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Leer J, Gaither SE, Gassman-Pines A. It's not what you say it's what you do: School diversity ideologies and adolescent mental health and academic engagement. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024. [PMID: 38989806 DOI: 10.1111/jora.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 06/20/2024] [Indexed: 07/12/2024]
Abstract
This study examined the relation between schools' color-evasive versus multicultural diversity ideologies, school characteristics, and adolescent development. Across two datasets linking individual-level survey data (N = 1692) and administrative records (N = 300,063; Mage = 12.4, 52% female, 48% male), schools' stated support for diversity (via a pro-diversity mission statement) was related to adolescent mental health and academic achievement, but in nuanced ways depending on individual racial/ethnic backgrounds, the racial/ethnic diversity of the student body and teachers, and the extent of racial disparities in discipline and gifted education. Findings suggest that communicating support for diversity without redressing systemic inequities in school discipline and academic tracking will not reduce racism-related achievement gaps and may instead exacerbate mental health disparities.
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Affiliation(s)
- Jane Leer
- Department of Psychology, San Diego State University, San Diego, California, USA
- Carolyn A. And Peter S. Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts, USA
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, USA
| | - Sarah E Gaither
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, USA
| | - Anna Gassman-Pines
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, USA
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2
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Pleasant V. A Public Health Emergency: Breast Cancer Among Black Communities in the United States. Obstet Gynecol Clin North Am 2024; 51:69-103. [PMID: 38267132 DOI: 10.1016/j.ogc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
While Black people have a similar incidence of breast cancer compared to White people, they have a 40% increased death rate. Black people are more likely to be diagnosed with aggressive subtypes such as triple-negative breast cancer. However, despite biological factors, systemic racism and social determinants of health create delays in care and barriers to treatment. While genetic testing holds incredible promise for Black people, uptake remains low and results may be challenging to interpret. There is a need for more robust, multidisciplinary, and antiracist interventions to reverse breast cancer-related racial disparities.
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Affiliation(s)
- Versha Pleasant
- Department of Obstetrics and Gynecology, Cancer Genetics & Breast Health Clinic, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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To SB, Gray J, Jain P, Porter JH, Comello MLG. Advocating, Unlearning, Tearing It All Down? How BIPOC Young Adults with Mental Health Concerns Perceive and Engage with the Media. HEALTH COMMUNICATION 2023:1-13. [PMID: 38058284 DOI: 10.1080/10410236.2023.2290882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
The COVID-19 pandemic has increased the salience of issues related to social justice, mental health, and health equity. During this time, the media have been instrumental in amplifying social movements but also in spreading mis/disinformation, violence, and hatred. Among communities who have been affected heavily during this time are Black, Indigenous, and People of Color (BIPOC) young adults who have a mental illness/significant mental health concerns. As frequent engagers and creators of media, their perspectives are critical to informing what aspects of the media should be leveraged to promote the health, well-being, and safety of people who have been marginalized. Thus, our study asks: How do BIPOC young adults (in the United States) who have a behavioral health diagnosis or significant mental health concerns perceive the media? Guided by intersectionality and grounded theory, we conducted in-depth interviews with 20 participants. The results reveal participants' 1) deep recognition of how the media uphold oppressive structures and 2) identification of ways that people have used and can use the media to fight those same structures. Researchers and media leaders should listen to, center the experiences of, collaborate with, and follow the lead of people who have been marginalized. This is critical to transforming the media such that they promote the well-being of all people.
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Affiliation(s)
- Sophie B To
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Jaz Gray
- Communication Division, Pepperdine University
| | - Parul Jain
- E.W. Scripps School of Journalism, Scripps College of Communication, Ohio University
| | - Jeannette H Porter
- Department of Strategic Communication, Missouri School of Journalism, University of Missouri
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Basinger ED, Quinlan MM, Rawlings M. Memorable Messages About Fat Bodies Before, During, and After Pregnancy. HEALTH COMMUNICATION 2023; 38:3069-3079. [PMID: 36199193 DOI: 10.1080/10410236.2022.2131982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Weight bias is prevalent for people in large bodies who are trying to conceive, pregnant, or postpartum. Using the theory of memorable messages as a framework, we explored the sources, valence, and content of messages that fat individuals (N = 237) recalled about their bodies before pregnancy through the postpartum stage. The most common source of memorable messages was healthcare providers, and most (77.2%) messages were negatively valenced. Thematic analysis revealed four overarching themes (fat mothers are bad mothers, denial of competent treatment, weight-normative commentary on fat bodies, and weight-inclusive counter-narratives). Our findings illuminate the significance of patient-practitioner communication across the pregnancy trajectory and highlight how counter-narratives can disrupt negative messages about fat pregnancy.
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Affiliation(s)
- Erin D Basinger
- Department of Communication Studies, University of North Carolina at Charlotte
| | - Margaret M Quinlan
- Department of Communication Studies, University of North Carolina at Charlotte
| | - Margaret Rawlings
- Department of Communication Studies, University of North Carolina at Charlotte
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MICHAELS ELIK, LAM‐HINE TRACY, NGUYEN THUT, GEE GILBERTC, ALLEN AMANIM. The Water Surrounding the Iceberg: Cultural Racism and Health Inequities. Milbank Q 2023; 101:768-814. [PMID: 37435779 PMCID: PMC10509530 DOI: 10.1111/1468-0009.12662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/03/2023] [Accepted: 05/08/2023] [Indexed: 07/13/2023] Open
Abstract
Policy Points Cultural racism-or the widespread values that privilege and protect Whiteness and White social and economic power-permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the "tip of the iceberg," whereas structural and institutional racism represent its base. This paper advances cultural racism as the "water surrounding the iceberg," allowing it to float while obscuring its base. Considering the fundamental role of cultural racism is needed to advance health equity. CONTEXT Cultural racism is a pervasive social toxin that surrounds all other dimensions of racism to produce and maintain racial health inequities. Yet, cultural racism has received relatively little attention in the public health literature. The purpose of this paper is to 1) provide public health researchers and policymakers with a clearer understanding of what cultural racism is, 2) provide an understanding of how it operates in conjunction with the other dimensions of racism to produce health inequities, and 3) offer directions for future research and interventions on cultural racism. METHODS We conducted a nonsystematic, multidisciplinary review of theory and empirical evidence that conceptualizes, measures, and documents the consequences of cultural racism for social and health inequities. FINDINGS Cultural racism can be defined as a culture of White supremacy, which values, protects, and normalizes Whiteness and White social and economic power. This ideological system operates at the level of our shared social consciousness and is expressed in the language, symbols, and media representations of dominant society. Cultural racism surrounds and bolsters structural, institutional, personally mediated, and internalized racism, undermining health through material, cognitive/affective, biologic, and behavioral mechanisms across the life course. CONCLUSIONS More time, research, and funding is needed to advance measurement, elucidate mechanisms, and develop evidence-based policy interventions to reduce cultural racism and promote health equity.
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Affiliation(s)
- ELI K. MICHAELS
- Division of Epidemiology, School of Public HealthUniversity of California
| | - TRACY LAM‐HINE
- Division of Epidemiology & Population HealthStanford University School of Medicine
| | | | - GILBERT C. GEE
- Jonathan and Karin Fielding School of Public HealthUniversity of California
| | - AMANI M. ALLEN
- Division of Epidemiology, School of Public HealthUniversity of California
- Division of Community Health Sciences, School of Public HealthUniversity of California
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Holloway TD, Harvanek ZM, Xu K, Gordon DM, Sinha R. Greater stress and trauma mediate race-related differences in epigenetic age between Black and White young adults in a community sample. Neurobiol Stress 2023; 26:100557. [PMID: 37501940 PMCID: PMC10369475 DOI: 10.1016/j.ynstr.2023.100557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
Black Americans suffer lower life expectancy and show signs of accelerated aging compared to other Americans. While previous studies observe these differences in children and populations with chronic illness, whether these pathologic processes exist or how these pathologic processes progress has yet to be explored prior to the onset of significant chronic illness, within a young adult population. Therefore, we investigated race-related differences in epigenetic age in a cross-sectional sample of young putatively healthy adults and assessed whether lifetime stress and/or trauma mediate those differences. Biological and psychological data were collected from self-reported healthy adult volunteers within the local New Haven area (399 volunteers, 19.8% Black, mean age: 29.28). Stress and trauma data was collected using the Cumulative Adversity Inventory (CAI) interview, which assessed specific types of stressors, including major life events, traumatic events, work, financial, relationship and chronic stressors cumulatively over time. GrimAge Acceleration (GAA), determined from whole blood collected from participants, measured epigenetic age. In order to understand the impact of stress and trauma on GAA, exploratory mediation analyses were then used. We found cumulative stressors across all types of events (mean difference of 6.9 p = 2.14e-4) and GAA (β = 2.29 years [1.57-3.01, p = 9.70e-10] for race, partial η2 = 0.091, model adjusted R2 = 0.242) were significantly greater in Black compared to White participants. Critically, CAI total score (proportion mediated: 0.185 [0.073-0.34, p = 6e-4]) significantly mediated the relationship between race and GAA. Further analysis attributed this difference to more traumatic events, particularly assaultive traumas and death of loved ones. Our results suggest that, prior to development of significant chronic disease, Black individuals have increased epigenetic age compared to White participants and that increased cumulative stress and traumatic events may contribute significantly to this epigenetic aging difference.
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Affiliation(s)
| | - Zachary M. Harvanek
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Yale Stress Center, Yale University, New Haven, CT, USA
| | - Ke Xu
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychiatry, Connecticut Veteran Healthcare System, West Haven, CT, USA
| | | | - Rajita Sinha
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Yale Stress Center, Yale University, New Haven, CT, USA
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Duncan DT, Cook SH, Wood EP, Regan SD, Chaix B, Tian Y, Chunara R. Structural racism and homophobia evaluated through social media sentiment combined with activity spaces and associations with mental health among young sexual minority men. Soc Sci Med 2023; 320:115755. [PMID: 36739708 PMCID: PMC10014849 DOI: 10.1016/j.socscimed.2023.115755] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research suggests that structural racism and homophobia are associated with mental well-being. However, structural discrimination measures which are relevant to lived experiences and that evade self-report biases are needed. Social media and global-positioning systems (GPS) offer opportunity to measure place-based negative racial sentiment linked to relevant locations via precise geo-coding of activity spaces. This is vital for young sexual minority men (YSMM) of color who may experience both racial and sexual minority discrimination and subsequently poorer mental well-being. METHODS P18 Neighborhood Study (n = 147) data were used. Measures of place-based negative racial and sexual-orientation sentiment were created using geo-located social media as a proxy for racial climate via socially-meaningfully-defined places. Exposure to place-based negative sentiment was computed as an average of discrimination by places frequented using activity space measures per person. Outcomes were number of days of reported poor mental health in last 30 days. Zero-inflated Poisson regression analyses were used to assess influence of and type of relationship between place-based negative racial or sexual-orientation sentiment exposure and mental well-being, including the moderating effect of race/ethnicity. RESULTS We found evidence for a non-linear relationship between place-based negative racial sentiment and mental well-being among our racially and ethnically diverse sample of YSMM (p < .05), and significant differences in the relationship for different race/ethnicity groups (p < .05). The most pronounced differences were detected between Black and White non-Hispanic vs. Hispanic sexual minority men. At two standard deviations above the overall mean of negative racial sentiment exposure based on activity spaces, Black and White YSMM reported significantly more poor mental health days in comparison to Hispanic YSMM. CONCLUSIONS Effects of discrimination can vary by race/ethnicity and discrimination type. Experiencing place-based negative racial sentiment may have implications for mental well-being among YSMM regardless of race/ethnicity, which should be explored in future research including with larger samples sizes.
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Affiliation(s)
- Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, NewYork, NY, USA
| | - Stephanie H Cook
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA; Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA
| | - Erica P Wood
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, NewYork, NY, USA
| | - Basile Chaix
- French National Institute of Health and Medical Research (INSERM), Sorbonne Université, Institut Pierre Louis D'Epidémiologie et de Santé Publique IPLESP, Nemesis Team, F75012, Paris, France
| | - Yijun Tian
- Department of Computer Science and Engineering, New York University Tandon School of Engineering, New York, NY, USA
| | - Rumi Chunara
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA; Department of Computer Science and Engineering, New York University Tandon School of Engineering, New York, NY, USA.
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Philip AA, King J, Durham J. Lived experiences of persons with disabilities living with HIV in accessing HIV services in Africa: a qualitative systematic review. Disabil Rehabil 2023; 45:937-949. [PMID: 35298321 DOI: 10.1080/09638288.2022.2051079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This qualitative review applies an intersectional lens to explore the lived experiences of persons with disabilities (PWDs) living with human immunodeficiency virus (HIV) in accessing HIV services. METHODS Using thematic analysis, the intersections relating to HIV, disability, gender, stigma, and poverty were explored. RESULTS Three themes were identified from the analysis: (1) intersection of gender, HIV, and disability - "For a man, it is easier because we women have a lot to take care of at the home and would not have enough time to go get services"; (2) intersection of stigma, HIV, and disability - "…Look at that one. He's disabled, at the same time HIV-positive. He doesn't even feel sorry for himself … to die quietly at home"; (3) intersection of poverty, HIV, and disability - "…maybe you don't even have money to buy food and if you're on medication you need to eat frequently". The findings highlighted how stigma, poverty, and gender collide in a hierarchy of identities to impede accessibility to HIV services. CONCLUSIONS Researchers and programme implementers should note the intersecting issues of marginalisation that influence inequities in access to HIV services for PWDs living with HIV. National Strategic Plans should address these specific barriers to ensure accessibility for this marginalised population.Implications for rehabilitationGovernments within Africa should commit to including persons with disabilities (PWDs) living with human immunodeficiency virus (HIV) in National Strategic Plans (NSPs), which will support disability-inclusive HIV programming. The development process of NSPs should also include PWDs living with HIV.The inaccessibility of HIV services for PWDs living with HIV is multifaceted and intersectional. Interventions that consider the different social identities such as gender and socioeconomic status of PWDs living with HIV may be more impactful.Understanding the specific dimensions of access that impacted both the demand and supply side will facilitate efficient HIV programming for PWDs living with HIV.
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Affiliation(s)
- Aaron Akpu Philip
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Australia
| | - Julie King
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Australia
| | - Joanne Durham
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Australia
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Chen E, Lam PH, Yu T, Brody GH. Racial Disparities in School Belonging and Prospective Associations With Diabetes and Metabolic Syndrome. JAMA Pediatr 2023; 177:141-148. [PMID: 36574239 PMCID: PMC9856891 DOI: 10.1001/jamapediatrics.2022.3856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/18/2022] [Indexed: 12/29/2022]
Abstract
Importance School belonging has important implications for academic, psychological, and health outcomes, but the associations between racial disparities in school belonging and health have not been explored to date. Objective To examine associations between school-level racial disparities in belonging and cardiometabolic health into adulthood in a national sample of Black and White children, adolescents, and young adults. Design, Setting, and Participants Prospective cohort study of a US national sample of 4830 Black and White students (National Longitudinal Study of Adolescent Health) followed up for 13 years. The study was conducted from 1994 to 1995 for wave 1 and in 2008 for wave 4. Data were analyzed from June 14 to August 13, 2021. Main Outcomes and Measures School-level racial disparities in belonging at baseline were calculated as the mean level of school belonging for Black students minus the mean level of school belonging for White students at the school that they attended when they were aged 12 to 20 years. Diabetes and metabolic syndrome were measured as outcomes for these same participants at 24 to 32 years of age. Results The study included 4830 students. For wave 1, mean (SD) age was 16.1 (1.7) years, and for wave 4, 29.0 (1.7) years. A total of 2614 (54.1%) were female, 2219 were non-Hispanic Black (45.9%), and 2611 were non-Hispanic White (54.1%). Among Black students, attending a school with a greater Black-White disparity in school belonging (more negative scores) was associated with an increased risk for diabetes (odds ratio, 0.66 [95% CI, 0.46-0.95]) and more risk factors for metabolic syndrome (rate ratio, 0.95 [95% CI, 0.90-1.00]) in adulthood 13 years later. These associations persisted above individual-level controls (age, sex, and body mass index) and school-level controls (school size, percentage of Black students, and percentage of Black teachers) and were not explained by either an individual's own perception of school belonging or the mean level of belonging across the whole school. Conclusions and Relevance In this prospective cohort study of US students, racial disparities in school belonging were associated with risks for diabetes and metabolic syndrome in Black students. Among students, fostering a more equal sense of school belonging across racial groups may have implications for health disparities in the cardiometabolic domain into adulthood.
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Affiliation(s)
- Edith Chen
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois
| | - Phoebe H. Lam
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois
| | - Tianyi Yu
- Center for Family Research, University of Georgia, Athens
| | - Gene H. Brody
- Center for Family Research, University of Georgia, Athens
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Hudson D, Collins-Anderson A, Hutson W. Understanding the Impact of Contemporary Racism on the Mental Health of Middle Class Black Americans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1660. [PMID: 36767028 PMCID: PMC9914282 DOI: 10.3390/ijerph20031660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 06/18/2023]
Abstract
Evidence from previous research indicates that while socioeconomic status (SES) narrows Black-White health inequities, these inequities do not completely disappear, and in some cases, worsen. Why do Black-White health inequities persist, even when controlling for SES? It is critical to examine how perceptions of unfair treatment, especially those that are nuanced and subtle, affect the mental health of Black Americans with greater levels of SES. This study, using a new sample composed exclusively of college-educated Black Americans, investigated whether experiences related to racism were associated with poorer mental health. Qualtrics provided the sample from their nationwide panelists that met the research criteria. Inclusion criteria included the following: (1) self-identified as Black or African American; (2) at least 24 years old; (3) completed a 4-year college degree or higher. The findings from this study indicated that the effects of unfair treatment are significantly associated with poorer mental health. These findings highlight the insidious nature of contemporary racism as the everyday experiences of unfair treatment have a tremendous effect on depressive symptoms among this sample of college-educated Black Americans. Efforts to simply improve SES among historically marginalized groups will not bring about health equity. Findings from this study indicate that there are mental health costs associated with upward social mobility. It is likely that these costs, particularly the experience of everyday unfair treatment, likely diminish the social, economic and health returns on the human capital.
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Predicting Decent Work Among US Black Workers: Examining Psychology of Working Theory. JOURNAL OF CAREER ASSESSMENT 2023. [DOI: 10.1177/10690727221149456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The U.S. has a history of marginalizing Black people. Marginalization impedes Black Americans’ ability to secure wealth, education, and meaningful work. The Psychology of Working Theory (PWT) uses a social justice lens to understand how contextual factors inform the labor market experiences of those who work and want to work. PWT highlights the ways economic constraints and marginalization predict access to decent work. We tested the PWT model with two measures of marginalization, general ethnic discrimination, and racial microaggressions, with a sample of 241 Black workers to add to the extant literature about the suitability of the PWT for racial minorities. Diverging from previous studies, we found that marginalization predicted career adaptability. Consistent with previous studies, marginalization and economic constraints predicted Black workers’ work volition and perceived access to decent work. Work volition mediated the relationship between general ethnic discrimination and economic constraints with the perception of attaining decent work.
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Jones NE, Lewis K, Brown AM. Navigating a hyperracialized space: exploring the intersections of whiteness, social control, and mental health in st. louis county, missouri. ETHNIC AND RACIAL STUDIES 2022; 46:966-986. [PMID: 36919022 PMCID: PMC10010681 DOI: 10.1080/01419870.2022.2085523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 05/26/2022] [Indexed: 06/18/2023]
Abstract
Places marred by a legacy of racial violence have contemporary implications for racial and ethnic minorities. However, there is limited work examining how racial and ethnic minorities perceive and navigate these spaces and how they may affect their health. We examine the daily lives of Black residents of St. Louis County, living in what we refer to as a hyperracialized space, or areas characterized by multiple forms of violence, to understand how navigating a hyperracialized space impacts how Black residents negotiate space and make meaning of their health. Qualitative interviews (n = 20) revealed three themes: (1) Whiteness and the maintenance of a hyperracialized space, (2) unspoken rules of police encounters and the embodiment of self-regulation, (3) and hypervigilance. Narratives reveal how individuals and institutions concretize a hyperracialized space through social control. Moreover, participants discussed how their environment influenced how they interacted with and navigated space, the toll of which elicited hypervigilance.
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Affiliation(s)
- Nicole E. Jones
- Department of Sociology, University of Missouri, Columbia, MO, US
| | - Kaleea Lewis
- Department of Public Health and Department of Women’s and Gender Studies, University of Missouri, Columbia, MO, US
| | - Alaysia M. Brown
- Department of Human Development and Family Science, University of Missouri, Columbia, MO, US
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Childhood adversity predicts black young adults' DNA methylation-based accelerated aging: A dual pathway model. Dev Psychopathol 2022; 34:689-703. [PMID: 34924087 PMCID: PMC9207155 DOI: 10.1017/s0954579421001541] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We expand upon prior work (Gibbons et al., ) relating childhood stressor effects, particularly harsh childhood environments, to risky behavior and ultimately physical health by adding longer-term outcomes - deoxyribonucleic acid (DNA) methylation-based measures of accelerated aging (DNAm-aging). Further, following work on the effects of early exposure to danger (McLaughlin et al., ), we also identify an additional pathway from harsh childhood environments to DNAm-aging that we label the danger/FKBP5 pathway, which includes early exposure to dangerous community conditions that are thought to impact glucocorticoid regulation and pro-inflammatory mechanisms. Because different DNAm-aging indices provide different windows on accelerated aging, we contrast effects on early indices of DNAm-aging based on chronological age with later indices that focused on predicting biological outcomes. We utilize data from Family and Community Health Study participants (N = 449) from age 10 to 29. We find that harshness influences parenting, which, in turn, influences accelerated DNAm-aging through the risky cognitions and substance use (i.e., behavioral) pathway outlined by Gibbons et al. (). Harshness is also associated with increased exposure to threat/danger, which, in turn, leads to accelerated DNAm-aging through effects on FKBP5 activity and enhanced pro-inflammatory tendencies (i.e., the danger/FKBP5 pathway).
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Sistrunk C, Tolbert N, Sanchez-Pino MD, Erhunmwunsee L, Wright N, Jones V, Hyslop T, Miranda-Carboni G, Dietze EC, Martinez E, George S, Ochoa AC, Winn RA, Seewaldt VL. Impact of Federal, State, and Local Housing Policies on Disparities in Cardiovascular Disease in Black/African American Men and Women: From Policy to Pathways to Biology. Front Cardiovasc Med 2022; 9:756734. [PMID: 35509276 PMCID: PMC9058117 DOI: 10.3389/fcvm.2022.756734] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/11/2022] [Indexed: 12/29/2022] Open
Abstract
Racist and discriminatory federal, state, and local housing policies significantly contribute to disparities in cardiovascular disease incidence and mortality for individuals that self-identify as Black or African American. Here we highlight three key housing policies - "redlining," zoning, and the construction of highways - which have wrought a powerful, sustained, and destructive impact on cardiovascular health in Black/African American communities. Redlining and highway construction policies have restricted access to quality health care, increased exposure to carcinogens such as PM2.5, and increased exposure to extreme heat. At the root of these policy decisions are longstanding, toxic societal factors including racism, segregation, and discrimination, which also serve to perpetuate racial inequities in cardiovascular health. Here, we review these societal and structural factors and then link them with biological processes such as telomere shortening, allostatic load, oxidative stress, and tissue inflammation. Lastly, we focus on the impact of inflammation on the immune system and the molecular mechanisms by which the inflamed immune microenvironment promotes the formation of atherosclerotic plaques. We propose that racial residential segregation and discrimination increases tissue inflammation and cytokine production, resulting in dysregulated immune signaling, which promotes plaque formation and cardiovascular disease. This framework has the power to link structural racism not only to cardiovascular disease, but also to cancer.
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Affiliation(s)
| | - Nora Tolbert
- Department of Cardiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Maria Dulfary Sanchez-Pino
- Department of Interdisciplinary Oncology, Stanley S. Scott Cancer Center, Louisiana State University, Baton Rouge, LA, United States
| | | | - Nikita Wright
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Veronica Jones
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Terry Hyslop
- Department of Biochemistry, Duke University, Durham, NC, United States
| | | | - Eric C. Dietze
- City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Ernest Martinez
- Department of Biostatistics and Bioinformatics, University of California, Riverside, Riverside, CA, United States
| | - Sophia George
- Sylvester Comprehensive Cancer Center, Miami, FL, United States
| | - Augusto C. Ochoa
- Department of Interdisciplinary Oncology, Stanley S. Scott Cancer Center, Louisiana State University, Baton Rouge, LA, United States
| | - Robert A. Winn
- VCU Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
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15
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Michaels EK, Board C, Mujahid MS, Riddell CA, Chae DH, Johnson RC, Allen AM. Area-level racial prejudice and health: A systematic review. Health Psychol 2022; 41:211-224. [PMID: 35254858 PMCID: PMC8930473 DOI: 10.1037/hea0001141] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND In recent years, there has been growing interest in "moving beyond the individual" to measure area-level racism as a social determinant of health. Much of this work has aggregated racial prejudice data collected at the individual-level to the area-level. OBJECTIVE As this is a rapidly emerging area of research, we conducted a systematic literature review to describe evidence of the relationship between area-level racial prejudice and health, whether results differed by race/ethnicity, and to characterize key conceptual and methodological considerations to guide future research. METHOD We searched four interdisciplinary databases for US-based, peer-reviewed articles measuring area level racial prejudice by aggregating individual-level indicators of racial prejudice and examining associations with mental or physical health outcome(s). Data extraction followed PRISMA guidelines and also included theory and conceptualization, pathways to health, and strengths and limitations. RESULTS Fourteen of 14,632 identified articles met inclusion criteria and were included in the review. Health outcomes spanned all-cause (n = 4) and cause-specific (n = 4) mortality, birth outcomes (n = 4), cardiovascular outcomes (n = 2), mental health (n = 1), and self-rated health (n = 1). All studies found a positive association between area-level racial prejudice and adverse health outcomes among racial/ethnic minoritized groups, with four studies also showing a similar association among Whites. Engagement with formal theory was limited and exposure conceptualization was mixed. Methodological considerations included unmeasured confounding and trade-offs between generalizability, self-censorship, and specificity of measurement. CONCLUSIONS Future research should continue to develop the conceptual and methodological rigor of this work and test hypotheses to inform evidence-based interventions to advance population health and reduce racial health inequities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Eli K. Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Christine Board
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Corinne A. Riddell
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Biostatistics, School of Public Health, University of California, Berkeley
| | - David H. Chae
- Department of Global Community Health & Behavioral Sciences, Tulane School of Public Health and Tropical Medicine
| | | | - Amani M. Allen
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley
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Hargrove TW, Gaydosh L, Dennis AC. Contextualizing Educational Disparities in Health: Variations by Race/Ethnicity, Nativity, and County-Level Characteristics. Demography 2022; 59:267-292. [PMID: 34964867 PMCID: PMC9190239 DOI: 10.1215/00703370-9664206] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Educational disparities in health are well documented, yet the education-health relationship is inconsistent across racial/ethnic and nativity groups. These inconsistencies may arise from characteristics of the early life environments in which individuals attain their education. We evaluate this possibility by investigating (1) whether educational disparities in cardiometabolic risk vary by race/ethnicity and nativity among Black, Hispanic, and White young adults; (2) the extent to which racial/ethnic-nativity differences in the education-health relationship are contingent on economic, policy, and social characteristics of counties of early life residence; and (3) the county characteristics associated with the best health at higher levels of education for each racial/ethnic-nativity group. Using data from the National Longitudinal Study of Adolescent to Adult Health, we find that Black young adults who achieve high levels of education exhibit worse health across a majority of contexts relative to their White and Hispanic counterparts. Additionally, we observe more favorable health at higher levels of education across almost all contexts for White individuals. For all other racial/ethnic-nativity groups, the relationship between education and health depends on the characteristics of the early life counties of residence. Findings highlight place-based factors that may contribute to the development of racial/ethnic and nativity differences in the education-health relationship among U.S. young adults.
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Affiliation(s)
- Taylor W. Hargrove
- Department of Sociology, Carolina Population Center, University of North Carolina at Chapel Hill
| | - Lauren Gaydosh
- Department of Sociology, Population Research Center, University of Texas at Austin
| | - Alexis C. Dennis
- Department of Sociology, Carolina Population Center, University of North Carolina at Chapel Hill
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17
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Lei MK, Berg MT, Simons RL, Beach SRH. Neighborhood structural disadvantage and biological aging in a sample of Black middle age and young adults. Soc Sci Med 2022; 293:114654. [PMID: 34923353 PMCID: PMC8810597 DOI: 10.1016/j.socscimed.2021.114654] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/31/2021] [Accepted: 12/11/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Research on the social determinants of health has suggested that neighborhood disadvantage may undermine healthy aging and is particularly relevant for understanding health disparities. Recently, this work has examined deoxyribonucleic acid methylation (DNAm)-based measures of biological aging to understand the risk factors for morbidity and mortality. However, it is unknown whether neighborhood disadvantage is related to different indices of DNAm-based aging among Black Americans and whether such neighborhood effects vary as a function of age or gender. METHODS Our analyses of a Black American sample included 448 young adults and 493 middle-aged adults. We measured neighborhood disadvantage using the Area Deprivation Index at the census block group level. DNAm-based accelerated aging indices were measured using established procedures. Regressions with clustered standard errors were used for the analysis. RESULTS Neighborhood disadvantage was independently associated with acceleration in PhenoAge, GrimAge, and DunedinPoAm, among young and middle-aged adults. Further, there was no evidence that gender conditioned the effects of neighborhood disadvantage on the aging indices. CONCLUSIONS Regardless of age groups or gender, accelerated biological aging among Black Americans is partly rooted in differences in neighborhood disadvantage. From a policy standpoint, our findings suggest that programs that decrease neighborhood disadvantage are likely to increase healthy aging, especially among Black Americans.
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Affiliation(s)
- Man-Kit Lei
- Department of Sociology, University of Georgia, USA.
| | - Mark T Berg
- Department of Sociology and Criminology & Public Policy Center, University of Iowa, USA
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18
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Brown LJ, Sear R. How do reproduction, parenting, and health cluster together? Exploring diverging destinies, life histories and weathering in two UK cohort studies. ADVANCES IN LIFE COURSE RESEARCH 2021; 50:100431. [PMID: 36661290 DOI: 10.1016/j.alcr.2021.100431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 06/17/2023]
Abstract
Life history theory researchers often assume reproductive, parenting and health behaviours pattern across a fast-slow continuum, with 'fast' life histories (typified by short lifespans, early maturation and investing in quantity over quality of children) favoured in poor quality environments and/or when resources are scarce. Some researchers further reduce this down to a simplistic 'fast' versus 'slow' dichotomy. Some of these ideas, with different theoretical motivations, are echoed in the 'diverging destinies' and 'weathering' frameworks developed in the social sciences. Whether clustering of reproductive, parenting and health traits exists has rarely been empirically tested, however. Using latent class analysis on data on mothers from the UK's Millennium Cohort (MCS) and Born in Bradford (BiB) studies, we explored whether reproduction and parenting traits clustered into 'diverging destinies', whether 'weathering' effects tied together health and reproduction, and whether all three domains were combined into either 'fast' vs 'slow' life histories, or into three groups more indicative of a fast-slow continuum. We leveraged ethnic diversity in these samples to examine four groups of mothers separately: 1. MCS White British/Irish (n = 15,423); 2. MCS Pakistani-origin (n = 923); 3. BiB White British (n = 3937); 4. BiB Pakistani-origin (n = 4351), and explored whether faster 'weathering' was evident amongst Pakistani-origin mothers. Both two and three class models emerged as potential descriptions of latent subgroups, potentially providing support for fast and slow life histories or a continuum of traits. However, response profiles provided only limited support for theoretical predictions of which traits should cluster together, with inconsistent and restricted clustering of traits both within and between the domains of reproduction, parenting, and health. In addition, trait clustering was more pronounced amongst White mothers and we found no clear evidence supporting faster 'weathering' amongst Pakistani-origin mothers; the observed clustering instead suggested that cultural constraints may influence linkages between traits. Our results therefore provide some limited support for models which suggest certain traits cluster together in predictable ways, but it is also clear that theoretical frameworks should not emphasise very rigid clustering of large numbers of traits and should allow for contextual influences on clustering.
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Affiliation(s)
- Laura J Brown
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, UK; Department of International Development, London School of Economics & Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Rebecca Sear
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, UK
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Lewis NA, Kougias DG, Takahashi KJ, Earl A. The Behavior of Same-Race Others and Its Effects on Black Patients' Attention to Publicly Presented HIV-Prevention Information. HEALTH COMMUNICATION 2021; 36:1252-1259. [PMID: 32323571 PMCID: PMC7581553 DOI: 10.1080/10410236.2020.1749369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Black Americans make up 13% of the U.S. population, yet account for 54% of HIV deaths and 44% of new HIV diagnoses. Why do Black Americans die from HIV at such a disproportionate rate? In the current study, we asked whether the presence and behavior of in-group peers in public health settings may influence Black Americans' attention to HIV information, given the racialized nature of HIV-stigma in Black American communities. In a quasi-experimental field study conducted in a public health clinic (N = 260), we found that Black patients were less likely to pay attention to HIV-prevention information in the presence of other Black patients, unless those patients were also paying attention to the information. In contrast, Black patients' attention was unaffected by the presence of White patients. We end by discussing the implications of these findings for health communication theories and health practice geared toward reducing racial-health disparities in the United States.
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Affiliation(s)
- Neil A. Lewis
- Department of Communication, Cornell University
- Division of General Internal Medicine, Weill Cornell Medical College
| | | | | | - Allison Earl
- Department of Psychology, University of Michigan
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20
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Aschbacher K, Hagan M, Steine IM, Rivera L, Cole S, Baccarella A, Epel ES, Lieberman A, Bush NR. Adversity in early life and pregnancy are immunologically distinct from total life adversity: macrophage-associated phenotypes in women exposed to interpersonal violence. Transl Psychiatry 2021; 11:391. [PMID: 34282132 PMCID: PMC8289995 DOI: 10.1038/s41398-021-01498-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
Early childhood and pregnancy are two sensitive periods of heightened immune plasticity, when exposure to adversity may disproportionately increase health risks. However, we need deeper phenotyping to disentangle the impact of adversity during sensitive periods from that across the total lifespan. This study examined whether retrospective reports of adversity during childhood or pregnancy were associated with inflammatory imbalance, in an ethnically diverse cohort of 53 low-income women seeking family-based trauma treatment following exposure to interpersonal violence. Structured interviews assessed early life adversity (trauma exposure ≤ age 5), pregnancy adversity, and total lifetime adversity. Blood serum was assayed for pro-inflammatory (TNF-a, IL-1ß, IL-6, and CRP) and anti-inflammatory (IL-1RA, IL-4, and IL-10) cytokines. CD14+ monocytes were isolated in a subsample (n = 42) and gene expression assayed by RNA sequencing (Illumina HiSeq 4000; TruSeq cDNA library). The primary outcome was a macrophage-associated M1/M2 gene expression phenotype. To evaluate sensitivity and specificity, we contrasted M1/M2 gene expression with a second, clinically-validated macrophage-associated immunosuppressive phenotype (endotoxin tolerance) and with pro-inflammatory and anti-inflammatory cytokine levels. Adjusting for demographics, socioeconomic status, and psychopathology, higher adversity in early life (ß = .337, p = 0.029) and pregnancy (ß = .332, p = 0.032) were each associated with higher M1/M2 gene expression, whereas higher lifetime adversity (ß = -.341, p = 0.031) was associated with lower immunosuppressive gene expression. Adversity during sensitive periods was uniquely associated with M1/M2 imbalance, among low-income women with interpersonal violence exposure. Given that M1/M2 imbalance is found in sepsis, severe COVID-19 and myriad chronic diseases, these findings implicate novel immune mechanisms underlying the impact of adversity on health.
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Affiliation(s)
- Kirstin Aschbacher
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA.
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, USA.
- The Institute for Integrative Health, San Francisco, USA.
| | - Melissa Hagan
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA
- Department of Psychology, College of Science & Engineering, San Francisco State University, San Francisco, USA
| | - Iris M Steine
- Department of Psychology, University of California, Berkeley, USA
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Luisa Rivera
- Department of Anthropology, Emory University, Atlanta, Georgia
| | - Steve Cole
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | | | - Elissa S Epel
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Alicia Lieberman
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Nicole R Bush
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA
- Center for Health and Community, University of California, San Francisco, USA
- Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco, USA
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Fikslin RA. Toward an Intersectional Psychological Science of Reproductive Norms: Generating Research Across the Natalism Spectrum. PSYCHOLOGY OF WOMEN QUARTERLY 2021. [DOI: 10.1177/03616843211011716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pronatalism is the belief system that encourages parenthood and reproduction, supporting the notion that a woman’s value is rooted in her ability to give birth to and parent children. Pronatalist expectations are disproportionately applied to high-status women in the United States, prescribing not only that women are supposed to reproduce, but which women are supposed to reproduce. Those who deviate from this hegemonic idea of a prototypical mother may disproportionately encounter antinatalist norms that prescribe that they should not bear or parent children. In the present article, I advocate for an intersectional psychological study of reproductive norms across the natalism spectrum, grounded in interdisciplinary insights and an understanding of systems of power and oppression. I discuss three common areas of interdisciplinary research related to reproductive norms: (a) pronatalism as a limit to women’s freedom, (b) racism and the control of Black women’s reproduction, and (c) queer perspectives on reproduction. Informed by intersectionality and stigma frameworks, I propose a generative model and six research questions that serve as a research agenda for the psychological study of reproductive norms across the natalism spectrum.
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Affiliation(s)
- Rachel A. Fikslin
- Basic and Applied Social Psychology PhD Program, Department of Psychology, The Graduate Center, City University of New York, NY, USA
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22
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Evaluating associations between area-level Twitter-expressed negative racial sentiment, hate crimes, and residents' racial prejudice in the United States. SSM Popul Health 2021; 13:100750. [PMID: 33665332 PMCID: PMC7901034 DOI: 10.1016/j.ssmph.2021.100750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/27/2020] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background The objective of the current study is to investigate whether an area-level measure of racial sentiment derived from Twitter data is associated with state-level hate crimes and existing measures of racial prejudice at the individual-level. Methods We collected 30,977,757 tweets from June 2015-July 2018 containing at least one keyword pertaining to specific groups (Asians, Arabs, Blacks, Latinos, Whites). We characterized sentiment of each tweet (negative vs all other) and averaged at the state-level. These racial sentiment measures were merged with other measures based on: hate crime data from the FBI Uniform Crime Reporting Program; implicit and explicit racial bias indicators from Project Implicit; and racial attitudes questions from General Social Survey (GSS). Results Living in a state with 10% higher negative sentiment in tweets referencing Blacks was associated with 0.57 times the odds of endorsing a GSS question that Black-White disparities in jobs, income, and housing were due to discrimination (95% CI: 0.40, 0.83); 1.64 times the odds of endorsing the belief that disparities were due to lack to will (95% CI: 0.95, 2.84); higher explicit racial bias (β: 0.11; 95% CI: 0.04, 0.18); and higher implicit racial bias (β: 0.09; 95% CI: 0.04, 0.14). Twitter-expressed racial sentiment was not statistically-significantly associated with incidence of state-level hate crimes against Blacks (IRR: 0.99; 95% CI: 0.52, 1.90), but this analysis was likely underpowered due to rarity of reported hate crimes. Conclusion Leveraging timely data sources for measuring area-level racial sentiment can provide new opportunities for investigating the impact of racial bias on society and health.
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GERONIMUS ARLINET, PEARSON JAYA, LINNENBRINGER ERIN, EISENBERG ALEXAK, STOKES CARMEN, HUGHES LANDOND, SCHULZ AMYJ. Weathering in Detroit: Place, Race, Ethnicity, and Poverty as Conceptually Fluctuating Social Constructs Shaping Variation in Allostatic Load. Milbank Q 2020; 98:1171-1218. [PMID: 33135829 PMCID: PMC7772642 DOI: 10.1111/1468-0009.12484] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Policy Points Despite 30 years of attention to eliminating population health inequity, it remains entrenched, calling for new approaches. Targeted universalism, wellness-based local development, and Jedi Public Health approaches that are community informed, evidence based, and focused on improving everyday settings and diverse lived experiences are important policy directions. State and federal revenue transfers are necessary to mitigate the harms of austerity and assure greater equity in fiscal and population health in places like Detroit, Michigan. CONTEXT US population health inequity remains entrenched, despite mandates to eliminate it. To promote a public health approach of consequence in this domain, stakeholders call for moving from risk-factor epidemiology toward consideration of dynamic local variations in the physiological impacts of structured lived experience. METHODS Using a community-based, participatory research approach, we collected and analyzed a unique data set of 239 black, white, and Mexican adults from a stratified, multistage probability sample of three Detroit, Michigan, neighborhoods. We drew venous blood, collected saliva, took anthropometric measurements, and assayed specimens to measure allostatic load (AL), an indicator of stress-mediated biological dysregulation, linking participants' AL scores and survey responses. In a series of nested Poisson models, we regressed AL on socioeconomic, psychosocial, neighborhood, and behavioral stressors to test the hypothesis that race/ethnicity and poverty-to-income ratio (PIR) are conceptually fluctuating variables whose impacts on AL are sensitive to structured lived experience. FINDINGS White and Mexican Detroit participants with PIR < 1 have higher AL than counterparts nationally; black participants in Detroit and nationwide had comparable AL. Within Detroit, disparities by PIR were higher in whites than blacks, with no significant difference by PIR in Mexicans. The size of estimated effects of having PIR < 1 for whites is 58 percentage points greater than that of Mexicans and twice that of blacks. CONCLUSIONS Structurally rooted unobserved heterogeneity bias threatens the validity of independent main effects interpretations of associations between race/ethnicity, socioeconomic characteristics, or place and health. One-size-fits-all analytic or policy models developed from the perspective of the dominant social group insufficiently address the experiences of diverse populations in specific settings and historical moments; nor do they recognize culturally mediated protective resources residents may have developed against material and psychosocial hardship.
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Affiliation(s)
- ARLINE T. GERONIMUS
- School of Public HealthUniversity of Michigan
- Institute for Social Research, University of Michigan
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25
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Brown LJ, Myers S, Page AE, Emmott EH. Subjective Environmental Experiences and Women's Breastfeeding Journeys: A Survival Analysis Using an Online Survey of UK Mothers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217903. [PMID: 33126713 PMCID: PMC7662350 DOI: 10.3390/ijerph17217903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/02/2023]
Abstract
Local physical and social environmental factors are important drivers of human health and behaviour. Environmental perception has been linked with both reproduction and parenting, but links between subjective environmental experiences and breastfeeding remain unclear. Using retrospective data from an online survey of UK mothers of children aged 0-24 months, Cox-Aalen survival models test whether negative subjective environmental experiences negatively correlated with any and exclusive breastfeeding (max n = 473). Matching predictions, hazards of stopping any breastfeeding were increased, albeit non-significantly, across the five environmental measures (HR: 1.05-1.26) Hazards for stopping exclusive breastfeeding were however (non-significantly) reduced (HR: 0.65-0.87). Score processes found no significant time-varying effects. However, estimated cumulative coefficient graphs showed that the first few weeks postpartum were most susceptible to environmental influences and that contrary to our predictions, mothers with worse subjective environmental experiences were less likely to stop breastfeeding at this time. In addition, the hazard of stopping exclusive breastfeeding declined over time for mothers who thought that littering was a problem. The predicted increased hazards of stopping breastfeeding were only evident in the later stages of any breastfeeding and only for mothers who reported littering as a problem or that people tended not to know each other. Perceived harsher physical and social environmental conditions are assumed to deter women from breastfeeding, but this may not always be the case. Women's hazards of stopping breastfeeding change over time and there may be particular timepoints in their breastfeeding journeys where subjective environmental experiences play a role.
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Affiliation(s)
- Laura J. Brown
- Department of International Development, London School of Economics & Political Science, London WC2A 2AE, UK
- Institute for Global Health, University College London, London NW3 2PF, UK
- Correspondence:
| | - Sarah Myers
- UCL Anthropology, University College London, London WC1H 0BW, UK; (S.M.); (E.H.E.)
- BirthRites Independent Max Planck Research Group, Max Planck Institute for Evolutionary Anthropology, 04103 Leipzig, Germany
| | - Abigail E. Page
- Department of Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Emily H. Emmott
- UCL Anthropology, University College London, London WC1H 0BW, UK; (S.M.); (E.H.E.)
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Schulz AJ, Omari A, Ward M, Mentz GB, Demajo R, Sampson N, Israel BA, Reyes AG, Wilkins D. Independent and joint contributions of economic, social and physical environmental characteristics to mortality in the Detroit Metropolitan Area: A study of cumulative effects and pathways. Health Place 2020; 65:102391. [PMID: 32738606 PMCID: PMC7511424 DOI: 10.1016/j.healthplace.2020.102391] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Previous studies have demonstrated associations between race-based residential segregation, neighborhood socioeconomic and physical environmental characteristics, and mortality. Relatively few studies have examined independent and joint effects of these multiple neighborhood characteristics and mortality, including potential mediating pathways. In this study we examine the extent to which associations between race-based residential segregation and all-cause mortality may be explained by multiple socioeconomic indicators and exposure to air pollutants. METHODS Drawing on data from multiple sources, we assessed bivariate associations between race-based residential segregation (operationalized as percent non-Hispanic Black), education (percent with graduate equivalency degree), poverty (percent below poverty), income inequality (GINI coefficient) and air pollution (ambient PM2.5) and age adjusted all-cause, all race mortality (henceforth all cause mortality) at the census tract level in the Detroit Metropolitan Area. We used inequality curves to assess the (in)equitable distribution of economic and environmental characteristics by census tract racial composition. Finally, we used generalized estimating equations (GEE) to examine independent and joint associations among percent NHB, education, income inequality, and air pollution to all-cause mortality, and test for mediating effects. RESULTS Bivariate associations between racial composition, education, poverty, income inequality, PM2.5 and all-cause mortality were statistically significant. Census tracts with higher concentrations of NHB residents had significantly lower educational attainment, higher poverty, and greater exposure to PM2.5. In multivariate models, education, income inequality and PM2.5 fully attenuated associations between racial composition and all-cause mortality. CONCLUSIONS Results are consistent with the hypothesis that race-based residential segregation is associated with heightened all-cause mortality, and that those effects are mediated by education, income inequality, and exposure to air pollution at the census tract level. Public health and cross-sector interventions to eliminate race-based residential segregation or to eliminate the maldistribution of educational and economic resources, and environmental exposures, across census tracts could substantially reduce regional inequities in all-cause mortality.
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Affiliation(s)
- Amy J Schulz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Amel Omari
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Melanie Ward
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Graciela B Mentz
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ricardo Demajo
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Natalie Sampson
- College of Education, Health and Human Services, University of Michigan Dearborn, Dearborn, MI, USA
| | - Barbara A Israel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, MI, USA
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Simons RL, Lei MK, Klopack E, Beach SRH, Gibbons FX, Philibert RA. The effects of social adversity, discrimination, and health risk behaviors on the accelerated aging of African Americans: Further support for the weathering hypothesis. Soc Sci Med 2020; 282:113169. [PMID: 32690336 DOI: 10.1016/j.socscimed.2020.113169] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/29/2020] [Accepted: 06/21/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The weathering hypothesis views the elevated rates of illness, disability, and mortality seen among Black Americans as a physiological response to the structural barriers, material hardships, and identity threats that comprise the Black experience. While granting that lifestyle may have some significance, the fundamental explanation for heath inequalities is seen as race-related stressors that accelerate biological aging. OBJECTIVE The present study tests the weathering hypothesis by examining the impact on accelerated aging of four types of adversity frequently experienced by Black Americans. Further, we investigate whether health risk behaviors mediate the effect of these conditions. METHOD Our analyses utilize data from 494 middle-age, African American men and women participating in the Family and Community Healthy Study. The newly developed GrimAge index of accelerated aging is used as an indicator of weathering. Education, income, neighborhood disadvantage, and discrimination serve as the independent variables. Three health risk behaviors - diet, exercise, and alcohol consumption - are included as potential mediators of the four types of adversity. Marital status and gender are entered as controls. RESULTS Multivariate analyses indicated that the four types of adversity predicted acceleration whereas marriage predicted deceleration in speed of aging. Males showed greater accelerated aging than females, but there was no evidence that gender conditioned the effect of adversity. The health risk behaviors were unrelated to accelerated aging and did not mediate the effect of the stressors. CONCLUSION Modern medicine's emphasis on life style as the primary explanation for race-based health disparities ignores the way race-related adversity rooted in structural and cultural conditions serves to accelerate biological decline, thereby increasing risk of early onset of illness and death. Importantly, these social conditions can only be addressed through social policies and programs that target institutional racism and promote economic equity.
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Affiliation(s)
- Ronald L Simons
- Department of Sociology, University of Georgia, 324 Baldwin Hall, Athens, GA, 30602, USA.
| | - Man-Kit Lei
- Center for Family Research, University of Georgia, 1095 College Station Road, Athens, GA, 30605, USA
| | - Eric Klopack
- Department of Sociology, University of Georgia, 104 Baldwin Hall, Athens, GA, 30602, USA
| | - Steven R H Beach
- Department of Psychology, University of Georgia, 157 IBR Psychology Building, Athens GA, 30602, USA
| | - Frederick X Gibbons
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Robert A Philibert
- Department of Psychiatry, University of Iowa, 2-126B Medical Education Building, Iowa City, IA, 52242, USA
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Doshi M, Lopez WD, Mesa H, Bryce R, Rabinowitz E, Rion R, Fleming PJ. Barriers & facilitators to healthcare and social services among undocumented Latino(a)/Latinx immigrant clients: Perspectives from frontline service providers in Southeast Michigan. PLoS One 2020; 15:e0233839. [PMID: 32502193 PMCID: PMC7274400 DOI: 10.1371/journal.pone.0233839] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 05/13/2020] [Indexed: 12/05/2022] Open
Abstract
Immigration- and enforcement-related policies and laws have significantly and negatively impacted the health and well-being of undocumented immigrants. We examine barriers and facilitators to healthcare and social services among undocumented Latino(a)/Latinx immigrants specifically in the post 2016 US presidential election socio-political climate. By grounding our study on the perspectives of frontline providers, we explore their challenges in meeting the needs of their undocumented clients. These include client access to healthcare and social services, the barriers providers face in providing timely and effective services, and avenues to reduce or overcome factors that impede service provision to improve quality of care for this population. Data are from 28 in-depth interviews with frontline healthcare and social service providers. Based on data analysis, we found that the domains of the Three Delays Model used in obstetric care provided a good framework for organizing and framing the responses. Our findings suggest that these undocumented clients encounter three phases of delay: delay in the decision to seek care, delay in identifying and traveling to healthcare facilities, and delay in receiving adequate and appropriate care at healthcare facilities. Given the current socio-political climate for immigrants, healthcare and social services organizations that serve undocumented clients should adapt existing services or introduce new services, including those that are not site-based.
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Affiliation(s)
- Monika Doshi
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- * E-mail:
| | - William D. Lopez
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Hannah Mesa
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Richard Bryce
- Community Health and Social Services (CHASS) Center, Detroit, MI, United States of America
| | | | - Raymond Rion
- Packard Health, Ann Arbor, MI, United States of America
| | - Paul J. Fleming
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
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Racial Discrimination, Inflammation, and Chronic Illness Among African American Women at Midlife: Support for the Weathering Perspective. J Racial Ethn Health Disparities 2020; 8:339-349. [PMID: 32488825 DOI: 10.1007/s40615-020-00786-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022]
Abstract
It is widely accepted that socioeconomic status (SES) is a fundamental cause of health inequality. There is evidence, however, that race is also a fundamental cause of disparities in health. Based on this idea, the weathering hypothesis developed by Geronimus and her colleagues views the elevated rates of illness and disability seen among Black Americans as a physiological response to the structural barriers, daily slights, and other threats to identity that comprise the Black experience. The current study tests the weathering hypothesis using chronic inflammation as an indicator of biological weathering. Specifically, we examine the extent to which persistent exposure to racial discrimination predicts elevated inflammation and, in turn, diagnosed chronic illness, after taking into account SES and several control variables. This mediation model was tested using zero-inflated Poisson path modeling with five waves of data collected from 391 African American women participating in the Family and Community Health Study (FACHS). A 13-item index was used to assess exposure to racial discrimination across 8 years. ELISA blood assays of seven cytokines central to the inflammatory response were used to construct an inflammatory index. Respondents reported their diagnosed chronic diseases. Consonant with the weathering hypothesis, persistent exposure to discrimination predicted inflammation which, in turn, predicted number of chronic diseases. This indirect effect was statistically significant. SES predicted having a chronic disease and the various controls showed no effect. The findings support the idea that race, like SES, is a fundamental cause of health inequalities.
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Wong JO, Benjamin M, Arnold EA. 'I want the heart of fierceness to arise within us': maintaining public space to promote HIV-related health with House Ball Community members in an era of gentrification. CULTURE, HEALTH & SEXUALITY 2020; 22:444-458. [PMID: 31050605 DOI: 10.1080/13691058.2019.1606281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The House Ball Community consists of sexual, gender and ethnic minority youth who form family-like houses and compete in balls. Many rely on community-based organisations as venues for socialising and accessing health-related resources. In recent years, urban gentrification has challenged the economic survival of the organisations that serve this community and its members. Between 2016 and 2017, we conducted 45 in-depth interviews with houses and gay families in the San Francisco Bay Area and regular participant observation at community events, including balls. In addition to forcing community organisations to close or move, rising rents have increased housing instability among Ballroom Community members, with some moving to distal locations. Participants felt nostalgia for organisations that provided HIV-related services and hosted balls in previous years, feeling the loss of space keenly. To maintain community and generate employment, the San Francisco Ballroom Community now offers Vogue classes at private dance studios. This allows participants to recruit new house members, welcoming a broader array of individuals into the community than those who have historically participated. However, accessing culturally appropriate sexual health services remains difficult. Health advocates should recognise that community organisations are necessary for diverse youth to build community and access sexual health services.
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Affiliation(s)
- Jeffrey O Wong
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael Benjamin
- California Prevention Education Project (CAL-PEP), Oakland, CA, USA
| | - Emily A Arnold
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Evans LA, Geronimus AT, Caldwell CH. SYSTEMATICALLY SHORTCHANGED, YET CARRYING ON: Black Adolescent Girls in the Detroit Metropolitan School Reform Environment. DU BOIS REVIEW : SOCIAL SCIENCE RESEARCH ON RACE 2020; 16:357-383. [PMID: 34707680 PMCID: PMC8547709 DOI: 10.1017/s1742058x19000316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
School reform policies, such as the closure of "low-performing" schools and the competitive introduction of school choice and charters, were presented to communities of color as the fix to educational inequities and the lifeline needed for urban Black students to have a chance at a quality education and social mobility. The ways in which reforms have under-delivered on this promise, and in some cases exacerbated negative academic outcomes, particularly for Black boys, are documented. Yet, research on the experience of Black adolescent girls is sparse. We explore ways that policies aimed at delivering a school choice environment have affected daily life for Black adolescent girls. We examine this issue in the context of the Detroit metropolitan area with Black adolescent girls, reflecting on their high school education experiences that spanned a time-period of rapid transitions in the schooling environment (2014-2016) prompted by a series of school reforms in Michigan. Through in-depth interviews we found that girls sought to invest in their high school education as a path to college; yet the very reforms advanced as ways to clear this path, hindered their ability to spend time on the human and social capital activities believed to be important to their academic success and social mobility. Our findings suggest advantages for those students with proximal access to high quality neighborhood schools cannot be replicated in a choice environment. There may also be health consequences of the coping strategies girls are compelled to employ to carry on under adverse educational circumstances.
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Affiliation(s)
- Linnea A Evans
- Department of Obstetrics and Gynecology, The University of Wisconsin - Madison
| | - Arline T Geronimus
- Department of Health Behavior and Health Education, The University of Michigan
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Gendered Race and Setting Matter: Sources of Complexity in the Relationships Between Reported Interpersonal Discrimination and Cardiovascular Health in the CARDIA Study. J Racial Ethn Health Disparities 2020; 7:687-697. [PMID: 31939080 PMCID: PMC10403804 DOI: 10.1007/s40615-020-00699-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Using data from black and white adults enrolled in a community-based, multi-city cohort assembled in the mid-1980s, we examined whether reported experiences of interpersonal racial and gender discrimination differentially impacted on future cardiovascular health (CVH) depending on gendered race and the setting in which the interactions were reported to have occurred. METHODS Discrimination in eight possible settings was assessed using the Experiences of Discrimination scale at year 7; CVH two decades later was examined using a modified Life's Simple 7 score, with higher scores indicating better health. Separate multivariable linear regressions evaluated the associations between reports of racial and gender discrimination and CVH score in each possible setting stratified by gendered race. RESULTS Mean (SD) CVH scores at year 30 were 7.8(1.9), 8.1(1.8), 8.9(2. 0), and 8.8(1.8) among black women, black men, white women, and white men, respectively. For black women, reporting both racial and gender discrimination while receiving medical care was associated with lower CVH score. Among black men, reporting both forms of discrimination while getting a job, at work, at school, and receiving medical care was associated with lower CVH score. Among whites, reported discrimination while obtaining housing and by the police or courts (women), and in public and at work (men), was associated with a lower CVH score. CONCLUSIONS The setting in which discrimination is reported may be an important indicator of whether discriminatory experiences are negatively associated with CVH, providing insight on distinct effect pathways among black and white women and men.
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Simons RL, Lei MK, Beach SRH, Simons LG, Barr AB, Gibbons FX, Philibert RA. Testing Life Course Models Whereby Juvenile and Adult Adversity Combine to Influence Speed of Biological Aging. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:291-308. [PMID: 31409156 PMCID: PMC7751897 DOI: 10.1177/0022146519859896] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The present study extends prior research on the links between social adversity and aging by employing more comprehensive measures of adversity and a new gene expression index of aging. Hierarchical regression and 20 years of data from a sample of 381 black Americans were used to test models regarding the impact of social adversity on speed of aging. Consistent with the early life sensitivity model, early adversity continued to predict accelerated aging after controlling for adult adversity. Contrary to the pathway model, adult adversity was not related to aging following controls for early adversity. The cumulative stress model received partial support as high adversity during adulthood amplified the effect of early adversity on aging. Finally, consonant with the social change model, low adversity during adulthood buffered the effect of early adversity on aging. These findings held after controlling for health behaviors such as smoking, diet, and exercise.
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Bey G, Jesdale B, Forrester S, Person S, Kiefe C. Intersectional effects of racial and gender discrimination on cardiovascular health vary among black and white women and men in the CARDIA study. SSM Popul Health 2019; 8:100446. [PMID: 31334327 PMCID: PMC6620618 DOI: 10.1016/j.ssmph.2019.100446] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022] Open
Abstract
Testing hypotheses from the emerging Identity Pathology (IP) framework, we assessed race-gender differences in the effects of reporting experiences of racial and gender discrimination simultaneously compared with racial or gender discrimination alone, or no discrimination, on future cardiovascular health (CVH). Data were from a sample of 3758 black or white adults in CARDIA, a community-based cohort recruited in Birmingham, AL; Chicago, IL; Minneapolis, MN, and Oakland, CA in 1985-6 (year 0). Racial and gender discrimination were assessed using the Experiences of Discrimination scale. CVH was evaluated using a 12-point composite outcome modified from the Life's Simple 7, with higher scores indicating better health. Multivariable linear regressions were used to evaluate the associations between different perceptions of discrimination and CVH scores two decades later by race and gender simultaneously. Reporting racial and gender discrimination in ≥2 settings were 48% of black women, 42% of black men, 10% of white women, and 5% of white men. Year 30 CVH scores (mean, SD) were 7.9(1.4), 8.1(1.6), 8.8(1.6), and 8.7(1.3), respectively. Compared with those of their race-gender groups reporting no discrimination, white women reporting only gender-based discrimination saw an adjusted score difference of +0.3 (95% CI: 0.0,0.6), whereas white men reporting only racial discrimination had on average a 0.4 (95% CI: 0.1,0.8) higher score, and scores among white men reporting both racial and gender discrimination were on average 0.6 (95% CI: 1.1,-0.1) lower than those of their group reporting no discrimination. Consistent with predictions of the IP model, the associations of reported racial and gender discrimination with future CVH were different for different racially-defined gender groups. More research is needed to understand why reported racial and gender discrimination might better predict deterioration in CVH for whites than blacks, and what additional factors associated with gender and race contribute variability to CVH among these groups.
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Affiliation(s)
- G.S. Bey
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr. Chapel Hill, NC, 27599, USA
| | - B. Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - S. Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - S.D. Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - C. Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
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Abstract
UNLABELLED In many wealthy countries, fatness is stigmatized as a sign of personal failure. Health care interactions can enact fat-related stigmatization, which can worsen health outcomes. The present analysis highlights how stigmatizing discourses about fat bodies emerge in primary care appointments, and examines immediate conversational effects. METHODS Observational study in three primary care clinics in Canada, using conversation and discourse analytic methods on transcripts of 29 audio-recorded appointments with adults. Talk about weight and blood pressure are contrasted. RESULTS During measurement and review of measurements, clinicians routinely interpreted the blood pressure result but rarely interpreted weight. Patients of varied ages and body sizes often filled the interpretative vacuum, and focused on behaviors. Overall, neither patients nor clinicians challenged the stigmatizing discourses associated with fat bodies, but sometimes agreed that the "personal failure" frame associated with fatness does not apply to the particular patient. Physicians rarely raised other determinants of weight, but often did so when talking about blood pressure. CONCLUSIONS Across most body types and ages, weight-related talk spurred stigma management from adult patients. Patients' interpretations were consistent with accepting or avoidant strategies to manage stigma. The findings challenge clinicians and researchers to frame patients' defensiveness or sensitivity as a predictable response to mitigate stigma, and consider how clinical care might be better structured to avoid stigmatization. Recognizing the range of determinants of weight with interpretation of weight may help, particularly if combined with other methods to de-stigmatize care. The results have implications for clinical weight management and behavior change support.
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Affiliation(s)
- Patricia Thille
- a The Wilson Centre , University Health Network/University of Toronto
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Simons RL, Lei MK, Carter S, Beach SRH, Gibbons FX, Gerrard M, Philibert RA. Inflammation mediates the effect of discrimination, religiosity, and friendship network on expression of the Tp53 cancer suppressor gene. SSM Popul Health 2019; 7:100389. [PMID: 31080868 PMCID: PMC6503223 DOI: 10.1016/j.ssmph.2019.100389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/17/2019] [Accepted: 03/17/2019] [Indexed: 01/24/2023] Open
Abstract
Objective Chronic inflammation and expression of the TP53 gene are two biomarkers that have been identified as particularly important in the etiology and progression of cancer. While much is known about the determinants of inflammation, there is currently little information regarding the causes of variation in the functioning of TP53, even though it has been recognized for 40 years as the most potent of the cancer suppressor genes. The current paper explores the interrelationship between these two biomarkers and investigates the extent to which they are influenced by the social environment. Methods Using structural equation modeling (SEM) and longitudinal observational data from a sample of several hundred African Americans, we tested the hypothesis that adversity – operationalized as racial discrimination- and coping resources – operationalized as religiosity and black friends - influence expression of TP53, for better or worse, through their impact on inflammation. Results Correlational analysis showed inflammation and TP53 to be inversely related. Further, discrimination was positively related to inflammation and negatively related to TP53 expression, whereas religiosity and black friends were both negatively related to inflammation and positively related to TP53 expression. Finally, SEM indicated that the effect of the social environmental variables on TP53 expression was indirect through level of inflammation. Conclusions In addition to its established contribution to cancer through DNA damage and cell proliferation, inflammation likely increases cancer risk indirectly by inhibiting expression of the TP53 cancer suppressor gene. Hence environmental and stress management interventions may do more than reduce inflammation's cell damaging effects; they may also lessen the chances of cancer by increasing expression of TP53. Discrimination, religiosity, and black friends showed significant associations with inflammation and TP53. The effect of discrimination, religiosity, and black friends on TP53 was indirect through level of inflammation. Inflammation likely increases cancer risk indirectly by suppressing the TP53 cancer suppressor gene. Environmental and stress management interventions may lessen the chances of cancer by increasing expression of TP53.
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Affiliation(s)
- Ronald L Simons
- Department of Sociology, University of Georgia, Athens, GA 30602, Greece
| | - Man-Kit Lei
- Department of Sociology and Center for Family Research, University of Georgia, Athens, GA 30605, Greece
| | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta, GA 30303, USA
| | - Steven R H Beach
- Department of Psychology, University of Georgia, Athens GA 30602, Greece
| | - Frederick X Gibbons
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Meg Gerrard
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
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Simons RL, Woodring D, Simons LG, Sutton TE, Lei MK, Beach SRH, Barr AB, Gibbons FX. Youth Adversities Amplify the Association between Adult Stressors and Chronic Inflammation in a Domain Specific Manner: Nuancing the Early Life Sensitivity Model. J Youth Adolesc 2019; 48:1-16. [PMID: 30603835 DOI: 10.1007/s10964-018-0977-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022]
Abstract
There is strong evidence that chronic, systemic inflammation hastens onset of the diseases of old age that ultimately lead to death. Importantly, several studies suggest that childhood adversity predicts chronic inflammation. Unfortunately, this research has been plagued by retrospective reports of childhood adversity, an absence of controls for adult stressors, and a failure to investigate various competing models of the link between childhood adversity and chronic inflammation. The present study was designed to address these limitations. Using 18 years of data collected from 413 African Americans (58% female) included in the Family and Community Health Study, hierarchical regression analyses provided support for a nuanced early life sensitivity explanation for the link between early adversity and adult chronic inflammation. Controlling for health risk behaviors and adult SES, late childhood (ages 10-12) adversity amplified the association between adult adversity (age 29) and chronic inflammation. This interaction operated in a domain-specific fashion. Harsh parenting amplified the relation between intimate partner hostility and inflammation, whereas early discrimination amplified the relation between adult discrimination and inflammation. These findings suggest that individuals may be primed to respond physiologically to adverse adult circumstances that resemble those experienced earlier in life.
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Affiliation(s)
- Ronald L Simons
- Department of Sociology, University of Georgia, Athens, GA, 30602, USA.
| | - David Woodring
- Department of Sociology, University of Georgia, Athens, GA, 30602, USA
| | | | - Tara E Sutton
- Department of Sociology, University of Georgia, Athens, GA, 30602, USA
| | - Man-Kit Lei
- Center for Family Research, University of Georgia, Athens, GA, 30605, USA
| | - Steven R H Beach
- Department of Psychology, University of Georgia, Athens, GA, 30602, USA
| | - Ashley B Barr
- Department of Sociology, SUNY Buffalo, Buffalo, NY, 14260, USA
| | - Frederick X Gibbons
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
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Simons RL, Lei MK, Beach SRH, Barr AB, Simons LG, Gibbons FX, Philibert RA. Discrimination, segregation, and chronic inflammation: Testing the weathering explanation for the poor health of Black Americans. Dev Psychol 2018; 54:1993-2006. [PMID: 30234347 DOI: 10.1037/dev0000511] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Several studies have reported a relation between race-related stressors and the poor health of Black Americans. Such findings raise questions regarding the mediating biological mechanisms that might account for this link. The present study investigated elevated systemic inflammation, a factor shown to be a strong predictor of chronic illness and mortality in all ethnic populations, as a possible factor. Using 7 waves of data from the Family and Community Health Study, collected over a 20-year period from over 400 Black Americans, we investigated the extent to which exposure to discrimination and segregation at various points in the life course predicted adult inflammation at age 28. Our analyses examined whether cumulative stress, stress generation, or predictive adaptive response (PAR) models best accounted for any associations that existed between these race-related stressors and adult inflammation. At every wave of data collection, assessments of discrimination and segregation were related to adult inflammation. However, multivariate analyses using structure equation modeling indicated that the PAR model best explained the effect of these race-related stressors on inflammation. Exposure to discrimination and segregation during the juvenile years predicted adult inflammation and amplified the inflammatory effect of adult exposure to these race-related stressors. These effects were considerably more robust than that of traditional health risk factors such as diet, exercise, smoking, and low SES. Implications of these findings are discussed, including the limitations of the widely accepted risk factor approach to increasing the health of Black Americans. (PsycINFO Database Record
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Affiliation(s)
| | - Man-Kit Lei
- Center for Family Research, University of Georgia
| | | | - Ashley B Barr
- Department of Sociology, State University of New York at Buffalo
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Bey GS, Ulbricht CM, Person SD. Theories for Race and Gender Differences in Management of Social Identity-Related Stressors: a Systematic Review. J Racial Ethn Health Disparities 2018; 6:117-132. [PMID: 29987597 DOI: 10.1007/s40615-018-0507-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022]
Abstract
Sociodemographic group-specific strategies for stress management may contribute to racial and gender disparities in health outcomes in the USA. We aimed to systematically review theoretical and empirical investigations of factors influencing variation in response to and management of identity-related stress among black and white Americans. OvidPsychInfo and PubMed databases were searched to identify eligible studies. Criteria were participant age of ≥ 18 years, conducted in the US sampling black or white participants, and published in English in a peer-reviewed journal. The final sample included 167 articles. Theories suggesting social status inequities as the primary contributor to disparate strategies employed by black and white women and men to manage social identity-related stress were most frequently tested and supported. Studies disproportionally focused on how women and black persons cope as targets of prejudice and discrimination rather than on how management strategies of men or white persons are affected as perpetrators. Finally, there was theoretical support for an interactive effect of race and gender on stress management, but empirical evidence was lacking, particularly among black men, white women, and white men. The literature could be strengthened through the use of prospective cohorts and nationally representative samples, as well as study designs accounting for potential within-race and within-gender variation in the effects of social identity-related stressors on coping. With greater consistency in methodology, future empirical studies may yield additional information regarding group differences in stress management pertinent to clarifying mechanisms for the health consequences of exposure to social inequity among black and white women and men.
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Affiliation(s)
- Ganga S Bey
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01605, USA.
| | - Christine M Ulbricht
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01605, USA
| | - Sharina D Person
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01605, USA
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Assari S. Unequal Gain of Equal Resources across Racial Groups. Int J Health Policy Manag 2018; 7:1-9. [PMID: 29325397 PMCID: PMC5745862 DOI: 10.15171/ijhpm.2017.90] [Citation(s) in RCA: 257] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 07/24/2017] [Indexed: 12/11/2022] Open
Abstract
The health effects of economic resources (eg, education, employment, and living place) and psychological assets (eg, self-efficacy, perceived control over life, anger control, and emotions) are well-known. This article summarizes the results of a growing body of evidence documenting Blacks' diminished return, defined as a systematically smaller health gain from economic resources and psychological assets for Blacks in comparison to Whites. Due to structural barriers that Blacks face in their daily lives, the very same resources and assets generate smaller health gain for Blacks compared to Whites. Even in the presence of equal access to resources and assets, such unequal health gain constantly generates a racial health gap between Blacks and Whites in the United States. In this paper, a number of public policies are recommended based on these findings. First and foremost, public policies should not merely focus on equalizing access to resources and assets, but also reduce the societal and structural barriers that hinder Blacks. Policy solutions should aim to reduce various manifestations of structural racism including but not limited to differential pay, residential segregation, lower quality of education, and crime in Black and urban communities. As income was not found to follow the same pattern demonstrated for other resources and assets (ie, income generated similar decline in risk of mortality for Whites and Blacks), policies that enforce equal income and increase minimum wage for marginalized populations are essential. Improving quality of education of youth and employability of young adults will enable Blacks to compete for high paying jobs. Policies that reduce racism and discrimination in the labor market are also needed. Without such policies, it will be very difficult, if not impossible, to eliminate the sustained racial health gap in the United States.
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Affiliation(s)
- Shervin Assari
- Center for Research on Ethnicity, Culture and Health (CRECH), School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation (IHPI), University of Michigan, Ann Arbor, MI, USA
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Novak NL, Wang X, Clarke PJ, Hajat A, Needham BL, Sánchez BN, Rodriguez CJ, Seeman TE, Castro-Diehl C, Golden SH, Diez Roux AV. Diurnal salivary cortisol and nativity/duration of residence in Latinos: The Multi-Ethnic Study of Atherosclerosis. Psychoneuroendocrinology 2017; 85:179-189. [PMID: 28886460 PMCID: PMC5623131 DOI: 10.1016/j.psyneuen.2017.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 08/13/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
Latino immigrants have lower prevalence of depression, obesity and cardiovascular disease than US-born Latinos when they are recently arrived in the US, but this health advantage erodes with increasing duration of US residence. Cumulative exposure to psychosocial stress and its physiological sequelae may mediate the relationship between nativity and duration of US residence and poor health. We used data from Latino cohort study participants ages 45-84 to examine cross-sectional (n=558) and longitudinal (n=248) associations between nativity and duration of US residence and features of the diurnal cortisol curve including: wake-up cortisol, cortisol awakening response (CAR, wake-up to 30min post-awakening), early decline (30min to 2h post-awakening) and late decline (2h post-awakening to bed time), wake-to-bed slope, and area under the curve (AUC). In cross-sectional analyses, US-born Latinos had higher wake-up cortisol than immigrants with fewer than 30 years of US residence. In the full sample, over 5 years the CAR and early decline became flatter and AUC became larger. Over 5 years, US-born Latinos had greater increases in wake-up cortisol and less pronounced flattening of the early diurnal cortisol decline than immigrants with fewer than 30 years of US residence. Immigrants with 30 or more years of US residence also had less pronounced flattening of the early decline relative to more recent immigrants, and also had a less pronounced increase in AUC. In sum, we saw limited cross-sectional evidence that US-born Latinos have more dysregulated cortisol than recently-arrived Latino immigrants, but over time US-born Latinos had slower progression of cortisol dysregulation.
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Affiliation(s)
- Nicole L Novak
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
| | - Xu Wang
- Dornsife School of Public Health, Drexel University, 3215 Market St., Philadelphia, PA 19104, USA.
| | - Philippa J Clarke
- Survey Research Center, Institute for Social Research, University of Michigan, 426 S. Thompson St., Ann Arbor, MI 48109, USA.
| | - Anjum Hajat
- University of Washington School of Public Health Department of Epidemiology, 4225 Roosevelt Way NE, Suite 303, Seattle, WA 98105, USA.
| | - Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
| | - Brisa N Sánchez
- Department of Biostatistics, University of Michigan School of Public Health, SPH II, Room 4164, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Carlos J Rodriguez
- Department of Internal Medicine, Section of Cardiology, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Teresa E Seeman
- Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA.
| | - Cecilia Castro-Diehl
- Departments of Medicine and Epidemiology, Columbia University College of Physicians and Surgeons and Mailman School of Public Health, 630 West 168th Street PH9 105, New York, NY 10032, USA.
| | - Sherita Hill Golden
- Departments of Medicine and Epidemiology, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Division of Endocrinology, Diabetes,and Metabolism, 1830 E. Monument Street, Suite 333, Baltimore, MD 21287, USA.
| | - Ana V Diez Roux
- Dornsife School of Public Health, Drexel University, 3215 Market St., Philadelphia, PA 19104, USA.
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Novak NL, Geronimus AT, Martinez-Cardoso AM. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol 2017; 46:839-849. [PMID: 28115577 PMCID: PMC5837605 DOI: 10.1093/ije/dyw346] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 12/30/2022] Open
Abstract
Background Growing evidence indicates that immigration policy and enforcement adversely affect the well-being of Latino immigrants, but fewer studies examine 'spillover effects' on USA-born Latinos. Immigration enforcement is often diffuse, covert and difficult to measure. By contrast, the federal immigration raid in Postville, Iowa, in 2008 was, at the time, the largest single-site federal immigration raid in US history. Methods We employed a quasi-experimental design, examining ethnicity-specific patterns in birth outcomes before and after the Postville raid. We analysed Iowa birth-certificate data to compare risk of term and preterm low birthweight (LBW), by ethnicity and nativity, in the 37 weeks following the raid to the same 37-week period the previous year ( n = 52 344). We model risk of adverse birth outcomes using modified Poisson regression and model distribution of birthweight using quantile regression. Results Infants born to Latina mothers had a 24% greater risk of LBW after the raid when compared with the same period 1 year earlier [risk ratio (95% confidence interval) = 1.24 (0.98, 1.57)]. No such change was observed among infants born to non-Latina White mothers. Increased risk of LBW was observed for USA-born and immigrant Latina mothers. The association between raid timing and LBW was stronger among term than preterm births. Changes in birthweight after the raid primarily reflected decreased birthweight below the 5th percentile of the distribution, not a shift in mean birthweight. Conclusions Our findings highlight the implications of racialized stressors not only for the health of Latino immigrants, but also for USA-born co-ethnics.
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Affiliation(s)
- Nicole L Novak
- Department of Epidemiology, University of Michigan School of Public Health,
Ann Arbor, MI, USA
| | - Arline T Geronimus
- Department of Health Behavior and Health Education, University of Michigan
School of Public Health, Ann Arbor, MI, USA
- Population Studies Center, Institute for Social Research, University of
Michigan, Ann Arbor, MI, USA
| | - Aresha M Martinez-Cardoso
- Department of Health Behavior and Health Education, University of Michigan
School of Public Health, Ann Arbor, MI, USA
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Iacovino JM, James SA. Retaining Students of Color in Higher Education: Expanding Our Focus to Psychosocial Adjustment and Mental Health. ACTA ACUST UNITED AC 2016. [DOI: 10.1108/s1479-364420160000019004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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