Racial/ethnic discrimination and health: findings from community studies

Mixed-methods protocol for the WiSSPr study: Women in Sex work, Stigma and psychosocial barriers to Pre-exposure prophylaxis in Zambia

INTRODUCTION

Women engaging in sex work (WESW) have 21 times the risk of HIV acquisition compared with the general population. However, accessing HIV pre-exposure prophylaxis (PrEP) remains challenging, and PrEP initiation and persistence are low due to stigma and related psychosocial factors. The WiSSPr (Women in Sex work, Stigma and PrEP) study aims to (1) estimate the effect of multiple stigmas on PrEP initiation and persistence and (2) qualitatively explore the enablers and barriers to PrEP use for WESW in Lusaka, Zambia.

METHODS AND ANALYSIS

WiSSPr is a prospective observational cohort study grounded in community-based participatory research principles with a community advisory board (CAB) of key population (KP) civil society organi sations (KP-CSOs) and the Ministry of Health (MoH). We will administer a one-time psychosocial survey vetted by the CAB and follow 300 WESW in the electronic medical record for three months to measure PrEP initiation (#/% ever taking PrEP) and persistence (immediate discontinuation and a medication possession ratio). We will conduct in-depth interviews with a purposive sample of 18 women, including 12 WESW and 6 peer navigators who support routine HIV screening and PrEP delivery, in two community hubs serving KPs since October 2021. We seek to value KP communities as equal contributors to the knowledge production process by actively engaging KP-CSOs throughout the research process. Expected outcomes include quantitative measures of PrEP initiation and persistence among WESW, and qualitative insights into the enablers and barriers to PrEP use informed by participants' lived experiences.

ETHICS AND DISSEMINATION

WiSSPr was approved by the Institutional Review Boards of the University of Zambia (#3650-2023) and University of North Carolina (#22-3147). Participants must give written informed consent. Findings will be disseminated to the CAB, who will determine how to relay them to the community and stakeholders.

A Co-Created Assessment Framework to Measure Inclusive Health and Wellbeing in a Vulnerable Context in the South of Europe

Rapid urbanisation exacerbates health and wellbeing disparities in vulnerable contexts and underscores the imperative need to develop innovative and participatory co-creation approaches to understand and address the specificities of these contexts. This paper presents a method to develop an assessment framework that integrates top-down dimensions with bottom-up perspectives to monitor the impact of inclusive health and wellbeing interventions tailored to the neighbourhood's needs in Las Palmeras, a vulnerable neighbourhood in Cordoba (Spain). Drawing upon studies in the literature examining urban health and wellbeing trends, it delineates a participatory and inclusive framework, emphasising the need for context-specific indicators and assessment tools. Involving diverse stakeholders, including residents and professionals, it enriches the process and identifies key indicators and assessment methods. This approach provides valuable insights for managing innovative solutions, aligning them with local expectations, and measuring their impact. It contributes to the discourse on inclusive urban health by advocating for participatory, context-specific strategies and interdisciplinary collaboration. While not universally applicable, the framework offers a model for health assessment in vulnerable contexts, encouraging further development of community-based tools for promoting inclusive wellbeing.

Initial Development and Validation of the Brief Internalized Heterosexist Racism Scale for Gay and Bisexual Black Men: A Measure of Internalized Heterosexist Racism

We introduce internalized heterosexist racism (IHR), or the internalization of damaging stereotypes, harmful beliefs, and negative attitudes about being a sexual minority person of color. We also present the initial development and validation of the Brief Internalized Heterosexist Racism Scale for gay and bisexual Black men (IHR-GBBM), a unidimensional, 10-item measure of IHR. Exploratory factor analyses on an internet-obtained sample of gay and bisexual Black men (N = 312; Mean age = 30.36 years) show that the IHR-GBBM had evidence of good internal consistency, and good convergent, discriminant, concurrent, and incremental validity. The IHR-GBBM was positively correlated with internalized racism, internalized heterosexism, and discrimination (racist, heterosexist). IHR was also negatively correlated with race stigma consciousness, weakly positively correlated with sexual identity stigma consciousness, but not correlated with either race identity, sexual identity, or social desirability. Hierarchical regressions showed that the IHR-GBBM explained an additional variance of 2.8% and 3.1% in anxiety symptoms and substance use coping, respectively, after accounting for (1) sociodemographics, (2) internalized racism and internalized heterosexism, and (3) an interaction of internalized racism and internalized heterosexism. Older participants and those who were "out" about their sexual identity reported lower IHR. Those who did not know/want to report their HIV status reported greater IHR. Results revealed no sexual identity, sexual position, relationship status, income, education, or employment status differences in IHR. We hope the development of the IHR-GBBM spurs future research on predictors and consequences of IHR. We discuss limitations and implications for the future study of internalized heterosexist racism.

A health equity framework to support the next generation of cancer population simulation models

Over the past 2 decades, population simulation modeling has evolved as an effective public health tool for surveillance of cancer trends and estimation of the impact of screening and treatment strategies on incidence and mortality, including documentation of persistent cancer inequities. The goal of this research was to provide a framework to support the next generation of cancer population simulation models to identify leverage points in the cancer control continuum to accelerate achievement of equity in cancer care for minoritized populations. In our framework, systemic racism is conceptualized as the root cause of inequity and an upstream influence acting on subsequent downstream events, which ultimately exert physiological effects on cancer incidence and mortality and competing comorbidities. To date, most simulation models investigating racial inequity have used individual-level race variables. Individual-level race is a proxy for exposure to systemic racism, not a biological construct. However, single-level race variables are suboptimal proxies for the multilevel systems, policies, and practices that perpetuate inequity. We recommend that future models designed to capture relationships between systemic racism and cancer outcomes replace or extend single-level race variables with multilevel measures that capture structural, interpersonal, and internalized racism. Models should investigate actionable levers, such as changes in health care, education, and economic structures and policies to increase equity and reductions in health-care-based interpersonal racism. This integrated approach could support novel research approaches, make explicit the effects of different structures and policies, highlight data gaps in interactions between model components mirroring how factors act in the real world, inform how we collect data to model cancer equity, and generate results that could inform policy.

Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016

Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population.

Racial discrimination, self-efficacy, and oral health behaviours in adolescents

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.

Racial/ethnic differences in acute and longer-term posttraumatic symptoms following traumatic injury or illness

BACKGROUND

Racial/ethnic differences in mental health outcomes after a traumatic event have been reported. Less is known about factors that explain these differences. We examined whether pre-, peri-, and post-trauma risk factors explained racial/ethnic differences in acute and longer-term posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in patients hospitalized following traumatic injury or illness.

METHODS

PTSD, depression, and anxiety symptoms were assessed during hospitalization and 2 and 6 months later among 1310 adult patients (6.95% Asian, 14.96% Latinx, 23.66% Black, 4.58% multiracial, and 49.85% White). Individual growth curve models examined racial/ethnic differences in PTSD, depression, and anxiety symptoms at each time point and in their rate of change over time, and whether pre-, peri-, and post-trauma risk factors explained these differences.

RESULTS

Latinx, Black, and multiracial patients had higher acute PTSD symptoms than White patients, which remained higher 2 and 6 months post-hospitalization for Black and multiracial patients. PTSD symptoms were also found to improve faster among Latinx than White patients. Risk factors accounted for most racial/ethnic differences, although Latinx patients showed lower 6-month PTSD symptoms and Black patients lower acute and 2-month depression and anxiety symptoms after accounting for risk factors. Everyday discrimination, financial stress, past mental health problems, and social constraints were related to these differences.

CONCLUSION

Racial/ethnic differences in risk factors explained most differences in acute and longer-term PTSD, depression, and anxiety symptoms. Understanding how these risk factors relate to posttraumatic symptoms could help reduce disparities by facilitating early identification of patients at risk for mental health problems.

Post-Burn Psychosocial Outcomes in Pediatric Minority Patients in the United States: An Observational Cohort Burn Model System Study

Racial and ethnic minority burn patients face barriers to longitudinal psychosocial support after injury. Studies utilizing the Burn Model System (BMS) National Database report adult minority patients experience worse psychosocial outcomes in domains such as body image during burn recovery. No study to date has investigated disparities in psychosocial outcomes by racial or ethnic category in the pediatric population using the BMS database. This observational cohort study addresses this gap and examines seven psychosocial outcomes (levels of anger, sadness, depression, anxiety, fatigue, peer relationships, and pain) in pediatric burn patients. The BMS database is a national collection of burn patient outcomes from four centers in the United States. BMS outcomes collected were analyzed using multi-level, linear mixed effects regression modeling to examine associations between race/ethnicity and outcomes at discharge after index hospitalization, and 6- and 12-months post-injury. A total of 275 pediatric patients were included, of which 199 (72.3%) were Hispanic. After burn injury, of which the total body surface area was significantly associated with racial/ethnicity category (p < 0.01), minority patients more often reported higher levels of sadness, fatigue, and pain interference and lower levels of peer relationships compared to Non-Hispanic, White patients, although no significant differences existed. Black patients reported significantly increased sadness at six months (β = 9.31, p = 0.02) compared to discharge. Following burn injury, adult minority patients report significantly worse psychosocial outcomes than non-minority patients. However, these differences are less profound in pediatric populations. Further investigation is needed to understand why this change happens as individuals become adults.

Association between major discrimination and deficit accumulation in African American cancer survivors: The Detroit Research on Cancer Survivors Study

BACKGROUND

Discrimination can adversely affect health and accelerate aging, but little is known about these relationships in cancer survivors. This study examines associations of discrimination and aging among self-identified African American survivors.

METHODS

A population-based sample of 2232 survivors 20-79 years old at diagnosis were enrolled within 5 years of breast (n = 787), colorectal (n = 227), lung (n = 223), or prostate (n = 995) cancer between 2017 and 2022. Surveys were completed post-active therapy. A deficit accumulation index measured aging-related disease and function (score range, 0-1, where <0.20 is robust, 0.20 to <0.35 is pre-frail, and 0.35+ is frail; 0.06 is a large clinically meaningful difference). The discrimination scale assessed ever experiencing major discrimination and seven types of events (score, 0-7). Linear regression tested the association of discrimination and deficit accumulation, controlling for age, time from diagnosis, cancer type, stage and therapy, and sociodemographic variables.

RESULTS

Survivors were an average of 62 years old (SD, 9.6), 63.2% reported ever experiencing major discrimination, with an average of 2.4 (SD, 1.7) types of discrimination events. Only 24.4% had deficit accumulation scores considered robust (mean score, 0.30 [SD, 0.13]). Among those who reported ever experiencing major discrimination, survivors with four to seven types of discrimination events (vs. 0-1) had a large, clinically meaningful increase in adjusted deficits (0.062, p < .001) and this pattern was consistent across cancer types.

CONCLUSION

African American cancer survivors have high deficit accumulated index scores, and experiences of major discrimination were positively associated with these deficits. Future studies are needed to understand the intersectionality between aging, discrimination, and cancer survivorship among diverse populations.

Students supporting students: evaluating the impact of the COVID-19 pandemic on resident assistant mental health

OBJECTIVE

To examine the impact of the novel coronavirus SARS-CoV2 (COVID-19) pandemic on Residents Assistants (RA) at a public university in the Midwest.

PARTICIPANTS

Sixty-seven RAs that had been offered an RA position for the '20-'21 academic year.

METHODS

An online cross-sectional survey measuring socio-demographics, stress, and well-being was fielded. MANCOVA models evaluated the impact of COVID-19 on well-being of Current RAs and compared to the non-current RA groups.

RESULTS

Sixty-seven RAs provided valid data. Overall, 47% of RAs had moderate-severe anxiety and 86.3% had moderate-high level of stress. Current RAs perceiving a great impact of COVID on life had significantly more stress, anxiety, burnout, and secondary traumatic stress than those who did not. RAs who started then quit experienced significantly higher secondary trauma compared to Current RAs.

CONCLUSIONS

Further research is needed to better understand the experiences and of RAs and to develop policies and programs to support RAs.

Baseline Assessment of Systemic Racism Education in Pharmacy Curricula

Objective. To determine, by survey, the inclusion of systemic racism education in US Doctor of Pharmacy (PharmD) curricula and identify barriers and facilitators to addressing this content.Methods. A survey was developed and distributed to curricular representatives at US colleges and schools of pharmacy. The survey assessed inclusion of systemic racism education in curricula, faculty involvement in teaching systemic racism content, barriers to adding systemic racism content in curricula, and future curricular plans. Data were analyzed using descriptive statistics for institutional background information, curricular content, and barriers to inclusion. Relationships between the inclusion of systemic racism content at public versus private programs were examined, and associations between traditional and accelerated programs were assessed.Results. Fifty-eight colleges and schools of pharmacy provided usable responses. Of the respondents, 84% indicated that teaching systemic racism content and its impact on health and health care was a low priority. For 24% of respondents, systemic racism content was not currently included in their curriculum, while 34% indicated that systemic racism content was included in one or more courses or modules but was not a focus. Despite systemic racism content being offered in any didactic year, it was rarely included in experiential curricula. Top barriers to inclusion were lack of faculty knowledge and comfort with content and limited curricular space. No significant differences were found between program types.Conclusion. Based on the current level of systemic racism education and barriers to inclusion, faculty need training and resources to teach systemic racism concepts within pharmacy curricula. The inclusion of systemic racism concepts and guidance in the Accreditation Council for Pharmacy Education's Accreditation Standards could help to drive meaningful change and promote health equity.

Exploratory study of race- or ethnicity-based discrimination among patients receiving procedural abortion care

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.

Comparison of Black and white individuals who report diagnoses of schizophrenia in a national sample of US adults: Discrimination and service use

BACKGROUND

While there is increasing recognition of disparities in healthcare for Black Americans, there have been no comparisons in a nationally representative U.S. sample of Black and White adults with clinical diagnoses of schizophrenia.

METHODS

Using nationally representative survey data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, we compared Black (n = 240, 36.2%) and White (n = 423, 63.8%) adults who report having been told by a physician that they have schizophrenia. Due to the large sample size, effect sizes (risk ratios and Cohen's d), rather than p-values, were used to identify the magnitude of differences in sociodemographic and clinical characteristics, including experiences of discrimination and service use. Multivariate analyses were used to identify independent factors.

RESULTS

Black individuals with diagnoses of schizophrenia reported multiple sociodemographic disadvantages, including lower rates of employment, educational attainment, income, marriage, and social support, with little difference in incarceration, violent behavior, and quality of life. They reported much higher scores on a general lifetime discrimination scale (Cohen's d = 0.75) and subscales representing job discrimination (d = 0.85), health system discrimination (d = 0.70), and public race-based abuse (d = 0.55) along with higher rates of past year alcohol and drug use disorders, but lower rates of co-morbid psychiatric disorders. Multivariable-adjusted regression analyses highlighted the independent association of Black race with measures of discrimination and religious service attendance; less likelihood of receiving psychiatric treatment (p = 0.02) but no difference in substance use treatment.

CONCLUSION

Black adults with schizophrenia report numerous social disadvantages, especially discrimination, but religious service attendance may be an important social asset.

Workplace discrimination and onset of depressive disorders in the Danish workforce: A prospective study

OBJECTIVES

Experiences of discrimination at work are a long-standing problem, but research on its mental health effect is sparse. The purpose of this study was to examine the prospective association between workplace discrimination and onset of depressive disorders among Danish workers.

METHODS

The prospective cohort study comprised 2157 workers, all free of depressive disorders at baseline. Using logistic regression models, we estimated the association between workplace discrimination at baseline and depressive disorders at 6-months follow-up, adjusted for demographics, health behaviors, job group, educational attainment and other psychosocial working conditions.

RESULTS

At baseline, 103 participants (4.8 %) reported workplace discrimination during the previous 12 months. Among the 103 exposed participants and the remaining 2054 unexposed participants, onset of depressive disorders during follow-up occurred in 16 (15.5 %) and 88 (4.3 %) participants, respectively. After adjustment for all covariates, the odds ratio was 2.73 (95 % confidence interval: 1.38-5.40) comparing exposed to unexposed participants.

LIMITATIONS

All measures were self-reported, entailing risk of common methods bias, and we also cannot rule out selection bias.

CONCLUSIONS

Exposure to workplace discrimination is a risk factor for onset of depressive disorders. Eliminating or reducing workplace discrimination may contribute to the prevention of depressive disorders in working populations.

Internalized Homophobia and Suicide Ideation Among Sexual Minority Adults: The Serial Mediation of Core Self-Evaluations and Depression

Internalized homophobia (IH) is the endorsement of negative attitudes and stereotypes about sexual minority individuals among those who are LGBQ + . However, although IH is associated with suicide ideation, the underlying mechanisms of this association are relatively understudied. To address this limitation, this research investigates Core Self-Evaluation (CSE; one's fundamental evaluations about themselves, their own abilities, and their own control) and depression as underlying mechanisms associating IH with suicide ideation. CSE comprises four traits: self-esteem, locus of control, emotional stability, and generalized self-efficacy. An online survey was completed by 404 sexual minority adults (Mean_age = 27.42 years, %Female = 51.50, %Male = 30.40, %Trans Female = 3.2, %Trans Male = 5.4). Participants were recruited via Prolific, an online crowdsourcing platform. Four serial mediation analyses examined the direct and indirect effects of IH on suicide ideation via each CSE trait and depression symptoms. Results showed support for the CSE-depression mediated pathway. Self-esteem, emotional stability, and general self-efficacy (but not locus of control) mediated the relationship between IH and suicide ideation via depression symptoms. Across three serial mediations, greater IH was associated with lower (1) self-esteem, (2) emotional stability, and (3) self-efficacy; lower self-esteem, emotional stability, and self-efficacy were associated with greater reported depression symptoms, which were then associated with greater suicide ideation. This research has implications for understanding the underlying mechanisms that associate IH with poor mental health among sexual minority adults. Studying the social and psychological mechanisms can help develop therapeutic interventions that target suicide ideation and promote positive self-evaluations among sexual minority individuals.

Dismantling "Race" in Health Research

In this era of confronting racism in public space, it is critical to keep addressing the covert systemic racism in the healthcare system. We want to bring attention to the continued unscientific practice of race-based medicine and the absurdity of treating race as a biological indicator in the 21st century. We believe race is a social construct that does not qualify as a scientific biological indicator for predicting health outcomes. In this paper, we first present arguments for inappropriate use of race in health research and then discuss alternative explanations for health disparity findings that use race as a predictor. Our main concern centers on two specific aspects of the concept of "race": (1) its fundamental lack of scientific basis as a predictor for health outcomes, (2) the misguided narrative that the term creates, placing the onus of racial discrimination on the victim, instead of highlighting the act of discrimination and the role researchers play in actively reinforcing racism when using "race" as a variable. We conclude by proposing that "race" be replaced by the variable "racism" in health.

Brain structural correlates of upward social mobility in ethnic minority individuals

PURPOSE

Perigenual anterior cingulate cortex (pACC) is a neural convergence site for social stress-related risk factors for mental health, including ethnic minority status. Current social status, a strong predictor of mental and somatic health, has been related to gray matter volume in this region, but the effects of social mobility over the lifespan are unknown and may differ in minorities. Recent studies suggest a diminished health return of upward social mobility for ethnic minority individuals, potentially due to sustained stress-associated experiences and subsequent activation of the neural stress response system.

METHODS

To address this issue, we studied an ethnic minority sample with strong upward social mobility. In a cross-sectional design, we examined 64 young adult native German and 76 ethnic minority individuals with comparable sociodemographic attributes using whole-brain structural magnetic resonance imaging.

RESULTS

Results showed a significant group-dependent interaction between perceived upward social mobility and pACC gray matter volume, with a significant negative association in the ethnic minority individuals. Post-hoc analysis showed a significant mediation of the relationship between perceived upward social mobility and pACC volume by perceived chronic stress, a variable that was significantly correlated with perceived discrimination in our ethnic minority group.

CONCLUSION

Our findings extend prior work by pointing to a biological signature of the "allostatic costs" of socioeconomic attainment in socially disadvantaged upwardly mobile individuals in a key neural node implicated in the regulation of stress and negative affect.

Strengths despite stress: Social-structural stressors and psychosocial buffers of depressive symptoms among U.S. Black men

We examined the association between social-structural stressors-racial discrimination, incarceration, and unemployment-and depressive symptoms among 578 predominantly low-income urban Black men, ages 18-45. We also examined the extent to which two protective factors-social support and problem-solving coping-moderated the relationship between social-structural stressors and depressive symptoms. Results showed that more everyday racial discrimination and incarceration, but not unemployment, significantly predicted more depressive symptoms. The links between discrimination, incarceration, and depressive symptoms were stronger for men who reported lower levels of problem-solving coping and social support than those with higher levels. Our study suggests that interventions emphasizing protective factors may help Black men cope with some of the deleterious effects of racial discrimination and incarceration. It also underscores a need for structural interventions that reduce racial discrimination and incarceration. Depression among Black men is not simply a biomedical or psychological condition, but also a critical health equity issue. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Older Lesbian, Gay, Bisexual, Transgender, and Queer Adults' Experiences With Discrimination and Impacts on Expectations for Long-Term Care: Results of a Survey in the Southern United States

The number of older adults in the United States is projected to increase in coming years, including the number of lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) older adults requiring long-term care (LTC) services. We conducted an online survey of older LGBTQ+ adults living in the Southern United States between January and March of 2018 to inquire about their anticipation of discrimination in and willingness to utilize LTC services. We found that 78.6% of respondents (N = 789) anticipated discrimination in LTC. Previous experiences with discrimination, higher educational attainment, and queer/questioning sexual orientation were associated with greater expectation of discrimination. Higher anticipation of discrimination was also associated with a greater preference for utilizing LTC services offered by LGBTQ+ providers or for LGBTQ+ older adults. These findings suggest that LTC staff and researchers may be uniquely positioned to craft outreach and policies to protect LGBTQ+ LTC residents.

Use of Food to Cope With Culturally Relevant Stressful Life Events Is Associated With Body Mass Index in African American Women

BACKGROUND

Although stress is an established contributor to obesity (in general population studies), mechanisms to explain this association in African American women that incorporate culturally relevant frameworks have received little attention.

OBJECTIVE

To investigate how stress is associated with body mass index (BMI) in this population, we examined multivariate models of BMI predicted by race-related, gender-related, and generic stressful life events and by use of food to cope with stress. We hypothesized that the three types of stressful life events would be indirectly associated with BMI through using food to cope with stress.

METHODS

Psychometrically robust measures were included in surveys administered to a socioeconomically diverse sample of 189 African American women aged 21-78 years. Hypotheses were tested using structural equation modeling. We examined race-related, gender-related, and generic stressful life events as latent constructs indicated by exposure to and appraisal of potential stressors predicting a mediator, using food to cope, which predicted BMI; this model also included direct paths from the three latent stressful life event constructs to BMI.

RESULTS

Almost every participant reported using food in some way to cope with stress; 33% and 42% met established criteria for overweight and obesity, respectively. The race-related stressful life event construct was the only latent construct predicting using food to cope with stress, and using food to cope with stress predicted BMI. A significance test of indirect effects demonstrated that the race-related stressful life event construct was indirectly associated with BMI through the mediator, using food to cope.

DISCUSSION

Culturally relevant stress exposures and stress-related eating are important areas of foci for tackling overweight, obesity, and related health inequities in African American women. Findings highlight the importance of developing more complex models to understand the stress-related factors that elevate risk for overweight and obesity in this population.

The self in context: brain systems linking mental and physical health

Increasing evidence suggests that mental health and physical health are linked by neural systems that jointly regulate somatic physiology and high-level cognition. Key systems include the ventromedial prefrontal cortex and the related default-mode network. These systems help to construct models of the 'self-in-context', compressing information across time and sensory modalities into conceptions of the underlying causes of experience. Self-in-context models endow events with personal meaning and allow predictive control over behaviour and peripheral physiology, including autonomic, neuroendocrine and immune function. They guide learning from experience and the formation of narratives about the self and one's world. Disorders of mental and physical health, especially those with high co-occurrence and convergent alterations in the functionality of the ventromedial prefrontal cortex and the default-mode network, could benefit from interventions focused on understanding and shaping mindsets and beliefs about the self, illness and treatment.

Whitest City in America: A Smaller Black Community's Experience of Gentrification, Displacement, and Aging in Place

BACKGROUND AND OBJECTIVES

The influx of people with higher socioeconomic status into large Black communities is well documented; less is known regarding smaller, aging Black communities. Older Black adults in Portland, Oregon, among America's fastest gentrifying cities with the smallest metropolitan Black population, discussed barriers to healthy aging. Perspectives centered on the experience of gentrification, displacement, and its impact on social microsystems, place security, and aging in place.

RESEARCH DESIGN AND METHODS

One-time focus groups engaged 41 Black adults aged ≥45. A demographic survey included residence area/duration. Discussions were thematically coded. Ecological Systems Theory guided interpretation.

RESULTS

The majority of participants resided within gentrifying historically Black neighborhoods (89.2%), were aged ≥65 (54.6%), and lived in their neighborhood ≥21 years (24.3%). Emergent discussion themes were: Rise and fall of Black ownership; Displacement; Race-related stress; and Financial burden. Gentrification contributed to the dismantling of Black property ownership curated over generations, increased financial burden, and threatened place security. Physical displacement strained social networks, diminishing intergenerational neighborhood ties that supported aging in place. Cultural and physical displacement weakened sense of social cohesion and belonging, and induced race-related stressful interactions with new residents within original and relocation neighborhoods.

DISCUSSION AND IMPLICATIONS

Gentrification in the Pacific Northwest echoes national trends, uprooting critical close-proximity social networks and deteriorating motivation to engage in neighborhood-based social activity. Smaller, aging Black communities may be particularly vulnerable to these effects which critically impact aging in place. Data inform researchers and policymakers to better understand how gentrification affects smaller, aging Black communities.

The Role of Stress in Breast Cancer Incidence: Risk Factors, Interventions, and Directions for the Future

Stress is a common belief among breast cancer patients and the public to explain variation in breast cancer incidence. Epidemiological studies interrogating the relationship between stress and cancer have reported mixed results. The impact of the topic and the lack of consensus has sparked this review of the literature to investigate gaps in knowledge and identify areas of research. We first present a brief summary of the biopsychosocial model generally used to conduct research on stress. We then divide the overview of the literature into areas of research focus. These include the role of distressing life events in breast cancer incidence, the role of adverse childhood events in later breast cancer incidence, the importance of race and socioeconomic status (SES) as social determinants of breast cancer incidence, and the specific role of chronic stress in relation to breast cancer. For each topic, we discuss the potential of stress as a risk factor and possible intervention strategies that could reduce the effects of stress. We then identify further research questions to be probed to fill the gaps in knowledge. We conclude with a discussion of future research directions for stress research as it relates to breast cancer incidence.

Review article: Implicit bias towards Aboriginal and Torres Strait Islander patients within Australian emergency departments

Aboriginal and Torres Strait Islander peoples continue to suffer adverse experiences in healthcare, with inequitable care prevalent in emergency settings. Individual, institutional and systemic factors play a significant part in these persisting healthcare disparities, with biases remaining entrenched in healthcare institutions. This includes implicit racial bias which can result in stereotyping of racial minorities and premature diagnostic closure. Furthermore, it may contribute to distrust of medical professionals resulting in higher rates of leave events and hinder racial minorities from seeking care or following treatment recommendations. The aim of this review is to analyse the effect of implicit bias on patient outcomes in the ED in international literature and explore how these studies correlate to an Australian context.

Race in association with physical and mental health among former professional American-style football players: findings from the Football Players Health Study

PURPOSE

Race differences in health are pervasive in the United States. American-style football players are a racially diverse group with social status and other benefits that may reduce health disparities. Whether race disparities in health exist among former professional football players, and whether they differ by era of play, is unknown.

METHODS

We examined the association of self-reported race with health outcomes (e.g., physical and cognitive function, pain, depression, and anxiety), among 3747 participants in the Football Players Health Study, comprising former National Football League players who played since 1960. We conducted analyses stratified by age.

RESULTS

Black players had increased risk of all five adverse health outcomes versus white players (risk ratio range = 1.36 to 1.89). Native Hawaiians and men of other races had greater risk of all health outcomes except impaired physical functioning, compared with white players (risk ratio range = 1.25 to 1.64). No clear patterns were observed by era of play. In general, race disparities were not accounted for by health-related exposures during playing years. Adjustment for current BMI somewhat attenuated associations.

CONCLUSIONS

Social and economic advantages of playing professional football did not appear to equalize race disparities in health.

Sarcoidosis Epidemiology: Race Matters

Rather than a single disease entity, sarcoidosis may be a constellation of "sarcoidoses" with a characteristic pattern of organ involvement and clinic course, depending upon the triggering exposure and underlying epidemiologic factors such as race. This review examines the racial disparities inherent to sarcoidosis disease course and mortality and discusses factors that may be responsible for these findings. In the United States, black patients with sarcoidosis experience more severe pulmonary disease, more multiorgan involvement, and an overall worse prognosis with higher rates of hospitalization and mortality. Beyond inherent genotype, ascertainment and access to medical care, physician implicit bias, and patient perceived discrimination likely play a role. Moving forward, epidemiologic concepts can be used to formulate strategies for control, treatment, and even prevention of disease in black Americans at risk for developing life-altering or life-threatening sarcoidosis phenotypes. Identification and rectification of modifiable risk factors such as socioeconomic status, lack of insurance, and financial barriers to care as well as the incorporation of implicit bias training for physician will likely lead to improvement in discordant outcomes.

Learning to See Racism: Perspective Transformation Among Stakeholders in a Regional Health and Equity Initiative

CONTEXT

Achieving a meaningful reduction in health inequities will require not only policy and programmatic changes but also an increased understanding of structural racism and its deleterious impact on health and well-being. One way to enhance understanding is to actively promote "perspective transformation" (PT) around race among health equity stakeholders. Experiences of PT are defined as moments or events that bring about a deepened understanding of racism and that may result in new ways of thinking and acting.

OBJECTIVE

To identify catalysts and effects of PT among health equity stakeholders.

DESIGN

Semistructured, in-person interviews were conducted with stakeholders (n = 50) as part of a 2-phase, mixed-methods study (n = 170). Interviews were audio-recorded, transcribed, and coded using a mixed-methods software platform.

SETTING

Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga), a regional health and equity initiative in Greater Cleveland, Ohio.

PARTICIPANTS

A purposive sample of participants in HIP-Cuyahoga spanning 5 groups: metro-wide decision makers, public health professionals, clinicians, community leaders, and community members.

RESULTS

More than two-thirds of interviewees reported at least one discrete experience that catalyzed PT, as defined earlier. Three catalysts were especially common: witnessing, learning, and personally experiencing racism. A fourth, less common catalyst involved getting uncomfortable during discussions of race and racism. Experiences of PT resulted in common effects including acquiring new terms, concepts, and frameworks; carrying the conversation forward; finding fellow travelers; and feeling energized and motivated to confront structural racism and its consequences. People of color tended to experience PT, and its catalysts and effects, differently than White interviewees.

CONCLUSIONS

Many health equity stakeholders have experienced PT around racism and its impact. Experiencing PT is associated with new skills, capacities, and motivations to confront racism and its impact on health and well-being. Understanding how different groups experience PT can help advance efforts to promote health equity.

Discrimination and Sleep Mediate Ethnic/Racial Identity and Adolescent Adjustment: Uncovering Change Processes With Slope-as-Mediator Mediation

This study employs slope-as-mediator techniques to explore how the daily association between ethnic/racial discrimination and sleep disturbances serves as an intermediary link between ethnic/racial identity (ERI) and psychological adjustment. In a diverse sample of 264 adolescents (Mage  = 14.3 years old, 70% female, 76% United States born, 25% African American, 32% Asian American, 43% Latinx), discrimination was associated with sleep disturbance. Furthermore, ERI commitment buffered the impact of discrimination on sleep, whereas ERI exploration exacerbated the impact of discrimination. Finally, the daily level association between discrimination and sleep (i.e., daily slope) mediated the association between ERI and adolescent adjustment. Substantive links between discrimination and sleep are discussed as well as broader applications of slope-as-mediator techniques.

The Relationship Between Discrimination and Missed HIV Care Appointments Among Women Living with HIV

Receiving regular HIV care is crucial for maintaining good health among persons with HIV. However, racial and gender disparities in HIV care receipt exist. Discrimination and its impact may vary by race/ethnicity and gender, contributing to disparities. Data from 1578 women in the Women's Interagency HIV Study ascertained from 10/1/2012 to 9/30/2016 were used to: (1) estimate the relationship between discrimination and missing any scheduled HIV care appointments and (2) assess whether this relationship is effect measure modified by race/ethnicity. Self-reported measures captured discrimination and the primary outcome of missing any HIV care appointments in the last 6 months. Log-binomial models accounting for measured sources of confounding and selection bias were fit. For the primary outcome analyses, women experiencing discrimination typically had a higher prevalence of missing an HIV care appointment. Moreover, there was no statistically significant evidence for effect measure modification by race/ethnicity. Interventions to minimize discrimination or its impact may improve HIV care engagement among women.

Mechanisms of Black–White disparities in health among older adults: Examining discrimination and personality

We tested whether personality traits help explain the association between discrimination and racial health disparities in a sample of 1033 Black and White older adults. Participants completed measures of discrimination, personality, and self-reported physical and mental health. Elevated discrimination among Black participants was indirectly linked to worse physical and mental health outcomes through elevated neuroticism and lower agreeableness, controlling income, education, and gender. The specific facets of depression, impulsiveness, and trust were the most robust intervening personality factors. Interventions that target cognitive, emotional, and behavioral sequelae of discrimination may lessen its impact on health disparities.

Measuring the impact of multiple discrimination on depression in Europe

BACKGROUND

The study of the health effects of perceived discrimination based on ethnic and social traits has a long-standing and widespread tradition in epidemiological research, but less attention has been paid to the study of multiple discrimination, particularly its effects on mental health. The present work aims to analyse the association between multiple discrimination and depressive symptoms in Europe, and the impact of contextual socioeconomic circumstances on this relationship.

METHODS

In this study, data from the 7th Round of the European Social Survey was used. Given that the outcome variable, CES-D8, is a depression scale from 0 to 24 possible values and the hierarchical organisation of individuals (level-1 units) clustered within countries (level-2 units), a linear multilevel model was carried out.

RESULTS

Our findings suggest that multiple discrimination increases our risk of suffering depressive disorder, but in addition this work provides an important step forward to explain and understand how the relationship between multiple discrimination and depression might vary depending the socioeconomic context. In particular, we can observe that differences in the prevalence of depressive symptoms along multiple discrimination levels decrease as GDP per capita increases among European countries.

CONCLUSION

This study is relevant since provides new evidence on how the association between multiple discrimination and depression operates at the micro and macro-level context, which is fundamental to understand how macro-economic fluctuations of countries may determine depressive disorders through the effect of single and combined forms of discrimination.

Depressive Symptomatology, Racial Discrimination Experience, and Brain Tissue Volumes Observed on Magnetic Resonance Imaging

Not much is known about brain structural change in younger populations and minorities. The cross-sectional relationship between depressive symptomatology and racial discrimination with structural measures of brain tissue volume was investigated using magnetic resonance images of 710 participants in the Coronary Artery Risk Development in Young Adults CARDIA Study in 2010. Those reporting depressive symptoms and racial discrimination had lower total brain matter volume compared with those who reported neither (-8.8 mL, 95% confidence interval (CI): -16.4, -1.2), those who reported depressive symptoms only (-10.9 mL, 95% CI: -20.4, -1.4), and those who reported racial discrimination only (-8.6 mL, 95% CI: -16.5, -0.8). Results were similar for total normal white matter. There were 103% higher odds (odds ratio = 2.03, 95% CI: 1.32, 3.14) of being in the highest quartile of white matter hyperintensities in those with depressive symptoms only compared to those without. Although tests for interaction by race were not statistically significant, sensitivity analyses stratified by race revealed inverse associations with total brain matter and total white matter volumes only among black participants with combined depressive symptomatology and experience of racial discrimination, and positive associations only among white participants with depressive symptoms with presence of white matter hyperintensities, suggesting future studies may focus on race.

Moderating the association between discrimination and adjustment: A meta-analysis of ethnic/racial identity

The detrimental effects of discrimination are well documented; however, the influence of ethnic/racial identity (ERI) on this association is equivocal. There is theoretical and empirical support for both protective and detrimental effects of ERI. This meta-analysis includes 53 effect sizes from 51 studies and 18,545 participants spanning early adolescence to adulthood to synthesize the interaction of ERI and discrimination for adjustment outcomes. Consistent with existing meta-analyses, discrimination was associated with compromised adjustment; further, this effect was buffered by overall ERI particularly for academic and physical health outcomes. Different ERI dimensions and adjustment outcomes revealed important patterns. ERI exploration increased vulnerabilities associated with discrimination, particularly for negative mental health and risky health behaviors. The exacerbating influence of ERI exploration was strongest at age 24, and more recent publications reported weaker exacerbating effects. In contrast, ERI commitment conferred protection. A composite score of ERI exploration and commitment also conferred protection against discrimination. Sample demographics mattered. The buffering effect of ERI commitment was stronger for Latinx (compared with Asian heritage) individuals. The buffering effect of public regard was stronger for Asian heritage (compared with African heritage) individuals. For positive mental health outcomes, a composite score of ERI exploration and commitment had a stronger buffering effect for Latinx (compared with African heritage) individuals. For risky health behaviors, Latinx individuals reported a stronger buffering effect of ERI (compared with African heritage and Asian heritage) individuals. The current meta-analysis identifies gaps in the literature and offers suggestions for future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Coding the Everyday Discrimination Scale: implications for exposure assessment and associations with hypertension and depression among a cross section of mid-life African American women

BACKGROUND

Studies suggest that racial discrimination impacts health via biological dysregulation due to continual adaptation to chronic psychosocial stress. Therefore, quantifying chronicity is critical for operationalising the relevant aetiological exposure and hence maximising internal validity. Using one of the most common discrimination scales in the epidemiological literature, we develop a novel approach for more accurately assessing chronicity and compare it with conventional approaches to determine whether coding influences differential exposure classification and associations with hypertension and depression among African American women.

METHODS

Data are from a socioeconomically diverse cross section of 208 mid-life African American women in Northern California (data collection: 2012-2013). Racial discrimination was assessed using the Everyday Discrimination Scale (α=0.95), and was coded using two conventional approaches: (1) situation-based coding: number of different situations ever experienced; (2) frequency-based coding: sum of Likert scale responses ranging from 'never' to 'almost everyday'; and (3) a new chronicity-based coding approach: sum of responses, weighted to capture annual chronicity (eg, 'a few times a month'=3×12=36×/year). Outcomes are hypertension and depressive symptomatology (10-item Center for Epidemiologic Studies-Depression Scale).

FINDINGS

Exposure classification differed by coding approach, by up to 41%. There was a positive association between racial discrimination and hypertension prevalence for chronicity coding only (prevalence ratio=1.61, 95% CI 1.03 to 2.49). For depressive symptoms, a dose-response relationship of similar magnitude was observed for all three coding approaches.

CONCLUSION

Scale coding is an important methodological consideration for valid exposure assessment in epidemiological research. Coding can impact exposure classification and associations with important indicators of African American women's mental and physical health.

Building Better Clinical Relationships With Patients: An Argument for Digital Health Solutions With Black Men

There is a rapid evolution of care delivery taking place across the globe in response to an explosion of novel health technologies. Growing in parallel to this expansion is the anticipation of mHealth technologies to drive patient-centered care into the future. Despite this hope, continuing reports of health inequities and lived experiences of substandard care fill national, state, and community health reports. The impact of these inequities is particularly pernicious on Black men and their long-term health status. As decades of robust evidence substantiates needed interventions, current progress is not seeing expected gains. In this commentary, we argue that at the heart of these inequities are issues of access, health literacy, institutional racism, and growing social distance between clinicians and Black men. To address these inequities, we suggest that digital interventions, designed to support decision-making, information exchange, and shared accountability have the best hope to overcome current inequities by promoting authentic relationships that ultimately drive better communication between Black men and their clinicians.

Race, psychosocial vulnerability and social support differences in inner-city women's symptoms of posttraumatic stress disorder

BACKGROUND/OBJECTIVES

Inner-city Black women may be more susceptible to posttraumatic stress disorder (PTSD) than White women, although mechanisms underlying this association are unclear. Living in urban neighborhoods distinguished by higher chronic stress may contribute to racial differences in women's cognitive, affective, and social vulnerabilities, leading to greater trauma-related distress including PTSD. Yet social support could buffer the negative effects of psychosocial vulnerabilities on women's health.

METHODS/DESIGN

Mediation and moderated mediation models were tested with 371 inner-city women, including psychosocial vulnerability (i.e., catastrophizing, anger, social undermining) mediating the pathway between race and PTSD, and social support moderating psychosocial vulnerability and PTSD.

RESULTS

Despite comparable rates of trauma, Black women reported higher vulnerability and PTSD symptoms, and lower support compared to White Hispanic and non-Hispanic women. Psychosocial vulnerability mediated the pathway between race and PTSD, and social support moderated vulnerability, reducing negative effects on PTSD. When examining associations by race, the moderation effect remained significant for Black women only.

CONCLUSIONS

Altogether these psychosocial vulnerabilities represent one potential mechanism explaining Black women's greater risk of PTSD, although cumulative psychosocial vulnerability may be buffered by social support. Despite higher support, inner-city White women's psychosocial vulnerability may actually outweigh support's benefits for reducing trauma-related distress.

Relationship Between Psychosocial Stressors and Atrial Fibrillation in Women >45 Years of Age

Negative emotions have been linked to the development of atrial fibrillation (AF), and positive effect may be protective. However, there are few large-scale studies examining the association between psychosocial stressors that may provoke these emotions and the occurrence of AF. We examined the cross-sectional relation between psychosocial stress and AF in 24,809 women participating in the Women's Health Study. Participants answered questions about work stress (e.g., excessive work, conflicting demands), work-family spillover stress (e.g., too stressed after work to participate in activities with family), financial stress (e.g., difficulty paying monthly bills), traumatic life events (e.g., death of a child), everyday discrimination (e.g., less respect, poor service), intimate partner stress (e.g., how judgmental is your spouse/partner), neighborhood stress (e.g., neighborhood safety, trust), negative life events within 5 years (e.g., life threatening illness, legal problems), and cumulative stress (a weighted measure of the stress domains). The prevalence of confirmed AF was 3.84% (N = 953) and risk factor profiles differed by AF status. Women with AF reported significantly higher financial stress, traumatic life events, and neighborhood stress (p_each < 0.05). Only traumatic life events (odds ratio 1.37, 95% confidence interval 1.19 to 1.59) was significantly associated with AF after adjustment for cardiovascular risk factors, socioeconomic and psychosocial status. These large-scale cross-sectional data thus indicate a potential relationship between traumatic life events and AF in older women.

Why Don't More Black Americans Offend? Testing a Theory of African American Offending's Ethnic-Racial Socialization Hypothesis

Criminology is replete with research on the correlates of African American offending, yet theorizing efforts have lagged. Unnever and Gabbidon recently proposed a Theory of African American Offending, an integrated explanation of African Americans' risks for and resilience to offending. Many of the theory's hypotheses remain untested, especially its major claim that positive ethnic-racial socialization is the main reason more Black Americans do not offend. The theory argues that positive ethnic-racial socialization inhibits African American offending by attenuating the criminogenic effect of weak social bonds. Using data from a prospective, longitudinal cohort of African Americans from the Woodlawn Project, we test whether these postulations hold for adolescent delinquency and adult offending and find general support: Positive ethnic-racial socialization buffers the effect of weak school bonds on adolescent substance use and adult offending for males, but not females, across most crime types. Advancing criminological discourse on race, offending, and resilience, this study has implications for broader criminological theorizing and crime-reduction efforts.

Precision Medicine: Familiarity, Perceived Health Drivers, and Genetic Testing Considerations Across Health Literacy Levels in a Diverse Sample

A clear awareness of a patient's knowledge, values, and perspectives is an important component of effective genetic counseling. Advances in precision medicine, however, have outpaced our understanding of patient perceptions of this new approach. Patient views may differ across the three domains of precision medicine (genetics, behavioral, and environmental determinants of health), ethnic/racial groups, and health literacy levels. This study describes and compares group differences in familiarity, perceptions, and preferences for precision medicine in a diverse sample. Between 2016 and 2017, 252 participants completed a 10-15-min survey in three primary care clinics in Florida and Tennessee. The final sample was 42.5% African American/Black, 25.8% Hispanic/Latino, 25.0% White, and 6.7% other ethnicity/race. Less than a quarter of participants reported being familiar with the term "precision medicine," but were more familiar with basic genetic terms. Participants with higher health literacy reported greater familiarity with terms (p ≤ .003). African Americans/Black participants were more likely to identify ethnicity/race and discrimination as influencing their health (p ≤ .004). When deciding to get a genetic test, individuals across ethnic/racial groups shared similar considerations. Those with higher health literacy, however, gave significantly greater importance to provider trust (p ≤ .008). Given the recent emergence of precision medicine, at present there may be limited differences in patient perceptions across ethnic/racial groups. Culturally sensitive efforts, tailored to health literacy level, may aid equitable precision medicine uptake.

Public health for paediatricians: engaging young people from marginalised groups

Young people from marginalised groups can be excluded from health services because of reduced access, increased stigma and health inequalities. In addition, the stress associated with discrimination and stigma can have serious effects on individual health. This article explores how stigma affects young people's access to services and how health professionals can improve their practice and support for marginalised young people to achieve the best possible health outcomes. A better understanding of local populations of young people and their needs is key to improving services and support. Working in partnership with voluntary and community sector organisations is also important. In addition, improvements can be made by promoting better communication with young people and providing extra support to help them follow treatment plans.

The research topic landscape in the literature of social class and inequality

The literature of social class and inequality is not only diverse and rich in sight, but also complex and fragmented in structure. This article seeks to map the topic landscape of the field and identify salient development trajectories over time. We apply the Latent Dirichlet Allocation topic modeling technique to extract 25 distinct topics from 14,038 SSCI articles published between 1956 to 2017. We classified three topics as "hot", eight as "stable" and 14 as "cold", based on each topic's idiosyncratic temporal trajectory. We also listed the three most cited references and the three most popular journal outlets per topic. Our research suggests that future effort may be devoted to Topics "urban inequalities, corporate social responsibility and public policy in connected capitalism", "education and social inequality", "community health intervention and social inequality in multicultural contexts" and "income inequality, labor market reform and industrial relations".

The Impact of Stigma on Community Reintegration of Veterans With Traumatic Brain Injury and the Well-Being of Their Caregivers

OBJECTIVE

To assess the association between perceived stigma and discrimination and caregiver strain, caregiver well-being, and patient community reintegration.

DESIGN

A cross-sectional survey study of 564 informal caregivers of U.S. military service veterans of wars in Iraq and Afghanistan who experienced traumatic brain injuries or polytrauma (TBI/PT).

SETTING

Care settings of community-dwelling former inpatients of U.S. Department of Veterans Affairs Polytrauma Rehabilitation Centers.

PARTICIPANTS

Caregivers of former inpatients (N=564), identified through next-of-kin records and subsequent nominations.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Caregiver strain, depression, anxiety, loneliness, and self-esteem; as well as care recipient community reintegration, a key aspect of TBI/PT rehabilitation.

RESULTS

Family stigma was associated with strain, depression, anxiety, loneliness, lower self-esteem, and less community reintegration. Caregiver stigma-by-association was associated with strain, depression, anxiety, loneliness, and lower self-esteem. Care recipient stigma was associated with caregiver strain, depression, anxiety, loneliness, lower self-esteem, and less community reintegration.

CONCLUSIONS

Perceived stigma may be a substantial source of stress for caregivers of U.S. military veterans with TBI/PT, and may contribute to poor outcomes for the health of caregivers and for the community reintegration of the veterans for whom they provide care.

Perceived racial/ethnic discrimination, marketing, and substance use among young adults

Perceived experiences of discrimination have been linked to negative health behaviors including tobacco, alcohol, and marijuana use across various racial/ethnic groups. Tobacco and alcohol marketing exposure have also been linked with substance use. This study examined the independent and interacting effects of perceived experiences of discrimination and exposure to alcohol and tobacco marketing, and receptivity to marijuana marketing on substance use in an online survey of a multiethnic sample of young adults in 6 metropolitan areas (n = 505). African Americans (mean (M) = 1.96, 9% 5CI [1.84, 2.09]) and Hispanics (M = 1.98, 95% CI [1.87, 2.09]) reported higher levels of perceived discrimination than Whites (M = 1.52, 95% CI [1.40, 1.64]), p <  .001. African Americans had higher levels of exposure to tobacco and alcohol marketing; Hispanics reported higher levels of exposure to alcohol marketing and receptivity to marijuana promotion. Discrimination and marketing exposure were independently associated with higher odds of all 3 outcomes, controlling for covariates (AOR from 2.1 to 3.4 for discrimination; AOR from 1.4 to 13.8 for marketing). Models showed a significant interaction of discrimination and tobacco marketing on past 30-day cigarette use (F = 5.5; p = .02). Individuals with high levels of tobacco marketing exposure were likely to report high past 30-day cigarette use regardless of level of discrimination, while those with low exposure were only at increased risk of reporting cigarette use at higher levels of discrimination. Both perceived discrimination and marketing exposure play a role in substance use. Interventions should consider discrimination as a significant risk factor underlying vulnerability to substance use among young adults.

The weight of racism: Vigilance and racial inequalities in weight-related measures

In the United States, racial/ethnic inequalities in obesity are well-documented, particularly among women. Using the Chicago Community Adult Health Study, a probability-based sample in 2001-2003 (N = 3105), we examined the roles of discrimination and vigilance in racial inequalities in two weight-related measures, body mass index (BMI) and waist circumference (WC), viewed through a cultural racism lens. Cultural racism creates a social environment in which Black Americans bear the stigma burden of their racial group while White Americans are allowed to view themselves as individuals. We propose that in this context, interpersonal discrimination holds a different meaning for Blacks and Whites, while vigilance captures the coping style for Blacks who carry the stigma burden of the racial group. By placing discrimination and vigilance within the context of cultural racism, we operationalize existing survey measures and utilize statistical models to clarify the ambiguous associations between discrimination and weight-related inequalities in the extant literature. Multivariate models were estimated for BMI and WC separately and were stratified by gender. Black women had higher mean BMI and WC than any other group, as well as highest levels of vigilance. White women did not show an association between vigilance and WC but did show a strong positive association between discrimination and WC. Conversely, Black women displayed an association between vigilance and WC, but not between discrimination and WC. These results demonstrate that vigilance and discrimination may hold different meanings for obesity by ethnoracial group that are concealed when all women are examined together and viewed without considering a cultural racism lens.

Examining within- and across-day relationships between transient and chronic stress and parent food-related parenting practices in a racially/ethnically diverse and immigrant population : Stress types and food-related parenting practices

BACKGROUND

Although prior research suggests that stress may play a role in parent's use of food-related parenting practices, it is unclear whether certain types of stress (e.g., transient, chronic) result in different food-related parenting practices. Identifying whether and how transient (i.e., momentary; parent/child conflict) and chronic (i.e., long-term; unemployment >6 months) sources of stress are related to parent food-related parenting practices is important with regard to childhood obesity. This is particularly important within racially/ethnically diverse parents who may be more likely to experience both types of stress and who have higher levels of obesity and related health problems. The current study examined the association between transient and chronic stressors and food-related parenting practices in a racially/ethnically diverse and immigrant sample.

METHODS

The current study is a cross-sectional, mixed-methods study using ecological momentary assessment (EMA). Parents (mean age = 35; 95% mothers) of children ages 5-7 years old (n = 61) from six racial/ethnic groups (African American, American Indian, Hispanic, Hmong, Somali, White) participated in this ten-day in-home observation with families.

RESULTS

Transient stressors, specifically interpersonal conflicts, had significant within-day effects on engaging in more unhealthful food-related parenting practices the same evening with across-day effects weakening by day three. In contrast, financial transient stressors had stronger across-day effects. Chronic stressors, including stressful life events were not consistently associated with more unhealthful food-related parenting practices.

CONCLUSIONS

Transient sources of stress were significantly associated with food-related parenting practices in racially/ethnically diverse and immigrant households. Chronic stressors were not consistently associated with food-related parenting practices. Future research and interventions may want to assess for transient sources of stress in parents and target these momentary factors in order to promote healthful food-related parenting practices.