Multiple forms of discrimination and inflammation in Black Americans: Are there differences by sex?

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.

Associations between multiple indicators of discrimination and allostatic load among middle-aged adults

The objective of this paper is to examine associations between multiple measures of discrimination (i.e., everyday, lifetime, and appraised burden) and components of allostatic load (AL). We drew on pooled cross-sectional data from the Biomarker Project of the Midlife in the United States study (n = 2118). Ages ranged from 25 to 84 years and included mostly Black (n = 389) and white (n = 1598) adults. Quasi-Poisson models were fit to estimate prevalence ratios for each discrimination measure and high-risk quartiles across seven physiological systems (i.e., sympathetic and parasympathetic nervous system; HPA axis; inflammation; cardiovascular; metabolic glucose; and metabolic lipids) and overall AL scores. In fully adjusted models, everyday discrimination was associated with elevated lipids (aPR: 1.07; 95% CI 1.01, 1.13). Lifetime experiences of discrimination were associated with lower sympathetic nervous system (aPR: 0.82; 95% CI: 0.69, 0.98) and greater cardiovascular risk scores (aPR: 1.17; 95% CI: 1.02, 1.34) among those reporting three or more experiences, as well as increased inflammation (aPR: 1.13; 95% CI: 1.02, 1.25; aPR: 1.28; 95% CI: 1.14, 1.43), metabolic glucose (aPR: 1.35; 95% CI: 1.19, 1.54; aPR: 1.45; 95% CI: 1.24, 1.68), and metabolic lipids (aPR: 1.13; 95% CI: 1.03, 1.24; aPR: 1.28; 95% CI: 1.15, 1.43) scores for those reporting one to two and three or more experiences. Appraised burden yielded nuanced associations with metabolic glucose and parasympathetic nervous system scores. Everyday and lifetime measures were also associated with higher overall AL, though burden of discrimination was only associated with AL among those reporting "a little" burden. While AL summary scores provide insight into the cumulative impacts of discrimination on health, there appear to be distinct physiologic pathways through which varying forms of discrimination contribute to AL and, ultimately, to poorer health. These unique pathways may be useful in identifying potential points of intervention to mitigate the impacts of discrimination on health inequities.

Exposure to negative stereotypes influences representations of monetary incentives in the nucleus accumbens

Contemporary society is saturated with negative representations of racial and ethnic minorities. Social science research finds that exposure to such negative stereotypes creates stress above and beyond pre-existing effects of income inequality and structural racism. Neuroscience studies in animals and humans show that life stress modulates brain responses to rewards. However, it is not known whether contending with negative representations of one’s social group spills overs to influence reward processing. We used functional magnetic resonance imaging to examine the effects of stigmatizing negative stereotypes on neural responding to the anticipation and consumption of monetary gains and losses in a Mexican American sample. Machine learning analyses indicated that incentive-related patterns of brain activity within the nucleus accumbens differed between Mexican Americans subjected to negative stereotypes and those who were not. This effect occurred for anticipating both gains and losses. Our work suggests that rhetoric stigmatizing Latinos and other minorities could alter how members of such groups process incentives in their environment. These findings contribute to our understanding of the linkage between stigmatizing experiences and motivated behavior, with implications for well-being and health.

Pathways from racial discrimination to cortisol/DHEA imbalance: protective role of religious involvement

Objective: Racial discrimination (RD) is hypothesized to dysregulate the production of stress reactive hormones among African Americans. Psychological processes that may mediate the association between RD and such dysregulation (e.g. cortisol/DHEA ratio) are not well articulated. Organizational religious involvement (ORI) has been discussed as a psychological protective factor within the context of RD, but our understanding of ORI as a physiological protective factor remains limited. We evaluated whether RD was directly and indirectly (through depressive symptoms) associated with an imbalance of cortisol and DHEA hormones, and whether ORI buffered these direct and/or indirect pathways.Design: Data were drawn from the Flint Adolescent Study, an ongoing interview study of youth that began in 1994. Participants were 188 African American emerging adults (47.3% Female, ages 20-22). We used mediation and moderated-mediation analyses, as outlined by Hayes [2012. PROCESS SPSS Macro. [Computer Software and Manual]. http://www.afhayes.com/public/process.pdf], to evaluate the study aims.Results: We found that depressive symptoms mediated the association between RD and the cortisol/DHEA ratio. We also found that depressive symptoms mediated the association between RD and the cortisol/DHEA ratio for individuals reporting low and moderate levels of ORI, but not at high levels.Conclusions: Our findings support the socio-psychobiological model of racism and health [Chae et al. 2011. "Conceptualizing Racial Disparities in Health: Advancement of a Socio-Psychobiological Approach." Du Bois Review: Social Science Research on Race 8 (1): 63-77. doi:10.1017/S1742058X11000166] and suggest that the psychological toll of RD can confer physiological consequences. Moreover, ORI may disrupt pathways from RD to cortisol/DHEA ratio by buffering the psychological toll of RD.

Does essentialism lead to racial prejudice? It is not so Black and White

Over half a century ago, psychologists hypothesized that social essentialism, an intuitive theory comprising the beliefs that social categories reflect naturally occurring distinctions and that category members share an underlying and fundamental essence, lays the foundation for prejudice. In the intervening decades, research has shown that although essentialism sometimes leads to prejudicial beliefs, attitudes, and behaviors, it does not always, sometimes even leading to decreased prejudice toward stigmatized groups. The relation between essentialism and prejudice is clearly complex, but this review proposes four questions that will help clarify how and when essentialism leads to prejudice: (1) What precisely is essentialism and how might a more nuanced understanding of its components and structure shed light on the mechanisms by which essentialist beliefs contribute to prejudice?; (2) Do essentialist beliefs orient group-based prejudice toward out-groups or toward stigmatized groups, and what are the consequences of essentialist beliefs among those with minoritized identities?; (3) Do essentialist beliefs engender group-based prejudice directly, or must essentialist beliefs interact with additional information or belief systems to lead to negative consequences?; and (4) Do essentialist beliefs lay a foundation for group-based prejudice to develop, or is essentialism strategically invoked to justify existing prejudice? By posing these questions, describing what is currently known about each, and proposing future lines of inquiry that focus on the importance of including participants from a diverse set of backgrounds and across developmental periods, this review aims to stimulate research studies best designed to fill the gaps in our knowledge. By understanding how and when essentialism contributes to prejudice, we will be better equipped to use this early-emerging, but malleable, aspect of cognition to decrease prejudice and create a more equitable society.

The Nature and Consequences of Essentialist Beliefs About Race in Early Childhood

It is widely believed that race divides the world into biologically distinct kinds of people-an essentialist belief inconsistent with reality. Essentialist views of race have been described as early emerging, but this study found that young children (n = 203, Mage  = 5.45) hold only the more limited belief that the physical feature of skin color is inherited and stable. Overall, children rejected the causal essentialist view that behavioral and psychological characteristics are constrained by an inherited racial essence. Although average levels of children's causal essentialist beliefs about race were low, variation in these beliefs was related to children's own group membership, exposure to diversity, as well as children's own social attitudes.

Students of color show health advantages when they attend schools that emphasize the value of diversity

As the United States becomes more diverse, the ways in which mainstream institutions recognize and address race and ethnicity will be increasingly important. Here, we show that one novel and salient characteristic of an institutional environment, that is, whether a school emphasizes the value of racial and ethnic diversity, predicts better cardiometabolic health among adolescents of color. Using a diverse sample of adolescents who attend more than 100 different schools in predominantly urban locations, we find that when schools emphasize the value of diversity (operationalized as mentioning diversity in their mission statements), students of color, but not white students, have lower values on a composite of five biomarkers of inflammation, have less insulin resistance and compensatory β-cell activity, and have fewer metabolic syndrome signs and score lower on a continuous metabolic syndrome composite. These results suggest that institutions that emphasize diversity may play an unacknowledged role in protecting the health of people of color and, thus, may be a site for future interventions to reduce health disparities.

Perceived discrimination and cardiovascular health disparities: a multisystem review and health neuroscience perspective

There are distinct racial disparities in cardiovascular disease (CVD) risk, with Black individuals at much greater risk than White individuals. Although many factors contribute to these disparities, recent attention has focused on the role of discrimination as a stress-related factor that contributes to racial disparities in CVD. As such, it is important to understand the mechanisms by which discrimination might affect CVD. Recent studies have examined these mechanisms by focusing on neurobiological mediators of CVD risk. Given this increase in studies, a systematic review of perceived discrimination and neurobiological mediators of CVD risk is warranted. Our review uses a multisystem approach to review studies on the relationship between perceived discrimination and (1) cardiovascular responses to stress, (2) hypothalamic-pituitary-adrenocortical axis function, and (3) the immune system, as well as (4) the brain systems thought to regulate these parameters of peripheral physiology. In addition to summarizing existing evidence, our review integrates these findings into a conceptual model describing multidirectional pathways linking perceived discrimination with a CVD risk.

Heart Rate Variability Moderates Challenge and Threat Reactivity to Sexism Among Women in STEM

Abstract. Using a biopsychosocial model of challenge and threat, we tested resting heart rate variability (HRV) as a moderator of physiological reactivity after experiencing sexism. Women science, technology, engineering, and mathematics (STEM) majors participated in a mock interview in which the male interviewer made a sexist or neutral comment. Resting HRV moderated physiological stress reactivity among women in the sexism condition, but not control, indicating lower resting HRV predicted greater physiological threat than challenge and higher resting HRV predicted greater physiological challenge than threat during the interview. These findings support the emotion regulation properties of HRV as applied to a biopsychosocial model of challenge and threat. Higher resting HRV may be adaptive for women experiencing sexism in male-dominated contexts like STEM.

Racial discrimination and cortisol output: A meta-analysis

RATIONALE

Although the relation between stress and physiology is well documented, attempts at understanding the link between racial discrimination and cortisol output, specifically, have produced mixed results, likely due to study characteristics such as racial/ethnic composition of the samples (e.g., African American, Latino), measures of discrimination, and research design (e.g., cross-sectional, experimental).

OBJECTIVES

To estimate the overall association between racial discrimination and cortisol output among racial/ethnic minority individuals and to determine if the association between racial discrimination and cortisol output is moderated by age, race/ethnicity, type of discrimination measure, sex, and research design.

RESULTS

Using a random effects model, the overall effect size based on k = 16 studies (19% unpublished) and N = 1506 participants was r¯ = 0.040, 95% CI = -0.038 to 0.117. Studies were conducted predominantly in the U.S. (81%). Notably, experimental studies (r¯ = 0.267) exhibited larger effect sizes compared to non-experimental studies (r¯ = -0.007). Age, race/ethnicity, type of discrimination measure, and sex did not moderate the effect sizes.

CONCLUSION

This meta-analysis provides evidence that the measurement of the association between racial discrimination and cortisol is complex, and it offers valuable insight regarding methods and designs that can inform future research on this topic. Limitations and future directions are discussed.

Essentialism promotes racial prejudice by increasing endorsement of social hierarchies

Why do essentialist beliefs promote prejudice? We proposed that essentialist beliefs increase prejudice toward Black people because they imply that existing social hierarchies reflect a naturally occurring structure. We tested this hypothesis in three studies (N = 621). Study 1 revealed that racial essentialism was associated with increased prejudice toward Blacks among both White and Black adult participants, suggesting that essentialism relates to prejudice according to social hierarchy rather than only to group membership. Studies 2 and 3 experimentally demonstrated that increasing essentialist beliefs induced stronger endorsement of social hierarchy in both Black and White participants, which in turn mediated the effect of essentialism on negative attitudes toward Black people. Together, these findings suggest that essentialism increases prejudice toward low status groups by increasing endorsement of social hierarchies and existing inequality.

Multicultural Developmental Experiences: Implications for Resilience in Transitional Age Youth

Transitional age youth were born into a world that is becomingly increasingly diverse. Youth who are ethnic or racial minorities encounter cultural stressors, including acculturative stress and discrimination that undermine their health and mental health. Decades of research demonstrate that cultural assets can serve as risk-reducing and resilience-enhancing mechanisms among minority and immigrant youth. Cultural assets include the development of a healthy ethnic-racial identity and maintenance of cultural values. Practitioners should assess for culturally relevant stressors and incorporate cultural assets such as ethnic-racial identity and cultural values to support the mental health of these youth.

Ethnically-Based Theme House Residency and Expected Discrimination Predict Downstream Markers of Inflammation Among College Students

We examined participation in an ethnically based residential program or “theme house” during the first year of college as a predictor of downstream immune system inflammation among undergraduates. Using a 4-year prospective design, we compared markers of inflammation among Latino/Latina students in a residential theme program with a matched sample of nonresidents. Students provided oral mucosal transudate samples for the assessment of circulating Interleukin 6 (IL-6), an inflammatory cytokine linked to health vulnerabilities. Findings suggest a protective benefit of theme house residency especially among students with anxious expectations of discrimination. Such expectations predicted higher levels of IL-6 after the first year of college among nonresidents only. In years 2–3, following exit from the theme house, the relationship between expected discrimination and IL-6 levels remained positive among nonresidents and was attenuated among residents, controlling for past IL-6 levels. Culturally based spaces may therefore offset the physiological burden of expected discrimination among undergraduates.

Minority stress and inflammatory mediators: covering moderates associations between perceived discrimination and salivary interleukin-6 in gay men

Physical health disparities by sexual orientation are widespread yet under-investigated. Drawing upon theories of biological embedding of social adversity, we tested whether minority stress (in the form of perceived discrimination) is associated with salivary interleukin-6 (IL-6), an inflammatory mediator. Furthermore, we examined whether covering, a strategy involving downplaying a stigmatized social identity, modified this association. A community sample (N = 99) of gay men (n = 78) and lesbian women (n = 21) completed self-report measures of minority stress and identity management and provided saliva samples which were assayed for IL-6. Among gay men, results from generalized linear models supported a hypothesized interaction between perceived discrimination and covering, such that perceived discrimination was predictive of higher levels of IL-6 for those who engaged in less covering but not for those who engaged in more covering. This interaction was robust to a number of potential covariates (alcohol, medication, body mass index, race and age). Results for lesbian women suggested a different pattern: the only statistically significant association detected was between greater perceived discrimination and lower levels of IL-6. Findings from the current study point to an important role for inflammatory processes in understanding and remediating health disparities based upon sexual orientation that stem from exposure to prejudice and discrimination.

Subtypes of depressive symptoms and inflammatory biomarkers: An exploratory study on a sample of HIV-positive patients

Depressive symptoms cause major impairment and may accelerate HIV progression despite the use of antiretroviral medication. The somatic symptoms criteria for HIV infection and depression partially overlap, which can make differential diagnosis challenging. Because of chronic inflammation caused by HIV infection, HIV-positive patients may develop somatic and affective-cognitive symptoms of depression. Inflammation-related depression is primarily characterized with severe somatic symptoms such as fatigue and sleep disturbance. This study sought to explore the patterns of somatic and cognitive-affective depressive symptoms that characterize HIV-positive patients. Our specific aims were (1) to identify subtypes of depressive symptoms in a sample of HIV-positive patients; and (2) to test the subtypes' difference on inflammatory and HIV disease progression biomarkers. HIV-positive men and women (N=102) with and without depressive symptoms were randomly selected from an Italian HIV clinic. Depressive symptoms (PHQ-9), viral load (VL), CD4+, Il-6, TNF-α, and monocytes were assessed. The three subtypes formed using Latent Class Analysis (LCA) identified patients with (1) severe cognitive-affective and somatic depressive symptoms; (2) severe/moderate somatic symptoms; and (3) absent or low depressive symptoms. The subtype with severe/moderate somatic symptoms was characterized with elevated levels of Il-6 and monocytes. No difference on HIV progression biomarkers was found. The subtypes of depressive symptoms might help differentiating depressive symptoms from HIV- and inflammatory-related somatic symptoms. When present, cognitive-affective and/or somatic symptoms cause significant impairment to patients' lives and thus warrant further assessment and treatment.

Is it always good to feel valued? The psychological benefits and costs of higher perceived status in one’s ethnic minority group

Two studies ( N = 1,048) examined how Blacks’, Asians’, and Latinos’ perceived value within their own ethnic group (ethnic intragroup status) shapes mental health (depression, anxiety, psychological distress). The proposed intragroup status and health (ISAH) model predicts that feeling valued among ethnic ingroup members has benefits for health, but also indirect costs. Costs arise because individuals who feel highly valued in their ethnic group see their ethnicity as more central to their self-concept; with stronger identity-centrality, individuals more frequently view daily social interactions through the “lens” of their ethnicity and ultimately perceive/experience more discrimination. Discrimination, in turn, adversely shapes mental health. Results of structural equation modeling supported these predictions across all groups in both studies. Thus, feeling valued in one’s minority group may be a double-edged sword for mental health. Overall, the ISAH model reveals how intragroup processes, when considered from an intergroup perspective, advance our understanding of minority mental health.

Racial discrimination predicts greater systemic inflammation in pregnant African American women

PURPOSE

Chronic exposure to racial discrimination by pregnant African American women may lead to allostatic overload; thereby, predisposing women to systemic inflammation. Thus, the goal of this study was to examine if experiences of racial discrimination are related to systemic inflammation in pregnant African Americans.

METHODS

A sample of 96 African American women from Chicago completed questionnaires and had blood drawn during the second trimester of pregnancy (19.7±2.5 weeks).

RESULTS

Experiences of racial discrimination were associated with higher cytokine levels of interleukin (IL)-4 (B=2.161, 95% CI = 1.02-3.30, p<.001) and IL-6 (B=1.859, 95% CI=.61-3.11, p=.004) when controlling for covariates.

CONCLUSION

These findings suggest that experiences of racial discrimination may cause physiological wear and tear on the body leading to alteration of immune functions. Nurses should inquire about women's experiences of racial discrimination and make referrals for community or church support groups for women who report racial discrimination.

Sources of Discrimination and Their Associations With Health in Sexual Minority Adults

Health disparities exist between sexual minorities and heterosexuals. These health disparities may be due to stressful social situations and environments that are created by discrimination. The current study recruited 277 sexual minorities to complete an online survey to examine the effects of discrimination on health. Discrimination from family and friends, compared to non-family and friends, was found to be more strongly associated with poorer health. This effect was partially statistically mediated by perceived stress reactivity. Findings from this study highlight the importance of distinguishing between different sources of discrimination when examining the effect of discrimination on health in sexual minority adults.

Perceived discrimination as a stressor for close relationships: identifying psychological and physiological pathways

Approaching the inverse association between perceived discrimination and close relationship functioning from a stress and coping framework, we propose and test a novel model incorporating psychological (emotion dysregulation) and physiological (chronic inflammation) pathways. Analyses of data from a sample of African American participants (N = 592) enrolled in the Midlife in the United States (MIDUS) study revealed support for the proposed model. Specifically, results from structural equation modeling analyses showed that perceived discrimination was indirectly associated with increased emotion dysregulation (venting and denial) through stressor appraisals and directly associated with increased inflammation (interluekin-6, e-selectin and c-reactive protein). Furthermore, relationship strain with family, friends and spouses was associated with greater levels of emotion dysregulation and chronic inflammation. Overall, the proposed model fit the data well and provides support for new avenues of research on the social, psychological and physiological correlates of perceived discrimination and close relationship functioning. To conclude, evidence for the proposed biopsychosocial model is summarized and directions for future research on these topics are discussed.

Performance and Inflammation Outcomes are Predicted by Different Facets of SES Under Stereotype Threat

We experimentally tested whether negative stereotypes linked to lower socioeconomic status (SES), in addition to impairing academic performance (Croizet & Claire, 1998), instigate inflammation processes that are implicated in numerous disease processes. In Study 1, verbal test performance and activation of inflammation processes (measured by levels of an inflammatory protein, Interleukin-6 [IL-6]) varied as a function of SES and test framing (i.e., diagnostic vs. nondiagnostic of intellectual ability), with low SES students underperforming and exhibiting greater IL-6 production in the “diagnostic” condition. In Study 2, students expected their verbal exam performance to be compared to peers of higher or lower SES. Low SES students in the upward comparison condition displayed the greatest inflammatory response and worst test performance. Across both studies, different facets of SES predicted vulnerability to negative outcomes, such that low early life SES predicted heightened inflammation responses, while low current SES predicted impaired academic performance.