The Cost of Color: Skin Color, Discrimination, and Health among African-Americans

Mental Health across the Early Life Course at the Intersection of Race, Skin Tone, and School Racial Context

Prior research documents higher levels of depressive symptoms among Black Americans relative to Whites. Yet, we know less about the role of other dimensions of stratification (e.g., skin tone) in shaping mental health inequality between Black and White adults, and whether mental health trajectories by race and skin tone among Black adults are contingent upon social contexts in childhood and adolescence. To address these gaps, this study asks: 1) to what extent do self-identified race and interviewer-rated skin tone among Black respondents shape inequalities in depressive symptoms between Black and White Americans across ages 12-42? 2) Are trajectories of depressive symptoms by race and skin tone among Black respondents contingent on school racial contexts (e.g., school racial composition)? Using five waves of data from the National Longitudinal Study of Adolescent to Adult Health and growth curve models, results suggest trajectories of depressive symptoms across ages 12-42 vary by race, school racial context, and skin tone among Black respondents. Specifically, Black students rated as having very dark, dark, and medium brown skin who attended high proportion Black schools in adolescence experienced lower levels of depressive symptoms than their White and light-skinned Black counterparts, particularly across the teen years and early 20s. Conversely, attending higher proportion White schools led to increases in depressive symptoms across earlier ages for Black students, particularly those who fell within the middle of the skin color continuum. Findings highlight competing advantages and disadvantages of navigating racialized spaces in childhood/adolescence for Black Americans of different skin tones.

The economic and social costs of body dissatisfaction and appearance-based discrimination in the United States

This study estimated the social and economic costs of body dissatisfaction and appearance-based discrimination (specifically, weight and skin-shade discrimination) in the United States (USA) in the 2019 calendar year. We used a prevalence-based approach and a cost-of-illness method to estimate the annual cost of harmful appearance ideals for cases of body dissatisfaction and discrimination based on weight and skin shade. Impacts on conditions/illnesses such as eating disorders that are attributable to body dissatisfaction, weight discrimination and skin-shade discrimination were identified through a quasi-systematic literature review, which captured financial, economic, and non-financial costs. For each impact attributable to body dissatisfaction or appearance-based discrimination, annual health system and productivity costs (or labor market costs) were primarily estimated by using a population attributable fraction methodology. Only direct costs that resulted from body dissatisfaction and appearance-based discrimination were included (for example, costs associated with conditions such as depression attributable to body dissatisfaction or appearance-based discrimination). In contrast, indirect costs (e.g. costs associated with a health condition developed following skin bleaching, which was undertaken as a result of body dissatisfaction) were not included. In 2019 body dissatisfaction incurred $84 billion in financial and economic costs and $221 billion through reduced well-being. Financial costs of weight discrimination and skin-shade discrimination were estimated to be $200 billion and $63 billion, respectively, and reduced well-being was estimated to be $206.7 billion due to weight discrimination and $8.4 billion due to skin-shade discrimination. Sensitivity testing revealed the costs likely range between $226 billion and $507 billion for body dissatisfaction, between $175 billion and $537 billion for skin-shade discrimination, and between $126 billion and $265 billion for weight discrimination. This study demonstrates that the prevalence and economic costs of body dissatisfaction and weight and skin-shade discrimination are substantial, which underscores the urgency of identifying policy actions designed to promote prevention.

A multisystem model for understanding stress and adaptation in ethnically and racially diverse youth

Contemporary biological and contextually based theoretical frameworks have conceptualized how stress exposure may influence adaptation in youth. However, nearly all of this scholarship neglects the role of specific contextual features and/or biological processes that are involved in ethnic-racial minority youth's responses and adaptation to sociocultural stressors. Drawing on the theoretical principles of the developmental psychopathology framework and contemporary models of stress and adaptation, this article proposes a new multisystem model that explains how multiple levels and systems within and outside of individual youth influence their sociocultural adaptation. We provide empirical evidence to support components of this multisystem model. We propose that research based on our new theoretical framework will capture the sociocultural experiences of ethnic-racial minority youth by centering processes that are relevant to their lived experiences, coping, and adjustment. In doing so, this model will inform psychosocial interventions focused on promoting healthy adaptation among ethnic and racial diverse youth. Finally, we offer recommendations to guide future research on stress and adaptation among ethnic and racial diverse youth, in particular, and developmental psychopathology more broadly.

Incomplete recording of race/colour in health information systems in Brazil: time trend, 2009-2018

This ecological study of time trends and multiple groups evaluated incompleteness in the race/colour field of Brazilian health information system records and the related time trend, 2009-2018, for the diseases and disorders most prevalent in the black population. The Romero and Cunha (2006) classification was applied in order to examine incompleteness using secondary data from Brazil's National Notifiable Diseases System, Hospital Information System and Mortality Information System, by administrative regions of Brazil, while percentage underreporting and time trend were calculated using simple linear regression models with Prais-Winsten correction (p-value<0.05). All records scored poorly except those for mortality from external causes (excellent), tuberculosis (good) and infant mortality (fair). An overall downward trend was observed in percentage incompleteness. Analysis by region found highest mean incompleteness in the North (30.5%), Northeast (33.3%) and Midwest (33.0%) regions. The Southeast and Northeast regions showed the strongest downward trends. The findings intended to increase visibility on the implications of the race/color field for health equity.

Whose Signals Are Being Amplified? Toward a More Equitable Clinical Psychophysiology

Research using psychophysiological methods holds great promise for refining clinical assessment, identifying risk factors, and informing treatment. Unfortunately, unique methodological features of existing approaches limit inclusive research participation and, consequently, generalizability. This brief overview and commentary provides a snapshot of the current state of representation in clinical psychophysiology, with a focus on the forms and consequences of ongoing exclusion of Black participants. We illustrate issues of inequity and exclusion that are unique to clinical psychophysiology, considering intersections among social constructions of Blackness and biased design of current technology used to measure electroencephalography, skin conductance, and other signals. We then highlight work by groups dedicated to quantifying and addressing these limitations. We discuss the need for reflection and input from a wider variety of stakeholders to develop and refine new technologies, given the risk of further widening disparities. Finally, we provide broad recommendations for clinical psychophysiology research.

Religious minority identity associates with stress and psychological health among Muslim and Hindu women in Bangladesh and London

OBJECTIVES

This study examined the association of minority religious identification (Hindu or Muslim) with self-reported stress and psychological symptoms among sedentee and immigrant Bangladeshi women.

METHODS

Women, aged 35-59 (n = 531) were drawn from Sylhet, Bangladesh and London, England. Muslim immigrants in London and Hindu sedentees in Sylhet represented minority religious identities. Muslim sedentees in Sylhet and Londoners of European descent represented majority religious identities. In bivariate analyses, minority religious identity was examined in relation to self-reported measures of stress, nervous tension, and depressed mood. Logistic regression was applied to examine the relationship between these variables while adjusting for marital status, parity, daily walking, and perceived financial comfort.

RESULTS

In bivariate analyses, religious minorities reported more stress than religious majorities in all group comparisons (p < .05), and minority Muslims reported more nervous tension and depressed mood than majority Muslims (p < .05). In logistic regression models, minority Muslims had greater odds of high stress than majority Muslims (OR 2.00, 95% CI 1.18-3.39). Minority Muslims had greater odds of stress (OR 3.05, 95% CI 1.51-6.17) and nervous tension (OR 3.37, 95% CI 1.66-6.87) than majority Londoners. Financial comfort reduced odds of stress and symptoms in all models.

CONCLUSIONS

Socioeconomic situation, immigration history, and minority ethnicity appear to influence the relationship between religious identity and psychosomatic symptoms in Bangladeshi women. Attention to personal and socioeconomic context is important for research examining the association between religion and mental health.

Deep learning-aided decision support for diagnosis of skin disease across skin tones

Although advances in deep learning systems for image-based medical diagnosis demonstrate their potential to augment clinical decision-making, the effectiveness of physician-machine partnerships remains an open question, in part because physicians and algorithms are both susceptible to systematic errors, especially for diagnosis of underrepresented populations. Here we present results from a large-scale digital experiment involving board-certified dermatologists (n = 389) and primary-care physicians (n = 459) from 39 countries to evaluate the accuracy of diagnoses submitted by physicians in a store-and-forward teledermatology simulation. In this experiment, physicians were presented with 364 images spanning 46 skin diseases and asked to submit up to four differential diagnoses. Specialists and generalists achieved diagnostic accuracies of 38% and 19%, respectively, but both specialists and generalists were four percentage points less accurate for the diagnosis of images of dark skin as compared to light skin. Fair deep learning system decision support improved the diagnostic accuracy of both specialists and generalists by more than 33%, but exacerbated the gap in the diagnostic accuracy of generalists across skin tones. These results demonstrate that well-designed physician-machine partnerships can enhance the diagnostic accuracy of physicians, illustrating that success in improving overall diagnostic accuracy does not necessarily address bias.

Measuring skin color inequality in women's health in Northeast Brazil: Evidence from the PCSVDFMulher survey

In this paper, we investigate whether skin color is a source of inequality in women's health by exploring the longitudinal framework of the PCSVDFMulher survey in Northeast Brazil. Specifically, we measure the skin color gradient in women's general and mental health, as well as in showing health risk behavior. We find that darker-skinned women show poorer mental health outcomes and a higher likelihood of drinking and smoking more frequently than their lighter-skinned counterparts. The skin color gradient is persistent and systematic, even when modeling different sources of unobserved heterogeneity and accounting for the existing socioeconomic inequalities and racial identity. We also find that racial identity is an important source of heterogeneous responses of women's health to skin tone.

Instrumental Variable Analysis of Racial Discrimination and Blood Pressure in a Sample of Young Adults

Racial inequities in blood pressure levels have been extensively documented. Experiences of racial discrimination could explain some of this disparity, although findings from previous studies have been inconsistent. To address limitations of prior literature, including measurement error, we implemented instrumental variable analysis to assess the relationship between racial discrimination in institutional settings and blood pressure. Using data from 3,876 Black and White adults with an average age of 32 years from examination 4 (1992-1993) of the Coronary Artery Risk Development in Young Adults Study, our primary analysis examined the relationship between self-reported experiences of racial discrimination in institutional settings and blood pressure using reflectance meter measurement of skin color as an instrument. Findings suggested that an increase in experiences of racial discrimination was associated with higher systolic and diastolic blood pressure (β = 2.23 mm Hg (95% confidence interval: 1.85, 2.61) and β = 1.31 (95% confidence interval: 1.00, 1.62), respectively). Our instrumental variable estimates suggest that experiences of racial discrimination within institutional settings contribute to racial inequities in elevated blood pressure and cardiovascular disease outcomes in a relatively young cohort of adults and may yield clinically relevant differences in cardiovascular health over the life course.

Impact of Spirometry Race-Correction on Preadolescent Black and White Children

BACKGROUND

Race-correction for Black patients is standard practice in spirometry testing. History suggests that these corrections are at least partially a result of racist assumptions regarding lung anatomy among Black individuals, which can potentially lead to less frequent diagnoses of pulmonary diseases in this population.

OBJECTIVE

To evaluate the impact of race-correction in spirometry testing among Black and White preadolescents, and examine the frequency of current asthma symptoms in Black children who were differentially classified depending on whether race-corrected or race-uncorrected reference equations were deployed.

METHODS

Data from Black and White children who completed a clinical examination at age 10 years from a Detroit-based unselected birth cohort were analyzed. Global Lung Initiative 2012 reference equations were applied to spirometry data using both race-corrected and race-uncorrected (ie, population-average) equations. Abnormal results were defined as values less than the fifth percentile. Asthma symptoms were assessed concurrently using the International Study of Asthma and Allergies in Childhood questionnaire, while asthma control was assessed using the Asthma Control Test.

RESULTS

The impact of race-correction on forced expiratory volume in 1 second (FEV1)/forced vital capacity ratio was minimal, but abnormal classification of FEV1 results more than doubled among Black children when race-uncorrected equations were used (7% vs 18.1%) and were almost 8 times greater based on forced vital capacity classification (1.5% vs 11.4%). More than half of Black children differentially classified on FEV1 (whose FEV1 was classified as normal with race-corrected equations but abnormal with race-uncorrected equations) experienced asthma symptoms in the past 12 months (52.6%), which was significantly higher than the percentage of Black children consistently classified as normal (35.5%, P = .049), but similar to that of Black children consistently classified as abnormal using both race-corrected and race-uncorrected equations (62.5%, P = .60). Asthma Control Test scores were not different based on classification.

CONCLUSIONS

Race-correction had an extensive impact on spirometry classification in Black children, and differentially classified children had a higher rate of asthma symptoms than children consistently classified as normal. Spirometry reference equations should be reevaluated to be aligned with current scientific perspectives on the use of race in medicine.

Investigating the role of perceived ingroup and outgroup colourism on body image and wellbeing among Black, Asian, and other racialised/ethnic minority groups living in the UK

Colourism is a form of prejudice and discrimination based on skin shade, disadvantaging people of colour with darker skin. This study investigates the relationship between perceived colourism, body image, and psychological wellbeing, considering perceived colourism from the ingroup (people of the same racialised group) and the outgroup (white people). A total of 516 Black, Asian, and other racialised/ethnic minority adults living in the UK (56.8 % women) completed an online survey. Using structural equation modelling, we tested a theoretically informed model: ingroup and outgroup colourism were predictors, body image and psychological distress were outcomes, and skin shade satisfaction and surveillance were hypothesised mediators. The model provided a good fit to the data. Ingroup colourism was related to lower skin shade satisfaction and higher skin shade surveillance, which in turn related to worse body image and greater psychological distress. Outgroup colourism was related to higher skin shade surveillance, which in turn was associated with worse body image. Outgroup colourism was directly associated with greater psychological distress. Results showed perceived colourism was associated with worse body image and psychological distress among people of colour in the UK. Therefore, colourism should be considered in the development of societal-, community-, and individual-level body image interventions.

The Sociocognitive Origins of Personal Mastery

This article examines the relationship between cognitive processing and mastery. While scholars have called for the integration of sociological and cognitive analyses of mastery, sociological research has focused almost exclusively on mapping its social correlates. As a result, sociologists have relied on untested and underspecified assumptions about cognition to explain the efficacy of mastery. Taking an interdisciplinary approach integrating research on mastery, dual-process models of cognition, and intersectionality, we specify and test the hypothesis that deliberate thinking dispositions are associated with a greater sense of control over one's life chances and assess whether this relationship varies across different intersections of social positions. Regression results from survey data in a diverse student sample (N = 982) suggest a positive correlation between deliberate cognitive style and personal mastery. However, results from a quantitative intersectional analysis demonstrate that this relationship does not hold for East Asian women.

Is inconsistent reporting of self-assessed health persistent and systematic? Evidence from the UKHLS

In this paper, we investigate whether individuals provide consistent responses to self-assessed health (SAH) questions in the UK Household Longitudinal Study (UKHLS), and the potential implications for empirical research in case of inconsistent reporting behaviour. We capitalise on an opportunity in the UKHLS, asking respondents the same SAH question twice: with a self-completion and an open interview mode, within the same household interview over four waves. We estimate multivariate models to explore which individual characteristics are systematically relevant for the likelihood and frequency of inconsistent reporting. About 11-24% of those reported a particular SAH category in the self-completion reported inconsistently in the open interview. The probability of inconsistency is systematically associated with individual's demographics, education, income, employment status, cognitive and non-cognitive skills. The same characteristics also predict the frequency of inconsistent reporting across four UKHLS waves. Analysis of the implications of reporting inconsistencies shows no impact of SAH measurement on the association between income and health. A set of dimensions of people's physiological and biological health, captured using biomarkers, is associated equally with both SAH measures, suggesting that the interview mode does not play a role in the relationship between SAH and more objective health measures.

Race-shifting in the United States: Latinxs, Skin Tone, and Ethnoracial Alignments

In the study, we engage the question of racial "fluidity" by examining patterns of ethnoracial identification in adolescence and, importantly, shifts in ethnoracial identification between adolescence and adulthood using two waves of data from a nationally representative, longitudinal study of adolescents who were in Grades 7 to 12 during the 1994 to 1995 school year. Our theoretical framework draws from social identity theory and brings together bodies of research in race and immigration to make a case for the importance of phenotype, ancestry, and sociocultural elements as potential mechanisms for patterns among Latinx youth, as shifts in ethnoracial identification are predominantly a Latinx phenomenon. The bulk of the findings suggest that both phenotype and immigration are important factors for ethnoracial self-identification among Latinx youth, as well as shifts in their ethnoracial identification in young adulthood. Given what we know about ethnoracial categorization and ascription, findings suggest that, overall, shifts in ethnoracial identification among Latinx youth are primarily about bringing their self-identification into alignment with how they think they tend to be (and most likely are) perceived by others, which we suggest represents a Sedimentation of the Color Line. We close by discussing the myriad implications of our findings for the U.S. racial order and the ongoing debate about how to "measure" the Latinx population.

Screening for adverse childhood experiences in pediatrics: A randomized trial of aggregate-level versus item-level response screening formats

BACKGROUND

While there is growing support for screening for Adverse Childhood Experiences (ACEs), rigorous evidence on the efficacy and preference of screening methods is needed.

OBJECTIVE

To examine caregiver: (1) rates of disclosure of their child's exposure to ACEs using item-level response (each item can be endorsed) versus aggregate-level response (only total score reported) screening format, (2) associations between family demographic factors and disclosure by screening format, and (3) emotional reaction and experience of screening formats in a diverse, low-income pediatric population.

METHODS

Caregiver participants (n = 367) were randomized to complete the Pediatric ACEs and Related Life Events Screener (PEARLS) tool, in an aggregate-level response vs item-level response format from 2016-2019. Select caregivers (n = 182) participated in debriefing interviews. T-test and chi-square analyses in 2019 compared PEARLS disclosure rates and reactions between the screening modalities. Regression models explored interactions with child characteristics. Thematic analysis of interview notes captured caregiver screening experience.

RESULTS

PEARLS disclosure rates were significantly higher in the aggregate-level response compared to the item-level response screening arm (p <0.05). This difference was accentuated for children identified as black and/or male (p <0.05). Caregiver reactions to PEARLS screening were rarely negative in either screening format. Qualitative data demonstrated strong caregiver preference for the item-level response format; additional themes include provider relationship, fear with disclosure, and screening outcome expectations.

CONCLUSION

While caregivers reported a preference for the item-level response format, the aggregate-level response screening format elicited higher disclosures rates particularly for children who are black or ma.

TRIAL REGISTRATION

Clinical trial registry: NCT04182906.

Detecting genetic heterogeneities in response to trauma: The case of 9/11

The current study evaluates genetic heterogeneities in response to trauma among U.S. young adults. Using Add Health Wave III, which coincidently overlapped with the September 11 attacks, and a depression mean and variance polygenic scores, we investigate how the polygenic scores moderate the causal effect of 9/11 on mental health. Our results show the presence of genetic heterogeneity, where those with high genetic plasticity experience an increase in depressive symptoms following trauma while those with low genetic plasticity do not. While the documented differences in reactions to trauma are important, we also note our ability to predict responses based only on genetic measures are too imprecise to identify susceptible clinical patients. We, therefore, contend that the expected benefits from genetic screening to identify susceptible individuals after trauma are limited. Our results provide novel evidence of a specific source of an additional heterogeneity contributing to the inequality of health following trauma.

Skin Tone and Mexicans’ Perceptions of Discrimination in New Immigrant Destinations

Colorism literature examines how skin tone—alongside prototypical group features and hairstyles—correlates with socioeconomic, health, and political outcomes. Yet few studies have explicitly operationalized how skin tone shapes Latinos’ experiences of racialization in “new” U.S. destinations. Here, we draw on a large, representative sample of Mexican immigrants (N = 500) living in two large metropolitan areas (Atlanta and Philadelphia) to investigate how skin tone shapes their perceptions about the frequency and sources of discrimination. Even after controlling for demographic, economic, and immigration–specific factors, including ethnoracial self–identification, we show darker skin tone is significantly associated with higher reports of racial discrimination, discrimination specifically from U.S.-born Whites, and a stronger tendency to struggle internally in response. Together, these results support colorism literature’s argument that skin tone is distinct from race and offer new insights into how skin tone shapes the lived experiences of Mexican immigrants outside the U.S. Southwest.

How Skin Tone Influences Relationships Between Discrimination, Psychological Distress, and Self-Rated Mental Health Among Older African Americans

OBJECTIVES

As within-group differences have emerged as a key area of inquiry for health disparities among African Americans, skin tone has been identified as an important factor. This study aims to examine: (a) the moderating role of skin tone in the relationship between discrimination, self-rated mental health, and serious psychological distress (SPD) and (b) whether this moderating effect differs across genders in a nationally representative sample of older African Americans.

METHODS

Analyses were conducted on a subsample of African Americans aged 55+ (N = 837) from the National Survey of American Life. The mental health outcomes were SPD and self-rated mental health. Discrimination was assessed with the Everyday Discrimination Scale. Skin tone was self-reported. Multiple linear regressions tested the study aims.

RESULTS

Discrimination was associated with worse self-rated mental health and SPD in the total sample and among women. Skin tone moderated the association between discrimination and SPD in the total sample and among men and women. The associations between discrimination and mental health outcomes were stronger among darker-skinned respondents than lighter respondents. Gender-stratified analyses indicated skin tone moderated the association between discrimination and self-rated mental health for men but not women.

DISCUSSION

This study contributes to the emerging body of literature on skin tone, discrimination, and mental health. Uncovering mechanisms behind the "why" is an important next step in understanding how skin tone influences the relationship between discrimination and mental health. The negative psychological effects associated with darker complexion provide several areas to be examined.

Stay out of the Sun: Exploring African American College Women’s Thoughts on the Dynamics Between Colorism and Sun-related Behavior

Colorism—systematic intragroup discrimination based on skin color—uniquely affects African American women. Using a sequential mixed methods design, this study explored perceptions of colorism and sun-related behavior among African American women in college. Study 1, which included 14 in-depth interviews, revealed perceptions that lighter skin is mostly preferred among African American women and that this preference can influence sun-related behavior. Study 2 featured a self-administered questionnaire ( n = 187) based on interview commentary. Findings indicated an internalized status quo: participants deemed colorism prevalent among African Americans and believed that preferences for lighter skin influenced daily life, including sun avoidance. Personal skin color preferences were less clear than participants’ perceptions of others’ preferences. Results pinpointed a possible connection between colorism and sun-related behavior, unveiling interrelationships among internalized beliefs, subjective norms, and behavior. Understanding colorism’s entrenched role and the social context of sun-related decisions extends colorism research from the psychosocial realm to the behavioral. Implications can increase practitioners’ awareness of colorism, enabling interventions to promote appropriate health education and wellbeing among African American women.

Shades of health: Skin color, ethnicity, and mental health among Black Americans

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.

Skin Tone and the Health Returns to Higher Status

This study addresses two questions. First, why do Black Americans exhibit worse health outcomes than White Americans even at higher levels of socioeconomic status (SES)? Second, are diminished health returns to higher status concentrated among Black Americans with darker skin color? Novel hypotheses are tested with biosocial panel data from Add Health, a nationally representative cohort of Black and White adolescents who have transitioned to adulthood. We find that White and light-skin Black respondents report improved health after achieving higher SES, on average, while their darker-skin Black peers report declining health. These patterns persist regardless of controls for adolescent health status and unmeasured between-person heterogeneity. Moreover, increased inflammation tied to unfair treatment and perceptions of lower status helps to account for patterns of diminished health returns for dark-skin Black groups. Our study is the first to document skin tone heterogeneity in diminished health returns and one of few studies to identify life course stress processes underlying such disparities. We consider additional processes that could be examined in future studies, as well as the broader health and policy implications of our findings.

Actions needed to promote health equity and the mental health of Canada's Black refugees

OBJECTIVES

The overall goal was to synthesize knowledge on actions that need to be taken to promote health equity and the mental health of Black refugees in Canada.

DESIGN

Group concept mapping systems were applied to generate and organize action-oriented statements related to the different social determinants of health. A total of 174 participants from the cities of Calgary and Edmonton with experience working with Black Canadians participated in four focus groups: (a) 2 focus groups that engaged 123 participants in brainstorming 84 statements guided by the following focus prompt: 'A specific action that would improve the mental health equity of Black refugees living in Canada is … ' and (b) 2 focus groups of 51 participants who sorted the generated statements and rated them by order of 'importance' and 'ideas seen in action.' Data was further computed and analysed by the research team and a select advisory group from the participants.

RESULTS

A 10-cluster map generated included the following clusters: (1) promoting cultural identity, (2) promoting ways of knowing, (3) addressing discrimination and racism, (4) addressing the criminalization of Black Canadians, (5) investing in employment for equity, (6) promoting equity in housing, (7) facilitating self-determination, (8) improving (public) services, (9) promoting appropriate and culturally relevant mental health services, and (10) working with and addressing faith and belief related issues. Clusters 4 and 9 ranked as the most important clusters in promoting health equity and the mental health of Black Canadians.

CONCLUSIONS

Addressing the criminalization of Black Canadians through a range of rehumanizing interventions at institutional levels will provide a platform from which they can participate and engage others in developing appropriate and culturally relevant mental health services.

Exploring the associations between discrimination, coping, skin tone, and the psychosocial health of young adults of color

Although valuable strides have been made in linking racial and ethnic discrimination to health outcomes, scholars have primarily used between-person methodological approaches, which assess the implications of reporting high or low mean levels of discrimination. Alternatively, within-person approaches assess the implications of intraindividual variation, or acute changes, in an individual's exposure to discrimination. These approaches pose two fundamentally different questions about the association between discrimination and health, and empirical work that disaggregates these effects remains scarce. Scholars have also called for research exploring whether sociocultural factors-such as race-related coping and skin tone-contour these associations. To address gaps in extant literature, the current study examined 1) how an individual's average level of exposure to discrimination (between-person) and weekly fluctuations in these encounters (within-person) relate to psychosocial health and 2) whether race-related coping (confrontational and passive coping) and skin tone moderate these associations. Analyses were conducted using weekly diary data from African American and Latinx young adults (n = 140). Findings indicated that reporting higher mean levels of exposure to discrimination and encountering more discrimination than usual on a given week were both associated with poorer psychosocial health. Results also suggest that the efficacy of young adults' coping mechanisms may depend on their skin tone and the nature of the discriminatory events encountered.

Is educational mobility harmful for health?

"Mobility effects" research to date provides mixed evidence about the health consequences of social mobility and pays limited attention to race differences in mobility effects. To address this gap in the literature, this study explores the association between downward mobility and upward mobility with health and how these associations vary between Black people and White people. Diagonal reference models are used to estimate the effects of intergenerational educational mobility on self-rated health and mortality using data from the U.S. General Social Survey (1972-2016) with linked mortality records (1978-2014). Results show that downward mobility is associated with worse self-rated health and higher mortality risk. Downward mobility appears more damaging to the health of White people relative to Black people. Upward mobility appears less beneficial to the health of Black people. These findings indicate that social mobility itself is consequential for health and suggest that downward mobility is detrimental to health.

Representation in medical illustration: the impact of model bias in a dermatology pilot study

As greater attention is paid to representation and the 'decolonizing' of education and media, the field of medical illustration must stay current. Multiple previous studies have concluded that the majority of medical textbooks depict primarily 'default' young, white men. Many have expressed that this lack of representation resulted in feelings of alienation; others posited it is a contributing factor for the disparity of care for marginalised groups. This research took arguably the most identifiable feature, skin colour, to explore this disparity - the variation of dermatological symptom expression on melanin-dense skin for four conditions. To evaluate the impact of having a diverse range of models, a study was devised to demonstrate identification rates of melanin-dependent dermatological symptoms in a quantifiable, though non-statistically significant manner. Participants were split into two groups and asked to review four different skin conditions (Group-A receiving illustrations of homogeneous pale skin tones, and Group-B receiving illustrations depicting diverse skin tones) before identifying clinical photographs. While the group with a diverse reference pool performed marginally better overall, they performed better identifying specific conditions in which melanin levels impact the appearance of the condition. This pilot study serves as a strong base for a more developed future study.

It's not all White: Implicit Racial Bias in Imagery Used in Plastic Surgery Resident Education

OBJECTIVE

Plastic surgery education relies heavily on images featuring patient skin tone; while images can be useful representations, it is highly susceptible to implicit bias, a known contributor to healthcare disparities. Using skin tone as a proxy, this study evaluates patient representation in images used in the American Society of Plastic Surgery Resident Education Curriculum.

DESIGN

Color photographs, graphics, and videos featured in the American Society of Plastic Surgery "Course Materials" for each module were categorized using the Fitzpatrick scale (I-II, III-IV, or V-VI) by six reviewers. Proportional data and average number ± standard deviation of photos and graphics for each category were reported. Significant difference between Fitzpatrick I to II and V to VI was investigated via a one-way analysis of variance with a Tukey's post-test to adjust for multiple comparisons.

RESULTS

An average of 1861 photographs and 237 graphics were assessed with 82% (1518 ± 25.11) of photos and 97% (231 ± 24.45) of graphics categorized as Fitzpatrick I to II. A one-way analysis of variance with a Tukey's post-test demonstrates a statistical difference between images and graphics categorized as Fitzpatrick I to II and Fitzpatrick V to VI (p < 0.001).

CONCLUSIONS

Our data reveals an opportunity to improve racial representation in resident education. When 76% of patients in the United States are white and 13% are Black, our findings demonstrate both an unequal and unrepresentative distribution of photos and graphics of non-white patients. Residency is a formative time in a surgeon's career and therefore, exposure to accurate representation of a diverse patient population is of the utmost importance.

Toward a Theory of the Underpinnings and Vulnerabilities of Structural Racism: Looking Upstream from Disease Inequities among People Who Use Drugs

Structural racism is increasingly recognized as a key driver of health inequities and other adverse outcomes. This paper focuses on structural racism as an "upstream" institutionalized process, how it creates health inequities and how structural racism persists in spite of generations of efforts to end it. So far, "downstream" efforts to reduce these health inequities have had little success in eliminating them. Here, we attempt to increase public health awareness of structural racism and its institutionalization and sociopolitical supports so that research and action can address them. This paper presents both a theoretic and an analytic approach to how structural racism contributes to disproportionate rates of HIV/AIDS and related diseases among oppressed populations. We first discuss differences in disease and health outcomes among people who use drugs (PWUD) and other groups at risk for HIV from different racial and ethnic populations. The paper then briefly analyzes the history of racism; how racial oppression, class, gender and other intersectional divisions interact to create health inequities; and how structural racism is institutionalized in ways that contribute to disease disparities among people who use drugs and other people. It examines the processes, institutions and other structures that reinforce structural racism, and how these, combined with processes that normalize racism, serve as barriers to efforts to counter and dismantle the structural racism that Black, indigenous and Latinx people have confronted for centuries. Finally, we discuss the implications of this analysis for public health research and action to undo racism and to enhance the health of populations who have suffered lifetimes of racial/ethnic oppression, with a focus on HIV/AIDS outcomes.

Deployments of Multiracial Masculinity and Anti-Black Violence: The Racial Framings of Barack Obama, George Zimmerman, and Daunte Wright

In this article, I examine how political and media discourses of multiraciality are deployed to justify guilt and innocence. I trace the deployment of multiraciality to determine who is deserving of life or death in media coverage, political rhetoric, and court records during Obama’s presidency, in George Zimmerman’s 2013 acquittal, and in the 2021 killing of Daunte Wright. I examine the weaponization of discourses of multiracial identities as tools of white supremacy and anti-Blackness. Through such weaponization, the construction of the multiracial man as an index of racial progress and post-racism evident in the Barack Obama era enabled the violence and miscarriages of justice in the killings of Trayvon Martin and Daunte Wright. I consider how transnational and U.S. narratives of multiraciality, joined with anti-Blackness and white supremacy, enabled the acquittal of George Zimmerman. Furthermore, I examine how white womanhood and fears of Black masculinity facilitated the sympathy garnered towards Kim Potter. In considering the killing of Daunte Wright, this paper shows how multiraciality and racial malleability are valuable only when utilized for preserving racial hierarchies.

Everyday discrimination in later life: A social network approach

What factors shape everyday discrimination among older adults? Existing perspectives focus on individual identities and social group membership (e.g., race/ethnicity, age) as key determinants of perceived discrimination. This paper examines the idea that individuals' broader social contexts - including their personal social networks - also shape perceived discrimination, and in ways that may differ across racial groups. Using data from Round 3 of the National Social Life, Health, and Aging Project (N = 3312), I consider how properties of personal networks are associated with how frequently older adults report everyday discrimination. Results indicate that more kin-centric personal networks protect against more frequent everyday discrimination, but that this protective effect may be stronger among White older adults. I propose why more kin-centric networks may play a different role in the perceived discrimination of White and Black older adults, and close by suggesting that social network composition may be a source of heterogeneity in the link between everyday discrimination and inequality in later life outcomes such as health.

White Students' Perceptions of the Costs and Consequences of Being Black

Many whites explicitly believe that their race has had no impact on their accomplishments in life. The current study used the contingent valuation method to implicitly measure the value of being white-or alternatively, the cost of being black-among a sample of white college students. Participants were presented with a hypothetical scenario in which their racial appearance was altered due to a medical mishap, and then asked to identify the negative consequences they would experience as a result of this change. Participants also assigned a dollar value to their race by reporting the smallest financial settlement they would accept as compensation for the mishap. Results revealed that white students who imagined being black anticipated financial consequences significantly more often than black students who imaged being white, but they anticipated psychosocial consequences significantly less often. The median financial settlement for whiteness was relatively low, while the mean value was quite large and highlighted the importance of whiteness among certain respondents. These findings are discussed, with suggestions for future research.

Mixed-Race Ancestry ≠ Multiracial Identification: The Role Racial Discrimination, Linked Fate, and Skin Tone Have on the Racial Identification of People with Mixed-Race Ancestry

Mixed-race identification may be complex, in that people with mixed-race ancestry may or may not identify as multiracial. Social experiences, such as experiencing racial discrimination, believing that your fate is connected with specific racialized others, and personal characteristics, such as skin color, all have been theorized to play a role in identification. The Mixed-Race Ancestry Survey (2020) conducted on Mechanical Turk allows me to ask unique questions with a large enough sample of this understudied population to disaggregate by racial ancestries. Only people with mixed-race ancestry are included in this study, but respondents may identify mono- or multiracially. Binary logistic regression models reveal that increased linked fate with a specific racial group is associated with greater odds of racially identifying, at least in part, with that group (e.g., among Asians, greater linked fate with Asians is associated with greater odds of identifying as mono- or multiracially Asian). Increased linked fate with multiracials as a group is also connected to greater odds of identifying as multiracial. In addition, personally experiencing racial discrimination is associated with a greater likelihood of identifying as Black and slightly lower odds of identifying as White or as Latinx. Finally, as skin tone darkens the odds of identifying as Black increase three-fold and the odds of identifying as multiracial increase by 1.3 times. I discuss these findings by racial ancestry groups, noting that being aware of having mixed-race ancestry does not in and of itself predict multiracial identification. Rather, in a social structure that uplifts Whiteness, feeling linked fate, experiencing discrimination, and having darker skin tone are important predictors of identification. These findings highlight the mechanisms connected to racial identification for a population that may feel tied to multiple racial groups and is navigating identification within a White-centric nation.

Doctors’ Perceptions of Multiracial Adolescents

Perceptions of race influence the way health care is delivered to minority populations, particularly multiracial people. Currently only 11% of American physicians are Black or Latinx, making the chances slim that Black and Latinx patients will be treated by a co-ethnic. White supremacy is well documented in the medical literature—along with efforts to combat it—yet medical education and health care are still largely based on studies by and about white people. This privileging of whiteness is increasingly evident as the COVID-19 pandemic has shone a renewed spotlight on disparities in health and care in the U.S. The current study considers how doctors perceive race and use it to make healthcare decisions. Among the (N = 509) doctors in this sample, few said they considered the patient’s race. Of those who did, many determined race by some method other than asking the patient directly. The most common methods were observing skin tone and observing cultural cues. Doctors perceived nearly half the multiracial targets as monoracial. Targets who followed the norm of hypodescent were significantly more likely to be identified congruently by doctors. Targets who identified at the extremes of the color spectrum (black and white) were easier to identify, while the beige tones in the middle of the spectrum were more challenging. Patient ancestry was the most relevant criterion in explaining the congruence of racial identification between patients and doctors, while characteristics of the doctors were nearly irrelevant.

A protective rung on the ladder? How past and current social status shaped changes in health during COVID-19

An emerging body of work has started to document population health consequences of the social and economic transformations during the COVID-19 pandemic. We consider an individual's relative social position in the stratification system-subjective social status (SSS)-and assess how past (childhood) and current SSS predict change in self-rated health during the pandemic. Using two waves of data from the Canadian Quality of Work and Economic Life Study, we follow respondents between the onset of lockdown measures in March and May of 2020 (N = 1886). Drawing from the life course perspective and stress process model, we find that lower current SSS predicts a greater likelihood of being in stable poor health and reporting declining health. Lower past SSS predicts a higher chance of being in stable poor health indirectly through current SSS. And lower cumulative SSS that sums both past and present SSS also predicts stable poor health, while perceived upward mobility over time is associated with stable good health. This robust relationship between SSS and health in such a short time period of two months at the start of the COVID-19 pandemic provides an important glimpse into the influence that SSS has on population health.

Color disparities in cognitive aging among Puerto Ricans on the archipelago

This research seeks to contribute new understanding of color disparities and gender in cognitive aging among older adults residing in Puerto Rico. We use the island-representative Puerto Rican Elderly Health Conditions (PREHCO) longitudinal study that measures cognitive health at baseline and cognitive decline between waves. In pooled models, we discern little or no color disparities in cognition at baseline. Sex-stratified models of baseline cognition indicate that Trigueño men slightly outperform white men. In contrast, color disparities in cognitive decline are apparent. In just four years between the two waves of PREHCO, on a 20-point cognitive test scale, Black men experienced 0.78 more points of cognitive decline, while Trigueño men experienced 0.44 more points of cognitive decline than white men in Puerto Rico. Mestiza women experience 0.80 less points of cognitive decline relative to white women. Nearly all of the color/race association with cognitive decline appears to be independent from health behaviors and conditions, individual human capital attainment, and family background. While lower-status color groups more frequently report discrimination, discrimination does not mediate the impact of color/skin tone and cognitive performance, suggesting the importance of further research on the role of broader dimensions of life course structural racism.

Consistent Divisions or Methodological Decisions? Assessing the U.S. Racial Hierarchy Across Outcomes

Scholars have offered a range of perspectives on the twenty-first century racial landscape with little consensus about either the current state of the U.S. racial hierarchy or its future trajectory. We offer a more comprehensive assessment, using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to study racial stratification across a number of socioeconomic outcomes. We pay particular attention to the robustness of results across different categorization schemes that account for self-identification and interviewer classification, as well as racial fluidity. Although we observe that White and Asian Americans generally have the best socioeconomic outcomes, on average, while Black Americans and American Indians have the worst, we also find meaningful differences in patterns of stratification both across outcomes and depending on how race is operationalized. These differences in stratification are reflected in the estimated number of strata as well as the rank order of racial categories. Our results suggest that ongoing debates about the nature of the U.S. racial hierarchy can be partly explained by methodological decisions about which outcomes to study and how best to measure race.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12552-021-09351-2.

A Scoping Review of Colorism in Schools: Academic, Social, and Emotional Experiences of Students of Color

Students of color experience academic, social, and emotional challenges due to colorism in schools. The purpose of this scoping review is to compare the experiences with colorism of students from varying racial backgrounds (African Americans, Native Americans, Asians, and Latin) in U.S. public schools. It is predicted that the understudied group of Latinx and indigenous students of color will uniquely experience colorism in academic settings when compared to African American and Asian students. A 30 article literature review utilizing search dates from 1990 to 2020 was conducted employing a scoping review framework. Themes emerged that include: the privileging of lighter skin and more Eurocentric features in academic outcomes, the complicated social status created for students of color experiencing colorism in schools, and the increased potential for emotional challenges as a result of colorism. This review highlights possible school reform efforts to affirm all skin tones, reduce colorist biases, and offer mediation to mitigate colorist experiences in the school environment.

The stigma system: How sociopolitical domination, scapegoating, and stigma shape public health

Stigma is a fundamental driver of adverse health outcomes. Although stigma is often studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural. This paper proposes a theoretical approach that synthesizes the literature on stigma with the literature on scapegoating and divide-and-rule as strategies that the wealthy and powerful use to maintain their power and wealth; the literatures on racial, gender, and other subordination; the literature on ideology and organization in sociopolitical systems; and the literature on resistance and rebellion against stigma, oppression and other forms of subordination. we develop a model of the "stigma system" as a dialectic of interacting and conflicting structures and processes. Understanding this system can help public health reorient stigma interventions to address the sources of stigma as well as the individual problems that stigma creates. On a broader level, this model can help those opposing stigma and its effects to develop alliances and strategies with which to oppose stigma and the processes that create it.

Skin Tone and Perceived Discrimination: Health and Aging Beyond the Binary in NSHAP 2015

OBJECTIVES

This paper introduces new measures of skin tone (self-reported) and perceived discrimination that are included in the third round of the National Social Life, Health, and Aging Project (NSHAP). We explain the rationale for these new measures, emphasizing, in particular, how they help researchers to conceptualize and measure the significance of race/ethnicity for health and aging beyond binary ethnoracial categories.

METHOD

We describe new measures of skin tone and perceived discrimination for use in NSHAP 2015. We provide descriptive statistics on the distribution of skin tone (self-reported) by race/ethnicity. As a proof of concept, we use logistic and ordinary least squares regression analyses to examine the relationship between skin tone, perceived discrimination, and perceived stress among ethnoracial minorities.

RESULTS

We find that there is significant variation in skin tone among non-White respondents in NSHAP 2015 (e.g., non-Hispanic Black and Latinx). We also find that skin tone (self-reported) is a significant predictor of the frequency of perceived discrimination and perceived stress among African American, but not Latinx respondents in NSHAP.

DISCUSSION

The inclusion of new skin tone and discrimination measures in NSHAP 2015 provides a unique and novel opportunity for researchers to more deeply understand how race/ethnicity is connected to health and aging among ethnoracial minorities. Furthermore, it will enable analyses of how stress and perceived discrimination also affect patterns of health and aging among Whites against the backdrop of steadily increasing socioeconomic inequalities and shifting ethnoracial demographics in the United States.

Discrimination of Black and Muslim Minority Groups in Western Societies: Evidence From a Meta-Analysis of Field Experiments

This article examines discrimination against black and Muslim minority groups in 20 Western labor markets. We analyze the outcomes of 94 field experiments, conducted between 1973 and 2016 and representing ∼240,000 fictitious job applications. Using meta-analysis, we find that black minority groups are more strongly discriminated against than non-black minority groups. The degree of discrimination of black minority groups varies cross-nationally, whereas Muslim minority groups are equally discriminated across national contexts. Unexpectedly, discrimination against black minority groups in the United States is mostly lower than in European countries. These findings suggest that racial–ethnic discrimination in hiring can be better understood by taking a multigroup and cross-country perspective.

Discrimination and Hypertension Among Older African Americans and Caribbean Blacks: The Moderating Effects of John Henryism

OBJECTIVES

Discrimination is a major contributor to health disparities between Black and White older adults. Although the health effects of discrimination are well established, less is known about factors that may intervene in the discrimination-health connection, such as coping strategies. The study aim was to determine whether John Henryism (JH; high-effort coping) moderates the association between racial discrimination and hypertension in nationally representative samples of older African Americans and Caribbean Blacks.

METHODS

The analytic sample was drawn from the National Survey of American Life-Reinterview, which was conducted 2001-2003, and included African Americans (N = 546) and Caribbean Blacks (N = 141) aged 55 and older. Study variables included racial discrimination, JH, and hypertension. Logistic regressions, which controlled key sociodemographic differences, were used to test the study aim.

RESULTS

Among both Black ethnic groups, discrimination and JH were not associated with hypertension. For African Americans low and moderate in JH, discrimination was unrelated to hypertension; discrimination was positively associated with hypertension for African Americans high in JH. For Caribbean Blacks, discrimination was positively associated with hypertension among respondents low in JH. Among Caribbean Blacks moderate and high in JH, discrimination was not associated with hypertension.

DISCUSSION

The findings indicate that JH, in the face of discrimination, is associated with hypertension of older African Americans but may be an effective coping strategy for older Caribbean Blacks due to cultural and sociodemographic differences between the 2 ethnic groups. Future research should investigate the differing mechanisms by which JH influences health in heterogeneous older Black populations.

A social history of racial disparities in breastfeeding in the United States

Over the past five decades in the United States, White women have breastfed at higher rates than Black women. While a small but growing body of social historical research has examined racial disparities in breastfeeding over time, empirical research, particularly quantitative research, has focused on single historical snapshots, unintentionally treating the persistent racial disparities in breastfeeding as a static phenomenon, rather than one with distinct social mechanisms at different points in time. Further, few studies on racial disparities in health deconstruct difference both within and across racial groups. But what if we thought about persistent racial disparities instead as discrete trends with distinct social mechanisms at different points in time? In a binary logistic regression of breastfeeding initiation rates from 1973 to 2015 using the National Survey of Family Growth (NSFG), I found that the persistent racial disparities were actually comprised of three distinct types of changing racial disparities: (1) increases in racial disparities that derive from improvements for Whites not captured by Blacks (1973-1982); (2) decreases in racial disparities that stem from improvements for Whites captured even more strongly by Blacks (1995-2006); and, (3) leveling off of racial disparities (2006-2015). Placing results of this quantitative analysis within the context of public policy and social movement history, I identify three distinct mechanisms that drive the different trends in racial disparities in breastfeeding. This paper contributes to the literature on motherhood, race, and health a more nuanced understanding of the social historical mechanisms that pattern breastfeeding, and more broadly, racial disparities in health.

Race/Ethnicity, Perceived Skin Color, and the Likelihood of Adult Arrest

Research has long-documented racial/ethnic disparities in criminal justice outcomes. However, despite race/ethnicity being a multidimensional social construct, prior research largely relies on self-identification measures, thereby disregarding research on skin tone stratification within-racial/ethnic groups. The current study extends beyond this by examining the relationship between race/ethnicity and arrest employing both self-identified race/ethnicity and perceived skin color. Using data from the National Longitudinal Study of Adolescent to Adult Health, we explore the main and intersecting effects of self-identified race/ethnicity and perceived skin color on experiencing an arrest in adulthood between- and within-self-identified Whites, Blacks, Latinos, Native Americans, and Asians. We use structural disadvantage as a framework for exploring how social structural factors as well as antisocial behavior mediate the relationship between race/ethnicity/color and arrest. Results suggest that focusing on the racial/ethnic disparities alone masks differences in arrest by color and that the effect of color varies by race/ethnicity. Results also suggest that measures indicative of disadvantage, but not offending, partially explain these associations.

Race, social pain minimization, and mental health

People often believe Black individuals experience less social pain and require less social support to cope with distress than White individuals (e.g., Deska, Kunstman, Lloyd, et al., 2020). However, researchers have not tested whether biases in third-person pain judgments translate to first-person experiences with social pain minimization. For example, do Black individuals feel their social pain is underrecognized to a greater extent than White individuals? The current work tested whether Black individuals felt their social pain was minimized more than White individuals and if the experience of social pain minimization was related to worse mental health and greater life stress. Data from two cross-sectional, correlational studies provide initial support for these predictions ( Ntotal = 1,501). Black participants felt their social pain was minimized more than White participants and this race difference in social pain minimization was associated with worse mental health and greater life stress. These results suggest that Black individuals feel their pain is underrecognized and this experience of social pain minimization is related to worse mental health outcomes.

Toxic stress and burnout: John Henryism and social dominance in the laboratory and STEM workforce

Persons Excluded from science because of Ethnicity and Race (PEERs) face chronic exposure to interpersonal stressors, such as social discrimination, throughout their scientific careers, leading to a long-term decline in physical and mental health. Many PEERs exhibit John Henryism, a coping mechanism to prolonged stress where an individual expends higher levels of effort and energy at the cost of their physical and mental health. In this article, we discuss how social dominance may increase John Henryism within the STEM community; the causes, effects and costs of John Henryism; and highlight solutions to combat these social adversity stressors within the academic institution.

Skin Tone, Discrimination, and Allostatic Load in Middle-Aged and Older Puerto Ricans

OBJECTIVE

A growing body of research suggests that skin tone may be a health risk indicator for Hispanics. Black and darker-skinned Hispanics have worse mental and physical outcomes than White and lighter-skinned Hispanics. Discrimination exposure has been implicated as a risk factor that may explain the association between skin tone and health. However, there is scant research examining the interrelationship between skin tone, discrimination, and health, particularly among Puerto Ricans. We examine the interrelationships between two measures of skin tone, two measures of discrimination, and allostatic load (AL) among Puerto Rican adults.

METHODS

Using cross-sectional data from wave 3 of the Boston Puerto Rican Health Study (n = 882), we examined the indirect association (IA) of skin tone on physiological dysregulated systems, also known as AL, through major discrimination and everyday discrimination. We tested these associations using two distinct measures of skin tone: interviewer-ascribed skin tone and spectrophotometer-measured skin tone.

RESULTS

Interviewer-ascribed skin tone was indirectly associated with AL through major discrimination (IA = 0.03, 95% confidence interval = 0.004 to 0.06). However, there was no evidence of an IA of interviewer-ascribed skin tone on AL through everyday discrimination (IA = -0.01, 95% confidence interval = -0.03 to 0.01). In addition, there was no evidence that spectrophotometer-measured skin tone was indirectly associated with AL through major discrimination or everyday discrimination.

CONCLUSIONS

The sociocultural significance of skin tone may affect how Puerto Ricans are perceived and treated by others, which can, in turn, have physiological health consequences. Future research is needed to replicate these findings and examine the interrelationship between skin tone, discrimination, and other health outcomes.

Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors

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.