The Impact of Perceived Personal Discrimination on Migrant Students' Social Integration: The Mediating Effect of Group Permeability and Moderating Effect of Parental Involvement

This study aimed to investigate how migrant students' group permeability and parental involvement affect the relationship between perceived personal discrimination and social integration. A total of 755 migrant students at three schools in mainland China were investigated in the study. The results indicated that perceived personal discrimination negatively predicted migrant students' group permeability, whereas group permeability had a positive effect on social integration. Group permeability partially mediated the relationship between perceived personal discrimination and social integration. In addition, parental involvement played a significant moderating role between perceived personal discrimination and group permeability and mitigated the negative effect of perceived personal discrimination on group permeability. These findings suggest that we could reduce migrant students' perceived personal discrimination by improving their group permeability and parental involvement, thereby increasing their social integration.

As Much As I Can - Utilizing Immersive Theatre to Reduce HIV-Related Stigma and Discrimination Toward Black Sexual Minority Men

BACKGROUND

Despite advances in biomedical HIV prevention modalities such as pre-exposure prophylaxis to prevent the transmission of HIV, racial/ethnic and sexual/gender minority populations are disproportionately impacted by HIV epidemic. Alarming rates of HIV have persisted among Black gay and bisexual men, particularly in Southern states.

METHODS

Utilizing data from the ViiV ACCELERATE! initiative, we explored the impact of As Much As I Can, an immersive theatre production, on HIV-related stigma behaviors. A self-administered post-performance survey was conducted with a cohort (n = 322) of randomly selected audience members.

RESULTS

Overall, the results showed participants had a highly favorable experience, rating the performance with a mean score of 9.77/10. Respondents indicated they intended to change behaviors to promote HIV prevention education and to reduce stigma and discrimination including: (1) Say something if I hear stigmatizing language against people living with HIV (75.4%), (2) Say something if I hear anti-gay language (69.7%) and (3) Tell others about HIV prevention options (e.g., PrEP, PEP, condoms (64.1%). The findings show there is an association between HIV-related behavior intention and linkage to HIV care. Respondents who reported they were more likely to say something about HIV stigma were almost three times (O.R. 2.77; 95% C.I. 0.98-7.8) more likely to indicate they would follow up with a healthcare professional.

CONCLUSIONS

This study suggests that immersive theatre is an effective method for communicating HIV prevention education and reducing HIV-related structural stigma and discrimination that increases HIV vulnerability for Black sexual minority men.

Discrimination and adherence in a cross-sectional study of Latino sexual minority men with HIV: Coping with discrimination as a mediator and coping self-efficacy as a moderator

Discrimination is associated with antiretroviral therapy non-adherence and reduced well-being among people with HIV. We examined the potential for coping to mediate the associations between intersectional discrimination and non-adherence and coping self-efficacy (confidence in one's ability to cope with discrimination) as a moderator that may buffer the negative effects of discrimination on non-adherence in a cross-sectional convenience sample of 82 Latino sexual minority men with HIV. In bivariate linear regressions, discrimination targeting Latino ethnic origin, undocumented residency status, and sexual orientation were each significantly associated with lower self-reported antiretroviral therapy non-adherence (percentage of prescribed doses taken in the last month) and greater use of disengagement coping (denial, substance use, venting, self-blame, behavioral disengagement). Associations between discrimination targeting Latino ethnicity and non-adherence, and discrimination targeting undocumented residency status and non-adherence, were each mediated by disengagement coping responses. Moderation analyses highlighted significant discrimination by coping self-efficacy interaction effects-both coping self-efficacy for problem solving and stopping unpleasant emotions/thoughts each moderated the associations between Latino discrimination and adherence, between undocumented residency status discrimination and adherence, and between HIV discrimination and adherence. Coping self-efficacy for getting social support moderated the association between undocumented residency status discrimination and adherence. Further, the interaction coefficients across models indicated that the negative effects of discrimination on adherence were attenuated at higher levels of coping self-efficacy. Findings highlight the need for structural interventions that reduce-and ultimately eliminate-discrimination, and interventions that address the harmful effects of discrimination and adherence improvement interventions to enhance coping skills among people faced with intersectional discrimination.

Immigration-Related Discrimination and Mental Health among Latino Undocumented Students and U.S. Citizen Students with Undocumented Parents: A Mixed-Methods Investigation

Research has consistently linked discrimination and poorer health; however, fewer studies have focused on immigration-related discrimination and mental health outcomes. Drawing on quantitative surveys (N = 1,131) and qualitative interviews (N = 63) with Latino undergraduate students who are undocumented or U.S. citizens with undocumented parents, we examine the association between perceived immigration-related discrimination and mental health outcomes and the process through which they are linked. Regression analyses identify an association between immigration-related discrimination and increased levels of depression and anxiety; this relationship did not vary by self and parental immigration status. Interview data shed light on this result as immigration-related discrimination manifested as individual discrimination as well as vicarious discrimination through family and community members. We contend that immigration-related discrimination is not limited to individual experiences but rather is shared within the family and community, with negative implications for the mental health of undocumented immigrants and mixed-status family members.

Associations of Discrimination, Low Social Support, and Limited English Proficiency with Depression in South Asian Immigrants

South Asians face stressors as a growing immigrant group in America. Work is needed to understand how these stressors impact mental health to identify those at risk of depression and design interventions. This study examined associations of three stressors (discrimination, low social support, limited English proficiency) with depressive symptoms in South Asians. Using cross-sectional data from the Mediators of Atherosclerosis in South Asians Living in America study (N = 887), we fit logistic regression models to evaluate independent/joint effects of three stressors on depression. Overall prevalence of depression was 14.8%; 69.2% of those with all three stressors had depression. The combined effect of high discrimination/low social support was significantly greater than the sum of the individual factors. Experiences of discrimination, low social support, or limited English proficiency, as well as a combination of these factors, should be considered when diagnosing/treating South Asian immigrants in a culturally appropriate manner.

Lessons Learned from Health Disparities in Coronavirus Disease-2019 in the United States

In the United States, the coronavirus disease-2019 (COVID-19) pandemic has disproportionally affected Black, Latinx, and Indigenous populations, immigrants, and economically disadvantaged individuals. Such historically marginalized groups are more often employed in low-wage jobs without health insurance and have higher rates of infection, hospitalization, and death from COVID-19 than non-Latinx White individuals. Mistrust in the health care system, language barriers, and limited health literacy have hindered vaccination rates in minorities, further exacerbating health disparities rooted in structural, institutional, and socioeconomic inequities. In this article, we discuss the lessons learned over the last 2 years and how to mitigate health disparities moving forward.

Daily discrimination, church support, personal mastery, and psychological distress in black people in the United States

OBJECTIVE

This study used the stress process model to test the mediating effects of personal mastery and moderating effects of church-based social support on the relationship between daily discrimination and psychological distress across three age groups of African American and Afro-Caribbean adults.

METHODS

Using a national sample of 5008 African Americans and Afro-Caribbean adults from the National Survey of American Life Study, this study employs structural equation modeling to investigate the relationships between daily discrimination, personal mastery, church-based social support, and psychological distress.

RESULTS

Daily discrimination was an independent predictor of psychological distress across all groups. Group- and age-specific comparisons revealed significant differences in the experience of daily discrimination and psychological distress. Mastery was a partial mediator of the relationship between discrimination and psychological distress among Afro-Caribbeans while church support was a significant moderator only among the young and older African Americans.

IMPLICATIONS

Together, our study findings provide useful first steps towards developing interventions to reduce the adverse psychological impacts of daily discrimination on African Americans and Afro-Caribbeans. Intervention efforts such as individual psychotherapy aimed to improve Afro-Caribbean individuals' sense of mastery would be a partial solution to alleviating the adverse effects of discrimination on their psychological health.

Barriers to Accessing Healthy Food and Food Assistance During the COVID-19 Pandemic and Racial Justice Uprisings: A Mixed-Methods Investigation of Emerging Adults' Experiences

Background

A steep rise in food insecurity is among the most pressing US public health problems that has resulted from the COVID-19 pandemic.

Objective

This study aimed to (1) describe how food-insecure emerging adults are adapting their eating and child-feeding behaviors during COVID-19 and (2) identify barriers and opportunities to improve local food access and access to food assistance.

Design

The COVID-19 Eating and Activity Over Time study collected survey data from emerging adults during April to October 2020 and completed interviews with a diverse subset of food-insecure respondents.

Participants/setting

A total of 720 emerging adults (mean age: 24.7 ± 2.0 years; 62% female; 90% living in Minnesota) completed an online survey, and a predominately female subsample (n = 33) completed an interview by telephone or videoconference.

Main outcome measures

Survey measures included the short-form of the US Household Food Security Survey Module and 2 items to assess food insufficiency. Interviews assessed eating and feeding behaviors along with barriers to healthy food access.

Analyses performed

Descriptive statistics and a hybrid deductive and inductive content analysis.

Results

Nearly one-third of survey respondents had experienced food insecurity in the past year. Interviews with food-insecure participants identified 6 themes with regard to changes in eating and feeding behavior (eg, more processed food, sporadic eating), 5 themes regarding local food access barriers (eg, limited enforcement of COVID-19 safety practices, experiencing discrimination), and 4 themes regarding barriers to accessing food assistance (eg, lack of eligibility, difficulty in locating pantries). Identified recommendations include (1) expanding the distribution of information about food pantries and meal distribution sites, and (2) increasing fresh fruit and vegetable offerings at these sites.

Conclusions

Interventions of specific relevance to COVID-19 (eg, stronger implementation of safety practices) and expanded food assistance services are needed to improve the accessibility of healthy food for emerging adults.

Public Concern About Violence, Firearms, and the COVID-19 Pandemic in California

IMPORTANCE

Violence is a significant public health problem that has become entwined with the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVE

To describe individuals' concerns regarding violence in the context of the pandemic, experiences of pandemic-related unfair treatment, prevalence of and reasons for firearm acquisition, and changes in firearm storage practices due to the pandemic.

DESIGN, SETTING, AND PARTICIPANTS

This survey study used data from the 2020 California Safety and Well-being Survey, a probability-based internet survey of California adults conducted from July 14 to 27, 2020. Respondents came from the Ipsos KnowledgePanel, an online research panel with members selected using address-based sampling methods. Responses were weighted to be representative of the adult population of California.

MAIN OUTCOMES AND MEASURES

Topics included worry about violence for oneself before and during the pandemic; concern about violence for someone else due to a pandemic-related loss; experiences of unfair treatment attributed to the pandemic; firearm and ammunition acquisition due to the pandemic; and changes in firearm storage practices due to the pandemic.

RESULTS

Of 5018 invited panel members, 2870 completed the survey (completion rate, 57%). Among respondents (52.3% [95% CI, 49.5%-55.0%] women; mean [SD] age, 47.9 [16.9] years; 41.9% [95% CI, 39.3%-44.6%] White individuals), self-reported worry about violence for oneself was significantly higher during the pandemic for all violence types except mass shootings, ranging from a 2.8 percentage point increase for robbery (from 65.5% [95% CI, 62.8%-68.0%] to 68.2% [95% CI, 65.6%-70.7%]; P = .008) to a 5.6 percentage point increase for stray bullet shootings (from 44.5% [95% CI, 41.7%-47.3%] to 50.0% [47.3%-52.8%]; P < .001). The percentage of respondents concerned that someone they know might intentionally harm themselves was 13.1% (95% CI, 11.5%-15.3%). Of those, 7.5% (95% CI, 4.5%-12.2%) said it was because the other person had experienced a pandemic-related loss. An estimated 110 000 individuals (2.4% [95% CI, 1.1%-5.0%] of firearm owners in the state) acquired a firearm due to the pandemic, including 47 000 new owners (43.0% [95% CI, 14.8%-76.6%] of those who had acquired a firearm). Of owners who stored at least 1 firearm in the least secure way, 6.7% (95% CI, 2.7%-15.6%) said they had adopted this unsecure storage practice in response to the pandemic.

CONCLUSIONS AND RELEVANCE

In this analysis of findings from the 2020 California Safety and Well-being Survey, the COVID-19 pandemic was associated with increases in self-reported worry about violence for oneself and others, increased firearm acquisition, and changes in firearm storage practices. Given the impulsive nature of many types of violence, short-term crisis interventions may be critical for reducing violence-related harm.

Identity, Couple and Intergroup Dynamics in Intercultural Families: Implications on Life Satisfaction of Partners

The current study analyzed how identity, couple, and intergroup dynamics are related to life satisfaction among 210 intercultural partners living in Italy. Three levels of analysis were considered: a micro level, taking into account the identity aspect of each partner in terms of self- or hetero-ethnic identification; a meso level, examining the passion, commitment, and intimacy of the couple sphere of the partners; a macro level investigating the discrimination that partners can perceive by the community as an effect of the relationship between dominant and minority groups. The results show that for both partners, foreign and Italian, the variables that have a predictive value on life satisfaction bring into play the couple and the intergroup dynamics, leaving out the identitary one. Specifically, increased perceived discrimination as a member of a mixed couple leads to decreased life satisfaction by partners. In turn, we can see that a strong intimacy between partners enhances their life satisfaction. These results introduce a reflection on the role of the differences about the ethnic identity, considered erroneously the main cause of dissatisfaction in the mixed couple. The implications of the study are described and suggestions for future research discussed.

Trajectories of Depressive Symptoms Among North American Indigenous Adolescents: Considering Predictors and Outcomes

We identified developmental trajectories of depressive symptoms among 674 Indigenous adolescents (Mage  = 11.10, SD = 0.83 years) progressing from early to late adolescence. Four depressive symptoms trajectories were identified: (a) sustained low, (b) initially low but increasing, (c) initially high but decreasing, and (d) sustained high levels of depressive symptoms. Trajectory group membership varied as a function of gender, pubertal development, caregiver major depression, and perceived discrimination. Moreover, participants in the different trajectory groups were at differential risk for the development of an alcohol use disorder. These results highlight the benefit of examining the development of depressive symptoms and the unique ways that depressive symptoms develop among North American Indigenous youth as they progress through adolescence.

The role of perceived discrimination in substance use trajectories in Hispanic young adults: A longitudinal cohort study from high school through emerging adulthood

PURPOSE

Associations between discrimination and substance use have been identified cross-sectionally in multiple populations including Hispanics. However, there is limited research exploring this phenomenon longitudinally in Hispanic youth over the transition from adolescence through emerging adulthood (EA).

METHODS

Hispanic youth in Southern California (n = 1457) completed surveys over 11 years, from 2006 to 2017, including three high school collection waves and five EA collection waves. Multinomial logistic regression models were used to explore the associations between perceived discrimination during high school and cigarette and marijuana use in both high school and EA, controlling for gender, socioeconomic status, acculturation, and EA discrimination.

RESULTS

Compared with those who never used cigarettes or marijuana in high school and EA, perceived discrimination in high school was a significant predictor of two patterns of use: high school initiators who discontinued use of smoking (RRR = 1.677, 95%CI = 1.292-2.176) and/or marijuana (RRR = 1.464, 95%CI = 1.162-1.844), and high school initiators who continued smoking (RRR = 1.492, 95%CI = 1.196-1.861) and/or marijuana use (RRR = 1.249, 95%CI = 1.052-1.482) into EA. For late initiators who did not use in high school but started in EA, perceived high school discrimination was a significant predictor for cigarette smoking (RRR = 1.193, 95%CI = 1.036-1.373) but not for marijuana use.

CONCLUSIONS

Perceived discrimination during adolescence is associated with substance use trajectories across both adolescence and EA. Culturally tailored prevention programs that provide training in skills to cope with psychosocial stressors could improve Hispanic adolescent health.

Impact of change over time in self-reported discrimination on blood pressure: implications for inequities in cardiovascular risk for a multi-racial urban community

Objectives: The 21st century has seen a rise in racism and xenophobia in the United States. Few studies have examined the health implications of heightened institutional and interpersonal racism. This study examines changes in reported discrimination and associations with blood pressure over time among non-Latino Blacks (NLBs), Latinos, and non-Latino Whites (NLWs) in an urban area, and variations by nativity among Latinos.Design: Data from a probability sample of NLB, Latino, and NLW Detroit, Michigan residents were collected in 2002-2003, with follow-up at the same addresses in 2007-2008. Surveys were completed at 80% of eligible housing units in 2008 (n = 460). Of those, 219 participants were interviewed at both time points and were thus included in this analysis. Discrimination patterns across racial/ethnic groups and associations with blood pressure were examined using generalized estimating equations.Results: From 2002 to 2008, NLBs and Latinos reported heightened interpersonal and institutional discrimination, respectively, compared with NLWs. There were no differences in associations between interpersonal discrimination and blood pressure. Increased institutional discrimination was associated with stronger increases in systolic and diastolic blood pressure for NLBs than NLWs, with no differences between Latinos and NLWs. Latino immigrants experienced greater increases in blood pressure with increased interpersonal and institutional discrimination compared to US-born Latinos.Conclusions: Together, these findings suggest that NLBs and Latinos experienced heightened discrimination from 2002 to 2008, and that increases in institutional discrimination were more strongly associated with blood pressure elevation among NLBs and Latino immigrants compared to NLWs and US-born Latinos, respectively. These findings suggest recent increases in discrimination experienced by NLBs and Latinos, and that these increases may exacerbate racial/ethnic health inequities.

The Intergenerational Transmission of Discrimination: Children's Experiences of Unfair Treatment and Their Mothers' Health at Midlife

A growing body of research suggests that maternal exposure to discrimination helps to explain racial disparities in children's health. However, no study has considered if the intergenerational health effects of unfair treatment operate in the opposite direction-from child to mother. To this end, we use data from mother-child pairs in the National Longitudinal Survey of Youth 1979 to determine whether adolescent and young adult children's experiences of discrimination influence their mother's health across midlife. We find that children who report more frequent instances of discrimination have mothers whose self-rated health declines more rapidly between ages 40 and 50 years. Furthermore, racial disparities in exposure to discrimination among children explains almost 10% of the black-white gap but little of the Hispanic-white gap in self-rated health among these mothers. We conclude that the negative health impacts of discrimination are likely to operate in a bidirectional fashion across key family relationships.

The intersectionality of identity-based victimization in Adolescence:A person-centered examination of mental health and academic achievement in a U.S. high school

INTRODUCTION

Growing evidence indicates that identity-based victimization (IBV; e.g., discrimination) is traumatic, and associated with mental health and academic concerns. Youth with multiple stigmatized identities face a higher risk of both victimization and poor mental health. The current study enhances a growing research base on intersectional IBV by examining 1) identity, rather than attribution, 2) a range of IBV experiences, 3) both mental health and academic achievement, 4) the mediating role of discrimination across multiple social identities, and 5) including gender expansive youth within a diverse sample representative of a high school population in the U.S.

METHODS

A cluster analysis was conducted to provide a nuanced depiction of intersectionality in a diverse sample of high school students (N = 946; ages 14-20, 44% cisgender boys, 53% cisgender girls, 3% gender expansive youth). Outcome and IBV differences across clusters were examined, in addition to the mediation of cluster membership and outcomes by discrimination.

RESULTS

Three distinct profiles of identity emerged: LGBTQ Youth (24%), Heterosexual Youth of Color (37%), and Heterosexual White Youth (39%). LGBTQ Youth and Heterosexual Youth of Color experienced the most IBV, and had higher levels of depression, lower wellbeing, and lower GPAs. Finally, discrimination partially mediated the association between identity and outcomes for LGBTQ youth, and fully mediated this association for Heterosexual Youth of Color.

CONCLUSIONS

The disproportionately of IBV, poor mental health, and lower academic achievement faced by LGBTQ youth and youth with intersecting stigmatized identities suggests that they may benefit from tailored and targeted treatments.

Characterizing Discrimination Experiences by Race among Homeless Adults

Objectives: Among domiciled samples, racial discrimination is a known stressor linked with poorer quality of life. However, homeless adults may be particularly vulnerable to discrimination due to multiple factors beyond race. In this study, we characterized perceived discrimination and its reported impact on quality of life in a sample of adults who were homeless. Methods: Homeless adults recruited from Oklahoma City self-reported their socio-demographics, past discrimination experiences, and their impact on quality of life via the MacArthur Major Experiences of Discrimination Questionnaire. Descriptive statistics and frequencies were used to characterize perceived discrimination experiences and impact. Racial differences were examined using ANO- VAs/Kruskal-Wallis tests and chi-square tests. Results: Discrimination experiences attributed to homelessness were common and consistent between the races. Black adults perceived significantly more lifetime discrimination experiences than white adults, and attributed the majority to race. Relative to Whites and American Indians, black adults were more likely to endorse links between discrimination and having a harder life. Conclusions: Results suggest that black homeless adults may represent the most vulnerable racial subgroup for hardships in life as a conse- quence of perceived discrimination among homeless adults.

The association of perceived discrimination and depressive symptoms among Chinese, Korean, and Vietnamese Americans

OBJECTIVES

Few studies have investigated ethnic differences in discrimination and depressive symptoms, and the link between them among foreign-born Asian Americans. This study identifies if depressive symptoms and perceived discrimination differ by Asian ethnicity, and if perceived discrimination is associated with depressive symptoms among foreign-born Chinese, Korean, and Vietnamese Americans.

METHODS

This study uses data from the Asian American Liver Cancer Prevention Program (N = 600). Using nonprobability sampling, foreign-born Asian American adults (58% female, Mage = 47.3 years, SD = 11.82) were recruited from the community in the Baltimore-Washington Metropolitan Area. Perceived discrimination was defined using everyday and major discrimination scales; the Centers for Epidemiological Studies-Depression Scale defined the outcome of depressive symptoms. Multiple logistic regressions were conducted to determine if this association exists.

RESULTS

A high prevalence of depressive symptoms (one third to one fifth per ethnicity) and ethnic differences between foreign-born Chinese, Korean, and Vietnamese Americans were found; increased perceived discrimination was associated with worse depressive symptomology. Those with "high" and "mild discrimination" had greater odds of being depressed than those who had never experienced discrimination; those with "unfair treatment" had greater odds of being depressed than those who had none. Major experiences of discrimination were less common and less likely associated with depressive symptoms than everyday experiences.

CONCLUSIONS

Foreign-born Asian Americans experience substantial discrimination and depressive symptoms. Future studies should stratify by Asian ethnicity and examine the differences between minor and major experiences of discrimination to provide appropriate mental health prevention and treatment for this population. (PsycINFO Database Record

The mediating effect of self-esteem on the relationship between perceived discrimination and psychological well-being in immigrants

The aim of the study is to analyze the mediating effect of self-esteem on the relationship between perceived discrimination and psychological well-being in South American immigrants in Chile. An analytical, cross sectional, non-experimental design was used. We evaluated 853 Peruvians and Colombians living in the northern cities of Arica, Antofagasta, and Santiago de Chile, the capital located in the center of the country. The instruments used were the Ryff Psychological Well-being Scale, the Rosenberg Self-Esteem Scale and the Perceived Discrimination Scale by Basabe, Paez, Aierdi and Jiménez-Aristizabal. We used the estimation method (RWLS) and polychoric correlation matrices, to estimate the effect size and overall fit of the direct effect models of discrimination and self-esteem on psychological well-being, and indirect and total effects of discrimination mediated by self-esteem. While both populations reported similar levels of perceived discrimination, it was found that the means in psychological well-being and self-esteem of the Colombian population were significantly higher than that of the Peruvian population. Regarding self-esteem, the results provided evidence for the possible mediating effect on the relationship between perceived discrimination and psychological well-being. This research aims to contribute to the development of interventions seeking to strengthen self-esteem in order to circumvent possible negative consequences of perceived discrimination, as a consequent, improving immigrants´ personal resources to successfully cope with the diverse demands of their new context.

Services, Stigma, and Discrimination: Perceptions of African Descendant Men Living with HIV/AIDS in Brazil and in the United States

This study aimed to give voice to 13 men of African descent from Salvador, Brazil, and East Texas, United States, living with HIV/AIDS regarding their perceptions on accessibility of services, and the stigma and discrimination they experience. Phenomenological research using in-depth interviews was used as methodology. Five themes emerged from the data analysis: perception of positive health, services and accessibility, not disclosing HIV status is a way to be protected, health professionals untrained in treating people living with HIV/AIDS, being of African descent increases discrimination in both countries, education would decrease stigma and discrimination. This study addresses how stigma and discrimination experienced by these men violate their human rights, and the need of policies to mitigate these practices.

Intersectional Discrimination of Romani Women Forcibly Sterilized in the Former Czechoslovakia and Czech Republic

This paper reviews domestic and international activism seeking justice for Romani and other women harmed by coercive, forced, and involuntary sterilization in the former Czechoslovakia and Czech Republic. Framed by Michel Foucault's theory of biopower, it summarizes the history of these abuses and describes human rights campaigns involving domestic and international litigation, advocacy, and grassroots activism, as well as the responses of the Czech governments. The paper describes how legal and policy work during the past decade has led to recognition of coercive, forced, and involuntary sterilization as a present-day human rights issue worldwide, to the adoption of new guidelines on female sterilization, and to a joint statement on the issue by seven UN agencies. Relying on academic literature, reports by domestic and international human rights groups, state investigations, judgments from Czech courts and the European Court of Human Rights (ECHR), media reports, and the experience of the authors, who have been allies of the Romani women harmed in the Czech Republic since 2005 and 2012, respectively, the paper describes the current state of play with respect to achieving redress for them, including current conceptual, legal, political, and social obstacles and their antecedents in 20th century notions of population control.

Addressing patient biases toward physicians

[Full article available at http://rimed.org/rimedicaljournal-2017-12.asp].

Discrimination and symptoms of obsessive-compulsive disorder among African Americans

This study examined symptoms of obsessive-compulsive disorder (OCD) in a nationally representative sample of African American adults (n = 3,570) and correlations between OCD symptom dimensions and experiences of discrimination. Two categories of discrimination were examined, everyday racial discrimination and everyday nonracial discrimination (e.g., because of gender, age, and weight), to determine if racial discrimination had a unique impact on OCD symptoms. Results indicated that everyday racial discrimination was related to both categories of obsessions and all 4 categories of compulsions. Everyday nonracial discrimination, however, was not related to any of the categories of obsessions or compulsions. This indicates that racial discrimination is uniquely related to obsessions and compulsions for African Americans. The implications of these findings are discussed. (PsycINFO Database Record

Perceived Discrimination and Cardiovascular Outcomes in Older African Americans: Insights From the Jackson Heart Study

OBJECTIVE

To assess the associations of perceived discrimination and cardiovascular (CV) outcomes in African Americans (AAs) in the Jackson Heart Study.

PATIENTS AND METHODS

In 5085 AAs free of clinical CV disease at baseline enrolled in the Jackson Heart Study from September 26, 2000, through March 31, 2004, and followed through 2012, associations of everyday discrimination (frequency of occurrences of perceived unfair treatment) and lifetime discrimination (perceived unfair treatment in 9 life domains) with CV outcomes (all-cause mortality, incident coronary heart disease [CHD], incident stroke, and heart failure [HF] hospitalization) were examined using Cox proportional hazards regression models.

RESULTS

Higher levels of everyday and lifetime discrimination were more common in participants who were younger and male and had higher education and income, lower perceived standing in the community, worse perceived health care access, and fewer comorbidities. Before adjustment, higher levels of everyday and lifetime discrimination were associated with a lower risk of all-cause mortality, incident CHD, stroke, and HF hospitalization. After adjustment for potential confounders, we found no association of everyday and lifetime discrimination with incident CHD, incident stroke, or HF hospitalization; however, a decrease in all-cause mortality with progressively higher levels of everyday discrimination persisted (hazard ratio per point increase in discrimination measure, 0.90; 95% CI, 0.82-0.99; P=.02). The unexpected association of everyday discrimination and all-cause mortality was partially mediated by perceived stress.

CONCLUSION

We found no independent association of perceived discrimination with risk of incident CV disease or HF hospitalization in this AA population. An observed paradoxical negative association of everyday discrimination and all-cause mortality was partially mediated by perceived stress.

Medical mistrust as a key mediator in the association between perceived discrimination and adherence to antiretroviral therapy among HIV-positive Latino men

Discrimination has been found to have deleterious effects on physical health. The goal of the present study was to examine the association between perceived discrimination and adherence to antiretroviral therapy (ART) among HIV-positive Latino men and the extent to which medical mistrust serves as a mediator of that association. A series of linear and logistic regression models was used to test for mediation for three types of perceived discrimination (related to being Latino, being perceived as gay and being HIV-positive). Medical mistrust was found to be significantly associated with perceived discrimination based on Latino ethnicity and HIV serostatus. Medical mistrust was found to mediate the associations between two types of perceived discrimination (related to being Latino and being HIV-positive) and ART adherence. Given these findings, interventions should be developed that increase the skills of HIV-positive Latino men to address both perceived discrimination and medical mistrust.

Serious physical violence among Arab-Palestinian adolescents: The role of exposure to neighborhood violence, perceived ethnic discrimination, normative beliefs, and, parental communication

This study adopted a social-ecological perspective to exploring perpetration of serious physical violence against others among Arab-Palestinian adolescents. A total of 3178 adolescents (aged 13-18) completed anonymous, structured, self-report questionnaire, which included selected items from several instruments that measured variables relating to the constructs examined in the study. We explored the association of individual characteristics (age, gender, normative beliefs about violence, and perceived ethnic discrimination), familial characteristics (parent-adolescent communication and socioeconomic status), and contextual characteristics (exposure to community violence in the neighborhood) with perpetration of serious physical violence against others. A moderation-mediation model was tested, and 28.4% of the adolescents reported that they had perpetrated serious physical violence against others at least once during the month preceding the study. The findings also show that exposure of youth to violence in their neighborhood correlated significantly and positively with their perpetration of serious physical violence against others. A similar trend was revealed with respect to personal perceptions of ethnic discrimination. These correlations were mediated by the adolescents' normative beliefs about violence. Furthermore, the correlation of direct exposure to violence in the neighborhood and normative beliefs about violence with perpetration of serious physical violence against others was stronger among adolescents who have poor communication with their parents than among those who have strong parental communication.

NEIGHBOURHOOD POVERTY, PERCEIVED DISCRIMINATION AND CENTRAL ADIPOSITY IN THE USA: INDEPENDENT ASSOCIATIONS IN A REPEATED MEASURES ANALYSIS

This study examines the independent effects of neighbourhood context (i.e. neighbourhood poverty) and exposure to perceived discrimination in shaping risk of obesity over time. Weighted three-level hierarchical linear regression models for a continuous outcome were used to assess the independent effects of neighbourhood poverty and perceived discrimination on obesity over time in a sample of 157 non-Hispanic Black, non-Hispanic White and Hispanic adults in Detroit, USA, in 2002/2003 and 2007/2008. Independent associations were found between neighbourhood poverty and perceived discrimination with central adiposity over time. Residents of neighbourhoods with high concentrations of poverty were more likely to show increases in central adiposity compared with those in neighbourhoods with lower concentrations of poverty. In models adjusted for BMI, neighbourhood poverty at baseline was associated with a greater change in central adiposity among participants who lived in neighbourhoods in the second (B=3.79, p=0.025) and third (B=3.73, p=0.024) poverty quartiles, compared with those in the lowest poverty neighbourhoods. The results from models that included both neighbourhood poverty and perceived discrimination showed that both were associated with increased risk of increased central adiposity over time. Residents of neighbourhoods in the second (B=9.58, p<0.001), third (B=8.25, p=0.004) and fourth (B=7.66, p=0.030) quartiles of poverty were more likely to show greater increases in central adiposity over time, compared with those in the lowest poverty quartile, with mean discrimination at baseline independently and positively associated with increases in central adiposity over time (B=2.36, p=0.020). The results suggest that neighbourhood poverty and perceived discrimination are independently associated with a heightened risk of increase in central adiposity over time. Efforts to address persistent disparities in central adiposity in the USA should include strategies to reduce high concentrations of neighbourhood poverty as well as discrimination.

Buried hatchets, marked locations: Forgiveness, everyday racial discrimination, and African American men's depressive symptomatology

Everyday racial discrimination (ERD) is linked to pronounced depressive symptomatology among African American men. Yet, many African American men do not experience depressive symptoms following ERD exposure often because they use positive coping strategies that offset its effects. Granting forgiveness is 1 coping strategy associated with less depression. However, extant findings about the mental health benefits of forgiveness are somewhat mixed and pay scarce attention to offenses which are fleeting, historically rooted, and committed outside of close personal relationships. Evidence further suggest age-related differences in forgiveness, ERD exposure, and depressive symptoms. We explore the extent to which 3 strategies of granting forgiveness of ERD-letting go of negative emotion (negative release), embracing positive emotion (positive embrace), or combining both (combined)-are associated with less depressive symptomatology in 674 African American men (ages 18 through 79). Building on past findings, we also test whether these forgiveness strategies moderate the ERD-depressive symptoms relationship for men in different age groups (18 through 25, 26 through 39, and 40). Higher combined and negative release forgiveness were directly related to lower depressive symptoms among 18 through 25 year olds. We also detected a less pronounced positive relationship between ERD and depressive symptoms among men reporting high levels of combined (18 through 25 and 26 through 39 groups) and negative release (26 through 39 and 40+ groups) forgiveness. We observed a more pronounced positive ERD-depressive symptoms relationship among 18 through 25 and 26 through 39 year olds reporting lower forgiveness. When faced with frequent ERD, younger African American men may have the most difficult time burying hatchets without marking their location but experience more positive mental health benefits when they do. (PsycINFO Database Record

Ethnic socialization, perceived discrimination, and psychological adjustment among transracially adopted and nonadopted ethnic minority adults

Little is known on how transracial adoptees (TRA) navigate issues of race and ethnicity. Using Shared Fate Theory as a framework, this study was interested in the moderating role of adoption status among a group of ethnic minority adults in explaining the relationship between ethnic socialization, perceived discrimination, and mental health outcomes. Nonadopted (NA; n = 83) and TRA (n = 87) ethnic minorities responded to measures on ethnic socialization, perceived discrimination, and psychological outcomes administered online. TRA and NA ethnic minorities reported similar levels of ethnic socialization, perceived discrimination, and psychological outcomes (depression and self-esteem). Perceived discrimination was significantly associated with depression for both TRA and NA ethnic minorities. Ordinal Least Squares (OLS) regressions that were run for a moderated moderational analysis suggest that the protective role of ethnic socialization depended on adoption status. Among the different forms of ethnic socialization, cultural socialization and preparation for bias significantly buffered against the effects of perceived discrimination, but the effects were more pronounced for TRA than for NA ethnic minorities. Because NA and TRA ethnic minorities were similarly affected by discrimination, it suggests that being a TRA does not confer any additional risk when experiencing discrimination. Additionally, the study found that ethnic socialization may continue to serve a protective role against the effects of discrimination into adulthood for TRA, but less so for NA ethnic minorities. These results have policy implications regarding the role of parental ethnicity in adoption decisions as well as the importance of educating adopted parents about ethnic socialization for ethnic minority children. (PsycINFO Database Record

Perceived discrimination and impaired mental health in Turkish immigrants and their descendents in Germany

OBJECTIVE

This study investigates the relationship between different forms of perceived ethnic discrimination, stress, and depressive and somatoform symptoms in Turkish immigrants and their descendents. Moreover, it was tested whether ethnic identification buffers the effect of discrimination on stress.

METHODS

Variables were assessed via online and paper-pencil questionnaires (e.g., Behaviors from Intergroup Affect and Stereotype Treatment Scale, Patient Health Questionnaire, Perceived Stress Scale) in Turkish immigrants and their descendents (N=214) from the general population in Germany. Mediation and moderated mediation models were tested.

RESULTS

Open aggression and discrimination in everyday situations showed large effects on depressive and somatoform symptoms. Also, paternalism showed a large indirect effect on impaired mental health via perceived stress, but only for persons lowly identified with being Turkish.

CONCLUSION

This study reveals the large detrimental effects of different forms of discrimination on mental health in Turkish immigrants. However, a high ethnic identification can act as a buffer against stress.

Perceived Discrimination and Incident Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis

Perceived discrimination is positively related to cardiovascular disease (CVD) risk factors; its relationship with incident CVD is unknown. Using data from the Multi-Ethnic Study of Atherosclerosis, a population-based multiethnic cohort study of 6,508 adults aged 45-84 years who were initially free of clinical CVD, we examined lifetime discrimination (experiences of unfair treatment in 6 life domains) and everyday discrimination (frequency of day-to-day occurrences of perceived unfair treatment) in relation to incident CVD. During a median 10.1 years of follow-up (2000-2011), 604 incident events occurred. Persons reporting lifetime discrimination in ≥2 domains (versus none) had increased CVD risk, after adjustment for race/ethnicity and sociodemographic factors, behaviors, and traditional CVD risk factors (hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.09, 1.70) and after control for chronic stress and depressive symptoms (HR = 1.28, 95% CI: 1.01, 1.60). Reported discrimination in 1 domain was unrelated to CVD (HR = 1.05, 95% CI: 0.86, 1.30). There were no differences by race/ethnicity, age, or sex. In contrast, everyday discrimination interacted with sex (P = 0.03). Stratified models showed increased risk only among men (for each 1-standard deviation increase in score, adjusted HR = 1.14, 95% CI: 1.03, 1.27); controlling for chronic stress and depressive symptoms slightly reduced this association (HR = 1.11, 95% CI: 0.99, 1.25). This study suggests that perceived discrimination is adversely related to CVD risk in middle-aged and older adults.

Racial/ethnic variations in the main and buffering effects of ethnic and nonethnic supports on depressive symptoms among five ethnic immigrant groups in Toronto

OBJECTIVES

This study examined variations in the main and buffering effects of ethnic and nonethnic social support on depressive symptoms associated with discrimination among five immigrant groups in Toronto.

DESIGN

Data were taken from the Toronto Study of Settlement and Health, a cross-sectional survey of adult immigrants from five ethnic communities (Vietnamese, Ethiopian, Iranian, Korean, and Irish) in Toronto. A total of 900 surveys were collected through face-to-face interviews conducted between April and September 2001.

RESULTS

Significant ethnic variations were observed in the effects of both ethnic and nonethnic social supports on discrimination-related depressive symptoms. Regarding the main effect, ethnic social support was significantly stronger for Iranian, Ethiopian, and Korean immigrants than for Irish immigrants. The benefits of nonethnic support were stronger for Iranian immigrants compared to the effect found in the Irish sample. With respect to stress-buffering or stress-moderating effects of social support, ethnic support was significant in all ethnic groups, except the Vietnamese group. Nonethnic support aggravated the negative impact of discrimination on depressive symptoms in the Irish group, but exerted a stress-buffering effect in the Iranian group.

CONCLUSIONS

Overall, social supports received from fellow ethnic group members had significant main effects (suppressing depressive symptoms) and stress-buffering effects and were most pronounced in the minority ethnic immigrant groups of Ethiopians, Koreans, and Iranians. The effects were least evident among the Vietnamese and Irish. Evidence for the stress-suppressing and stress-buffering role of cross-ethnic group supports was unclear, and even inverted among Irish immigrants. Empirical evidence from the current study seems to support the sociocultural similarity hypothesis of social support.

'Stereotypes are reality': addressing stereotyping in Canadian Aboriginal medical education

CONTEXT

Efforts are underway in many parts of the world to develop medical education curricula that address the health care issues of indigenous populations. The topic of stereotypes and their impact on such peoples' health, however, has received little attention. An examination of stereotypes will shed light on dominant cultural attitudes toward Aboriginal people that can affect quality of care and health outcomes in Aboriginal patients.

OBJECTIVES

This study examines the views of undergraduate medical students regarding Canadian Aboriginal stereotypes and how they potentially affect Aboriginal people's health. The goal of this study was to gain insight into how medical learners perceive issues related to racism, discrimination and social stereotypes and to draw attention to gaps in Aboriginal health curricula.

METHODS

This study involved a convenience sample of medical learners drawn from one undergraduate medical programme in western Canada. Using a semi-structured interview guide, we conducted a total of seven focus group interviews with 38 first- and second-year undergraduate medical students. Data were analysed using a thematic content analysis approach.

RESULTS

Medical students recognise that stereotypes are closely related to processes of racism and discrimination. However, they generally feel that stereotypes of Aboriginal people are rooted in reality. Students also identified medical school as one of the environments in which they are commonly exposed to negative views of Aboriginal people. Student responses suggest they see the cultural gap between Aboriginal and non-Aboriginal people as being both a cause and a consequence of discrimination against Aboriginal people.

CONCLUSIONS

The results of this study suggest that teaching medical students about the realities and impacts of stereotypes on Aboriginal peoples is a good starting point from which to address issues of racism and health inequities affecting the health of Aboriginal people.

Wright angle

Stephen Wright's monthly take on nursing in the news.

Should patients be cared for in a culturally standard way?

Ami David (Letters February 19) makes some interesting points about lack of career progression among black and minority ethnic (BME) nurses that raise many questions and need further, in-depth exploration.

Perceived weight discrimination in the CARDIA study: differences by race, sex, and weight status

OBJECTIVE

To examine self-reported weight discrimination and differences based on race, sex, and BMI in a biracial cohort of community-based middle-aged adults.

DESIGN AND METHODS

Participants (3,466, mean age = 50 years, mean BMI = 30 kg/m²) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study who completed the 25-year examination of this epidemiological investigation in 2010-2011 were reported. The sample included normal weight, overweight, and obese participants. CARDIA participants are distributed into four race-sex groups, with about half being African-American and half White. Participants completed a self-reported measure of weight discrimination.

RESULTS

Among overweight/obese participants, weight discrimination was lowest for White men (12.0%) and highest for White women (30.2%). The adjusted odds ratio (95% CI) for weight discrimination in those with class 2/3 obesity (BMI ≥ 35 kg/m²) versus the normal-weight was most pronounced: African American men, 4.59 (1.71-12.34); African American women, 7.82 (3.57-17.13); White men, 6.99 (2.27-21.49); and White women, 18.60 (8.97-38.54). Being overweight (BMI = 25-29.9 kg/m²) vs. normal weight was associated with increased discrimination in White women only: 2.10 (1.11-3.96).

CONCLUSIONS

Novel evidence for a race-sex interaction on perceived weight discrimination, with White women more likely to report discrimination at all levels of overweight and obesity was provided. Pychosocial mechanisms responsible for these differences deserve exploration.

Perceived discrimination and self-rated health in Europe: evidence from the European Social Survey (2010)

INTRODUCTION

Studies have shown that perceived discrimination has an impact on our physical and mental health. A relevant part of literature has highlighted the influence of discrimination based on race or ethnicity on mental and physical health outcomes. However, the influence of other types of discrimination on health has been understudied. This study is aimed to explore how different types of discrimination are related to our subjective state of health, and so to compare the intensity of these relationships in the European context.

METHODS

We have performed a multilevel ordered analysis on the fifth wave of the European Social Survey (ESS 2010). This dataset has 52,458 units at individual level that are grouped in 26 European countries. In this study, the dependent variable is self-rated health (SRH) that is analyzed in relationship to ten explanatory variables of perceived discrimination: color or race, nationality, religion, language, ethnic group, age, gender, sexuality, disability and others.

RESULTS

The model identifies statistically significant differences in the effect that diverse types of perceived discrimination can generate on the self-rated health of Europeans. Specifically, this study identifies three well-defined types of perceived discrimination that can be related to poor health outcomes: (1) age discrimination; (2) disability discrimination; and (3) sexuality discrimination. In this sense, the effect on self-rated health of perceived discrimination related to aging and disabilities seems to be more relevant than other types of discrimination in the European context with a longer tradition in literature (e.g. ethnic and/or race-based).

CONCLUSION

The present study shows that the relationship between perceived discrimination and health inequities in Europe are not random, but systematically distributed depending on factors such as age, sexuality and disabilities. Therefore the future orientation of EU social policies should aim to reduce the impact of these social determinants on health equity.

Examining cultural competence in health care: implications for social workers

This article examines and unpacks the "black box" of cultural competence in health interventions with racial and ethnic minority populations. The analysis builds on several recent reviews of evidence-based efforts to reduce health disparities, with a focus on how cultural competence is defined and operationalized. It finds that the use of multiple similar and indistinct terms related to cultural competence, as well as the lack of a mutually agreeable definition for cultural competence itself, has resulted in an imprecise concept that is often invoked but rarely defined and only marginally empirically validated as an effective health intervention. This article affirms the centrality of cultural competence as an essential values-based component of optimal social work practice, while also suggesting future directions for operationalizing, measuring, and testing cultural competence to build an evidence base on whether and how it works to reduce health disparities.

Health-related quality of life, ethnicity and perceived discrimination among immigrants and natives in Spain

OBJECTIVES

The current study compares subjective mental and physical health among native Spaniards and immigrant groups, and examines the effects of ethnicity and perceived discrimination (PD) on subjective health in immigrants.

DESIGN

Two random samples of 1250 immigrants to Spain from Colombia, Bolivia, Romania, Morocco, and Sub-Saharan Africa and 500 native Spaniards, aged between 18 and 65, were recruited for this cross-sectional study. Several hierarchical regression analyses of ethnicity and PD on subjective mental and physical health (assessed using the health-related quality of life items, HRQLSF-12) were carried out separately for men and women.

RESULTS

Male immigrants from Colombia and Sub-Saharan Africa showed better physical health than natives, controlling for age and socioeconomic and marital status. The immigrants - except for the Colombians - had poorer mental health than natives, especially African men and Bolivian women. Socioeconomic status had no impact on these differences. Among immigrants, PD was the best predictor of physical and mental health (controlling for socio-demographic variables). African men, Bolivian women and women without legal status exhibited the poorest self-rated mental health.

CONCLUSION

Clear differences in health status among natives and immigrants were recorded. The self-selection hypothesis was plausible for physical health of Colombians and Sub-Saharan African men. Acculturation stress could explain poorer mental health in immigrants compared with natives. The association between ethnicity and poor self-reported mental health appears to be partially mediated by discrimination.

Bedouin in Lebanon: Social discrimination, political exclusion, and compromised health care

Global inequalities in health have long been associated with disparities between rich and poor nations. The middle-income countries of the Levant (Lebanon, Syria and Jordan) have developed models of health care delivery that mirror the often complex make-up of their states. In Lebanon, which is characterized by political clientelism and sectarian structures, access to health care is more contingent on ethnicity and religious affiliation than on poverty. This case study of the Bedouin of the Middle Bekaa Valley of Lebanon is based on interviews with policymakers, health care providers and the Bedouin as part of a study funded by the European Commission between 2006 and 2010. The study explores the importance of considering social discrimination and political exclusion in understanding compromised health care. Three decades after the Declaration of Alma Ata (1978), which declared that an acceptable level of health care for all should be attained by the year 2000, the Bedouin community of Lebanon remains largely invisible to the government and, thus, invisible to national health care policy and practice. They experience significant social discrimination from health practitioners and policymakers alike. Their unfair treatment under the health system is generally disassociated from issues of wealth or poverty; it is manifested in issues of access and use, discrimination, and resistance and agency. Overcoming their political exclusion and recognizing the social discrimination they face are steps that can be taken to protect and promote equal access to basic reproductive and child health care. This case study of the Bedouin in Lebanon is also relevant to the health needs of other marginalized populations in remote and rural areas.

Perceived discrimination, group identification, and life satisfaction among multiracial people: a test of the rejection-identification model

Like other racial minority groups, multiracial people face discrimination as a function of their racial identity, and this discrimination represents a threat to psychological well-being. Following the Rejection-Identification Model (RIM; Branscombe, Schmitt, & Harvey, 1999), we argue that perceived discrimination will encourage multiracial people to identify more strongly with other multiracials, and that multiracial identification, in turn, fosters psychological well-being. Thus, multiracial identification is conceptualized as a coping response that reduces the overall costs of discrimination on well-being. This study is the first to test the RIM in a sample of multiracial people. Multiracial participants' perceptions of discrimination were negatively related to life satisfaction. Consistent with the RIM, perceived discrimination was positively related to three aspects of multiracial group identification: stereotyping the self as similar to other multiracial people, perceiving people within the multiracial category as more homogenous, and expressing solidarity with the multiracial category. Self-stereotyping was the only aspect of group identification that mediated a positive relationship between perceived discrimination and life satisfaction, suggesting that multiracial identification's protective properties rest in the fact that it provides an collective identity where one "fits."