Perceived racism and vascular reactivity in black college women: moderating effects of seeking social support

Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer

PURPOSE

Adjuvant endocrine therapy (AET) increases sexual health challenges for women with early-stage breast cancer. Black women are more likely than women of other racial/ethnic groups to report adverse symptoms and least likely to initiate and maintain AET. Little is known about how sexual health challenges influence patient-clinician communication and treatment adherence. This study explores facilitators of and barriers to patient-clinician communication about sexual health and how those factors might affect AET adherence among Black women with early-stage breast cancer.

METHODS

We conducted 32 semi-structured, in-depth interviews among Black women with early-stage breast cancer in the U.S. Mid-South region. Participants completed an online questionnaire prior to interviews. Data were analyzed using thematic analysis.

RESULTS

Participants' median age was 59 (range 40-78 years, SD = 9.0). Adverse sexual symptoms hindered participants' AET adherence. Facilitators of patient-clinician communication about sexual health included female clinicians and peer support. Barriers included perceptions of male oncologists' disinterest in Black women's sexual health, perceptions of male oncologists' biased beliefs about sexual activity among older Black women, cultural norms of sexual silence among Southern Black women, and medical mistrust.

CONCLUSIONS

Adverse sexual symptoms and poor patient-clinician communication about sexual health contribute to lower AET adherence among Black women with early-stage breast cancer. New interventions using peer support models and female clinicians trained to discuss sexual health could ameliorate communication barriers and improve treatment adherence.

IMPLICATIONS FOR CANCER SURVIVORS

Black women with early-stage breast cancer in the U.S. Mid-South may require additional resources to address sociocultural and psychosocial implications of cancer survivorship to enable candid discussions with oncologists.

Minority stressors and suicidal ideation in sexual and gender minority youth assigned female at birth: Prospective associations and racial differences

INTRODUCTION

Suicidal ideation (SI) disproportionately affects sexual and gender minority (SGM) versus cisgender/heterosexual youth, likely due to the minority stressors (MS) they face. Research has shown cross-sectional associations between SGM MS and suicidality; however, few studies have used longitudinal data or examined racial differences in the effects of MS on SI. The current study tested whether MS prospectively predict next-year SI and whether race moderates these prospective associations.

METHOD

Three hundred and sixty-nine Black, Latinx, and White SGM youth completed baseline measures of MS, SI, and demographics, and SI 6 and 12 months later.

RESULTS

Internalized stigma, microaggressions, and low support from family and from significant others demonstrated associations with next-year SI. When controlling for baseline SI, however, only low significant other support predicted next-year SI. Moderation analyses indicated that internalized stigma predicted SI for White, but not Black or Latinx, individuals and that lower friend support was associated with SI for Latinx, but not White or Black, individuals.

CONCLUSIONS

Though minority stressors appear to raise risk for SI among SGM, effects may differ by race. Internalized stigma may be particularly influential for SI among White SGM whereas lack of support from friends may be most influential for SI among Latinx SGM youth.

Discrimination, Racial Identity, and Hypertension Among Black Americans Across Young, Middle, and Older Adulthood

OBJECTIVES

Substantial evidence documents the protective role of racial identity-or the meaning and significance that individuals attribute to race-among Black Americans, yet the impact of racial identity on physical health outcomes beyond young adulthood is unclear. To clarify the extent to which racial identity remains influential for physical health across the life course, this study investigated (a) the direct associations between discrimination, racial identity, and hypertension, (b) whether racial identity buffered the negative effects of discrimination, and (c) the extent to which these patterns varied among young (21-35), middle-aged (36-49), and older (>50) Black adults.

METHODS

Data from the Nashville Stress and Health Study (N = 627) were used to examine two identity dimensions: "racial centrality" (i.e., importance of Black identity to one's sense of self) and "closeness to other Black people" (COBP). Modified Poisson models estimated relationships between racial identity, discrimination, and hypertension. Interactions determined whether racial identity moderated the discrimination-hypertension association within and across age groups.

RESULTS

High centrality and moderate COBP were directly linked to elevated hypertension odds among young adults, but lower odds among older adults; racial identity was not directly associated with hypertension among middle-aged adults. Results also indicated that racial identity conditioned the discrimination-hypertension relationship in distinct ways across age groups.

DISCUSSION

Findings underscore the significance of racial identity as sources of both psychosocial vulnerability and resilience for minority aging. Clinicians and public health professionals should consider racial identity beyond young adulthood to promote healthy aging via hypertension management among Black Americans.

Gendered racism and subjective cognitive complaints among older black women: The role of depression and coping

Objective: Psychosocial stress is a risk factor for cognitive impairment and a potential pathway through which disparities in cognitive functioning emerge and disproportionately disadvantage older Black adults. Gendered racism is a psychosocial stressor that has negative implications for Black women's mental and physical health. This study tested the association between lifetime experiences of gendered racism and subjective cognitive complaints, taking into account the extent to which depressive symptoms and coping styles may explain this association. Method: Data from 75 older Black women (M_age = 62.43, SD = 6.23 years) were collected using an online survey assessing lifetime experiences of gendered racism, depressive symptoms, coping styles (i.e. spirituality, social support, problem-oriented/engagement, and disengagement), and subjective cognitive complaints (i.e. memory, attention, executive functioning, language, and overall cognition). The association between gendered racism and subjective cognitive complaints was examined with simple linear regression. Two mediation models examined depressive symptoms and coping styles as independent mediators of this association. Results: More gendered racism across the lifetime was associated with more subjective cognitive complaints separately through depressive symptoms and disengagement coping, but no other coping styles. Conclusion: Gendered racism is linked to increased subjective cognitive complaints via depressive symptoms and disengagement coping. The study highlights the importance of taking into account lived experiences (gendered racism) that are inextricably linked to social positioning (race and gender) within neuropsychology. Results evidence the negative impact of psychosocial stress, specifically gendered racism, on older Black women's subjective cognitive functioning, and illuminate avenues for clinical intervention and social justice advocacy.

The Weight of Racial Discrimination: Examining the Association Between Racial Discrimination and Change in Adiposity Among Emerging Adult Women Enrolled in a Behavioral Weight Loss Program

BACKGROUND

Non-Hispanic Black (NHB) emerging adult (EA) women are at disproportionate risk for obesity but experience limited benefit from behavioral weight loss (BWL) programs. Race-related stress could play a role; the goal of this study was to examine the association between racial discrimination (RD) and early (3 months) changes in adiposity, and to explore potential protective factors, among EA in an adapted BWL program.

METHODS

This is an ancillary study of non-Hispanic White (NHW) and NHB EA women enrolled in an adapted BWL trial (N = 49; 55.1% NHB; Age 21.2 (2.1); BMI = 33.0 + 4.3 kg/m²). At baseline, group- and personal-level RD (RD-group and RD-personal), racial identity (NHB women only), vigilant coping, and social support were assessed via validated questionnaires. Weight and waist circumference were measured objectively at 0 and 3 months.

RESULTS

NHW women manifested greater reductions in waist circumference relative to NHB women (p = .004). RD-personal did not predict change in waist circumference at 3 months (p = .402); however, the association between RD-group and change in waist circumference was statistically significant (p = .015), such that reporting greater group-level discrimination predicted a smaller decrease in waist circumference; the model explained 22% of the variance. Social support and vigilant coping were not statistically significant in the model. Among NHB women only, higher racial identity-centrality predicted greater reduction in waist circumference (p = .019).

CONCLUSION

Findings suggest racial discrimination could contribute to greater cardiometabolic risk during this developmental period. Future research should examine how experiences of racial discrimination unfold in the daily lives of NHB women to inform mechanistic interventions to enhance health and well-being.

TRIAL REGISTRATION

NCT02736981. Low Intensity Weight Loss for Young Adults.

Preliminary evidence for a race-based stress reduction intervention for Black women at risk for cardiovascular disease

OBJECTIVE

Despite evidence that chronic stress, racism, and discrimination impact the well-being and the risk for cardiovascular disease (CVD) in Black women, there are few evidence-based interventions that improve well-being and reduce the risk for CVD in women of minority groups. The purpose of this pilot study was to evaluate the psychobehavioral and anti-inflammatory benefit of a race-based stress reduction program "Resilience, Stress, and Ethnicity (RiSE) for Black women at risk for CVD.

METHODS

Black women were recruited from the Chicagoland community and randomized to either the 8-week RiSE intervention (n = 40) or control group (n = 34). Participants were assessed for coping strategies, psychological distress, and blood levels of TNF-alpha and high sensitivity C-reactive protein (hsCRP) at baseline and at 4 and 8 weeks after baseline.

RESULTS

Participation in RiSE was associated with a more rapid decline in the use of avoidance coping (b = -0.3585, SE = 0.1705, p < .01). Reductions over time in TNF-alpha (b = -0.0163, SE = .0087, p = .08) and hsCRP (b= -0.4064, SE = 0.2270, p = .08) approached statistical significance.

CONCLUSIONS

Findings provide preliminary evidence in Black women at risk for CVD that RiSE contributes to decreases in avoidance coping. Although preliminary, these results suggest RiSE to be an effective intervention to promote improved coping associated with racism and discrimination in minorities.

Perceived racism, affectivity, and C-reactive protein in healthy African Americans: Do religiosity and racial identity provide complementary protection?

Perceived racism contributes to cardiovascular disease (CVD) disparities among African Americans. Psychosocial factors that protect against the effects of perceived racism therefore may be reflected by indicators of CVD risk, including C-reactive protein (CRP). The current cross-sectional study examined whether CRP is linked to religiosity and racial identity-two culturally-enshrined individual differences that can protect against the harmful effects of racism. Healthy African Americans completed self-report measures of everyday racism, religious intensity (a measure of the importance of religion/spirituality), and racial centrality (a measure of racial identity strength). We measured positive and negative affectivity as outcomes (N = 534), and we collected a dried bloodspot measure of CRP (N = 118). Religious intensity and racial centrality were independently associated with greater positive affectivity, and interactively associated with negative affectivity and CRP-when perceived racism was high, strongly identified African Americans had significantly higher CRP, but lower negative affectivity, when they were also low in religious intensity. Results highlight that religiosity and racial identity may interactively protect against the effects of racism and may play a role in CVD disparities.

Racial exclusion causes acute cortisol release among emerging-adult African Americans: The role of reduced perceived control

Racial discrimination contributes to stress-related health disparities among African Americans, but less is known about the acute effects of racial exclusion on the hypo-pituitary-adrenocortical response and psychological mediators. Participants were 276 Black/African American emerging-adults (54% female; M _age = 21.74, SD = 2.21) who were randomly assigned to be excluded or included by White peers via the game Cyberball. Racial exclusion (vs. inclusion) predicted: greater negative affect (F(1, 276) = 104.885, p < .0001), lower perceived control (F(1, 276) = 205.523, p < .0001), and greater cortisol release (F(1, 274) = 4.575, p = .033). Racial exclusion's impact on cortisol release was mediated by lower perceived control (95% CI: .027, .112), but not negative affect (-.041, .013). These findings suggest that racial exclusion contributes to acute cortisol release, and that reduced perceived control is a consequence of racial discrimination that has important implications for the health of those who experience discrimination.

What Mediates the Relationship Between Ethnic Discrimination and Stress? Coping Strategies and Perceived Social Support of Russian Immigrants in Germany

OBJECTIVE

Experiences of ethnic discrimination may constitute major stressors for ethnic minority groups. This study examined the associations between different forms of ethnic discrimination and levels of perceived stress in Russian immigrants living in Germany, taking into account potential moderating (in-group identification) and mediating (coping and social support) factors.

METHODS

Russian immigrants (N = 308) were assessed using online questionnaires (e.g., perceived stress scale, behaviors from intergroup affect and stereotype treatment scale, and brief COPE). Three forms of ethnic discrimination were examined: active harm (e.g., open aggression), passive harm (e.g., paternalistic behavior), and everyday discrimination (e.g., receiving poor service). Moderation by in-group identification and mediation via coping and social support were tested.

RESULTS

Passive harm was more prevalent than everyday discrimination and active harm. Passive harm and everyday discrimination were associated with higher perceived stress (rs = .22 and .18, ps <.01), and in-group identification did not moderate these associations (ps >.27). The coping strategy self-blame mediated the association between active harm and stress. Substance use and self-blame mediated the association between passive harm and stress, whereas venting, behavioral disengagement, denial, self-blame, and social support mediated the association between everyday discrimination and stress. A direct effect remained for passive harm and everyday discrimination.

CONCLUSION

The present study revealed that Russian immigrants encounter different forms of ethnic discrimination, and that this is associated with higher levels of stress. This association was partly explained by coping and social support, illustrating possibilities for interventions aimed at improving the use of adaptive coping strategies and promoting social support-seeking for Russian immigrants.

Effects of Social Support on the Stress-Health Relationship: Gender Comparison among Military Personnel

The purpose of this study was to investigate how the role of workplace social support and gender affect the relationship between work stress and the physical and mental health of military personnel in Taiwan. The analysis results reveal that military personnel expressed significantly high perceptions of work-related stress. Social support from supervisors and colleagues is a crucial factor in buffering the effect of work-related stress on perceived health, and increasing the physical and mental health among military personnel. This study shows that male personnel who perceived higher stress and gained more social support from supervisors and colleagues than female personnel were less likely to have physical and mental issues than female personnel. Managerial implications and suggestions could serve as references in managing work-related stress, enhancing social support occurring in the military workplace, and reducing job dissatisfaction, which in turn improves the health and well-being of military personnel in Taiwan.

High-Effort Coping and Cardiovascular Disease among Women: A Systematic Review of the John Henryism Hypothesis

African-American women living in the United States experience higher cardiovascular disease risk (CVD) mortality compared to White women. Unique mechanisms, including prolonged high-effort coping in the face of discriminatory stressors might contribute to these racial disparities. The John Henryism hypothesis is a conceptual framework used to explain poor health outcomes observed among individuals with low resources who repeatedly utilize active coping to overcome barriers. The aims of our study were to summarize the literature related to John Henryism and CVD-related factors with a particular focus on women and to identify gaps for areas of future inquiry. We searched MEDLINE, EMBASE, Scopus, and CINAHL to identify literature that used the John Henryism Active Coping scale. Reviewers independently reviewed eligible full-text study articles and conducted data extraction. We qualitatively summarized the literature related to John Henryism and cardiovascular disease (CVD)-related health behaviors (e.g., smoking or physical activity) and risk factors (e.g., hypertension) with a focus on study populations inclusive of women. Our review included 21 studies that used the John Henryism Active Coping scale, of which 10 explicitly reported on the interaction between John Henryism and socioeconomic status (SES) and CVD-related factors. With respect to the original hypothesis, three studies reported results in line with the hypothesis, four were null, and three reported findings in opposition to the hypothesis. The remaining studies included in the review examined the main effects of John Henryism, with similarly mixed results. The literature related to the interaction between John Henryism and SES on CVD-related factors among women is mixed. Additional studies of John Henryism that incorporate biological measures, varied indicators of resources, and larger study populations may illuminate the relationship between coping and deleterious health outcomes among women.

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

There are distinct racial disparities in cardiovascular disease (CVD) risk, with Black individuals at much greater risk than White individuals. Although many factors contribute to these disparities, recent attention has focused on the role of discrimination as a stress-related factor that contributes to racial disparities in CVD. As such, it is important to understand the mechanisms by which discrimination might affect CVD. Recent studies have examined these mechanisms by focusing on neurobiological mediators of CVD risk. Given this increase in studies, a systematic review of perceived discrimination and neurobiological mediators of CVD risk is warranted. Our review uses a multisystem approach to review studies on the relationship between perceived discrimination and (1) cardiovascular responses to stress, (2) hypothalamic-pituitary-adrenocortical axis function, and (3) the immune system, as well as (4) the brain systems thought to regulate these parameters of peripheral physiology. In addition to summarizing existing evidence, our review integrates these findings into a conceptual model describing multidirectional pathways linking perceived discrimination with a CVD risk.

A Preliminary Study of the Relationship between Perceived Racism and Cardiovascular Reactivity and Recovery in Native Hawaiians

Native Hawaiians, compared to other ethnic groups in Hawai‘i, have significantly higher mortality rates and die at a younger average age from cardiovascular disease (CVD). This may be partially explained by elevated cardiovascular responses to racial stressors. Our study examined the degree to which blood pressure (BP) and heart rate (HR) reactivity and recovery, and ratings of subjective distress to racial stressors, differ as a function of Native Hawaiian college students’ levels of perceived racism. This study had three phases. Phase 1 involved the development of a blatant and subtle racial stressor. Phase 2 involved assigning 132 students into high- or low-perceived racism groups based on scores on two perceived interpersonal racism measures. Phase 3 involved a psychophysiology laboratory experiment conducted with 35 of the 132 students. BP, HR, and subjective distress were measured during exposure to the blatant and subtle racial stressors. Systolic blood pressure (SBP) recovery following exposure to both stressors was significant for both groups. Although not significant, three trends were observed among the high-perceived racism group, which included: (1) greater reactivity to exposure to the subtle stressor than to the blatant stressor, (2) incomplete HR recovery following exposure to both stressors, and (3) incomplete SBP and diastolic blood pressure recovery following exposure to the subtle stressor. Participants also reported significantly greater subjective distress following exposure to the blatant than to the subtle stressor. Specific interventions, such as increased self-awareness of physiological responses to racial stressors, targeted at at-risk individuals are necessary to reduce a person’s risk for CVD.

Associations Between Discrimination and Cardiovascular Health Among Asian Indians in the United States

Asian Indians (AI) have a high risk of atherosclerotic cardiovascular disease. The study investigated associations between discrimination and (1) cardiovascular risk and (2) self-rated health among AI. Higher discrimination scores were hypothesized to relate to a higher cardiovascular risk score (CRS) and poorer self-rated health. Asian Indians (n = 757) recruited between 2010 and 2013 answered discrimination and self-reported health questions. The CRS (0-8 points) included body-mass index, systolic blood pressure, total cholesterol, and fasting blood glucose levels of AI. Multiple linear regression analyses were conducted to evaluate relationships between discrimination and the CRS and discrimination and self-rated health, adjusting for psychosocial and clinical factors. There were no significant relationships between discrimination and the CRS (p ≥ .05). Discrimination was related to poorer self-reported health, B = -.41 (SE = .17), p = .02. Findings suggest perhaps there are important levels at which discrimination may harm health.

Perceived Racial Discrimination, Social Support, and Psychological Adjustment Among African American College Students

The purpose of this study was to examine three competing models of the relations among perceived discrimination, social support, and indicators of psychological adjustment in a sample of 135 African American college students. The three competing models, social support buffering, social support mobilization, and social support deterioration, were tested within a regression framework. The buffering model, which predicted that social support would interact with perceived discrimination such that individuals with high levels of social support would be protected from the harmful effects of discrimination, was not supported. The social support mobilization model, which predicted that support networks would mobilize to support individuals exposed to discrimination, was also not supported. Support was only obtained for the social support deterioration model, which predicted that social support would decrease for those exposed to discrimination. Perceived racial discrimination was associated with lower perceptions of social support, greater symptoms of depression, and lower levels of life satisfaction.

The relationship between cumulative unfair treatment and intima media thickness and adventitial diameter: The moderating role of race in the study of women's health across the nation

OBJECTIVE

Unfair treatment may have a detrimental effect on cardiovascular health. However, little research on chronic health outcomes uses cumulative measures of unfair treatment. We tested whether cumulative unfair treatment was associated with greater subclinical cardiovascular disease in a diverse sample of African-American, Caucasian, Chinese, and Hispanic women. We also examined whether this relationship varied by race.

METHOD

The Study of Women's Health Across the Nation is a longitudinal study of midlife women. Cumulative unfair treatment was calculated as the average of unfair treatment assessed over 10 years at 6 time points. Subclinical cardiovascular disease, specifically carotid intima media thickness and adventitial diameter, was assessed via carotid ultrasound conducted at study year 12 in 1,056 women. We tested whether cumulative unfair treatment was related to subclinical cardiovascular disease via linear regression, controlling for demographic factors including socioeconomic status and cardiovascular risk factors.

RESULTS

The relation between unfair treatment and subclinical cardiovascular disease significantly varied by race (ps < .05), with unfair treatment related to higher intima media thickness (B = .03, SE = .01, p = .009) and adventitial diameter (B = .02, SE = .009, p = .013) only among Caucasian women. No significant relations between unfair treatment and subclinical cardiovascular disease outcomes were observed for African-American, Hispanic, and Chinese women.

CONCLUSIONS

Our findings indicate that cumulative unfair treatment is related to worse subclinical cardiovascular disease among Caucasian women. These findings add to the growing literature showing that Caucasian women's experience of unfair treatment may have detrimental health implications. (PsycINFO Database Record

Coalitional affiliation as a missing link between ethnic polarization and well-being: An empirical test from the European Social Survey

Many studies converge in suggesting (a) that ethnic and racial minorities fare worse than host populations in reported well-being and objective measures of health and (b) that ethnic/racial diversity has a negative impact on various measures of social trust and well-being, including in the host or majority population. However, there is much uncertainty about the processes that connect diversity variables with personal outcomes. In this paper, we are particularly interested in different levels of coalitional affiliation, which refers to people's social allegiances that guide their expectations of social support, in-group strength and cohesion. We operationalize coalitional affiliation as the extent to which people rely on a homogeneous social network, and we measure it with indicators of friendships across ethnic boundaries and frequency of contact with friends. Using multi-level models and data from the European Social Survey (Round 1, 2002-2003) for 19 countries, we demonstrate that coalitional affiliation provides an empirically reliable, as well as theoretically coherent, explanation for various effects of ethnic/racial diversity.

Cannabis use frequency and use-related impairment among African-American and White users: the impact of cannabis use motives

OBJECTIVES

Cannabis use motives are differentially related to cannabis-related impairment and coping motives appear to have the strongest relation to use-related impairment. However, it is currently unknown whether African-American individuals differ from White persons in reasons for using cannabis. It is also unknown whether motives' relations to cannabis use and related impairment vary as a function of race. The present study examined the role of race on cannabis use motives and tested whether motives' relations with cannabis use and related impairment differed by race.

DESIGN

The sample consisted of 111 (67.6% non-Hispanic White, 32.4% African-American) current cannabis-using adults.

RESULTS

African-American participants did not significantly differ from White participants on cannabis use frequency or use-related impairment. African-American participants endorsed more social motives than White participants. Race interacted with social, coping, and conformity motives to predict cannabis-related impairment such that these motives were positively related to cannabis impairment among African-American, but not White, participants.

CONCLUSION

Although African-American and White participants do not differ in their cannabis use frequency or cannabis-related impairment, they appear to use cannabis for different reasons. Further, conformity, coping, and social motives were differentially associated with cannabis-related impairment as a function of race. Findings suggest motives for cannabis use should be contexualised in the context of race.

The association between discrimination and depressive symptoms among older African Americans: the role of psychological and social factors

BACKGROUND/STUDY CONTEXT: Several studies have demonstrated a link between perceived discrimination and depression in ethnic minority groups, yet most have focused on younger or middle-aged African Americans and little is known about factors that may moderate the relationship.

METHODS

Participants were 487 older African Americans (60-98 years old) enrolled in the Minority Aging Research Study. Discrimination, depressive symptoms, and psychological and social resources were assessed via interview using validated measures. Ordinal logistic regression models were used to assess (1) the main relationship between discrimination and depression and (2) resilience, purpose in life, social isolation, and social networks as potential moderators of this relationship.

RESULTS

In models adjusted for age, sex, education, and income, perceived discrimination was positively associated with depressive symptoms (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.10-1.31; p < .001). However, there was no evidence of effect modification by resilience, purpose in life, social isolation, or social networks (all ps ≤ .05).

CONCLUSION

Findings provide support for accumulating evidence on the adverse mental health effects of discrimination among older African Americans. Because the association was not modified by psychological or social factors, these findings do not support a role for a buffering effect of resources on discrimination and depressive symptoms. Further studies are needed to examine a wider range of coping resources among older adults.

Exposure to Discrimination and Heart Rate Variability Reactivity to Acute Stress among Women with Diabetes

Exposure to racial discrimination has been linked to physiological reactivity. This study investigated self-reported exposure to racial discrimination and parasympathetic [high-frequency heart rate variability (HF-HRV)] and sympathetic (norepinephrine and cortisol) activity at baseline and then again after acute laboratory stress. Lifetime exposure to racial discrimination was measured with the Schedule of Racist Events scale. Thirty-two women (16 Black and 16 White) with type 2 diabetes performed a public speaking stressor. Beat-to-beat intervals were recorded on electrocardiograph recorders, and HF-HRV was calculated using spectral analysis and natural log transformed. Norepinephrine and cortisol were measured in blood. Higher discrimination predicted lower stressor HF-HRV, even after controlling for baseline HF-HRV. When race, age, A1c and baseline systolic blood pressure were also controlled, racial discrimination remained a significant independent predictor of stressor HF-HRV. There was no association between lifetime discrimination and sympathetic markers. In conclusion, preliminary data suggest that among women with type 2 diabetes mellitus (T2DM), exposure to racial discrimination is adversely associated with parasympathetic, but not sympathetic, reactivity.

A multi-method exploratory study of stress, coping, and substance use among high school youth in private schools

There is growing awareness that students' experiences of stress may impede academic success, compromise mental health, and promote substance use. We examined these factors in an under-studied population, private/independent high school students, using a multi-method (qualitative and quantitative), iterative data collection and analytic process. We first conducted qualitative interviews with faculty and staff at a number of highly competitive private schools, followed by an anonymous quantitative survey with 128 11th grade students from two of these settings. We then conducted a qualitative exploration of the quantitative results with a subset of students. Next, a set of Expert Panel members participated in qualitative interviews to reflect on and interpret study findings. Overall, we found students experienced high levels of chronic stress, particularly in relation to academic performance and the college admissions process. While students described a range of effective, adaptive coping strategies, they also commonly internalized these serious pressures and turned to alcohol and drugs to cope with chronic stress, although not typically at problematic levels. We discuss study implications for both schools and families derived from the Expert Panel.

"It's Killing Us!" Narratives of Black Adults About Microaggression Experiences and Related Health Stress

Perceived racism contributes to persistent health stress leading to health disparities. African American/Black persons (BPs) believe subtle, rather than overt, interpersonal racism is increasing. Sue and colleagues describe interpersonal racism as racial microaggressions: "routine" marginalizing indignities by White persons (WPs) toward BPs that contribute to health stress. In this narrative, exploratory study, Black adults (n = 10) were asked about specific racial microaggressions; they all experienced multiple types. Categorical and narrative analysis captured interpretations, strategies, and health stress attributions. Six iconic narratives contextualized health stress responses. Diverse mental and physical symptoms were attributed to racial microaggressions. Few strategies in response had positive outcomes. Future research includes development of coping strategies for BPs in these interactions, exploration of WPs awareness of their behaviors, and preventing racial microaggressions in health encounters that exacerbate health disparities.

Self-reported racial discrimination and endothelial reactivity to acute stress in women

This study investigated the effect of self-reported racial discrimination on endothelial responses to acute laboratory mental stress among post-menopausal women. One-hundred thirteen women (n = 94 self-identified as White and n = 19 self-identified as racial/ethnic minority), 43% with type 2 diabetes, reported lifetime experiences of racial/ethnic discrimination. Repeated assessments of flow-mediated dilation were performed at baseline, immediately after 5 min of mental arithmetic and at 20-min recovery. Both White and racial/ethnic minority women reported lifetime discrimination, with rates significantly higher among minorities. Self-reported lifetime discrimination was associated with attenuated flow-mediated dilation at recovery. Confounding variables, including clinical characteristics, mood, personality traits, other life stressors and general distress, did not better account for the effect of racial discrimination. Neither race/ethnicity nor diabetes status moderated the effect. The perceived stressfulness of the mental arithmetic was not associated with the endothelial response. In conclusion, self-reported lifetime discrimination is associated with attenuated endothelial recovery from acute mental stress. Elucidating the effects of discrimination and the biological mechanisms through which it affects the vasculature may suggest interventions to improve health.

Perceived Discrimination, Coping Strategies, and Mexican Origin Adolescents' Internalizing and Externalizing Behaviors: Examining the Moderating Role of Gender and Cultural Orientation

The literature identifying effective coping strategies related to perceived discrimination has yielded mixed findings, suggesting that recommendations for effective coping may vary by individual and group differences. The current study examined the influence of perceived discrimination and coping strategies on Mexican origin adolescents' later internalizing symptoms and externalizing behaviors, and assessed the moderating roles of gender and cultural orientation. Participants included 189 adolescents (46% male, 54% female) interviewed at 7^th and 8^th grade. Results suggested that the associations between perceived discrimination and internalizing symptoms were buffered by distraction coping among youth that were low on Anglo orientation but not among youth high on Anglo orientation. In addition, the associations between perceived discrimination and externalizing behaviors were buffered by social support seeking, but only among youth that were low on Mexican orientation. Directions for future research and application of the current research are discussed.

The protective role of racial identity and Africentric worldview in the association between racial discrimination and blood pressure

OBJECTIVE

To examine the protective effects of racial identity and Africentric worldview on the association between racial discrimination and blood pressure (BP).

METHODS

Two hundred ten African American young adults completed questionnaires assessing demographic characteristics, prior racial discrimination experiences, racial identity, and Africentric worldview. Resting BP was assessed before and after completion of the study measures.

RESULTS

Racial discrimination was unrelated to BP in the overall sample (systolic BP, p = .444; diastolic BP [DBP], p = .915; mean arterial pressure, p = .774). However, racial identity and Africentric worldview moderated the association between racial discrimination and BP. Racial discrimination was negatively related to DBP for participants who felt that others viewed African Americans less favorably and who endorsed the uniqueness of the African American experience (B = -2.59, standard error [SE] = 1.29, p = .046). These individuals also had the lowest DBP at high levels of racial discrimination. Racial discrimination was positively associated with DBP for individuals with low levels of Africentric orientation (B = 1.43, SE = 0.72, p = .048) but was unrelated to DBP at moderate (B = 0.24, SE = 0.65, p = .718) and high (B = -0.96, SE = 1.01, p = .341) levels of Africentric worldview.

CONCLUSIONS

Racial and cultural personal characteristics such as racial identity and Africentric orientation may serve an important protective function for BP in African American young adults.

Perceived discrimination and diurnal cortisol: examining relations among Mexican American adolescents

Perceived discrimination remains a salient and significant environmental stressor for ethnic and racial minority youth. Although many studies have examined the impact of racial/ethnic discrimination on mental health symptomatology and physical health, little is known of the potential physiological processes underlying such experiences, especially during adolescence. In an attempt to understand how varying perceptions of discrimination relate to functioning of the hypothalamic-pituitary-adrenal axis (HPA axis), the current study examined the relation between Mexican American adolescents' (N = 100, M(age) = 15.3 years old) perceptions of discrimination and aspects of their diurnal cortisol profiles. Three salivary samples (wakeup, +30 waking, bedtime) were collected across 3 days (total of 9 samples). Utilizing multi-level modeling, results revealed that adolescents' perceived discrimination related to greater overall cortisol output (area under the curve; AUC) after controlling for other life stressors, depressive symptoms, family income, acculturation level, daily stress levels and daily behaviors. Findings also revealed that perceived discrimination was marginally related to a steeper cortisol awakening response (CAR). Together, these findings suggest that perceived discrimination is a salient and impactful stressor for Mexican American adolescents. Understanding the physiological correlates of discrimination can provide insight into larger health disparities among ethnic and racial minority individuals.

Racism and hypertension: a review of the empirical evidence and implications for clinical practice

BACKGROUND

Despite improved hypertension (HTN) awareness and treatment, racial disparities in HTN prevalence persist. An understanding of the biopsychosocial determinants of HTN is necessary to address racial disparities in the prevalence of HTN. This review examines the evidence directly and indirectly linking multiple levels of racism to HTN.

METHODS

Published empirical research in EBSCO databases investigating the relationships of three levels of racism (individual/interpersonal, internalized, and institutional racism) to HTN was reviewed.

RESULTS

Direct evidence linking individual/interpersonal racism to HTN diagnosis is weak. However, the relationship of individual/interpersonal racism to ambulatory blood pressure (ABP) is more consistent, with all published studies reporting a positive relationship of interpersonal racism to ABP. There is no direct evidence linking internalized racism to BP. Population-based studies provide some evidence linking institutional racism, in the forms of residential racial segregation (RRS) and incarceration, to HTN incidence. Racism shows associations to stress exposure and reactivity as well as associations to established HTN-related risk factors including obesity, low levels of physical activity and alcohol use. The effects vary by level of racism.

CONCLUSIONS

Overall the findings suggest that racism may increase risk for HTN; these effects emerge more clearly for institutional racism than for individual level racism. All levels of racism may influence the prevalence of HTN via stress exposure and reactivity and by fostering conditions that undermine health behaviors, raising the barriers to lifestyle change.

Obesity stigma: important considerations for public health

Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.

Perceived discrimination and health: a meta-analytic review

Perceived discrimination has been studied with regard to its impact on several types of health effects. This meta-analysis provides a comprehensive account of the relationships between multiple forms of perceived discrimination and both mental and physical health outcomes. In addition, this meta-analysis examines potential mechanisms by which perceiving discrimination may affect health, including through psychological and physiological stress responses and health behaviors. Analysis of 134 samples suggests that when weighting each study's contribution by sample size, perceived discrimination has a significant negative effect on both mental and physical health. Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors. These findings suggest potential pathways linking perceived discrimination to negative health outcomes.

Perceived discrimination and health: a meta-analytic review

Perceived discrimination has been studied with regard to its impact on several types of health effects. This meta-analysis provides a comprehensive account of the relationships between multiple forms of perceived discrimination and both mental and physical health outcomes. In addition, this meta-analysis examines potential mechanisms by which perceiving discrimination may affect health, including through psychological and physiological stress responses and health behaviors. Analysis of 134 samples suggests that when weighting each study's contribution by sample size, perceived discrimination has a significant negative effect on both mental and physical health. Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors. These findings suggest potential pathways linking perceived discrimination to negative health outcomes.

Reactions to discrimination, stigmatization, ostracism, and other forms of interpersonal rejection: a multimotive model

This article describes a new model that provides a framework for understanding people's reactions to threats to social acceptance and belonging as they occur in the context of diverse phenomena such as rejection, discrimination, ostracism, betrayal, and stigmatization. People's immediate reactions are quite similar across different forms of rejection in terms of negative affect and lowered self-esteem. However, following these immediate responses, people's reactions are influenced by construals of the rejection experience that predict 3 distinct motives for prosocial, antisocial, and socially avoidant behavioral responses. The authors describe the relational, contextual, and dispositional factors that affect which motives determine people's reactions to a rejection experience and the ways in which these 3 motives may work at cross-purposes. The multimotive model accounts for the myriad ways in which responses to rejection unfold over time and offers a basis for the next generation of research on interpersonal rejection.

Perceived discrimination and blood pressure in older African American and white adults

BACKGROUND

The current study was designed to examine the cross-sectional association between perceived discrimination and blood pressure (BP) in a sample of older African American and white adults. We hypothesized that perceived discrimination would be associated with higher levels of BP and that this association would be stronger for older African Americans compared with whites.

METHODS

Participants were 4,694 (60% African American, 60% women) community-dwelling older adults. Perceived discrimination and other relevant risk factors were assessed via interview, and BP was measured using standard sphygmomanometers. Multivariate linear regression models were conducted to test associations among race, perceived discrimination, and BP.

RESULTS

In models adjusted for age, sex, race, and education, perceived discrimination was not associated with higher levels of systolic blood pressure (p=.10) but was associated with higher levels of diastolic blood pressure (DBP) (p=.01). Further analyses revealed that the association between perceived discrimination and DBP was present in older African Americans (p=.0003) but not whites (p=.46). Results persisted after adjusting for relevant risk factors.

CONCLUSIONS

Findings suggest that discrimination may be a unique risk factor for elevated DBP in older African Americans. Because these findings are cross-sectional, additional research is needed to determine whether the observed associations persist over time.

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

Interpretations of ambiguous social situations and cardiovascular responses in adolescents

BACKGROUND

Previous research has documented effects of ambiguous outcome social situations on individual differences in cardiovascular reactivity in laboratory contexts.

PURPOSE

This study tested whether interpretations of ambiguous social situations are associated with daily life cardiovascular responses using ambulatory approaches.

METHODS

There were 206 high school adolescents assessed on interpretations of ambiguous social situations in the laboratory who then completed ambulatory monitoring of blood pressure (BP) and heart rate (HR) for 2 days.

RESULTS

Adolescents who perceived threat during ambiguous situations exhibited higher systolic BP when talking to others compared to occasions of not talking with anyone, whereas the opposite was true for those with low threat perception. For high-threat adolescents, higher systolic BP was found when interacting with friends, whereas for low threat adolescents, lower systolic BP was found when interacting with parents. Greater threat interpretations were also associated with elevated HR at night.

CONCLUSIONS

Understanding how adolescents perceive social interactions may help in gauging their daily cardiovascular responses.

Racism and ambulatory blood pressure in a community sample

OBJECTIVE

Racism has been identified as a psychosocial stressor that may contribute to disparities in the prevalence of cardiovascular disease. The goal of the present article was to investigate the relationship of perceived racism to ambulatory blood pressure (ABP) in a sample of American-born Blacks and Latinos.

METHODS

Participants included English-speaking Black or Latino(a) adults between the ages of 24 and 65. They completed daily mood diaries and measures of perceived racism, socioeconomic status, and hostility. Participants were outfitted with ABP monitors; 357 provided data on waking hours only, and 245 provided data on both waking and nocturnal ABP.

RESULTS

Perceived racism was positively associated with nocturnal ABP even when controlling for personality factors and socioeconomic status.

CONCLUSIONS

The results suggest that racism may influence cardiovascular disease risk through its effects on nocturnal BP recovery.

Interactive effects of perceived racism and coping responses predict a school-based assessment of blood pressure in black youth

BACKGROUND

Research indicates that perceived racism and coping responses are associated with basal blood pressure (BP) levels and BP reactivity in Black adults. No study could be found, however, that has explored the independent and interactive effects of perceived racism and coping responses in a cohort who probably has the greatest risk of developing primary hypertension--Black youth.

PURPOSE

This study examined the relationship of perceived racism and coping responses to a continuous measure of BP and to a categorical measure of BP status (normal vs. high-normal or high).

METHODS

The convenience sample consisted of 217 Black youth (M age = 11.4 years, SD = 1.3). Participants reported on perceived racism and coping responses (Accepting It, Self-Blame, Taking Action, and Talking to Someone). BP was assessed with an automated monitor in school.

RESULTS

Approximately 32% of the sample had average BP levels that were high-normal or high. Hierarchical linear and logistic regression analyses were used to assess the predictive utility of perceived racism and the four coping responses to the continuous and categorical BP assessments. Although perceived racism and the coping response variables did not emerge as significant independent predictors in the linear or logistic regression analyses, perceived racism interacted with Accepting It (p = .009) in the linear regression analysis predicting systolic BP. Follow-up linear regression analyses indicated that perceived racism was not significantly associated with systolic BP among participants low in Accepting It but was inversely related to systolic BP among participants high in Accepting It. Perceived racism also interacted with Accepting It (p = .016) and Talking to Someone (p = .0009) in the logistic regression analysis predicting BP status. Follow-up logistic regression analyses revealed that (a) perceived racism was not significantly associated with BP status among participants low in Accepting It but was inversely related to BP status among participants high in Accepting It, and (b) perceived racism was inversely associated with BP status among participants low in Talking to Someone but was not significantly related to BP status among participants high in Talking to Someone.

CONCLUSIONS

The contribution of environmental and psychosocial factors to hypertension risk should be considered when exploring correlates of continuous and categorical assessments of BP in Black youth.