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LeBrón AMW, Rodriguez VE, Sinco BR, Caldwell CH, Kieffer EC. Racialization processes and depressive symptoms among pregnant Mexican-origin immigrant women. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38713848 DOI: 10.1002/ajcp.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/22/2024] [Accepted: 04/24/2024] [Indexed: 05/09/2024]
Abstract
This study examines how racialization processes (conceptualized as multilevel and dynamic processes) shape prenatal mental health by testing the association of discrimination and the John Henryism hypothesis on depressive symptoms for pregnant Mexican-origin immigrant women. We analyzed baseline data (n = 218) from a healthy lifestyle intervention for pregnant Latinas in Detroit, Michigan. Using separate multiple linear regression models, we examined the independent and joint associations of discrimination and John Henryism with depressive symptoms and effect modification by socioeconomic position. Discrimination was positively associated with depressive symptoms (β = 2.84; p < .001) when adjusting for covariates. This association did not vary by socioeconomic position. Women primarily attributed discrimination to language use, racial background, and nativity. We did not find support for the John Henryism hypothesis, meaning that the hypothesized association between John Henryism and depressive symptoms did not vary by socioeconomic position. Examinations of joint associations of discrimination and John Henryism on depressive symptoms indicate a positive association between discrimination and depressive symptoms (β = 2.81; p < .001) and no association of John Henryism and depressive symptoms (β = -0.83; p > .05). Results suggest complex pathways by which racialization processes affect health and highlight the importance of considering experiences of race, class, and gender within racialization processes.
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Affiliation(s)
- Alana M W LeBrón
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Department of Chicano/Latino Studies, School of Social Sciences, University of California, Irvine, Irvine, California, USA
| | - Victoria E Rodriguez
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Brandy R Sinco
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Cleopatra H Caldwell
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Edith C Kieffer
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Roy A, Patten S, Thurston W, Beran T, Crowshoe LL, Tough S. Race as a determinant of prenatal depressive symptoms: analysis of data from the 'All Our Families' study. ETHNICITY & HEALTH 2024; 29:395-422. [PMID: 38332731 DOI: 10.1080/13557858.2024.2312420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Prenatal depression is a serious maternal-child health concern. Risk factors and health consequences appear more prevalent in Indigenous communities and ethnic minority groups; however, research on these populations is limited. We examined the following questions: (A) How do pregnant Indigenous women, ethnic minority women, and White women compare on levels of depressive symptoms and possible clinical depression, and on major risk and protective factors? (B) Is non-dominant (non-White) race associated with higher depressive symptoms and possible clinical depression? (C) What factors mediate and moderate the relationship between race and depression? DESIGN Data were from the All Our Families study (n = 3354 pregnant women from Alberta, Canada). Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics and multivariable regression methods were used to assess the hypotheses that Indigenous and ethnic minority women would have significantly higher mean EPDS score estimates and higher proportions scoring above cut-offs for possible clinical depression, relative to White women. The association between race and depressive symptoms was hypothesised to be partially mediated by risk factors of socioeconomics, health background, discrimination, domestic violence, and psychosocial stress. Potential confounders were age, marital status, and parity. Diet and social support were hypothesised as protective buffers between stress and depressive symptoms. RESULTS A higher proportion of White women were married, had family income over $80,000, were employed, and had adequate social support, relative to other women. They had significantly lower mean depressive symptom score, and a smaller proportion scored above cut-offs for possible clinical depression. The positive association between race and depressive symptoms appeared to be partially mediated by socioeconomic factors and psychosocial stress. Social support appeared to moderate the association between stress and depressive symptoms. CONCLUSIONS Strategies to address socioeconomic status, stress, and social support among racialized minority women may reduce the risk for prenatal depression.
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Affiliation(s)
- Amrita Roy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Wilfreda Thurston
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tanya Beran
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lynden Lindsay Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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3
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Garland M, Wilbur J, Schoeny M, Reed M, Semanik P, Halloway S, Waters T. Determinants of Physical Activity Among Black Women During Pregnancy. J Obstet Gynecol Neonatal Nurs 2024; 53:172-184. [PMID: 38072009 DOI: 10.1016/j.jogn.2023.11.006] [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: 05/16/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE To describe associations among background determinants of physical activity, modifiable theoretical determinants of physical activity, and measures of physical activity during the second and third trimesters of pregnancy among Black women. DESIGN Longitudinal cohort. SETTING Medical center obstetric clinic. PARTICIPANTS Pregnant Black women (n = 40 in second trimester, n = 38 in third trimester) METHODS: We measured background determinants (demographic and pregnancy characteristics, discrimination, and neighborhood walkability) during the second trimester. We measured modifiable theoretical determinants (self-efficacy and social support) and physical activity using self-report and device measures during the second and third trimesters. We used paired t tests to determine differences in the modifiable theoretical determinants from the second trimester to third trimester and used Pearson correlations among background and modifiable determinants and physical activity measures during the second trimester. RESULTS Participants' physical activity levels were low during the second and third trimesters (32% and 22% met recommendation, respectively). We found no changes in self-efficacy or social support between trimesters and found no associations between these modifiable determinants and actual physical activity. We found a positive correlation between previous pregnancies and physical activity measured by devices, r(36) = .33, p = .048. Pregnancy-specific stress, r(38) = -.40, p = .013, was negatively correlated, and age, r(38) = .38, p = .017, was positively correlated with self-reported physical activity. CONCLUSIONS Low levels of physical activity during pregnancy coupled with the absence of an association with modifiable factors affecting pregnancy physical activity indicate a need to further examine the social, cultural, and environmental determinants of physical activity.
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Kaur A, Charles ST, Molina KM, Almeida DM. Adding Insult to Injury: Everyday Discrimination Moderates Stressor-Related Negative Affect. Behav Med 2024; 50:26-36. [PMID: 35834177 PMCID: PMC9839892 DOI: 10.1080/08964289.2022.2092441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 05/20/2022] [Accepted: 06/16/2022] [Indexed: 01/17/2023]
Abstract
Studies examining the effects of discrimination on emotional well-being have often overlooked (a) differential effects of both everyday and lifetime discrimination and (b) how both types of discrimination may exacerbate stressor-related affect-even when daily stressors are unrelated to discrimination. The current study examined the effects of daily stressors not attributed to discrimination (i.e., nondiscrimination-related daily stressors) on daily negative and positive affect in the presence of either form of discrimination (everyday and lifetime). Participants who completed the second wave of the Survey of Midlife Development in the US (MIDUS-II) and the National Study of Daily Experiences (NSDE-II) answered questionnaires about everyday and lifetime discrimination. Later, they completed daily phone interviews across 8 consecutive days, asking about the nondiscrimination-related daily stressors and the positive and negative affect they had experienced that day. Multilevel model analyses revealed that everyday discrimination was associated with decreased daily positive affect and lifetime discrimination was associated with increased daily negative affect. Moreover, higher frequency of everyday discrimination exacerbated the within-person effects of nondiscriminatory daily stressors on negative affect. Results underscore the importance of considering both independent and synergistic effects of discrimination on daily emotional well-being.
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Affiliation(s)
- Amandeep Kaur
- Department of Psychological Science, University of California, Irvine, Irvine, USA
| | - Susan T. Charles
- Department of Psychological Science, University of California, Irvine, Irvine, USA
| | - Kristine M. Molina
- Department of Psychological Science, University of California, Irvine, Irvine, USA
| | - David M. Almeida
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, USA
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5
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Liu SR, Sandman CA, Davis EP, Glynn LM. Intergenerational risk and resilience pathways from discrimination and acculturative stress to infant mental health. Dev Psychopathol 2023; 35:899-911. [PMID: 35256027 PMCID: PMC9452603 DOI: 10.1017/s0954579422000141] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Preconception and prenatal stress impact fetal and infant development, and women of color are disproportionately exposed to sociocultural stressors like discrimination and acculturative stress. However, few studies examine links between mothers' exposure to these stressors and offspring mental health, or possible mitigating factors. Using linear regression, we tested associations between prenatally assessed maternal acculturative stress and discrimination on infant negative emotionality among 113 Latinx/Hispanic, Asian American, Black, and Multiethnic mothers and their children. Additionally, we tested interactions between stressors and potential pre- and postnatal resilience-promoting factors: community cohesion, social support, communalism, and parenting self-efficacy. Discrimination and acculturative stress were related to more infant negative emotionality at approximately 12 months old (M = 12.6, SD = .75). In contrast, maternal report of parenting self-efficacy when infants were 6 months old was related to lower levels of infant negative emotionality. Further, higher levels of parenting self-efficacy mitigated the relation between acculturative stress and negative emotionality. Preconception and prenatal exposure to sociocultural stress may be a risk factor for poor offspring mental health. Maternal and child health researchers, policymakers, and practitioners should prioritize further understanding these relations, reducing exposure to sociocultural stressors, and promoting resilience.
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Affiliation(s)
- Sabrina R Liu
- Conte Center, Department of Pediatrics, University of California Irvine, CA, USA
- Department of Psychology, Chapman University, Orange, CA, USA
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California Irvine, Orange, CA, USA
| | - Elysia Poggi Davis
- Conte Center, Department of Pediatrics, University of California Irvine, CA, USA
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA, USA
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6
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Johnson A, Dobbs PD, Coleman L, Maness S. Pregnancy-Specific Stress and Racial Discrimination Among U.S. Women. Matern Child Health J 2023; 27:328-334. [PMID: 36609938 DOI: 10.1007/s10995-022-03567-3] [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: 06/21/2021] [Revised: 10/20/2022] [Accepted: 12/20/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Adverse birth outcomes among children born to women of color (WOC) have been associated with discrimination during pregnancy; however, little research has explored stressed caused by discrimination as well as pregnancy-specific stress. The purpose of this study was to examine differences in stress and racial discrimination (lifetime and during pregnancy) between U.S. women of different racial/ethnic groups. METHODS Women between 18 and 45 years (n = 198; 101 non-Hispanic White, 58 Black, and 39 other WOC [i.e., Hispanic, Asian/Pacific Islander, American Indian, Mixed Race]) completed an online, cross-sectional survey between December 2019 and March 2020. Participants reported pregnancy-specific stress using the pregnancy distress questionnaire (PDQ) and pregnancy life events scale (PLE) and discrimination via the general ethnic discrimination scale (GED). ANOVAs explored differences between racial/ethnic groups' stress and discrimination. RESULTS We found non-Hispanic White (p < 0.05) and other WOC (p < 0.01) reported higher distress during pregnancy than Black women, and other WOC (p < 0.05) reported more stressful prenatal life events (p < 0.05) than non-Hispanic Whites. However, Black (p < 0.001) and other WOC (p < 0.001) both experienced more ethnic discrimination throughout their lifetime and during their pregnancy than non-Hispanic Whites. Also, Black women experienced five times the stress from these encounters than White women (p < 0.001). CONCLUSIONS FOR PRACTICE Previously developed pregnancy distress questionnaires may be better suited for non-Hispanic White populations and may miss important experiences unique to marginalized populations such as racial/ethnic discrimination. Adaptations to pregnancy-related stress scales are warranted given the toxicity of discrimination during pregnancy.
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Affiliation(s)
- Aleyah Johnson
- Department of Health and Exercise Science, University of Oklahoma, 73019, Norman, OK, USA
| | - Page D Dobbs
- Department of Health and Exercise Science, University of Oklahoma, 73019, Norman, OK, USA.
- Human Performance and Recreation Department, University of Arkansas, 72701, Health, Fayetteville, AR, USA.
- Center for Public Health and Technology, University of Arkansas, 72701, Fayetteville, AR, USA.
| | - Lois Coleman
- Department of Health and Exercise Science, University of Oklahoma, 73019, Norman, OK, USA
- Department of Health Promotion Sciences, University of Oklahoma Health Science Center, Hudson College of Public Health, 73104, Oklahoma City, OK, USA
| | - Sarah Maness
- Department of Health and Exercise Science, University of Oklahoma, 73019, Norman, OK, USA
- College of Charleston, Public Health Department, 29424, Charleston, South Caroline, USA
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Health Behaviors and Behavior Change during Pregnancy: Theory-Based Investigation of Predictors and Interrelations. SEXES 2022. [DOI: 10.3390/sexes3030027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
(1) Background: Preventing pregnancy complications and maternal deaths and helping women stay healthy before, during, and after pregnancy by means of sexual health and behavior is imperative. Previous research demonstrated that a lack of social support and perceived discrimination have adverse effects on pregnancy outcomes. These determinants may impact health behavior as an important mediator of pregnancy outcomes. To better understand this relation, the Compensatory Carry-Over Action Model (CCAM) was applied. The research question was: how do predictors of health behavior, specifically intention, planning, self-efficacy, social support, and discrimination, interrelate with different health behaviors during pregnancy? (2) Methods: By means of qualitative interviews with ten pregnant women (20–39 years, mean = 28.6) from different cultural backgrounds, the predictors of health behaviors and experiences with pregnancy, including racial discrimination, were investigated. (3) Results: Not all women changed their unhealthy behaviors even though their higher-level goal was to ensure their baby’s and their own health. This appeared partially due to lack of social support, racial discrimination, and unexpected pregnancy side effects. The women who previously performed health behaviors revealed a healthier pattern with maintaining or even expanding their health behaviors, while those performing no health behavior in the past reported more obstacles with a healthy lifestyle. (4) Conclusions: Pregnant women appear to be having difficulties translating good intentions into behavior. The reasons include lack of support, fear, and insecurity, which impact self-efficacy and planning. Improvements in health behaviors were facilitated by specific circumstances, such as working from home. Policy and practice should take these aspects into account and help mobilize support and overcome discrimination by means of more rights and support for pregnant women while also empowering the individuals.
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8
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Weeks F, Zapata J, Rohan A, Green T. Are Experiences of Racial Discrimination Associated with Postpartum Depressive Symptoms? A Multistate Analysis of Pregnancy Risk Assessment Monitoring System Data. J Womens Health (Larchmt) 2022; 31:158-166. [PMID: 34967671 PMCID: PMC10941332 DOI: 10.1089/jwh.2021.0426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Postpartum depression (PPD) is a serious public health crisis disproportionately affecting women of color. We examine whether interpersonal racial discrimination is associated with higher odds of postpartum depressive symptoms (PPDS) among women of color and how it may vary by race/ethnicity and maternal educational attainment. Materials and Methods: We present a secondary analysis of cross-sectional data from Pregnancy Risk Assessment Monitoring System (PRAMS) postnatal surveys conducted in nine jurisdictions between 2012 and 2015 that included a question about being upset by experiences of racial discrimination within 12 months before giving birth. Results: Being upset by racial discrimination was associated with nearly three times higher odds of PPDS. Among women of color with at least some college education, the higher odds of PPDS associated with racial discrimination were greater than threefold, and for women with less than a high school education were less than twofold. Conclusion: Addressing risk factors for PPD, including racial discrimination, may inform strategies to reduce racial disparities in maternal mental health.
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Affiliation(s)
- Fiona Weeks
- Wisconsin Department of Health Services, Madison, Wisconsin, USA
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Center for Demography and Ecology, Department of Sociology, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Jasmine Zapata
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Angela Rohan
- Wisconsin Department of Health Services, Madison, Wisconsin, USA
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tiffany Green
- Department of Population Health Sciences, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Center for Demography and Ecology, Department of Sociology, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Department of Obstetrics and Gynecology, University of Wisconsin–Madison, Madison, Wisconsin, USA
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The contribution of racism-related stress and adversity to disparities in birth outcomes: evidence and research recommendations. F S Rep 2021; 3:5-13. [PMID: 35937456 PMCID: PMC9349247 DOI: 10.1016/j.xfre.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/14/2022] Open
Abstract
Currently, racial and ethnic differences in adverse birth outcomes and infant mortality are some of the largest and most persistent health disparities in the United States. This narrative review article synthesizes existing literature to present a conceptual model of how racism-related stress and adversity are critical determinants of such disparities. We describe how historical and ongoing racism has created conditions wherein women of color are disproportionately exposed to chronic, multilayered stress and adversity and how the biological consequences of exposure to these stressors confers risk for adverse birth outcomes. Next, we identify important priorities and considerations for future research, including the heterogeneity of racism-related stressors, biomarkers and mechanisms, chronicity and sensitive periods of exposure, developmental programming of lifespan health, resilience, and community-engaged research methodologies. Historical and ongoing racism has created conditions wherein women of color are disproportionately exposed to stress and adversity. The consequences of exposure to racism-related stress and adversity can confer risk for health conditions implicated in adverse birth outcomes and alter maternal physiology associated with fetal development and timing of parturition. Conjointly studying racism-related stress, biologic profiles, and birth outcomes is a priority for future research. It is important to identify factors that mitigate the impact of racism-related stress and adversity on birth outcomes.
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Torain MJ, Bennett GG, Matsouaka RA, Olsen MK, Yang H, Bolton JH, Johnson KS, Svetkey LP. The Patient's Point of View: Characterizing Patient-Level Factors Associated with Perceptions of Health Care. Health Equity 2021; 5:457-465. [PMID: 34235371 PMCID: PMC8252902 DOI: 10.1089/heq.2021.0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose: We explored the association between perception of care, as measured by the Interpersonal Processes of Care (IPC) survey, and patient-level factors, including (1) Trust in physicians; (2) Perceived empathy; (3) Stereotype threat; (4) Perceived everyday discrimination; and (5) Self-Reported Health. Methods: Fifty participants from diverse racial backgrounds and education levels were surveyed. We examined the associations between the five patient-level factors and each subdomain of the IPC using multiple linear regression. We added a race interaction term to assess whether associations between IPC subdomains and predictors differed by race. We tested for correlation among factors found to be significantly associated with the IPC. Results: In adjusted analyses, trust in the physician, perceived empathy from the provider, and perceived everyday discrimination were significantly associated with most subdomains of the IPC. There was no significant race interaction. Conclusion: This exploratory study suggests that empathy, trust, and perceived everyday discrimination are significantly linked to patient perception of quality care, which are linked to clinical outcomes. Results present modifiable factors that may potentially improve patient care. Practice Implications: Increased efforts to improve clinician communication of empathy and general communication skill may have a positive effect on quality of care.
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Affiliation(s)
- Maya J Torain
- Duke Center for Research to Advance Healthcare Equity, Durham, North Carolina, USA.,Duke University School of Medicine, Durham, North Carolina, USA
| | - Gary G Bennett
- Duke Center for Research to Advance Healthcare Equity, Durham, North Carolina, USA.,Department of Psychology and Neuroscience, Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Roland A Matsouaka
- Duke Center for Research to Advance Healthcare Equity, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Maren K Olsen
- Duke Center for Research to Advance Healthcare Equity, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Hongqiu Yang
- Duke Center for Research to Advance Healthcare Equity, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jamiyla H Bolton
- Duke Center for Research to Advance Healthcare Equity, Durham, North Carolina, USA.,Department of Psychology and Neuroscience, Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kimberly S Johnson
- Duke Center for Research to Advance Healthcare Equity, Durham, North Carolina, USA.,Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Administration, Durham, North Carolina, USA.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Laura P Svetkey
- Duke Center for Research to Advance Healthcare Equity, Durham, North Carolina, USA.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Gu J, Ming X. Daily Social Pressure and Alcohol Consumption Among Chinese Women: A Cross-Sectional Study. Asia Pac J Public Health 2021; 33:396-403. [PMID: 33666091 DOI: 10.1177/1010539521998522] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine the daily social pressure and socioeconomic factors related to women's alcohol consumption in China. Cross-sectional data were obtained from the 2012 China Family Panel Studies. A multivariate logistic regression analysis of a sample of 16 339 female adults with the mean age of 45.3 years was used to examine the relationships between dependent and independent variables. According to the results, first, the greater the daily social pressure, the more likely women were to engage in general alcohol consumption (odds ratio = 1.061) and risk drinking (odds ratio = 1.057). Second, while there is a positive relationship between the general level of social pressure and women's alcohol consumption, the relationship between the severe level of social pressure and women's alcohol consumption was not significant. Finally, women in the Central region were less likely to engage in risk drinking than women in the Western region; women with secondary school education were more likely to engage in risk drinking than women with primary school education or below; and age was significantly positively associated with both general and risk drinking. In conclusion, increasing alcohol consumption among women may be due to increased social pressure.
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Affiliation(s)
| | - Xing Ming
- Shanghai University, Shanghai, China
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12
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The Effects of Life Stress on Men’s Alcohol Use: a Reassessment of Data from the 2012 China Family Panel Studies. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00495-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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13
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Saelee R, Vaccarino V, Sullivan S, Hammadah M, Shah A, Wilmot K, Abdelhadi N, Elon L, Pimple P, Kaseer B, Levantsevych O, Bremner JD, Lewis TT. Longitudinal associations between self-reported experiences of discrimination and depressive symptoms in young women and men post- myocardial infarction. J Psychosom Res 2019; 124:109782. [PMID: 31371836 PMCID: PMC6673666 DOI: 10.1016/j.jpsychores.2019.109782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives Research suggests that following a myocardial infarction (MI), women under the age of 60 have more elevated depressive symptoms and adverse outcomes than similarly aged men. Identifying risk factors that contribute to gender differences in depressive symptoms among this group may be critical to the development of psychosocial interventions. Experiences of discrimination may be an important correlate of depressive symptoms in this group; however, studies of this relationship have largely been cross-sectional and focused on healthy populations. This study examines longitudinal associations among gender, discrimination, and depressive symptoms in a young post-MI cohort. Methods Participants were 313 adults from the Myocardial Infarction and Mental Stress Ischemia Study 2 of young (≤60 yrs) post-MI patients. At baseline and 6 month follow-up, depressive symptoms were measured with the Beck Depression Inventory-II and discrimination was assessed with the 10-item version Everyday Discrimination scale. Linear regression models were used to assess the longitudinal association between reports of discrimination and depressive symptoms adjusted for sociodemographic characteristics, psychosocial factors and health status indicators and tested for gender differences. Results The mean age was 51.2, 49.6% were women, and 69.5% were African-American. Although the discrimination-by-gender interaction was marginally significant (p=.09) in the fully adjusted model, findings suggest that the association between changes in reports of discrimination and depressive symptoms over time may be more pronounced for women (β=.61, standard error=.15, p<.001) than men (β=.27, standard error=.13, p=.033). Conclusion Our findings suggest that discrimination is a risk factor for depressive symptoms in young post-MI populations over time.
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Affiliation(s)
- Ryan Saelee
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Samaah Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Muhammad Hammadah
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA
| | - Amit Shah
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA
| | - Kobina Wilmot
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA
| | - Naser Abdelhadi
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA
| | - Lisa Elon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Pratik Pimple
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Belal Kaseer
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA
| | | | - JD Bremner
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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14
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Yang I, Hall L. Factors related to prenatal smoking among socioeconomically disadvantaged women. Women Health 2019; 59:1026-1074. [PMID: 30835645 DOI: 10.1080/03630242.2019.1584145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Socioeconomically disadvantaged pregnant women are especially at risk for smoking. To understand better this health behavior disparity, this systematic, integrative, comprehensive review aimed to identify factors related to prenatal smoking among socioeconomically disadvantaged women in the United States. A comprehensive literature search yielded 67 articles published between 2008 and 2016. Associated factors included any study variable related to persistent prenatal smoking. The Social Ecological Model (SEM), a multidimensional ecological framework, was used to organize the findings. Thirty-eight factors were explored in the reviewed studies and categorized according to SEM dimensions: individual, interpersonal, organizational, community, public policies and laws. At the individual level, most studies identified the socioeconomically disadvantaged prenatal smoker as older, US-born, White, unmarried, and multiparous. Other individual-level factors included alcohol abuse, nicotine dependence, and psychosocial factors such as stress and depressive symptoms. For broader levels of the SEM, associated factors included abuse/trauma, secondhand smoke exposure, lack of prenatal care, smoking cessation interventions, neighborhood risk, and state level initiatives such as cigarette taxes. The results of this review suggested multiple directions for future research to move science toward effective, scalable, and sustainable approaches that effectively address prenatal smoking among socioeconomically disadvantaged women.
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Affiliation(s)
- Irene Yang
- Nell Hodgson Woodruff School of Nursing, Emory University , Atlanta , GA , USA
| | - Lynne Hall
- School of Nursing, University of Louisville , Louisville , KY , USA
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Unger JB. Perceived Discrimination as a Risk Factor for Use of Emerging Tobacco Products: More Similarities Than Differences Across Demographic Groups and Attributions for Discrimination. Subst Use Misuse 2018; 53:1638-1644. [PMID: 29338581 PMCID: PMC7392176 DOI: 10.1080/10826084.2017.1421226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Perceived discrimination has been associated with cigarette smoking and other substance use among members of disadvantaged minority groups. However, most studies have focused on a single minority group, have not considered the individual's attribution for the discrimination, and have not considered emerging tobacco products. OBJECTIVE This study examined the associations between perceived discrimination and use of six tobacco products (cigarettes, e-cigarettes, cigars, pipe tobacco, hookah, and smokeless tobacco) in a diverse sample of 1,068 adults in the United States. METHODS Participants were recruited on Amazon's Mechanical Turk and participated in an online survey. Logistic regression models were used to examine the association between perceived discrimination and use of each tobacco product. Interactions between discrimination and demographic characteristics, and between discrimination and perceived reasons for discrimination, were evaluated. RESULTS Controlling for age, sex, race/ethnicity, education, and socioeconomic status, perceived discrimination was a risk factor for current use of five of the six tobacco products. These associations were consistent across racial/ethnic groups and regardless of the individual's attribution for the reason for the discrimination. CONCLUSIONS Results indicate that perceived discrimination is a risk factor for the use of multiple tobacco products, and that this association is not limited to particular demographic groups or types of discrimination. Public health programs could potentially reduce tobacco-related disease by teaching healthier ways to cope with discrimination.
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Affiliation(s)
- Jennifer B Unger
- a Tobacco Center of Regulatory Science, Department of Preventive Medicine , University of Southern California, Keck School of Medicine , Los Angeles , California , USA
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Stepanikova I, Kukla L. Is Perceived Discrimination in Pregnancy Prospectively Linked to Postpartum Depression? Exploring the Role of Education. Matern Child Health J 2018; 21:1669-1677. [PMID: 28116534 PMCID: PMC5515992 DOI: 10.1007/s10995-016-2259-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives The role of perceived discrimination in postpartum depression is largely unknown. We investigate whether perceived discrimination reported in pregnancy contributes to postpartum depression, and whether its impact varies by education level. Methods Prospective data are a part of European Longitudinal Study of Pregnancy and Childhood, the Czech Republic. Surveys were collected in mid-pregnancy and at 6 months after delivery. Depression was measured using Edinburgh Postnatal Depression Scale. Generalized linear models were estimated to test the effects of perceived discrimination on postpartum depression. Results Multivariate models revealed that among women with low education, discrimination in pregnancy was prospectively associated with 2.43 times higher odds of postpartum depression (p < .01), after adjusting for antenatal depression, history of earlier depression, and socio-demographic background. In contrast, perceived discrimination was not linked to postpartum depression among women with high education. Conclusions Perceived discrimination is a risk factor for postpartum depression among women with low education. Screening for discrimination and socio-economic disadvantage during pregnancy could benefit women who are at risk for mental health problems.
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Affiliation(s)
- Irena Stepanikova
- Sociology Department, University of Alabama, Birmingham, USA. .,Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic. .,Institute for Research in Social Sciences, Stanford University, Stanford, USA.
| | - Lubomir Kukla
- Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic
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El-Khoury F, Sutter-Dallay AL, Panico L, Charles MA, Azria E, Van der Waerden J, Melchior M. Women’s mental health in the perinatal period according to migrant status: the French representative ELFE birth cohort. Eur J Public Health 2018; 28:458-463. [DOI: 10.1093/eurpub/cky008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Fabienne El-Khoury
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France
| | - Anne-Laure Sutter-Dallay
- Bordeaux University, Bordeaux, France; INSERM U657, Bordeaux, France
- University Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France
| | - Lidia Panico
- Institut National d'Etudes Démographiques, Paris, France
| | - Marie-Aline Charles
- Early ORigin of the Child’s Health and Development Team (ORCHAD),INSERM, UMR1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris Descartes University, Paris, France
| | - Elie Azria
- Obstetrical, Perinatal and Pediatric Epidemiology Team, NSERM, U-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center, Paris, France
- Department of Obstetrics and Gynecology, Groupe Hospitalier Paris Saint Joseph, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Judith Van der Waerden
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France
| | - Maria Melchior
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France
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Social Status, Discrimination, and Minority Individuals' Mental Health: a Secondary Analysis of US National Surveys. J Racial Ethn Health Disparities 2017; 5:485-494. [PMID: 28812239 DOI: 10.1007/s40615-017-0390-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/14/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Our study measured minority individuals' social status factors and frequency of discrimination experiences, in order to delineate social mechanisms linking race/ethnicity to mental status (specifically, to current mood/anxiety disorder and self-rated mental health). METHODS In this nationally representative secondary research, our data analyses drew on the cross-sectional "Collaborative Psychiatric Epidemiology Surveys," dating 2001-2003. The sample for the final model numbered 9368 respondents (2016 Asians, 2676 Latinos, 4676 blacks). RESULTS Across races/ethnicities, better mental health was associated with male gender, higher income, marriage, more education, and less-frequent discrimination experiences; discrimination experiences could impair health, especially among blacks. Marriage's strong contribution to Asians' mental health did not hold among blacks; education's contribution to Latinos' mental health did not hold among blacks either. Blacks' mental health was unaffected by immigration status, but Asian and Latino immigrants showed less-robust mental health than native-born counterparts. CONCLUSIONS Across the three racial/ethnic groups studied, differences were noted in relationships between self-reported mental health status and the employed social status and discrimination factors.
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Janevic T, Osypuk T, Stojanovski K, Jankovic J, Gundersen D, Rogers M. Associations between racial discrimination, smoking during pregnancy and low birthweight among Roma. Eur J Public Health 2017; 27:410-415. [PMID: 28064241 DOI: 10.1093/eurpub/ckw214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Racial discrimination may increase the risk of low birthweight (LBW), but has not been studied among Roma, the largest minority population in Europe. Moreover, few studies test both institutional and interpersonal forms of racial discrimination on health. Our objective was to examine associations between institutional and interpersonal racial discrimination with LBW, and to test potential mediation by smoking during pregnancy. In 2012-2013, Romani women interviewers surveyed 410 Romani women in Serbia and Macedonia. We measured institutional discrimination (neighborhood segregation, legal status of housing and neighborhood socioeconomic status), interpersonal discrimination [Everyday Discrimination Scale (EDS)], birthweight and smoking by self-report or interviewer report. We estimated relative risks for discrimination on LBW and separately on smoking during pregnancy using log-binomial regression, adjusting for age, parity, years at residence and wealth. The indirect effect of high EDS via smoking on LBW was estimated using inverse odds weighting mediation. Living in a low SES neighborhood showed a 2-fold risk of LBW [adjusted risk ratio (aRR) = 2.4, 95% CI = 1.2, 5.0]; aRRs for segregation and illegal housing were weaker (aRR = 1.8, 95% CI = 0.7, 4.3; aRR = 1.3, 95% CI = 0.6, 2.6, respectively). Institutional measures were not associated with smoking. High EDS was associated with LBW (aRR = 2.4, 95% CI = 1.1, 5.2) and smoking during pregnancy (aRR = 1.4, 95% CI = 1.1, 1.8); the indirect effect of EDS on LBW via smoking was not significant. Interpersonal discrimination and living in a low SES neighborhood were associated with LBW among Roma. Interventions to improve Romani health may benefit from a human rights approach.
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Affiliation(s)
- Teresa Janevic
- Department of Population Health Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Theresa Osypuk
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Kristefer Stojanovski
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Janko Jankovic
- Faculty of Medicine University of Belgrade, Institute of Social Medicine, Belgrade, Serbia
| | - Daniel Gundersen
- Division of Population Sciences, Dana-Farber/Harvard Cancer Center, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Maggie Rogers
- Department of Population Health Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, New York 10029
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Damron KR. Review of the Relationships Among Psychosocial Stress, Secondhand Smoke, and Perinatal Smoking. J Obstet Gynecol Neonatal Nurs 2017; 46:325-333. [PMID: 28390924 DOI: 10.1016/j.jogn.2017.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To summarize and evaluate the recently published literature in which the relationships among psychosocial stress, smoking, and exposure to secondhand smoke during the perinatal period are examined, and to describe the characteristics and demographics of the samples. DATA SOURCES Electronic databases MEDLINE, Academic Search Complete, CINAHL, Psychology and Behavioral Sciences Collection, and PsychINFO. In addition, hand searches of reference lists supplemented the electronic search. STUDY SELECTION English language, peer-reviewed studies published between 2010 and 2015 on the relationships of self-reported or perceived stress, smoking, and secondhand smoke exposure during pregnancy and postpartum were included. Twenty-four studies met the inclusion criteria. DATA EXTRACTION Data that specified the relationships among smoking, stress, and secondhand smoke exposure during pregnancy and postpartum were extracted from the studies. A table matrix, available as supplemental material, to summarize the literature and sample characteristics and demographics was created. DATA SYNTHESIS Evidence from the included studies supported an association between psychosocial stress specific to pregnancy or from other sources and smoking or smoking relapse during pregnancy or in the postpartum period. In the studies in which it was included, exposure to secondhand smoke was cited as a barrier to abstinence. CONCLUSION It is probable that women who persistently smoke in pregnancy experience elevated stress. Further research with longitudinal designs and inclusion of secondhand smoke as a variable are needed.
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Anticipated Negative Police-Youth Encounters and Depressive Symptoms among Pregnant African American Women: A Brief Report. J Urban Health 2017; 94:259-265. [PMID: 28283944 PMCID: PMC5391334 DOI: 10.1007/s11524-017-0136-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The widely publicized violent encounters between police and African American youth have unknown consequences for the emotional and mental health of pregnant African American women. Since studies document the hypervigilance black mothers exert to protect children from violence and racism and findings also reveal the association between racial and gendered stress (which includes parenting stressors) and depressive symptoms during pregnancy, an examination of the effects of stress from anticipated negative experiences between black youth and police on maternal mental health is warranted. Between July and August 2014, 100 mostly low income pregnant African American women who lived in metropolitan Atlanta and were in their first and second trimesters completed the Edinburgh postnatal depression scale, selected items from the Jackson, Hogue, Phillips contextualized stress measure, and a demographic form. Bivariate and logistic regression analyses were conducted in response to questions that asked: (1) is the anticipation of negative encounters between black youth and police associated with antenatal depressive symptoms and (2) how does the presence of prior children, male or female, contribute to the association? For question 1, the results showed that anticipated negative African American youth-police experiences were significantly associated with antenatal depressive symptoms χ 2 (2, N = 87) = 12.62, p = .002. For question 2, the presence of a preschool-aged male child in the home was significantly associated with antenatal depression (p = .009, odds ratio = 13.23). The observed associations between antenatal depressive symptoms and anticipated negative police-youth encounters have implications for clinical- and community-based interventions responding to the unique psychosocial risks for pregnant African American women.
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22
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Gilbert PA, Zemore SE. Discrimination and drinking: A systematic review of the evidence. Soc Sci Med 2016; 161:178-94. [PMID: 27315370 PMCID: PMC4921286 DOI: 10.1016/j.socscimed.2016.06.009] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 11/17/2022]
Abstract
Although it is widely accepted that discrimination is associated with heavy and hazardous drinking, particularly within stress and coping frameworks, there has been no comprehensive review of the evidence. In response, we conducted a systematic review of the English language peer-reviewed literature to summarize studies of discrimination and alcohol-related outcomes, broadly defined. Searching six online data bases, we identified 938 non-duplicative titles published between 1980 and 2015, of which 97 met all inclusion criteria for our review and reported quantitative tests of associations between discrimination and alcohol use. We extracted key study characteristics and assessed quality based on reported methodological details. Papers generally supported a positive association; however, the quantity and quality of evidence varied considerably. The largest number of studies was of racial/ethnic discrimination among African Americans in the United States, followed by sexual orientation and gender discrimination. Studies of racial/ethnic discrimination were notable for their frequent use of complex modeling (i.e., mediation, moderation) but focused nearly exclusively on interpersonal discrimination. In contrast, studies of sexual orientation discrimination (i.e., heterosexism, homophobia) examined both internalized and interpersonal aspects; however, the literature largely relied on global tests of association using cross-sectional data. Some populations (e.g., Native Americans, Asian and Pacific Islanders) and types of discrimination (e.g., systemic/structural racism; ageism) received scant attention. This review extends our knowledge of a key social determinant of health through alcohol use. We identified gaps in the evidence base and suggest directions for future research related to discrimination and alcohol misuse.
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Affiliation(s)
- Paul A Gilbert
- Department of Community and Behavioral Health, University of Iowa College of Public Health, 145N. Riverside Drive, N414 CPHB, Iowa City, IA 52242, USA; Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608-1010, USA.
| | - Sarah E Zemore
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608-1010, USA
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Castro Y, Heck K, Forster JL, Widome R, Cubbin C. Social and Environmental Factors Related to Smoking Cessation among Mothers: Findings from the Geographic Research on Wellbeing (GROW) Study. Am J Health Behav 2015; 39:809-22. [PMID: 26450549 DOI: 10.5993/ajhb.39.6.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The current study examined associations between race/ethnicity and psychosocial/environmental factors with current smoking status, and whether psychosocial/environmental factors accounted for racial differences in smoking status in a population-based sample of mothers in California. METHODS Cross-sectional data from 542 women with a history of smoking were used. Analyses adjusted for age, partner status, and educational attainment. RESULTS In models adjusted for sociodemographics, black women had significantly lower odds, and Latina immigrants had significantly higher odds of being a former smoker compared to white women. Persons smoking in the home, having a majority of friends who smoke, having perceptions of their neighborhood as being somewhat or very unsafe, and experiencing food insecurity were associated with decreased odds of being a former smoker. When these variables were entered into a single model, only being a Latina immigrant and having a majority of friends who smoke were significantly associated with smoking status. CONCLUSIONS Black women demonstrated a notable disparity compared with white women in smoking status, accounted for by psychosocial/environmental factors. Immigrant Latinas demonstrated notable success in ever quitting smoking. Social networks may be important barriers to smoking cessation among women.
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Affiliation(s)
- Yessenia Castro
- University of Texas at Austin, School of Social Work, Austin, TX, USA
| | - Katherine Heck
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, USA
| | - Jean L Forster
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Catherine Cubbin
- University of Texas at Austin, School of Social Work, Austin, TX, USA.
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Bennett IM, Schott W, Krutikova S, Behrman JR. Maternal mental health, and child growth and development, in four low-income and middle-income countries. J Epidemiol Community Health 2015; 70:168-73. [PMID: 26359503 DOI: 10.1136/jech-2014-205311] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 08/20/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Extend analyses of maternal mental health and infant growth in low- and middle-income countries (LMICs) to children through age eight years, and broaden analyses to cognitive and psychosocial outcomes. DESIGN Community-based longitudinal cohort study in four LMICs (Ethiopia, India, Peru and Vietnam). Surveys and anthropometric assessments were carried out when the children were approximately ages 1, 5 and 8 years. Risk of maternal common mental disorders (rCMDs) was assessed with the Self-Reporting Questionnaire (SRQ)-20 (score ≥8). SETTING Rural and urban as well as low- and middle-income communities. PARTICIPANTS 7722 mothers and their children. MAIN OUTCOME MEASURES Child stunting and underweight (Z score ≤2 of height and weight for age), and <20th centile for: cognitive development (Peabody Picture Vocabulary Test), and the psychosocial outcomes self pride and life satisfaction. RESULTS A high rate of rCMD, stunting and underweight was seen in the cohorts. After adjusting for confounders, significant associations were found between maternal rCMDs and growth variables in the first year of life, with persistence to age 8 years in India and Vietnam, but not in the other countries. India and Vietnam also showed significant associations between rCMDs and lower cognitive development. After adjustment, rCMD was associated with low life satisfaction in Ethiopia but not in the other cohorts. CONCLUSIONS Associations of maternal rCMD in the first year of life with child outcomes varied across the study cohorts and, in some cases, persisted across the first 8 years of life of the child, and included growth, cognitive development and psychosocial domains.
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Affiliation(s)
- Ian M Bennett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Whitney Schott
- The Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jere R Behrman
- The Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Acculturative stress negatively impacts maternal depressive symptoms in Mexican-American women during pregnancy. J Affect Disord 2015; 176:35-42. [PMID: 25699668 PMCID: PMC4721928 DOI: 10.1016/j.jad.2015.01.036] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 01/15/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mexican-American women exhibit high rates of prenatal maternal depressive symptoms relative to the general population. Though pregnant acculturated Mexican-American women experience cultural stressors such as acculturation, acculturative stress and discrimination that may contribute to elevated depressive symptoms, the contribution of these socio-cultural correlates to depressive symptomology is unknown. METHOD Ninety-eight pregnant women of Mexican descent were recruited from a community hospital clinic during their first trimester. Women completed surveys about acculturation, acculturative stress, perceived discrimination, general perceived stress, and maternal depressive symptoms as well as the potential protective factor of Mexican cultural values. RESULTS Women who experienced greater acculturative and perceived stress, but not perceived discrimination or acculturation, reported significantly elevated depressive symptoms during pregnancy. Also, women who experienced greater acculturative stress identified with a mixture of Mexican and American cultural values. However, only the Mexican cultural value of respect was protective against maternal depressive symptoms while adhering to the Anglo value of independence and self-reliance was a risk factor. LIMITATIONS A limitation in the study is the cross-sectional and descriptive self-report nature of the work, underscoring the need for additional research. Moreover, physiological measures of stress were not analyzed in the current study. CONCLUSIONS Results point to acculturative stress, above other cultural stressors, as a potential intervention target in culturally competent obstetric care. These findings have implications for maternal mental health treatment during pregnancy, which likely affects maternal-fetal programming and may favorably affect perinatal outcomes in the vulnerable Mexican-American population.
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Webb DA, Mathew L, Culhane JF. Lessons learned from the Philadelphia Collaborative Preterm Prevention Project: the prevalence of risk factors and program participation rates among women in the intervention group. BMC Pregnancy Childbirth 2014; 14:368. [PMID: 25361563 PMCID: PMC4230507 DOI: 10.1186/s12884-014-0368-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 10/15/2014] [Indexed: 11/21/2022] Open
Abstract
Background Women who deliver preterm infants are at a much greater risk for repeating a preterm birth (PTB), compared to women without a history of PTB. However, little is known about the prevalence of the risk factors which account for this markedly increased risk. Moreover, little or nothing is known about the feasibility of providing treatments and services to these women, outside of the context of prenatal care, during the inter-conception period, which provides the best opportunity for successful risk-reduction interventions. Methods The Philadelphia Collaborative Preterm Prevention Project (PCPPP), a large randomized control trial designed to identify and reduce six major risk factors for a repeat preterm birth among women immediately following the delivering of a preterm infant. For the women assigned to the PCPPP treatment group, we calculated the prevalence of the six risk factors in question, the percentages of women who agreed to receive high quality risk-appropriate treatments or services, and the of rates of participation among those who were offered and eligible for these treatments or services. Results Urogenital tract infections were identified in 57% of the women, while 59% were found to have periodontal disease. More than 39% were active smokers, and 17% were assessed with clinical depression. Low literacy, and housing instability were identified in, 22 and 83% of the study sample, respectively. Among women eligible for intervention, the percentages who accepted and at least minimally participated in treatment ranged from a low of 28% for smoking, to a high of 85% for urogenital tract infection. Most PCPPP enrollees (57%) had three or more major risk factors. Participation rates associated with the PCPPP treatments or services varied markedly, and were quite low in some cases, despite considerable efforts to reduce the barriers to receiving care. Conclusion The efficacy of individual level risk-reduction efforts designed to prevent preterm/repeat preterm in the pre- or inter-conception period may be limited if participation rates associated with interventions to reduce major risk factors for PTB are low. Achieving adequate participation may require identifying, better understanding, and eliminating barriers to access, beyond those associated with cost, transportation, childcare, and service location or hours of operation. Trial registration ClinicalTrials.gov (NCT01117922)
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Affiliation(s)
- David A Webb
- Children's Hospital of Philadelphia, National Children's Study Center, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - Leny Mathew
- Children's Hospital of Philadelphia, National Children's Study Center, 3535 Market Street, Philadelphia, PA, 19104, USA.
| | - Jennifer F Culhane
- Department of Pediatrics, University of Pennsylvania School of Medicine, and Department of Adolescent Medicine, Children's Hospital of Philadelphia, 3535 Market Street, Philadelphia, PA, 19104, USA.
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Nakhaie R, Wijesingha R. Discrimination and Health of Male and Female Canadian Immigrant. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2014. [DOI: 10.1007/s12134-014-0392-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dutra LM, Williams DR, Kawachi I, Okechukwu CA. Racial and non-racial discrimination and smoking status among South African adults 10 years after apartheid. Tob Control 2014; 23:e114-21. [PMID: 24789604 DOI: 10.1136/tobaccocontrol-2013-051478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite a long history of discrimination and persisting racial disparities in smoking prevalence, little research exists on the relationship between discrimination and smoking in South Africa. METHODS This analysis examined chronic (day-to-day) and acute (lifetime) experiences of racial and non-racial (eg, age, gender or physical appearance) discrimination and smoking status among respondents to the South Africa Stress and Health study. Logistic regression models were constructed using SAS-Callable SUDAAN. RESULTS Both chronic racial discrimination (RR=1.45, 95% CI 1.14 to 1.85) and chronic non-racial discrimination (RR=1.69, 95% CI 1.37 to 2.08) predicted a higher risk of smoking, but neither type of acute discrimination did. Total (sum of racial and non-racial) chronic discrimination (RR=1.46, 95% CI 1.20 to 1.78) and total acute discrimination (RR=1.28, 95% CI 1.01 to 1.60) predicted a higher risk of current smoking. CONCLUSIONS Racial and non-racial discrimination may be related to South African adults' smoking behaviour, but this relationship likely varies by the timing and frequency of these experiences. Future research should use longitudinal data to identify the temporal ordering of the relationships studied, include areas outside of South Africa to increase generalisability and consider the implications of these findings for smoking cessation approaches in South Africa.
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Affiliation(s)
- Lauren M Dutra
- The Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Cassandra A Okechukwu
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
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Dearing RL, Hequembourg AL. Culturally (in)competent? Dismantling health care barriers for sexual minority women. SOCIAL WORK IN HEALTH CARE 2014; 53:739-761. [PMID: 25255338 DOI: 10.1080/00981389.2014.944250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Lesbian and bisexual (LB) women exhibit elevated rates of a variety of behaviors (i.e., smoking, excessive caloric intake, physical inactivity, heavy alcohol consumption) that put them at risk for adverse health consequences. Furthermore, LB women experience numerous barriers to obtaining culturally competent health care. In this article we review risk behaviors and health care barriers and we discuss the role of stress as an important contributing factor in LB women's health outcomes. We suggest future research, health care delivery changes, and training improvements that will prepare social workers to effectively address the needs of their LB clients.
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Affiliation(s)
- Ronda L Dearing
- a Research Institute on Addictions, University at Buffalo, The State University of New York , Buffalo , New York , USA
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Abstract
Starting in the late 1980s and throughout the 1990s, reports appeared in the literature describing the poor health status and poor health outcomes experienced by minority populations, especially blacks, in the United States. Additionally, attention was brought to the limited access to health services for minority populations. These reports prompted Congress to request the Institute of Medicine (IOM) to conduct a study to assess differences in the kinds and quality of healthcare received by US racial and ethnic minorities and nonminorities. The study culminated in the report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.(1) Among the recommendations included in the report published in 2003 is a need for (1) change in legal, regulatory, and policy interventions and (2) health systems interventions. The committee extended the recommendations to include (3) implementation of programs to enhance individual education and empowerment, (4) a need for research into identifying racial and ethnic disparities and the development of and assessment of intervention strategies, and (5) a need to integrate cross-cultural education into the training of all health professionals.(1) Subsequent to this report, there has been an increase in efforts to increase diversity among healthcare providers and research investigators.(2) The American Association of Medical Colleges (AAMC) continues to encourage recruitment of minorities to careers in medicine, to stress the importance of a diverse medical school faculty and administration, and to graduate culturally competent healthcare providers who will decrease health disparities and improve health equity. Additionally, as noted by Ginther et al in 2011, there continues to be a need to increase diversity at the National Institutes of Health (NIH) not only among the workforce but also among the recipients of awards.(3) To this end, the NIH has established the Working Group on Diversity in the Biomedical Research Workforce to monitor the efforts of the NIH to increase diversity and to suggest remedies.(4.)
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Affiliation(s)
- Gloria E Sarto
- Center for Women's Health and Health Disparities Research, Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, United States
| | - Julia Brasileiro
- Center for Women's Health and Health Disparities Research, Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, United States
| | - Doris J Franklin
- Center for Women's Health and Health Disparities Research, Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, United States
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Ertel KA, James-Todd T, Kleinman K, Krieger N, Gillman M, Wright R, Rich-Edwards J. Racial discrimination, response to unfair treatment, and depressive symptoms among pregnant black and African American women in the United States. Ann Epidemiol 2012; 22:840-6. [PMID: 23123506 DOI: 10.1016/j.annepidem.2012.10.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 09/28/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess the association between self-reported racial discrimination and prenatal depressive symptoms among black women. METHODS Our study population consisted of two cohorts of pregnant women: the Asthma Coalition on Community, Environment, and Social Stress project (ACCESS) and Project Viva. We measured self-reported racial discrimination among black women using a modified Experiences of Discrimination scale (score 0-8). We assessed elevated depressive symptoms (EDS) with the Edinburgh Postnatal Depression Scale (≥13 on a 0-30 scale). RESULTS Fifty-four percent of ACCESS and 78% of Viva participants reported experiencing racial discrimination. After adjusting for age, marital status, income, education, and nativity, a 1-U increment in Experiences of Discrimination score was associated with 48% increased odds of EDS (odds ratio, 1.48; 95% confidence interval, 1.24-1.76) for ACCESS participants but was not significantly associated among Viva participants (odds ratio, 1.12; 95% confidence interval, 0.92-1.37). In both cohorts, responding to unfair treatment by talking to others was associated with the lowest odds of EDS. CONCLUSIONS Our findings suggest that higher levels of perceived racial discrimination may increase depressive symptoms during pregnancy among U.S. black women. Interventions involving talking to others may aid in reducing the risk of depressive symptoms among black women experiencing higher levels of racial discrimination.
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Affiliation(s)
- Karen A Ertel
- Division of Biostatistics and Epidemiology, Department of Public Health, University of Massachusetts Amherst, Amherst, MA, USA.
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Yelland JS, Sutherland GA, Brown SJ. Women's experience of discrimination in Australian perinatal care: the double disadvantage of social adversity and unequal care. Birth 2012; 39:211-20. [PMID: 23281903 DOI: 10.1111/j.1523-536x.2012.00550.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Discrimination in women's health care, particularly perinatal care, has received minimal attention. The aim of this study is to describe women's experience of discrimination in different models of maternity care and to examine the relationship between maternal social characteristics and perceived discrimination in perinatal care. METHODS A population-based postal survey was mailed 6 months postpartum to all women who gave birth in two Australian states in September and October 2007. Perceived discrimination was assessed using a five-item measure designed to elicit information about experiences of unequal treatment by health professionals. RESULTS A total of 4,366 eligible women completed the survey. Women attending public models of maternity care were significantly more likely to report perceived discrimination compared with women attending a private obstetrician (30.7% vs 19.7%, OR 1.79, 95% CI 1.5-2.1). Compared with women reporting no stressful life events or social health issues in pregnancy, those reporting three or more stressful life events or social health issues had a twofold increase in adjusted odds of perceived discrimination (41.1% vs 20.4%, adj OR 2.27, 95% CI 1.8-2.8). Young women (< 25 yr) and women who were smoking in pregnancy were also at increased risk of experiencing perceived discrimination. CONCLUSIONS Discrimination is an unexplored factor in how women experience perinatal care. Developing approaches to perinatal care that incorporate the capacity to respond to the needs of vulnerable women and families requires far-reaching changes to the organization and provision of care.
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Lee H, Turney K. Investigating the Relationship between Perceived Discrimination, Social Status, and Mental Health. SOCIETY AND MENTAL HEALTH 2012; 2:1-20. [PMID: 22900235 PMCID: PMC3418139 DOI: 10.1177/2156869311433067] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A growing body of evidence suggests that experiences with discrimination have implications for mental health and that these associations may vary by social status. We use data from the Chicago Community Adult Health Study (CCAHS) to examine how two types of perceived discrimination, chronic everyday discrimination and major lifetime discrimination, are linked to mental health, and how this association varies by race/ethnicity, gender, and socioeconomic status. Results indicate that everyday discrimination is generally independently linked to greater depressive symptoms, loneliness, and hostility across all social status groups. Major discrimination is not associated with depressive symptoms or loneliness after adjusting for a host of covariates, but is associated with hostility, especially for certain groups. These findings highlight the need to examine multiple indicators of discrimination and mental health, and to pay attention to both differences and similarities in these associations by social status.
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Affiliation(s)
- Hedwig Lee
- Department of Sociology, University of Washington
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Krieger N, Waterman PD, Kosheleva A, Chen JT, Carney DR, Smith KW, Bennett GG, Williams DR, Freeman E, Russell B, Thornhill G, Mikolowsky K, Rifkin R, Samuel L. Exposing racial discrimination: implicit & explicit measures--the My Body, My Story study of 1005 US-born black & white community health center members. PLoS One 2011; 6:e27636. [PMID: 22125618 PMCID: PMC3220691 DOI: 10.1371/journal.pone.0027636] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 10/20/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To date, research on racial discrimination and health typically has employed explicit self-report measures, despite their potentially being affected by what people are able and willing to say. We accordingly employed an Implicit Association Test (IAT) for racial discrimination, first developed and used in two recent published studies, and measured associations of the explicit and implicit discrimination measures with each other, socioeconomic and psychosocial variables, and smoking. METHODOLOGY/PRINCIPAL FINDINGS Among the 504 black and 501 white US-born participants, age 35-64, randomly recruited in 2008-2010 from 4 community health centers in Boston, MA, black participants were over 1.5 times more likely (p<0.05) to be worse off economically (e.g., for poverty and low education) and have higher social desirability scores (43.8 vs. 28.2); their explicit discrimination exposure was also 2.5 to 3.7 times higher (p<0.05) depending on the measure used, with over 60% reporting exposure in 3 or more domains and within the last year. Higher IAT scores for target vs. perpetrator of discrimination occurred for the black versus white participants: for "black person vs. white person": 0.26 vs. 0.13; and for "me vs. them": 0.24 vs. 0.19. In both groups, only low non-significant correlations existed between the implicit and explicit discrimination measures; social desirability was significantly associated with the explicit but not implicit measures. Although neither the explicit nor implicit discrimination measures were associated with odds of being a current smoker, the excess risk for black participants (controlling for age and gender) rose in models that also controlled for the racial discrimination and psychosocial variables; additional control for socioeconomic position sharply reduced and rendered the association null. CONCLUSIONS Implicit and explicit measures of racial discrimination are not equivalent and both warrant use in research on racial discrimination and health, along with data on socioeconomic position and social desirability.
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Affiliation(s)
- Nancy Krieger
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, United States of America.
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Peek ME, Nunez-Smith M, Drum M, Lewis TT. Adapting the everyday discrimination scale to medical settings: reliability and validity testing in a sample of African American patients. Ethn Dis 2011; 21:502-9. [PMID: 22428358 PMCID: PMC3350778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Despite evidence that discrimination within the health care system may play an important role in perpetuating health disparities, instruments designed to measure discrimination within the health care setting have not been adequately tested or validated. Consequently, we sought to test the psychometric properties of a modified version of the Everyday Discrimination scale, adapted for medical settings. DESIGN Cross-sectional study. SETTING Academic medical center in Chicago. PARTICIPANTS Seventy-four African American patients. OUTCOME MEASURES We measured factor analysis, internal consistency, test-retest reliability, convergent validity and discriminant validity. RESULTS Seventy-four participants completed the baseline interviews and 66 participants (89%) completed the follow-up interviews. Eighty percent were women. The Discrimination in Medical Settings (DMS) Scale had a single factor solution (eigenvalue of 4.36), a Cronbach's alpha of 0.89 and test-retest reliability of .58 (P<.0001). The DMS was significantly correlated with an overall measure of societal discrimination (EOD) (r=.51, P<.001) as well as two of its three subscales (unfair: r=-.04, P=.76; discrimination: r=.45, P<0.001; worry: r=-.36, P=.002). The DMS was associated with the overall African American Trust in Health Care Scale (r=.27, P=.02) as well as two key subscales (racism: r=.31, P<.001; disrespect: r=.44, P<.001). The DMS scale was inversely associated with the Social Desirability Scale (r=.18, P=.13). The DMS scale was not correlated with the Center for Epidemiologic Studies Depression Scale (r=.03, P=.80). CONCLUSIONS The Discrimination in Medical Settings Scale has excellent internal consistency, test-retest reliability, convergent validity and discriminant validity among our sample of African American patients. Further testing is warranted among other racial/ethnic groups.
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Affiliation(s)
- Monica E Peek
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
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