersonal and interpersonal factors on later SUDs in adulthood. There was a good fit of the structural equation model (CFI = 0.91; RMSEA = 0.06; and SRMR = 0.06), which revealed three main pathways from adolescence to the spousal/partner relationship and SUDs in adulthood. One pathway linked a weak parent-adolescent attachment relationship with the participant's psychological symptoms in emerging adulthood (p < 0.01), which in turn were related to affiliation with deviant and drug-using peers, also in emerging adulthood (p < 0.001). Peer deviance and drug use were associated with the participant's substance use in young adulthood (p < 0.001), which predicted both an unsupportive spousal/partner relationship (p < 0.05) and SUDs (p < 0.001) later in adulthood. Other pathways highlighted the continuity of psychological symptoms as related to both substance use in young adulthood (p < 0.001) and an unsupportive spousal/partner relationship in adulthood (p < 0.001). Findings showed that the associations of both distal stressors and the parent-adolescent relationship with more proximal intra- and interpersonal problems predicted unsupportive spousal/partner relationships and SUDs among urban adults. Several aspects of the individual's life, at different developmental stages, provide opportunities for interventions to prevent or reduce unsupportive spousal/partner relationships and SUDs.

Relationships between discrimination in health care and health care outcomes among four race/ethnic groups

Discrimination has been found to be detrimental to health, but less is known about the influence of discrimination in health care. To address this, the current study (1) compared levels of racial/ethnic discrimination in health care among four race/ethnic groups; (2) determined associations between this type of discrimination and health care outcomes; and (3) assessed potential mediators and moderators as suggested by previous studies. Multivariate logistic regression models were used within a population-based sample of 1,699 White, African American, Mexican, and Puerto Rican respondents. Overall, 23% of the sample reported discrimination in health care, with levels varying substantially by race/ethnicity. In adjusted models, this type of discrimination was associated with an increased likelihood of having unmet health care needs (OR = 2.48, CI = 1.57-3.90) and lower odds of perceiving excellent quality of care (OR = 0.43, CI = 0.28-0.66), but not with the use of a physician when not sick or use of alternative medicine. The mediating role of mental health factors was inconsistently observed and the relationships were not moderated by race/ethnicity. These findings expand the literature and provide preliminary evidence that can eventually inform the development of interventions and the training of health care providers.