Perceived weight discrimination and changes in weight, waist circumference, and weight status

OBJECTIVE

To examine associations between perceived weight discrimination and changes in weight, waist circumference, and weight status.

METHODS

Data were from 2944 men and women aged ≥50 years participating in the English Longitudinal Study of Ageing. Experiences of weight discrimination were reported in 2010-2011 and weight and waist circumference were objectively measured in 2008-2009 and 2012-2013. ANCOVAs were used to test associations between perceived weight discrimination and changes in weight and waist circumference. Logistic regression was used to test associations with changes in weight status. All analyses adjusted for baseline BMI, age, sex, and wealth.

RESULTS

Perceived weight discrimination was associated with relative increases in weight (+1.66 kg, P < 0.001) and waist circumference (+1.12 cm, P = 0.046). There was also a significant association with odds of becoming obese over the follow-up period (OR = 6.67, 95% CI 1.85-24.04) but odds of remaining obese did not differ according to experiences of weight discrimination (OR = 1.09, 95% CI 0.46-2.59).

CONCLUSIONS

Our results indicate that rather than encouraging people to lose weight, weight discrimination promotes weight gain and the onset of obesity. Implementing effective interventions to combat weight stigma and discrimination at the population level could reduce the burden of obesity.

Perceived discrimination and injecting risk among people who inject drugs attending Needle and Syringe Programmes in Sydney, Australia

BACKGROUND

Previous research indicates that stigma and discrimination have negative consequences for both healthcare delivery and for health outcomes of people who inject drugs (PWID). Also important but not as well researched is the association between perceived discrimination and increased engagement in risky behaviours. This research aimed to explore whether perceived discrimination from workers in Needle and Syringe programmes (NSPs) is associated with increased engagement in injecting risk practices such as the sharing of injecting equipment.

METHOD

Convenience sampling was used across eight NSP sites within Western Sydney, Australia. All clients who attended one of the NSPs were eligible to participate.

RESULTS

A total of 236 clients completed the survey. Perceived discrimination from NSP staff was found to be significantly associated with some injecting risk practices. Respondents who reported greater perceived discrimination from NSP staff were significantly more likely to report being injected by someone else after they had injected themselves (OR 1.2, 95%CI 1.1-1.3) and reusing a needle or syringe (OR 1.1, 95%CI 1.0-1.3) in the last month. Although clients reported perceiving more discrimination from general health workers than from NSP workers (12.8 vs. 10.2, t=7.739, df=226, p<0.001), perceived discrimination from general health workers was not associated with increased injecting risk practices.

CONCLUSIONS

The findings of this study suggest that NSP workers need to be aware that although they work in a model that is usually non-judgemental, their clients may still have a heightened sensitivity to discrimination which can then have consequences for on-going engagement in risk practices.

Strategies for managing impressions of racial identity in the workplace

This article deepens understanding of the workplace experiences of racial minorities by investigating racial identity-based impression management (RIM) by Asian American journalists. Racial centrality, directly or indirectly, predicted the use of 4 RIM strategies (avoidance, enhancement, affiliation, and racial humor). Professional centrality also predicted strategy use, which was related to life satisfaction and perceived career success. By shedding light on proactive strategies that individuals use to influence colleagues' impressions of their racial identity, we contribute to research on diversity in organizations, impression management, and racial identity.

Relationship between perceived discrimination and sedentary behavior in adults

OBJECTIVE

To identify psychosocial factors associated with sedentary behavior, we tested whether perceived discrimination is associated with sedentary behavior.

METHODS

Black and white men and women (N = 3270) from the Coronary Artery Risk Development in Young Adults (CARDIA) Study reported experiences of discrimination and time engaged in total and screen time sedentary behaviors in 2010-11.

RESULTS

There were no associations of discriminatory experiences with total sedentary behavior time. However, discriminatory experiences were positively associated with screen time for black men (OR 1.81, 95% CI: 1.14, 2.86) and white women (OR 1.51, 95% CI: 1.14, 2.00) after adjusting for demographic and traditional cardiovascular disease risk factors.

CONCLUSION

Among black men and white women, discriminatory experiences were correlated with more screen time sedentary behavior.

Reducing obesity prejudice in medical education

BACKGROUND

Healthcare worker attitudes toward obese individuals facilitate discrimination and contribute to poor health outcomes. Previous studies have demonstrated medical student bias toward obese individuals, but few have examined effects of the educational environment on these prejudicial beliefs. We sought to determine whether an innovative educational intervention (reading a play about obesity) could diminish obesity prejudice relative to a standard medical lecture.

METHODS

We conducted a randomized, controlled trial enrolling medical students (n = 129) from three universities. Students were assigned to play-reading or a standard lecture. Explicit attitudes and implicit bias toward obese individuals were assessed prior to intervention and after four months.

RESULTS

At baseline, students demonstrated moderate explicit and implicit bias toward obese people despite high scores on empathy. Students randomized to the play-reading group had significantly decreased explicit fat bias (P = 0.01) at follow-up, while students in the lecture group showed increased endorsement of a prescriptive model of care at the expense of a patient-centered approach (P = 0.03). There was a significant increase in empathy for those in both the theater (P = 0.007) and lecture group (P = 0.02). The intervention had no significant effect on implicit bias or regard for obesity as a civil rights issue.

DISCUSSION

Dramatic reading may be superior to traditional medical lectures for showcasing patient rights and preferences. The present study demonstrates for the first time that play-reading diminishes conscious obesity bias. Further research should determine whether nontraditional methods of instruction promote improved understanding of and care for obese patients.

Contemporary heterosexism on campus and psychological distress among LGBQ students: the mediating role of self-acceptance

Contemporary heterosexism includes both overt and subtle discrimination. Minority stress theory posits that heterosexism puts sexual minorities at risk for psychological distress and other negative outcomes. Research, however, tends to focus only on 1 form at a time, with minimal attention being given to subtle heterosexism. Further, little is known about the connection between minority stressors and underlying psychological mechanisms that might shape mental health outcomes. Among a convenience sample of lesbian, gay, bisexual, and queer (LGBQ) college students (n = 299), we investigated the role of blatant victimization and LGBQ microaggressions, both together and separately, on psychological distress and the mediating role of self-acceptance. We conducted structural equation modeling to examine hypothesized relationships. Heterosexism was measured as blatant victimization, interpersonal microaggressions, and environmental microaggressions. Self-acceptance included self-esteem and internalized LGBTQ pride. Anxiety and perceived stress comprised the psychological distress factor. Our results suggest that students with greater atypical gender expression experience, greater overall heterosexism and victimization, and younger students experience more overall heterosexism, and undergraduates report more victimization. Microaggressions, particularly environmental microaggressions, are more influential on overall heterosexism than blatant victimization. Overall heterosexism and microaggressions demonstrated main effects with self-acceptance and distress, whereas victimization did not. Self-acceptance mediated the path from discrimination to distress for both overall heterosexism and microaggressions. Our findings advance minority stress theory research by providing a nuanced understanding of the nature of contemporary discrimination and its consequences, as well as illuminating the important role self-acceptance plays as a mediator in the discrimination-psychological distress relationship.

HIV-related discrimination among grade six students in nine Southern African countries

BACKGROUND

HIV-related stigmatisation and discrimination by young children towards their peers have important consequences at the individual level and for our response to the epidemic, yet research on this area is limited.

METHODS

We used nationally representative data to examine discrimination of HIV-positive children by grade six students (n = 39,664) across nine countries in Southern Africa: Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Descriptive statistics are used to compare discrimination by country, gender, geographic location and socioeconomic status. Multivariate logistic regression is employed to assess potential determinants of discrimination.

RESULTS

The levels and determinants of discrimination varied significantly between the nine countries. While one in ten students in Botswana, Malawi, South Africa and Swaziland would "avoid or shun" an HIV positive friend, the proportions in Lesotho, Mozambique, Zambia and Zimbabwe were twice as high (approximately 20%). A large proportion of students believed that HIV positive children should not be allowed to continue to attend school, particularly in Zambia (33%), Lesotho (37%) and Zimbabwe (42%). The corresponding figures for Malawi and Swaziland were significantly lower at 13% and 12% respectively. Small differences were found by gender. Children from rural areas and poorer schools were much more likely to discriminate than those from urban areas and wealthier schools. Importantly, we identified factors consistently associated with discrimination across the region: students with greater exposure to HIV information, better general HIV knowledge and fewer misconceptions about transmission of HIV via casual contact were less likely to report discrimination.

CONCLUSIONS

Our study points toward the need for early interventions (grade six or before) to reduce stigma and discrimination among children, especially in schools situated in rural areas and poorer communities. In particular, interventions should focus on correcting misconceptions that HIV can be transmitted via casual contact.

Spreading of intolerance under economic stress: results from a reputation-based model

When a population is engaged in successive prisoner's dilemmas, indirect reciprocity through reputation fosters cooperation through the emergence of moral and action rules. A simplified model has recently been proposed where individuals choose between helping others or not and are judged good or bad for it by the rest of the population. The reputation so acquired will condition future actions. In this model, eight strategies (referred to as "leading eight") enforce a high level of cooperation, generate high payoffs, and are therefore resistant to invasions by other strategies. Here we show that, by assigning each individual one of two labels that peers can distinguish (e.g., political ideas, religion, and skin color) and allowing moral and action rules to depend on the label, intolerant behaviors can emerge within minorities under sufficient economic stress. We analyze the sets of conditions where this can happen and also discuss the circumstances under which tolerance can be restored. Our results agree with empirical observations that correlate intolerance and economic stress and predict a correlation between the degree of tolerance of a population and its composition and ethical stance.

Historical trauma and substance use among Native Hawaiian college students

OBJECTIVES

To test the relationships among historical trauma, perceived discrimination, and substance use (cigarette, alcohol, and marijuana use) among Native Hawaiians.

METHODS

Cross sectional self-report data were collected online from 128 Native Hawaiian community college students (M age = 27.5; SD = 9.5; 65% Women). Hypotheses were tested using structural equation modeling.

RESULTS

Historical trauma had 2 paths to substance use: an indirect path to higher substance use through higher perceived discrimination and a direct path to lower substance use.

CONCLUSIONS

Thoughts, knowledge, or experience associated with historical trauma may enhance substance use behavior via increased perceived discrimination and may also be protective against substance use, possibly via increased pride in one's cultural heritage. This research has implications for historical trauma, discrimination, and substance use research concerning Native Hawaiians.

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.

A survey on depression among infertile women in Ghana

BACKGROUND

The desire of many young women to become parents may be influenced by the premium placed on children by society. In Africa, children are highly valued for social, cultural and economic reasons. Infertile and childless women in Africa are therefore confronted with a series of societal discrimination and stigmatization which may lead to psychological disorders such as anxiety and depression. Even though some research has been done on the prevalence of infertility in Ghana, very little is known about the psychological impact of childlessness among infertile women. The present study aimed to examine prevalence and severity of depression in relation to age, type of infertility and duration of infertility in Ghanaian infertile women.

METHODS

A total of 100 infertile women who met the selection criteria and had agreed to participate in the study were interviewed using the Beck Depression Inventory questionnaire from December 2012 to April 2013 at the Tamale Teaching Hospital, Tamale/Ghana. Data concerning socio-demographic characteristics such as age, monthly income, duration of infertility, marital status, educational level, number of previous conception, number of previous children, religion, as well as occupation of the respondents were recorded.

RESULTS

The prevalence of depression among the women was 62.0% with the level of depression showing a significant positive correlation with age of the women and the duration of infertility. The level of depression was significantly higher among subjects with low or no formal education and among the unemployed. Women with primary infertility also presented with high depression scores as measured by BDI.

CONCLUSIONS

In conclusion, the prevalence of depression among the infertile women is high, especially among infertile women age 26 and above, those who are less educated, those with primary infertility, as well as those who have been diagnosed as infertile for more than 3 years. Interventions to decrease and prevent the development of severe depression among these patients should be considered.

Experiences of social harm and changes in sexual practices among volunteers who had completed a phase I/II HIV vaccine trial employing HIV-1 DNA priming and HIV-1 MVA boosting in Dar es Salaam, Tanzania

Background

Volunteers in phase I/II HIV vaccine trials are assumed to be at low risk of acquiring HIV infection and are expected to have normal lives in the community. However, during participation in the trials, volunteers may encounter social harm and changes in their sexual behaviours. The current study aimed to study persistence of social harm and changes in sexual practices over time among phase I/II HIV vaccine immunogenicity (HIVIS03) trial volunteers in Dar es Salaam, Tanzania.

Methods and Results

A descriptive prospective cohort study was conducted among 33 out of 60 volunteers of HIVIS03 trial in Dar es Salaam, Tanzania, who had received three HIV-1 DNA injections boosted with two HIV-1 MVA doses. A structured interview was administered to collect data. Analysis was carried out using SPSS and McNemars’ chi-square (χ2) was used to test the association within-subjects. Participants reported experiencing negative comments from their colleagues about the trial; but such comments were less severe during the second follow up visits (χ2 = 8.72; P<0.001). Most of the comments were associated with discrimination (χ2 = 26.72; P<0.001), stigma (χ2 = 6.06; P<0.05), and mistrust towards the HIV vaccine trial (χ2 = 4.9; P<0.05). Having a regular sexual partner other than spouse or cohabitant declined over the two follow-up periods (χ2 = 4.45; P<0.05).

Conclusion

Participants in the phase I/II HIV vaccine trial were likely to face negative comments from relatives and colleagues after the end of the trial, but those comments decreased over time. In this study, the inherent sexual practice of having extra sexual partners other than spouse declined over time. Therefore, prolonged counselling and support appears important to minimize risky sexual behaviour among volunteers after participation in HIV Vaccine trials.

Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination

OBJECTIVE

The internalized stigma of mental illness impedes recovery and is associated with increased depression, reduced self-esteem, reduced recovery orientation, reduced empowerment, and increased perceived devaluation and discrimination. The Internalized Stigma of Mental Illness (ISMI) scale is a 29-item self-report questionnaire developed with consumer input that includes the following subscales: Alienation, Discrimination Experience, Social Withdrawal, Stereotype Endorsement, and Stigma Resistance. Here we present a 10-item version of the ISMI containing the two strongest items from each subscale.

METHOD

Participants were all outpatient veterans with serious mental illness. Following the rigorous scale-reduction methods set forth by Stanton and colleagues (2002), we selected the 10 items, tested the psychometrics of the shortened scale in the original validation sample (N = 127), and cross-checked the results in a second dataset (N = 760).

RESULTS

As expected, the ISMI-10 retained the essential properties of the ISMI-29, including adequate internal consistency reliability and external validity in relation to depression, self-esteem, recovery orientation, perceived devaluation and discrimination, and empowerment. The ISMI-10 scores are normally distributed and have similar descriptive statistics to the ISMI-29. The reliability and depression findings were replicated in a cross-validation sample.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

We conclude that the ISMI-10 has strong psychometric properties and is a practical, reliable, and valid alternative to the original ISMI-29. Future work should test the ISMI-10 in more diverse samples. This shorter version should reduce respondent burden in program evaluation projects that seek to determine whether participation in psychosocial rehabilitation programming reduces internalized stigma.

Family contexts: parental experiences of discrimination and child mental health

Research on the mental health correlates of discrimination traditionally has been intra-individual, focusing exclusively on the individual directly experiencing discrimination. A small number of studies have begun to consider the links between parental experiences of discrimination and child mental health, but little is known about potential underlying mechanisms. The present study tested the independent mediating effects of parent mental health and household socioeconomic status on the associations between parental experiences of discrimination (past-year perceived discrimination and perceptions of being unaccepted culturally) and child mental health (internalizing and externalizing symptoms) using a bootstrapping analytic approach. Data were drawn from racial/ethnic minority (n = 383) and White (n = 574) samples surveyed in an urban Midwestern county. For all measures of discrimination and child mental health, findings supported an association between parental experiences of discrimination and child mental health. Whereas parent mental health served as a significant mediator in all analyses, socioeconomic status did not. Mediation findings held for both the White and racial/ethnic minority samples. Results suggest that parental experiences of discrimination and mental health may contribute to child mental health concerns, thus highlighting the role of family contexts in shaping child development.

Development and preliminary evaluation of a decision aid for disclosure of mental illness to employers

OBJECTIVE

Many mental health service users delay disclosing to employers or never do so due to previous experience of, or anticipation of discrimination. However, non-disclosure precludes requesting 'reasonable workplace adjustments'. Service users may experience conflicting needs and values in deciding whether to disclose. No evidence-based interventions exist to support this decision.

METHODS

A decision aid (CORAL, or COnceal or ReveAL) to support mental health service users in reaching disclosure decisions was developed and subjected to preliminary evaluation (n=15).

RESULTS

The majority found the decision aid quick (60%) and relevant (60%) and would recommend it (80%). Eighty percent reported that they would definitely or probably use it in making disclosure decisions. Forty percent each were positive or neutral on its ease of use. Semi-structured interviews revealed a demand for more information on the legal implications of disclosure. The mean level of 'decisional conflict' regarding disclosure reduced from 52.0 to 35.5 and mean Stage of Decision-making Scale score from 4.6 to 4.3.

CONCLUSION

The results suggest that the CORAL decision aid is feasible, relevant and valuable in supporting decisions about disclosing a mental illness to an employer.

PRACTICE IMPLICATIONS

The decision aid could be deployed in routine care without significant resource implications.

The intersectionality of discrimination attributes and bullying among youth: an applied latent class analysis

Discrimination is commonly experienced among adolescents. However, little is known about the intersection of multiple attributes of discrimination and bullying. We used a latent class analysis (LCA) to illustrate the intersections of discrimination attributes and bullying, and to assess the associations of LCA membership to depressive symptoms, deliberate self harm and suicidal ideation among a sample of ethnically diverse adolescents. The data come from the 2006 Boston Youth Survey where students were asked whether they had experienced discrimination based on four attributes: race/ethnicity, immigration status, perceived sexual orientation and weight. They were also asked whether they had been bullied or assaulted for these attributes. A total of 965 (78%) students contributed to the LCA analytic sample (45% Non-Hispanic Black, 29% Hispanic, 58% Female). The LCA revealed that a 4-class solution had adequate relative and absolute fit. The 4-classes were characterized as: low discrimination (51%); racial discrimination (33%); sexual orientation discrimination (7%); racial and weight discrimination with high bullying (intersectional class) (7%). In multivariate models, compared to the low discrimination class, individuals in the sexual orientation discrimination class and the intersectional class had higher odds of engaging in deliberate self-harm. Students in the intersectional class also had higher odds of suicidal ideation. All three discrimination latent classes had significantly higher depressive symptoms compared to the low discrimination class. Multiple attributes of discrimination and bullying co-occur among adolescents. Research should consider the co-occurrence of bullying and discrimination.

Health consequences of racist and antigay discrimination for multiple minority adolescents

Individuals who belong to a marginalized group and who perceive discrimination based on that group membership suffer from a variety of poor health outcomes. Many people belong to more than one marginalized group, and much less is known about the influence of multiple forms of discrimination on health outcomes. Drawing on literature describing the influence of multiple stressors, three models of combined forms of discrimination are discussed: additive, prominence, and exacerbation. The current study examined the influence of multiple forms of discrimination in a sample of African American lesbian, gay, or bisexual (LGB) adolescents ages 14-19. Each of the three models of combined stressors were tested to determine which best describes how racist and antigay discrimination combine to predict depressive symptoms, suicidal ideation, and substance use. Participants were included in this analysis if they identified their ethnicity as either African American (n = 156) or African American mixed (n = 120). Mean age was 17.45 years (SD = 1.36). Results revealed both forms of mistreatment were associated with depressive symptoms and suicidal ideation among African American LGB adolescents. Racism was more strongly associated with substance use. Future intervention efforts should be targeted toward reducing discrimination and improving the social context of multiple minority adolescents, and future research with multiple minority individuals should be attuned to the multiple forms of discrimination experienced by these individuals within their environments.

Perceived discrimination, ruminative subtypes, and risk for depressive symptoms in emerging adulthood

Perceived discrimination has been found to increase risk for depression in emerging adulthood, but explanatory cognitive mechanisms have not been well studied. We examined whether the brooding and reflective subtypes of rumination would mediate the relation between perceived discrimination and depressive symptoms among racial/ethnic minority, versus White, emerging adults, and whether a strong ethnic identity would buffer against this effect. Emerging adults (N = 709; 70% female; 68% racial/ethnic minority), ages 18-25, completed measures of perceived discrimination, rumination, depressive symptoms, and ethnic identity. Perceived discrimination was positively associated with depressive symptoms among racial/ethnic minority and White participants. Brooding--but not reflection--mediated this relation only among racial/ethnic minorities. Ethnic identity, though negatively associated with depressive symptoms, did not buffer against the mediating effect of brooding on the discrimination-depression relation. Interventions for depression among racial/ethnic minority emerging adults should address maladaptive cognitive responses, such as brooding, associated with perceived discrimination.

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.

The struggle for recognition by people living with HIV/AIDS in Sudan

In settings with high HIV/AIDS-related stigma and where HIV is at low prevalence, the political space is often not conducive to making the epidemic more visible to public debate. In the Middle East and North Africa people living with HIV are only beginning to be prominent players in the policy planning in response to the epidemic. We conducted a qualitative case study analyzing an emerging nongovernmental support group association of people living with HIV/AIDS in Sudan. The study consisted of 16 interviews, with 15 HIV-positive members and the president of the association. We also conducted eight interviews with leaders of HIV-related institutions in Khartoum and reviewed relevant published and unpublished literature. We document the challenges faced by the association's members and illustrate the potential for community mobilization to counter HIV-related stigma. We also point out the need to create the political space for addressing the needs of people living with HIV.

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.

Armed conflict, homonegativity and forced internal displacement: implications for HIV among Colombian gay, bisexual and transgender individuals

Colombia has endured six decades of civil unrest, population displacement and violence. We examined the relationships between contextual conditions, displacement and HIV among gay, bisexual and transgender individuals in Bogotá, Colombia. A total of 19 key informants provided information about internal displacement of sexual minorities. Life-history interviews were conducted with 42 participants aged 18 to 48 years and included questions about displacement experiences, sexual behaviour, life prior to displacement and participants' economic and social situation in Bogotá. The interplay of a variety of factors - including internal conflict and violence, homonegativity and 'social cleansing', gender and sexual identity and poverty - strongly shaped the varied experiences of displacement. Migration, sexual violence, exchange sex and low rates of HIV testing were risk factors that increased vulnerability for HIV in this displaced sample. Although displacement and HIV in Colombia are major problems, both are understudied.

Disentangling immigrant status in mental health: psychological protective and risk factors among Latino and Asian American immigrants

This study aimed to disentangle the psychological mechanisms underlying immigrant status by testing a model of psychological protective and risk factors to predict the mental health prevalence rates among Latino and Asian American immigrants based on secondary analysis of the National Latino and Asian American Study. The first research question examined differences on the set of protective and risk factors between immigrants and their U.S.-born counterparts and found that immigrants reported higher levels of ethnic identity, family cohesion, native language proficiency, and limited English proficiency than their U.S.-born counterparts. The second research question examined the effect of the protective and risk factors on prevalence rates of depressive, anxiety, and substance-related disorders and found that social networking served as a protective factor. Discrimination, acculturative stress, and family conflict were risk factors on the mental health for both ethnic groups. Clinical implications and directions for future research are provided.