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Maletta RM, Daly M, Noonan R, Putra IGNE, Vass V, Robinson E. Accumulation of perceived discrimination over time and likelihood of probable mental health problems in UK adults: A longitudinal cohort study. J Affect Disord 2025; 369:913-921. [PMID: 39306008 DOI: 10.1016/j.jad.2024.09.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 09/09/2024] [Accepted: 09/18/2024] [Indexed: 10/27/2024]
Abstract
BACKGROUND Limited research has examined whether accumulation of discrimination over time is associated with worse mental health and whether such experiences are related to socioeconomic status (SES). METHODS A sample of UK adults with self-reported discrimination experiences (n = 3863) was taken from three waves of the UK Household Longitudinal Study (2015-2020). Multinomial logistic regression assessed associations between SES (income, education, occupation) and cumulative discrimination (number of timepoints discrimination was reported). Logistic regression models assessed prospective associations between cumulative discrimination and probable mental health problems (GHQ-12; 4+ threshold). RESULTS Those with lower income were more likely to report discrimination at one timepoint (vs. none). No SES measures were associated with experiencing discrimination at multiple timepoints. Participants who reported one timepoint of discrimination (vs. no experiences) were significantly more likely to report probable mental health problems (OR = 1.47, p < .001, 95% CI 1.20-1.80). Moreover, compared to those experiencing one timepoint, participants reporting multiple timepoints of discrimination were significantly more likely to report probable mental health problems (OR = 1.46, p = .002, 95% CI 1.15-1.86), indicating a cumulative association between discrimination and mental health. There was limited evidence that SES moderated this cumulative association. LIMITATIONS Mental health measures were based on self-report questionnaires and not a clinical diagnosis. CONCLUSIONS Amongst a sample of UK adults, perceiving discrimination at multiple timepoints increased the likelihood of experiencing probable mental health problems. There was limited evidence that this cumulative association differed by SES. National measures designed to reduce discrimination may benefit mental health.
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Affiliation(s)
| | - Michael Daly
- Department of Psychology, Maynooth University, Ireland
| | - Rob Noonan
- Faculty of Health and Wellbeing, University of Bolton, Bolton, UK
| | | | - Victoria Vass
- Department of Psychology, University of Liverpool, UK
| | - Eric Robinson
- Department of Psychology, University of Liverpool, UK
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Pinillos-Franco S, Cantarero-Prieto D, Lera J. Feeling discriminated means poor self-perceived health: a gender analysis using SHARE. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024:10.1007/s10754-024-09383-2. [PMID: 39325097 DOI: 10.1007/s10754-024-09383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 09/03/2024] [Indexed: 09/27/2024]
Abstract
Most part of the literature has highlighted the detrimental effects of discrimination on health. However, the influence of past and perceived discrimination on older workers' self-assessed health has been understudied. Firstly, we aim at studying whether reported discrimination is associated with self-assessed health among adults of working ages (50-65 years of age). Secondly, we analyze the existence of differences by gender. Data was retrieved from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to obtain the regular panel of questions, and the third and seventh waves of the SHARELIFE questionnaire, that includes information about discrimination (n = 30,019). We develop logistic regression models to determine the relationship of discrimination on male and female workers' self-assessed health separately. Our results show that 49.0% of our sample was composed of highly discriminated women, while the remaining percentage covered men and women (42.3% males and 8.7% females) that reported lower levels of discrimination. Our estimations reveal a significant association between discrimination and poor health status, especially in the case of men ranging from OR = 1.802 (95% CI 1.502-2.163) to OR = 1.565 (95% CI 1.282-1.910). In the case of women our results range from OR = 1.728 (95% CI 1.463-2.040) to OR = 1.196 (95% CI 0.992-1.442). These findings are essential to highlight the importance of tackling discrimination as a determinant of health that negatively affects both sexes, men and women.
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Affiliation(s)
- Sara Pinillos-Franco
- Dpto. Análisis Económico, Facultad de Ciencias Económicas y Empresariales, Universidad Autónoma de Madrid, Calle Francisco Tomás y Valiente 5, Madrid, 28049, Spain.
| | - David Cantarero-Prieto
- Department of Economics, Research Group of Health Economics and Health Services Management, University of Cantabria, IDIVAL, Cantabria, Spain
| | - Javier Lera
- Research Group of Health Economics and Health Services Management, IDIVAL, Cantabria, Spain
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Vu C, C Arcaya M, Kawachi I, Williams D. The mental health toll of the Great Migration: a comparison of mental health outcomes among descendants of African American migrators. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1497-1507. [PMID: 38231395 DOI: 10.1007/s00127-023-02605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Research is beginning to examine the health outcomes of migrators of the Great Migration, a movement of up to eight million African Americans from the South to the North and West during the twentieth century. However, sparse evidence exists studying the health outcomes of the descendants of Great Migration movers. The aim for this study was to compare the lifetime prevalence of mental health disorders by migration status. METHODS We used a sample of 3183 African American adults from the National Survey of American Life (2001-2003). Using birthplaces of participants and their mothers, we classified adults as (1) Southern stayers, (2) migrators to the South, (3) migrators to the North or (4) Northern stayers. The outcomes were lifetime prevalence of any mental health, mood, anxiety, and substance use disorders. We used weighted log-Poisson regression models and adjusted for demographic characteristics and socioeconomic status. RESULTS Migrators to the North and Northern stayers had higher risks of any lifetime mental health, mood, anxiety, and substance use disorders compared to Southern stayers in the adjusted models. Migrators to the North and Northern stayers were more likely to report perceived discrimination. CONCLUSION This study suggests that migrating families to the North may have experienced mental health adversities.
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Affiliation(s)
- Cecilia Vu
- Harvard TH Chan School of Public Heath, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Mariana C Arcaya
- Department of Urban Studies at Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02138, USA
| | - Ichiro Kawachi
- Harvard TH Chan School of Public Heath, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - David Williams
- Harvard TH Chan School of Public Heath, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, USA
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Savell SM, Niguse M, Caluori N, Brown-Iannuzzi JL, Wilson MN, Lemery-Chalfant K, Shaw DS. Cascading Influences of Caregiver Experiences of Discrimination and Adolescent Antisocial Behavior. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-15. [PMID: 38252485 PMCID: PMC11260903 DOI: 10.1080/15374416.2024.2301770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Although a growing body of work has found that parents' experiences of racial and socioeconomic (SES) based discrimination are directly related to their children's behavior problems , more work is needed to understand possible pathways by which these factors are related and to identify potential targets for prevention and/or intervention. METHOD Using a large (N = 572), longitudinal sample of low-income families from diverse racial backgrounds, the current study explored whether caregivers' experiences of racial and SES discrimination during their children's middle childhood (i.e. ages 7.5-9.5) predicted youth-reported antisocial behavior during adolescence and potential factors mediating these associations (e.g. caregiver depressive symptoms and positive parenting practices). RESULTS We found that higher levels of caregiver experiences of discrimination at child ages 7.5-9.5 predicted higher levels of caregiver depressive symptoms at child age 10.5, which were related to lower levels of caregiver endorsement of positive parenting practices at child age 14.5, which in turn, predicted higher levels of youth-reported antisocial behavior at age 16. CONCLUSION The findings highlight the adverse effects of racism and discrimination in American society. Second, the findings underscore the need to develop interventions which mitigate racism and discrimination among perpetrators and alleviate depressive symptoms among caregivers.
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Affiliation(s)
- Shannon M. Savell
- Department of Psychology, University of Virginia, Charlottesville, VA
| | - Mihret Niguse
- Department of Psychology, University of Virginia, Charlottesville, VA
| | - Nava Caluori
- Department of Psychology, University of Virginia, Charlottesville, VA
| | | | - Melvin N. Wilson
- Department of Psychology, University of Virginia, Charlottesville, VA
| | | | - Daniel S. Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
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Brady SS, Arguedas A, Huling JD, Hellemann G, Lewis CE, Fok CS, Van Den Eeden SK, Markland AD. Discrimination and bladder health among women in the CARDIA cohort study: Life course and intersectionality perspectives. Soc Sci Med 2024; 341:116547. [PMID: 38159485 PMCID: PMC10840419 DOI: 10.1016/j.socscimed.2023.116547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 09/10/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study examines whether discriminatory experiences are associated with lower urinary tract symptoms (LUTS) and their impact among 972 women in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study, which recruited participants from 4 cities in the United States. METHOD Exposure to discrimination was assessed 3 times (1992-93, 2000-01, 2010-11) and averaged across assessments. Participants separately reported whether they experienced discrimination on the basis of their gender, race or color, and socioeconomic position or social class. For each social identity, discrimination was assessed in 6-7 settings (e.g., when getting a job, medical care, or housing). At different time points, women who reported discriminatory experiences for a given social identity were asked how frequently the discrimination occurred and how stressful experience(s) were. Following the 2010-11 assessment, data on LUTS and their impact were collected. Women were classified into bladder health versus mild, moderate, or severe symptoms/impact clusters. RESULTS More Black than White women reported discriminatory experiences across all social identities and most settings. Perceived stress of discriminatory experiences did not differ between Black and White women. In analyses stratified by race and social identity, White women reported LUTS/impact with discriminatory experiences in more settings, more frequent discriminatory experiences across settings, and each additional social identity for which discrimination was experienced. Black women reported LUTS/impact with more frequent discriminatory experiences across settings. For Black women, greater perceived stress of both gender and race discrimination were associated with LUTS/impact. For White women, only greater perceived stress of race discrimination was associated with LUTS/impact. CONCLUSIONS This is one of the first studies to examine discrimination in relation to LUTS/impact. Additional research is needed to better understand differences in how discriminatory experiences based on potentially intersecting identities may be related to bladder health among women.
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Affiliation(s)
- Sonya S Brady
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Program in Health Disparities Research, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Andrés Arguedas
- Division of Biostatistics, University of Minnesota School of Public Health, University Office Plaza 2221 University Ave SE, Suite 200, Minneapolis, MN, 55414, USA.
| | - Jared D Huling
- Division of Biostatistics, University of Minnesota School of Public Health, University Office Plaza 2221 University Ave SE, Suite 200, Minneapolis, MN, 55414, USA.
| | - Gerhard Hellemann
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Ryals Public Health Building (RPHB), 1665 University Boulevard, Birmingham, AL, 35233, USA.
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Ryals Public Health Building (RPHB), 1665 University Boulevard, Birmingham, AL, 35233, USA.
| | - Cynthia S Fok
- Department of Urology, University of Minnesota Medical School, Mayo Building 420 Delaware St. Se. MMC 394, Minneapolis, MN, 55454, USA.
| | - Stephen K Van Den Eeden
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Oakland, CA, 94612, USA; Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine, 933 19th Street South, CH19 201 Birmingham, AL, 35294, USA; Birmingham VA Medical Center, 700 19th St S, Birmingham, AL, 35233, USA.
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Forbes N, Yang LC, Lim S. Intersectional discrimination and its impact on Asian American women's mental health: A mixed-methods scoping review. Front Public Health 2023; 11:993396. [PMID: 36923035 PMCID: PMC10008964 DOI: 10.3389/fpubh.2023.993396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/08/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction Gendered racism against Asian American women has become an increasing public health threat in recent years. Although intersectional discrimination (i.e., co-occurring race- and gender-based discrimination) against Asian American women is not new, research on this topic is lacking. The present scoping review sought to explore how Asian American women report experiences of intersectional discrimination through a systematic examination of the current literature. We included studies that explicitly or implicitly discuss intersectional discrimination. We also aimed to identify indicators of psychological wellbeing and coping associated with these experiences. Methods Following PRISMA Guidelines for Systematic Scoping Reviews, database searches were conducted for peer-reviewed articles. A total of 1,476 studies were title- and abstract-screened by two independent reviewers. Then, 148 articles were full-text screened for eligibility. Results A final sample of 23 studies was identified (15 qualitative and 8 quantitative). Only nine of the included studies explicitly used an intersectional framework. Results from qualitative studies revealed that Asian American women experience intersectional discrimination through fetishization, the ascription of passivity, invalidation through lack of representation and pervasive white beauty ideals, and workplace tokenization and scrutiny. Study findings suggested that Asian American women experience these forms of intersectional discrimination across multiple levels of influence (i.e., internalized, interpersonal, institutional, structural). Findings from both qualitative and quantitative studies also indicated how discrimination, whether explicitly or implicitly intersectional, contributes to adverse mental health outcomes such as body shame, disordered eating, depression, and suicidality. Studies also touched on common coping mechanisms employed by Asian American women when facing or anticipating discrimination, such as avoidance, shifting, proactive coping, and leaning on networks of support. There was a lack of studies using quantitative assessments of intersectional discrimination. Also, most studies did not include disaggregated data by ethnicity, age, sexual identity, religion, socioeconomic status, immigration status, or skin color, all of which are likely to shape their experiences. Discussion Our scoping review highlights how the marginalization of Asian American women is an urgent threat to their mental wellbeing. These findings are discussed to inform future research, interventions, and policy changes that prevent racialized and gendered violence against Asian American women.
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Affiliation(s)
- Nicola Forbes
- Applied Developmental Psychology, Department of Psychology, Fordham University, The Bronx, NY, United States
| | - Lauren C. Yang
- Department of Biology, New York University, New York, NY, United States
| | - Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
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Bécares L, Shaw RJ, Katikireddi SV, Irizar P, Amele S, Kapadia D, Nazroo J, Taylor H. Racism as the fundamental cause of ethnic inequities in COVID-19 vaccine hesitancy: A theoretical framework and empirical exploration using the UK Household Longitudinal Study. SSM Popul Health 2022; 19:101150. [PMID: 35765366 PMCID: PMC9225926 DOI: 10.1016/j.ssmph.2022.101150] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/12/2022] [Accepted: 06/16/2022] [Indexed: 11/01/2022] Open
Abstract
Ethnic inequities in COVID-19 vaccine hesitancy have been reported in the United Kingdom (UK), and elsewhere. Explanations have mainly focused on differences in the level of concern about side effects, and in lack of trust in the development and efficacy of vaccines. Here we propose that racism is the fundamental cause of ethnic inequities in vaccine hesitancy. We introduce a theoretical framework detailing the mechanisms by which racism at the structural, institutional, and interpersonal level leads to higher vaccine hesitancy among minoritised ethnic groups. We then use data from Wave 6 of the UK Household Longitudinal Study COVID-19 Survey (November to December 2020) to empirically examine these pathways, operationalised into institutional, community, and individual-level factors. We use the Karlson-Holm-Breen method to formally compare the relationship between ethnicity and vaccine hesitancy once age and gender, sociodemographic variables, and institutional, community, and individual-level factors are accounted for. Based on the Average Partial Effects we calculate the percentage of ethnic inequities explained by each set of factors. Findings show that institutional-level factors (socioeconomic position, area-level deprivation, overcrowding) explained the largest part (42%) of the inequity in vaccine hesistancy for Pakistani or Bangladeshi people, and community-level factors (ethnic density, community cohesion, political efficacy, racism in the area) were the most important factors for Indian and Black groups, explaining 35% and 15% of the inequity, respectively. Our findings suggest that if policy intervened on institutional and community-level factors - shaped by structural and institutional racism - considerable success in reducing ethnic inequities might be achieved.
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Affiliation(s)
- Laia Bécares
- Department of Social Work and Social Care, University of Sussex, Falmer, UK
| | - Richard J. Shaw
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Patricia Irizar
- Department of Sociology, University of Manchester, Manchester, UK
| | - Sarah Amele
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Dharmi Kapadia
- Department of Sociology, University of Manchester, Manchester, UK
| | - James Nazroo
- Department of Sociology, University of Manchester, Manchester, UK
| | - Harry Taylor
- Department of Social Statistics, University of Manchester, Manchester, UK
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Stopforth S, Kapadia D, Nazroo J, Bécares L. The enduring effects of racism on health: Understanding direct and indirect effects over time. SSM Popul Health 2022; 19:101217. [PMID: 36091297 PMCID: PMC9450139 DOI: 10.1016/j.ssmph.2022.101217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Experiences of racism and racial discrimination are associated with poorer mental and physical health outcomes for people from minoritised ethnic groups. One mechanism by which racism leads to poor health is through reduced socio-economic resources, but the evidence documenting the direct and indirect effects of racism on health via socio-economic inequality over time is under-developed. The central aims of this paper are to better understand how racism affects health over time, by age, and via the key mechanism of socio-economic inequality. This paper analyses large-scale, nationally representative data from the UK Household Longitudinal Study (Understanding Society) 2009–2019. Findings from longitudinal structural equation models clearly indicate the enduring effects of racism on health, which operate over time both directly and indirectly through lower income and poorer prior health. Repeated exposure to racism severely and negatively impacts the health of people from minoritised ethnic groups. These findings make an important contribution to the existing evidence base, demonstrating the enduring effects of racism on health over time and across age groups. We examine the role of racism as a key driver of ethnic inequalities in health. We examine the direct and indirect effects of racism on mental and physical health. Racism severely and negatively impacts health over time and across the life course. Repeated exposure to racism leads to accumulation of disadvantage and poorer health. Policy and academic debates must focus on the fundamental role of racism on health.
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9
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Van Dyke ME, Kramer MR, Kershaw KN, Vaccarino V, Crawford ND, Lewis TT. Inconsistent Reporting of Discrimination Over Time Using the Experiences of Discrimination Scale: Potential Underestimation of Lifetime Burden. Am J Epidemiol 2022; 191:370-378. [PMID: 34017974 PMCID: PMC9214248 DOI: 10.1093/aje/kwab151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Miriam E Van Dyke
- Correspondence to Dr. Miriam Van Dyke, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322 (e-mail: )
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10
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Harlow SD, Burnett-Bowie SAM, Greendale GA, Avis NE, Reeves AN, Richards TR, Lewis TT. Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women's Health Across the Nation (SWAN). Womens Midlife Health 2022; 8:3. [PMID: 35130984 PMCID: PMC8822825 DOI: 10.1186/s40695-022-00073-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/03/2022] [Indexed: 01/28/2023] Open
Abstract
This paper reviews differences in the experience of the menopause transition and midlife health outcomes between Black and White women who participated in the Study of Women's Health Across the Nation (SWAN), a 25-year, longitudinal, multi-racial/ethnic cohort study. We identify health disparities, i.e., instances in which Black women's outcomes are less favorable than those of White women, and consider whether structural racism may underlie these disparities. Although SWAN did not explicitly assess structural racism, Black women in SWAN grew up during the Jim Crow era in the United States, during which time racism was legally sanctioned. We consider how we might gain insight into structural racism by examining proxy exposures such as socioeconomic characteristics, reports of everyday discrimination, and a range of life stressors, which likely reflect the longstanding, pervasive and persistent inequities that have roots in systemic racism in the US. Thus, this paper reviews the presence, magnitude, and longitudinal patterns of racial disparities observed in SWAN in six areas of women's health - menopause symptoms, sleep, mental health, health related quality of life, cardio-metabolic health, and physical function -and elucidates the contextual factors that are likely influencing these disparities. We review the strengths and weaknesses of SWAN's design and approach to analysis of racial disparities and use this as a springboard to offer recommendations for future cohort studies.
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Affiliation(s)
- Siobán D Harlow
- Department of Epidemiology, University of Michigan, School of Public Health, United States, 1415 Washington Heights, Ann Arbor, MI, 48104-2029, USA.
| | - Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Gail A Greendale
- Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA
| | - Nancy E Avis
- Department of Social Sciences & Health Policy Wake Forest School of Medicine, Winston-Salem, USA
| | - Alexis N Reeves
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Thomas R Richards
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
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Quist AJL, Han X, Baird DD, Wise LA, Wegienka G, Woods-Giscombe CL, Vines AI. Life Course Racism and Depressive Symptoms among Young Black Women. J Urban Health 2022; 99:55-66. [PMID: 35031943 PMCID: PMC8760080 DOI: 10.1007/s11524-021-00574-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/25/2022]
Abstract
The objective of this study is to evaluate the life course effects of racism on depressive symptoms in young Black women and to identify particularly sensitive periods. Guided by life-course theory and using logistic regression, we analyzed baseline data on racism frequency and stress from racism at two time periods (before age 20 and during the 20s) and follow-up data (at approximate 20-month intervals) on depressive symptoms (using a modified 11-item Center for Epidemiologic Studies Depression Scale, CES-D) among 1612 Black women participants aged 23-34 years living in Detroit, MI. Of the 1612 women, 65% reported experiencing some racism at baseline, and 36.5% had high depressive symptoms at follow-up. Those who experienced high frequency of racism before age 20 had an increased risk for high depressive symptoms (RR = 1.26, 95% CI: 1.07, 1.46) compared to participants in the low racism frequency group. We observed similar associations for high vs. low stress from racism (RR = 1.30, 95% CI : 1.06, 1.54) and high vs. low combination of racism frequency and stress (RR = 1.38, 95% CI: 1.13, 1.64). These findings did not hold or were weaker when assessing racism during the 20s. Among women who experienced high racism across the two time periods, the risk of high depressive symptoms was higher than those who experienced low racism during both periods (RR = 1.49, 95% CI: 1.14, 1.86). The slightly stronger associations between racism and depressive symptoms in childhood and adolescence than in young adulthood suggest that early life might be a sensitive period for experiencing racism.
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Affiliation(s)
- Arbor J L Quist
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Xiaoxia Han
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Donna D Baird
- Epidemiology Branch, Women's Health Group, National Institute for Environmental Health Sciences, Research Triangle, NC, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | | | - Anissa Irvin Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Luo J, Zhang B, Willroth EC, Mroczek DK, Roberts BW. The Roles of General and Domain-Specific Perceived Stress in Healthy Aging. J Gerontol B Psychol Sci Soc Sci 2021; 77:536-549. [PMID: 34265038 DOI: 10.1093/geronb/gbab134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Theoretical and empirical evidence suggests the existence of a general perceived stress factor overarching different life domains. The present study investigated the general perceived stress relative to domain-specific perceived stress as predictors of 26 diverse health outcomes, including mental and physical health, health behaviors, cognitive functioning, and physiological indicators of health. METHOD A bifactor exploratory structural equational modelling (BiESEM) approach was adopted in two aging samples from the Health and Retirement Study (HRS; N = 8325 in Sample 1, N = 7408 in Sample 2). RESULTS Across the two samples, perceived stress was well-represented by a bifactor structure where there was a robust general perceived stress factor representing a general propensity towards stress perception. Meanwhile, after controlling for the general perceived stress factor, specific factors that represent perceived stress in different life domains were still clearly present. Results also suggested age, sex, race, education, personality traits, and past and recent stressor exposure as possible factors underlying individual differences in the general perceived stress factor. The general perceived stress factor was the most robust predictor of the majority of health outcomes, as well as changes in mental health outcomes. The specific factor of perceived neighborhood stress demonstrated incremental predictive effects across different types of health outcomes. DISCUSSION The current study provides strong evidence for the existence of a general perceived stress factor that captures variance shared among stress across life domains, and the general perceived stress factor demonstrated substantial prospective predictive effects on diverse health outcomes in older adulthood.
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Affiliation(s)
- Jing Luo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bo Zhang
- Department of Psychological and Brain Sciences, Texas A&M University, TAMU, College Station, TX, USA
| | - Emily C Willroth
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel K Mroczek
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brent W Roberts
- Department of Psychology, University of Illinois at Urbana-Champaign, 603 E. Daniel St., Champaign, IL, USA
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Abstract
Although the incidence of new cases of human immunodeficiency virus (HIV) has decreased in the past decade, in 2018 more than 7000 women with HIV were diagnosed in the United States (US). Globally, per recent reports, 48% of the new HIV infections were among women. There is still no vaccine to prevent HIV transmission. However, pre-exposure prophylaxis (PrEP) was approved in 2012 by the Food and Drug Administration, providing a powerful tool to block HIV infection and help prevent the subsequent development of acquired immunodeficiency syndrome (AIDS). The uptake of PrEP has been slow globally and among the most vulnerable populations in the US, even though the Centers for Disease Control (CDC) recommended its use in high-risk populations, including women. Furthermore, women represent one-quarter of people living with HIV in the US; however, PrEP is underutilized in this group. Thus, it is imperative to make women’s voices heard through conducting more research, ensuring sufficient access to PrEP, and enhancing knowledge about PrEP as a viable prevention strategy for women. This article aims to promote women’s health by changing the narrative, providing key information on empowering women, and increasing the usage of PrEP.
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Holman D, Walker A. Understanding unequal ageing: towards a synthesis of intersectionality and life course analyses. Eur J Ageing 2020; 18:239-255. [PMID: 33082738 PMCID: PMC7561228 DOI: 10.1007/s10433-020-00582-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Abstract
Intersectionality has received an increasing amount of attention in health inequalities research in recent years. It suggests that treating social characteristics separately—mainly age, gender, ethnicity, and socio-economic position—does not match the reality that people simultaneously embody multiple characteristics and are therefore potentially subject to multiple forms of discrimination. Yet the intersectionality literature has paid very little attention to the nature of ageing or the life course, and gerontology has rarely incorporated insights from intersectionality. In this paper, we aim to illustrate how intersectionality might be synthesised with a life course perspective to deliver novel insights into unequal ageing, especially with respect to health. First we provide an overview of how intersectionality can be used in research on inequality, focusing on intersectional subgroups, discrimination, categorisation, and individual heterogeneity. We cover two key approaches—the use of interaction terms in conventional models and multilevel models which are particularly focussed on granular subgroup differences. In advancing a conceptual dialogue with the life course perspective, we discuss the concepts of roles, life stages, transitions, age/cohort, cumulative disadvantage/advantage, and trajectories. We conclude that the synergies between intersectionality and the life course hold exciting opportunities to bring new insights to unequal ageing and its attendant health inequalities.
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Affiliation(s)
- Daniel Holman
- Department of Sociological Studies, The University of Sheffield, Elmfield, Northumberland Road, Sheffield, S10 2TU UK
| | - Alan Walker
- Department of Sociological Studies, The University of Sheffield, Elmfield, Northumberland Road, Sheffield, S10 2TU UK
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15
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Tong L, Kawachi I. Experiences of discrimination and self-reported health in Chinese migrants: a structural equation model. BMC Public Health 2020; 20:1477. [PMID: 32993614 PMCID: PMC7526124 DOI: 10.1186/s12889-020-09588-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/22/2020] [Indexed: 01/18/2023] Open
Abstract
Background Many migrants suffer from discrimination and poor health in China. We sought to examine the associations between experiences of discrimination and self-reported health among internal migrants in China, as well as the mediators of social integration and perceived stress. Methods The data was obtained from a specific survey of migrants, as a part of the National Health and Family Planning Dynamic Monitoring for Migrants conducted in 2014. A total of 15,999 migrants aged 15 to 59 years were recruited by a stratified, multistage clustered sampling procedure in eight Chinese cities. Structural Equation Modeling (SEM) was conducted. Results The results indicated that experiences of discrimination were associated with worse self-reported health (β = − 0.32, P < 0.001), less social integration (β = − 0.25, P < 0.001), as well as higher perceived stress (β = 0.21, P < 0.01). Both objectively measured socioeconomic status (β = 0.21, P < 0.001) and subjective social status (β = 0.21, P < 0.01) had significantly positive correlations with self-reported health. Conclusions The discrimination, social exclusion and perceived stress experienced by migrants have significant implications on their health.
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Affiliation(s)
- Lian Tong
- Department of Maternal and Child Health, School of Public Health, Fudan University, Shanghai, China. .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA. .,Key Laboratory Public Health Safety, Chinese Ministry of Education, P.O. Box 244, 138 Yixueyuan Road, Shanghai, 200032, China.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
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White K, Bell BA, Huang SJ, Williams DR. Perceived Discrimination Trajectories and Depressive Symptoms Among Middle-Aged and Older Black Adults. Innov Aging 2020; 4:igaa041. [PMID: 33324760 PMCID: PMC7724643 DOI: 10.1093/geroni/igaa041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Perceived discrimination is a risk factor for poor mental health. However, most studies measure discrimination at one time point, which does not account for heterogeneity in the cumulative patterning of exposure to discrimination. To address this gap, we examine the association between discrimination trajectories and depressive symptoms among black middle-aged and older adults. RESEARCH DESIGN AND METHODS Data were analyzed from a subsample of black Health and Retirement Study respondents (2006-2018, N = 2926, older than 50 years). General discrimination and racial discrimination trajectories were constructed based on the Everyday Discrimination Scale using repeated measures latent profile analyses. We examined the extent to which the association between discrimination trajectories are differentially associated with depressive symptoms (8-item Center for Epidemiological Studies-Depression scale) using negative binomial regression models adjusted for potential confounders. Effect modification by age and gender was tested. RESULTS Individuals in the persistently high (incident rate ratio [IRR]: 1.70; 95% confidence interval [CI]: 1.49-1.95) and moderate general discrimination trajectories (IRR: 1.19; 95% CI: 1.06-1.33) were more likely to have elevated depressive symptoms in comparison to those in the persistently low trajectory. This relationship was strongest among older adults aged older than 65 years. Respondents in the persistently high racial discrimination trajectory (IRR: 1.50; 95% CI: 1.29-1.73) had a higher risk of elevated depressive symptoms in comparison to respondents in the persistently low trajectory. Sensitivity analyses indicated that there was an independent association between persistently high racial discrimination trajectory class and elevated depressive symptoms, after adjusting for racial discrimination measured at a single time point. DISCUSSION AND IMPLICATIONS Characterizing longitudinal patterns of perceived discrimination may facilitate the stratification of mental health risk and vulnerability among black middle-aged and older adults. Trajectories of racial discrimination may inform risk of worse depressive symptoms more accurately than a single assessment of discrimination.
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Affiliation(s)
- Kellee White
- Department of Health Policy and Management, University of Maryland College Park School of Public Health
| | - Bethany A Bell
- College of Social Work, University of South Carolina, Columbia
| | - Shuo J Huang
- Department of Health Policy and Management, University of Maryland College Park School of Public Health
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of African and African American Studies, Harvard University, Cambridge, Massachusetts
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Chin D, Loeb TB, Zhang M, Liu H, Cooley-Strickland M, Wyatt GE. Racial/ethnic discrimination: Dimensions and relation to mental health symptoms in a marginalized urban American population. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2020; 90:614-622. [PMID: 32584076 DOI: 10.1037/ort0000481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
That racial/ethnic discrimination has adverse physical and psychological consequences, including stress, anxiety, depression, and their attendant health effects, is well documented. However, the particular dimensions within the broad construct of discrimination and their role in mental health are less well understood. This study investigates the dimensions of discrimination and explores their relation to depression and posttraumatic stress (PTS) symptoms. Using the Brief Perceived Ethnic/Racial Discrimination Questionnaire-Community Version, discrimination experiences were assessed among a community sample of African American and Latinx participants (N = 500). Factor analyses revealed 4 dimensions: Social Rejection, Stereotyping, Direct Threats/Attacks, and Police Mistreatment. In multivariate analyses, full regression models were significantly related to PTS and depression symptoms. Among the individual predictors, Social Rejection and ethnicity (Latinx) uniquely contributed to PTS symptoms in men, whereas Stereotyping and Direct Threat/Attack were associated with PTS symptoms for women. In regards to depressive symptoms, income, ethnicity (Latinx), and Social Rejection were significant predictors for men, while Social Rejection had an independent contribution for women. Thus, social rejection emerged as a significant unique predictor in 3 of the four models, suggesting that social ostracism may be a particularly harmful aspect of discrimination. Implications of these findings include the use of proactive and intervention strategies that emphasize a sense of belonging and mitigate the effects of exclusion and rejection. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Dorothy Chin
- Semel Institute for Neuroscience and Human Behavior
| | - Tamra B Loeb
- Semel Institute for Neuroscience and Human Behavior
| | - Muyu Zhang
- Semel Institute for Neuroscience and Human Behavior
| | | | | | - Gail E Wyatt
- Semel Institute for Neuroscience and Human Behavior
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18
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Semu LL. The Intersectionality of Race and Trajectories of African Women into the Nursing Career in the United States. Behav Sci (Basel) 2020; 10:bs10040069. [PMID: 32218235 PMCID: PMC7225980 DOI: 10.3390/bs10040069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 11/16/2022] Open
Abstract
This paper uses narratives of Malawian-born registered nurses working in the United States to capture pathways through which African women are entering the nursing profession. The paper highlights how race, immigrant status and language acts as potential sources of discrimination within the nursing profession. The paper utilizes intersectionality as a feminist framework that places black women's experiences at the center of analysis to capture the multidimensionality of their experiences. The qualitative study highlights the multiple pathways through which African immigrant women enter the nursing profession and how being African, immigrant female nurses predisposes them to discrimination in their interactions with employment institutions and patients. Focusing on African women's experiences as recent immigrants enriches the global migration narrative and helps contextualize the intersectionality of race, gender and discrimination within particular contexts.
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Affiliation(s)
- Linda L Semu
- Department of Sociology, McDaniel College, Westminster, MD 21157, USA
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19
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Ulusoy N, Schablon A. Discrimination in In-Patient Geriatric Care: A Qualitative Study on the Experiences of Employees with a Turkish Migration Background. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072205. [PMID: 32218323 PMCID: PMC7178028 DOI: 10.3390/ijerph17072205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022]
Abstract
In most studies, nurses with a migrant background report experiences of interpersonal discrimination. These often occur in interaction with those in need of care. However, in Germany this topic has remained largely unexplored, although a large proportion of the employees in geriatric care have a migration background. The aim of the study was to investigate whether care workers with Turkish migration background in in-patient geriatric care are exposed to discrimination from residents. Furthermore, the reasons for discrimination, handling of discrimination and recommendations for in-patient geriatric facilities to avoid/reduce discrimination were examined. In a qualitative, explorative study, 24 employees with Turkish migrant background working in in-patient geriatric care were interviewed in 2017. The semi-structured interviews were evaluated using a qualitative content analysis according to Mayring. The majority (N = 20) experienced or observed discrimination. This occurred mainly in the form of xenophobic insults and rejections. They perceived visible traits (dark hair and eye color, clothing) as potential reasons. To deal with the discrimination, most of them temporarily left the scene. They recommend that institutions should primarily make the diversity of the workforce transparent to avoid/reduce discrimination. More research is needed about discrimination against care workers with migration background because discrimination may have serious psychological effects that impact employee retention and the quality of care.
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Abstract
BACKGROUND To provide an overview of the empirical research linking self-reports of racial discrimination to health status and health service utilization. METHODS A review of literature reviews and meta-analyses published from January 2013 to 2019 was conducted using PubMed, PsycINFO, Sociological Abstracts, and Web of Science. Articles were considered for inclusion using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) framework. RESULTS Twenty-nine studies met the criteria for review. Both domestic and international studies find that experiences of discrimination reported by adults are adversely related to mental health and indicators of physical health, including preclinical indicators of disease, health behaviors, utilization of care, and adherence to medical regimens. Emerging evidence also suggests that discrimination can affect the health of children and adolescents and that at least some of its adverse effects may be ameliorated by the presence of psychosocial resources. CONCLUSIONS Increasing evidence indicates that racial discrimination is an emerging risk factor for disease and a contributor to racial disparities in health. Attention is needed to strengthen research gaps and to advance our understanding of the optimal interventions that can reduce the negative effects of discrimination.
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Affiliation(s)
- David R. Williams
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
- Department of African and African American StudiesDepartment of SociologyHarvard UniversityCambridgeMassachusetts
| | - Jourdyn A. Lawrence
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Brigette A. Davis
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Cecilia Vu
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
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21
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Abstract
BACKGROUND To provide an overview of the empirical research linking self-reports of racial discrimination to health status and health service utilization. METHODS A review of literature reviews and meta-analyses published from January 2013 to 2019 was conducted using PubMed, PsycINFO, Sociological Abstracts, and Web of Science. Articles were considered for inclusion using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) framework. RESULTS Twenty-nine studies met the criteria for review. Both domestic and international studies find that experiences of discrimination reported by adults are adversely related to mental health and indicators of physical health, including preclinical indicators of disease, health behaviors, utilization of care, and adherence to medical regimens. Emerging evidence also suggests that discrimination can affect the health of children and adolescents and that at least some of its adverse effects may be ameliorated by the presence of psychosocial resources. CONCLUSIONS Increasing evidence indicates that racial discrimination is an emerging risk factor for disease and a contributor to racial disparities in health. Attention is needed to strengthen research gaps and to advance our understanding of the optimal interventions that can reduce the negative effects of discrimination.
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Affiliation(s)
- David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of African and African American Studies, Department of Sociology, Harvard University, Cambridge, Massachusetts
| | - Jourdyn A Lawrence
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Brigette A Davis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Cecilia Vu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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22
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Priest N, Kavanagh A, Bécares L, King T. Cumulative Effects of Bullying and Racial Discrimination on Adolescent Health in Australia. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:344-361. [PMID: 31526020 DOI: 10.1177/0022146519868847] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examined how cumulative exposure to racial discrimination and bullying victimization influences the health of Australian adolescents (n = 2802) aged 10 to 11 years (19.3% visible ethnic minorities [nonwhite, non-Indigenous]; 2.6% Indigenous) using data from three waves (2010-2014) of the nationally representative Longitudinal Study of Australian Children (LSAC). Cumulative exposure to racial discrimination and bullying victimization had incremental negative effects on socioemotional difficulties. Higher accumulated exposure to both stressors across time was associated with increased body mass index z-scores and risk of overweight/obesity. Studies that examine exposure to single risk factors such as bullying victimization or racial discrimination at one time point only are likely to miss key determinants of health for adolescents from stigmatized racial-ethnic backgrounds and underestimate their stressor burden.
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Affiliation(s)
- Naomi Priest
- ANU Centre for Social Research and Methods, Australian National University, Canberra, Australian Capital Territory, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Australia
| | - Anne Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Laia Bécares
- Department of Social Work and Social Care, University of Sussex, Brighton, UK
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
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