Self-reported experiences of discrimination and visceral fat in middle-aged African-American and Caucasian women

Does everyday discrimination account for the increased risk of vasomotor symptoms in Black women?: the Study of Women's Health Across the Nation (SWAN)

OBJECTIVES

Vasomotor symptoms (VMS), including hot flashes and night sweats, are hallmark symptoms of the menopause transition. Previous research has documented greater frequency, duration, and severity of VMS in Black women compared with women from other racial/ethnic groups, even after accounting for other factors. This analysis examined the association between discrimination and VMS and the extent to which discrimination accounts for the disproportionate burden of VMS in Black women.

METHODS

Using available discrimination and VMS data from the SWAN cohort study (n = 2,377, 48% White, 32% Black, 6% Japanese, 4% Chinese, and 9% Hispanic women) followed approximately yearly in midlife from premenopause (42-52 y) through postmenopause (~20 y), we assessed concurrent associations between discrimination and VMS frequency in the past 2 weeks using weighted generalized mixed models. We also assessed associations between chronic discrimination across first four visits and VMS trajectories from premenopause to postmenopause using weighted multinomial logistic regression. Models were adjusted for known risk factors for VMS.

RESULTS

Higher levels of discrimination were associated with concurrent reporting of any (odds ratio [OR], 1.57 [1.31-1.89]) and frequent (≥6 d) VMS (OR, 1.55 [1.21-1.99]). After adjustment, associations remained significant for any (OR, 1.30 [1.09-1.54]) but not frequent VMS. For any VMS trajectories, chronic discrimination was associated with "continuously high" (OR, 1.69 [1.03-2.77]) and "high pre-FMP-decline post-FMP" (OR, 1.70 [1.01-2.88]) versus "FMP-onset low" trajectories. After adjusting for discrimination, odds of reporting any, frequent, and of being in the "continuously high" any VMS trajectory remained elevated for Black versus White women.

CONCLUSIONS

Discrimination is associated with greater concurrent risk of any (but not frequent) VMS, and chronic discrimination is associated with a continuously high reporting of any VMS over time, independent of known risk factors. Adjusting for discrimination attenuates but does not eliminate the increased risk of VMS for Black women.

Everyday discrimination for American Indian tribal college students enrolled in the Internet All Nations Breath of Life program

OBJECTIVE

Identify factors associated with perceived discrimination, including depression, body image satisfaction, body mass index (BMI), social support, stress, and self-reported social status.

PARTICIPANTS

A total of 249 American Indian tribal college students.

METHODS

Students were recruited for an Internet-based smoking cessation program. A total of 249 students answered the Everyday Discrimination Scale questions to assess perceived discrimination. We conducted bivariate analyses to determine potential significant associations between perceived discrimination and health outcomes at baseline.

RESULTS

We found 63% of the sample reported racial discrimination. Among those who reported moderate/severe depression, 87% reported discrimination. Among those who were not satisfied with their body image, 70% reported racial discrimination.

CONCLUSION

Reports of racial discrimination are highly prevalent among our participants. We found reports of discrimination are significantly associated with depression and dissatisfaction with body image. Our study highlights a high priority population that perceives racial discrimination, potentially increasing their risk for adverse health outcomes.

The Influence of Contested Racial Identity and Perceived Everyday Discrimination Exposure on Body Mass Index in US Adults

Contested racial identity-the discrepancy between one's self-identified race and socially assigned race-is a social determinant of health and may contribute to overweight and obesity. Obesity is associated with a host of short- and long-term health conditions, including cardiovascular disease, a leading cause of death. Individuals racialized as Black, Hispanic, and Latino are at the greatest risk of obesity. Previous research indicates that experiencing interpersonal discrimination is associated with higher body mass index (BMI) in adults, and individuals with a contested racial identity are disproportionately exposed to interpersonal discrimination. However, the association between BMI and contested racial identity is unknown. This cross-sectional study measured the relationship between contested racial identity and perceived everyday discrimination on BMI in a nationally representative sample of US adults. Contested racial identity was measured with a binary variable indicating agreement between participants' self-identified race and socially assigned race. Weighted unadjusted and adjusted multiple linear regression models quantified the associations between BMI and contested racial identity with and without the mean discrimination score. Covariates included nativity status, income, education, racial identity salience, gender, and age. Among 1689 participants, 18.3% had a contested racial identity. Contested identity was associated with significantly higher BMI (β = 1.01, 95% CI = 0.06, 1.92), but the relationship was attenuated when adjusting for interpersonal discrimination, suggesting that individuals with contested identity may face a greater risk of obesity due to their disproportionately high exposure to interpersonal racial discrimination. Further research is needed to elucidate the impact of racism on BMI and obesity risk.

Transgenerational effect of Mothers' experiences of discrimination on Black youths' hormone coupling in response to laboratory stress

Exposure to pervasive racial discrimination of Black Americans is transgenerational in that mothers' experiences of discriminatory violence impacts their children. This study explored whether stress-related biomarkers reflect transgenerational racial stress by implementing a "dual activation" framework to probe how adrenal and gonadal hormones underlying adolescent development are co-regulated during a laboratory stressor. Data were collected from 120 Black families in the United States. Children completed the Trier Social Stress Task (TSST-C) and provided 4 saliva samples across 2 days that were assayed for cortisol (C), dehydroepiandrosterone (DHEA), and testosterone (T). Mothers reported their experiences of total discrimination and racial discrimination related to skin color/race. Thirty four percent reported experiences of discrimination and on average 46.7% reported experiences of discrimination due to their race or skin tone. Mothers' experiences of racial discrimination were associated with their child's hormonal reactivity to and recovery from the TSST-C. Youth showed stronger positive hormone coupling between C-T if their mother experienced greater discrimination. Mothers' experiences of racial discrimination influenced both C-T coupling and youths' cortisol recovery from the TSST-C. For youths with high testosterone, cortisol recovery was blunted. Results suggest that associations between racism and hormonal stress response may be transgenerational. Mothers' experiences of discrimination had a profound impact on their children's hormonal co-regulation.

Assessing the Impact of Relationship Profile Test Scores, Self-Identified Ethnic Group, and Gender on Adult Attachment Style

Research shows that the subscales of the Relationship Profile Test (RPT) are related to adult attachment. Gender differences have been implicated, but findings are inconsistent in terms of replication. A limited amount of research has been conducted on ethnic differences in the context of interpersonal dependency. This study aims to bridge the gap in the literature in terms of using the RPT to predict attachment styles and to assess gender and ethnic group differences in RPT scores. Four samples from various treatment settings were combined to yield a heterogeneous group of ethnically diverse men and women (N = 470) with a mean age of 31.96. No gender differences were observed; however, ethnic differences were noted, with the RPT scales predicting unique variance in secure and insecure attachment styles. This study evidences the incremental validity of the RPT scales when predicting adult attachment style with consideration of ethnic group differences, which can help inform the treatment and assessment process.

Stress Overload and DNA Methylation in African American Women in the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure Study

Introduction:

Experiencing psychosocial stress is associated with poor health outcomes such as hypertension and obesity, which are risk factors for developing cardiovascular disease. African American women experience disproportionate risk for cardiovascular disease including exposure to high levels of psychosocial stress. We hypothesized that psychosocial stress, such as perceived stress overload, may influence epigenetic marks, specifically DNA methylation (DNAm), that contribute to increased risk for cardiovascular disease in African American women.

Methods:

We conducted an epigenome-wide study evaluating the relationship of psychosocial stress and DNAm among African American mothers from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) cohort. Linear mixed effects models were used to explore the epigenome-wide associations with the Stress Overload Scale (SOS), which examines self-reported past-week stress, event load and personal vulnerability.

Results:

In total, n = 228 participants were included in our analysis. After adjusting for known epigenetic confounders, we did not identify any DNAm sites associated with maternal report of stress measured by SOS after controlling for multiple comparisons. Several of the top differentially methylated CpG sites related to SOS score (P < 1 × 10⁻⁵), mapped to genes of unknown significance for hypertension or heart disease, namely, PXDNL and C22orf42.

Conclusions:

This study provides foundational knowledge for future studies examining epigenetic associations with stress and other psychosocial measures in African Americans, a key area for growth in epigenetics. Future studies including larger sample sizes and replication data are warranted.

The Association Between Perceived Discrimination and BMI Trajectory: A Prospective Study of African American and White Adults

Evidence suggests that socioenvironmental stressors, such as discrimination, may serve as determinants of the ongoing obesity epidemic and persisting disparities in obesity prevalence. The objectives of these analyses were to examine whether perceived discrimination was associated with body mass index (BMI) trajectory and whether this relationship differed by race or sex. Data for these analyses came from the Healthy Aging in Neighborhoods of Diversity across the Life Span study, a prospective cohort study in Baltimore City. Mixed-effects linear regression was used in a sample of 1962 African American and white adults to test our hypotheses. We found that race was an effect modifier in the relationship between perceived discrimination and BMI trajectory (B = 0.063, P = .014). Specifically, higher baseline perceived discrimination was associated with positive BMI trajectory in African American adults (B = 0.031, P = .033) but not in white adults (B = -0.032 P = .128). In this longitudinal study of African American and white adults, the relationship between perceived discrimination and BMI trajectory differed by race. Future research should be conducted in diverse samples to understand the risk socioenvironmental stressors pose on the development and progression of overweight and obesity, in addition to how these differ in subgroups.

Impact of Federal, State, and Local Housing Policies on Disparities in Cardiovascular Disease in Black/African American Men and Women: From Policy to Pathways to Biology

Racist and discriminatory federal, state, and local housing policies significantly contribute to disparities in cardiovascular disease incidence and mortality for individuals that self-identify as Black or African American. Here we highlight three key housing policies - "redlining," zoning, and the construction of highways - which have wrought a powerful, sustained, and destructive impact on cardiovascular health in Black/African American communities. Redlining and highway construction policies have restricted access to quality health care, increased exposure to carcinogens such as PM2.5, and increased exposure to extreme heat. At the root of these policy decisions are longstanding, toxic societal factors including racism, segregation, and discrimination, which also serve to perpetuate racial inequities in cardiovascular health. Here, we review these societal and structural factors and then link them with biological processes such as telomere shortening, allostatic load, oxidative stress, and tissue inflammation. Lastly, we focus on the impact of inflammation on the immune system and the molecular mechanisms by which the inflamed immune microenvironment promotes the formation of atherosclerotic plaques. We propose that racial residential segregation and discrimination increases tissue inflammation and cytokine production, resulting in dysregulated immune signaling, which promotes plaque formation and cardiovascular disease. This framework has the power to link structural racism not only to cardiovascular disease, but also to cancer.

Recent Progress of Chronic Stress in the Development of Atherosclerosis

With the development of the times, cardiovascular diseases have become the biggest cause of death in the global aging society, causing a serious social burden. Atherosclerosis is a chronic inflammatory disease, which can occur in large and medium-sized blood vessels in the whole body. It takes atherosclerotic plaque as the typical pathological change and endothelial injury as the core pathophysiological mechanism. It is the pathological basis of coronary heart disease, peripheral artery disease, cerebrovascular disease, and other diseases. Recent studies have shown that chronic stress plays an important role in the occurrence and development of atherosclerosis, endothelial injury, lipid metabolism, and chronic inflammation. This process involves a large number of molecular targets. It is usually the cause of atherosclerotic cardiovascular and cerebrovascular diseases. If chronic stress factors exist for a long time, patients have genetic susceptibility, and the combination of environmental factors triggers the pathogenesis, which may eventually lead to complete blockage of the blood vessels, unstable rupture of plaques, and serious adverse cardiovascular events. This paper reviews the role of chronic stress in the occurrence and development of atherosclerosis, focusing on the pathophysiological mechanism.

Inconsistent Reporting of Discrimination Over Time Using the Experiences of Discrimination Scale: Potential Underestimation of Lifetime Burden

Studies documenting self-reported experiences of discrimination over the life course have been limited. Such information could be important for informing longitudinal epidemiologic studies of discrimination and health. We characterized trends in self-reports of racial, socioeconomic status, and gender discrimination over time measured using the Experiences of Discrimination Scale, with a focus on whether individuals' reports of lifetime discrimination were consistent over time. Overall experiences of discrimination and the number of settings in which discrimination was reported in 1992, 2000, and 2010 were examined among 2,774 African-American and White adults in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Reports of "ever" experiencing discrimination decreased for all forms of discrimination across the 3 study visits. Approximately one-third (30%-41%) of the sample inconsistently reported ever experiencing any discrimination over time, which contributed to the observed decreases. Depending on the form of discrimination, inconsistent reporting patterns over time were more common among African-American, younger, less educated, and lower-income individuals and women-groups who are often most exposed to and severely impacted by the health effects of discrimination. Our findings highlight the possible underestimation of the lifetime burden of discrimination when utilizing the Experiences of Discrimination Scale to capture self-reports of discrimination over time.

Age and gender differences in the relationship between obesity and disability with self-perceived employment discrimination: Results from a retrospective study of an Australian national sample

BACKGROUND

Health status is a crucial determinant of an individuals' labour market outcomes. The present study investigates the association between obesity and disability with perceived employment discrimination within Australia.

METHODS

A total of 17,174 person-year observations from the 11,079 respondents were analysed using four waves of data from the Household, Income, and Labour Dynamics in Australia (HILDA) survey. The primary outcome examined was employment discrimination, using obesity and disability as the main exposure variables. The longitudinal random-effects regression technique was applied to investigate the between-person differences in employment discrimination associated with obesity and disability.

RESULTS

The findings suggest that more than one in ten (12.68 %) Australians experienced employment discrimination. The odds of being discriminated against while applying for a job were 1.56 times (aOR: 1.56, 95 % CI: 1.15-2.11) higher for obese than their healthy weight counterparts in youngest women. Adults with a disability had 1.89 times (aOR: 1.89, 95 % CI: 1.65-2.17) higher odds of being discriminated against than peers without disability.

CONCLUSION

The results provide evidence that obesity and disability contribute to employment discrimination in Australia. The findings can assist government and related agencies to consider the adequacy of existing discrimination legislation and help organisations to develop appropriate policies to address discrimination against obese and disabled people in their workplaces.

Experiences With Everyday and Major Forms of Racial/Ethnic Discrimination and Type 2 Diabetes Risk Among White, Black, and Hispanic/Latina Women: Findings From the Sister Study

Racial/ethnic discrimination may contribute to the risk of type 2 diabetes mellitus (T2DM), but few studies have prospectively examined this relationship among racially/ethnically diverse populations. We analyzed prospective data from 33,833 eligible Sister Study participants enrolled from 2003 to 2009. In a follow-up questionnaire (2008-2012), participants reported their lifetime experiences of everyday and major forms of racial/ethnic discrimination. Self-reported physician diagnoses of T2DM were ascertained through September 2017. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards models, overall and by race/ethnicity. Mean age at enrollment was 54.9 (standard deviation, 8.8) years; 90% of participants self-identified as non-Hispanic (NH) White, 7% as NH Black, and 3% as Hispanic/Latina. Over an average of 7 years of follow-up, there were 1,167 incident cases of T2DM. NH Black women most frequently reported everyday (75%) and major (51%) racial/ethnic discrimination (vs. 4% and 2% of NH White women, respectively, and 32% and 16% of Hispanic/Latina women, respectively). While everyday discrimination was not associated with T2DM risk, experiencing major discrimination was marginally associated with higher T2DM risk overall (hazard ratio = 1.26, 95% confidence interval: 0.99, 1.61) after adjustment for sociodemographic characteristics and body mass index. Associations were similar across racial/ethnic groups; however, racial/ethnic discrimination was more frequently reported among racial/ethnic minority women. Antidiscrimination efforts may help mitigate racial/ethnic disparities in T2DM risk.

Chronic Stress Burden, Visceral Adipose Tissue, and Adiposity-Related Inflammation: The Multi-Ethnic Study of Atherosclerosis

OBJECTIVE

We investigated the role of chronic stress burden on adiposity and adiposity-related inflammation with two hypotheses: a) greater chronic stress is associated with higher central adiposity and selective accumulation of visceral adipose tissue (VAT) compared with subcutaneous adipose tissue (SAT), and b) associations between VAT and inflammatory biomarkers are exacerbated when chronic stress is high.

METHODS

Data come from 1809 participants included in a Multi-Ethnic Study of Atherosclerosis ancillary study of body composition and adiposity-related inflammation. Chronic psychosocial stress was measured with a five-item version of the Chronic Stress Burden Scale. First, we tested associations between chronic stress (three-level categorical variable) and VAT, SAT, and VAT/SAT ratio. Second, we tested whether associations between VAT and inflammatory biomarkers varied by level of chronic stress.

RESULTS

Participants were approximately 65 years, 50% female, and 40.5% White, 25.6% Hispanic, 21.2% African American, and 12.8% Chinese American. About half of the sample reported little to no stress, and a quarter and a fifth of the sample reported medium and high levels of stress. Higher levels of chronic stress were associated with greater VAT and SAT, but not VAT/SAT ratio. Greater levels of VAT were associated with increased levels of adiposity-related inflammation in a graded pattern. These associations did not vary by stress level.

CONCLUSIONS

Greater chronic stress burden is associated with both central and subcutaneous adiposity. We found no evidence that the associations between VAT and inflammatory biomarkers are exacerbated by chronic stress. Findings contribute to ongoing literature untangling pathways in which psychosocial stress contributes to adiposity-related inflammation.

Use of Food to Cope With Culturally Relevant Stressful Life Events Is Associated With Body Mass Index in African American Women

BACKGROUND

Although stress is an established contributor to obesity (in general population studies), mechanisms to explain this association in African American women that incorporate culturally relevant frameworks have received little attention.

OBJECTIVE

To investigate how stress is associated with body mass index (BMI) in this population, we examined multivariate models of BMI predicted by race-related, gender-related, and generic stressful life events and by use of food to cope with stress. We hypothesized that the three types of stressful life events would be indirectly associated with BMI through using food to cope with stress.

METHODS

Psychometrically robust measures were included in surveys administered to a socioeconomically diverse sample of 189 African American women aged 21-78 years. Hypotheses were tested using structural equation modeling. We examined race-related, gender-related, and generic stressful life events as latent constructs indicated by exposure to and appraisal of potential stressors predicting a mediator, using food to cope, which predicted BMI; this model also included direct paths from the three latent stressful life event constructs to BMI.

RESULTS

Almost every participant reported using food in some way to cope with stress; 33% and 42% met established criteria for overweight and obesity, respectively. The race-related stressful life event construct was the only latent construct predicting using food to cope with stress, and using food to cope with stress predicted BMI. A significance test of indirect effects demonstrated that the race-related stressful life event construct was indirectly associated with BMI through the mediator, using food to cope.

DISCUSSION

Culturally relevant stress exposures and stress-related eating are important areas of foci for tackling overweight, obesity, and related health inequities in African American women. Findings highlight the importance of developing more complex models to understand the stress-related factors that elevate risk for overweight and obesity in this population.

Stress interventions and hypertension in Black women

Hypertension is a risk factor for cardiovascular disease. Black women have high rates of hypertension compared to women of other racial or ethnic groups and are disproportionately affected by psychosocial stressors such as racial discrimination, gender discrimination, and caregiving stress. Evidence suggests that stress is associated with incident hypertension and hypertension risk. Stress management is associated with improvements improved blood pressure outcomes. The purpose of this review is to synthesize evidence on effects of stress management interventions on blood pressure in Black women. A comprehensive search of scientific databases was conducted. Inclusion criteria included studies that were: (1) primary research that tested an intervention; (2) in the English language; (3) included African-American women; (4) incorporated stress in the intervention; (5) included blood pressure as an outcome; and (6) were US based. Eighteen studies met inclusion criteria. Ten (56%) studies tested meditation-based interventions, two (11%) tested coping and affirmation interventions, and six (33%) tested lifestyle modification interventions that included stress management content. Thirteen of the studies were randomized controlled trials. Reductions in blood pressure were observed in all of the meditation-based interventions, although the magnitude and statistical significance varied. Comprehensive lifestyle interventions were also efficacious for reducing blood pressure, although the relative contribution of stress management versus behavior modification could not be evaluated. Coping and affirmation interventions did not affect blood pressure. Most of the reviewed studies included small numbers of Black women and did not stratify results by race and gender, so effects remain unclear. This review highlights the urgent need for studies specifically focusing on Black women. Given the extensive disparities in cardiovascular disease morbidity and mortality, whether stress management can lower blood pressure and improve primary and secondary cardiovascular disease prevention among Black women is an important question for future research.

Everyday Discrimination and Mental Stress-Induced Myocardial Ischemia

OBJECTIVE

Mental stress-induced myocardial ischemia (MSIMI), a transient myocardial ischemic response to mental stress, is associated with poorer outcomes among patients with coronary heart disease and is more likely to occur among women. However, predictors of MSIMI are not well explored. The current study investigated the association between experiences of everyday discrimination and MSIMI among patients with recent myocardial ischemia and contrasted the results with conventional stress-induced myocardial ischemia (CSIMI). We examined sex differences in associations.

METHODS

We studied 295 post-MI patients (145 women, 150 men). Provocation of myocardial ischemia with mental stress (speech task) and conventional stress (exercise or pharmacologic) was assessed by myocardial perfusion imaging. Frequency of exposure to everyday discrimination was assessed via questionnaire using the Everyday Discrimination Scale (EDS).

RESULTS

The mean age was 51 years in both women and men, and the EDS score ranged from 10 to 38 (mean [standard deviation] = 17 [6] years). After multivariable analysis, each standard deviation increase in the EDS score (more frequent exposure) was associated with an increased odds of MSIMI (odds ratio [OR] = 1.57 [1.10-2.23]). The EDS score was not associated with CSIMI (OR = 0.86 [0.64-1.17]). Women demonstrated a twofold increase (OR = 1.96 [1.13-3.38], p = .02) in the adjusted odds of MSIMI, with each standard deviation increase in the EDS score compared with a 1.4-fold increase (OR = 1.40 [0.80-2.44], p = .24) among men; however, interaction was not statistically significant.

CONCLUSIONS

Among post-MI patients, everyday discrimination was positively associated with occurrence of MSIMI, but not with CSIMI; associations were more pronounced among women.

Perceived racial discrimination and healthy behavior among African Americans

OBJECTIVE

Numerous studies have found evidence of a link between perceived discrimination and unhealthy behavior, especially substance use. Within this body of literature, however, several studies have found unexpected evidence of a positive relation between perceived racial discrimination among African Americans-mostly women-and certain types of healthy behavior, primarily exercise and healthy eating. The current study further examined this positive relation, including an anticipated moderator: optimism. It also examined the relation between perceived racial discrimination and a correlate of unhealthy behavior: BMI.

METHOD

Six waves of data were collected over 14 years in three related samples of African Americans from families participating in the Family and Community Health Study. Each family included an adolescent (Mage = 10.5 at Wave 1), the adolescent's primary caregiver (Mage = 37), and, in some cases, an older sibling of that adolescent (Mage = 13). Wave 1 Ns were 889, 889, and 295, respectively. Healthy behavior was defined as diet and exercise.

RESULTS

There was very little evidence of a long-term relation between perceived racial discrimination and BMI in any sample, and no evidence of a relation between discrimination and healthy behavior among the males. However, correlational analyses revealed a positive prospective relation between discrimination and healthy behavior among all three groups of females; structural equation modeling indicated that this relation was stronger among women who were high in optimism.

CONCLUSIONS

Perceived racial discrimination does not appear to be related to BMI among African Americans, but it is related to healthy behavior among Black females who are high in dispositional optimism. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Fear, xenophobia and collectivism as predictors of well-being during Coronavirus disease 2019: An empirical study from India

BACKGROUND

The Coronavirus disease 2019 (COVID-19) has emerged as a global health threat. Biological disasters like this can generate immense prejudice, xenophobia, stigma and othering, all of which have adverse consequences on health and well-being. In a country as diverse and populous in India, such crisis can trigger communalism and mutual blame. Keeping this in context, this study explored the relationship between well-being and xenophobic attitudes towards Muslims, collectivism and fear of COVID-19 in India.

METHODS

The study was carried out on 600 non-Islamic Indians (231 males, 366 females and 3 others; mean age: 38.76 years), using convenience sampling. An online survey containing Fear of Coronavirus scale, Warwick-Edinburgh Mental Well-Being Scale and Collectivism Scale was used. Xenophobia was assessed using two scales: generalized prejudice towards Muslims and specific xenophobic tendencies towards Muslims during COVID-19. The data were analysed using correlational methods and multiple regression.

RESULTS

The findings showed that positively significant relationship exists between well-being and age as well as with collectivism, while an inversely significant relationship between well-being and fear of COVID-19 was found. The results of the multiple regression analysis shows that fear of COVID-19, age, collectivism and generalized xenophobia, in the order of their importance, together contributed to nearly 20% of variance in well-being.

CONCLUSION

The findings are reflective of the importance of collectivism in enhancing well-being in these times of uncertainty. Xenophobia, one of the common offshoots of pandemics, can also harm the overall well-being. Implications are discussed in the light of India's diverse socio-religious background and global context.

Racial Discrimination, Racial Identity, and Obesity in Collegiate African American Women

OBJECTIVE

To investigate relationships among racial discrimination, explicit racial identity, and obesity in young collegiate African American (AA) women aged 18-25.

DESIGN

Researchers recruited 136 women who self-identified as AA from a large Midwestern university. Racial discrimination (RD) was measured using lifetime overt experiences of discrimination, recent microaggressions, and vicarious RD directed towards close others. Explicit racial identity included dimensions of private regard, public regard, and centrality. Generalized obesity (elevated body mass index) and abdominal obesity (increased fat distribution in the midsection) were measured biometrically using kg/m² and waist circumference, respectively. Hierarchical multiple regression was employed to explore main and interaction effects.

RESULTS

After controlling for adverse life events and income, overt RD, recent microaggressions, and private regard directly accounted for variance in both BMI and waist circumference. Public regard and centrality moderated relationships between RD variables and waist circumference.

CONCLUSIONS

RD and racial identity accounted for up to 13% of variance in BMI and waist circumference in main effects models among young collegiate AA women. While obesity is a multifactorial phenomenon, racial discrimination and racial identity may affect observed racial disparities in obesity rates among young women.

Various Types of Perceived Job Discrimination and Sleep Health Among Working Women: Findings From the Sister Study

Job discrimination, a social stressor, may lead to sleep health disparities among workers; yet, limited research has examined this relationship and specific sources of job discrimination. We used a US sample of working women (n = 26,085), participants in the Sister Study (2008-2016), to examine the associations of perceived job discrimination due to sex, race, age, health conditions, and/or sexual orientation with sleep health. Cross-sectionally, linear or logistic regression models revealed that each source of job discrimination was independently associated with different sleep problems after controlling for other sources of job discrimination. Longitudinally, among participants without short sleep (<7 hours/night) at time 1 (2012-2014), age-specific job discrimination was associated with 21% increased odds of new-onset short sleep (odds ratio = 1.21, 95% confidence interval: 1.03, 1.43) at time 2 (2014-2016). Among those without insomnia symptoms at time 1, race-specific job discrimination was associated with 37% increased odds of new-onset insomnia symptoms (odds ratio = 1.37, 95% confidence interval: 1.07, 1.75) at time 2. Sex- and health-specific job discrimination also predicted new-onset sleepiness. There were dose-response relationships such that a greater number of sources of job discrimination (≥3) was associated with greater odds of prevalent and incident sleep problems. Perceived job discrimination may contribute to working women's poor sleep health over time, raising concerns about sleep health disparities emanating from the workplace.

Discrimination as a social determinant of stress and health among New York City taxi drivers

Discrimination is associated with poorer mental and physical health outcomes. Taxi drivers have a higher risk of exposure to discrimination and higher rates of chronic conditions. A cross-sectional needs assessment was conducted with a multilingual group of 535 male taxi drivers in New York City. Drivers reporting higher discrimination were more likely to have higher perceived stress and were more likely to have anxiety/depression and chronic pain, adjusting for confounders. Workplace-based interventions designed to help drivers cope with discrimination, stress, and chronic health conditions, interventions to educate the taxi-riding public, and greater attention to these issues from administrative agencies are warranted.

New research directions on disparities in obesity and type 2 diabetes

Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.

The moderating role of race/ethnicity and nativity in the relationship between perceived discrimination and overweight and obesity: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND

The overweight/obesity epidemic is a public health issue in the United States (US), that disproportionately affect certain racial/ethnic minority groups. Perceived discrimination has been implicated as a health risk factor. However, research on race/ethnicity, perceived discrimination, and obesity has been mixed. Researchers suggest that perceptions of discrimination may be dependent upon nativity status. This study evaluated the role that nativity status and race/ethnicity play in the relationship between perceived discrimination and overweight/obesity.

METHODS

We used Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005) [N = 33,319]). Multinomial logistic regression assessed a three-way interaction (perceived discrimination × race/ethnicity × nativity) on overweight and obesity, adjusting for sociodemographic factors and health-related behaviors.

RESULTS

The three-way interaction was significant for overweight [F (17, 49) = 3.35; p < 0.001] and obesity [F (17, 49) = 5.05; p < 0.001]. Among US-born individuals, US-born non-Hispanic Blacks had a decreased risk of being obese compared to US-born non-Hispanic Whites at mean levels of perceived discrimination [aRRR = 0.71; 95% CI (0.51-0.98); p = 0.04). Among foreign-born individuals, foreign-born South Americans had an increased risk of being overweight at mean levels of perceived discrimination compared to foreign-born non-Hispanic Whites [aRRR = 8.07; 95% CI (1.68-38.77); p = 0.01], whereas foreign-born Dominicans had a decreased risk of being obese compared to foreign-born non-Hispanic Whites [aRRR = 0.05; 95% CI (0.01-0.20); p < 0.001].

CONCLUSION

Perceived racial discrimination is a risk factor for overweight/obesity for certain groups. Race/ethnicity and nativity may play important roles in the relationship between perceived discrimination and overweight/obesity. Future research is needed to identify the behavioral and psychological pathways that link perceived discrimination and overweight/obesity.

Expectations of Racism and Carotid Intima-Media Thickness in African American Women

OBJECTIVE

Several researchers have argued that racism-related stressors play an important role in adverse cardiovascular outcomes among African American women. However, studies have primarily focused on experiences of racism; thus, the role of expectations of racism is insufficiently understood. The current proof-of-concept study was designed to examine associations among expectations of racism, self-reported experiences of racism, and carotid intima-media thickness (IMT), a marker of cardiovascular risk, in African American women.

METHODS

Participants were 52 healthy African American women, aged 30 to 50 years (M (SD) = 40.8 (4.3)). Expectations of racism were assessed with a modified version of the Race-Based Rejection Sensitivity Questionnaire, experiences of racism were assessed with the Schedule of Racist Events, and carotid IMT was measured using B-mode ultrasound.

RESULTS

In linear regression analyses adjusted for age, expectations of racism were associated with higher levels of carotid IMT (b = .04, SE = .014, p = .013), after adjusting for experiences of racism. Findings remained significant after additional adjustments for cardiovascular risk factors (b = .03, SE = .014, p = .032). Associations were not confounded by additional stressors, hostility, or negative affect (depressive symptoms).

CONCLUSIONS

Independent of actual reports of racism, "expectations" of racism may be associated with increased cardiovascular risk in African American women. In addition, although experiences of discrimination were associated with depressive symptoms, expectations of racism were not, suggesting that other negative emotions likely play a role. Future studies are needed to replicate these results in larger samples and to explore the psychological and physiological pathways through which expectations of racism might affect cardiovascular disease risk across a range of populations.

The association between perceived discrimination in midlife and peripheral neuropathy in a population-based cohort of women: the Study of Women's Health Across the Nation

PURPOSE

Peripheral neuropathy (PN) is a highly prevalent condition with serious sequelae. Many studies of the condition have been restricted to populations with diabetes, limiting evidence of potential contributing risk factors including salient psychosocial risk factors such as discrimination.

METHODS

The longitudinal Study of Women's Health Across the Nation was used to assess the relationship between perceived discrimination and prevalent PN in 1718 ethnically diverse midlife women. We used multivariable logistic regression to determine the association between perceived discrimination (Detroit Area Study Everyday Discrimination Scale) and PN (symptom questionnaire and monofilament testing) and conducted an assessment of the mediating effects of body mass index (BMI).

RESULTS

The prevalence of PN was 26.1% in the total sample and 40.9% among women with diabetes. Women who reported perceived discrimination had 29% higher odds of PN compared with women who did not report perceived discrimination (95% confidence interval, 1.01-1.66). Approximately 30% of the total effect of discrimination on PN was mediated indirectly by BMI.

CONCLUSIONS

More research is needed to determine the contributing factors to nondiabetic PN. Our findings reaffirm the impact of financial strain, BMI, and diabetes as significant correlates of PN and highlight discrimination as an important risk factor.

Differential associations between everyday versus institution-specific racial discrimination, self-reported health, and allostatic load among black women: implications for clinical assessment and epidemiologic studies

PURPOSE

Black women have the highest estimated allostatic load (AL). AL and self-perceived health are strong health predictors and have been linked to racial discrimination. Research suggests that everyday and institution-specific racial discrimination may predict different AL and self-reported health (SRH) outcomes. Furthermore, discrepancies between AL and self-perceived health could widen disparities. We estimated associations between everyday versus institution-specific racial discrimination with AL and SRH.

METHODS

Data are from a San Francisco Bay Area community sample of 208 black women aged 30-50 years. Participation involved a questionnaire, self-interview, blood draw, and anthropometric measurements. Adjusted generalized linear regression models estimated associations of racial discrimination with AL and SRH.

RESULTS

After adjusting for age, socioeconomic position, and medication use, institution-specific discrimination was negatively associated with AL (i.e., better health), whereas everyday experiences showed no association. Those reporting very-high (vs. moderate) institution-specific discrimination had lower AL (β = -1.31 [95% CI: -2.41, -0.20]; AL range: 0-15). No racial discrimination-SRH association was found.

CONCLUSIONS

For black women, (1) institution-specific racial discrimination may be differentially embodied compared with everyday experiences and (2) institutional racism may contribute to physiologic stress-regulation regardless of self-perceived health status. Potential factors that may contribute to an inverse racial discrimination-AL association, and future research, are discussed.

Racial Discrimination and Low Household Education Predict Higher Body Mass Index in African American Youth

OBJECTIVE

The purpose of this study was to examine the relationships between environmental factors, including household education, community violence exposure, racial discrimination, and cultural identity, and BMI in African American adolescents.

METHODS

A community-based sample of 198 African American youth (120 girls, 78 boys; ages 11-19 years) from Washtenaw County, Michigan, were included in this analysis. Violence exposure was assessed by using the Survey of Children's Exposure to Community Violence; racial discrimination by using the Adolescent Discrimination Distress Index; cultural identity by using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents; and household education by using a seven-category variable. Measured height and body weight were used to calculate BMI.

RESULTS

Racial discrimination was positively associated with BMI, whereas household education was inversely associated with BMI in African American adolescents (discrimination: β = 0.11 ± 0.04, p = 0.01; education: β = -1.13 ± 0.47, p = 0.02). These relationships were significant when accounting for the confounding effects of stress, activity, diet, and pubertal development. Significant gender interactions were observed with racial discrimination and low household education associated with BMI in girls only (discrimination: β = 0.16 ± 0.05, p = 0.003; education: β = -1.12 ± 0.55, p = 0.045). There were no significant relationships between culture, community violence exposure, and BMI (all p's > 0.05).

CONCLUSION

Environmental factors, including racial discrimination and low household education, predicted higher BMI in African American adolescents, particularly among girls. Longitudinal studies are needed to better understand the mechanisms by which these environmental factors increase obesity risk in African American youth.

Dark and sick, light and healthy: black women's complexion-based health disparities

Objective: Although research on skin tone inequalities suggest that darker-skinned Black women should experience worse health outcomes than lighter-skinned women, findings have been mixed. The present study investigates the possibility that the manner that stress and health are measured (i.e. global versus count measures) may explain the conflicting findings. Design: Black American women of different skin tones were investigated in two cross-sectional samples: the National Longitudinal Study of Adolescent to Adult Health (N = 571) and the Detroit Area Study (N = 290). Women's skin tone health disparities were examined using both objective (i.e. directly measured) or count measures (i.e. number of diagnosed chronic health conditions) as well as a global measure of health (i.e. self-rated health - SRH). Additionally, in the Detroit Area Study (DAS), disparities in stress exposure were examined using count and global measures. Results: Skin tone did not predict global measures of health (i.e. SRH) in both samples. In contrast, skin tone predicted objective and count measures of health in both samples, and the disparities between dark- and light-skinned women were starker among higher SES populations. Furthermore, DAS analyses of stress measures indicated that skin tone did not predict a global measure of stress but significantly predicted a count measure of stress (i.e. life events) since dark-skinned women reported worse outcomes. Conclusions: Health disparities research will benefit from accounting for Black women's skin tones as an important social determinant of health. Additionally, use of subjective measurements of health (e.g. SRH) may conceal within-race health disparities across complexions as well as obscure the magnitude of disparities across race.

Spilling the T on Trans-Misogyny and Microaggressions: An Intersectional Oppression and Social Process Among Trans Women

Minority stress frameworks seek to explain how stress impacts the health of minorities. Examining the social location of trans women in society is critical to understand the unique forms of oppression that engender stress and microaggression for trans women. This article uses intersectionality to examine the lived experiences of young trans women and develop new theoretical concepts to understand the social process of trans-misogyny. We use grounded theory to analyze semistructured, in-depth interviews conducted with 38 young trans women ages 16-24 in Los Angeles and Chicago. Our findings describe key concepts: trans-misogyny, cis-sexism, the passing complex, and transition work. We describe how trans-misogyny acts as an intersectional, interlocking structure of oppression, fueling the passing complex, and, as a result, how trans women experience overt and covert forms of discrimination.

Lifetime discrimination, global sleep quality, and inflammation burden in a multiethnic sample of middle-aged adults

OBJECTIVE

Despite considerable evidence that greater exposure to discrimination over the life course increases risk for systemic inflammation, little is known about the mechanisms responsible for this association. Here we examine the role of global sleep quality as a potential pathway by which self-reported experiences of discrimination contribute to inflammatory dysfunction in a multiethnic sample of middle-aged adults.

METHOD

Participants were 300 adults (36-85 years; 65% women) from Milwaukee, Wisconsin, a subset of the Midlife in the United States Study 2 (2004-2006). Racial/ethnic representation included African American (77.7%), Hispanic (12.7%), Asian/Pacific Islander (5.6%), and Native American (4.0%). Global sleep quality and perceptions of lifetime and daily discrimination were measured by questionnaire. A composite score of inflammation burden was computed as the sum of five markers including C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, E-selectin, and intracellular adhesion molecule-1 (ICAM-1).

RESULTS

Greater lifetime exposure to discrimination was associated with higher inflammation burden. This relationship remained significant after adjustments for potential confounding factors, including demographics, medication use, health behaviors, psychological distress, and daily discrimination. Mediation analyses suggested that poor global sleep quality was a key mechanism underlying the link between lifetime discrimination and inflammation burden.

CONCLUSION

These results add to a growing literature on the effects of bias and unfair treatment experienced by people of color and other marginalized groups by demonstrating how such experiences may be particularly consequential for sleep and physiological functioning in midlife. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

It Weigh(t)s on You: Everyday Discrimination and Adiposity Among Latinos

OBJECTIVE

Evidence suggests discrimination increases the risk of obesity. The biopsychosocial model of racism posits that psychological factors such as depressive symptoms may link experiences of perceived interpersonal discrimination to obesity. This study tested whether self-reported experiences of everyday discrimination were associated with adiposity indicators and whether depressive symptoms explained these associations.

METHODS

Cross-sectional survey data of 602 Latino adults living in Lawrence, Massachusetts, from the Latino Health and Well-being Project (2011-2013) were used. Participants completed questionnaires assessing perceived everyday discrimination and depressive symptoms. Anthropometric measures (i.e., BMI and waist circumference [WC]) were obtained by trained staff. Structural equation modeling was employed to test for direct and indirect effects of perceived everyday discrimination on adiposity.

RESULTS

Perceived everyday discrimination was directly and positively associated with higher BMI and WC, independent of sociodemographic factors, physical activity, and stressful life events. Perceived everyday discrimination was not indirectly associated with BMI and WC through depressive symptoms. However, perceived everyday discrimination was associated with higher levels of depressive symptoms.

CONCLUSIONS

Self-reported everyday discrimination among Latino adults is associated with adiposity. Day-to-day interpersonal discrimination may be implicated in obesity disparities for Latino adults.

Social Determinants of Health and Preclinical Glycemic Control in Newly Diagnosed First-Episode Psychosis Patients

BACKGROUND

The abnormally high incidence of disorders of glucose metabolism (DGM) in psychotic-spectrum disorders (PSD) has often been attributed to the side effects of antipsychotics and unhealthy lifestyles. The influence of social determinants of health has been largely ignored, despite ample evidence linking social adversity with both PSD and DGM. The aim of this study is to examine the influence of well-established social determinants of health on preclinical levels of glycated hemoglobin (HbA1c) in a sample of first-episode psychosis (FEP) patients.

METHODS

In a sample of newly admitted FEP patients, univariate analyses were used to select the main predictors of HbA1c levels from the following social determinants of health: childhood trauma, immigrant background, visible minority status, and indices of social and material deprivation. The predictors identified in the univariate analyses were tested in multivariate linear regression models including age, sex, BMI, depression, and physical anergia (proxy of sedentary behaviour) as covariates.

RESULTS

Univariate analyses identified visible minority status and childhood physical abuse as predictors of HbA1c. After controlling for covariates, minority status significantly predicted higher levels of glycated hemoglobin (β = 0.23; P = 0.01), and physical abuse had a marginally significant effect (β = 0.23; P = 0.06). Other predictors were not significantly associated.

CONCLUSION

FEP patients from a visible minority or who were victims of childhood physical abuse have higher levels of HbA1c at admission compared with other patients. This might suggest an increase in risk for the development of future DGM. If confirmed, preventive strategies could be tailored for these groups.

Workplace Racial Composition Explains High Perceived Discrimination of High Socioeconomic Status African American Men

BACKGROUND

Sociological and epidemiological literature have both shown that socioeconomic status (SES) protects populations and individuals against health problems. Recent research, however, has shown that African Americans gain less from their SES and African Americans of high SES, particularly males, may be vulnerable to perceived discrimination, as explained by the Minorities' Diminished Returns theory. One potential mechanism for this phenomenon is that high SES African Americans have a higher tendency to work in predominantly White workplaces, which increases their perceived discrimination. It is, however, unknown if the links between SES, working in predominantly White work groups and perceived discrimination differ for male and female African Americans.

AIM

To test the associations between SES, workplace racial composition and perceived discrimination in a nationally representative sample of male and female African American adults.

METHODS

This study included a total number of 1775 employed African American adults who were either male (n = 676) or female (n = 1099), all enrolled from the National Survey of American Life (NSAL). The study measured gender, age, SES (educational attainment and household income), workplace racial composition and perceived discrimination. Structural Equation Modeling (SEM) was applied in the overall sample and also by gender.

RESULTS

In the pooled sample that included both genders, high education and household income were associated with working in a predominantly White work group, which was in turn associated with more perceived discrimination. We did not find gender differences in the associations between SES, workplace racial composition and perceived discrimination.

CONCLUSION

Although racial composition of workplace may be a mechanism by which high SES increases discriminatory experiences for African Americans, males and females may not differ in this regard. Policies are needed to reduce discrimination in racially diverse workplaces. This is particularly the case for African Americans who work in predominantly White work environments.

Stress-Related Biosocial Mechanisms of Discrimination and African American Health Inequities

This review describes stress-related biological mechanisms linking interpersonal racism to life course health trajectories among African Americans. Interpersonal racism, a form of social exclusion enacted via discrimination, remains a salient issue in the lives of African Americans, and it triggers a cascade of biological processes originating as perceived social exclusion and registering as social pain. Exposure to discrimination increases sympathetic nervous system activation and upregulates the HPA axis, increasing physiological wear and tear and elevating the risks of cardiometabolic conditions. Consequently, discrimination is associated with morbidities including low birth weight, hypertension, abdominal obesity, and cardiovascular disease. Biological measures can provide important analytic tools to study the interactions between social experiences such as racial discrimination and health outcomes over the life course. We make future recommendations for the study of discrimination and health outcomes, including the integration of neuroscience, genomics, and new health technologies; interdisciplinary engagement; and the diversification of scholars engaged in biosocial inequities research.

Everyday discrimination, negative emotions, and academic achievement in Filipino secondary school students: Cross-sectional and cross-lagged panel investigations

Different forms of overt discrimination have been consistently linked to maladaptive psychological, physical health, and educational outcomes. However, limited research has been carried out to assess the link of subtle forms of discrimination like everyday discrimination on academic functioning in the school context. The current study addressed this research gap through examining the association of everyday discrimination with negative emotions and academic achievement among Filipino high school students. A cross-sectional study (Study 1) showed that everyday discrimination was positively associated with negative emotions and negatively linked to perceived academic achievement. Furthermore, everyday discrimination had indirect effects on academic achievement through the intermediate variable negative emotions. Then, a two-wave cross-lagged panel investigation (Study 2) demonstrated that Time 1 everyday discrimination was linked to higher Time 2 negative emotions. Reciprocal associations were also found among the constructs because Time 1 academic achievement was linked to lower levels Time 2 negative emotions and Time 2 everyday discrimination. The theoretical and practical implications of the research are elucidated.

Chronic discrimination and bodily pain in a multiethnic cohort of midlife women in the Study of Women's Health Across the Nation

A growing literature links discrimination to key markers of biobehavioral health. While racial or ethnic differences in pain are seen in experimental and clinical studies, the authors were interested in how chronic discrimination contributes to pain within multiple racial or ethnic groups over time. Participants were 3056 African American, Caucasian, Chinese, Hispanic, and Japanese women from the Study of Women's Health Across the Nation. The Everyday Discrimination Scale was assessed from baseline through 13 follow-up examinations. The bodily pain subscale of the MOS 36-Item Short-Form Health Survey (SF-36) was assessed annually. There were large racial or ethnic differences in reports of discrimination and pain. Discrimination attributions also varied by race or ethnicity. In linear mixed model analyses, initially adjusted for age, education, and pain medications, chronic everyday discrimination was associated with more bodily pain in all ethnic groups (beta = -5.84; P < 0.002 for Japanese; beta = -6.17; P < 0.001 for African American; beta = -8.74; P < 0.001 for Chinese; beta = -10.54; P < 0.001 for Caucasians; beta = -12.82; P < 0.001 for Hispanic). Associations remained significant in all ethnic groups after adjusting for additional covariates in subsequent models until adding depressive symptoms as covariate; in the final fully-adjusted models, discrimination remained a significant predictor of pain for African American (beta = -4.50; P < 0.001), Chinese (beta = -6.62; P < 0.001), and Caucasian (beta = -7.86; P < 0.001) women. In this longitudinal study, experiences of everyday discrimination were strongly linked to reports of bodily pain for the majority of women. Further research is needed to determine if addressing psychosocial stressors, such as discrimination, with patients can enhance clinical management of pain symptoms.

Perceived Discrimination and Adolescent Sleep in a Community Sample

Sleep is a key restorative process, and poor sleep is linked to disease and mortality risk. The adolescent population requires more sleep on average than adults but are most likely to be sleep deprived. Adolescence is a time of rapid social upheaval and sensitivity to social stressors including discrimination. This study uses two weeks of daily e-diary measures documenting discrimination exposure and concurrent objective sleep indicators measured using actigraphy. We assess associations between daily discrimination and contemporaneous sleep with a diverse sample of adolescents. This novel study shows youth with higher average discrimination reports have worse average sleep relative to their counterparts. Interestingly, youth reporting daily discrimination have better sleep the day of the report than youth who do not.

Everyday discrimination in a racially diverse sample of patients with obesity

Weight discrimination affects a significant proportion of individuals with obesity and contributes to poor mental and physical health. Prior research on weight discrimination has been limited by a lack of racial diversity in samples and has not considered other potential forms of discrimination that individuals with obesity may experience. The current study assessed different reasons for discrimination in a racially diverse sample of treatment-seeking individuals with obesity (N = 122, 66.4% black, mean body mass index = 38.5 ± 6.2 kg/m² ). Results showed that over half of participants reported experiencing at least one form of repeated discrimination, and 30% reported two or more reasons for discrimination. Race and weight were the most commonly reported reasons for repeated, everyday instances of discrimination. Among participants who reported experiencing weight discrimination (28.7%), over 80% reported experiencing at least one other form of discrimination, with 60% reporting discrimination due to race. These findings indicate that individuals with obesity may face multiple forms of discrimination in their daily lives. Further research is needed to understand how all forms of discrimination contribute to obesity-related health problems.

Lower depression scores associated with greater weight loss among rural black women in a behavioral weight loss program

Depression and stress have been associated with less weight loss among some participants in behavioral weight loss (BWL) programs. The purpose of this study was to (1) measure the levels of depression and stress among a sample of black women living in rural Alabama and Mississippi who were participating in a BWL program and (2) examine the association between these psychosocial variables and weight loss outcomes of participants at 6 months. Overweight and obese black women in a BWL program (n = 409) completed validated surveys to measure depression and stress at baseline and 6 months. Weight and height were also measured at baseline and 6 months. Statistical tests were conducted to examine associations between depression, stress, and weight loss. Mean BMI at baseline was 38.68 kg/m². Participants achieved a 1.17 kg/m² reduction in BMI at 6 months. When comparing by baseline depression or stress categories, no significant differences in weight loss outcomes were observed. Analysis of continuous data revealed a significant correlation between baseline depression score and change in BMI. In adjusted models, change in depression score over time was significantly associated with change in weight. No differences in weight loss outcomes at 6 months were observed when comparing participants with and without elevated depressive symptoms or elevated stress at baseline. This suggests that potential participants may not need to be excluded from BWL programs based on pre-specified cut points for these psychological conditions. Greater improvements in depression were associated with better weight loss outcomes suggesting that more emphasis on reducing depression may lead to greater weight losses for black women in BWL programs.

Association between perceived racial discrimination and hypertension: findings from the ELSA-Brasil study

"Pardos" and blacks in Brazil and blacks in the USA are at greater risk of developing arterial hypertension than whites, and the causes of this inequality are still little understood. Psychosocial and contextual factors, including racial discrimination, are indicated as conditions associated with this inequality. The aim of this study was to identify the association between perceived racial discrimination and hypertension. The study evaluated 14,012 workers from the ELSA-Brazil baseline population. Perceived discrimination was measured by the Lifetime Major Events Scale, adapted to Portuguese. Classification by race/color followed the categories proposed by Brazilian Institute of Geography and Statistics (IBGE). Hypertension was defined by standard criteria. The association between the compound variable - race/racial discrimination - and hypertension was estimated by Poisson regression with robust variance and stratified by the categories of body mass index (BMI) and sex. Choosing white women as the reference group, in the BMI < 25kg/m2 stratum, "pardo" women showed adjusted OR for arterial hypertension of 1.98 (95%CI: 1.17-3.36) and 1.3 (95%CI: 1.13-1.65), respectively, whether or not they experienced racial discrimination. For black women, ORs were 1.9 (95%CI: 1.42-2.62) and 1.72 (95%CI: 1.36-2.18), respectively, for the same categories. Among women with BMI > 25kg/m2 and men in any BMI category, no effect of racial discrimination was identified. Despite the differences in point estimates of prevalence of hypertension between "pardo" women who reported and those who did not report discrimination, our results are insufficient to assert that an association exists between racial discrimination and hypertension.

The weight of racism: Vigilance and racial inequalities in weight-related measures

In the United States, racial/ethnic inequalities in obesity are well-documented, particularly among women. Using the Chicago Community Adult Health Study, a probability-based sample in 2001-2003 (N = 3105), we examined the roles of discrimination and vigilance in racial inequalities in two weight-related measures, body mass index (BMI) and waist circumference (WC), viewed through a cultural racism lens. Cultural racism creates a social environment in which Black Americans bear the stigma burden of their racial group while White Americans are allowed to view themselves as individuals. We propose that in this context, interpersonal discrimination holds a different meaning for Blacks and Whites, while vigilance captures the coping style for Blacks who carry the stigma burden of the racial group. By placing discrimination and vigilance within the context of cultural racism, we operationalize existing survey measures and utilize statistical models to clarify the ambiguous associations between discrimination and weight-related inequalities in the extant literature. Multivariate models were estimated for BMI and WC separately and were stratified by gender. Black women had higher mean BMI and WC than any other group, as well as highest levels of vigilance. White women did not show an association between vigilance and WC but did show a strong positive association between discrimination and WC. Conversely, Black women displayed an association between vigilance and WC, but not between discrimination and WC. These results demonstrate that vigilance and discrimination may hold different meanings for obesity by ethnoracial group that are concealed when all women are examined together and viewed without considering a cultural racism lens.

Interpersonal discrimination and markers of adiposity in longitudinal studies: a systematic review

While the impact of interpersonal discrimination on mental health is well established, its effects on physical health outcomes have not been fully elucidated. This study systematically reviewed the literature on the prospective association between interpersonal discrimination and markers of adiposity. Medline, Web of Science, Scopus, PsycInfo, SciELO, LILACS, Google Scholar, Capes/Brazil and ProQuest databases were used to retrieve relevant information in November 2016. The results from the 10 studies that met the inclusion criteria support an association between interpersonal self-reported discrimination and the outcomes. In general, the most consistent findings were for weight and body mass index (BMI) among women, i.e. high levels of self-reported discrimination were related to increased weight and BMI. Waist circumference (WC) showed a similar pattern of association with discrimination, in a positive direction, but an inverted U-shaped association was also found. Despite a few inverse associations between discrimination and markers of adiposity, none of the associations were statistically significant. Overall, markers of adiposity were consistently associated with discrimination, mainly through direct and nonlinear associations. This review provides evidence that self-reported discrimination can play an important role in weight, BMI and WC changes.

Experiences of Discrimination and Incident Type 2 Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis (MESA)

Experiences of discrimination are associated with increased risk of adverse health outcomes; however, it is unknown whether discrimination is related to incident type 2 diabetes mellitus (diabetes). We investigated the associations of major experiences of discrimination (unfair treatment in 6 situations) and everyday discrimination (frequency of day-to-day experiences of unfair treatment) with incident diabetes among 5,310 participants from the Multi-Ethnic Study of Atherosclerosis, enrolled in 2000-2002. Using Cox proportional hazards models, we estimated hazard ratios and confidence intervals, adjusting for demographic factors, depressive symptoms, stress, smoking, alcohol, physical activity, diet, waist circumference, and body mass index. Over a median follow-up of 9.4 years, 654 diabetes cases were accrued. Major experiences of discrimination were associated with greater risk of incident diabetes when modeled continuously (for each additional experience of discrimination, hazard ratio = 1.09, 95% confidence interval: 1.01, 1.17) or categorically (for ≥2 experiences vs. 0, hazard ratio = 1.34, 95% confidence interval: 1.08, 1.66). Similar patterns were observed when evaluating discrimination attributed to race/ethnicity or to a combination of other sources. Everyday discrimination was not associated with incident diabetes. In conclusion, major experiences of discrimination were associated with increased risk of incident diabetes, independent of obesity or behavioral and psychosocial factors. Future research is needed to explore the mechanisms of the discrimination-diabetes relationship.

Socioeconomic, health, and psychosocial mediators of racial disparities in cognition in early, middle, and late adulthood

Racial disparities in cognitive performance exist across the life course, but it is not known whether mediators of disparities differ by age. Understanding sources of cognitive disparities at different ages can inform policies and interventions. Data were obtained for non-Hispanic Black and White respondents to The National Survey of Midlife Development in the United States from 3 age groups: 28-44 (N = 1210; 20% Black); 45-64 (N = 2693; 15% Black); and 65-85 (N = 1298; 11% Black). Moderated mediation models characterized direct and indirect effects of race on episodic memory and executive function composite scores through economic, health, and psychosocial variables as a function of age group. Education, income, chronic health conditions, and external locus of control mediated cognitive disparities across the life course, although income was a stronger mediator at younger ages. Perceived discrimination was a weaker mediator among young adults due to an absence of racial differences in perceived discrimination in that group. Despite multiple indirect effects, there were still significant unexplained effects of race on cognition that were not moderated by age group. Interventional work is needed to determine whether increasing educational attainment and income, and reducing chronic health conditions and perceived constraints among Blacks, reduce cognitive disparities. Targeting income inequality and discrimination (or buffering the impact of those variables) may be differently effective at reducing cognitive disparities at different stages of the adult life course. (PsycINFO Database Record

Socioeconomic status discrimination and C-reactive protein in African-American and White adults

OBJECTIVES

We examined the association between socioeconomic status (SES) discrimination and C-reactive protein (CRP) in a biracial cohort of middle-aged adults using an intersectionality framework.

METHODS

Participants were 401 African-American and White adults from a population-based cohort in the Southeastern United States. SES discrimination was self-reported with a modified Experiences of Discrimination Scale, and CRP levels were assayed from blood samples. Linear regression analyses were used to examine the associations among SES discrimination, race, education, and CRP after controlling for age, gender, racial and gender discrimination, financial and general stress, body mass index, smoking, sleep quality, and depressive symptoms. Intersectional effects were tested using race×SES discrimination, education×SES discrimination and race×education×SES discrimination interactions.

RESULTS

Adjusting for sociodemographics, racial discrimination, gender discrimination, and all relevant two-way interaction terms, we observed a significant race×education×SES discrimination interaction (p=0.019). In adjusted models stratified by race and education, SES discrimination was associated with elevated CRP among higher educated African-Americans (β=0.29, p=0.018), but not lower educated African-Americans (β=-0.13, p=0.32); or lower educated (β=-0.02, p=0.92) or higher educated (β=-0.01, p=0.90) Whites.

CONCLUSIONS

Findings support the relevance of SES discrimination as an important discriminatory stressor for CRP specifically among higher educated African-Americans.

Perceived Stress and Cognitive Decline in Different Cognitive Domains in a Cohort of Older African Americans

BACKGROUND

Research indicates that stress is linked to cognitive dysfunction. However, few community-based studies have explored the relationship between perceived stress and cognitive decline, and fewer still have utilized cognitive domains rather than a global measure of cognition.

OBJECTIVE

We examined the relation between perceived stress and the rate of decline in different cognitive domains.

METHODS

Participants were older African Americans without dementia from the Minority Aging Research Study (MARS; N = 467, mean age: 73 years, SD: 6.1 years). A battery of 19 cognitive tests was administered at baseline and at annual intervals for up to 9 years (mean follow-up: 4 years), from which composite measures of global cognitive function and five specific cognitive domains were derived. The four-item Cohen's Perceived Stress Scale (PSS) was also administered at baseline.

RESULTS

In linear mixed-effects models adjusted for age, sex, education, and vascular risk factors, higher perceived stress was related to faster declines in global cognition (β = -0.019; SE: 0.008; t₍₁₉₅₁₎ = -2.46), episodic memory (β = -0.022; SE: 0.011; t₍₁₉₅₄₎ = -1.99), and visuospatial ability (β = -0.021; SE: 0.009; t₍₁₉₃₉₎ = -2.38) all p < 0.05. Findings were similar in subsequent models adjusted for demographics, vascular diseases, and depressive symptoms.

CONCLUSIONS

Results indicate that older African Americans with higher levels of perceived stress have more rapid declines in global cognition than those with lower levels, most notably for episodic memory and visuospatial ability.

Perceived Ethnic Discrimination and the Metabolic Syndrome in Ethnic Minority Groups: The Healthy Life in an Urban Setting Study

OBJECTIVE

Ethnic differences in the metabolic syndrome could be explained by perceived ethnic discrimination (PED). It is unclear whether PED is associated with the metabolic syndrome. We assessed this association and quantified the contribution of PED to the metabolic syndrome.

METHODS

Baseline data were used from the Healthy Life in an Urban Setting study collected in the Netherlands from 2011 to 2014. The population-based sample included South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan participants (aged 18 to 70 years). PED was measured using the Everyday Discrimination Scale. The metabolic syndrome was determined according to the harmonized definition of the International Diabetes Federation, American Heart Association, and others. Logistic regression was used for analysis. population-attributable fraction was used to calculate the contribution of PED.

RESULTS

PED was positively associated with the metabolic syndrome in South-Asian Surinamese, African Surinamese, and Moroccan participants (odds ratio [95% confidence interval] = 1.13 [0.99-1.30], 1.15 [1.00-1.32], and 1.19 [1.03-1.38], respectively) after adjusting for potential confounders and mediators. No significant association was observed among Ghanaian and Turkish participants. For the individual components, the associations were statistically significant for blood pressure, fasting glucose, and waist circumference among Surinamese participants. PED was associated with dyslipidemia in Moroccan participants. The population-attributable fractions were 5% for South-Asian Surinamese and Moroccan participants, and 7% for African Surinamese participants.

CONCLUSIONS

We found a positive association of PED with the metabolic syndrome in some ethnic groups, with PED contributing around 5% to 7% to the metabolic syndrome among Surinamese and Moroccans. This suggests that PED might contribute to ethnic differences in the metabolic syndrome.