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

Financial strain is associated with poorer cardiovascular health: The multi-ethnic study of atherosclerosis

Objective

Psychosocial stress is associated with increased cardiovascular disease (CVD) risk. The relationship between financial strain, a toxic form of psychosocial stress, and ideal cardiovascular health (CVH) is not well established. We examined whether financial strain was associated with poorer CVH in a multi-ethnic cohort free of CVD at baseline.

Methods

This was a cross-sectional analysis of 6,453 adults aged 45-84 years from the Multi-Ethnic Study of Atherosclerosis. Financial strain was assessed by questionnaire and responses were categorized as yes or no. CVH was measured from 7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood glucose and blood pressure). A CVH score of 14 was calculated by assigning points to the categories of each metric (poor = 0 points, intermediate = 1 point, ideal = 2 points). Multinomial logistic regression was used to examine the association of financial strain with the CVH score (inadequate 0-8, average 9-10, and optimal 11-14 points) adjusting for sociodemographic factors, depression and anxiety.

Results

The mean age (SD) was 62 (10) and 53 % were women. Financial strain was reported by 25 % of participants. Participants who reported financial strain had lower odds of average (OR, 0.82 [95 % CI, 0.71, 0.94]) and optimal (0.73 [0.62, 0.87]) CVH scores. However, in the fully adjusted model, the association was only significant for optimal CVH scores (0.81, [0.68, 0.97]).

Conclusion

Financial strain was associated with poorer CVH. More research is needed to understand this relationship so the burden of CVD can be decreased, particularly among people experiencing financial hardship.

C-reactive protein moderates associations between racial discrimination and ventromedial prefrontal cortex activation during attention to threat in Black American women

Prior research has shown that racial discrimination (RD) impacts activation in threat network regions, including the ventromedial prefrontal cortex (vmPFC) and middle occipital cortex during attention to threat-relevant stimuli. However, little is known about the biological mechanisms that may modulate these effects; inflammation may be a pathway linking RD and threat network activation. As such, the current study aimed to explore whether systemic inflammation, measured by C-reactive protein (CRP) levels, may moderate the relationship between RD and activation in the vmPFC and middle occipital cortex during attention to threat. Blood samples for inflammatory marker (CRP) assays were obtained from forty Black American women (mean [SD] age, 39.93 [9.97] years; range, 22-58 years) recruited from an ongoing trauma study; participants also viewed threat-relevant stimuli as part of an attention task during fMRI. We found that CRP moderated the relationship between RD and vmPFC activation during attention to threat, such that participants with relatively higher concentrations of CRP ( ≥ 23.97 mg/L) demonstrated significant positive associations between RD and vmPFC activation [β = 0.18, CI (0.04, 0.32), t = 2.65, p = 0.01]. No significant associations were observed for participants who showed moderate (10.89 mg/L) or low (0.20 mg/L) CRP concentrations. CRP did not moderate the relationship between RD and middle occipital cortex activation. Our data present a mechanism through which RD may influence immune system activation and, in turn, threat network activation. Inflammation may contribute to brain health vulnerabilities in Black Americans via its effects on threat circuits; this merits further investigation in large-scale studies.

A systematic review of how social connectedness influences associations between racism and discrimination on health outcomes

Racial discrimination is a well-known risk factor of racial disparities in health. Although progress has been made in identifying multiple levels through which racism and racial discrimination influences health, less is known about social factors that may buffer racism's associations with health. We conducted a systematic review of the literature with a specific focus on social connectedness, racism, and health, retrieving studies conducted in the United States and published between January 1, 2012, and July 30, 2022, in peer-reviewed journals. Of the 787 articles screened, 32 were selected for full-text synthesis. Most studies (72%) were at the individual level, cross-sectional, and among community/neighborhood, school, or university samples. Studies had good methodological rigor and low risk of bias. Measures of racism and racial discrimination varied. Discrimination scales included unfair treatment because of race, schedule of racist events, experiences of lifetime discrimination, and everyday discrimination. Measures of social connectedness (or disconnectedness) varied. Social-connectedness constructs included social isolation, loneliness, and social support. Mental health was the most frequently examined outcome (75%). Effect modification was used in 56% of studies and mediation in 34% of studies. In 81% of studies, at least 1 aspect of social connectedness significantly buffered or mediated the associations between racism and health. Negative health associations were often weaker among people with higher social connectedness. Social connectedness is an important buffering mechanism to mitigate the associations between racial discrimination and health. In future studies, harmonizing metrics of social connectedness and racial discrimination can strengthen causal claims to inform interventions.

Black-White differences in perceived lifetime discrimination by education and income in the MIDUS Study in the U.S

There is growing evidence on the negative effects of perceived discrimination on health outcomes and their interactions with indicators of socioeconomic status. However, less has been studied on whether income and education lead individuals of a different race to encounter different discriminatory experiences in their lifetime. Using data from the national survey of the Midlife Development in the United States-MIDUS 1 (1995-1996) and MIDUS Refresher (2011-2014)-on eight measures of perceived lifetime discrimination, this study compares discriminatory experiences of Black and White persons in two time periods. We applied generalized structural equation models and generalized linear models to test multiplicative effects of income and education by race on lifetime discrimination. In both periods, we find substantive disparities between White and Black people in all types of lifetime discrimination, with Black people reporting much higher levels of discrimination. Such disparities exacerbated in the top cohorts of society, yet these associations have changed in time, with White individuals reporting increasing levels of discrimination. Results show that, for Black people in the mid-1990s, perceived discrimination increased as education and income increased. This finding persisted for education by the early 2010s; income effects changed as now both, low- and high-income Black people, reported the highest levels of discrimination. These findings highlight a policy conundrum, given that increasing income and education represent a desirable course of action to improve overall discrimination and health outcomes. Yet, we show that they may unintendingly exacerbate racial disparities in discrimination. We also show that the U.S. is moving toward a stagnation period in health outcomes improvement, with racial disparities in discrimination shrinking at the expense of a deterioration of whites' lifetime discriminatory experiences. Our results highlight the need for a multi-systems policy approach to prevent all forms of discrimination including those due to historical, institutional, legal, and sociopolitical structures.

Multiple forms of discrimination and inflammation in Black Americans: Are there differences by sex?

RATIONALE

Discrimination is a risk factor and potential pathway through which social determinants such as race and sex contribute to chronic inflammation in Black Americans in middle and later adulthood. Questions remain regarding which forms of discrimination are most salient for inflammatory dysregulation, and whether there are sex-based differences in these pathways.

OBJECTIVE

This exploratory study investigates sex differences in the relationships between four forms of discrimination and inflammatory dysregulation among middle aged and older Black Americans.

METHODS

Using cross-sectionally linked data from participants in the Midlife in the United States (MIDUS II) Survey (2004-2006) and Biomarker Project (2004-2009) (N = 225, ages 37-84, 67% female), this study conducted a series of multivariable regression analyses. Inflammatory burden was measured using a composite indicator comprised of five biomarkers: C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, E-selectin, and intercellular adhesion molecule (ICAM). Discrimination measures were lifetime, daily, and chronic job discrimination and perceived inequality at work.

RESULTS

Black men generally reported higher levels of discrimination than Black women (3 out of 4 forms), though only sex differences in job discrimination achieved statistical significance (p < .001). In contrast, Black women exhibited more overall inflammatory burden than Black men (2.09 vs. 1.66, p = .024), particularly elevated levels of fibrinogen (p = .003). Lifetime discrimination and inequality at work were associated with higher levels of inflammatory burden, after adjusting for demographic and health factors (p = .057 and p = .029, respectively). The discrimination-inflammation relationships further varied by sex, such that more lifetime and job discrimination predicted greater inflammatory burden in Black women, but not in Black men.

CONCLUSION

These findings highlight the potentially detrimental impact of discrimination and emphasize the importance of sex-specific research on biological mechanisms of health and health disparities in Black Americans.

Perceived ethnic discrimination and cognitive function: A 12-year longitudinal study of Mexican-origin adults

OBJECTIVES

Hispanic/Latinx adults are at increased risk for cognitive impairment, and it is critically important to identify modifiable risk factors for cognitive impairment in this population. We addressed two key questions: (1) How does perceived discrimination change across middle adulthood? And, (2) how are discrimination and the trajectory of discrimination associated with cognitive function?

METHODS

We used data from 1,110 Mexican-origin adults between 26 and 62 years old (63% female; 85% born in Mexico). Participants completed a perceived ethnic discrimination scale five times across 12 years and completed cognitive assessments in the last wave, which were composited into a measure of overall cognitive function. We used latent growth curve models to estimate the longitudinal trajectory of perceived ethnic discrimination and growth mixture models to identify sub-groups of change trajectories. We evaluated whether patterns of perceived discrimination trajectories, baseline, intermediary, and concurrent discrimination predicted cognitive function at the last wave.

RESULTS

Perceived ethnic discrimination decreased over time on average. Significant individual differences in within-person change revealed two change trajectory classes: Stable Low and High Declining. The Stable Low class had better cognitive performance compared to the High Declining class, but this effect was not robust to educational attainment. Perceived discrimination at the last wave was associated with worse cognitive function, and this effect remained after accounting for covariates.

CONCLUSIONS

This study is among the first to evaluate changes in perceived ethnic discrimination in a sample of Mexican-origin adults and their associations with cognitive function. The results highlight the need for more research to better understand the role of discrimination and other social stressors on cognitive health outcomes.

A systematic review and meta-analysis of the Everyday Discrimination Scale and biomarker outcomes

Discrimination has consistently been associated with multiple adverse health outcomes. Like other psychosocial stressors, discrimination is thought to impact health through stress-related physiologic pathways including hypothalamic-pituitary-adrenal (HPA) axis activation, dysregulation of inflammation responses, and accelerated cellular aging. Given growing attention to research examining the biological pathways through which discrimination becomes embodied, this systematic review and meta-analysis synthesizes empirical evidence examining relationships between self-reported discrimination and four biomarker outcomes (i.e., cortisol, C-reactive protein (CRP), interleukin-6 (IL-6), and telomere length) among studies that have used the Everyday Discrimination Scale. We conducted a systematic review of studies discussing self-reported, everyday, or chronic discrimination in the context of health by searching Medline / PubMed (National Library of Medicine, NCBI), PsycInfo (APA, Ebsco) and Web of Science Core Collection (Clarivate). Twenty-five articles met the criteria for meta-analysis, with several reporting on multiple outcomes. Discrimination was associated with elevated CRP levels (r = 0.11; 95% CI: 0.01, 0.20, k = 10), though not cortisol (r = 0.05; 95% CI: -0.06, 0.16, k = 9), IL-6 (r = 0.05; 95% CI: -0.32, 0.42, k = 5), or telomere length (r = 0.03; 95% CI: -0.01, 0.07, k = 6). We identify several points of consideration for future research including addressing heterogeneity in assessment of biomarker outcomes and the need for longitudinal assessments of relationships between discrimination and biomarker outcomes.

Acute versus chronic inflammatory markers and cognition in older black adults: Results from the Minority Aging Research Study

Peripheral inflammation is elevated in older Black adults, an elevation which prior work has suggested may be due to chronic stress associated with systemic racism and related adverse cardiovascular health conditions. Inflammation is also involved in the pathogenic processes of dementia; however, limited (and mixed) results exist concerning inflammation and cognitive decline in Black adults. We characterized patterns of inflammation and their role in cognitive decline in 280 older Black adults (age = 72.99 ± 6.00 years; 69.6% female) from the Minority Aging Research Study (MARS) who were without dementia at baseline and followed between 2 and 15 years (mean = 9 years). Participants completed a blood draw at baseline and annual cognitive evaluations. Serum was assayed for 9 peripheral inflammatory markers; 19 neuropsychological test scores were used to create indices of global cognition and five cognitive domains. Principal component analysis with varimax rotation characterized patterns of inflammation with factor loadings > 0.6 per component contributing to two composite scores representing acute/upstream and chronic/downstream inflammation. These composites were used as separate predictors in linear mixed regression models to determine associations with level and change in cognition adjusting for relevant covariates. Higher baseline upstream/acute inflammation associated with lower baseline semantic memory (p = .040) and perceptual speed (p = .046); it was not related to cognitive decline. By contrast, higher baseline downstream/chronic inflammation associated with faster declines in global cognition (p = .010), episodic (p = .027) and working memory (p = .006); it was not related to baseline cognition. For older Black adults, chronic, but not acute, inflammation may be a risk factor for changes in cognition.

Lower Life Satisfaction and Inflammation in African American Adults: Body Adiposity Mediation and Sex Moderation

Both lower life satisfaction (LLS) and chronic inflammation are underlying conditions for numerous diseases. We investigated their associations in African American adults, within the context of three hypotheses: (a) perceived LLS will be positively associated with inflammation measured by serum C-reactive protein (CRP); (b) this association will be mediated by body adiposity; and (c) these associations will be moderated by sex. Participants (n = 83; >45 years; 59% women) were a subsample of a larger church-based intervention to reduce cardiovascular risks and were assessed at baseline and after 6 months. Body adiposity (BMI/hip/waist circumferences) was measured by standardized methods and CRP with ELISA. LLS was self-reported. The analyses were conducted in the structural equation modeling (SEM) framework. The direct relationship between LLS and CRP was significant for all participants but was mediated by BMI/hip/waist circumferences. Multi-group SEM analysis provided evidence for sex moderation by showing that the mediating pathway from LLS to CRP through BMI, and to a lesser extent through hip/waist circumferences, was significant only in women. In conclusion, perceived LLS was positively associated with the level of inflammation mediated by BMI/hip/waist circumference, with the association between LLS and CRP being stronger in women. These findings contribute to the current literature untangling mediation/moderation processes in which perceived LLS may contribute to adiposity-related inflammation. They also add to precision medicine development, suggesting that stress and inflammation-reducing interventions should focus on African Americans, particularly women.

Associations between multiple indicators of discrimination and allostatic load among middle-aged adults

The objective of this paper is to examine associations between multiple measures of discrimination (i.e., everyday, lifetime, and appraised burden) and components of allostatic load (AL). We drew on pooled cross-sectional data from the Biomarker Project of the Midlife in the United States study (n = 2118). Ages ranged from 25 to 84 years and included mostly Black (n = 389) and white (n = 1598) adults. Quasi-Poisson models were fit to estimate prevalence ratios for each discrimination measure and high-risk quartiles across seven physiological systems (i.e., sympathetic and parasympathetic nervous system; HPA axis; inflammation; cardiovascular; metabolic glucose; and metabolic lipids) and overall AL scores. In fully adjusted models, everyday discrimination was associated with elevated lipids (aPR: 1.07; 95% CI 1.01, 1.13). Lifetime experiences of discrimination were associated with lower sympathetic nervous system (aPR: 0.82; 95% CI: 0.69, 0.98) and greater cardiovascular risk scores (aPR: 1.17; 95% CI: 1.02, 1.34) among those reporting three or more experiences, as well as increased inflammation (aPR: 1.13; 95% CI: 1.02, 1.25; aPR: 1.28; 95% CI: 1.14, 1.43), metabolic glucose (aPR: 1.35; 95% CI: 1.19, 1.54; aPR: 1.45; 95% CI: 1.24, 1.68), and metabolic lipids (aPR: 1.13; 95% CI: 1.03, 1.24; aPR: 1.28; 95% CI: 1.15, 1.43) scores for those reporting one to two and three or more experiences. Appraised burden yielded nuanced associations with metabolic glucose and parasympathetic nervous system scores. Everyday and lifetime measures were also associated with higher overall AL, though burden of discrimination was only associated with AL among those reporting "a little" burden. While AL summary scores provide insight into the cumulative impacts of discrimination on health, there appear to be distinct physiologic pathways through which varying forms of discrimination contribute to AL and, ultimately, to poorer health. These unique pathways may be useful in identifying potential points of intervention to mitigate the impacts of discrimination on health inequities.

Social stress and risk of declining cognition: a longitudinal study of men and women in the United States

Limited research is available on the relationship between social stress and risk of declining cognition. We sought to examine whether social stress has adverse effects on risk of declining episodic memory and executive functioning in aging individuals. We used data from the MIDUS study, a national probability sample of non-institutionalized, English speaking respondents aged 25-74 living in the 48 contiguous states of the United States. The initial wave (1995) included 4963 non-institutionalized adults aged 32-84 (M = 55, SD = 12.4). We used an analytic sample from MIDUS-II (1996/1997) and MIDUS-III (2013) (n = 1821). The dependent variables are episodic memory and executive functioning, which were assessed with the Brief Test for Cognition (BTACT). The independent variables were social stress variables (subjective social status, family and marital stress, work stress and discrimination). To evaluate episodic memory and executive functioning changes over a time period of 10 years, we estimated adjusted linear regression models. Women report significantly lower subjective social status and more discrimination stress than men across all age groups. Controlling for education and income, age, and baseline episodic memory and executive functioning, lower subjective social status had additional adverse effects on declines in episodic memory in men and women. Marital risk had adverse effects on episodic memory in men but not in women. Daily discrimination had adverse effects on executive functioning on all individuals. Public health strategies should focus on reducing social stress in a socio-ecological perspective. Especially, subjective social status and discrimination stress might be a target for prevention efforts.

More than Hurt Feelings: The Wear and Tear of Day-to-Day Discrimination in Adults with Chronic Pain

OBJECTIVE

To examine the extent to which self-reported experiences of discrimination are associated with pain interference among men and women with chronic non-cancer pain.

METHODS

Data are from the Study of Midlife in the United States (MIDUS) Refresher Cohort. The analytic sample consisted of 207 adults with chronic pain (54.2 ± 12.8 years; 53.6% female) who completed the Major Experiences of Discrimination and Everyday Discrimination scales. Regression analyses examined cross-sectional relations between discrimination and pain interference.

RESULTS

On average, the level of pain interference was moderate in the sample (mean = 3.46, standard deviation = 2.66; observed range 0-10). Approximately a third of respondents reported at least one major discriminatory event in their lifetime, while 22% reported three or more discriminatory lifetime events. Everyday discrimination scores averaged 14.19 ± 5.46 (observed range 0-33). With adjustment for sociodemographics, physical health, cognitive and psychological factors, social isolation, and loneliness, everyday discrimination was associated with increased pain interference (B = 0.099; 95% confidence interval [CI]: 0.02 to 0.17).

CONCLUSION

These findings add weight to the importance of day-to-day experiences of interpersonal discrimination by documenting independent associations with functional interference in adults with chronic pain.

Experiences of Discrimination and Urinary Catecholamine Concentrations: Longitudinal Associations in a College Student Sample

BACKGROUND

Experiences of discrimination are a risk factor for subsequent cardiovascular disease. However, there is a lack of longitudinal research examining associations between discrimination and urinary catecholamines. This is surprising given the likely mediating role of sympathetic nervous system dysregulation in the association between psychosocial stress and cardiovascular morbidity.

PURPOSE

The current study examined the 3 year longitudinal association between experiences of discrimination and urinary catecholamines.

METHODS

The sample included 149 college students (mean age at baseline = 18.8, standard deviation = 0.96; 45% Black/African American; 55% White/European American). Concentrations of epinephrine and norepinephrine-urinary catecholamines with established links to psychosocial stress exposure and subsequent morbidity-were determined from 12 hr overnight samples.

RESULTS

Results indicated that experiences of discrimination were associated with increases in both epinephrine (β = .284, standard error [SE] = .117, p = .015) and norepinephrine (β = .306, SE = .114, p = .001). These longitudinal associations persisted after adjusting for negative affect, depression, and rejection sensitivity and did not vary as a function of race/ethnicity.

CONCLUSIONS

Results suggest that examination of overnight urinary catecholamines as a biological mediator of associations between experiences of discrimination and cardiovascular morbidity is warranted.

Self-reported experiences of discrimination in older black adults are associated with insula functional connectivity

Self-reported experiences of discrimination are associated with a number of negative health outcomes. However, the neurobiological correlates of discrimination remain elusive. Recent neuroimaging work suggests that the amygdala is sensitive to forms of social adversity and the insula is involved in assessments of trust. We hypothesized that functional connectivity (FC) of these brain regions may be associated with discrimination in older Black adults. One-hundred and twenty-four nondemented older Black adults participating in the Minority Aging Research Study or the Clinical Core study of the Rush Alzheimer's Disease Center completed a measure of self-reported experiences of discrimination and a 3T MRI brain scan including structural T1 and resting-state fMRI EPIBOLD sequences. The right and left amygdala and insula regions were anatomically delineated as ROIs according to the Harvard-Oxford Brain Atlas and whole-brain voxelwise FC analyses were conducted using default parameters in the CONN toolbox. In regression analyses controlling for demographics and global cognition, self-reported experiences of discrimination were associated with greater FC between the left insula and the bilateral intracalcarine cortex, weaker FC between the left insula and the left dorsolateral prefrontal cortex, and weaker FC between the right insula and the left supplementary motor area. Amygdala analyses yielded no significant findings. Greater self-reported experiences of discrimination are associated with differential insula functional connectivity in older adults. More specifically, results suggest that discrimination is associated with differential connectivity of a key region (the insula) involved in trust perception.

Race and other sociodemographic categories are differentially linked to multiple dimensions of interpersonal-level discrimination: Implications for intersectional, health research

Objectives

To examine whether intersections of race with other key sociodemographic categories contribute to variations in multiple dimensions of race- and non-race-related, interpersonal-level discrimination and burden in urban-dwelling African Americans and Whites.

Methods

Data from 2,958 participants aged 30–64 in the population-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to estimate up to four-way interactions of race, age, gender, and poverty status with reports of racial and everyday discrimination, discrimination across multiple social statuses, and related lifetime discrimination burden in multiple regression models.

Results

We observed that: 1) African Americans experienced all forms of discrimination more frequently than Whites, but this finding was qualified by interactions of race with age, gender, and/or poverty status; 2) older African Americans, particularly African American men, and African American men living in poverty reported the greatest lifetime discrimination burden; 3) older African Americans reported greater racial discrimination and greater frequency of multiple social status-based discrimination than younger African Americans; 4) African American men reported greater racial and everyday discrimination and a greater frequency of social status discrimination than African American women; and, 5) White women reported greater frequency of discrimination than White men. All p’s < .05.

Conclusions

Within African Americans, older, male individuals with lower SES experienced greater racial, lifetime, and multiple social status-based discrimination, but this pattern was not observed in Whites. Among Whites, women reported greater frequency of discrimination across multiple social statuses and other factors (i.e., gender, income, appearance, and health status) than men. Efforts to reduce discrimination-related health disparities should concurrently assess dimensions of interpersonal-level discrimination across multiple sociodemographic categories, while simultaneously considering the broader socioecological context shaping these factors.

Discrimination and systemic inflammation: A critical review and synthesis

Exposure to discrimination or unfair treatment has emerged as an important risk factor for illness and disease that disproportionately affects racial and ethnic minorities. Discriminatory experiences may operate like other stressors in that they activate physiological responses that adversely affect the maintenance of homeostasis. Research suggests that inflammation plays a critical role in the pathophysiology of stress-related diseases. Recent findings on discrimination and inflammation are discussed. We highlight limitations in the current evidence and provide recommendations for future studies that seek to examine the association between discrimination and inflammation.

The Perfect Storm: COVID-19 Health Disparities in US Blacks

Coronavirus disease 2019 (COVID-19) accounts for over 180,000 deaths in the USA. Although COVID-19 affects all racial ethnicities, non-Hispanic Blacks have the highest mortality rates. Evidence continues to emerge, linking the disproportion of contagion and mortality from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a result of adverse social determinants of health. Yet, genetic predisposition may also play a credible role in disease transmission. SARS-CoV-2 enters cells by interaction between SARS-CoV-2 spike protein and the receptor molecule angiotensin converting enzyme 2 (ACE2) expressed on the surface of the target cells, such that polymorphisms and the expression level of ACE2 influence infectivity and consequent pathogenesis of SARS-CoV-2. Genetic polymorphisms in other multiple genes, such as acetylcholinesterase (AChE) and interleukin-6, are also closely associated with underlying diseases, such as hypertension and type 2 diabetes mellitus, which substantially raise SARS-CoV-2 mortality. However, it is unknown how these genetic polymorphisms contribute to the disparate mortality rates, with or without underlying diseases. Of particular interest is the potential that genetic polymorphisms in these genes may be influencing the disparity of COVID-19 mortality rates in Black communities. Here, we review the evidence that biological predisposition for high-risk comorbid conditions may be relevant to our ability to fully understand and therefore address health disparities of COVID-19 deaths in Blacks.

Everyday discrimination and subsequent cognitive abilities across five domains

OBJECTIVE

Previous research suggests that everyday discrimination is associated with worse concomitant performance in several cognitive domains, as well as faster subsequent declines in episodic memory. This study aimed to extend knowledge on the specificity, durability, and mechanisms of associations between everyday discrimination and cognition by using a comprehensive neuropsychological battery and a longitudinal mediation design.

METHOD

Participants included 3,304 older adults in the Health and Retirement Study Harmonized Cognitive Assessment Protocol. Discrimination was assessed using the Everyday Discrimination Scale. Depressive symptoms were assessed with the 8-item Center for Epidemiological Studies Depression Scale. Vascular diseases were quantified as the self-reported presence of hypertension, diabetes, and heart disease. Confirmatory factor analysis was used to estimate episodic memory, executive functioning, processing speed, language, and visuoconstruction across a battery of 13 neuropsychological tests. Structural equation models controlled for sociodemographics and baseline cognition ascertained 2 to 4 years prior.

RESULTS

Discrimination was associated with more depressive symptoms and vascular diseases. Depressive symptoms mediated negative effects of discrimination on subsequent functioning across all 5 cognitive domains. Vascular diseases additionally mediated negative effects of discrimination on processing speed. After accounting for mediators, direct negative effects of discrimination remained for executive functioning and visuoconstruction.

CONCLUSIONS

This national longitudinal study in the United States provides evidence for broad and enduring effects of everyday discrimination on cognitive aging, which appear to be partially mediated by mental and physical health. Future research should examine additional mechanisms as well as moderators of these associations to better understand points of intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Chronic stress and endothelial dysfunction: mechanisms, experimental challenges, and the way ahead

Although chronic stress is an important risk factor for cardiovascular diseases (CVD) onset, the underlying mechanisms driving such pathophysiological complications remain relatively unknown. Here, dysregulation of innate stress response systems and the effects of downstream mediators are strongly implicated, with the vascular endothelium emerging as a primary target of excessive glucocorticoid and catecholamine action. Therefore, this review article explores the development of stress-related endothelial dysfunction by focusing on the following: 1) assessing the phenomenon of stress and complexities surrounding this notion, 2) discussing mechanistic links between chronic stress and endothelial dysfunction, and 3) evaluating the utility of various preclinical models currently employed to study mechanisms underlying the onset of stress-mediated complications such as endothelial dysfunction. The data reveal that preclinical models play an important role in our efforts to gain an increased understanding of mechanisms underlying stress-mediated endothelial dysfunction. It is our understanding that this provides a good foundation going forward, and we propose that further efforts should be made to 1) more clearly define the concept of stress and 2) standardize protocols of animal models with specific guidelines to better indicate the mental complications that are simulated.

Racial discrimination and child and adolescent health in longitudinal studies: A systematic review

RATIONALE

The association between racial discrimination and adverse health outcomes has been documented across an increasing body of evidence in recent years, although a close examination of longitudinal studies has not yet taken place. This review applied a life course lens in examining the evidence for a longitudinal association between racial discrimination exposure during childhood and adolescence, and later mental and physical health outcomes.

METHOD

Medline, PsycINFO, Global Health, ERIC, CINAHL Plus, Academic Search Premier and SocINDEX were searched from earliest records to October 2017 for eligible articles. Results were described through a narrative synthesis of the evidence.

RESULTS

Findings from 46 studies reported in 88 empirical articles published between 2003 and 2017 were identified. Studies were primarily based on cohorts from the United States, comprised of young people aged 11-18 years, and were published since 2010. Data were most frequently collected over two to three timepoints at intervals exceeding 12 months. Statistically significant associations with racial discrimination were most commonly reported for behaviour problems including delinquency and risk-taking behaviour, with significant adverse effects found in 74% of these associations. Statistically significant adverse effects were also reported in 63% of associations with health-harming behaviours including substance use, and 61% found associations with mental health outcomes. Consistently significant associations were reported between accumulated racism and later health outcomes, and the health effects of racism were reported to vary with developmental periods, although few studies featured these analyses.

CONCLUSIONS

Evidence from this review highlights that the duration and timing of exposure to racial discrimination matters. This review emphasises the need to gain evidence for the mechanisms linking early racism exposure to adverse health outcomes in later life. Future longitudinal research can address this need by capitalising on prospective cohort studies and ensuring that proposed analysis informs variable selection and timing of data collection.

Cumulative Psychosocial Stress and Ideal Cardiovascular Health in Older Women

BACKGROUND

Research implicates acute and chronic stressors in racial/ethnic health disparities, but the joint impact of multiple stressors on racial/ethnic disparities in cardiovascular health is unknown.

METHODS

In 25 062 women (24 053 white; 256 Hispanic; 440 black; 313 Asian) articipating in the Women's Health Study follow-up cohort, we examined the relationship between cumulative psychosocial stress (CPS) and ideal cardiovascular health (ICH), as defined by the American Heart Association's 2020 strategic Impact Goals. This health metric includes smoking, body mass index, physical activity, diet, blood pressure, total cholesterol, and glucose, with higher levels indicating more ICH and less cardiovascular risk (score range, 0-7). We created a CPS score that summarized acute stressors (eg, negative life events) and chronic stressors (eg, work, work-family spillover, financial, discrimination, relationship, and neighborhood) and traumatic life event stress reported on a stress questionnaire administered in 2012 to 2013 (score range, 16-385, with higher scores indicating higher levels of stress).

RESULTS

White women had the lowest mean CPS scores (white: 161.7±50.4; Hispanic: 171.2±51.7; black: 172.5±54.9; Asian: 170.8±50.6; P_overall<0.01). Mean CPS scores remained higher in Hispanic, black, and Asian women than in white women after adjustment for age, socioeconomic status (income and education), and psychological status (depression and anxiety) ( P<0.01 for each). Mean ICH scores varied by race/ethnicity ( P<0.01) and were significantly lower in black women and higher in Asian women compared with white women (β-coefficient [95% CI]: Hispanics, -0.02 [-0.13 to -0.09]; blacks, -0.34 [-0.43 to -0.25]; Asians, 0.34 [0.24 to 0.45]); control for socioeconomic status and CPS did not change these results. Interactions between CPS and race/ethnicity in ICH models were not significant.

CONCLUSIONS

Both CPS and ICH varied by race/ethnicity. ICH remained worse in blacks and better in Asians compared with whites, despite taking into account socioeconomic factors and CPS.

Racial discrimination, the superwoman schema, and allostatic load: exploring an integrative stress-coping model among African American women

Racial discrimination has been linked to allostatic load (i.e., cumulative biological stress) among African American women. However, limited attention has been given to psychosocial processes involved in the stress response-critical for understanding biological pathways to health-in studies examining racial discrimination as a social determinant of health. We examined whether the superwoman schema (SWS), a multidimensional culture-specific framework characterizing psychosocial responses to stress among African American women, modifies the association between racial discrimination and allostatic load. We used purposive sampling to recruit a community sample of African American women ages 30-50 from five San Francisco Bay Area counties (n = 208). Path analysis was used to test for interactions while accounting for the covariance among SWS subscales using both linear and quadratic models. Significant interactions were observed between racial discrimination and four of the five SWS subscales. Feeling obligated to present an image of strength and an obligation to suppress emotions were each protective whereas feeling an intense motivation to succeed and feeling an obligation to help others exacerbated the independent health risk associated with experiencing racial discrimination. Our findings affirm the need to consider individual variability in coping and potentially other psychosocial processes involved in the stress response process, and offer several insights that may help elucidate the mechanisms by which racial discrimination gets "under the skin."

Scientific imperatives vis-à-vis growing inequality in America

A landmark article published in the American Psychologist (Adler et al., 1994) encouraged psychologists to engage in research on socioeconomic inequality and health. Numerous contributions followed to fill in psychosocial and behavioral pathways. Specifically, we review advances on health inequalities research from a large public-use study (Midlife in the United States [MIDUS]). The Great Recession of 2007 to 2009 and its lingering effects are then reviewed to underscore widening inequality in access to education, employment, and income. Two MIDUS national samples of same-aged adults recruited 2 decades apart are then compared to assess historical changes in socioeconomic, physical health, and well-being profiles from the 1990s to postrecession. Despite historical gains in educational attainment over time, we show that indicators of socioeconomic status, health, and well-being are more compromised in the postrecession sample relative to the 1990s sample. Building on these preliminary findings, we elaborate opportunities for further inquiry by the scientific community to examine whether widening socioeconomic inequalities exacerbated by the Great Recession translate to widening health inequalities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Financial strain and ideal cardiovascular health in middle-aged and older women: Data from the Women's health study

Financial strain is a prevalent form of psychosocial stress in the United States; however, information about the relationship between financial strain and cardiovascular health remains sparse, particularly in older women.

METHODS

The cross-sectional association between financial strain and ideal cardiovascular health were examined in the Women's Health Study follow-up cohort (N = 22,048; mean age = 72± 6.0 years).Six self-reported measures of financial strain were summed together to create a financial strain index and categorized into 4 groups: No financial strain, 1 stressor, 2 stressors, and 3+ stressors. Ideal cardiovascular health was based on the American Heart Association strategic 2020 goals metric, including tobacco use, body mass index, physical activity, diet, blood pressure, total cholesterol and diabetes mellitus. Cardiovascular health was examined as continuous and a categorical outcome (ideal, intermediate, and poor). Statistical analyses adjusted for age, race/ethnicity, education and income.

RESULTS

At least one indicator of financial strain was reported by 16% of participants. Number of financial stressors was associated with lower ideal cardiovascular health, and this association persisted after adjustment for potential confounders (1 financial stressor (FS): B = -0.10, 95% Confidence Intervals (CI) = -0.13, -0.07; 2 FS: B = -0.20, 95% CI = -0.26, -0.15; 3+ FS: B = -0.44, 95% CI = -0.50, -0.38).

CONCLUSION

Financial strain was associated with lower ideal cardiovascular health in middle aged and older female health professional women. The results of this study have implications for the potential cardiovascular health benefit of financial protections for older individuals.

The Association Between Perceived Discrimination and Allostatic Load in the Boston Puerto Rican Health Study

OBJECTIVE

Perceived discrimination is a risk factor for poor health among ethnic and racial minority groups. However, few studies have examined the association between major lifetime and everyday perceived discrimination and allostatic load (AL), a preclinical indicator of disease. We examine the association between two measures of discrimination and AL among Puerto Rican adults.

METHODS

Using primarily wave 3 data from the longitudinal Boston Puerto Rican Health Study, we examined the association between major lifetime and everyday perceived discrimination and AL (multisystem dysregulation of 11 physiological components) among Puerto Rican adults residing in the Boston metro area (N = 882). Five models were tested using multivariable regression. The final model adjusted for demographic factors, migration factors, socioeconomic status and work history, health behaviors/risk factors, and depressive symptom.

RESULTS

Respondents had a M (SD) AL score of 5.11 (1.76; range = 0-11). They had an average score of 0.21 (0.42) for major lifetime perceived discrimination (0-3) and 0.29 (0.49) for everyday perceived discrimination (0-3). In a fully adjusted model, major lifetime perceived discrimination was associated with greater AL (b = 0.56; 95% CI = 0.19 to 0.92), whereas greater everyday perceived discrimination was marginally, but not significantly, associated with lower AL (b = -0.42; 95% CI = -0.87 to 0.04).

CONCLUSIONS

Perceived discrimination remains a common stressor and may be a determinant of AL for Puerto Ricans, although the type of perceived discrimination may have differing effects. Further research is needed to better understand the ways in which major lifetime and everyday perceived discrimination operate to effect physiological systems among Puerto Ricans.

Associations between major dietary patterns and biomarkers of endothelial dysfunction in two urban midsized cities in Argentina

OBJECTIVE

We examined whether dietary patterns (DPS) are associated with endothelial dysfunction (ED) markers in an Argentinian population.

RESEARCH METHODS & PROCEDURES

The sample in this cross-sectional study was derived from 1,983 subjects from two mid-sized cities in Argentina who were involved in the CESCAS I Study. To define DP, a food-frequency questionnaire was applied. In a subsample randomly selected from the primary cohort, serum concentrations of C-reactive protein (hs-CRP), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble E selectin (sSELE) were determined. Correlations and multiple linear regression models were used to assess the relation between each quartile of DP adherence score and ED markers (Q1 lowest adherence; Q4 highest adherence).

RESULTS

Three DPs were identified: Traditional (TDP), Prudent (PDP), and Convenience and processed (CDP). TDP was characterized by higher intake of refined grains, red meat, whole fat dairy products, vegetable oils, and "mate", a traditional South American infused drink; PDP was characterized by higher intake of vegetables, fruit, low-fat dairy products, whole grains, and legumes; and CDP consisted mainly of processed meat, snacks, pizza, and "empanadas", a stuffed bread served baked or fried. Lower scores (Q2, Q3) in TDP were inversely associated with concentrations of sSELE (P < 0.0001 and P < 0.05, respectively). In PDP, higher scores were inversely associated with hs-CRP, whereas lower scores showed a positive relation with sSELE (P < 0.05). Contrariwise, higher scores in CDP were directly associated with sSELE concentrations (P < 0.05).

CONCLUSION

Adherence for each DP identified is differentially related to ED markers in the studied population.

HIV microaggressions: a novel measure of stigma-related experiences among people living with HIV

Since the beginning of the HIV epidemic stigma has served as a strong barrier to effectively delivering HIV prevention and treatment. Due in part to its complex nature, stigma is difficult to address and novel methods of understanding stigma are needed. Based on formative and empirical research with N = 236 primarily Black men living with HIV, a HIV microaggressions scale was developed and evaluated in order to assess this component of stigma. Factor analysis resulted in a 13-item scale (α = .83) with 3 subscales explaining 51% of the total variance. The microaggressions scale demonstrated convergent validity (with internalized, enacted, and anticipated stigmas) and discriminant validity (with social support). HIV microaggressions was associated with longer gaps since last care appointment and depressive symptoms, and subscales were associated with barriers to accessing health care, disclosure, and HIV care self-efficacy. The HIV microaggressions scale is a novel tool for assessing a critical subcomponent of stigma.

Longitudinal effects of race, ethnicity, and psychosocial disadvantage on systemic inflammation

Objective

Psychosocial factors likely contribute to racial and ethnic inequalities in cardiovascular diseases (CVDs). However, precise social, psychological, and physiological pathways linking race and ethnicity to the development of CVDs are not well understood. Systemic inflammation, commonly indexed by C-reactive protein (CRP), is a biomarker for CVD risk and progression. The objective of this study was to identify mediating pathways from race and ethnicity to CRP through social, psychological, and behavioral variables.

Methods

Using data from 12,382 participants aged 51 and older in the Health and Retirement Study, structural equation models tested for direct and indirect effects of race and ethnicity on CRP measured over four years through educational disadvantage, everyday discrimination, depressive symptoms, external locus of control, and smoking.

Results

Educational disadvantage mediated Black-White and Hispanic-White disparities in baseline CRP directly, as well as indirectly through elevated depressive symptoms, higher external locus of control, and smoking. Educational disadvantage also mediated Black-White and Hispanic-White disparities in CRP change directly, as well as indirectly through higher external locus of control and smoking. Independent of education, discrimination mediated Black-White differences in baseline CRP via elevated depressive symptoms, higher external locus of control, and smoking. Discrimination also mediated Black-White disparities in CRP change via external locus of control.

Conclusions

Results from this population-based, longitudinal study support the view that racially patterned social disadvantage is prospectively associated with longitudinal inflammatory processes, and some of these effects are independently mediated by psychological and behavioral factors. Biopsychosocial pathways to health disparities also differ between minority groups.

Perceived relationship support moderates the association of contextual stress with inflammation among African Americans

We followed 402 African American young adults from ages 24 to 29, a period of emerging committed relationships, to examine the association of contextual stress (CS), for example, experiences of financial strain, victimization, and racial discrimination, with inflammation, and to test predictions that greater perceived relationship warmth and support (PRWS) at age 29 would moderate the association between earlier CS and inflammation, using a multiplex assessment of cytokines to construct an index of the ratio between predominantly proinflammatory cytokines versus predominantly anti-inflammatory cytokines. CS experienced at age 24 was associated with greater inflammation at age 29 in the full sample (b = .112, p = .004). PRWS at age 29 moderated the association of earlier CS with inflammation (b = -.114, p = .011), but there was no significant main effect of PRWS (b = -.053, p = .265). Finally, using an internal moderator approach, we compared the association of CS with inflammation among those not in a committed relationship to those in more or less supportive relationships, showing a significant and stronger association of CS with inflammation for those with low PRWS (-1 SD; b = .182, p < .001), a weaker and nonsignificant association of CS with inflammation among those with higher PRWS (+1 SD; b = -.002, p = .975), and an intermediate and nonsignificant association of CS with inflammation among those with no committed romantic relationship (b = .077, p = .227). Results were robust to number of cytokines included in the inflammation index. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Association of Psychological Well-Being with Disablement Processes in a National Sample

OBJECTIVE

Objectives were to explore subgroups of individuals with differential disability trajectories and evaluate the protective effects of psychological well-being (i.e. hedonic and eudaimonic) in the presence of multiple disease conditions (or multimorbidity) and sociodemographic disadvantages.

METHODS

Data come from the prospective longitudinal cohort study the Midlife Development in the United States (n = 3,904). Three waves of data spanning a 20-year period were used to identify subgroups with different disability trajectories. Subgroup membership was then modelled as a function of psychological well-being assessed at wave 1 of the study using multinomial logistic regression.

RESULTS

Three unique groups were identified: a normative group with initially low and slowly increasing levels of disability; a group with high levels of disability that was stable over time; and a group with moderate initial levels of disability that increased over time. Hedonic well-being at wave 1 was associated with membership in the risk groups relative to the normative group.

CONCLUSION

Individuals may follow one of three disability pathways mostly as a function of multimorbidity. However, hedonic well-being was associated with having an advantageous disability trajectory regardless of multimorbidity status. Cultivating psychological well-being may improve disability outcomes in aging individuals.

Interpersonal-level discrimination indices, sociodemographic factors, and telomere length in African-Americans and Whites

OBJECTIVE

Studies have linked self-reported discrimination to telomere attrition, a biological marker of accelerated cellular aging. However, it is unknown whether intersections between social categories-race, socioeconomic status (SES), sex, and age-influence the association of varying forms of discrimination with telomere length. We examined these associations in a socioeconomically and racially/ethnically diverse urban sample.

METHODS

Cross-sectional data were from 341 middle-aged (30-64 years) African American and White, community participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span Study (HANDLS). Multiple regression models examined up to 3-way interactions between a discrimination measure (i.e., everyday, racial, gender, lifetime burden, and frequency of discrimination across sources) and two social categories.

RESULTS

After adjusting for depressive symptoms, waist circumference, and lifetime substance use, two themes emerged: 1) among women with higher SES, a) greater lifetime discrimination burden (b = -0.23, p =  .011), gender discrimination (b = -0.29, p =  .040), and racial discrimination (b = -0.24, p = 0.023) and 2) among younger adults, irrespective of race and sex, greater frequency of discrimination across sources (b = 0.002, p =  .008) was associated with shorter telomeres.

CONCLUSIONS

Irrespective of race, women with higher SES and younger adults reporting greater discrimination may be at particular risk for accelerated aging. Telomere attrition promotes and accelerates chronic health conditions for which there are health disparities. Future research explicating intersections among specific discrimination indices and social categories is warranted.

Racial discrimination, educational attainment, and biological dysregulation among midlife African American women

OBJECTIVE

To examine the association between self-reported racial discrimination and allostatic load, and whether the association differs by socioeconomic position.

METHODS

We recruited a purposive cross-section of midlife (ages 30-50) African American women residing in four San Francisco Bay area counties (n = 208). Racial discrimination was measured using the Experience of Discrimination scale. Allostatic load was measured as a composite of 15 biomarkers assessing cardiometabolic, neuroendocrine, and inflammatory activity. We calculated four composite measures of allostatic load and three system-specific measures of biological dysregulation. Multivariable regression was used to examine associations, while adjusting for relevant confounders.

RESULTS

In the high education group, reporting low (b = -1.09, P = .02, 95% CI = -1.99, -0.18) and very high (b = -1.88, P = .003, 95% CI = -3.11, -0.65) discrimination was associated with lower allostatic load (reference=moderate). Among those with lower education, reporting low (b = 2.05, P = .008, 95% CI = 0.55,3.56) discrimination was associated with higher allostatic load. Similar but less consistent associations were found for poverty status. Associations were similar for cardiometabolic functioning, but not for neuroendocrine or inflammatory activity.

CONCLUSIONS

Racial discrimination may be an important predictor of cumulative physiologic dysregulation. Factors associated with educational attainment may mitigate this association for African American women and other groups experiencing chronic social stress.

Inflammatory mechanisms underlying the effects of everyday discrimination on age-related memory decline

BACKGROUND/OBJECTIVES

Previous research suggests that everyday discrimination is associated with worse episodic memory and partially mediates Black-White disparities in memory aging. The biological mechanisms underlying the link between everyday discrimination and memory are unclear but may involve inflammatory processes. This study aimed to determine whether systemic inflammation, indexed by blood levels of C-reactive protein (CRP), mediates associations between everyday discrimination and episodic memory over 6 years.

DESIGN

A longitudinal mediation model quantified associations between baseline everyday discrimination, 4-year change in CRP, and 6-year change in episodic memory.

SETTING

The Health and Retirement Study (HRS).

PARTICIPANTS

12,624 HRS participants aged 51 and older.

MEASUREMENTS

Everyday Discrimination Scale, high-sensitivity CRP assays of dried blood spots, composite scores of immediate and delayed recall of a word list.

RESULTS

Black participants reported greater everyday discrimination. Greater discrimination was associated with lower baseline memory and faster memory decline. Higher CRP at baseline partially mediated the negative association between discrimination and baseline memory, but CRP change did not mediate the association between discrimination and memory decline.

CONCLUSION

This U.S.-representative longitudinal study provides evidence for deleterious effects of discrimination on subsequent episodic memory. The fact that elevated CRP only partially explained the concurrent association between discrimination and memory highlights the need for more comprehensive investigations of biological mechanisms underlying the link between social stress and age-related memory decline in order to better characterize potential intervention targets to reduce racial inequalities in memory aging.

Lifetime discrimination, global sleep quality, and inflammation burden in a multiethnic sample of middle-aged adults

OBJECTIVE

Despite considerable evidence that greater exposure to discrimination over the life course increases risk for systemic inflammation, little is known about the mechanisms responsible for this association. Here we examine the role of global sleep quality as a potential pathway by which self-reported experiences of discrimination contribute to inflammatory dysfunction in a multiethnic sample of middle-aged adults.

METHOD

Participants were 300 adults (36-85 years; 65% women) from Milwaukee, Wisconsin, a subset of the Midlife in the United States Study 2 (2004-2006). Racial/ethnic representation included African American (77.7%), Hispanic (12.7%), Asian/Pacific Islander (5.6%), and Native American (4.0%). Global sleep quality and perceptions of lifetime and daily discrimination were measured by questionnaire. A composite score of inflammation burden was computed as the sum of five markers including C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, E-selectin, and intracellular adhesion molecule-1 (ICAM-1).

RESULTS

Greater lifetime exposure to discrimination was associated with higher inflammation burden. This relationship remained significant after adjustments for potential confounding factors, including demographics, medication use, health behaviors, psychological distress, and daily discrimination. Mediation analyses suggested that poor global sleep quality was a key mechanism underlying the link between lifetime discrimination and inflammation burden.

CONCLUSION

These results add to a growing literature on the effects of bias and unfair treatment experienced by people of color and other marginalized groups by demonstrating how such experiences may be particularly consequential for sleep and physiological functioning in midlife. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Lifetime discrimination burden, racial discrimination, and subclinical cerebrovascular disease among African Americans

OBJECTIVE

Explore interactive relations of lifetime discrimination burden and racial discrimination-chronic stressors among African Americans (AAs)-and age with MRI-assessed white matter lesion volume (WMLV), a prognostic indicator of poor clinical brain health outcomes.

METHOD

AAs (N = 71; 60.6% female, mean age = 50) participating in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) SCAN study underwent quantitative magnetic resonance imaging coded for WMLV. Participants self-reported lifetime discrimination burden and racial discrimination approximately 5 years earlier. Multivariable regression models assessed interactions of linear and quadratic effects of discrimination and age with WMLV adjusted for sex and socioeconomic status.

RESULTS

Findings revealed significant interactive relations of age and (a) quadratic, lifetime discrimination burden, B = .05, p = .014, ηpartial2 = .092, and (b) quadratic, racial discrimination, B = .03, p = .001, ηpartial2 = .155, with WMLV. Among older AA, increases in lifetime discrimination burden and racial discrimination were associated with increases in WMLV (ps < .03); in younger AA, decreasing levels of racial discrimination were related to increases in WMLV (p = .006).

CONCLUSIONS

Among older AA, as lifetime discrimination burden and racial discrimination increased, so did WMLV. However, in younger AA, decreases in racial discrimination were associated with increased WMLV. Elucidation of complex mechanistic underpinnings, including potentially differential impacts of the acknowledgment versus suppression or underreporting of discriminatory experiences, among AA of different age cohorts, is critical to understanding the present pattern of findings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Health of parents of individuals with developmental disorders or mental health problems: Impacts of stigma

OBJECTIVE

Parents of individuals with developmental disorders or mental health problems often provide life-long care and support to their children, which negatively affects their health in part due to chronic stress. This study aimed to examine the experience of stigma as a source of chronic stress among parents of individuals with developmental disorders or mental health problems and the effect of stigma on parental health outcomes.

METHOD

Using data from the Survey of Midlife in the United States (MIDUS 2 and 3), we constructed a sample for a longitudinal analysis including 128 parents of individuals with developmental disorders (e.g., autism, cerebral palsy, epilepsy, Down syndrome, intellectual disabilities, brain injury, ADD/ADHD) or mental health problems (e.g., bipolar disorder, schizophrenia, major depression) and 2256 parents whose children were nondisabled.

RESULTS

Parents who had children with developmental disorders or mental health problems prior to the beginning of the study (i.e., at MIDUS 1) reported higher levels of stigma related to embarrassment/shame and daily discrimination than parents of nondisabled individuals ten years later at MIDUS 2, which in turn were associated with poorer parental health outcomes (poorer self-rated health and a greater number of chronic conditions) nearly a decade after that at MIDUS 3.

CONCLUSIONS

The findings suggest that the stigma associated with parenting a child with disabilities may be one mechanism that places such parents at risk for poor health. Efforts to alleviate the stigma associated with developmental disorders or mental health problems may have beneficial effects on health of parents of individuals with such conditions.

Perceived discrimination and cardiovascular health disparities: a multisystem review and health neuroscience perspective

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.

Racial disparities in health among nonpoor African Americans and Hispanics: The role of acute and chronic discrimination

Racial disparities in health tend to be more pronounced at the upper ends of the socioeconomic (SES) spectrum. Despite having access to above average social and economic resources, nonpoor African Americans and Latinos report significantly worse health compared to nonpoor Whites. We combine data from the parents and children of the 1979 National Longitudinal Survey of Youth (NLSY79) to address two specific research aims. First, we generate longitudinal SES trajectories over a 33-year period to estimate the extent to which socioeconomic mobility is associated with exposure to discrimination (acute and chronic) across different racial/ethnic groups (nonHispanic Whites, nonHispanic Blacks, and Hispanics). Then we determine if the disparate relationship between SES and self-rated health across these groups can be accounted for by more frequent exposure to unfair treatment. For Whites, moderate income gains over time result in significantly less exposure to both acute and chronic discrimination. Upwardly mobile African Americans and Hispanics, however, were significantly more likely to experience acute and chronic discrimination, respectively, than their socioeconomically stable counterparts. We also find that differential exposure to unfair treatment explains a substantial proportion of the Black/White, but not the Hispanic/White, gap in self-rated health among this nationally representative sample of upwardly mobile young adults. The current study adds to the debate that the shape of the SES/health gradient differs, in important ways, across race and provides empirical support for the diminishing health returns hypothesis for racial/ethnic minorities.

Experiences of Discrimination Are Associated With Greater Resting Amygdala Activity and Functional Connectivity

BACKGROUND

Social discrimination, a type of psychological stressor, is associated with poorer physical and mental health outcomes, yet we have little understanding of how discrimination affects neural functions in marginalized populations. By contrast, the effects of psychological stress on neural functions are well documented, with evidence of significant effects on the amygdala-a neural region that is central to psychosocial functions. Accordingly, we conducted an examination of the relation between self-reported discrimination exposure and amygdala activity in a diverse sample of adults.

METHODS

Seventy-four adults (43% women; 72% African American; 23% Hispanic; 32% homosexual/bisexual) completed self-report ratings of discrimination exposure. Spontaneous amygdala activity and functional connectivity were assessed during resting-state functional magnetic resonance imaging.

RESULTS

Greater discrimination exposure was associated with higher levels of spontaneous amygdala activity. Increases in discrimination were also associated with stronger functional connectivity between the amygdala and several neural regions (e.g., anterior insula, putamen, caudate, anterior cingulate, medial frontal gyrus), with the most robust effects observed in the thalamus. These effects were independent of several demographic (e.g., race, ethnicity, sex) and psychological (e.g., current stress, depression, anxiety) factors.

CONCLUSIONS

Collectively, our findings provide the first evidence that social discrimination is independently associated with elevations in intrinsic amygdala activity and functional connectivity, thus revealing clear parallels between the neural substrates of discrimination and psychological stressors of other origins. Such results should spur future investigations of amygdala-based networks as potential etiological factors linking discrimination exposure to adverse physical and mental health outcomes.

Perceived discrimination and health-related quality-of-life: gender differences among older African Americans

PURPOSE

Emerging data suggest that African-American women may fare worse than African-American men in health-related quality-of-life (HRQOL). Perceived discrimination is an important contributor to poor health overall among African Americans, but few studies examined the intersecting effects of perceived discrimination and gender in explaining HRQOL disparities. We investigated gender differences in HRQOL and tested whether perceived discrimination accounted for these differences.

METHODS

We examined data from the Chicago Health and Aging Project in which 5652 African-American adults aged 65 and older completed structured questionnaires about demographic and socioeconomic characteristics, HRQOL, perceived discrimination, and health-related variables. Logistic regression models were used to identify associations between perceived discrimination and gender differences in poor HRQOL outcomes (defined as 14+ unhealthy days in overall, physical, or mental health over the past 30 days) when controlling for the other variables.

RESULTS

More women reported poor overall HRQOL than men (24 vs. 16% respectively). Higher perceived discrimination was significantly associated with worse overall HRQOL (OR 1.11; 95% CI 1.08, 1.15), with stronger effects for women in overall and mental HRQOL. These gender disparities remained significant until controlling for potentially confounding variables. Perceived discrimination did not account for gender differences in poor physical HRQOL.

CONCLUSIONS

Perceived discrimination is associated with poor HRQOL in older African Americans, with this association appearing stronger in women than men for mental HRQOL. These findings warrant further investigation of effects of perceived discrimination in gender disparities in overall health, and such research can inform and guide efforts for reducing these disparities.

Chronic Stress and C-Reactive Protein in Mothers During the First Postpartum Year

OBJECTIVE

Elevated levels of C-reactive protein (CRP) are associated with increased risk of cardiovascular and metabolic disease. The current study tested associations between psychosocial stress and CRP in a large sample of women during the first postpartum year.

METHODS

We analyzed data collected by the five-site Community Child Health Network study, which studied a predominately poor population. Participants (n = 1206 women; 54% African American, 23% white, 23% Hispanic/Latina) were recruited shortly after the birth of a child. Multiple linear regression analyses tested associations of psychosocial stress in several life domains (financial, neighborhood, family, coparenting, partner relationship, discrimination, and interpersonal violence) with log-transformed CRP concentrations at 6-month and 1-year postpartum.

RESULTS

Forty-eight percent of participants showed evidence of elevated CRP (≥3 mg/L) at 6-month postpartum, and 46% had elevated CRP at 12-month postpartum. Chronic financial stress at 1-month postpartum predicted higher levels of CRP at 6- (b = .15, SE = .05, p = .006) and 12-month postpartum (b = .15, SE = .06, p = .007) adjusting for race/ethnicity, income, education, parity, health behaviors, and chronic health conditions, though associations became nonsignificant when adjusted for body mass index.

CONCLUSIONS

In this low-income and ethnic/racially diverse sample of women, higher financial stress at 1-month postbirth predicted higher CRP. Study findings suggest that perceived financial stress stemming from socioeconomic disadvantage may be a particular deleterious form of stress affecting maternal biology during the year after the birth of a child.

Upregulation of TH/IL-17 Pathway-Related Genes in Human Coronary Endothelial Cells Stimulated with Serum of Patients with Acute Coronary Syndromes

Background

Inflammation plays an essential role in the development and complications of atherosclerosis plaques, including acute coronary syndromes (ACS). Indeed, previous reports have shown that within the coronary circulation of ACS patients, several soluble mediators are released. Moreover, it has been demonstrated that endothelial dysfunction might play an important role in atherosclerosis as well as ACS pathophysiology. However, the mechanisms by which these soluble mediators might affect endothelial functions are still largely unknown. We have evaluated whether soluble mediators contained in serum from coronary circulation of ACS patients might promote changes of gene profile in human coronary endothelial cells (HCAECs).

Methods

HCAECs were stimulated in vitro for 12 h with serum obtained from the coronary sinus (CS) and the aorta (Ao) of ACS patients; stable angina (SA) patients served as controls. Gene expression profiles of stimulated cells were evaluated by microarray and real-time PCR.

Results

HCAECs stimulated with serum from CS of ACS patients showed a significant change (upregulation and downregulation) in gene expression profile as compared with cells stimulated with serum from CS of SA patients. Moreover, ad hoc sub analysis indicated the upregulation of Th-17/IL-17 pathway-related genes.

Conclusion

This study demonstrates that, in ACS patients, the chemical mediators released in the coronary circulation might be able to perturb coronary endothelial cells (ECs) modifying their gene profile. These modified ECs, through downregulation of protective gene and, mainly, through upregulation of gene able to modulate the Th-17/IL-17 pathway, might play a key role in progression of coronary atherosclerosis and in developing future acute events.

Discrimination and Telomere Length Among Older Adults in the United States

OBJECTIVES

Chronic stress from experiencing discrimination can lead to long-term changes in psychological and physiologic responses, including shorter leukocyte telomere length. We examined the association between leukocyte telomere length and variations in the association by race or type of discrimination.

METHODS

Our study consisted of 3868 US-born non-Hispanic black (hereinafter, black) and non-Hispanic white (hereinafter, white) adult participants from the 2008 Health and Retirement Study biomarker sample with complete sociodemographic and discrimination information. We examined major lifetime unfair treatment and everyday discrimination. Coarsened exact matching matched exposed and unexposed participants on several sociodemographic factors. Coarsened exact matching creates analytic weights for the matched data sets. We applied weighted linear regression to the matched data sets. We conducted 2 subanalyses in which we matched on potential mediators-physical activity, smoking status, and obesity-and examined if racism was associated with shorter telomere length compared with other attributes. All analyses were stratified by race.

RESULTS

We found no difference in telomere length for black and white participants reporting major lifetime unfair treatment (β = 0.09; 95% CI, -0.33 to 0.15) or everyday discrimination (β = 0.04; 95% CI, -0.12 to 0.40). Everyday discrimination was associated with shorter leukocyte telomere length among black people (β = -0.23; 95% CI, -0.44 to -0.01) but not among white people (β = 0.05; 95% CI, -0.01 to 0.10). Matching on potential mediators generally decreased the effect estimate among black people.

CONCLUSIONS

Experiencing everyday discrimination was associated with shortened telomere length among older black adults. Further research is needed to understand the adverse physiologic effects of discrimination to create effective interventions.

Everyday unfair treatment and multisystem biological dysregulation in African American adults

OBJECTIVE

Increasing evidence suggests that chronic exposure to unfair treatment or day-to-day discrimination increases risk for poor health, but data on biological stress mechanisms are limited. This study examined chronic experiences of unfair treatment in relation to allostatic load (AL), a multisystem index of biological dysregulation.

METHOD

Data are from a sample of 233 African-American adults (37-85 years; 64% women). Perceptions of everyday unfair treatment were measured by questionnaire. An AL index was computed as the sum of 7 separate physiological system risk indices (cardiovascular regulation, lipid, glucose, inflammation, sympathetic nervous system, parasympathetic nervous system, hypothalamic pituitary adrenal axis).

RESULTS

Adjusting for sociodemographics, medication use, smoking status, alcohol consumption, depressive symptoms, lifetime discrimination, and global perceived stress, everyday mistreatment was associated with higher AL.

CONCLUSIONS

The results add to a growing literature on the effects of chronic bias and discrimination by demonstrating how such experiences are instantiated in downstream physiological systems. (PsycINFO Database Record

Systemic Inflammation in Midlife: Race, Socioeconomic Status, and Perceived Discrimination

INTRODUCTION

This study investigates social determinants of systemic inflammation, focusing on race, SES, and perceived discrimination.

METHODS

Data on 884 white and 170 black participants were obtained from the Survey of Midlife in the U.S., a cross-sectional observational study combining survey measures, anthropometry, and biomarker assay. Data, collected in 2004-2009, were analyzed in 2016. Main outcome measures were fasting blood concentrations of C-reactive protein, interleukin 6, fibrinogen, and E-selectin. For each biomarker, series of multivariate linear regression models were estimated for the pooled sample and separately for blacks and whites. Full models included social determinants; psychological, lifestyle, and health factors; and demographic covariates.

RESULTS

Bivariate analyses indicated higher concentrations of all inflammation markers among blacks compared with whites (p<0.001). In fully adjusted models using the pooled sample, racial differences persisted for interleukin 6 (p<0.001) and fibrinogen (p<0.01). For E-selectin and C-reactive protein, racial differences were explained after adjusting for covariates. Education was linked to lower fibrinogen concentration (p<0.05) in the fully adjusted model and C-reactive protein concentration (p<0.01) after adjusting for demographic factors and income. Lifetime perceived discrimination was related to higher concentrations of fibrinogen (p<0.05) in the fully adjusted model, and higher concentrations of E-selectin and interleukin 6 (p<0.05) after adjusting for socioeconomic status (SES) and demographic factors.

CONCLUSIONS

This study clarifies the contributions of race, SES, and perceived discrimination to inflammation. It suggests that inflammation-reducing interventions should focus on blacks and individuals facing socioeconomic disadvantages, especially low education.

Chronic Stress and Endothelial Dysfunction: The Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND

Endothelial dysfunction may represent an important link between chronic stress and cardiovascular disease (CVD) risk. However, few studies have examined the impact of chronic stress on endothelial dysfunction. The purpose of this study was to examine whether chronic stress was associated with flow-mediated dilation (FMD) and 2 biomarkers of endothelial dysfunction (intercellular adhesion molecule-1 (ICAM-1) and E-selectin) in a multiethnic sample of adults (ages 45-84 years).

METHODS

Data come from the baseline examination of Multi-Ethnic Study of Atherosclerosis participants. Chronic stress was assessed based on self-report of the presence and severity of ongoing problems in 5 domains. FMD was obtained using high-resolution ultrasound; biomarkers were assayed in different subsets of participants.

RESULTS

Higher chronic stress was associated with lower absolute FMD (mm FMD) in models adjusted for demographic and socioeconomic characteristics (0.169mm in high-stress participants vs. 0.178 and 0.179mm in medium and low-stress participants; P for trend = 0.04). This association remained unchanged with further adjustment for behavioral and biological CVD risk factors. Higher stress was related to higher ICAM-1 in models adjusted for sociodemographic characteristics and biological risk factors (P for trend = 0.005), but this association attenuated with adjustment for cigarette smoking (P for trend = 0.07). Chronic stress was not associated with E-selectin.

CONCLUSIONS

Our findings suggest chronic stress is related to endothelial dysfunction, possibly in part through other stress-associated CVD risk factors such as cigarette smoking.

Self-reported experiences of discrimination and inflammation among men and women: The multi-ethnic study of atherosclerosis

OBJECTIVE

To examine associations of lifetime and everyday discrimination with inflammation independent of sociodemographic characteristics.

METHOD

Cross-sectional associations of self-reported experiences of everyday discrimination and lifetime discrimination with interleukin-6 (IL-6) and C-reactive protein (CRP) were examined by gender in a multiethnic sample of 3,099 men and 3,468 women aged 45-84 years. Everyday discrimination, lifetime discrimination due to any attribution, and lifetime discrimination attributed to race/ethnicity were based on self-report, and IL-6 and CRP were assayed from blood samples.

RESULTS

Among women, higher levels of all 3 discrimination measures were significantly associated with higher IL-6 in models adjusted for sociodemographic characteristics, recent infection, anti-inflammatory medication use, and hormone replacement therapy use. All associations were attenuated with adjustment for body mass index (BMI). For men, everyday discrimination was inversely associated with IL-6 in all adjusted models. Lifetime discrimination was not related to IL-6 among men. Discrimination was unassociated with CRP in all models for both men and women.

CONCLUSIONS

The association between discrimination and inflammation varied by gender and marker of inflammation. These findings highlight the complex relationship between discrimination and cardiovascular disease (CVD) risk and point to areas in need of further research. (PsycINFO Database Record

Allostatic Load as a Complex Clinical Construct: A Case-Based Computational Modeling Approach

Allostatic load (AL) is a complex clinical construct, providing a unique window into the cumulative impact of stress. However, due to its inherent complexity, AL presents two major measurement challenges to conventional statistical modeling (the field's dominant methodology): it is comprised of a complex causal network of bioallostatic systems, represented by an even larger set of dynamic biomarkers; and, it is situated within a web of antecedent socioecological systems, linking AL to differences in health outcomes and disparities. To address these challenges, we employed case-based computational modeling (CBM), which allowed us to make four advances: (1) we developed a multisystem, 7-factor (20 biomarker) model of AL's network of allostatic systems; (2) used it to create a catalog of nine different clinical AL profiles (causal pathways); (3) linked each clinical profile to a typology of 23 health outcomes; and (4) explored our results (post hoc) as a function of gender, a key socioecological factor. In terms of highlights, (a) the Healthy clinical profile had few health risks; (b) the pro-inflammatory profile linked to high blood pressure and diabetes; (c) Low Stress Hormones linked to heart disease, TIA/Stroke, diabetes, and circulation problems; and (d) high stress hormones linked to heart disease and high blood pressure. Post hoc analyses also found that males were overrepresented on the High Blood Pressure (61.2%), Metabolic Syndrome (63.2%), High Stress Hormones (66.4%), and High Blood Sugar (57.1%); while females were overrepresented on the Healthy (81.9%), Low Stress Hormones (66.3%), and Low Stress Antagonists (stress buffers) (95.4%) profiles.

Ethnically-Based Theme House Residency and Expected Discrimination Predict Downstream Markers of Inflammation Among College Students

We examined participation in an ethnically based residential program or “theme house” during the first year of college as a predictor of downstream immune system inflammation among undergraduates. Using a 4-year prospective design, we compared markers of inflammation among Latino/Latina students in a residential theme program with a matched sample of nonresidents. Students provided oral mucosal transudate samples for the assessment of circulating Interleukin 6 (IL-6), an inflammatory cytokine linked to health vulnerabilities. Findings suggest a protective benefit of theme house residency especially among students with anxious expectations of discrimination. Such expectations predicted higher levels of IL-6 after the first year of college among nonresidents only. In years 2–3, following exit from the theme house, the relationship between expected discrimination and IL-6 levels remained positive among nonresidents and was attenuated among residents, controlling for past IL-6 levels. Culturally based spaces may therefore offset the physiological burden of expected discrimination among undergraduates.

Minority stress and inflammatory mediators: covering moderates associations between perceived discrimination and salivary interleukin-6 in gay men

Physical health disparities by sexual orientation are widespread yet under-investigated. Drawing upon theories of biological embedding of social adversity, we tested whether minority stress (in the form of perceived discrimination) is associated with salivary interleukin-6 (IL-6), an inflammatory mediator. Furthermore, we examined whether covering, a strategy involving downplaying a stigmatized social identity, modified this association. A community sample (N = 99) of gay men (n = 78) and lesbian women (n = 21) completed self-report measures of minority stress and identity management and provided saliva samples which were assayed for IL-6. Among gay men, results from generalized linear models supported a hypothesized interaction between perceived discrimination and covering, such that perceived discrimination was predictive of higher levels of IL-6 for those who engaged in less covering but not for those who engaged in more covering. This interaction was robust to a number of potential covariates (alcohol, medication, body mass index, race and age). Results for lesbian women suggested a different pattern: the only statistically significant association detected was between greater perceived discrimination and lower levels of IL-6. Findings from the current study point to an important role for inflammatory processes in understanding and remediating health disparities based upon sexual orientation that stem from exposure to prejudice and discrimination.