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Robinson-Dooley V, Sterling E, Collard C, Williams J, Collette T. Introducing Healthy Together: A Monograph of African American Men, Chronic Disease, and Self-Management. SOCIAL WORK IN PUBLIC HEALTH 2024:1-17. [PMID: 39101808 DOI: 10.1080/19371918.2024.2387021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Previous research has outlined evident disparities in the prevalence of chronic conditions among African Americans compared to other groups, with low-income African American men disproportionately affected by almost every disorder. Self-management programs are useful tools for managing chronic disorders beyond the doctor's office. This monograph provides a detailed looking into the current state of the research on low-income African American men with chronic health conditions. An intersectional approach is used to provide a nuanced synthesis of relevant literature. The project outlines the need for programs designed to engage low-income African American men with skills, resources, and tools for managing chronic conditions. Authors argue that improvements to traditional self-management programs can be realized by emphasizing culture, including end-users in the creation of programs, and offering culturally tailored strategies to improve health. Thus, any targeted program must include culturally detailed information about nutrition, exercise, stress, mental health, and leveraging social support.
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Affiliation(s)
| | - Evelina Sterling
- Department of Sociology & Criminal Justice, Kennesaw State University, Kennesaw, Georgia, USA
| | - Carol Collard
- Department of Social Work & Human Services, Kennesaw State University, Kennesaw, Georgia, USA
| | - Jordan Williams
- Department of Social Work & Human Services, Kennesaw State University, Kennesaw, Georgia, USA
| | - Tyler Collette
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia, USA
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2
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Giner-Sorolla R, Montoya AK, Reifman A, Carpenter T, Lewis NA, Aberson CL, Bostyn DH, Conrique BG, Ng BW, Schoemann AM, Soderberg C. Power to Detect What? Considerations for Planning and Evaluating Sample Size. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2024; 28:276-301. [PMID: 38345247 PMCID: PMC11193916 DOI: 10.1177/10888683241228328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
ACADEMIC ABSTRACT In the wake of the replication crisis, social and personality psychologists have increased attention to power analysis and the adequacy of sample sizes. In this article, we analyze current controversies in this area, including choosing effect sizes, why and whether power analyses should be conducted on already-collected data, how to mitigate the negative effects of sample size criteria on specific kinds of research, and which power criterion to use. For novel research questions, we advocate that researchers base sample sizes on effects that are likely to be cost-effective for other people to implement (in applied settings) or to study (in basic research settings), given the limitations of interest-based minimums or field-wide effect sizes. We discuss two alternatives to power analysis, precision analysis and sequential analysis, and end with recommendations for improving the practices of researchers, reviewers, and journal editors in social-personality psychology. PUBLIC ABSTRACT Recently, social-personality psychology has been criticized for basing some of its conclusions on studies with low numbers of participants. As a result, power analysis, a mathematical way to ensure that a study has enough participants to reliably "detect" a given size of psychological effect, has become popular. This article describes power analysis and discusses some controversies about it, including how researchers should derive assumptions about effect size, and how the requirements of power analysis can be applied without harming research on hard-to-reach and marginalized communities. For novel research questions, we advocate that researchers base sample sizes on effects that are likely to be cost-effective for other people to implement (in applied settings) or to study (in basic research settings). We discuss two alternatives to power analysis, precision analysis and sequential analysis, and end with recommendations for improving the practices of researchers, reviewers, and journal editors in social-personality psychology.
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Affiliation(s)
| | | | | | | | - Neil A. Lewis
- Cornell University & Weill Cornell Medical College, Ithaca, NY, USA
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Goetz SMM, Lucas T, Granger DA. Salivary uric acid dynamics are associated with stress response hormones among African American in an urban sample. Psychoneuroendocrinology 2024; 168:107120. [PMID: 39002453 DOI: 10.1016/j.psyneuen.2024.107120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/20/2024] [Accepted: 06/27/2024] [Indexed: 07/15/2024]
Abstract
Acute physiological responses to psychosocial stressors are a potential pathway underlying racial disparities in stress-related illnesses. Uric acid (UA) is a potent antioxidant that has been linked to disparities in stress-related illnesses, and recent research has shown that UA is responsive to acute social stress. However, an examination of the relationships between the purinergic system and other commonly measured stress systems is lacking. Here, we measure and characterize associations of salivary uric acid (sUA) with markers of hypothalamic-pituitary-adrenal (HPA) axis activation, sympathetic-adreno-medullar (SAM) axis activation, and acute inflammation. A community sample of 103 African Americans (33 male, 70 female) completed the Trier Social Stress Test to induce social-evaluative threat. Passive drool collected before, during, and after the stressor task provided salivary reactivity measures of UA (sUA), cortisol, dehydroepiandrosterone sulfate (DHEAS), salivary alpha amylase (sAA - a surrogate marker of SAM activity) and C-reactive protein (sCRP). Multiple regressions revealed that total activation of cortisol, DHEAS, and sCRP were each positively associated with higher total activation of sUA. Additionally, DHEAS reactivity was positively associated with sUA reactivity. Relationships between HPA-axis markers and sUA were especially observed among younger and male participants. Overall, findings suggest potential coordination of stress systems with sUA in response to acute stress, which may further the contributions of biological stress processes to racial health disparities.
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Affiliation(s)
- Stefan M M Goetz
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI 48502, USA.
| | - Todd Lucas
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI 48502, USA.
| | - Douglas A Granger
- Department of Psychological Science, School of Social Ecology, University of California at Irvine, Irvine, CA 92697-1075, USA; Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, 4201 SBSG, Irvine, CA 92697-7085, USA; John Hopkins University School of Medicine, 615 North Wolfe St., Baltimore, MD 21205, USA.
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Wang Y, Zhang Y, Zhao Z, Jelsma E, Cham H, Wadsworth H, Yan J, Johnson S, Alegría M, Yip T. Multiple Discrimination and Substance Use Intention in Late Childhood: Findings From the Adolescent Brain Cognitive Development (ABCD) Study. J Adolesc Health 2024; 74:1217-1224. [PMID: 38483374 PMCID: PMC11102326 DOI: 10.1016/j.jadohealth.2024.01.028] [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: 05/15/2023] [Revised: 11/24/2023] [Accepted: 01/10/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The study aimed to investigate longitudinal, bidirectional associations between discrimination due to multiple reasons (race/ethnicity, sexual orientation, weight; termed multiple discrimination) and substance use (SU) intention in late childhood. These associations were compared across youth with no, single, and multiple (i.e., intersecting) marginalized identities based on race/ethnicity, sexual orientation, and overweight status. METHODS Data were drawn from a national sample of youth in the Adolescent Brain Cognitive Development study (N = 8,530; 9-12 years old). Youth reported both their experiences of multiple discrimination (the number of forms of discrimination youth experienced) and SU intention at one-year and two-year follow-ups. Theoretically relevant covariates were included. RESULTS Compared to non-marginalized youth (n = 2,689) and youth with single marginalized identities (n = 3,399), youth with intersecting marginalized identities (n = 2,442) reported the highest SU intention and multiple discrimination across waves. Only for this last group, multiple discrimination predicted stronger SU intention subsequently (β = 0.07, 95% confidence interval [0.02, 0.11]), whereas stronger SU intention predicted lower levels of multiple discrimination over time (β = -0.06, 95% confidence interval [-0.09, -0.02]). Sensitivity analyses yielded similar patterns with some nuances among subgroups of youth with varying intersecting marginalized identities. DISCUSSION Multiple discrimination predicted stronger SU intention over time in late childhood, particularly among youth with intersecting marginalized identities. Policies and practices should consider addressing multiple discrimination to reduce SU disparities among diverse youth.
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Affiliation(s)
- Yijie Wang
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan.
| | - Youchuan Zhang
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan
| | - Zhenqiang Zhao
- Psychology Department, Fordham University, Bronx, New York
| | - Elizabeth Jelsma
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan; Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas
| | - Heining Cham
- Psychology Department, Fordham University, Bronx, New York
| | - Hannah Wadsworth
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan
| | - Jinjin Yan
- Psychology Department, Fordham University, Bronx, New York
| | | | - Margarita Alegría
- the Desparities Research Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Tiffany Yip
- Psychology Department, Fordham University, Bronx, New York
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Wilson EJ, Primgaard AR, Hambrick EP, Marszalek JM, Berkley-Patton J, Nilsson JE, Bennett KK. Rumination mediates associations between microaggressions and sleep quality in Black Americans: the toll of racial microstressors. J Behav Med 2024; 47:515-530. [PMID: 38281260 PMCID: PMC11031310 DOI: 10.1007/s10865-023-00464-0] [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] [Received: 05/22/2023] [Accepted: 12/08/2023] [Indexed: 01/30/2024]
Abstract
Disparities in health outcomes between Black and White Americans are well-documented, including sleep quality, and disparities in sleep may lead to disparities in health over the life course. A meta-model indicates that cognitive processes may underly the connection between race and poor sleep quality, and ultimately, health disparities. That is, there are race-specific stressors that disproportionately affect Black Americans, which are associated with poor health through biological, cognitive, and behavioral mechanisms (e.g., sleep). Among these race-specific stressors is discrimination, which has been linked to poor sleep quality, and there is a body of literature connecting perseverative cognition (e.g., rumination and worry or vigilance) to poor sleep. Microaggressions, a more subtle but pervasive form of discrimination, are another race-specific stressor. Although less research has considered the connection of microaggressions to perseverative cognition, there are some studies linking microaggressions to health outcomes and sleep. Therefore, using a cross-sectional survey, we tested the following hypotheses: racism-related vigilance and rumination would mediate the relationship between discrimination and poor sleep as well as between microaggressions and poor sleep among Black Americans (N = 223; mean age = 35.77 years, 53.8% men, 86% employed, 66.8% with college degree or higher education). Results of seven parallel mediation models showed that neither rumination nor racism-related vigilance mediated a relationship between discrimination and poor sleep quality. However, rumination partially mediated relationships between the six microaggression sub-scales and poor sleep quality: there were significant indirect effects for Foreigner/Not Belonging (β = .13, SE = 0.03, 95% CI 0.08, 0.20), Criminality (β = .11, SE = 0.03, 95% CI 0.05, 0.17), Sexualization (β = .10, SE = 0.03, 95% CI 0.05, 0.17), Low-Achieving/Undesirable (β = .10, SE = 0.03, 95% CI 0.05, 0.15), Invisibility (β = .15, SE = 0.04, 95% CI 0.08, 0.23), and Environmental Invalidations (β = .15, SE = 0.04, 95% CI 0.08, 0.23). Overall, these findings indicate support for the meta-model, demonstrating a specific pathway from racial microstressors to poor sleep quality. Furthermore, these results suggest the importance of developing clinical and community approaches to address the impact of microaggressions on Black Americans' sleep quality.
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Affiliation(s)
- Elizabeth J Wilson
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA.
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Anahi R Primgaard
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Erin P Hambrick
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jacob M Marszalek
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jannette Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Johanna E Nilsson
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kymberley K Bennett
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
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Erving CL, McKinnon II, Van Dyke ME, Murden R, Udaipuria S, Vaccarino V, Moore RH, Booker B, Lewis TT. Superwoman Schema and self-rated health in black women: Is socioeconomic status a moderator? Soc Sci Med 2024; 340:116445. [PMID: 38043442 PMCID: PMC10959495 DOI: 10.1016/j.socscimed.2023.116445] [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] [Received: 11/02/2022] [Revised: 10/12/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The Superwoman Schema (SWS) construct elucidates Black women's socialization to be strong, suppress their emotions, resist vulnerability, succeed despite limited resources, and help others at their own expense. Drawing from intersectionality and social psychological research on self-schemas, this study examined the extent to which SWS was associated with Black women's self-rated health. We also investigated whether socioeconomic status (SES) moderated the association between SWS, its five dimensions, and self-rated health. METHODS Data were from the Mechanisms Underlying Stress and Emotions (MUSE) in African-American Women's Health Study, a cohort of African American self-identified women. SWS was assessed using Giscombé's 35-item Superwoman Schema Scale. Socioeconomic status was measured by household income and educational attainment. Ordered logistic regression models were used and statistical interactions were run to test for moderation (N = 408). RESULTS First, SWS dimension "obligation to help others" was associated with worse self-rated health (p < .05). Second, household income, but not education, moderated the association between SWS and self-rated health (p < .05): SWS overall was associated with worse self-rated health among higher income women but better self-rated health among lower income women. Third, income moderated the association between SWS dimension "obligation to present an image of strength" and self-rated health (p < .05): presenting strength was associated with better self-rated health for lower income women only. Fourth, moderation results revealed that SWS dimension "obligation to help others" was inversely associated with self-rated health particularly among higher income women. CONCLUSIONS Findings speak to the complex interplay between SES and SWS dimensions as they relate to Black women's perceived health.
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Affiliation(s)
- Christy L Erving
- The University of Texas at Austin, College of Liberal Arts, Department of Sociology, Population Research Center, USA.
| | - Izraelle I McKinnon
- Emory University, Rollins School of Public Health, Department of Epidemiology, USA
| | - Miriam E Van Dyke
- Emory University, Rollins School of Public Health, Department of Epidemiology, USA
| | - Raphiel Murden
- Emory University, Rollins School of Public Health, Biostatistics and Bioinformatics Department, USA
| | - Shivika Udaipuria
- Emory University, Rollins School of Public Health, Department of Epidemiology, USA
| | - Viola Vaccarino
- Emory University, Rollins School of Public Health, Department of Epidemiology, USA
| | - Reneé H Moore
- Drexel University, Dornsife School of Public Health, Department of Epidemiology and Biostatistics, USA
| | - Bianca Booker
- Emory University, Rollins School of Public Health, Department of Epidemiology, USA
| | - Tené T Lewis
- Emory University, Rollins School of Public Health, Department of Epidemiology, USA
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Lawrence JA, Kawachi I, White K, Bassett MT, Williams DR. Instrumental Variable Analysis of Racial Discrimination and Blood Pressure in a Sample of Young Adults. Am J Epidemiol 2023; 192:1971-1980. [PMID: 37401004 PMCID: PMC10691201 DOI: 10.1093/aje/kwad150] [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: 04/25/2022] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 07/05/2023] Open
Abstract
Racial inequities in blood pressure levels have been extensively documented. Experiences of racial discrimination could explain some of this disparity, although findings from previous studies have been inconsistent. To address limitations of prior literature, including measurement error, we implemented instrumental variable analysis to assess the relationship between racial discrimination in institutional settings and blood pressure. Using data from 3,876 Black and White adults with an average age of 32 years from examination 4 (1992-1993) of the Coronary Artery Risk Development in Young Adults Study, our primary analysis examined the relationship between self-reported experiences of racial discrimination in institutional settings and blood pressure using reflectance meter measurement of skin color as an instrument. Findings suggested that an increase in experiences of racial discrimination was associated with higher systolic and diastolic blood pressure (β = 2.23 mm Hg (95% confidence interval: 1.85, 2.61) and β = 1.31 (95% confidence interval: 1.00, 1.62), respectively). Our instrumental variable estimates suggest that experiences of racial discrimination within institutional settings contribute to racial inequities in elevated blood pressure and cardiovascular disease outcomes in a relatively young cohort of adults and may yield clinically relevant differences in cardiovascular health over the life course.
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Affiliation(s)
- Jourdyn A Lawrence
- Correspondence to Dr. Jourdyn A. Lawrence, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 5th Floor, 3215 Market Street, Philadelphia, PA 19104 (e-mail: )
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Doherty EA, Cartmell K, Griffin S, Heo M, Chen L, Britt JL, Crockett AH. Discrimination and Adverse Perinatal Health Outcomes: A Latent Class Analysis. Prev Chronic Dis 2023; 20:E96. [PMID: 37917614 PMCID: PMC10625434 DOI: 10.5888/pcd20.230094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION An intersectionality framework recognizes individuals as simultaneously inhabiting multiple intersecting social identities embedded within systems of disadvantage and privilege. Previous research links perceived discrimination with worsened health outcomes yet is limited by a focus on racial discrimination in isolation. We applied an intersectional approach to the study of discrimination to examine the association with adverse perinatal health outcomes. METHODS We analyzed data from a cohort of 2,286 pregnant participants (Black, n = 933; Hispanic, n = 471; White, n = 853; and Other, n = 29) from the Centering and Racial Disparities trial. Perceived discrimination was assessed via the Everyday Discrimination Scale (EDS) and perinatal health outcomes collected via electronic medical record review. Latent class analysis was used to identify subgroups of discrimination based on EDS item response and the rate of adverse perinatal health outcomes compared between subgroups using a Bolck, Croon and Hagenaars 3-step approach. RESULTS Four discrimination subgroups were identified: no discrimination, general discrimination, discrimination attributed to one or several social identities, and discrimination attributed to most or all social identities. Experiencing general discrimination was associated with postpartum depression symptoms when compared with experiencing no discrimination among Black (9% vs 5%, P = .04) and White participants (18% vs 9%, P = .01). White participants experiencing general discrimination gave birth to low birthweight infants at a higher rate than those experiencing no discrimination (11% vs 6%, P = .04). No significant subgroup differences were observed among Hispanic participants. CONCLUSION Perceived discrimination may play an influential role in shaping perinatal health. More research applying an intersectional lens to the study of discrimination and perinatal health outcomes is needed.
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Affiliation(s)
- Emily A Doherty
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
- Center of Rural Health, Oklahoma State University Center for Health Sciences, Department of Public Health Sciences, 1111 W 17th St, Tulsa, OK 74107
| | - Kathleen Cartmell
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
| | - Sarah Griffin
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
| | - Moonseong Heo
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Jessica L Britt
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health, Greenville, South Carolina
| | - Amy H Crockett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Prisma Health, Greenville, South Carolina
- University of South Carolina School of Medicine, Greenville, South Carolina
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Gaston SA, Forde AT, Green M, Sandler DP, Jackson CL. Racial and Ethnic Discrimination and Hypertension by Educational Attainment Among a Cohort of US Women. JAMA Netw Open 2023; 6:e2344707. [PMID: 37991758 PMCID: PMC10665977 DOI: 10.1001/jamanetworkopen.2023.44707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/30/2023] [Indexed: 11/23/2023] Open
Abstract
Importance Although understudied, there are likely within-group differences among minoritized racial and ethnic groups in associations between racial and ethnic discrimination (RED) and hypertension risk, as minoritized individuals with higher educational attainment may more frequently encounter stress-inducing environments (eg, professional workplace settings, higher-income stores and neighborhoods) characterized by, for instance, exclusion and antagonism. Objectives To investigate educational attainment as a potential effect modifier of associations between RED and hypertension risk among US women; the study hypothesis was that the magnitude of associations would be stronger among participants with higher vs lower educational attainment. Design, Setting, and Participants This is a nested case-control study using Sister Study data collected at enrollment (2003-2009) and over follow-up visits until September 2019. Among eligible US Black or African American (hereafter Black), Latina, and non-Hispanic White women without prior hypertension diagnoses, incidence density sampling was performed to select self-reported hypertension cases that developed over a mean (SD) follow-up 11 (3) years. Data were analyzed August 2022 to February 2023. Exposures Participants reported lifetime everyday (eg, unfair treatment at a business) and major (eg, mistreatment by police) RED via a self-administered questionnaire. Main Outcome and Measures Adjusting for sociodemographic characteristics, conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs for associations between RED and hypertension by educational attainment category at baseline (college or higher, some college, and high school or less) within racial and ethnic groups. Results Among 5179 cases (338 [6.5%] Black; 200 [3.9%] Latina; and 4641 [89.6%] non-Hispanic White) and 10:1 race and ethnicity- and age-matched control participants with a mean (SD) age of 55 (9) years at enrollment, half (49.9%) of women reported attaining college or higher education, and Black women with college or greater education had the highest burden of RED (eg, 83% of case participants with college or higher education reported everyday RED compared with 64% of case participants with high school or less education). Everyday RED was associated with higher hypertension risk among Black women with college or higher education (OR, 1.56 [95% CI, 1.06-2.29]) but not among Black women with some college (OR, 0.72 [95% CI, 0.47-1.11]), with evidence of both multiplicative and additive interaction. Results for Black women with high school or less education suggested increased risk, but confidence intervals were wide, and the result was not statistically significant but may be clinically significant (OR, 1.89 [95% CI, 0.83-4.31]). Educational attainment was not a modifier among other racial and ethnic groups or for associations with major RED. Conclusions and Relevance In this nested case-control study of RED and hypertension risk, chronic or everyday RED-associated hypertension disproportionately affected Black women with the highest levels of educational attainment.
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Affiliation(s)
- Symielle A. Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Allana T. Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Michael Green
- Population Health Sciences Department, Duke University School of Medicine, Durham, North Carolina
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
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Parenteau AM, Boyer CJ, Campos LJ, Carranza AF, Deer LK, Hartman DT, Bidwell JT, Hostinar CE. A review of mental health disparities during COVID-19: Evidence, mechanisms, and policy recommendations for promoting societal resilience. Dev Psychopathol 2023; 35:1821-1842. [PMID: 36097815 PMCID: PMC10008755 DOI: 10.1017/s0954579422000499] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Social and economic inequality are chronic stressors that continually erode the mental and physical health of marginalized groups, undermining overall societal resilience. In this comprehensive review, we synthesize evidence of greater increases in mental health symptoms during the COVID-19 pandemic among socially or economically marginalized groups in the United States, including (a) people who are low income or experiencing homelessness, (b) racial and ethnic minorities, (c) women and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) communities, (d) immigrants and migrants, (e) children and people with a history of childhood adversity, and (f) the socially isolated and lonely. Based on this evidence, we propose that reducing social and economic inequality would promote population mental health and societal resilience to future crises. Specifically, we propose concrete, actionable recommendations for policy, intervention, and practice that would bolster five "pillars" of societal resilience: (1) economic safety and equity, (2) accessible healthcare, including mental health services, (3) combating racial injustice and promoting respect for diversity, equity, and inclusion, (4) child and family protection services, and (5) social cohesion. Although the recent pandemic exposed and accentuated steep inequalities within our society, efforts to rebuild offer the opportunity to re-envision societal resilience and policy to reduce multiple forms of inequality for our collective benefit.
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Affiliation(s)
- Anna M. Parenteau
- Psychology Department, University of California-Davis
- Center for Poverty and Inequality Research, University of California-Davis
| | - Chase J. Boyer
- Department of Human Ecology, University of California-Davis
| | | | | | - LillyBelle K. Deer
- Psychology Department, University of California-Davis
- Center for Poverty and Inequality Research, University of California-Davis
| | | | - Julie T. Bidwell
- Betty Irene Moore School of Nursing, University of California-Davis
| | - Camelia E. Hostinar
- Psychology Department, University of California-Davis
- Center for Poverty and Inequality Research, University of California-Davis
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Scott LE, Varner F. Who, what, and where? How racial composition and gender influence the association between racial discrimination and racial socialization messages. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2023; 29:447-458. [PMID: 37384443 PMCID: PMC10543602 DOI: 10.1037/cdp0000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVES This study investigated the moderating roles of contextual racial composition (neighborhood, school, and job) and parent-adolescent gender dyads on the relation between familial racial discrimination experiences and parental racial socialization messages. METHOD The analytic sample included 565 Black parents (Mage = 44.7; 56% mothers, 44% fathers) who reported on their personal and adolescents' racial discrimination experiences and their communication of cultural socialization and preparation for bias messages. RESULTS Regression analyses in a structural equation modeling framework (path analyses) revealed that parents who personally experienced more racial discrimination or were in workplaces with more Black people communicated higher cultural socialization messages. They communicated high preparation for bias messages when reporting personal and adolescent racial discrimination. Racial discrimination experiences were positively related to preparation for bias messages among parents who worked in jobs with fewer Black people but were unrelated among parents working with more Black people. Multiple-group analyses indicated no gender differences in these associations. CONCLUSIONS The findings demonstrate that Black parents vary in their racial socialization messages based on their family's contexts and experiences. The findings highlight the importance of parents' work contexts for adolescent development and family processes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Lorraine E Scott
- Department of Human Development and Family Sciences, University of Texas at Austin
| | - Fatima Varner
- Department of Human Development and Family Sciences, University of Texas at Austin
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12
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Cintron DW, Matthay EC, McCoach DB. Testing for intersectional measurement invariance with the alignment method: Evaluation of the 8-item patient health questionnaire. Health Serv Res 2023. [PMID: 37290788 DOI: 10.1111/1475-6773.14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To demonstrate the use of the alignment method to evaluate whether surveys function similarly (i.e., have evidence of measurement invariance) across culturally diverse intersectional groups. Intersectionality theory recognizes the interconnected nature of social categories such as race, gender, ethnicity, and socioeconomic status. DATA SOURCES A total of 30,215 American adult's responses to the eight-item Patient Health Questionnaire depression assessment scale (PHQ-8) from the 2019 National Health Interview Survey (NHIS). STUDY DESIGN Using the alignment method, we examined the measurement invariance (equivalence) of the PHQ-8 depression assessment scale across 16 intersectional subgroups defined at the intersection of age (under 52, 52 and older), gender (male, female), race (Black, non-Black), and education (no bachelor's degree, bachelor's degree). PRINCIPAL FINDINGS Overall, 24% of the factor loadings and 5% of the item intercepts showed evidence of differential functioning across one or more of the intersectional groups. These levels fall beneath the benchmark of 25% suggested for determining measurement invariance with the alignment method. CONCLUSIONS The results of the alignment study suggest that the PHQ-8 functions similarly across the intersectional groups examined, despite some evidence of different factor loadings and item intercepts in some groups (i.e., noninvariance). By examining measurement invariance through an intersectional lens, researchers can investigate how a person's multiple identities and social positions possibly contribute to their response behavior on an assessment scale.
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Affiliation(s)
- Dakota W Cintron
- Center for Integrative Developmental Science, Cornell University, Ithaca, New York, USA
- Department of Psychology, Cornell University, Ithaca, New York, USA
| | - Ellicott C Matthay
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - D Betsy McCoach
- Department of Educational Psychology, University of Connecticut, Storrs, Connecticut, USA
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13
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Brown A, Wilson DK, Sweeney AM, van Horn ML, Zarrett N, Pate RR. Buffering effects of protective factors on light and moderate-to-vigorous physical activity among african american women. J Behav Med 2023; 46:405-416. [PMID: 36260160 PMCID: PMC10113398 DOI: 10.1007/s10865-022-00360-z] [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] [Received: 01/23/2022] [Accepted: 08/22/2022] [Indexed: 10/24/2022]
Abstract
Physical activity (PA) plays an integral role in reducing risk for the leading causes of death and has also been shown to buffer stress. Based on the stress-buffering hypothesis, the present study examined whether protective factors (self-efficacy and informal social control) buffered the effects of perceived stress on PA over time. Secondary data analyses of female African American caregivers (N = 143) were conducted using data from the Families Improving Together (FIT) trial. Validated measures of stressors and protective factors were assessed at baseline. Light PA and moderate-to-vigorous PA were assessed using seven-day accelerometry estimates over sixteen weeks. Multilevel growth modeling was used to assess whether protective factors moderated the effects of perceived stress on PA outcomes across 16 weeks. There was a significant two-way interaction between informal social control and time (B = 0.40, SE = 0.17, p = .019) such that higher informal social control was positively associated with MVPA over time. There was a marginal three-way interaction (B = -18.90, SE = 10.31, p = .067) such that stress was associated with greater LPA at baseline under conditions of high but not low self-efficacy. This study provides preliminary support that social factors may be important for maintaining MVPA regardless of stress levels, while cognitive resources may be more important to target for influencing LPA engagement under conditions of high stress.
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Affiliation(s)
- Asia Brown
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | | | - M Lee van Horn
- Department of Educational Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Nicole Zarrett
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Russell R Pate
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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14
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Sweeney AM, Wilson DK, Zarrett N, Martin P, Hardin JW, Fairchild A, Mitchell S, Decker L. An overview of the Together Everyone Achieves More Physical Activity (TEAM-PA) trial to increase physical activity among African American women. Contemp Clin Trials 2023; 129:107207. [PMID: 37116644 PMCID: PMC10225344 DOI: 10.1016/j.cct.2023.107207] [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] [Received: 02/24/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The Together Everyone Achieves More Physical Activity (TEAM-PA) trial is a randomized controlled trial testing the efficacy of a group-based intervention for increasing physical activity (PA) among insufficiently active African American women. DESIGN The TEAM-PA trial uses a group cohort design, is implemented at community sites, and will involve 360 African American women. The trial compares a 10-week group-based intervention vs. a standard group-delivered PA comparison program. Measures include minutes of total PA/day using 7-day accelerometer estimates (primary outcome), and body mass index, blood pressure, waist circumference, walking speed, sedentary behavior, light physical activity, and the percentage achieving ≥150 min of moderate to vigorous PA/week (secondary outcomes) at baseline, post-intervention, and 6-months post-intervention. INTERVENTION The intervention integrates elements from Social Cognitive Theory, Self-Determination Theory, Group Dynamics Theory, and a focus on collectivism to evaluate different components of social affiliation (relatedness, reciprocal support, group cohesion, and collective efficacy). The intervention integrates shared goal-setting via Fitbits, group-based problem-solving, peer-to-peer positive communication, friendly competition, and cultural topics related to collectivism. Compared to the standard group-delivered PA program, participants in the intervention are expected to show greater improvements from baseline to post- and 6-month follow-up on minutes of total PA/day and secondary outcomes. Social affiliation variables (vs. individual-level factors) will be evaluated as mediators of the treatment effect. IMPLICATIONS The results of the TEAM-PA trial will determine the efficacy of the intervention and identify which aspects of social affiliation are most strongly related to increased PA among African American women. TRIAL REGISTRATION This study was registered on Clinicaltrials.gov (# NCT05519696) in August 2022 prior to initial participant enrollment.
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Affiliation(s)
- Allison M Sweeney
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC 29201, United States of America.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, United States of America
| | - Nicole Zarrett
- Department of Psychology, University of South Carolina, Columbia, SC, United States of America
| | - Pamela Martin
- Department of Psychology, University of South Carolina, Columbia, SC, United States of America
| | - James W Hardin
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Amanda Fairchild
- Department of Psychology, University of South Carolina, Columbia, SC, United States of America
| | - Sheryl Mitchell
- Department of Advanced Professional Nursing Practice and Leadership, College of Nursing, University of South Carolina, Columbia, SC, United States of America
| | - Lindsay Decker
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, United States of America
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15
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Nguyen AW, Qin W, Wei W, Keith VM, Mitchell UA. Racial discrimination and 12-month and lifetime anxiety disorders among African American men and women: Findings from the National Survey of American Life. J Affect Disord 2023; 330:180-187. [PMID: 36907462 PMCID: PMC10065954 DOI: 10.1016/j.jad.2023.03.004] [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: 09/12/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND The purpose of this study was to assess the associations between racial discrimination and 12-month and lifetime DSM-IV anxiety disorders among African American men and women. METHODS Data was drawn from the African American sample of the National Survey of American Life (N = 3570). Racial discrimination was assessed with the Everyday Discrimination Scale. 12-month and lifetime DSM-IV outcomes were any anxiety disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and agoraphobia (AG). Logistic regressions were utilized to assess the relationships between discrimination and anxiety disorders. RESULTS The data indicated that racial discrimination was associated with increased odds for 12-month and lifetime anxiety disorders, AG, and PD and lifetime SAD among men. Regarding 12-month disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, SAD, and PD. With respect to lifetime disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, GAD, SAD, and PD. LIMITATIONS The limitations of this study include the utilization of cross-sectional data, self-reported measures, and the exclusion of non-community dwelling individuals. CONCLUSIONS The current investigation showed that African American men and women are not impacted by racial discrimination in the same ways. These findings suggest that the mechanisms through which discrimination operates among men and women to influence anxiety disorders is potentially a relevant target for interventions to address gender disparities in anxiety disorders.
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Affiliation(s)
- Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America.
| | - Weidi Qin
- Population Studies Center, University of Michigan, United States of America
| | - Wenxing Wei
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America
| | - Verna M Keith
- Department of Sociology, University of Alabama at Birmingham, United States of America
| | - Uchechi A Mitchell
- School of Public Health, University of Illinois Chicago, United States of America
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16
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Mhaimeed N, Mhaimeed N, Mhaimeed O, Alanni J, Burney Z, Elshafeey A, Laws S, Choi JJ. Shared decision making with black patients: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 110:107646. [PMID: 36739706 DOI: 10.1016/j.pec.2023.107646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/15/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The purpose of this review is to explore the breadth of research conducted on SDM in the care of Black patients. METHODS We conducted a scoping review following the methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We searched articles related to original research on SDM in the care of Black patients in October 2022 using PubMed, Embase, and Google Scholar databases. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. A standardized data extraction form and thematic analysis were used to facilitate data extraction by two independent reviewers. RESULTS After removal of duplicates and screening, 30 articles were included in the final analysis. Black patients and clinician were found to not share the same understanding of SDM, and patients highly valued SDM in their care. Interventions to improve SDM yielded mixed results to enhance intent, participation in SDM, as well as health outcomes. Decision aids were the most effective form of intervention to enhance SDM. The most common barrier to SDM was patient-clinician communication, and was exacerbated by racial discordance, clinician mistrust, past experiences, and paternalistic clinician-patient dynamics. CONCLUSIONS SDM has the potential to improve health outcomes in Black patients when implemented contextually within Black patients' experiences and concerns. Significant barriers such as clinician mistrust exist, and the overall perception in the Black community is that SDM does not occur sufficiently. Barriers to SDM seem to be most pronounced when there is patient-clinician racial discordance. Several interventions aimed at improving SDM with Black patients have shown mixed results. Future studies should evaluate larger-scale interventions with longer follow-up. Practice implications Shared decision making (SDM) has been proposed as a useful tool for improving quality and equity in Black patients' care. However, Black patients experience lower rates of SDM compared to other populations. SDM has the potential to improve health outcomes in Black patients when implemented contextually within Black patients' experiences and concerns.
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Affiliation(s)
| | | | - Omar Mhaimeed
- Department of Medicine, John Hopkins Medicine, Baltimore, MD, USA
| | - Jamal Alanni
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Zain Burney
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Sa'ad Laws
- Health Sciences Library, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Justin J Choi
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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17
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Slavich GM, Roos LG, Mengelkoch S, Webb CA, Shattuck EC, Moriarity DP, Alley JC. Social Safety Theory: Conceptual foundation, underlying mechanisms, and future directions. Health Psychol Rev 2023; 17:5-59. [PMID: 36718584 PMCID: PMC10161928 DOI: 10.1080/17437199.2023.2171900] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023]
Abstract
Classic theories of stress and health are largely based on assumptions regarding how different psychosocial stressors influence biological processes that, in turn, affect human health and behavior. Although theoretically rich, this work has yielded little consensus and led to numerous conceptual, measurement, and reproducibility issues. Social Safety Theory aims to address these issues by using the primary goal and regulatory logic of the human brain and immune system as the basis for specifying the social-environmental situations to which these systems should respond most strongly to maximize reproductive success and survival. This analysis gave rise to the integrated, multi-level formulation described herein, which transforms thinking about stress biology and provides a biologically based, evolutionary account for how and why experiences of social safety and social threat are strongly related to health, well-being, aging, and longevity. In doing so, the theory advances a testable framework for investigating the biopsychosocial roots of health disparities as well as how health-relevant biopsychosocial processes crystalize over time and how perceptions of the social environment interact with childhood microbial environment, birth cohort, culture, air pollution, genetics, sleep, diet, personality, and self-harm to affect health. The theory also highlights several interventions for reducing social threat and promoting resilience.
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Affiliation(s)
- George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Lydia G. Roos
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Christian A. Webb
- McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Eric C. Shattuck
- Institute for Health Disparities Research and Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Daniel P. Moriarity
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jenna C. Alley
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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18
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Byrd DR, Allen JO. Multiple forms of discrimination and inflammation in Black Americans: Are there differences by sex? Soc Sci Med 2023; 321:115785. [PMID: 36801746 PMCID: PMC10072201 DOI: 10.1016/j.socscimed.2023.115785] [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] [Received: 12/02/2021] [Revised: 01/26/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023]
Abstract
RATIONALE Discrimination is a risk factor and potential pathway through which social determinants such as race and sex contribute to chronic inflammation in Black Americans in middle and later adulthood. Questions remain regarding which forms of discrimination are most salient for inflammatory dysregulation, and whether there are sex-based differences in these pathways. OBJECTIVE This exploratory study investigates sex differences in the relationships between four forms of discrimination and inflammatory dysregulation among middle aged and older Black Americans. METHODS Using cross-sectionally linked data from participants in the Midlife in the United States (MIDUS II) Survey (2004-2006) and Biomarker Project (2004-2009) (N = 225, ages 37-84, 67% female), this study conducted a series of multivariable regression analyses. Inflammatory burden was measured using a composite indicator comprised of five biomarkers: C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, E-selectin, and intercellular adhesion molecule (ICAM). Discrimination measures were lifetime, daily, and chronic job discrimination and perceived inequality at work. RESULTS Black men generally reported higher levels of discrimination than Black women (3 out of 4 forms), though only sex differences in job discrimination achieved statistical significance (p < .001). In contrast, Black women exhibited more overall inflammatory burden than Black men (2.09 vs. 1.66, p = .024), particularly elevated levels of fibrinogen (p = .003). Lifetime discrimination and inequality at work were associated with higher levels of inflammatory burden, after adjusting for demographic and health factors (p = .057 and p = .029, respectively). The discrimination-inflammation relationships further varied by sex, such that more lifetime and job discrimination predicted greater inflammatory burden in Black women, but not in Black men. CONCLUSION These findings highlight the potentially detrimental impact of discrimination and emphasize the importance of sex-specific research on biological mechanisms of health and health disparities in Black Americans.
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Affiliation(s)
- DeAnnah R Byrd
- Edson College of Nursing and Health Innovation, Arizona State University, Health North, Suite 301, 550 N 3rd Street, Phoenix, AZ, 85004, USA.
| | - Julie Ober Allen
- Department of Health and Exercise Science, University of Oklahoma, 1401 Asp Ave., Room 118, S.J. Sarkeys Complex, Norman, OK, 73019, USA; Research Center for Group Dynamics, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48106, USA.
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19
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Intersectional vulnerability in the relationship between discrimination and inflammatory gene expression. Brain Behav Immun Health 2023; 27:100580. [PMID: 36632340 PMCID: PMC9826875 DOI: 10.1016/j.bbih.2022.100580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/31/2022] [Accepted: 12/23/2022] [Indexed: 01/01/2023] Open
Abstract
Addressing social disparities in health and well-being requires understanding how the effects of discrimination become biologically embedded, and how embedding processes might vary across different demographic contexts. Emerging research suggests that a threat-related gene expression response may contribute to social disparities in health. We tested a contextual vulnerability model of discrimination embedding using an empirical intersectionality (interaction discovery) analysis of pro-inflammatory gene expression in a national sample of non-institutionalized, English-speaking adults with RNA biomarker data (n = 543). At the time of data collection, the average age of participants was 55 years (SD = 13.26) and approximately half identified as female (50.46%). Most participants identified as White (∼73%) and had some college experience (∼60%). Results showed significant variation in the strength of association between daily discrimination and inflammatory gene expression by race and sex (b = -0.022; 95% CI:-0.038,-0.005, p = .009) with the estimated marginal association larger for racially-minoritized males (b = 0.007; 95% CI:-0.003,0.017, p = .163), compared to White males (b = -0.006; 95% CI:-0.013,0.001, p = .076). This study indicates that the link between daily discrimination and inflammatory gene expression may vary by sociodemographic characteristics. To improve initiatives and policies aimed at ameliorating disparities within populations, greater attention is needed to understand how interlocking systems of inequalities contribute to physiological health.
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20
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Lieberman AG, Stock ML, AuBuchon KE, Beekman JB, Lambert SF. Intersectional discrimination from black women, white women, black men, or white men impacts young adult black women's affective states and risky health cognitions. Psychol Health 2023; 38:1-17. [PMID: 34180327 DOI: 10.1080/08870446.2021.1941962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Black women experience pronounced inequalities in alcohol use and sexual risk outcomes. Racial discrimination is a known contributor to health inequalities. However, Black women face unique and intersectional forms of discrimination beyond racial discrimination. The current study investigates how exclusion from four distinct social groups effects Black women's negative affect and risky health cognitions. DESIGN Black women (N = 124; ages 18-29) were randomly assigned to be excluded in Cyberball by Black women, Black men, White women, or White men. MAIN OUTCOME MEASURES Participants responded to measures of internalising (depressive, anxious) and externalising (anger) affect, heavy alcohol use willingness, and risky sex expectations. RESULTS Participants primarily attributed exclusion from White women to racial discrimination, exclusion from Black men to gender discrimination, and exclusion from White men to both gender and racial discrimination. When excluded by White women, participants reported the highest levels of anger, depressive affect, and anxiety. Exclusion by White men predicted the greatest heavy drinking willingness, though exclusion by Black men predicted the greatest risky sex expectations. CONCLUSION This study is the first to demonstrate that exclusion from different social groups leads to differing patterns of negative affect and risky health cognitions in young adult Black women.
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Affiliation(s)
- Abby G Lieberman
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
| | - Michelle L Stock
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
| | - Katarina E AuBuchon
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
| | - Janine B Beekman
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
| | - Sharon F Lambert
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
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21
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Reid AE, Earnshaw VA. Embracing heterogeneity: Implications for research on stigma, discrimination, and African Americans' health. Soc Sci Med 2023; 316:115111. [PMID: 35717276 DOI: 10.1016/j.socscimed.2022.115111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 01/11/2023]
Abstract
There has been substantial progress in research on the roles of stigma and discrimination in African Americans' health. Yet, Black-White health disparities persist. Research must, therefore, build on and address the heterogeneity that exists in stigma- and discrimination-related pathways, experiences, interventions, and research methodology. Specifically, research is needed that identifies the unique versus common mechanisms linking various forms of stigma and discrimination with African Americans' health. Moreover, beyond gender, the role of intersectionality in stigma's health effects remains unclear, and interventions are sorely needed that both enhance coping and eliminate the existence of stigma. Finally, experimental designs, though underutilized, hold promise as a method for examining mechanisms, intersectionality, and intervention efficacy.
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Affiliation(s)
- Allecia E Reid
- University of Massachusetts, Amherst, Department of Psychological and Brain Sciences, 135 Hicks Way, Tobin Hall, Amherst, MA, 01003, USA.
| | - Valerie A Earnshaw
- University of Delaware, Department of Human Development and Family Sciences, 111 Alison Hall West, Newark, DE, 19716, USA.
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22
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McKinnon II, Johnson DA, Murden RJ, Erving CL, Parker R, Van Dyke ME, Vaccarino V, Booker B, Moore RH, Lewis TT. Extreme racism-related events and poor sleep in African-American women. Soc Sci Med 2023; 316:115623. [PMID: 36581549 DOI: 10.1016/j.socscimed.2022.115623] [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] [Indexed: 12/28/2022]
Abstract
RATIONALE Much of the research linking racism-related stressors to poor health has focused on fairly non-violent forms of racism that directly impact individuals under study. Exposure to particularly extreme and/or violent racist events are increasingly visible via smartphone recordings and social media, with consistent anecdotal reports of the effects of seeing and hearing about these events on sleep among minorities who racially identify with the victims. OBJECTIVE This study examines whether exposure to direct and vicarious racism-related events (RREs), including more extreme events, are associated with sleep quality. Additionally, we examine effects of less and more violent direct RREs and vicarious RREs witnessed in person and via social media. METHODS Among 422 African-American women, we assessed exposure to RREs using a modified version of the Race-Related Events Scale and assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Linear regression analyses were used to model continuous global sleep. RESULTS Direct (β = 0.24 [95% CI: 0.13, 0.35]) RREs were associated with worse continuous global sleep quality scores in analyses adjusted for sociodemographics and risk factors for poor sleep. More violent direct RREs (β = 0.59 [95% CI: 0.30, 0.89]) had stronger associations with poor sleep quality than less violent direct RREs (β = 0.25 [95% CI: 0.11, 0.40]). Vicarious RREs overall (β = 0.04 [95% CI: 0.14, 0.21]) and those witnessed via social media (β = -0.07 [95% CI: 0.29, 0.14]) were not associated with global sleep quality; conversely, vicarious RREs witnessed in person were (β = 0.52 [95% CI: 0.21, 0.83]). CONCLUSION Extreme, direct experiences of racism, particularly those that are violent in nature, are associated with poor sleep quality. However, extreme vicarious experiences are not-- unless witnessed in person.
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Affiliation(s)
- Izraelle I McKinnon
- Department of Epidemiology (I.I.M., D.A.J., M.E.V.D., V.V., T.T.L.), Emory University, Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Dayna A Johnson
- Department of Epidemiology (I.I.M., D.A.J., M.E.V.D., V.V., T.T.L.), Emory University, Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Raphiel J Murden
- Department of Biostatistics (R.J.M., R.P.), Emory University, Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Christy L Erving
- Vanderbilt University (C.L.E.), Department of Sociology, 2301 Vanderbilt Place, 201E Garland Hall, Nashville, TN, 37235-1811, USA
| | - Rachel Parker
- Department of Biostatistics (R.J.M., R.P.), Emory University, Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Miriam E Van Dyke
- Department of Epidemiology (I.I.M., D.A.J., M.E.V.D., V.V., T.T.L.), Emory University, Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Viola Vaccarino
- Department of Epidemiology (I.I.M., D.A.J., M.E.V.D., V.V., T.T.L.), Emory University, Rollins School of Public Health, Atlanta, GA, 30322, USA; From the Division of Cardiology, Department of Medicine (V.V.), Emory University, School of Medicine, Atlanta, GA, 30322, USA
| | - Bianca Booker
- Department of Epidemiology (I.I.M., D.A.J., M.E.V.D., V.V., T.T.L.), Emory University, Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Renee H Moore
- Department of Epidemiology and Biostatistics (R.H.M), Drexel University, Dornsife School of Public Health, Philadelphia, PA, 19104, USA
| | - Tené T Lewis
- Department of Epidemiology (I.I.M., D.A.J., M.E.V.D., V.V., T.T.L.), Emory University, Rollins School of Public Health, Atlanta, GA, 30322, USA.
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Cohen MF, Corwin EJ, Johnson DA, Amore AD, Brown AL, Barbee NR, Brennan PA, Dunlop AL. Discrimination is associated with poor sleep quality in pregnant Black American women. Sleep Med 2022; 100:39-48. [PMID: 36007430 PMCID: PMC9709719 DOI: 10.1016/j.sleep.2022.07.015] [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: 02/08/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Heightened exposure to racial/ethnic discrimination is associated with poorer sleep health among non-pregnant adults. This relationship has received limited research attention among pregnant women, despite the importance of prenatal sleep quality for optimal maternal and child health outcomes. METHODS We utilized perinatal data from a sample of Black American women (n = 600) participating in a cohort study who reported their lifetime experiences of racial/ethnic discrimination and gendered racial stress during early pregnancy and reported on their sleep quality and depressive symptoms during early and mid-pregnancy. Hierarchical multiple linear regression models were fit to examine associations between lifetime experiences of racial/ethnic discrimination or gendered racial stress and sleep quality during early and mid-pregnancy. We also adjusted for women's concurrent depressive symptoms and tested whether the discrimination/sleep quality association varied by socioeconomic status. RESULTS Greater exposure to racial/ethnic discrimination was associated with poorer sleep quality during early (ΔR2 = 0.04, ΔF = 26.08, p < 0.001) and mid-pregnancy (ΔR2 = 0.02, ΔF = 9.88, p = 0.002). Similarly, greater gendered racial stress was associated with poorer sleep quality during early (ΔR2 = 0.10, ΔF = 65.72, p < 0.001) and mid-pregnancy (ΔR2 = 0.06, ΔF = 40.43, p < 0.001. These findings largely held after adjustment for concurrent prenatal depressive symptoms. Socioeconomic status did not modify the observed relationships. CONCLUSIONS Efforts to decrease institutional and interpersonal experiences of racial/ethnic discrimination and gendered racism would benefit the sleep quality of pregnant Black American women, particularly during early pregnancy.
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Affiliation(s)
| | | | - Dayna A Johnson
- Emory University Department of Epidemiology, Rollins School of Public Health, United States
| | - Alexis Dunn Amore
- Emory University Nell Hodgson Woodruff School of Nursing, United States
| | - April L Brown
- Emory University Department of Psychology, United States
| | - Nia R Barbee
- Emory University Department of Psychology, United States
| | | | - Anne L Dunlop
- Emory University School of Medicine Department of Gynecology and Obstetrics, United States
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24
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Hamler TC, Nguyen AW, Keith V, Qin W, Wang F. How Skin Tone Influences Relationships Between Discrimination, Psychological Distress, and Self-Rated Mental Health Among Older African Americans. J Gerontol B Psychol Sci Soc Sci 2022; 77:2026-2037. [PMID: 35976084 PMCID: PMC9683503 DOI: 10.1093/geronb/gbac115] [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] [Received: 07/05/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES As within-group differences have emerged as a key area of inquiry for health disparities among African Americans, skin tone has been identified as an important factor. This study aims to examine: (a) the moderating role of skin tone in the relationship between discrimination, self-rated mental health, and serious psychological distress (SPD) and (b) whether this moderating effect differs across genders in a nationally representative sample of older African Americans. METHODS Analyses were conducted on a subsample of African Americans aged 55+ (N = 837) from the National Survey of American Life. The mental health outcomes were SPD and self-rated mental health. Discrimination was assessed with the Everyday Discrimination Scale. Skin tone was self-reported. Multiple linear regressions tested the study aims. RESULTS Discrimination was associated with worse self-rated mental health and SPD in the total sample and among women. Skin tone moderated the association between discrimination and SPD in the total sample and among men and women. The associations between discrimination and mental health outcomes were stronger among darker-skinned respondents than lighter respondents. Gender-stratified analyses indicated skin tone moderated the association between discrimination and self-rated mental health for men but not women. DISCUSSION This study contributes to the emerging body of literature on skin tone, discrimination, and mental health. Uncovering mechanisms behind the "why" is an important next step in understanding how skin tone influences the relationship between discrimination and mental health. The negative psychological effects associated with darker complexion provide several areas to be examined.
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Affiliation(s)
- Tyrone C Hamler
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Verna Keith
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Weidi Qin
- Center for Social Epidemiology and Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
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25
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Extreme racism-related events and poor sleep in African-American women. Soc Sci Med 2022; 310:115269. [PMID: 36041238 PMCID: PMC9598673 DOI: 10.1016/j.socscimed.2022.115269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 07/23/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022]
Abstract
RATIONALE Much of the research linking racism-related stressors to poor health has focused on fairly non-violent forms of racism that directly impact individuals under study. Exposure to particularly extreme and/or violent racist events are increasingly visible via smartphone recordings and social media, with consistent anecdotal reports of the effects of seeing and hearing about these events on sleep among minorities who racially identify with the victims. OBJECTIVE This study examines whether exposure to direct and vicarious racism-related events (RREs), including more extreme events, are associated with sleep quality. Additionally, we examine effects of less and more violent direct RREs and vicarious RREs witnessed in person and via social media. METHODS Among 422 African-American women, we assessed exposure to RREs using a modified version of the Race-Related Events Scale and assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Linear regression analyses were used to model continuous global sleep. RESULTS Direct (β = 0.24 [95% CI: 0.13, 0.35]) RREs were associated with worse continuous global sleep quality scores in analyses adjusted for sociodemographics and risk factors for poor sleep. More violent direct RREs (β = 0.59 [95% CI: 0.30, 0.89]) had stronger associations with poor sleep quality than less violent direct RREs (β = 0.25 [95% CI: 0.11, 0.40]). Vicarious RREs overall (β = 0.04 [95% CI: 0.14, 0.21]) and those witnessed via social media (β = -0.07 [95% CI: 0.29, 0.14]) were not associated with global sleep quality; conversely, vicarious RREs witnessed in person were (β = 0.52 [95% CI: 0.21, 0.83]). CONCLUSION Extreme, direct experiences of racism, particularly those that are violent in nature, are associated with poor sleep quality. However, extreme vicarious experiences are not-- unless witnessed in person.
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26
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Erving CL, Cobb RJ, Sheehan C. Attributions for Everyday Discrimination and All-Cause Mortality Risk Among Older Black Women: A Latent Class Analysis Approach. THE GERONTOLOGIST 2022:6604582. [PMID: 35678164 DOI: 10.1093/geront/gnac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study examined the relationship between number of attributed reasons for everyday discrimination and all-cause mortality risk, developed latent classes of discrimination attribution, and assessed whether these latent classes were related to all-cause mortality risk among US older Black women. RESEARCH DESIGN AND METHOD Participants were from the 2006 and 2008 waves of the Health and Retirement Study (N = 1133; 335 deaths). Vital status was collected through the National Death Index through 2013 and key informant reports through 2019. Latent Class Analyses were conducted on discrimination attributions. Weighted Cox proportional hazards model were used to predict all-cause mortality. Analyses controlled for demographic characteristics, socioeconomic status, and health. RESULTS Reporting greater attributions for everyday discrimination was associated with higher mortality risk (HR = 1.117; 95% CI: 1.038 - 1.202; p <.01), controlling for demographic characteristics, socioeconomic status, and health as well as health behaviors. A four-class solution of the Latent Class Analysis specified the following attribution classes: No/Low Attribution; Ancestry/Gender/Race/Age; Age/Physical Disability; High on All Attributions. When compared to the No/Low Attribution class, membership in the High on All Attributions class was associated with greater mortality risk (HR = 2.809; CI: 1.458 - 5.412; p < .01). DISCUSSION AND IMPLICATIONS Findings underscore the importance of everyday discrimination experiences from multiple sources in shaping all-cause mortality risk among older Black women. Accordingly, this study problematizes the homogenization of Black women in aging research and suggests the need for health interventions that consider Black women's multiplicity of social statuses.
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Affiliation(s)
- Christy L Erving
- Department of Sociology and Population Research Center, The University of Texas at Austin, Austin, TX, USA
| | - Ryon J Cobb
- Program for Research on Black Americans, Michigan Center for Urban African American Aging Research, Ann Arbor, MI, USA
| | - Connor Sheehan
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
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27
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Cundiff JM, Bennett A, Carson AP, Judd SE, Howard VJ. Socioeconomic status and psychological stress: Examining intersection with race, sex and US geographic region in the REasons for Geographic and Racial Differences in Stroke study. Stress Health 2022; 38:340-349. [PMID: 34461676 DOI: 10.1002/smi.3095] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022]
Abstract
Socioeconomic status (SES) is a well-established determinant of health. Disparities in stress are thought to partially account for SES-health disparities. We tested whether multiple indicators of SES show similar associations with psychological stress and whether race, sex, and geographic region moderate associations. Participants (n = 26,451) are from a well-characterized national cohort of Black and White US adults aged 45 years or older. Psychological stress was measured using the 4-item perceived stress scale. Income was assessed as annual household income and education as highest level of education completed. Occupation was assessed during a structured interview and subsequently coded hierarchically. For all sex-race-region groups, the largest SES-stress associations were for income and the smallest were for occupation. Race moderated SES-stress associations, such that income and education were more closely associated with stress in Black adults than White adults. Additionally, education was more strongly associated with stress in individuals living in the stroke belt region. Black Americans with lower income and education reported greater psychological stress and may be at higher risk for disease through stress-related pathways. Thus, which SES indicator is examined and for whom may alter the magnitude of the association between SES and psychological stress.
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Affiliation(s)
| | - Aleena Bennett
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - April P Carson
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suzanne E Judd
- University of Alabama at Birmingham, Birmingham, Alabama, USA
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28
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Cohen MF, Dunlop AL, Johnson DA, Dunn Amore A, Corwin EJ, Brennan PA. Intergenerational Effects of Discrimination on Black American Children's Sleep Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074021. [PMID: 35409703 PMCID: PMC8997890 DOI: 10.3390/ijerph19074021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 01/27/2023]
Abstract
Greater exposure to racial/ethnic discrimination among pregnant Black American women is associated with elevated prenatal depressive symptomatology, poorer prenatal sleep quality, and poorer child health outcomes. Given the transdiagnostic importance of early childhood sleep health, we examined associations between pregnant women's lifetime exposure to racial/ethnic discrimination and their two-year-old children's sleep health. We also examined women's gendered racial stress as a predictor variable. In exploratory analyses, we examined prenatal sleep quality and prenatal depressive symptoms as potential mediators of the prior associations. We utilized data from a sample of Black American women and children (n = 205). Women self-reported their lifetime experiences of discrimination during early pregnancy, their sleep quality and depressive symptoms during mid-pregnancy, and their children's sleep health at age two. Hierarchical linear multiple regression models were fit to examine direct associations between women's experiences of discrimination and children's sleep health. We tested our mediation hypotheses using a parallel mediator model. Higher levels of gendered racial stress, but not racial/ethnic discrimination, were directly associated with poorer sleep health in children. Higher levels of racial/ethnic discrimination were indirectly associated with poorer sleep health in children, via women's prenatal depressive symptomatology, but not prenatal sleep quality. Clinical efforts to mitigate the effects of discrimination on Black American women may benefit women's prenatal mental health and their children's sleep health.
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Affiliation(s)
- Madeleine F. Cohen
- Department of Psychology, Emory University, Atlanta, GA 30322, USA;
- Correspondence:
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Dayna A. Johnson
- Department of Epidemiology, Emory University, Atlanta, GA 30322, USA;
| | - Alexis Dunn Amore
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA;
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Gee GC, Morey BN, Bacong AM, Doan TT, Penaia CS. Considerations of Racism and Data Equity Among Asian Americans, Native Hawaiians, And Pacific Islanders in the Context of COVID-19. CURR EPIDEMIOL REP 2022; 9:77-86. [PMID: 35342687 PMCID: PMC8932682 DOI: 10.1007/s40471-022-00283-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/22/2022]
Abstract
Purpose of Review The COVID-19 pandemic has revealed the importance of considering social determinants of health, including factors such as structural racism. This review discusses some of the evidence that triangulates on this issue, including data from hate crime statistics, social media analysis, and survey-based research. It also examines the data needs for Asian Americans, Native Hawaiian, and Pacific Islander (NHPI) communities. Recent Findings The available data provides evidence that the pandemic has contributed to an increase in anti-Asian sentiment and discriminatory incidents. Many reports have surfaced showing a surge in anti-Chinese discrimination, which has "spilled over" into other Asian communities. Research is beginning to emerge to show that such discrimination may also impact health issues such as psychological distress. Given prior research, we would expect many more studies to emerge in the future. Also, the pandemic has illustrated the major gaps in data available to disentangle the health and social concerns facing Asian Americans and NHPI communities. Significant issues include the lack of systematic reporting of data for these communities both across states, and even among agencies within a state; erroneous aggregation of Asians with NHPIs; and censoring of data. These gaps and issues contribute to bias that obscures objective data and amplifies health inequalities. Summary The COVID-19 pandemic has had a negative impact on the well-being of Asian American and NHPI communities. It is critical to provide disaggregated data, not only so that we can have accurate reporting, but also to ensure data and health equity.
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Affiliation(s)
- Gilbert C. Gee
- Department of Community Health Sciences, University of California Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA USA
| | - Brittany N. Morey
- Department of Health, Society, & Behavior, Program in Public Health, University of California Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA USA
| | - Adrian M. Bacong
- Department of Community Health Sciences, University of California Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA USA
| | - Tran T. Doan
- Department of Health Management and Policy, University of Michigan, 1415 Washington Heights, Ann Arbor, MI USA
| | - Corina S. Penaia
- Asian Pacific Islander Forward Movement, 905 East 8th Street, Los Angeles, CA USA
- Department of Health Policy and Management, University of California Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA USA
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30
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Chen E, Yu T, Brody GH, Lam PH, Goosby BJ, Miller GE. Discrimination and Inflammation in Adolescents of Color. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 3:204-212. [PMID: 37124354 PMCID: PMC10140455 DOI: 10.1016/j.bpsgos.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background This study examined how experiences with discrimination relate to inflammation, a key biological pathway in mental and physical illnesses, and whether associations are moderated by gender across two samples of adolescents of color. Methods Study 1 was a longitudinal study of 419 African American adolescents assessed on discrimination (ages 19-20), with trajectories of biomarkers of low-grade inflammation (C-reactive protein and soluble urokinase plasminogen activator receptor) measured from ages 25 to 29. Study 2 was a cross-sectional study of 201 eighth graders of color assessed on discrimination and mechanistic indicators of a proinflammatory phenotype: 1) in vitro studies of immune cells' inflammatory cytokine responses to stimuli; 2) in vitro studies of cells' sensitivity to anti-inflammatory agents; 3) circulating numbers of classical monocytes, key cellular drivers of low-grade inflammation; and 4) a composite of six biomarkers of low-grade inflammation. Results Interactions of discrimination by gender were found across both studies. In study 1, African American males experiencing high discrimination showed increasing trajectories of soluble urokinase plasminogen activator receptor over time (p < .001). In study 2, adolescent boys of color experiencing greater discrimination evinced a more proinflammatory phenotype: larger cytokine responses to stimuli (p = .003), lower sensitivity to anti-inflammatory agents (p = .003), higher numbers of classical monocytes (p = .008), and more low-grade inflammation (p = .003). No such associations were found in females. Conclusions Discrimination is a pressing societal issue that will need to be addressed in efforts to promote health equity. This study suggests that adolescent males of color may be particularly vulnerable to its effects on mental health-relevant inflammatory processes.
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Affiliation(s)
- Edith Chen
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois
- Address correspondence to Edith Chen, Ph.D.
| | - Tianyi Yu
- Center for Family Research, University of Georgia, Athens, Georgia
| | - Gene H. Brody
- Center for Family Research, University of Georgia, Athens, Georgia
| | - Phoebe H. Lam
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois
| | - Bridget J. Goosby
- Department of Sociology, University of Texas at Austin, Austin, Texas
| | - Gregory E. Miller
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois
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31
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Ahuja M, Haeny AM, Sartor CE, Bucholz KK. Perceived racial and social class discrimination and cannabis involvement among Black youth and young adults. Drug Alcohol Depend 2022; 232:109304. [PMID: 35124388 DOI: 10.1016/j.drugalcdep.2022.109304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/09/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The current study examines the association of perceived racial and social class discrimination with cannabis involvement among Black youth and young adults. METHODS This secondary analysis used data from the Missouri Family Study (MOFAM), a high-risk longitudinal family study of alcohol use disorder, oversampled for Black families. Offspring (n = 806) and their mothers were interviewed by telephone. Cox proportional hazards regression analyzes were used to examine associations of racial and social class discrimination (experienced by offspring and their mothers) with offspring cannabis involvement. Two stages of cannabis involvement were analyzed: timing of 1) initiation and 2) transition from initiation to first cannabis use disorder (CUD) symptom. RESULTS The study found that offspring report of experiencing racial (HR: 1.28, CI: 1.01-1.62) and social class discrimination (HR: 1.45, CI: 1.14-1.84) were associated with cannabis initiation in our fully adjusted model. Mothers' report of discrimination predicted a lower hazard of cannabis initiation among offspring (HR: 0.79, CI: 0.64-0.98). Offspring social class discrimination (HR: 2.45, CI: 1.71-3.51) predicted an increased hazard of transition from initiation to first CUD symptom, while offspring racial discrimination (HR: 0.57, CI: 0.39-0.85) was associated with lower hazard of transition in our fully adjusted model. CONCLUSIONS As rates for cannabis use among Black youth are disproportionately rising, there is a critical need to identify pathways to its use among Black youth. These findings suggest racial and social class discrimination may be important targets in efforts to prevent cannabis involvement among Black youth and emerging adults.
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Affiliation(s)
- Manik Ahuja
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, United States.
| | - Angela M Haeny
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Carolyn E Sartor
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Psychiatry, Washington University School of Medicine, United States
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine, United States
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32
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Van Dyke ME, Kramer MR, Kershaw KN, Vaccarino V, Crawford ND, Lewis TT. Inconsistent Reporting of Discrimination Over Time Using the Experiences of Discrimination Scale: Potential Underestimation of Lifetime Burden. Am J Epidemiol 2022; 191:370-378. [PMID: 34017974 DOI: 10.1093/aje/kwab151] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022] Open
Abstract
Studies documenting self-reported experiences of discrimination over the life course have been limited. Such information could be important for informing longitudinal epidemiologic studies of discrimination and health. We characterized trends in self-reports of racial, socioeconomic status, and gender discrimination over time measured using the Experiences of Discrimination Scale, with a focus on whether individuals' reports of lifetime discrimination were consistent over time. Overall experiences of discrimination and the number of settings in which discrimination was reported in 1992, 2000, and 2010 were examined among 2,774 African-American and White adults in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Reports of "ever" experiencing discrimination decreased for all forms of discrimination across the 3 study visits. Approximately one-third (30%-41%) of the sample inconsistently reported ever experiencing any discrimination over time, which contributed to the observed decreases. Depending on the form of discrimination, inconsistent reporting patterns over time were more common among African-American, younger, less educated, and lower-income individuals and women-groups who are often most exposed to and severely impacted by the health effects of discrimination. Our findings highlight the possible underestimation of the lifetime burden of discrimination when utilizing the Experiences of Discrimination Scale to capture self-reports of discrimination over time.
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33
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Van Dyke ME, Crawford ND, Lewis TT. Van Dyke et al. Respond to "Methodological Considerations in Investigating Discrimination". Am J Epidemiol 2022; 191:384-385. [PMID: 34431496 DOI: 10.1093/aje/kwab224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/01/2021] [Accepted: 08/18/2021] [Indexed: 11/14/2022] Open
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34
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Cobb RJ, Sheehan CM, Louie P, Erving CL. Multiple Reasons for Perceived Everyday Discrimination and All-Cause Mortality Risk Among Older Black Adults. J Gerontol A Biol Sci Med Sci 2022; 77:310-314. [PMID: 34605539 PMCID: PMC9012980 DOI: 10.1093/gerona/glab281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study assessed whether reporting multiple reasons for perceived everyday discrimination was associated with an increased risk for all-cause mortality risk among older Black adults. METHODS This study utilized data from a subsample of older Black adults from the Health and Retirement Study (HRS), a nationally representative panel study of older adults in the United States. Our measure of multiple reasons for perceived everyday discrimination was based on self-reports from the 2006/2008 HRS waves. Respondents' vital status was obtained from the National Death Index and reports from key household informants (spanning 2006-2019). Cox proportional hazard models, which accounted for covariates linked to mortality, were used to estimate the risk of all-cause mortality. RESULTS During the observation period, 563 deaths occurred. Twenty percent of Black adults attributed perceived everyday discrimination to 3 or more sources. In demographic adjusted models, attributing perceived everyday discrimination to 3 or more sources was a statistically significant predictor of all-cause mortality risk (hazard ratio = 1.45; 95% confidence interval = 1.12-1.87). The association remained significant (hazard ratio = 1.49; 95% confidence interval = 1.15-1.93) after further adjustments for health, behavioral, and economic characteristics. CONCLUSIONS Examining how multiple reasons for perceived everyday discrimination relate to all-cause mortality risk has considerable utility in clarifying the unique contributions of perceived discrimination to mortality risk among older Black adults. Our findings suggest that multiple reasons for perceived everyday discrimination are a particularly salient risk factor for mortality among older Black adults.
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Affiliation(s)
- Ryon J Cobb
- Department of Sociology, University of Georgia, Athens, Georgia, USA
| | - Connor M Sheehan
- School of Social and Family Dynamics, Arizona State University, Tempe, Arizona, USA
| | - Patricia Louie
- Department of Sociology, University of Washington, Seattle, Washington, USA
| | - Christy L Erving
- Department of Sociology, Vanderbilt University, Nashville, Tennessee, USA
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35
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Webb EK, Bird CM, deRoon-Cassini TA, Weis CN, Huggins AA, Fitzgerald JM, Miskovich T, Bennett K, Krukowski J, Torres L, Larson CL. Racial Discrimination and Resting-State Functional Connectivity of Salience Network Nodes in Trauma-Exposed Black Adults in the United States. JAMA Netw Open 2022; 5:e2144759. [PMID: 35072718 PMCID: PMC8787596 DOI: 10.1001/jamanetworkopen.2021.44759] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/29/2021] [Indexed: 12/21/2022] Open
Abstract
Importance For Black US residents, experiences of racial discrimination are still pervasive and frequent. Recent empirical work has amplified the lived experiences and narratives of Black people and further documented the detrimental effects of racial discrimination on both mental and physical health; however, there is still a need for further research to uncover the mechanisms connecting experiences of racial discrimination with adverse health outcomes. Objective To examine neurobiological mechanisms that may offer novel insight into the association of racial discrimination with adverse health outcomes. Design, Setting, and Participants This cross-sectional study included 102 Black adults who had recently experienced a traumatic injury. In the acute aftermath of the trauma, participants underwent a resting-state functional magnetic resonance imaging scan. Individuals were recruited from the emergency department at a Midwestern level 1 trauma center in the United States between March 2016 and July 2020. Data were analyzed from February to May 2021. Exposures Self-reported lifetime exposure to racial discrimination, lifetime trauma exposure, annual household income, and current posttraumatic stress disorder (PTSD) symptoms were evaluated. Main Outcomes and Measures Seed-to-voxel analyses were conducted to examine the association of racial discrimination with connectivity of salience network nodes (ie, amygdala and anterior insula). Results A total of 102 individuals were included, with a mean (SD) age of 33 (10) years and 58 (57%) women. After adjusting for acute PTSD symptoms, annual household income, and lifetime trauma exposure, greater connectivity between the amygdala and thalamus was associated with greater exposure to discrimination (t(97) = 6.05; false discovery rate (FDR)-corrected P = .03). Similarly, racial discrimination was associated with greater connectivity between the insula and precuneus (t(97) = 4.32; FDR-corrected P = .02). Conclusions and Relevance These results add to the mounting literature that racial discrimination is associated with neural correlates of vigilance and hyperarousal. The study findings extend this theory by showing that this association is apparent even when accounting for socioeconomic position, lifetime trauma, and symptoms of psychological distress related to an acute trauma.
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Affiliation(s)
- E. Kate Webb
- Department of Psychology, University of Wisconsin–Milwaukee
| | - Claire M. Bird
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - Terri A. deRoon-Cassini
- Division of Trauma & Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Carissa N. Weis
- Institute for Health and Equity, Department of Epidemiology, Medical College of Wisconsin, Milwaukee
| | - Ashley A. Huggins
- Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
| | | | | | | | - Jessica Krukowski
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - Lucas Torres
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
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Abstract
In a context where epidemiologic research has been heavily influenced by a biomedical and individualistic approach, the naming of “social epidemiology” allowed explicit emphasis on the social production of disease as a powerful explanatory paradigm and as critically important for interventions to improve population health. This review briefly highlights key substantive areas of focus in social epidemiology over the past 30 years, reflects on major advances and insights, and identifies challenges and possible future directions. Future opportunities for social epidemiology include grounding research in theoretically based and systemic conceptual models of the fundamental social drivers of health; implementing a scientifically rigorous yet realistic approach to drawing conclusions about social causes; using complementary methods to generate valid explanations and identify effective actions; leveraging the power of harmonization, replication, and big data; extending interdisciplinarity and diversity; advancing emerging critical approaches to understanding the health impacts of systemic racism and its policy implications; going global; and embracing a broad approach to generating socially useful research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ana V. Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Clarke LS, Riley HEM, Corwin EJ, Dunlop AL, Hogue CJR. The unique contribution of gendered racial stress to depressive symptoms among pregnant Black women. WOMEN'S HEALTH 2022; 18:17455057221104657. [PMID: 35900027 PMCID: PMC9340355 DOI: 10.1177/17455057221104657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Pregnant Black women are at disproportionate risk for adverse birth outcomes,
in part associated with higher prevalence of stress. Stress increases risk
of depression, a known risk factor for preterm birth. In addition, multiple
dimensions of stress, including perceived stress and stressful life events,
are associated with adverse birth outcomes, independent of their association
with prenatal depression. We use an intersectional and contextualized
measure of gendered racial stress to assess whether gendered racial stress
constitutes an additional dimension to prenatal depression, independent of
stressful life events and perceived stress. Methods: In this cross-sectional study of 428 Black women, we assessed gendered racial
stress (using the 39-item Jackson Hogue Phillips Reduced Common
Contextualized Stress Measure), perceived stress (using the Perceived Stress
Scale), and stressful life events (using a Stressful Life Event Index) as
psychosocial predictors of depressive symptoms (measured by the Edinburgh
Depression Scale). We used bivariate analyses and multivariable regression
to assess the association between the measures of stress and prenatal
depression. Results: Results revealed significant bivariate associations between participant
scores on the full Jackson Hogue Phillips Reduced Common Contextualized
Stress Measure and its 5 subscales, and the Edinburgh Depression Scale. In
multivariable models that included participant Perceived Stress Scale and/or
Stressful Life Event Index scores, the Jackson Hogue Phillips Reduced Common
Contextualized Stress Measure contributed uniquely and significantly to
Edinburgh Depression Scale score, with the burden subscale being the
strongest contributor among all variables. No sociodemographic
characteristics were found to be significant in multivariable models. Conclusion: For Black women in early pregnancy, gendered racial stress is a distinct
dimension of stress associated with increased depressive symptoms.
Intersectional stress measures may best uncover nuances within Black women’s
complex social environment.
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Affiliation(s)
- Lasha S Clarke
- Morehouse School of Medicine, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Halley EM Riley
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Anne L Dunlop
- School of Medicine, Emory University, Atlanta, GA, USA
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Gary KM, Hoque M, Yashkin AP, Yashin AI, Akushevich I. Does the Chronic Stress of Everyday Discrimination or Race Itself Better Predict AD Onset Risk? Gerontol Geriatr Med 2022; 8:23337214221142944. [PMID: 36544849 PMCID: PMC9761247 DOI: 10.1177/23337214221142944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Using evidence from the Health and Retirement Study, we explore racial disparities in Alzheimer's Disease (AD) onset risk. From a stress process perspective, there is substantial evidence in the literature that everyday discrimination is a chronic strain for Black individuals that acts as a social determinant of illness. However, few studies have examined specific relationships between this social stressor, race, and AD onset risk. Using Cox Proportional Hazard Models, we examined racial differences in exposure and vulnerability to everyday discrimination. Findings suggest that everyday discrimination predicts AD onset risk, and Black individuals experience more frequent exposure to everyday discrimination as a chronic strain. However, contrary to the stress process model, Black respondents were not more vulnerable to the effect of everyday discrimination on AD onset risk. Racial bias from medical professionals during the diagnostic process and mortality selection bias may explain this effect. Overall, the results of this study provide further evidence that discrimination is a key factor in predicting AD while also considering that many racial minorities with high rates of this type of social stress may not receive an unbiased diagnosis and/or survive to late life to develop AD.
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Affiliation(s)
- Katharine M. Gary
- Duke University, Durham, NC, USA
- Katharine Gary, Duke University, Erwin Mill
Building, 2024 W. Main Street, Durham, NC 27705, USA.
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Rhead RD, Woodhead C, Ahmad G, Das-Munshi J, McManus S, Hatch SL. A comparison of single and intersectional social identities associated with discrimination and mental health service use: data from the 2014 Adult Psychiatric Morbidity Survey in England. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2049-2063. [PMID: 35254450 PMCID: PMC9477952 DOI: 10.1007/s00127-022-02259-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/18/2022] [Indexed: 02/05/2023]
Abstract
Inequities in mental health service use (MHSU) and treatment are influenced by social stratification processes linked to socially contextualised interactions between individuals, organisations and institutions. These complex relations underpin observed inequities and their experience by people at the intersections of social statuses. Discrimination is one important mechanism influencing such differences. We compared inequities in MHSU/treatment through single and intersectional status analyses, accounting for need. We assessed whether past-year discrimination differentially influences MHSU/treatment across single and intersecting statuses. Data came from a population survey (collected 2014-2015) nationally representative of English households (N = 7546). We used a theory and datadriven approach (latent class analysis) which identified five intersectional groups in the population comprising common combinations of social statuses. Single status analyses identified characteristics associated with MHSU/treatment (being a sexual minority (adjusted odds ratio (AOR) 1.65 95% CI:1.09-2.50), female (AOR 1.71, 95% CI:1.45-2.02), economically inactive (AOR 2.02, 95% CI:1.05-3.90), in the most deprived quintile (AOR 1.33, 95% CI:1.02-1.74), and Black (AOR 0.36 95% CI:0.20-0.66)). Intersectional analyses detected patterns not apparent from single status analyses. Compared to the most privileged group ("White British, highly educated, employed, high social class"), "Retired White British" had greater odds of MHSU/treatment (AOR 1.88, 95% CI:1.53-2.32) while "Employed migrants" had lower odds (AOR 0.39, 95% CI:0.27-0.55). Past-year discrimination was associated with certain disadvantaged social statuses and greater MHSU/treatment but-except for sexual minorities-adjusting for discrimination had little influence using either analytic approach. Observing patterns only by single social statuses masks potentially unanticipated and contextually varying inequities. The latent class approach offers policy-relevant insights into patterns and mechanisms of inequity but may mask other key intersectional patterns by statuses less common or under represented in surveys (e.g. UK-born ethnic minority groups). We propose multiple, context-relevant, theory-driven approaches to intersectional understanding of mental health inequalities.
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Affiliation(s)
- Rebecca D. Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,ESRC Centre for Society and Mental Health, King’s College London, London, UK
| | - Gargie Ahmad
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,South London and Maudsley (SLaM) NHS Trust, London, UK
| | - Sally McManus
- National Centre for Social Research, London, UK ,Violence and Society Centre, City, University of London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,ESRC Centre for Society and Mental Health, King’s College London, London, UK
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Johnson DA, Lewis TT, Guo N, Jackson CL, Sims M, Wilson JG, Diez Roux AV, Williams DR, Redline S. Associations between everyday discrimination and sleep quality and duration among African-Americans over time in the Jackson Heart Study. Sleep 2021; 44:zsab162. [PMID: 34197610 PMCID: PMC8664593 DOI: 10.1093/sleep/zsab162] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/14/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES African-Americans have a high burden of poor sleep, yet, psychosocial determinants (e.g. discrimination) are understudied. We investigated longitudinal associations between everyday discrimination and sleep quality and duration among African-Americans (N = 3404) in the Jackson Heart Study. METHODS At Exam 1 (2000-2004) and Exam 3 (2008-2013), participants completed the Everyday Discrimination Scale, rated their sleep quality (1 = poor to 5 = excellent), and self-reported hours of sleep. A subset of participants (N = 762) underwent 7-day actigraphy to objectively measure sleep duration and sleep quality (Sleep Exam 2012-2016). Changes in discrimination were defined as low stable (reference), increasing, decreasing, and high stable. Within-person changes in sleep from Exam 1 to Exam 3 were regressed on change in discrimination from Exam 1 to Exam 3 while adjusting for age, sex, education, income, employment, physical activity, smoking, body mass index, social support, and stress. RESULTS At Exam 1, the mean age was 54.1 (12.0) years; 64% were female, mean sleep quality was 3.0 (1.1) and 54% were short sleepers. The distribution of the discrimination change trajectories were 54.1% low stable, 13.5% increasing, 14.6% decreasing, and 17.7% were high stable. Participants who were in the increasing (vs. low stable) discrimination group had greater decrease in sleep quality. There was no association between change in discrimination and change in sleep duration. Among Sleep Exam participants, higher discrimination was cross-sectionally associated with shorter self-reported sleep duration, independent of stress. CONCLUSION Discrimination is a unique stressor for African-Americans; thus, future research should identify interventions to reduce the burden of discrimination on sleep quality.
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Affiliation(s)
- Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Na Guo
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
- Division of Intramural Program, Department of Health and Human Services, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - James G Wilson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ana V Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - David R Williams
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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41
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Gaston SA, Atere-Roberts J, Ward J, Slopen NB, Forde AT, Sandler DP, Williams DR, Jackson CL. Experiences With Everyday and Major Forms of Racial/Ethnic Discrimination and Type 2 Diabetes Risk Among White, Black, and Hispanic/Latina Women: Findings From the Sister Study. Am J Epidemiol 2021; 190:2552-2562. [PMID: 34215871 DOI: 10.1093/aje/kwab189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/22/2023] Open
Abstract
Racial/ethnic discrimination may contribute to the risk of type 2 diabetes mellitus (T2DM), but few studies have prospectively examined this relationship among racially/ethnically diverse populations. We analyzed prospective data from 33,833 eligible Sister Study participants enrolled from 2003 to 2009. In a follow-up questionnaire (2008-2012), participants reported their lifetime experiences of everyday and major forms of racial/ethnic discrimination. Self-reported physician diagnoses of T2DM were ascertained through September 2017. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards models, overall and by race/ethnicity. Mean age at enrollment was 54.9 (standard deviation, 8.8) years; 90% of participants self-identified as non-Hispanic (NH) White, 7% as NH Black, and 3% as Hispanic/Latina. Over an average of 7 years of follow-up, there were 1,167 incident cases of T2DM. NH Black women most frequently reported everyday (75%) and major (51%) racial/ethnic discrimination (vs. 4% and 2% of NH White women, respectively, and 32% and 16% of Hispanic/Latina women, respectively). While everyday discrimination was not associated with T2DM risk, experiencing major discrimination was marginally associated with higher T2DM risk overall (hazard ratio = 1.26, 95% confidence interval: 0.99, 1.61) after adjustment for sociodemographic characteristics and body mass index. Associations were similar across racial/ethnic groups; however, racial/ethnic discrimination was more frequently reported among racial/ethnic minority women. Antidiscrimination efforts may help mitigate racial/ethnic disparities in T2DM risk.
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42
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Hill PL, Sin NL, Edmonds GW, Burrow AL. Associations Between Everyday Discrimination and Sleep: Tests of Moderation by Ethnicity and Sense of Purpose. Ann Behav Med 2021; 55:1246-1252. [PMID: 33760911 PMCID: PMC8601048 DOI: 10.1093/abm/kaab012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Everyday discrimination holds pernicious effects across most aspects of health, including a pronounced stress response. However, work is needed on when discrimination predicts sleep outcomes, with respect to potential moderators of these associations. PURPOSE The current study sought to advance the past literature by examining the associations between everyday discrimination and sleep outcomes in an ethnically diverse sample, allowing tests of moderation by ethnic group. We also examined the role of sense of purpose, a potential resilience factor, as another moderator. METHODS Participants in the Hawaii Longitudinal Study of Personality and Health (n = 758; 52.8% female; mage: 60 years, sd = 2.03) completed assessments for everyday discrimination, sleep duration, daytime dysfunction due to sleep, sleep quality, and sense of purpose. RESULTS In the full sample, everyday discrimination was negatively associated with sleep duration, sleep quality, and sense of purpose, while positively associated with daytime dysfunction due to sleep. The associations were similar in magnitude across ethnic groups (Native Hawaiian, White/Caucasian, Japanese/Japanese-American), and were not moderated by sense of purpose, a potential resilience factor. CONCLUSIONS The ill-effects on health due to everyday discrimination may operate in part on its role in disrupting sleep, an issue that appears to similarly impact several groups. The current research extends these findings to underrepresented groups in the discrimination and sleep literature. Future research is needed to better disentangle the day-to-day associations between sleep and discrimination, and identify which sources of discrimination may be most problematic.
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Affiliation(s)
- Patrick L Hill
- Department of Psychological and Brain Sciences, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1125, St. Louis, MO 63130, USA
| | - Nancy L Sin
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | | | - Anthony L Burrow
- Department of Human Development, Cornell University, Ithaca, NY, USA
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43
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Mingo TM. “When Surviving Jim Crow Is a Preexisting Condition”: The Impact of COVID‐19 on African Americans in Late Adulthood and Their Perceptions of the Medical Field. ADULTSPAN JOURNAL 2021. [PMCID: PMC8652717 DOI: 10.1002/adsp.12112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article examines how the trauma of historical and structural racism affects one's health and well‐being across the life span, specifically for African Americans identified as descendants of Africans enslaved in the United States (DAEUS). Counselors are provided with antiracist strategies to support the intersection of multiple social identities for DAEUS citizens in late adulthood disproportionately affected by COVID‐19.
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Affiliation(s)
- Taryne M. Mingo
- Department of Counseling University of North Carolina at Charlotte
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44
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Christian LM, Cole SW, McDade T, Pachankis JE, Morgan E, Strahm AM, Kamp Dush CM. A biopsychosocial framework for understanding sexual and gender minority health: A call for action. Neurosci Biobehav Rev 2021; 129:107-116. [PMID: 34097981 PMCID: PMC8429206 DOI: 10.1016/j.neubiorev.2021.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022]
Abstract
The number of US adults identifying as lesbian, gay, bisexual, transgender, or a different sexual identity has doubled since 2008, and about 40 % of the sexual and gender minority population identify as people of color. Minority stress theory posits that sexual and gender minorities are at particular risk for stress via stigma and discrimination at the structural, interpersonal, and individual levels. This stress, in turn, elevates the risk of adverse health outcomes across several domains. However, there remains a conspicuously limited amount of research on the psychoneuroimmunology of stress among sexual and gender minorities. We developed the Biopsychosocial Minority Stress Framework which posits that sexual minority status leads to unique experiences of minority stress which results in adverse health behavioral factors, elevated psychological distress and sleep disturbance, and immune dysregulation. Moderators in the model include both individual differences and intersectional identities. There is a crucial need to understand the biological-psychological axis of stress among the increasingly visible sexual and gender minority population to increase their health, longevity, and quality of life.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Steve W Cole
- Department of Psychiatry & Biobehavioral Sciences and Medicine, UCLA School of Medicine, Los Angeles, CA, USA
| | - Thomas McDade
- Department of Anthropology, Northwestern University, Evanston, IL, USA; Institute for Policy Research, Northwestern University, Evanston, IL, USA; Child and Brain Development Program, Canadian Institute for Advanced Research, Toronto, ON, Canada
| | - John E Pachankis
- Yale School of Public Health, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Anna M Strahm
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Claire M Kamp Dush
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA; Department of Sociology, University of Minnesota, Minneapolis, MN, USA
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45
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Bromfield SG, Sullivan S, Saelee R, Elon L, Lima B, Young A, Uphoff I, Li L, Quyyumi A, Bremner JD, Vaccarino V, Lewis TT. Race and Gender Differences in the Association Between Experiences of Everyday Discrimination and Arterial Stiffness Among Patients With Coronary Heart Disease. Ann Behav Med 2021; 54:761-770. [PMID: 32227162 PMCID: PMC7516092 DOI: 10.1093/abm/kaaa015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Self-reported experiences of discrimination have been linked to indices of cardiovascular disease. However, most studies have focused on healthy populations. Thus, we examined the association between experiences of everyday discrimination and arterial stiffness among patients with a history of myocardial infarction (MI). PURPOSE We hypothesized that higher reports of discrimination would be associated with greater arterial stiffness and that associations would be more pronounced among Black women, in particular, relative to other race-gender groups, using an "intersectionality" perspective. METHODS Data were from 313 participants (49.2% female, mean age: 50.8 years) who were 6 months post-MI in the Myocardial Infarction and Mental Stress 2 study. Data were collected via self-reported questionnaires, medical chart review, and a clinic visit during which arterial stiffness was measured noninvasively using pulse wave velocity. RESULTS Reports of discrimination were highest in Black men and women and arterial stiffness was greatest in Black and White women. After adjustment for demographics and relevant clinical variables, discrimination was not associated with arterial stiffness in the overall study sample. However, discrimination was associated with increased arterial stiffness among Black women but not White women, White men, or Black men. CONCLUSIONS Despite no apparent association between discrimination and arterial stiffness in the overall study sample, further stratification revealed an association among Black women but not other race-gender groups. These data not only support the utility of an intersectionality lens but also suggest the importance of implementing psychosocial interventions and coping strategies focused on discrimination into the care of clinically ill Black women.
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Affiliation(s)
- Samantha G Bromfield
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Samaah Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ryan Saelee
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa Elon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bruno Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - An Young
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Irina Uphoff
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Lian Li
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Arshed Quyyumi
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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46
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Smith NC. Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors. SOCIAL SCIENCE RESEARCH 2021; 99:102593. [PMID: 34429206 DOI: 10.1016/j.ssresearch.2021.102593] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 05/18/2023]
Abstract
Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.
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Affiliation(s)
- Nicholas C Smith
- Indiana University - Bloomington, Department of Sociology Ballantine Hall 744, 1020 East Kirkwood Avenue Bloomington, IN, 47405, USA.
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Sullivan JM, Harman M, Sullivan S. Gender differences in African Americans' reactions to and coping with discrimination: Results from The National Study of American Life. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:2424-2440. [PMID: 34320229 PMCID: PMC8442879 DOI: 10.1002/jcop.22677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 05/31/2023]
Abstract
The aim of this paper is to examine coping behaviors in the context of discrimination and possible gender-specific differences among a national sample of African American adults in the 2001-2003 National Survey of American Life (NSAL). Results show that in multivariable logistic regression models, African American women (vs. African American men) were less likely to accept discrimination as a fact of life but were more likely to get mad about experiences of discrimination, pray about it, and talk to someone. After adjusting for differences in the frequency of discrimination, African American women were also significantly more likely to try to do something about it. African American men were more likely to accept discrimination as a fact of life with higher frequency of day-to-day discrimination while women tended to talk to someone with a higher frequency of day-to-day discrimination and lifetime discrimination. These findings suggest gender differences in behavior concerning discrimination.
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Affiliation(s)
- Jas M Sullivan
- Department of Psychology, Political Science and African American Studies, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Moriah Harman
- Department of Political Science, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Samaah Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Book Review of Invisible Visits: Black Middle-Class Women in the American Healthcare System. JOURNAL OF BLACK PSYCHOLOGY 2021. [DOI: 10.1177/00957984211041083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rizzo MT, Green ER, Dunham Y, Bruneau E, Rhodes M. Beliefs about social norms and racial inequalities predict variation in the early development of racial bias. Dev Sci 2021; 25:e13170. [PMID: 34423885 DOI: 10.1111/desc.13170] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/23/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
Racism remains a pervasive force around the world with widespread and well documented harmful consequences for members of marginalized racial groups. The psychological biases that maintain structural and interpersonal racism begin to emerge in early childhood, but with considerable individual variation-some children develop more racial bias than others. The present study (N = 116; 4-year-old children) provides novel insights into the developmental mechanisms underlying the emergence of racial bias by longitudinally documenting how two psychological processes-normative beliefs about interracial friendships and explanatory beliefs about racial inequalities-developmentally predict the emergence of pro-White/anti-Black racial bias during early childhood. In a 6-month, three-wave, longitudinal study, we found that 4-year-old children's beliefs that their parents and peers do not value interracial friendships predicted increased racial bias in and across time and that children's endorsement of essentialist over extrinsic explanations for racial inequalities predicted the developmental trajectory of racial bias over time. These findings suggest that children's foundational beliefs about the social world developmentally predict the emergence of racial bias in early childhood and speak to the importance of early and persistent intervention efforts targeting children's normative beliefs about interracial friendships and explanatory beliefs about racial inequalities.
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Affiliation(s)
- Michael T Rizzo
- Department of Psychology, New York University, New York, New York, USA.,Beyond Conflict Innovation Lab, Boston, Massachusetts, USA
| | - Emily R Green
- Department of Psychology, New York University, New York, New York, USA
| | | | - Emile Bruneau
- Beyond Conflict Innovation Lab, Boston, Massachusetts, USA.,University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marjorie Rhodes
- Department of Psychology, New York University, New York, New York, USA
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Dixon JS, Coyne AE, Duff K, Ready RE. Predictors of cognitive decline in a multi-racial sample of midlife women: A longitudinal study. Neuropsychology 2021; 35:514-528. [PMID: 34014752 PMCID: PMC8352567 DOI: 10.1037/neu0000743] [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: 11/08/2022] Open
Abstract
Objective: Hypertension, diabetes, depressive symptoms, and smoking are predictors of cognitive decline in late life. It is unknown if these risk factors are associated with cognition during midlife or if the associations between these risk factors and cognition vary by race. This longitudinal study examined (a) risk factors for decline in episodic memory, processing speed, and working memory in midlife women and (b) if the associations between risk factors and cognitive decline were moderated by race. Method: Participants (aged 42-52) were European American (n = 1,000), African American (n = 516), and Asian American (n = 437) women from the Study of Women's Health Across the Nation. Two-level hierarchical linear models tested risk factors, race, and their interactions as predictors of cognitive change over time. Results: African Americans had poorer baseline episodic memory, processing speed, and working memory and greater episodic memory decline compared to European Americans. Asian Americans had poorer episodic memory and working memory, but better processing speed than European Americans. Depressive symptoms were associated with poorer episodic memory and processing speed at baseline; further, diabetes was associated with poorer processing speed at baseline. Greater depressive symptoms were associated with poorer episodic memory at baseline for African Americans but not European Americans. Conclusions: Our study results highlight racial disparities in cognition during midlife. Depressive symptoms may be particularly detrimental to the cognitive health of African Americans. Clinical and public health interventions for healthy cognitive aging should be tailored to the unique risks of racial groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jasmine S. Dixon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Alice E. Coyne
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA
| | - Kevin Duff
- Department of Neurology, University of Utah, Salt Lake City, UT
| | - Rebecca E. Ready
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA
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