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

The Effectiveness of a Race-Based Stress Reduction Intervention on Improving Stress-Related Symptoms and Inflammation in African American Women at Risk for Cardiometabolic Disease: Protocol for Recruitment and Intervention for a Randomized Controlled Trial

BACKGROUND

In recent years, the prevalence of cardiometabolic disease (CMD) in African American women has risen; the risk also increases with age, in comparison to men. Evidence demonstrates that stressful life events, including experiences of racism and perceived discrimination, contribute substantially to inflammatory diseases, such as CMD. Despite this evidence, few evidence-based interventions are available to assist individuals from minoritized communities in coping with the chronic stress related to their racial or ethnic identity.

OBJECTIVE

Our proposed randomized controlled trial will test a novel, race-based intervention tailored to African American women, called Resilience, Stress, and Ethnicity (RiSE).

METHODS

In this randomized controlled trial, we will randomize participants 1:1 to the 8-week, group-based RiSE program (intervention) or a health education program (active control group). Both programs will consist of synchronous classes on Zoom and will be led by experts. The primary end point will be stress at 6 months after the intervention, and the efficacy of RiSE will be evaluated for improving stress-related symptoms (current perceived stress, depressive symptoms, fatigue, and sleep disturbance), improving coping strategies, and reducing inflammatory burden in African American women at risk for CMD. Validated survey measures and inflammatory biomarkers will be assessed at baseline, midintervention, intervention completion, and 6 months after the intervention, and differences over time by intervention will be evaluated using mixed effects models.

RESULTS

This study was funded by the National Institute on Aging on March 30, 2023, with recruitment and enrollment beginning in October 2023. The study is underway, with 120 participants enrolled as of March 2025.

CONCLUSIONS

This study will be one of the first to examine a race-based stress reduction intervention in African American women and has the potential to improve the health of minoritized groups faced with chronic stress associated with experiencing racism and discrimination. We anticipate that RiSE will reduce stress-related symptoms, enhance adaptive coping, and reduce inflammation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05902741; https://www.clinicaltrials.gov/study/NCT05902741.

Associations between experiences of discrimination and quality of life in Black breast cancer survivors

BACKGROUND

Racial discrimination has been associated with decreased health-related quality of life (QOL) in the general population; however, its impact on QOL in cancer survivors is unclear. This study aims to examine how experiences of discrimination (EOD) impact QOL in breast cancer survivors and whether these associations vary by individual- and structural-level factors.

METHODS

The association of EOD assessed at baseline (∼12 months post-diagnosis) was assessed in the Women's Circle of Health Follow-up Study, a population-based longitudinal cohort study of Black breast cancer survivors in New Jersey. QOL was assessed at follow-up (∼24 months postdiagnosis) using the Functional Assessment of Cancer Therapy - Breast (FACT-B). Multivariable linear regression models adjusted for confounders assessed the association of EOD (none, low, high) with QOL. We also examined statistical interaction by individual-level factors (coping and spirituality) and structural-level factors (neighborhood socioeconomic status and residential segregation).

RESULTS

Of 216 study participants, 74% reported experiencing discrimination. In fully adjusted models, women with high EOD had lower overall QOL (no discrimination, mean FACT-B: 114.8; 95% CI, 107.9-121.7; high discrimination, mean FACT-B: 101.1; 95% CI, 94.2-108.0). Although no evidence was observed of statistically significant interaction, women with high spirituality had better overall QOL, regardless of EOD (high spirituality/low discrimination: 128.2; 95% CI, 121.9-134.5; high spirituality/high discrimination: 115.4; 95% CI, 108.5-122.3; low spirituality/no discrimination: 103.5; 95% CI, 93.8-113.2).

CONCLUSIONS

Among Black breast cancer survivors, discrimination was associated with poorer QOL. Spirituality may mitigate the harmful effects, as women with high spirituality, even in the context of high discrimination, reported higher QOL.

Cadmium exposure and thyroid hormone disruption: a systematic review and meta-analysis

INTRODUCTION

This meta-analysis aimed to analyze the effect of cadmium (Cd) exposure on thyroid hormone disruption.

CONTENT

Databases including PubMed, Embase, Cochrane Library, and Scopus were searched for studies published up to December 14, 2022. Studies evaluating the association between Cd exposure (blood Cd [BCd] or urine Cd [UCd]) and thyroid function (thyroid-stimulating hormone [TSH], free thyroxine [FT4], total triiodothyronine [TT3]) or thyroid autoimmunity (thyroglobulin antibody [TgAb] or thyroperoxidase Ab [TPOAb]) were included.

SUMMARY AND OUTLOOK

This systematic review included 12 cross-sectional studies. Cd exposure showed a neutral association with TSH (pooled correlation=0.016, 95 % confidence interval [CI]=-0.013 to 0.045, p=0.277), FT4 (pooled correlation=0.028, 95 % CI=-0.005 to 0.061, p=0.098), and thyroid autoimmunity (pooled odds ratio=1.143, 95 % CI=0.820-1.591, p=0.430). However, Cd exposure showed a positive association with TT3 (pooled correlation=0.065, 95 % CI=0.050-0.080, p<0.001), which was consistent with the BCd and UCd subgroup analyses (pooled correlation=0.053 and 0.081, respectively, both p<0.001). Cd exposure was not associated with TSH, FT4, or thyroid autoimmunity but tended to increase with TT3.

Differences in inflammation among black and white individuals: A systematic review and meta-analysis

IMPORTANCE

Despite persisting health disparities between Black and White individuals, racial differences in inflammation have yet to be comprehensively examined.

OBJECTIVE

To determine if significant differences in circulating levels of inflammatory markers between Black and White populations exist.

DATA SOURCES

Studies were identified through systematic searches of four electronic databases in January 2022. Additional studies were identified via reference lists and e-mail contact.

STUDY SELECTION

Eligible studies included full-text empirical articles that consisted of Black and White individuals and reported statistics for inflammatory markers for each racial group. Of the 1368 potentially eligible studies, 84 (6.6 %) representing more than one million participants met study selection criteria.

DATA EXTRACTION AND SYNTHESIS

Risk of bias was assessed via meta regressions that considered relevant covariates. Data heterogeneity was tested using both the Cochrane Q-statistic and the standard I2 index. Random effects models were used to calculate estimates of effect size from standardized mean differences.

MAIN OUTCOMES AND MEASURES

Outcome measures included 12 inflammatory markers, including C-reactive protein (CRP), Fibrinogen, Interleukin-6 (IL-6), Tumor necrosis factor-alpha (TNF-α), and soluble intercellular adhesion molecule 1 (sICAM-1).

RESULTS

Several markers had robust sample sizes for analysis, including CRP (White N = 934,594; Black N = 55,234), Fibrinogen (White N = 80,880; Black N = 18,001), and IL-6 (White N = 20,269; Black N = 14,675). Initial results indicated significant effects on CRP (k = 56, pooled Hedges' g = 0.24), IL-6 (k = 33, g = 0.15), and Fibrinogen (k = 19, g = 0.49), with Black individuals showing higher levels. Results also indicated significant effects on sICAM-1 (k = 6, g = -0.46), and Interleukin-10 (k = 4, g = -0.18), with White individuals showing higher levels. Sensitivity analyses confirmed robust effects for CRP, IL-6, Fibrinogen, and sICAM-1 while also revealing significant effects on TNF-α (k = 18, g = -0.17) and Interleukin-8 (k = 5, g = -0.19), with White individuals showing higher levels of both.

CONCLUSIONS AND RELEVANCE

Current meta-analytic results provide evidence for marked racial differences in common circulating inflammatory markers and illustrate the complexity of the inflammatory profile differences between Black and White individuals. Review Pre-Registration: PROSPERO Identifier - CRD42022312352.

Discrimination, Depression, and Anxiety Among US Adults

Importance

Examining how discrimination is associated with mental health across different demographic groups can guide efforts to improve mental well-being.

Objectives

To analyze associations between discrimination and mental health and explore how these associations may vary by race and ethnicity and sex.

Design, Setting, and Participants

Cross-sectional data of 29 522 adults weighted to represent a population of 258 237 552 US adults from the 2023 US National Health Interview Survey were analyzed.

Exposures

Exposure to discrimination was measured using the Everyday Discrimination Scale, which assesses frequency of being treated with less courtesy, receiving poor service, being treated as not smart, being feared, and experiencing harassment. A summative scale and a nominal variable (none, low, and high) measured degree and levels of discrimination exposure.

Main Outcomes and Measures

Outcomes included depression (measured with the Patient Health Questionnaire-2 scale) and anxiety (measured with the Generalized Anxiety Disorder-2 scale), with scores of 3 or greater indicating positive screening results for each scale. Multinomial logistic regression analyses examined associations of interest and tests of interaction explored effect modification by race and ethnicity and sex.

Results

Among a sample of 29 522 adults weighted to represent a population of 258 237 552 US adults (mean age, 48.1 years [95% CI, 47.8-48.4 years]; 51.1% female; 17.5% Hispanic or Latino, 2.5% multiracial or other, 6.2% non-Hispanic Asian, 11.6% non-Hispanic or non-Latino Black, and 62.2% non-Hispanic or non-Latino White), each unit increase in exposure to discrimination was associated with increased odds of positive screening results for depression (odds ratio [OR], 1.15 [95% CI, 1.12-1.17]), anxiety (OR, 1.14 [95% CI, 1.12-1.16]), and both depression and anxiety (OR, 1.19 [95% CI, 1.16-1.21]). Compared with no exposure to discrimination, low and high exposure to discrimination were associated with increased odds of positive screening results for depression (low exposure: OR, 2.20 [95% CI, 1.77-2.72]; high exposure: OR, 5.39 [95% CI, 3.61-8.04]), anxiety (low exposure: OR, 1.97 [95% CI, 1.66-2.33]; high exposure: OR, 4.98 [95% CI, 3.59-6.91]), and both depression and anxiety (low exposure: OR, 2.60 [95% CI, 2.13-3.18]; high exposure: OR, 8.84 [95% CI, 6.44-12.14]). Associations between discrimination and positive screening results for depression alone (F4,607 = 3.35; P = .01) and between discrimination and positive screening results for both depression and anxiety (F4,607 = 2.80; P = .03) varied by race and ethnicity. Associations of interest did not differ by sex.

Conclusions and Relevance

Findings of this cross-sectional study suggest an association between discrimination and mental health across US adults, emphasizing the need for further evaluation and increased awareness of how these associations may vary across different demographic groups.

From Discrimination to Disease: The Role of Inflammation

ABSTRACT

Discrimination is an established social determinant of mental health that contributes to psychiatric illness disparities among marginalized populations. There is emerging research elucidating the biological mechanisms connecting discrimination to mental health outcomes, revealing inflammation as a key pathway. This column synthesizes evidence from existing literature on the links between discrimination and inflammation, and outlines both the opportunities and challenges in this field. The discussion highlights the necessity of a multifaceted approach to address discrimination, and thus, reduce inflammation at both individual and population levels.

Experiences of discrimination and snacking behavior in Black and Latinx children

Little is known about how discrimination contributes to health behaviors in childhood. We examined the association between children's exposure to discrimination and their snacking behavior in a sample of youth of color (N = 164, Mage = 11.5 years, 49% female, 60% Black, 40% Hispanic/Latinx). We also explored whether children's body mass index (BMI) or sleepiness moderated the association between discrimination and calorie consumption. The significant link between discrimination and calorie consumption was moderated by children's BMI, such that discrimination was associated with calorie consumption for children with BMI percentiles above 79%. Children's sleepiness did not serve as an additional moderator. Efforts to promote health should consider children's broader socio-contextual experiences, including discrimination, as factors that may shape eating patterns.

Parent discrimination clusters and pediatric health in a national survey: The modifying effect of parenting

•The study uses unsupervised machine learning to identify discrimination clusters in parents.•Four distinct clusters of parental discrimination were identified using machine learning.•Parental discrimination clusters are associated with poorer pediatric health outcomes.•Positive parenting may mitigate the negative effects of parent discrimination on child health.•Negative parenting may exacerbate the health risks associated with parental discrimination.

Societal Discrimination, Vigilance, and Patient-Provider Relationships Among Perinatal Women: A Mixed Methods Study

INTRODUCTION

In the United States, maternal mortality is high and patterned by race and socioeconomic status (SES). Patient-provider relationships and societal discrimination have been separately associated with poor maternal outcomes, but it is not clear how such mechanisms may be interrelated. Thus, the present study investigates how societal experiences of discrimination are associated with and manifest in patient-provider relationship quality among perinatal women.

METHODS

The study uses a mixed methods design with an explanatory-sequential approach. First, a path analysis using structural equation modeling of a cross-sectional representative survey of 244 perinatal women in Kalamazoo County, Michigan, was conducted. Second, a thematic qualitative analysis was conducted of focus groups composed of survey participants (n = 34).

RESULTS

In the quantitative analyses, race and SES were associated with experiences of societal discrimination in the expected directions (race: b, 1.87; SE, 0.58; P = .001; SES: b, 2.18; SE, 0.60; P < .001), discrimination positively predicted vigilant behaviors (b, 0.81; SE, 0.15; P < .001), and more vigilant behaviors predicted worse patient-provider relationship quality (b, 0.18; SE, 0.07; P < .001). In the qualitative findings, we found detailed accounts linking provider discrimination, vigilance, and patient-provider relationships among focus groups composed of only women of color (n = 9).

DISCUSSION

Overall, the quantitative analyses find support for the conceptual model showing race and SES are associated with societal discrimination, which is associated with vigilant behaviors and, in turn, quality of patient-provider relationships. The qualitative analyses provide preliminary evidence for how these pathways manifest in care settings and demonstrate the importance of establishing trust in patient-provider relationships, especially among women of color.

Ethnic Disparities in Cardiovascular Disease: A Comparative Analysis of Asian and Central Asian Populations

BACKGROUND

Cardiovascular diseases (CVD) are the leading cause of death globally, with a significant burden on the Asian and Central Asian populations. Ethnic discrimination is an emerging determinant of CVD risk, yet comprehensive analyses in these populations are sparse.

OBJECTIVES

This systematic review aimed to assess the association between ethnic discrimination and CVD among Asian and Central Asian populations, quantifying risks and examining contributing factors.

METHODS

Following the PRISMA guidelines, we reviewed 23 studies across PubMed, Scopus, and the Web of Science, including 10 on Central Asian and 13 on broader Asian populations. Risk measures such as odds ratios (ORs) and hazard ratios (HRs) were extracted where available.

RESULTS

The findings indicate a robust association between ethnic discrimination and increased CVD risks. Among Kyrgyz and Kazakh populations, discrimination was linked to hypertension with an OR of 2.4, while ethnic Kazakhs experiencing discrimination had a 70% higher risk of all-cause mortality (HR 1.7). In South Asians, discrimination was associated with a 30% higher prevalence of premature cardiovascular events, while Chinese populations exposed to everyday discrimination demonstrated a 15.2% higher prevalence of hypertension. Rural populations in Central Asia showed clustering of CVD risk factors with an OR of 1.9.

CONCLUSIONS

Discrimination is a significant contributor to CVD disparities, with its effects varying across ethnic groups and regions. These findings underscore the need for culturally tailored public health interventions and policies addressing social determinants of health. Future research should explore longitudinal impacts and the efficacy of targeted community-based programs to mitigate these risks.

Hearing Loss and Discrimination: Evidence of Intersectionality in the All of Us Research Program

OBJECTIVES

Hearing loss (HL) has significant implications on social functioning. Here, we study the relationship between HL, race, and these combined categories as risk factors for discrimination in the large national All of Us cohort.

METHODS

The National Institutes of Health All of Us dataset was analyzed after including individuals who completed the Everyday Discrimination Survey between November 2021 and January 2022. HL and potential medical confounders were defined per ICD-10 codes or demographics. Multivariable linear regressions analyzing the relationship between HL and discrimination were adjusted for potential confounders, including age, gender, race, ethnicity, other demographic factors, and relevant medical conditions, such as depression and dementia. Additional regressions were conducted to evaluate how combined HL and race categories associated with discrimination risk.

RESULTS

Totally 8,722 individuals ≥18 years old had complete data. The mean age was 65 years (SD = 13.0 years), and 41% were women. Individuals with HL, compared with those without, were more likely to report discrimination in six out of nine questions on the Everyday Discrimination Survey (p < 0.05, with effect sizes ranging from -0.05 to -0.16 on a 6-point scale from 0 = "Almost everyday" to 5 = "Never"). Notably, for four out of those six questions, combined Black race and HL was associated with a risk of discrimination independent from the risk conveyed by race and/or HL individually.

CONCLUSIONS

This study offers evidence of HL as a risk factor for self-reported discrimination. Further, this study provides support for an intersectional understanding between discrimination, race, and HL.

LEVEL OF EVIDENCE

III, Laryngoscope, 2024 Laryngoscope, 2025.

Sociodemographic disparities in everyday discrimination among a national sample of adults in the United States, 2023

Objective

Discrimination is a social determinant contributing to health inequities in the United States (US). This study investigated the prevalence of, and sociodemographic disparities in, perceived everyday discrimination among a national sample of US adults.

Methods

We used data from the 2023 National Health Interview Survey (n = 27,538) and estimated the prevalence of three perceived everyday discrimination outcomes (1) any discrimination, (2) unique components of the discrimination experience, and (3) the Everyday Discrimination Scale (EDS) (range: 0-20) overall and by age, sex assigned at birth, race and ethnicity, sexual orientation, educational attainment, income-to-poverty ratio, and urban-rural status.

Results

Over half of US adults experienced any discrimination (55.8 %), and the most common form of perceived discrimination was being treated with less respect (45.2 %). Adults who were younger (aged 18-44), female, non-Hispanic Black, sexual minority, some college-educated, low income, or urban-living generally reported higher discrimination. For example, among the sample, non-Hispanic Black (vs. non-Hispanic White) (OR: 1.61, 95 % CI: 1.44-1.81) and sexual minority (vs. heterosexual) (OR: 2.48, 95 % CI: 2.12-2.90) adults had the highest odds of any discrimination and EDS scores (β: 1.38 (95 % CI: 1.17-1.59) and β: 1.65 (95 % CI: 1.35-1.94), respectively). The odds of perceived discrimination varied in magnitude by specific experience; for example, sexual minority adults had the highest odds of being threatened or harassed (OR: 2.93, 95 % CI: 2.52-3.42).

Conclusions

Perceived everyday discrimination is prevalent and differentially affects adults, especially members of marginalized and underserved populations. Understanding discrimination patterns will benefit public health and medical efforts aimed at mitigating exposure and deleterious health consequences.

Imposter phenomenon and experiences of discrimination among students at a predominantly White institution

Objective: To compare the experiences of Imposter Phenomenon and discrimination among non-Hispanic White (NHW) and racial and ethnic minority (REM) students at a predominantly White Institution (PWI). Participants: 125 undergraduate students (89.6% women, 68.8% NHW, and 31.2% REM). Methods: Participants completed an online questionnaire including the Clance Imposter Phenomenon Scale (CIPS), Everyday Discrimination Scale (EDS), demographic variables (class year, gender, first generation student status), and 5 items assessing students' feelings of belonging and support. Descriptive statistics and bivariate analyses were performed. Results: Mean CIPS scores were similar for NHW (64.05 ± 14.68) and REM students (63.62 ± 15.90, P =  . 882), but EDS scores were significantly higher among REM students (13.00 ± 9.24 vs. 8.00 ± 5.21, P =  . 009). REM students more frequently felt that they don't belong, are excluded, and lack resources to succeed. Conclusions: Racial and ethnic minority students at PWIs may need additional resources and social support.

Racial and nonracial discrimination and tobacco use among high school students in California

BACKGROUND

The public health literature has established a relationship between discrimination, health outcomes, and health and well-being in adolescence. The objective of this study is to add vaping to the existing studies on discrimination and tobacco use among youth. To achieve this objective, the analysis examined the relationship between discrimination, type of discrimination, and current tobacco use, including current vape use, among adolescents in California.

METHODS

This study uses data from the 2023 California Youth Tobacco Survey, which was administered to a representative sample of middle and high school students (8th, 10th, and 12th graders) attending public and private schools in California. The analysis focused on high school students in public schools. Outcome variables were current use of any tobacco product and current vape use. Predictor variables were any, racial, and nonracial discrimination. Covariates included race/ethnicity, gender identity and sexual orientation, and age. Separate logistic regression models examined the relationship between any discrimination or racial and nonracial discrimination and current tobacco use or current vape use, adjusting for covariates. Analyses were adjusted by sampling weights and stratification variables to account for complex sampling techniques.

RESULTS

Any, racial, and nonracial discrimination were associated with significantly higher odds of current tobacco use. Any discrimination was also associated with significantly higher odds of current vape use. Nonracial, but not racial, discrimination was significantly associated with significantly higher odds of current vape use.

CONCLUSION

The results of this analysis are consistent with other analyses demonstrating a significant positive relationship between experiences of discrimination and tobacco use. These results contribute to existing knowledge by revealing that this relationship also exists for vaping among youth. Discrimination remains a public health crisis, including for youth in California. Increased use of supportive, rather than punitive, tobacco control approaches and cessation resources should be considered for schools in California.

Medical mistrust in racial minorities during the COVID-19 pandemic: Attitudes, actions and mental health outcomes

Numerous studies have demonstrated that minority groups had a higher level of medical mistrust than non-minority groups, and minority communities were criticized for noncompliance with the public health guidelines during the COVID-19 pandemic. This study explores racial minorities' attitudes and actual behavioral responses to the COVID-19 pandemic public health guidelines. A total of 221 adults responded to an online survey (mean age = 41.5; 48.0% female; 24.4% non-White). Study results indicate that racial minorities have lower trust in public health guidelines compared to non-minority groups but have taken more actions according to the public health guidelines. Analysis also uncovers the mediating roles of perceived pandemic severity and perceived public health action benefits, on the relation between minority status and public health compliance. This study contextualizes how racial minorities respond to public health crises in action, and the dissonance between that and their historical mistrust of medical authorities. This work highlights the importance of recognizing the minority's historical burden and fostering trust in government and professionals during public health crisis.

Racial Discrimination and Multiple Health Outcomes: An Umbrella Review of Systematic Reviews and Meta-Analyses

OBJECTIVE

We aimed to systematically investigate the associations between racial discrimination and various health outcomes and to evaluate the certainty of evidence from existing meta-analyses of observational studies.

METHOD

We systemically searched the associations between racial discrimination and health outcomes for PubMed/MEDLINE, Embase, WoS, and Google Scholar up until January 31, 2024. Notably, the included studies were predominantly conducted in the USA and Europe, limiting the generalizability of our findings to a global context.

RESULTS

Eight meta-analyses of observational studies involving over 1 million individuals were included, describing 15 potential health outcomes related to racial discrimination. The quality assessment revealed that most included meta-analyses were of low quality. For oncological health outcomes, significant associations were found with the mortality of hepatocellular carcinoma (HCC); black patients had a higher risk, while Asian patients had a lower risk when compared to white patients. In addition, black patients with disparities on the cancer care continuum are a protective factor for early-stage HCC diagnosis. For gastroenterological health outcomes, Hispanic patients with nonalcoholic fatty liver disease and black patients with socioeconomic status/differential access to health care, compared to white patients (reference), showed significant associations. For mental health outcomes, racial discriminations were significantly associated with increased odds of psychotic experiences, suicidal ideation, and suicidal attempts. Numerous significant associations were from weak to suggestive evidence levels, indicating variability in the evidence.

CONCLUSION

Despite the complexity of measuring its impact, racial discrimination shows a profound influence across clinical areas, including an unexpected protective association in early-stage HCC diagnosis among black patients.

OBJECTIVE

We aimed to systematically investigate the associations between racial discrimination and various health outcomes and to evaluate the certainty of evidence from existing meta-analyses of observational studies.

METHOD

We systemically searched the associations between racial discrimination and health outcomes for PubMed/MEDLINE, Embase, WoS, and Google Scholar up until January 31, 2024. Notably, the included studies were predominantly conducted in the USA and Europe, limiting the generalizability of our findings to a global context.

RESULTS

Eight meta-analyses of observational studies involving over 1 million individuals were included, describing 15 potential health outcomes related to racial discrimination. The quality assessment revealed that most included meta-analyses were of low quality. For oncological health outcomes, significant associations were found with the mortality of hepatocellular carcinoma (HCC); black patients had a higher risk, while Asian patients had a lower risk when compared to white patients. In addition, black patients with disparities on the cancer care continuum are a protective factor for early-stage HCC diagnosis. For gastroenterological health outcomes, Hispanic patients with nonalcoholic fatty liver disease and black patients with socioeconomic status/differential access to health care, compared to white patients (reference), showed significant associations. For mental health outcomes, racial discriminations were significantly associated with increased odds of psychotic experiences, suicidal ideation, and suicidal attempts. Numerous significant associations were from weak to suggestive evidence levels, indicating variability in the evidence.

CONCLUSION

Despite the complexity of measuring its impact, racial discrimination shows a profound influence across clinical areas, including an unexpected protective association in early-stage HCC diagnosis among black patients.

Perspectives on Integrating Biological Assessments to Address the Health Effects of Childhood Adversities

ABSTRACT

A majority of adults in the United States (US) report a range of stressful and potentially traumatic childhood experiences (e.g., physical or sexual abuse, witnessing violence, neglect). Such adversities are associated with a range of mental (e.g., anxiety, mood, and behavioral difficulties) and physical (e.g., cardiovascular illnesses, diabetes, asthma) health problems. Increasingly, precision medicine approaches seek to prevent and treat such multifinal downstream health problems by identifying common etiological pathways (e.g., inflammation and immune pathways) and candidate biomarkers to target interventions. In this context, we review the rationale for continued research to identify biomarkers of childhood adversity. Building on the bioecological theory, we emphasize that individual neurobiological profiles develop within multiple ecological levels (individual, family, neighborhood, macrosocial) that confer both risk and protective factors that can attenuate or amplify biological effects of childhood adversity. Given the limited data on adversity-associated biomarkers for children and adolescents, we discuss future recommendations for research, implications for clinical care, and ethical considerations. Preventing childhood adversity and supporting adversity- and trauma-informed systemic intervention approaches remains our primary recommendation. We highlight the continued need to consider both biomarkers of risk and protective factors across ecological levels in future research.

Profiles of community support and challenges associated with insomnia symptoms: Findings from the pilot Bhutanese Community of Central Ohio Health Study

STUDY OBJECTIVES

We investigated profiles of community support and challenges in relation to insomnia symptoms among the Bhutanese living in the United States.

METHODS

Using data from the pilot Bhutanese Community of Central Ohio Health Study (N = 495; 51.5% men, 69.8% aged 18-44years), we used latent class analysis to identify distinct profiles of neighborhood social cohesion, social support, and community challenges (e.g., limited access to healthcare services and transportation, crime and safety issues, substance use, intimate partner violence) and their associations with insomnia symptoms. Insomnia symptoms were self-reported as difficulty falling and staying asleep and dichotomized as "not at all" vs. "some to always." Identified classes/profiles were further differentiated by self-reported sociodemographic, socioeconomic, health, acculturative, and discrimination factors.

RESULTS

Latent class analysis revealed four distinct classes/profiles. The High Cohesion (class 1) profile (30.1% of sample) had the lowest likelihood of insomnia symptoms at 6.5%, followed by class 2 or High Support (23.6%) with a 15.3% likelihood. Class 3 or High Challenges profile (11.5%) had a moderate likelihood of insomnia symptoms at 49%. Class 4 or the Low Cohesion/Support profile (34.7%) had a 100% likelihood of reporting insomnia symptoms. Class 4 when compared to class 1 was more likely to report cardiometabolic conditions, experiences of everyday discrimination, limited English linguistic proficiency, and not using telehealth.

CONCLUSION

Community social cohesion and support may play an important role in mitigating insomnia symptoms among Bhutanese refugees. Further investigations are warranted.

Conceptual Framework for African American Kinship Caregiver's Susceptibility to Alzheimer's Disease

Kinship caregivers (e.g., grandparents raising grandchildren) have been increasing over the last several decades. Approximately 3.5 million grandparents and other relatives are the primary caregivers for their related children, and African Americans are more likely to be kinship caregivers than persons from other groups. Kinship caregivers face unique challenges, such as parenting for uncertain periods of time and often with insufficient financial resources and support, placing them at significant risk of stress. Given the findings linking chronic stress to Alzheimer's disease (AD), there is a need for research to identify possible stressors and mitigate risks for outcomes such as AD among kin caregivers. Additionally, research indicates that African Americans (AAs) experience unusually high levels of stress due to factors often associated with structural racism, and they are disproportionately affected by cardiovascular disease (CVD), which is often a consequence of stress and another risk factor for AD. Regrettably, AA kin caregivers often incur a host of negative stress-related outcomes, including poor physical and mental health. Thus, there is an urgent need for research to identify modifiable risk factors for both stress and CVD to potentially mitigate the onset of AD in this population. The purpose of this paper is to provide a conceptual framework to examine the links between African Americans who commit to the unselfish act of providing kinship caregiving and their susceptibility to AD. Future research should investigate modifiable mechanisms to reduce the risks of AD in African American caregivers.

Racism and health and wellbeing among children and youth-An updated systematic review and meta-analysis

BACKGROUND

Evidence of racism's health harms among children and youth is rapidly increasing, though attention to impacts on physical health and biomarker outcomes is more emergent. We performed a systematic review of recent publications to examine the association between racism and health among children and youth, with a meta-analysis of the specific relationships between racism and physical health and biomarkers.

METHODS

We conducted a systematic literature search using four databases: Medline, PsycINFO, PubMed, and ERIC. Four inclusion criteria were used to identify eligible studies: (1) exposure was experiences of racism, (2) outcome was health and wellbeing, (3) quantitative methods were used to estimate the association between racism and health outcomes, and (4) the effect size of associations between racism and health and wellbeing was reported for participants aged 0-24 years. Correlation coefficients were used to report the pooled effect size for each outcome indicator.

RESULTS

There were 463 eligible studies included in the screening process, with 42 studies focusing on physical health or biomarker outcomes. Random-effects meta-analysis found minimal to moderate positive associations between racism and C-reactive protein, Interleukin 6, body mass index (BMI), obesity, systolic blood pressure, salivary cortisol, asthma, and somatic symptoms. There were marginal positive associations between racism and Tumour Necrosis Factor-α, cortisol collected via saliva, urine and hair, BMI-z score, and diastolic blood pressure, with imprecise estimates and wide confidence intervals.

CONCLUSIONS

Racism is associated with negative physical health and biomarker outcomes that relate to multiple physiological systems and biological processes in childhood and adolescence. This has implications for health and wellbeing during childhood and adolescence and future chronic disease risk. Collective and structural changes to eliminate racism and create a healthy and equitable future for all children and youth are urgently required.

Early adolescents' ethnic-racial discrimination and pubertal development: Parents' ethnic-racial identities promote adolescents' resilience

Ethnically and racially underrepresented adolescents are experiencing pubertal development earlier in life than prior cohorts and their White American peers. This early onset of puberty is partly attributable to ethnic-racial discrimination. To contribute to adolescents' resilience and posttraumatic growth in the face of ethnic-racial discrimination, parents' ethnic-racial identities may spill over into their parenting beliefs and practices. Parents who have a sense of belonging with and commitment to their ethnic-racial identities may be aware of discrimination and actively and consistently engage in practices that build supportive home environments to support their children's development in the context of ethnic-racial discrimination. To assess whether parents' ethnic-racial identity commitment predicted adolescents' resilience against ethnic-racial discrimination, we used multiple waves of survey data from adolescent siblings and their parents participating in the Adolescent Brain Cognitive Development study (N-adolescents = 1,651; N-families = 805; 35% Black, 37% Latinx, 3% Asian, 25% other ethnically and racially underrepresented youth; 49% boys, 50% girls, 1% gender nonconforming youth; Mage = 11.49, SD = 0.51). Results indicated that adolescents who experienced more frequent ethnic-racial discrimination than their siblings showed more advanced pubertal development. Parental ethnic-racial identity commitment reduced the relation between discrimination and pubertal development within a family. Results suggest that ethnic-racial identity commitment in parents can protect children when they experience ethnic-racial discrimination. Building on extant propositions related to resilience (Infurna & Luthar, 2018), the present study amplifies the depiction of resilience, yields recommendations for analysis of future research, and provides implications regarding the role of ethnicity-race in familial practices. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perceived Weight Discrimination and General Coping Strategies

BACKGROUND

Perceived weight discrimination is associated consistently with worse health outcomes. Coping strategies may be one mechanism of this association. The present research examined the association between perceived weight discrimination and strategies used to cope with general stress (not weight-specific) and whether these strategies accounted for part of the association with markers of health.

METHOD

Participants (N = 1882) completed a cross-sectional survey with a comprehensive measure of coping strategies and reported on their perceived experience of weight discrimination and markers of physical, mental, and social health.

RESULTS

Perceived weight discrimination was associated with greater use of disengaged coping strategies (β = .19, p < .01) and was unrelated to active and support coping strategies. Disengaged coping mediated the association between weight discrimination and worse physical, mental, and social health (proportion of mediation ranged from 14 to 47%). This pathway was independent of body mass index (BMI). Individuals in the obesity weight category (BMI ≥ 30 kg/m2) were less likely to use active (β =  - .11, p < .01) and support (β =  - .09, p < .01) coping strategies, which did not consistently mediate the association with health.

CONCLUSION

Perceived experiences of weight discrimination are associated with disengaged coping strategies to manage stressful experiences, and these strategies are one mechanism that may contribute to the worse health associated with unfair treatment due to weight.

Multi-discrimination exposure and biological aging: Results from the midlife in the United States study

Discrimination is a social determinant of health and health disparities for which the biological mechanisms remain poorly understood. This study investigated the hypothesis that discrimination contributes to poor health outcomes by accelerating biological processes of aging. We analyzed survey and blood DNA methylation data from the Midlife in the United States (MIDUS) study (N = 1967). We used linear regression analysis to test associations of everyday, major, and workplace discrimination with biological aging measured by the DunedinPACE, PhenoAge, and GrimAge2 epigenetic clocks. MIDUS participants who reported more discrimination tended to exhibit a faster pace of aging and older biological age as compared to peers who reported less discrimination. Effect-sizes for associations tended to be larger for the DunedinPACE pace-of-aging clock (effect-size range r = 0.1-0.2) as compared with the PhenoAge and GrimAge2 biological-age clocks (effect-sizes r < 0.1) and for experiences of everyday and major discrimination as compared with workplace discrimination. Smoking status and body-mass index accounted for roughly half of observed association between discrimination and biological aging. Reports of discrimination were more strongly associated with accelerated biological aging among White as compared with Black participants, although Black participants reported more discrimination overall and tended to exhibit older biological age and faster biological aging. Findings support the hypothesis that experiences of interpersonal discrimination contribute to accelerated biological aging and suggest that structural and individual-level interventions to reduce discrimination and promote adaptive coping have potential to support healthy aging and build health equity.

Education, Income, Wealth, and Discrimination in Black-White Allostatic Load Disparities

INTRODUCTION

Allostatic load (AL) is a significant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities.

METHODS

Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023.

RESULTS

Having a college degree or more (b = -0.32; 95% CI: -0.46, -0.17), higher income (b = -0.06; 95% CI: -0.11, -0.01), and greater wealth (b = -0.11; 95% CI: -0.16, -0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities.

CONCLUSIONS

Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities.

Healthcare Provider-Based Contraceptive Coercion: Understanding U.S. Patient Experiences and Describing Implications for Measurement

Despite growing concerns over coercion in contraceptive care, few studies have described its frequency and manifestations. Further, there is no established quantitative method of measuring this construct. We begin to fill this gap by detailing nuance in contraceptive coercion experiences and testing a novel measure: the Coercion in Contraceptive Care Checklist. In early 2023, we surveyed reproductive-aged people in the United States who were assigned female at birth about their contraceptive care. We describe the frequency of contraceptive coercion in our sample (N = 1197) and use open-ended descriptions to demonstrate nuances in these experiences. Finally, we debut our checklist and present psychometric testing results. Among people who had ever talked to a healthcare provider about contraception, over one in six participants (18.46%) reported experiencing coercion during their last contraceptive counseling, and over one in three (42.27%) reported it at some point in their lifetime. Being made to use or keep using birth control pills was the most common form of coercion reported by patients (14.62% lifetime frequency). Factor analysis supported the two-factor dimensionality of the Coercion in Contraceptive Care Checklist. Inter-item correlations were statistically significant (p < 0.001), providing evidence of reliability. The checklist was also related to measures of quality in family planning care (downward coercion: t[1194] = 7.54, p < 0.001; upward coercion: t[1194] = 14.76, p < 0.001) and discrimination in healthcare (downward coercion: t[1160] = -14.77, p < 0.001; upward coercion: t[1160] = -18.27, p < 0.001), providing evidence of construct validity. Findings provide critical information about the frequency and manifestations of contraceptive coercion. Psychometric tests reveal evidence of the Coercion in Contraceptive Care Checklist's validity, reliability, and dimensionality while also suggesting avenues for future testing and refinement.

Study protocol for the implementation of Centering Patients with Fibroids, a novel group education and empowerment program for patients with symptomatic uterine fibroids

BACKGROUND

Black women and people with uteri have utilized collectivistic and relational practices to improve health outcomes in the face of medical racism and discrimination for decades. However, there remains a need for interventions to improve outcomes of uterine fibroids, a condition that disproportionately impacts Black people with uteri. Leveraging personalized approaches alongside evidence that demonstrates the positive impact of social and peer support on health outcomes, we adapted from CenteringPregnancy, an evidence based group prenatal care intervention, for the education and empowerment of patients with uterine fibroids.

METHODS

The present report provides  an overview of the study design and planned implementation of CPWF in cohorts at Boston Medical Center and Emory University / Grady Memorial Hospital. After receiving training from the Centering Healthcare Institute (CHI), we adapted the 10-session CenteringPregnancy curriculum to an 8-session hybrid group intervention called Centering Patients with Fibroids (CPWF). The study began in 2022 with planned recruitment of six cohorts of 10-12 participants at each institution. We will conduct a mixed methods evaluation of the program using validated survey tools and qualitative methods, including focus groups and 1:1 interviews.

DISCUSSION

To date, we have successfully recruited 4 cohorts at Boston Medical Center and are actively implementing BMC Cohort 5 and the first cohort at Emory University / Grady Memorial Hospital. Evaluation of the program is forthcoming.

Association of Epigenetic Age and Everyday Discrimination With Longitudinal Trajectories of Chronic Health Conditions in Older Adults

We investigated the strength of the association between baseline epigenetic age, everyday discrimination, and trajectories of chronic health conditions (CHCs) across 3 study waves, among adults 50 years of age and older. We used 2016-2020 data from the Health and Retirement Study (HRS). Data for the PhenoAge and DNAm GrimAge second-generation epigenetic clocks were from the 2016 HRS Venous Blood Study. CHC trajectories were constructed using latent class growth curve models. Multinomial logistic regression models assessed the strength of the association between accelerated epigenetic age, everyday discrimination, and the newly constructed CHC trajectories for participants with complete data (n = 2 893). In the fully adjusted model, accelerated PhenoAge (relative risk ratios [RRR] = 2.53, 95% confidence interval [95% CI] = 1.81, 3.55) and DNAm GrimAge (RRR = 2.79, 95% CI = 1.95, 4.00) were associated with classification into the high CHC trajectory class. Racial disparities were evident, with increased risk of classification into the high trajectory class for Black (PhenoAge: RRR = 1.69, 95% CI = 1.07, 2.68) and reduced risk for Hispanic (PhenoAge: RRR = 0.32, 95% CI = 0.16, 0.64; DNAm GrimAge: RRR = 0.34, 95% CI = 0.17, 0.68), relative to White participants. Everyday discrimination was associated with classification into the medium-high (RRR = 1.28, 95% CI = 1.00, 1.64) and high (RRR = 1.52, 95% CI = 1.07, 2.16) trajectory classes in models assessing DNAm GrimAge. More research is needed to better understand the longitudinal health outcomes of accelerated aging and adverse social exposures. Such research may provide insights into vulnerable adults who may need varied welfare supports earlier than the mandated chronological age for access to federal and state resources.

Perceived discrimination in health care in Germany- results of a population survey

BACKGROUND

It has consistently been shown that perceived discrimination is associated with adverse health outcomes. Despite this uncontested relevance, there is a lack of research on the experiences of discrimination in health care. Therefore, the following research questions were addressed: (1) How often do people in Germany report having been discriminated in health care due to different reasons? (2) Which socio-demographic groups are most afflicted by perceived discrimination in health care?

METHODS

Analyses are based on a cross-sectional online survey conducted in Germany. An adult population sample was randomly drawn from a panel which was recruited offline (N = 2,201). Respondents were asked whether they have ever been discriminated in health care due to the following reasons: age, sex/gender, racism (i.e. migration history, religion, language problems, colour of skin), health issues or disability (i.e. overweight, mental illness/addiction, disability), socio-economic status (SES, i.e. income, education, occupation).

RESULTS

26.6% of the respondents reported discrimination experiences. Perceived discrimination due to health issues or disability was most frequent (15%), followed by age (9%) and SES (8.9%). Discrimination due to racism and sex/gender was less frequently reported (4.1% and 2.5%). Younger age groups, women, and 2nd generation migrants as well as respondents with low income and low education were more likely to report any kind of discrimination in health care. Two groups were found to be at special risk for reporting discrimination in health care across different reasons: women and younger age groups. Discrimination due to racism was more prevalent among respondents who have immigrated themselves than those who were born in Germany but whose parents have immigrated. Discrimination due to SES was significantly associated with (low) income but not with education.

CONCLUSIONS

More than a quarter of the adult population in Germany reported experiences of discrimination in health care. Such experiences were more frequent among lower SES groups, migrants, women, and younger people. Results underline the necessity of interventions to reduce the magnitude and consequences of discrimination in health care. Future studies should apply an intersectional approach to consider interactions between social inequality indicators regarding discrimination and to identify risk groups that are potentially afflicted by multiple discrimination.

Experiences of Discrimination Among Native Hawaiians and Pacific Islanders Living in the USA

Experiences of racism and discrimination are stressors that adversely affect the well-being of marginalized populations, including Native Hawaiians and Pacific Islanders (NHPI). However, commonly used data aggregation methods obscure information on NHPI communities and their lived experiences. The aim of our study is to understand the types and frequency of discrimination experienced by NHPI adults in the USA. The study utilized online survey data collected from 252 NHPI adults living in the USA between September and October 2021. Younger NHPI adults, those who report constantly thinking about their race/ethnicity, and those who are socially assigned a race/ethnicity that does not match their own report experiencing more types of discrimination. NHPI who constantly think about their race/ethnicity and those who are socially assigned a race/ethnicity that does not match their own report a greater frequency of discrimination. Findings indicate the need to understand the experiences of discrimination in this population.

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.

Racial discrimination moderates associations between sociopolitical discussions and internalizing problems among racially minoritized college students

OBJECTIVE

The present study investigated whether associations between sociopolitical discussions and mental health differed by racial discrimination among racially minoritized college students. We also tested whether associations differed between election years-when sociopolitical discussions may be more frequent-and nonelection years.

METHOD

In November 2020, racially minoritized college students (N = 225; Mage = 19.84, SD = 1.41; 72.89% female; 52.00% Asian, 22.67% Latino, 16.00% multiracial, 9.33% races including Black and Middle Eastern) reported how often they had experienced racial discrimination, their frequency of sociopolitical discussions with friends and family, and their mental health.

RESULTS

Results indicated that participants who had more frequent sociopolitical discussions with friends-but not family-only reported more internalizing problems if they had never or rarely experienced racial discrimination in the past year. To determine whether results were unique to discussions during election years, a second sample (N = 262; Mage = 20.18, SD = 2.30; 82.53% female; 48.86% Asian, 18.56% Latino, 15.42% multiracial, 17.78% races including Black and Middle Eastern) was recruited 1 year later, and racial discrimination did not moderate associations between sociopolitical discussions and internalizing problems.

CONCLUSIONS

Sociopolitical discussions with friends during presidential elections may be related to greater internalizing problems for racially minoritized college students who experience racial discrimination less frequently, potentially because they may feel less prepared or less motivated to have these conversations compared to racially minoritized college students who experience racial discrimination more frequently. Future studies should investigate means of promoting sociopolitical discussions on campus while attenuating the association between sociopolitical discussions and internalizing problems. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Neighborhood Disadvantage, African Genetic Ancestry, Cancer Subtype, and Mortality Among Breast Cancer Survivors

Importance

Racial disparities in breast cancer (BC) survival arise from multilevel causes, which may exert influence at different stages of BC progression. Clarifying the importance of genetic and social factors could help prioritize interventions.

Objective

To jointly examine associations between African genetic ancestry, social environment, and mortality from any cause and BC in Black BC survivors.

Design, Setting, and Participants

This population-based cohort study enrolled self-identified Black women aged 20 to 75 years with histologically confirmed BC from June 2005 to May 2019 and followed them up until death or censoring in September 2021. Participants lived in 10 New Jersey counties. Data were analyzed between December 2022 and April 2023.

Exposures

A neighborhood socioeconomic status (nSES) index composed of census tract measures (education, income, wealth, employment status, and occupation) was linked to residential addresses at diagnosis. Percentage African ancestry was estimated using the ADMIXTURE program.

Main Outcomes and Measures

Sequentially adjusted (age adjusted: age and interview year; fully adjusted: age adjusted with individual SES, lifestyle factors, and comorbidities) logistic regression models were fit to estimate associations with tumor subtypes (estrogen receptor-negative [ER-] vs estrogen receptor-positive [ER+]; triple-negative breast cancer [TNBC] vs luminal A), and Cox models were fit for associations with all-cause mortality (ACM) and breast cancer-specific mortality (BCSM). Models for BCSM were fit using Fine-Gray competing risks models, and robust standard errors were used to account for census tract-level clustering.

Results

Among 1575 participants, median (IQR) African ancestry was 85% (76%-90%), and median (IQR) age was 55 (46-63) years. A 10-percentage point increase in African ancestry was associated with higher odds of ER- vs ER+ (adjusted odds ratio [aOR], 1.08; 95% CI, 0.98-1.18) and TNBC vs luminal (aOR, 1.15; 95% CI, 1.02-1.31) tumors, but not with ACM or BCSM. A 1-IQR increase in nSES was associated with lower ACM (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.63-0.93), and the HR for BCSM was less than 1 but not statistically significant (aHR, 0.81; 95% CI, 0.62-1.04) in age-adjusted models, but associations attenuated following further adjustment for potential mediators (individual SES, lifestyles, comorbidities).

Conclusions and Relevance

In this cohort study of Black female BC survivors, higher African ancestry was associated with aggressive tumor subtypes. Compared with genetic ancestry, mediating pathways related to social environments may be more important for survival in these patients.

Incident racial discrimination predicts elevated C-Reactive protein in the Black Women's experiences Living with Lupus (BeWELL) study

INTRODUCTION

Racial discrimination is a distinct health threat that increases disease risk among Black Americans. Psychosocial stress may compromise health through inflammatory mechanisms. This study examines incident experiences of racial discrimination and changes in the inflammatory biomarker C-reactive protein (CRP) over a two-year period among Black women with systemic lupus erythematosus (SLE)-an inflammatory autoimmune disease sensitive to psychosocial stress and characterized by stark racial inequities in outcomes.

METHODS

Data are from the Black Women's Experiences Living with Lupus (BeWELL) Study. Participants (n = 380) from metropolitan Atlanta, Georgia were enrolled from April 2015 to May 2017. Incident racial discrimination was assessed bi-annually via self-report using the Experiences of Discrimination measure. CRP was assessed annually over a two-year period. Latent change score analyses modeled longitudinal within-person associations between incident racial discrimination and change in log-transformed CRP from baseline to Year 2.

RESULTS

Incident experiences of racial discrimination were associated with elevated log-CRP across the two-year study period (b = 0.039, SE = 0.017, 95% CI: 0.006, 0.071). For each domain of incident racial discrimination experienced, CRP increased 3.98%.

CONCLUSION

This study contributes to growing evidence on the biological consequences of racism and is the first to document an association between incident racial discrimination and changes in inflammation among Black women with SLE. Racial inequities in SLE outcomes and other diseases driven by inflammatory pathways may be explained in part through experiences of racial discrimination.

Association of Racial Discrimination With Adiposity in Children and Adolescents

Importance

Childhood obesity is a major public health issue and is disproportionately prevalent among children from minority racial and ethnic groups. Personally mediated racism (commonly referred to as racial discrimination) is a known stressor that has been linked to higher body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) in adults, but little is known about the association of racial discrimination and childhood and adolescent adiposity.

Objective

To assess the prospective association between self-reported experiences of racial discrimination and adiposity (BMI and waist circumference) in a large sample of children and adolescents in the Adolescent Brain Cognitive Development (ABCD) study.

Design, Setting, and Participants

This cohort study used complete data from the ABCD study (2017 to 2019), involving a total of 6463 participants. The ABCD study recruited a diverse sample of youths from across the US, with rural, urban, and mountain regions. Data were analyzed from January 12 to May 17, 2023.

Exposure

The child-reported Perceived Discrimination Scale was used to quantify racial discrimination, reflecting participants' perceptions of being treated unfairly by others or unaccepted by society based on their race or ethnicity.

Main Outcomes and Measures

Weight, height, and waist circumference were measured by trained research assistants. BMI z scores were computed by applying the US Centers for Disease Control and Prevention's age and sex-specific reference standards for children and adolescents. Waist circumference (inches) was quantified as the mean of 3 consecutive measures. Measurements were taken from time 1 (ie, 2017 to 2019) and time 2 (ie, 2018 to 2020).

Results

Of the 6463 respondents with complete data, 3090 (47.8%) were female, and the mean (SD) age was 9.95 (0.62) years. Greater racial discrimination exposure at time 1 was associated with higher BMI z score in both unadjusted (β, 0.05; 95% CI, 0.02-0.08) and adjusted regression models (β, 0.04; 95% CI, 0.01-0.08). Discrimination at time 1 was associated with higher waist circumference in unadjusted (β, 0.35; 95% CI, 0.15-0.54) and adjusted (β, 0.24; 95% CI, 0.04-0.44) models.

Conclusions and Relevance

In this cohort study of children and adolescents, racial discrimination was positively associated with adiposity, quantified by BMI z score and waist circumference. Interventions to reduce exposure to racial discrimination in early life may help reduce the risk of excess weight gain across throughout life.

Readiness of a U.S. Black community to address suicide

Communities need to be ready to address increased suicide among Black Americans. The Community Readiness Model (CRM) provides an established assessment for marginalized communities facing suicide. CRM assessment of the Northeast Ohio Black community involved interviews with 25 representatives, analysis using rating scales, co-scoring, and calculation. Results include a marginal overall score and low to average scores for five dimensions: knowledge of efforts to address suicide, leadership, community climate, knowledge of suicide, and resources. The vague awareness readiness stage indicates the community is unclear about what can be done to address suicide and has not taken ownership of the issue. We highlight implications for mental health practice, prevention and funding campaigns, and consultation with community leadership for culturally informed prevention strategies targeting areas of lowest readiness. Future research should use expanded designs to examine readiness changes from intervention in this and other Black communities.

Embedded racism: Inequitable niche construction as a neglected evolutionary process affecting health

Racial health disparities are a pervasive feature of modern experience and structural racism is increasingly recognized as a public health crisis. Yet evolutionary medicine has not adequately addressed the racialization of health and disease, particularly the systematic embedding of social biases in biological processes leading to disparate health outcomes delineated by socially defined race. In contrast to the sheer dominance of medical publications which still assume genetic 'race' and omit mention of its social construction, we present an alternative biological framework of racialized health. We explore the unifying evolutionary-ecological principle of niche construction as it offers critical insights on internal and external biological and behavioral feedback processes environments at every level of the organization. We Integrate insights of niche construction theory in the context of human evolutionary and social history and phenotype-genotype modification, exposing the extent to which racism is an evolutionary mismatch underlying inequitable disparities in disease. We then apply ecological models of niche exclusion and exploitation to institutional and interpersonal racial constructions of population and individual health and demonstrate how discriminatory processes of health and harm apply to evolutionarily relevant disease classes and life-history processes in which socially defined race is poorly understood and evaluated. Ultimately, we call for evolutionary and biomedical scholars to recognize the salience of racism as a pathogenic process biasing health outcomes studied across disciplines and to redress the neglect of focus on research and application related to this crucial issue.

Discrimination Exposure and Polygenic Risk for Obesity in Adulthood: Testing Gene-Environment Correlations and Interactions

INTRODUCTION

Exposure to discrimination has emerged as a risk factor for obesity. It remains unclear, however, whether the genotype of the individual can modulate the sensitivity or response to discrimination exposure (gene × environment interaction) or increase the likelihood of experiencing discrimination (gene-environment correlation).

METHODS

This was an observational study of 4,102 white/European Americans in the Health and Retirement Study with self-reported, biological assessments, and genotyped data from 2006 to 2014. Discrimination was operationalized using the average of nine Everyday Discrimination Scale items. Polygenic risk scores (PRSs) for body mass index (BMI) and waist circumference (WC) were calculated using the weighted sum of risk alleles based on studies conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium.

RESULTS

We found that greater PRS-BMI was significantly associated with more reports of discrimination (β = 0.04 ± 0.02; p = 0.037). Further analysis showed that measured BMI partially mediated the association between PRS-BMI and discrimination. There was no evidence that the association between discrimination and BMI, or the association between discrimination and WC, differed by PRS-BMI or PRS-WC, respectively.

CONCLUSION

Our findings suggest that individuals with genetic liability for obesity may experience greater discrimination in their lifetime, consistent with a gene-environment correlation hypothesis. There was no evidence of a gene-environment interaction. More genome-wide association studies in diverse populations are needed to improve generalizability of study findings. In the meantime, prevention and clinical intervention efforts that seek to reduce exposure to all forms of discrimination may help reduce obesity at the population level.