Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease: Development of a Situation-Specific Theory for African American Emerging Adults

BACKGROUND

Emerging adulthood (18-25 years old) is a distinct developmental period in which multiple life transitions pose barriers to engaging in healthy lifestyle behaviors that reduce cardiovascular disease risk. There is limited theory-based research on African American emerging adults.

OBJECTIVE

This article introduces a synthesized empirically testable situation-specific theory for cardiovascular disease prevention in African American emerging adults.

METHODOLOGY

Im and Meleis' integrative approach was used to develop the situation-specific theory.

RESULTS

Unlocking Population-Specific Treatments to Render Equitable Approach and Management in Cardiovascular Disease is a situation-specific theory developed based on theoretical and empirical evidence and theorists' research and clinical practice experiences.

DISCUSSION

African American emerging adults have multifaceted factors that influence health behaviors and healthcare needs. Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease has the potential to inform theory-guided clinical practice and nursing research. Recommendations for integration in nursing practice, research, and policy advocacy are presented. Further critique and testing of the theory are required.

It’s More Than Skin-Deep: Gendered Racial Microaggressions, Skin Tone Satisfaction, and Traumatic Stress Symptoms Among Black Women

This study examined the moderating effects of skin tone and skin tone satisfaction on the relations between gendered racial microaggressions and traumatic stress symptoms ( N = 237) among self-identified Black women between 18 and 50 years old. It was hypothesized that skin tone and skin tone satisfaction would moderate the relation between gendered racial microaggressions and traumatic stress, such that having a darker skin tone and lower levels of skin tone satisfaction would exacerbate the association between gendered racial microaggressions and traumatic stress symptoms. Results from two hierarchical multiple linear regression analyses indicated skin tone satisfaction significantly moderated the association between gendered racial microaggressions and traumatic stress symptoms, whereas skin tone did not. Findings suggest that skin tone satisfaction may play a bigger role in buffering or exacerbating the link between gendered racial microaggressions and mental health among Black women than skin tone alone. The results can inform future research and clinical practice on the important role of skin tone satisfaction in the link between gendered racial microaggressions and traumatic stress among Black women.

A tale of two generations: Maternal skin color and adverse birth outcomes in Black/African American women

We examined how sociopolitical context (marked by generational cohort) and maternal skin color interacted to influence preterm delivery (PTD) rates in sample of Black women. Data were from 1410 Black women, ages 18-45 years, residing in Metropolitan Detroit, MI enrolled (2009-2011) in the Life-course Influences on Fetal Environments (LIFE) Study. Because we hypothesized that generational differences marked by changes in the sociopolitical context would influence exposure to racism, we categorized women into two cohorts by maternal birth year: a) Generation X, 1964-1983 and b) Millennial, 1984-1993. Descriptive results showed similar PTD rates by generational cohort, Generation X: 16.3% vs. Millennials: 16.1%. Yet, within each generation, PTD rates varied by women's skin tone (categorized: light, medium, and dark brown). Poisson regression models confirmed a significant interaction between generational cohort and maternal skin tone predicting PTD (P = 0.001); suggesting a salubrious association between light brown skin tone (compared to medium and dark) and PTD for Generation X. However, Millennials with medium and dark brown skin experienced lower PTD rates than their light Millennial counterparts. Research should consider sociopolitical context and the salience of skin tone bias when investigating racial health disparities, including those in perinatal health.

The role of feature-based discrimination in driving health disparities among Black Americans

Objective: A growing body of research finds that darker skin tone is often associated with poorer physical and mental health in Blacks. However, the psychosocial mechanisms underlying the skin tone-health link remain elusive. The present study seeks to address this knowledge gap by investigating the direct and indirect (through perceived discrimination, socioeconomic status, and self-esteem) effects of skin tone on self-reported physical and mental health.Design: An urban sample of 130 Blacks aged 35 and above completed a self-administered computerized survey as a part of larger cross-sectional study.Results: Self-esteem played a particularly important role in mediating the associations between skin tone and self-reported physical and mental health. This suggests that self-esteem could be a point of intervention to help Blacks with darker skin tone achieve better health.Conclusion: The present study highlights the important role feature-based discrimination plays in determining mental and physical health outcomes among Blacks.

Skin-Tone Trauma: Historical and Contemporary Influences on the Health and Interpersonal Outcomes of African Americans

Empirical evidence demonstrates that racism is a source of traumatic stress for racial/ethnic minorities, particularly African Americans. Like race and racism, skin tone and experiences of colorism—an often overlooked form of discrimination that privileges lighter skinned over darker skinned individuals, although not uniformly, may also result in traumatic stress. This article proposes a new conceptual model of skin-tone trauma. The model depicts how historical and contemporary underpinnings of colorism lead to colorist incidents that may directly and indirectly, by eliciting traumatic stress reactions, lead to negative effects on the health and interpersonal relationships of African Americans. Key tenets of critical race and intersectionality theories are used to highlight the complexities of skin-tone trauma as a result of intersectional identities on the basis of existing social hierarchies. Last, we present suggestions for researchers, as well as recommendations and strategies for practitioners, to unmask “skin-tone wounds” and promote healing for individuals, families, and communities that suffer from skin-tone trauma. Skin-tone trauma should be acknowledged by researchers, scholars, and practitioners to better understand and assess the widespread scope of trauma in the African American community.

BEYOND RACE/ETHNICITY: SKIN COLOR, GENDER, AND THE HEALTH OF YOUNG ADULTS IN THE UNITED STATES

Researchers typically identify health disparities using self-reported race/ethnicity, a measure identifying individuals' social and cultural affiliations. In this study, we use data from Waves 1, 3, and 4 of Add Health to examine health disparities by interviewer-ascribed skin color, a measure capturing the perceptions of race/ethnicity ascribed to individuals by others. Individuals with darker skin tones may face greater exposure to serious stressors such as perceived discrimination, poverty, and economic hardship which can accumulate over the lifecourse and increase the likelihood of poor health. We found significant gradients in Body Mass Index (BMI), obesity, self-reported health, and depressive symptoms by interviewer-ascribed skin color but results differed by gender. Associations of BMI, obesity, and fair/poor health among women were only partially mediated by discrimination, self-reported stress, or low socio-economic status and persisted after controlling for race/ethnicity. Among men, initial associations between skin color and both fair/poor health and depressive symptoms did not persist after controlling for race/ethnicity. This study demonstrates the value of considering stratification by skin color and gender in conjunction with race/ethnicity.

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

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

Beyond Race/Ethnicity: Skin Color and Cardiometabolic Health Among Blacks and Hispanics in the United States

We investigated whether darker interviewer-ascribed skin color is associated with worse cardiometabolic health among young adult Blacks and Hispanics in the United States. Our sample was comprised of 2,128 non-Hispanic Blacks and 1603 Hispanics aged 24-32, who were in high school in the United States in 1994. We used logistic and OLS regression to predict obesity, hypertension, diabetes, and cardiometabolic risk. We tested the interaction between Hispanic immigrant generation and ascribed skin color. Darker ascribed skin color predicted worse cardiometabolic health among both young adult Blacks and Hispanics. Among Hispanics, the associations were strongest among third and higher generation respondents. Our findings suggest that among US Blacks and Hispanics how individuals are perceived by others via their skin color is significantly associated with their health and well-being. Gradients in cardiometabolic health in young adulthood will likely contribute to gradients in cardiovascular disease and all-cause mortality later in life.

Coloration in different areas of facial skin is a cue to health: The role of cheek redness and periorbital luminance in health perception

Looking healthy is a desirable trait, and facial skin color is a predictor of perceived health. However, skin conditions that cause dissatisfaction with appearance are specific to particular facial areas. We investigated whether color variation in facial skin is related to perceived health. Study 1 defined three areas based on color differences between faces perceived as healthy or unhealthy: the forehead, periorbital areas, and the cheeks. Periorbital luminance and cheek redness predicted perceived health, as did global skin yellowness. In Study 2, increased luminance and redness caused faces to be perceived as healthier, but only when the increase was in the periorbital and cheek areas, respectively. Manipulating each area separately in Study 3 revealed cheek redness and periorbital luminance equally increased perceived health, with low periorbital luminance more negatively affecting perceptions. These findings show that color variation in facial skin is a cue for health perception in female faces.

Racial Classifications, Biomarkers, and the Challenges of Health Disparities Research in the African Diaspora

Current scholarly research, both sociologically and biologically based, continues to be inundated with notions of race operating as a biological construct and as a proxy for poor health outcomes. Medical research and practice have fostered an environment where diagnostics, treatment, and the creation and dissemination of drug regimens often are influenced by a patient's skin color and ethnicity. The emergence of biological markers in social science-based surveys has fueled recent health disparities research that is shaping the meaning, interpretation, and policy of the health of people of color. Using hypertension as an example, this paper focuses on ways in which biological markers are discussed within the realm of health in the African diaspora. Additionally, the paper discusses how the quantification of disease etiology devoid of social and historical contexts can be troubling to both the social science and medical fields. Finally, the paper identifies the ways in which black scholars can shape the conversation of health inequity in future research. The notion of "racial diseases"-that people of different races suffer from peculiar diseases and experience common diseases differently-is centuries old. It is tied to the original use of biology in inventing the political category of race. -Dorothy Roberts, Fatal Invention.