Comparing Cognitive Interviewing and Psychometric Methods to Evaluate a Racial/Ethnic Discrimination Scale

Discrimination Experiences among Asian American and Pacific Islander Adults during the COVID-19 Pandemic and Their Association with Mental Health Outcomes: Updated Findings from the COMPASS Study

BACKGROUND

Reports of escalated discrimination experiences among Asian American and Native Hawaiian Pacific Islanders (AANHPI) continue.

METHODS

Using the original and follow-up surveys of the COVID-19 Effects on the Mental and Physical Health of AAPI (Asian American and Pacific Islanders) Survey Study (COMPASS I and COMPASS II) (n = 3177), we examined changes over approximately a 1-year period in discrimination experiences attributable to being AAPI and factors associated with worse mental health outcomes.

RESULTS

Experiences of discrimination remained high in COMPASS II with 60.6% (of participants (compared to 60.2% among the same people in COMPASS I) reporting one or more discrimination experiences, and 28.6% reporting worse mental health outcomes. Experiences of discrimination were associated with modest but significant increase in the odds of worse mental health: adjusted OR 1.02 (95% CI 1.01-1.04). Being younger, being of Native Hawaiian/Pacific Islander or Hmong descent (relative to Asian Indian), and having spent 50% or less of their lifetime in the US (vs. US born), were significantly associated with worse mental health.

CONCLUSIONS

The fall-out from the pandemic continues to adversely impact AANHPI communities. These findings may help influence policy initiatives to mitigate its effects and support interventions designed to improve mental health outcomes.

Sociocultural factors associated with persistent prescription opioid use (PPOU) among Puerto Rican adults in Massachusetts

BACKGROUND

Increasing numbers of opioid-overdose deaths have been witnessed among Hispanics and other underserved populations in Massachusetts. Puerto Rican adults (PRs) have a disproportionately higher prevalence of chronic diseases than non-Hispanic White adults-conditions linked to increased prescription opioid use and misuse. Stress indicators, including low acculturation, low social support, and perceived discrimination, have been recognized as correlates of chronic diseases. However, little research has been undertaken on how these socio-cultural factors relate to persistent prescription opioid use among PRs. This study evaluated the prevalence of prescription opioid use and socio-cultural factors associated with persistent prescription opioid use among PRs.

METHODS

Data from the prospective population-based Boston Puerto Rican Health Study, at baseline, ~2-year, and ~ 6-year follow-up, were used to estimate prescription opioid use prevalence and its associations with acculturation, social support, and perceived discrimination. Analyses were conducted using multivariable binary logistic regression modeling.

RESULTS

The study sample was comprised of 798 PRs (age 56.5 ± 7.5y) with data at all three-time points. A high prevalence of prescription opioid use was observed and was associated with lower household income. PRs with experiences of perceived discrimination had higher odds of persistent prescription opioid use (y/n; OR = 2.85, 95% CI: 1.46-5.58). No significant associations were found between acculturation, social support, and persistent prescription opioid use.

CONCLUSION

Our study reported a high prevalence of prescription opioid use in PRs, with persistent prescription opioid use significantly associated with perceived discrimination. Future programs to limit discrimination practices may reduce persistent prescription opioid use and opioid-related complications among PRs.

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BACKGROUND

The Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.

METHODS

This was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.

RESULTS

In the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).

CONCLUSION

This study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways.

A Culturally Adapted Breast and Cervical Cancer Screening Intervention Among Muslim Women in New York City: Results from the MARHABA Trial

We examine the efficacy of MARHABA, a social marketing-informed, lay health worker (LHW) intervention with patient navigation (PN), to increase breast and cervical cancer screening among Muslim women in New York City. Muslim women were eligible if they were overdue for a mammogram and/or a Pap test. All participants attended a 1-h educational seminar with distribution of small media health education materials, after which randomization occurred. Women in the Education + Media + PN arm received planned follow-ups from a LHW. Women in the Education + Media arm received no further contact. A total of 428 women were randomized into the intervention (214 into each arm). Between baseline and 4-month follow-up, mammogram screening increased from 16.0 to 49.0% in the Education + Media + PN arm (p < 0.001), and from 14.7 to 44.6% in the Education + Media arm (p < 0.001). Pap test screening increased from 16.9 to 42.3% in the Education + Media + PN arm (p < 0.001) and from 17.3 to 37.1% in the Education + Media arm (p < 0.001). Cancer screening knowledge increased in both groups. Between group differences were not statistically significant for screening and knowledge outcomes. A longer follow-up period may have resulted in a greater proportion of up-to-date screenings, given that many women had not yet received their scheduled screenings. Findings suggest that the educational session and small media materials were perhaps sufficient to increase breast and cervical cancer screening among Muslim American women. ClinicalTrials.gov NCT03081507.

Investigating gender-based differential item functioning on the Kansas City Cardiomyopathy Questionnaire (KCCQ) using qualitative content analysis

PURPOSE

The purpose of this study is to evaluate potential gender-based differences in interpreting the Kansas City Cardiomyopathy Questionnaire (KCCQ-23) and to explore if there are aspects of health-related quality of life (HRQOL) not captured by the KCCQ-23 that are important to assess in men and/or women with heart failure (HF).

METHODS

Patients ≥ 22 years of age with clinician-diagnosed HF and left ventricular ejection fraction ≤ 40% were recruited from two academic medical centers to participate in semi-structured concept elicitation and cognitive debriefing interviews. Enrollment was stratified by patient-identified gender (half women/half men). All interviews were conducted over the phone/web and audio recorded. Interviews were transcribed and descriptive qualitative content analysis was used to summarize findings overall and by gender.

RESULTS

Twenty-five adults (56% women) diagnosed with HF participated. The average age was 67 years (range: 25-88). Women attributed a wider variety of symptoms to HF than men. Some participants had difficulty differentiating whether their experiences were due to HF, side effects of their medications, or age. We found very little evidence that participants interpreted KCCQ-23 items differently based on gender.

CONCLUSIONS

Overall, our findings indicate that interpretation of the KCCQ-23 items were similar in men and women. However, some modifications to items may improve clarity of interpretation for a wide range of patients.

Translation and Validation of the Pancreatic Cancer Disease Impact Score for Chinese Patients with Pancreatic Cancer：a Methodological and Cross-sectional Study

Objective

We aimed to establish and validate the Chinese version of the Pancreatic Cancer Disease Impact (C-PACADI) score for Chinese patients with pancreatic cancer (PC).

Methods

This was a methodological and cross-sectional study. We established the C-PACADI score following Beaton's translation guidelines and then included 209 patients with PC to evaluate C-PACADI's reliability and validity.

Results

The Cronbach's alpha coefficient of the C-PACADI score was 0.822. The correlation coefficient between "skin itchiness" score and the total score was 0.224, while the correlation coefficients ranged from 0.515 to 0.688 (P ​< ​0.001) for all the other items. The item content validity index and the scale content validity index, evaluated by eight experts were 0.875 and 0.98, respectively. Regarding concurrent validity, the total score of the C-PACADI score was moderately correlated with the EuroQol-5D (EQ-5D) index and the EQ-5D VAS score (r ​= ​-0.738, P ​< ​0.01; r ​= ​-0.667, P ​< ​0.01, respectively); the individual-item scores of C-PACADI on pain/discomfort, anxiety, loss of appetite, fatigue, and nausea were strongly associated with the corresponding symptoms of the Edmonton Symptom Assessment System scale (r ranged from 0.879 to 0.916, P ​< ​0.01). The known-group validity was demonstrated by C-PACADI's ability to detect significant symptom differences between groups stratified by treatment modalities (P ​< ​0.05) and health status (P ​< ​0.001).

Conclusions

The C-PACADI score is a suitable disease-specific tool for measuring the prevalence and severity of multiple symptoms in the Chinese population with PC.

Do PRO Measures Function the Same Way for all Individuals With Heart Failure?

Women diagnosed with heart failure report worse quality of life than men on patient-reported outcome (PRO) measures. An inherent assumption of PRO measures in heart failure is that women and men interpret questions about quality of life the same way. If this is not the case, the risk then becomes that the PRO scores cannot be used for valid comparison or to combine outcomes by subgroups of the population. Inability to compare subgroups validly is a broad issue and has implications for clinical trials, and it also has specific and important implications for identifying and beginning to address health inequities. We describe this threat to validity (the psychometric term is differential item functioning), why it is so important in heart-failure outcomes, the research that has been conducted thus far in this area, the gaps that remain, and what we can do to avoid this threat to validity. PROs bring unique information to clinical decision making, and the validity of PRO measures is key to interpreting differences in heart failure outcomes.

Discrimination, Sexual Violence, Depression, Post-traumatic Stress Disorder, and Social Support among Black Women

BACKGROUND

Black Americans face significant discrimination associated with mental health disorder, which may be exacerbated among sexually victimized people. Social support may buffer that relationship.

METHODS

Cross-sectional data from a retrospective cohort study were analyzed to examine if discrimination and sexual victimization overlap to exacerbate symptoms of depression and post-traumatic stress disorder (PTSD) and to determine the extent to which social support moderated that association among Black women living in Baltimore, Maryland [138 non-abused (no physical/sexual victimization) and 98 abused (sexually victimized) since age 18].

RESULTS

Symptoms of depression and PTSD were independently associated with discrimination. Multilinear regression showed social support from friends moderated the association between discrimination and depressive symptoms among sexually abused participants only.

CONCLUSION

Discrimination may exacerbate symptoms of depression and PTSD more for sexually victimized Black women, but sources of informal social support may attenuate adverse effects of discrimination on depressive symptoms among members of that group.

Cross-cultural adaptation of discrimination and vigilance scales in ELSA-Brasil

OBJECTIVE

To describe the process of cross-cultural adaptation for the use in Brazil of the everyday discrimination scale (EDS) and the heightened vigilance scale (HVS) applied in the Longitudinal Study of Adult Health (ELSA-Brasil).

METHODS

Conceptual, item and semantic equivalence analyses were conducted by a group of four epidemiologists; evaluation of measurement equivalence (factorial analysis of configural, metric and scalar structures, according to sociodemographic characteristics) and reliability. A total of 11,987 participants responded to the discrimination scale, and a subsample of 260 people participated in the test-retest study. In the case of HVS, 8,916 people responded, while 149 individuals did so in the test-retest study.

RESULTS

The scales presented conceptual, item and semantic equivalence pertinent in the Brazilian context, in addition to adequate correspondence of referential/denotative meaning of terms and also of the general/connotative of the items. The confirmatory factor analysis of EDS revealed a unidimensional structure, with residual correlations between two pairs of items, presenting configural and metric invariance among the four subgroups evaluated. Scalar invariance was identified according to sex and age group, but it was not observed for race/color and education. Heightened vigilance showed low loads and high residuals, with inadequate adjustment indicators. For the items of the discrimination scale the weighted kappa coefficient (Kp) ranged from 0.44 to 0.78, and the intraclass correlation coefficient (ICC) was 0.87. For HVS items, the Kp ranged from 0.47 to 0.59 and the ICC was 0.83.

CONCLUSIONS

Although there are correlated items, it was concluded that the EDS is a promising scale to evaluate experiences of perceived discrimination in Brazilian daily life. However, the heightened vigilance scale did not present equivalence of measurement in the current format.

Analysis of the social consequences and value implications of the Everyday Discrimination Scale (EDS): implications for measurement of discrimination in health research

The Everyday Discrimination Scale (EDS) is one of the most widely used measures of discrimination in health research, and has been useful for capturing the impact of discrimination on health. However, psychometric analysis of this measure has been predominantly among Black Americans, with limited examination of its effectiveness in capturing discrimination against other social groups. This paper explores the theoretical and historical foundations of the EDS, and draws on the analytic framework of Messick's theory of unified validity to examine the effectiveness of the EDS in capturing diverse experiences of discrimination. Encompassing both social consequences and value implications, Messick's unified validity contends that psychometric evaluation alone is insufficient to justify instrument use or ensure social resonance of findings. We argue that despite the robust psychometric properties and utility in addressing anti-Black race-related discrimination, the theoretical foundations and research use of the EDS have yet to respond to current discrimination theory, particularly intersectionality. This paper concludes with guidance for researchers in using the EDS in health research across diverse populations, including in data collection, analysis, and presentation of findings.

Mixed-methods analysis of select issues reported in the 2016 World Health Organization verbal autopsy questionnaire

BACKGROUND

Use of a standardized verbal autopsy (VA) questionnaire, such as the World Health Organization (WHO) instrument, can improve the consistency and reliability of the data it collects. Systematically revising a questionnaire, however, requires evidence about the performance of its questions. The purpose of this investigation was to use a mixed methods approach to evaluate the performance of questions related to 14 previously reported issues in the 2016 version of the WHO questionnaire, where there were concerns of potential confusion, redundancy, or inability of the respondent to answer the question. The results from this mixed methods analysis are discussed across common themes that may have contributed to the underperformance of questions and have been compiled to inform decisions around the revision of the current VA instrument.

METHODS

Quantitative analysis of 19,150 VAs for neonates, children, and adults from five project teams implementing VAs predominately in Sub-Saharan Africa included frequency distributions and cross-tabulations to evaluate response patterns among related questions. The association of respondent characteristics and response patterns was evaluated using prevalence ratios. Qualitative analysis included results from cognitive interviewing, an approach that provides a detailed understanding of the meanings and processes that respondents use to answer interview questions. Cognitive interviews were conducted among 149 participants in Morocco and Zambia. Findings from the qualitative and quantitative analyses were triangulated to identify common themes.

RESULTS

Four broad themes contributing to the underperformance or redundancy within the instrument were identified: question sequence, overlap within the question series, questions outside the frame of reference of the respondent, and questions needing clarification. The series of questions associated with one of the 14 identified issues (the series of questions on injuries) related to question sequence; seven (tobacco use, sores, breast swelling, abdominal problem, vomiting, vaccination, and baby size) demonstrated similar response patterns among questions within each series capturing overlapping information. Respondent characteristics, including relationship to the deceased and whether or not the respondent lived with the deceased, were associated with differing frequencies of non-substantive responses in three question series (female health related issues, tobacco use, and baby size). An inconsistent understanding of related constructs was observed between questions related to sores/ulcers, birth weight/baby size, and diagnosis of dementia/presence of mental confusion. An incorrect association of the intended construct with that which was interpreted by the respondent was observed in the medical diagnosis question series.

CONCLUSIONS

In this mixed methods analysis, we identified series of questions which could be shortened through elimination of redundancy, series of questions requiring clarification due to unclear constructs, and the impact of respondent characteristics on the quality of responses. These changes can lead to a better understanding of the question constructs by the respondents, increase the acceptance of the tool, and improve the overall accuracy of the VA instrument.

Discrimination Experiences during COVID-19 among a National, Multi-Lingual, Community-Based Sample of Asian Americans and Pacific Islanders: COMPASS Findings

Reports of escalated discrimination among Asian Americans and Pacific Islanders (AAPIs) due to COVID-19 are alarming, making this a public health priority. However, there are limited empirical studies on the scope and impact of COVID-19-related discrimination among AAPIs. Using the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) data (N = 4971; survey period: October 2020-February 2021), which is a U.S.-wide multi-lingual survey, we examined the prevalence of, and factors associated with discrimination experiences attributable to being an AAPI during the COVID-19 pandemic. Overall, 60.7% reported experiencing discrimination; the group prevalence ranged from 80.0% (Hmong) to 40.5% (Native Hawaiians and Pacific Islanders). Multivariable logistic regression models revealed that COVID-19-related factors were associated with many discrimination experiences: having a shelter-in-place order of ≥1 month, living in areas with perceived similar/higher COVID-19 severity, and negative impact in family income/employment due to COVID-19. Additionally, being Asian American (versus Native Hawaiians and Pacific Islanders), females, non-heterosexuals, younger, more severe effect on family income, living in the non-West, and poorer health were significantly correlated with discrimination experiences. Findings may assist in formulating anti-AAPI-discrimination policies and programs at the local, state, and federal levels. Culturally appropriate programs and policies to combat this are urgently needed.

Mother-Child Relationships in U.S. Latinx Families in Middle Childhood: Opportunities and Challenges in the 21st Century

The 21st century has brought unique opportunities and challenges for parents, and this is particularly true for Latinx families, whose children comprise more than one-fourth of the school-age population in the U.S. today. Taking an ecological and strengths-based approach, the current study examined the role of mothers' cultural assets (familism values, family cohesion) and challenges (economic hardship, ethnic-race-based discrimination) on children's educational adjustment in middle childhood, as well as the indirect role of mother-child warmth and conflict in these associations. The sample included 173 Latinx mothers and their middle childhood offspring (i.e., 5th graders and younger sisters/brothers in the 1st through 4th grade). Mothers participated in home visits and phone interviews and teachers provided ratings of children's educational adjustment (academic and socioemotional competence, aggressive/oppositional behaviors). Findings revealed family cohesion was indirectly linked to children's educational adjustment via mother-child warmth and conflict, particularly for younger siblings. Discussion focuses on the culturally based strengths of Latinx families and highlights potential implications for family-based prevention in middle childhood.

Discrimination as a Moderator of the Effects of Acculturation and Cultural Values on Mental Health Among Pregnant and Postpartum Latina Women

It is important to consider how identity, culture, and social adversity influence maternal mental health among Latina women both because this community faces unique cultural stressors and also because factors that undermine women's mental health during pregnancy and postpartum could have injurious consequences that cascade across generations. This study uses data from a questionnaire administered to Latina pregnant and postpartum women in Southern California, examining cultural orientation, discrimination, and mental health. Results demonstrate mental health benefits for both American and Latino cultural orientations, but the latter's benefit of lower anxiety was only apparent with high discrimination. American and Latino cultural values systems had opposite relationships with depression, with the latter protective and also positively associated with happiness. More traditional gender roles values were associated with greater perceived stress and lower happiness. Different aspects of familism had opposite effects as obligation was associated with less anxiety and referent (defining oneself communally with kin) with more. Results suggest that social adversity and cultural identity and values influence maternal psychology. This study makes a unique contribution by integrating anthropological and biopsychosocial methods and theories towards addressing an issue of public-health importance.

What do we measure when we measure perceptions of everyday discrimination?

RATIONALE

The Everyday Discrimination Scale forms the backbone of hundreds of studies documenting the health effects of perceived discrimination. Researchers regularly use the scale to examine specific types of discrimination (e.g., racial, ethnic, gender- and age-based) as well as discrimination more generally among the "general population." To date, no study has analyzed the frameworks respondents use to interpret and answer the questions that comprise the scale. As such, what exactly researchers are measuring when they ask about "everyday discrimination" - and how this may vary within and across social groups - remains unknown.

OBJECTIVE

This study analyzes data from cognitive interviews to assess patterns of interpretation and response to the EDS to assess whether the meaning of the resulting data may vary across diverse social groups.

METHODS

Researchers conducted structured cognitive interviews with a diverse sample of thirty-eight adults in the Southeastern United States (US). Interview transcripts were qualitatively analyzed using MAXQDA, in a process of reiterative coding.

RESULTS

Results show that respondents interpret the survey questions in markedly different ways, with some interpreting the scale as asking about negative interactions; others viewing it through a lens of social inequalities; and still others through a lens specifically of racism. Racial/ethnic and gender statuses may structure question interpretation.

CONCLUSIONS

Pronounced and patterned variation in respondents' interpretation raises questions about its validity. Findings underscore the importance of schemas for assessing the meaning of data generated by the EDS and for measuring the health effects of perceived discrimination and mistreatment.

The Influence of Distressed Coping on the Relationship between Perceived Racial Discrimination and Cannabis Use among Black College Students

Approximately one in five Black students report cannabis use, which is associated with academic challenges, mental health, and interpersonal problems. Understanding motivators to use cannabis among Black students at predominantly White institutions (PWIs) warrants more research. Perceived racial discrimination (PRD), believing one is treated unjustly due to race, is related to substance use and variables associated with poor coping, such as depression and anxiety. Given that research is unavailable for Black college students on the factor structure of the Everyday Discrimination Scale (EDS) using chronicity-based coding, the first aim of the study is to examine the factor structure of the chronicity-based version of the EDS. The second aim is to investigate whether distressed coping is an intervening construct between PRD and cannabis use among Black college students. Participants, recruited from a midwestern PWI (N = 119), completed the EDS, the coping subscale of the Comprehensive Marijuana Motivations Measure, and reported past-year cannabis use. Factor analysis examined the measurement model of the EDS, while path analysis assessed the mediation models. A two-factor model assessing subtle and blatant PRD on the EDS fit the data. The path analysis revealed that distressed coping fully mediated the relationship between subtle PRD and cannabis use. Distressed coping did not mediate the relation between blatant PRD and cannabis use. Institutions might focus on reducing PRD and provide support to Black students to lessen its link to distressed coping and cannabis use.

The cultural equivalence of measurement in substance use research

Across a wide range of substance use outcomes, ethnic/racial minorities in the U.S. experience a disproportionately higher burden of negative health outcomes and/or lower levels of access to care (relative to non-Latinx White individuals). Various explanations for these substance use-related health disparities have been proposed. This narrative review will not focus on the theoretical content of these explanations but will instead focus on the underlying statistical frameworks that are used to test such theories. Here, we provide a narrative review of psychometric critiques of cross-cultural research, which collectively suggest that (a) research testing similarities and differences among ethnic/racial groups often miss or omit to test statistical assumptions of equal instrument functioning across the ethnic/racial groups being compared; (b) testing the assumptions of equal instrument functioning is feasible using established guidelines from modern measurement theories; and (c) substance use research may need to explicitly incorporate the tests of equal instrument functioning to prevent bias when making inferences across ethnic/racial groups. We provide recommendations for evaluating the cultural equivalence of measurement using structural equation modeling, and advocate that cross-cultural substance use research move toward statistical approaches that are better positioned to test for (and model) bias in measurement. Explicitly testing the cultural equivalence of measurement when making inferences across cultural groups (within a falsifiable psychometric framework) can advance our understanding of similarities and differences among ethnic/racial groups, and hence can provide a more socially just (and statistically robust) scientific base. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mask-Wearing Behavior During the COVID-19 Pandemic: A Cross-Cultural Comparison Between the United States and South Korea

This study identified and compared factors that directly and indirectly influenced face mask-wearing in the United States and South Korea during the COVID-19 pandemic by applying the theory of reasoned action. The overall levels of attitudes and future mask-wearing behavioral intention were lower for United States than Korean participants (N _US = 150 and N _{South Korea} = 150). Differences between the groups were noted in the impact of norms and background characteristics on attitudes and behavioral intention. Messages communicating the importance of wearing masks should be tailored to different cultures. Americans should be encouraged to try wearing masks on their own while Koreans should hear about the social benefits of mask-wearing.

Advancing Intersectional Discrimination Measures for Health Disparities Research: Protocol for a Bilingual Mixed Methods Measurement Study

Background

Guided by intersectionality frameworks, researchers have documented health disparities at the intersection of multiple axes of social status and position, particularly race and ethnicity, gender, and sexual orientation. To advance from identifying to intervening in such intersectional health disparities, studies that examine the underlying mechanisms are required. Although much research demonstrates the negative health impacts of perceived discrimination along single axes, quantitative approaches to assessing the role of discrimination in generating intersectional health disparities remain in their infancy. Members of our team recently introduced the Intersectional Discrimination Index (InDI) to address this gap. The InDI comprises three measures of enacted (day-to-day and major) and anticipated discrimination. These attribution-free measures ask about experiences of mistreatment because of who you are. These measures show promise for intersectional health disparities research but require further validation across intersectional groups and languages. In addition, the proposal to remove attributions is controversial, and no direct comparison has ever been conducted.

Objective

This study aims to cognitively and psychometrically evaluate the InDI in English and Spanish and determine whether attributions should be included.

Methods

The study will draw on a preliminary validation data set and three original sequentially collected sources of data: qualitative cognitive interviews in English and Spanish with a sample purposively recruited across intersecting social status and position (gender, sexual orientation, race and ethnicity, socioeconomic status, age, and nativity); a Spanish quantitative survey (n=500; 250/500, 50% sexual and gender minorities); and an English quantitative survey (n=3000), with quota sampling by race and ethnicity (Black, Latino/a/x, and White), sexual or gender minority status, and gender.

Results

The study was funded by the National Institute on Minority Health and Health Disparities in May 2021, and data collection began in July 2021.

Conclusions

The key deliverables of the study will be bilingual measures of anticipated, day-to-day, and major discrimination validated for multiple health disparity populations using qualitative, quantitative, and mixed methods.

International Registered Report Identifier (IRRID)

PRR1-10.2196/30987

Feasibility and diagnostic accuracy of Telephone Administration of an adapted wound heaLing QuestiONnaire for assessment for surgical site infection following abdominal surgery in low and middle-income countries (TALON): protocol for a study within a trial (SWAT)

Background

Surgical site infection is the most common complication of abdominal surgery, with a global impact on patients and health systems. There are no tools to identify wound infection that are validated for use in the global setting. The overall aim of the study described in this protocol is to evaluate the feasibility and validity of a remote, digital pathway for wound assessment after hospital discharge for patients in low- and middle-income countries (LMICs).

Methods

A multi-centre, international, mixed-methods study within a trial, conducted in two stages (TALON-1 and TALON-2). TALON-1 will adapt and translate a universal reporter outcome measurement tool (Bluebelle Wound Healing Questionnaire, WHQ) for use in global surgical research (SWAT store registration: 126) that can be delivered over the telephone. TALON-2 will evaluate a remote wound assessment pathway (including trial retention) and validate the diagnostic accuracy of this adapted WHQ through a prospective cohort study embedded within two global surgery trials. Embedded community engagement and involvement activities will be used to optimise delivery and ensure culturally attuned conduct. TALON-1 and TALON-2 are designed and will be reported in accordance with best practice guidelines for adaptation and validation of outcome measures, and diagnostic test accuracy studies.

Discussion

Methods to identify surgical site infection after surgery for patients after hospital discharge have the potential to improve patient safety, trial retention, and research efficiency. TALON represents a large, pragmatic, international study co-designed and delivered with LMIC researchers and patients to address an important research gap in global surgery trial methodology.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05398-z.

Multilevel IRT analysis of the Everyday Discrimination Scale and the Racial/Ethnic Discrimination Index

Unfair treatment based on race is an unfortunate reality. While there is increasing interest in mapping the daily and longer-term impact of discrimination in psychology, studies that examine the psychometric properties of indicators spanning these timeframes are limited. Item response analysis examined the measurement characteristics of two daily measures of ethnic/racial discrimination: (a) the six-item Racial/Ethnic Discrimination Index (REDI), and (b) the modified five-item Everyday Discrimination Scale (EDS; Williams et al., Journal of Health Psychology, 1997, 2, 335). This study investigated whether the two scales can be appropriately adapted to access adolescents' daily-level ethnic/racial discrimination experiences. Both measures were administered for 14 consecutive days in a sample of 350 adolescents attending public schools in a large, urban area. Results suggest that the REDI has high loading and high difficulty. All REDI items functioned similarly at daily and person levels, suggesting that any single REDI item measured on a single day is sufficient for measuring daily ethnic/racial discrimination experiences. The EDS also shows high loading and high difficulty. However, EDS items functioned differently at the daily and person levels. REDI items were invariant across gender and race/ethnicity (African Americans, Asians, and Latinx). Recommendations for measuring daily ethnic/racial discrimination are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Chinese Consumers' Attitudes and Potential Acceptance toward Artificial Meat

The interest for artificial meat has recently expanded. However, from the literature, perception of artificial meat in China is not well known. A survey was thus carried out to investigate Chinese attitudes toward artificial meat. The answers of 4666 respondents concluded that 19.9% and 9.6% of them were definitely willing and unwilling to try artificial meat respectively, whereas 47.2% were not willing to eat it regularly, and 87.2% were willing to pay less for it compared to conventional meat. Finally, 52.9% of them will accept artificial meat as an alternative to conventional meat. Emotional resistance such as the perception of "absurdity or disgusting" would lead to no willingness to eat artificial meat regularly. The main concerns were related to safety and unnaturalness, but less to ethical and environmental issues as in Western countries. Nearly half of the respondents would like artificial meat to be safe, tasty, and nutritional. Whereas these expectations have low effects on willingness to try, they may induce consumers' rejection to eat artificial meat regularly, underlying the weak relationship between wishes to try and to eat regularly. Thus, potential acceptance of artificial meat in China depends on Chinese catering culture, perception of food and traditional philosophy.

Developing and validating measures of self-reported everyday and healthcare discrimination for Aboriginal and Torres Strait Islander adults

BACKGROUND

It is well established that racism is a fundamental contributor to poor health and inequities. There is consistent evidence of high exposure to discrimination among Aboriginal and Torres Strait Islander (Indigenous Australian) peoples, but impacts have not been fully quantified, in part due to limited measurement tools. We aim to validate instruments developed to measure interpersonal discrimination.

METHODS

Instruments were discussed at five focus groups and with experts, and field tested in developing Mayi Kuwayu: The National Study of Aboriginal and Torres Strait Islander Wellbeing. Data from 7501 baseline survey participants were analysed. Acceptability was assessed according to extent of missingness, construct validity using exploratory and confirmatory factor analysis, and reliability using Cronbach's alpha. Associations between each instrument and outcomes conceptually understood to be closely (community-level racism) or less closely (family wellbeing) related were quantified to test convergent and discriminant validity.

RESULTS

An 8-item instrument captures experiences of discrimination in everyday life and a 4-item instrument experiences in healthcare, each followed by a global attribution item. Item missingness was 2.2-3.7%. Half (55.4%) of participants reported experiencing any everyday discrimination, with 65.7% attributing the discrimination to Indigeneity; healthcare discrimination figures were 34.1% and 51.1%. Items were consistent with two distinct instruments, differentiating respondents with varying experiences of discrimination. Scales demonstrated very good reliability and convergent and divergent validity.

CONCLUSION

These brief instruments demonstrate face validity and robust psychometric properties in measuring Aboriginal and Torres Strait Islander adults' experiences of interpersonal discrimination in everyday life and in healthcare. They can be used to quantify population-level experiences of discrimination, and associated wellbeing consequences, and monitor change.

Social determinants of alcohol and cigarette use by race/ethnicity: Can we ignore measurement issues?

Psychometric critiques of cross-cultural research emphasize testing whether instruments measure the same construct across cultural groups. We tested for measurement invariance (by race/ethnicity) of instruments used to evaluate the relationship between alcohol and tobacco use with perceived discrimination and socioeconomic status (SES). Tests of psychometric equivalence across race/ethnicity focused on: the latent organization of constructs (configural invariance); if observed indicators have equal factor loadings or "true score" variance (metric invariance); and whether manifest indicators change uniformly contingent on change in the latent variable (scalar invariance). A cross-sectional survey of 2,376 cigarette smokers (794 Black, 786 Latinx, 796 White; mean age = 43 [SD = 12]; 58% female) was recruited via an online research panel. Discrimination was indicated by self-report; SES was indicated by self-reported education, employment, income, and the "SES Ladder;" alcohol use was indicated by frequency and typical quantity of drinking, and frequency of heavy drinking; tobacco use was indicated by frequency of smoking, cigarettes per smoking day, and time to first cigarette. All instruments demonstrated configural invariance; either full metric invariance (alcohol and discrimination) or partial metric invariance (tobacco and SES); and all constructs demonstrated partial scalar invariance. Results support psychometric critiques; for example, all of the SES indicators violated assumptions of classical measurement theory for valid between group comparisons. All of our instruments displayed some degree of systematic bias in measurement across race/ethnicity. Studies testing ethnic/racial differences may need to move beyond classical measurement theory, and may benefit from using statistical approaches that can test for (and model) bias in measurement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

An Arabic Translation, Reliability, Validity, and Feasibility of the Richards-Campbell Sleep Questionnaire for Sleep Quality Assessment in ICU: Prospective-Repeated Assessments

BACKGROUND AND PURPOSE

To translate Richards-Campbell Sleep Questionnaire (RCSQ) into the Arabic language (RCSQ-A), to assess content validity of the translated tool, to analyze the internal consistency, and to evaluate its feasibility.

METHODS

A rigorous translation was completed using the process of translation by World Health Organization. Cognitive debriefing interviews were performed. Repeated assessments using RCSQ-A was conducted in critical care patients in Saudi Arabia.

RESULT

Cronbach's alpha of .89 was seen in the RCSQ-A. The cognitive interviews showed that the RCSQ-A well understood and interpreted correctly and consistently. Fifty-seven participants reported their sleep using RCSQ-A a total of 110 times.

CONCLUSION

RCSQ-A has adequate translation validity, provided good internal consistency and content validity, making it suitable for use as a measurement tool in practice and research in Arabic-speaking countries.

What can we learn from open questions in surveys? A case study on non-voting reported in the 2013 German longitudinal election study

Open survey questions are often used to evaluate closed questions. However, they can fulfil this function only if there is a strong link between answers to open questions and answers to related closed questions. Using reasons for non-voting reported in the German Longitudinal Election Study 2013, we investigated this link by examining whether the reported reasons for non-voting may be substantive reasons or ex-post legitimations. We tested five theoretically derived hypotheses about respondents who gave, or did not give, a specific reason. Results showed that (a) answers to open questions were indeed related to answers to closed questions and could be used in explanatory turnout models to predict voting behavior, and (b) the relationship between answers to open and closed questions and the predictive power of reasons given in response to the open questions were stronger in the post-election survey (reported behavior) than in the pre-election survey (intended behavior).

Associations between perceived everyday discrimination, discrimination attributions, and binge eating among Latinas: results from the National Latino and Asian American Study

PURPOSE

The aim of the study was to quantify the association between perceived everyday discrimination and binge eating among Latinas in the United States.

METHODS

Participants included 1014 Latinas from the 2002-2003 National Latino and Asian American Study. Modified Poisson models with robust standard errors were used to estimate sociodemographic-adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) of binge eating associated with overall and attribution-specific discrimination.

RESULTS

Approximately 7% of Latinas reported binge eating. Increased frequency of discrimination was associated with a higher prevalence of binge eating (aPR, 1.59; 95% CI, 1.23-2.06), and Latinas reporting frequencies of discrimination in the top tertile had the greatest prevalence elevation (aPR, 3.63; 95% CI, 1.32-10.00). There were important differences by discrimination attribution: Latinas experiencing primarily height/weight-based or skin color-based discrimination had the greatest prevalence elevation relative to those reporting no discrimination (aPR, 10.24; 95% CI, 2.95-35.51; and aPR, 8.83; 95% CI, 2.08-37.54, respectively), whereas Latinas reporting primarily race-based discrimination had the lowest prevalence elevation (aPR, 1.64; 95% CI, 0.47-5.69).

CONCLUSIONS

Discrimination may be an important social determinant of Latinas' binge eating. Future research should incorporate expanded conceptual models that account for Latinas' complex social environment, focusing on intersecting dimensions of identity.

Psychometric Performance of the Arabic Versions of the Cancer Behavior Inventory-Brief and the Functional Assessment of Cancer Therapy-Breast

BACKGROUND

Valid and reliable instruments in Arabic are needed to measure self-efficacy and quality of life for Arabic patients with cancer.

OBJECTIVE

The aim of this study was to test the psychometric performance of the Cancer Behavior Inventory-Brief Arabic (CBI-BA), including participant understanding of items, and the Functional Assessment of Cancer Therapy-Breast Arabic (FACT-BA).

METHODS

Using a cross-sectional design, 438 cancer patients completed the CBI-BA, 30 of whom completed cognitive interviews. A subsample 167 women with breast cancer also completed the FACT-BA. Internal consistency evidence was assessed with Cronbach's α and construct validity with principal axis factoring.

RESULTS

Internal consistency estimates were acceptable for the total CBI-BA (α = .81) and FACT-BA (α = .88) scales. Exploratory factor analyses showed evidence of construct validity for the CBI-BA; 1 factor was derived, compared with four in the original English version. Cognitive interviews indicated satisfactory patient understanding of CBI-BA items. The Arabic version of the general FACT-General scale had 4 factors according to expectation.

CONCLUSION

The CBI-BA has adequate psychometric performance for the measurement of self-efficacy for coping with cancer in Arabic patients. The FACT-General Arabic has adequate evidence of reliability and validity for the measurement of quality of life in Arabic women with breast cancer.

IMPLICATIONS FOR PRACTICE

The availability of culturally sensitive and psychometrically sound instruments for Arabic patients diagnosed with cancer should be valuable for healthcare clinicians and researchers to assess self-efficacy for coping with cancer and quality of life.

Strategies for overcoming language barriers in research

AIM

This paper seeks to describe best practices for conducting cross-language research with individuals who have a language barrier.

DESIGN

Discussion paper.

DATA SOURCES

Research methods papers addressing cross-language research issues published between 2000-2017.

IMPLICATIONS FOR NURSING

Rigorous cross-language research involves the appropriate use of interpreters during the research process, systematic planning for how to address the language barrier between participant and researcher and the use of reliably and validly translated survey instruments (when applicable). Biases rooted in those who enter data into "big data" systems may influence data quality and analytic approaches in large observational studies focused on linking patient language preference to health outcomes.

CONCLUSION

Cross-language research methods can help ensure that those individuals with language barriers have their voices contributing to the evidence informing healthcare practice and policies that shape health services implementation and financing. Understanding the inherent conscious and unconscious biases of those conducting research with this population and how this may emerge in research studies is also an important part of producing rigorous, reliable, and valid cross-language research.

IMPACT

This study synthesized methodological recommendations for cross-language research studies with the goal to improve the quality of future research and expand the evidence-base for clinical practice. Clear methodological recommendations were generated that can improve research rigor and quality of cross-language qualitative and quantitative studies. The recommendations generated here have the potential to have an impact on the health and well-being of migrants around the world.

Measuring perceived mistreatment across diverse social groups: An evaluation of the Everyday Discrimination Scale

RATIONALE

Research assessing the health-related consequences of perceived discrimination depends upon high quality measures of perceived discrimination. The Everyday Discrimination Scale (EDS) is among the most frequently used instruments to assess perceptions of discrimination in general, as well as specific types of discrimination (e.g., based on race/ethnicity or age). While numerous studies attest to its validity and reliability for racial/ethnic minority groups, no existing study has examined its psychometric equivalence across gender, age, or socio-economic groups. This study fills this gap.

HYPOTHESIS

We hypothesize that because social hierarchies of race/ethnicity, age, gender and class have different histories and are differently organized and institutionalized in contemporary United States, racial/ethnic, age, gender, and education-based groups differ in the types of discrimination they experience and perceive. As a result, the EDS may not be equivalent across these social groups.

METHOD

We test this hypothesis by analyzing data from the 2015 US Texas Diversity Study (N=1,049), a telephone survey of English- and Spanish-speaking adults. We examine two forms of the EDS - one focusing on discrimination regardless of attribution and one focusing specifically on discrimination attributed to respondents' race/ethnicity.

RESULTS

Multi-group confirmatory factor analyses revealed that neither version of the scale generates estimates of discrimination that can be meaningfully compared across all racial/ethnic, age, gender, and education-based groups.

CONCLUSIONS

Our results urge caution when drawing comparisons of perceived discrimination across diverse social groups based on the EDS and point to avenues for future scale development.

Using Rasch analysis to investigate the validity of the Everyday Discrimination Scale in a national sample

The Everyday Discrimination Scale (EDS) is a widely used measure of discrimination. Rasch analysis was used to examine the psychometric properties of the EDS based on a national sample (N = 2666). Items largely fit the Rasch model and yielded excellent separation and item reliability. However, severe floor effects were observed. Implications are discussed for use of the scale in populations that experience low levels of discrimination. An ordinal-to-interval conversion table for the EDS is also provided.

It Weigh(t)s on You: Everyday Discrimination and Adiposity Among Latinos

OBJECTIVE

Evidence suggests discrimination increases the risk of obesity. The biopsychosocial model of racism posits that psychological factors such as depressive symptoms may link experiences of perceived interpersonal discrimination to obesity. This study tested whether self-reported experiences of everyday discrimination were associated with adiposity indicators and whether depressive symptoms explained these associations.

METHODS

Cross-sectional survey data of 602 Latino adults living in Lawrence, Massachusetts, from the Latino Health and Well-being Project (2011-2013) were used. Participants completed questionnaires assessing perceived everyday discrimination and depressive symptoms. Anthropometric measures (i.e., BMI and waist circumference [WC]) were obtained by trained staff. Structural equation modeling was employed to test for direct and indirect effects of perceived everyday discrimination on adiposity.

RESULTS

Perceived everyday discrimination was directly and positively associated with higher BMI and WC, independent of sociodemographic factors, physical activity, and stressful life events. Perceived everyday discrimination was not indirectly associated with BMI and WC through depressive symptoms. However, perceived everyday discrimination was associated with higher levels of depressive symptoms.

CONCLUSIONS

Self-reported everyday discrimination among Latino adults is associated with adiposity. Day-to-day interpersonal discrimination may be implicated in obesity disparities for Latino adults.

Chronic discrimination and bodily pain in a multiethnic cohort of midlife women in the Study of Women's Health Across the Nation

A growing literature links discrimination to key markers of biobehavioral health. While racial or ethnic differences in pain are seen in experimental and clinical studies, the authors were interested in how chronic discrimination contributes to pain within multiple racial or ethnic groups over time. Participants were 3056 African American, Caucasian, Chinese, Hispanic, and Japanese women from the Study of Women's Health Across the Nation. The Everyday Discrimination Scale was assessed from baseline through 13 follow-up examinations. The bodily pain subscale of the MOS 36-Item Short-Form Health Survey (SF-36) was assessed annually. There were large racial or ethnic differences in reports of discrimination and pain. Discrimination attributions also varied by race or ethnicity. In linear mixed model analyses, initially adjusted for age, education, and pain medications, chronic everyday discrimination was associated with more bodily pain in all ethnic groups (beta = -5.84; P < 0.002 for Japanese; beta = -6.17; P < 0.001 for African American; beta = -8.74; P < 0.001 for Chinese; beta = -10.54; P < 0.001 for Caucasians; beta = -12.82; P < 0.001 for Hispanic). Associations remained significant in all ethnic groups after adjusting for additional covariates in subsequent models until adding depressive symptoms as covariate; in the final fully-adjusted models, discrimination remained a significant predictor of pain for African American (beta = -4.50; P < 0.001), Chinese (beta = -6.62; P < 0.001), and Caucasian (beta = -7.86; P < 0.001) women. In this longitudinal study, experiences of everyday discrimination were strongly linked to reports of bodily pain for the majority of women. Further research is needed to determine if addressing psychosocial stressors, such as discrimination, with patients can enhance clinical management of pain symptoms.

Discrimination and Sleep Difficulties during Adolescence: The Mediating Roles of Loneliness and Perceived Stress

Irregular and insufficient sleep place youth at risk for adverse psychological and physical health outcomes. Recent research indicates that discrimination constitutes a type of stressor that interferes with adolescent sleep; however, the mechanisms through which discrimination affects sleep are not well understood. This study examined whether ethnic and non-ethnic (i.e., gender, age, and height/weight) discrimination were associated with adolescents' sleep duration, variability, and quality, and whether loneliness and perceived stress mediated these associations. An ethnically-diverse sample (42% Latino, 29% European American, 23% Asian) of adolescents (N = 316; M age = 16.40 years, 57% girls) reported on their experiences of discrimination, perceived stress, and loneliness. Sleep duration and variability were assessed by actigraphy and sleep quality through self-reports. Ethnic discrimination was related to shorter sleep duration and both ethnic and non-ethnic discrimination were associated with worse sleep quality. Loneliness and perceived stress partially mediated the relation between discrimination and sleep quality. Discriminatory experiences can heighten feelings of loneliness and stress, which, in turn, may contribute to diminished sleep quality during adolescence.

Reliability Estimates for the Arabic Versions of the Cancer Behavior Inventory-Brief and the Functional Assessment of Cancer Therapy-Breast

PURPOSE

The study aims were to (a) test reliability of the Arabic versions of the Cancer Behavior Inventory-Brief Arabic (CBI-BA) among patients diagnosed with any type of cancer and the Functional Assessment of Cancer Therapy-Breast (FACT-BA) in women with breast cancer and (b) assess participant understanding of CBI-BA items.

METHODS

A cross-sectional design was used to assess preliminary evidence for internal consistency reliability of the CBI-BA and the FACT-BA in a community-dwelling sample of Arabicspeaking persons diagnosed with cancer. Participants were randomly selected for cognitive interview.

RESULTS

Cronbach's alphas were ≥.76 for the CBI-BA, .91 for the FACT-BA, and .43-.89 for the FACT-BA subscales. Cognitive interviews revealed several CBI-BA items required revision.

CONCLUSION

The total CBI-BA and the FACT-BA scales have adequate internal consistency reliability estimates.

Racism as a Determinant of Health: A Systematic Review and Meta-Analysis

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.

Love, Trust, and HIV Risk Among Female Sex Workers and Their Intimate Male Partners

OBJECTIVES

We examined correlates of love and trust among female sex workers and their noncommercial male partners along the Mexico-US border.

METHODS

From 2011 to 2012, 322 partners in Tijuana and Ciudad Juárez, Mexico, completed assessments of love and trust. Cross-sectional dyadic regression analyses identified associations of relationship characteristics and HIV risk behaviors with love and trust.

RESULTS

Within 161 couples, love and trust scores were moderately high (median 70/95 and 29/40 points, respectively) and correlated with relationship satisfaction. In regression analyses of HIV risk factors, men and women who used methamphetamine reported lower love scores, whereas women who used heroin reported slightly higher love. In an alternate model, men with concurrent sexual partners had lower love scores. For both partners, relationship conflict was associated with lower trust.

CONCLUSIONS

Love and trust are associated with relationship quality, sexual risk, and drug use patterns that shape intimate partners' HIV risk. HIV interventions should consider the emotional quality of sex workers' intimate relationships.

Sources of Interactional Problems in a Survey of Racial/Ethnic Discrimination

Cross-cultural variability in respondent processing of survey questions may bias results from multiethnic samples. We analyzed behavior codes, which identify difficulties in the interactions of respondents and interviewers, from a discrimination module contained within a field test of the 2007 California Health Interview Survey. In all, 553 (English) telephone interviews yielded 13,999 interactions involving 22 items. Multilevel logistic regression modeling revealed that respondent age and several item characteristics (response format, customized questions, length, and first item with new response format), but not race/ethnicity, were associated with interactional problems. These findings suggest that item function within a multi-cultural, albeit English language, survey may be largely influenced by question features, as opposed to respondent characteristics such as race/ethnicity.

Associations between self-reported discrimination and diurnal cortisol rhythms among young adults: The moderating role of racial-ethnic minority status

Discrimination is theorized to set in motion a neuroendocrine response, which includes cortisol secretion from the hypothalamic-pituitary-adrenal axis. Repeated exposure to perceived discrimination is thought to contribute to alterations in diurnal cortisol rhythms and to have implications for health. Discrimination may have particularly strong effects on racial/ethnic minority individuals, based on histories of past exposure and/or greater perceived implications of discriminatory events. Utilizing an ethnically and racially diverse sample of young adults (N=140; Mage=22.8 years) and a multiple-day naturalistic cortisol protocol, the present study examined associations between self-reported discrimination and diurnal cortisol rhythms, and whether this relation was moderated by racial/ethnic minority status. Results revealed that self-reported discrimination predicted flatter diurnal cortisol slopes for racial/ethnic minority individuals only. These findings align with theory suggesting that discrimination experiences are important among racial/ethnic minorities.

Race/ethnicity and measurement equivalence of the Everyday Discrimination Scale

The present study examines the effect of race/ethnicity on measurement equivalence of the Everyday Discrimination Scale (EDS; Williams, Yu, Jackson, & Anderson, 1997). Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES; Alegría, Jackson, Kessler, & Takeuchi, 2008), adults aged 18 and older from four racial/ethnic groups were selected for analyses: 884 non-Hispanic Whites, 4,950 Blacks, 2,733 Hispanics/Latinos, and 2,089 Asians. Multiple-group confirmatory factor analyses were conducted. After adjusting for age and gender, the underlying construct of the EDS was invariant across four racial/ethnic groups, with Item 7 ("People act as if they're better than you are") associated with lower intercepts for the Hispanic/Latino and Asian groups relative to the non-Hispanic White and Black groups. In terms of latent factor differences, Blacks tended to score higher on the latent construct compared to other racial/ethnic groups, whereas Asians tended to score lower on the latent construct compared to Whites and Hispanics/Latinos. Findings suggest that although the EDS in general assesses the underlying construct of perceived discrimination equivalently across diverse racial/ethnic groups, caution is needed when Item 7 is used among Hispanics/Latinos or Asians. Implications are discussed in cultural and methodological contexts.

A multiple-group path analysis of the role of everyday discrimination on self-rated physical health among Latina/os in the USA

BACKGROUND

Few studies have examined the psychosocial mechanisms through which self-reported discrimination may influence the health status of Latinos.

PURPOSE

This study examined the mediating role of subjective social status in the USA and psychological distress on the relation between everyday discrimination and self-rated physical health, and the moderating role of gender and ethnicity.

METHODS

A US population-based sample of Latinos (N = 2,554) was drawn from the National Latino and Asian American Study. Respondents completed measures of everyday discrimination, subjective social status, psychological distress, and self-rated physical health.

RESULTS

Path analysis revealed that among the total sample, subjective social status and psychological distress sequentially mediated the effect of everyday discrimination on self-rated physical health. Psychological distress was a more consistent mediator across Latino subgroups. Gender and ethnicity moderated the mediation model.

CONCLUSIONS

This study provides a systematic examination of how psychosocial mechanisms may operate differently or similarly across Latino subgroups.

Everyday discrimination and chronic health conditions among Latinos: the moderating role of socioeconomic position

Emerging research has revealed that everyday discrimination and socioeconomic position may have synergistic effects on the health of racial/ethnic minorities. The present study examined the association between self-reported everyday discrimination and count of chronic health conditions, and explored the moderating role of objective and subjective socioeconomic position on the discrimination-health relation. We utilized nationally representative data of Latino adults (N = 2,554) from the National Latino and Asian American Study. Weighted negative binomial regression modeling was used to estimate the association between self-reported everyday discrimination and count of chronic health conditions, and to test whether this relation was modified by markers of socioeconomic position. Binomial regressions revealed that everyday discrimination was associated with a greater count of chronic conditions. However, moderation analyses indicated that household income moderated the discrimination-health relation, controlling for sociodemographic variables. More specifically, the adverse effects of discrimination were stronger for Latinos in middle-income tertiles compared to their lower income counterparts, such that as frequency of discrimination increased, Latinos with medium levels of household income were predicted to have greater counts of chronic conditions. This was only marginally significant among those in the high-income tertile. Our findings suggest that identifying segments of the Latino population that may be at greatest (and lowest) risk of ill health in the context of perceiving being discriminated against may prove useful for understanding Latino health "paradoxes," and may have implications for tailoring prevention and intervention efforts to particular segments of the Latino population.

A systematic review of studies examining the relationship between reported racism and health and wellbeing for children and young people

Racial discrimination is increasingly recognised as a determinant of racial and ethnic health inequalities, with growing evidence of strong associations between racial discrimination and adult health outcomes. There is a growing body of literature that considers the effects of racial discrimination on child and youth health. The aim of this paper is to provide a systematic review of studies that examine relationships between reported racial discrimination and child and youth health. We describe the characteristics of 121 studies identified by a comprehensive search strategy, including definitions and measurements of racial discrimination and the nature of reported associations. Most studies were published in the last seven years, used cross-sectional designs and were conducted in the United States with young people aged 12-18 years. African American, Latino/a, and Asian populations were most frequently included in these studies. Of the 461 associations examined in these studies, mental health outcomes (e.g. depression, anxiety) were most commonly reported, with statistically significant associations with racial discrimination found in 76% of outcomes examined. Statistically significant associations were also found for over 50% of associations between racial discrimination and positive mental health (e.g. self esteem, resilience), behaviour problems, wellbeing, and pregnancy/birth outcomes. The field is currently limited by a lack of longitudinal studies, limited psychometrically validated exposure instruments and poor conceptualisation and definition of racial discrimination. There is also a need to investigate the complex and varying pathways by which reported racial discrimination affect child and youth health. Ensuring study quality in this field will allow future research to reveal the complex role that racial discrimination plays as a determinant of child and youth health.

MEASURING EVERYDAY RACIAL/ETHNIC DISCRIMINATION IN HEALTH SURVEYS: How Best to Ask the Questions, in One or Two Stages, Across Multiple Racial/Ethnic Groups?

While it is clear that self-reported racial/ethnic discrimination is related to illness, there are challenges in measuring self-reported discrimination or unfair treatment. In the present study, we evaluate the psychometric properties of a self-reported instrument across racial/ ethnic groups in a population-based sample, and we test and interpret findings from applying two different widely-used approaches to asking about discrimination and unfair treatment. Even though we found that the subset of items we tested tap into a single underlying concept, we also found that different groups are more likely to report on different aspects of discrimination. Whether race is mentioned in the survey question affects both frequency and mean scores of reports of racial/ethnic discrimination. Our findings suggest caution to researchers when comparing studies that have used different approaches to measure racial/ethnic discrimination and allow us to suggest practical empirical guidelines for measuring and analyzing racial/ethnic discrimination. No less important, we have developed a self-reported measure of recent racial/ethnic discrimination that functions well in a range of different racial/ethnic groups and makes it possible to compare how racial/ethnic discrimination is associated with health disparities among multiple racial/ethnic groups.