Chronic discrimination predicts higher circulating levels of E-selectin in a national sample: the MIDUS study

Assessing the Everyday Discrimination Scale among American Indians and Alaska Natives

The Everyday Discrimination Scale (EDS) has been used widely as a measure of subjective experiences of discrimination. The usefulness of this measure for assessments of perceived experiences of discrimination by American Indian and Alaska Native (AI/AN) peoples has not been explored. Data derived from the Special Diabetes Program for Indians--Healthy Heart Demonstration Project (SDPI-HH), a large-scale initiative to reduce cardiovascular risk among AI/ANs with Type 2 diabetes. Participants (N = 3,039) completed a self-report survey that included the EDS and measures of convergent and divergent validity. Missing data were estimated by multiple imputation techniques. Reliability estimates for the EDS were calculated, yielding a single factor with high internal consistency (α = .92). Younger, more educated respondents reported greater perceived discrimination; retired or widowed respondents reported less. Convergent validity was evidenced by levels of distress, anger, and hostility, which increased as the level of perceived discrimination increased (all p < .001). Divergent validity was evidenced by the absence of an association between EDS and resilient coping. Resilient coping and insulin-specific diabetes knowledge were not significantly associated with perceived discrimination (p = .61 and 0.16, respectively). However, general diabetes-related health knowledge was significantly associated with perceived discrimination (p = .02). The EDS is a promising measure for assessing perceived experiences of discrimination among those AI/ANs who participated in the SDPI-HH.

Discrimination, mental health, and leukocyte telomere length among African American men

African American men in the US experience disparities across multiple health outcomes. A common mechanism underlying premature declines in health may be accelerated biological aging, as reflected by leukocyte telomere length (LTL). Racial discrimination, a qualitatively unique source of social stress reported by African American men, in tandem with poor mental health, may negatively impact LTL in this population. The current study examined cross-sectional associations between LTL, self-reported racial discrimination, and symptoms of depression and anxiety among 92 African American men 30-50 years of age. LTL was measured in kilobase pairs using quantitative polymerase chain reaction assay. Controlling for sociodemographic factors, greater anxiety symptoms were associated with shorter LTL (b=-0.029, standard error [SE]=0.014; p<0.05). There were no main effects of racial discrimination or depressive symptoms on LTL, but we found evidence for a significant interaction between the two (b=0.011, SE=0.005; p<0.05). Racial discrimination was associated with shorter LTL among those with lower levels of depressive symptoms. Findings from this study highlight the role of social stressors and individual-level psychological factors for physiologic deterioration among African American men. Consistent with research on other populations, greater anxiety may reflect elevated stress associated with shorter LTL. Racial discrimination may represent an additional source of social stress among African American men that has detrimental consequences for cellular aging among those with lower levels of depression.

Perceived Discrimination and Social Relationship Functioning among Sexual Minorities: Structural Stigma as a Moderating Factor

Work on structural stigma shows how public policy affects health outcomes for members of devalued groups, including sexual minorities. In the current research, structural stigma is proposed as a moderating variable that strengthens deleterious associations between perceived discrimination and social relationship functioning. Hypotheses were tested in two cross-sectional studies, including both online (N = 214; Study 1) and community (N = 94; Study 2) samples of sexual minority men and women residing throughout the United States. Structural stigma was coded from policy related to sexual minority rights within each state. Confirming hypotheses, support for the moderating role of structural stigma was found via multilevel models across studies. Specifically, associations between perceived discrimination and friendship strain, loneliness (Study 1) and familial strain (Study 2) were increased for those who resided in states with greater levels of structural stigma and attenuated for those who resided in states with lesser levels. In Study 1, these results were robust to state-level covariates (conservatism and religiosity), but conservatism emerged as a significant moderator in lieu of structural stigma in Study 2. Results are discussed in the context of the shifting landscape of public policy related to sexual minority rights within the United States.

Perceived discrimination as a stressor for close relationships: identifying psychological and physiological pathways

Approaching the inverse association between perceived discrimination and close relationship functioning from a stress and coping framework, we propose and test a novel model incorporating psychological (emotion dysregulation) and physiological (chronic inflammation) pathways. Analyses of data from a sample of African American participants (N = 592) enrolled in the Midlife in the United States (MIDUS) study revealed support for the proposed model. Specifically, results from structural equation modeling analyses showed that perceived discrimination was indirectly associated with increased emotion dysregulation (venting and denial) through stressor appraisals and directly associated with increased inflammation (interluekin-6, e-selectin and c-reactive protein). Furthermore, relationship strain with family, friends and spouses was associated with greater levels of emotion dysregulation and chronic inflammation. Overall, the proposed model fit the data well and provides support for new avenues of research on the social, psychological and physiological correlates of perceived discrimination and close relationship functioning. To conclude, evidence for the proposed biopsychosocial model is summarized and directions for future research on these topics are discussed.

Discrimination and Cumulative Disease Damage Among African American Women With Systemic Lupus Erythematosus

OBJECTIVES

We examined associations between unfair treatment, attributions of unfair treatment to racial discrimination, and cumulative disease damage among African American women with systemic lupus erythematosus (SLE).

METHODS

We used multivariable regression models to examine SLE damage among 578 African American women in metropolitan Atlanta, Georgia, recruited to the Georgians Organized Against Lupus cohort.

RESULTS

When we controlled for demographic, socioeconomic, and health-related covariates, reporting any unfair treatment was associated with greater SLE damage compared with reporting no unfair treatment (b = 0.55; 95% confidence interval = 0.14, 0.97). In general, unfair treatment attributed to nonracial factors was more strongly associated with SLE damage than was unfair treatment attributed to racial discrimination, although the difference was not statistically significant.

CONCLUSIONS

Unfair treatment may contribute to worse disease outcomes among African American women with SLE. Unfair treatment attributed to nonracial causes may have a more pronounced negative effect on SLE damage. Future research may further examine possible differences in the effect of unfair treatment by attribution.

The association between bereavement and biomarkers of inflammation

Bereavement is a major life event that has been associated with a range of negative health outcomes. To assess whether levels of inflammation markers and cortisol vary significantly by bereavement status and/or number of recent bereavements. The study was based on a secondary analysis of data from the Midlife in the United States (MIDUS) II biomarkers project. After excluding participants suffering from conditions which directly affect immune functions, 529 participants were included (age 34-84 years), of whom 260 experienced the death of a person close to them 5-63 months prior to assessment. Levels of interleukin 6 (IL-6), C-reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-I), Soluble E-selectin (sE-selectin) and cortisol were examined controlling for demographic and health characteristics. Bereaved respondents had higher levels of inflammatory biomarkers IL-6 and sE-selectin, but not CRP and sICAM-I than the non-bereaved. Number of recent bereavements significantly predicted levels of IL-6 in the unadjusted and adjusted regression models. Body Mass Index (BMI) and number of chronic conditions partially mediated the association between number of bereavements and IL-6 levels. Number of recent bereavements is associated with higher levels of inflammation, particularly among individuals with higher BMI and/or chronic health problems.

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.

Stereotypes, Prejudice, and Depression: The Integrated Perspective

Social psychologists fighting prejudice and clinical psychologists fighting depression have long been separated by the social-clinical divide, unaware that they were facing a common enemy. Stereotypes about others leading to prejudice (e.g., Devine, 1989) and schemas about the self leading to depression (e.g., A. T. Beck, 1967) are fundamentally the same type of cognitive structure. According to the integrated perspective on prejudice and depression, negative stereotypes (i.e., schemas) are activated in a Source, who expresses prejudice toward the Target, causing the Target to experience depression. This linking of prejudice and depression (i.e., "comorbid" prejudice and depression) can occur at the societal level (e.g., Nazis' prejudice causing Jews' depression), the interpersonal level (e.g., an abuser's prejudice causing an abusee's depression), and the intrapersonal level (e.g., a person's self-prejudice causing his or her depression). The integrated perspective addresses several longstanding paradoxes, controversies, and questions; generates new areas of inquiry; and spotlights specific methods and findings that have direct cross-disciplinary applications in the battle against prejudice and depression. Ironically, some interventions developed by depression researchers may be especially useful against prejudice, and some interventions developed by prejudice researchers may be especially useful against depression.

Perceived discrimination and markers of cardiovascular risk among low-income African American youth

OBJECTIVES

Our study examines the relationship between perceived discrimination and levels of C-reactive protein and blood pressure in low-income youth ages 10-15 years old.

METHODS

Data were collected from 10 to 15 year old focal children and their mothers. Face-to-face interviews were implemented to collect data on stressors including experiences of everyday discrimination from youth. High sensitivity CRP in dried blood spot samples and diastolic and systolic blood pressure were also collected at the time of the interview.

RESULTS

Perceived discrimination among youth was significantly associated with higher levels of CRP, systolic, and diastolic blood pressure. CRP, systolic, and diastolic blood pressure remained significant after controlling for age-adjusted BMI, waist circumference, and other factors.

CONCLUSIONS

Discrimination is a salient risk factor for inflammation and cardiovascular health. Early life course inflammation and cardiovascular reactivity are important candidate pathways through which the repeated exposure to discrimination for minority group members contributes to racial and economic health inequities in adulthood.

Association between an Internet-Based Measure of Area Racism and Black Mortality

Racial disparities in health are well-documented and represent a significant public health concern in the US. Racism-related factors contribute to poorer health and higher mortality rates among Blacks compared to other racial groups. However, methods to measure racism and monitor its associations with health at the population-level have remained elusive. In this study, we investigated the utility of a previously developed Internet search-based proxy of area racism as a predictor of Black mortality rates. Area racism was the proportion of Google searches containing the "N-word" in 196 designated market areas (DMAs). Negative binomial regression models were specified taking into account individual age, sex, year of death, and Census region and adjusted to the 2000 US standard population to examine the association between area racism and Black mortality rates, which were derived from death certificates and mid-year population counts collated by the National Center for Health Statistics (2004-2009). DMAs characterized by a one standard deviation greater level of area racism were associated with an 8.2% increase in the all-cause Black mortality rate, equivalent to over 30,000 deaths annually. The magnitude of this effect was attenuated to 5.7% after adjustment for DMA-level demographic and Black socioeconomic covariates. A model controlling for the White mortality rate was used to further adjust for unmeasured confounders that influence mortality overall in a geographic area, and to examine Black-White disparities in the mortality rate. Area racism remained significantly associated with the all-cause Black mortality rate (mortality rate ratio = 1.036; 95% confidence interval = 1.015, 1.057; p = 0.001). Models further examining cause-specific Black mortality rates revealed significant associations with heart disease, cancer, and stroke. These findings are congruent with studies documenting the deleterious impact of racism on health among Blacks. Our study contributes to evidence that racism shapes patterns in mortality and generates racial disparities in health.

Stress and coping with racism and their role in sexual risk for HIV among African American, Asian/Pacific Islander, and Latino men who have sex with men

The deleterious effects of racism on a wide range of health outcomes, including HIV risk, are well documented among racial/ethnic minority groups in the United States. However, little is known about how men of color who have sex with men (MSM) cope with stress from racism and whether the coping strategies they employ buffer against the impact of racism on sexual risk for HIV transmission. We examined associations of stress and coping with racism with unprotected anal intercourse (UAI) in a sample of African American (N = 403), Asian/Pacific Islander (N = 393), and Latino (N = 400) MSM recruited in Los Angeles County, CA during 2008-2009. Almost two-thirds (65 %) of the sample reported being stressed as a consequence of racism experienced within the gay community. Overall, 51 % of the sample reported having UAI in the prior 6 months. After controlling for race/ethnicity, age, nativity, marital status, sexual orientation, education, HIV serostatus, and lifetime history of incarceration, the multivariate analysis found statistically significant main effects of stress from racism and avoidance coping on UAI; no statistically significant main effects of dismissal, education/confrontation, and social-support seeking were observed. None of the interactions of stress with the four coping measures were statistically significant. Although stress from racism within the gay community increased the likelihood of engaging in UAI among MSM of color, we found little evidence that coping responses to racism buffered stress from racism. Instead, avoidance coping appears to suggest an increase in UAI.

Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues

Over the past two decades, research examining the impact of self-reported experiences of discrimination on mental and physical health has increased dramatically. Studies have found consistent associations between exposure to discrimination and a wide range of Diagnostic and Statistical Manual of Mental Disorders (DSM)-diagnosed mental disorders as well as objective physical health outcomes. Associations are seen in cross-sectional as well as longitudinal studies and persist even after adjustment for confounding variables, including personality characteristics and other threats to validity. However, controversies remain, particularly around the best approach to measuring experiences of discrimination, the significance of racial/ethnic discrimination versus overall mistreatment, the need to account for "intersectionalities," and the importance of comprehensive assessments. These issues are discussed in detail, along with emerging areas of emphasis including cyber discrimination, anticipatory stress or vigilance around discrimination, and interventions with potential to reduce the negative effects of discrimination on health. We also discuss priorities for future research and implications for interventions and policy.

'Even though it's a small checkbox, it's a big deal': stresses and strains of managing sexual identity(s) on Facebook

Facebook offers a socialisation context in which young people from ethnic, gender and sexual minorities must continually manage the potential for prejudice and discrimination in the form of homophobia and racism. In-depth interviews were conducted with eight young women, aged 16-19 years, who self-identified as queer and as women of colour. A detailed analysis of these interviews--focusing in particular on how young people described navigating expectations of rejection from family and friends--offered insight into the psychological and health consequences associated with managing sexual identity(s) while online. The 'closet' ultimately takes on new meaning in this virtual space: participants described trying to develop social relationships within Facebook, which demands sharing one's thoughts, behaviours and ideas, while also hiding and silencing their emerging sexuality. In this 'virtual closet', tempering self-presentation to offset social exclusion has become a continuous, yet personally treacherous, activity during the daily practice of using Facebook.

Epigenetics and social context: implications for disparity in cardiovascular disease

BACKGROUND

Although it is well established that African Americans (AA) experience greater social stressors than non-Hispanic Whites (NHW), the extent to which early life adversity and cumulative social stressors such as perceived discrimination, neighborhood violence, subjective social status, and socioeconomic status contribute to disparity in coronary heart disease (CHD) and stroke between AA and NHW are not well understood.

PURPOSE

The purpose of this paper is to propose a conceptual model based upon McEwen's Allostatic Load Model suggesting how the relationships among social context, early life adversity, psychological stress, inflammation, adaptation, and epigenetic signature may contribute to the development of CHD and ischemic stroke. We hypothesize that social context and prior life adversity are associated with genome-wide as well as gene-specific epigenetic modifications that confer a proinflammatory epigenetic signature that mediates an enhanced proinflammatory state. Exposure to early life adversity, coupled with an increased allostatic load places individuals at greater risk for inflammatory based diseases, such as CHD and ischemic stroke.

RESULTS

Based on a review of the literature, we propose a novel model in which social context and psychological stress, particularly during early life, engenders a proinflammatory epigenetic signature, which drives a heightened inflammatory state that increases risk for CHD and stroke. In the proposed model, a proinflammatory epigenetic signature and adaptation serve as mediator variables.

CONCLUSIONS

Understanding the extent to which epigenetic signature bridges the psycho-social environment with inflammation and risk for CHD may yield novel biomarkers that can be used to assess risk, development, and progression of CHD/stroke. Epigenetic biomarkers may be used to inform preventive and treatment strategies that can be targeted to those most vulnerable, or to those with early signs of CHD, such as endothelial dysfunction. Furthermore, epigenetic approaches, including lifestyle modification and stress reduction programs, such as mindfulness-based stress reduction, offer promise to reduce health inequity linked to social disadvantage, as emerging evidence demonstrates that adverse epigenetic marks can be reversed.

Everyday Discrimination Prospectively Predicts Inflammation Across 7-Years in Racially Diverse Midlife Women: Study of Women's Health Across the Nation

Self-reported discrimination has emerged as a predictor of negative psychological and physical health outcomes across racial/ethnic groups. The goals of this study were to determine whether C-reactive protein (CRP), a marker of inflammation and risk factor for future cardiovascular disease (CVD) was independently predicted by everyday discrimination or whether race or body mass index (BMI) modified this association over a 7-year period among 2,490 women from racially diverse backgrounds. At baseline, the 10-item Williams' measure of everyday discrimination was administered. Generalized estimating equations were used to assess these associations. Descriptive results showed that Black and Chinese women reported greater discrimination than White, Japanese, and Hispanic women, while Black and Hispanic women had the highest levels of CRP over the 7-year period. There was no main effect of everyday discrimination (B = .003, SE = .005, p = .58) and this association did not differ as a function of race (p's > .05). The everyday discrimination × BMI interaction term significantly predicted higher CRP levels over time in the full sample of women (p = .03). Specifically, in non-obese women (BMI less than 30), higher perceived everyday discrimination was associated with higher CRP levels over the 7-year period. These findings were independent of demographic, negative affect, biomedical, and behavioral factors. The results demonstrate that greater everyday discrimination is associated with increased inflammation over time in non-obese women. These findings highlight the implications of interpersonal sources of social stress for long-term physical health via their impact on intermediary biological pathways, specifically inflammation. Greater emphasis on such linkages is warranted as we work towards ameliorating health disparities exacerbated by individual-level factors.

Self-Reported Experiences of Discrimination and Cardiovascular Disease

Researchers have long speculated that exposure to discrimination may increase cardiovascular disease (CVD) risk but compared to other psychosocial risk factors, large-scale epidemiologic and community based studies examining associations between reports of discrimination and CVD risk have only emerged fairly recently. This review summarizes findings from studies of self-reported experiences of discrimination and CVD risk published between 2011-2013. We document the innovative advances in recent work, the notable heterogeneity in these studies, and the considerable need for additional work with objective clinical endpoints other than blood pressure. Implications for the study of racial disparities in CVD and clinical practice are also discussed.

The H1N1 pandemic: media frames, stigmatization and coping

Background

Throughout history, people have soothed their fear of disease outbreaks by searching for someone to blame. Such was the case with the April 2009 H1N1 flu outbreak. Mexicans and other Latinos living in the US were quickly stigmatized by non-Latinos as carriers of the virus, partly because of news reports on the outbreak’s alleged origin in Mexican pig farms.

Methods

In this exploratory study we examined the psychological processes of cue convergence and associative priming, through which many people likely conflated news of the H1N1 outbreak with pre-existing cognitive scripts that blamed Latino immigrants for a variety of social problems. We also used a transactional model of stress and coping to analyze the transcripts from five focus groups, in order to examine the ways in which a diverse collection of New England residents appraised the threat of H1N1, processed information about stereotypes and stigmas, and devised personal strategies to cope with these stressors.

Results

Twelve themes emerged in the final wave of coding, with most of them appearing at distinctive points in the stress and coping trajectories of focus group participants. Primary and secondary appraisals were mostly stressful or negative, with participants born in the USA reporting more stressful responses than those who were not. Latino participants reported no stressful primary appraisals, but spoke much more often than Whites or Non-Hispanic Blacks about negative secondary appraisals. When interactions between participants dealt with stigmas regarding Latinos and H1N1, Latinos in our focus groups reported using far more negative coping strategies than Whites or Non-Hispanic Blacks. When discussions did not focus on stereotypes or stigmas, Latino participants spoke much more often about positive coping strategies compared to members of these same groups.

Conclusions

Participants in all five focus groups went through a similar process of stress and coping in response to the threat of H1N1, though individual responses varied by race and ethnicity. Stigmatization has often been common during pandemics, and public health and emergency preparedness practitioners can help to mitigate its impacts by developing interventions to address the social stressors that occur during outbreaks in highly-localized geographic regions.

Associations among daily stressors and salivary cortisol: findings from the National Study of Daily Experiences

While much research has focused on linking stressful experiences to emotional and biological reactions in laboratory settings, there is an emerging interest in extending these examinations to field studies of daily life. The current study examined day-to-day associations among naturally occurring daily stressors and salivary cortisol in a national sample of adults from the second wave of the National Study of Daily Experiences (NSDE). A sample of 1694 adults (age=57, range=33-84; 44% male) completed telephone interviews detailing their stressors and emotions on eight consecutive evenings. Participants also provided saliva samples upon waking, 30min post-waking, before lunch and before bed, on four consecutive interview days resulting in 5995 days of interview/cortisol data. Analyses revealed three main findings. First, cortisol AUC was significantly higher on stressor days compared to stressor-free days, particularly for arguments and overloads at home, suggesting that daily stressors are associated with increased cortisol output, but that not all daily stressors have such an influence. Second, individuals reporting a greater frequency of stressor days also exhibited a steeper diurnal cortisol slope. Finally, daily stressor-cortisol associations were unaltered after adjustment for daily negative affect and physical symptoms. Our discussion focuses on the influence of naturally occurring daily stressors on daily cortisol and the role of daily diary approaches for studying healthy cortisol responses to psychosocial stressors outside of traditional laboratory settings.

Biological correlates of adult cognition: midlife in the United States (MIDUS)

Multiple biological processes are related to cognitive impairment in older adults, but their combined impact on cognition in midlife is not known. Using an array of measurements across key regulatory physiological systems and a state-of-the-art cognition battery that is sensitive to early changes, in a large, national sample of middle-aged and older adults, we examined the associations of individual biological systems and a combined, multi-system index, allostatic load, with cognitive performance. Allostatic load was strongly inversely associated with performance in both episodic memory and executive function. Of 7 biological systems, only the cardiovascular system was associated inversely with both; inflammation was associated inversely with episodic memory only, and glucose metabolism with executive function only. The associations of allostatic load with cognition were not different by age, suggesting that the implications of high allostatic load on cognitive functioning are not restricted to older adults. Findings suggest that a multi-system score, like allostatic load, may assist in the early identification of adults at increased risk for cognitive impairment.

Chronic exposure to everyday discrimination and sleep in a multiethnic sample of middle-aged women

OBJECTIVE

Researchers have suggested that poor sleep may play a role in the association between discrimination and health, but studies linking experiences of discrimination to sleep are limited. The authors examined associations between reports of everyday discrimination over 4 years (chronic everyday discrimination) and subjective and objective indicators of poor sleep.

METHOD

Participants were 368 African American, Caucasian, and Chinese women from the Study of Women's Health Across the Nation Sleep Study. Everyday discrimination was assessed each year from baseline through the third follow-up exam via questionnaire with the Everyday Discrimination Scale (intraclass correlation coefficient over 4 years = .90). Subjective sleep complaints were measured beginning in Year 5 with the Pittsburgh Sleep Quality Index. Objective indices of sleep continuity, duration, and architecture were assessed via in-home polysomnography, beginning in Year 5.

RESULTS

In linear regression analyses adjusted for age, race/ethnicity, and financial strain, chronic everyday discrimination was associated with more subjective sleep complaints (Estimate = 1.52, p < .001) and polysomnography-assessed wakefulness after sleep onset (Estimate = .19, p < .02), a marker of sleep continuity. Findings did not differ by race/ethnicity and remained significant after adjusting for menopausal status, body mass index, medication use, and depressive symptoms.

CONCLUSION

Experiences of chronic everyday discrimination are independently associated with both subjective and objective indices of poor sleep. Findings add to the growing literature linking discrimination to key markers of biobehavioral health.

Racial discrimination is associated with a measure of red blood cell oxidative stress: a potential pathway for racial health disparities

BACKGROUND

There are racial health disparities in many conditions for which oxidative stress is hypothesized to be a precursor. These include cardiovascular disease, diabetes, and premature aging. Small clinical studies suggest that psychological stress may increase oxidative stress. However, confirmation of this association in epidemiological studies has been limited by homogenous populations and unmeasured potential confounders.

PURPOSE

We tested the cross-sectional association between self-reported racial discrimination and red blood cell (RBC) oxidative stress in a biracial, socioeconomically heterogeneous population with well-measured confounders.

METHODS

We performed a cross-sectional analysis of a consecutive series of 629 participants enrolled in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Conducted by the National Institute on Aging Intramural Research Program, HANDLS is a prospective epidemiological study of a socioeconomically diverse cohort of 3,721 Whites and African Americans aged 30-64 years. Racial discrimination was based on self-report. RBC oxidative stress was measured by fluorescent heme degradation products. Potential confounders were age, smoking status, obesity, and C-reactive protein.

RESULTS

Participants had a mean age of 49 years (SD = 9.27). In multivariable linear regression models, racial discrimination was significantly associated with RBC oxidative stress (Beta = 0.55, P < 0.05) after adjustment for age, smoking, C-reactive protein level, and obesity. When stratified by race, discrimination was not associated with RBC oxidative stress in Whites but was associated significantly for African Americans (Beta = 0.36, P < 0.05).

CONCLUSIONS

These findings suggest that there may be identifiable cellular pathways by which racial discrimination amplifies cardiovascular and other age-related disease risks.

Theory-guided selection of discrimination measures for racial/ ethnic health disparities research among older adults

OBJECTIVE

Discrimination may contribute to health disparities among older adults. Existing measures of perceived discrimination have provided important insights but may have limitations when used in studies of older adults. This article illustrates the process of assessing the appropriateness of existing measures for theory-based research on perceived discrimination and health.

METHOD

First, we describe three theoretical frameworks that are relevant to the study of perceived discrimination and health-stress-process models, life course models, and the Public Health Critical Race (PHCR) praxis. We then review four widely-used measures of discrimination, comparing their content and describing how well they address key aspects of each framework, and discussing potential areas of modification.

DISCUSSION

Using theory to guide measure selection can help improve understanding of how perceived discrimination may contribute to racial/ethnic health disparities among older adults.

The social patterns of a biological risk factor for disease: race, gender, socioeconomic position, and C-reactive protein

OBJECTIVE

Understand the links between race and C-reactive protein (CRP), with special attention to gender differences and the role of class and behavioral risk factors as mediators.

METHOD

This study utilizes the National Social Life, Health, and Aging Project data, a nationally representative study of older Americans aged 57-85 to explore two research questions. First, what is the relative strength of socioeconomic versus behavioral risk factors in explaining race differences in CRP levels? Second, what role does gender play in understanding race differences? Does the relative role of socioeconomic and behavioral risk factors in explaining race differences vary when examining men and women separately?

RESULTS

When examining men and women separately, socioeconomic and behavioral risk factor mediators vary in their importance. Indeed, racial differences in CRP among men aged 57-74 are little changed after adjusting for both socioeconomic and behavioral risk factors with levels 35% higher for black men as compared to white men. For women aged 57-74, however, behavioral risk factors explain 30% of the relationship between race and CRP.

DISCUSSION

The limited explanatory power of socioeconomic position and, particularly, behavioral risk factors, in elucidating the relationship between race and CRP among men, signals the need for research to examine additional mediators, including more direct measures of stress and discrimination.

Racial Differences in Exposure and Reactivity to Daily Family Stressors

Using data from the National Study of Daily Experiences (NSDE), this study examined racial differences in exposure and reactivity to daily stressors involving family members. Respondents included African American and European American adults aged 34 to 84 (N = 1,931) who participated in 8 days of daily interviews where they reported on daily stressors, affect, and physical health symptoms. Results revealed racial similarities in family stressor exposure. Both races were also emotionally reactive to family arguments and family network events (i.e., events that happen to a family member), whereas African Americans were more physically reactive to family arguments. For African Americans, reactivity to family arguments endured; the increased negative affect and physical symptoms associated with family arguments lasted into the next day. Findings provide evidence for racial similarities and differences, suggesting that family relationships are universally stressful, whereas the negative effects of family stressors are more enduring among African Americans.

The relationship between perceived discrimination and coronary artery obstruction

BACKGROUND

Chronic stressors such as perceived discrimination might underlie race disparities in cardiovascular disease. This study focused on the relationship between perceived discrimination and risk of severe coronary obstruction while also accounting for multiple psychosocial variables and clinical factors.

METHODS

Data from 793 (629 white and 164 black) male veterans with positive nuclear imaging studies were analyzed. Participants were categorized as being at low/moderate or high risk for severe coronary obstruction based on results of their nuclear imaging studies. Hierarchical logistic regression models were tested separately for blacks and whites. The first step of the models included clinical factors. The second step included the psychosocial variables of optimism, religiosity, negative affect, and social support. The final step included perceived discrimination.

RESULTS

Perceived discrimination was positively related to risk of severe obstruction among blacks but not among whites after controlling for clinical and psychosocial variables. Similar results were found in patients who underwent coronary angiography (n = 311).

CONCLUSIONS

Perceived discrimination was associated with risk of severe coronary obstruction among black male veterans and could be an important target for future interventions.

Research on discrimination and health: an exploratory study of unresolved conceptual and measurement issues

OBJECTIVES

Our goal in this study was to better understand racial and socioeconomic status (SES) variations in experiences of racial and nonracial discrimination.

METHODS

We used 1999 and 2000 data from the YES Health Study, which involved a community sample of 50 Black and 50 White respondents drawn from 4 neighborhoods categorized according to racial group (majority Black or majority White) and SES (≤ 150% or > 250% of the poverty line). Qualitative and quantitative analyses examined experiences of discrimination across these neighborhoods.

RESULTS

More than 90% of Blacks and Whites described the meaning of unfair treatment in terms of injustice and felt certain about the attribution of their experiences of discrimination. These experiences triggered similar emotional reactions (most frequently anger and frustration) and levels of stress across groups, and low-SES Blacks and Whites reported higher levels of discrimination than their moderate-SES counterparts.

CONCLUSIONS

Experiences of discrimination were commonplace and linked to similar emotional responses and levels of stress among both Blacks and Whites of low and moderate SES. Effects were the same whether experiences were attributed to race or to other reasons.

Racial/ethnic differences in responses to the everyday discrimination scale: a differential item functioning analysis

The authors examined the impact of race/ethnicity on responses to the Everyday Discrimination Scale, one of the most widely used discrimination scales in epidemiologic and public health research. Participants were 3,295 middle-aged US women (African-American, Caucasian, Chinese, Hispanic, and Japanese) from the Study of Women's Health Across the Nation (SWAN) baseline examination (1996-1997). Multiple-indicator, multiple-cause models were used to examine differential item functioning (DIF) on the Everyday Discrimination Scale by race/ethnicity. After adjustment for age, education, and language of interview, meaningful DIF was observed for 3 (out of 10) items: "receiving poorer service in restaurants or stores," "being treated as if you are dishonest," and "being treated with less courtesy than other people" (all P's < 0.001). Consequently, the "profile" of everyday discrimination differed slightly for women of different racial/ethnic groups, with certain "public" experiences appearing to have more salience for African-American and Chinese women and "dishonesty" having more salience for racial/ethnic minority women overall. "Courtesy" appeared to have more salience for Hispanic women only in comparison with African-American women. Findings suggest that the Everyday Discrimination Scale could potentially be used across racial/ethnic groups as originally intended. However, researchers should use caution with items that demonstrated DIF.

Living well with medical comorbidities: a biopsychosocial perspective

OBJECTIVES

We take a biopsychosocial perspective on age-related diseases by examining psychological correlates of having multiple chronic conditions and determining whether positive psychological functioning predicts advantageous profiles of biological risk factors.

METHOD

Respondents to the national survey of Midlife in the United States who participated in clinical assessments of health and biological processes (n = 998) provided information on chronic medical conditions and multiple domains of psychological functioning. Serum concentrations of interleukin-6 (IL-6) and C-reactive protein (CRP) were determined from fasting blood samples.

RESULTS

Life satisfaction declined with increasing comorbidity while negative affect increased. In contrast, positive affect, purpose in life, and positive relations with others were unrelated to comorbidity status. Significant interactions showed that although IL-6 and CRP increased with increasing number of chronic conditions, respondents with higher levels of purpose in life, positive relations with others, and (in the case of CRP) positive affect had lower levels of inflammation compared with those with lower well-being scores.

DISCUSSION

The results suggest that many older adults with medical comorbidities maintain high levels of positive psychological functioning that are in turn linked to better profiles of biological disease risk.

Sleep quality, social well-being, gender, and inflammation: an integrative analysis in a national sample

Social isolation and poor sleep quality are independent predictors of poor health outcomes and increased biological risk for disease. We previously found in a small sample of older women that the presence of social ties compensated for poor sleep in associations with the inflammatory protein interleukin 6 (IL-6). The current study extended those findings to a national sample of middle-aged and older men and women. Using both subjective and objective sleep assessments, we found that in men, but not in women, social engagement moderated the association of subjective sleep complaints with both IL-6 and the soluble adhesion molecule E-selectin. Social engagement also moderated the link between sleep efficiency-assessed by actigraphy-and IL-6 levels in men, but not in women. These results extend our previous work and bolster the suggestion that positive psychological functioning may compensate for other risk factors in predicting advantageous profiles of biological risk in aging adults.

Self-reported experiences of discrimination and visceral fat in middle-aged African-American and Caucasian women

The authors examined the association between self-reported experiences of discrimination and subtypes of abdominal fat (visceral, subcutaneous) in a population-based cohort of African-American and Caucasian women. Prior studies examining associations between discrimination and abdominal fat have yielded mixed results. A major limitation of this research has been the reliance on waist circumference, which may be a poor marker of visceral fat, particularly for African-American women. Participants were 402 (45% African-American, 55% Caucasian) middle-aged women from the Chicago, Illinois, site of the Study of Women's Health Across the Nation. Visceral and subcutaneous fat were assessed via computed tomography scans between 2002 and 2005. Linear regression models were conducted to test associations among discrimination and visceral and subcutaneous fat. After adjustment for age and race, every one-point increase on the discrimination scale was associated with a 13.03-cm(2) higher amount of visceral fat (P = 0.04). This association remained significant after further adjustments for total body fat and relevant risk factors, including depressive symptoms. Discrimination was not associated with subcutaneous fat in minimally (P = 0.95) or fully adjusted models. Associations did not differ by race. Findings suggest that visceral fat may be one potential pathway through which experiences of discrimination increase cardiovascular risk.

Unfair treatment is associated with poor sleep in African American and Caucasian adults: Pittsburgh SleepSCORE project

OBJECTIVE

To test the association between self-reported unfair treatment and objective and self-reported sleep characteristics in African American and Caucasian adults.

DESIGN

Cross-sectional study of 97 African American and 113 Caucasian middle-aged adults.

MAIN OUTCOME MEASURES

Participants completed: (a) two-night in-home, polysomnography (PSG) sleep study, (b) sleep diaries and actigraph assessments across 9 days and nights, and (c) self-report measures of sleep quality in the past month, and daytime sleepiness in the past 2 weeks.

RESULTS

Greater unfair treatment was associated with reports of poorer self-reported sleep quality and greater daytime sleepiness, shorter sleep duration, and lower sleep efficiency as measured by actigraphy and PSG, and a smaller proportion of rapid eye movement (REM) sleep. Racial/ethnic differences were few. Exploratory analyses showed that nightly worry partially mediated the associations of unfair treatment with sleep quality, daytime sleepiness, sleep efficiency (actigraphy), and proportion of REM sleep.

CONCLUSION

Perceptions of unfair treatment are associated with sleep disturbances in both African American and Caucasian adults. Future studies are needed to identify the pathways that account for the association between unfair treatment and sleep.

Measuring multiple minority stress: the LGBT People of Color Microaggressions Scale

Lesbian, gay, and bisexual individuals who are also racial/ethnic minorities (LGBT-POC) are a multiply marginalized population subject to microaggressions associated with both racism and heterosexism. To date, research on this population has been hampered by the lack of a measurement tool to assess the unique experiences associated with the intersection of these oppressions. To address this gap in the literature, we conducted a three-phase, mixed method empirical study to assess microaggressions among LGBT-POC. The LGBT People of Color Microaggressions Scale is an 18-item self-report scale assessing the unique types of microaggressions experienced by ethnic minority LGBT adults. The measure includes three subscales: (a) Racism in LGBT communities, (b) Heterosexism in Racial/Ethnic Minority Communities, and (c) Racism in Dating and Close Relationships, that are theoretically consistent with prior literature on racial/ethnic minority LGBTs and have strong psychometric properties including internal consistency and construct validity in terms of correlations with measures of psychological distress and LGBT-identity variables. Men scored higher on the LGBT-PCMS than women, lesbians and gay men scored higher than bisexual women and men, and Asian Americans scored higher than African Americans and Latina/os.

Early life adversity and inflammation in African Americans and whites in the midlife in the United States survey

OBJECTIVES

To determine whether early life adversity (ELA) was predictive of inflammatory markers and to determine the consistency of these associations across racial groups.

METHODS

We analyzed data from 177 African Americans and 822 whites aged 35 to 86 years from two preliminary subsamples of the Midlife in the United States biomarker study. ELA was measured via retrospective self-report. We used multivariate linear regression models to examine the associations between ELA and C-reactive protein, interleukin-6, fibrinogen, endothelial leukocyte adhesion molecule-1, and soluble intercellular adhesion molecule-1, independent of age, gender, and medications. We extended race-stratified models to test three potential mechanisms for the observed associations.

RESULTS

Significant interactions between ELA and race were observed for all five biomarkers. Models stratified by race revealed that ELA predicted higher levels of log interleukin-6, fibrinogen, endothelial leukocyte adhesion molecule-1, and soluble intercellular adhesion molecule-1 among African Americans (p < .05), but not among whites. Some, but not all, of these associations were attenuated after adjustment for health behaviors and body mass index, adult stressors, and depressive symptoms.

CONCLUSIONS

ELA was predictive of high concentrations of inflammatory markers at midlife for African Americans, but not whites. This pattern may be explained by an accelerated course of age-related disease development for African Americans.

Self-reported racial discrimination, response to unfair treatment, and coronary calcification in asymptomatic adults--the North Texas Healthy Heart study

Background

Accruing evidence supports the hypothesis that psychosocial factors are related to cardiovascular disease. However, a limited number of studies have investigated the pathophysiologic pathways through which these associations occur. The purpose of this study was to assess whether experiences of self-reported racial discrimination and reactions to unfair treatment were associated with coronary artery calcification (CAC), an indicator of subclinical coronary heart disease (CHD).

Methods

This cross-sectional study recruited 571 subjects (45 years and older) who were asymptomatic of CHD from Fort Worth, Texas from 2006 to 2008. Subjects completed a questionnaire, a multi-slice computed tomography scan to assess for CAC presence (measured as Agatston score >0), and serum chemistries. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between self-reported discrimination and CAC. Results were stratified by response to unfair treatment as it was found to significantly modify the relationship between discrimination and CAC.

Results

Among those who passively responded to unfair treatment, the odds of having CAC present were approximately 3 times higher for those experiencing discrimination (OR, 2.95; 95% CI, 1.19-7.32) after adjusting for age, gender, race/ethnicity, education, body mass index, hyperlipidemia, smoking status, hypertension, diabetes, and first degree relative with heart disease.

Conclusions

This is the first multi-racial/ethnic study to find racial discrimination associated with CAC, which differs based on how one responds to unfair treatment.

Self-reported racial discrimination, response to unfair treatment, and coronary calcification in asymptomatic adults--the North Texas Healthy Heart study

BACKGROUND

Accruing evidence supports the hypothesis that psychosocial factors are related to cardiovascular disease. However, a limited number of studies have investigated the pathophysiologic pathways through which these associations occur. The purpose of this study was to assess whether experiences of self-reported racial discrimination and reactions to unfair treatment were associated with coronary artery calcification (CAC), an indicator of subclinical coronary heart disease (CHD).

METHODS

This cross-sectional study recruited 571 subjects (45 years and older) who were asymptomatic of CHD from Fort Worth, Texas from 2006 to 2008. Subjects completed a questionnaire, a multi-slice computed tomography scan to assess for CAC presence (measured as Agatston score >0), and serum chemistries. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between self-reported discrimination and CAC. Results were stratified by response to unfair treatment as it was found to significantly modify the relationship between discrimination and CAC.

RESULTS

Among those who passively responded to unfair treatment, the odds of having CAC present were approximately 3 times higher for those experiencing discrimination (OR, 2.95; 95% CI, 1.19-7.32) after adjusting for age, gender, race/ethnicity, education, body mass index, hyperlipidemia, smoking status, hypertension, diabetes, and first degree relative with heart disease.

CONCLUSIONS

This is the first multi-racial/ethnic study to find racial discrimination associated with CAC, which differs based on how one responds to unfair treatment.

Self-reported experiences of everyday discrimination are associated with elevated C-reactive protein levels in older African-American adults

Self-reported experiences of "everyday" discrimination have been linked to indices of cardiovascular disease and overall mortality and findings have been particularly pronounced for African-American populations. However, the biological mechanisms underlying these associations remain unclear. C-reactive protein (CRP), a marker of inflammation, is a known correlate of cardiovascular and other health outcomes and has also been linked to several psychosocial processes. To our knowledge, no studies have examined the association between experiences of discrimination and CRP. We examined the cross-sectional association between self-reported experiences of discrimination and CRP in a sample of 296 older African-American adults (70% female, mean age=73.1). Experiences of discrimination were assessed with the 9-item everyday discrimination scale and CRP was assayed from blood samples. In linear regression models adjusted for age, sex and education, experiences of discrimination were associated with higher levels of CRP (B=.10, p=.03). This association remained significant after additional adjustments for depressive symptoms (B=.10, p=.04), smoking, and chronic health conditions (heart disease, diabetes, hypertension) that might influence inflammation (B=.11, p=.02). However, results were attenuated when body mass index (BMI) was added to the model (B=.09, p=.07). In conclusion, self-reported experiences of everyday discrimination are associated with higher levels of CRP in older African-American adults, although this association is not completely independent of BMI.

Under the skin: using theories from biology and the social sciences to explore the mechanisms behind the black-white health gap

Equity and social well-being considerations make Black-White health disparities an area of important concern. Although previous research suggests that discrimination- and poverty-related stressors play a role in African American health outcomes, the mechanisms are unclear. Allostatic load is a concept that can be employed to demonstrate how environmental stressors, including psychosocial ones, may lead to a cumulative physiological toll on the body. We discuss both the usefulness of this framework for understanding how discrimination can lead to worse health among African Americans, and the challenges for conceptualizing biological risk with existing data and methods. We also contrast allostatic load with theories of historical trauma such as posttraumatic slavery syndrome. Finally, we offer our suggestions for future interdisciplinary research on health disparities.