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

Sociocultural determinants of health-associated quality of life among Afghan refugees in Pakistan: evidence from a multi-stage cross-sectional study

BACKGROUND

In the past few decades, there has been a significant increase in the number of refugees worldwide. Every individual deserves access to the fundamental right to health, and migration can have a substantial beneficial or detrimental effect on one's health. Foreign invasions and political instability in Afghanistan affected neighboring countries with the large influx of refugees. Discrepancies in quality of life between the host and refugee populations may lead to health inequalities. Investigations in Pakistan on the quality of life of Afghan refugees were scarce despite more than four decades of refugee status. Therefore, this study was initiated to assess the sociocultural determinants influencing health-associated quality of life among Afghan refugees in Pakistan.

METHODS

The Punjab province and Khyber Pakhtunkhwa province refugee populations were selected as the study population for cross-sectional research based on the inclusion criteria of majority refugee representation and female participation. Quantitative research methodology with pre-validated WHOQOL-BREF questionnaires was used for data collection via multi-stage probability sampling techniques. We collected data from 1,185 study participants and applied univariate and bivariate analyses. Inferential analyses included independent t-tests and ANOVA.

RESULTS

The average scores for the entire sample of Afghan refugees were highest for the social domain (58.78 ± 22.74), followed by the physical domain (53.29 ± 19.46), the general health domain (50.44 ± 20.10), the environmental domain (48.43 ± 16.30), and the psychological domain (46.52 ± 14.78). Age, marital status, family setup, mother language, number of years in the host country, residence type, family monthly income, access to health care, current health status, chronic health illness, substance abuse (smoking), cultural compatibility, linguistic barriers, and social inclusion were non-significant with all the subdomains in the inferential analysis using the independent t-test and analysis of variance.

CONCLUSION

The Afghan refugees' average scores across all health-associated quality-of-life domains were lower than Pakistan's host population and the standard cutoff criteria (< 60 indicates poor quality of life). The development of a national policy to include refugees in health insurance programs seems essential to improve the health-associated quality of life among Afghan refugees in Pakistan.

The Sense of Coherence as a Mediator of the Negative Effect of Discrimination on the Quality of Life in the Migrant Population

Migration generates changes in the quality of life (QoL) of immigrants. One of the difficulties that the process of migrating can entail is discrimination, which is the set of negative attitudes towards a person, in this case, because of their nationality. Objective: To analyze the effect that the sense of coherence (SOC) has on the relationship that discrimination by national origin has on quality of life. Method: The WHOQOL-BREF questionnaire was used to assess QoL, and Krieger's Perceived Discrimination Experiences scale and Antonovsky's SOC-13 scale were applied to 2144 participants (49.9% women), aged between 18 and 82 years, from Venezuela, Colombia and Peru, all of them being first generation migrants living in Chile. Results: In all the national groups evaluated, discrimination has an inverse relationship with both QoL and SOC, while the latter has a positive relationship with QoL. The direct effect of discrimination on QoL life is found to be smaller when this relationship is mediated by the presence of the SOC. This proposed model has good goodness-of-fit indicators in the three national groups evaluated. Conclusions: A strong and well-defined life purpose, a perception of greater control over surrounding events and situations, and perceiving life events as understandable and consistent can be an effective tools to diminish the effect of discrimination on quality of life in the migrant population.

The relationship of cultural variables to attitudes toward prescription drug usage among Iranian/Persian Americans

The present study examined the effects of cultural factors(ethnic identity, acculturation, perceived discrimination, and religiosity), derived from the Multicultural Assessment-Intervention Process (MAIP) model, on attitudes toward prescription drug use among Iranian/Persian Americans across the United States. The study consisted of a final sample of 454 Iranian/Persian American adult participants. The results indicated that Iranian/Persian American attitudes toward prescription drug use are impacted by demographic and cultural factors. Less heritage acculturation was found to be a predictor of attitudes toward the use of recreational and achievement-oriented prescription drug use. Further, perceived discrimination, specifically, perceived stigmatization and threat/aggression as well as less identification with Iranian/Persian heritage culture, were found to predict more positive attitudes toward prescription drug use among Iranian/Persian Americans. Religiosity was not found to be predictive of prescription drug usage. The present study underscores the usefulness of considering the impact of Iranian/Persian American ethnic identity, acculturation, and perceived discrimination in treating substance abuse within this population. Clinical implications, limitations, and future research are discussed.

Racial and gender differences in discrimination and psychological distress among young adults

Racial and gender differences in the effects of discrimination on health are well-established. The evidence has derived largely from studies of older adults, with less attention paid to younger adults. The current study takes an intersectional approach to address this gap. Using nationally representative, longitudinal data from the 2017 and 2019 Panel Study of Income Dynamics Transitioning to Adulthood Supplement (PSID-TAS), we assess the effects of everyday discrimination on psychological distress among Black and White young adults aged 18-28 (n = 3894). We examine cumulative discrimination and individual items of the cumulative measure based on the Everyday Discrimination Scale. The analysis reveals that perceived discrimination is positively associated with psychological distress for each race-gender group. However, the magnitude of the association varied by group and dimension of discrimination. Black men and women reported more frequent experiences of each type of discrimination than their White counterparts. The positive association between discrimination and distress, however, was lower for Black men and women relative to White men- suggesting that White men may be more sensitive to and/or less resilient against the effects of perceived discrimination. In contrast, associations for White women did not differ significantly from those of White men. Our findings demonstrate that the health-harming effects of discrimination on psychological distress begin early in the life course and suggest that resilience-based coping mechanisms found in older samples of Black adults may also exist for younger adults.

Asian Hate, religion, and perceived changes in physical health: exploring the flip side of minority stress during the COVID-19 pandemic

OBJECTIVES

Prior research suggests that racism is associated with adverse mental health outcomes for Asians in the United States. Relatively less research has been conducted to examine the effects of racism on physical health, particularly the changes in physical health among Asians and Asian Americans. This study aims to fill in this gap in prior research.

DESIGN

Survey was conducted via Qualtrics in March 2023. A panel sample of 356 Asian and Asian American adults from across the US was collected. Ordinary Least Squares Regression was employed to examine the interrelationships among racism, religion, and perceived changes in physical health during the COVID-19 pandemic.

RESULTS

Contrary to conventional wisdom, more frequent experience with blatant racism was associated with a perceived improvement in physical health after controlling for subtle racism, anxiety, acculturation, and various sociodemographic variables. Interestingly, this robust relationship was more significant among Asians who attended religious services more frequently. Additional three-way interactions revealed that the interaction between blatant racism and religious service attendance on perceived changes in physical health was more significant for US-born Asians and Asians of Indian or Japanese ethnicity.

CONCLUSION

Racism exerts a significant influence on physical health outcomes among Asians and Asian Americans. However, this relationship was contingent upon the specific aspect of racism and intersected with religiosity, acculturation, and ethnic identity.