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Currie CL, Motz T, Copeland JL. The Impact of Racially Motivated Housing Discrimination on Allostatic Load among Indigenous University Students. J Urban Health 2020; 97:365-376. [PMID: 32495119 PMCID: PMC7305270 DOI: 10.1007/s11524-020-00446-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Allostatic load (AL) is an aggregate measure of wear and tear on the body due to the chronic activation of the stress response system. The goal of this study was to examine the association between racially motivated housing discrimination (HD) and AL score within a sample of Indigenous university students. Data for this cross-sectional study were collected from Indigenous adults attending university in a small city in western Canada between 2015 and 2017 (N = 104; mean age = 27.8 years). An item adapted from the Experience of Discrimination Scale was to assess racially motivated HD in the past 12 months. AL was measured as a composite of 7 biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function. Bias-corrected and accelerated bootstrapped linear regression models were used to examine associations adjusting for age, income, parenthood, and other situations in which discrimination had been experienced. Indigenous university students who experienced racially motivated HD in the past year (16.8% of the sample) had an average AL score of approximately 4, which was almost double that of their peers who had not. In an adjusted model, racially motivated HD was associated with a 1.5 point increase in AL score. This model explained 35% of the adjusted variance in AL score, of which racially motivated HD explained 24%. These results suggest Indigenous adults who experienced racially motivated HD in the past year had early and more pronounced wear and tear on neuroendocrine, cardiovascular, metabolic, and immune system functioning in young and middle adulthood than Indigenous peers who did not. These findings combine with others to highlight the need for increased efforts to prevent racially motivated HD in urban centers.
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Affiliation(s)
- Cheryl L Currie
- Faculty of Health Sciences, University of Lethbridge, M3083 Markin Hall, 4401 University Drive, Lethbridge, AB, T1K3M4, Canada.
| | - Takara Motz
- Faculty of Health Sciences, University of Lethbridge, M3083 Markin Hall, 4401 University Drive, Lethbridge, AB, T1K3M4, Canada
| | - Jennifer L Copeland
- Department of Kinesiology and Physical Education, Faculty of Arts & Science, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K3M4, Canada
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Terry EL, Fullwood MD, Booker SQ, Cardoso JS, Sibille KT, Glover TL, Thompson KA, Addison AS, Goodin BR, Staud R, Hughes LB, Bradley LA, Redden DT, Bartley EJ, Fillingim RB. Everyday Discrimination in Adults with Knee Pain: The Role of Perceived Stress and Pain Catastrophizing. J Pain Res 2020; 13:883-895. [PMID: 32431537 PMCID: PMC7200232 DOI: 10.2147/jpr.s235632] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/03/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Research indicates pain-related disparities in the impact of knee osteoarthritis (OA) across both sex and ethnicity/race. While several factors likely contribute to these disparities, experiences of discrimination are associated with poor OA-related pain, disability, and functional performance. However, the mechanisms that mediate experiences of discrimination and OA-related outcomes are unclear. The current cross-sectional study examined the associations between everyday experiences of discrimination and clinical pain, disability and functional performance among non-Hispanic Black (NHB) and non-Hispanic White (NHW) persons with or at risk of knee OA and assessed the serial mediated model of perceived stress and pain catastrophizing on these relationships in women only. PATIENTS AND METHODS Participants were 188 community-dwelling adults who presented with unilateral or bilateral knee pain and screened positive for clinical knee pain. Participants completed several measures including experiences of discrimination, Perceived Stress Scale, Coping Strategies Questionnaire-Revised (CSQ-R): Pain Catastrophizing subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Graded Chronic Pain Scale (GCPS), and Short Physical Performance Battery (SPPB). RESULTS As compared to NHW participants, NHB individuals reported experiencing significantly higher levels of discrimination (F(1, 175)=26.660, p<0.001), greater levels of pain catastrophizing (F(1, 180)=12.919, p<0.001), higher levels of clinical pain and disability, and lower levels of physical function (ps<0.05). However, perceived stress was positively correlated with discrimination in the NHW group only (NHW females: r=0.40, p<0.01; NHW males: r=0.37, p<0.05). Further, perceived stress and pain catastrophizing mediated the relationship between discrimination and outcome variables (WOMAC pain, GCPS interference [pain disability], and SPPB function) in female participants after controlling for relevant sociodemographic variables (study site, age, race, income, and body mass index). CONCLUSION These results may have implications for the treatment of perceived stress and catastrophizing as a means to reduce the negative impact of experiences of discrimination on the experience of chronic pain, particularly for women.
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Affiliation(s)
- Ellen L Terry
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, United States
| | - M Dottington Fullwood
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, United States
| | - Staja Q Booker
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, United States
| | - Josue S Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida, United States
| | - Kimberly T Sibille
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, United States
| | - Toni L Glover
- Oakland University, School of Nursing, Rochester, MI, United States
| | - Kathryn A Thompson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Adriana S Addison
- University of Alabama at Birmingham, Division of Clinical Immunology & Rheumatology, Birmingham, Alabama, United States
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Laura B Hughes
- University of Alabama at Birmingham, Division of Clinical Immunology & Rheumatology, Birmingham, Alabama, United States
| | - Laurence A Bradley
- University of Alabama at Birmingham, Division of Clinical Immunology & Rheumatology, Birmingham, Alabama, United States
| | - David T Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Emily J Bartley
- University of Florida, Community Dentistry and Behavioral Science, Gainesville, Florida, United States
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida, United States
- University of Florida, Community Dentistry and Behavioral Science, Gainesville, Florida, United States
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Salomon RE, Tan KR, Vaughan A, Adynski H, Muscatell KA. Minimally-invasive methods for examining biological changes in response to chronic stress: A scoping review. Int J Nurs Stud 2020; 103:103419. [PMID: 31945603 DOI: 10.1016/j.ijnurstu.2019.103419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nurse researchers are increasingly interested in incorporating biological indicators related to chronic stress, or repeated or constant exposure to psychological stressors. Minimally invasive collection methods may improve access to vulnerable populations. OBJECTIVE To map biological indicators measured through minimally invasive methods investigating biological changes in response to chronic stress. DESIGN, DATA SOURCES, AND METHODS The paper seeks to answer two questions: What are the characteristics of the minimally-invasive methods used to measure the biological correlates of chronic stress? What are the limitations regarding the use of the minimally-invasive methods and/or biological indicators identified above? Authors completed a scoping review following guidelines from the Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. A literature search was completed in PubMed, PsycINFO, and Scopus. 2518 articles were screened and 145 studies were included. Data were extracted using a standardized extraction tool, compiled, and coded. RESULTS Studies included minimally-invasive methods to measure the hypothalamic-adrenal-pituitary axis (N = 173), immune and inflammatory markers (N = 118), and adult neurogenesis (N = 6). Cortisol was most frequently measured (N = 136), usually in saliva (N = 86). Studies included a variety of limitations for the methods and indicators, including concerns about timing and accuracy of collection, frequency of sampling, and controlling for acute stressors. CONCLUSIONS Nurse researchers have access to many minimally-invasive methods to measure altered biological processes related to chronic stress. A gap identified by this review is the paucity of minimally-invasive methods for investigating neurogenesis; the measurement of brain derived neurotrophic factor in plasma is a distal proxy and further research is needed to test the response of peripheral levels to psychosocial stress interventions. Additionally, while this scoping review allows nurse researchers to consider possible biological indicators to include in their research, future research is still needed on some of the basic premises of stress research, including agreement on the conceptualization of chronic stress.
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Affiliation(s)
- Rebecca E Salomon
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Kelly R Tan
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Ashley Vaughan
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Harry Adynski
- School of Nursing, University of California San Francisco, 2 Koret Way, UCSF Box 0608, San Francisco, CA 94143-0608, USA.
| | - Keely A Muscatell
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Campus Box #3270, 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Campus Box #7295, 450 West Drive, Chapel Hill, NC 27599-7295, USA.
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Abstract
OBJECTIVE This study aimed to examine the association between racial discrimination and allostatic load (AL) and whether this association was moderated by cultural continuity among Indigenous adults. METHODS Data were collected from Indigenous adults attending university in a small city in western Canada between 2015 and 2017 (mean age = 27.8 years). The Experience of Discrimination Situation Score and the Vancouver Index Enculturation Subscale were used to assess racial discrimination and cultural continuity, respectively. AL was measured as a composite of seven biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function. Bias-corrected and accelerated bootstrapped linear regression models were used to examine associations adjusting for confounders (n = 104; 72.5% women). RESULTS Across the full sample, racial discrimination was associated with a linear, dose-response increase in AL score after adjustment for confounders. Among adults with low cultural continuity, past-year discrimination was associated with increased AL and explained 22% (adjusted R) of the variance in AL score. Taken together, the full model including age, sex, and income explained 38% of the variance in AL score in this subgroup. Among adults with high cultural continuity, racial discrimination was not associated with AL, whereas age remained significant and explained 13% of the variance in AL score. CONCLUSIONS Past-year racial discrimination was associated with early and more pronounced wear and tear on stress response systems among Indigenous adults relative to peers. Indigenous cultural continuity served as an important buffer that promoted biological resilience against the adverse effects of racial discrimination on physiologic regulation among Indigenous adults.
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Mitchell UA, Dellor ED, Sharif MZ, Brown LL, Torres JM, Nguyen A. When Is Hope Enough? Hopefulness, Discrimination and Racial/Ethnic Disparities in Allostatic Load. Behav Med 2020; 46:189-201. [PMID: 32787721 PMCID: PMC7458691 DOI: 10.1080/08964289.2020.1729086] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hopefulness is associated with better health and may be integral for stress adaptation and resilience. Limited research has prospectively examined whether hopefulness protects against physiological dysregulation or does so similarly for U.S. whites, blacks and Hispanics. We examined the association between baseline hopefulness and future allostatic load using data from the Health and Retirement Study (n = 8,486) and assessed differences in this association by race/ethnicity and experiences of discrimination. Four items measured hopefulness and allostatic load was a count of seven biomarkers for which a respondent's measured value was considered high-risk for disease. A dichotomous variable assessed whether respondents experienced at least one major act of discrimination in their lifetime. We used Poisson regression to examine the association between hopefulness and allostatic load and included a multiplicative interaction term to test racial/ethnic differences in this association. Subsequent analyses were stratified by race/ethnicity and tested the interaction between hopefulness and discrimination within each racial/ethnic group. Hopefulness was associated with lower allostatic load scores, but its effects varied significantly by race/ethnicity. Race-stratified analyses suggested that hopefulness was protective among whites and not associated with allostatic load among Hispanics irrespective of experiencing discrimination. Hopefulness was associated with lower allostatic load among blacks reporting discrimination but associated with higher allostatic load among those who did not. Findings suggest that hopefulness plays differing roles for older whites, blacks and Hispanics and, for blacks, its protective effects on physiological dysregulation are intricately tied to their experiences of discrimination.
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Affiliation(s)
- Uchechi A. Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | | | - Mienah Z. Sharif
- Center for Racism, Social Justice and Health, University of California Los Angeles
| | - Lauren L. Brown
- Population Studies Center, Institute for Social Research, University of Michigan
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Ann Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University
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Okoro ON, Hillman LA, Cernasev A. " We get double slammed!": Healthcare experiences of perceived discrimination among low-income African-American women. WOMEN'S HEALTH (LONDON, ENGLAND) 2020; 16:1745506520953348. [PMID: 32856564 PMCID: PMC7457641 DOI: 10.1177/1745506520953348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 05/27/2020] [Accepted: 07/20/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND On account of their racial/ethnic minority status, class, and gender, African-American women of low socioeconomic status are among the least privileged, underserved, and most marginalized groups in the United States. Generally, African Americans continue to experience poorer health outcomes, in which disparities have been attributed to socioeconomic inequities and structural racism. This objective of this study was to explore the lived experiences of low-income African-American women in interacting with the healthcare system and healthcare providers. METHODS Twenty-two in-depth one-on-one interviews were conducted with low-income African-American women. The audio-recorded interviews were transcribed verbatim. An inductive content analysis was performed, using an analytical software, Dedoose® to enabled hierarchical coding. Codes were grouped into categories which were further analyzed for similarities that led to the emergence of themes. RESULTS A key finding was the experience of discriminatory treatment. The three themes that emerged relevant to this category were (1) perceived discrimination based on race/ethnicity, (2) perceived discrimination based on socioeconomic status, and (3) stereotypical assumptions such as drug-seeking and having sexually transmitted diseases. CONCLUSION AND RECOMMENDATIONS Low-income African-American women experience less than satisfactory patient care, where participants attribute to their experience of being stereotyped and their perception of discrimination in the healthcare system and from providers. Patients' experiences within the healthcare system have implications for their healthcare-seeking behaviors and treatment outcomes. Healthcare personnel and providers need to be more aware of the potential for implicit bias toward this population. Healthcare workforce training on culturally responsive patient care approaches and more community engagement will help providers better understand the context of patients from this population and more effectively meet their healthcare needs.
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Affiliation(s)
- Olihe N Okoro
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, USA
| | - Lisa A Hillman
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Alina Cernasev
- College of Pharmacy, The University of Tennessee Health Science Center, Nashville, TN, USA
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57
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Allen AM, Wang Y, Chae DH, Price MM, Powell W, Steed TC, Black AR, Dhabhar FS, Marquez-Magaña L, Woods-Giscombe CL. Racial discrimination, the superwoman schema, and allostatic load: exploring an integrative stress-coping model among African American women. Ann N Y Acad Sci 2019; 1457:104-127. [PMID: 31403707 PMCID: PMC6904516 DOI: 10.1111/nyas.14188] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/30/2019] [Accepted: 06/11/2019] [Indexed: 12/12/2022]
Abstract
Racial discrimination has been linked to allostatic load (i.e., cumulative biological stress) among African American women. However, limited attention has been given to psychosocial processes involved in the stress response-critical for understanding biological pathways to health-in studies examining racial discrimination as a social determinant of health. We examined whether the superwoman schema (SWS), a multidimensional culture-specific framework characterizing psychosocial responses to stress among African American women, modifies the association between racial discrimination and allostatic load. We used purposive sampling to recruit a community sample of African American women ages 30-50 from five San Francisco Bay Area counties (n = 208). Path analysis was used to test for interactions while accounting for the covariance among SWS subscales using both linear and quadratic models. Significant interactions were observed between racial discrimination and four of the five SWS subscales. Feeling obligated to present an image of strength and an obligation to suppress emotions were each protective whereas feeling an intense motivation to succeed and feeling an obligation to help others exacerbated the independent health risk associated with experiencing racial discrimination. Our findings affirm the need to consider individual variability in coping and potentially other psychosocial processes involved in the stress response process, and offer several insights that may help elucidate the mechanisms by which racial discrimination gets "under the skin."
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Affiliation(s)
- Amani M. Allen
- Divisions of Community Health Sciences and Epidemiology,
University of California Berkeley School of Public Health, Berkeley,
California
| | - Yijie Wang
- Department of Human Development and Family Studies,
Michigan State University, East Lansing, Michigan
| | - David H. Chae
- Department of Human Development and Family Studies, College
of Human Sciences, Auburn University, Auburn, Alabama
| | - Melisa M. Price
- Phil R. Lee Institute for Health Policy Studies, University
of California, San Francisco, California
| | - Wizdom Powell
- Department of Psychiatry and Health Disparities Institute,
UConn Health
| | - Teneka C. Steed
- Department of Educational Research Methodology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Angela Rose Black
- University of Wisconsin-Madison Department of Family
Medicine and Community Health, Madison, Wisconsin
| | - Firdaus S. Dhabhar
- Department of Psychiatry and Behavioral Sciences, Sylvester
Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami,
Florida
| | - Leticia Marquez-Magaña
- Department of Cell and Molecular Biology, San Francisco
State University, San Francisco, California
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Michaels EK, Reeves AN, Thomas MD, Price MM, Hasson RE, Chae DH, Allen AM. Everyday Racial Discrimination and Hypertension among Midlife African American Women: Disentangling the Role of Active Coping Dispositions versus Active Coping Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4759. [PMID: 31783683 PMCID: PMC6935759 DOI: 10.3390/ijerph16234759] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/24/2019] [Accepted: 11/24/2019] [Indexed: 12/23/2022]
Abstract
Racial discrimination, a psychosocial stressor, may contribute to disproportionate rates of hypertension among African American women. Coping moderates the effects of psychosocial stress on health. Coping dispositions describe stable personality characteristics, whereas contextual frameworks emphasize flexible coping behaviors in response to specific stressful encounters. Using data from the African American Women's Heart and Health Study-a non-probability cross-section of 208 midlife African American women in Northern California-we estimated the association between everyday racial discrimination (Everyday Discrimination Scale, EDS) and prevalence of hypertension (HTN), and evaluated moderation by coping disposition (John Henryism Active Coping scale, JH) versus context-specific active coping behavior (Active Coping with Racism scale, ACR). There were no main associations between EDS, JH, or ACR on HTN prevalence. There was evidence of statistical interaction between EDS and ACR (p-int = 0.05), but not JH (p-int = 0.90). Among those with high levels of ACR, reporting monthly (prevalence ratio (PR) = 2.35, 95% confidence interval (CI) = 1.13, 4.87), weekly (PR = 2.15, 95% CI = 1.01, 4.61), or daily (PR = 2.36, 95% CI = 1.14, 4.88) EDS was associated with higher HTN prevalence, versus reporting racial discrimination yearly or less. In contrast, among those with low levels of ACR, reporting more chronic racial discrimination was associated with lower hypertension prevalence, although results were less precise. Findings suggest that ongoing active coping with chronic racial discrimination may contribute to hypertension risk among African American women.
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Affiliation(s)
- Eli K. Michaels
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA; (A.N.R.); (M.D.T.)
| | - Alexis N. Reeves
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA; (A.N.R.); (M.D.T.)
| | - Marilyn D. Thomas
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA; (A.N.R.); (M.D.T.)
| | - Melisa M. Price
- Division of Community Health Sciences, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA;
| | - Rebecca E. Hasson
- Schools of Kinesiology and Public Health, University of Michigan, 2110 Observatory Lodge/1402 Washington Heights, Ann Arbor, MI 48109-2029, USA;
| | - David H. Chae
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, 210 Spidle Hall, Auburn, GA 36849, USA;
| | - Amani M. Allen
- Divisions of Community Health Sciences and Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA;
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Coleman SRM, Gaalema DE, Nighbor TD, Kurti AA, Bunn JY, Higgins ST. Current cigarette smoking among U.S. college graduates. Prev Med 2019; 128:105853. [PMID: 31654730 PMCID: PMC6879857 DOI: 10.1016/j.ypmed.2019.105853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 01/28/2023]
Abstract
Although U.S. college graduates are at relatively low risk for smoking, 12-15% of U.S. smokers (~8 million people) are college graduates. Few studies have examined smoking risk among college graduates. To address that gap, the present study examined smoking risk among U.S. college graduates and those who did not graduate from college in a nationally representative sample of adults (National Survey on Drug Use and Health 2011-2017, n = 202,137). We examined smoking risk in association with well-established risk factors: alcohol abuse/dependence, drug abuse/dependence, mental illness, age, sex, race/ethnicity, and poverty status, using group contrasts and Classification and Regression Tree (CART) modeling. Smoking prevalence among U.S. college graduates and non-graduates was 10% and 26%, respectively. College graduates initiated any smoking and daily smoking at a later age and were lighter smokers than smokers who did not graduate college. Within college graduate and non-graduate groups, prevalence rates varied by orders of magnitude across different risk-factor profiles (ranges = 3-37% and 14-73% among graduates and non-graduates, respectively). Past year drug abuse/dependence was a robust predictor of smoking prevalence in both populations. For college graduates, past year alcohol abuse/dependence and mental illness were stronger predictors of smoking compared to those who did not graduate college, for whom race/ethnicity and age were stronger predictors. Overall, smoking risk increases to surprisingly high levels, even among college graduates, when select risk factors co-occur, particularly psychiatric conditions. Socio-demographic risk factors appear to be less robust predictors of smoking risk among college graduates relative to those who did not graduate college.
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Affiliation(s)
- Sulamunn R M Coleman
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America.
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychological Science, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America
| | - Tyler D Nighbor
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America
| | - Allison A Kurti
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America
| | - Janice Y Bunn
- Department of Mathematics and Statistics, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America; Department of Psychological Science, University of Vermont, 1 South Prospect Street, MS 482, Burlington, VT 05401-1419, United States of America
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Woods-Giscombe CL, Allen AM, Black AR, Steed TC, Li Y, Lackey C. The Giscombe Superwoman Schema Questionnaire: Psychometric Properties and Associations with Mental Health and Health Behaviors in African American Women. Issues Ment Health Nurs 2019; 40:672-681. [PMID: 31081707 PMCID: PMC7220093 DOI: 10.1080/01612840.2019.1584654] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this research was to examine the psychometric properties of the Giscombe Superwoman Schema Questionnaire. Three separate studies conducted with 739 African American women provided preliminary evidence that the Questionnaire's factor structure aligns with the Superwoman Schema Conceptual Framework and has good reliability. In addition, it is positively associated with perceived stress, depressive symptoms, using food to cope with stress, poor sleep quality, and physical inactivity. This study provides preliminary evidence to suggest that the Giscombe Superwoman Schema Questionnaire is psychometrically sound; Superwoman Schema is associated with health behaviors and psychological states that may increase risk for illness.
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Affiliation(s)
- Cheryl L Woods-Giscombe
- a School of Nursing , The University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Amani M Allen
- b University of California , Berkeley, Berkeley , California , USA
| | - Angela R Black
- c University of Wisconsin , Madison, Madison , Wisconsin , USA.,f Mindfulness for the People , Milwaukee , Wisconsin , USA
| | - Teneka C Steed
- d University of North Carolina at Greensboro , Greensboro , North Carolina , USA
| | - Yin Li
- e Emory University , Atlanta , Georgia , USA
| | - Charity Lackey
- a School of Nursing , The University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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61
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Thomas MD, Michaels EK, Reeves AN, Okoye U, Price MM, Hasson RE, Chae DH, Allen AM. Differential associations between everyday versus institution-specific racial discrimination, self-reported health, and allostatic load among black women: implications for clinical assessment and epidemiologic studies. Ann Epidemiol 2019; 35:20-28.e3. [PMID: 31235363 PMCID: PMC7179332 DOI: 10.1016/j.annepidem.2019.05.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Black women have the highest estimated allostatic load (AL). AL and self-perceived health are strong health predictors and have been linked to racial discrimination. Research suggests that everyday and institution-specific racial discrimination may predict different AL and self-reported health (SRH) outcomes. Furthermore, discrepancies between AL and self-perceived health could widen disparities. We estimated associations between everyday versus institution-specific racial discrimination with AL and SRH. METHODS Data are from a San Francisco Bay Area community sample of 208 black women aged 30-50 years. Participation involved a questionnaire, self-interview, blood draw, and anthropometric measurements. Adjusted generalized linear regression models estimated associations of racial discrimination with AL and SRH. RESULTS After adjusting for age, socioeconomic position, and medication use, institution-specific discrimination was negatively associated with AL (i.e., better health), whereas everyday experiences showed no association. Those reporting very-high (vs. moderate) institution-specific discrimination had lower AL (β = -1.31 [95% CI: -2.41, -0.20]; AL range: 0-15). No racial discrimination-SRH association was found. CONCLUSIONS For black women, (1) institution-specific racial discrimination may be differentially embodied compared with everyday experiences and (2) institutional racism may contribute to physiologic stress-regulation regardless of self-perceived health status. Potential factors that may contribute to an inverse racial discrimination-AL association, and future research, are discussed.
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Affiliation(s)
- Marilyn D Thomas
- Division of Epidemiology, School of Public Health, University of California, Berkeley.
| | - Elizabeth K Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Alexis N Reeves
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Uche Okoye
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Melisa M Price
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Rebecca E Hasson
- Schools of Kinesiology and Public Health, University of Michigan, Ann Arbor
| | - David H Chae
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, AL
| | - Amani M Allen
- Division of Epidemiology, School of Public Health, University of California, Berkeley
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Nystedt TA, Rosvall M, Lindström M. The association of self-reported discrimination to all-cause mortality: A population-based prospective cohort study. SSM Popul Health 2019; 7:100360. [PMID: 30766909 PMCID: PMC6360602 DOI: 10.1016/j.ssmph.2019.100360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/13/2019] [Accepted: 01/17/2019] [Indexed: 11/25/2022] Open
Abstract
Discrimination has is an important social determinant of health and though some research has been carried out on this it is mostly from the United States, which may not be generalisable to Europe and Sweden. This study investigated the association between self-reported experiences of repeated discrimination and all-cause mortality in Scania, Sweden. The Scania Public Health survey was sent out in 2008 with a follow-up in 2013 through the Swedish national cause of death register (N=28,062). The exposure variable under investigation was self-reported discrimination and the outcome variable was all-cause mortality. Additional variables included demographics (age, sex, marital status, immigrant status), health behaviours (smoking, alcohol consumption, physical exercise), BMI, social participation, economic stress, and mental health. Time was measured as total number of days. Statistical analysis included association of the different variables to discrimination (ORs) and to all-cause mortality (HRs) adjusting for different covariates. Effect modification was tested for social participation, economic stress and mental health. The odds of discrimination was higher among the most vulnerable groups in society. All-cause mortality was strongly associated to age and sex, with a much higher risk among men than women. The association of repeated discrimination to all-cause mortality remained significant after adjusting for demographic variables, health behaviours and either social participation or economic stress, but not both. The association was non-significant after adjusting for demographic variables and mental health. Social participation was found to be an effect modifier with low participation strengthening the effect of the association of repeated discrimination to all-cause mortality. Repeated discrimination clearly has a strong impact on mental health but also on economic stress and social participation which in turn have a strong impact on mortality.
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Affiliation(s)
- Tanya Andersson Nystedt
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden
| | - Maria Rosvall
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden
- Department of Community Medicine and Public Health, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martin Lindström
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden
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63
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Zimmer Z, Rojo F, Ofstedal MB, Chiu CT, Saito Y, Jagger C. Religiosity and health: A global comparative study. SSM Popul Health 2019; 7:006-6. [PMID: 30581957 PMCID: PMC6293091 DOI: 10.1016/j.ssmph.2018.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/09/2018] [Accepted: 11/11/2018] [Indexed: 01/29/2023] Open
Abstract
The objective of this paper is to understand global connections between indicators of religiosity and health and how these differ cross-nationally. Data are from World Values Surveys (93 countries, N=121,770). Health is based on a self-assessed question about overall health. First, country-specific regressions are examined to determine the association separately in each country. Next, country-level variables and cross-level interactions are added to multilevel models to assess whether and how context affects health and religiosity slopes. Results indicate enormous variation in associations between religiosity and health across countries and religiosity indicators. Significant positive associations between all religiosity measures and health exist in only three countries (Georgia, South Africa, and USA); negative associations in only two (Slovenia and Tunisia). Macro-level variables explain some of this divergence. Greater participation in religious activity relates to better health in countries characterized as being religiously diverse. The importance in god and pondering life's meaning is more likely associated with better health in countries with low levels of the Human Development Index. Pondering life's meaning more likely associates with better health in countries that place more stringent restrictions on religious practice. Religiosity is less likely to be related to good health in communist and former communist countries of Asia and Eastern Europe. In conclusion, the association between religiosity and health is complex, being partly shaped by geopolitical and macro psychosocial contexts.
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Affiliation(s)
- Zachary Zimmer
- Department of Family Studies and Gerontology, Global Aging and Community Initiative, Mount Saint Vincent University, 166 Bedford Highway, McCain Centre Room 201C, Halifax, Nova Scotia, Canada B3M2J6
| | - Florencia Rojo
- Social and Behavioral Sciences University of California San Francisco, 3333 California Street, San Francisco, CA, United States
| | - Mary Beth Ofstedal
- Institute of Social Research, University of Michigan, 426 Thompson, Ann Arbor, MI, United States
| | - Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, No. 128, Section 2, Academia Rd., Nangang District, Taipei City, Taiwan
| | - Yasuhiko Saito
- Population Research Institute, Nihon University, 12-5 Goban-cho, Chiyoda-ku, Tokyo, Japan
| | - Carol Jagger
- Institute of Aging, Newcastle University, Biogerontology Research Building, Camputs for Ageing and Vitality, Newcastel upon Tyne, United Kingdom
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Michaels E, Thomas M, Reeves A, Price M, Hasson R, Chae D, Allen A. Coding the Everyday Discrimination Scale: implications for exposure assessment and associations with hypertension and depression among a cross section of mid-life African American women. J Epidemiol Community Health 2019; 73:577-584. [PMID: 30894420 DOI: 10.1136/jech-2018-211230] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 02/08/2019] [Accepted: 02/16/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Studies suggest that racial discrimination impacts health via biological dysregulation due to continual adaptation to chronic psychosocial stress. Therefore, quantifying chronicity is critical for operationalising the relevant aetiological exposure and hence maximising internal validity. Using one of the most common discrimination scales in the epidemiological literature, we develop a novel approach for more accurately assessing chronicity and compare it with conventional approaches to determine whether coding influences differential exposure classification and associations with hypertension and depression among African American women. METHODS Data are from a socioeconomically diverse cross section of 208 mid-life African American women in Northern California (data collection: 2012-2013). Racial discrimination was assessed using the Everyday Discrimination Scale (α=0.95), and was coded using two conventional approaches: (1) situation-based coding: number of different situations ever experienced; (2) frequency-based coding: sum of Likert scale responses ranging from 'never' to 'almost everyday'; and (3) a new chronicity-based coding approach: sum of responses, weighted to capture annual chronicity (eg, 'a few times a month'=3×12=36×/year). Outcomes are hypertension and depressive symptomatology (10-item Center for Epidemiologic Studies-Depression Scale). FINDINGS Exposure classification differed by coding approach, by up to 41%. There was a positive association between racial discrimination and hypertension prevalence for chronicity coding only (prevalence ratio=1.61, 95% CI 1.03 to 2.49). For depressive symptoms, a dose-response relationship of similar magnitude was observed for all three coding approaches. CONCLUSION Scale coding is an important methodological consideration for valid exposure assessment in epidemiological research. Coding can impact exposure classification and associations with important indicators of African American women's mental and physical health.
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Affiliation(s)
- Eli Michaels
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Marilyn Thomas
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Alexis Reeves
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Melisa Price
- Division of Community Health Sciences, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Rebecca Hasson
- University of Michigan School of Kinesiology, Ann Arbor, Michigan, USA.,Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - David Chae
- Department of Human Development and Family Studies, Auburn University College of Human Sciences, Auburn, Alabama, USA
| | - Amani Allen
- Divisions of Epidemiology and Community Health Sciences, University of California Berkeley School of Public Health, Berkeley, California, USA
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Lee RT, Perez AD, Boykin CM, Mendoza-Denton R. On the prevalence of racial discrimination in the United States. PLoS One 2019; 14:e0210698. [PMID: 30629706 PMCID: PMC6328188 DOI: 10.1371/journal.pone.0210698] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 12/21/2018] [Indexed: 11/24/2022] Open
Abstract
Boutwell, Nedelec, Winegard, Shackelford, Beaver, Vaughn, Barnes, & Wright (2017) published an article in this journal that interprets data from the Add Health dataset as showing that only one-quarter of individuals in the United States experience discrimination. In Study 1, we attempted to replicate Boutwell et al.'s findings using a more direct measure of discrimination. Using data from the Pew Research Center, we examined a large sample of American respondents (N = 3,716) and explored the prevalence of discrimination experiences among various racial groups. Our findings stand in contrast to Boutwell et al.'s estimates, revealing that between 50% and 75% of Black, Hispanic, and Asian respondents (depending on the group and analytic approach) reported discriminatory treatment. In Study 2, we explored whether question framing affected how participants responded to Boutwell's question about experiencing less respect and courtesy. Regardless of question framing, non-White participants reported more experiences than White participants. Further, there was an interaction of participant race and question framing such that when participants were asked about experiences of less respect or courtesy broadly, there were no differences between non-White participants and White participants, but when they were asked about experiences that were specifically race-based, non-White participants reported more experiences than White participants. The current research provides a counterweight to the claim that discrimination is not a prevalent feature of the lives of minority groups and the serious implications this claim poses for research and public policy.
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Affiliation(s)
- Randy T. Lee
- Department of Psychology, Cornell University, Ithaca, New York, United States of America
| | - Amanda D. Perez
- Department of Psychology, University of California, Berkeley, Berkeley, California, United States of America
| | - C. Malik Boykin
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, Rhode Island, United States of America
| | - Rodolfo Mendoza-Denton
- Department of Psychology, University of California, Berkeley, Berkeley, California, United States of America
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