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Choi KR, Bravo L, La Charite J, Cardona E, Elliott T, James KF, Wisk LE, Dunn EC, Saadi A. Associations between Positive Childhood Experiences (PCEs), Discrimination, and Internalizing/Externalizing in Pre-Adolescents. Acad Pediatr 2024:S1876-2859(24)00275-4. [PMID: 39004299 DOI: 10.1016/j.acap.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE This study aimed to investigate the relationships between four types of perceived discrimination (based on race and ethnicity, nationality/country of origin, gender identity, weight/body size), individually and cumulatively; positive childhood experiences (PCEs); and behavioral symptoms among pre-adolescent youth. METHODS This study was a secondary analysis of data from the Adolescent Brain Cognitive Development (ABCD) Study, a US-based cohort study of pre-adolescent youth in the United States (N = 10,915). Our outcome was emotional/behavioral symptoms measured by the Child Behavior Checklist. Primary exposures were four types of discrimination, a count of 0-5 PCEs, and other adverse childhood experiences (ACEs). Multiple logistic regression models were used to estimate the relationship between perceived discrimination and clinical-range behavioral symptoms, including the role of PCEs and ACEs. RESULTS Weight discrimination was the most frequent exposure (n = 643, 5.9%). Race and weight perceived discrimination were associated with clinical-range externalizing and internalizing symptoms, respectively, but these associations were non significant once other ACEs were added to models. Cumulative discrimination was associated with clinical-range Child Behavior Checklist (CBCL) scores, even when accounting for other ACEs (aOR=1.47, 95% CI=1.2-1.8). PCEs slightly reduced the strength of this relationship and were independently associated with reduced symptoms (aOR=0.82, 95% CI=0.72-0.93). CONCLUSIONS Results of this national study suggest cumulative discrimination can exert emotional/behavioral health harm among youth. PCEs were independently associated with reduced behavioral symptoms. There is a need for further research on how to prevent discrimination and bolster PCEs by targeting upstream social inequities in communities.
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Affiliation(s)
- Kristen R Choi
- School of Nursing (KR Choi and E Cardona), UCLA, Los Angeles, Calif; Department of Health Policy and Management (KR Choi, J La Charite, and LE Wisk), Fielding School of Public Health, Los Angeles, Calif.
| | - Lilian Bravo
- National Clinician Scholars Program (L Bravo and T Elliott), Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, Calif
| | - Jaime La Charite
- Department of Health Policy and Management (KR Choi, J La Charite, and LE Wisk), Fielding School of Public Health, Los Angeles, Calif
| | | | - Thomas Elliott
- National Clinician Scholars Program (L Bravo and T Elliott), Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, Calif
| | | | - Lauren E Wisk
- Department of Health Policy and Management (KR Choi, J La Charite, and LE Wisk), Fielding School of Public Health, Los Angeles, Calif; Division of General Internal Medicine & Health Services Research (LE Wisk), Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, Calif
| | - Erin C Dunn
- Psychiatric and Neurodevelopmental Genetics Unit (EC Dunn), Center for Genomic Medicine, Massachusetts General Hospital, Boston, Mass; Department of Psychiatry (EC Dunn), Harvard Medical School, Boston, Mass
| | - Altaf Saadi
- Harvard Medical School (A Saadi), Boston, Mass; Department of Neurology (A Saadi), Massachusetts General Hospital, Boston, Mass
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2
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Brandford A, Fernander A, Rayens MK. Reliability and Validity of the Perceived Racism Scale-Racism on the Job Subscale-in a Sample of Black Nurses. J Nurs Meas 2024; 32:157-164. [PMID: 38538042 DOI: 10.1891/jnm-2023-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Background and Purpose: We utilized the Perceived Racism Scale-Racism on the Job subscale-to assess how frequently Black nurses experienced racism on the job in the past year (ROTJ-Y) and throughout their lifetime (ROTJ-L). We aimed to assess the reliability and assess construct validity of each subscale in a sample of 53 nurses. Methods: Reliability was evaluated using coefficient alphas, item correlations, and interitem correlations. Construct validity was examined using exploratory factor analysis. Results: Results demonstrated that the subscales are reliable and valid. Coefficient alphas for the ROTJ-Y and ROTJ-L were .93 and .91, respectively. Exploratory factor analysis revealed a unidimensional factor for both subscales. Conclusion: This study demonstrated that the Racism on the Job subscales are psychometrically sound measures of workplace racism among Black nurses.
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Affiliation(s)
- Arica Brandford
- School of Nursing and Health Professions, Southern New Hampshire University, Manchester, NH, USA
| | - Anita Fernander
- Department of Family and Community Medicine, School of Medicine, University of New Mexico Health Sciences, Albuquerque, NM, USA
| | - Mary Kay Rayens
- School of Nursing, University of Kentucky, Lexington, KY, USA
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3
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Zvolensky MJ, Clausen BK, Shepherd JM, Redmond BY. Neighborhood Vigilance in Terms of Abstinence Expectancies for Smoking and Severity of Problems When Quitting. Subst Use Misuse 2024; 59:1495-1502. [PMID: 38831539 PMCID: PMC11225064 DOI: 10.1080/10826084.2024.2360092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Background: Although social determinants of health (SDoH) have increasingly been understood as clinically important factors in the onset, maintenance, and relapse of substance use behavior, little research has evaluated neighborhood vigilance in terms of smoking. Objectives: The present investigation sought to evaluate the role of neighborhood vigilance in terms of smoking abstinence expectancies (i.e., perceived consequences of refraining from smoking, including negative mood, somatic symptoms, harmful consequences, and positive consequences) and severity of problems when trying to quit among adults who smoke. Results: Participants included 93 treatment-seeking people who smoke (45.2 years of age and 29% identified as female). Results: indicated that greater levels of neighborhood vigilance were associated with negative mood and harmful consequences abstinence expectancies. No effect was evident for somatic symptom abstinence expectancies after Bonferroni correction. Conclusions: As expected, neighborhood vigilance was not predictive of positive abstinence expectancies, offering explanatory specificity. Neighborhood vigilance was also associated with more severe problems when trying to quit smoking. The current findings suggest neighborhood vigilance represents an important contextual factor involved in certain negative beliefs about abstinence and challenges in quitting.
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
| | - Bryce K. Clausen
- Department of Psychology, University of Houston, Houston, TX, USA
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4
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Bond C, Datta S, Milne WK. Hot off the press: Microaggressions in the emergency department. Acad Emerg Med 2024; 31:404-407. [PMID: 38465881 DOI: 10.1111/acem.14891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Affiliation(s)
| | - Suchisimita Datta
- NYU Grossman Long Island School of Medicine, New York, New York, USA
| | - William K Milne
- University of Western Ontario OH5, Goderich, Ontario, Canada
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Nie F. Asian Hate, religion, and perceived changes in physical health: exploring the flip side of minority stress during the COVID-19 pandemic. ETHNICITY & HEALTH 2024; 29:279-294. [PMID: 38332734 DOI: 10.1080/13557858.2024.2314593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Prior research suggests that racism is associated with adverse mental health outcomes for Asians in the United States. Relatively less research has been conducted to examine the effects of racism on physical health, particularly the changes in physical health among Asians and Asian Americans. This study aims to fill in this gap in prior research. DESIGN Survey was conducted via Qualtrics in March 2023. A panel sample of 356 Asian and Asian American adults from across the US was collected. Ordinary Least Squares Regression was employed to examine the interrelationships among racism, religion, and perceived changes in physical health during the COVID-19 pandemic. RESULTS Contrary to conventional wisdom, more frequent experience with blatant racism was associated with a perceived improvement in physical health after controlling for subtle racism, anxiety, acculturation, and various sociodemographic variables. Interestingly, this robust relationship was more significant among Asians who attended religious services more frequently. Additional three-way interactions revealed that the interaction between blatant racism and religious service attendance on perceived changes in physical health was more significant for US-born Asians and Asians of Indian or Japanese ethnicity. CONCLUSION Racism exerts a significant influence on physical health outcomes among Asians and Asian Americans. However, this relationship was contingent upon the specific aspect of racism and intersected with religiosity, acculturation, and ethnic identity.
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Affiliation(s)
- Fanhao Nie
- Department of Sociology, University of Massachusetts Lowell, Lowell, USA
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6
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Lui PP, Kamata A. Harmonizing Assessments of Everyday Racial Discrimination Experiences: The Multigroup Everyday Racial Discrimination Scale (MERDS). Assessment 2024; 31:397-417. [PMID: 37029544 DOI: 10.1177/10731911231162357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Reliable and valid assessment of direct racial discrimination experiences in everyday life is critical to understanding one key determinant of ethnoracial minority health and health disparities. To address psychometric limitations of existing instruments and to harmonize the assessment of everyday racial discrimination, the new Multigroup Everyday Racial Discrimination Scale (MERDS) was developed and validated. This investigation included 1,355 college and graduate students of color (Mage = 21.54, 56.0% women). Factor analyses were performed to provide evidence for structural validity of everyday racial discrimination scores. Item response theory modeling was used to investigate item difficulty relative to the level of everyday racial discrimination, and measurement error conditioned on the construct. MERDS scores were reliable, supported construct unidimensionality, and distinguished individuals who reported low to very high frequency of everyday racial discrimination. Results on the associations with racial identity and psychopathology symptoms, and utility of the scale are discussed.
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Affiliation(s)
- P Priscilla Lui
- Southern Methodist University, Dallas, TX, USA
- University of Washington, Seattle, USA
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Zvolensky MJ, Shepherd JM, Garey L, Woody M, Otto MW, Clausen B, Smit T, Mayorga NA, Bakhshaie J, Buitron V. Negative emotional reactivity to minority stress: measure development and testing. Cogn Behav Ther 2024; 53:1-28. [PMID: 37766610 PMCID: PMC10840979 DOI: 10.1080/16506073.2023.2260560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
The purpose of the present investigation was to develop and test a measure of negative emotional reactivity to racial/ethnic minoritized stress. In Study 1, we developed item content for a measure of negative emotional reactivity to racial/ethnic minoritized stress. We then evaluated item performance and produced a refined 15-item scale among a large sample of racial/ethnic minority adults (N = 1,343). Results supported a unidimensional construct and high levels of internal consistency. The factor structure and internal consistency were replicated and extended to a sample of Latinx persons who smoke (N = 338) in Study 2. There was evidence of convergent validity of the Emotional Reactivity to Minoritized Stress (ERMS) total score in terms of theoretically consistent and statistically significant relations with indices of mental health problems, social determinants of health, and substance use processes. There was also evidence that the ERMS demonstrated divergent validity in that it was negatively associated with psychological well-being, health literacy, subjective social status in Study 1, and positive abstinence expectancies in Study 2. Overall, the present study establishes the reliability and validity of measuring individual differences in negative emotional reactivity to racial/ethnic minority stress with the ERMS and that such responsivity is associated with behavioral health problems.
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
| | | | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
| | - Mary Woody
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael W. Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Bryce Clausen
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Victor Buitron
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Ryu S, Hirschtick JL, Allgood KL, Orellana R, Fleischer NL. Racial discrimination in healthcare settings and mental health among a population-based sample of racial and ethnic minoritized adults with COVID-19 in Michigan. Prev Med Rep 2023; 36:102529. [PMID: 38116267 PMCID: PMC10728443 DOI: 10.1016/j.pmedr.2023.102529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023] Open
Abstract
The COVID-19 pandemic has worsened existing racial health disparities and racial discrimination in healthcare; however, little is known about how racial discrimination in healthcare settings is related to mental health during the pandemic. Using a population-based probability sample of racial and ethnic minoritized adults with a polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection in Michigan, we examined how measures of perceived racial discrimination in (1) seeking healthcare for COVID-19 (n = 1,210) and (2) receiving testing/treatment for COVID-19 (n = 1,364) were associated with binary variables of depressive and anxiety symptoms. We conducted a modified Poisson regression analysis with robust standard errors to estimate associations between each measure of racial discrimination and each mental health outcome separately, adjusting for demographic and socio-economic variables, health insurance, and pre-existing physical and psychiatric conditions. 7.3 % and 8.7 % of adults reported racial discrimination in seeking healthcare for COVID-19 and in getting testing/treatment for COVID-19, respectively. Although the overall prevalence of racial discrimination in healthcare settings was low, experiences of racial discrimination were associated with depressive symptoms. Adults who experienced racial discrimination in seeking healthcare had 1.74 times higher prevalence of reporting depressive symptoms (95 % CI:1.21-2.52) than those who did not. Moreover, adults who experienced racial discrimination in getting testing/treatment had 1.86 times higher prevalence of reporting depressive symptoms (95 % CI:1.36-2.53) than those who did not. Neither measure of racial discrimination was associated with anxiety symptoms in the adjusted models. There is a need for promoting anti-racial discrimination policies, educational programs, and awareness efforts in healthcare settings.
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Affiliation(s)
- Soomin Ryu
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Jana L. Hirschtick
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Kristi L. Allgood
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, United States of America
| | - Robert Orellana
- CDC Foundation, Atlanta, GA, United States of America
- Michigan Department of Health and Human Services, Lansing MI, United States of America
| | - Nancy L. Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
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Punches BE, Osuji E, Bischof JJ, Li-Sauerwine S, Young H, Lyons MS, Southerland LT. Patient perceptions of microaggressions and discrimination toward patients during emergency department care. Acad Emerg Med 2023; 30:1192-1200. [PMID: 37335980 PMCID: PMC11075179 DOI: 10.1111/acem.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Disparities in emergency department (ED) care based on race and ethnicity have been demonstrated. Patient perceptions of emergency care can have broad impacts, including poor health outcomes. Our objective was to measure and explore patient experiences of microaggressions and discrimination during ED care. METHODS This mixed-methods study of adult patients from two urban academic EDs integrates quantitative discrimination measures and semistructured interviews of discrimination experiences during ED care. Participants completed demographic questionnaires and the Discrimination in Medical Settings (DMS) scale and were invited for a follow-up interview. Transcripts of recorded interviews were analyzed leveraging conventional content analysis with line-by-line coding for thematic descriptions. RESULTS The cohort included 52 participants, with 30 completing the interview. Nearly half the participants were Black (n = 24, 46.1%) and half were male (n = 26, 50%). "No" or "rare" experiences of discrimination during the ED visit were reported by 22/48 (46%), some/moderate discrimination by 19/48 (39%), and significant discrimination in 7/48 (15%). Five main themes were found: (1) clinician behaviors-communication and empathy, (2) emotional response to health care team actions, (3) perceived reasons for discrimination, (4) environmental pressures in the ED, and (5) patients are hesitant to complain. We found an emergent concept where persons with moderate/high DMS scores, in discussing instances of discrimination, frequently reflected on previous health care experiences rather than on their current ED visit. CONCLUSIONS Patients attributed microaggressions to many factors beyond race and gender, including age, socioeconomic status, and environmental pressures in the ED. Of those who endorsed moderate to significant discrimination via survey response during their recent ED visit, most described historical experiences of discrimination during their interview. Previous experiences of discrimination may have lasting effects on patient perceptions of current health care. System and clinician investment in patient rapport and satisfaction is important to prevent negative expectations for future encounters and counteract those already in place.
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Affiliation(s)
- Brittany E. Punches
- The Ohio State University College of Nursing, Columbus, Ohio, USA
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Evans Osuji
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jason J. Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Simiao Li-Sauerwine
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Henry Young
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael S. Lyons
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lauren T. Southerland
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Bohlouli S, Dolatabadi S, Bohlouli B, Amin M. Racial discrimination, self-efficacy, and oral health behaviours in adolescents. PLoS One 2023; 18:e0289783. [PMID: 37582117 PMCID: PMC10426965 DOI: 10.1371/journal.pone.0289783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/26/2023] [Indexed: 08/17/2023] Open
Abstract
To examine the mediation effect of discrimination on the association of self-efficacy and oral health behaviours among adolescents. A cross sectional study of adolescents aged 12 to 18 years who were recruited from the University outpatient dental clinic were asked to complete a questionnaire consisting of: demographics (12 items), oral health behaviours (7 items), general self-efficacy (10 items) and self-efficacy for self-care (SESS, 15 items). Perceived discrimination was assessed if the adolescent had ever been treated unfairly based on their race. Perceived discrimination was assessed if the adolescent had ever been treated unfairly based on their race. Using pathway analyses, the relationship between oral health behaviours, self-efficacy, and discrimination was explored. Mediation and hierarchal logistic regression analyses were conducted. Of 252 participants, mean (SD) age was 14 (1.8) years old. 60% were female, 81% were born in Canada, 56% identified themselves as White, and 20% perceived discrimination. Mean score of all task-specific self-efficacies were significantly different within respective oral health behaviour categories (P-value <0.001). Of demographics, age and ethnicity (White) were significantly associated with discrimination (OR = 1.25: 95% CI; 1.06-1.48 and OR = 0.29: 95% CI; 0.15-0.55, respectively). Perceived discrimination was positively associated with higher sugar consumption and mediate the association between diet self-efficacy and adolescent's dietary behaviour. Significant mediation effect of perceived discrimination on the association of diet specific self-efficacy and diet oral health behaviour was observed. Oral health behaviours were self-reported which may have influenced the results.
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Affiliation(s)
- Sanaz Bohlouli
- Department of Biological Sciences, University of Alberta, Edmonton, Canada
| | | | - Babak Bohlouli
- School of Dentistry, University of Alberta, Edmonton, Canada
| | - Maryam Amin
- School of Dentistry, University of Alberta, Edmonton, Canada
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Sturm ET, Thomas ML, Sares AG, Dave S, Baron D, Compton MT, Palmer BW, Jester DJ, Jeste DV. Review of Major Social Determinants of Health in Schizophrenia-Spectrum Disorders: II. Assessments. Schizophr Bull 2023; 49:851-866. [PMID: 37022911 PMCID: PMC10318889 DOI: 10.1093/schbul/sbad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND AND AIMS Social determinants of health (SDoHs) impact the development and course of schizophrenia-spectrum psychotic disorders (SSPDs). Yet, we found no published scholarly reviews of psychometric properties and pragmatic utility of SDoH assessments among people with SSPDs. We aim to review those aspects of SDoH assessments. STUDY DESIGN PsychInfo, PubMed, and Google Scholar databases were examined to obtain data on reliability, validity, administration process, strengths, and limitations of the measures for SDoHs identified in a paired scoping review. STUDY RESULTS SDoHs were assessed using different approaches including self-reports, interviews, rating scales, and review of public databases. Of the major SDoHs, early-life adversities, social disconnection, racism, social fragmentation, and food insecurity had measures with satisfactory psychometric properties. Internal consistency reliabilities-evaluated in the general population for 13 measures of early-life adversities, social disconnection, racism, social fragmentation, and food insecurity-ranged from poor to excellent (0.68-0.96). The number of items varied from 1 to more than 100 and administration time ranged from less than 5 minutes to over an hour. Measures of urbanicity, low socioeconomic status, immigration status, homelessness/housing instability, and incarceration were based on public records or targeted sampling. CONCLUSIONS Although the reported assessments of SDoHs show promise, there is a need to develop and test brief but validated screening measures suitable for clinical application. Novel assessment tools, including objective assessments at individual and community levels utilizing new technology, and sophisticated psychometric evaluations for reliability, validity, and sensitivity to change with effective interventions are recommended, and suggestions for training curricula are offered.
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Affiliation(s)
- Emily T Sturm
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Anastasia G Sares
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | | | - David Baron
- Western University of Health Sciences, CA, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center, San Diego, CA, USA
| | - Dylan J Jester
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, CA, USA (Retired)
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12
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Aguilar GA, Lundsberg LS, Stanwood NL, Gariepy AM. Exploratory study of race- or ethnicity-based discrimination among patients receiving procedural abortion care. Contraception 2023; 120:109949. [PMID: 36641096 DOI: 10.1016/j.contraception.2023.109949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Explore relationships of race and ethnicity with experiences of race- or ethnicity-based discrimination during abortion care. STUDY DESIGN English- or Spanish-speaking individuals aged 18 to 50 completed cross-sectional, self-administered online surveys within 30 days of procedural abortion at 5 Northeastern U.S. reproductive health clinics from June 2020 toFebruary 2021. We considered any affirmative response on the Discrimination in Medical Settings (DMS) scale evidence of race- or ethnicity-based discrimination. We performed bivariate analyses and logistic regression examining discrimination among Black non-Latinx, Latinx any race, Other race non-Latinx compared to White non-Latinx participants. We assessed associations between discrimination and healthcare quality and satisfaction. RESULTS Participants (n = 163) averaged 27(±6) years and self-identified as Black non-Latinx (36.2%), White non-Latinx (28.8%), Latinx of any race (27.0%), and Other non-Latinx (8.0%). Most were publicly insured (52.8%) and <14 weeks gestation (90.8%).Overall, 15.3% reported race- or ethnicity-based discrimination during abortion care with Black non-Latinx more likely to report discrimination (23.7%; OR 7.00, 95% CI 1.50-32.59), while Latinx any race (15.9%, OR 4.26, 95% CI 0.83-21.74) and Other race non-Latinx participants (15.4%, OR 4.09, 95% CI 0.52-32.35) demonstrated statistically nonsignificant trend toward increased odds of discrimination compared to White non-Latinx (4.3%). Discrimination was associated with negative perceptions of: time with physician (p = 0.03), patient care involvement (p < 0.05), physician communication (p = 0.01), care quality (p = 0.02), and care satisfaction (p < 0.01). CONCLUSION Racially minoritized participants were more likely to report race- or ethnicity-based discrimination during abortion care; Black non-Latinx reported highest odds of discrimination compared to White non-Latinx. Discrimination was associated with unfavorable healthcare quality measures. IMPLICATIONS Race- or ethnicity-based discrimination during abortion care is disproportionately reported by racially minoritized populations, especially Black individuals, compared to White non-Latinx individuals. Discrimination is significantly associated with negative experiences of care. Future work should verify findings in different regions and larger studies, and design and test discrimination-reduction interventions.
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Affiliation(s)
- Gabriela A Aguilar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States.
| | - Lisbet S Lundsberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Nancy L Stanwood
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Aileen M Gariepy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
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Akinade T, Kheyfets A, Piverger N, Layne TM, Howell EA, Janevic T. The influence of racial-ethnic discrimination on women's health care outcomes: A mixed methods systematic review. Soc Sci Med 2023; 316:114983. [PMID: 35534346 DOI: 10.1016/j.socscimed.2022.114983] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/29/2022] [Accepted: 04/15/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In the U.S, a wide body of evidence has documented significant racial-ethnic disparities in women's health, and growing attention has focused on discrimination in health care as an underlying cause. Yet, there are knowledge gaps on how experiences of racial-ethnic health care discrimination across the life course influence the health of women of color. Our objective was to summarize existing literature on the impact of racial-ethnic health care discrimination on health care outcomes for women of color to examine multiple health care areas encountered across the life course. METHODS We systematically searched three databases and conducted study screening, data extraction, and quality assessment. We included quantitative and qualitative peer-reviewed literature on racial-ethnic health care discrimination towards women of color, focusing on studies that measured patient-perceived discrimination or differential treatment resulting from implicit provider bias. Results were summarized through narrative synthesis. RESULTS In total, 84 articles were included spanning different health care domains, such as perinatal and cancer care. Qualitative studies demonstrated the existence of racial-ethnic discrimination across care domains. Most quantitative studies reported a mix of positive and null associations between discrimination and adverse health care outcomes, with variation by the type of health care outcome. For instance, over three-quarters of the studies exploring associations between discrimination/bias and health care-related behaviors or beliefs found significant associations, whereas around two-thirds of the studies on clinical interventions found no significant associations. CONCLUSIONS This review shows substantial evidence on the existence of racial-ethnic discrimination in health care and its impact on women of color in the U.S. However, the evidence on how this phenomenon influences health care outcomes varies in strength by the type of outcome investigated. High-quality, targeted research using validated measures that is grounded in theoretical frameworks on racism is needed. This systematic review was registered [PROSPERO ID: CRD42018105448].
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Affiliation(s)
- Temitope Akinade
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Anna Kheyfets
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Naissa Piverger
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Tracy M Layne
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Teresa Janevic
- Departments of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women's Health Research Institute, New York, NY, USA.
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14
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Degnan A, Berry K, Vaughan M, Crossley N, Edge D. Engagement with services in Black African and Caribbean people with psychosis: The role of social networks, illness perceptions, internalized stigma, and perceived discrimination. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1134-1153. [PMID: 35906819 PMCID: PMC9796907 DOI: 10.1111/bjc.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/24/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Research and policies in the United Kingdom have repeatedly highlighted the need to reduce ethnic disparities and improve engagement with mental health services among Black African and Caribbean people with psychosis. The aim of this study was to examine the role of social network characteristics and psychological factors in engagement with services in Black people with psychosis. METHODS A cross-sectional study was conducted with 51 Black African and Caribbean adults with non-affective psychosis and currently receiving care from mental health services in England. Measures were completed to examine relationships between social networks, illness perceptions, perceived racial or ethnic discrimination in services, internalized stigma, and current engagement with services from service user and staff perspectives. RESULTS Social network composition (ethnic homogeneity) moderately correlated with better service user and staff reported engagement. Greater perceived personal control over problems was associated with better staff reported engagement. Lower perceived ethnic or racial discrimination in services, and specific illness perceptions (higher perceived treatment control, greater self-identification with psychosis symptoms, more concern and greater emotional response related to problems) were associated with better service user reported engagement. Internalized stigma was not associated with service engagement. Multivariate regression analyses suggested that a more ethnically homogenous social network was the strongest predictor of better service user and staff reported engagement. CONCLUSIONS Psychosocial interventions that target social networks, perceived ethnic and racial discrimination in services, and illness perceptions may facilitate better engagement and improve outcomes. Further longitudinal studies are required to examine causal mechanisms.
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Affiliation(s)
- Amy Degnan
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Matthew Vaughan
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Nick Crossley
- School of Social SciencesThe University of ManchesterManchesterUK
| | - Dawn Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
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15
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Perceived racial discrimination and suicidal behaviors among racial and ethnic minority adolescents in the United States: Findings from the 2021 adolescent behaviors and experiences survey. Psychiatry Res 2022; 317:114877. [PMID: 36244159 DOI: 10.1016/j.psychres.2022.114877] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 01/05/2023]
Abstract
The objectives of this study were to investigate: (1) the prevalence of perceived racial discrimination (PRD) in school, among racial/ethnic minority adolescents, and (2) the association between PRD and suicidal behaviors among racial/ethnic minority adolescents in the United States. Data from a sample of 3241 racial/ethnic minority adolescents (53.7% female) from the 2021 Adolescent Behaviors and Experiences Survey were analyzed using binary logistic regression. Controlling for other factors, racial/ethnic minority adolescents who experienced PRD had 1.57 times higher odds of experiencing suicidal ideation (adjusted odds ratio (AOR) = 1.57, 95% Confidence Intervals (CI) = 1.09-2.25), 1.64 times higher odds of making a suicide plan (AOR = 1.64, 95% CI = 1.09-2.49), and 1.67 times higher odds of attempting suicide (AOR = 1.67, 95% CI = 1.04-2.68) during the past year. Other factors associated with suicidal behaviors included self-identifying as lesbian/gay, bisexual, or other/questioning; experiencing cyberbullying; feeling sad or hopeless; and poor mental health during the pandemic. The findings of this study extend past research and demonstrate that racial/ethnic minority adolescents who experienced PRD were more likely to report suicidal behaviors over and above other well-established risk factors for suicidal behaviors. Future studies that employ longitudinal designs are needed to elucidate mechanisms underlying these associations.
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16
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Brown TN, Lesane-Brown CL, Davis R, Carroll MA. Viral Racism via Videos: A Study of Asians' Experiences of Interpersonal Discrimination Because of COVID-19. SOCIAL CURRENTS 2022; 9:486-505. [PMID: 38603136 PMCID: PMC9125131 DOI: 10.1177/23294965221098973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
This study analyzes five publicly posted videos wherein Asians experience interpersonal discrimination because of COVID-19. We think social scientists ignore how videos provide data for investigating interpersonal discrimination. We characterize the videos according to multiple features including context, characteristics, and responses of individuals involved, type of threat or mistreatment, and level of psychological and physical harm. We then summarize features across the videos. Among other things, analyses uncover implicit, explicit, and historically specific anti-Asian sentiment alongside evidence perpetrators are men and bystanders do not intervene typically. The Discussion contrasts Asians' experiences of interpersonal discrimination because of COVID-19 against the interpersonal and institutional discrimination faced by American Indians, blacks, and Hispanics in the United States. That contrast brings Asians' positionality into sharp relief.
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Affiliation(s)
- Tony N. Brown
- Department of Sociology, Rice University, Houston, TX, USA
| | | | - Rachell Davis
- Department of Sociology, Rice University, Houston, TX, USA
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17
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Jung MY, Juon HS, Slopen N, He X, Thomas SB, Lee S. Racial Discrimination and Health-Related Quality of Life: An Examination Among Asian American Immigrants. J Racial Ethn Health Disparities 2022; 9:1262-1275. [PMID: 34086197 PMCID: PMC8176876 DOI: 10.1007/s40615-021-01067-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/25/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aimed to examine the relationship between everyday and major racial discrimination with health-related quality of life (HRQOL), which consists of self-rated health, days of poor physical health, mental health, and activity limitation. DESIGN In a cross-sectional analytic sample of 524 foreign-born Asian adults, aged 18 years and older, we conducted multivariable logistic regression and multivariable negative binomial regression to examine associations between discrimination and HRQOL. Furthermore, potential effect modification was tested by gender, ethnicity, and social support. RESULTS Associations were found between everyday racial discrimination and days of poor physical health (incidence rate ratio, IRR = 1.05), mental health (IRR = 1.03), and activity limitation (IRR = 1.05). Stronger significant associations were observed between major racial discrimination and days of poor physical health (IRR = 1.21), mental health (IRR = 1.16), and activity limitation (IRR = 1.53), adjusting for all covariates. Racial discrimination was not associated with poor self-rated health. In addition, gender significantly modified the relationship between continuous racial discrimination and activity limitation days with associations of greater magnitude among men, while social support significantly modified the association between categorized major racial discrimination and physically unhealthy days. When stratified, the association was only significant among those with low social support (IRR = 3.04; 95% CI: 1.60, 5.79) as opposed to high social support. CONCLUSIONS This study supports the association between racial discrimination and worse HRQOL among Asian Americans, which can inform future interventions, especially among men and those with low social support, aimed at improving the quality of life in this population.
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Affiliation(s)
- Mary Y Jung
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD, 20742, USA.
| | - Hee-Soon Juon
- Department of Medical Oncology, Division of Population Science, Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD, 20742, USA
| | - Stephen B Thomas
- Department of Health Policy and Management, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD, 20742, USA
| | - Sunmin Lee
- Department of Medicine, School of Medicine, University of California, Irvine, 653 E Peltason Drive, Irvine, CA, 92697, USA
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18
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Sanford K, Pizzuto AE. The Healthcare Discrimination Experience Scale: Assessing a Variable Crucial for Explaining Racial/Ethnic Inequities in Patient Activation and Health. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01350-2. [PMID: 35731463 DOI: 10.1007/s40615-022-01350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/23/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
Healthcare discrimination experience is expected to be a consequential variable that explains racial/ethnic inequities in patient activation and health; however, existing scales assessing healthcare discrimination experience are limited by insufficient psychometric development and overly narrow construct definitions. A new Healthcare Discrimination Experience Scale was developed, validated, compared to an existing scale, and used to estimate effects in explaining racial/ethnic health inequities. Across two studies, 975 patients with hypertension or diabetes (43% Black, 10% other Persons of Color, 47% White, 53% having household incomes < 40 thousand dollars) were recruited through marketing research panels to complete online questionnaires. Compared to an existing measure, the new scale better detected differences between People of Color and White people. It produced good results in confirmatory factor analysis and item response theory analysis, and it mediated the effects of racial/ethnic identity on eight variables regarding patient-practitioner relationships, treatment adherence, general health, blood pressure, and life stress. The new scale is valid for assessing a broadly defined healthcare discrimination experience construct in diverse patients with chronic medical conditions, and it is more sensitive to group differences than the best existing alternative scale. Compared to research using unvalidated scales, the results of this study demonstrate that healthcare discrimination experience plays a larger role in explaining racial/ethnic inequities in patient activation and health.
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Affiliation(s)
- Keith Sanford
- Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798-7334, USA.
| | - Alexandra E Pizzuto
- Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798-7334, USA
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19
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Sorice KA, Fang CY, Wiese D, Ortiz A, Chen Y, Henry KA, Lynch SM. Systematic review of neighborhood socioeconomic indices studied across the cancer control continuum. Cancer Med 2022; 11:2125-2144. [PMID: 35166051 PMCID: PMC9119356 DOI: 10.1002/cam4.4601] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is extensive interest in understanding how neighborhood socioeconomic status (nSES) may affect cancer incidence or survival. However, variability regarding items included and approaches used to form a composite nSES index presents challenges in summarizing overall associations with cancer. Given recent calls for standardized measures of neighborhood sociodemographic effects in cancer disparity research, the objective of this systematic review was to identify and compare existing nSES indices studied across the cancer continuum (incidence, screening, diagnosis, treatment, survival/mortality) and summarize associations by race/ethnicity and cancer site to inform future cancer disparity studies. METHODS Using PRISMA guidelines, peer-reviewed articles published between 2010 and 2019 containing keywords related to nSES and cancer were identified in PubMed. RESULTS Twenty-four nSES indices were identified from 75 studies. In general, findings indicated a significant association between nSES and cancer outcomes (n = 64/75 studies; 85.33%), with 42/64 (65.63%) adjusting for highly-correlated individual SES factors (e.g., education). However, the direction of association differed by cancer site, race/ethnicity, and nSES index. CONCLUSIONS This review highlights several methodologic and conceptual issues surrounding nSES measurement and potential associations with cancer disparities. Recommendations pertaining to the selection of nSES measures are provided, which may help inform disparity-related disease processes and improve the identification of vulnerable populations in need of intervention.
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Affiliation(s)
- Kristen A. Sorice
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Carolyn Y. Fang
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Daniel Wiese
- Geography and Urban StudiesTemple UniversityPhiladelphiaPAUSA
| | - Angel Ortiz
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Yuku Chen
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
| | - Kevin A. Henry
- Geography and Urban StudiesTemple UniversityPhiladelphiaPAUSA
| | - Shannon M. Lynch
- Cancer Prevention and ControlFox Chase Cancer CenterPhiladelphiaPAUSA
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20
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Ibekwe LN, Fernández-Esquer ME, Pruitt SL, Ranjit N, Fernández ME. Racism and Cancer Screening among Low-Income, African American Women: A Multilevel, Longitudinal Analysis of 2-1-1 Texas Callers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11267. [PMID: 34769784 PMCID: PMC8583140 DOI: 10.3390/ijerph182111267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022]
Abstract
Although racism is increasingly being studied as an important contributor to racial health disparities, its relation to cancer-related outcomes among African Americans remains unclear. The purpose of this study was to help clarify the relation between two indicators of racism-perceived racial discrimination and racial residential segregation-and cancer screening. We conducted a multilevel, longitudinal study among a medically underserved population of African Americans in Texas. We assessed discrimination using the Experiences of Discrimination Scale and segregation using the Location Quotient for Racial Residential Segregation. The outcome examined was "any cancer screening completion" (Pap test, mammography, and/or colorectal cancer screening) at follow-up (3-10 months post-baseline). We tested hypothesized relations using multilevel logistic regression. We also conducted interaction and stratified analyses to explore whether discrimination modified the relation between segregation and screening completion. We found a significant positive relation between discrimination and screening and a non-significant negative relation between segregation and screening. Preliminary evidence suggests that discrimination modifies the relation between segregation and screening. Racism has a nuanced association with cancer screening among African Americans. Perceived racial discrimination and racial residential segregation should be considered jointly, rather than independently, to better understand their influence on cancer screening behavior.
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Affiliation(s)
- Lynn N. Ibekwe
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.E.F.-E.); (M.E.F.)
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Maria Eugenia Fernández-Esquer
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.E.F.-E.); (M.E.F.)
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Nalini Ranjit
- Michael and Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston–Austin Regional Campus, Austin, TX 78701, USA;
| | - Maria E. Fernández
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.E.F.-E.); (M.E.F.)
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21
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Abstract
BACKGROUND Patterns of food security persistently vary by race, yet limited research has examined how community-specific experiences of race and racism are associated with nutritional outcomes. OBJECTIVES This analysis describes a novel approach for classifying experiences of race and racism and explores the relationship between identified classes and measures of food security and diet quality. METHODS Cross-sectional self-reported survey data from 306 African American adults living in two urban midwestern cities were collected in 2017-2018. Measures of racialized experiences assessed consciousness of race, perceived discrimination, and health effects of perceived discrimination. Food security was measured with a six-item screener and diet quality with the Healthy Eating Index-2010. Latent class analysis was used to generate racialized classes. Bivariate analyses were conducted to examine differences in class membership by sociodemographics and nutrition outcomes. RESULTS Participants were majority women who were receiving Supplemental Nutrition Assistance Program benefits. Three racialized classes were identified: Class 1 reported few racialized experiences (42.8% of the sample), Class 2 was racially conscious with few experiences of discrimination (45.1%), and Class 3 was both racially conscious and affected by racialized actions (12.1%). Racialized classes were significantly different in mean household income, level of education, home ownership, and job loss in the past year. Class 3 was the least represented among those that were food secure and the most represented among those that were very low food secure. There were no differences by class in Healthy Eating Index-2010 scores. DISCUSSION Findings offer an innovative method for measuring exposures to racism and for assessing its relationship to food security. Findings highlight heterogeneity of racialized experiences in similar contexts as well as potential root cause targets such as wages, education, home ownership, and employment that may be modulated to mitigate the effects of racism on food insecurity.
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22
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McClendon J, Kressin N, Perkins D, Copeland LA, Finley EP, Vogt D. The Impact of Discriminatory Stress on Changes in Posttraumatic Stress Severity at the Intersection of Race/Ethnicity and Gender. J Trauma Dissociation 2021; 22:170-187. [PMID: 33460360 DOI: 10.1080/15299732.2020.1869079] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Given the diversity of military veterans and growing evidence of ethnoracial disparities in posttraumatic stress disorder (PTSD) within this population, elucidating the role of discrimination-related stress in contributing to these disparities is crucial. We examined the relative impact of discriminatory stress (i.e., due to race/ethnicity, religion, nationality, gender, sexual orientation, or physical appearance) on 6-month changes in PTSD symptom severity among trauma-exposed White (74%), Black (11%) and Hispanic/Latino/a/x (15%) veterans (17% female). PTSD symptoms were measured with the 8-item PTSD Checklist for DSM-5. A measure of the extent to which discrimination has caused stress for the respondent assessed discriminatory stress. Hierarchical regression analyses examined interactions among race/ethnicity, gender and discriminatory stress in predicting six-month changes in PTSD severity. Black and Hispanic/Latino/a/x veterans reported higher baseline PTSD severity and discriminatory stress than White veterans, with some variation by gender. Three-way interactions of race/ethnicity by discriminatory stress by gender were significant, controlling for income, education and age. The relationship between discriminatory stress and increases in PTSD severity was significantly stronger for Black women compared with Black men and did not differ between White men and women. There was also a stronger relationship between discriminatory stress and increases in PTSD severity for Hispanic/Latino/x men as compared to Black men. These findings suggest that discriminatory stress impacts PTSD severity differentially for various ethnoracial/gender groups and highlight the value of applying an intersectional framework that accounts for the synergistic connections among multiple identities to future screening, intervention, and research efforts.
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Affiliation(s)
- Juliette McClendon
- National Center for PTSD (116B-3), Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nancy Kressin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Daniel Perkins
- Clearinghouse for Military Family Readiness, the Pennsylvania State University, Philadelphia, Pennsylvania, USA.,Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, 107 Ferguson Building, University Park, Philadelphia, Pennsylvania, USA.,Social Science Research Institute, The Pennsylvania State University, 114 Henderson Building, University Park, Pennsylvania, USA
| | - Laurel A Copeland
- Research Service, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Erin P Finley
- Veterans Evidence-based Research Dissemination and Implementation Center, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Departments of Medicine and Psychiatry, UT Health San Antonio, San Antonio, Texas, USA
| | - Dawne Vogt
- National Center for PTSD (116B-3), Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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23
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Ali A, Rumbold AR, Kapellas K, Lassi ZS, Hedges J, Jamieson L. The impact of interpersonal racism on oral health related quality of life among Indigenous South Australians: a cross-sectional study. BMC Oral Health 2021; 21:46. [PMID: 33541319 PMCID: PMC7860008 DOI: 10.1186/s12903-021-01399-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/14/2021] [Indexed: 12/28/2022] Open
Abstract
Background Interpersonal racism has had a profound impact on Indigenous populations globally, manifesting as negative experiences and discrimination at an individual, institutional and systemic level. Interpersonal racism has been shown to negatively influence a range of health outcomes but has received limited attention in the context of oral health. The aim of this paper was to examine the effects of experiences of interpersonal racism on oral health-related quality of life (OHRQoL) among Indigenous South Australians. Methods Data were sourced from a large convenience sample of Indigenous South Australian adults between February 2018 and January 2019. Questionnaires were used to collect data on sociodemographic characteristics, cultural values, utilization of dental services, and other related factors. OHRQoL was captured using the Oral Health Impact Profile (OHIP-14) questionnaire. We defined the dependent variable 'poor OHRQoL' as the presence of one or more OHIP-14 items rated as ‘very often’ or ‘fairly often'. Experiences of racism were recorded using the Measure of Indigenous Racism Experiences instrument. Interpersonal racism was classified into two categories (‘no racism’ vs ‘any racism in ≥ 1 setting’) and three categories ('no racism', 'low racism' (experienced in 1–3 settings), and 'high racism' (experienced in 4–9 settings)). Logistic regression was used to examine associations between interpersonal racism, covariates and OHRQoL, adjusting for potential confounding related to socioeconomic factors and access to dental services. Results Data were available from 885 participants (88.7% of the total cohort). Overall, 52.1% reported experiencing any interpersonal racism in the previous 12 months, approximately one-third (31.6%) were classified as experiencing low racism, and one-fifth (20.5%) experienced high racism. Poor OHRQoL was reported by half the participants (50.2%). Relative to no experiences of racism in the previous 12 months, those who experienced any racism (≥ 1 setting) were significantly more likely to report poor OHRQoL (Odds Ratio (OR): 1.43; 95% Confidence Interval (CI): 1.08–1.92), after adjusting for age, education level, possession of an income-tested health care card, car ownership, self-reported oral health status, timing of and reason for last dental visit, not going to a dentist because of cost, and having no family support. This was particularly seen among females, where, relative to males, the odds of having poor OHRQoL among females experiencing racism were 1.74 times higher (95% CI: 1.07–2.81). Conclusion Our findings indicate that the experience of interpersonal racism has a negative impact on OHRQoL among Indigenous Australians. The association persisted after adjusting for potential confounding factors. Identifying this link adds weight to the importance of addressing OHRQoL among South Australian’s Indigenous population by implementing culturally-sensitive strategies to address interpersonal racism.
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Affiliation(s)
- Anna Ali
- Robinson Research Institute, The University of Adelaide, 30 Frome Road, Adelaide, SA, 5000, Australia.
| | - Alice R Rumbold
- Robinson Research Institute, The University of Adelaide, 30 Frome Road, Adelaide, SA, 5000, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia
| | - Kostas Kapellas
- Australian Research Centre for Population Oral Health, Adelaide Health and Medical Sciences, The University of Adelaide, 4 North Terrace, Adelaide, 5005, Australia
| | - Zohra S Lassi
- Robinson Research Institute, The University of Adelaide, 30 Frome Road, Adelaide, SA, 5000, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Health and Medical Sciences, The University of Adelaide, 4 North Terrace, Adelaide, 5005, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Health and Medical Sciences, The University of Adelaide, 4 North Terrace, Adelaide, 5005, Australia
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24
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Rosa PLFS, Borges ALV, Araújo EMD. Validação de conteúdo do instrumento Percepção sobre Discriminação Racial Interpessoal nos Serviços de Saúde (Driss). SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021200410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Com o objetivo de elaborar e validar o conteúdo do instrumento de medida das Percepções sobre Discriminação Racial Interpessoal nos Serviços de Saúde Brasileiros (Driss), foi conduzido um estudo do tipo metodológico com base na Teoria Clássica dos Testes. O pool de itens inicial, com 49 itens, foi elaborado a partir dos resultados de uma revisão abrangente de literatura, um estudo qualitativo prévio e recomendações de um grupo de pesquisa sobre desigualdades étnico-raciais. Para a validação de conteúdo, um comitê de especialistas foi formado. Critérios qualitativos e quantitativos foram empregados para garantir rigor metodológico. Após a avaliação da versão 1 do Driss pelo comitê de especialistas, houve exclusão de 28 itens, além do desmembramento e/ou modificação de outros dez. A partir disso, elaborou-se a versão 2, submetida a pré-teste, que mostrou a necessidade de se incluírem questões introdutórias para melhor entendimento por parte da população-alvo quanto aos objetivos do estudo. Posteriormente, elaborou-se a versão 3, com conteúdo que busca valorizar as percepções e sentimentos experimentados pelos indivíduos que sofreram discriminação racial nos serviços de saúde. A validade de conteúdo da versão 3 foi verificada, por meio da Razão de Validade de Conteúdo, sendo considerada satisfatória e pronta para a verificação da validade de constructo.
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Chin D, Loeb TB, Zhang M, Liu H, Cooley-Strickland M, Wyatt GE. Racial/ethnic discrimination: Dimensions and relation to mental health symptoms in a marginalized urban American population. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2020; 90:614-622. [PMID: 32584076 DOI: 10.1037/ort0000481] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
That racial/ethnic discrimination has adverse physical and psychological consequences, including stress, anxiety, depression, and their attendant health effects, is well documented. However, the particular dimensions within the broad construct of discrimination and their role in mental health are less well understood. This study investigates the dimensions of discrimination and explores their relation to depression and posttraumatic stress (PTS) symptoms. Using the Brief Perceived Ethnic/Racial Discrimination Questionnaire-Community Version, discrimination experiences were assessed among a community sample of African American and Latinx participants (N = 500). Factor analyses revealed 4 dimensions: Social Rejection, Stereotyping, Direct Threats/Attacks, and Police Mistreatment. In multivariate analyses, full regression models were significantly related to PTS and depression symptoms. Among the individual predictors, Social Rejection and ethnicity (Latinx) uniquely contributed to PTS symptoms in men, whereas Stereotyping and Direct Threat/Attack were associated with PTS symptoms for women. In regards to depressive symptoms, income, ethnicity (Latinx), and Social Rejection were significant predictors for men, while Social Rejection had an independent contribution for women. Thus, social rejection emerged as a significant unique predictor in 3 of the four models, suggesting that social ostracism may be a particularly harmful aspect of discrimination. Implications of these findings include the use of proactive and intervention strategies that emphasize a sense of belonging and mitigate the effects of exclusion and rejection. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Dorothy Chin
- Semel Institute for Neuroscience and Human Behavior
| | - Tamra B Loeb
- Semel Institute for Neuroscience and Human Behavior
| | - Muyu Zhang
- Semel Institute for Neuroscience and Human Behavior
| | | | | | - Gail E Wyatt
- Semel Institute for Neuroscience and Human Behavior
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Schroeder EB, Moore KR, Manson SM, Baldwin MA, Goodrich GK, Malone AS, Pieper LE, Xu S, Fort MP, Son‐Stone L, Johnson D, Steiner JF. A randomized clinical trial of an interactive voice response and text message intervention for individuals with hypertension. J Clin Hypertens (Greenwich) 2020; 22:1228-1238. [DOI: 10.1111/jch.13909] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/13/2020] [Accepted: 04/17/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Emily B. Schroeder
- Kaiser Permanente Colorado Institute for Health Research Aurora CO USA
- Department of Medicine University of Colorado Anschutz Medical Campus Aurora CO USA
- Parkview Health Fort Wayne IN USA
| | - Kelly R. Moore
- Centers for American Indian and Alaska Native Health University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Megan A. Baldwin
- Kaiser Permanente Colorado Institute for Health Research Aurora CO USA
| | - Glenn K. Goodrich
- Kaiser Permanente Colorado Institute for Health Research Aurora CO USA
| | - Allen S. Malone
- Kaiser Permanente Colorado Institute for Health Research Aurora CO USA
| | - Lisa E. Pieper
- Kaiser Permanente Colorado Institute for Health Research Aurora CO USA
| | - Stanley Xu
- Kaiser Permanente Colorado Institute for Health Research Aurora CO USA
| | - Meredith P. Fort
- Centers for American Indian and Alaska Native Health University of Colorado Anschutz Medical Campus Aurora CO USA
| | | | - David Johnson
- First Nations Community HealthSource Albuquerque NM USA
| | - John F. Steiner
- Kaiser Permanente Colorado Institute for Health Research Aurora CO USA
- Department of Medicine University of Colorado Anschutz Medical Campus Aurora CO USA
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Krieger N. Measures of Racism, Sexism, Heterosexism, and Gender Binarism for Health Equity Research: From Structural Injustice to Embodied Harm-An Ecosocial Analysis. Annu Rev Public Health 2019; 41:37-62. [PMID: 31765272 DOI: 10.1146/annurev-publhealth-040119-094017] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Racism. Sexism. Heterosexism. Gender binarism. Together, they comprise intimately harmful, distinct, and entangled societal systems of self-serving domination and privilege that structure the embodiment of health inequities. Guided by the ecosocial theory of disease distribution, I synthesize key features of the specified "isms" and provide a measurement schema, informed by research from both the Global North and the Global South. Metrics discussed include (a) structural, including explicit rules and laws, nonexplicit rules and laws, and area-based or institutional nonrule measures; and (b) individual-level (exposures and internalized) measures, including explicit self-report, implicit, and experimental. Recommendations include (a) expanding the use of structural measures to extend beyond the current primary emphasis on psychosocial individual-level measures; (b) analyzing exposure in relation to both life course and historical generation; (c) developing measures of anti-isms; and (d) developing terrestrially grounded measures that can reveal links between the structural drivers of unjust isms and their toll on environmental degradation, climate change, and health inequities.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
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Valois RF, Zullig KJ, Brown LK, Carey MP, Vanable PA, Romer D, DiClemente RJ. Is the Brief Multidimensional Student's Life Satisfaction Scale Valid and Reliable for African American Adolescents? AMERICAN JOURNAL OF HEALTH EDUCATION 2019; 50:344-355. [PMID: 32983312 PMCID: PMC7518648 DOI: 10.1080/19325037.2019.1662348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 04/29/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Health promotion/education strive to promote healthful conditions that improve quality of life1 based on the perceptions of those whose lives are affected.2-4 Though health promotion/education might have instrumental value in reducing risks for premature morbidity and mortality, their ultimate value lies in contributions to quality of life.1 Life satisfaction (LS) has been defined as an individual's assessment of their quality of life based upon personal criteria5,6 and linked to adolescent health risk behaviors7,8 and developmental assets.9. PURPOSE We investigated the psychometrics of the Brief Multidimensional Students' Life Satisfaction Scale [BMSLSS] with an adolescent sample of African Americans (N=1,658) from four mid-sized cities in the United States (US). Reliability and validity of the BMSLSS has not been determined for samples of exclusively African American adolescents. METHODS Data analysis included calculating mean ratings, standard deviations and effect sizes (Cohen's d) and inspecting the scale's internal structure, reliability, and relationships to other variables. RESULTS Evidence of internal structure, internal consistency reliability, and hypothesized relationships to other variables for participants were determined. TRANSLATION TO HEALTH EDUCATION PRACTICE The BMSLSS is a useful indicator of LS for research and health education assessment purposes among African American adolescents where brevity of psychometric measures is imperative.
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Affiliation(s)
- Robert F Valois
- Department of Health Promotion, Education & Behavior, Department of Family & Preventive Medicine, Schools of Public Health and Medicine, University of South Carolina, Columbia, SC 29208 USA
| | - Keith J Zullig
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506 USA
| | - Larry K Brown
- Miriam Hospital and Brown University, Centers for Behavioral & Preventive Medicine, Providence, RI, 02903 USA
| | - Michael P Carey
- Miriam Hospital and Brown University, Centers for Behavioral & Preventive Medicine, Providence, RI, 02903 USA
| | - Peter A Vanable
- Department of Psychology, Center for Health and Behavior, Syracuse University, Syracuse, NY 13244 USA
| | - Daniel Romer
- Adolescent Communication Institute, Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY 10003 USA
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Thomas MD, Michaels EK, Reeves AN, Okoye U, Price MM, Hasson RE, Chae DH, Allen AM. Differential associations between everyday versus institution-specific racial discrimination, self-reported health, and allostatic load among black women: implications for clinical assessment and epidemiologic studies. Ann Epidemiol 2019; 35:20-28.e3. [PMID: 31235363 PMCID: PMC7179332 DOI: 10.1016/j.annepidem.2019.05.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Black women have the highest estimated allostatic load (AL). AL and self-perceived health are strong health predictors and have been linked to racial discrimination. Research suggests that everyday and institution-specific racial discrimination may predict different AL and self-reported health (SRH) outcomes. Furthermore, discrepancies between AL and self-perceived health could widen disparities. We estimated associations between everyday versus institution-specific racial discrimination with AL and SRH. METHODS Data are from a San Francisco Bay Area community sample of 208 black women aged 30-50 years. Participation involved a questionnaire, self-interview, blood draw, and anthropometric measurements. Adjusted generalized linear regression models estimated associations of racial discrimination with AL and SRH. RESULTS After adjusting for age, socioeconomic position, and medication use, institution-specific discrimination was negatively associated with AL (i.e., better health), whereas everyday experiences showed no association. Those reporting very-high (vs. moderate) institution-specific discrimination had lower AL (β = -1.31 [95% CI: -2.41, -0.20]; AL range: 0-15). No racial discrimination-SRH association was found. CONCLUSIONS For black women, (1) institution-specific racial discrimination may be differentially embodied compared with everyday experiences and (2) institutional racism may contribute to physiologic stress-regulation regardless of self-perceived health status. Potential factors that may contribute to an inverse racial discrimination-AL association, and future research, are discussed.
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Affiliation(s)
- Marilyn D Thomas
- Division of Epidemiology, School of Public Health, University of California, Berkeley.
| | - Elizabeth K Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Alexis N Reeves
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Uche Okoye
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Melisa M Price
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Rebecca E Hasson
- Schools of Kinesiology and Public Health, University of Michigan, Ann Arbor
| | - David H Chae
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, AL
| | - Amani M Allen
- Division of Epidemiology, School of Public Health, University of California, Berkeley
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Desalu JM, Goodhines PA, Park A. Racial discrimination and alcohol use and negative drinking consequences among Black Americans: a meta-analytical review. Addiction 2019; 114:957-967. [PMID: 30714661 PMCID: PMC6510626 DOI: 10.1111/add.14578] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/31/2018] [Accepted: 01/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Findings of the association between racial discrimination and alcohol use and related consequences are inconsistent, and the role of potential moderators in the association is largely unknown. This meta-analysis aimed to synthesize the discrimination-alcohol literature among Black Americans, estimate the magnitude of associations and explore differences as a function of sample characteristics. METHODS Empirical studies reporting the association of racial discrimination with alcohol-related behaviors in an all-black sample were identified via systematic literature search. A random-effects meta-analysis was conducted using 33 effect sizes extracted from 27 studies, all of which used US samples (n = 26 894). RESULTS Significant positive associations were found for racial discrimination with alcohol consumption [k = 9, confidence interval (CI) = 0.08, 0.17, I2 = 49%, r = 0.12], heavy/binge drinking (k = 12, CI = 0.02, 0.10), I2 = 27%, r = 0.06), at-risk drinking (k = 4, CI = 0.06, 0.23, I2 = 0%, r = 0.14) and negative drinking consequences (k = 5, CI = 0.09, 0.25, I2 = 94%, r = 0.25), but not with alcohol use disorder (k = 3, CI = -0.01, 0.20, I2 = 90%, r = 0.10). Only alcohol consumption and negative drinking consequences showed significant between-study heterogeneity and had a sufficient quantity of studies for moderation analysis (i.e., 4 or more studies). The positive association of racial discrimination with negative drinking consequences was stronger among younger samples; the association with alcohol consumption did not differ by age or proportion of men. CONCLUSIONS Experiences of racial discrimination are associated with diverse alcohol-related behaviors among Black Americans, with a stronger association with problematic alcohol use, particularly among younger individuals.
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Affiliation(s)
| | | | - Aesoon Park
- Department of PsychologySyracuse University Syracuse NY USA
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31
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Sabbah W, Gireesh A, Chari M, Delgado-Angulo EK, Bernabé E. Racial Discrimination and Uptake of Dental Services among American Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1558. [PMID: 31060202 PMCID: PMC6540199 DOI: 10.3390/ijerph16091558] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/17/2022]
Abstract
This study examined the relationship between racial discrimination and use of dental services among American adults. We used data from the 2014 Behavioral Risk Factor Surveillance System, a health-related telephone cross-sectional survey of a nationally representative sample of adults in the United States. Racial discrimination was indicated by two items, namely perception of discrimination while seeking healthcare within the past 12 months and emotional impact of discrimination within the past 30 days. Their association with dental visits in the past year was tested in logistic regression models adjusting for predisposing (age, gender, race/ethnicity, income, education, smoking status), enabling (health insurance), and need (missing teeth) factors. Approximately 3% of participants reported being discriminated when seeking healthcare in the past year, whereas 5% of participants reported the emotional impact of discrimination in the past month. Participants who experienced emotional impact of discrimination were less likely to have visited the dentist during the past year (Odds Ratios (OR): 0.57; 95% CI 0.44-0.73) than those who reported no emotional impact in a crude model. The association was attenuated but remained significant after adjustments for confounders (OR: 0.76, 95% CI 0.58-0.99). There was no association between healthcare discrimination and last year dental visit in the fully adjusted model. Emotional impact of racial discrimination was an important predictor of use of dental services. The provision of dental health services should be carefully assessed after taking account of racial discrimination and its emotional impacts within the larger context of social inequalities.
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Affiliation(s)
- Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Bessemer Road, London SE5 9RS, UK.
| | - Aswathikutty Gireesh
- Institute of Child Health, Department of Population, Policy and Practice, University College London, 30 Guilford St, London WC1N 1EH, UK.
| | - Malini Chari
- Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, ON M5G 1G6, Canada.
| | - Elsa K Delgado-Angulo
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Bessemer Road, London SE5 9RS, UK.
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Bessemer Road, London SE5 9RS, UK.
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Benjamins MR, Middleton M. Perceived discrimination in medical settings and perceived quality of care: A population-based study in Chicago. PLoS One 2019; 14:e0215976. [PMID: 31022267 PMCID: PMC6483224 DOI: 10.1371/journal.pone.0215976] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/11/2019] [Indexed: 11/18/2022] Open
Abstract
Perceived discrimination in medical settings remains prevalent within the U.S. health care system. However, the details of these experiences and their associations with perceived quality of care are not well understood. Our study assessed multiple measures of perceived racial/ethnic discrimination in medical settings and investigated the locations and purported perpetrators of the discriminatory experiences within a population-based sample of 1,543 Black, White, Mexican, Puerto Rican, and Other adults. We used logistic regression to estimate associations between perceived discrimination in the medical setting and three quality of care indicators. Overall, 40% of the sample reported one or more types of perceived discrimination in a medical setting, with significant differences by race/ethnicity. Discrimination was perceived across health settings and from a variety of providers and staff. In adjusted logistic regression models, individuals reporting discrimination had more than twice the odds of reporting fair or poor quality of care (OR = 2.4 [95% CI: 1.4-4.3]). In addition, perceived discrimination in medical settings was significantly associated with report of not having enough time with the physician and not being as involved in decision-making as desired. These findings expand our understanding of perceived discriminatory experiences in health care and the consequences of it for patients, providers, and health care systems. This information is essential for identifying future provider interventions and improving the training of health care professionals.
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Affiliation(s)
- Maureen R. Benjamins
- Sinai Urban Health Institute, Sinai Health System, Chicago, Illinois, United States of America
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, United States of America
| | - Megan Middleton
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, United States of America
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Schroeder EB, Moore K, Manson SM, Baldwin MA, Goodrich GK, Malone AS, Pieper LE, Xu S, Fort MM, Johnson D, Son-Stone L, Steiner JF. An Interactive Voice Response and Text Message Intervention to Improve Blood Pressure Control Among Individuals With Hypertension Receiving Care at an Urban Indian Health Organization: Protocol and Baseline Characteristics of a Pragmatic Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11794. [PMID: 30938688 PMCID: PMC6465973 DOI: 10.2196/11794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/15/2019] [Accepted: 01/22/2019] [Indexed: 01/09/2023] Open
Abstract
Background Efficient and effective strategies for treating chronic health conditions such as hypertension are particularly needed for under-resourced clinics such as Urban Indian Health Organizations (UIHOs). Objective The objective of the Controlling Blood Pressure Trial is to assess the impact of an interactive voice response and text message (IVR-T) intervention compared with usual care among individuals with hypertension receiving care at a UIHO in Albuquerque, New Mexico. This manuscript presents the baseline characteristics of individuals enrolled in the trial and compares their characteristics with those in the hypertension registry who did not enroll in the trial. Methods A hypertension registry developed from the clinic’s electronic health record was used for recruitment. Potentially eligible participants were contacted by letter and then by phone. Those who expressed interest completed an in-person baseline visit that included a baseline survey and blood pressure measurement using standardized procedures. Individuals randomized to the intervention group could opt to receive either automated text messages or automated phone calls in either English or Spanish. The messages include reminders of upcoming appointments at First Nations Community HealthSource, requests to reschedule recently missed appointments, monthly reminders to refill medications, and weekly motivational messages to encourage self-care, appointment keeping, and medication taking for hypertension. Individuals in the IVR-T arm could opt to nominate a care partner to also receive notices of upcoming and missed appointments. Individuals in the IVR-T arm were also offered a home blood pressure monitor. Follow-up visits will be conducted at 6 months and 12 months. Results Over a 9.5-month period from April 2017 to January 2018, 295 participants were enrolled from a recruitment list of 1497 individuals. The enrolled cohort had a mean age of 53 years, was 25.1% (74/295) American Indian or Alaska Native and 51.9% (153/295) Hispanic, and 39.0% (115/295) had a baseline blood pressure greater than or equal to 140/90 mmHg. Overall, the differences between those enrolled in the trial and patients with hypertension who were ineligible, those who could not be reached, or those who chose not to enroll were minimal. Enrolled individuals had a slightly lower blood pressure (129/77 mmHg vs 132/79 mmHg; P=.04 for systolic blood pressure and P=.01 for diastolic blood pressure), were more likely to self-pay for their care (26% vs 10%; P<.001), and had a more recent primary care visit (164 days vs 231 days; P<.001). The enrolled cohort reported a high prevalence of poor health, low socioeconomic status, and high levels of basic material needs. Conclusions The Controlling Blood Pressure Trial has successfully enrolled a representative sample of individuals receiving health care at a UIHO. Trial follow-up will conclude in February 2019. Trial Registration ClinicalTrials.gov NCT03135405; http://clinicaltrials.gov/ct2/show/NCT03135405 (Archived by WebCite http://www.webcitation.org/76H2B4SO6) International Registered Report Identifier (IRRID) DERR1-10.2196/11794
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Affiliation(s)
- Emily B Schroeder
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, United States.,Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kelly Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Megan A Baldwin
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, United States
| | - Glenn K Goodrich
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, United States
| | - Allen S Malone
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, United States
| | - Lisa E Pieper
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, United States
| | - Stanley Xu
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, United States
| | - Meredith M Fort
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - David Johnson
- First Nations Community HealthSource, Albuquerque, NM, United States
| | - Linda Son-Stone
- First Nations Community HealthSource, Albuquerque, NM, United States
| | - John F Steiner
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, United States.,Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Nguyen TT, Vable AM, Maria Glymour M, Allen AM. Discrimination in health care and biomarkers of cardiometabolic risk in U.S. adults. SSM Popul Health 2019. [PMID: 30581957 PMCID: PMC6595270 DOI: 10.1016/j.ssmph.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction Methods Results Conclusions Reports of health care discrimination were common in a national sample of older adults. Reported health care discrimination was associated with elevated CRP and HbA1c. Interactions between health care discrimination and race/ethnicity were detected for HbA1c.
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Affiliation(s)
- Thu T. Nguyen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
- Correspondence to: University of California, San Francisco, Mission Hall, 550 16th Street, San Francisco, CA 94158, USA.
| | - Anusha M. Vable
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - M. Maria Glymour
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amani M. Allen
- Divisions of Community Health Sciences and Epidemiology, University of California, Berkeley, Berkeley, CA, USA
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Zimmer Z, Rojo F, Ofstedal MB, Chiu CT, Saito Y, Jagger C. Religiosity and health: A global comparative study. SSM Popul Health 2019; 7:006-6. [PMID: 30581957 PMCID: PMC6293091 DOI: 10.1016/j.ssmph.2018.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/09/2018] [Accepted: 11/11/2018] [Indexed: 01/29/2023] Open
Abstract
The objective of this paper is to understand global connections between indicators of religiosity and health and how these differ cross-nationally. Data are from World Values Surveys (93 countries, N=121,770). Health is based on a self-assessed question about overall health. First, country-specific regressions are examined to determine the association separately in each country. Next, country-level variables and cross-level interactions are added to multilevel models to assess whether and how context affects health and religiosity slopes. Results indicate enormous variation in associations between religiosity and health across countries and religiosity indicators. Significant positive associations between all religiosity measures and health exist in only three countries (Georgia, South Africa, and USA); negative associations in only two (Slovenia and Tunisia). Macro-level variables explain some of this divergence. Greater participation in religious activity relates to better health in countries characterized as being religiously diverse. The importance in god and pondering life's meaning is more likely associated with better health in countries with low levels of the Human Development Index. Pondering life's meaning more likely associates with better health in countries that place more stringent restrictions on religious practice. Religiosity is less likely to be related to good health in communist and former communist countries of Asia and Eastern Europe. In conclusion, the association between religiosity and health is complex, being partly shaped by geopolitical and macro psychosocial contexts.
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Affiliation(s)
- Zachary Zimmer
- Department of Family Studies and Gerontology, Global Aging and Community Initiative, Mount Saint Vincent University, 166 Bedford Highway, McCain Centre Room 201C, Halifax, Nova Scotia, Canada B3M2J6
| | - Florencia Rojo
- Social and Behavioral Sciences University of California San Francisco, 3333 California Street, San Francisco, CA, United States
| | - Mary Beth Ofstedal
- Institute of Social Research, University of Michigan, 426 Thompson, Ann Arbor, MI, United States
| | - Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, No. 128, Section 2, Academia Rd., Nangang District, Taipei City, Taiwan
| | - Yasuhiko Saito
- Population Research Institute, Nihon University, 12-5 Goban-cho, Chiyoda-ku, Tokyo, Japan
| | - Carol Jagger
- Institute of Aging, Newcastle University, Biogerontology Research Building, Camputs for Ageing and Vitality, Newcastel upon Tyne, United Kingdom
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Matsuzaka S, Knapp M. Anti-racism and substance use treatment: Addiction does not discriminate, but do we? J Ethn Subst Abuse 2019; 19:567-593. [DOI: 10.1080/15332640.2018.1548323] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sara Matsuzaka
- Fordham University Graduate School of Social Service, New York, New York
| | - Margaret Knapp
- Fordham University Graduate School of Social Service, New York, New York
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Powell W, Richmond J, Mohottige D, Yen I, Joslyn A, Corbie-Smith G. Medical Mistrust, Racism, and Delays in Preventive Health Screening Among African-American Men. Behav Med 2019; 45:102-117. [PMID: 31343960 PMCID: PMC8620213 DOI: 10.1080/08964289.2019.1585327] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The contribution of medical mistrust to healthcare utilization delays has gained increased public health attention. However, few studies examine these associations among African-American men, who delay preventive healthcare more often and report higher levels of medical mistrust than non-Hispanic White men. Additionally, studies rarely account for other factors reportedly working in tandem with medical mistrust to increase African-American men's preventive health screening delays (i.e., everyday racism and perceived racism in healthcare). We examined associations between medical mistrust, perceived racism in healthcare, everyday racism, and preventive health screening delays. Analyses were conducted using cross-sectional data from 610 African-American men aged 20 years and older recruited primarily from barbershops in four US regions (2003-2009). Independent variables were medical mistrust (MM), everyday racism (ER), and perceived racism in healthcare (PRH). Dependent variables were self-reported routine checkup, blood pressure screening, and cholesterol screening delays. Using multiple logistic regression and tests for mediation, we calculated odds ratios and 95% confidence intervals to assess associations between the independent and dependent variables. After final adjustment, African-American men with higher MM were significantly more likely to delay blood pressure screenings. Men with more frequent ER exposure were significantly more likely to delay routine checkups and blood pressure screenings. Higher levels of PRH were associated with a significant increased likelihood of delaying cholesterol screening. MM did not mediate associations between ER and screening delays. Increasing preventive health screening among African-American men requires addressing medical mistrust and racism in and outside healthcare institutions.
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Affiliation(s)
- Wizdom Powell
- University of Connecticut Health Center, Health Disparities Institute
| | - Jennifer Richmond
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior
| | | | - Irene Yen
- University of California Merced, Public Health Department
| | - Allison Joslyn
- University of Connecticut Health Center, Health Disparities Institute
| | - Giselle Corbie-Smith
- University of North Carolina at Chapel Hill, Departments of Social Medicine and Medicine
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The development of the cortisol response to dyadic stressors in Black and White infants. Dev Psychopathol 2018; 30:1995-2008. [PMID: 30328402 DOI: 10.1017/s0954579418001232] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acute reactivity of the stress hormone cortisol is reflective of early adversity and stress exposure, with some studies finding that the impact of adversity on the stress response differs by race. The objectives of the current study were to characterize cortisol reactivity to two dyadically based stress paradigms across the first year of life, to examine cortisol reactivity within Black and White infants, and to assess the impact of correlates of racial inequity including socioeconomic status, experiences of discrimination, and urban life stressors, as well as the buffering by racial socialization on cortisol patterns. Salivary cortisol reactivity was assessed at 4 months of age during the Still Face paradigm (N = 207) and at 12 months of age across the Strange Situation procedure (N = 129). Infants demonstrated the steepest recovery after the Still Face paradigm and steepest reactivity to the Strange Situation procedure. Race differences in cortisol were not present at 4 months but emerged at 12 months of age, with Black infants having higher cortisol. Experiences of discrimination contributed to cortisol differences within Black infants, suggesting that racial discrimination is already "under the skin" by 1 year of age. These findings suggest that race-related differences in hypothalamic-pituitary-adrenal reactivity are present in infancy, and that the first year of life is a crucial time period during which interventions and prevention efforts for maternal-infant dyads are most likely able to shape hypothalamic-pituitary-adrenal reactivity thereby mitigating health disparities early across the life course.
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Nguyen TT, Vable AM, Glymour MM, Nuru-Jeter A. Trends for Reported Discrimination in Health Care in a National Sample of Older Adults with Chronic Conditions. J Gen Intern Med 2018; 33:291-297. [PMID: 29247435 PMCID: PMC5834956 DOI: 10.1007/s11606-017-4209-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/22/2017] [Accepted: 10/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Discrimination in health care settings is associated with poor health outcomes and may be especially harmful to individuals with chronic conditions, who need ongoing clinical care. Although efforts to reduce discrimination are growing, little is known about national trends in discrimination in health care settings. METHODS For Black, White, and Hispanic respondents with chronic disease in the 2008-2014 Health and Retirement Study (N = 13,897 individuals and 21,078 reports), we evaluated trends in patient-reported discrimination, defined based on frequency of receiving poorer service or treatment than other people from doctors or hospitals ("never" vs. all other). Respondents also reported the perceived reason for the discrimination. In addition, we evaluated whether wealth predicted lower prevalence of discrimination for Blacks or Whites. We used generalized estimating equation models to account for dependency of repeated measures on individuals and wave-specific weights to represent the US non-institutionalized population aged 54+ . RESULTS The estimated prevalence of experiencing discrimination in health care among Blacks with a major chronic condition was 27% (95% CI: 23, 30) in 2008 and declined to 20% (95% CI: 17, 22) in 2014. Reports of receiving poorer service or treatment were stable for Whites (17%, 95% CI: 16, 19 in 2014). The Black-White difference in reporting any health care discrimination declined from 8.2% (95% CI: 4.5, 12.0) in 2008 to 2.5% (95% CI: -1.1, 6.0) in 2014. There was no clear trend for Hispanics. Blacks reported race and Whites reported age as the most common reason for discrimination. CONCLUSIONS Findings suggest national declines in patient-reported discrimination in health care among Blacks with chronic conditions from 2008 to 2014, although reports of discrimination remain common for all racial/ethnic groups. Our results highlight the critical importance of monitoring trends in reports of discrimination in health care to advance equity in health care.
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Affiliation(s)
- Thu T Nguyen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| | - Anusha M Vable
- Center for Primary Care and Outcome Research and Center for Population Health Sciences, Departments of Medicine and of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - M Maria Glymour
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amani Nuru-Jeter
- Divisions of Community Health Sciences and Epidemiology, University of California, Berkeley, Berkeley, CA, USA
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D’Anna L, Hansen M, Mull B, Canjura C, Lee E, Sumstine S. Social Discrimination and Health Care: A Multidimensional Framework of Experiences among a Low-Income Multiethnic Sample. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:187-201. [PMID: 29424681 PMCID: PMC6464629 DOI: 10.1080/19371918.2018.1434584] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The study aims to describe the perceived discriminatory health care treatment experiences and its impact on care among minority urban-dwelling adults. Semistructured qualitative interviews (N = 51) were conducted with patients from community-based health care settings, and systematic, grounded theory approach was used. Three distinct themes emerged: (a) the sources of discriminatory experiences, (b) its impact on health care, and (c) the provider/organization recommendations to address discriminatory practices. The study highlights the relevance of perceived discrimination in avoidance of health care services, nonadherence to treatment, and adverse health-related sequelae by low-income urban-dwelling adults with little access to health care.
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Affiliation(s)
- Laura D’Anna
- California State University, Long Beach, United States
| | | | - Brittney Mull
- College of Medicine, Howard University, Washington, USA
| | - Carol Canjura
- California State University, Long Beach, United States
| | - Esther Lee
- California State University, Long Beach, United States
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Hemmings C, Evans AM. Identifying and Treating Race-Based Trauma in Counseling. JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT 2018. [DOI: 10.1002/jmcd.12090] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carrie Hemmings
- Department of Counselor, Leadership, and Special Education; Auburn University Montgomery
| | - Amanda M. Evans
- Department of Special Education, Rehabilitation, and Counseling; Auburn University
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42
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Hong HC, Ferrans CE, Park C, Lee H, Quinn L, Collins EG. Effects of Perceived Discrimination and Trust on Breast Cancer Screening among Korean American Women. Womens Health Issues 2017; 28:188-196. [PMID: 29223326 DOI: 10.1016/j.whi.2017.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 10/23/2017] [Accepted: 11/03/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Korean American (KA) women continue to have lower breast cancer screening rates than other racial groups. Perceived discrimination and trust have been associated with breast cancer screening adherence, but little is known about the associations in KA women. METHODS Surveys were completed by 196 KA women in the Chicago metropolitan area. Multiple and Firth logistic regression analyses were performed to identify factors (perceived discrimination, trust, acculturation, cultural beliefs, health care access) influencing breast cancer screening adherence (mammogram). In addition, SPSS macro PROCESS was used to examine the mediating role of trust between perceived discrimination and breast cancer screening adherence. RESULTS Ninety-three percent of the women surveyed had health insurance and 54% reported having a mammogram in the past 2 years. Predictors of having a mammogram were knowing where to go for a mammogram, having a regular doctor or usual place for health care, greater trust in health care providers, and lower distrust in the health care system. Perceived discrimination had an indirect effect on breast cancer screening through trust. CONCLUSIONS The breast cancer screening rate among KA women is low. Perceived discrimination in health care, trust in health care providers, and distrust in the health care system directly or indirectly influenced breast cancer screening adherence in KA women. Trust is a factor that can be strengthened with educational interventions.
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Affiliation(s)
| | | | - Chang Park
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | | | - Lauretta Quinn
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Eileen G Collins
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois
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Carter RT, Lau MY, Johnson V, Kirkinis K. Racial Discrimination and Health Outcomes Among Racial/Ethnic Minorities: A Meta-Analytic Review. JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1002/jmcd.12076] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robert T. Carter
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
| | - Michael Y. Lau
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
- Now at The Chicago School of Professional Psychology; Washington DC
| | - Veronica Johnson
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
- Now at the Department of Psychology, John Jay College of Criminal Justice; City University of New York
| | - Katherine Kirkinis
- Department of Counseling and Clinical Psychology, Teachers College; Columbia University
- Now at Department of Counseling Psychology; University at Albany-State University of New York
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Irby-Shasanmi A, Leech TGJ. 'Because I Don't know': uncertainty and ambiguity in closed-ended reports of perceived discrimination in US health care. ETHNICITY & HEALTH 2017; 22:458-479. [PMID: 27741709 DOI: 10.1080/13557858.2016.1244659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective Surveys often ask respondents to assess discrimination in health care. Yet, patients' responses to one type of widely used measure of discrimination (single-item, personally mediated) tend to reveal prevalence rates lower than observational studies would suggest. This study examines the meaning behind respondents' closed-ended self-reports on this specific type of measure, paying special attention to the frameworks and references used within the medical setting. Design Twenty-nine respondents participated in this study. They were asked the widely used question: 'Within the past 12 months, when seeking health care do you feel your experiences were worse than, the same as, or better than people of other races?' We then conducted qualitative interviews focusing on their chosen response and past experiences. Descriptive analyses focus on both the quantitative and qualitative data, including a comparison of conveyed perceived discrimination according to the different sources of data. Results To identify discrimination, respondents drew upon observations of dynamics in the waiting room or the health providers' communication style. Our respondents were frequently ambivalent and uncertain about how their personal treatment in health care compared to people of other races. When participants were unable to make observable comparisons, they tended to assume equal treatment and report 'same as' in the close-ended reports. Conclusion Respondents' responses to single-item, closed-ended questions may be influenced by characteristics specific to the health care realm. An emphasis on privacy and assumptions about the health care field (both authority and benevolence of providers) may limit opportunities for comparison and result in assumptions of racial parity in treatment.
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Affiliation(s)
- Amy Irby-Shasanmi
- a Department of Social and Behavioral Sciences , Indiana University Purdue University, Indianapolis (IUPUI) , Indianapolis , IN , USA
| | - Tamara G J Leech
- a Department of Social and Behavioral Sciences , Indiana University Purdue University, Indianapolis (IUPUI) , Indianapolis , IN , USA
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Dunbar M, Mirpuri S, Yip T. Ethnic/racial discrimination moderates the effect of sleep quality on school engagement across high school. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2017; 23:527-540. [PMID: 28394166 PMCID: PMC6090546 DOI: 10.1037/cdp0000146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Previous research has indicated that school engagement tends to decline across high school. At the same time, sleep problems and exposure to social stressors such as ethnic/racial discrimination increase. The current study uses a biopsychosocial perspective to examine the interactive and prospective effects of sleep and discrimination on trajectories of academic performance. METHOD Growth curve models were used to explore changes in 6 waves of academic outcomes in a sample of 310 ethnically and racially diverse adolescents (mean age = 14.47 years, SD = .78, and 64.1% female). Ethnic/racial discrimination was assessed at Time 1 in a single survey. Sleep quality and duration were also assessed at Time 1 with daily diary surveys. School engagement and grades were reported every 6 months for 3 years. RESULTS Higher self-reported sleep quality in the ninth grade was associated with higher levels of academic engagement at the start of high school. Ethnic/racial discrimination moderated the relationship between sleep quality and engagement such that adolescents reporting low levels of discrimination reported a steeper increase in engagement over time, whereas their peers reporting poor sleep quality and high levels of discrimination reported the worse engagement in the ninth grade and throughout high school. CONCLUSION The combination of poor sleep quality and high levels of discrimination in ninth grade has downstream consequences for adolescent academic outcomes. This study applies the biopsychosocial model to understand the development and daily experiences of diverse adolescents. (PsycINFO Database Record
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Affiliation(s)
- Margaret Dunbar
- Applied Developmental Psychology Program, Fordham University
| | - Sheena Mirpuri
- Applied Developmental Psychology Program, Fordham University
| | - Tiffany Yip
- Applied Developmental Psychology Program, Fordham University
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Bernardo CDO, Bastos JL, González-Chica DA, Peres MA, Paradies YC. Interpersonal discrimination and markers of adiposity in longitudinal studies: a systematic review. Obes Rev 2017; 18:1040-1049. [PMID: 28569010 DOI: 10.1111/obr.12564] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/16/2017] [Accepted: 04/25/2017] [Indexed: 01/02/2023]
Abstract
While the impact of interpersonal discrimination on mental health is well established, its effects on physical health outcomes have not been fully elucidated. This study systematically reviewed the literature on the prospective association between interpersonal discrimination and markers of adiposity. Medline, Web of Science, Scopus, PsycInfo, SciELO, LILACS, Google Scholar, Capes/Brazil and ProQuest databases were used to retrieve relevant information in November 2016. The results from the 10 studies that met the inclusion criteria support an association between interpersonal self-reported discrimination and the outcomes. In general, the most consistent findings were for weight and body mass index (BMI) among women, i.e. high levels of self-reported discrimination were related to increased weight and BMI. Waist circumference (WC) showed a similar pattern of association with discrimination, in a positive direction, but an inverted U-shaped association was also found. Despite a few inverse associations between discrimination and markers of adiposity, none of the associations were statistically significant. Overall, markers of adiposity were consistently associated with discrimination, mainly through direct and nonlinear associations. This review provides evidence that self-reported discrimination can play an important role in weight, BMI and WC changes.
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Affiliation(s)
- C de O Bernardo
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - J L Bastos
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - D A González-Chica
- Discipline of General Practice, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - M A Peres
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Y C Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, Victoria, Australia
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Campo-Arias A, Herazo E, Oviedo HC. [Psychometric assessment of a brief Modern Racism Scale]. Rev Salud Publica (Bogota) 2017; 18:437-446. [PMID: 28453106 DOI: 10.15446/rsap.v18n3.41291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 10/12/2015] [Indexed: 11/09/2022] Open
Abstract
Objective To find the internal consistency of the Modern Racism Scale (MRS) among medical students in Bucaramanga, Colombia. Methods A total of 352 medical students, mean age=20.0 years (SD=1.9) reported their attitudes towards Afro-Colombians; 59.4 % were women. Students completed the 10-item version of MRS. Cronbach alpha and McDonald omega were calculated. Exploratory factor analyses were done to propose a brief version of the MRS. Results The 10-item version showed a Cronbach alpha of 0.48 and a McDonald omega of 0.15. The short version, the Brief Modern Racism Scale (BMRS) (items 1, 4, 5, 7 and 8) presented a Cronbach alpha of 0.64 and McDonald omega of 0.65. The BMRS showed one salient factor responsible of 41.6 % of the total variance. Conclusions A Spanish-language short version of the MRS shows better psychometric performance than the original version. Further study is needed to corroborate these findings or make adjustments for Colombian cultural regions.
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Affiliation(s)
| | - Edwin Herazo
- Instituto de Investigación del Comportamiento Humano, Bogotá, Colombia,
| | - Heidi C Oviedo
- Instituto de Investigación del Comportamiento Humano, Bogotá, Colombia,
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Heard-Garris NJ, Cale M, Camaj L, Hamati MC, Dominguez TP. Transmitting Trauma: A systematic review of vicarious racism and child health. Soc Sci Med 2017; 199:230-240. [PMID: 28456418 DOI: 10.1016/j.socscimed.2017.04.018] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 01/11/2023]
Abstract
Racism is a pervasive stressor. Although most research focuses on direct targets, racism can also have unintended victims. Because children's lives are inevitably linked to the experiences of other individuals, and they are in critical phases of development, they are especially vulnerable to such stressors. Despite the growing body of literature on children's direct exposure to racism, little is known about the relationship between vicarious racism (i.e. secondhand exposure to racism) and child health. To examine the state of this literature, we performed a systematic review and screened 1371 articles drawn from 7 databases, with 30 studies meeting inclusion criteria. For these 30, we reviewed research methodology, including conceptualization and measurement of vicarious exposure, sample characteristics, significant associations with child health outcomes, and mediators and/or moderators of those associations. Most studies were published after 2011 in urban areas in the U.S., employed longitudinal designs, and focused on African American populations. Socioemotional and mental health outcomes were most commonly reported with statistically significant associations with vicarious racism. While all studies examined racism indirectly experienced by children, there was no standard definition of vicarious racism used. We organize the findings in a schematic diagram illustrating indirectly-experienced racism and child health outcomes to identify current gaps in the literature and ways in which to bridge those gaps. To further the field, vicarious racism should be uniformly defined and directly measured using psychometrically validated tools. Future studies should consider using children as the informants and follow children into early adulthood to better understand causal mechanisms. Given the recent national exposure to racially-charged events, a deeper understanding of the association between vicarious racism and child health is crucial in fueling research-informed social action to help children, families, and communities exposed to racism. PROSPERO registration number: CRD42016039608.
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Affiliation(s)
- N J Heard-Garris
- Robert Wood Johnson Clinical Scholars Program, North Campus Research Complex, 2800 Plymouth Road, Building #10, Room G016, Ann Arbor, MI 48109, USA; Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Medical Professional Building, Room D3202, Box: 5718, 1522 Simpson Road East, Ann Arbor, MI 48109-5718, USA.
| | - M Cale
- Robert Wood Johnson Clinical Scholars Program, North Campus Research Complex, 2800 Plymouth Road, Building #10, Room G016, Ann Arbor, MI 48109, USA.
| | - L Camaj
- Robert Wood Johnson Clinical Scholars Program, North Campus Research Complex, 2800 Plymouth Road, Building #10, Room G016, Ann Arbor, MI 48109, USA.
| | - M C Hamati
- Robert Wood Johnson Clinical Scholars Program, North Campus Research Complex, 2800 Plymouth Road, Building #10, Room G016, Ann Arbor, MI 48109, USA.
| | - T P Dominguez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Montgomery Ross Fisher Building, Los Angeles, CA 90089-0411, USA.
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Mancini T, Caricati L, Marletta G. Does contact at work extend its influence beyond prejudice? Evidence from healthcare settings. The Journal of Social Psychology 2017; 158:173-186. [PMID: 28436745 DOI: 10.1080/00224545.2017.1319792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This article reports on two studies investigating the role of intergroup contact on the reduction of prejudice against migrants and on organizational and health outcomes. Study 1 enrolled 624 native healthcare professionals and showed that frequent and positive contact with non-native co-workers was associated with a decrease in the professionals' prejudice and an increase in the professionals' perception of team functioning. These effects were mediated by reduced in-group threat perception. Study 2 enrolled 201 native patients and showed that frequent and positive contact with non-native healthcare providers was associated with a decrease in patients' prejudice and an increase in patients' satisfaction for the care received. These effects were mediated by reduced in-group threat perception. These novel findings showed that frequent and positive contact with non-native individuals can improve health and organizational outcomes along with facilitating positive intergroup relations.
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Crusto CA, Dantzler J, Roberts YH, Hooper LM. Psychometric Evaluation of Data From the Race-Related Events Scale. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1177/0748175615578735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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