Racism and ambulatory blood pressure in a community sample

Racial/Ethnic Discrimination and Cardiometabolic Diseases: A Systematic Review

INTRODUCTION

Racial discrimination has been identified as a risk factor for cardiometabolic diseases, the leading cause of morbidity and mortality among racial/ethnic minority groups; however, there is no synthesis of current knowledge on the association between discrimination and cardiometabolic diseases. The objective of this systematic review was to summarize evidence linking racial/ethnic discrimination and cardiometabolic diseases.

METHODS

The review was conducted based on studies identified via electronic searches of 5 databases (PubMed, Google Scholar, WorldWideScience.org, ResearchGate and Microsoft Academic) using terms related to discrimination and cardiometabolic disease.

RESULTS

Of the 123 eligible studies included in the review, 87 were cross-sectional, 25 longitudinal, 8 quasi-experimental, 2 randomized controlled trials and 1 case-control. Cardiometabolic disease outcomes discussed were hypertension (n = 46), cardiovascular disease (n = 40), obesity (n = 12), diabetes (n = 11), metabolic syndrome (n = 9), and chronic kidney disease (n = 5). Although a variety of discrimination measures was employed across the studies, the Everyday Discrimination Scale was used most often (32.5%). African Americans/Blacks were the most frequently studied racial/ethnic group (53.1%), and American Indians the least (0.02%). Significant associations between racial/ethnic discrimination and cardiometabolic disease were found in 73.2% of the studies.

DISCUSSION

Racial/ethnic discrimination is positively associated with increased risk of cardiometabolic disease and higher levels of cardiometabolic biomarkers. Identifying racial/ethnic discrimination as a potential key contributor to the health inequities associated with cardiometabolic diseases is important for addressing the significant burden borne by racial/ethnic minorities.

Discrimination, Smoking, and Cardiovascular Disease Risk: A Moderated Mediation Analysis With MESA

BACKGROUND

Carotid intima-media thickness (cIMT) and carotid plaque are reliable indicators of cardiovascular disease risk, and research highlights that racial and ethnic minority individuals generally exhibit higher cIMT and carotid plaque than White individuals. At present, the mechanisms driving these disparities among different racial and ethnic and biological sex groups are poorly understood.

METHODS AND RESULTS

Data came from the baseline examination of MESA (Multi-Ethnic Study of Atherosclerosis). A total of 6814 participants aged 45 to 84 years free of clinical cardiovascular disease completed assessments on health behavior and perceived discrimination. Four sex-stratified moderated mediation models examined associations between discrimination, cigarette smoking, and mean cIMT and plaque. We hypothesized that cigarette use would mediate the association between discrimination and carotid artery disease features, and that these would differ by race and ethnicity. Indirect effects of discrimination on plaque were observed among Hispanic women such that discrimination was associated with cigarette use and, in turn, higher plaque (β=0.04 [95% CI, 0.01-0.08]). Indirect effects of discrimination on mean cIMT were found among Hispanic (β=0.003 [95% CI, 0.0001-0.007]) and White men (β=0.04 [95% CI, 0.01-0.08]) such that discrimination was associated with cigarette use and, in turn, higher cIMT. Finally, a positive indirect effect of discrimination on plaque was observed among Hispanic men (β=0.03 [95% CI, 0.004-0.07]). No other racial and ethnic differences were observed.

CONCLUSIONS

To understand and address social determinants of cardiovascular disease, researchers must incorporate an intersectional framework that will allow us to understand the complex nature of discrimination and cardiovascular disease risk for individuals of varying intersecting identities and social positions.

Obesity and hypertension: Obesity medicine association (OMA) clinical practice statement (CPS) 2023

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides an overview of the mechanisms and treatment of obesity and hypertension.

Methods

The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

Mechanisms contributing to obesity-related hypertension include unhealthful nutrition, physical inactivity, insulin resistance, increased sympathetic nervous system activity, renal dysfunction, vascular dysfunction, heart dysfunction, increased pancreatic insulin secretion, sleep apnea, and psychosocial stress. Adiposopathic factors that may contribute to hypertension include increased release of free fatty acids, increased leptin, decreased adiponectin, increased renin-angiotensin-aldosterone system activation, increased 11 beta-hydroxysteroid dehydrogenase type 1, reduced nitric oxide activity, and increased inflammation.

Conclusions

Increase in body fat is the most common cause of hypertension. Among patients with obesity and hypertension, weight reduction via healthful nutrition, physical activity, behavior modification, bariatric surgery, and anti-obesity medications mostly decrease blood pressure, with the greatest degree of weight reduction generally correlated with the greatest degree of blood pressure reduction.

Acute Experiences of Negative Interpersonal Interactions: Examining the Dynamics of Negative Mood and Ambulatory Blood Pressure Responses Among Black and Hispanic Urban Adults

BACKGROUND

Negative interpersonal interactions are associated with acute increases in ambulatory blood pressure (ABP). Yet, the mechanisms underlying this relationship are unclear.

PURPOSE

This study tested whether negative interpersonal interactions predict higher ABP both in the moment and during subsequent observations, and whether increases in negative mood mediate these relations. These associations were tested among Black and Hispanic urban adults who may be at higher risk for negative interpersonal interactions as a function of discrimination. Race/ethnicity and lifetime discrimination were tested as moderators.

METHODS

Using a 24-hr ecological momentary assessment (EMA) design, 565 Black and Hispanic participants (aged 23-65, M = 39.06, SD = 9.35; 51.68% men) had their ABP assessed every 20 min during daytime accompanied by an assessment of negative interpersonal interactions and mood. This produced 12,171 paired assessments of ABP and self-reports of participants' interpersonal interactions, including how much the interaction made them feel left out, harassed, and treated unfairly, as well as how angry, nervous, and sad they felt.

RESULTS

Multilevel models revealed that more intense negative interpersonal interactions predicted higher momentary ABP. Mediation analyses revealed that increased negative mood explained the relationship between negative interpersonal interactions and ABP in concurrent and lagged analyses. Discrimination was associated with more negative interpersonal interactions, but neither race/ethnicity nor lifetime discrimination moderated findings.

CONCLUSIONS

Results provide a clearer understanding of the psychobiological mechanisms through which interpersonal interactions influence cardiovascular health and may contribute to health disparities. Implications include the potential for just-in-time interventions to provide mood restoring resources after negative interactions.

Implications of Social Disadvantage Score in Cardiovascular Outcomes and Risk Assessment: Findings From the Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Social determinants of health contribute to disparate cardiovascular outcomes, yet they have not been operationalized into the current paradigm of cardiovascular risk assessment.

METHODS

Data from the Multi-Ethnic Study of Atherosclerosis, which includes participants from 6 US field centers, were used to create an index of baseline Social Disadvantage Score (SDS) to explore its association with incident atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality and impact on ASCVD risk prediction. SDS, which ranges from 0 to 4, was calculated by tallying the following social factors: (1) household income less than the federal poverty level; (2) educational attainment less than a high school diploma; (3) single-living status; and (4) experience of lifetime discrimination. Cox models were used to examine the association between SDS and each outcome with adjustment for traditional cardiovascular risk factors. Changes in the discrimination and reclassification of ASCVD risk by incorporating SDS into the pooled cohort equations were examined.

RESULTS

A total of 6434 participants (mean age, 61.9±10.2 years; female 52.8%; non-white 60.9%) had available SDS 1733 (26.9%) with SDS 0; 2614 (40.6%) with SDS 1; 1515 (23.5%) with SDS 2; and 572 (8.9%) with SDS ≥3. In total, 775 incident ASCVD events and 1573 deaths were observed over a median follow-up of 17.0 years. Increasing SDS was significantly associated with incident ASCVD and all-cause mortality after adjusting for traditional risk factors (ASCVD: per unit increase in SDS hazard ratio, 1.15 [95% CI, 1.07-1.24]; mortality: per unit increase in SDS hazard ratio, 1.13 [95% CI, 1.08-1.19]). Adding SDS to pooled cohort equations components in a Cox model for 10-year ASCVD risk prediction did not significantly improve discrimination (P=0.208) or reclassification (P=0.112).

CONCLUSIONS

Although SDS is independently associated with incident ASCVD and all-cause mortality, it does not improve 10-year ASCVD risk prediction beyond pooled cohort equations.

Food insecurity among New York City taxi and for-hire vehicle drivers

BACKGROUND

New York City's (NYC's) taxi/for-hire vehicle (FHV) drivers have occupational and demographic characteristics associated with food insecurity (low income, comorbidities, minority race/ethnicity).

OBJECTIVE

To analyze food insecurity rates in a sample of NYC drivers and to identify associated factors.

METHODS

At health fairs, we recruited a cross-sectional sample of licensed taxi/FHV drivers willing to receive study text messages. Most lacked a primary care provider. Food insecurity prevalence and associations with health and economic indicators were analyzed.

RESULTS

Of 503 participants who completed a 2-item food security screener, 39.2% were food insecure. Significantly fewer food insecure than food secure drivers reported a doctor visit within the past year (48% vs 25%; P < .001). Food insecure drivers had greater weekly traffic ticket expenditure ($34 vs $24; P = .02) and were more likely to report insufficient household income (61% vs 39%; P < .001) and history of depression (14% vs 7%; P = .02), to have elevated (>200) measured total cholesterol (50% vs 37%; P = .02), and to have Perceived Stress Scale scores indicating greater stress than food secure drivers (14 vs 11; P = .002). In a binary logistic regression analysis, drivers who reported that their total household income was enough to meet their basic needs had significantly lower odds of being food insecure (0.695 odds ratio; P = .016).

CONCLUSION

Food insecurity was high in this group of taxi/FHV drivers. Food insecurity interventions are needed and could be occupationally based, with worksite screening and resource navigation. Policies should address improving wages and healthcare access.

Neural Impacts of Stigma, Racism, and Discrimination

Racism is a chronic stressor fueled by stigma that can result in significant distress and dysfunction as well as negatively affect emotions, behavior, quality of life, and brain health. The effects of stigma and discrimination emerge early in life and have long-term consequences. In this review, we sought to use neuroscience research to describe how stigma, racism, and discrimination can impact brain and mental health. Societal stigmas may be encoded by associative fear learning and pattern completion networks, and experiences of racial discrimination may similarly affect threat-responsive regions and circuits. Race-related differences in brain function and structure supporting threat circuitry are largely attenuated when negative life experiences and discrimination are taken into account. Downstream, chronic activation of the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal-medullary axis in the context of discrimination and stigma can contribute to physical health disparities in minoritized and marginalized groups. Finally, we discuss models that provide a framework for interventions and societal-level strategies across ecologic systems to build resilience and foster posttraumatic growth.

Complex Racial Trauma: Evidence, Theory, Assessment, and Treatment

Racial trauma refers to experiences related to threats, prejudices, harm, shame, humiliation, and guilt associated with various types of racial discrimination, either for direct victims or witnesses. In North American, European, and colonial zeitgeist societies, Black, Indigenous, and people of color (BIPOC) experience racial microaggressions and interpersonal, institutional, and systemic racism on a repetitive, constant, inevitable, and cumulative basis. Although complex trauma differs from racial trauma in its origin, the consistency of racist victimization beyond childhood, and the internalized racism associated with it, strong similarities exist. Similar to complex trauma, racial trauma surrounds the victims’ life course and engenders consequences on their physical and mental health, behavior, cognition, relationships with others, self-concept, and social and economic life. There is no way to identify racial trauma other than through a life-course approach that captures the complex nature of individual, collective, historical, and intergenerational experiences of racism experienced by BIPOC communities in Western society. This article presents evidence for complex racial trauma (CoRT), a theoretical framework of CoRT, and guidelines for its assessment and treatment. Avenues for future research, intervention, and training are also presented.

Stress and perceived discrimination among the Arab population in Israel: the mediation role of the perceived COVID-19 threat and trust in the healthcare system

During pandemics, minorities may experience high stress levels, which could harm their mental and physical health. However, to the best of our knowledge, this has not been examined among minorities in Israel during the COVID-19 pandemic. This study, therefore, explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population's perceived COVID-19 threat, trust in the healthcare system, adherence to preventative guidelines, and perceived discrimination.The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines.Hierarchical regression analysis showed that age, religion, trust in the healthcare system, perceived threat, and adherence to guidelines were all significant predictors of stress [F(11,600), p < .001]. The model explained 24% of the variance in stress. Structural equation modeling (SEM) revealed that the participants' perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect = 0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (β = -0.52), which, in turn, was negatively associated with stress (β = -0.10). Furthermore, discrimination was positively associated with perceived threat (β = 0.21), which, in turn, was positively associated with stress (β = 0.35). Discrimination is an important social determinant of health - especially during health emergencies when trust in healthcare systems and perceived threats are crucial. As such, our findings could assist policymakers in developing fair policies that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving both their mental and physical health.

Investigation of Differences in Allostatic Load among Black Men by Level of Educational Attainment: High School Graduates Experience the Highest Levels of Stress

Allostatic load (AL)—the biological assessment of long-term exposure to stress—may explain mortality-rate disparities among non-Hispanic Black (Black) men. We aimed to investigate AL among Black men with equivalent education status after controlling for income. A cross-sectional study was employed to investigate AL among 4113 Black men who participated in the National Health and Nutrition Examination Survey between 1999–2018. A summation of 8 biomarker factors were used to compute AL, differences in socio-demographic characteristics by education status were evaluated, and health behaviors that may influence AL were examined. To determine the high-risk thresholds for each AL component, we examined each component’s distribution among NHB men for whom complete biomarker data were available in the NHANES sample. High-risk thresholds were determined as either (1) above the 75th percentile for body mass index (BMI), diastolic blood pressure (DBP), glycated hemoglobin, systolic blood pressure (SBP), total cholesterol, and serum triglycerides; or (2) below the 25th percentile for serum albumin and serum creatinine. Modified Poisson regression models were used to estimate prevalence ratios and their associated 95% confidence intervals for high AL risk while adjusting for potential confounders. Black men with a high school diploma/GED had a greater prevalence of high AL compared with Black men who had other levels of education, and a slightly higher prevalence of high AL compared with Black men who had less than a high school education. Black men with college degrees had a lower prevalence of high AL than Black men with the lowest levels of educational attainment. Researchers must further examine the hidden costs stemming from the interplay between discrimination associated with being Black in America and systemic racism in the educational system—which may be preventing Black men from achieving optimal health.

Racial Stress and Trauma and the Development of Adolescent Depression: A Review of the Role of Vigilance Evoked by Racism-Related Threat

There are known disparities in the burden of illness and access/quality of care for African, Latino/a, Asian, and Native American (ALANA) patients diagnosed with depressive disorders, which may occur because of health inequities. Racial stress and trauma (RST), or the significant fear and distress that can be imparted from exposure to racism, is one such inequity linked to the development of depression. The current review summarizes past research examining the association between racism, RST, and depression, as well as avenues in which RST becomes biologically embedded in ALANA individuals. We describe multimodal research that supports vigilance as a potential mediator of the association between RST and depression and consider the nuanced role that vigilance plays during experiences with racism. Finally, we describe methodological advances in the assessment of vigilance evoked by RST and the clinical implications that may be generated by future improvements. In each of these areas, we present examples of how ongoing and future research can be leveraged to provide support for psychosocial programs that facilitate autonomous community healing and resilience, increase calls for public policy changes, and support clinical interventions that lessen the burden of racism on ALANA communities.

Measuring the biological embedding of racial trauma among Black Americans utilizing the RDoC approach

The National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) initiative aims to understand the mechanisms influencing psychopathology through a dimensional approach. Limited research thus far has considered potential racial/ethnic differences in RDoC constructs that are influenced by developmental and contextual processes. A growing body of research has demonstrated that racial trauma is a pervasive chronic stressor that impacts the health of Black Americans across the life course. In this review article, we examine the ways that an RDOC framework could allow us to better understand the biological embedding of racial trauma among Black Americans. We also specifically examine the Negative Valence System domain of RDoC to explore how racial trauma is informed by and can help expand our understanding of this domain. We end the review by providing some additional research considerations and future research directives in the area of racial trauma that build on the RDoC initiative.

Commentary on the special issue on disproportionate exposure to trauma: Trauma, stress, and adversities and health disparities among disenfranchised groups globally during the COVID pandemic

The papers in this Journal of Traumatic Stress special issue on disproportionate adversity cover the gamut of discrimination traumas and stressors, including microaggressions, a more insidious forms of discrimination, and their often-devastating and wide-ranging mental health sequelae, in disproportionately affected disenfranchised groups. Discrimination based on race, ethnicity, gender, and sexual orientation commonly confers cumulative and chronic effects. In the field of traumatic stress studies, several types of identity-linked traumatic events have been identified and empirically investigated as posttraumatic stress disorder (PTSD)-producing experiences. Collectively, the 13 papers included in this special issue raise questions about the definition, conceptualization, and categorization of various forms of explicit and implicit identity-linked trauma. These papers highlight the need for acceptance of a shared nomenclature and better differentiation of both causal and correlational associations with acute and chronic PTSD, depression, suicide risk, alcohol misuse, and other mental health outcomes. In this commentary, the discussion is extended to COVID-19, a disease that has been globally devastating for many. On multiple levels (i.e., physical, mental, emotional, economic, and social), COVID-19 has magnified the prepandemic fault lines of race, ethnicity, gender, gender identity, and sexual orientation. Applying a syndemic framework to the health impact of COVID-19 and, arguably, the most pervasive identity linked epidemic worldwide-systemic racism-brings perspective to the biological and social forces that are likely to be driving the convergence of COVID-19, systemic racism, and chronic health inequities, and may be informative in guiding evidence-based strategies for managing racial trauma in the context of COVID-19.

Temporal changes in allostatic load patterns by age, race/ethnicity, and gender among the US adult population; 1988-2018

The objective of this study is to provide an assessment of allostatic load (AL) burden among US adults across race/ethnicity, gender, and age groups over a 30-year time period. We analyzed data from 50,671 participants of the National Health and Nutrition Examination Survey (NHANES) years 1988 through 2018. AL score was defined as the sum total for abnormal measures of the following components: serum albumin, body mass index, serum C - reactive protein, serum creatinine, diastolic blood pressure, glycated hemoglobin, systolic blood pressure, total cholesterol, and serum triglycerides. We performed modified Poisson regression to estimate the adjusted Relative Risks (aRRs) of allostatic load, and generalized linear models to determine adjusted mean differences accounting for NHANES sampling weights. Among US adults aged 18 or older, the prevalence of high AL increased by more than 45% from 1988 to 1991 to 2015-2018, from 33.5% to 48.6%. By the latest period, 2015-2018, Non-Hispanic Black women (aRR: 1.292; 95% CI: 1.290-1.293) and Latina women (aRR: 1.266; 95% CI: 1.265-1.267) had higher risks of AL than non-Hispanic White women. Similar trends were observed among men. Age-adjusted mean AL score among NH-Black and Latinx adults was higher than for NH-Whites of up to a decade older regardless of gender. From 1988 through 2018, Adults aged 40 years old and older had over 2-fold increased risks of high AL when compared to adults 18-29 years old. After 30-years of collective data, racial disparities in allostatic load persist for NH-Black and Latinx adults.

Historical Loss: Implications for Health of American Indians in the Blackfeet Community

BACKGROUND

Historical loss in American Indians (AIs) is believed to contribute to high incidence of mental health disorders, yet less is known about the associations between historical loss and physical health.

PURPOSE

To investigate whether frequency of thought about historical loss predicts risk factors for chronic physical health conditions in an AI community.

METHODS

Using Community Based Participatory research (CBPR) and Ecological Momentary Assessment (EMA), we measured frequency of thoughts about historical loss in 100 AI adults residing on the Blackfeet reservation. Participants completed a 1-week monitoring period, during which ambulatory blood pressure and daily levels of psychological stress were measured. At the end of the week, we collected a dried blood spot sample for measurement of C-reactive protein (CRP).

RESULTS

In hierarchical linear regression models controlling for demographics and relevant covariates, greater frequency of thoughts about historical loss predicted higher average daily psychological stress (B = .55, t = 6.47, p < .001, ΔR2 = .30) and higher levels of CRP (B = .33, t = 3.93, p < .001, ΔR2 = .10). Using linear mixed modeling with relevant covariates, we found that greater thoughts about historical loss were associated with higher systolic ambulatory blood pressure (B = .32, 95% CI = .22-.42, t = 6.48, p < .001, ΔR2 = .25; Fig. 1c) and greater diastolic ambulatory blood pressure (B = .19, 95% CI = .11-.27, t = 4.73, p < .001, ΔR2 = .19).

CONCLUSIONS

The data suggest that frequency of thought about historical loss may contribute to increased subclinical risk for cardiovascular disease in the Blackfeet community.

Discrimination and hair cortisol concentration among asian, latinx and white young adults

Discrimination is a form of chronic stress and hair cortisol concentration is an emerging biomarker of chronic stress. In a sample of 83 first-year college students (age x⋅⋅−=17.65, SD=48, 69% female, 84% United States-born, 24% Asian, 21% Latinx, and 55% White), the current study investigates associations between hair cortisol concentration with discrimination stress assessed across two timeframes: past year and past two weeks. Significant associations were observed for past year discrimination and hair cortisol concentration levels, but not for discrimination over the past two weeks. The current study contributes to a growing body of evidence linking discrimination stress exposure to neuroendocrine functioning.

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Analyzes hair cortisol concentration (HCC) to measure chronic discrimination.

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HCC was significantly associated with discrimination over the past year.

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HCC was not associated with discrimination over the past 2 weeks.

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Highlights HCC as a neuroendocrine biomarker of discrimination.

The Weight of Racial Discrimination: Examining the Association Between Racial Discrimination and Change in Adiposity Among Emerging Adult Women Enrolled in a Behavioral Weight Loss Program

BACKGROUND

Non-Hispanic Black (NHB) emerging adult (EA) women are at disproportionate risk for obesity but experience limited benefit from behavioral weight loss (BWL) programs. Race-related stress could play a role; the goal of this study was to examine the association between racial discrimination (RD) and early (3 months) changes in adiposity, and to explore potential protective factors, among EA in an adapted BWL program.

METHODS

This is an ancillary study of non-Hispanic White (NHW) and NHB EA women enrolled in an adapted BWL trial (N = 49; 55.1% NHB; Age 21.2 (2.1); BMI = 33.0 + 4.3 kg/m²). At baseline, group- and personal-level RD (RD-group and RD-personal), racial identity (NHB women only), vigilant coping, and social support were assessed via validated questionnaires. Weight and waist circumference were measured objectively at 0 and 3 months.

RESULTS

NHW women manifested greater reductions in waist circumference relative to NHB women (p = .004). RD-personal did not predict change in waist circumference at 3 months (p = .402); however, the association between RD-group and change in waist circumference was statistically significant (p = .015), such that reporting greater group-level discrimination predicted a smaller decrease in waist circumference; the model explained 22% of the variance. Social support and vigilant coping were not statistically significant in the model. Among NHB women only, higher racial identity-centrality predicted greater reduction in waist circumference (p = .019).

CONCLUSION

Findings suggest racial discrimination could contribute to greater cardiometabolic risk during this developmental period. Future research should examine how experiences of racial discrimination unfold in the daily lives of NHB women to inform mechanistic interventions to enhance health and well-being.

TRIAL REGISTRATION

NCT02736981. Low Intensity Weight Loss for Young Adults.

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.

Everyday Discrimination Prospectively Predicts Blood Pressure Across 10 Years in Racially/Ethnically Diverse Midlife Women: Study of Women's Health Across the Nation

BACKGROUND

Interpersonal discrimination is linked to greater risk for cardiovascular disease (CVD) and this association varies by race/ethnicity.

PURPOSE

To examine whether exposure to everyday discrimination prospectively predicts elevated blood pressure (BP), whether this association differs by race/ethnicity, and is mediated by adiposity indices.

METHODS

Using data for 2,180 self-identified White, Black, Chinese, Japanese, and Hispanic participants from the Study of Women's Health Across the Nation, we examined associations among exposure to (higher vs. lower) everyday discrimination at baseline and BP and hypertension (HTN; systolic blood pressure [SBP] ≥ 140 mmHg; diastolic blood pressure [DBP] ≥ 90 mmHg; or self-reported HTN medication use) risk over a 10 year period. Additionally, we used the bootstrap method to assess repeated, time-varying markers of central and overall adiposity (waist circumference and body mass index [BMI] (kg/m2), respectively) as potential mediators.

RESULTS

Exposure to everyday discrimination predicted increases in SBP and DBP over time, even after adjusting for known demographic, behavioral, or medical risk factors. However, greater waist circumference or BMI (examined separately) mediated these observations. Notably, there were no racial/ethnic differences in the observed association and HTN risk was not predicted.

CONCLUSIONS

The current findings suggest that everyday discrimination may contribute to elevated BP over time in U.S. women, in part, through increased adiposity. These findings demonstrate the complexity of the linkage of discrimination to CVD risk and raise the need to closely examine biobehavioral pathways that may serve as potential mediators.

Identifying Moderators in the Link Between Workplace Discrimination and Health/Well-Being

The stress that arises from workplace discrimination can have a large impact on an employee's work attitude, their work and life satisfaction, and oftentimes whether or not they stay in a job. Workplace discrimination can also have a considerable influence on employees' short- and long-term health. However, less is known about the factors that might mitigate or exacerbate the effects of discrimination on health. The current study focused not only on the links between workplace discrimination and health, and but also on the effects of potential moderators of the discrimination-health link (i.e., perceived control, Big Five personality traits, optimism, and coworker/supervisor support). People with high neuroticism, high extraversion and high agreeableness were more negatively affected by workplace discrimination than those low on neuroticism, extraversion, and agreeableness. Perceived control was found to be a protective factor, such that those high in perceived control had fewer chronic illnesses in the context of high levels of workplace discrimination.

Passively-sensed Behavioral Correlates of Discrimination Events in College Students

A deep understanding of how discrimination impacts psychological health and well-being of students could allow us to better protect individuals at risk and support those who encounter discrimination. While the link between discrimination and diminished psychological and physical well-being is well established, existing research largely focuses on chronic discrimination and long-term outcomes. A better understanding of the short-term behavioral correlates of discrimination events could help us to concretely quantify such experiences, which in turn could support policy and intervention design. In this paper we specifically examine, for the first time, what behaviors change and in what ways in relation to discrimination. We use actively-reported and passively-measured markers of health and well-being in a sample of 209 first-year college students over the course of two academic quarters. We examine changes in indicators of psychological state in relation to reports of unfair treatment in terms of five categories of behaviors: physical activity, phone usage, social interaction, mobility, and sleep. We find that students who encounter unfair treatment become more physically active, interact more with their phone in the morning, make more calls in the evening, and spend more time in bed on the day of the event. Some of these patterns continue the next day. Our results further our understanding of the impact of discrimination and can inform intervention work.

Association of Social Adversity with Comorbid Diabetes and Depression Symptoms in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study: A Syndemic Framework

BACKGROUND

U.S. Hispanics/Latinos experience high lifetime risk for Type 2 diabetes and concurrent psychological depression. This comorbidity is associated with poorer self-management, worse disease outcomes, and higher mortality. Syndemic theory is a novel social epidemiological framework that emphasizes the role of economic and social adversity in promoting disease comorbidity and health disparities.

PURPOSE

Informed by the syndemic framework, this study explored associations of socioeconomic and psychosocial adversity (low income/education, trauma history, adverse childhood experiences, ethnic discrimination, neighborhood problems [e.g., violence]) with comorbidity of diabetes and depression symptoms in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and Sociocultural Ancillary Study.

METHODS

Participants were 5,247 Latino adults, aged 18-74, enrolled in four U.S. cities from 2008 to 2011. Participants completed a baseline physical exam and measures of depression symptoms and psychosocial adversity. Multinomial logistic regression analyses were conducted to examine associations of adversity variables with comorbid diabetes and high depression symptoms.

RESULTS

Household income below $30,000/year was associated with higher odds of diabetes/depression comorbidity (odds ratio [OR] = 4.61; 95% confidence interval [CI]: 2.89, 7.33) compared to having neither condition, as was each standard deviation increase in adverse childhood experiences (OR = 1.41; 95% CI: 1.16, 1.71), ethnic discrimination (OR = 1.23; 95% CI: 1.01, 1.50), and neighborhood problems (OR = 1.53; 95% CI: 1.30, 1.80).

CONCLUSION

Low household income, adverse childhood experiences, ethnic discrimination, and neighborhood problems are related to comorbid diabetes and depression in U.S. Latinos. Future studies should explore these relationships longitudinally.

Ambulatory Blood Pressure Trajectory and Perceived Stress in Relation to Birth Outcomes in Healthy Pregnant Adolescents

OBJECTIVE

An early decline in resting blood pressure (BP), followed by an upward climb, is well documented and indicative of a healthy pregnancy course. Although BP is considered both an effector of stress and a clinically meaningful measurement in pregnancy, little is known about its trajectory in association with birth outcomes compared with other stress effectors. The current prospective longitudinal study examined BP trajectory and perceived stress in association with birth outcomes (gestational age (GA) at birth and birth weight (BW) percentile corrected for GA) in pregnant adolescents, a group at risk for stress-associated poor birth outcomes.

METHODS

Healthy pregnant nulliparous adolescents (n = 139) were followed from early pregnancy through birth. At three time points (13-16, 24-27, and 34-37 gestational weeks ±1 week), the Perceived Stress Scale was collected along with 24-hour ambulatory BP (systolic and diastolic) and electronic diary reporting of posture. GA at birth and BW were abstracted from medical records.

RESULTS

After adjustment for posture and pre-pregnancy body mass index, hierarchical mixed-model linear regression showed the expected early decline (B = -0.18, p = .023) and then increase (B = 0.01, p < .001) of diastolic BP approximating a U-shape; however, systolic BP displayed only an increase (B = 0.01, p = .010). In addition, the models indicated a stronger systolic and diastolic BP U-shape for early GA at birth and lower BW percentile and an inverted U-shape for late GA at birth and higher BW percentile. No effects of perceived stress were observed.

CONCLUSIONS

These results replicate the pregnancy BP trajectory from previous studies of adults and indicate that the degree to which the trajectory emerges in adolescence may be associated with variation in birth outcomes, with a moderate U-shape indicating the healthiest outcomes.

Perceived Discrimination and Suicide Ideation: Moderating Roles of Anxiety Symptoms and Ethnic Identity among Asian American, African American, and Hispanic Emerging Adults

Suicide is a leading cause of death for vulnerable ethnic minority emerging adults in the United States (Web-based injury statistics query and reporting system [WISQARS], 2015). Perceived discrimination (Journal of Youth and Adolescence, 40, 2011, 1465) and anxiety symptoms (Asian American Journal of Psychology, 1, 2010, 18) are two predictors that are theoretically and conceptually related, but have yet to be examined in a simultaneous model for suicide ideation. Existing theory and research suggest that these variables activate similar pathways (American Behavioral Scientist, 51, 2007, 551). This study sought to address this gap in the literature by examining the simultaneous relationship between perceived discrimination and anxiety symptoms as predictors of suicide ideation. The moderating effect of anxiety symptoms on the relationship between perceived discrimination and suicide ideation was examined in a multiethnic sample of emerging adults. Results indicated that anxiety symptoms moderated the perceived discrimination-suicide ideation relationship for Hispanic emerging adults, but not for their Asian American and African American counterparts. Furthermore, ethnic identity has been shown to mitigate suicide risk in the face of other stressors (Cultural Diversity and Ethnic Minority Psychology, 14, 2008, 75). Ethnic identity emerged as a protective factor for Hispanic emerging adults by further interacting with perceived discrimination and anxiety symptoms to negatively predict suicide ideation. The implications of these findings are discussed.

Gender/Sex as a Social Determinant of Cardiovascular Risk

The social gradient for cardiovascular disease (CVD) onset and outcomes is well established. The American Heart Association's Social Determinants of Risk and Outcomes of Cardiovascular Disease Scientific Statement advocates looking beyond breakthroughs in biological science toward a social determinants approach that focuses on socioeconomic position, race and ethnicity, social support, culture and access to medical care, and residential environments to curb the burden of CVD going forward. Indeed, the benefits of this approach are likely to be far reaching, enhancing the positive effects of advances in CVD related to prevention and treatment while reducing health inequities that contribute to CVD onset and outcomes. It is disappointing that the role of gender has been largely neglected despite being a critical determinant of cardiovascular health. It is clear that trajectories and outcomes of CVD differ by biological sex, yet the tendency for sex and gender to be conflated has contributed to the idea that both are constant or fixed with little room for intervention. Rather, as distinct from biological sex, gender is socially produced. Overlaid on biological sex, gender is a broad term that shapes and interacts with one's cognition to guide norms, roles, behaviors, and social relations. It is a fluid construct that varies across time, place, and life stage. Gender can interact with biological sex and, indeed, other social determinants, such as ethnicity and socioeconomic position, to shape cardiovascular health from conception, through early life when health behaviors and risk factors are shaped, into adolescence and adulthood. This article will illustrate how gender shapes the early adoption of health behaviors in childhood, adolescence, and young adulthood by focusing on physical activity, drinking, and smoking behaviors (including the influence of role modeling). We will also discuss the role of gender in psychosocial stress with a focus on trauma from life events (childhood assault and intimate partner violence) and work, home, and financial stresses. We conclude by exploring potential biological pathways, with a focus on autonomic functioning, which may underpin gender as a social determinant of cardiovascular health. Finally, we discuss implications for cardiovascular treatment and awareness campaigns and consider whether gender equality strategies could reduce the burden of CVD for men and women at the population level.

Past Discrimination, Race-Related Vigilance, and Depressive Symptoms: The Moderating Role of Mindfulness

Objectives

African Americans experience numerous adverse health consequences due to race-related stress. Yet, mindfulness may serve as a relevant and vital protective factor in the link between race-related stressors and depressive symptoms for this population.

Methods

Data from 190 African American participants, ages 18-53, were used to investigate if past discrimination and race-related vigilance, two types of race-related stressors, interactively predicted greater depressive symptomatology among this sample. We also assessed if mindfulness moderated the association between race-related stressors, as indicated by past discrimination and race-related vigilance, and depressive symptomatology.

Results

Our results indicated that past discrimination and race-related vigilance did not interactively predict depressive symptomatology in our sample; however, these stressors were independently related to greater depressive symptoms. Additionally, we found that greater levels of mindfulness were associated with lower levels of depressive symptoms, and mindfulness significantly moderated the association between both race-related stressors and depressive symptoms.

Conclusions

These findings support mindfulness' ability to buffer the negative health consequences of past discrimination and race-related vigilance for African Americans. Additional conclusions and future research directions are discussed.

Neighborhood disorder, exposure to violence, and perceived discrimination in relation to symptoms in midlife women

BACKGROUND

Some symptoms at midlife are associated with stress, such as hot flashes, trouble sleeping, headaches, or depressed mood. Hot flashes have been studied in relation to laboratory stressors, physiological biomarkers, and self-reported stress, but less is known about hot flashes in relation to the larger context of women's lives. This study examined the risk of symptoms in relation to neighborhood disorder, exposure to neighborhood violence, social cohesion and perceived discrimination. We hypothesized that women exposed to more negative neighborhood characteristics and discrimination would be more likely to report hot flashes and other midlife symptoms.

METHODS

Participants were black and white women, aged 40 to 60, drawn from a cross-sectional investigation of race/ethnicity, socioeconomic status, and blood pressure in New York City (n = 139). Demographic information, medical history, menopausal status, and symptoms were measured by questionnaire. Likert scales were used to measure neighborhood characteristics, specifically, the Neighborhood Disorder Scale, the Exposure to Violence Scale, the Perceived Violence Subscale, the Neighborhood Social Cohesion and Trust Scale, and the Everyday Discrimination Scale. Ten symptoms were included in analyses: lack of energy, feeling blue/depressed, backaches, headaches, aches/stiffness in joints, shortness of breath, hot flashes, trouble sleeping, nervous tension, and pins/needles in hands/feet. Each scale with each symptom outcome was examined using logistic regression analyses adjusting for significant covariates.

RESULTS

Black women reported higher scores on all negative neighborhood characteristics and discrimination, and a lower score on the positive Neighborhood Social Cohesion and Trust. Neighborhood Disorder was associated with feeling blue/depressed, aches/stiffness in joints, and hot flashes, and Perceived Violence was associated with aches/stiffness in joints, after controlling for model-specific covariates. There was a lower risk of backaches with increasing Neighborhood Social Cohesion and Trust score. The Everyday Discrimination Scale was associated with lack of energy. Lack of energy, feeling blue/depressed, aches/stiffness in joints, and hot flashes appeared to be most vulnerable to negative neighborhood context and discrimination.

CONCLUSIONS

This study adds to the literature linking neighborhood environments to health outcomes. The associations between negative neighborhood contexts and discrimination with diverse symptoms, and the association between social cohesion and back pain, point to the need to expand analyses of stress to multiple physiological systems.

Combining ecological momentary assessment with objective, ambulatory measures of behavior and physiology in substance-use research

Whereas substance-use researchers have long combined self-report with objective measures of behavior and physiology inside the laboratory, developments in mobile/wearable electronic technology are increasingly allowing for the collection of both subjective and objective information in participants' daily lives. For self-report, ecological momentary assessment (EMA), as implemented on contemporary smartphones or personal digital assistants, can provide researchers with near-real-time information on participants' behavior and mood in their natural environments. Data from portable/wearable electronic sensors measuring participants' internal and external environments can be combined with EMA (e.g., by timestamps recorded on questionnaires) to provide objective information useful in determining the momentary context of behavior and mood and/or validating participants' self-reports. Here, we review three objective ambulatory monitoring techniques that have been combined with EMA, with a focus on detecting drug use and/or measuring the behavioral or physiological correlates of mental events (i.e., emotions, cognitions): (1) collection and processing of biological samples in the field to measure drug use or participants' physiological activity (e.g., hypothalamic-pituitary-adrenal axis activity); (2) global positioning system (GPS) location information to link environmental characteristics (disorder/disadvantage, retail drug outlets) to drug use and affect; (3) ambulatory electronic physiological monitoring (e.g., electrocardiography) to detect drug use and mental events, as advances in machine learning algorithms make it possible to distinguish target changes from confounds (e.g., physical activity). Finally, we consider several other mobile/wearable technologies that hold promise to be combined with EMA, as well as potential challenges faced by researchers working with multiple mobile/wearable technologies simultaneously in the field.

Linking perceived discrimination during adolescence to health during mid-adulthood: Self-esteem and risk-behavior mechanisms

RATIONALE

The literature on the effect of perceived discrimination on health has three gaps. First, the long-term relationship between perceived discrimination and health is underexplored. Second, the mechanisms through which perceived discrimination affects health remain unclear. Third, most studies focus on racial/ethnic discrimination, and other aspects of discrimination are overlooked.

OBJECTIVE

This study aims to fill these gaps by testing a research framework that links the discriminatory experience during adolescence to an individual's health during mid-adulthood via self-esteem and risk behaviors at early adulthood.

METHOD

Structural equation modeling is applied to the National Longitudinal Survey of Youth, 1979 Cohort (N = 6478).

RESULTS

The discriminatory experience during adolescence imposes an adverse impact on health during mid-adulthood even after accounting for other potential covariates, a detrimental effect lasting for over 30 years. In addition, while perceived discrimination reduces self-esteem at early adulthood, it affects only mental health during mid-adulthood, rather than general health. Finally, the discriminatory experience promotes risk behaviors at early adulthood and the risk behaviors subsequently compromise health during mid-adulthood.

CONCLUSIONS

Using a life course perspective, we find that the effect of perceived discrimination is more profound than the literature suggested and that risk behaviors may account for approximately 17% of the total effect of perceived discrimination on health. Our findings highlight the importance of early interventions in coping with perceived discrimination during adolescence.

West African Ancestry and Nocturnal Blood Pressure in African Americans: The Jackson Heart Study

BACKGROUND

African Americans have a higher prevalence of nocturnal hypertension and nondipping blood pressure than European Americans, but the genetic contribution to these racial differences remains unclear. We assessed the association of the percentage West African genetic ancestry with nocturnal hypertension and nondipping blood pressure in 932 African Americans from the Jackson Heart Study.

METHODS

Using percentage West African ancestry determined from 389 ancestry informative markers, participants were categorized into tertiles (tertile 1 [low]: <79.3%, tertile 2: ≥79.3-86.3%, and tertile 3 [high]: >86.3%). Nocturnal hypertension was defined as mean nighttime (midnight-6 am) systolic (SBP)/diastolic blood pressure ≥120/70 mm Hg. Nondipping blood pressure was defined as mean nighttime-to-daytime (10 am-8 pm) SBP ratio >0.90.

RESULTS

Nocturnal hypertension was present in 57.9% of participants; 66.6% had nondipping blood pressure. The mean age was 59.4 years, 32.8% were male, and 56.0% were taking antihypertensive medication. The prevalence ratios (95% confidence interval) adjusted for age, sex, cardiovascular disease risk factors, and socioeconomic and psychosocial factors comparing participants with moderate and high to those with low percentage West African ancestry for nocturnal hypertension were 0.98 (0.87-1.10) and 0.95 (0.84-1.08), respectively, and for nondipping blood pressure was 0.96 (0.86-1.07) and 0.98 (0.88-1.09), respectively.

CONCLUSIONS

West African ancestry was not associated with nocturnal hypertension and nondipping blood pressure among African Americans. While rare genetic variants cannot be ruled out, these data highlight the need to better understand how environmental and behavioral factors contribute to differences in nocturnal blood pressure among African Americans compared with European Americans.

A Preliminary Study of the Relationship between Perceived Racism and Cardiovascular Reactivity and Recovery in Native Hawaiians

Native Hawaiians, compared to other ethnic groups in Hawai‘i, have significantly higher mortality rates and die at a younger average age from cardiovascular disease (CVD). This may be partially explained by elevated cardiovascular responses to racial stressors. Our study examined the degree to which blood pressure (BP) and heart rate (HR) reactivity and recovery, and ratings of subjective distress to racial stressors, differ as a function of Native Hawaiian college students’ levels of perceived racism. This study had three phases. Phase 1 involved the development of a blatant and subtle racial stressor. Phase 2 involved assigning 132 students into high- or low-perceived racism groups based on scores on two perceived interpersonal racism measures. Phase 3 involved a psychophysiology laboratory experiment conducted with 35 of the 132 students. BP, HR, and subjective distress were measured during exposure to the blatant and subtle racial stressors. Systolic blood pressure (SBP) recovery following exposure to both stressors was significant for both groups. Although not significant, three trends were observed among the high-perceived racism group, which included: (1) greater reactivity to exposure to the subtle stressor than to the blatant stressor, (2) incomplete HR recovery following exposure to both stressors, and (3) incomplete SBP and diastolic blood pressure recovery following exposure to the subtle stressor. Participants also reported significantly greater subjective distress following exposure to the blatant than to the subtle stressor. Specific interventions, such as increased self-awareness of physiological responses to racial stressors, targeted at at-risk individuals are necessary to reduce a person’s risk for CVD.

Racial disparities in health among nonpoor African Americans and Hispanics: The role of acute and chronic discrimination

Racial disparities in health tend to be more pronounced at the upper ends of the socioeconomic (SES) spectrum. Despite having access to above average social and economic resources, nonpoor African Americans and Latinos report significantly worse health compared to nonpoor Whites. We combine data from the parents and children of the 1979 National Longitudinal Survey of Youth (NLSY79) to address two specific research aims. First, we generate longitudinal SES trajectories over a 33-year period to estimate the extent to which socioeconomic mobility is associated with exposure to discrimination (acute and chronic) across different racial/ethnic groups (nonHispanic Whites, nonHispanic Blacks, and Hispanics). Then we determine if the disparate relationship between SES and self-rated health across these groups can be accounted for by more frequent exposure to unfair treatment. For Whites, moderate income gains over time result in significantly less exposure to both acute and chronic discrimination. Upwardly mobile African Americans and Hispanics, however, were significantly more likely to experience acute and chronic discrimination, respectively, than their socioeconomically stable counterparts. We also find that differential exposure to unfair treatment explains a substantial proportion of the Black/White, but not the Hispanic/White, gap in self-rated health among this nationally representative sample of upwardly mobile young adults. The current study adds to the debate that the shape of the SES/health gradient differs, in important ways, across race and provides empirical support for the diminishing health returns hypothesis for racial/ethnic minorities.

Discrimination and Health Among Taxi Drivers in New York and Toronto

Immigrant taxi drivers in metropolitan cities are exposed to experiences of discrimination and occupation-based health risks. Given the structural differences in health care systems in the United States and Canada, we investigated the differences in reports of discrimination, health conditions and concern about health conditions between taxi drivers in New York City and Toronto, Ontario. Participants were recruited for a taxi driver Needs Assessment Survey as part of a Taxi Network needs assessment project using a street side convenience sampling technique in New York City and Toronto. The matched sample contained 33 drivers from Toronto and 33 drivers from NYC. All Toronto drivers in our sample reported having health insurance while over a quarter of NYC drivers did not have health insurance. Toronto drivers reported greater everyday and workplace discrimination. Drivers in both cities experienced higher rates than average, and reported concern about, major health conditions. We also found preliminary evidence suggesting a relationship between experiencing discrimination and reporting chronic pain. Our findings suggest the need for future research to more closely examine the associations between discrimination and health among the taxi driver population.

Narratives of Stress in Health Meanings of African Americans in Lake County, Indiana

Across the life course, African Americans bear an unequal burden of disease compared to other racial groups. In spite of the widespread acknowledgment of racial health disparities, the voices of African Americans, their articulations of health and their local etiologies of health disparities are limited. In this article, we highlight the important role of communication scholarship to understand the everyday enactment of health disparities. Drawing upon the culture-centered approach (CCA) to co-construct narratives of health with African Americans residents of Lake County, Indiana, we explore the presence of stress in the everyday narratives of health. These narratives voice the social and structural sources of stress, and articulate resistive coping strategies embedded in relationship to structures.

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

Lifetime racial/ethnic discrimination and ambulatory blood pressure: The moderating effect of age

OBJECTIVE

To determine whether the relationships of lifetime discrimination to ambulatory blood pressure (ABP) varied as a function of age in a sample of Black and Latino(a) adults ages 19 - 65.

METHOD

Participants were 607 Black (n = 318) and Latino(a) (n = 289) adults (49% female) who completed the Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV), which assesses lifetime exposure to racism/ethnic discrimination. They were outfitted with an ABP monitor to assess systolic and diastolic blood pressure (SBP, DBP) across a 24-hr period. Mixed-level modeling was conducted to examine potential interactive effects of lifetime discrimination and age to 24-hr, daytime, and nighttime ABP after adjustment for demographic, socioeconomic, personality and life stress characteristics, and substance consumption covariates (e.g., smoking, alcohol).

RESULTS

There were significant interactions of Age × Lifetime Discrimination on 24-hr and daytime DBP (ps ≤ .04), and in particular significant interactions for the Social Exclusion component of Lifetime Discrimination. Post hoc probing of the interactions revealed the effects of Lifetime Discrimination on DBP were seen for older, but not younger participants. Lifetime discrimination was significantly positively associated with nocturnal SBP, and these effects were not moderated by age. All associations of Lifetime Discrimination to ABP remained significant controlling for recent exposure to discrimination as well as all other covariates.

CONCLUSIONS

Exposure to racial/ethnic discrimination across the life course is associated with elevated ABP in middle to older aged Black and Latino(a) adults. Further research is needed to understand the mechanisms linking discrimination to ABP over the life course. (PsycINFO Database Record

Racial Discrimination and Stigma Consciousness Are Associated with Higher Blood Pressure and Hypertension in Minority Men

OBJECTIVE

We examined whether lifetime racial discrimination and stigma consciousness (expecting to be stigmatized) are associated with blood pressure in minority and White middle-aged and older adult men.

DESIGN

Participants were 1533 men (mean age = 63.2 [SD = 7.9, range = 37.4-89.2]; 12.4 % Black, 7.8 % Hispanic, 2.0 % other) diagnosed with clinically localized prostate cancer. We separately modeled associations between discrimination/stigma consciousness and blood pressure outcomes for minorities and Whites controlling for education, income, employment status, age, marital status, BMI, and recruitment site.

RESULTS

Minorities reported more racial discrimination and stigma consciousness than Whites (ps < .001). For minorities, having experienced more racial discrimination was associated with having higher diastolic blood pressure (B = 0.15, p = .016) and having greater stigma consciousness was associated with greater odds of having hypertension (OR = 1.04, p = .047). Greater stigma consciousness was associated with lower systolic blood pressure in Whites (B = -0.24, p = .012).

CONCLUSION

Discrimination and stigma consciousness are associated with common risk factors for chronic disease and premature death that disproportionately affect minorities. Findings for stigma consciousness suggest that anticipatory vigilance may be impacting minority health.

Exposure to Racial Discrimination and Ambulatory Blood Pressure in Women with Type 2 Diabetes

Diabetes is the only disorder in which women's risk for heart disease exceeds men's. Elevated blood pressure (BP) increases cardiovascular risk in people with type 2 diabetes. Racial discrimination and neuroticism are both associated with BP levels but have not been examined in concert. This study investigated self-reported racial discrimination, neuroticism and ambulatory BP in women with type 2 diabetes. Thirty-nine Black and 38 White women completed a race-neutral version of the Schedule of Racist Events; BP was evaluated using ambulatory monitoring devices. Actigraphy and diaries were used to document times of sleep and wakefulness. Racial discrimination interacted with neuroticism to predict systolic and diastolic BP both while awake and during sleep, after adjustment for covariates. For each, the influence of racist events was stronger at lower levels of neuroticism. Racial discrimination is associated with higher levels of 24-h BP in diabetic women who are low in neuroticism. Copyright © 2015 John Wiley & Sons, Ltd.

Perceived Discrimination and Nocturnal Blood Pressure Dipping Among Hispanics: The Influence of Social Support and Race

OBJECTIVE

Little is known about the relationship of perceived racism to ambulatory blood pressure (ABP) in Hispanics. We explored possible associations between ABP nocturnal dipping and perceived racism in a Hispanic cohort.

METHODS

Participants included 180 community-dwelling Hispanics from the Northern Manhattan Study. Measures included perceived racism, socioeconomic status, social support, and ABP monitoring. Nocturnal ABP nondipping was defined as a less than 10% decline in the average asleep systolic blood pressure relative to the awake systolic blood pressure.

RESULTS

Overall, 77.8% of participants reported some form of perceived racism (Perceived Ethnic Discrimination Questionnaire scores >1.0). Greater social support was associated with less perceived discrimination (Spearman r = -0.54, p < .001). Those with higher perceived discrimination scores reported more depressive symptoms (r = 0.25, p < .001). Those with higher Perceived Ethnic Discrimination Questionnaire scores were less likely to show nocturnal ABP nondipping in multivariate models (odds ratio = 0.40, confidence interval = 0.17-0.98, p = .045). Among those with low perceived racism, black Hispanic participants were more likely to have nocturnal ABP nondipping (82.6%) compared with white Hispanics (53.9%; p = .02). Among those with high perceived racism, no associations between race and the prevalence of ABP nondipping was found (black Hispanic = 61.5% versus white Hispanic = 51.4%, p = .39; p interaction = .89).

CONCLUSIONS

Perceived racism is relatively common among US Hispanics and is associated with ABP. Nondipping of ABP, a potential cardiovascular risk factor, was more common in black Hispanic participants with low perceived racism. This finding may reflect different coping mechanisms between black versus white Hispanics and related blood pressure levels during daytime exposures to discrimination.

Psychosocial Correlates of Nocturnal Blood Pressure Dipping in African Americans: The Jackson Heart Study

BACKGROUND

African Americans exhibit a lower degree of nocturnal blood pressure (BP) dipping compared with Whites, but the reasons for reduced BP dipping in this group are not fully understood. The aim of this study was to identify psychosocial factors associated with BP dipping in a population-based cohort of African Americans.

METHODS

This cross-sectional study included 668 Jackson Heart Study (JHS) participants with valid 24-hour ambulatory BP data and complete data on psychosocial factors of interest including stress, negative emotions, and psychosocial resources (e.g., perceived support). The association of each psychosocial factor with BP dipping percentage and nondipping status (defined as <10% BP dipping) was assessed using linear and Poisson regression models, respectively, with progressive adjustment for demographic, socioeconomic, biomedical, and behavioral factors.

RESULTS

The prevalence of nondipping was 64%. Higher depressive symptoms, higher hostility, and lower perceived social support were associated with a lower BP dipping percentage in unadjusted models and after adjustment for age, sex, body mass index, and mean 24-hour systolic BP (P < 0.05). Only perceived support was associated with BP dipping percentage in fully adjusted models. Also, after full multivariable adjustment, the prevalence ratio for nondipping BP associated with 1 SD (7.1 unit) increase in perceived support was 0.93 (95% CI: 0.88-0.99). No other psychosocial factors were associated with nondipping status.

CONCLUSIONS

Lower perceived support was associated with reduced BP dipping in this study. The role of social support as a potentially modifiable determinant of nocturnal BP dipping warrants further investigation.

The relationship between cumulative unfair treatment and intima media thickness and adventitial diameter: The moderating role of race in the study of women's health across the nation

OBJECTIVE

Unfair treatment may have a detrimental effect on cardiovascular health. However, little research on chronic health outcomes uses cumulative measures of unfair treatment. We tested whether cumulative unfair treatment was associated with greater subclinical cardiovascular disease in a diverse sample of African-American, Caucasian, Chinese, and Hispanic women. We also examined whether this relationship varied by race.

METHOD

The Study of Women's Health Across the Nation is a longitudinal study of midlife women. Cumulative unfair treatment was calculated as the average of unfair treatment assessed over 10 years at 6 time points. Subclinical cardiovascular disease, specifically carotid intima media thickness and adventitial diameter, was assessed via carotid ultrasound conducted at study year 12 in 1,056 women. We tested whether cumulative unfair treatment was related to subclinical cardiovascular disease via linear regression, controlling for demographic factors including socioeconomic status and cardiovascular risk factors.

RESULTS

The relation between unfair treatment and subclinical cardiovascular disease significantly varied by race (ps < .05), with unfair treatment related to higher intima media thickness (B = .03, SE = .01, p = .009) and adventitial diameter (B = .02, SE = .009, p = .013) only among Caucasian women. No significant relations between unfair treatment and subclinical cardiovascular disease outcomes were observed for African-American, Hispanic, and Chinese women.

CONCLUSIONS

Our findings indicate that cumulative unfair treatment is related to worse subclinical cardiovascular disease among Caucasian women. These findings add to the growing literature showing that Caucasian women's experience of unfair treatment may have detrimental health implications. (PsycINFO Database Record

Place of birth effects on self-reported discrimination: Variations by type of discrimination

Researchers have suggested that perceptions of discrimination may vary depending on place of birth and the length of time spent living in the U.S., variables related to acculturation. However, the existing literature provides a mixed picture, with data suggesting that the effects of acculturation on perceptions of discrimination vary by race and other sociodemographic factors. This study evaluated the role of place of birth (POB: defined as U.S.-born vs. foreign-born), age at immigration, and length of residence in the U.S. on self-reported discrimination in a sample of urban-dwelling Asian and Black adults (n= 1454). Analyses examined POB effects on different types of discrimination including race-related stigmatization, exclusion, threat, and workplace discrimination. Sociodemographic variables (including age, gender, employment status and education level) were tested as potential moderators of the relationship between POB and discrimination. The results revealed a significant main effect for POB on discrimination, with U.S.-born individuals reporting significantly more discrimination than foreign-born individuals, although the effect was reduced when sociodemographic variables were controlled. Across the sample, POB effects were seen only for race-related stigmatization and exclusion, not for threat and workplace discrimination. With the exception of limited effects for gender, sociodemographic variables did not moderate these effects. Younger age at immigration and greater years of residence in the U.S. were also positively associated with higher levels of perceived discrimination. These findings suggest increasing acculturation may shape the experience and perception of racial and ethnic discrimination.

A qualitative study assessing cardiovascular risk factors: the accumulative stressors influencing societal integration of teenage African immigrants

Background

This study examines the nature of disparities in cardiovascular risk by exploring chronic stressors and other cardiovascular risk factors on youth of African descent who are integrating into an industrialized society.

Methods

Qualitative data on cardiovascular risk and acclimation to the dominant society were collected from three groups of key informants: (1) community leaders; (2) youth; and (3) a community advisory group.

Results

Youth of Ethiopian descent engaged in the same western diets, computerized social networking, and habits in smoking and alcohol use as did youth from the dominant society. However, informants of Ethiopian descent encountered and witnessed racism, institutional discrimination and evidence of devaluing Ethiopian culture, influencing youths’ ability to integrate into the society.

Conclusion

Immigrant youth of Ethiopian descent face an accumulation of conflicting social support, psychosocial factors, and stressors, including: living in low-income, high-crime areas; encountering pervasive discrimination; acclimating to a new and industrialized culture; and navigating within an often unhospitable society. Contributing to these factors are changes in health behaviors such as adding processed foods and sugary drinks to the diet, increasing heavy alcohol use and substituting screen use for physical activity. The accumulative impact of these factors contributes to the marginalization of youth of Ethiopian descent in the dominant society and perpetuates a cycle of increasing cardiovascular risk.