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Wang VHC, Cuevas AG, Osokpo OH, Chang JE, Zhang D, Hu A, Yun J, Lee A, Du S, Williams DR, Pagán JA. Discrimination in Medical Settings across Populations: Evidence From the All of Us Research Program. Am J Prev Med 2024; 67:568-580. [PMID: 38844146 DOI: 10.1016/j.amepre.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations. METHODS Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023-2024. RESULTS About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05. CONCLUSIONS The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the healthcare system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing healthcare disparities.
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Affiliation(s)
- Vivian Hsing-Chun Wang
- Department of Foundations of Medicine, Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine, New York, New York
| | - Adolfo G Cuevas
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York; Center for Anti-Racism, Social Justice and Public Health, New York University School of Global Public Health, New York, New York
| | - Onome Henry Osokpo
- Department of Population Health Nursing Science, University of Illinois College of Nursing, Chicago, Illinois
| | - Ji Eun Chang
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, New York
| | - Donglan Zhang
- Department of Foundations of Medicine, Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine, New York, New York; Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Anqing Hu
- Department of Civil and Engineering, Urban Systems Doctoral Program, New York University Tandon School of Engineering, Brooklyn, New York
| | - Jeongwook Yun
- Department of Biomedical Engineering, University of Texas at Austin Cockrell School of Engineering, Austin, Texas
| | - Adaora Lee
- Center for Anti-Racism, Social Justice and Public Health, New York University School of Global Public Health, New York, New York
| | - Shilei Du
- Department of Biostatistics, New York University School of Global Public Health, New York, New York
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of African and African American Studies, Harvard University, Cambridge, Massachusetts
| | - José A Pagán
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, New York.
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Wang VHC, Holm J, Pagán JA. Use of calibration to improve the precision of estimates obtained from All of Us data. J Am Med Inform Assoc 2024:ocae181. [PMID: 38981110 DOI: 10.1093/jamia/ocae181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/19/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVES To highlight the use of calibration weighting to improve the precision of estimates obtained from All of Us data and increase the return of value to communities from the All of Us Research Program. MATERIALS AND METHODS We used All of Us (2017-2022) data and raking to obtain prevalence estimates in two examples: discrimination in medical settings (N = 41 875) and food insecurity (N = 82 266). Weights were constructed using known population proportions (age, sex, race/ethnicity, region of residence, annual household income, and home ownership) from the 2020 National Health Interview Survey. RESULTS About 37% of adults experienced discrimination in a medical setting. About 20% of adults who had not seen a doctor reported being food insecure compared with 14% of adults who regularly saw a doctor. CONCLUSIONS Calibration using raking is cost-effective and may lead to more precise estimates when analyzing All of Us data.
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Affiliation(s)
- Vivian Hsing-Chun Wang
- Center for Population and Health Services Research, Department of Foundations of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, United States
| | - Julie Holm
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY 10003, United States
| | - José A Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY 10003, United States
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McNeil J, Clark KG, Adams WM, Pickett S, Propper CB, McCoy TP, Edwards KE, Exford TJ, Hemphill MA, Wideman L. Sleep, Health Outcomes and Body Weight (SHOW) study: a measurement burst design study on sleep and risk factors for obesity in black emerging adults in North Carolina, USA. BMJ Open 2024; 14:e087950. [PMID: 38977366 PMCID: PMC11256040 DOI: 10.1136/bmjopen-2024-087950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION Black emerging adults (18-28 years) have the highest risk of short sleep duration and obesity. This increased risk may be partly explained by greater stress levels, which may result from race-related stress (racial discrimination and heightened race-related vigilance) or living in more disadvantaged home and neighbourhood environments. Insufficient sleep may also impact obesity risk via several weight-related mechanisms including energy balance, appetite and food reward, cortisol profiles and hydration status. This paper describes the rationale, design and methods for the Sleep, Health Outcomes and Body Weight (SHOW) study. This study aims to prospectively assess the effects of sleep, race-related stress and home/neighbourhood environments on weight-related mechanisms and obesity markers (body weight, waist circumference and fat mass) in 150 black emerging adults. METHODS AND ANALYSIS The SHOW study follows a measurement burst design that includes 3, 7-day data collection bursts (baseline, 6-month and 12-month follow-ups). Sleep is measured with three methods: sleep diary, actigraphy and polysomnography. Energy balance over 7 days is based on resting and postprandial energy expenditure measured via indirect calorimetry, physical activity via accelerometry and self-reported and ad libitum energy intake methods. Self-reported methods and blood biomarkers assess fasting and postprandial appetite profiles and a behavioural-choice task measures food reward. Cortisol awakening response and diurnal cortisol profiles over 3 days are assessed via saliva samples and chronic cortisol exposure via a hair sample. Hydration markers are assessed with 24-hour urine collection over 3 days and fasting blood biomarkers. Race-related stress is self-reported over 7 days. Home and neighbourhood environments (via the Windshield Survey) is observer assessed. ETHICS AND DISSEMINATION Ethics approval was granted by the University of North Carolina at Greensboro's Institutional Review Board. Study findings will be disseminated through peer-reviewed publications, presentations at scientific meetings and reports, briefs/infographics for lay and community audiences.
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Affiliation(s)
- Jessica McNeil
- Department of Kinesiology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Krista G Clark
- Department of Kinesiology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - William M Adams
- Department of Kinesiology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
- Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, Colorado, USA
| | - Stephanie Pickett
- School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Cathi B Propper
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thomas P McCoy
- School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Kathleen E Edwards
- Department of Educational Leadership and Cultural Foundations, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - T J Exford
- Dayton Veterans Affairs Medical Center, Dayton, Ohio, USA
| | - Michael A Hemphill
- Department of Kinesiology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Laurie Wideman
- Department of Kinesiology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Sheehy S, Brock M, Palmer JR, Albert MA, Cozier Y, Rosenberg L. Perceived Interpersonal Racism in Relation to Incident Coronary Heart Disease Among Black Women. Circulation 2024; 149:521-528. [PMID: 38235551 PMCID: PMC10926238 DOI: 10.1161/circulationaha.123.066471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Racism is highly prevalent in the United States. Few data exist about whether perceived interpersonal racism is associated with risk of coronary heart disease (CHD). METHODS We followed 48 305 participants in the Black Women's Health Study through biennial mailed and Internet-based health questionnaires from 1997, when they provided information on perceived interpersonal racism and were free of cardiovascular disease and cancer, until the end of 2019. We averaged participant responses to 5 validated questions about perceived interpersonal racism in everyday activities, such as "people act as if they think you are dishonest." We summed the positive responses to 3 questions about perceived racism in interactions that involved jobs, housing, and police; scores ranged from 0 (no to all) to 3 (yes to all). CHD cases were defined as nonfatal myocardial infarctions confirmed through medical records, fatal cases identified through the National Death Index, and self-reported revascularization events. We used Cox proportional hazard models adjusting for major confounders to estimate hazard ratios (HRs). RESULTS During 22 years of follow-up, we identified 1947 incident CHD cases. For women who reported experiences of racism in employment, housing, or involving the police relative to women who reported no such experiences, the age-adjusted HR for CHD was 1.35 (95% CI, 1.13-1.61; Ptrend=0.006), and the multivariable HR for CHD was 1.26 (95% CI, 1.05-1.51; Ptrend=0.05). For women in the highest quartile of perceived interpersonal racism in daily life relative to women in the lowest quartile, the age-adjusted HR for CHD was 1.25 (95% CI, 1.07-1.46; Ptrend=0.006). After multivariable adjustment, the HR was attenuated and no longer statistically significant. CONCLUSIONS Perceived experiences of interpersonal racism in employment, in housing, and with the police were associated with higher incidence of CHD among Black women, whereas perceived racism in everyday life was not associated with higher risk.
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Affiliation(s)
| | | | | | | | - Yvette Cozier
- Slone Epidemiology Center at Boston University, Boston,
MA
- Boston University School of Public Health
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston,
MA
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Ruiz-Narváez EA, Cozier Y, Zirpoli G, Rosenberg L, Palmer JR. Perceived Experiences of racism in Relation to Genome-Wide DNA Methylation and Epigenetic Aging in the Black Women's Health Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01915-3. [PMID: 38324238 PMCID: PMC11303595 DOI: 10.1007/s40615-024-01915-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND African American women have a disproportionate burden of disease compared to US non-Hispanic white women. Exposure to psychosocial stressors may contribute to these health disparities. Racial discrimination, a major stressor for African American women, could affect health through epigenetic mechanisms. METHODS We conducted an epigenome-wide association study (EWAS) to examine the association of interpersonal racism (in daily life and in institutional settings) with DNA methylation in blood in 384 participants of the Black Women's Health Study (BWHS). We also evaluated whether a greater number of perceived experiences of racism was associated with epigenetic aging as measured using different methylation clocks. Models were adjusted for chronological age, body mass index, years of education, neighborhood SES, geographic region of residence, alcohol drinking, smoking, and technical covariates. RESULTS Higher scores of racism in daily life were associated with higher methylation levels at the cg04494873 site in chromosome 5 (β = 0.64%; 95% CI = 0.41%, 0.87%; P = 6.35E-08). We also replicated one CpG site, cg03317714, which was inversely associated with racial discrimination in a previous EWAS among African American women. In the BWHS, higher scores of racism in daily life were associated with lower methylation levels at that CpG site (β = -0.94%; 95% CI = -1.37%, -0.51%; P = 2.2E-05). Higher racism scores were associated with accelerated epigenetic aging in more than one methylation clock. CONCLUSIONS Exposure to discriminatory events may affect the epigenome and accelerate biological aging, which may explain in part the earlier onset of disease in African American women.
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Affiliation(s)
- Edward A Ruiz-Narváez
- Department of Nutritional Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, 1860 SPH I, Ann Arbor, MI, 48109, USA.
| | - Yvette Cozier
- Slone Epidemiology Center at, Boston University, Boston, MA, USA
| | - Gary Zirpoli
- Slone Epidemiology Center at, Boston University, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at, Boston University, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at, Boston University, Boston, MA, USA
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Fanton M, Rodrigues YE, Schuch I, de Lima Cunha CM, Pattussi MP, Canuto R. Direct and indirect associations of experience of racial discrimination, dietary patterns and obesity in adults from southern Brazil. Public Health Nutr 2024; 27:e60. [PMID: 38297464 PMCID: PMC10897576 DOI: 10.1017/s1368980024000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To analyse the direct and indirect associations of experience of racial discrimination on dietary patterns (DP), obesity and abdominal obesity. DESIGN This is a cross-sectional population-based study. The main exposure was self-reported experiences of racial discrimination (Experiences of Discrimination scale). The mediator variables were the DP: healthy, Brazilian traditional, sugar and carbohydrates, and fast food. The outcomes were obesity (BMI ≥ 30 kg/m2) and abdominal obesity (waist circumference ≥ 88 cm for women; ≥ 102 cm for men). Structural equation modelling was applied. SETTING Porto Alegre, Brazil. PARTICIPANTS Totally, 400 adults aged between 20 and 70 years were participated. RESULTS The mean age of participants was 47·2 years (sd = 13·9), and 75 % were women. Experiencing racial discrimination had a positive direct effect on obesity (healthy DP: β = 0·153, P < 0·05; Brazilian DP: β = 0·156, P < 0·05; sugar and carbohydrates DP: β = 0·156, P < 0·05; and fast-food DP: β = 0·153, P < 0·05) and abdominal obesity (healthy DP: β = 0·206, P < 0·01; Brazilian DP: β = 0·210, P < 0·01; sugar and carbohydrates DP: β = 0·204, P < 0·01; and fast-food DP: β = 0·204, P < 0·01). The experience of racial discrimination did not have a direct effect on DP, nor did it exert an indirect effect on obesity and abdominal obesity through any DP. CONCLUSIONS A higher experience of racial discrimination is associated with obesity and abdominal obesity, independent of diet.
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Affiliation(s)
- Marcos Fanton
- Postgraduate Program in Philosophy. Universidade Federal de Santa Maria. Santa Maria, RS, Brazil
| | - Ylana Elias Rodrigues
- Postgraduate Program in Nutrition Sciences. Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Ilaine Schuch
- Postgraduate Program in Food, Nutrition and Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Caroline Marques de Lima Cunha
- Postgraduate Program in Food, Nutrition and Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil
| | - Marcos Pascoal Pattussi
- Postgraduate Program in Collective Health, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | - Raquel Canuto
- Postgraduate Program in Food, Nutrition and Health, Faculty of Medicine, Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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Puklin LS, Li F, Cartmel B, Zhao J, Sanft T, Lisevick A, Winer EP, Lustberg M, Spiegelman D, Sharifi M, Irwin ML, Ferrucci LM. Post-diagnosis weight trajectories and mortality among women with breast cancer. NPJ Breast Cancer 2023; 9:98. [PMID: 38042922 PMCID: PMC10693588 DOI: 10.1038/s41523-023-00603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/16/2023] [Indexed: 12/04/2023] Open
Abstract
Weight gain after breast cancer diagnosis is associated with adverse health outcomes. Yet, few studies have characterized post-diagnosis weight change in the modern treatment era or populations most at risk for weight changes. Among women diagnosed with stages I-III breast cancer in the Smilow Care Network (2013-2019; N = 5441), we abstracted demographic and clinical characteristics from electronic health records and survival data from tumor registries. We assessed if baseline characteristics modified weight trajectories with nonlinear multilevel mixed-effect models. We evaluated body mass index (BMI) at diagnosis and weight change 1-year post-diagnosis in relation to all-cause and breast cancer-specific mortality with Cox proportional hazard models. Women had 34.4 ± 25.5 weight measurements over 3.2 ± 1.8 years of follow-up. Weight gain was associated with ER/PR-, HER2+ tumors, BMI ≤ 18.5 kg/m2, and age ≤ 45 years (+4.90 kg (standard error [SE] = 0.59), +3.24 kg (SE = 0.34), and +1.75 kg (SE = 0.10), respectively). Weight loss was associated with BMI ≥ 35 kg/m2 and age ≥ 70 years (-4.50 kg (SE = 0.08) and -4.34 kg (SE = 0.08), respectively). Large weight loss (≥10%), moderate weight loss (5-10%), and moderate weight gain (5-10%) 1-year after diagnosis were associated with higher all-cause mortality (hazard ratio [HR] = 2.93, 95% confidence interval [CI] = 2.28-3.75, HR = 1.32, 95% CI = 1.02-1.70 and HR = 1.39, 95% CI = 1.04-1.85, respectively). BMI ≥ 35 kg/m2 or BMI ≤ 18.5 kg/m2 at diagnosis were also associated with higher all-cause mortality. Weight change after a breast cancer diagnosis differed by demographic and clinical characteristics highlighting subgroups at-risk for weight change during a 5-year period post-diagnosis. Monitoring and interventions for weight management early in clinical care are important.
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Affiliation(s)
- Leah S Puklin
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA.
| | - Fangyong Li
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Brenda Cartmel
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
| | - Julian Zhao
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Tara Sanft
- Yale Cancer Center, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Alexa Lisevick
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
- Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Eric P Winer
- Yale Cancer Center, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Maryam Lustberg
- Yale Cancer Center, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Donna Spiegelman
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
| | - Mona Sharifi
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA
| | - Melinda L Irwin
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
| | - Leah M Ferrucci
- Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Yale Cancer Center, New Haven, CT, 06510, USA
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Rivera FB, Cha SW, Ansay MFM, Taliño MKV, Flores GP, Nguyen RT, Bonuel N, Happy Araneta MR, Volgman AS, Shah N, Vahidy F, Cainzos-Achirica M. Cardiovascular disease in Filipino American men and women: A 2023 update. Am Heart J 2023; 266:1-13. [PMID: 37544493 DOI: 10.1016/j.ahj.2023.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/15/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
With more than 4.2 million people, Filipino Americans are the third largest Asian group in the US and the largest Southeast Asian group in the country. Despite relatively favorable average socioeconomic indicators compared to the general US population, Filipino Americans face a significant burden of traditional cardiovascular risk factors, particularly among men. Moreover, Filipino Americans have high rates of cardiovascular death, often occurring at a younger age compared to other minority groups and Non-Hispanic White adults. In view of these trends, in 2010 the American Heart Association designated Filipino Americans as a high cardiovascular risk group. Despite this, in 2023, Filipino Americans remain underrepresented in landmark cardiovascular cohort studies and are often over looked as a group at increased cardiovascular risk. In this updated narrative review, we summarize the current state of knowledge about the burden of cardiovascular risk factors and diseases experienced by the Filipino American population. Our aim is to inform enhanced clinical, population, and policy-level prevention interventions and boost research in this space.
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Affiliation(s)
| | | | | | | | | | - Ryan T Nguyen
- Department of Medicine, Houston Methodist, Houston, TX
| | | | | | | | - Nilay Shah
- Blum Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Farhaan Vahidy
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
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Palmer JR, Cozier YC, Rosenberg L. Research on Health Disparities: Strategies and Findings From the Black Women's Health Study. Am J Epidemiol 2023; 192:1806-1810. [PMID: 35136921 PMCID: PMC11004793 DOI: 10.1093/aje/kwac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 01/10/2023] Open
Abstract
The American Journal of Epidemiology has been a platform for findings from the Black Women's Health Study (BWHS) that are relevant to health disparities. Topics addressed have included methods of follow-up of a large cohort of Black women, disparities in health-care delivery, modifiable risk factors for health conditions that disproportionately affect Black women, associations with exposures that are highly prevalent in Black women, and methods for genetic research. BWHS papers have also highlighted the importance of considering social context, including perceived experiences of racism, in understanding health disparities. In the future, BWHS investigators will contribute to documentation of the role that structural racism plays in health disparities.
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Affiliation(s)
| | | | - Lynn Rosenberg
- Correspondence to Dr. Lynn Rosenberg, Slone Epidemiology Center at Boston University, 72 East Concord Street L7, Boston, MA 02118 (e-mail: )
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10
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Davidson JC, Kent BV, Cozier YC, Kanaya AM, Warner ET, Eliassen AH, Williams DR, Shields AE. "Does Religious Service Attendance Modify the Relationship between Everyday Discrimination and Risk of Obesity? Results from the Study on Stress, Spirituality and Health". J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01765-5. [PMID: 37921946 PMCID: PMC11065965 DOI: 10.1007/s40615-023-01765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 07/18/2023] [Accepted: 08/15/2023] [Indexed: 11/05/2023]
Abstract
This study examined the association of everyday discrimination with risk of obesity and the potential modifying effect of religious service attendance. Participants included Black, South Asian, and white women in three cohort studies that belong to the Study on Stress, Spirituality and Health. Logistic regression models estimated odds of obesity classification (BMI ≥ 30) relative to experiences of everyday discrimination. In initial pooled analyses, high levels of discrimination were related to increased odds of obesity. Race-specific analyses revealed marginal associations for white and South Asian women. Among Black women, high levels of discrimination and religious service attendance were both associated with higher odds of obesity. However, among women who attended religious services frequently, higher levels of everyday discrimination were associated with slightly lower odds of obesity. These findings underline the complex association between obesity and religion/spirituality, suggesting that higher levels of discrimination may uniquely activate religious resources or coping strategies. Findings highlight the need for additional studies to examine the impact of everyday discrimination on risk of obesity across racial/ethnic communities and how religious practices or coping strategies might affect these dynamics.
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Affiliation(s)
- James Clark Davidson
- Massachussetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Westmont College, Santa Barbara, CA, USA.
| | - Blake Victor Kent
- Massachussetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Westmont College, Santa Barbara, CA, USA
| | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Alka M Kanaya
- University of California San Francisco, San Francisco, CA, USA
| | - Erica T Warner
- Massachussetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - A Heather Eliassen
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | | | - Alexandra E Shields
- Massachussetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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11
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Sheehy S, Aparicio HJ, Palmer JR, Cozier Y, Lioutas VA, Shulman JG, Rosenberg L. Perceived Interpersonal Racism and Incident Stroke Among US Black Women. JAMA Netw Open 2023; 6:e2343203. [PMID: 37948073 PMCID: PMC10638652 DOI: 10.1001/jamanetworkopen.2023.43203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/04/2023] [Indexed: 11/12/2023] Open
Abstract
Importance Black individuals in the US experience stroke and stroke-related mortality at younger ages and more frequently than other racial groups. Studies examining the prospective association of interpersonal racism with stroke are lacking. Objective To examine the association of perceived interpersonal racism with incident stroke among US Black women. Design, Setting, and Participants The Black Women's Health Study, a prospective cohort study of 59 000 Black women from across the US, assessed the longitudinal association between perceived interpersonal racism and stroke incidence. Stroke-free participants were followed up from 1997 until onset of stroke, death, loss to follow-up, or the end of the study period (December 31, 2019). Cox models were used to estimate hazard ratios (HRs) and 95% CIs, adjusting for major confounders, including education, neighborhood socioeconomic environment, and cardiometabolic factors. Data analysis was performed from March 2021 until December 2022. Exposure On a questionnaire completed in 1997, participants reported experiences of racism in everyday life and when dealing with situations that involved employment, housing, and interactions with police. Main Outcomes and Measures Strokes were identified through self-report on biennial questionnaires, medical records adjudication, and linkage with the National Death Index. Results In 1997, 48 375 Black women (mean [SD] age, 41 [10] years) provided information on perceived interpersonal racism and were free of cardiovascular disease and cancer. During the 22 years of follow-up, 1664 incident stroke cases were identified; among them, 550 were definite cases confirmed by neurologist review and/or National Death Index linkage. Multivariable HRs for reported experiences of racism in all 3 domains of employment, housing, and interactions with police vs no such experiences were 1.38 (95% CI, 1.14-1.67), a 38% increase, for all incident cases and 1.37 (95% CI, 1.00-1.88) for definite cases. For comparisons of women in the highest quartile of everyday interpersonal racism score vs women in the lowest quartile, multivariable HRs were 1.14 (95% CI, 0.97-1.35) for analyses that included all incident stroke and 1.09 (95% CI, 0.83-1.45) for analyses that included definite cases only. Conclusions and Relevance In this study, Black women who reported experiences of interpersonal racism in situations involving employment, housing, and interactions with police appeared to have an increased risk of stroke, even after accounting for demographic and vascular risk factors, suggesting that the high burden of racism experienced by Black US women may contribute to racial disparities in stroke incidence.
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Affiliation(s)
- Shanshan Sheehy
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Hugo J. Aparicio
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Boston Medical Center, Boston, Massachusetts
- Boston University Center for Antiracist Research, Boston, Massachusetts
| | - Julie R. Palmer
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Yvette Cozier
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
- Boston University School of Public Health, Boston, Massachusetts
| | | | - Julie G. Shulman
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Boston Medical Center, Boston, Massachusetts
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
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12
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Machado AV, Camelo LV, Menezes STD, Guimarães JMN, Chor D, Griep RH, Matos SMAD, Molina MDCB, Giatti L, Barreto SM. Racial discrimination predicts the increase in body weight and BMI in Black individuals from ELSA-Brasil cohort. CIENCIA & SAUDE COLETIVA 2023; 28:1655-1662. [PMID: 37255143 DOI: 10.1590/1413-81232023286.14992022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/29/2022] [Indexed: 06/01/2023] Open
Abstract
We investigated whether racial discrimination accelerates the weight and Body Mass Index (BMI) gain in Blacks and Browns participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in four years of follow-up. We compared body weight and BMI between the 1st (2008-2010) and 2nd visit (2012-2014) of 5,983 Blacks and Browns participants. Exposure to racial discrimination and covariates (age, sex, education, and research center) were obtained at the 1st visit. Linear mixed effects models stratified by race/skin color were used. Report of racial discrimination was more frequent among Blacks (32.1%) than Browns (6.3%). During the follow-up period, Blacks and Browns gained an average of 1.4kg and 1.2kg, respectively. This increase was greater among those who reported discrimination when compared to those who did not, both in Blacks (2.1kg vs.1.0kg, p < 0.001) and Browns (1.9kg vs. 1.1kg, p < 0.05). The results of the interaction between racial discrimination and time showed that Blacks, but not Browns, who reported racial discrimination had greater weight and BMI gains between visits. Our results suggest that reducing racial discrimination would contribute to prevent and/or control obesity increase in the country.
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Affiliation(s)
- Amanda Viana Machado
- Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo HorizonteMG Brasil
| | - Lidyane V Camelo
- Escola de Medicina e Hospital de Clínicas da Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190. 30130-100 Belo Horizonte MG Brasil.
| | - Sara Teles de Menezes
- Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo HorizonteMG Brasil
| | - Joanna M N Guimarães
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Dora Chor
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Rosane Harter Griep
- Laboratório de Educação em Saúde e Meio Ambiente, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | | | - Maria Del Carmen Bisi Molina
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo. Programa de Pós-Graduação em Nutrição e Saúde da Universidade Federal de Ouro Preto. Vitória ES Brasil
| | - Luana Giatti
- Escola de Medicina e Hospital de Clínicas da Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190. 30130-100 Belo Horizonte MG Brasil.
| | - Sandhi Maria Barreto
- Escola de Medicina e Hospital de Clínicas da Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190. 30130-100 Belo Horizonte MG Brasil.
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13
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Nightingale H, Mnatzaganian G, Hooker L, Barrett S, Kingsley M. The effect of motivational interviewing and/or cognitive behaviour therapy techniques on gestational weight gain - a systematic review and meta-analysis. BMC Public Health 2023; 23:626. [PMID: 37005572 PMCID: PMC10067184 DOI: 10.1186/s12889-023-15446-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/15/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Women with gestational weight gain (GWG) that is below or above recommendations are at risk of adverse perinatal outcomes. Motivational interviewing and/or cognitive behaviour therapy have demonstrated efficacy in initiating and sustaining behaviour change, including weight control. The objective of this review was to investigate the effect of antenatal interventions that include components of motivational interviewing and/or cognitive behaviour therapy on gestational weight gain. METHODS This review was designed and reported in accordance with guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Five electronic databases were systematically searched to March 2022. Randomised controlled trials evaluating interventions with identified components of motivational interviewing and/or cognitive behaviour therapies were included. Pooled proportions of appropriate GWG and GWG above or below guidelines, and standardised mean difference for total gestational weight gain, were calculated. Risk of bias in included studies was evaluated using the Risk of Bias 2 tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. RESULTS Twenty-one studies (8030 participants) were included. Overall, MI and/or CBT interventions had a small effect on the total gestational weight gain (SMD: -0.18, 95% confidence interval: -0.27 to -0.09, p < 0.001) and improved the proportion of women achieving recommended gestational weight gain (29% versus 23% in the comparison, p < 0.001). The GRADE assessment indicated that overall quality of evidence is very uncertain, however sensitivity analyses to account for high risk of bias produced similar results to original meta-analyses. The magnitude of effect was greater in women with overweight or obesity when compared to women with BMI < 25 kg/m2. CONCLUSION Motivational interviewing and/or cognitive behaviour therapy techniques may be effective for promoting healthy gestational weight gain. Nevertheless, a high proportion of women do not achieve recommended gestational weight gain. Future interventions should consider factors, including clinician and consumer perspectives, in the design and delivery of psychosocial interventions that aim to support healthy gestational weight gain. TRIAL REGISTRATION The protocol for this review was registered with the PROSPERO International register of systematic reviews (registration number CRD42020156401).
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Affiliation(s)
- Helen Nightingale
- Rural Department of Nursing & Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Australia.
| | - George Mnatzaganian
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Leesa Hooker
- Rural Department of Nursing & Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
| | - Stephen Barrett
- Research and Innovation, Bendigo Health, Bendigo, Australia
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Michael Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
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14
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Fields ND, VanKim NA, Whitcomb BW, Bertone-Johnson ER, Martínez AD, Chae DH. Racism-Related Experiences and Adiposity: Findings From the Black Women's Experiences Living With Lupus (BeWELL) Study. Womens Health Issues 2023; 33:153-159. [PMID: 36319516 PMCID: PMC10010936 DOI: 10.1016/j.whi.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Studies suggest that higher rates of excess adiposity in Black women may in part be driven by experiences of racism. Racial microaggressions, which include unintentional and subtle slights and insults, and responses to racism such as racism-related vigilance, may contribute to adiposity in this population. This study examined these understudied racism-related facets as well as interpersonal racial discrimination in relation to adiposity in a cohort of Black women with systemic lupus erythematosus. METHODS Data are from the Black Women's Experiences Living with Lupus (BeWELL) Study (2015-2017; n = 432). Linear regression was used to examine adiposity measures (body mass index [BMI], percent body fat, and waist-to-hip ratio), measured during a physical examination, in relation to self-reported measures of racial microaggressions, racism-related vigilance, and interpersonal racial discrimination. RESULTS Compared with infrequent microaggressions, very frequent experiences of microaggressions were associated with 2.9 kg/m2 higher BMI (95% confidence [CI], 0.63-5.21) and 2.6% higher body fat (95% CI, 0.32-4.80) after adjusting for covariates. Racism-related vigilance, measured continuously, was positively associated with BMI (b = 0.84; 95% CI-0.08, 1.61) and percent body fat (b = 0.89; 95% CI, 0.14-1.64). Very frequent experiences of everyday discrimination were associated with a higher BMI (b = 2.70; 95% CI, 0.58-4.83) and waist-to-hip ratio (b = 0.32; 95% CI, 0.09-0.55) compared with less frequent everyday discrimination. CONCLUSIONS Our results suggest that various dimensions of racism are associated with excess adiposity. Efforts to address obesity among Black women with systemic lupus erythematosus should consider these multiple aspects to decrease racial inequities in adiposity.
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Affiliation(s)
- Nicole D Fields
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Nicole A VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts; Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Airín D Martínez
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - David H Chae
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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15
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Hyer S, Vaughan S, Davis JW, Xie R, Misra D, Giurgescu C. The Association of Avoidance Coping with Gestational Weight Gain among Pregnant Black Women. West J Nurs Res 2023; 45:226-233. [PMID: 36196018 PMCID: PMC10165848 DOI: 10.1177/01939459221127800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gestational weight gain (GWG) outside recommended parameters can lead to pregnancy or birth complications. Avoidance coping may influence GWG. We examined the association of avoidance coping with GWG among a sample of 112 pregnant Black women in the Midwest. Participants completed avoidance coping questionnaires at three time points throughout pregnancy. Data were abstracted from medical records for BMI and GWG. Overall, 23.2% gained inadequate weight, 30.4% adequate weight, and 46.4% excess weight. Multinomial logistic regression models indicated associations between avoidance coping and GWG adjusted for covariates. Participants with higher avoidance coping scores at 22-29 weeks' gestation were more likely to experience excess weight gain (odds ratio [OR] = 1.19, 95% CI [1.02, 1.37]). Participants with higher avoidance coping scores at 30-36 weeks' gestation were less likely to experience excess weight gain, (OR = 0.82, 95% CI [0.72, 0.93]). The impact of higher avoidance coping on excess weight gain depends on the time period in pregnancy.
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Affiliation(s)
- Suzanne Hyer
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Sarah Vaughan
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Jean W Davis
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Rui Xie
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, USA
| | - Dawn Misra
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL, USA
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16
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Park HJ, Francisco SC, Pang MR, Peng L, Chi G. Exposure to anti-Black Lives Matter movement and obesity of the Black population. Soc Sci Med 2023; 316:114265. [PMID: 34366168 PMCID: PMC10120863 DOI: 10.1016/j.socscimed.2021.114265] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 01/11/2023]
Abstract
RATIONALE Black Lives Matter (BLM) is a social movement against systematic injustice and police violence toward Black people whose goal is to ensure their safety and the expression of their culture. As BLM gained momentum, counter-movements emerged, such as All Lives Matter (ALM), White Lives Matter (WLM), and Blue Lives Matter (BlueLM). Because they undermine support for Black people's safety and culture, exposure to stances against BLM can be a race-related stressor. Although the perception of racial discrimination has been associated with negative health outcomes in Black people, it is not clear whether exposure to negative stances on a race-related social issue is associated with worse health outcomes. OBJECTIVE We investigated whether living in areas of the United States with a high prevalence of negative stances on BLM is associated with worse health outcomes, such as higher body mass index (BMI) and prevalence of obesity. METHODS We scraped geo-coded tweets (N = 51,020) that contained #BLM, #ALM, #WLM, and #BlueLM from 2014 to 2016. We determined the stances of the tweets on BLM using machine learning algorithms and aggregated stances at the metropolitan or micropolitan statistical area (MMSA) levels. Participants' BMI and obesity status were derived from the 2017 BRFSS SMART data in 76 MMSAs, as compiled by the Centers for Disease Control and Prevention (N = 20,530). RESULTS After controlling for individual- and regional-level covariates, regional measures of racism and police brutality rate, and baseline BMI in 2014 aggregated on MMSA level, Black people had a higher BMI and prevalence of obesity in areas that showed higher negative stances on BLM. Stances against BLM were positively associated with implicit racism against Black people and can be an acute race-related stressor associated with negative downstream health outcomes. CONCLUSION Negative societal sentiments around race-related issues may be detrimental to the health outcomes of minority populations.
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Affiliation(s)
- Hyun Joon Park
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Sara Chari Francisco
- Department of Sociology, The Pennsylvania State University, University Park, PA, USA
| | - M Rosemary Pang
- Department of Political Science, The Pennsylvania State University, University Park, PA, USA
| | - Lulu Peng
- School of Journalism and Information Communication, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Guangqing Chi
- Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, University Park, PA, USA
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17
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Bell CN, Robles B, Singleton CR, Thomas Tobin CS, Spears EC, Thorpe RJ. Association between Proximity to Food Sources and Dietary Behaviors in Black and White College Graduates. Am J Health Behav 2022; 46:515-527. [PMID: 36333832 DOI: 10.5993/ajhb.46.5.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Unequal access to healthy food environments is often implicated in racial inequities in health and behaviors that are largest among college graduates. The aim of this study was to determine associations between perceived proximity to food sources and dietary behaviors between black and white college graduates. METHODS In a cross-sectional online survey of dietary behaviors between black and white adults who have a ≥ 4-year bachelor's degree, respondents were asked how long it typically takes for them to get to grocery stores and fast-food restaurants from home. We used ordinal logit regression models to assess associations between perceived proximity to food sources and dietary behaviors. RESULTS Among black men, perceiving that a grocery store was ≥ 10 minutes from their home was associated with lower fruit consumption (beta=-0.94, SE=0.48). Perceiving that a grocery store was ≥ 10 minutes from their home was associated with more frequent fast-food consumption among black men (beta=1.21, SE=0.39), Black women (beta=0.98, SE=0.34), and white men (beta=0.74, SE=0.30). CONCLUSIONS The associations between perceived proximity to food sources and dietary behaviors differ by race and sex among college graduates with important implications for racial disparities in diet quality and obesity across SES.
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Affiliation(s)
- Caryn N Bell
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Brenda Robles
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Courtney S Thomas Tobin
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Erica C Spears
- Louisiana Public Health Institute, New Orleans, LA, United States
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, and Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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18
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Miller HN, Perrin N, Thorpe RJ, Evans MK, Zonderman AB, Allen J. The Association Between Perceived Discrimination and BMI Trajectory: A Prospective Study of African American and White Adults. FAMILY & COMMUNITY HEALTH 2022; 45:206-213. [PMID: 35385415 PMCID: PMC9156529 DOI: 10.1097/fch.0000000000000326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Evidence suggests that socioenvironmental stressors, such as discrimination, may serve as determinants of the ongoing obesity epidemic and persisting disparities in obesity prevalence. The objectives of these analyses were to examine whether perceived discrimination was associated with body mass index (BMI) trajectory and whether this relationship differed by race or sex. Data for these analyses came from the Healthy Aging in Neighborhoods of Diversity across the Life Span study, a prospective cohort study in Baltimore City. Mixed-effects linear regression was used in a sample of 1962 African American and white adults to test our hypotheses. We found that race was an effect modifier in the relationship between perceived discrimination and BMI trajectory (B = 0.063, P = .014). Specifically, higher baseline perceived discrimination was associated with positive BMI trajectory in African American adults (B = 0.031, P = .033) but not in white adults (B = -0.032 P = .128). In this longitudinal study of African American and white adults, the relationship between perceived discrimination and BMI trajectory differed by race. Future research should be conducted in diverse samples to understand the risk socioenvironmental stressors pose on the development and progression of overweight and obesity, in addition to how these differ in subgroups.
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Affiliation(s)
- Hailey N Miller
- School of Nursing, Duke University, Durham, North Carolina (Dr Miller); School of Nursing (Drs Perrin and Allen) and Bloomberg School of Public Health (Dr Thorpe), Johns Hopkins University, Baltimore, Maryland; and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland (Drs Evans and Zonderman)
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19
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Kiplagat K, Antoine F, Ramos R, Nahid M, Forte V, Taiwo E, Godfrey K, Butryn M, Phillips E. An Acceptance Based Lifestyle Intervention in Black Breast Cancer Survivors with Obesity. J Immigr Minor Health 2022; 24:645-655. [PMID: 34355298 PMCID: PMC11290457 DOI: 10.1007/s10903-021-01261-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/01/2022]
Abstract
To assess the feasibility and early efficacy of a combined lifestyle and acceptance-based therapy (ABT) intervention on weight loss at 16 weeks among Black breast cancer (BC) survivors with obesity. Thirty black breast cancer survivors with a BMI ≥ 30 kg/m2 at least 6 months post-treatment were enrolled. Outcomes included feasibility process measures, physical well-being assessed using the subscale of QOL-Breast Cancer (QOL-BC), physical activity assessed by Global Physical Activity Questionnaire (GPAQ), and weight. Fisher's Exact/Chi-Squared tests and Wilcoxon rank-sum tests were used to explore differences between responders and non-responders, as well as within-group changes during the intervention. Within the first 4 weeks, responders (participants who lost any weight) lost a median of 2.6 lbs. compared to non-responders (no weight loss) who gained a median of 2.6 lbs. At 16 weeks, participants reported greater physical well-being (p < 0.0001), increased time in recreational activities (p = 0.03), and a median weight loss of 5.6 pounds in responders vs. 0.7 pounds in non-responders (p ≤ 0.001). Non-responders were more likely to have developed a new health condition compared to responders (44% vs. 0%; p = 0.014). In this study, weight loss at 4 weeks and new-onset health conditions were significant factors associated with non-response to the combined intervention. Black BC with obesity are at high risk for recurrent cancer and secondary health conditions. ABT may be a suitable adjunct therapeutic option to lifestyle interventions implemented soon after a cancer diagnosis to improve physical well-being, increase physical activity, and promote weight loss.
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Affiliation(s)
- Kimberly Kiplagat
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Francesse Antoine
- Division of General Internal Medicine, Department of Medicine Weill Cornell, New York, USA
| | - Rosio Ramos
- Division of General Internal Medicine, Department of Medicine Weill Cornell, New York, USA
| | - Musarrat Nahid
- Division of General Internal Medicine, Department of Medicine Weill Cornell, New York, USA
| | - Victoria Forte
- Division of Hematology-Oncology, King's County Hospital Center, New York, USA
| | - Evelyn Taiwo
- Division of Hematology-Oncology, Department of Medicine Weill Cornell, New York, USA
| | - Kathryn Godfrey
- Department of Psychology, Drexel University, Philadelphia, USA
| | - Meghan Butryn
- Department of Psychology, Drexel University, Philadelphia, USA
| | - Erica Phillips
- Division of General Internal Medicine, Department of Medicine Weill Cornell, New York, USA.
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, USA.
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20
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Mackey ER, Burton ET, Cadieux A, Getzoff E, Santos M, Ward W, Beck AR. Addressing Structural Racism Is Critical for Ameliorating the Childhood Obesity Epidemic in Black Youth. Child Obes 2022; 18:75-83. [PMID: 34491828 DOI: 10.1089/chi.2021.0153] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.
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Affiliation(s)
- Eleanor R Mackey
- Children's National Hospital, Center for Translational Research, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Adelle Cadieux
- Department of Behavioral Health, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, Lansing MI, USA
| | - Elizabeth Getzoff
- Department of Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - Melissa Santos
- Division of Pediatric Psychology, Connecticut Children's, Hartford, CT, USA
| | - Wendy Ward
- Department of Pediatrics, College of Medicine, University of Arkansas Medical Center, Little Rock, AR, USA
| | - Amy R Beck
- Center for Children's Healthy Lifestyles and Nutrition and Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA
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21
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Lee SY, Agocha VB, Hernandez PR, Park CL, Williams M, Carney LM. Coping styles moderate the relationship between perceived discrimination and eating behaviors during the transition to college. Appetite 2022; 168:105699. [PMID: 34543691 PMCID: PMC8671288 DOI: 10.1016/j.appet.2021.105699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023]
Abstract
The transition to college is a critical developmental window during which eating behaviors are susceptible to dysregulation. Changes in exposure to discrimination contribute to alterations in eating behaviors, which may be exacerbated or attenuated by coping styles. The present longitudinal study examines whether increases in perceived discrimination predict increases in overeating and decreases in eating well during the transition to college. We expect that adaptive coping styles will buffer against, while maladaptive coping styles will exacerbate, the effects of increases in perceived discrimination on increases in overeating and decreases in eating well. First year students (n = 804) were assessed at two time points: the spring before freshman year (Time 1) and one year later during the spring semester of freshman year (Time 2). Two distinct coping styles emerged from a factor analysis: adaptive (active coping, planning, emotional support, positive reframing, acceptance, instrumental support) and maladaptive coping (denial, venting, self-blame, self-distraction). Increases in perceived discrimination, lower adaptive coping, and higher maladaptive coping had main effects for predicting more overeating at Time 2. Among students who reported increases in perceived discrimination, higher use of adaptive coping was associated with less overeating at Time 2 while higher use of maladaptive coping was associated with more overeating. While adaptive and maladaptive coping styles had main effects on eating well, change in perceived discrimination did not. Neither adaptive nor maladaptive coping styles interacted with change in perceived discrimination to predict eating well. Findings inform a gap in the literature about the relationship between discrimination and eating behaviors from a developmental perspective by demonstrating that adaptive and maladaptive coping styles influence the effects of changes in perceived discrimination on overeating during the college transition.
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Affiliation(s)
- Sharon Y. Lee
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020
| | - V. Bede Agocha
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020
| | - Paul R. Hernandez
- Department of Teaching, Learning, and Culture, Texas A&M University, 308 Harrington Tower, College Station, TX, 77843
| | - Crystal L. Park
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020
| | - Michelle Williams
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020
| | - Lauren M. Carney
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020
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22
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Barber LE, Zirpoli GR, Cozier YC, Rosenberg L, Petrick JL, Bertrand KA, Palmer JR. Neighborhood disadvantage and individual-level life stressors in relation to breast cancer incidence in US Black women. Breast Cancer Res 2021; 23:108. [PMID: 34809694 PMCID: PMC8609879 DOI: 10.1186/s13058-021-01483-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on psychosocial stress and risk of breast cancer has produced conflicting results. Few studies have assessed this relation by breast cancer subtype or specifically among Black women, who experience unique chronic stressors. METHODS We used prospective data from the Black Women's Health Study, an ongoing cohort study of 59,000 US Black women, to assess neighborhood- and individual-level psychosocial factors in relation to risk of breast cancer. We used factor analysis to derive two neighborhood score variables after linking participant addresses to US Census data (2000 and 2010) on education, employment, income and poverty, female-headed households, and Black race for all households in each residential block group. We used Cox proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for established breast cancer risk factors. RESULTS During follow-up from 1995 to 2017, there were 2167 incident invasive breast cancer cases (1259 estrogen receptor positive (ER +); 687 ER negative (ER-)). For ER- breast cancer, HRs were 1.26 (95% CI 1.00-1.58) for women living in the highest quartile of neighborhood disadvantage relative to women in the lowest quartile, and 1.24 (95% CI 0.98-1.57) for lowest versus highest quartile of neighborhood socioeconomic status (SES). For ER+ breast cancer, living in the lowest quartile of neighborhood SES was associated with a reduced risk of ER+ breast cancer (HR = 0.83, 95% CI 0.70-0.98). With respect to individual-level factors, childhood sexual abuse (sexual assault ≥ 4 times vs. no abuse: HR = 1.35, 95% CI 1.01-1.79) and marital status (married/living together vs. single: HR = 1.29, 95% CI 1.08-1.53) were associated with higher risk of ER+, but not ER- breast cancer. CONCLUSION Neighborhood disadvantage and lower neighborhood SES were associated with an approximately 25% increased risk of ER- breast cancer in this large cohort of Black women, even after control for multiple behaviors and lifestyle factors. Further research is need to understand the underlying reasons for these associations. Possible contributing factors are biologic responses to the chronic stress/distress experienced by individuals who reside in neighborhoods characterized by high levels of noise, crime and unemployment or the direct effects of environmental toxins.
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Affiliation(s)
- Lauren E Barber
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center at Boston University, 72 East Concord Street, L-7, Boston, MA, 02118, USA
| | - Gary R Zirpoli
- Slone Epidemiology Center at Boston University, 72 East Concord Street, L-7, Boston, MA, 02118, USA
| | - Yvette C Cozier
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center at Boston University, 72 East Concord Street, L-7, Boston, MA, 02118, USA
| | - Lynn Rosenberg
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center at Boston University, 72 East Concord Street, L-7, Boston, MA, 02118, USA
| | - Jessica L Petrick
- Slone Epidemiology Center at Boston University, 72 East Concord Street, L-7, Boston, MA, 02118, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kimberly A Bertrand
- Slone Epidemiology Center at Boston University, 72 East Concord Street, L-7, Boston, MA, 02118, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, 72 East Concord Street, L-7, Boston, MA, 02118, USA. .,Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
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23
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Bell CN, Thomas Tobin CS, Robles B, Spears EC, Thorpe RJ. Familial Financial Assistance and Body Mass Index in Black College Graduates. J Racial Ethn Health Disparities 2021; 9:1850-1860. [PMID: 34363186 DOI: 10.1007/s40615-021-01122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 11/27/2022]
Abstract
Racial disparities in obesity are larger between Black and White college graduates compared to disparities among those who did not complete high school. A possible explanation is that Black adults with higher socioeconomic status (SES) experience unique obesogenic determinants. Black adults who have completed a 4-year college degree can report "uplift stress" from providing financial assistance to family members. The aim of this study is to determine whether the association between familial financial assistance and body mass index (BMI) varies among college-educated Black women and men. This study utilized data from an online survey of Qualtrics standing panels including 451 non-Hispanic Black college graduates. Respondents were asked if they had provided or received any monetary gift or financial help from a family member in the past 12 months as well as their height and weight. Using linear regression and multiplicative interaction terms, the association between familial financial assistance and BMI was assessed by sex. Those who reported both giving and receiving familial financial assistance had higher BMI than those who neither gave nor received assistance (β = 2.80, standard error (s.e.) = 1.16). There was a significant interaction such that this association was observed among women only (β = 6.67, s.e. = 2.32). Future studies should seek to understand the gendered impact of familial financial assistance on BMI in college-educated Black women.
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Affiliation(s)
- Caryn N Bell
- Department of Social, Behavioral and Population Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, 70112, USA.
| | - Courtney S Thomas Tobin
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Brenda Robles
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | | | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Baltimore, MD, USA.,Program for Research On Men's Health, Nashville, TN, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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24
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Tyler KM, Stevens-Watkins D, Burris JL, Fisher SD, Hargons CN. Black Psychology and Whiteness: Toward a Conceptual Model of Black Trauma through the Prism of Whiteness. JOURNAL OF BLACK PSYCHOLOGY 2021. [DOI: 10.1177/00957984211034948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main objective of this article is to introduce and examine whiteness as a source of trauma for Black people. We explore Black psychology scholarship to conceptually ground whiteness as the impetus for racism, while identifying it as an interpersonal, psychosocial, and contextual phenomenon that informs the race-based traumatic experiences of Black people. The primary factors constituting whiteness are ethnocentric monoculturalism, White standardization, ontological expansiveness, White emotions, attitudes, reactions to race, and White privilege. While racism operates through oppression and exclusion to produce trauma among Black people, we argue that whiteness operates similarly to produce race-based traumatic stress. With this premise, we offer and explain a conceptual model to promote empirical research that identifies and operationalizes whiteness and its components as observable contributors to the traumatic experiences of Black persons.
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25
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Machado AV, Camelo LV, Chor D, Griep RH, Guimarães JMN, Giatti L, Barreto SM. Racial inequality, racial discrimination and obesity incidence in adults from the ELSA-Brasil cohort. J Epidemiol Community Health 2021; 75:695-701. [PMID: 33419789 DOI: 10.1136/jech-2020-214740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study investigated whether self-reported race/skin colour and perceived racial discrimination predict higher obesity incidence after approximately 4-year follow-up of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We also investigated whether these associations are modified by educational level. METHODS Following exclusion of individuals defined as obese (body mass index ≥30 kg/m2) at baseline, associations between race/skin colour and obesity incidence between the first (2008-2010) and second (2012-2014) visits were investigated in 10 130 participants. Next, associations between perceived racial discrimination and obesity incidence among black (n=1532) and brown (n=2958) individuals were investigated separately. Racial discrimination (yes/no) was assessed using the Lifetime Major Event Scale. Logistic regression models adjusted for age, sex and research site were used. All analyses were stratified for educational level. RESULTS Obesity risk was higher in Blacks with high education compared with white individuals to the same education level (OR: 2.22; 95% CI 1.62 to 3.04) following adjustments. After adjustments, obesity incidence was higher among black individuals reporting racial discrimination compared with peers who did not report this experience, but only among the low education group (OR: 1.64; 95% CI 1.08 to 2.51). No statistical association with perceived discrimination was observed among brown individuals. CONCLUSION Results are congruent with findings from other studies reporting associations between racial inequality and obesity incidence and also suggest racial discrimination may be one of the mechanisms leading to such inequalities. Also, it supports the paradox theory by which education modify the association in distinct directions.
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Affiliation(s)
- Amanda Viana Machado
- Postgraduate Program in Public Health, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lidyane V Camelo
- Department of Preventive and Social Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Dora Chor
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Foundation-National School of Public Health, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joanna M N Guimarães
- Department of Epidemiology and Quantitative Methods, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luana Giatti
- Department of Preventive and Social Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandhi Maria Barreto
- Department of Preventive and Social Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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26
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Gibbons FX, Gerrard M, Fleischli ME, Simons RL, Kingsbury JH. Perceived racial discrimination and healthy behavior among African Americans. Health Psychol 2021; 40:155-165. [PMID: 33630637 DOI: 10.1037/hea0001056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Numerous studies have found evidence of a link between perceived discrimination and unhealthy behavior, especially substance use. Within this body of literature, however, several studies have found unexpected evidence of a positive relation between perceived racial discrimination among African Americans-mostly women-and certain types of healthy behavior, primarily exercise and healthy eating. The current study further examined this positive relation, including an anticipated moderator: optimism. It also examined the relation between perceived racial discrimination and a correlate of unhealthy behavior: BMI. METHOD Six waves of data were collected over 14 years in three related samples of African Americans from families participating in the Family and Community Health Study. Each family included an adolescent (Mage = 10.5 at Wave 1), the adolescent's primary caregiver (Mage = 37), and, in some cases, an older sibling of that adolescent (Mage = 13). Wave 1 Ns were 889, 889, and 295, respectively. Healthy behavior was defined as diet and exercise. RESULTS There was very little evidence of a long-term relation between perceived racial discrimination and BMI in any sample, and no evidence of a relation between discrimination and healthy behavior among the males. However, correlational analyses revealed a positive prospective relation between discrimination and healthy behavior among all three groups of females; structural equation modeling indicated that this relation was stronger among women who were high in optimism. CONCLUSIONS Perceived racial discrimination does not appear to be related to BMI among African Americans, but it is related to healthy behavior among Black females who are high in dispositional optimism. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Meg Gerrard
- Department of Psychological Sciences, University of Connecticut
| | - Mary E Fleischli
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut
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Earnshaw VA, Karpyn A. Understanding stigma and food inequity: a conceptual framework to inform research, intervention, and policy. Transl Behav Med 2020; 10:1350-1357. [PMID: 33421077 PMCID: PMC8218858 DOI: 10.1093/tbm/ibaa087] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
There is increasing understanding that stigma associated with poverty, race, nationality, gender, obesity, and other intersecting, socially devalued characteristics is a key social determinant of health that plays a role in food inequities; yet, the processes linking stigma with food inequities are poorly defined. Building on prior conceptual and empirical stigma research in public health, this paper introduces The Stigma and Food Inequity Framework. Supporting empirical evidence for the associations proposed by the framework is reviewed. The framework proposes that stigma is manifested at the structural (e.g., neighborhood infrastructure and targeted marketing) and individual (e.g., internalized stigma and stereotypes) levels. These stigma manifestations are associated with food inequities via a series of mediating mechanisms, including access to resources, the home food environment, and psychosocial and behavioral processes, which ultimately undermine healthy food consumption, contribute to food insecurity, and impact diet quality. The framework further proposes that processes linking stigma with food inequities are situated within contexts of history, culture, and human development. Future directions to address stigma and enhance food equity include the value of addressing the broad range of underlying structural stigma manifestations when creating policy to promote food equity.
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Affiliation(s)
- Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Allison Karpyn
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
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28
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Roberts AL, Taylor HA, Whittington AJ, Zafonte RD, Speizer FE, Pascual-Leone A, Baggish A, Weisskopf MG. Race in association with physical and mental health among former professional American-style football players: findings from the Football Players Health Study. Ann Epidemiol 2020; 51:48-52.e2. [PMID: 32738401 DOI: 10.1016/j.annepidem.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Race differences in health are pervasive in the United States. American-style football players are a racially diverse group with social status and other benefits that may reduce health disparities. Whether race disparities in health exist among former professional football players, and whether they differ by era of play, is unknown. METHODS We examined the association of self-reported race with health outcomes (e.g., physical and cognitive function, pain, depression, and anxiety), among 3747 participants in the Football Players Health Study, comprising former National Football League players who played since 1960. We conducted analyses stratified by age. RESULTS Black players had increased risk of all five adverse health outcomes versus white players (risk ratio range = 1.36 to 1.89). Native Hawaiians and men of other races had greater risk of all health outcomes except impaired physical functioning, compared with white players (risk ratio range = 1.25 to 1.64). No clear patterns were observed by era of play. In general, race disparities were not accounted for by health-related exposures during playing years. Adjustment for current BMI somewhat attenuated associations. CONCLUSIONS Social and economic advantages of playing professional football did not appear to equalize race disparities in health.
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Affiliation(s)
- Andrea L Roberts
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Herman A Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Frank E Speizer
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Aaron Baggish
- Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center, Boston, MA, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
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29
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Xu T, Magnusson Hanson LL, Clark AJ, Ersbøll AK, Westerlund H, Madsen IEH, Rugulies R, Pentti J, Stenholm S, Vahtera J, Sørensen JK, Nordentoft M, Westendorp RGJ, Hansen ÅM, Oksanen T, Virtanen M, Kivimäki M, Rod NH. Onset of Workplace Bullying and Risk of Weight Gain: A Multicohort Longitudinal Study. Obesity (Silver Spring) 2020; 28:2216-2223. [PMID: 32929892 DOI: 10.1002/oby.22956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/26/2020] [Accepted: 06/29/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to examine the onset of workplace bullying as a risk factor for BMI increase. METHODS Repeated biennial survey data from three Nordic cohort studies were used, totaling 46,148 participants (67,337 participant observations) aged between 18 and 65 who did not have obesity and who were not bullied at the baseline. Multinomial logistic regression was applied for the analysis under the framework of generalized estimating equations. RESULTS Five percent reported onset of workplace bullying within 2 years from the baseline. In confounder-adjusted models, onset of workplace bullying was associated with a higher risk of weight gain of ≥ 1 BMI unit (odds ratio = 1.09; 95% CI: 1.01-1.19) and of ≥ 2.5 BMI units (odds ratio = 1.24; 95% CI: 1.06-1.45). A dose-response pattern was observed, and those exposed to workplace bullying more frequently showed a higher risk (Ptrend = 0.04). The association was robust to adjustments, restrictions, stratifications, and use of relative/absolute scales for BMI change. CONCLUSIONS Participants with exposure to the onset of workplace bullying were more likely to gain weight, a possible pathway linking workplace bullying to increased long-term risk of type 2 diabetes.
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Affiliation(s)
- Tianwei Xu
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- National Research Center for the Working Environment, Copenhagen, Denmark
| | | | - Alice J Clark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Annette K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Hugo Westerlund
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Ida E H Madsen
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Reiner Rugulies
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Research Center for the Working Environment, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jaana Pentti
- Clinicum, Faculty of Medicine, University of Helsinki, Finland
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Jeppe K Sørensen
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Mads Nordentoft
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Åse M Hansen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Tuula Oksanen
- Finnish Institute of Occupational Health, Helsinki and Turku, Finland
| | - Marianna Virtanen
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Mika Kivimäki
- Clinicum, Faculty of Medicine, University of Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Naja H Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Stress Research Institute, Stockholm University, Stockholm, Sweden
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30
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Assari S, Boyce S, Bazargan M, Caldwell CH. A Dream Deferred: African American Women's Diminished Socioeconomic Returns of Postponing Childbearing from Teenage to Adulthood. ACTA ACUST UNITED AC 2020; 1:62-76. [PMID: 32803191 DOI: 10.3390/reprodmed1020005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Brookings Institution has identified postponing childbirth from teenage to adulthood as a major strategy that is needed for upward social mobility of women. However, according to the Minorities' Diminished Returns (MDRs), the associations between aspirations, investments, behaviors, and socioeconomic position (SEP) may be diminished for marginalized groups such as African Americans. Objective To extend the existing knowledge on the MDRs, the current study had two aims: First to compare White and African American women for the association between postponing childbearing to adulthood and SEP in a national sample of American women. Second, to test correlates of postponing childbearing to adulthood and SEP at birth with long term outcomes 15 years later when the child was 15 years old. Methods For this longitudinal study, data came from the Fragile Families and Child Well-being Study (FFCWS), a national longitudinal prospective study in the United States (US) that followed an ethnically diverse sample of women from childbirth for 15 years from 1998 to 2016. For the first aim, this study included 2679 women composed of 723 Whites and 1956 African Americans. For the second aim, among 1842 individuals who had available data 15 years later, we measured various economic, behavioral, and mental health outcomes when the child was 15 years old. For aim 1 we ran linear regression. Postponing childbearing to adulthood was the independent variable. The dependent variable, SEP (poverty) was treated as a continuous measure with higher score indicating more poverty. Confounders included marital status and delivery characteristics. For the aim 2, we ran Pearson correlation test (exploratory analysis) to test if baseline SEP correlates with future outcomes. Results Postponing childbearing from adolescence to adulthood was associated with higher SEP in adulthood, net of all confounders including marital status and education. We found a significant interaction between postponing childbearing from adolescence to adulthood and race on SEP, suggesting that the economic reward of postponing childbearing may be weaker for African American women than for White women. Conclusions Although postponing the age at childbirth is a recommended strategy for women who wish to maximize their chance of upward social mobility, this strategy may be associated with smaller economic returns for African American women than White women. The results can also be interpreted as MDRs in investments in terms of a postponing childbearing. In a fair society, the same investment should be similarly rewarded across diverse racial groups. In the reality, however, the US society differently rewards White and African American women who postpone childbearing. Research should explore the roles of social stratification, blocked opportunities, and concentrated poverty in explaining the unequal return of such an investment for African American and White women.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles Drew University, Los Angeles, CA 90059, USA
| | - Shanika Boyce
- Department of Pediatrics, Charles Drew University, Los Angeles, CA 90059, USA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles Drew University, Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Cleopatra H Caldwell
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI 48109-2029, USA
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31
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Pickett S, Burchenal CA, Haber L, Batten K, Phillips E. Understanding and effectively addressing disparities in obesity: A systematic review of the psychological determinants of emotional eating behaviours among Black women. Obes Rev 2020; 21:e13010. [PMID: 32067355 DOI: 10.1111/obr.13010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/21/2019] [Accepted: 01/17/2020] [Indexed: 11/28/2022]
Abstract
Emotional eating may be a particularly important contributor to differences in body weight and weight loss response to behavioural interventions among non-Hispanic Black women. We performed a systematic review on the impact of psychological factors (stress, anxiety, depression, and discrimination) upon emotional eating and weight among non-Hispanic Black women, applying the Preferred Reporting Items for Systematic Reviews and Meta-analysis for relevant studies. The initial search yielded 4593 articles with 15 accepted for review. Based on this review, there is a suggestion that negative emotions, in particular, perceived stress, may be predictive of emotional eating among non-Hispanic Black women. Results from the only two longitudinal studies identified by the review indicate that stress influences emotional eating, and emotional eating predicts weight gain over time. Findings from this review highlight the need for more studies that examine various negative emotions that may lead to emotional eating and weight gain among non-Hispanic Black women. Findings from this review also highlight the need for more rigorous studies to differentiate the effects of emotional eating from that of the physiologic (ie, activation of the hypothalamic-pituitary axis) responses to stress and its impact on high-risk groups.
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Affiliation(s)
- Stephanie Pickett
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Clare A Burchenal
- School of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Leora Haber
- School of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kendra Batten
- School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Erica Phillips
- Division of General Internal Medicine, Weill Cornell Medical College, New York, NY, USA
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Sims KD, Sims M, Glover LM, Smit E, Odden MC. Perceived Discrimination and Trajectories of C-Reactive Protein: The Jackson Heart Study. Am J Prev Med 2020; 58:199-207. [PMID: 31831294 PMCID: PMC6985923 DOI: 10.1016/j.amepre.2019.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Perceiving discriminatory treatment may contribute to systemic inflammation, a risk factor of cardiovascular pathophysiology. This study evaluated the association of self-reported discrimination with changes in high-sensitivity C-reactive protein and the mediating role of adiposity. METHODS The sample included 5,145 African-Americans, aged 21-92 years, in the Jackson Heart Study. Everyday, lifetime, and burden from perceived discrimination comprised primary predictors in 3 sets of multivariable linear regression models of baseline (2000-2004) discrimination and natural logarithm of high-sensitivity C-reactive protein. Multivariable linear mixed models assessed mean changes in natural logarithm of high-sensitivity C-reactive protein over the study period (2000-2013). Mediation was quantified by percentage changes in estimates adjusted for BMI, waist circumference, and waist-to-height ratio. Multiple imputation addressed missingness in baseline covariates and in high-sensitivity C-reactive protein taken at all 3 study examinations. Analyses were conducted in 2018. RESULTS In cross-sectional analyses, male participants in the middle and highest tertiles of lifetime discrimination had natural logarithm of high-sensitivity C-reactive protein levels that were 0.13 (95% CI= -0.24, -0.01) and 0.15 (95% CI= -0.27, -0.02) natural logarithm(mg/dL) lower than those in the lowest tertile. In longitudinal analyses, all participants reporting more frequent everyday discrimination had a 0.07 natural logarithm(mg/dL) greater increase in natural logarithm of high-sensitivity C-reactive protein per examination than those reporting none (95% CI=0.01, 0.12). A similar trend emerged for lifetime discrimination and changes in natural logarithm of high-sensitivity C-reactive protein (adjusted mean increase per visit: 0.04 natural logarithm[mg/dL], 95% CI=0.01, 0.08). Adiposity did not mediate the longitudinal associations. CONCLUSIONS Everyday and lifetime discrimination were associated with significant high-sensitivity C-reactive protein increases over 13 years. The physiologic response to discrimination may lead to systemic inflammation.
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Affiliation(s)
- Kendra D Sims
- Program in Epidemiology, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - LáShauntá M Glover
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ellen Smit
- Program in Epidemiology, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Michelle C Odden
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
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Bethea TN, Zhou ES, Schernhammer ES, Castro-Webb N, Cozier YC, Rosenberg L. Perceived racial discrimination and risk of insomnia among middle-aged and elderly Black women. Sleep 2020; 43:zsz208. [PMID: 31555803 PMCID: PMC6955644 DOI: 10.1093/sleep/zsz208] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/26/2019] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVE To assess whether perceived racial discrimination is associated with insomnia among Black women. METHODS Data on everyday and lifetime racism and insomnia symptoms were collected from questionnaires administered in the Black Women's Health Study, an ongoing prospective cohort of Black women recruited in 1995 from across the United States. In 2009, participants completed five questions on the frequency of discriminatory practices in daily life (everyday racism) and six questions on ever experiencing unfair treatment in key institutional contexts (lifetime racism). In 2015, the Insomnia Severity Index was used to assess insomnia symptoms. We estimated odds ratios and 95% confidence intervals for associations of racism with insomnia, using multivariable logistic regression models adjusted for potential confounders. RESULTS The 26 139 participants in the analytic sample were 40-90 years old (median = 57 years, SD = 9.6 years). Higher levels of everyday racism and lifetime racism were positively associated with subthreshold (ptrend < .01) and clinical insomnia (ptrend < .01). Results remained unchanged after further adjustment for sleep duration and shift work. CONCLUSIONS Higher levels of perceived racism were associated with increased odds of insomnia among middle-aged and elderly Black women. Thus, perceived racism may contribute to multiple racial health disparities resulting from insomnia. Helping minority populations cope with their experiences of discrimination may decrease the significant public health impact of sleep disruption and subsequent diagnoses.
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Affiliation(s)
- Traci N Bethea
- Slone Epidemiology Center, Boston University, Boston, MA
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Eric S Zhou
- Dana-Farber Cancer Institute, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Eva S Schernhammer
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | | | - Yvette C Cozier
- Slone Epidemiology Center, Boston University, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA
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Hicks K. The role of biocultural approaches in assessing interventions for maternal weight and gestational weight gain. Am J Hum Biol 2019; 32:e23310. [PMID: 31486203 DOI: 10.1002/ajhb.23310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/30/2019] [Accepted: 08/09/2019] [Indexed: 11/09/2022] Open
Abstract
Public health and other researchers express growing concern for the role of maternal adiposity and gestational weight gain in driving the obesity epidemic and health disparities based on race and class. Biocultural scholars must continue to contribute to conversations on how best to address issues of population health including the developmental context of obesity, drawing from both evolutionary and social theory. I discuss a number of intervention studies designed to address gestational weight gain in low-income and minority women and consider the degree to which they address the social, political, and economic context, and developmental history of mothers. I further examine the potential for these interventions, focused on the individual behavior of mothers, to contribute to stigma based on socially defined race, class, and body shape and size, and to draw attention away from the powerful economic interests that contribute to and benefit from the obesity epidemic. I end with a discussion of the value of developmental systems theory for thinking critically about obesity and other health interventions.
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Affiliation(s)
- Kathryn Hicks
- Department of Anthropology, College of Arts and Sciences, University of Memphis, Memphis, Tennessee
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Adkins-Jackson PB, Turner-Musa J, Chester C. The Path to Better Health for Black Women: Predicting Self-Care and Exploring Its Mediating Effects on Stress and Health. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958019870968. [PMID: 31486346 PMCID: PMC6728668 DOI: 10.1177/0046958019870968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Stress leads to poor self-rated health for many black women because of racial and
economic discrimination which results in psychological distress and restricted
access to resources. Resilience factors such as self-care may be able to buffer
the impact of stress; however, the role of self-care in reducing the effect of
stress on self-rated health has not been explored. Self-care involves the
utilization of self-awareness and agency to seek remedy for imbalance and to
sustain equilibrium. Despite anecdotal exploration of these factors, there has
not been a systematic investigation of whether self-awareness and agency indeed
predict self-care. Subsequently, this study sought to provide evidence that
self-awareness and resilience predict self-care, and self-care can mediate the
negative relationship between stress and self-rated health. A cross-section of
223 black women living in the United States completed a battery of assessments
of self-care, mindfulness, perceived stress, resilience, and self-rated health.
Through a series of regression analyses exploring mediating effects, a path
emerged. Findings indicate that awareness and resilience do predict self-care,
and self-care mediates the negative relationship between stress and health.
These analyses suggest that the role of stress on black women’s health can be
reduced by the implementation of awareness and resilience.
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Lu D, Palmer JR, Rosenberg L, Shields AE, Orr EH, DeVivo I, Cozier YC. Perceived racism in relation to telomere length among African American women in the Black Women's Health Study. Ann Epidemiol 2019; 36:33-39. [PMID: 31387775 PMCID: PMC7048405 DOI: 10.1016/j.annepidem.2019.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Telomere length is considered a biomarker of human aging and premature morbidity and mortality which has been associated with chronic stress. METHODS We assessed the relation between perceived racism and telomere length in the Black Women's Health Study, a follow-up study of U.S. black women begun in 1995. Participants were asked about frequency of "everyday racism" (e.g., "people act as if they think you are not intelligent") and "institutional racism" (e.g., "ever treated unfairly due to race by police"). Using quantitative real-time polymerase chain reaction assay, relative telomere lengths (RTL) were measured as the copy number ratio of telomere repeat to a single control gene in 997 participants. Associations of racism variables with log-RTL were estimated by multivariable linear regression, with adjustment for age at blood draw and potential confounders. RESULTS Participants were aged 40-70 years (mean = 55.6 years), and mean telomere length was 0.77 (range 0.21-1.38). In stratified analyses, there was an inverse association between everyday racism and log-RTL among women who did not discuss their experiences of racism with others (β = -0.1104; 95% CI = -0.2140 to -0.0067; P = .045). CONCLUSIONS Everyday racism was associated with shorter telomere length among women who reported not discussing those experiences with others.
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Affiliation(s)
- Darlene Lu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA; Slone Epidemiology Center at Boston University, Boston, MA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Alexandra E Shields
- Department of Medicine, Harvard Medical School, Boston, MA; Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, MA
| | - Esther H Orr
- Brigham and Women's Hospital, Boston, MA; Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Immaculata DeVivo
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA.
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The role of emotional eating in the links between racial discrimination and physical and mental health. J Behav Med 2019; 42:1091-1103. [PMID: 31079258 DOI: 10.1007/s10865-019-00044-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 04/09/2019] [Indexed: 02/07/2023]
Abstract
The environmental affordances (EA) model posits that maladaptive self-regulatory strategies (e.g., emotional eating) directly and indirectly heighten African Americans' risk for downstream medical morbidities while also potentially mitigating the psychological impact of stressors. We empirically tested the full EA model. In doing so, we investigated the associations among racial discrimination, depressive symptomatology, and physical health proxies as well as the intervening role of emotional eating in these associations among 150 African Americans aged 18-27. The increased frequency of experiencing racial discrimination was significantly associated with poorer self-reported health, greater depressive symptomatology, and more emotional eating. There was no significant association between emotional eating and physical health and emotional eating did not mediate the relation between racial discrimination and physical health. Finally, racial discrimination was associated with depressive symptomatology, but only among African Americans with mean or high levels of emotional eating.
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Baskind MJ, Taveras EM, Gerber MW, Fiechtner L, Horan C, Sharifi M. Parent-Perceived Stress and Its Association With Children's Weight and Obesity-Related Behaviors. Prev Chronic Dis 2019; 16:E39. [PMID: 30925139 PMCID: PMC6464048 DOI: 10.5888/pcd16.180368] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction Psychosocial stress is associated with obesity in adult and pediatric populations, but few studies have examined the relationship between parent-perceived stress and risk of child obesity and related behaviors. Methods We studied 689 pairs of parents and children aged 2 to 12 in Massachusetts with a body mass index (BMI) at or above the 85th percentile. Recruitment occurred from June 2014 to March 2015, and data collection ended in March 2016. We asked parents about their perceived stress and categorized responses as low, moderate, or high. We examined associations of parents’ stress with children’s BMI, expressed as a percentage of the 95th percentile (%BMIp95), and obesity-related behaviors by using multivariable regression models adjusted for child and parent characteristics. We stratified results by race/ethnicity, annual household income, and the child’s age. Results In fully adjusted models, the association between high versus low parent-reported stress and children’s %BMIp95 remained significant only for children in low-income households (β = 5.12; 95% confidence interval [CI], 0.94–9.30) and for non-Hispanic black children (β = 7.76; 95% CI, 1.85–13.66). Parents with high or moderate stress versus low stress were less likely to report that their children met recommendations for fast-food consumption (high stress, prevalence ratio [PR] = 0.79; 95% CI, 0.65–0.96; moderate stress, PR = 0.70; 95% CI, 0.59–0.82), but parents with high versus low stress were more likely to report meeting daily physical activity recommendations (PR = 1.21; 95% CI, 1.01–1.45). Conclusion Among children with overweight or obesity, parent-perceived stress was associated with fast-food consumption and physical activity. Parent-perceived stress was associated with child %BMIp95 among children in low-income households and non-Hispanic black children. Obesity interventions should consider parent-perceived stress and potential differences in the nature of stress experienced by parents of different racial/ethnic and socioeconomic backgrounds.
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Affiliation(s)
- Melanie J Baskind
- Department of Pediatrics, University of California-San Francisco, San Francisco, California
| | - Elsie M Taveras
- Harvard Medical School, Boston, Massachusetts.,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Monica W Gerber
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Lauren Fiechtner
- Harvard Medical School, Boston, Massachusetts.,Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts.,Division of Gastroenterology and Nutrition, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Chrissy Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, 333 Cedar St, PO Box 208064, New Haven, CT 06520-8064.
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Nelson DS, Gerras JM, McGlumphy KC, Shaver ER, Gill AK, Kanneganti K, Ajibewa TA, Hasson RE. Racial Discrimination and Low Household Education Predict Higher Body Mass Index in African American Youth. Child Obes 2019; 14:114-121. [PMID: 29211516 DOI: 10.1089/chi.2017.0218] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the relationships between environmental factors, including household education, community violence exposure, racial discrimination, and cultural identity, and BMI in African American adolescents. METHODS A community-based sample of 198 African American youth (120 girls, 78 boys; ages 11-19 years) from Washtenaw County, Michigan, were included in this analysis. Violence exposure was assessed by using the Survey of Children's Exposure to Community Violence; racial discrimination by using the Adolescent Discrimination Distress Index; cultural identity by using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents; and household education by using a seven-category variable. Measured height and body weight were used to calculate BMI. RESULTS Racial discrimination was positively associated with BMI, whereas household education was inversely associated with BMI in African American adolescents (discrimination: β = 0.11 ± 0.04, p = 0.01; education: β = -1.13 ± 0.47, p = 0.02). These relationships were significant when accounting for the confounding effects of stress, activity, diet, and pubertal development. Significant gender interactions were observed with racial discrimination and low household education associated with BMI in girls only (discrimination: β = 0.16 ± 0.05, p = 0.003; education: β = -1.12 ± 0.55, p = 0.045). There were no significant relationships between culture, community violence exposure, and BMI (all p's > 0.05). CONCLUSION Environmental factors, including racial discrimination and low household education, predicted higher BMI in African American adolescents, particularly among girls. Longitudinal studies are needed to better understand the mechanisms by which these environmental factors increase obesity risk in African American youth.
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Affiliation(s)
- Devin S Nelson
- 1 School of Kinesiology, University of Michigan , Ann Arbor, MI.,2 Childhood Disparities Research Laboratory, University of Michigan , Ann Arbor, MI
| | - Julia M Gerras
- 1 School of Kinesiology, University of Michigan , Ann Arbor, MI.,2 Childhood Disparities Research Laboratory, University of Michigan , Ann Arbor, MI
| | - Kellye C McGlumphy
- 1 School of Kinesiology, University of Michigan , Ann Arbor, MI.,2 Childhood Disparities Research Laboratory, University of Michigan , Ann Arbor, MI
| | - Erika R Shaver
- 2 Childhood Disparities Research Laboratory, University of Michigan , Ann Arbor, MI.,3 School of Public Health, University of Michigan , Ann Arbor, MI
| | - Amaanat K Gill
- 1 School of Kinesiology, University of Michigan , Ann Arbor, MI.,2 Childhood Disparities Research Laboratory, University of Michigan , Ann Arbor, MI
| | - Kamala Kanneganti
- 2 Childhood Disparities Research Laboratory, University of Michigan , Ann Arbor, MI
| | - Tiwaloluwa A Ajibewa
- 1 School of Kinesiology, University of Michigan , Ann Arbor, MI.,2 Childhood Disparities Research Laboratory, University of Michigan , Ann Arbor, MI
| | - Rebecca E Hasson
- 1 School of Kinesiology, University of Michigan , Ann Arbor, MI.,2 Childhood Disparities Research Laboratory, University of Michigan , Ann Arbor, MI.,3 School of Public Health, University of Michigan , Ann Arbor, MI
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Affiliation(s)
- John A Batsis
- a Geisel School of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice , Lebanon , NH , USA.,b Sections of General Internal Medicine and Weight and Wellness , Dartmouth-Hitchcock Medical Center , Lebanon , NH , USA.,c Dartmouth Centers for Health and Aging , Dartmouth College , Hanover , NH , USA.,d Health Promotion Research Center at Dartmouth , Lebanon , NH , USA
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Samson FL. An association between multiculturalism and psychological distress. PLoS One 2018; 13:e0208490. [PMID: 30521627 PMCID: PMC6283566 DOI: 10.1371/journal.pone.0208490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022] Open
Abstract
Amidst increasing focus on rising rates of substance abuse and suicide among white Americans and extending prior research on intergroup attitudes and health, this study examines a novel factor associated with psychological distress: disagreement with multiculturalism. Using the Portraits of American Life Study (N = 2,292), logistic regressions indicate that for Whites and Hispanics, increased likelihood of psychological distress (depression, hopelessness and worthlessness) is associated with stronger disagreement with multiculturalism, measured as "If we want to create a society where people get along, we must recognize that each ethnic group has the right to maintain its own unique traditions." For Blacks, however, attitudes toward multiculturalism are not associated with psychological distress. Future research might determine if these results can be replicated, and if so, identify the causal mechanism(s) at work.
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Affiliation(s)
- Frank L. Samson
- UCLA Institute for Research on Labor and Employment, Los Angeles, California, United States of America
- * E-mail:
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Molina KM, Estrella ML, Rivera-Olmedo N, Frisard C, Lemon S, Rosal MC. It Weigh(t)s on You: Everyday Discrimination and Adiposity Among Latinos. Obesity (Silver Spring) 2018; 26:1474-1480. [PMID: 30175908 PMCID: PMC6159926 DOI: 10.1002/oby.22248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 10/31/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Evidence suggests discrimination increases the risk of obesity. The biopsychosocial model of racism posits that psychological factors such as depressive symptoms may link experiences of perceived interpersonal discrimination to obesity. This study tested whether self-reported experiences of everyday discrimination were associated with adiposity indicators and whether depressive symptoms explained these associations. METHODS Cross-sectional survey data of 602 Latino adults living in Lawrence, Massachusetts, from the Latino Health and Well-being Project (2011-2013) were used. Participants completed questionnaires assessing perceived everyday discrimination and depressive symptoms. Anthropometric measures (i.e., BMI and waist circumference [WC]) were obtained by trained staff. Structural equation modeling was employed to test for direct and indirect effects of perceived everyday discrimination on adiposity. RESULTS Perceived everyday discrimination was directly and positively associated with higher BMI and WC, independent of sociodemographic factors, physical activity, and stressful life events. Perceived everyday discrimination was not indirectly associated with BMI and WC through depressive symptoms. However, perceived everyday discrimination was associated with higher levels of depressive symptoms. CONCLUSIONS Self-reported everyday discrimination among Latino adults is associated with adiposity. Day-to-day interpersonal discrimination may be implicated in obesity disparities for Latino adults.
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Affiliation(s)
- Kristine M Molina
- Department of Psychology, Community and Prevention Research Program, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mayra L Estrella
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Noemi Rivera-Olmedo
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Christine Frisard
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Stephenie Lemon
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Lockwood KG, Marsland AL, Matthews KA, Gianaros PJ. Perceived discrimination and cardiovascular health disparities: a multisystem review and health neuroscience perspective. Ann N Y Acad Sci 2018; 1428:170-207. [PMID: 30088665 DOI: 10.1111/nyas.13939] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/03/2018] [Accepted: 07/09/2018] [Indexed: 12/19/2022]
Abstract
There are distinct racial disparities in cardiovascular disease (CVD) risk, with Black individuals at much greater risk than White individuals. Although many factors contribute to these disparities, recent attention has focused on the role of discrimination as a stress-related factor that contributes to racial disparities in CVD. As such, it is important to understand the mechanisms by which discrimination might affect CVD. Recent studies have examined these mechanisms by focusing on neurobiological mediators of CVD risk. Given this increase in studies, a systematic review of perceived discrimination and neurobiological mediators of CVD risk is warranted. Our review uses a multisystem approach to review studies on the relationship between perceived discrimination and (1) cardiovascular responses to stress, (2) hypothalamic-pituitary-adrenocortical axis function, and (3) the immune system, as well as (4) the brain systems thought to regulate these parameters of peripheral physiology. In addition to summarizing existing evidence, our review integrates these findings into a conceptual model describing multidirectional pathways linking perceived discrimination with a CVD risk.
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Affiliation(s)
- Kimberly G Lockwood
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anna L Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karen A Matthews
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Schroeder K, Malone SK, McCabe E, Lipman T. Addressing the Social Determinants of Health: A Call to Action for School Nurses. J Sch Nurs 2018; 34:182-191. [PMID: 29343161 PMCID: PMC6083826 DOI: 10.1177/1059840517750733] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Social determinants of health (SDOH), the conditions in which children are born, grow, live, work or attend school, and age, impact child health and contribute to health disparities. School nurses must consider these factors as part of their clinical practice because they significantly and directly influence child well-being. We provide clinical guidance for addressing the SDOH when caring for children with three common health problems (obesity, insufficient sleep, and asthma). Given their unique role as school-based clinical experts, care coordinators, and student advocates, school nurses are well suited to serve as leaders in addressing SDOH.
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Affiliation(s)
- Krista Schroeder
- University of Pennsylvania School of Nursing, Philadelphia,
PA, USA
| | - Susan Kohl Malone
- Center for Sleep and Circadian Neurobiology, University of
Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Rory Meyers College of Nursing, New York University, New
York, NY, USA
| | - Ellen McCabe
- University of Pennsylvania School of Nursing, Philadelphia,
PA, USA
| | - Terri Lipman
- University of Pennsylvania School of Nursing, Philadelphia,
PA, USA
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Chronic discrimination and bodily pain in a multiethnic cohort of midlife women in the Study of Women's Health Across the Nation. Pain 2018; 158:1656-1665. [PMID: 28753588 DOI: 10.1097/j.pain.0000000000000957] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A growing literature links discrimination to key markers of biobehavioral health. While racial or ethnic differences in pain are seen in experimental and clinical studies, the authors were interested in how chronic discrimination contributes to pain within multiple racial or ethnic groups over time. Participants were 3056 African American, Caucasian, Chinese, Hispanic, and Japanese women from the Study of Women's Health Across the Nation. The Everyday Discrimination Scale was assessed from baseline through 13 follow-up examinations. The bodily pain subscale of the MOS 36-Item Short-Form Health Survey (SF-36) was assessed annually. There were large racial or ethnic differences in reports of discrimination and pain. Discrimination attributions also varied by race or ethnicity. In linear mixed model analyses, initially adjusted for age, education, and pain medications, chronic everyday discrimination was associated with more bodily pain in all ethnic groups (beta = -5.84; P < 0.002 for Japanese; beta = -6.17; P < 0.001 for African American; beta = -8.74; P < 0.001 for Chinese; beta = -10.54; P < 0.001 for Caucasians; beta = -12.82; P < 0.001 for Hispanic). Associations remained significant in all ethnic groups after adjusting for additional covariates in subsequent models until adding depressive symptoms as covariate; in the final fully-adjusted models, discrimination remained a significant predictor of pain for African American (beta = -4.50; P < 0.001), Chinese (beta = -6.62; P < 0.001), and Caucasian (beta = -7.86; P < 0.001) women. In this longitudinal study, experiences of everyday discrimination were strongly linked to reports of bodily pain for the majority of women. Further research is needed to determine if addressing psychosocial stressors, such as discrimination, with patients can enhance clinical management of pain symptoms.
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Archibald PC, Parker L, Thorpe R. Criminal Justice Contact, Stressors, and Obesity-Related Health Problems Among Black Adults in the USA. J Racial Ethn Health Disparities 2018; 5:387-397. [PMID: 28597246 PMCID: PMC5722707 DOI: 10.1007/s40615-017-0382-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 01/14/2023]
Abstract
Criminal justice contact-defined as lifetime arrest, parole, or incarceration, seems to exacerbate chronic conditions, and those who are most likely to have had contact with the criminal justice system, such as Black adults, often already have pre-existing disproportionately high rates of stress and chronic conditions due to the social determinants of health that affect underrepresented minorities. Findings from this study suggest that there is a mechanism that links the stressors among Black adults manifested by such factors as family, financial, neighborhood, and personal problems with criminal justice contact to obesity-related health status. Using the National Survey of American Life (NSAL), modified Poisson regression analyses were used to determine the association between criminal justice contact, stressors, and obesity-related health problems among a national sample of Black adults (n = 5008). In the full model, the odds of experiencing obesity-related health problems for Black adults who had criminal justice contact was reduced (PR, 1.23 to 1.14) and not statistically significant. Black adults who reported experiencing family stressors (PR, 1.21; 95% CI, 1.08, 1.36), financial stressors (PR, 1.30; 95% CI, 1.16, 1.47), and personal stressors (PR, 1.16; 95% CI, 1.02, 1.31) were statistically significant and higher than those who reported not experiencing any of these stressors; neighborhood stressors was not statistically significant. The evidence suggests a relationship between the stressors associated with criminal justice contact and obesity-related health status. These findings emphasize the need to further explore the family, financial, and personal stressors for Black adults with criminal justice contact in order to further our understanding of their obesity-related health problems.ᅟ.
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Affiliation(s)
- Paul C Archibald
- Morgan State University, School of Social Work, 1700 E. Coldspring Lane, Jenkins Building - Room 426, Baltimore, MD 21251, 443-885-4308
| | - Lauren Parker
- Johns Hopkins University, Bloomberg School of Public Health, 624 N. Broadway, Hampton House, Suite 904, Baltimore, Maryland 21205, , 703) 795-2454
| | - Roland Thorpe
- Johns Hopkins University, Bloomberg School of Public Health, Director, Program for Research on Men's Health Hopkins Center for Health Disparities Solutions, 624 N. Broadway, Hampton House, Suite 708, Baltimore, Maryland 21205, , 410-502-8977
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47
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Hicken MT, Lee H, Hing AK. The weight of racism: Vigilance and racial inequalities in weight-related measures. Soc Sci Med 2018; 199:157-166. [PMID: 28372829 PMCID: PMC5617791 DOI: 10.1016/j.socscimed.2017.03.058] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/22/2017] [Accepted: 03/27/2017] [Indexed: 02/08/2023]
Abstract
In the United States, racial/ethnic inequalities in obesity are well-documented, particularly among women. Using the Chicago Community Adult Health Study, a probability-based sample in 2001-2003 (N = 3105), we examined the roles of discrimination and vigilance in racial inequalities in two weight-related measures, body mass index (BMI) and waist circumference (WC), viewed through a cultural racism lens. Cultural racism creates a social environment in which Black Americans bear the stigma burden of their racial group while White Americans are allowed to view themselves as individuals. We propose that in this context, interpersonal discrimination holds a different meaning for Blacks and Whites, while vigilance captures the coping style for Blacks who carry the stigma burden of the racial group. By placing discrimination and vigilance within the context of cultural racism, we operationalize existing survey measures and utilize statistical models to clarify the ambiguous associations between discrimination and weight-related inequalities in the extant literature. Multivariate models were estimated for BMI and WC separately and were stratified by gender. Black women had higher mean BMI and WC than any other group, as well as highest levels of vigilance. White women did not show an association between vigilance and WC but did show a strong positive association between discrimination and WC. Conversely, Black women displayed an association between vigilance and WC, but not between discrimination and WC. These results demonstrate that vigilance and discrimination may hold different meanings for obesity by ethnoracial group that are concealed when all women are examined together and viewed without considering a cultural racism lens.
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Affiliation(s)
- Margaret T Hicken
- Institute for Social Research, University of Michigan, United States.
| | - Hedwig Lee
- Department of Sociology, University of Washington, United States
| | - Anna K Hing
- Department of Community Health Sciences, University of California, Los Angeles, United States
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48
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Kelly NR, Smith TM, Hall GCN, Guidinger C, Williamson G, Budd EL, Giuliani NR. Perceptions of general and postpresidential election discrimination are associated with loss of control eating among racially/ethnically diverse young men. Int J Eat Disord 2018; 51:28-38. [PMID: 29149497 DOI: 10.1002/eat.22803] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the association between young men's perceived experiences with discrimination, both general and following the 2016 presidential election, and their loss of control (LOC) eating. The degree to which men identified with their ethnic identity was evaluated as a moderator. METHOD The sample included 798 men (18-30 years; M = 24.0 ± 3.6) who identified as African American (n = 261), Asian/Asian American (n = 266), or Hispanic/Latino (n = 271). Participants completed an online survey of items assessing demographic characteristics; perceived discrimination; perceptions of race-related discrimination following the 2016 U.S. presidential election; ethnic identity; and LOC eating. RESULTS After adjusting for income, education, generational status and body mass index, perceived discrimination was positively associated with LOC eating frequency in African American and Hispanic/Latino men (ps < .01). Ethnic identity was inversely associated with LOC eating frequency in Hispanic/Latino men (p < .001). In Asian/Asian American men, perceived discrimination was only associated with more LOC eating among those with a low ethnic identity (p < .001). Higher levels of perceived discrimination following the presidential election were uniquely associated with more frequent LOC eating (p < .01) only among Asian/Asian American men who were not born in the United States or whose parents were not born in the United States. DISCUSSION LOC eating may partially explain known associations between discrimination and heightened risk for obesity and chronic diseases among African American and Hispanic/Latino men. Asian/Asian American men's LOC eating may be linked to postpresidential election and general experiences with racial discrimination, particularly if they report a low sense of belonging to their ethnic group.
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Affiliation(s)
- Nichole R Kelly
- Counseling Psychology and Human Services, University of Oregon, Eugene, Oregon.,The Prevention Science Institute, University of Oregon, Eugene, Oregan
| | - Tasia M Smith
- Counseling Psychology and Human Services, University of Oregon, Eugene, Oregon.,The Prevention Science Institute, University of Oregon, Eugene, Oregan
| | | | - Claire Guidinger
- Counseling Psychology and Human Services, University of Oregon, Eugene, Oregon.,The Prevention Science Institute, University of Oregon, Eugene, Oregan
| | - Gina Williamson
- Counseling Psychology and Human Services, University of Oregon, Eugene, Oregon.,The Prevention Science Institute, University of Oregon, Eugene, Oregan
| | - Elizabeth L Budd
- Counseling Psychology and Human Services, University of Oregon, Eugene, Oregon.,The Prevention Science Institute, University of Oregon, Eugene, Oregan
| | - Nicole R Giuliani
- The Prevention Science Institute, University of Oregon, Eugene, Oregan.,Special Education and Clinical Sciences, University of Oregon, Eugene, Oregan
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49
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Bacon KL, Stuver SO, Cozier YC, Palmer JR, Rosenberg L, Ruiz-Narváez EA. Perceived racism and incident diabetes in the Black Women's Health Study. Diabetologia 2017; 60:2221-2225. [PMID: 28812096 PMCID: PMC5817630 DOI: 10.1007/s00125-017-4400-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/06/2017] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS Our aim was to assess the association of perceived racism with type 2 diabetes, and the possible mediating influence of diet and BMI. METHODS The Black Women's Health Study, a follow-up of 59,000 African-American women, began in 1995. Over 16 years 5344 incident cases of diabetes occurred during 576,577 person-years. Cox proportional hazards models were used to estimated HRs and 95% CIs for categories of 'everyday racism' (interpersonal racism in daily life) and 'lifetime racism' (reporting ever treated unfairly due to race with respect to police, housing or work) and incident type 2 diabetes. Models were adjusted for age, questionnaire cycle, marital status, socioeconomic status, education, family history of diabetes, physical activity, alcohol use and smoking status, with and without inclusion of terms for dietary patterns and adult BMI. RESULTS Compared with women in the lowest quartile of exposure, women in the highest quartile of exposure to everyday racism had a 31% increased risk of diabetes (HR 1.31; 95% CI 1.20, 1.42) and women with the highest exposure to lifetime racism had a 16% increased risk (HR 1.16; 95% CI 1.05, 1.27). Mediation analysis estimated that BMI accounted for half of the association between either the everyday or lifetime racism measure and incident diabetes. CONCLUSIONS/INTERPRETATION Perceived everyday and lifetime racism were associated with increased risk of type 2 diabetes in this cohort of African-American women and appear to be at least partly mediated by BMI.
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Affiliation(s)
- Kathryn L Bacon
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Sherri O Stuver
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Yvette C Cozier
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Slone Epidemiology Center at Boston University, Boston University Medical Campus, 72 East Concord Street, L-7, Boston, MA, 02118, USA
| | - Julie R Palmer
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Slone Epidemiology Center at Boston University, Boston University Medical Campus, 72 East Concord Street, L-7, Boston, MA, 02118, USA
| | - Lynn Rosenberg
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Slone Epidemiology Center at Boston University, Boston University Medical Campus, 72 East Concord Street, L-7, Boston, MA, 02118, USA
| | - Edward A Ruiz-Narváez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
- Slone Epidemiology Center at Boston University, Boston University Medical Campus, 72 East Concord Street, L-7, Boston, MA, 02118, USA.
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50
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Carter RT, Lau MY, Johnson V, Kirkinis K. Racial Discrimination and Health Outcomes Among Racial/Ethnic Minorities: A Meta-Analytic Review. JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1002/jmcd.12076] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robert T. Carter
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
| | - Michael Y. Lau
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
- Now at The Chicago School of Professional Psychology; Washington DC
| | - Veronica Johnson
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
- Now at the Department of Psychology, John Jay College of Criminal Justice; City University of New York
| | - Katherine Kirkinis
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
- Now at Department of Counseling Psychology; University at Albany-State University of New York
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