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Yodlorchai R, Suttiwan P, Walch S, Ngamake S. Developing and Validating Thai Sexual Orientation Microaggression and Microaffirmation Scales. JOURNAL OF HOMOSEXUALITY 2024; 71:3023-3051. [PMID: 37921788 DOI: 10.1080/00918369.2023.2275301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Mental health disparities exist for sexual minority populations globally. Microaggressions and microaffirmations related to sexual orientation may negatively or positively impact well-being. Culturally validated tools are needed to assess these constructs among LGBQ+ (lesbian, gay, bisexual, queer/questioning) individuals in Thailand's high-context culture. This study aimed to develop and validate the Thai Sexual Orientation Microaggressions Scale (T-SOMG) and the Thai Sexual Orientation Microaffirmations Scale (T-SOMF) to quantify experiences among LGBQ+ Thais. A mixed-methods approach was utilized. Initial scale items were derived from a literature review, expert consultation, and interviews with LGBQ+ Thais. Exploratory factor analysis (n = 164) refined the item pools. Confirmatory factor analysis (n = 200) confirmed the factor structures. Reliability and validity were examined. The final 18-item T-SOMG contained two subscales-Interpersonal and Environmental Microaggressions. The 13-item T-SOMF contained Interpersonal and Environmental Microaffirmations subscales. All scales demonstrated good model fit, reliability, convergent validity, and discriminant validity. The T-SOMG and T-SOMF are culturally valid tools for assessing microaggressions and microaffirmations among LGBQ+ Thais. These localized scales can enable research on factors impacting LGBQ+ well-being. Further validation in diverse samples is warranted.
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Affiliation(s)
| | - Panrapee Suttiwan
- Psychology Center for Life-span Development and Intergeneration (LIFE Di), Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand
| | - Susan Walch
- Department of Psychology, University of West Florida, Pensacola, Florida, USA
| | - Sakkaphat Ngamake
- Psychology Center for Life-span Development and Intergeneration (LIFE Di), Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand
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Hernandez AE, Borowsky PA, Lubarsky M, Carroll C, Choi S, Kesmodel S, Antoni M, Goel N. Associations Between Perceived Discrimination, Screening Mammography, and Breast Cancer Stage at Diagnosis: A Prospective Cohort Analysis. Ann Surg Oncol 2024; 31:8012-8020. [PMID: 39060693 PMCID: PMC11467043 DOI: 10.1245/s10434-024-15757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Despite higher breast cancer screening rates, black women still are more likely to have late-stage disease diagnosed. This disparity is influenced in part by structural and interpersonal racism. This prospective study sought to determine how interpersonal factors, including perceived discrimination, influence screening and stage of disease at diagnosis. METHODS A prospective cohort study analyzed adult women with stages I to IV breast cancer from the Miami Breast Cancer Disparities Study. Perceived discrimination and mistrust of providers were assessed using previously validated questionnaires. Multivariable logistic regression was used to evaluate the odds of screening mammography utilization and late-stage breast cancer at diagnosis. RESULTS The study enrolled 342 patients (54.4 % Hispanic, 15.8 % white, and 17.3 % black). Multivariate regression, after control for both individual- and neighborhood-level factors, showed that a higher level of perceived discrimination was associated with greater odds of late-stage disease (adjusted odds ratio [aOR], 1.06; range, 1.01-1.12); p = 0.022) and lower odds of screening mammography (aOR, 0.96; range, 0.92-0.99; p = 0.046). A higher level of perceived discrimination also was negatively correlated with multiple measures of provider trust. DISCUSSION This study identified that high perceived level of discrimination is associated with decreased odds of ever having a screening mammogram and increased odds of late-stage disease. Efforts are needed to reach women who experience perceived discrimination and to improve the patient-provider trust relationship because these may be modifiable risk factors for barriers to screening and late-stage disease presentation, which ultimately have an impact on breast cancer survival.
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Affiliation(s)
- Alexandra E Hernandez
- Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Peter A Borowsky
- Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maya Lubarsky
- University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carin Carroll
- University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Seraphina Choi
- University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susan Kesmodel
- Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael Antoni
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neha Goel
- Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA.
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Olaniran MO, Kapti EG, Mathew MS, Schellinger JN, Allicock MA, Messiah SE, Almandoz JP. Sex differences in perceived discrimination among patients with obesity. Clin Obes 2024:e12711. [PMID: 39415683 DOI: 10.1111/cob.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 09/11/2024] [Accepted: 09/29/2024] [Indexed: 10/19/2024]
Abstract
The negative impacts of perceived discrimination on health have been documented, but how perceptions of discrimination vary by sex among people with obesity (PWO) is not well understood. This study assessed sex differences in perceived discrimination among PWO. This cross-sectional study analysed self-reported data from racially/ethnically diverse PWO attending an academic obesity program. The primary outcome was perceived discrimination, assessed by the Major Experiences of Discrimination (MED) and Everyday Discrimination Scale (EDS). Sex differences were evaluated by univariate and multivariable regression analysis adjusted for key descriptive variables. The final analytical sample included 60 PWO (62% female, 61% non-Hispanic white (NHW), 12% Hispanic, 39% non-Hispanic black (NHB), mean age 53 years, mean BMI 34 kg/m2). Women experienced everyday discrimination 59% less than men but this was not significant (OR 0.41; 95% CI 0.08-2.16; p = .29). Participant highest BMI was correlated with acute discrimination (total MED score) (r = 0.39; p = .0024) and chronic discrimination (total EDS score) (r = 0.28; p = .03). Most participants reported more chronic discrimination compared to acute discrimination (85% vs. 48%). Mean MED (β -0.18; 95% CI -0.93 to +0.56; p = .62) and EDS scores (β -0.25; 95% CI -3.37 to +2.87; p = .87) were not significantly different between women and men. Perceived discrimination was common and experienced equally between men and women with obesity. Incorporating discrimination experiences into obesity care models may be an important step to improving quality of care and outcomes.
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Affiliation(s)
- Marianne O Olaniran
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA
| | - Eda G Kapti
- Department of Epidemiology, University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA
| | - M Sunil Mathew
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marlyn A Allicock
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA
| | - Sarah E Messiah
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Mansuri S, Daniel MN, Halloway S, Abboud S, Schoeny ME, Buchholz SW. Correlates of Lifestyle Physical Activity Among Young Arab American Women. West J Nurs Res 2024:1939459241285696. [PMID: 39367712 DOI: 10.1177/01939459241285696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2024]
Abstract
BACKGROUND Young Arab American women are at risk for cardiovascular disease, but there is limited data on their physical activity (PA) engagement. OBJECTIVES The aim of this study was to examine the relationship between PA and its correlates in young Arab American women. The objectives of this study were to: (1) describe self-reported lifestyle PA behaviors of young Arab American women and (2) examine the relationship between their self-reported lifestyle PA, device-measured lifestyle PA (combined moderate/vigorous and steps), and potentially associated factors (demographics, physical measures, individual factors, and behavior cognition factors). METHODS This cross-sectional study was conducted with women 18 to 35 years of age and Arab American (n = 50) in the Midwest Region of the United States. Participants wore ActiGraph GT3X-BT monitors for 7 days; self-report measures included the International Physical Activity Questionnaire, demographics, acculturation, discrimination, religiosity, self-efficacy, and social support. RESULTS The mean age of participants was 25.5 years (SD: 5.5; range: 18-35). Per ActiGraph, the average daily steps were 5946 (SD: 2783); only 24% met the moderate-intensity PA guidelines. Self-efficacy was significantly associated with increased moderate-to-vigorous PA (B = 0.37; P = .012). CONCLUSION The average daily steps for the young Arab American women in this study were of low active classification. More than 75% of the women failed to meet the recommended weekly moderate/vigorous PA guidelines. Our study supports the importance of targeting and tailoring PA interventions on young Arab American women who have low self-efficacy for overcoming barriers to lifestyle PA.
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Affiliation(s)
| | | | | | - Sarah Abboud
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | | | - Susan W Buchholz
- College of Nursing, Michigan State University, East Lansing, MI, USA
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Gnall KE, Hooker JE, Doorley JD, Bakhshaie J, Vranceanu AM. Perceived discrimination and pain outcomes among black adults with chronic musculoskeletal pain: identifying modifiable psychosocial risk factors. J Behav Med 2024:10.1007/s10865-024-00522-1. [PMID: 39367237 DOI: 10.1007/s10865-024-00522-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 09/05/2024] [Indexed: 10/06/2024]
Abstract
Chronic musculoskeletal pain (CMP) is highly prevalent, frequently associated with negative health outcomes, and disproportionately impacts Black Americans. Perceived racial and ethnic discrimination has emerged as a factor that may influence the experience of chronic pain in this population. Identifying modifiable psychosocial factors that influence the link between perceived discrimination and pain and that can be directly targeted in treatment is vital to reducing the disproportionate burden of CMP among Black individuals. The present study examines the moderating role of five risk factors (i.e., pain avoidance, pain fusion, experiential avoidance, pain catastrophizing, and pain anxiety) on the relationship between perceived discrimination and pain outcomes (i.e., pain intensity and interference) in a sample of 401 Black adults with CMP. We recruited 401 Black individuals (Mage = 35.98, 51.9% female) with self-reported CMP and assessed their self-reported perceived discrimination, pain intensity, pain interference, and pain-related psychosocial risk factors. Results indicated that higher scores on each of the psychosocial risk factors (i.e., pain avoidance, pain fusion, experiential avoidance, pain catastrophizing, and pain anxiety) were significantly associated with greater pain intensity and pain interference (all ps < 0.01). Further, pain avoidance (B = 0.12, p = .006), pain fusion (B = 0.13, p = .002), and pain anxiety (B = 0.13, p = .002) each significantly moderated the relation between perceived discrimination and pain intensity. Greater perceived discrimination was associated with greater pain intensity at higher levels of avoidance and fusion, and was associated with less pain intensity at lower levels of avoidance and pain anxiety. In interaction models predicting pain interference, both pain fusion (B = 0.14, p = .001) and pain anxiety (B = 0.10, p = .01) significantly moderated the relation between perceived discrimination and pain interference. Perceived discrimination was associated with greater pain interference at higher levels of pain fusion and pain anxiety, and was not associated with pain interference at lower levels of pain fusion and pain anxiety. The present findings provide important insights into psychosocial risk factors that moderate the link between perceived discrimination and pain outcomes, providing important clinical implications for the treatment of Black adults with chronic musculoskeletal pain.
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Affiliation(s)
- Katherine E Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Julia E Hooker
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - James D Doorley
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Department of Sports Medicine, United States Olympic & Paralympic Committee Colorado Springs, CO, USA
| | - Jafar Bakhshaie
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
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Schnarrs PW, Dorri AA, Russell ST, Grigsby TJ, Charak R, Dawes H, Stone AL, Yockey RA, Rosenberger JG. Adverse Childhood Experiences, Perceived Discrimination, and Mental Health in Sexual and Gender Minoritized Adults: Comparing Stress Accumulation and Stress Sensitization Models. LGBT Health 2024. [PMID: 39361476 DOI: 10.1089/lgbt.2023.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024] Open
Abstract
Purpose: The purpose of this study was to assess the relationship between adverse childhood experiences (ACEs) exposure, perceived discrimination, and anxiety and depressive symptoms in sexual and gender minoritized (SGM) adults in the United States. Methods: Respondents (n = 4445) from a national Qualtrics research panel completed a web-based survey. Guided by the stress proliferation (mediation model) and stress sensitization (moderation model) models, we examined the relationships between ACEs and perceived discrimination and the severity of anxiety and depressive symptoms in adulthood. Results: Cumulative ACEs exposure was positively associated with everyday discrimination scale (EDS) scores. ACEs and EDS scores had a significant direct association with anxiety and depressive symptoms. We found support for EDS as a mediator for anxiety (β = 0.12, p < 0.001) and depressive symptoms (β = 0.14, p < 0.001) and for ACEs as a moderator of the relationship between EDS and anxiety (β = -0.04, p = 0.004) and depressive (β = -0.05, p = 0.001) symptoms. Conclusions: These findings suggest that both stress proliferation and stress sensitization likely contribute to disparities in anxiety and depressive symptoms in SGM adults. This finding supports the integration of social safety and minority stress perspectives regarding health disparities in SGM populations. Exposure to early life adversity likely alters neurodevelopment, which in turn increases awareness of the lack of social safety in adulthood, reduces capacity to cope with minority stress exposure, and ultimately contributes to increased anxiety and depressive symptoms. Prevention efforts should focus on building positive and compensatory childhood experiences.
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Affiliation(s)
- Phillip W Schnarrs
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
- Texas Institute for Sexual and Gender Minority Health Research, The University of Texas at Austin, Austin, Texas, USA
| | - Armin A Dorri
- Texas Institute for Sexual and Gender Minority Health Research, The University of Texas at Austin, Austin, Texas, USA
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - Stephen T Russell
- Texas Institute for Sexual and Gender Minority Health Research, The University of Texas at Austin, Austin, Texas, USA
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - Timothy J Grigsby
- Department of Social and Behavioral Health, The University of Nevada, Las Vegas, Nevada, USA
| | - Ruby Charak
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Hayden Dawes
- School of Social Work, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amy L Stone
- Department of Sociology and Anthropology, Trinity University, San Antonio, Texas, USA
| | - R Andrew Yockey
- Department of Population and Community Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
- Department of Internal Medicine and Geriatrics, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
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Doyle DM, Barreto M. Stigma salience increases loneliness among ethnic minorities. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2024; 63:1625-1639. [PMID: 38558020 DOI: 10.1111/bjso.12742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
Research shows that ethnic minorities are at increased risk of loneliness compared to the general population of the United Kingdom. We hypothesized that stigma salience increases loneliness among ethnic minorities, conducting two experimental studies with ethnic minorities (Study 1: N = 134, Study 2: N = 267) in which participants were randomly assigned to a stigma salience (recalling a personal experience of discrimination based on ethnicity) or control condition (recalling a past meal in Study 1 and the experience of reading a book in Study 2). Across these two studies, we demonstrated that stigma salience consistently increased self-reported loneliness relative to the control conditions. Study 1 additionally showed evidence for an indirect effect of stigma salience on loneliness through feelings of anxiety. Study 2 replicated the effect of self-relevant (but not non-self-relevant) stigma salience on loneliness and provided suggestive evidence for a more specific indirect effect through identity-related social anxiety.
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Chu W, Tam CC, Harrison S. Associations between perceived discrimination experiences, treatment adherence self-efficacy, and depressive symptoms among people living with HIV in the Southern United States. AIDS Care 2024; 36:1382-1391. [PMID: 38623601 DOI: 10.1080/09540121.2024.2341231] [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] [Received: 07/25/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024]
Abstract
This study examined associations between perceived discrimination, treatment adherence self-efficacy, and depressive symptoms among people living with HIV (PLHIV) in the Southern United States. Cross-sectional survey data were collected from 402 PLHIV who self-reported on interpersonal discrimination experiences based on HIV status, sexuality, gender, income, and living condition. Participants also reported on adherence self-efficacy and depressive symptoms. We employed K-means clustering to identify groups based on discrimination experiences, and logistic regressions to examine group differences on adherence self-efficacy and depressive symptoms. Results suggested three groups: a cluster with high perceived discrimination across all identities/conditions (n = 41; 11%; Cluster 1); a cluster with high perceived discrimination based on HIV status, income, and living condition (n = 49; 13%; Cluster 2); and a cluster with low perceived discrimination across all identities/conditions (n = 288; 76%; Cluster 3). Compared to Cluster 3, Cluster 1 and 2 had 2.22 times (p = .037) and 3.98 times (p<.001) greater odds of reporting depressive symptoms. Compared to Cluster 3, Cluster 2 had 3.40 times (p = .003) greater odds of reporting lower adherence self-efficacy. Findings demonstrate the need for individual-level support for PLHIV with discrimination histories, and broader efforts to end the stigma, discrimination, and marginalization of PLHIV based on HIV status and other characteristics.
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Affiliation(s)
- Wendy Chu
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
| | - Cheuk Chi Tam
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Sayward Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, USA
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Wang VHC, Cuevas AG, Osokpo OH, Chang JE, Zhang D, Hu A, Yun J, Lee A, Du S, Williams DR, Pagán JA. Discrimination in Medical Settings across Populations: Evidence From the All of Us Research Program. Am J Prev Med 2024; 67:568-580. [PMID: 38844146 DOI: 10.1016/j.amepre.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations. METHODS Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021-2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023-2024. RESULTS About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p<0.05. CONCLUSIONS The findings indicate a high prevalence of DMS, particularly among some population groups. Characterizing DMS may be a valuable tool for identifying populations at risk within the healthcare system and optimizing the overall patient care experience. Implementing relevant policies remains an essential strategy for mitigating the prevalence of DMS and reducing healthcare disparities.
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Affiliation(s)
- Vivian Hsing-Chun Wang
- Department of Foundations of Medicine, Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine, New York, New York
| | - Adolfo G Cuevas
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York; Center for Anti-Racism, Social Justice and Public Health, New York University School of Global Public Health, New York, New York
| | - Onome Henry Osokpo
- Department of Population Health Nursing Science, University of Illinois College of Nursing, Chicago, Illinois
| | - Ji Eun Chang
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, New York
| | - Donglan Zhang
- Department of Foundations of Medicine, Center for Population Health and Health Services Research, New York University Grossman Long Island School of Medicine, New York, New York; Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Anqing Hu
- Department of Civil and Engineering, Urban Systems Doctoral Program, New York University Tandon School of Engineering, Brooklyn, New York
| | - Jeongwook Yun
- Department of Biomedical Engineering, University of Texas at Austin Cockrell School of Engineering, Austin, Texas
| | - Adaora Lee
- Center for Anti-Racism, Social Justice and Public Health, New York University School of Global Public Health, New York, New York
| | - Shilei Du
- Department of Biostatistics, New York University School of Global Public Health, New York, New York
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of African and African American Studies, Harvard University, Cambridge, Massachusetts
| | - José A Pagán
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, New York.
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Rowlands CE, Folberg AM, Beickman ZK, Devor EJ, Leslie KK, Givens BE. Particles and Prejudice: Nanomedicine Approaches to Reducing Health Disparities in Endometrial Cancer. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2300096. [PMID: 37312613 PMCID: PMC10716380 DOI: 10.1002/smll.202300096] [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: 01/04/2023] [Revised: 05/25/2023] [Indexed: 06/15/2023]
Abstract
Endometrial cancer is the most common gynecological malignancy worldwide and unfortunately has a much higher mortality rate in Black women compared with White women. Many potential factors contribute to these mortality rates, including the underlying effects of systemic and interpersonal racism. Furthermore, other trends in medicine have potential links to these rates including participation in clinical trials, hormone therapy, and pre-existing health conditions. Addressing the high incidence and disparate mortality rates in endometrial cancer requires novel methods, such as nanoparticle-based therapeutics. These therapeutics have been growing in increasing prevalence in pre-clinical development and have far-reaching implications in cancer therapy. The rigor of pre-clinical studies is enhanced by the likeness of the model to the human body. In systems for 3D cell culture, for example, the extracellular matrix mimics the tumor more closely. The increasing emphasis on precision medicine can be applied to cancer using nanoparticle-based methods and applied to pre-clinical models by using patient-derived model data. This review highlights the intersections of nanomedicine, precision medicine, and racial disparities within endometrial cancer and provides insights into reducing health disparities using recent scientific advances on the nanoscale.
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Affiliation(s)
- Claire E Rowlands
- Department of Chemical and Materials Engineering, University of Kentucky, 512 Administration Drive, Lexington, KY, 40506, USA
| | - Abigail M Folberg
- Department of Psychology, University of Nebraska at Omaha, 6100 W. Dodge Road, ASH 347E, Omaha, NE, 68182, USA
| | - Zachary K Beickman
- Department of Chemical Engineering, Purdue University, 480 Stadium Mall Drive, West Lafayette, IN, 47907, USA
| | - Eric J Devor
- Department of Obstetrics and Gynecology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Kimberly K Leslie
- Division of Molecular Medicine, Department of Internal Medicine, Department of Obstetrics and Gynecology, The University of New Mexico Comprehensive Cancer Center | The University of New Mexico Health Sciences Center, 1021 Medical Arts Ave NE, Albuquerque, NM, 87131, USA
| | - Brittany E Givens
- Department of Chemical and Materials Engineering, University of Kentucky, 512 Administration Drive, Lexington, KY, 40506, USA
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Gonçalves G, Sousa C, Arasaratnam-Smith LA. The Effect of Multicultural Attitudes and Perceived Intergroup Threat on Attitudes Towards Immigrants in Portugal: A Polynomial Regression With Response Surface Analysis. Psychol Rep 2024; 127:2368-2392. [PMID: 36596269 PMCID: PMC11457440 DOI: 10.1177/00332941221149182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Supported by the Intergroup Threat Theory (ITT), this study analyzes the effect of multicultural ideology on attitudes towards immigrants mediated by realistic, symbolic, and zero-sum threats. With a sample of Portuguese participants (N = 404)), polynomial regression analysis with response surface methodology was used to test the effects of multicultural attitude (MA) and perceived intergroup threat (PIT) on attitudes towards immigrants (ATI). This study also tested a model in which positive MA leads to a lower PIT, and consequently to more favorable ATI. Four hypotheses were proposed; all of which were confirmed. The results further showed that the direction of discrepancy between MA and PIT can provide a more comprehensive understanding of the complex role of multicultural ideology in predicting ATI. Findings, limitations, and directions for future research are discussed.
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Affiliation(s)
| | - Cátia Sousa
- Centre for Research in Psychology (CIP/UAL) and University of Algarve, Faro, Portugal
| | - Lily A Arasaratnam-Smith
- Faculty of Business, Arts, Education and Social Sciences, Alphacrucis College, Sydney, Australia
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12
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Mutambudzi M, Boakye K, Green O, Heffernan K. Chronic Work Discrimination, Allostatic Load, and HbA1c in Older Workers. THE GERONTOLOGIST 2024; 64:gnae094. [PMID: 39086193 DOI: 10.1093/geront/gnae094] [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] [Received: 12/13/2023] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Work discrimination is an important public health problem with consequences for health. This study examined the effect of chronic work discrimination on 4-year changes in HbA1c, as a reflection of glucose control and type 2 diabetes risk in older workers and assessed whether allostatic load (AL) affected the strength of this association. RESEARCH DESIGN AND METHODS We used Health and Retirement Study data (2010-2016, n = 3,246). Conditional change multinomial logistic regression examined the association between chronic work discrimination, high AL (4 or more out of 8 high-risk biomarkers), and HbA1c, while accounting for relevant covariates. RESULTS Black participants had the highest rates of baseline (22.7%) and follow-up (28%) HbA1c levels, AL (38%), and chronic work discrimination (39%; p < .01). Severe chronic work discrimination was associated with elevated HbA1c (relative risk ratio [RRR] = 1.61, 95% confidence interval [CI] = 1.07, 2.43). AL was associated with elevated HbA1c (RRR = 1.49, 95% CI = 1.04, 2.14). Relative to White participants, Hispanic (RRR = 1.52, 95% CI = 1.07, 2.16, RRR = 1.81, 95% CI = 1.051, 3.12), and Black (RRR = 2.42, 95% CI = 1.82, 3.23; RRR = 3.00, 95% CI = 1.97, 4.56) participants had an increased risk of intermediate and elevated HbA1c, respectively. Among those with long job tenure (≥5 years), both moderate (RRR = 1.81, 95% CI = 1.11, 2.96) and severe (RRR = 1.90, 95% CI = 1.15, 3.12) chronic work discrimination was associated with elevated HbA1c. DISCUSSION AND IMPLICATIONS Chronic work discrimination was associated with HbA1c; however, no moderating effects of AL were observed. Findings underscore a need for organizational and public health measures to establish strong anti-discrimination laws in the workplace to improve the work environment of older workers and reduce diabetes risk.
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Affiliation(s)
- Miriam Mutambudzi
- Department of Public Health, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, New York, USA
| | - Kelvin Boakye
- Department of Public Health, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, New York, USA
| | - Olutoyin Green
- College of Arts & Sciences, Syracuse University, Syracuse, New York, USA
| | - Kevin Heffernan
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
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13
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Bigham Z, Boms O, Guardado R, Bunn DA, Glenn JE, Wurcel AG. Increased Mortality of Black Incarcerated and Hospitalized People: a Single State Cohort Analysis. J Racial Ethn Health Disparities 2024; 11:2973-2980. [PMID: 37672188 DOI: 10.1007/s40615-023-01755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE To quantify racial disparities in mortality and post-hospitalization outcomes among incarcerated individuals that were hospitalized during their incarceration period. METHODS We designed a retrospective cohort study using administrative and hospital data collected from a preferred healthcare referral center for all Massachusetts jails and prisons between January 2011 and December 2018 with linkage to Massachusetts Vital Records and Statistics. We identified 4260 incarcerated individuals with complete data on race/ethnicity that were hospitalized during the study period. The primary study indicators were age, race, ethnicity, length of hospital stay, Elixhauser comorbidity score, incarceration facility type, and number of hospital admissions. The primary outcome was time to death. RESULTS Of the incarcerated individuals that were hospitalized, 2606 identified as White, 1214 identified as Black, and 411 people who identified as some other race. The hazard of death significantly increased by 3% (OR: 1.03; 95% CI: 1.02-1.03) for each additional yearly increase in age. After adjusting for the interaction between race and age, Black race was significantly associated with 3.01 increased hazard (95% CI: 1.75-5.19) of death for individuals hospitalized while incarcerated compared to White individuals hospitalized while incarcerated. Hispanic ethnicity and being incarcerated in a prison facility was not associated with time to mortality, while increased mean Elixhauser score (HR: 1.07; 95% CI: 1.06-1.08) and ≥ 3 hospital admissions (HR: 2.47; 95% CI: 2.07-2.95) increased the hazard of death. CONCLUSIONS Our findings suggest disparities exist in the mortality outcomes among Black and White individuals who are hospitalized during incarceration, with an increased rate of death among Black individuals. Despite hypothesized equal access to healthcare within correctional facilities, our findings suggest that incarcerated and hospitalized Black individuals may experience worse disparities than their White counterparts, which has not been previously explored or reported in the literature. In addition to decarceration, advocacy, and political efforts, increased efforts to support research access to datasets of healthcare outcomes, including hospitalization and death, for incarcerated people should be encouraged. Further research is needed to identify and address the implicit and explicit sources of these racial health disparities across the spectrum of healthcare provision.
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Affiliation(s)
- Zahna Bigham
- Tufts University Graduate School of Biomedical Sciences, 35 Kneeland Street, 8Th Floor , Boston, MA, USA.
| | - Okechi Boms
- Harvard Medical School, Boston, MA, USA
- Department of Medicine and Department of Pediatrics, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rubeen Guardado
- Tufts University School of Medicine, Boston, MA, USA
- Williams Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - David A Bunn
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jason E Glenn
- Department of History and Philosophy of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Alysse G Wurcel
- Tufts University School of Medicine, Boston, MA, USA
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA, USA
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14
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Pinillos-Franco S, Cantarero-Prieto D, Lera J. Feeling discriminated means poor self-perceived health: a gender analysis using SHARE. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024:10.1007/s10754-024-09383-2. [PMID: 39325097 DOI: 10.1007/s10754-024-09383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 09/03/2024] [Indexed: 09/27/2024]
Abstract
Most part of the literature has highlighted the detrimental effects of discrimination on health. However, the influence of past and perceived discrimination on older workers' self-assessed health has been understudied. Firstly, we aim at studying whether reported discrimination is associated with self-assessed health among adults of working ages (50-65 years of age). Secondly, we analyze the existence of differences by gender. Data was retrieved from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to obtain the regular panel of questions, and the third and seventh waves of the SHARELIFE questionnaire, that includes information about discrimination (n = 30,019). We develop logistic regression models to determine the relationship of discrimination on male and female workers' self-assessed health separately. Our results show that 49.0% of our sample was composed of highly discriminated women, while the remaining percentage covered men and women (42.3% males and 8.7% females) that reported lower levels of discrimination. Our estimations reveal a significant association between discrimination and poor health status, especially in the case of men ranging from OR = 1.802 (95% CI 1.502-2.163) to OR = 1.565 (95% CI 1.282-1.910). In the case of women our results range from OR = 1.728 (95% CI 1.463-2.040) to OR = 1.196 (95% CI 0.992-1.442). These findings are essential to highlight the importance of tackling discrimination as a determinant of health that negatively affects both sexes, men and women.
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Affiliation(s)
- Sara Pinillos-Franco
- Dpto. Análisis Económico, Facultad de Ciencias Económicas y Empresariales, Universidad Autónoma de Madrid, Calle Francisco Tomás y Valiente 5, Madrid, 28049, Spain.
| | - David Cantarero-Prieto
- Department of Economics, Research Group of Health Economics and Health Services Management, University of Cantabria, IDIVAL, Cantabria, Spain
| | - Javier Lera
- Research Group of Health Economics and Health Services Management, IDIVAL, Cantabria, Spain
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15
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Lo Hog Tian JM, Watson JR, Cioppa L, Murphy M, Boni AR, Parsons JA, Maunder RG, Rourke SB. The Role of Dimensions of Social Support in the Relationship Between Stigma and Mental Health: A Moderation Analysis. AIDS Behav 2024:10.1007/s10461-024-04506-9. [PMID: 39325117 DOI: 10.1007/s10461-024-04506-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2024] [Indexed: 09/27/2024]
Abstract
HIV stigma remains a barrier to good health and understanding how social support may reduce the negative impact of stigma on health may help with designing stigma interventions. This study aims to understand how different types of social support may moderate or change the nature of the relationship between stigma and mental health. We recruited 327 participants to complete the People Living with HIV Stigma Index at baseline (t1) between August 2018 and September 2019 and at follow-up (t2) between February 2021 and October 2021. Separate moderation models were created with different types of social support (emotional/informational, tangible, affectionate, positive social interaction) as moderators, baseline stigma (internalized, enacted, anticipated) as the antecedent, and mental health (t2) as the outcome. Emotional/informational support was a significant moderator for the relationship between enacted (b = -2.12, 95% CI: -3.73, -0.51), internalized (b = -1.72, 95% CI: -3.24, -0.20), and anticipated (b = -2.59, 95% CI: -4.59, -0.60) stigma at t1 and mental health at t2. Tangible support was a significant moderator for internalized stigma (b = -1.54, 95% CI: -2.74, -0.35). Lastly, positive social interaction was a significant moderator for internalized (b = -1.38, 95% CI: -2.71, -0.04) and anticipated stigma (b = -2.14, 95% CI: -3.93, -0.36). In general, the relationship between social support and better mental health was stronger for participants with low stigma. Intervention strategies aimed at both stigma reduction and boosting social supports with different functions may be important for improving the mental health of people living with HIV.
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Affiliation(s)
- Jason M Lo Hog Tian
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Lynne Cioppa
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Michael Murphy
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Anthony R Boni
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Janet A Parsons
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
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16
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Pereira NP, Lisboa CSDM, Bastos JL. Psychometric evaluation of the Intersectional Discrimination Index for use in Brazil. CAD SAUDE PUBLICA 2024; 40:e00009724. [PMID: 39319922 PMCID: PMC11423766 DOI: 10.1590/0102-311xen009724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/23/2024] [Indexed: 09/26/2024] Open
Abstract
This cross-sectional study evaluated the configural and metric structures of the Intersectional Discrimination Index (InDI), an instrument that measures anticipated (InDI-A), dat-to-day (InDI-D), and major (InDI-M) discrimination. Data from a broader study, focused on the impacts of discrimination on the mental health of women living in Brazil, were used. Approximately 1,000 women, selected according to a convenience sampling scheme, answered the InDI and questions about sociodemographic characteristics in an electronic form that was administered in 2021. Exploratory factor analyses and exploratory structural equation modeling were applied to the first half of the sample; for the second, confirmatory factor analysis was conducted. Taken together, the findings suggest that each of the three measures is one-dimensional. However, unlike the study that originally proposed the InDI for use in Canada and the United States, we observed the presence of residual correlations in the three subscales evaluated, all of which were suggestive of content redundancy between specific pairs of items. The three measures showed moderate to strong factor loadings and acceptable fit to the data. InDI exhibited reasonable internal validity, potentially becoming a valuable instrument for investigating the health effects of intersectional discrimination in Brazil. Future studies should evaluate the consistency of these findings, examine the scalar structure of the instrument, and analyze its invariance among different marginalized groups.
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17
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Giesebrecht J, Reich H, Weise C, Nater UM, Mewes R. Links between ethnic discrimination, mental health, protective factors, and hair cortisol concentrations in asylum seekers living in Germany. Eur J Psychotraumatol 2024; 15:2400835. [PMID: 39297220 DOI: 10.1080/20008066.2024.2400835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 08/22/2024] [Accepted: 08/22/2024] [Indexed: 09/22/2024] Open
Abstract
Objective: Asylum seekers often experience ethnic discrimination on the flight or in the host country, which may be associated with chronic stress and impaired mental health. Dysregulation of the hypothalamic-pituitary-adrenal axis, a known physiological correlate of chronic stress, can be assessed using hair cortisol concentrations (HCC). The present study aimed to investigate how different forms of perceived ethnic discrimination are associated with mental health outcomes, HCC, and protective factors in asylum seekers living in Germany.Methods: Somatic symptoms (PHQ-15), symptoms of posttraumatic stress (PDS), depressive symptoms (PHQ-9), different forms of ethnic discrimination (active harm, passive harm, institutional discrimination), and protective factors (in-group identification, social support) were assessed cross-sectionally in 144 asylum seekers (average age 32 years, average duration of stay in Germany nine months; 67% men). HCC were obtained from 68 participants. Multiple regression analyses were conducted and social support and in-group identification were tested as potential moderators.Results: Active ethnic discrimination was positively associated with all assessed mental health outcomes, and all forms of ethnic discrimination positively correlated with depressive symptoms. Ethnic discrimination was not associated with HCC. When controlling for other possible influences (e.g. age, gender, traumatic events), passive harm was negatively associated with depressive symptoms (β = -0.17, p = .033) and active harm was positively associated (β = 0.28, p = .022) with somatic symptoms. After the inclusion of the protective factors, the associations were no longer significant. Lower social support was associated with higher depressive symptoms (β = -0.35, p < .001), posttraumatic stress (β = -0.77, p < .001), and somatic symptoms (β = -0.32, p < .001), but did not moderate the associations between ethnic discrimination and the mental health outcomes.Conclusions: Perceived ethnic discrimination may negatively influence asylum seekers' mental health but does not seem to be associated with HCC. Social support was associated with psychological symptom severity, but did not buffer the effects of ethnic discrimination on mental health.
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Affiliation(s)
- Julia Giesebrecht
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, Marburg, Germany
| | - Hanna Reich
- Depression Research Centre of the German Depression Foundation, Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt am Main, Germany
| | - Cornelia Weise
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, Marburg, Germany
| | - Urs M Nater
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Ricarda Mewes
- Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
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18
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Emmanuelli B, Knorst JK, Amaral-Júnior OLD, Fagundes MLB, Giordani JMDA, Ardenghi TM. Discrimination due to sexual orientation and oral health-related quality of life among adolescents. Braz Oral Res 2024; 38:e085. [PMID: 39292124 PMCID: PMC11404854 DOI: 10.1590/1807-3107bor-2024.vol38.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/14/2024] [Indexed: 09/19/2024] Open
Abstract
To evaluate the association between discrimination based on sexual orientation and oral health-related quality of life (OHRQoL) in adolescents. This was a cross-sectional study nested in a cohort performed in southern Brazil. The baseline assessment was carried out in 2010 with a sample of preschoolers (1 to 5 years). Subsequently, these individuals were reassessed, and for the present study, only the data from the final follow-up in 2020 were considered. OHRQoL was assessed by the short version of the Child Perceptions Questionnaire 11-14 (CPQ11-14). The discrimination due to sexual orientation was measured using item 10 of the Olweus Bully/Victim Questionnaire. Sociodemographic (sex, age, skin color, maternal education, household income) psychosocial (sense of coherence), and clinical variables (untreated dental caries) were also evaluated. Multilevel Poisson regression analysis was performed to verify the associations. Results are present as rate ratio (RR) and 95% confidence interval (95% CI). A total of 429 adolescents were evaluated - about 67.1% of those assessed at baseline. The prevalence of discrimination due to sexual orientation was 3.3%. Adolescents who reported suffering episodes of discrimination due to sexual orientation presented overall CPQ11-14 scores 16% higher (RR 1.16, 95%CI 1.01-1.36) than their counterparts. Adolescents who reported suffering episodes of discrimination due to sexual orientation presented poorer OHRQoL.
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Affiliation(s)
- Bruno Emmanuelli
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Jessica Klöckner Knorst
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | | | | | | | - Thiago Machado Ardenghi
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
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19
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Ertanir B, Meca A, Cobb C, Zeledon I, Unger JB, Lorenzo-Blanco E, Montero-Zamora P, Zamboanga BL, Baezconde-Garbanati L, Soto DW, Aksoy D, Kassis W, Duque M, Alpysbekova A, Schwartz SJ. Disentangling the directionality among cultural stressors and psychosocial outcomes in recently immigrated Hispanic families: A random intercept cross-lagged panel model approach. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024. [PMID: 39245848 DOI: 10.1111/jora.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 08/12/2024] [Indexed: 09/10/2024]
Abstract
Research shows the impact of cultural stressors (e.g. perceived discrimination, bicultural stressors, negative context of reception) on adolescents' psychosocial outcomes. Given the presence of multiple cultural stressors in many Hispanic adolescents' lives, it is essential to examine the (a) developmental sequencing of cultural stressors among recent immigrant youth and (b) predictive effects of cultural stressors on adolescents' psychosocial outcomes. We employed a random intercept cross-lagged panel model to examine the longitudinal interplay among cultural stressors and their effects on youth outcomes using longitudinal data with six waves among 302 recently immigrated Hispanic adolescents (47% girls, Mage = 14.51, SD = .88). We observed bidirectional within-person relations and between-person associations among cultural stressors. At the within-person level, bidirectional cross-lagged effects emerged between perceived discrimination and bicultural stress, between perceived discrimination and negative context of reception, and between negative context of reception and bicultural stress. At the between-person level, bidirectional cross-lagged effects emerged only between perceived discrimination and bicultural stressors. Our findings indicate that cultural stressors explain heterogeneity in psychosocial outcomes: self-esteem was inversely predicted by all cultural stressors, whereas depressive symptoms were predicted only by perceived discrimination. In addition, optimism was predicted only by bicultural stressors, and externalizing behavior was predicted by both bicultural stressors and perceived discrimination. These results suggest that the longitudinal relationships among cultural stressors are (partly) bidirectional. Additionally, cultural stressors demonstrated differential predictive effects on psychosocial outcomes, indicating the added value of considering multiple cultural stressors and their longitudinal effects on adolescents' psychosocial outcomes.
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Affiliation(s)
- Beyhan Ertanir
- University of Basel, Muttenz, Switzerland
- University of Applied Sciences and Arts Northwestern Switzerland, Windisch, Switzerland
| | - Alan Meca
- The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Cory Cobb
- Texas A&M University, College Station, College Station, Texas, USA
| | - Ingrid Zeledon
- University of Southern California, Los Angeles, California, USA
| | | | | | | | | | | | - Daniel W Soto
- University of Southern California, Los Angeles, California, USA
| | - Dilan Aksoy
- University of Applied Sciences and Arts Northwestern Switzerland, Windisch, Switzerland
| | - Wassilis Kassis
- University of Applied Sciences and Arts Northwestern Switzerland, Windisch, Switzerland
| | - Maria Duque
- Boston College, Chestnut Hill, Massachusetts, USA
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20
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Xu Y, Feng J, Rahman Q. Gender nonconformity and common mental health problems: A meta-analysis. Clin Psychol Rev 2024; 114:102500. [PMID: 39260105 DOI: 10.1016/j.cpr.2024.102500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 07/22/2024] [Accepted: 09/05/2024] [Indexed: 09/13/2024]
Abstract
We tested the association between gender nonconformity and common mental health outcomes, including generalized anxiety symptoms, depressive symptoms, self-esteem, self-harm attempts, and suicide attempts using an exhaustive meta-analysis. PsycInfo, ProQuest Central, EBSCOhost, and PubMed were searched for eligible articles using either cross-sectional or longitudinal designs on 11th July 2024. A total number of 1975 articles were identified and selected following PRISMA. Twenty-five, 48, 32, seven, and nine studies were included on generalized anxiety symptoms, depressive symptoms, self-esteem, self-harm attempts, and suicide attempts, reaching a total sample size of 142,069, 188,681, 27,488, 47,523, and 25,573, respectively. Meta-analyses were performed using a random-effects model stratified by mental health outcomes. We found that higher levels of gender nonconformity were associated with higher levels of generalized anxiety (r = 0.06) and depressive symptoms (r = 0.11), lower levels of self-esteem (r = 0.18), and increased risk of self-harm (r = 0.17) and suicide attempts (r = 0.14). Gender nonconformity had stronger links to generalized anxiety symptoms, depressive symptoms, and self-esteem in men than in women. Behaviors-based gender nonconformity showed stronger links to depressive symptoms and self-esteem compared to traits-based gender nonconformity. The effect size for the association between gender nonconformity and depressive symptoms was significantly larger in adolescent samples than in childhood samples. There was no significant moderation by sexual orientation. While gender nonconformity is robustly associated with a range of common mental health problems, the magnitude of this association varies depending on the specific mental health outcomes considered and sex. Interventions to mitigate mental health differences and improve overall well-being among individuals who display greater gender nonconformity are needed.
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Affiliation(s)
- Yin Xu
- Department of Sociology & Psychology, School of Public Administration, Sichuan University, Chengdu, China.
| | - Jinghao Feng
- Department of Sociology & Psychology, School of Public Administration, Sichuan University, Chengdu, China
| | - Qazi Rahman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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21
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Vaillancourt M, Deville-Stoetzel JB, deMontigny F, Dubeau D, Gervais C, Meunier S, Pierce T, Ditto B, Da Costa D. A qualitative study exploring the perinatal experiences of social stress among first- and second-generation immigrant parents in Quebec, Canada. BMC Pregnancy Childbirth 2024; 24:575. [PMID: 39227888 PMCID: PMC11370249 DOI: 10.1186/s12884-024-06768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/19/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Perinatal psychological distress adversely impacts the well-being and social adjustment of parents and their children. Expectant parents who have migrated may be at higher risk for perinatal psychological distress due to various migration-specific stressors and healthcare service barriers. Limited studies have examined the perceived determinants of perinatal distress in immigrant parents, particularly men. This study explored first and second-generation immigrant parents' lived experiences of social stressors and facilitators of perinatal psychological well-being. METHODS Participants were recruited by convenience and purposive sampling as part of a larger study. Semi-structured interviews were conducted virtually with first and second-generation immigrant women and men in Quebec, Canada. An inductive thematic analysis was performed. RESULTS Sixteen women (age = 34.8 ± 3.7 years) and ten men (age = 35.1 ± 4.9 years) from various ethnic backgrounds participated in the study at 7.4 ± 0.73 and 7.5 ± 0.72 months postpartum, respectively. Three themes were identified: (1) cultural pressures (cultural differences in parenting, gender-related cultural pressures, health and baby-related practices), (2) health and social service access (social benefits and resources, and systemic barriers in health care), and (3) discrimination (physical appearance or parental-related discrimination, gender-related discrimination, ethnic-related discrimination). First-generation immigrant parents reported greater acculturative stress (i.e. mental health stigma, health care access) and ethnic discrimination concerns related to their distress. Among men, barriers include feeling as though the paternal role was devalued by society and not receiving consideration by health care. CONCLUSIONS Our results highlight different social factors of perinatal well-being perceived by men and women from various ethnic and immigration backgrounds during the perinatal period. Perceived factors include macro-level factors, such as a country's social climate, health and social policies and services, and social aspects of acculturative stress. Our findings suggest the need for continued efforts to challenge and eliminate discriminatory practices. Interventions and resources directed at first-generation immigrant parents should be bolstered. Understanding what parents perceive to facilitate or hinder their psychological well-being can help inform the development of tailored evidence-based programs and policies to better meet the mental health needs of Canadians and reduce gender disparities in the treatment of perinatal distress.
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Affiliation(s)
- Monica Vaillancourt
- Department of Psychology, McGill University, 2001 McGill College Ave, Montreal, QC, H3A 1G1, Canada.
- Centre for Outcomes Research & Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada.
| | - Jean-Benoît Deville-Stoetzel
- Centre for Outcomes Research & Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada
| | - Francine deMontigny
- Department of Nursing, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Diane Dubeau
- Department of Psychology and Psychoeducation, Université du Québec en Outaouais, St-Jérome, QC, Canada
| | - Christine Gervais
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme, QC, Canada
| | - Sophie Meunier
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Tamarha Pierce
- Psychology School, Laval University, Pavillon Félix-Antoine-Savard, Québec City, QC, Canada
| | - Blaine Ditto
- Department of Psychology, McGill University, 2001 McGill College Ave, Montreal, QC, H3A 1G1, Canada
| | - Deborah Da Costa
- Centre for Outcomes Research & Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
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22
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Ndobo A, Faure A, Galharret JM, Sarda E, Debont L. The coping strategies of individuals in multiple jeopardy settings: the case of unemployed older women. THE JOURNAL OF SOCIAL PSYCHOLOGY 2024; 164:640-665. [PMID: 36416218 DOI: 10.1080/00224545.2022.2143313] [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] [Received: 09/28/2021] [Accepted: 10/03/2022] [Indexed: 11/24/2022]
Abstract
This research investigates the harmful consequences of discrimination on self-esteem and examines the coping options of individuals belonging to several stigmatized groups (i.e., unemployed older women) within the multiple jeopardy perspective. Our sample comprised 420 individuals selected by age, gender and professional status. We tested whether the positive and negative links between discrimination and psychological distress induced by discrimination, would vary according to the number of disadvantaged categories individuals belong to. An analysis of the mediating role of some coping options was also conducted. Overall, the results support most of our hypotheses and suggest that the assumed impact of perceived discrimination on psychological outcome increase with the cumulation of discriminations. We also found that, among the various coping options used by individuals in our sample, commitment, but not age-group identification, mediated the links between the cumulated discrimination and self-esteem. The discussion addresses issues related to workplace discrimination in light of the multiple jeopardy perspective.
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Affiliation(s)
- André Ndobo
- Nantes University
- Laboratoire de Psychologie des Pays de la Loire, LPPL
| | - Alice Faure
- Nantes University
- Laboratoire de Psychologie des Pays de la Loire, LPPL
| | | | - Elisa Sarda
- Nantes University
- Laboratoire de Psychologie des Pays de la Loire, LPPL
| | - Leslie Debont
- Nantes University
- Centre de Recherche sur les Identités Nationales et l'Interculturalité, CRINI
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Nwanaji-Enwerem U, Beitel M, Oberleitner DE, Gazzola MG, Eggert KF, Oberleitner LMS, Jegede O, Zheng X, Redeker NS, Madden LM, Barry DT. Correlates of Perceived Discrimination Related to Substance Use Disorders Among Patients in Methadone Maintenance Treatment. J Psychoactive Drugs 2024; 56:530-540. [PMID: 37399330 PMCID: PMC10761588 DOI: 10.1080/02791072.2023.2230571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 07/05/2023]
Abstract
This study sought to examine demographic, treatment-related, and diagnosis-related correlates of substance use disorder (SUD)-related perceived discrimination among patients receiving methadone maintenance treatment (MMT). Participants were 164 patients at nonprofit, low-barrier-to-treatment-access MMT programs. Participants completed measures of demographics, diagnosis-related characteristics (Brief Symptom Inventory (BSI-18) and Depressive Experiences Questionnaire (DEQ)), and treatment-related characteristics. Perceived discrimination was measured on a seven-point Likert-type scale ranging from 1 ("Not at all") to 7 ("Extremely") in response to the item: "I often feel discriminated against because of my substance abuse." Given the variable's distribution, a median split was used to categorize participants into "high" and "low" discrimination groups. Correlates of high and low discrimination were analyzed with bivariate and logistic regression models. Ninety-four participants (57%) reported high SUD-related perceived discrimination. Bivariate analyses identified six statistically significant correlates of SUD-related perceived discrimination (P < .05): age, race, age of onset of opioid use disorder, BSI-18 Depression, DEQ Dependency, and DEQ Self-Criticism. In the final logistic regression model, those with high (versus low) SUD-related perceived discrimination were more likely to report depressive symptoms and be self-critical. Patients in MMT with high compared to low SUD-related perceived discrimination may be more likely to report being depressed and self-critical.
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Affiliation(s)
| | - Mark Beitel
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | | | | | | | - Lindsay M. S. Oberleitner
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Oluwole Jegede
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | - Xiaoying Zheng
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | - Nancy S. Redeker
- Yale School of Nursing, New Haven, CT
- Yale School of Medicine, New Haven, CT
| | - Lynn M. Madden
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
| | - Declan T. Barry
- Yale School of Medicine, New Haven, CT
- APT Foundation, New Haven, CT
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Coates MM, Arah OA, Matthews TA, Sandler DP, Jackson CL, Li J. Multiple forms of perceived job discrimination and hypertension risk among employed women: Findings from the Sister Study. Am J Ind Med 2024; 67:844-856. [PMID: 38953171 PMCID: PMC11340861 DOI: 10.1002/ajim.23634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/16/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Hypertension has been linked to socially patterned stressors, including discrimination. Few studies have quantified the risk of hypertension associated with exposure to perceived job discrimination. METHODS We used prospective cohort data from the Sister Study (enrollment from 2003-2009) to estimate self-reported incident hypertension associated with perceived job discrimination based on race, gender, age, sexual orientation, or health status. Job discrimination in the prior 5 years was assessed in 2008-2012, and incident doctor-diagnosed hypertension was ascertained in previously hypertension-free participants. RESULTS Among the 16,770 eligible participants aged 37-78 years at the start of follow-up, 10.5% reported job discrimination in the past 5 years, and 19.2% (n = 3226) reported incident hypertension during a median follow-up of 9.7 years (interquartile range 8.2-11.0 years). Self-reported poor health or inclusion in minoritized groups based on race/ethnicity or sexual orientation were more frequent among those reporting job discrimination. In a Cox proportional hazards model adjusting for covariates, report of at least one type of job discrimination (compared to none) was associated with a 14% (hazard ratio = 1.14 [95% confidence: 1.02-1.27]) higher hypertension risk. Results from sensitivity analyses reinforced the findings. CONCLUSIONS Results suggest that interventions addressing job discrimination could have workplace equity and health benefits.
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Affiliation(s)
- Matthew M. Coates
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Onyebuchi A. Arah
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
- Department of Statistics, Division of Physical Sciences, College of Letters and Science, University of California Los Angeles, Los Angeles, CA, United States
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Timothy A. Matthews
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
- Department of Environmental and Occupational Health, California State University Northridge, Northridge, CA, United States
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, United States
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, United States
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Jian Li
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
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25
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Gerend MA, Wilkinson LJ, Sutin AR, Rosado JI, Ehrlich KB, Smith DW, Maner JK. Sociodemographic predictors of perceived weight discrimination. Int J Obes (Lond) 2024; 48:1231-1237. [PMID: 38740855 DOI: 10.1038/s41366-024-01535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination. SUBJECTS/METHODS A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model. RESULTS At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults. CONCLUSIONS Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.
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Affiliation(s)
- Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA.
| | | | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Javier I Rosado
- College of Medicine, Florida State University, Immokalee Regional Campus, Immokalee, FL, USA
| | | | - David W Smith
- Cardiology, Southern Medical Group, Tallahassee, FL, USA
| | - Jon K Maner
- Department of Psychology, College of Arts and Sciences, Florida State University, Tallahassee, FL, USA
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Trovato D, Zimmerman GM. Contextualizing school discipline: Examining the role of general peer and teacher discrimination at the individual- and school-level on individual suspension. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024; 34:897-911. [PMID: 38716808 DOI: 10.1111/jora.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 04/24/2024] [Indexed: 08/28/2024]
Abstract
Past research has linked peer and teacher discrimination to risk factors for school discipline, but few studies have examined whether peer and teacher discrimination have a direct impact on school discipline. This study examines the effects of general peer and teacher discrimination at the individual- and school-level on school suspension using nationally representative, secondary data on almost 12,000 youth across 131 schools. Hierarchical logistic regression models indicated that general teacher discrimination at the individual- and school-level-but not general peer discrimination-increased the odds of receiving school suspension. Findings suggest that general discrimination by direct learning instructors and teachers representing the broader school culture can shape student conduct. Reducing school discipline thus falls on teachers, staff, principals, and learners.
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Affiliation(s)
- Daniel Trovato
- School of Criminology and Criminal Justice, Northeastern University, Boston, Massachusetts, USA
| | - Gregory M Zimmerman
- School of Criminology and Criminal Justice, Northeastern University, Boston, Massachusetts, USA
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27
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Teren K. Depathologization of trans* experience in ICD-11: Suggestions for context-sensitive psychotherapeutic work. BEHAVIORAL SCIENCES & THE LAW 2024; 42:607-619. [PMID: 39031882 DOI: 10.1002/bsl.2683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 07/22/2024]
Abstract
The current changes to the treatment recommendations and the diagnostic categorization of trans* identities in the ICD-11 require a new consideration of past therapeutic methods and approaches. The depathologization of trans* lives in the ICD-11 finally enables trans* people to access psychotherapeutic services more freely, as the compulsory therapy that has thus far been required for access to transition-related treatments, as well as the so-called "diagnosis" and "treatment" of "transsexuality", have been removed. Trans* people will nevertheless be interested in qualified psychotherapeutic treatment options. Due to the decades-long discrimination and treatment in the health system that has disregarded the human rights of trans* people, a trans*-affirmative approach is necessary, one that takes into account the context of the treatment and critically reflects upon one's own position as a health professional. This affirmative and self-reflective approach provides the basis upon which therapeutic concerns and topics related to a life lived in accordance with a self-determined (gender) identity, related needs, and the fulfillment of those needs, can be discussed. The consequences of experiences of discrimination, violence and exclusion are, moreover, important elements of therapy that require a structural and social contextualization in order to address internalized trans*-negativity and to empower trans* people in their self-assertion.
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Maher L, Leece B, Sheaves F, Wilson A, Brown J, O'Connell L, Carnegie-Brown M, Stanbury L, Turalic U, Mooney D, Hoyling L, Cama E, Treloar C. Moving from 'stigma reduction' to 'inclusion': development of the inclusion collaborative at Nepean Blue Mountains Local Health District, New South Wales. Harm Reduct J 2024; 21:158. [PMID: 39192243 DOI: 10.1186/s12954-024-01080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
This commentary outlines the development of an Inclusion Collaborative in a large health district in Sydney, New South Wales Australia. The Collaborative grew out of ongoing efforts to reduce stigma associated with blood borne viruses while recognising that there are many health conditions and situations where people feel judged when attending services for health care. The formation of the Collaborative drew in health workers in other sectors to create a critical mass of voices calling for stigma reduction, move beyond siloed responses to stigma and to reframe conversations about stigma to a more positive description of "inclusion". The involvement of consumer representatives (paid for their time) was a key principle of the Collaborative. The members of the Collaborative identified the common experience of their clients being 'othered' by the mainstream services and that services can be unwelcoming or not supportive of difference, and therefore create a significant barrier to accessing healthcare. The group considered ways to highlight these issues among colleagues from mainstream services and community members who were not 'othered'. The Collaborative designed and carried out a range of activities including a Festival of Inclusion, a series of seeding grants for staff and consumer-focused initiatives, promotion of diversity days and an audit of compliance with strategic priorities. The Inclusion Collaborative is an example of a structured approach for efforts to reducing stigma that draws on the ambitions of many parts of a large, complex public health service to deliver better outcomes for its staff and consumers.
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Affiliation(s)
- Louise Maher
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Bronwyn Leece
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | | | - Andrew Wilson
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - James Brown
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | | | | | - Linda Stanbury
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Una Turalic
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Deanna Mooney
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Larissa Hoyling
- Nepean Blue Mountains Local Health District, Sydney, Australia
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Derricks V, Hirsh AT, Perkins AJ, Daggy JK, Matthias MS. Health Care Discrimination Affects Patient Activation, Communication Self-Efficacy, and Pain for Black Americans. THE JOURNAL OF PAIN 2024:104663. [PMID: 39214439 DOI: 10.1016/j.jpain.2024.104663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/12/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
This study examines whether a key psychosocial factor-perceiving racial discrimination in health care-is associated with worse patient activation, communication self-efficacy, and physical health outcomes for Black veterans with chronic pain. Moreover, we explore the role of physician-patient working alliance as a moderator that may alleviate the potential consequences of perceiving racial discrimination. This work is a secondary analysis of baseline data from a clinical trial with 250 U.S. Black veterans with chronic musculoskeletal pain. Participants were recruited from primary care clinics at a Midwestern VA hospital between 2018 and 2021. Perceiving racial discrimination in health care was associated with lower patient activation, lower self-efficacy in communicating with one's physician, higher pain intensity, and lower pain management self-efficacy (ps < .049) but was unrelated to reports of pain interference or use of pain coping strategies (ps > .157). Although the relationship between perceived discrimination and patient activation was moderated by working alliance (P = .014), having a stronger working alliance improved patient activation to varying degrees across levels of perceived discrimination (rather than buffering against negative outcomes when perceiving higher levels of discrimination). Moderation was not significant on any other measures. This study deepens our understanding of the broad range of health outcomes that are (not) associated with perceiving racial discrimination in health care. Contrary to prior theorizing, this work also indicates that having a strong working alliance does not attenuate the consequences of perceiving discrimination among Black individuals living with pain. These results highlight the need for system-level interventions to address perceptions of racial mistreatment in health care. PERSPECTIVE: This work has important public health implications by identifying the broad range of outcomes associated with perceived discrimination in health care among Black Americans. Importantly, a strong physician-patient relationship did not buffer Black individuals from the consequences of perceiving discrimination. These findings inform intervention targets to mitigate racial health disparities.
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Affiliation(s)
- Veronica Derricks
- Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana.
| | - Adam T Hirsh
- Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana
| | - Anthony J Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Joanne K Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Marianne S Matthias
- VA HSR Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Suberry A, Bodner E. Psychological Well-Being and Self-Aging Attitudes Moderate the Association between Subjective Age and Age Discrimination in the Workplace. Behav Sci (Basel) 2024; 14:742. [PMID: 39335958 PMCID: PMC11428681 DOI: 10.3390/bs14090742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/05/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024] Open
Abstract
Views of aging include peoples' assessment of their own aging process and their subjective age. Positive views of aging relate to a improved psychological well-being which predicts better physical and mental health. While these relationships were substantially studied, the moderating roles of self-aging attitudes and psychological well-being in the subjective age-age discrimination connection have been much less explored. The current study used a convenience sample of 568 participants (mean = 66.21y, SD = 11.95, age range 50-95), 55.8% women, 67.1% employed. In line with the hypotheses, young subjective age and psychological well-being were connected to less age discrimination in the workplace, and higher psychological well-being mitigated the subjective age-age discrimination at work connection. When the perception of old age as a period of loss was added to the model, adults who perceived old age as a period of loss and reported lower levels of psychological well-being demonstrated the strongest relationship between an increase in subjective age and an increase in age-related discrimination at work. The findings emphasize the importance of the psychological well-being of older employees as a resource for improving their attitudes towards their last years at work.
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Affiliation(s)
- Assaf Suberry
- Department of Social & Health Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Ehud Bodner
- Department of Social & Health Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel
- Music Department, Bar-Ilan University, Ramat Gan 5290002, Israel
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31
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Xu Y, Rahman Q. The Chain Mediation Effect of Victimization and Neuroticism on the Association Between Sexual Orientation and Depressive Symptoms: A Prospective Birth Cohort Study. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02979-2. [PMID: 39179929 DOI: 10.1007/s10508-024-02979-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/11/2024] [Accepted: 08/05/2024] [Indexed: 08/26/2024]
Abstract
This study tested whether sexual orientation differences in depressive symptoms were partially explained by the chain mediation effect of neuroticism and victimization. Using the Avon Longitudinal Study of Parents and Children from the UK (N = 4647, 36.52% men, 88% White), self-reported neuroticism, sexual orientation, and depressive symptoms were measured at age 13.5, 21, and 22 years, respectively. Childhood abuse between birth and age 11 years and the individuals' experiences of being bullied at age 17.5 years were measured as the components of victimization. Structural equation modeling was used to analyze the data. Non-heterosexual individuals reported higher depressive symptoms than heterosexual individuals, with a total effect (standardized path coefficient) of 0.590 and 0.768 for men and women, respectively. This association was partially explained by childhood abuse (indirect effect = 0.043 and 0.046 for men and women, respectively) and neuroticism directly (indirect effect = 0.036 and 0.056 for men and women, respectively). Sexual orientation differences in depressive symptoms were also partially explained by a path through increased risk of experiencing childhood abuse leading to higher levels of neuroticism (indirect effect = 0.004 and 0.009 for men and women, respectively) and by a path through higher levels of neuroticism leading to increased risk of being bullied (indirect effect = 0.004 and 0.002 for men and women, respectively). The findings suggest that while some of the association between sexual orientation and depression might be explained by neuroticism and experiences of victimization measured prospectively, these factors do not account for most of this relationship.
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Affiliation(s)
- Yin Xu
- Department of Sociology & Psychology, School of Public Administration, Sichuan University, Chengdu, Sichuan, 610065, China.
| | - Qazi Rahman
- Department of Psychology, Institute of Psychiatry, King's College London, Psychology & Neuroscience, London, UK
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32
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Bastos JL, Bernardo FR, Reichenheim ME. One step further in mistreatment research: Assessing the scalability of the Explicit Discrimination Scale among Brazilian working-age adult respondents. JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 39171502 DOI: 10.1002/jcop.23146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 07/30/2024] [Accepted: 08/08/2024] [Indexed: 08/23/2024]
Abstract
Though the Explicit Discrimination Scale (EDS) has been subjected to extensive psychometric evaluation in Brazil, the instrument has yet to be comprehensively assessed among working-age adult respondents in the country. This study aimed to fill this knowledge gap. Data from around 1200 diverse members of a cohort investigation were used to examine: (1) the positioning of respondents along the continuum of the EDS latent trait; (2) how well the corresponding items represent the EDS construct map; and (3) the extent to which the EDS items follow their expected levels of intensity. We assessed these properties with Loevinger's H, Guttman errors, and Item Response Theory parameters. Findings suggest that two abridged versions of the instrument-but especially the eight-item EDS-may adequately arrange respondents along the latent trait continuum. Analyses also revealed that scale items are reasonably spread over the construct map, with some discrepancy between the expected levels of intensity and their empirical positioning in the corresponding plot. The shortened versions of EDS have good psychometric properties among Brazilian working-age adult respondents. In addition to examining the invariance of the EDS across multiple groups, future psychometric evaluations should assess the external validity of the scale.
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Affiliation(s)
- João L Bastos
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Fabiula R Bernardo
- Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Michael E Reichenheim
- Graduate Program in Public Health, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Kenny KS, Wanigaratne S, Merry L, Siddiqi A, Urquia ML. Discrimination and Racial Inequities in Self-reported Mental Health Among Immigrants and Canadian-Born Individuals in a Large, Nationally Representative Canadian Survey. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02128-4. [PMID: 39164490 DOI: 10.1007/s40615-024-02128-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 08/22/2024]
Abstract
We examined the link between discrimination and self-rated mental health (SRMH) among immigrants and Canadian-born individuals, stratified according to an individual's identification as racialized or white. Using data from Canada's General Social Survey (2014) (weighted N = 27,575,000) with a novel oversample of immigrants, we estimated the association of perceived discrimination with SRMH separately among immigrants and Canadian-born individuals and stratified by racialized status. Among immigrants, we also investigated whether age-at-arrival attenuated or strengthened associations. The prevalence of discrimination was higher among racialized compared to white immigrants (18.9% versus 11.8%), and among racialized compared to white non-immigrants (20.0% versus 10.5%). In the adjusted model with immigrants, where white immigrants not reporting discrimination were the referent group, both white (adjusted prevalence odds ratio [aPOR] 6.11, 95% confidence interval [CI] 3.08, 12.12) and racialized immigrants (aPOR 2.28, 95% CI 1.29, 4.04) who experienced discrimination reported poorer SRMH. The associations were weaker among immigrants who immigrated in adulthood. In the adjusted model with non-immigrants, compared to unexposed white respondents, Canadian-born white respondents who experienced discrimination reported poorer SRMH (aPOR 3.62, 95% CI 2.99, 4.40) while no statistically significant association was detected among racialized respondents (aPOR 2.24, 95% CI 0.90, 5.58). Racialized respondents experienced significant levels of discrimination compared to white respondents irrespective of immigrant status. Discrimination was associated with poor SRMH among all immigrants, with some evidence of a stronger association for white immigrants and immigrants who migrated at a younger age. For Canadian-born individuals, discrimination was associated with poor SRMH among white respondents only.
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Affiliation(s)
- Kathleen S Kenny
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Susitha Wanigaratne
- Edwin S.H. Leong Centre for Healthy Children, SickKids Research Institute & the University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Lisa Merry
- Faculty of Nursing, University of Montreal, Montreal, Canada
- SHERPA University Institute, Montreal, Canada
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Kabangu JLK, Bah MG, Enogela EM, Judd SE, Hobson JM, Levitan EB, Eden SV. The Association Between Experienced Discrimination and Pain in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02130-w. [PMID: 39158830 DOI: 10.1007/s40615-024-02130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/03/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND The relationship between experienced discrimination and its effects on pain interference and management among racial disparities is not well explored. This research investigated these associations among Black and White U.S. adults. METHODS The analysis involved 9369 Black and White adults in the REasons for Geographic and Racial Differences in Stroke (REGARDS), assessing experiences of discrimination, pain interference (SF-12), and pain treatment, incorporating factors like demographics, comorbidities, and stress. RESULTS Black participants experiencing moderate discrimination were found to have a 41% increased likelihood of pain interference (aOR 1.41, 95% CI 1.02-1.95), similaritythose facing high levels of discrimination also showed a 41% increase (aOR 1.41, 95% CI 1.06-1.86) compared to those without such experiences. White individuals reporting moderate discrimination also faced a heightened risk, with a 21% greater chance of pain interference (aOR 1.21, 95% CI 1.01-1.45). Notably, the presence of moderate discrimination among Black participants correlated with a 12% reduced probability of receiving pain treatment (aOR 0.88, 95% CI 0.56-1.37). Furthermore, Black, and White individuals who reported discrimination when seeking employment had a 33% (aOR 0.67, 95% CI 0.45-0.98) and 32% (aOR 0.68, 95% CI 0.48-0.96) lower likelihood, respectively, of receiving treated pain. CONCLUSION The study elucidates how discrimination exacerbates pain interference and restricts access to treatment, affecting Black and White individuals differently. These findings underscore an urgent need for strategies to counteract discrimination's negative effects on healthcare outcomes. Addressing these disparities is crucial for advancing health equity and improving the overall quality of care.
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Affiliation(s)
- Jean-Luc K Kabangu
- Department of Neurological Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Momodou G Bah
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Ene M Enogela
- Department of Epidemiology, School of Public Health, University of Alabama Birmingham, Birmingham, AL, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama Birmingham, Birmingham, AL, USA
| | - Joanna M Hobson
- Department of Psychology, College of Arts and Science, University of Alabama Birmingham, Birmingham, AL, USA
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama Birmingham, Birmingham, AL, USA
| | - Sonia V Eden
- Semmes-Murphey Clinic, Memphis, TN, USA
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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Sutin AR, Gerend MA, Stephan Y, Terracciano A. Perceived Weight Discrimination and General Coping Strategies. Int J Behav Med 2024:10.1007/s12529-024-10314-1. [PMID: 39143431 DOI: 10.1007/s12529-024-10314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Perceived weight discrimination is associated consistently with worse health outcomes. Coping strategies may be one mechanism of this association. The present research examined the association between perceived weight discrimination and strategies used to cope with general stress (not weight-specific) and whether these strategies accounted for part of the association with markers of health. METHOD Participants (N = 1882) completed a cross-sectional survey with a comprehensive measure of coping strategies and reported on their perceived experience of weight discrimination and markers of physical, mental, and social health. RESULTS Perceived weight discrimination was associated with greater use of disengaged coping strategies (β = .19, p < .01) and was unrelated to active and support coping strategies. Disengaged coping mediated the association between weight discrimination and worse physical, mental, and social health (proportion of mediation ranged from 14 to 47%). This pathway was independent of body mass index (BMI). Individuals in the obesity weight category (BMI ≥ 30 kg/m2) were less likely to use active (β = - .11, p < .01) and support (β = - .09, p < .01) coping strategies, which did not consistently mediate the association with health. CONCLUSION Perceived experiences of weight discrimination are associated with disengaged coping strategies to manage stressful experiences, and these strategies are one mechanism that may contribute to the worse health associated with unfair treatment due to weight.
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Affiliation(s)
- Angelina R Sutin
- Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL, 32306, USA.
| | - Mary A Gerend
- Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL, 32306, USA
| | | | - Antonio Terracciano
- Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL, 32306, USA
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Kowal DR. Regression with race-modifiers: towards equity and interpretability. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.04.23300033. [PMID: 38464140 PMCID: PMC10925363 DOI: 10.1101/2024.01.04.23300033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The pervasive effects of structural racism and racial discrimination are well-established and offer strong evidence that the effects of many important variables on health and life outcomes vary by race. Alarmingly, standard practices for statistical regression analysis introduce racial biases into the estimation and presentation of these race-modified effects. We advocate abundance-based constraints (ABCs) to eliminate these racial biases. ABCs offer a remarkable invariance property: estimates and inference for main effects are nearly unchanged by the inclusion of race-modifiers. Thus, quantitative researchers can estimate race-specific effects "for free"-without sacrificing parameter interpretability, equitability, or statistical efficiency. The benefits extend to prominent statistical learning techniques, especially regularization and selection. We leverage these tools to estimate the joint effects of environmental, social, and other factors on 4th end-of-grade readings scores for students in North Carolina (n = 27,638) and identify race-modified effects for racial (residential) isolation, PM2.5 exposure, and mother's age at birth.
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Affiliation(s)
- Daniel R. Kowal
- Department of Statistics and Data Science, Cornell University, Ithaca, NY 14850
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Hauck F, Borho A, Romero Gibu L, Atal M, Dederer S, Bendel P, Morawa E, Erim Y, Jansen S, Rohleder N. The association of perceived ethnic discrimination and institutional verbal violence with chronic stress in an immigrant sample: The role of protective factors - results from the VIOLIN study. J Migr Health 2024; 10:100260. [PMID: 39220099 PMCID: PMC11365374 DOI: 10.1016/j.jmh.2024.100260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 07/10/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
Immigrants are exposed to a variety of stressors, such as ethnic discrimination, and therefore experience a higher risk of developing adverse health outcomes. However, the role of potentially protective psychological factors is not well-studied. The present study addresses the question how discrimination and institutional verbal violence (IVV) are associated with chronic stress in an immigrant sample. In addition, this study highlights moderating effects of migration-specific variables (first or second migration generation and citizenship status). Participants (n = 232; 69.4 % female) completed an online-survey, which included demographics, questionnaires (Everyday Discrimination Scale, EDS; Perceived Stress Scale, PSS-4; Resilience Scale, RS-11; Self-Compassion Scale, SCS-SF) as well as a self-developed questionnaire on institutional verbal violence. Only participants living in Germany with migration background (self or one parent migrated to Germany) were included. Results showed that perceived discrimination and institutional verbal violence were highly associated with chronic stress. Further, self-compassion buffered the connection between discrimination and stress, whereas resilience was no protective factor. The inclusion of migration-specific variables showed that the second-generation sub-group experienced less discrimination-related stress and self-compassion was shown to be particularly protective within this sub-group. Citizenship status did not appear to be a moderator, but especially persons with temporary or permanent residence status, compared to German/EU-citizens, reported higher values of verbal violence and discrimination-related stress. These findings highlight the importance of considering not only psychological but also structural and societal protective and risk factors, as they may be differentially associated with immigrants' stress perceptions. Implications for future research and practical implementations are presented.
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Affiliation(s)
- Felicitas Hauck
- Department of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Nägelsbachstraße 49a, 91052 Erlangen, Germany
| | - Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Hartmannstraße 14, 91052 Erlangen, Germany
| | - Lucía Romero Gibu
- Department of Romance Studies, Friedrich-Alexander-University Erlangen-Nürnberg, Bismarkstraße 1, 91054 Erlangen, Germany
| | - Mojib Atal
- Institute of Political Science, Friedrich-Alexander-University Erlangen-Nürnberg, Kochstraße 4, 91054 Erlangen, Germany
| | - Sevil Dederer
- Department of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Nägelsbachstraße 49a, 91052 Erlangen, Germany
| | - Petra Bendel
- Institute of Political Science, Friedrich-Alexander-University Erlangen-Nürnberg, Kochstraße 4, 91054 Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Hartmannstraße 14, 91052 Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Hartmannstraße 14, 91052 Erlangen, Germany
| | - Silke Jansen
- Department of Romance Studies, Friedrich-Alexander-University Erlangen-Nürnberg, Bismarkstraße 1, 91054 Erlangen, Germany
| | - Nicolas Rohleder
- Department of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Nägelsbachstraße 49a, 91052 Erlangen, Germany
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Morales A, Burnett-Zeigler I. A Scoping Review of Culturally Adapted Mindfulness-Based Interventions for Communities of Color. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 39093941 DOI: 10.1089/jicm.2023.0807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Introduction: Mindfulness-based interventions (MBIs) are effective in improving mental health outcomes, including depression, anxiety, and post-traumatic stress disorder (PTSD). However, research on how MBIs have been tailored for racial and ethnic minoritized communities is limited. To address this gap, this scoping review utilizes the Ecological Validity Framework to systematically explore cultural adaptations in MBIs for communities of color. Concurrently, this review examines the effectiveness of culturally adapted MBIs. Methods: Following PRISMA guidelines, the authors conducted a search on MEDLINE, PsycINFO, and Embase databases from 2010 to 2023. Inclusion criteria required studies to be published in English, accessible in full-text, and peer-reviewed, focusing primarily on communities of color or diverse non-White populations (comprising 75% or more of the sample). Exclusion criteria were studies primarily centered on behavioral interventions other than MBIs, studies lacking primary outcomes, and studies not explicitly addressing cultural adaptations. Results: Search results identified 371 publications, 13 of which met the inclusion criteria. The most frequently reported cultural adaptations were surface-level adaptations, which can enhance the relevance of MBIs by modifying the language, content, format, or intervention delivery. MBIs with surface-level adaptations reported significant improvements in mental health outcomes, including depression, anxiety, and stress levels. Conclusion: Findings from this review indicate that culturally adapted MBIs for communities of color could potentially make them more relevant and acceptable. Surface-level and deep structure adaptations are both necessary to ensure MBIs are responsive, relevant, and sustainable across diverse contexts and populations.
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Affiliation(s)
- Anthony Morales
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Inger Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Bruse LM. CORR Insights®: How Much Bullying and Discrimination Are Reported by Sexual and Gender Minorities in Orthopaedics? Clin Orthop Relat Res 2024; 482:1293-1295. [PMID: 38546707 PMCID: PMC11272296 DOI: 10.1097/corr.0000000000003058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Laura Marie Bruse
- Orthopaedic Surgeon, Beautiful Bones Orthopaedics, Henderson, NV, USA
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Hobden B, Bryant J, Davis R, Heard T, Rumbel J, Newman J, Rose B, Lambkin D, Sanson-Fisher R, Freund M. Co-occurring psychological distress and alcohol or other drug use among Indigenous Australians: Data from the National Aboriginal and Torres Strait Islander Health Survey. Aust N Z J Psychiatry 2024; 58:668-677. [PMID: 38581252 PMCID: PMC11308262 DOI: 10.1177/00048674241244601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
OBJECTIVES To determine the prevalence and demographic, social and health characteristics associated with co-occurring psychological distress symptoms, risky alcohol and/or substance use among a national sample of Aboriginal and Torres Strait Islander people aged 15 years or older. METHODS This study uses secondary cross-sectional data from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). Data were collected via face-to-face interviews with those living in private dwellings across Australia. Participants were Aboriginal and Torres Strait Islander people (n = 10,579) aged 15 years or older. Data pertaining to psychological distress, alcohol and substance use were obtained and weighted to represent the total population of Aboriginal and Torres Strait Islander people in Australia. RESULTS A total of 20.3% participants were found to have co-occurring psychological distress, risky alcohol use and/or substance use, and 4.0% reported co-occurrence of all three conditions. Female participants in a registered marriage and fully engaged in study or employment had lower rates of co-occurring conditions. Poorer self-rated health, one or more chronic conditions and increased experiences of unfair treatment and physical harm in the past 12 months were associated with increased rates of co-occurring conditions. CONCLUSION A range of potential risk and protective factors were identified for co-occurring psychological distress, risky alcohol and/or substance use among Aboriginal and Torres Strait Islander people. This information is critical for planning effective holistic strategies to decrease the burden of suffering imposed upon the individual, family and community members impacted by co-occurring conditions.
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Affiliation(s)
- Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Robert Davis
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Todd Heard
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Wiyiliin ta CAMHS, Hunter New England Local Health District, NSW Health, Newcastle, NSW, Australia
- Systems Neuroscience Group, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jenn Rumbel
- Systems Neuroscience Group, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Wollotuka Institute, Purai Global Indigenous History Centre, The University of Newcastle, Callaghan, NSW, Australia
| | - Jamie Newman
- Orange Aboriginal Medical Service, Orange, NSW, Australia
| | - Bron Rose
- Yimamulinbinkaan, Aboriginal Mental Health Service & Social Emotional Wellbeing Workforce, Hunter New England Mental Health Service, Hunter New England Local Health District, NSW Health, Newcastle, NSW, Australia
| | - David Lambkin
- Clinical Research Design and Statistics, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Megan Freund
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Equity in Health and Wellbeing Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Chu Y. Labor market discrimination and suicidal ideation: A longitudinal study of Korean women. Soc Sci Med 2024; 354:117080. [PMID: 38971044 PMCID: PMC11423394 DOI: 10.1016/j.socscimed.2024.117080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/23/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
This study investigates the impact of gender discrimination in the labor market on suicidal ideation among Korean women, taking into consideration women's multiple social locations and their discriminatory experiences across various aspects of employment. Analysis using waves 4 to 8 data of the Korean Longitudinal Survey of Women and Family, with response rates ranging from 68.3% to 78.2%, indicates that gender discrimination in hiring, dismissal, promotion, job allocation, training, wage, and sexual harassment is strongly associated with suicidal thoughts among women. This relationship remains significant even after controlling for stress, depression, and other forms of discrimination. Subgroup analysis further highlights that women with lower income levels are particularly susceptible to the adverse effects of gender discrimination. The findings underscore the importance of policy intervention to mitigate labor market discrimination against women as a crucial step in preventing suicides among Korean women.
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Boswell RG, Launius KN, Lydecker JA. Multiple marginalization, discrimination, and disordered eating among youth aged 10-11. Int J Eat Disord 2024; 57:1783-1790. [PMID: 38572625 PMCID: PMC11343651 DOI: 10.1002/eat.24211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Although rates of weight discrimination are on-par with racial, ethnic, and gender discrimination, comparatively less work has examined impacts of weight-based discrimination in youth, including on disordered eating. Knowing whether experiences of weight-based discrimination, including in youth with multiply-marginalized identities, are associated with disordered eating could identify vulnerable youth and inform intervention efforts. METHOD Youth (N = 11,875) ages 10-11 were recruited through the Adolescent Brain Cognitive Development (ABCD) study. Logistic regressions using cross-sectional data examined discrimination experiences (weight, perceived sexual orientation, race/ethnicity, national origin) and disordered eating (binge-eating, vomiting, weight-gain fear, weight self-worth). Models included race/ethnicity, age, sex, parental income, and degree of elevated weight. Raked poststratification weights were used. RESULTS Rates of weight-based discrimination (6.2%) were similar to rates of race/ethnicity (4.4%) and sexual orientation discrimination (4.5%). Weight-based discrimination was associated with more disordered eating. Youth reporting multiple experiences of discrimination had significantly increased disordered eating compared to youth who did not report discrimination. DISCUSSION Weight-based discrimination is common in youth and associated with disordered eating. Youth with elevated weight are more likely to be multiply marginalized and experience disordered eating. These findings suggest discrimination, including weight-based discrimination, is a critical intervention target to prevent and treat eating disorders. PUBLIC SIGNIFICANCE Experiences of discrimination contribute to poorer health; however, weight-based discrimination is relatively understudied. Data from a large sample of youth ages 10-11 showed that youth with elevated weight reported experiencing multiple types of discrimination, and multiply-marginalized youth had increased odds of disordered eating with each additional type of discrimination. Together, this suggests that weight-based discrimination is a critical target to prevent and treat eating disorders, especially in multiply-marginalized youth.
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Affiliation(s)
- Rebecca G. Boswell
- Penn Medicine Princeton Center for Eating Disorders, Princeton, NJ
- Princeton University, Department of Psychology, Princeton, NJ
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, 06511
| | - Kellsey N. Launius
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, 06511
- Eastern Michigan University, Department of Psychology, Ypsilanti, MI
| | - Janet A. Lydecker
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, 06511
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Lewis CT, Toman J, Sanchez VA, Corvin J, Arnold ML. Examining the Relationship Between Hearing Health Beliefs and Social Determinants of Health in Black Adults. Ear Hear 2024:00003446-990000000-00321. [PMID: 39106324 DOI: 10.1097/aud.0000000000001562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
OBJECTIVES Hearing loss is a highly prevalent condition; however, it is widely under-treated, and Black Americans have been found to have significantly lower rates of hearing aid utilization than other ethnic/racial groups. In this exploratory study, we aimed to identify hearing health beliefs among Black adults, guided by the Health Belief Model, with social determinants of health, and examine individual differences in these perspectives. DESIGN The Hearing Beliefs Questionnaire (HBQ) was administered online to measure constructs of the Health Belief Model among 200 Black adults aged 18 to 75 (M = 39.14, SD = 14.24). Approximately 13% reported hearing difficulty. In addition, 11 social determinants of health questions were included. Participants were recruited from a university otolaryngology clinic and local Black congregations, meeting inclusion criteria of being 18 or older and Black/African American. Mean scores and SDs for HBQ subscales were calculated. Analysis included analysis of variance and t tests to explore relationships with demographic variables and social determinants of health. Multiple regression analyses predicted HBQ subscale scores from sociodemographic variables. RESULTS Mean HBQ subscale scores ranged from 3.88 (SD = 2.28) for Perceived Barriers to 6.76 (SD = 1.93) for Perceived Benefits. Positive correlations were observed between Perceived Severity, Perceived Benefits, and Perceived Self-Efficacy scores and participant educational attainment. Lower economic stability was correlated with poorer scores in Perceived Self-Efficacy, Perceived Severity, and Perceived Benefits. Black adults' willingness to purchase a hearing aid was heavily influenced by their Perceived Benefit, Perceived Severity, and Perceived Self-Efficacy scores, with lower scores correlating with unwillingness to purchase devices. Higher frequency of racism/discrimination and financial hardship correlated with increased Perceived Barriers scores for accessing hearing healthcare. In addition, hearing health beliefs between participants with self-reported hearing difficulty and those without trouble only exhibited differences in the Perceived Susceptibility subscale, with those experiencing hearing difficulty having higher scores in this subscale; no other distinctions were identified. CONCLUSIONS The Health Belief Model, used with social determinants of health, revealed associations, and variations, in the hearing health beliefs held by Black adults. The present investigation reveals heterogeneity within this group and pinpoints individuals at higher risk for untreated hearing loss, stemming from their negative perceptions about hearing healthcare. These beliefs are influenced by demographics and social determinants of health, underscoring areas ripe for intervention.
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Affiliation(s)
- Charity T Lewis
- Auditory Rehabilitation & Clinical Trials Laboratory, University of South Florida, Tampa, Florida, USA
- School of Aging Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Julia Toman
- Department of Otolaryngology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Victoria A Sanchez
- Auditory Rehabilitation & Clinical Trials Laboratory, University of South Florida, Tampa, Florida, USA
- Department of Otolaryngology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jaime Corvin
- Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Michelle L Arnold
- Auditory Rehabilitation & Clinical Trials Laboratory, University of South Florida, Tampa, Florida, USA
- Department of Communication Sciences & Disorders, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida, USA
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Gutierrez S, Whitmer RA, Soh Y, Peterson R, George KM, Lor Y, Barnes LL, Mayeda ER, Allen IE, Torres JM, Glymour MM, Gilsanz P. School-based racial segregation, social support, and late-life cognitive function in the Study of Healthy Aging in African Americans (STAR). Alzheimers Dement 2024. [PMID: 39054568 DOI: 10.1002/alz.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 05/28/2024] [Accepted: 06/13/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION School-based social support for Black students may mediate or modify the association between school segregation and late-life cognition. METHODS Study of Healthy Aging in African Americans participants (n = 574) reported segregated school attendance and school-based social support. Associations of segregated schooling with domain-specific cognitive outcomes and effect modification or mediation by school-based social support were evaluated with linear mixed models. RESULTS Segregated school attendance was associated with increased likelihood of school-based social support. Segregated (vs. desegregated in 6th grade) school attendance was associated with lower executive function (β = -0.18 [-0.34, -0.02]) and semantic memory z-scores (β = -0.31 [-0.48, -0.13]). Social support did not mediate these associations. Estimates for segregated school attendance were attenuated among those who felt supported, although there was limited evidence of statistically significant effect modification. DISCUSSION Early-childhood school segregation was associated with poorer cognitive function. Sources of resilience within racialized educational experiences should be further evaluated to bridge inequities. HIGHLIGHTS School segregation is a form of structural racism that affected the educational experiences of Black youth with potentially lasting consequences for healthy brain aging. Black students who attended a segregated school experienced greater school-based social support, which may highlight a potential source of resilience and resistance against the effects of racism-related stressors on cognitive function. The estimated adverse association between attending a segregated school on cognition was larger for students without an adult at school who cared about them versus those with an adult at school who cared about them, but estimates were imprecise.
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Affiliation(s)
- Sirena Gutierrez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Rachel A Whitmer
- Alzheimer's Disease Center, University of California, Davis, Sacramento, California, USA
- Department of Public Health Sciences, University of California, Davis, Medical Sciences 1-C, Davis, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Yenee Soh
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Rachel Peterson
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Kristen M George
- Department of Public Health Sciences, University of California, Davis, Medical Sciences 1-C, Davis, California, USA
| | - Yi Lor
- Department of Public Health Sciences, University of California, Davis, Medical Sciences 1-C, Davis, California, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jacqueline M Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Paola Gilsanz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Obeng-Nyarko CN, Ralston PA, Wickrama KKAS, Lemacks JL, Ilich JZ. Health for Hearts United Longitudinal Trial: Improving Perceived Stress and Allostatic Load Outcomes of Mid-Life and Older African American Women. HEALTH EDUCATION & BEHAVIOR 2024:10901981241263027. [PMID: 39051464 DOI: 10.1177/10901981241263027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Cardiovascular disease (CVD) continues to be the leading cause of death in the United States, with African Americans experiencing higher age-adjusted mortality compared to Whites. African American women in particular carry a high CVD burden due to more exposure to adverse personal and socioenvironmental challenges. Church-based interventions can improve health behaviors and health status of African Americans, yet few have addressed stress-related health. The purpose of this study was to determine the effectiveness of the 18-month Health for Hearts United intervention in relation to stress-related outcomes (perceived stress, allostatic load) of mid-life and older African American women (≥45 years of age; n = 152 overall sample, n = 65 clinical subsample). The results of the repeated measures analysis of variance (ANOVA) analyses showed overall significant decreases in perceived stress and allostatic load for both treatment and comparison groups over the measurement occasions (baseline and 18 months) with educational level remaining as a significant correlate over time. There was no significant interaction between treatment and time, yet there were trends in improvements for the treatment group compared to the comparison group. The findings demonstrate the potential of church-based interventions in reducing both self-reported stress and allostatic load in African American women, and highlight the need for further investigation of educational level and other possible factors influencing stress management in these settings.
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Sekher TV, Pai M, Muhammad T. Subjective social status and socio-demographic correlates of perceived discrimination among older adults in India. BMC Geriatr 2024; 24:617. [PMID: 39030500 PMCID: PMC11265011 DOI: 10.1186/s12877-024-05114-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/29/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Considering India's diversity, marked by differences in caste, class, ethnicity, religion, region, and language, discrimination can take on varying forms across social-structural locations. We examined the association between subjective social status (SSS) and perceived discrimination, and assessed the sociodemographic correlates of perceived discrimination among older persons in India. METHODS Data come from the 2017-18 wave 1 of the Longitudinal Aging Study in India (LASI) with a sample of 30,253 adults 60 years or older. SSS was examined using the Macarthur scale with a ladder technique. Perceived discrimination was evaluated with the Everyday Discrimination Scale. Multivariable logistic regression models examined the odds of reporting discrimination by its types and attributions. RESULTS 39% of older adults reported low SSS, whereas 7.3% reported high SSS. Older adults with low SSS had significantly higher odds of experiencing some discrimination than those with high SSS. Compared to high-SSS peers, low-SSS individuals attributed age, gender, caste, financial, and health status as reasons for discrimination. Older women attributed gender as a reason for discrimination. Caste was reported as a reason for discrimination by rural but not urban dwellers. Relative to northerners, those from southern India reported age, financial, and health statuses as reasons for discrimination. CONCLUSIONS That low-SSS older adults reported age, gender, caste, financial status, and health status as reasons for discrimination and that this association persisted after considering objective indicators of socioeconomic status (SES) is suggestive of SSS as independently consequential for perceived discrimination. These findings are useful for care providers and practitioners as they encourage older patients -- especially those with low SSS who may feel stigmatized -- to seek care, comply with care regimen, and engage in behaviors that protect and promote health.
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Affiliation(s)
- T V Sekher
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
| | - T Muhammad
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, 16802, USA.
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Bernardo FR, Bastos JL, Reichenheim ME. Factorial invariance of the abridged version of the Explicit Discrimination Scale among adults living in southern Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240038. [PMID: 39016389 PMCID: PMC11251642 DOI: 10.1590/1980-549720240038] [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] [Received: 11/02/2023] [Revised: 03/08/2024] [Accepted: 04/10/2024] [Indexed: 07/18/2024] Open
Abstract
OBJECTIVE The Explicit Discrimination Scale (EDS) was developed to assess experiences with discrimination in Brazilian epidemiologic surveys. Though previous analyses have demonstrated that the EDS has good configural, metric, and scalar properties, its invariance has not yet been investigated. In this study, we examined the factorial invariance of two abridged versions of the EDS, according to skin color/ethnicity, sex, socioeconomic status, and their intersections. METHODS Data from the EpiFloripa Adult Study were used, which include a representative sample of adults residing in a state capital of southern Brazil (n=1,187). Over half of the respondents were women, and around 90% identified as white; the mean age of the participants was 39 years. Two abridged versions of the EDS were analyzed, with seven and eight items, using Multigroup Confirmatory Analysis and the Alignment method. RESULTS The two versions of the scale may be used to provide estimates of discrimination that are comparable across skin color/ethnicity, sex, socioeconomic status, and their intersections. In the seven-item version of the scale, only one parameter lacked invariance (i.e., threshold of item i13 - called by names you do not like), specifically among black respondents with less than 12 years of formal education. CONCLUSION The EDS may provide researchers with valid, reliable, and comparable estimates of discrimination between different segments of the population, including those at the intersections of skin color/ethnicity, sex, and socioeconomic status. However, future research is needed to determine whether the patterns we identified here are consistent in other population domains.
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Affiliation(s)
- Fabiula Renilda Bernardo
- Universidade Federal de Santa Catarina, Graduate Program in Public Health – Florianópolis (SC), Brazil
| | - João Luiz Bastos
- Universidade Federal de Santa Catarina, Graduate Program in Public Health – Florianópolis (SC), Brazil
- Simon Fraser University, Faculty of Health Sciences – Burnaby, British Columbia, Canada
| | - Michael Eduardo Reichenheim
- Universidade do Estado do Rio de Janeiro, Hésio Cordeiro Institute of Social Medicine – Rio de Janeiro (RJ), Brazil
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Glover CM, Yu L, Lichtenberg PA, Han SD, Lamar M, Stewart CC, Bennett DA, Barnes LL, Boyle PA. Factors Associated With Healthcare and Financial Decision Making Among Older Black Adults Without Dementia. Clin Gerontol 2024:1-17. [PMID: 38992940 DOI: 10.1080/07317115.2024.2375326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
OBJECTIVES The study aims to identify factors associated with health care and financial decision-making among older Black adults without dementia. METHODS Participants (N = 326) underwent assessments of decision-making and completed measurements of factors from four categories: cognitive, contextual, psychosocial, and personality. We performed separate linear regression models to examine the association between each factor and decision-making and created a fully adjusted model. RESULTS Higher global cognition (estimate = 1.92, SE = 0.21, p < .0001) was associated with better decision-making. Contextual factors including higher current annual income (estimate = 0.23, SE = 0.05, p < .0001), higher childhood socioeconomic status (estimate = 0.48, SE = 0.18, p = .006), higher health and financial literacy (estimate = 0.08, SE = 0.01, p < .0001), and lower financial stress (estimate = -0.19, SE = 0.07, p = .01) were associated with better decision-making. More psychological well-being (estimate = 0.07, SE = 0.22, p = .001), a psychosocial factor, and less neuroticism (estimate = -0.06, SE = 0.02, p = .002), a personality factor, were associated with better decision-making. In the fully adjusted model, two factors, higher global cognition and higher literacy (health and financial), remained associated with better decision-making. CONCLUSIONS Cognitive and contextual factors serve as drivers of decision-making among older Black adults. CLINICAL IMPLICATIONS Clinicians may implement strategies to bolster cognition and improve health and financial literacy to facilitate optimal decision-making among older Black adults.
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Affiliation(s)
- Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Peter A Lichtenberg
- Institute of Gerontology, Wayne State University, Detroit, Michigan, USA
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - S Duke Han
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Department of Family Medicine, University of Southern California, Los Angeles, California, USA
- Department of Neurology, University of Southern California, Los Angeles, California, USA
- School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Christopher C Stewart
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
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Assemi K, Lombardero A, West DM, Smith G, Li I, Houmanfar RA, Jacobs NN. Exploring The Impact of Acceptance and Commitment Based Cultural Humility Training on Standardized Patient Interactions: Revisiting the Measurement Process. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10026-4. [PMID: 38980549 DOI: 10.1007/s10880-024-10026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 07/10/2024]
Abstract
Recent findings in health sciences and medical education highlight the importance of training healthcare professionals to interact with their patients in a culturally humble manner (Nadal et al., in Journal of Counseling and Development 92: 57-66, 2014; Pascoe & Smart Richman, in Psychological Bulletin 135: 531, 2009; Sirois & Burg, in Behavior Modification 27: 83-102, 2003; Williams & Mohammed, in Journal of Behavioral Medicine 32: 20-47, 2009). An important piece in the progression of our ability to address training challenges is the assessment of cultural humility. As an extension of previous research (Lombardero et al., in Journal of Clinical Psychology in Medical Settings, 30: 261-273, 2023), this study implemented an evidence-based cultural humility intervention (based on Acceptance and Commitment Training) to improve medical students' interactions with standardized patients (SPs) which was assessed via direct behavioral observation. Specifically, the observational measurement system was focused on culturally humble responses to patients reporting microaggressions to the medical professional. A pre-post comparison of the results demonstrated statistically significant improvements pertaining to participants' culturally humble responses to SPs' reports of microaggressions for one of the measurement scales used (i.e., ARISE), but not the other (i.e., Responsiveness to Racial Challenges Scale). Further analyses, on the bottom quartile of performers, were conducted to assess a possible ceiling effect of the scale that did not demonstrate significant change. These results and implications for future research will be discussed.
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Affiliation(s)
- Kian Assemi
- Reno Behavior Analysis Program, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA.
| | - Anayansi Lombardero
- Reno School of Medicine, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
| | - Donna M West
- Reno Behavior Analysis Program, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
| | - Greg Smith
- Reno Behavior Analysis Program, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
| | - Irene Li
- Reno School of Medicine, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
| | - Ramona A Houmanfar
- Reno Behavior Analysis Program, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
| | - Negar N Jacobs
- Reno School of Medicine, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
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Perez LG, Troxel WM, Tucker JS, Dunbar MS, Rodriguez A, Klein DJ, D'Amico EJ. Discrimination experiences and problematic alcohol and cannabis use in young adulthood. Am J Addict 2024. [PMID: 38978344 DOI: 10.1111/ajad.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/24/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Limited research has examined how discrimination in young adulthood relates to substance use. We examined how multiple and specific types (e.g., race-based) of experiences of unfair treatment are related to problematic alcohol and cannabis use. METHODS We analyzed cross-sectional data from a diverse cohort of young adults (mean age 24.7) predominantly residing in southern California (n = 2303) to examine associations of multiple (count) and specific experiences (race-, sexual orientation-, gender-based) of perceived everyday discrimination with self-reported alcohol and cannabis use outcomes (consequences, use disorders, and solitary use). We also tested interactions between the three specific discrimination experiences and sociodemographic characteristics (e.g., race-based discrimination × race/ethnicity). RESULTS In this diverse sample (e.g., 47% Latinx/o and 22% Asian; 22% sexual/gender diverse; 56% female) of young adults, about 46% reported up to four different discrimination experiences and 27% reported race-, 26% gender-, and 5% sexual orientation-based discrimination. Race- and gender-based discrimination and experiencing more types of discrimination were associated with worse cannabis use outcomes. Race-based discrimination was associated with fewer alcohol consequences and lower Alcohol Use Disorders Identification Test (AUDIT) scores. Associations with sexual orientation-based discrimination and the interactions were not significant. DISCUSSION AND CONCLUSIONS Findings build on limited research on associations of discrimination with cannabis use in young adults. More work is needed to understand the mechanisms by which discrimination influences drinking behaviors. SCIENTIFIC SIGNIFICANCE This study advances the field by examining the unique contributions of specific and multiple types of discrimination experiences in young adulthood, a critical developmental period in which substance use peaks.
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