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Orom H, Sharma C, Homish GG, Underwood W, Homish DL. Racial Discrimination and Stigma Consciousness Are Associated with Higher Blood Pressure and Hypertension in Minority Men. J Racial Ethn Health Disparities 2016; 4:10.1007/s40615-016-0284-2. [PMID: 27800597 PMCID: PMC5411333 DOI: 10.1007/s40615-016-0284-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/16/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We examined whether lifetime racial discrimination and stigma consciousness (expecting to be stigmatized) are associated with blood pressure in minority and White middle-aged and older adult men. DESIGN Participants were 1533 men (mean age = 63.2 [SD = 7.9, range = 37.4-89.2]; 12.4 % Black, 7.8 % Hispanic, 2.0 % other) diagnosed with clinically localized prostate cancer. We separately modeled associations between discrimination/stigma consciousness and blood pressure outcomes for minorities and Whites controlling for education, income, employment status, age, marital status, BMI, and recruitment site. RESULTS Minorities reported more racial discrimination and stigma consciousness than Whites (ps < .001). For minorities, having experienced more racial discrimination was associated with having higher diastolic blood pressure (B = 0.15, p = .016) and having greater stigma consciousness was associated with greater odds of having hypertension (OR = 1.04, p = .047). Greater stigma consciousness was associated with lower systolic blood pressure in Whites (B = -0.24, p = .012). CONCLUSION Discrimination and stigma consciousness are associated with common risk factors for chronic disease and premature death that disproportionately affect minorities. Findings for stigma consciousness suggest that anticipatory vigilance may be impacting minority health.
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Affiliation(s)
- Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA.
| | - Chaman Sharma
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Elm & Carlton Buffalo, Buffalo, NY, 14263, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA
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102
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Wagner J, Tennen H, Finan P, Feinn R, Burg MM, Seawell A, White WB. Exposure to Racial Discrimination and Ambulatory Blood Pressure in Women with Type 2 Diabetes. Stress Health 2016; 32:337-345. [PMID: 25641796 DOI: 10.1002/smi.2622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/13/2014] [Accepted: 10/20/2014] [Indexed: 11/11/2022]
Abstract
Diabetes is the only disorder in which women's risk for heart disease exceeds men's. Elevated blood pressure (BP) increases cardiovascular risk in people with type 2 diabetes. Racial discrimination and neuroticism are both associated with BP levels but have not been examined in concert. This study investigated self-reported racial discrimination, neuroticism and ambulatory BP in women with type 2 diabetes. Thirty-nine Black and 38 White women completed a race-neutral version of the Schedule of Racist Events; BP was evaluated using ambulatory monitoring devices. Actigraphy and diaries were used to document times of sleep and wakefulness. Racial discrimination interacted with neuroticism to predict systolic and diastolic BP both while awake and during sleep, after adjustment for covariates. For each, the influence of racist events was stronger at lower levels of neuroticism. Racial discrimination is associated with higher levels of 24-h BP in diabetic women who are low in neuroticism. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Julie Wagner
- Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USA.
| | - Howard Tennen
- Community Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Patrick Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard Feinn
- Medical Sciences, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
| | - Matthew M Burg
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City, NY, USA
| | - Asani Seawell
- Department of Psychology, Grinnell College, Grinnell, IA, USA
| | - William B White
- Calhoun Cardiology Center, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
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103
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Taylor RJ, Miller R, Mouzon D, Keith VM, Chatters LM. Everyday Discrimination among African American Men: The Impact of Criminal Justice Contact. RACE AND JUSTICE 2016; 8:154-177. [PMID: 29552376 PMCID: PMC5849240 DOI: 10.1177/2153368716661849] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present study examined the impact of criminal justice contact on experiences of everyday discrimination among a national sample of African American men. African American men have a high likelihood of being targets of major discrimination, as well as experiencing disproportionate contact with the criminal justice system. Few studies, however, examine everyday discrimination (e.g., commonplace social encounters of unfair treatment) among this group. Using data from the National Survey of American Life, we provide a descriptive assessment of different types of everyday discrimination among African American men. Specifically, we examined differences in everyday discrimination among men who have never been arrested, those who have been arrested but not incarcerated, and men who have a previous history of criminal justice intervention categorized by type of incarceration experienced (i.e., reform school, detention, jail, or prison). Study findings indicated overall high levels of reported everyday discrimination, with increased likelihood and a greater number of experiences associated with more serious forms of criminal justice contact. However, in many instances, there were no or few differences in reported everyday discrimination for African American men with and without criminal justice contact, indicating comparable levels of exposure to experiences with unfair treatment.
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Affiliation(s)
| | - Reuben Miller
- School of Social Work, Institute for Social Research, University of Michigan
| | - Dawne Mouzon
- Edward J. Bloustein School of Planning & Public Policy, Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey
| | - Verna M Keith
- Department of Sociology, Race and Ethnic Studies Institute, Texas A & M University
| | - Linda M Chatters
- School of Public Health, School of Social Work, Institute for Social Research, University of Michigan
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Ornelas IJ, Lapham GT, Salgado H, Williams EC, Gotman N, Womack V, Davis S, Penedo F, Smoller S, Gallo LC. Binge drinking and perceived ethnic discrimination among Hispanics/Latinos: Results from the Hispanic community health study/study of Latinos sociocultural ancillary study. J Ethn Subst Abuse 2016; 15:223-239. [PMID: 26643869 PMCID: PMC5214998 DOI: 10.1080/15332640.2015.1024374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The study assessed whether overall perceived ethnic discrimination and four unique discrimination types were associated with binge drinking in participants from the Hispanic Community Health Study/Study of Latinos who also completed the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (n = 5,313). In unadjusted analyses that were weighted for sampling strategy and design, each unit increase in discrimination type was associated with a 12-63% increase in odds of binge drinking; however, after adjusting for important demographic variables including age, sex, heritage group, language, and duration of U.S. residence, there was no longer an association between discrimination and binge drinking. Further research still needs to identify the salient factors that contribute to increased risk for binge drinking among Hispanics/Latinos.
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Affiliation(s)
- India J Ornelas
- a Department of Health Services , University of Washington , Seattle , Washington
| | - Gwen T Lapham
- b Group Health Research Institute , Seattle , Washington
| | - Hugo Salgado
- c Graduate School of Public Health , San Diego State University , San Diego , California
| | - Emily C Williams
- d Veterans Affairs (VA) Puget Sound Health Care System , Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care , Seattle , Washington
| | - Nathan Gotman
- e Collaborating Studies Coordinating Center , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina
| | - Veronica Womack
- f Feinberg School of Medicine , Northwestern University , Chicago , Illinois
| | - Sonia Davis
- e Collaborating Studies Coordinating Center , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina
| | - Frank Penedo
- f Feinberg School of Medicine , Northwestern University , Chicago , Illinois
| | - Sylvia Smoller
- g Department of Epidemiology & Population Health , Albert Einstein College of Medicine , Bronx , New York, New York
| | - Linda C Gallo
- c Graduate School of Public Health , San Diego State University , San Diego , California
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105
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Lee AK, Corneille MA, Hall NM, Yancu CN, Myers M. The stressors of being young and Black: Cardiovascular health and Black young adults. Psychol Health 2016; 31:578-91. [PMID: 26654702 PMCID: PMC4975165 DOI: 10.1080/08870446.2015.1127373] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To examine the impact of stressors relevant to the lives of Black young adults including racial, financial, occupational, and general stress and psychological distress on cardiovascular disease (CVD) risk. Specifically, this study examined the relationship between multiple psychosocial stressors and two CVD risk indicators (i.e. obesity and blood pressure). DESIGN This study used a quantitative design which included surveys, the collection of anthropometric and blood pressure (BP) measures. Participants were 124 Black college students aged 18 to 27 years old. MAIN OUTCOME MEASURES Participants completed measures to assess psychological distress, general, occupational, financial and racial stress. Measures of body mass index (BMI), waist-to-hip ratio (WHR) and BP were collected to assess CVD risk. RESULTS Findings indicated a significant effect of internalised racism on BMI and a significant effect of individual racial stress on diastolic BP. Also, depression was significantly associated with systolic BP. There were no significant results for WHR. CONCLUSION Findings suggested that the relationship among racial stress, psychological distress and CVD be further explored.
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Affiliation(s)
- Anna K Lee
- a Department of Psychology , North Carolina Agricultural & Technical State University , Greensboro , NC , USA
| | - Maya A Corneille
- a Department of Psychology , North Carolina Agricultural & Technical State University , Greensboro , NC , USA
| | - Naomi M Hall
- b Department of Psychological Sciences , Winston Salem State University , Winston-Salem , NC , USA
| | - Cecile N Yancu
- b Department of Psychological Sciences , Winston Salem State University , Winston-Salem , NC , USA
| | - Micha Myers
- b Department of Psychological Sciences , Winston Salem State University , Winston-Salem , NC , USA
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106
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Spence ND, Wells S, Graham K, George J. Racial Discrimination, Cultural Resilience, and Stress. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:298-307. [PMID: 27254805 PMCID: PMC4841285 DOI: 10.1177/0706743716638653] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Racial discrimination is a social determinant of health for First Nations people. Cultural resilience has been regarded as a potentially positive resource for social outcomes. Using a compensatory model of resilience, this study sought to determine if cultural resilience (compensatory factor) neutralized or offset the detrimental effect of racial discrimination (social risk factor) on stress (outcome). METHODS Data were collected from October 2012 to February 2013 (N = 340) from adult members of the Kettle and Stony Point First Nation community in Ontario, Canada. The outcome was perceived stress; risk factor, racial discrimination; and compensatory factor, cultural resilience. Control variables included individual (education, sociability) and family (marital status, socioeconomic status) resilience resources and demographics (age and gender). The model was tested using sequential regression. RESULTS The risk factor, racial discrimination, increased stress across steps of the sequential model, while cultural resilience had an opposite modest effect on stress levels. In the final model with all variables, age and gender were significant, with the former having a negative effect on stress and women reporting higher levels of stress than males. Education, marital status, and socioeconomic status (household income) were not significant in the model. The model had R(2) = 0.21 and adjusted R(2) = 0.18 and semipartial correlation (squared) of 0.04 and 0.01 for racial discrimination and cultural resilience, respectively. CONCLUSIONS In this study, cultural resilience compensated for the detrimental effect of racial discrimination on stress in a modest manner. These findings may support the development of programs and services fostering First Nations culture, pending further study.
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Affiliation(s)
| | - Samantha Wells
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, London, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada School of Psychology, Deakin University, Australia
| | - Kathryn Graham
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, London, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Department of Psychology, Western University, London, Ontario, Canada National Drug Research Institute, Curtin University, Perth, Western Australia
| | - Julie George
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, London, Ontario, Canada Mental Health and Addiction Services, Kettle & Stony Point Health Services, Kettle & Stony Point First Nation, Ontario, Canada
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107
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Peterson LM, Matthews KA, Derby CA, Bromberger JT, Thurston RC. The relationship between cumulative unfair treatment and intima media thickness and adventitial diameter: The moderating role of race in the study of women's health across the nation. Health Psychol 2016; 35:313-21. [PMID: 27018722 PMCID: PMC4817355 DOI: 10.1037/hea0000288] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Unfair treatment may have a detrimental effect on cardiovascular health. However, little research on chronic health outcomes uses cumulative measures of unfair treatment. We tested whether cumulative unfair treatment was associated with greater subclinical cardiovascular disease in a diverse sample of African-American, Caucasian, Chinese, and Hispanic women. We also examined whether this relationship varied by race. METHOD The Study of Women's Health Across the Nation is a longitudinal study of midlife women. Cumulative unfair treatment was calculated as the average of unfair treatment assessed over 10 years at 6 time points. Subclinical cardiovascular disease, specifically carotid intima media thickness and adventitial diameter, was assessed via carotid ultrasound conducted at study year 12 in 1,056 women. We tested whether cumulative unfair treatment was related to subclinical cardiovascular disease via linear regression, controlling for demographic factors including socioeconomic status and cardiovascular risk factors. RESULTS The relation between unfair treatment and subclinical cardiovascular disease significantly varied by race (ps < .05), with unfair treatment related to higher intima media thickness (B = .03, SE = .01, p = .009) and adventitial diameter (B = .02, SE = .009, p = .013) only among Caucasian women. No significant relations between unfair treatment and subclinical cardiovascular disease outcomes were observed for African-American, Hispanic, and Chinese women. CONCLUSIONS Our findings indicate that cumulative unfair treatment is related to worse subclinical cardiovascular disease among Caucasian women. These findings add to the growing literature showing that Caucasian women's experience of unfair treatment may have detrimental health implications. (PsycINFO Database Record
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Affiliation(s)
| | | | - Carol A Derby
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
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108
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Sewell W, Horsford CE, Coleman K, Watkins CS. Vile vigilance: An integrated theoretical framework for understanding the state of Black surveillance. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2016; 26:287-302. [PMID: 33100821 PMCID: PMC7581301 DOI: 10.1080/10911359.2015.1127735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The family is the principal source of socialization and protection against racism for many Blacks. Transmitting values, norms, morals, and beliefs (i.e., racial socialization) to successive generations is done to promote racial awareness and to prepare an individual to survive in racist environments. Further, developing a sense of security, resiliency, and cultural pride provides psychological protection against racial prejudice and discrimination. Protective socialization is even more critical when it becomes the difference between life and death at the hands of law enforcement-a fate faced by too many Black males as a result of racist policing practices, including the over-patrolling of Black communities. Because discriminatory surveillance and over-patrolling can incite a number of social, physical, and mental health issues, a holistic approach to understanding the interaction between Blacks and law enforcement is critical. This article reviews the Mundane Extreme Environmental Stress (MEES) model, racial socialization theory, and Family Stress Model in the development of a theoretical framework for understanding the patterns of interactions between Blacks and law enforcement, the immediate and long-term effects of unjustified shootings on Black families and communities, and the response of sociopolitical systems. The new theoretical framework will be used to inform the work of human service providers and practitioners by identifying targets for interventions to improve relations and trust between Black communities and law enforcement institutions.
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Affiliation(s)
- Whitney Sewell
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Christina E. Horsford
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kanisha Coleman
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charity S. Watkins
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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109
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Hopkins KD, Shepherd CCJ, Taylor CL, Zubrick SR. Relationships between Psychosocial Resilience and Physical Health Status of Western Australian Urban Aboriginal Youth. PLoS One 2015; 10:e0145382. [PMID: 26716829 PMCID: PMC4696679 DOI: 10.1371/journal.pone.0145382] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 12/01/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Psychosocial processes are implicated as mediators of racial/ethnic health disparities via dysregulation of physiological responses to stress. Our aim was to investigate the extent to which factors previously documented as buffering the impact of high-risk family environments on Aboriginal youths' psychosocial functioning were similarly beneficial for their physical health status. METHOD AND RESULTS We examined the relationship between psychosocial resilience and physical health of urban Aboriginal youth (12-17 years, n = 677) drawn from a representative survey of Western Australian Aboriginal children and their families. A composite variable of psychosocial resilient status, derived by cross-classifying youth by high/low family risk exposure and normal/abnormal psychosocial functioning, resulted in four groups- Resilient, Less Resilient, Expected Good and Vulnerable. Separate logistic regression modeling for high and low risk exposed youth revealed that Resilient youth were significantly more likely to have lower self-reported asthma symptoms (OR 3.48, p<.001) and carer reported lifetime health problems (OR 1.76, p<.04) than Less Resilient youth. CONCLUSION The findings are consistent with biopsychosocial models and provide a more nuanced understanding of the patterns of risks, resources and adaptation that impact on the physical health of Aboriginal youth. The results support the posited biological pathways between chronic stress and physical health, and identify the protective role of social connections impacting not only psychosocial function but also physical health. Using a resilience framework may identify potent protective factors otherwise undetected in aggregated analyses, offering important insights to augment general public health prevention strategies.
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Affiliation(s)
- Katrina D. Hopkins
- Telethon Kids Institute, The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Catherine L. Taylor
- Telethon Kids Institute, The University of Western Australia, Crawley, Western Australia, Australia
| | - Stephen R. Zubrick
- Telethon Kids Institute, The University of Western Australia, Crawley, Western Australia, Australia
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Duraimani S, Schneider RH, Randall OS, Nidich SI, Xu S, Ketete M, Rainforth MA, Gaylord-King C, Salerno JW, Fagan J. Effects of Lifestyle Modification on Telomerase Gene Expression in Hypertensive Patients: A Pilot Trial of Stress Reduction and Health Education Programs in African Americans. PLoS One 2015; 10:e0142689. [PMID: 26571023 PMCID: PMC4646647 DOI: 10.1371/journal.pone.0142689] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 10/25/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND African Americans suffer from disproportionately high rates of hypertension and cardiovascular disease. Psychosocial stress, lifestyle and telomere dysfunction contribute to the pathogenesis of hypertension and cardiovascular disease. This study evaluated effects of stress reduction and lifestyle modification on blood pressure, telomerase gene expression and lifestyle factors in African Americans. METHODS Forty-eight African American men and women with stage I hypertension who participated in a larger randomized controlled trial volunteered for this substudy. These subjects participated in either stress reduction with the Transcendental Meditation technique and a basic health education course (SR) or an extensive health education program (EHE) for 16 weeks. Primary outcomes were telomerase gene expression (hTERT and hTR) and clinic blood pressure. Secondary outcomes included lifestyle-related factors. Data were analyzed for within-group and between-group changes. RESULTS Both groups showed increases in the two measures of telomerase gene expression, hTR mRNA levels (SR: p< 0.001; EHE: p< 0.001) and hTERT mRNA levels (SR: p = 0.055; EHE: p< 0.002). However, no statistically significant between-group changes were observed. Both groups showed reductions in systolic BP. Adjusted changes were SR = -5.7 mm Hg, p< 0.01; EHE = -9.0 mm Hg, p < 0.001 with no statistically significant difference between group difference. There was a significant reduction in diastolic BP in the EHE group (-5.3 mm Hg, p< 0.001) but not in SR (-1.2 mm Hg, p = 0.42); the between-group difference was significant (p = 0.04). The EHE group showed a greater number of changes in lifestyle behaviors. CONCLUSION In this pilot trial, both stress reduction (Transcendental Meditation technique plus health education) and extensive health education groups demonstrated increased telomerase gene expression and reduced BP. The association between increased telomerase gene expression and reduced BP observed in this high-risk population suggest hypotheses that telomerase gene expression may either be a biomarker for reduced BP or a mechanism by which stress reduction and lifestyle modification reduces BP. TRIAL REGISTRATION ClinicalTrials.gov NCT00681200.
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Affiliation(s)
- Shanthi Duraimani
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
- MUM Molecular Biology Laboratory, Maharishi University of Management, Fairfield Iowa, United States of America
| | - Robert H. Schneider
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
| | - Otelio S. Randall
- Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America
| | - Sanford I. Nidich
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
| | - Shichen Xu
- Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America
| | - Muluemebet Ketete
- Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America
| | - Maxwell A. Rainforth
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
| | - Carolyn Gaylord-King
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
| | - John W. Salerno
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
| | - John Fagan
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
- MUM Molecular Biology Laboratory, Maharishi University of Management, Fairfield Iowa, United States of America
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Chae DH, Drenkard CM, Lewis TT, Lim SS. Discrimination and Cumulative Disease Damage Among African American Women With Systemic Lupus Erythematosus. Am J Public Health 2015; 105:2099-107. [PMID: 26270300 PMCID: PMC4566545 DOI: 10.2105/ajph.2015.302727] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- David H Chae
- David H. Chae is with the Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park. Cristina M. Drenkard and S. Sam Lim are with the Division of Rheumatology, School of Medicine, and Tené T. Lewis is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cristina M Drenkard
- David H. Chae is with the Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park. Cristina M. Drenkard and S. Sam Lim are with the Division of Rheumatology, School of Medicine, and Tené T. Lewis is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Tené T Lewis
- David H. Chae is with the Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park. Cristina M. Drenkard and S. Sam Lim are with the Division of Rheumatology, School of Medicine, and Tené T. Lewis is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - S Sam Lim
- David H. Chae is with the Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park. Cristina M. Drenkard and S. Sam Lim are with the Division of Rheumatology, School of Medicine, and Tené T. Lewis is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, Gupta A, Kelaher M, Gee G. Racism as a Determinant of Health: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0138511. [PMID: 26398658 PMCID: PMC4580597 DOI: 10.1371/journal.pone.0138511] [Citation(s) in RCA: 1237] [Impact Index Per Article: 137.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/30/2015] [Indexed: 12/20/2022] Open
Abstract
Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.
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Affiliation(s)
- Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
| | - Jehonathan Ben
- Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
| | - Nida Denson
- School of Social Sciences and Psychology, University of Western Sydney, Sydney, New South Wales, Australia
| | - Amanuel Elias
- Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
| | - Naomi Priest
- Australian Centre for Applied Social Research Methods, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alex Pieterse
- Division of Counseling Psychology, University at Albany, State University of New York, New York, New York, United States of America
| | - Arpana Gupta
- Oppenheimer Center for Neurobiology of Stress, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Margaret Kelaher
- Centre for Health Policy Programs and Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gilbert Gee
- Department of Community Health Sciences, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California, United States of America
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Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, Davey-Smith G, Dennison-Himmelfarb CR, Lauer MS, Lockwood DW, Rosal M, Yancy CW. Social Determinants of Risk and Outcomes for Cardiovascular Disease. Circulation 2015; 132:873-98. [DOI: 10.1161/cir.0000000000000228] [Citation(s) in RCA: 738] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Brondolo E, Monge A, Agosta J, Tobin JN, Cassells A, Stanton C, Schwartz J. Perceived ethnic discrimination and cigarette smoking: examining the moderating effects of race/ethnicity and gender in a sample of Black and Latino urban adults. J Behav Med 2015; 38:689-700. [PMID: 26054448 DOI: 10.1007/s10865-015-9645-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
Abstract
Perceived ethnic discrimination has been associated with cigarette smoking in US adults in the majority of studies, but gaps in understanding remain. It is unclear if the association of discrimination to smoking is a function of lifetime or recent exposure to discrimination. Some sociodemographic and mood-related risk factors may confound the relationship of discrimination to smoking. Gender and race/ethnicity differences in this relationship have been understudied. This study examines the relationship of lifetime and recent discrimination to smoking status and frequency, controlling for sociodemographic and mood-related variables and investigating the moderating role of race/ethnicity and gender. Participants included 518 Black and Latino(a) adults from New York, US. Lifetime and past week discrimination were measured with the Perceived Ethnic Discrimination Questionnaire-Community Version. Ecological momentary assessment methods were used to collect data on smoking and mood every 20 min throughout one testing day using an electronic diary. Controlling for sociodemographic and mood-related variables, there was a significant association of recent (past week) discrimination exposure to current smoking. Lifetime discrimination was associated with smoking frequency, but not current smoking status. The association of recent discrimination to smoking status was moderated by race/ethnicity and gender, with positive associations emerging for both Black adults and for men. The association of lifetime discrimination on smoking frequency was not moderated by gender or race/ethnicity. Acute race/ethnicity-related stressors may be associated with the decision to smoke at all on a given day; whereas chronic stigmatization may reduce the barriers to smoking more frequently.
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Mueller M, Purnell TS, Mensah GA, Cooper LA. Reducing racial and ethnic disparities in hypertension prevention and control: what will it take to translate research into practice and policy? Am J Hypertens 2015; 28:699-716. [PMID: 25498998 DOI: 10.1093/ajh/hpu233] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 10/30/2014] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Despite available, effective therapies, racial and ethnic disparities in care and outcomes of hypertension persist. Several interventions have been tested to reduce disparities; however, their translation into practice and policy is hampered by knowledge gaps and limited collaboration among stakeholders. METHODS We characterized factors influencing disparities in blood pressure (BP) control by levels of an ecological model. We then conducted a literature search using PubMed, Scopus, and CINAHL databases to identify interventions targeted toward reducing disparities in BP control, categorized them by the levels of the model at which they were primarily targeted, and summarized the evidence regarding their effectiveness. RESULTS We identified 39 interventions and several state and national policy initiatives targeted toward reducing racial and ethnic disparities in BP control, 5 of which are ongoing. Most had patient populations that were majority African-American. Of completed interventions, 27 demonstrated some improvement in BP control or related process measures, and 7 did not; of the 6 studies examining disparities, 3 reduced, 2 increased, and 1 had no effect on disparities. CONCLUSIONS Several effective interventions exist to improve BP in racial and ethnic minorities; however, evidence that they reduce disparities is limited, and many groups are understudied. To strengthen the evidence and translate it into practice and policy, we recommend rigorous evaluation of pragmatic, sustainable, multilevel interventions; institutional support for training implementation researchers and creating broad partnerships among payers, patients, providers, researchers, policymakers, and community-based organizations; and balance and alignment in the priorities and incentives of each stakeholder group.
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Affiliation(s)
- Michael Mueller
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Hoggard LS, Hill LK, Gray DL, Sellers RM. Capturing the cardiac effects of racial discrimination: Do the effects "keep going"? Int J Psychophysiol 2015; 97:163-70. [PMID: 25931114 DOI: 10.1016/j.ijpsycho.2015.04.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 11/17/2022]
Abstract
Racial discrimination negatively impacts cardiac functioning, but few studies examine the more distal cardiac effects of racial discrimination experiences. The present study examined the momentary and prolonged impact of lab-based intergroup and intragroup racial discrimination on heart rate variability (HRV) and heart rate (HR) in a sample (N = 42) of African American (AA) women across two days. On day one, the women were exposed to simulated racial discrimination from either a European American (EA) or AA confederate in the lab. On day two, the women returned to the lab for additional physiological recording and debriefing. Women insulted by the EA confederate exhibited lower HRV on day one and marginally lower HRV on day two. These women also exhibited marginally higher HR on day two. The HRV and HR effects on day two were not mediated by differences in perseveration about the stressor. The findings indicate that racial discrimination - particularly intergroup racial discrimination - may have both momentary and prolonged effects on cardiac activity in AAs.
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Affiliation(s)
- Lori S Hoggard
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
| | - LaBarron K Hill
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Center for Biobehavioral Health Disparities Research, Duke University, Durham, NC, USA
| | - DeLeon L Gray
- College of Education, North Carolina State University, Raleigh, NC, USA
| | - Robert M Sellers
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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Sutin AR, Stephan Y, Carretta H, Terracciano A. Perceived discrimination and physical, cognitive, and emotional health in older adulthood. Am J Geriatr Psychiatry 2015; 23:171-9. [PMID: 24745563 PMCID: PMC4170050 DOI: 10.1016/j.jagp.2014.03.007] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 03/05/2014] [Accepted: 03/16/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether perceived discrimination based on multiple personal characteristics is associated with physical, emotional, and cognitive health concurrently, prospectively, and with change in health over time among older adults. DESIGN Longitudinal. SETTING Health and Retirement Study (HRS). PARTICIPANTS Participants (N = 7,622) who completed the Leave-Behind Questionnaire as part of the 2006 HRS assessment (mean age 67 years); participants (N = 6,450) completed the same health measures again in 2010. MEASUREMENTS Participants rated their everyday experience with discrimination and attributed those experiences to eight personal characteristics: race, ancestry, sex, age, weight, physical disability, appearance, and sexual orientation. At both the 2006 and 2010 assessments, participants completed measures of physical health (subjective health, disease burden), emotional health (life satisfaction, loneliness), and cognitive health (memory, mental status). RESULTS Discrimination based on age, weight, physical disability, and appearance was associated with poor subjective health, greater disease burden, lower life satisfaction, and greater loneliness at both assessments and with declines in health across the four years. Discrimination based on race, ancestry, sex, and sexual orientation was associated with greater loneliness at both time points, but not with change over time. Discrimination was mostly unrelated to cognitive health. CONCLUSIONS The detrimental effect of discrimination on physical and emotional health is not limited to young adulthood but continues to contribute to health and well-being in old age. These effects were driven primarily by discrimination based on personal characteristics that change over time (e.g., age, weight) rather than discrimination based on more stable characteristics (e.g., race, sex).
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118
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Slopen N, Lewis TT, Williams DR. Discrimination and sleep: a systematic review. Sleep Med 2015; 18:88-95. [PMID: 25770043 DOI: 10.1016/j.sleep.2015.01.012] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/26/2014] [Accepted: 01/20/2015] [Indexed: 01/19/2023]
Abstract
An increasing body of literature indicates that discrimination has a negative impact on health; poor sleep may be an underlying mechanism. The primary objective of this review was to examine existing studies on the relationship between discrimination and sleep to clarify (a) the potential role of discrimination in shaping population patterns of sleep and sleep disparities, and (b) the research needed to develop interventions at individual and institutional levels. We identified articles from English-language publications in PubMed and EBSCO databases from inception through July 2014. We employed a broad definition of discrimination to include any form of unfair treatment and all self-reported and objectively assessed sleep outcomes, including duration, difficulties, and sleep architecture. Seventeen studies were identified: four prospective, 12 cross-sectional, and one that utilized a daily-diary design. Fifteen of the 17 studies evaluated interpersonal discrimination as the exposure and the majority of studies included self-reported sleep as the outcome. Only four studies incorporated objective sleep assessments. All 17 studies identified at least one association between discrimination and a measure of poorer sleep, although studies with more detailed consideration of either discrimination or sleep architecture revealed some inconsistencies. Taken together, existing studies demonstrate consistent evidence that discrimination is associated with poorer sleep outcomes. This evidence base can be strengthened with additional prospective studies that incorporate objectively measured aspects of sleep. We outline important extensions for this field of inquiry that can inform the development of interventions to improve sleep outcomes, and consequently promote well-being and reduce health inequities across the life course.
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Affiliation(s)
- Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland College Park, School of Public Health, College Park, MD, USA.
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA, USA; Department of African and American Studies and Sociology, Harvard University, Cambridge, MA, USA
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119
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Lewis TT, Cogburn CD, Williams DR. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol 2015; 11:407-40. [PMID: 25581238 DOI: 10.1146/annurev-clinpsy-032814-112728] [Citation(s) in RCA: 558] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
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.
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Affiliation(s)
- Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322;
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120
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Cooper DC, Thayer JF, Waldstein SR. Coping with racism: the impact of prayer on cardiovascular reactivity and post-stress recovery in African American women. Ann Behav Med 2014; 47:218-30. [PMID: 24122482 DOI: 10.1007/s12160-013-9540-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prayer is often used to cope with racism-related stress. Little is known about its impact on cardiovascular function. PURPOSE This study examined how prayer coping relates to cardiovascular reactivity (CVR), post-stress recovery, and affective reactivity in response to racism-related stress. METHODS African American women (n =81; mean age=20 years) reported their use of prayer coping on the Perceived Racism Scale and completed anger recall and racism recall tasks while undergoing monitoring of systolic and diastolic blood pressure (DBP), heart rate, heart rate variability (HRV), and hemodynamic measures. Prayer coping was examined for associations with CVR, recovery, and affective change scores using general linear models with repeated measures. RESULTS Higher prayer coping was associated with decreased state stress and DBP reactivity during racism recall (p's<0.05) and with decreased DBP and increased HRV during racism recall recovery(p's<0.05). CONCLUSIONS Coping with racism by utilizing prayer may have cardiovascular benefits for African American women.
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121
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Krieger N. Discrimination and Health Inequities. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2014; 44:643-710. [DOI: 10.2190/hs.44.4.b] [Citation(s) in RCA: 429] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In 1999, only 20 studies in the public health literature employed instruments to measure self-reported experiences of discrimination. Fifteen years later, the number of empirical investigations on discrimination and health easily exceeds 500, with these studies increasingly global in scope and focused on major types of discrimination variously involving race/ethnicity, indigenous status, immigrant status, gender, sexuality, disability, and age, separately and in combination. And yet, as I also document, even as the number of investigations has dramatically expanded, the scope remains narrow: studies remain focused primarily on interpersonal discrimination, and scant research investigates the health impacts of structural discrimination, a gap consonant with the limited epidemiologic research on political systems and population health. Accordingly, to help advance the state of the field, this updated review article: ( a) briefly reviews definitions of discrimination, illustrated with examples from the United States; ( b) discusses theoretical insights useful for conceptualizing how discrimination can become embodied and produce health inequities, including via distortion of scientific knowledge; ( c) concisely summarizes extant evidence—both robust and inconsistent—linking discrimination and health; and ( d) addresses several key methodological controversies and challenges, including the need for careful attention to domains, pathways, level, and spatiotemporal scale, in historical context.
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Beatty DL, Matthews KA, Bromberger JT, Brown C. Everyday Discrimination Prospectively Predicts Inflammation Across 7-Years in Racially Diverse Midlife Women: Study of Women's Health Across the Nation. THE JOURNAL OF SOCIAL ISSUES 2014; 70:298-314. [PMID: 25342861 PMCID: PMC4203661 DOI: 10.1111/josi.12061] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
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.
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Affiliation(s)
| | - Karen A. Matthews
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA
| | - Joyce T. Bromberger
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA
| | - Charlotte Brown
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA
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Madowitz J, Boutelle KN. Ethical Implications of Using the Term “Non-white” in Psychological Research. ETHICS & BEHAVIOR 2014. [DOI: 10.1080/10508422.2013.858604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cois A, Ehrlich R. Analysing the socioeconomic determinants of hypertension in South Africa: a structural equation modelling approach. BMC Public Health 2014; 14:414. [PMID: 24885860 PMCID: PMC4021547 DOI: 10.1186/1471-2458-14-414] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/22/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Epidemiological research has long observed a varying prevalence of hypertension across socioeconomic strata. However, patterns of association and underlying causal mechanisms are poorly understood in sub-Saharan Africa. Using education and income as indicators, we investigated the extent to which socioeconomic status is linked to blood pressure in the first wave of the National Income Dynamics Study--a South African longitudinal study of more than 15,000 adults--and whether bio-behavioural risk factors mediate the association. METHODS In a cross-sectional analysis, structural equation modelling was employed to estimate the effect of socioeconomic status on systolic and diastolic blood pressure and to assess the role of a set of bio-behavioural risk factors in explaining the observed relationships. RESULTS After adjustment for age, race and antihypertensive treatment, higher education and income were independently associated with higher diastolic blood pressure in men. In women higher education predicted lower values of both diastolic and systolic blood pressure while higher income predicted lower systolic blood pressure. In both genders, body mass index was a strong mediator of an adverse indirect effect of socioeconomic status on blood pressure. Together with physical exercise, alcohol use, smoking and resting heart rate, body mass index therefore contributed substantially to mediation of the observed relationships in men. By contrast, in women unmeasured factors played a greater role. CONCLUSION In countries undergoing epidemiological transition, effects of socioeconomic status on blood pressure may vary by gender. In women, factors other than those listed above may have substantial role in mediating the association and merit investigation.
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Affiliation(s)
- Annibale Cois
- School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
| | - Rodney Ehrlich
- School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
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Dolezsar CM, McGrath JJ, Herzig AJM, Miller SB. Perceived racial discrimination and hypertension: a comprehensive systematic review. Health Psychol 2014; 33:20-34. [PMID: 24417692 DOI: 10.1037/a0033718] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Discrimination is posited to underlie racial disparities in hypertension. Extant literature suggests a possible association between racial discrimination and blood pressure, although inconsistent findings have been reported. The aim of this comprehensive systematic review was to quantitatively evaluate the association between perceived racial discrimination with hypertensive status and systolic, diastolic, and ambulatory blood pressure. METHOD Electronic database search of PubMed and PsycINFO (keywords: blood pressure/hypertension/diastolic/systolic, racism/discrimination/prejudice/unfair treatment) was combined with descendancy and ascendancy approaches. Forty-four articles (N = 32,651) met inclusion criteria. Articles were coded for demographics, hypertensive diagnosis, blood pressure measurement, discrimination measure and constructs, study quality, and effect sizes. RESULTS Random effects meta-analytic models were tested based on Fisher's Z, the derived common effect size metric. Overall, perceived racial discrimination was associated with hypertensive status, Zhypertension = 0.048, 95% CI [.013, .087], but not with resting blood pressure, Zsystolic = 0.011, 95% CI [-.006, .031], Zdiastolic = .016, 95% CI [-.006, .034]. Moderators that strengthened the relation included sex (male), race (Black), age (older), education (lower), and hypertensive status. Perceived discrimination was most strongly associated with nighttime ambulatory blood pressure, especially among Blacks. CONCLUSIONS Despite methodological limitations in the existing literature, there was a small, significant association between perceived discrimination and hypertension. Future studies should consider ambulatory nighttime blood pressure, which may more accurately capture daily variation attributable to experienced racial discrimination. Perceived discrimination may partly explain racial health disparities.
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Perceived discrimination and medication adherence in black hypertensive patients: the role of stress and depression. Psychosom Med 2014; 76:229-36. [PMID: 24677163 DOI: 10.1097/psy.0000000000000043] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the relationship between perceived discrimination and medication adherence among black people with hypertension and the role of stress and depressive symptoms in this relationship. Perceived racial discrimination has been associated with poor health outcomes in blacks; its relationship to medication adherence among hypertensive patients remains untested. METHODS We measured perceived racial discrimination at baseline, stress and depressive symptoms at 6 months, and medication adherence at 12 months among patients enrolled in a 30-site cluster-randomized controlled trial testing a patient and physician-targeted intervention to improve blood pressure. A mediational method with bootstrapping (stratified by site) confidence intervals was used to estimate the indirect association between perceived discrimination and medication adherence through stress and depression. RESULTS Of 1056 patients from 30 sites enrolled in the trial, 463 had complete data on all four measures at 6 and 12 months and were included in the analyses. Adjusting for clustering, perceived discrimination was associated with poor medication adherence (B = 0.138, p = .011) at 12 months, and with stress (B = 2.24, p = .001) and depression (B = 1.47, p = .001) at 6 months. When stress and depression were included in the model, there was a 65% reduction in the total association of perceived discrimination with medication adherence, and the relationship was no longer significant (B = 0.049, p = .35). CONCLUSIONS Perceived discrimination is associated with poor medication adherence among hypertensive blacks, and stress and depressive symptoms may account for this relationship. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00233220.
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Nikulina V. Do race, neglect, and childhood poverty predict physical health in adulthood? A multilevel prospective analysis. CHILD ABUSE & NEGLECT 2014; 38:414-24. [PMID: 24189205 PMCID: PMC4462241 DOI: 10.1016/j.chiabu.2013.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/09/2013] [Accepted: 09/13/2013] [Indexed: 05/03/2023]
Abstract
Childhood neglect and poverty often co-occur and both have been linked to poor physical health outcomes. In addition, Blacks have higher rates of childhood poverty and tend to have worse health than Whites. This paper examines the unique and interacting effects of childhood neglect, race, and family and neighborhood poverty on adult physical health outcomes. This prospective cohort design study uses a sample (N=675) of court-substantiated cases of childhood neglect and matched controls followed into adulthood (M(age)=41). Health indicators (C-Reactive Protein [CRP], hypertension, and pulmonary functioning) were assessed through blood collection and measurements by a registered nurse. Data were analyzed using hierarchical linear models to control for clustering of participants in childhood neighborhoods. Main effects showed that growing up Black predicted CRP and hypertension elevations, despite controlling for neglect and childhood family and neighborhood poverty and their interactions. Multivariate results showed that race and childhood adversities interacted to predict adult health outcomes. Childhood family poverty predicted increased risk for hypertension for Blacks, not Whites. In contrast, among Whites, childhood neglect predicted elevated CRP. Childhood neighborhood poverty interacted with childhood family poverty to predict pulmonary functioning in adulthood. Gender differences in health indicators were also observed. The effects of childhood neglect, childhood poverty, and growing up Black in the United States are manifest in physical health outcomes assessed 30 years later. Implications are discussed.
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Abstract
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.
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Brewer LC, Carson KA, Williams DR, Allen A, Jones CP, Cooper LA. Association of race consciousness with the patient-physician relationship, medication adherence, and blood pressure in urban primary care patients. Am J Hypertens 2013; 26:1346-52. [PMID: 23864583 DOI: 10.1093/ajh/hpt116] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Race consciousness (the frequency with which one thinks about his or her own race) is a measure that may be useful in assessing whether racial discrimination negatively impacts blood pressure (BP). However, the relation between race consciousness and BP has yet to be empirically tested, especially within the context of the patient-physician relationship and medication adherence. METHODS Race-stratified generalized estimating equations were used to assess the relationship of race consciousness on BP, measures of the patient-physician relationship, and self-reported medication adherence, controlling for patients being nested within physicians and for patient age and sex. RESULTS The mean age of the patients was 61.3 years, 62% were black, and 65% were women. Black patients were more likely to ever think about race than were white patients (49% vs. 21%; P < 0.001). Race-conscious blacks had significantly higher diastolic BP (79.4 vs. 74.5 mm Hg; P = 0.004) and somewhat higher systolic BP (138.8 vs. 134.7 mm Hg; P = 0.13) than blacks who were not race conscious. Race-conscious whites were more likely to perceive respect from their physician (57.1% vs. 25.8%; P = 0.01) but had lower medication adherence (62.4% vs. 82.9%; P = 0.05) than whites who were not race-conscious. CONCLUSIONS Among blacks, race consciousness was associated with higher diastolic BP. In contrast, among whites, there was no association between race consciousness and BP, but race consciousness was associated with poor ratings of adherence, despite more favorable ratings of the patient-physician relationship. Future work should explore disparities in race consciousness and its impact on health and health-care disparities.
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Affiliation(s)
- LaPrincess C Brewer
- Department of Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Allyssa Allen
- Department of Community & Applied Social Psychology, University of Maryland, Baltimore County, Baltimore, Maryland
| | - Camara P Jones
- Morehouse School of Medicine, Atlanta, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lisa A Cooper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;
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Krieger N, Waterman PD, Kosheleva A, Chen JT, Smith KW, Carney DR, Bennett GG, Williams DR, Thornhill G, Freeman ER. Racial discrimination & cardiovascular disease risk: my body my story study of 1005 US-born black and white community health center participants (US). PLoS One 2013; 8:e77174. [PMID: 24204765 PMCID: PMC3799698 DOI: 10.1371/journal.pone.0077174] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 08/30/2013] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To date, limited and inconsistent evidence exists regarding racial discrimination and risk of cardiovascular disease (CVD). METHODS Cross-sectional observational study of 1005 US-born non-Hispanic black (n = 504) and white (n = 501) participants age 35-64 randomly selected from community health centers in Boston, MA (2008-2010; 82.4% response rate), using 3 racial discrimination measures: explicit self-report; implicit association test (IAT, a time reaction test for self and group as target vs. perpetrator of discrimination); and structural (Jim Crow status of state of birth, i.e. legal racial discrimination prior 1964). RESULTS Black and white participants both had adverse cardiovascular and socioeconomic profiles, with black participants most highly exposed to racial discrimination. Positive crude associations among black participants occurred for Jim Crow birthplace and hypertension (odds ratio (OR) 1.92, 95% confidence interval (CI) 1.28, 2.89) and for explicit self-report and the Framingham 10 year CVD risk score (beta = 0.04; 95% CI 0.01, 0.07); among white participants, only negative crude associations existed (for IAT for self, for lower systolic blood pressure (SBP; beta = -4.86; 95% CI -9.08, -0.64) and lower Framingham CVD score (beta = -0.36, 95% CI -0.63, -0.08)). All of these associations were attenuated and all but the white IAT-Framingham risk score association were rendered null in analyses that controlled for lifetime socioeconomic position and additional covariates. Controlling for racial discrimination, socioeconomic position, and other covariates did not attenuate the crude black excess risk for SBP and hypertension and left unaffected the null excess risk for the Framingham CVD score. CONCLUSION Despite worse exposures among the black participants, racial discrimination and socioeconomic position were not associated, in multivariable analyses, with risk of CVD. We interpret results in relation to constrained variability of exposures and outcomes and discuss implications for valid research on social determinants of health.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Pamela D. Waterman
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Anna Kosheleva
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Jarvis T. Chen
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Kevin W. Smith
- Senior Data Analyst, RTI International Waltham, Massachusetts, United States of America
| | - Dana R. Carney
- Haas School of Business, University of California, Berkeley, California, United States of America
| | - Gary G. Bennett
- Psychology and Neuroscience and Duke Global Health Initiative, Duke University, Durham, North Carolina, United States of America
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Professor, Department of Sociology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Gisele Thornhill
- Center for Community Health Education Research and Service, Boston, Massachusetts, United States of America
| | - Elmer R. Freeman
- Center for Community Health Education Research and Service, Boston, Massachusetts, United States of America
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131
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Holmes L, Hossain J, Ward D, Opara F. Racial/Ethnic Variability in Hypertension Prevalence and Risk Factors in National Health Interview Survey. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/257842] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective. Hypertension is one of the leading causes of death attributed to cardiovascular diseases, and the prevalence varies across racial/ethnic groups, with African Americans being disproportionately affected. The underlying causes of these disparities are not fully understood despite volume of literature in this perspective. We aimed in this current study to examine ethnic/racial disparities in hypertension utilizing Hispanics as the base racial/ethnic group for comparison. Research Design and Methods. We utilized the National Health Interview Survey (NHIS), which is a large cross-sectional survey of the United States non-institutionalized residents to investigate the racial/ethnic disparities in hypertension after the adjustment of other socio-economic, demographic, and prognostic risk factors. The study participants were adults (n = 30,852). Data were analyzed using Chi square statistic, and logistic regression model. Results. There were statistically significant differences by race/ethnicity with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, P < 0.01, but not insurance coverage, P > 0.01. Hispanic ethnicity (18.9%) compared to either non-Hispanic white (27.7%) or non-Hispanic black (35.5%) was associated with the lowest prevalence of hypertension. Race/ethnicity was a single independent predictor of hypertension, with non-Hispanic black more likely to be hypertensive compare with Hispanic, prevalence odds ratio (POR), 2.38, 99% Confidence Interval (CI), 2.17–2.61 and non-Hispanic white, POR, 1.64, 99% CI, 1.52–1.77. After controlling for the confounding variables, the racial/ethnic differences in hypertension persisted. Conclusions. Racial/ethnic disparities in hypertension persisted after controlling for potential predictors of hypertension in NHIS, implying the inability of known hypertension risk factors to account for racial/ethnic variability in hypertension in US.
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Affiliation(s)
- L. Holmes
- American Health Research Institute, Houston, TX 77008, USA
- University of Delaware, Newark, DE, USA
- Nemours/A.I.duPont Hospital for Children, Office of Health Equity & Inclusion, Newark, DE 19716, USA
| | - J. Hossain
- University of Delaware, Newark, DE, USA
- Nemours Biomedical Research, Wilmington, DE 19803, USA
| | - D. Ward
- Christiana Care Health System, Newark, DE, USA
| | - F. Opara
- American Health Research Institute, Houston, TX 77008, USA
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132
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Fuller-Rowell TE, Williams DR, Love GD, McKinley PS, Sloan RP, Ryff CD. Race differences in age-trends of autonomic nervous system functioning. J Aging Health 2013; 25:839-62. [PMID: 23781017 PMCID: PMC3758802 DOI: 10.1177/0898264313491427] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this study was to consider race differences in age-trends of autonomic nervous system functioning, using a national data set with a broad age range. METHODS Measures of baseline heart rate variability (HRV) and HRV reactivity were derived from electrocardiograph (ECG) recordings taken at rest and during cognitive stress tasks. Age-trends in HRV and HRV reactivity were compared among 204 African Americans and 833 Whites ages 34 to 83 years (M = 53.7, SD = 11.4), before and after controlling for socioeconomic status (SES). RESULTS For HRV-reactivity, age-trends were steeper among African Americans and lower SES participants than Whites and higher SES participants. For baseline HRV, age-trends varied by SES but not race. DISCUSSION Results relating to HRV-reactivity (but not baseline HRV) were consistent with hypotheses suggesting that African Americans are exposed to higher levels of stress and experience accelerated declines in health across the life span. The relevance of the findings to research on social stress and health disparities is discussed.
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Affiliation(s)
- Thomas E Fuller-Rowell
- Robert Wood Johnson Health & Society Scholar, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA.
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133
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Neblett EW, Roberts SO. Racial identity and autonomic responses to racial discrimination. Psychophysiology 2013; 50:943-53. [PMID: 23889076 DOI: 10.1111/psyp.12087] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 05/14/2013] [Indexed: 11/26/2022]
Abstract
Several studies identify racial identity-the significance and meaning that individuals attribute to race-as a mitigating factor in the association between racial discrimination and adjustment. In this study, we employed a visual imagery paradigm to examine whether racial identity would moderate autonomic responses to blatant and subtle racial discrimination analogues with Black and White perpetrators. We recruited 105 African American young adults from a public, southeastern university in the United States. The personal significance of race as well as personal feelings about African Americans and feelings about how others view African Americans moderated autonomic responses to the vignettes. We use polyvagal theory and a stress, appraisal, and coping framework to interpret our results with an eye toward elucidating the ways in which racial identity may inform individual differences in physiological responses to racial discrimination.
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Affiliation(s)
- Enrique W Neblett
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven O Roberts
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
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134
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Latkin CA, German D, Vlahov D, Galea S. Neighborhoods and HIV: a social ecological approach to prevention and care. AMERICAN PSYCHOLOGIST 2013; 68:210-24. [PMID: 23688089 PMCID: PMC3717355 DOI: 10.1037/a0032704] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neighborhood factors have been linked to HIV risk behaviors, HIV counseling and testing, and HIV medical care. However, the social-psychological mechanisms that connect neighborhood factors to HIV-related behaviors have not been fully determined. In this article we review the research on neighborhood factors and HIV-related behaviors, approaches to measuring neighborhoods, and mechanisms that may help to explain how the physical and social environment within neighborhoods may lead to HIV-related behaviors. We then discuss organizational, geographic, and social network approaches to intervening in neighborhoods to reduce HIV transmission and facilitate HIV medical care with the goal of reducing morbidity and mortality and increasing social and psychological well-being.
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Affiliation(s)
- Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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135
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Chaudoir SR, Earnshaw VA, Andel S. "Discredited" Versus "Discreditable": Understanding How Shared and Unique Stigma Mechanisms Affect Psychological and Physical Health Disparities. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2013; 35:75-87. [PMID: 23729948 PMCID: PMC3666955 DOI: 10.1080/01973533.2012.746612] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In his classic treatise, Goffman (1963) delineates between people who are discredited-whose stigma is clearly known or visible-and people who are discreditable-whose stigma is unknown and can be concealable. To what extent has research in the past 50 years advanced Goffman's original ideas regarding the impact of concealability on stigma management strategies and outcomes? In the current article, we outline a framework that articulates how stigma can "get under the skin" in order to lead to psychological and physical health disparities. Further, we consider when and to what degree concealability moderates these effects, creating divergent outcomes for the discredited and discreditable. Does the stigmatized individual assume his differentness is known about already or is evident on the spot, or does he assume it is neither known about by those present nor immediately perceivable by them? In the first case one deals with the plight of the discredited, in the second with that of the discreditable. This is an important difference.- Goffman (1963, p. 4).
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136
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Taber DJ, Pilch NA, Meadows HB, McGillicuddy JW, Bratton CF, Chavin KD, Baliga PK, Egede LE. The impact of cardiovascular disease and risk factor treatment on ethnic disparities in kidney transplant. J Cardiovasc Pharmacol Ther 2012; 18:243-50. [PMID: 23258931 DOI: 10.1177/1074248412469298] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
There is limited data on the use of cardiovascular disease (CVD) risk factor medications following renal transplant, especially when comparing use across ethnicities. The aim of this study was to compare the incidence, treatment, and impact of CVD between ethnicities in kidney transplant recipients. This was a retrospective cohort study of adults who underwent transplant between 2000 and 2008 within our academic medical transplant center. Pediatrics, multiorgan transplants, and those lost to follow-up were excluded. Data collection included all transplant and sociodemographic characteristics, medication use, CVD risk factor management, and follow-up events, including acute rejection, graft loss, and death. A total of 987 patients were included and followed for a mean of 6.7 ± 3.0 years. The baseline demographics revealed black patients were equally likely to have preexisting CVD (24% vs 25%, P = .651), but more likely to have preexisting diabetes (35% vs 23%, P < .001) or hypertension (97% vs 94%, P = .029). Black patients had poorer treatment of CVD risk factors, with lower rates of control of diabetes (35% vs 51%, P < .05) and dyslipidemia (37% vs 42%, P < .05). Black renal transplant recipients who had preexisting CVD had reduced graft survival rates compared to white patients (10-year rate 50% vs 60%, P = .033), but similar rates of graft survival were found in those without CVD (10-year rate 70% vs 71% in white patients, P = .483). CVD is common in transplant recipients, with black patients having higher rates and poorer control of diabetes and dyslipidemia.
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Affiliation(s)
- David J Taber
- Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
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137
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Greater cardiovascular reactivity to a cold stimulus is due to higher cold pain perception in black Africans. J Hypertens 2012; 30:2416-24. [DOI: 10.1097/hjh.0b013e328358faf7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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138
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Bastos JL, Faerstein E. Conceptual and methodological aspects of relations between discrimination and health in epidemiological studies. CAD SAUDE PUBLICA 2012; 28:177-83. [PMID: 22267078 DOI: 10.1590/s0102-311x2012000100019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/04/2011] [Indexed: 11/22/2022] Open
Abstract
This article addresses conceptual and methodological aspects of the relations between discrimination and health from an epidemiological perspective. Definitions of discrimination and related constructs are reviewed, and the main theories underlying their association with health are presented. Scales developed to assess discrimination are discussed, in conjunction with a new instrument, devised to operationalize the concept in Brazilian epidemiological surveys. As a relatively unpredictable and uncontrollable source of psychosocial stress, discrimination has been consistently associated with adverse health outcomes and behaviors, particularly mental disorders, smoking, and alcohol use. However, progress in the area depends partly on dealing with aspects related to the assessment of the phenomenon, such as the definition of a construct map and simultaneous measurement of different types of discrimination. Research involving these aspects will enhance our understanding of discrimination and its health consequences, thus increasing our ability to reduce its social occurrence.
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Affiliation(s)
- João Luiz Bastos
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal de Santa Catarina, Florianópolis, Brasil.
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139
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Borrell LN, Kiefe CI, Diez-Roux AV, Williams DR, Gordon-Larsen P. Racial discrimination, racial/ethnic segregation, and health behaviors in the CARDIA study. ETHNICITY & HEALTH 2012; 18:227-43. [PMID: 22913715 PMCID: PMC3523091 DOI: 10.1080/13557858.2012.713092] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Racial discrimination has been associated with unhealthy behaviors, but the mechanisms responsible for these associations are not understood and may be related to residential racial segregation. We investigated associations between self-reported racial discrimination and health behaviors before and after controlling for individual- and neighborhood-level characteristics; and potential effect modification of these associations by segregation. DESIGN We used data from the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) study for 1169 African-Americans and 1322 whites. To assess racial discrimination, we used a four category variable to capture the extent and persistence of self-reported discrimination between examination at years 7 (1992-1993) and 15 (2000-2001). We assessed smoking status, alcohol consumption, and physical activity at year 20 (2005-2006). Segregation was examined as the racial/ethnic composition at the Census tract level. RESULTS Discrimination was more common in African-Americans (89.1%) than in whites (40.0%). Living in areas with high percentage of blacks was associated with less reports of discrimination in African-Americans but more reports in whites. After adjustment for selected characteristics including individual- and neighborhood-level socioeconomic conditions and segregation, we found significant positive associations of discrimination with smoking and alcohol consumption in African-Americans and with smoking in whites. African-Americans experiencing moderate or high discrimination were more physically active than those reporting no discrimination. Whites reporting some discrimination were also more physically active than those reporting no discrimination. We observed no interactions between discrimination and segregation measures in African-Americans or whites for any of the three health behaviors. CONCLUSIONS Racial discrimination may impact individuals' adoption of healthy and unhealthy behaviors independent of racial/ethnic segregation. These behaviors may help individuals buffer or reduce the stress of discrimination.
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Affiliation(s)
- Luisa N Borrell
- Department of Health Sciences, Lehman College, City University of New York, Bronx, NY, USA.
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140
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Duru OK, Harawa NT, Kermah D, Norris KC. Allostatic load burden and racial disparities in mortality. J Natl Med Assoc 2012; 104:89-95. [PMID: 22708252 DOI: 10.1016/s0027-9684(15)30120-6] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Black-white disparities in mortality persist after adjustment for socioeconomic status and health behaviors. We examined whether allostatic load, the physiological profile influenced by repeated or chronic life stressors, is associated with black-white mortality disparities independent of traditional sociobehavioral risk factors. METHODS We studied 4515 blacks and whites aged 35 to 64 years from the third National Health and Nutrition Examination Survey (1988-1994), using the linked mortality file, to ascertain participant deaths through 2006. We estimated unadjusted sex-specific black-white disparities in cardiovascular/diabetes-related mortality and noninjury mortality. We constructed baseline allostatic load scores based on 10 biomarkers and examined attenuation of mortality disparities in 4 sets of sex-stratified multivariate models, sequentially adding risk factors: (1) age/clinical conditions, (2) socioeconomic status (SES) variables, (3) health behaviors, and (4) allostatic load. RESULTS Blacks had higher allostatic load scores than whites; for men, 2.5 vs 2.1, p < .01; and women, 2.6 vs 1.9, p < .01. For cardiovascular/diabetes-related mortality among women, the magnitude of the disparity after adjustment for other risk factors (hazard ratio [HR], 1.63; 95% confidence interval [CI], 0.96-2.75) decreased after adjustment for allostatic load (HR, 1.15; 95% CI, 0.70-1.88). For noninjury mortality among women, the magnitude of the disparity after adjustment for other risk factors (HR, 1.43; 95% CI, 1.00-2.04) also decreased after adjustment for allostatic load (HR, 1.26; 95% CI, 0.90-1.78). For men, disparities were attenuated but persisted after adjustment for allostatic load. CONCLUSIONS Allostatic load burden partially explains higher mortality among blacks, independent of SES and health behaviors. These findings underscore the importance of chronic physiologic stressors as a negative influence on the health and lifespan of blacks in the United States.
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Affiliation(s)
- O Kenrik Duru
- Division of General Infernal Medicine/Health Services Research, University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90095, USA.
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141
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The protective role of racial identity and Africentric worldview in the association between racial discrimination and blood pressure. Psychosom Med 2012; 74:509-16. [PMID: 22685241 DOI: 10.1097/psy.0b013e3182583a50] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To examine the protective effects of racial identity and Africentric worldview on the association between racial discrimination and blood pressure (BP). METHODS Two hundred ten African American young adults completed questionnaires assessing demographic characteristics, prior racial discrimination experiences, racial identity, and Africentric worldview. Resting BP was assessed before and after completion of the study measures. RESULTS Racial discrimination was unrelated to BP in the overall sample (systolic BP, p = .444; diastolic BP [DBP], p = .915; mean arterial pressure, p = .774). However, racial identity and Africentric worldview moderated the association between racial discrimination and BP. Racial discrimination was negatively related to DBP for participants who felt that others viewed African Americans less favorably and who endorsed the uniqueness of the African American experience (B = -2.59, standard error [SE] = 1.29, p = .046). These individuals also had the lowest DBP at high levels of racial discrimination. Racial discrimination was positively associated with DBP for individuals with low levels of Africentric orientation (B = 1.43, SE = 0.72, p = .048) but was unrelated to DBP at moderate (B = 0.24, SE = 0.65, p = .718) and high (B = -0.96, SE = 1.01, p = .341) levels of Africentric worldview. CONCLUSIONS Racial and cultural personal characteristics such as racial identity and Africentric orientation may serve an important protective function for BP in African American young adults.
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142
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Sims M, Diez-Roux AV, Dudley A, Gebreab S, Wyatt SB, Bruce MA, James SA, Robinson JC, Williams DR, Taylor HA. Perceived discrimination and hypertension among African Americans in the Jackson Heart Study. Am J Public Health 2012; 102 Suppl 2:S258-65. [PMID: 22401510 PMCID: PMC3477918 DOI: 10.2105/ajph.2011.300523] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Using Jackson Heart Study data, we examined whether perceived discrimination was associated with prevalent hypertension in African Americans. METHODS Everyday discrimination, lifetime discrimination, burden of discrimination, and stress from discrimination were examined among 4939 participants aged 35 to 84 years (women = 3123; men = 1816). We estimated prevalence ratios of hypertension by discrimination, and adjusted for age, gender, socioeconomic status, and risk factors. RESULTS The prevalence of hypertension was 64.0% in women and 59.7% in men. After adjustment for age, gender, and socioeconomic status, lifetime discrimination and burden of discrimination were associated with greater hypertension prevalence (prevalence ratios for highest vs lowest quartile were 1.08 [95% confidence interval (CI) = 1.02, 1.15] and 1.09 [95% CI = 1.02,1.16] for lifetime discrimination and burden of discrimination, respectively). Associations were slightly weakened after adjustment for body mass index and behavioral factors. No associations were observed for everyday discrimination. CONCLUSIONS Further understanding the role of perceived discrimination in the etiology of hypertension may be beneficial in eliminating hypertension disparities.
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Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39213, USA.
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143
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Gee GC, Walsemann KM, Brondolo E. A life course perspective on how racism may be related to health inequities. Am J Public Health 2012; 102:967-74. [PMID: 22420802 PMCID: PMC3483932 DOI: 10.2105/ajph.2012.300666] [Citation(s) in RCA: 300] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2011] [Indexed: 11/04/2022]
Abstract
Recent studies show that racism may influence health inequities. As individuals grow from infancy into old age, they encounter social institutions that may create new exposures to racial bias. Yet, few studies have considered this idea fully. We suggest a framework that shows how racism and health inequities may be viewed from a life course perspective. It applies the ideas of age-patterned exposures, sensitive periods, linked lives, latency period, stress proliferation, historic period, and cohorts. It suggests an overarching idea that racism can structure one's time in asset-building contexts (e.g., education) or disadvantaged contexts (e.g., prison). This variation in time and exposure can contribute to racial inequities in life expectancy and other health outcomes across the life course and over generations.
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Affiliation(s)
- Gilbert C Gee
- Department of Community Health Sciences, University of California, Los Angeles, CA, USA.
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144
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Brewis AA, Wutich A. Explicit versus implicit fat-stigma. Am J Hum Biol 2012; 24:332-8. [PMID: 22345092 DOI: 10.1002/ajhb.22233] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 12/12/2011] [Accepted: 12/17/2011] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Human biologists are increasingly engaging with current global trends toward obesity. However, little is considered about how variation in cultural views of "fat" might shape the biology of obesity, such as through pathways related to socially induced stress. Recent research indicates elevated levels of explicit fat-stigma in middle income nations, suggesting potentially high levels of psychosocial stress around "being fat." We use the case of Paraguay to test if high levels of explicit prejudice around "being fat" also suggest internalization of those ideas in ways that might predict stress effects. METHODS Using a sample of women in Paraguay (N = 200), we test if the statement of anti-fat beliefs on standard scales correlates with similarly strong level of cognitive bias against fat based on an implicit association test. We confirm reasonable comparability of the findings to prior published studies by collecting data for U.S. undergraduates (N = 66) using the same set of tools. RESULTS Women in Paraguay reveal high levels of explicit anti-fat bias in an interview on a standard (Attitudes to Obese People) scale, suggesting a shared cultural norm of fat-is-bad. However, Paraguayan women display, on average, no anti-fat stigma in cognitive testing. CONCLUSION In contrast to what has been observed in industrialized nations, the high levels of explicit fat-stigma does not necessarily correlate with high levels of implicit fat-stigma. This means that pathways between obesity, psychosocial stress, and health outcomes may be very different across socioecological contexts.
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Affiliation(s)
- Alexandra A Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe, 85284-2402, USA.
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Paradies YC, Cunningham J. The DRUID study: racism and self-assessed health status in an indigenous population. BMC Public Health 2012; 12:131. [PMID: 22333047 PMCID: PMC3305656 DOI: 10.1186/1471-2458-12-131] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 02/14/2012] [Indexed: 11/10/2022] Open
Abstract
Background There is now considerable evidence from around the world that racism is associated with both mental and physical ill-health. However, little is known about the mediating factors between racism and ill-health. This paper investigates relationships between racism and self-assessed mental and physical health among Indigenous Australians as well as potential mediators of these relationships. Methods A total of 164 adults in the Darwin Region Urban Indigenous Diabetes (DRUID) study completed a validated instrument assessing interpersonal racism and a separate item on discrimination-related stress. Self-assessed health status was measured using the SF-12. Stress, optimism, lack of control, social connections, cultural identity and reactions/responses to interpersonal racism were considered as mediators and moderators of the relationship between racism/discrimination and self-assessed health status. Results After adjusting for socio-demographic factors, interpersonal racism was significantly associated with the SF-12 mental (but not the physical) health component. Stress, lack of control and feeling powerless as a reaction to racism emerged as significant mediators of the relationship between racism and general mental health. Similar findings emerged for discrimination-related stress. Conclusions Racism/discrimination is significantly associated with poor general mental health among this indigenous population. The mediating factors between racism and mental health identified in this study suggest new approaches to ameliorating the detrimental effects of racism on health. In particular, the importance of reducing racism-related stress, enhancing general levels of mastery, and minimising negative social connections in order to ameliorate the negative consequences of racism.
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Affiliation(s)
- Yin C Paradies
- McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia.
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Harris R, Cormack D, Tobias M, Yeh LC, Talamaivao N, Minster J, Timutimu R. The pervasive effects of racism: Experiences of racial discrimination in New Zealand over time and associations with multiple health domains. Soc Sci Med 2012; 74:408-415. [DOI: 10.1016/j.socscimed.2011.11.004] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 09/09/2011] [Accepted: 11/01/2011] [Indexed: 11/27/2022]
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Lang T, Lepage B, Schieber AC, Lamy S, Kelly-Irving M. Social Determinants of Cardiovascular Diseases. Public Health Rev 2011. [DOI: 10.1007/bf03391652] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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