Assessing quality of care for African Americans with hypertension

Discrimination and Chronic Kidney Disease among Caribbean Blacks: The Effects of Immigration and Social Status

This study examined the association between discrimination and chronic kidney disease (CKD) among Caribbean blacks and how this association varies by marital status, educational attainment, and length of U.S. residency within the frameworks for the stress buffering hypothesis and stress process model. The analysis was based on the Caribbean black subsample of the National Survey of American Life (N = 1551). Logistic regression models were conducted to test the aims of this study. The findings indicate that the association between discrimination and CKD varied by length of U.S. residency, marital status, and education. Overall, the findings demonstrate the importance of considering immigration and sociodemographic context when investigating the relation between discrimination and CKD in immigrant populations.

Weight- and race-based bullying: health associations among urban adolescents

Stigma-based bullying is associated with negative mental and physical health outcomes. In a longitudinal study, surveys and physical assessments were conducted with mostly Black and Latino, socioeconomically disadvantaged, urban students. As hypothesized, greater weight- and race-based bullying each was significantly indirectly associated with increased blood pressure and body mass index, as well as decreased overall self-rated health across 2 years, through the mechanism of more negative emotional symptoms. Results support important avenues for future research on mechanisms and longitudinal associations of stigma-based bullying with health. Interventions are needed to reduce stigma-based bullying and buffer adolescents from adverse health effects.

The Role of Sensory Gating in the Racism/Blood Pressure Relationship

African Americans bear a disproportionate burden of hypertension with racism postulated as a unique stressor contributing to the noted disparities. Epidemiological studies have found differences in the prevalence of hypertension among African Americans based on the amount of perceived racism reported, and experimental studies have shown increased cardiovascular reactivity to racially-aversive stressors. A difference in individual response to racial stressors may create subgroups of African Americans at highest risk for hypertension and its complications. Although sensory gating is the brain’s capacity to selectively regulate its sensitivity to environmental sensory stimuli, scant research has been done regarding the role of sensory gating in the stress response, and no research has explored sensory gating with racial stressors. To address this gap, we examined whether P50 sensory gating was associated with cardiovascular and central nervous system responses to an experimentally-induced racial stressor among 15 African Americans. A paired-click paradigm was administered prior to the experimental condition, which involved exposure to a neutral and then a racially-aversive photo stimulus. Participants with weak gating showed a significant within-subjects decrease in alpha-band activity when viewing the racially aversive stimulus and had significantly decreased alpha activity when viewing the aversive stimuli compared to participants with strong gating. Increased cardiovascular reactivity occurred with the aversive stimulus, and gender differences were noted. A gating effect on cardiovascular reactivity could not be determined given the small sample size and the fact that few men qualified as having ‘good’ gating. Although subjects reported no conscious awareness of distress when viewing the racially-aversive stimulus, both cardiovascular and central nervous system reactions occurred, with the responses varying based on the level of sensory gating. These results suggest sensory gating as a potential physiologic factor that may influence the relationship between perceived racial stressors and health outcomes.

Trust, mistrust, racial identity and patient satisfaction in urban African American primary care patients of nurse practitioners

PURPOSE

To analyze relationships between cultural mistrust, medical mistrust, and racial identity and to predict patient satisfaction among African American adults who are cared for by primary-care nurse practitioners using Cox's Interaction Model of Client Health Behaviors.

DESIGN

A descriptive-correlational study was conducted with a convenience sample of 100 community-dwelling adults.

METHODS

Participants completed the Cultural Mistrust Inventory; Group Based Medical Mistrust Scale; Black Racial Identity Attitude Scale; Trust in Physician Scale; Michigan Academic Consortium Patient Satisfaction Questionnaire; and provided demographic and primary care data.

ANALYSIS

Correlations and stepwise multiple regression techniques were used to examine the study aims and correlational links between the theoretical constructs of client singularity, client-professional interaction, and outcome.

FINDINGS AND CONCLUSIONS

Cox's model indicated a complex view of African American patients' perspectives on nurse practitioners. Participants simultaneously held moderate cultural mistrust of European American providers and mistrust of the health care system, and high levels of trust and satisfaction with their nurse practitioners. One racial identity schema (conformity) and trust of nurse-practitioner (NP) providers explained 41% of variance in satisfaction.

CLINICAL RELEVANCE

An African American patient's own attitudes about racial identity and the client-professional relationship have a significant effect on satisfaction with primary care.

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.