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Bather JR, Cuevas AG, Harris A, Kaphingst KA, Goodman MS. Associations between perceived discrimination over the life course, subjective social status, and health literacy: A racial/ethnic stratification analysis. PEC INNOVATION 2024; 5:100334. [PMID: 39257628 PMCID: PMC11384512 DOI: 10.1016/j.pecinn.2024.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 08/03/2024] [Accepted: 08/18/2024] [Indexed: 09/12/2024]
Abstract
Objective To analyze the relationship between perceived discrimination over the life course, social status, and limited health literacy (HL). Methods 5040 adults who participated in the 2023 Survey of Racism and Public Health. We applied stratified multilevel models adjusted for sociodemographic characteristics. Results The average age was 47 years, 48% identified as White, 20% as Latinx, and 17% as Black. In the overall sample, we observed associations of perceived discrimination (b = 0.05, 95% CI: 0.01, 0.09), subjective social status (b = -0.16, 95% CI: -0.23, -0.10), and their interaction (b = 0.02, 95% CI: 0.01, 0.03). More perceived discrimination was associated with lower HL in the White and Multiracial participants. Higher subjective social status was associated with higher HL in the White and Latinx participants. There was a statistically significant interaction between perceived discrimination and subjective social status on HL among the White, Latinx, and Multiracial participants. Conclusion This analysis has implications for public health practice, indicating that multi-level interventions are needed to address limited HL. Innovation Our findings provide novel insights for identifying key SDOH indicators to assess in clinical settings to provide health literate care.
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Affiliation(s)
- Jemar R Bather
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Biostatistics, New York University School of Global Public Health, New York, NY 10003, USA
| | - Adolfo G Cuevas
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY 10003, USA
| | - Adrian Harris
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
- Department of Communication, University of Utah, Salt Lake City, UT 84112, USA
| | - Melody S Goodman
- Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, NY 10003, USA
- Department of Biostatistics, New York University School of Global Public Health, New York, NY 10003, USA
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Lawrence JA, Kawachi I, White K, Bassett MT, Williams DR. Instrumental Variable Analysis of Racial Discrimination and Blood Pressure in a Sample of Young Adults. Am J Epidemiol 2023; 192:1971-1980. [PMID: 37401004 PMCID: PMC10691201 DOI: 10.1093/aje/kwad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 07/05/2023] Open
Abstract
Racial inequities in blood pressure levels have been extensively documented. Experiences of racial discrimination could explain some of this disparity, although findings from previous studies have been inconsistent. To address limitations of prior literature, including measurement error, we implemented instrumental variable analysis to assess the relationship between racial discrimination in institutional settings and blood pressure. Using data from 3,876 Black and White adults with an average age of 32 years from examination 4 (1992-1993) of the Coronary Artery Risk Development in Young Adults Study, our primary analysis examined the relationship between self-reported experiences of racial discrimination in institutional settings and blood pressure using reflectance meter measurement of skin color as an instrument. Findings suggested that an increase in experiences of racial discrimination was associated with higher systolic and diastolic blood pressure (β = 2.23 mm Hg (95% confidence interval: 1.85, 2.61) and β = 1.31 (95% confidence interval: 1.00, 1.62), respectively). Our instrumental variable estimates suggest that experiences of racial discrimination within institutional settings contribute to racial inequities in elevated blood pressure and cardiovascular disease outcomes in a relatively young cohort of adults and may yield clinically relevant differences in cardiovascular health over the life course.
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Affiliation(s)
- Jourdyn A Lawrence
- Correspondence to Dr. Jourdyn A. Lawrence, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 5th Floor, 3215 Market Street, Philadelphia, PA 19104 (e-mail: )
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Ahmed MK, Scretching D, Lane SD. Study designs, measures and indexes used in studying the structural racism as a social determinant of health in high income countries from 2000-2022: evidence from a scoping review. Int J Equity Health 2023; 22:4. [PMID: 36609274 PMCID: PMC9817325 DOI: 10.1186/s12939-022-01796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Globally, structural racism has been well documented as an important social determinant of health (SODH) resulting in racial inequality related to health. Although studies on structural racism have increased over the years, the selection of appropriate designs, measures, and indexes of measurement that respond to SODH has not been comprehensively documented. Therefore, the lack of evidence seems to exist. This scoping review was conducted to map and summarize global evidence on the use of various designs, measures, and indexes of measurement when studying structural racism as a social determinant of health. METHODS We performed a scoping review of global evidence from 2000 to 2022 published in 5 databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Web of Science, ProQuest, and relevant grey literature on structural racism. We conducted a systematic search using keywords and subject headings around 3 concepts. We included peer reviewed original research/review articles which conceived the framework of social determinants of health (SODH) and studied structural racism. RESULTS Our review identified 1793 bibliographic citations for screening and 54 articles for final review. Articles reported 19 types of study design, 87 measures of exposure and 58 measures of health outcomes related to structural racism. 73 indexes or scales of measurement were used to assess health impacts of structural racism. Majority of articles were primary research (n = 43/54 articles; 79.6%), used quantitative research method (n = 32/54 articles; 59.3%) and predominantly conducted in the United States (n = 46/54 articles; 85.2.6%). Cross-sectional study design was the most used design (n = 17/54 articles; 31.5%) followed by systematic review (n = 7/54 articles; 13.0%) and narrative review (n = 6/54 articles; 11.1%). Housing and residential segregation was the largest cluster of exposure with the highest impact in infant health outcome. CONCLUSIONS Our review found several key gaps and research priorities on structural racism such as lack of longitudinal studies and availability of structural or ecological data, lack of consensus on the use of consolidated appropriate measures, indexes of measurement and appropriate study designs that can capture complex interactions of exposure and outcomes related to structural racism holistically.
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Affiliation(s)
- Md Koushik Ahmed
- grid.264484.80000 0001 2189 1568Department of Public Health, Falk College of Sports and Human Dynamics, Syracuse University, 150 Crouse Dr, 430 White Hall, Syracuse, NY 13244 USA
| | - Desiree Scretching
- grid.264484.80000 0001 2189 1568School of Information Studies, Syracuse University, 343 Hinds Hall, Syracuse, NY 13244 USA
| | - Sandra D. Lane
- grid.264484.80000 0001 2189 1568Department of Public Health, Falk College of Sports and Human Dynamics, 439 White Hall, Syracuse University, Syracuse, NY 13244 USA
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Hamler TC, Nguyen AW, Keith V, Qin W, Wang F. How Skin Tone Influences Relationships Between Discrimination, Psychological Distress, and Self-Rated Mental Health Among Older African Americans. J Gerontol B Psychol Sci Soc Sci 2022; 77:2026-2037. [PMID: 35976084 PMCID: PMC9683503 DOI: 10.1093/geronb/gbac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES As within-group differences have emerged as a key area of inquiry for health disparities among African Americans, skin tone has been identified as an important factor. This study aims to examine: (a) the moderating role of skin tone in the relationship between discrimination, self-rated mental health, and serious psychological distress (SPD) and (b) whether this moderating effect differs across genders in a nationally representative sample of older African Americans. METHODS Analyses were conducted on a subsample of African Americans aged 55+ (N = 837) from the National Survey of American Life. The mental health outcomes were SPD and self-rated mental health. Discrimination was assessed with the Everyday Discrimination Scale. Skin tone was self-reported. Multiple linear regressions tested the study aims. RESULTS Discrimination was associated with worse self-rated mental health and SPD in the total sample and among women. Skin tone moderated the association between discrimination and SPD in the total sample and among men and women. The associations between discrimination and mental health outcomes were stronger among darker-skinned respondents than lighter respondents. Gender-stratified analyses indicated skin tone moderated the association between discrimination and self-rated mental health for men but not women. DISCUSSION This study contributes to the emerging body of literature on skin tone, discrimination, and mental health. Uncovering mechanisms behind the "why" is an important next step in understanding how skin tone influences the relationship between discrimination and mental health. The negative psychological effects associated with darker complexion provide several areas to be examined.
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Affiliation(s)
- Tyrone C Hamler
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Verna Keith
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Weidi Qin
- Center for Social Epidemiology and Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
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Lee KA, Bright CL, Sacco P, Smith ME. The Influence of Adverse Childhood Experiences on Perpetration of Intimate Partner Violence Among Black Men: The Moderating Role of Alcohol Use. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP17248-NP17275. [PMID: 34192964 DOI: 10.1177/08862605211027997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study examined the moderating role of alcohol use on the association between adverse childhood experiences (ACEs) and intimate partner violence (IPV) perpetration among Black men in the United States. We conducted bivariate and logistic regression analyses using data from Wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). Bivariate results revealed significant relationships between eight of the 10 ACE factors physical neglect; emotional, physical and sexual abuse; witnessing a mother being abused; and having a parent guardian with an alcohol and drug problem and who was incarcerated and IPV perpetration. Similarly, examination of the relationship between ACEs and alcohol use in adulthood also revealed significant associations, with the exception of exposure to emotional neglect, emotional and sexual abuse, and witnessing a mother being abused. Findings from the logistic regression models revealed that alcohol use significantly moderated the relationship between ACEs and IPV perpetration, but only for men exposed to 1, 2, and ≥4 adversities in childhood. However, alcohol use appeared to exacerbate the relationship between ACEs and IPV perpetration for men without childhood adversity. Implications for practice, policy, and areas for further research are discussed.
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Affiliation(s)
- Kerry A Lee
- University of Maryland, College Park, MD, USA
| | | | - Paul Sacco
- University of Maryland, Baltimore, MD, USA
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Pro G, Camplain R, Lea CH. The competing effects of racial discrimination and racial identity on the predicted number of days incarcerated in the US: A national profile of Black, Latino/Latina, and American Indian/Alaska Native populations. PLoS One 2022; 17:e0268987. [PMID: 35675290 PMCID: PMC9176760 DOI: 10.1371/journal.pone.0268987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/12/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Racial discrimination and racial identity may compete to influence incarceration risk. We estimated the predicted days incarcerated in a national US sample of Black, Latino/Latina, and American Indian/Alaska Native (AI/AN) individuals. METHODS We used the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 14,728) to identify individual incarceration history. We used zero-inflated Poisson regression to predict the number of days incarcerated across racial discrimination and racial identity scores. RESULTS Racial discrimination and identity varied between races/ethnicities, such that racial discrimination exposure was highest among Hispanic individuals, while racial identity was highest among Black individuals. Racial discrimination was positively associated with days incarcerated among Black individuals (β = 0.070, p<0.0001) and AI/AN individuals (β = 0.174, p<0.000). Racial identity was negatively associated with days incarcerated among Black individuals (β = -0.147, p<0.0001). The predicted number of days incarcerated was highest among Black individuals (130 days) with high discrimination scores. CONCLUSION Racial discrimination and racial identity were associated with days incarcerated, and the association varied by racial/ethnic sub-group. Informed by these findings, we suggest that intervention strategies targeting incarceration prevention should be tailored to the unique experiences of racial/ethnic minoritized individuals at the greatest risk. Policies aimed at reversing mass incarceration should consider how carceral systems fit within the wider contexts of historical racism, discrimination, and structural determinants of health.
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Affiliation(s)
- George Pro
- Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Ricky Camplain
- Department of Health Sciences, Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Charles H. Lea
- Graduate College of Social Work, University of Houston, Houston, Texas, United States of America
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Monk EP, Kaufman J, Montoya Y. Skin Tone and Perceived Discrimination: Health and Aging Beyond the Binary in NSHAP 2015. J Gerontol B Psychol Sci Soc Sci 2021; 76:S313-S321. [PMID: 34918148 PMCID: PMC8678440 DOI: 10.1093/geronb/gbab098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This paper introduces new measures of skin tone (self-reported) and perceived discrimination that are included in the third round of the National Social Life, Health, and Aging Project (NSHAP). We explain the rationale for these new measures, emphasizing, in particular, how they help researchers to conceptualize and measure the significance of race/ethnicity for health and aging beyond binary ethnoracial categories. METHOD We describe new measures of skin tone and perceived discrimination for use in NSHAP 2015. We provide descriptive statistics on the distribution of skin tone (self-reported) by race/ethnicity. As a proof of concept, we use logistic and ordinary least squares regression analyses to examine the relationship between skin tone, perceived discrimination, and perceived stress among ethnoracial minorities. RESULTS We find that there is significant variation in skin tone among non-White respondents in NSHAP 2015 (e.g., non-Hispanic Black and Latinx). We also find that skin tone (self-reported) is a significant predictor of the frequency of perceived discrimination and perceived stress among African American, but not Latinx respondents in NSHAP. DISCUSSION The inclusion of new skin tone and discrimination measures in NSHAP 2015 provides a unique and novel opportunity for researchers to more deeply understand how race/ethnicity is connected to health and aging among ethnoracial minorities. Furthermore, it will enable analyses of how stress and perceived discrimination also affect patterns of health and aging among Whites against the backdrop of steadily increasing socioeconomic inequalities and shifting ethnoracial demographics in the United States.
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Affiliation(s)
- Ellis P Monk
- Department of Sociology, Harvard University, Cambridge, Massachusetts, USA
| | - Jerry Kaufman
- Department of Sociology, University of Chicago, Illinois, USA
- NORC, University of Chicago, Illinois, USA
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Warne RT. Between-Group Mean Differences in Intelligence in the United States Are >0% Genetically Caused: Five Converging Lines of Evidence. AMERICAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.5406/amerjpsyc.134.4.0479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
The past 30 years of research in intelligence has produced a wealth of knowledge about the causes and consequences of differences in intelligence between individuals, and today mainstream opinion is that individual differences in intelligence are caused by both genetic and environmental influences. Much more contentious is the discussion over the cause of mean intelligence differences between racial or ethnic groups. In contrast to the general consensus that interindividual differences are both genetic and environmental in origin, some claim that mean intelligence differences between racial groups are completely environmental in origin, whereas others postulate a mix of genetic and environmental causes. In this article I discuss 5 lines of research that provide evidence that mean differences in intelligence between racial and ethnic groups are partially genetic. These lines of evidence are findings in support of Spearman’s hypothesis, consistent results from tests of measurement invariance across American racial groups, the mathematical relationship that exists for between-group and within-group sources of heritability, genomic data derived from genome-wide association studies of intelligence and polygenic scores applied to diverse samples, and admixture studies. I also discuss future potential lines of evidence regarding the causes of average group differences across racial groups. However, the data are not fully conclusive, and the exact degree to which genes influence intergroup mean differences in intelligence is not known. This discussion applies only to native English speakers born in the United States and not necessarily to any other human populations.
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Ezell JM, Pasquale D, Poudyal S, Azhar S, Monk E, Vidula M, Yeldandi V, Laumann E, Liao C, Schneider JA. Are skin color and body mass index associated with social network structure? Findings from a male sex market study. ETHNICITY & HEALTH 2021; 26:863-878. [PMID: 30870001 PMCID: PMC6745014 DOI: 10.1080/13557858.2019.1590537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Objectives: There is a growing burden of HIV and sex-related diseases in South Asia and India. Sociological research illustrates that key axes of social stratification, such as race and ethnicity, affect social network structure which, in turn, impacts sexual health and wellbeing. Research on networks has increasingly begun to examine the ways in which networks drive or harness sexual behaviors, but has largely neglected the influence of culture and cultural markers in this continuum. Furthermore, much of the existing scholarship has been conducted in the U.S. or in Western contexts.Design: As part of an exploratory effort, we examined how skin color and body mass index (BMI) affected networks among 206 men who have with men (MSM) frequenting sex markets in Hyderabad, India. A novel phone-based network generation method of respondent-driven sampling was used for recruitment. In assessing how skin color and BMI drive these structures, we also compared how these factors contribute to networks relative to two more commonly referenced markers of social difference among Indians, caste and religion.Results: Our findings suggest that skin color and BMI contribute significantly more to network structure than do caste and religion.Conclusions: These findings tentatively illuminate the importance of individual-level heterogeneity in bodily attributes, factors which are seldom considered in conventional approaches to researching how social stratification and health inequalities are animated during the formation of networks.
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Affiliation(s)
- Jerel M. Ezell
- Department of Sociology, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Dana Pasquale
- Department of Sociology, Duke University, Durham, NC
| | - Shirish Poudyal
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Sameena Azhar
- School of Social Service Administration, University of Chicago, Chicago, IL
| | - Ellis Monk
- Department of Sociology, Harvard University, Cambridge, MA
| | | | - Vijay Yeldandi
- International Center for Human Health Advancement, SHARE India, Hyderabad, India
- Department of Medicine, University of Illinois, Chicago, IL
| | - Edward Laumann
- Department of Sociology, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
| | - John A. Schneider
- Department of Medicine, University of Chicago, Chicago, IL
- Department of Public Health Sciences, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
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Monk EP. Colorism and Physical Health: Evidence from a National Survey. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:37-52. [PMID: 33426926 DOI: 10.1177/0022146520979645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study uses nationally representative data to extend a steadily growing body of research on the health consequences of skin color by comparatively examining the consequences of perceived ingroup and outgroup skin color discrimination (perceived colorism) for physical health among African Americans. Using a comprehensive set of measures of physical health, I find that perceived ingroup colorism is significantly associated with worse physical health outcomes among African Americans. Notably, the magnitude of ingroup colorism's associations with most of these outcomes rivals or even exceeds that of major lifetime discrimination, everyday discrimination, and perceived outgroup colorism. These findings compellingly suggest the inclusion of perceived colorism measures in future survey data collection efforts.
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Batai K, Cui Z, Arora A, Shah-Williams E, Hernandez W, Ruden M, Hollowell CMP, Hooker SE, Bathina M, Murphy AB, Bonilla C, Kittles RA. Genetic loci associated with skin pigmentation in African Americans and their effects on vitamin D deficiency. PLoS Genet 2021; 17:e1009319. [PMID: 33600456 PMCID: PMC7891745 DOI: 10.1371/journal.pgen.1009319] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023] Open
Abstract
A recent genome-wide association study (GWAS) in African descent populations identified novel loci associated with skin pigmentation. However, how genomic variations affect skin pigmentation and how these skin pigmentation gene variants affect serum 25(OH) vitamin D variation has not been explored in African Americans (AAs). In order to further understand genetic factors that affect human skin pigmentation and serum 25(OH)D variation, we performed a GWAS for skin pigmentation with 395 AAs and a replication study with 681 AAs. Then, we tested if the identified variants are associated with serum 25(OH) D concentrations in a subset of AAs (n = 591). Skin pigmentation, Melanin Index (M-Index), was measured using a narrow-band reflectometer. Multiple regression analysis was performed to identify variants associated with M-Index and to assess their role in serum 25(OH)D variation adjusting for population stratification and relevant confounding variables. A variant near the SLC24A5 gene (rs2675345) showed the strongest signal of association with M-Index (P = 4.0 x 10-30 in the pooled dataset). Variants in SLC24A5, SLC45A2 and OCA2 together account for a large proportion of skin pigmentation variance (11%). The effects of these variants on M-Index was modified by sex (P for interaction = 0.009). However, West African Ancestry (WAA) also accounts for a large proportion of M-Index variance (23%). M-Index also varies among AAs with high WAA and high Genetic Score calculated from top variants associated with M-Index, suggesting that other unknown genomic factors related to WAA are likely contributing to skin pigmentation variation. M-Index was not associated with serum 25(OH)D concentrations, but the Genetic Score was significantly associated with vitamin D deficiency (serum 25(OH)D levels less than 12 ng/mL) (OR, 1.30; 95% CI, 1.04-1.64). The findings support the hypothesis suggesting that skin pigmentation evolved responding to increased demand for subcutaneous vitamin D synthesis in high latitude environments.
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Affiliation(s)
- Ken Batai
- Department of Urology, University of Arizona, Tucson, Arizona, United States of America
| | - Zuxi Cui
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Amit Arora
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, United States of America
| | - Ebony Shah-Williams
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, Indiana United States of America
| | - Wenndy Hernandez
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Maria Ruden
- Department of Surgery, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Courtney M. P. Hollowell
- Department of Surgery, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Stanley E. Hooker
- Division of Health Equities, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America
| | - Madhavi Bathina
- Division of Health Equities, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America
| | - Adam B. Murphy
- Department of Urology, Northwestern University, Chicago, Illinois, United States of America
| | - Carolina Bonilla
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Rick A. Kittles
- Division of Health Equities, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America
- * E-mail:
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Tekola-Ayele F, Ouidir M, Shrestha D, Workalemahu T, Rahman ML, Mendola P, Grantz KL, Hinkle SN, Wu J, Zhang C. Admixture mapping identifies African and Amerindigenous local ancestry loci associated with fetal growth. Hum Genet 2021; 140:985-997. [PMID: 33590300 DOI: 10.1007/s00439-021-02265-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/04/2021] [Indexed: 12/31/2022]
Abstract
Fetal growth is an important determinant of cardiometabolic disease risk during childhood and adulthood. The genetic architecture of fetal growth remains largely understudied in ancestrally diverse populations. We conducted genome-wide admixture mapping scan and analysis of genetic ancestry among Hispanic American, African American, European American, and Asian American pregnant women to identify genetic loci associated with fetal growth measures across 13-40 weeks gestation. Fetal growth measures were associated with genome-wide average African, European, Amerindigenous and East Asian ancestry proportions (P ranged from10-3 to 4.8 × 10-2). Admixture mapping analysis identified ten African ancestry loci and three Amerindigenous ancestry loci significantly associated with fetal growth measures at Bonferroni-corrected levels of significance (P ranged from 2.18 × 10-8 to 3.71 × 10-6). At the chr2q23.3-24.2 locus in which higher African ancestry was associated with long bone (femur and humerus) lengths, the T allele of rs13030825 (GALNT13) was associated with longer humerus length in African Americans (β = 0.44, P = 6.25 × 10-6 at week 27; β = 0.39, P = 7.72 × 10-5 at week 40). The rs13030825 SNP accounted for most of the admixture association at the chr2q23.3-24.2 locus and has substantial allele frequency difference between African and European reference samples (FST = 0.55, P = 0.03). Regulatory annotation shows that rs13030825 overlaps with the serum response factor (SRF) transcription factor previously implicated in postnatal bone development of mice. Overall, we identified ancestry-related maternal genetic loci that influence fetal growth, shedding light on molecular pathways that regulate fetal growth and potential effects on health across the lifespan.Clinical trials registration ClinicalTrials.gov, NCT00912132.
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Affiliation(s)
- Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, 6710B-3204, Bethesda, MD, 20892-7004, USA.
| | - Marion Ouidir
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, 6710B-3204, Bethesda, MD, 20892-7004, USA
| | - Deepika Shrestha
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, 6710B-3204, Bethesda, MD, 20892-7004, USA
| | - Tsegaselassie Workalemahu
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, 6710B-3204, Bethesda, MD, 20892-7004, USA
| | - Mohammad L Rahman
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, 6710B-3204, Bethesda, MD, 20892-7004, USA.,Department of Population Medicine and Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, MA, USA
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, 6710B-3204, Bethesda, MD, 20892-7004, USA.,Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, 6710B-3204, Bethesda, MD, 20892-7004, USA
| | - Stefanie N Hinkle
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, 6710B-3204, Bethesda, MD, 20892-7004, USA
| | - Jing Wu
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, 6710B-3204, Bethesda, MD, 20892-7004, USA
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13
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Slaughter-Acey JC, Brown TN, Keith VM, Dailey R, Misra DP. A tale of two generations: Maternal skin color and adverse birth outcomes in Black/African American women. Soc Sci Med 2020; 265:113552. [PMID: 33277068 PMCID: PMC7781157 DOI: 10.1016/j.socscimed.2020.113552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/17/2020] [Accepted: 11/23/2020] [Indexed: 01/03/2023]
Abstract
We examined how sociopolitical context (marked by generational cohort) and maternal skin color interacted to influence preterm delivery (PTD) rates in sample of Black women. Data were from 1410 Black women, ages 18-45 years, residing in Metropolitan Detroit, MI enrolled (2009-2011) in the Life-course Influences on Fetal Environments (LIFE) Study. Because we hypothesized that generational differences marked by changes in the sociopolitical context would influence exposure to racism, we categorized women into two cohorts by maternal birth year: a) Generation X, 1964-1983 and b) Millennial, 1984-1993. Descriptive results showed similar PTD rates by generational cohort, Generation X: 16.3% vs. Millennials: 16.1%. Yet, within each generation, PTD rates varied by women's skin tone (categorized: light, medium, and dark brown). Poisson regression models confirmed a significant interaction between generational cohort and maternal skin tone predicting PTD (P = 0.001); suggesting a salubrious association between light brown skin tone (compared to medium and dark) and PTD for Generation X. However, Millennials with medium and dark brown skin experienced lower PTD rates than their light Millennial counterparts. Research should consider sociopolitical context and the salience of skin tone bias when investigating racial health disparities, including those in perinatal health.
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Affiliation(s)
- Jaime C Slaughter-Acey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Tony N Brown
- Department of Sociology, Rice University, Houston, TX, USA
| | - Verna M Keith
- Department of Sociology, University of Alabama Birmingham, Birmingham, AL, USA
| | - Rhonda Dailey
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Dawn P Misra
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA
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14
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Mayne SL, Loizzo L, Bancks MP, Carnethon MR, Barber S, Gordon-Larsen P, Carson AP, Schreiner PJ, Bantle AE, Whitaker KM, Kershaw KN. Racial residential segregation, racial discrimination, and diabetes: The Coronary Artery Risk Development in Young Adults study. Health Place 2020; 62:102286. [PMID: 32479363 PMCID: PMC7266830 DOI: 10.1016/j.healthplace.2020.102286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 12/23/2022]
Abstract
Although racial residential segregation and interpersonal racial discrimination are associated with cardiovascular disease, few studies have examined their link with diabetes risk or management. We used longitudinal data from 2,175 black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study to examine associations of racial residential segregation (Gi* statistic) and experiences of racial discrimination with diabetes incidence and management. Multivariable Cox models estimated associations for incident diabetes and GEE logistic regression estimated associations with diabetes management (meeting targets for HbA1c, systolic blood pressure, and LDL cholesterol). Neither segregation nor discrimination were associated with diabetes incidence or management.
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Affiliation(s)
- Stephanie L Mayne
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Luigi Loizzo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael P Bancks
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - April P Carson
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Anne E Bantle
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kara M Whitaker
- Department of Health and Human Physiology, University of Iowa College of Liberal Arts and Sciences, Iowa City, IA, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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15
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Dent RB, Hagiwara N, Stepanova EV, Green TL. The role of feature-based discrimination in driving health disparities among Black Americans. ETHNICITY & HEALTH 2020; 25:161-176. [PMID: 29105509 DOI: 10.1080/13557858.2017.1398314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
Objective: A growing body of research finds that darker skin tone is often associated with poorer physical and mental health in Blacks. However, the psychosocial mechanisms underlying the skin tone-health link remain elusive. The present study seeks to address this knowledge gap by investigating the direct and indirect (through perceived discrimination, socioeconomic status, and self-esteem) effects of skin tone on self-reported physical and mental health.Design: An urban sample of 130 Blacks aged 35 and above completed a self-administered computerized survey as a part of larger cross-sectional study.Results: Self-esteem played a particularly important role in mediating the associations between skin tone and self-reported physical and mental health. This suggests that self-esteem could be a point of intervention to help Blacks with darker skin tone achieve better health.Conclusion: The present study highlights the important role feature-based discrimination plays in determining mental and physical health outcomes among Blacks.
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Affiliation(s)
- Randl B Dent
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Elena V Stepanova
- Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Tiffany L Green
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
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16
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Rej PH, Gravlee CC, Mulligan CJ. Shortened telomere length is associated with unfair treatment attributed to race in African Americans living in Tallahassee, Florida. Am J Hum Biol 2019; 32:e23375. [PMID: 31867825 DOI: 10.1002/ajhb.23375] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Experiences of interpersonal discrimination are pervasive stressors in the lives of African Americans. Increased discrimination stress may cause premature aging. Telomere length (TL) is a plastic genetic trait that is an emerging indicator of cellular health and aging. Short TL is a risk factor for the earlier onset of disease. TL shortens with age, a process that may be accelerated by psychosocial stress. Our study explores the relationship between TL and experiences of discrimination in the form of self-reported unfair treatment (UT). METHODS Using a qPCR-based method, we measured TL in DNA from saliva samples provided by 135 African American adults from Tallahassee, FL. We developed discrimination measures using a modified survey that explores nine social domains of self-reported unfair treatment experienced both directly and indirectly. We used multiple regression to examine associations between UT and TL. RESULTS We found that racial discrimination in the form of self-reported unfair treatment attributed to race (UT-Race-Self) is inversely associated with TL. CONCLUSIONS The significant association between increased UT-Race-Self and shorter telomeres supports the hypothesis that psychosocial stress stemming from racial discrimination may affect TL. The potential impact of discrimination on TL may contribute to premature biological aging and racial health inequalities seen in African Americans.
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Affiliation(s)
- Peter H Rej
- Department of Anthropology, University of Washington, Seattle, Washington.,Department of Anthropology, University of Florida, Gainesville, Florida.,Genetics Institute, University of Florida, Gainesville, Florida
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- Health Equity Alliance of Tallahassee Steering Committee, Tallahassee, Florida: James Bellamy, Qasimah Boston, Edward Holifield, Miaisha Mitchell, and Cynthia Seaborn
| | - Clarence C Gravlee
- Department of Anthropology, University of Florida, Gainesville, Florida.,Genetics Institute, University of Florida, Gainesville, Florida
| | - Connie J Mulligan
- Department of Anthropology, University of Florida, Gainesville, Florida.,Genetics Institute, University of Florida, Gainesville, Florida
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17
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Perreira KM, Wassink J, Harris KM. BEYOND RACE/ETHNICITY: SKIN COLOR, GENDER, AND THE HEALTH OF YOUNG ADULTS IN THE UNITED STATES. POPULATION RESEARCH AND POLICY REVIEW 2019; 38:271-299. [PMID: 31595099 PMCID: PMC6781627 DOI: 10.1007/s11113-018-9503-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/03/2018] [Indexed: 11/24/2022]
Abstract
Researchers typically identify health disparities using self-reported race/ethnicity, a measure identifying individuals' social and cultural affiliations. In this study, we use data from Waves 1, 3, and 4 of Add Health to examine health disparities by interviewer-ascribed skin color, a measure capturing the perceptions of race/ethnicity ascribed to individuals by others. Individuals with darker skin tones may face greater exposure to serious stressors such as perceived discrimination, poverty, and economic hardship which can accumulate over the lifecourse and increase the likelihood of poor health. We found significant gradients in Body Mass Index (BMI), obesity, self-reported health, and depressive symptoms by interviewer-ascribed skin color but results differed by gender. Associations of BMI, obesity, and fair/poor health among women were only partially mediated by discrimination, self-reported stress, or low socio-economic status and persisted after controlling for race/ethnicity. Among men, initial associations between skin color and both fair/poor health and depressive symptoms did not persist after controlling for race/ethnicity. This study demonstrates the value of considering stratification by skin color and gender in conjunction with race/ethnicity.
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18
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Assari S, Khoshpouri P, Chalian H. Combined Effects of Race and Socioeconomic Status on Cancer Beliefs, Cognitions, and Emotions. Healthcare (Basel) 2019; 7:E17. [PMID: 30682822 PMCID: PMC6473681 DOI: 10.3390/healthcare7010017] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 12/24/2022] Open
Abstract
AIM To determine whether socioeconomic status (SES; educational attainment and income) explains the racial gap in cancer beliefs, cognitions, and emotions in a national sample of American adults. METHODS For this cross-sectional study, data came from the Health Information National Trends Survey (HINTS) 2017, which included a nationally representative sample of American adults. The study enrolled 2277 adults who were either non-Hispanic Black (n = 409) or non-Hispanic White (n = 1868). Race, demographic factors (age and gender), SES (i.e., educational attainment and income), health access (insurance status, usual source of care), family history of cancer, fatalistic cancer beliefs, perceived risk of cancer, and cancer worries were measured. We ran structural equation models (SEMs) for data analysis. RESULTS Race and SES were associated with perceived risk of cancer, cancer worries, and fatalistic cancer beliefs, suggesting that non-Hispanic Blacks, low educational attainment and low income were associated with higher fatalistic cancer beliefs, lower perceived risk of cancer, and less cancer worries. Educational attainment and income only partially mediated the effects of race on cancer beliefs, emotions, and cognitions. Race was directly associated with fatalistic cancer beliefs, perceived risk of cancer, and cancer worries, net of SES. CONCLUSIONS Racial gap in SES is not the only reason behind racial gap in cancer beliefs, cognitions, and emotions. Racial gap in cancer related beliefs, emotions, and cognitions is the result of race and SES rather than race or SES. Elimination of racial gap in socioeconomic status will not be enough for elimination of racial disparities in cancer beliefs, cognitions, and emotions in the United States.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA.
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Hamid Chalian
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
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19
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Carter RT, Lau MY, Johnson V, Kirkinis K. Racial Discrimination and Health Outcomes Among Racial/Ethnic Minorities: A Meta-Analytic Review. JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1002/jmcd.12076] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robert T. Carter
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
| | - Michael Y. Lau
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
- Now at The Chicago School of Professional Psychology; Washington DC
| | - Veronica Johnson
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
- Now at the Department of Psychology, John Jay College of Criminal Justice; City University of New York
| | - Katherine Kirkinis
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
- Now at Department of Counseling Psychology; University at Albany-State University of New York
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20
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The Race Project: Researching Race in the Social Sciences Researchers, Measures, and Scope of Studies. ACTA ACUST UNITED AC 2017. [DOI: 10.1017/rep.2017.15] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AbstractWhile the concept and measurement of race has been a longstanding focus of social science research, capturing its significance requires a broader notion than utilizing only racial group categories. More recently, race has been treated as both a “characteristic” and a set of experiences that affect a multitude of life conditions and outcomes. This discussion and analysis moves away from treating race as only a categorical and static characteristic to a multi-dimensional concept that is dynamic, relational, and represents the intersection of individual, ecological, and structural components. By exploring the data collection of the Inter-University Consortium for Political and Social Research and studies that include race as a variable, we were able to trace how race has been used by social scientists over the past 60 years. Using an extensive coding protocol, we have attained key characteristics of the principal investigator(s) (PI), funders, scope of the overall study, and the use of different measures of race. As a result, this “meta-analysis” of social science surveys enabled this researcher to examine how these studies use a wide scope of racial “variables,” and the way in which PI characteristics affected the inclusion of race-related items. In addition, bivariate analysis is presented to examine social scientists’ tendencies in investigating race and inclusion of qualitative examples of item wordings and response categories. This overview of social science studies is placed in the context of conceptual and measurement issues surrounding the use and meaning of race. Hopefully this can serve to advance the discussion and strategic approaches in doing research about race and what should be incorporated in studying race as a lived experience.
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21
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Blanchet Garneau A, Browne AJ, Varcoe C. Drawing on antiracist approaches toward a critical antidiscriminatory pedagogy for nursing. Nurs Inq 2017; 25. [PMID: 28685947 DOI: 10.1111/nin.12211] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 01/24/2023]
Abstract
Although nursing has a unique contribution to advancing social justice in health care practices and education, and although social justice has been claimed as a core value of nursing, there is little guidance regarding how to enact social justice in nursing practice and education. In this paper, we propose a critical antidiscriminatory pedagogy (CADP) for nursing as a promising path in this direction. We argue that because discrimination is inherent to the production and maintenance of inequities and injustices, adopting a CADP offers opportunities for students and practicing nurses to develop their capacity to counteract racism and other forms of individual and systemic discrimination in health care, and thus promote social justice. The CADP we propose has the following features: it is grounded in a critical intersectional perspective of discrimination, it aims at fostering transformative learning, and it involves a praxis-oriented critical consciousness. A CADP challenges the liberal individualist paradigm that dominates much of western-based health care, and the culturalist and racializing processes prevalent in nursing education. It also situates nursing practice as responsive to health inequities. Thus, a CADP is a promising way to translate social justice into nursing practice and education through transformative learning.
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Affiliation(s)
| | - Annette J Browne
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Colleen Varcoe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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22
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Szaflarski M, Klepinger DH, Cubbins LA. Alcohol use/abuse and help-seeking among U.S. adults: The role of racial-ethnic origin and foreign-born status. J Ethn Subst Abuse 2017; 18:183-210. [PMID: 28678640 DOI: 10.1080/15332640.2017.1333476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We used data from Wave 1 and Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions to examine racial-ethnic and nativity-based variations in alcohol use/abuse and treatment seeking while accounting for acculturation, stress, and social integration factors. The dependent variables included alcohol use, risky drinking, DSM-IV alcohol use disorder, and treatment seeking in the past 12 months. Racial-ethnic categories included African, European, Asian/Pacific Islander, Mexican, Puerto Rican, and other Hispanic/Latino. Acculturation, social stress, and social integration were assessed with previously validated, detailed measures. Bivariate probit models with sample selection were estimated for women and men. Immigrant status and origin associations with alcohol use/abuse and treatment seeking were strong and largely unaffected by other social factors. Europeans and men of Mexican origin had the highest while women of African, Asian/Pacific Islander, and Puerto Rican origins had the lowest rates of alcohol use/abuse. Years in the United States was associated with a higher risk of alcohol use/abuse for all immigrant groups. Foreign-born individuals were no less likely than U.S. natives to seek treatment if they were abusing or were dependent on alcohol. Further modeling of these relationships among specific immigrant groups is warranted. These findings inform alcohol rehabilitation and mental health services for racial-ethnic minorities and immigrants.
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Affiliation(s)
| | | | - Lisa A Cubbins
- b Battelle Health and Analytics , Seattle , Washington (retired).,c University of Washington , Seattle , Washington
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23
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Vargas ED, Sanchez GR, Juárez M. The Impact of Punitive Immigrant Laws on the Health of Latina/o Populations. POLITICS & POLICY (STATESBORO, GA.) 2017; 45:312-337. [PMID: 29200985 PMCID: PMC5703223 DOI: 10.1111/polp.12203] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study examines how anti-immigrant policies affect the physical health of Latina/os in the United States. Merging two unique datasets: sum of anti-immigrant policies by state from 2005-2011 and a 2011 Robert Wood Johnson Center for Health Policy nationally representative sample of Latina/os (n=1,200), we estimate a series of logistic regressions to understand how anti-immigrant legislations are affecting the health of Latina/os. Our modeling approach takes into consideration Latinos' diverse experience, context that is widely overlooked in datasets that treat Latina/os as a homogeneous ethnic group. Our findings suggest that an increase in anti-immigrant laws enacted by a state decreases the probability of respondents reporting optimal health, even when controlling for other relevant factors, such as citizenship status, language of interview, and interethnic variation. The implication and significance of this work has tremendous impacts for scholars, policy makers, health service providers and applied researchers interested in reducing health disparities among minority populations.
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24
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Cortes TR, Faerstein E, Struchiner CJ. [Use of causal diagrams in Epidemiology: application to a situation with confounding]. CAD SAUDE PUBLICA 2017; 32:e00103115. [PMID: 27509550 DOI: 10.1590/0102-311x00103115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 03/11/2016] [Indexed: 11/21/2022] Open
Abstract
Epidemiological research still rarely uses causal diagrams, despite growing recognition of their explanatory potential. One possible reason is that many research programs involve themes in which there is a certain degree of uncertainty as to mechanisms in the processes that generate the data. In this study, the relationship between occupational stress and obesity is used as an example of the application of causal diagrams to questions related to confounding. The article presents the selection stages for variables in statistical adjustment and the derivation of a causal diagram's statistical implications. The main advantage of causal diagrams is that they explicitly reveal the respective model's underlying hypotheses, allowing critical analysis of the implications and thereby facilitating identification of sources of bias and uncertainty in the epidemiological study's results.
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Affiliation(s)
- Taísa Rodrigues Cortes
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Eduardo Faerstein
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Claudio José Struchiner
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.,Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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25
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Kim IH, Noh S. Ethnic and gender differences in the association between discrimination and depressive symptoms among five immigrant groups. J Immigr Minor Health 2016; 16:1167-75. [PMID: 24375383 DOI: 10.1007/s10903-013-9969-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines ethnic and gender differences in exposure to discrimination and its association with depressive symptoms among five immigrant groups. Data were derived from a cross-sectional survey of 900 adult immigrants (50.8% men, 49.2% women) sampled from five ethnic immigrant communities in Toronto between April and September 2001. Men reported higher levels of discrimination than women. Ethiopians had the highest perception of discrimination followed by Korean, Iranian, Vietnamese, and Irish immigrants. With regard to discrimination-related depressive symptoms, Iranian and Korean men showed a greater risk than their Irish counterparts. Among women, Vietnamese and Irish seemed to be more vulnerable to discrimination than other ethnic groups. Despite experiencing the highest level of discrimination, Ethiopian men and women showed no association between discrimination and depressive symptoms. The exposure and psychological response to discrimination vary significantly across ethnicities and gender.
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Affiliation(s)
- Il-Ho Kim
- Social and Epidemiological Research, Centre for Addiction and Mental Health, 33 Russell Street, Suite T-306, Toronto, ON, M5S 2S1, Canada,
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26
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Self-identified race, socially assigned skin tone, and adult physiological dysregulation: Assessing multiple dimensions of "race" in health disparities research. SSM Popul Health 2016; 2:595-602. [PMID: 29349174 PMCID: PMC5757885 DOI: 10.1016/j.ssmph.2016.06.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 11/22/2022] Open
Abstract
Despite a general acceptance of “race” as a social, rather than biological construct in the social sciences, racial health disparities research has given less consideration to the dimensions of race that may be most important for shaping persistent disparities in adult physical health status. In this study, we incorporate the social constructionist view that race is multidimensional to evaluate the health significance of two measures of race, racial self-identification and the socially perceived skin tone of black Americans, in a sample of black and white adults in the Nashville Stress and Health Study (N=1186). First, we use the approach most common in disparities research—comparing group differences in an outcome—to consider self-identified racial differences in allostatic load (AL), a cumulative biological indicator of physical dysregulation. Second, we examine intragroup variations in AL among blacks by skin tone (i.e. light, brown, or dark skin). Third, we assess whether the magnitude of black-white disparities are equal across black skin tone subgroups. Consistent with prior research, we find significantly higher rates of dysregulation among blacks. However, our results also show that racial differences in AL vary by blacks’ skin tone; AL disparities are largest between whites and dark-skinned blacks and smallest between whites and light-skinned blacks. This study highlights the importance of blacks’ skin tone as a marker of socially-assigned race for shaping intragroup and intergroup variations in adult physiological dysregulation. These results demonstrate the importance of assessing multiple dimensions of race in disparities research, as this approach may better capture the various mechanisms by which “race” continues to shape health. Blacks have higher allostatic load (i.e. physiological dysregulation) than whites. Skin tone is a source of intragroup variation in allostatic load among blacks. Black-white differences in allostatic load vary by blacks’ perceived skin tone. Allostatic load disparity is smallest between whites and light-skinned blacks. Results show importance of self-identified and socially assigned race measures.
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27
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Clark R. Interethnic Group and Intraethnic Group Racism: Perceptions and Coping in Black University Students. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798404268286] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explored perceived racism and the usual ways of coping with these perceptions in a sample of 269 Black university students (53% female). Perceptions of inter- and intragroup racism were assessed with the Life Experiences and Stress scale, and coping was measured with the Coping Orientations to Problems Experienced scale. A principal component analysis suggested that inter- and intragroup racism were separable constructs. Correlation analyses revealed that inter- and intragroup racism were negatively associated with self-deception.Relative to females, t-test analyses indicated that males perceived more inter- and intragroup racism. The t-test analyses also revealed that females were more likely than males to use emotion-focused and religious coping responses, when negotiating perceptions of inter- and intragroup racism; and, when negotiating perceptions of intragroup racism, males were more likely than females to use alcohol as a coping response. The limitations of the study and directions for future research are discussed.
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Finch BK, Hummer RA, Kol B, Vega WA. The Role of Discrimination and Acculturative Stress in the Physical Health of Mexican-Origin Adults. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/0739986301234004] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors propose that perceived discrimination has an effect on self-reported health statuses, which are known to affect future morbidity and mortality. A sample of 3,012 Mexican-origin adults from the Mexican American Prevalence and Services Study in California is utilized to test this hypothesis. Dependent variables include a self-rating of health and a count of self-reported chronic conditions; the key independent variable is a scale of overall discrimination specific to one’s Mexican origin. Results indicate that discrimination is related to poor physical health—net of controls for acculturation stress, national heritage, sociodemographic variables, and social support. Depression is identified as a major mechanism through which discrimination may affect physical health. Notably, job market stress/discrimination has a very strong association with poorer physical health, net of depression. Individual-level effects of discrimination found in this study, as well as institutional-level conditions and contextual effects, should be treated as crucial to future studies of individual-level physical health differentials.
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Affiliation(s)
- Brian Karl Finch
- Florida State University and University of California at Berkeley
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Seaton EK. An Examination of the Factor Structure of the Index of Race-Related Stress among a Sample of African American Adolescents. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798403254211] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the present study, the Index of Race-Related Stress (IRRS) was administered to a sample of urban African American adolescents. This instrument has been used among samples of adult and collegiate African Americans, and the purpose of the present study was to examine the factor structure of adolescent responses. The scale was modified and administered to a sample of 324 African American adolescents. The results provided empirical evidence of validity for the IRRS, particularly as a measure of race-related stress among adolescents. The measure required some modifications, which included deletion of items and rewording some questions to make them relevant for an adolescent sample. Future research should consider the assessment of race-related stress among adolescent samples to understand its association with mental and physical health.
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Skin tone bias among African Americans: Antecedents and consequences across the life span. DEVELOPMENTAL REVIEW 2016. [DOI: 10.1016/j.dr.2016.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Lipsky S, Kernic MA, Qiu Q, Hasin DS. Posttraumatic stress disorder and alcohol misuse among women: effects of ethnic minority stressors. Soc Psychiatry Psychiatr Epidemiol 2016; 51:407-19. [PMID: 26266627 PMCID: PMC4752921 DOI: 10.1007/s00127-015-1109-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of this study were to examine the relationship between adult-onset posttraumatic stress disorder (PTSD) and subsequent alcohol use outcomes (frequent heavy drinking, alcohol abuse, and alcohol dependence) in non-Hispanic white, non-Hispanic black, and Hispanic US women, and whether this relationship was moderated by ethnic minority stressors (discrimination and acculturation). METHODS The study sample was drawn from two waves of the National Epidemiologic Surveys of Alcohol and Related Conditions, employing time-dependent data to conduct multiple extended Cox regression. RESULTS Women with PTSD were over 50 % more likely than those without PTSD to develop alcohol dependence [adjusted hazards ratio (aHR) 1.55; 95 % confidence interval (CI) 1.15, 2.08]. Hispanic and black women were at lower risk of most alcohol outcomes than white women. In race-/ethnic-specific analyses, however, PTSD only predicted alcohol abuse among Hispanic women (aHR 3.02; CI 1.33, 6.84). Higher acculturation was positively associated with all alcohol outcomes among Hispanic women and discrimination was associated with AUD among Hispanic and black women. Acculturation and discrimination modified the effect of PTSD on AUD among Hispanic women: PTSD predicted alcohol dependence among those with low acculturation (aHR 10.2; CI 1.27, 81.80) and alcohol abuse among those without reported discrimination (aHR 6.39; CI 2.76, 16.49). CONCLUSIONS PTSD may influence the development of hazardous drinking, especially among Hispanic women. The influence of PTSD on alcohol outcomes is most apparent, however, when ethnic minority stressors are not present.
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Affiliation(s)
- Sherry Lipsky
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA.
| | - Mary A Kernic
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Qian Qiu
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA
| | - Deborah S Hasin
- Columbia University/New York State Psychiatric Institute, New York, NY, USA
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Sudhinaraset M, Wigglesworth C, Takeuchi DT. Social and Cultural Contexts of Alcohol Use: Influences in a Social-Ecological Framework. Alcohol Res 2016; 38:35-45. [PMID: 27159810 PMCID: PMC4872611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Alcohol use and misuse account for 3.3 million deaths every year, or 6 percent of all deaths worldwide. The harmful effects of alcohol misuse are far reaching and range from individual health risks, morbidity, and mortality to consequences for family, friends, and the larger society. This article reviews a few of the cultural and social influences on alcohol use and places individual alcohol use within the contexts and environments where people live and interact. It includes a discussion of macrolevel factors, such as advertising and marketing, immigration and discrimination factors, and how neighborhoods, families, and peers influence alcohol use. Specifically, the article describes how social and cultural contexts influence alcohol use/misuse and then explores future directions for alcohol research.
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Monk EP. The Cost of Color: Skin Color, Discrimination, and Health among African-Americans. AJS; AMERICAN JOURNAL OF SOCIOLOGY 2015; 121:396-444. [PMID: 26594713 DOI: 10.1086/682162] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In this study, the author uses a nationally representative survey to examine the relationship(s) between skin tone, discrimination, and health among African-Americans. He finds that skin tone is a significant predictor of multiple forms of perceived discrimination (including perceived skin color discrimination from whites and blacks) and, in turn, these forms of perceived discrimination are significant predictors of key health outcomes, such as depression and self-rated mental and physical health. Intraracial health differences related to skin tone (and discrimination) often rival or even exceed disparities between blacks and whites as a whole. The author also finds that self-reported skin tone, conceptualized as a form of embodied social status, is a stronger predictor of perceived discrimination than interviewer-rated skin tone. He discusses the implications of these findings for the study of ethnoracial health disparities and highlights the utility of cognitive and multidimensional approaches to ethnoracial and social inequality.
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Different measures, different mechanisms: A new perspective on racial disparities in health care. ACTA ACUST UNITED AC 2015. [DOI: 10.1108/s0275-4959(2009)0000027004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Fujimura JH. A different kind of association between socio-histories and health. THE BRITISH JOURNAL OF SOCIOLOGY 2015; 66:58-67. [PMID: 25789804 DOI: 10.1111/1468-4446.12117_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Garcia JA, Sanchez GR, Sanchez-Youngman S, Vargas ED, Ybarra VD. RACE AS LIVED EXPERIENCE: The Impact of Multi-Dimensional Measures of Race/Ethnicity on the Self-Reported Health Status of Latinos. DU BOIS REVIEW : SOCIAL SCIENCE RESEARCH ON RACE 2015; 12:349-373. [PMID: 26681972 PMCID: PMC4678876 DOI: 10.1017/s1742058x15000120] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A growing body of social science research has sought to conceptualize race as a multidimensional concept in which context, societal relations, and institutional dynamics are key components. Utilizing a specially designed survey, we develop and use multiple measures of race (skin color, ascribed race, and discrimination experiences) to capture race as "lived experience" and assess their impact on Latinos' self-rated health status. We model these measures of race as a lived experience to test the explanatory power of race, both independently and as an integrated scale with categorical regression, scaling, and dimensional analyses. Our analyses show that our multiple measures of race have significant and negative effects on Latinos' self-reported health. Skin color is a dominant factor that impacts self-reported health both directly and indirectly. We then advocate for the utilization of multiple measures of race, adding to those used in our analysis, and their application to other health and social outcomes. Our analysis provides important contributions across a wide range of health, illness, social, and political outcomes for communities of color.
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Affiliation(s)
- John A. Garcia
- Inter-University Consortium for Political and Social Research, University of Michigan
| | - Gabriel R. Sanchez
- Department of Political Science and RWJF Center for Health Policy, University of New Mexico
| | | | - Edward D. Vargas
- Center for Women’s Health and Health Disparities Research, University of Wisconsin-Madison
| | - Vickie D. Ybarra
- Department of Political Science and RWJF Center for Health Policy, University of New Mexico
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Pino-Yanes M, Thakur N, Gignoux CR, Galanter JM, Roth LA, Eng C, Nishimura KK, Oh SS, Vora H, Huntsman S, Nguyen EA, Hu D, Drake KA, Conti DV, Moreno-Estrada A, Sandoval K, Winkler CA, Borrell LN, Lurmann F, Islam TS, Davis A, Farber HJ, Meade K, Avila PC, Serebrisky D, Bibbins-Domingo K, Lenoir MA, Ford JG, Brigino-Buenaventura E, Rodriguez-Cintron W, Thyne SM, Sen S, Rodriguez-Santana JR, Bustamante CD, Williams LK, Gilliland FD, Gauderman WJ, Kumar R, Torgerson DG, Burchard EG. Genetic ancestry influences asthma susceptibility and lung function among Latinos. J Allergy Clin Immunol 2015; 135:228-35. [PMID: 25301036 PMCID: PMC4289103 DOI: 10.1016/j.jaci.2014.07.053] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 07/18/2014] [Accepted: 07/22/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Childhood asthma prevalence and morbidity varies among Latinos in the United States, with Puerto Ricans having the highest and Mexicans the lowest. OBJECTIVE To determine whether genetic ancestry is associated with the odds of asthma among Latinos, and secondarily whether genetic ancestry is associated with lung function among Latino children. METHODS We analyzed 5493 Latinos with and without asthma from 3 independent studies. For each participant, we estimated the proportion of African, European, and Native American ancestry using genome-wide data. We tested whether genetic ancestry was associated with the presence of asthma and lung function among subjects with and without asthma. Odds ratios (OR) and effect sizes were assessed for every 20% increase in each ancestry. RESULTS Native American ancestry was associated with lower odds of asthma (OR = 0.72, 95% CI: 0.66-0.78, P = 8.0 × 10(-15)), while African ancestry was associated with higher odds of asthma (OR = 1.40, 95% CI: 1.14-1.72, P = .001). These associations were robust to adjustment for covariates related to early life exposures, air pollution, and socioeconomic status. Among children with asthma, African ancestry was associated with lower lung function, including both pre- and post-bronchodilator measures of FEV1 (-77 ± 19 mL; P = 5.8 × 10(-5) and -83 ± 19 mL; P = 1.1 x 10(-5), respectively) and forced vital capacity (-100 ± 21 mL; P = 2.7 × 10(-6) and -107 ± 22 mL; P = 1.0 x 10(-6), respectively). CONCLUSION Differences in the proportions of genetic ancestry can partially explain disparities in asthma susceptibility and lung function among Latinos.
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Affiliation(s)
- Maria Pino-Yanes
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Neeta Thakur
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | | | - Joshua M Galanter
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, UCSF, San Francisco, Calif
| | - Lindsey A Roth
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Katherine K Nishimura
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Sam S Oh
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Hita Vora
- Department of Preventative Medicine, University of Southern California, Los Angeles, Calif
| | - Scott Huntsman
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Elizabeth A Nguyen
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Katherine A Drake
- Department of Bioengineering and Therapeutic Sciences, UCSF, San Francisco, Calif
| | - David V Conti
- Department of Preventative Medicine, University of Southern California, Los Angeles, Calif
| | | | - Karla Sandoval
- Department of Genetics, Stanford University, Palo Alto, Calif
| | - Cheryl A Winkler
- Basic Research Laboratory, SAIC-Frederick, Inc, Center for Cancer Research, National Cancer Institute, Frederick, Md
| | - Luisa N Borrell
- Department of Health Sciences, Graduate Program in Public Health, City University of New York, Bronx, NY
| | | | - Talat S Islam
- Department of Preventative Medicine, University of Southern California, Los Angeles, Calif
| | - Adam Davis
- Children's Hospital and Research Center Oakland, Oakland, Calif
| | - Harold J Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Kelley Meade
- Children's Hospital and Research Center Oakland, Oakland, Calif
| | - Pedro C Avila
- Department of Medicine, Northwestern University, Chicago, Ill
| | | | | | | | - Jean G Ford
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | | | | | - Shannon M Thyne
- Department of Pediatrics, UCSF, San Francisco General Hospital, San Francisco, Calif
| | - Saunak Sen
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, Calif
| | | | | | - L Keoki Williams
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Mich; Department of Internal Medicine, Henry Ford Health System, Detroit, Mich
| | - Frank D Gilliland
- Department of Preventative Medicine, University of Southern California, Los Angeles, Calif
| | - W James Gauderman
- Department of Preventative Medicine, University of Southern California, Los Angeles, Calif
| | - Rajesh Kumar
- Children's Memorial Hospital and the Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Dara G Torgerson
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif
| | - Esteban G Burchard
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, UCSF, San Francisco, Calif
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Perreira KM, Telles EE. The color of health: skin color, ethnoracial classification, and discrimination in the health of Latin Americans. Soc Sci Med 2014; 116:241-50. [PMID: 24957692 PMCID: PMC4117723 DOI: 10.1016/j.socscimed.2014.05.054] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 05/04/2014] [Accepted: 05/30/2014] [Indexed: 12/01/2022]
Abstract
Latin America is one of the most ethnoracially heterogeneous regions of the world. Despite this, health disparities research in Latin America tends to focus on gender, class and regional health differences while downplaying ethnoracial differences. Few scholars have conducted studies of ethnoracial identification and health disparities in Latin America. Research that examines multiple measures of ethnoracial identification is rarer still. Official data on race/ethnicity in Latin America are based on self-identification which can differ from interviewer-ascribed or phenotypic classification based on skin color. We use data from Brazil, Colombia, Mexico, and Peru to examine associations of interviewer-ascribed skin color, interviewer-ascribed race/ethnicity, and self-reported race/ethnicity with self-rated health among Latin American adults (ages 18-65). We also examine associations of observer-ascribed skin color with three additional correlates of health - skin color discrimination, class discrimination, and socio-economic status. We find a significant gradient in self-rated health by skin color. Those with darker skin colors report poorer health. Darker skin color influences self-rated health primarily by increasing exposure to class discrimination and low socio-economic status.
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Affiliation(s)
- Krista M Perreira
- University of North Carolina, Carolina Population Center, 123 West Franklyn St, CB#8120, Chapel Hill, NC 27516, USA.
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Abstract
Using the 2012 American National Election Study, the present article explored the relationship between interviewers’ assessment of respondent skin tone and their perception of respondent intelligence ( n = 459). Results from logistic regression analyses indicated that Hispanic respondents with the lightest skin were several times more likely to be seen as having high intelligence compared with those with the darkest skin. Importantly, this relationship was independent of respondent self-identified race, educational attainment, vocabulary test score, and several other respondent and interviewer characteristics. Implications for the growing body of research on colorism are discussed.
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Branigan AR, Freese J, Patir A, McDade TW, Liu K, Kiefe CI. Skin color, sex, and educational attainment in the post-civil rights era. SOCIAL SCIENCE RESEARCH 2013; 42:1659-1674. [PMID: 24090859 DOI: 10.1016/j.ssresearch.2013.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 06/19/2013] [Accepted: 07/09/2013] [Indexed: 06/02/2023]
Abstract
We assess the relationship between skin color and educational attainment for native-born non-Hispanic Black and White men and women, using data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. CARDIA is a medical cohort study with twenty years of social background data and a continuous measure of skin color, recorded as the percent of light reflected off skin. For Black men and women, we find a one-standard-deviation increase in skin lightness to be associated with a quarter-year increase in educational attainment. For White women, we find an association approximately equal in magnitude to that found for Black respondents, and the pattern of significance across educational transitions suggests that skin color for White women is not simply a proxy for family background. For White men, any relationship between skin color and attainment is not robust and, analyses suggest, might primarily reflect differences in family background. Findings suggest that discrimination on the basis of skin color may be less specific to race than previously thought.
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Affiliation(s)
- Amelia R Branigan
- Department of Sociology, Northwestern University, 1812 Chicago Avenue, Evanston, IL 60208, United States.
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Cuffee YL, Hargraves JL, Rosal M, Briesacher BA, Schoenthaler A, Person S, Hullett S, Allison J. Reported racial discrimination, trust in physicians, and medication adherence among inner-city African Americans with hypertension. Am J Public Health 2013; 103:e55-62. [PMID: 24028222 PMCID: PMC3828720 DOI: 10.2105/ajph.2013.301554] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We sought to determine if reported racial discrimination was associated with medication nonadherence among African Americans with hypertension and if distrust of physicians was a contributing factor. METHODS Data were obtained from the TRUST project conducted in Birmingham, Alabama, 2006 to 2008. All participants were African Americans diagnosed with hypertension and receiving care at an inner city, safety net setting. Three categories of increasing adherence were defined based on the Morisky Medication Adherence Scale. Trust in physicians was measured with the Hall General Trust Scale, and discrimination was measured with the Experiences of Discrimination Scale. Associations were quantified by ordinal logistic regression, adjusting for gender, age, education, and income. RESULTS The analytic sample consisted of 227 African American men and 553 African American women, with a mean age of 53.7 ± 9.9 years. Mean discrimination scores decreased monotonically across increasing category of medication adherence (4.1, 3.6, 2.9; P = .025), though the opposite was found for trust scores (36.5, 38.5, 40.8; P < .001). Trust mediated 39% (95% confidence interval = 17%, 100%) of the association between discrimination and medication adherence. CONCLUSIONS Within our sample of inner city African Americans with hypertension, racial discrimination was associated with lower medication adherence, and this association was partially mediated by trust in physicians. Patient, physician and system approaches to increase "earned" trust may enhance existing interventions for promoting medication adherence.
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Affiliation(s)
- Yendelela L Cuffee
- Yendelela L. Cuffee and Antoinette Schoenthaler are with the Department of Population Health, Langone Medical Center, New York University, New York, NY. J. Lee Hargraves is with the Division of Family Medicine, Milagros Rosal is with the Department of Preventive Behavioral Medicine, Becky A. Briesacher is with the Division of Geriatric Medicine, and Sharina Person and Jeroan Allison are with the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Sandral Hullett is with Cooper Green Mercy Hospital, Birmingham, AL
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Landor AM, Simons LG, Simons RL, Brody GH, Bryant CM, Gibbons FX, Granberg EM, Melby JN. Exploring the impact of skin tone on family dynamics and race-related outcomes. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2013; 27:817-26. [PMID: 24040901 PMCID: PMC3970169 DOI: 10.1037/a0033883] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Racism has historically been a primary source of discrimination against African Americans, but there has been little research on the role that skin tone plays in explaining experiences with racism. Similarly, colorism within African American families and the ways in which skin tone influences family processes is an understudied area of research. Using data from a longitudinal sample of African American families (n = 767), we assessed whether skin tone impacted experiences with discrimination or was related to differences in quality of parenting and racial socialization within families. Findings indicated no link between skin tone and racial discrimination, which suggests that lightness or darkness of skin does not either protect African Americans from or exacerbate the experiences of discrimination. On the other hand, families displayed preferential treatment toward offspring based on skin tone, and these differences varied by gender of child. Specifically, darker skin sons received higher quality parenting and more racial socialization promoting mistrust compared to their counterparts with lighter skin. Lighter skin daughters received higher quality parenting compared with those with darker skin. In addition, gender of child moderated the association between primary caregiver skin tone and racial socialization promoting mistrust. These results suggest that colorism remains a salient issue within African American families. Implications for future research, prevention, and intervention are discussed.
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Affiliation(s)
- Antoinette M. Landor
- Postdoctoral Research Fellow, Center for Developmental Science, University of North Carolina at Chapel Hill, 100 East Franklin Street Suite 200, Campus Box 8115, Chapel Hill, NC 27599-8115, cell 337.802.2296, fax 919.966.4520,
| | - Leslie Gordon Simons
- Professor, School of Criminology and Criminal Justice, Arizona State University,
| | - Ronald L. Simons
- Foundation Professor, School of Criminology and Criminal Justice, Arizona State University and Fellow, Institute for Behavioral Research, University of Georgia
| | - Gene H. Brody
- Regent's Professor, Human Development and Family Science and Director, Center for Family Research, University of Georgia,
| | - Chalandra M. Bryant
- Professor, Department of Human Development and Family Science, University of Georgia,
| | | | - Ellen M. Granberg
- Associate Professor, Department of Sociology and Anthropology, Clemson University,
| | - Janet N. Melby
- Adjunct Associate Professor, Human Development and Family Studies and Manager, Behavioral Coding Unit, Survey and Behavioral Research Services, Iowa State University,
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Abstract
This study describes the relative influence of facial skin color, lifetime exposure to racial discrimination, chronic stress, and traditional prehypertension risk factors (family history of hypertension and age) on resting blood pressure and body mass index (BMI) among 196 southern African American (AA) female undergraduate students. Stepwise regression analyses indicated that skin color was the strongest predictor of systolic blood pressure (SBP), diastolic blood pressure (DBP), and BMI. Skin color, chronic stress, and family history of hypertension predicted 53% of the SBP variance. Skin color, chronic stress, and family history of hypertension predicted 30.2% of the DBP variance. Racism and age were not significant predictors of SBP or DBP. Of the variance in BMI, 33% was predicted by skin color, chronic stress, and racism. Age and family history of hypertension were not predictors of BMI. The current study provides evidence of the relationship of skin color and chronic stress to blood pressure among young southern AA women. The study identifies an important relationship between increased racial stress exposure and heavier BMIs, a predictor of prehypertensive risk.
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McGibbon E, Mulaudzi FM, Didham P, Barton S, Sochan A. Toward decolonizing nursing: the colonization of nursing and strategies for increasing the counter-narrative. Nurs Inq 2013; 21:179-91. [DOI: 10.1111/nin.12042] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Paula Didham
- Western Regional School of Nursing; Corner Brook NL Canada
| | | | - Ann Sochan
- University of Ottawa School of Nursing; Ottawa ON Canada
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Reed E, Santana MC, Bowleg L, Welles SL, Horsburgh CR, Raj A. Experiences of racial discrimination and relation to sexual risk for HIV among a sample of urban black and African American men. J Urban Health 2013; 90:314-22. [PMID: 22674464 PMCID: PMC3675717 DOI: 10.1007/s11524-012-9690-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to examine racial discrimination and relation to sexual risk for HIV among a sample of urban black and African American men. Participants of this cross-sectional study were black and African American men (N = 703) between the ages of 18 and 65 years, recruited from four urban clinical sites in the northeast. Multivariate logistic regression models were used to analyze the relation of reported racial discrimination to the following: (1) sex trade involvement, (2) recent unprotected sex, and (3) reporting a number of sex partners in the past 12 months greater than the sample average. The majority of the sample (96%) reported racial discrimination. In adjusted analyses, men reporting high levels of discrimination were significantly more likely to report recent sex trade involvement (buying and/or selling) (adjusted odds ratio (AOR) range = 1.7-2.3), having recent unprotected vaginal sex with a female partner (AOR = 1.4, 95% confidence interval (CI), 1.1-2.0), and reporting more than four sex partners in the past year (AOR = 1.4, 95% CI, 1.1-1.9). Findings highlight the link between experiences of racial discrimination and men's sexual risk for HIV.
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Affiliation(s)
- E Reed
- Department of Prevention and Community Health, George Washington University School of Public Health, Washington, DC, USA.
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Rumpel JA, Ahmedani BK, Peterson EL, Wells KE, Yang M, Levin AM, Yang JJ, Kumar R, Burchard EG, Williams LK. Genetic ancestry and its association with asthma exacerbations among African American subjects with asthma. J Allergy Clin Immunol 2012; 130:1302-6. [PMID: 23069492 DOI: 10.1016/j.jaci.2012.09.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/17/2012] [Accepted: 09/01/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND There are large and persisting disparities in severe asthma exacerbations by race-ethnicity, and African American subjects are among those at greatest risk. It is unclear whether this increased risk solely represents differences in environmental exposures and health care or whether there is a predisposing genetic component. OBJECTIVE We sought to assess the relationship between genetic ancestry and severe exacerbations among African American subjects with asthma. METHODS Participants were part of the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-ethnicity (SAPPHIRE). These subjects were 12 to 56 years of age, received care from a single large health system, and had a physician's diagnosis of asthma. Genetic ancestry was estimated by using a set of validated ancestry informative markers. Severe exacerbations (ie, asthma-related emergency department visits, hospitalizations, and burst oral steroid use) were prospectively identified from health care claims. RESULTS We assessed genetic ancestry in 392 African American subjects with asthma. The average proportion of African ancestry was 76.1%. A significant interaction was identified between ancestry and sex on severe exacerbations, such that the risk was significantly higher with increasing African ancestry among male but not female subjects. The association among male subjects persisted after adjusting for potential confounders (relative rate, 4.30 for every 20% increase in African ancestry; P = .029). CONCLUSIONS African ancestry was significantly and positively associated with severe exacerbations among male African American subjects. These findings suggest that a portion of the risk of asthma exacerbations in this high-risk group is attributable to a genetic risk factor that partitions with ancestry.
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Affiliation(s)
- Jennifer A Rumpel
- Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
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Garza CF, Gasquoine PG. Implicit Race/Ethnic Prejudice in Mexican Americans. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2012. [DOI: 10.1177/0739986312462083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Implicit race/ethnic prejudice was assessed using Spanish- and English-language versions of an Implicit Association Test that used Hispanic/Anglo first names and pleasant/unpleasant words as stimuli. This test was administered to a consecutive sample of Mexican American adults residing in the Rio Grande Valley region of Texas of whom about two-thirds chose to be tested in English and one-third preferred Spanish. Participants were mostly female (73%) with a mean age of 32 years and mean education of 13 years. Among 83 participants, 43% demonstrated in-group implicit prejudice while 26% showed out-group implicit prejudice toward Anglos. There was a significant negative correlation between family values (familism and filial piety) and implicit race/ethnic prejudice scores but no significant association was found between implicit race/ethnic prejudice scores and acculturation or skin tone. Results contribute to the ongoing controversy regarding the validity of implicit race/ethnic prejudice, supporting the concept that societal not individual prejudices are being measured.
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Otlowski M, Taylor S, Bombard Y. Genetic Discrimination: International Perspectives. Annu Rev Genomics Hum Genet 2012; 13:433-54. [DOI: 10.1146/annurev-genom-090711-163800] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - S. Taylor
- School of Sociology and Social Work, University of Tasmania, Hobart, Tasmania 7001, Australia;
| | - Y. Bombard
- Department of Epidemiology and Public Health, Division of Health Policy and Administration, Yale University, New Haven, Connecticut 06510
- Department of Epidemiology and Biostatistics, Center for Health Policy and Outcomes, Memorial Sloan-Kettering Cancer Center, New York, NY 10065;
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Golden SH, Brown A, Cauley JA, Chin MH, Gary-Webb TL, Kim C, Sosa JA, Sumner AE, Anton B. Health disparities in endocrine disorders: biological, clinical, and nonclinical factors--an Endocrine Society scientific statement. J Clin Endocrinol Metab 2012; 97:E1579-639. [PMID: 22730516 PMCID: PMC3431576 DOI: 10.1210/jc.2012-2043] [Citation(s) in RCA: 271] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim was to provide a scholarly review of the published literature on biological, clinical, and nonclinical contributors to race/ethnic and sex disparities in endocrine disorders and to identify current gaps in knowledge as a focus for future research needs. PARTICIPANTS IN DEVELOPMENT OF SCIENTIFIC STATEMENT: The Endocrine Society's Scientific Statement Task Force (SSTF) selected the leader of the statement development group (S.H.G.). She selected an eight-member writing group with expertise in endocrinology and health disparities, which was approved by the Society. All discussions regarding the scientific statement content occurred via teleconference or written correspondence. No funding was provided to any expert or peer reviewer, and all participants volunteered their time to prepare this Scientific Statement. EVIDENCE The primary sources of data on global disease prevalence are from the World Health Organization. A comprehensive literature search of PubMed identified U.S. population-based studies. Search strategies combining Medical Subject Headings terms and keyword terms and phrases defined two concepts: 1) racial, ethnic, and sex differences including specific populations; and 2) the specific endocrine disorder or condition. The search identified systematic reviews, meta-analyses, large cohort and population-based studies, and original studies focusing on the prevalence and determinants of disparities in endocrine disorders. consensus process: The writing group focused on population differences in the highly prevalent endocrine diseases of type 2 diabetes mellitus and related conditions (prediabetes and diabetic complications), gestational diabetes, metabolic syndrome with a focus on obesity and dyslipidemia, thyroid disorders, osteoporosis, and vitamin D deficiency. Authors reviewed and synthesized evidence in their areas of expertise. The final statement incorporated responses to several levels of review: 1) comments of the SSTF and the Advocacy and Public Outreach Core Committee; and 2) suggestions offered by the Council and members of The Endocrine Society. CONCLUSIONS Several themes emerged in the statement, including a need for basic science, population-based, translational and health services studies to explore underlying mechanisms contributing to endocrine health disparities. Compared to non-Hispanic whites, non-Hispanic blacks have worse outcomes and higher mortality from certain disorders despite having a lower (e.g. macrovascular complications of diabetes mellitus and osteoporotic fractures) or similar (e.g. thyroid cancer) incidence of these disorders. Obesity is an important contributor to diabetes risk in minority populations and to sex disparities in thyroid cancer, suggesting that population interventions targeting weight loss may favorably impact a number of endocrine disorders. There are important implications regarding the definition of obesity in different race/ethnic groups, including potential underestimation of disease risk in Asian-Americans and overestimation in non-Hispanic black women. Ethnic-specific cut-points for central obesity should be determined so that clinicians can adequately assess metabolic risk. There is little evidence that genetic differences contribute significantly to race/ethnic disparities in the endocrine disorders examined. Multilevel interventions have reduced disparities in diabetes care, and these successes can be modeled to design similar interventions for other endocrine diseases.
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Affiliation(s)
- Sherita Hill Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Borrell LN, Kiefe CI, Diez-Roux AV, Williams DR, Gordon-Larsen P. Racial discrimination, racial/ethnic segregation, and health behaviors in the CARDIA study. ETHNICITY & HEALTH 2012; 18:227-43. [PMID: 22913715 PMCID: PMC3523091 DOI: 10.1080/13557858.2012.713092] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Racial discrimination has been associated with unhealthy behaviors, but the mechanisms responsible for these associations are not understood and may be related to residential racial segregation. We investigated associations between self-reported racial discrimination and health behaviors before and after controlling for individual- and neighborhood-level characteristics; and potential effect modification of these associations by segregation. DESIGN We used data from the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) study for 1169 African-Americans and 1322 whites. To assess racial discrimination, we used a four category variable to capture the extent and persistence of self-reported discrimination between examination at years 7 (1992-1993) and 15 (2000-2001). We assessed smoking status, alcohol consumption, and physical activity at year 20 (2005-2006). Segregation was examined as the racial/ethnic composition at the Census tract level. RESULTS Discrimination was more common in African-Americans (89.1%) than in whites (40.0%). Living in areas with high percentage of blacks was associated with less reports of discrimination in African-Americans but more reports in whites. After adjustment for selected characteristics including individual- and neighborhood-level socioeconomic conditions and segregation, we found significant positive associations of discrimination with smoking and alcohol consumption in African-Americans and with smoking in whites. African-Americans experiencing moderate or high discrimination were more physically active than those reporting no discrimination. Whites reporting some discrimination were also more physically active than those reporting no discrimination. We observed no interactions between discrimination and segregation measures in African-Americans or whites for any of the three health behaviors. CONCLUSIONS Racial discrimination may impact individuals' adoption of healthy and unhealthy behaviors independent of racial/ethnic segregation. These behaviors may help individuals buffer or reduce the stress of discrimination.
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Affiliation(s)
- Luisa N Borrell
- Department of Health Sciences, Lehman College, City University of New York, Bronx, NY, USA.
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