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Costa M, Griswold MK, Canty L. Nursing student perceptions of racism and health disparities in the United States: A critical race theory perspective. Nurs Outlook 2024; 72:102172. [PMID: 38636305 DOI: 10.1016/j.outlook.2024.102172] [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: 07/31/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Limited research has been done on nursing students' awareness of racial disparities and their readiness to address bias and racism in clinical practice. PURPOSE This study investigated nursing students' perceptions of how racial disparities affect health outcomes, including maternal outcomes, in the United States. METHODS Interpretive description was used and supported by the critical race theory as a framework to guide the data collection, analysis, and interpretation to understand participants' perceptions surrounding racism and health disparities. DISCUSSION Nurse educators should guide students to look beyond individual behavioral and risk factors and consider systemic issues as a leading contributors to health disparities. CONCLUSION The most critical finding was the lack of participants' understanding of systemic racism and its impact on health disparities. While they often attributed racial disparities to low socioeconomic status and lack of education, they did not understand the relationships between social determinants of health and systemic racism.
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Affiliation(s)
- Monika Costa
- School of Interdisciplinary Health and Science, University of Saint Joseph, West Hartford, CT.
| | - Michele K Griswold
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, CT
| | - Lucinda Canty
- Seedworks Health Equity in Nursing Program, University of Massachusetts Amherst, Amherst, MA
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2
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Bey GS, Pike JR, Palta P. Distinct moderating pathways for psychosocial risk and resilience in the association of neighborhood disadvantage with incident heart failure among Black persons. SSM Popul Health 2023; 24:101475. [PMID: 37736261 PMCID: PMC10509709 DOI: 10.1016/j.ssmph.2023.101475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/20/2023] [Accepted: 07/23/2023] [Indexed: 09/23/2023] Open
Abstract
Objective To assess whether psychosocial factors moderate the associations between neighborhood disadvantage and incident heart failure (HF). Methods Among 1448 Non-Hispanic (NH) Black persons dually enrolled in two community-based cohorts in Jackson, Mississippi who were free of HF as of January 1, 2000, 336 HF events classified by reviewer panel accrued through December 31, 2017. Multilevel, multivariable Cox regression models were used to examine whether optimism and negative affect moderated the associations of two measures of neighborhood characteristics (the national Area Deprivation Index (ADI) and perceived neighborhood problems) on incident hospitalized HF. Results Optimism moderated the association of the ADI with incident HF. Compared to participants reporting the lowest tertile of optimism, those in the highest tertile of optimism had a 29% lower rate of HF associated with increasing ADI in fully adjusted models. We found no evidence for a moderating effect of negative affect. Conclusions This study supports optimism as a source of resilience to the detrimental effects of neighborhood disadvantage on HF risk. Population-level strategies to promote sociocultural antecedents to optimism may serve as a viable method of reducing the disproportionate burden of HF among NH Black persons.
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Affiliation(s)
- Ganga S. Bey
- University of North Carolina at Chapel Hill, Department of Epidemiology, USA
| | - James R. Pike
- Johns Hopkins University Bloomberg School of Public Health, USA
| | - Priya Palta
- University of North Carolina School of Medicine, Department of Neurology, USA
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3
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Martinez JH, Tahirkheli NN, Roemer L, Ying A, Abdullah T. Coping with racial discrimination: a preliminary examination of coping strategies in college students at a University in Northeastern U.S. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 38015172 DOI: 10.1080/07448481.2023.2283737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/03/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE We examined the associations between coping strategies in response to racism and distress symptoms. SAMPLE One hundred forty-four racially minoritized students at a northeastern university completed an online survey. METHODS Participants completed self-report active and emotion-focused coping and distress symptom (i.e., depression and anxiety) measures. Hierarchical regressions were conducted to test: 1) correlations between coping strategies in response to racism and distress symptoms, and 2) whether emotional acceptance moderates the association between active coping in response to racism and distress symptoms. RESULTS Students' self-compassionate responses to their emotional reactions to discrimination uniquely predicted less distress. In contrast, reports of using resistance and education in response to discrimination were positively correlated with distress symptoms; however, these associations were no longer significant when accounting for emotional acceptance. CONCLUSIONS Our findings suggest that emotional acceptance coping may be associated with lower distress symptoms. Active coping was associated with increased distress symptoms, except when accounting for emotional acceptance coping.
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Affiliation(s)
| | - Noor N Tahirkheli
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Lizabeth Roemer
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Anna Ying
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Tahirah Abdullah
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
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Jones DM, Masyn KE, Spears CA. Associations among discrimination, psychological functioning, and substance use among US Black adults aged 18-28: Moderation by racial attribution and sex. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 153:209080. [PMID: 37230392 PMCID: PMC10526892 DOI: 10.1016/j.josat.2023.209080] [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: 06/30/2022] [Revised: 01/02/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Discrimination is associated with poor mental health and substance use among Black Americans, but research is needed on mediators and moderators of these relationships. This study tested whether: 1) discrimination is associated with current alcohol, tobacco (cigarette or e-cigarette), and cannabis use among US Black emerging adults; 2) psychological distress (PD) and positive well-being (PW) are mediators of discrimination-substance use relationships; and 3) these relationships are moderated by sex and attributions to discrimination (racial vs. nonracial). METHODS Using data from a 2017 US nationally representative survey, we conducted bivariate and multiple-group moderated mediation analyses among 1118 Black American adults aged 18-28. The study assessed discrimination and attribution to discrimination using the Everyday Discrimination scale, past 30-day PD with the Kessler-6 scale, and past 30-day PW with the Mental Health Continuum Short Form. We utilized probit regression for all structural equation models and adjusted final models for age. RESULTS Discrimination was positively associated with past 30-day cannabis and tobacco use directly and indirectly through PD in the overall model. Among males who reported race as the sole/main attribution to discrimination, discrimination was positively associated with alcohol, cannabis, and tobacco use through PD. Among females who reported race as the sole/main attribution to discrimination, discrimination was positively associated with cannabis use through PD. Discrimination was positively associated with tobacco use among those who reported nonracial attributions to discrimination and with alcohol use among those whose attribution was not assessed. Discrimination was positively associated with PD among those who reported race as a secondary attribution to discrimination. CONCLUSIONS Discrimination specifically attributed to race may contribute to greater PD and in turn alcohol, cannabis, and tobacco use among Black emerging adults, especially males. Future substance use prevention and treatment efforts targeted to Black American emerging adults may benefit from addressing racial discrimination and PD.
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Affiliation(s)
- Dina M Jones
- Center for the Study of Tobacco, Department Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Box #820, Little Rock, AR 72205, USA.
| | - Katherine E Masyn
- Department of Population Health Sciences, School of Public Health, Georgia State University, 140 Decatur St., Suite 471, Atlanta, GA 30303, USA.
| | - Claire A Spears
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, 140 Decatur St., Suite 612, Atlanta, GA 30303, USA.
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Schmidt IM, Shohet M, Serrano M, Yadati P, Menn-Josephy H, Ilori T, Eneanya ND, Cleveland Manchanda EC, Waikar SS. Patients' Perspectives on Race and the Use of Race-Based Algorithms in Clinical Decision-Making: a Qualitative Study. J Gen Intern Med 2023; 38:2045-2051. [PMID: 36811702 PMCID: PMC9945816 DOI: 10.1007/s11606-023-08035-4] [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: 07/07/2022] [Accepted: 12/30/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Clinical algorithms that incorporate race as a modifying factor to guide clinical decision-making have recently been criticized for propagating racial bias in medicine. Equations used to calculate lung or kidney function are examples of clinical algorithms that have different diagnostic parameters depending on an individual's race. While these clinical measures have multiple implications for clinical care, patients' awareness of and their perspectives on the application of such algorithms are unknown. OBJECTIVE To examine patients' perspectives on race and the use of race-based algorithms in clinical decision-making. DESIGN Qualitative study using semi-structured interviews. PARTICIPANTS Twenty-three adult patients recruited at a safety-net hospital in Boston, MA. APPROACH Interviews were analyzed using thematic content analysis and modified grounded theory. KEY RESULTS Among the 23 study participants, 11 were women and 15 self-identified as Black or African American. Three categories of themes emerged: The first theme described definitions and the individual meanings participants ascribed to the term race. The second theme described perspectives on the role and consideration of race in clinical decision-making. Most study participants were unaware that race has been used as a modifying factor in clinical equations and rejected the incorporation of race in these equations. The third theme related to exposure to and experience of racism in healthcare settings. Experiences described by non-White participants ranged from microaggressions to overt acts of racism, including perceived racist encounters with healthcare providers. In addition, patients alluded to a deep mistrust in the healthcare system as a major barrier to equitable care. CONCLUSIONS Our findings suggest that most patients are unaware of how race has been used to make risk assessments and guide clinical care. Further research on patients' perspectives is needed to inform the development of anti-racist policies and regulatory agendas as we move forward to combat systemic racism in medicine.
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Affiliation(s)
- Insa M Schmidt
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA.
| | - Merav Shohet
- Department of Anthropology, Boston University College of Arts and Sciences, Boston, MA, USA
| | - Mariana Serrano
- UMass Memorial Health's Office for Diversity, Equity, Inclusion and Belonging, Boston, MA, USA
| | - Pranav Yadati
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
| | - Hanni Menn-Josephy
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
| | - Titilayo Ilori
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
| | - Nwamaka D Eneanya
- Division of Renal-Electrolyte and Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Global Medical Office Fresenius Medical Care, Waltham, MA, USA
| | - Emily C Cleveland Manchanda
- Department of Emergency Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Sushrut S Waikar
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
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Muruthi JR, Muruthi BA, Thompson Cañas RE, Romero L, Taiwo A, Ehlinger PP. Daily discrimination, church support, personal mastery, and psychological distress in black people in the United States. ETHNICITY & HEALTH 2023; 28:503-521. [PMID: 35733281 DOI: 10.1080/13557858.2022.2078481] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study used the stress process model to test the mediating effects of personal mastery and moderating effects of church-based social support on the relationship between daily discrimination and psychological distress across three age groups of African American and Afro-Caribbean adults. METHODS Using a national sample of 5008 African Americans and Afro-Caribbean adults from the National Survey of American Life Study, this study employs structural equation modeling to investigate the relationships between daily discrimination, personal mastery, church-based social support, and psychological distress. RESULTS Daily discrimination was an independent predictor of psychological distress across all groups. Group- and age-specific comparisons revealed significant differences in the experience of daily discrimination and psychological distress. Mastery was a partial mediator of the relationship between discrimination and psychological distress among Afro-Caribbeans while church support was a significant moderator only among the young and older African Americans. IMPLICATIONS Together, our study findings provide useful first steps towards developing interventions to reduce the adverse psychological impacts of daily discrimination on African Americans and Afro-Caribbeans. Intervention efforts such as individual psychotherapy aimed to improve Afro-Caribbean individuals' sense of mastery would be a partial solution to alleviating the adverse effects of discrimination on their psychological health.
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Affiliation(s)
- James R Muruthi
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Bertranna A Muruthi
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Reid E Thompson Cañas
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Lindsey Romero
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
| | - Abiola Taiwo
- Department of School Psychology, University of Oregon, Eugene, USA
| | - Peter P Ehlinger
- Department of Counseling Psychology and Human Services, University of Oregon, Eugene, USA
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7
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Ricci F, Torales J, Bener A, Castaldelli-Maia JM, Chumakov E, Bellomo A, Ventriglio A. Mental health of ethnic minorities: the role of racism. Int Rev Psychiatry 2023; 35:258-267. [PMID: 37267026 DOI: 10.1080/09540261.2023.2189951] [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] [Received: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 06/03/2023]
Abstract
Racism and racial discrimination heavily impact on health and mental health of ethnic minorities. In this conceptual paper and narrative review, we aim to report on relevant evidence from the international literature describing the prevalence and the qualitative aspects of mental illness due to racism and ethnic- discrimination in different settings and populations. Some variables related to racism, such as cultural, institutional, interpersonal factors, as well as the concepts of perceived and internalised racism will be described and discussed. These are relevant characteristics in the explanatory model of the relationship between racism and mental health. Epidemiological data on the prevalence of depressive and psychotic symptoms as well as substance abuse/misuse among ethnic minorities in large catchment areas, such as United States and United Kingdom, will be represented. We conclude that anti-racism policies are essential in order to address racism and racial discrimination around the world. Pluralistic societies should be promoted in order to understand mental illnesses among ethnic and cultural minorities. Also, anti-racism programs should be delivered in the educational and health-care settings and their impact evaluated.
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Affiliation(s)
- Fabiana Ricci
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, Asunción, Paraguay
| | - Abdulbari Bener
- Department of Biostatistics and Public Health, Schools of Medicine, Dentistry and Pharmacy, Istanbul Medipol University, İstanbul, Turkey
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, Brazil
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | - Egor Chumakov
- Department of Psychiatry and Addiction, St. Petersburg State University, St. Petersburg, Russia
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Oh H, Anglin DM. Discrimination, psychotic experiences, and racial identity among Black Americans: Findings from the National Survey of American Life. Schizophr Res 2023; 253:14-21. [PMID: 34312039 DOI: 10.1016/j.schres.2021.07.021] [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: 01/05/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND An emerging body of evidence suggests racial and ethnic identity may buffer the effects of discrimination on psychotic experiences, though the buffering effects have not been consistent across studies. More research is needed to clarify the conditions under which aspects of racial identity modify the effects of various forms of discrimination on psychotic experiences among Black Americans. METHODS We analyzed data from the National Survey of American Life (2001-2003). Using multivariable logistic regression, we examined the relations between various forms of discrimination and lifetime psychotic experiences, testing the interactive effects of two aspects of racial identity (racial group identification and racial private regard), adjusted for sociodemographic covariates. RESULTS The relation between everyday discrimination and psychotic experiences was stronger for African Americans who reported higher levels of racial group identification. Conversely, the relation between major discriminatory events and psychotic experiences was stronger for Caribbean Black Americans who reported lower levels of racial group identification. Higher racial private regard moderated the associations between everyday discrimination and psychotic experiences, and outgroup colorism and psychotic experiences among Caribbean Black Americans. CONCLUSION The role of racial identity is complex and appears to moderate the relation between some (but not all) forms of discrimination and lifetime psychotic experiences, depending on ethnicity.
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Affiliation(s)
- Hans Oh
- University of Southern California, Suzanne Dworak Peck School of Social Work, 1149 Hill St Suite #1422, Los Angeles, CA 90015, United States of America.
| | - Deidre M Anglin
- Department of Psychology, The City College of New York, 160 Convent Avenue, North Academic Center, New York, NY 10031, United States of America; The Graduate Center, City University of New York, 365 5th Avenue, New York, NY 10016, United States of America
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Rivera R, Capers T, Chandler M, Matthews E, Rzewinski J, Rees J, Israel S, Lushin V. Socioeconomic Stability Buffers Racial Discrimination Effect on Depression in a Marginalized Community. J Racial Ethn Health Disparities 2023; 10:130-140. [PMID: 35040107 DOI: 10.1007/s40615-021-01203-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
Depression disproportionately burdens poverty-affected minority communities. Racism and racial discrimination are well-known determinants of depression among members of marginalized minority communities. Less is known about potential buffers of the discrimination effects on depression, particularly those that could serve as targets for efficient community-based policies and interventions. Our secondary analysis of data from a community needs assessment survey (N = 677) in an urban minority neighborhood of low socio-economic status revealed that high school completion and current employment significantly weakened the association between discrimination and depression. Our findings frame community-level efforts to foster high school completion and employment as potential strategies to reduce the footprint of racism on the mental health of marginalized community members. Implications for future research and policy are discussed.
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Affiliation(s)
- Rebecca Rivera
- Long Island University Brooklyn Campus, Brooklyn, NY, USA
| | - Tracey Capers
- Bedford Stuyvesant Restoration Corporation, Brooklyn, NY, USA
| | | | | | | | - Jo Rees
- School of Health Professions, Long Island University Brooklyn Campus, Brooklyn, NY, USA
| | - Shimonah Israel
- Bedford Stuyvesant Restoration Corporation, Brooklyn, NY, USA
| | - Victor Lushin
- Long Island University Brooklyn Campus, Brooklyn, NY, USA.
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10
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The impact of systemic racism on health outcomes among Black women: Recommendations for change. Nurse Pract 2023; 48:23-32. [PMID: 36700792 DOI: 10.1097/01.npr.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
ABSTRACT Black women suffer disproportionately from healthcare inequities in comparison to their White counterparts. Using the Public Health Critical Race framework, this article explores the lasting effects of systemic racism on the health outcomes of Black women across the lifespan. A case study and specific strategies are presented to examine how clinicians, educators, and policymakers can work with Black women to mitigate and eliminate health inequities.
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Labaran RS, Johnson S, Johnson DA. The association of stress and work hours with sleep duration and insomnia symptoms among U.S.-born and Foreign-born Black adults. Sleep Health 2023; 9:56-63. [PMID: 36402727 PMCID: PMC9991989 DOI: 10.1016/j.sleh.2022.09.011] [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: 01/31/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine associations between stress and work hours with sleep duration and insomnia symptoms among U.S.-born and Foreign-born Black adults. DESIGN A cross-sectional analysis of the National Health Interview Survey. PARTICIPANTS Black adults (N = 16,315) with a mean age of 40 ± 0.1 years, mostly women (52.7%), college graduates (40.7%), and U.S.-born (82.5%). MEASUREMENTS Participants self-reported sleep duration, insomnia symptoms, frequent stress (yes/no), and work hours in the prior week (1-39 hours, 40 hours, ≥41 hours). Poisson regression with robust variance was used to test associations overall and by nativity. RESULTS Working ≥41 hours, frequent stress, and short sleep duration (<7 hours) were reported by 22%, 24.9%, and 43% of participants, respectively. U.S.-born and Foreign-born Black adults who reported frequent stress and working ≥41 hours vs. 40 hours had 60% and 19% higher prevalence of short sleep duration (adjusted prevalence ratio [aPR] = 1.60, 95% confidence interval [CI]: 1.47, 1.74 and aPR = 1.19, 95% CI: 1.12, 1.25, respectively). Foreign-born Black adults who worked 1-39 hours vs. 40 hours, had higher prevalence of short sleep duration, aPR = 1.18, 95% CI: 1.01, 1.37. U.S.-born Black adults who worked ≥41 hours vs. 40 hours had higher prevalence of insomnia symptoms (trouble falling asleep: aPR = 1.33 [95% CI: 1.13, 1.56], trouble staying asleep: aPR = 1.33 [95% CI: 1.16, 1.53]). CONCLUSION Frequent stress and working ≥41 hours are likely salient determinants of sleep health for U.S. and Foreign-born Black individuals. Further, less work hours (Foreign-born) while longer work hours (U.S.-born) were associated with short sleep duration. Stress and work hours may be factors for sleep health interventions among Black adults.
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Affiliation(s)
- Rukkayya S Labaran
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Sheroi Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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12
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Jeudin PP, Sanchez-Covarrubias AP, Thiele AR, Reis IM, Kobetz E, George SHL, Schlumbrecht MP. Differences in Cervical Cancer Outcomes by Caribbean Nativity in Black and White Women in Florida. Cancer Control 2023; 30:10732748231176642. [PMID: 37226430 PMCID: PMC10226035 DOI: 10.1177/10732748231176642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE Racial disparities among women with cervical cancer have been reported but are understudied in Caribbean immigrants. The objective of this study is to describe the disparities in clinical presentation and outcomes between Caribbean-born (CB) and US-born (USB) women with cervical cancer by race and nativity. METHODS An analysis of the Florida Cancer Data Service (FCDS), the statewide cancer registry, was performed to identify women diagnosed with invasive cervical cancer between 1981 and 2016. Women were classified as USB White or Black and CB White or Black. Clinical data were abstracted. Analyses were done using chi square, ANOVA, Kaplan-Meier and Cox proportional hazards models, with significance set at P < .05. RESULTS 14 932 women were included in the analysis. USB Black women had the lowest mean age at diagnosis, while CB Black women were diagnosed at later stages of disease. USB White women and CB White women had better OS (median OS 70.4 and 71.5 months, respectively) than USB Black and CB Black women (median OS 42.4 and 63.8 months, respectively) (P < .0001). In multivariable analysis, relative to USB Black women, CB Blacks (HR .67, CI .54-.83), and CB White (HR .66, CI .55-.79) had better odds of OS. White race among USB women was not significantly associated with improved survival (P = .087). CONCLUSION Race alone is not a determinant of cancer mortality in women with cervical cancer. Understanding the impact of nativity on cancer outcomes is crucial to improve health outcomes.
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Affiliation(s)
- Patricia P. Jeudin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Alex P. Sanchez-Covarrubias
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - Isildinha M. Reis
- Department of Public Health Services, Division of Biostatistics, University of Miami, Miami, FL, USA
| | - Erin Kobetz
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Sophia H. L. George
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Matthew P. Schlumbrecht
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
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13
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Schouler-Ocak M, Moran JK. Racial discrimination and its impact on mental health. Int Rev Psychiatry 2022:1-9. [PMID: 36519290 DOI: 10.1080/09540261.2022.2155033] [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: 12/23/2022]
Abstract
There is evidence that racial discrimination at different levels has a major impact on mental health over the whole life span. It is related generally to poor health, with the relationship being particularly strong for mental health. All forms of structural, institutionalised, interpersonal and internalised racism as well as the cumulative impact of intersectional discrimination appear to be linked to mental health and well-being. Studies also show links between effects of racial discrimination and neurophysiology especially on the brain volume. All forms of racism need to be addressed in inter- and transdisciplinary ways in order to dismantle racial discrimination. This review provides an overview of these interconnections.
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Affiliation(s)
- Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital Berlin, Berlin, Germany
| | - James Kenneth Moran
- Department of Psychiatry and Psychotherapy, Multisensory Integration Lab, Charité Universitätsmedizin Berlin, Berlin, Germany
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Bijou C, Colen CG. Shades of health: Skin color, ethnicity, and mental health among Black Americans. Soc Sci Med 2022; 313:115387. [PMID: 36223699 PMCID: PMC10731906 DOI: 10.1016/j.socscimed.2022.115387] [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: 04/25/2022] [Revised: 08/17/2022] [Accepted: 09/19/2022] [Indexed: 01/26/2023]
Abstract
Skin color is an important predictor of health outcomes among Black Americans. Black Americans with darker complexions experience worse physical and psychological functioning than those with lighter complexions. However, most research on the health effects of colorism focuses solely on African Americans, omitting the experiences of other Black subpopulations. Using data from the National Survey of American Life (NSAL), we investigate the relationship between skin color and mental health among African Americans (N = 3393) and Caribbean Blacks (N = 1378). Findings from multivariate logistic regressions reveal that Black Americans with the lightest complexions-regardless of ethnicity-report worse psychological functioning. However, the shape of the association between skin tone and mental health varies significantly based on ethnicity and the specific psychiatric outcome under study. For Caribbean Blacks, the association between skin color and any mental disorders and mood disorders is linear, while the relationship for anxiety disorders is curvilinear. For African Americans, the relationship between skin color and mental health shows an elevated risk among only those with the lightest skin tones. These results illustrate the heterogeneity within the Black community and highlight the importance of recognizing ethnicity in health disparities research.
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Affiliation(s)
- Christina Bijou
- Department of Sociology, The Ohio State University, USA; Institute for Population Research, The Ohio State University, USA.
| | - Cynthia G Colen
- Department of Sociology, The Ohio State University, USA; Institute for Population Research, The Ohio State University, USA.
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15
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Rose B, Brown E. Healing Through Authentic Connection: Utilizing Relational Cultural Therapy With Black Gay Men. JOURNAL OF LGBTQ ISSUES IN COUNSELING 2022. [DOI: 10.1080/26924951.2022.2067284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Breon Rose
- Department of Education Sciences and Professional Programs, University of Missouri - St. Louis, St. Louis MO, USA
| | - Emily Brown
- Department of Education Sciences and Professional Programs, University of Missouri - St. Louis, St. Louis MO, USA
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16
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Cénat JM. Complex Racial Trauma: Evidence, Theory, Assessment, and Treatment. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2022; 18:675-687. [PMID: 36288462 DOI: 10.1177/17456916221120428] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Racial trauma refers to experiences related to threats, prejudices, harm, shame, humiliation, and guilt associated with various types of racial discrimination, either for direct victims or witnesses. In North American, European, and colonial zeitgeist societies, Black, Indigenous, and people of color (BIPOC) experience racial microaggressions and interpersonal, institutional, and systemic racism on a repetitive, constant, inevitable, and cumulative basis. Although complex trauma differs from racial trauma in its origin, the consistency of racist victimization beyond childhood, and the internalized racism associated with it, strong similarities exist. Similar to complex trauma, racial trauma surrounds the victims’ life course and engenders consequences on their physical and mental health, behavior, cognition, relationships with others, self-concept, and social and economic life. There is no way to identify racial trauma other than through a life-course approach that captures the complex nature of individual, collective, historical, and intergenerational experiences of racism experienced by BIPOC communities in Western society. This article presents evidence for complex racial trauma (CoRT), a theoretical framework of CoRT, and guidelines for its assessment and treatment. Avenues for future research, intervention, and training are also presented.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa
- Interdisciplinary Centre for Black Health, University of Ottawa
- University of Ottawa Research on Black Health, University of Ottawa
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17
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James D. An initial framework for the study of internalized racism and health: Internalized racism as a racism‐induced identity threat response. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2022. [DOI: 10.1111/spc3.12712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Drexler James
- Department of Psychology University of Minnesota Minneapolis Minnesota USA
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18
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Mullany A, Barbieri M, Smith S, Gubrium A, Valdez LA. "Who is our real enemy?" internalized racism in the Puerto Rican diaspora and the role of political education within community health intervention. Soc Sci Med 2022; 311:115334. [PMID: 36108561 DOI: 10.1016/j.socscimed.2022.115334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 02/10/2022] [Accepted: 08/26/2022] [Indexed: 11/20/2022]
Abstract
RATIONALE Puerto Ricans experience disproportionately high levels of emotional distress and co-occurring adverse health outcomes. Our study sought to elicit Puerto Rican men's perceptions of health disparities while centering dialogue on stressors, coping mechanisms, and general well-being. This paper focuses on one pronounced finding in our study, that of internalized racism and the effect it has on both individual well-being and intra-group cohesion. A significant gap within racial health disparity work is the role of internalized racism and its connection to psychological distress, ruptures in social unity, and resulting ill-health of racial and ethnic populations. Based on this, we probed this particular finding to further understand internalized racism within this Puerto Rican population. METHODS Using a hybrid thematic analysis approach, this study presents qualitative findings from in-depth interviews with Latino (92.5% Puerto Rican) men living in Springfield, Massachusetts and conducted between October 2019 and January 2020. RESULTS Our findings reveal a duality throughout: The acceptance and propagation of negative Latinx stereotypes and consequent intragroup division exists alongside expressions of community pride and desire for Latinx unity. This duality is analyzed by using W.E.B. Du Bois's theory of double consciousness. Double consciousness not only explains the self-disparagement toward oneself and one's own racial and ethnic group, but also elucidates a liberatory pathway toward political consciousness and well-being. The concept of "second sight" within double consciousness is particularly germane, speaking to one's awakening to the learned self-subjugation imposed by White supremacy. CONCLUSIONS Internalized racism contributes to the persistent propagation of disparate health burdens in minoritized communities. Remediation can and should include community-led frameworks for the development of efficacious multilevel health interventions. The Young Lords community health activism provides such a model. These findings provide viable evidence-based examples of how the academy can synergize with community-led efforts to achieve collective agency.
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Affiliation(s)
- Anna Mullany
- Health Promotion and Policy.University of Massachusetts Amherst 715 N. Pleasant Street Amherst, MA, 01002, USA.
| | - Marielena Barbieri
- Department of Psychological and Brain Sciences 135 Hicks Way University of Massachusetts Amherst Amherst, MA, 01003, USA.
| | - Stevaughn Smith
- Health Promotion and Policy.University of Massachusetts Amherst 715 N. Pleasant Street Amherst, MA, 01002, USA.
| | - Aline Gubrium
- Health Promotion and Policy.University of Massachusetts Amherst 715 N. Pleasant Street Amherst, MA, 01002, USA.
| | - Luis A Valdez
- Health Promotion and Policy.University of Massachusetts Amherst 715 N. Pleasant Street Amherst, MA, 01002, USA.
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Abstract
There has been an increasing focus on the impact of racism both within pediatrics and throughout society as a whole. This focus has emerged as a result of the current sociopolitical climate in the United States coupled with the recent deaths of Black Americans by law enforcement and the maltreatment of Latina/o immigrants. In 2019, the American Academy of Pediatrics released the landmark policy statement "The Impact of Racism on Child and Adolescent Health," which describes the profound effects of racism on health, its function in perpetuating health disparities, and the potential role of child health professionals in addressing racism as a public health issue. (1) Foundational knowledge regarding race, racism, and their relation to health are not consistently included in standard medical education curricula. This leaves providers, including pediatricians, with varying levels of understanding regarding these concepts. This article seeks to provide an overview of the intersection of race, racism, and child/adolescent health in an effort to reduce knowledge gaps among pediatric providers with the ultimate goal of attenuating racial health disparities among children and adolescents. Please reference the Table for additional resources to reinforce concepts described throughout this article.
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Affiliation(s)
- Monique Jindal
- Department of Medicine, University of Illinois Chicago, Chicago, IL
| | - Maria Trent
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Division of Adolescent and Young Adult Medicine and
| | - Kamila B Mistry
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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20
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Ifatunji MA, Faustin Y, Lee W, Wallace D. Black Nativity and Health Disparities: A Research Paradigm for Understanding the Social Determinants of Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9166. [PMID: 35954520 PMCID: PMC9367942 DOI: 10.3390/ijerph19159166] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
Abstract
After more than a century of research and debate, the scientific community has yet to reach agreement on the principal causes of racialized disparities in population health. This debate currently centers on the degree to which "race residuals" are a result of unobserved differences in the social context or unobserved differences in population characteristics. The comparative study of native and foreign-born Black populations represents a quasi-experimental design where race is "held constant". Such studies present a unique opportunity to improve our understanding of the social determinants of population health disparities. Since native and foreign-born Black populations occupy different sociocultural locations, and since populations with greater African ancestry have greater genetic diversity, comparative studies of these populations will advance our understanding of the complex relationship between sociocultural context, population characteristics and health outcomes. Therefore, we offer a conceptual framing for the comparative study of native and foreign-born Blacks along with a review of 208 studies that compare the mental and physical health of these populations. Although there is some complexity, especially with respect to mental health, the overall pattern is that foreign-born Blacks have better health outcomes than native-born Blacks. After reviewing these studies, we conclude with suggestions for future studies in this promising area of social and medical research.
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Affiliation(s)
- Mosi Adesina Ifatunji
- Departments of African American Studies and Sociology, College of Letters and Science, University of Wisconsin at Madison, Madison, WI 53706, USA
| | - Yanica Faustin
- Department of Public Health Studies, College of Arts and Sciences, Elon University, Elon, NC 27244, USA;
| | - Wendy Lee
- Department of Sociology, College of Letters and Science, University of Wisconsin at Madison, Madison, WI 54706, USA;
| | - Deshira Wallace
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
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21
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McCall CS, Romero ME, Yang W, Weigand T. A Call for Equity-Focused Social-Emotional Learning. SCHOOL PSYCHOLOGY REVIEW 2022. [DOI: 10.1080/2372966x.2022.2093125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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22
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Racism and the Reproductive Health Experiences of U.S.-Born Black Women. Obstet Gynecol 2022; 139:407-416. [PMID: 35115434 DOI: 10.1097/aog.0000000000004675] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/18/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To explore Black women's lived experiences of racism and the associated effects on reproductive health decisions and the reproductive health care experience. METHODS We recruited participants through social media and community outreach. We conducted semi-structured individual interviews focusing on Black women's lived experiences of racism and their effects on reproductive health. We coded and analyzed interview transcripts using process coding methodology. RESULTS Participants (N=21) were 21-45 years old and from Boston, Chicago, and Atlanta. Our primary themes were: 1) reproductive health racism across the life course, 2) anti-Black racism in the reproductive health care system, and 3) self-protective actions when interacting with the reproductive health care system. Reproductive racism across the life course included subthemes of early sexualization of Black women, heightened awareness of reproductive health inequities, and knowledge of reproductive oppression. Anti-Black racism in the reproductive health care system included subthemes of absence of shared decision making; vicarious reproductive health experiences; stereotyping, invalidation, and dismissal by reproductive health professionals; and medical mistrust. Participants guarded themselves against racism within reproductive health care by engaging in a variety of self-protective actions including seeking a health care professional of color, overpreparing for their appointments, enlisting advocates, seeking care only when desperate, and heightening symptoms to be heard. CONCLUSION Personal, vicarious, and historical experiences of racism within reproductive health care triggered participants to perform self-protective actions when interacting with the reproductive health care system. These actions served to promote safety, autonomy and rehumanization within a system that has historically and contemporarily devalued Black reproductive health.
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23
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Khatri UG, Delgado MK, South E, Friedman A. Racial Disparities in the Management of Emergency Department Patients Presenting with Psychiatric Disorders. Ann Epidemiol 2022; 69:9-16. [DOI: 10.1016/j.annepidem.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/23/2021] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
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24
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Robinson MA, Kim I, Mowbray O, Disney L. African Americans, Caribbean Blacks and Depression: Which Biopsychosocial Factors Should Social Workers Focus On? Results from the National Survey of American Life (NSAL). Community Ment Health J 2022; 58:366-375. [PMID: 33963456 PMCID: PMC10784325 DOI: 10.1007/s10597-021-00833-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/28/2021] [Indexed: 11/27/2022]
Abstract
Research suggests that African Americans may be more likely to experience depression, especially severe depression, than other racial or ethnic groups in the United States. Overall there is scant research comparing the relationship between ethnicity and depression among the U.S. Black population. The purpose of this study is to identify the most significant biopsychosocial factors social workers can address in the prevention and treatment of depression in African American and first generations Caribbean Black clients. Data was from the National Survey of American Life (NSAL). Bivariate associations showed that respondents who reported higher self-esteem, lower hopelessness, higher sense of mastery, and lower discrimination showed lower likelihood of having Major Depressive Disorder (MDD). The logistic regression model suggested that respondents who have ever had a chronic disease were more likely to report depression than those who have not ever had a chronic disease. Caribbean Blacks were more likely to report depression compared to African Americans. Additionally, respondents who reported higher discrimination scores were more likely to report depression. This study suggests that social workers should embrace the interconnectedness and holistic approach of the biopsychosocial model in their case conceptualizations, prevention strategies, and treatment modalities.
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Affiliation(s)
- Michael A Robinson
- School of Social Work, University of Georgia, 279 Williams St., Athens, GA, 30602, USA.
| | - Irang Kim
- Tulane University, New Orleans, LA, 70112, USA
| | - Orion Mowbray
- School of Social Work, University of Georgia, 279 Williams St., Athens, GA, 30602, USA
| | - Lindsey Disney
- The University at Albany, 1400 Washington Ave, Albany, NY, 12222, USA
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25
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Letang SK, Lin SSH, Parmelee PA, McDonough IM. Ethnoracial disparities in cognition are associated with multiple socioeconomic status-stress pathways. Cogn Res Princ Implic 2021; 6:64. [PMID: 34626254 PMCID: PMC8502192 DOI: 10.1186/s41235-021-00329-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022] Open
Abstract
Systemic racism can have broad impacts on health in ethnoracial minorities. One way is by suppressing socioeconomic status (SES) levels through barriers to achieve higher income, wealth, and educational attainment. Additionally, the weathering hypothesis proposes that the various stressful adversities faced by ethnoracial minorities lead to greater wear and tear on the body, known as allostatic load. In the present study, we extend these ideas to cognitive health in a tri-ethnic sample of young adults-when cognition and brain health is arguably at their peak. Specifically, we tested competing mediation models that might shed light on how two key factors caused by systemic racism-SES and perceived stress-intersect to explain ethnoracial disparities in cognition. We found evidence for partial mediation via a pathway from SES to stress on episodic memory, working memory capacity, and executive function in Black Americans relative to non-Hispanic White Americans. Additionally, we found that stress partially mediated the ethnoracial disparities in working memory updating for lower SES Black and Hispanic Americans relative to non-Hispanic White Americans, showing that higher SES can sometimes reduce the negative effects stress has on these disparities in some cognitive domains. Overall, these findings suggest that multiple pathways exist in which lower SES creates a stressful environment to impact ethnoracial disparities cognition. These pathways differ depending on the specific ethnoracial category and cognitive domain. The present results may offer insight into strategies to help mitigate the late-life risk for neurocognitive disorders in ethnoracial minorities.
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Affiliation(s)
- Sarah K Letang
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, BOX 870348, Tuscaloosa, AL, 35487, USA
| | - Shayne S-H Lin
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, BOX 870348, Tuscaloosa, AL, 35487, USA
| | - Patricia A Parmelee
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, BOX 870348, Tuscaloosa, AL, 35487, USA
- Alabama Research Institute on Aging, Tuscaloosa, USA
| | - Ian M McDonough
- Department of Psychology, The University of Alabama, 505 Hackberry Lane, BOX 870348, Tuscaloosa, AL, 35487, USA.
- Alabama Research Institute on Aging, Tuscaloosa, USA.
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26
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Smith NC. Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors. SOCIAL SCIENCE RESEARCH 2021; 99:102593. [PMID: 34429206 DOI: 10.1016/j.ssresearch.2021.102593] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 05/18/2023]
Abstract
Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.
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Affiliation(s)
- Nicholas C Smith
- Indiana University - Bloomington, Department of Sociology Ballantine Hall 744, 1020 East Kirkwood Avenue Bloomington, IN, 47405, USA.
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27
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Willis HA, Sosoo EE, Bernard DL, Neal A, Neblett EW. The Associations Between Internalized Racism, Racial Identity, and Psychological Distress. EMERGING ADULTHOOD (PRINT) 2021; 9:384-400. [PMID: 34395061 PMCID: PMC8356901 DOI: 10.1177/21676968211005598] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Internalized racism, or the acceptance of negative stereotypes about one's own racial group, is associated with psychological distress; yet, few studies have explored the longitudinal impact of internalized racism on the psychological well-being of African American emerging adults. Furthermore, racial identity's role as a protective factor in the context of internalized racism remains unclear. This study examined the longitudinal impact of internalized racism on psychological distress (depressive and anxiety symptoms) and the moderating role of racial identity beliefs among 171 African American emerging adults. Full cross-lagged panel models revealed no main effects of internalized racism beliefs on psychological distress. However, several racial identity beliefs moderated the relationship between internalized racism beliefs and changes in psychological distress over a year later. Initial levels of alteration of physical appearance, internalization of negative stereotypes, and hair change internalized racism beliefs were related to subsequent psychological distress, but only for those with certain levels of racial centrality, private regard, public regard, and assimilationist, humanist, and nationalist ideology beliefs. These findings suggest that, over time, internalized racism and racial identity beliefs can combine to influence the psychological well-being of African American emerging adults.
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28
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Keum BT, Ahn LH. Impact of online racism on psychological distress and alcohol use severity: Testing ethnic-racial socialization and silence about race as moderators. COMPUTERS IN HUMAN BEHAVIOR 2021. [DOI: 10.1016/j.chb.2021.106773] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Conroy K, Frech N, Sanchez AL, Hagan MB, Bagner DM, Comer JS. Caregiver stress and cultural identity in families of preschoolers with developmental delay and behavioral problems. Infant Ment Health J 2021; 42:573-585. [PMID: 33961711 PMCID: PMC8363575 DOI: 10.1002/imhj.21923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Research on families of young children with developmental delay and disruptive behavior problems has failed to examine caregiver stress in the context of cultural factors. METHODS Families of 3-year-old children with developmental delay and behavior problems were recruited from Early Intervention sites. All caregivers in the current analysis (n = 147) were from immigrant and/or cultural minority backgrounds. Regarding income-to-needs, most families (57.8%) fell into the extreme poverty, poor, or low-income categories. Caregivers reported on their own experiences of acculturation and enculturation as well as their child's problems. RESULTS Path analyses revealed that higher caregiver acculturation was associated with less parenting-specific stress, and higher caregiver enculturation was associated with less caregiver general stress. Severity of child problems was associated with more parenting-specific stress and general stress. Exploratory analysis yielded significant differences in associations between acculturation, enculturation, and caregiver stress in Black/African American caregivers versus Hispanic White caregivers. CONCLUSION Findings suggest that among cultural minority caregivers of young children with developmental and behavioral problems, acculturation and enculturation may influence caregiver stress. While the cross-sectional nature of the study precludes causal conclusions, clinicians should consider how cultural factors can be harnessed to strengthen caregiver resiliency and improve engagement in parenting interventions.
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Affiliation(s)
- Kristina Conroy
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Natalie Frech
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Amanda L. Sanchez
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary B. Hagan
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Daniel M. Bagner
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Jonathan S. Comer
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
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Schouler-Ocak M, Bhugra D, Kastrup MC, Dom G, Heinz A, Küey L, Gorwood P. Racism and mental health and the role of mental health professionals. Eur Psychiatry 2021; 64:e42. [PMID: 34134809 PMCID: PMC8278246 DOI: 10.1192/j.eurpsy.2021.2216] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
The concept of "race" and consequently of racism is not a recent phenomenon, although it had profound effects on the lives of populations over the last several hundred years. Using slaves and indentured labor from racial groups designated to be "the others," who was seen as inferior and thus did not deserve privileges, and who were often deprived of the right to life and basic needs as well as freedoms. Thus, creation of "the other" on the basis of physical characteristics and dehumanizing them became more prominent. Racism is significantly related to poor health, including mental health. The impact of racism in psychiatric research and clinical practice is not sufficiently investigated. Findings clearly show that the concept of "race" is genetically incorrect. Therefore, the implicit racism that underlies many established "scientific" paradigms need be changed. Furthermore, to overcome the internalized, interpersonal, and institutional racism, the impact of racism on health and on mental health must be an integral part of educational curricula, from undergraduate levels through continuing professional development, clinical work, and research. In awareness of the consequences of racism at all levels (micro, meso, and macro), recommendations for clinicians, policymakers, and researchers are worked out.
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Affiliation(s)
- M. Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - D. Bhugra
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - M. C. Kastrup
- Specialist in Psychiatryformer Treasurer World Association Social Psychiatryformer Secretary General European Psychiatric Associationformer Member Executive Committee World Psychiatric Association Copenhagen, Denmark
| | - G. Dom
- CAPRI, University of Antwerp (UAntwerp), Antwerp, Belgium
| | - A. Heinz
- Department for Psychiatry and Psychotherapy, CCM, Charité—University Medicine, Berlin, Germany
| | - L. Küey
- Istanbul Bilgi University, Istanbul, Turkey
| | - P. Gorwood
- CMME, Hopital Sainte-Anne GHU Paris Psychiatrie et Neurosciences Université de Paris, INSERM U894, Paris, France
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31
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Kline EA, Warner CM, Grapin SL, Reyes-Portillo JA, Bixter MT, Cunningham DJ, Mahmud F, Singh T, Weeks C. The Relationship Between Social Anxiety and Internalized Racism in Black Young Adults. J Cogn Psychother 2021; 35:JCPSY-D-20-00030. [PMID: 33397783 DOI: 10.1891/jcpsy-d-20-00030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The study examined the relationships between social anxiety (SA), generalized anxiety (GA), and depression with racial microaggressions and internalized racism (IR) among Black young adults. Given SA's core features, we expected it to have a unique association with IR, and to moderate the connection between racial microaggressions and IR. Participants were 182 Black university students who completed measures of SA, GA, depressive symptoms, racial microaggressions, and IR. Linear regression models indicated that IR was a significant predictor of SA, but not GA or depression. Racial microaggressions were only positively associated with depressive symptoms. SA and racial microaggressions each predicted IR, but no interaction was found. Black young adults with elevated concerns of others' evaluation may be more prone to accepting negative stereotypes about one's racial group.
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Affiliation(s)
| | - Carrie Masia Warner
- Montclair State University, Montclair, NJ and Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
| | | | | | | | | | | | | | - Cody Weeks
- Montclair State University, Montclair, NJ
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Brown TN, Solazzo A, Gorman BK. "Yes We Can!" The Mental Health Significance for U.S. Black Adults of Barack Obama's 2008 Presidential Election. SOCIOLOGY OF RACE AND ETHNICITY (THOUSAND OAKS, CALIF.) 2021; 7:101-115. [PMID: 34084872 PMCID: PMC8168787 DOI: 10.1177/2332649220911387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study examines the mental health significance of Barack Obama's 2008 presidential election for black adults. His election was a milestone moment. Hence, we expect black adults would experience improved mental health after the first self-identified black person wins election to the most powerful position in the United States. Using nationally representative survey data from the Behavioral Risk Factor Surveillance System (BRFSS), we address this expectation by predicting poor mental health days that black adults report pre-election and post-election. We find no overall difference in poor mental health days between the time periods. However, a statistical interaction between gender and time period demonstrates black men report 1.01 fewer poor mental health days after the election, whereas black women report .45 more poor mental health days after the election.
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Sosoo EE, Bernard DL, Neblett EW. The influence of internalized racism on the relationship between discrimination and anxiety. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2020; 26:570-580. [PMID: 31886684 PMCID: PMC7359777 DOI: 10.1037/cdp0000320] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES This study used 2 waves of data to longitudinally examine whether internalized racism moderated the association between racial discrimination and anxiety symptom distress. METHOD Participants were 157 Black college students attending a predominantly White institution who completed measures of racial discrimination, internalized racism, and psychological distress. RESULTS Using hierarchical linear regression, results indicated a positive association between racial discrimination and subsequent anxiety symptom distress for individuals with moderate and high levels of internalization of negative stereotypes and hair change. CONCLUSIONS Findings suggest that experiences of anxiety symptom distress, in the context of racial discrimination, may differ as a function of one's acceptance and internalization of dominant White culture's actions and beliefs toward Black people. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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A CBT Approach to Internalized Racism among African Americans. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2020. [DOI: 10.1007/s10447-020-09402-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Novak P, Chu J, Ali MM, Chen J. Racial and Ethnic Disparities in Serious Psychological Distress Among Those With Alzheimer's Disease and Related Dementias. Am J Geriatr Psychiatry 2020; 28:478-490. [PMID: 31500897 PMCID: PMC7021571 DOI: 10.1016/j.jagp.2019.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Alzheimer's disease and related dementias (ADRD) is a growing public health challenge. Prior research suggests that non-Hispanic whites (whites), non-Hispanic African Americans (African Americans), and Hispanics have differing risks for ADRD. OBJECTIVE To examine the existence of serious psychological distress (SPD) among whites, African Americans, and Hispanics; to calculate the predicted probability of ADRD in whites, African Americans, and Hispanics, and to decompose the differences among ADRD populations, quantifying the burden of higher SPD among African Americans and Hispanics, compared to whites. DATA AND METHOD The authors use nationally representative data from the Medical Expenditure Panel Survey (2007-2015) to estimate the association between ADRD and race, ethnicity, and SPD. Using Blinder-Oaxaca decomposition analysis, the authors estimate to what extent higher SPD among Hispanics and African Americans was associated with higher ADRD rates compared to whites. RESULTS After controlling for individuals' demographic and socioeconomic characteristics and co-existing medical conditions, the presence of SPD was still significantly associated with a higher likelihood of having ADRD. The model predicted significantly higher likelihood of having ADRD among African Americans (7.1%) and Hispanics (5.7%) compared to whites (4.5%). Higher rates of having SPD among African Americans explained 15% of white-black difference and 40% of the white-Hispanic difference in ADRD rates, respectively. DISCUSSION AND CONCLUSION Our findings suggest a significant relationship between SPD and ADRD and that the burden of SPD was greater among African Americans and Hispanics with ADRD. Efficient screening using self-reported SPD, compared to simply using diagnoses codes of mental illness, may be more helpful to reduce racial and ethnic disparities in ADRD.
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Affiliation(s)
- Priscilla Novak
- Department of Health Policy and Management (PN), University of Maryland College Park, School of Public Health, College Park, MD.
| | - Jun Chu
- University of Maryland College Park
| | - Mir M. Ali
- University of Maryland College Park, AND U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation
| | - Jie Chen
- University of Maryland College Park
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Gale MM, Pieterse AL, Lee DL, Huynh K, Powell S, Kirkinis K. A Meta-Analysis of the Relationship Between Internalized Racial Oppression and Health-Related Outcomes. COUNSELING PSYCHOLOGIST 2020. [DOI: 10.1177/0011000020904454] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Internalized racism represents a critical component of the system of racial oppression wherein People of Color adopt the negative beliefs about their race held by members of the White majority group. In this meta-analysis, the authors reviewed 29 studies (32 effect sizes) on the relationships between internalized racism and negative physical and mental health outcomes published between 1999 and 2015 and tested for literature-driven moderator effects using subgroup analyses. Results suggested that the direct overall relation between internalized racism and health was strongest for negative mental health outcomes ( r = .26), followed by negative physical health outcomes ( r = .11). Significant moderator effects were found for scale of measurement, country of sample (United States vs. international), and sampling method. Moderator effects of gender, publication type, year, and sample setting were not statistically significant. These findings are discussed and their implications for practice, advocacy, education/training, and research are described.
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Affiliation(s)
| | | | | | - Kiet Huynh
- University of Miami, Coral Gables, FL, USA
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James D. Health and Health-Related Correlates of Internalized Racism Among Racial/Ethnic Minorities: a Review of the Literature. J Racial Ethn Health Disparities 2020; 7:785-806. [DOI: 10.1007/s40615-020-00726-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/30/2020] [Accepted: 02/09/2020] [Indexed: 10/25/2022]
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Amuta-Jimenez AO, Jacobs W, Smith G. Health Disparities and the Heterogeneity of Blacks/African Americans in the United States: Why Should We Care? Health Promot Pract 2019; 21:492-495. [PMID: 31876190 DOI: 10.1177/1524839919895507] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Each year, millions of dollars are spent on research and public health interventions targeted toward reducing health disparities primarily among the "Black/African Americans" community, yet the progress made lags far behind the amount of money and effort spent. We hypothesize that part of the problem is that sociocultural factors play a significant role in disease prevention. Most studies and programs aggregate "Black immigrants" (BIs) and "African Americans" (AAs) as "Black/African American." This categorization assumes that the sociocultural determinants that influence BIs are the same as for AAs. BIs have health and mortality profiles that vary from AAs. This commentary aims to (1) introduce this idea in more depth and provide a brief scope of the problem, (2) provide scientific evidence of noteworthy differences between AAs and BIs in areas of sociodemographics, health behaviors, and health outcomes, (3) discuss implications of considering the Black/AA group as homogeneous and provide recommendations for disaggregation.
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Affiliation(s)
| | - Wura Jacobs
- California State University Stanislaus, Turlock, CA, USA
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Krieger N. Measures of Racism, Sexism, Heterosexism, and Gender Binarism for Health Equity Research: From Structural Injustice to Embodied Harm-An Ecosocial Analysis. Annu Rev Public Health 2019; 41:37-62. [PMID: 31765272 DOI: 10.1146/annurev-publhealth-040119-094017] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Racism. Sexism. Heterosexism. Gender binarism. Together, they comprise intimately harmful, distinct, and entangled societal systems of self-serving domination and privilege that structure the embodiment of health inequities. Guided by the ecosocial theory of disease distribution, I synthesize key features of the specified "isms" and provide a measurement schema, informed by research from both the Global North and the Global South. Metrics discussed include (a) structural, including explicit rules and laws, nonexplicit rules and laws, and area-based or institutional nonrule measures; and (b) individual-level (exposures and internalized) measures, including explicit self-report, implicit, and experimental. Recommendations include (a) expanding the use of structural measures to extend beyond the current primary emphasis on psychosocial individual-level measures; (b) analyzing exposure in relation to both life course and historical generation; (c) developing measures of anti-isms; and (d) developing terrestrially grounded measures that can reveal links between the structural drivers of unjust isms and their toll on environmental degradation, climate change, and health inequities.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
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Dixon S. Intersectionality of Cultural Identities in Health Psychology: Key Recommendations for Working With African-Caribbean Immigrant Women. FRONTIERS IN SOCIOLOGY 2019; 4:51. [PMID: 33869374 PMCID: PMC8022647 DOI: 10.3389/fsoc.2019.00051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/03/2019] [Indexed: 06/12/2023]
Abstract
While the field of health psychology has progressed over the years, much work still needs to be done when considering immigrants' health care and well-being. Particularly, for African-Caribbean immigrants, the intersectionality of their cultural identities in the health care system require much attention moving forward. Therefore, this article is particularly relevant for Canada's multicultural society; it describes cultural identity reconstruction within health psychology as a common issue for diverse groups, particularly African-Caribbean immigrant women. The article speaks to the holistic worldview that is required in a paradigm shift which engages a pluralistic society that is Canada. The author presents a key cultural identity model and assessment tool that should be integrated into the health care system to ensure culturally-sensitive and inclusive care for immigrants, especially women. As is argued in the article, contemporary research, advocacy, and social movements speak to invoking alternative ways to complement the prevailing downstream approach to health psychology. In a growing multicultural society that should strive on honoring and respecting the pluralistic cultural worldviews of all people in the health care system, many immigrant women struggle to cope with the social determinants of health post-migration. Their concerns are often pushed to the margins of health care services, with several individuals relying on their faith for coping strategies. This article concludes with culturally-informed and socially-just recommendations for health care professionals working with immigrant populations, particularly African Caribbean immigrant women.
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Affiliation(s)
- Sandra Dixon
- Faculty of Education, University of Lethbridge, Lethbridge, AB, Canada
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Amuta-Jimenez AO, Cisse-Egbounye N, Jacobs W, Smith GPA. Two Peas in a Pod? An Exploratory Examination Into Cancer-Related Psychosocial Characteristics and Health Behaviors Among Black Immigrants and African Americans. HEALTH EDUCATION & BEHAVIOR 2019; 46:1035-1044. [PMID: 31257933 DOI: 10.1177/1090198119859399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. Most studies lump Black immigrants (BIs) and African Americans (AAs) as "Black/African American" during investigation. Such categorization assumes that the sociocultural determinants that influence BIs are the same as for AAs. This study attempts to disentangle the AA and BI subgroups to recognize the differences in cancer-related psychosocial characteristics and health behaviors. Methods. Merged data from the Health Information National Survey (2011-2017) were used. Two groups were created: those who identified as AA and those who identified as AA but were born outside the United States (BI). Between-group differences were assessed with Mann-Whitney U and chi-square tests. Results. Positive communication patterns with health care providers were significantly higher among AAs (M [mean] = 3.41, SD [standard deviation] = 0.68) compared with BIs (M = 3.28, SD = 0.71) (p = .004). A greater proportion of BIs indicated that their health was excellent (14.2%), compared with AAs (7.9%). AAs reported higher cancer family history (75.1%) than BIs (46.5%). More AAs had smoked at least 100 cigarettes in their lifetime (41.5%) than BIs (16.7%). BIs consumed significantly more fruits each day (M = 2.77, SD = 1.43) than AAs (M = 2.40, SD = 1.44) (p < .001). BIs also reported more physical activity (M = 2.62, SD = 2.15) than AAs (M = 2.37, SD = 2.18) (p = .030). AA women were more likely to have had a pap smear test (M = 2.07, SD = 1.44) compared with BI women (M = 1.73, SD = 1.21) (p = .002). Discussion. Evidence suggests the need to disentangle the "Black/African American" ethnic grouping. Lumping the BI populations together with the AAs, who have been in the United States for generations, may limit the ability to uncover and consequently address culturally driven disease prevention efforts and promote understanding of the biological, environmental, and psychosocial risk factors within Black heterogeneous populations.
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Affiliation(s)
| | | | - Wura Jacobs
- California State University Stanislaus, Turlock, CA, USA
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Thomas SC, Umer A, Commodore-Mensah Y, Davidov D, Abildso CG. Length of Residence and Cardiovascular Health among Afro-Caribbean Immigrants in New York City. J Racial Ethn Health Disparities 2019; 6:487-496. [PMID: 30547300 PMCID: PMC6500463 DOI: 10.1007/s40615-018-00547-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/31/2018] [Accepted: 11/22/2018] [Indexed: 01/16/2023]
Abstract
Cardiovascular disease (CVD) disproportionately affects non-Hispanic blacks (NHB) in the United States (U.S.). Afro-Caribbean (AC) immigrants comprise over 50% of the immigrant black population and are critical in understanding the health trajectories of blacks in the U.S. We assessed the relationship between length of residence (proxy measure for acculturation) and cardiovascular health (CVH) based on the American Heart Association's (AHA) seven ideal cardiovascular health components among AC immigrants in New York City (NYC). CVH scores were categorized into poor/intermediate CVH (0-3 components) or ideal CVH (≥ 4 components). Multivariable logistic regression was used to examine the association between length of residence in the U.S. and poor/intermediate CVH. In adjusted models, the odds of poor/intermediate CVH were significantly higher for Guyanese (OR = 3.51; 95% CI 1.03-11.95) and Haitian immigrants (OR = 8.02; 95% CI 1.88-34.12) residing in the U.S. for ≥ 10 years than for those living in the U.S. for < 10 years. Length of residence was not significantly associated with CVH among Jamaican immigrants. We found evidence of ethnic differences in the association between acculturation and CVH among AC immigrants in a major metropolitan city. Culturally tailored interventions are needed to improve the CVH of AC immigrants as they become integrated into the U.S., with special consideration of country of birth.
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Affiliation(s)
- Sabena C Thomas
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506-9190, USA
| | - Amna Umer
- Department of Pediatrics, West Virginia University School of Medicine, 64 Medical Center Drive, P.O. Box 9214, Morgantown, WV, 26506-9214, USA
| | | | - Danielle Davidov
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506-9190, USA
| | - Christiaan G Abildso
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26506-9190, USA.
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Moon H, Badana ANS, Hwang SY, Sears JS, Haley WE. Dementia Prevalence in Older Adults: Variation by Race/Ethnicity and Immigrant Status. Am J Geriatr Psychiatry 2019; 27:241-250. [PMID: 30573327 DOI: 10.1016/j.jagp.2018.11.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/26/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine differences in prevalence and risk factors of dementia by race/ethnicity and immigrant status using a nationally representative sample of Medicare beneficiaries. METHODS This was a cross-sectional study performed in the United States among non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and other Medicare beneficiaries from round 1 of the National Health and Aging Trends Study (N = 7,609). The authors used log-binomial regression analyses to investigate risk factors and interactions between race/ethnicity and immigrant status and dementia. Stratified log-binomial regression analyses by race/ethnicity were used to interpret the results of interaction effects of immigrant status found in these surveys. Analyses were conducted in three forms: probable dementia versus possible and no dementia, probable and possible dementia versus no dementia; and probable dementia versus no dementia. RESULTS Consistent with previous studies, U.S.-born NHBs have a higher prevalence of dementia than U.S.-born whites, Hispanics, and others. Immigrant status moderated the relationship between race/ethnicity and dementia. NHWs, Hispanics, and other immigrants had a higher prevalence of dementia compared with their U.S.-born counterparts. However, U.S.-born NHBs had a higher prevalence of dementia compared with NHB immigrants. Results were consistent across the three forms of analysis. Greater age predicted higher dementia across the four racial/ethnic groups. CONCLUSION Immigrant status may have complex effects on dementia risk. Selection factors affecting immigration-varied health and educational systems in diverse countries of origin, acculturative stress, and validity of dementia assessment across diverse groups-deserve further attention.
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Affiliation(s)
- Heehyul Moon
- Raymond A. Kent School of Social Work (HM, JSS), University of Louisville, Louisville.
| | - Adrian N S Badana
- the School of Aging Studies (ANSB, WEH), University of South Florida, Tampa, FL
| | - So-Yeon Hwang
- Department of Social Welfare (SH), Seoul National University, Seoul, South Korea
| | - Jeanelle S Sears
- Raymond A. Kent School of Social Work (HM, JSS), University of Louisville, Louisville
| | - William E Haley
- the School of Aging Studies (ANSB, WEH), University of South Florida, Tampa, FL
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Williams DR. Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-related Stressors. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2018; 59:466-485. [PMID: 30484715 PMCID: PMC6532404 DOI: 10.1177/0022146518814251] [Citation(s) in RCA: 418] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This article provides an overview of research on race-related stressors that can affect the mental health of socially disadvantaged racial and ethnic populations. It begins by reviewing the research on self-reported discrimination and mental health. Although discrimination is the most studied aspect of racism, racism can also affect mental health through structural/institutional mechanisms and racism that is deeply embedded in the larger culture. Key priorities for research include more systematic attention to stress proliferation processes due to institutional racism, the assessment of stressful experiences linked to natural or manmade environmental crises, documenting and understanding the health effects of hostility against immigrants and people of color, cataloguing and quantifying protective resources, and enhancing our understanding of the complex association between physical and mental health.
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Affiliation(s)
- David R Williams
- 1 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- 2 Department of African and African American Studies and of Sociology, Harvard University, Cambridge, MA, USA
- 3 Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Doll KM. Investigating Black-White disparities in gynecologic oncology: Theories, conceptual models, and applications. Gynecol Oncol 2018; 149:78-83. [PMID: 29605054 DOI: 10.1016/j.ygyno.2017.10.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/22/2017] [Accepted: 10/02/2017] [Indexed: 10/17/2022]
Abstract
Within gynecologic oncology are two of the top five widest Black-White mortality gaps among all cancer diagnoses in the United States. A rich body of work from the social sciences, including anthropology, sociology and social epidemiology, have broadened the understanding of and research approaches to the study of health and healthcare inequity experienced by Black Americans. Yet, these intellectual advancements in understanding are virtually absent from the gynecologic oncology literature. The goal of this analytic essay will be to introduce three current frameworks of studying racial inequity: The Ecosocial Theory of Disease Distribution, The Fundamental Cause Theory, and The Public Health Critical Race Praxis. Applications of each conceptual model to gynecologic oncology are illustrated. The Ecosocial Theory, in particular the concept of embodiment, can be used to design and interpret racial differences in molecular and genetic studies. The Fundamental Cause Theory explains the relationship of socioeconomic position with the evolving treatability of a given disease over time, and provides understanding to the contrast in racial disparities within ovarian, endometrial, and cervical cancers. The Public Health Critical Race Praxis is an iterative methodology that helps frame how to study the impact of racism on healthcare delivery. Different analytic approaches that account for the interaction of race and socioeconomic factors are reviewed. Finally, considerations for racial equity research in gynecologic oncology are proposed.
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Affiliation(s)
- Kemi M Doll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, University of Washington, United States; Seattle Cancer Care Alliance, United States.
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46
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Hopkins PD, Shook NJ. A review of sociocultural factors that may underlie differences in African American and European American anxiety. J Anxiety Disord 2017; 49:104-113. [PMID: 28494387 DOI: 10.1016/j.janxdis.2017.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 04/10/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022]
Abstract
Preliminary evidence indicates there may be differences in the prevalence and severity of anxiety in African Americans and European Americans. A number of sociocultural risk and protective factors have been suggested to contribute to these group differences, such as salience of physical illnesses, discrimination, stigma toward mental illness, religiosity, and ethnic identity. In this paper, the literature concerning each of these factors is reviewed. Overall, the strongest evidence was found for ethnic identity and stigma toward mental illness as factors underlying group differences in anxiety. Ethnic identity and stigma toward mental illness consistently differed by racial group and were associated with anxiety in African Americans. Ethnic identity may buffer against the negative consequences of anxiety, reducing prevalence rates in African Americans. Stigma toward mental illness may decrease African Americans willingness to report anxiety symptoms, reducing overall prevalence rates but increasing the severity of treated cases. The research regarding discrimination, salience of physical illnesses, and religiosity was less clear. Much more research is required, but the findings of this review suggest that future studies should put particular emphasis on stigma toward mental illness and ethnic identity as important factors in understanding African American anxiety outcomes.
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