Perceived discrimination among migrants in Germany: Does social capital moderate harmful effects on mental health?

BACKGROUND

The harmful mental health effects of perceived discrimination for migrant populations are well established. The potential buffering effect of regional-level social capital, however, has not previously been explored.

METHODS

Using data from the German Socio-Economic Panel (SOEP; 2009-2018) we apply multilevel models to assess the effect of frequent or infrequent perceived discrimination on mental health (MCS subscale of the SF-12) adjusting for individual- and regional-level confounding in a cross-sectional research design. We assess interaction with general social capital (civic engagement, electoral participation, generalised trust) and migrant-specific resources (proportion of non-nationals). We juxtapose non-refugee migrants (n = 13478) with refugees subject to mobility restrictions (n = 5558) to account for bias introduced by selective mobility into regions.

RESULTS

In the non-refugee sample, we confirm the negative effects of discrimination experiences on MCS (ß frequent: -3.74, 95%-CI: [-4.40; -3.09]/ß infrequent: -1.88, 95%-CI: [-2.24; -1.52]). Moderation analyses among non-refugees show no buffering of general social capital, but a negative interaction effect of the proportion of non-nationals with experiences of discrimination (ß frequent: -0.54, 95%-CI: [-0.87; -0.21]/ß infrequent: -0.68, 95%-CI: [-1.29; -0.07]). Analyses among refugees also demonstrate a negative effect of discrimination on MCS with stronger overall effects than in the migrant sample (ß frequent: -6.24, 95%-CI: [-7.44; -5.05]/ß infrequent: -3.56, 95%-CI: [-4.25; -2.86]). In the refugee sample, the effect is exacerbated by the proportion of non-nationals (ß frequent: -1.70, 95%-CI: [-2.84; -0.56]) and buffered by generalised trust (ß: 0.87, 95%-CI: [0.13; 1.60]).

CONCLUSIONS

When faced with experiences of discrimination, levels of community trust seem to buffer the negative mental health impacts for refugees. We do not find buffering effects of social capital on the mental health of non-refugee migrants, possibly due to established social networks. Furthermore, our results suggest that the proportion of non-nationals within a community may have a negative reinforcing impact on the relationship between discrimination and mental health for both migrant samples. As this dynamic is currently underexplored in the German context, more community-based research is needed to develop appropriate policy interventions.

Racism, discrimination, medical mistrust, stigma, and lung cancer screening: a scoping review

OBJECTIVE

Lung cancer screening can reduce lung cancer-specific mortality, but it is widely underutilized, especially among minoritized populations that bear a disproportionate burden of lung cancer, such as Black Americans. Racism, discrimination, medical mistrust, and stigma contribute to lower uptake of preventive screenings in general, but the role these factors play in lung cancer screening is unclear. We therefore conducted a scoping review to synthesize the literature regarding how racism, discrimination, medical mistrust, and stigma relate to lung cancer screening.

DESIGN

Informed by PRISMA-ScR guidelines, we searched five databases for relevant literature, and two trained researchers independently reviewed articles for relevance. We conducted a narrative, descriptive analysis of included articles.

RESULTS

A total of 45 studies met our inclusion criteria. Most articles reported on medical mistrust or one of its cognates (e.g. trust and distrust, n = 37) and/or stigma (n = 25), with several articles focusing on multiple constructs. Few articles reported on racism (n = 3), and n = 1 article reported on discrimination. Results from empirical studies suggest that medical mistrust, distrust, and stigma may be barriers to lung cancer screening, whereas trust in health care providers may facilitate screening. The articles reporting on racism were commentaries calling attention to the impact of racism on lung cancer screening in Black populations.

CONCLUSIONS

Overall, novel interventions are needed to promote trust and reduce mistrust, distrust, and stigma in lung cancer screening initiatives. Dedicated efforts are especially needed to understand and address the roles that racism and discrimination may play in lung cancer screening.

Racial Disparities in COVID-19 Severity Are Partially Mediated by Chronic Stress-Evidence from a Large Integrated Healthcare System

BACKGROUND

Racial and ethnic minorities have experienced a disproportionate burden of severe COVID-19. Whether chronic stress, also disproportionately experienced by racial and ethnic minorities, explains this excess risk is unknown.

METHODS

We identified 9577 adults (≥ 18 years) diagnosed with COVID-19 from January 1, 2020, through September 30, 2021, enrolled in Kaiser Permanente Georgia (KPGA) with complete biomarker data. Self-reported race (Black or White) was defined from electronic medical records. Chronic stress, defined as allostatic load (AL), a composite score (scale 0-7) based on seven cardio-metabolic biomarkers, was categorized as below (low AL) or above (high AL) the median. Severe COVID-19 was defined as hospitalization or mortality within 30 days of COVID-19 diagnosis. The association between race, AL, and severe COVID-19 was assessed using multivariable Poisson regression. The mediating effect of AL was assessed using the Valeri and VanderWeele method. All results were expressed as risk ratios (RRs) with 95% confidence intervals.

RESULTS

Overall, Black (vs. White) KPGA members had an 18% excess risk of AL (RR: 1.18, 95%CI: 1.14-1.23) and a 24% excess risk of severe COVID-19 (RR: 1.24, 95%CI: 1.12, 1.37). AL explained 23% of the Black-White disparities in severe COVID-19.

CONCLUSIONS

In our study, chronic stress, characterized by AL, partially mediated Black-White disparities in severe COVID-19 outcomes.

Stressor-Evoked Brain Activity, Cardiovascular Reactivity, and Subclinical Atherosclerosis in Midlife Adults

BACKGROUND

Cardiovascular responses to psychological stressors have been separately associated with preclinical atherosclerosis and hemodynamic brain activity patterns across different studies and cohorts; however, what has not been established is whether cardiovascular stress responses reliably link indicators of stressor-evoked brain activity and preclinical atherosclerosis that have been measured in the same individuals. Accordingly, the present study used cross-validation and predictive modeling to test for the first time whether stressor-evoked systolic blood pressure responses statistically mediated the association between concurrently measured brain activity and a vascular marker of preclinical atherosclerosis in the carotid arteries.

METHODS AND RESULTS

Six hundred twenty-four midlife adults (aged 28-56 years, 54.97% women) from 2 different cohorts underwent 2 information-conflict functional magnetic resonance imaging tasks, with concurrent systolic blood pressure measures collected. Carotid artery intima-media thickness was measured by ultrasonography. A mediation framework that included harmonization, cross-validation, and penalized principal component regression was then used. Brain areas where functional magnetic resonance imaging activity exhibited reliable direct and indirect effects were identified through bootstrapping. Sensitivity analysis further tested the robustness of findings after accounting for prevailing levels of cardiovascular disease risk and brain imaging data quality. Task-averaged patterns of functional magnetic resonance imaging activity across distributed brain areas exhibited a generalizable association with carotid artery intima-media thickness, which was reliably mediated by an area under the curve measure of aggregate systolic blood pressure reactivity. Importantly, this effect held in sensitivity analyses. Implicated brain areas in this mediation included the ventromedial prefrontal cortex, anterior cingulate cortex, insula, and amygdala.

CONCLUSIONS

These novel findings support a link between stressor-evoked brain activity and preclinical atherosclerosis, which is accounted for by individual differences in corresponding levels of stressor-evoked cardiovascular reactivity.

Combined effects of life course maternal psychosocial experiences on perinatal mental health

OBJECTIVES

Identifying experiences that place women at higher risk for mental health impairment is critical to inform perinatal care. This study's purpose was to identify the individual and combined association between early life adversity, discrimination, and perinatal mental health.

STUDY DESIGN

Prospective cohort study.

METHODS

The Pregnancy and Infant Development Study (PRIDE) is a prospective cohort study that follows pregnant women in Cincinnati, Ohio through 18 months postnatal. Measures of socioeconomic factors, adverse childhood experiences, discrimination, and maternal mental health were collected at home study visits. Multiple linear regression identified associations between psychosocial measures and perinatal mental health.

RESULTS

Adjusting for socioeconomic factors, early life adversity, and discrimination were significantly associated with perinatal mental health (β range from 0.20 to 1.64). The strongest association was observed for the association between emotional neglect and depression β = 2.53 (p = 0.006). The joint effect of high early adversity and high discrimination demonstrated the strongest effect.

CONCLUSION

Women who experienced early life trauma, in particular emotional neglect and discrimination, also experienced depression and distress during the perinatal period. Identification of women at risk for mental health problems should be a priority for programs that are positioned to help mitigate future consequences to mothers and their families.

Assessing Equitable Implementation of a Social Care Initiative Integrating Medical and Social Services for Medicaid Members

OBJECTIVE

To assess the equitable implementation of a case management program integrating medical and social services for Medicaid members.

STUDY SETTING AND DESIGN

This qualitative study assessed the equitable implementation of a case management program in Contra Costa County, CA. Study participants were identified using purposive sampling. Semi-structured interviews were conducted in person or by phone.

DATA SOURCES AND ANALYTIC SAMPLE

Primary data were collected between Fall 2019 and Spring 2021 and included 92 semi-structured interviews with patients (n = 31), case managers (n = 47), and county administrators (n = 14). Data were coded using an inductive-deductive framework analysis approach informed by the Health Equity Implementation Framework (HEIF).

PRINCIPAL FINDINGS

Characteristics of the innovation influencing equitable implementation included experienced public health nursing leadership and inclusion of social risk factors in a predictive algorithm determining patient program eligibility. Recipient factors included inequitable emotional demands of medical and social service integration work on case management teams from diverse racial/ethnic and training backgrounds, and patient experiences of mistreatment from medical and social service institutions. Clinical encounter factors highlighted the necessity for trust building between patients and case managers and the importance of multidisciplinary expertise to address patients' interconnected medical and social needs. Contextual factors described organizational readiness in the form of multidisciplinary teams with reduced hierarchical power imbalances, system-wide investments in a universal data infrastructure and data insights team, and strong intra- and inter-organizational partnerships. Societal factors included systemic discrimination and racism, insufficient affordable housing and public transit, pervasive administrative barriers in accessing health and social services, and federal funding for holistic approaches to integrated care.

CONCLUSIONS

Case management programs aiming to equitably integrate social and medical services should invest in multidisciplinary case management teams, organizational readiness for equitable implementation via committed, experienced leadership, and interventions to address systemic factors hindering the engagement of historically marginalized groups.

Gender Discrimination is Associated with Greater Chronic Pain Interference Among Women

Pain disparities between men and women are found in multiple domains; women have been shown to experience greater pain intensity, pain disability, and risk for chronic pain. While often ascribed to biological differences, recent research has demonstrated the significance of social determinants of gendered pain disparities. Gender discrimination is one factor that disproportionally affects women and has been associated with adverse health outcomes, yet has received less attention in pain research. Discrimination is intrusive and stressful, and may exacerbate the extent to which chronic pain interferes with life. Prior work has shown that among women, general experiences of discrimination are indirectly associated with pain interference through perceived stress. However, the direct relationship between gender discrimination specifically and pain interference has not been explored. Here, using data from the Midlife in the United States national survey, we first assessed the relationship between daily experiences of discrimination due to any aspect of identity and pain interference in those with chronic pain. We further explored whether discrimination due to gender specifically was associated with pain interference among women. Results indicated that daily discrimination was associated with greater pain interference within the whole sample; however, within-group analyses found that this relationship was only significant for women, and not men. Exploring further within women only, discrimination due to gender predicted greater pain interference, controlling for health-related covariates. These findings support recent calls for probes into the role of discrimination on health outcomes and suggests that experiencing discrimination contributes to disruption of life and pain disparities. PERSPECTIVE: The findings presented here advance our understanding of the harmful impact of discrimination on pain outcomes, broadening its scope by providing evidence regarding the association between gender discrimination and pain interference. Considering known pain disparities between men and women, we discuss potential insight into mechanisms contributing to this burden.

Discrimination, Depression, and Anxiety Among US Adults

Importance

Examining how discrimination is associated with mental health across different demographic groups can guide efforts to improve mental well-being.

Objectives

To analyze associations between discrimination and mental health and explore how these associations may vary by race and ethnicity and sex.

Design, Setting, and Participants

Cross-sectional data of 29 522 adults weighted to represent a population of 258 237 552 US adults from the 2023 US National Health Interview Survey were analyzed.

Exposures

Exposure to discrimination was measured using the Everyday Discrimination Scale, which assesses frequency of being treated with less courtesy, receiving poor service, being treated as not smart, being feared, and experiencing harassment. A summative scale and a nominal variable (none, low, and high) measured degree and levels of discrimination exposure.

Main Outcomes and Measures

Outcomes included depression (measured with the Patient Health Questionnaire-2 scale) and anxiety (measured with the Generalized Anxiety Disorder-2 scale), with scores of 3 or greater indicating positive screening results for each scale. Multinomial logistic regression analyses examined associations of interest and tests of interaction explored effect modification by race and ethnicity and sex.

Results

Among a sample of 29 522 adults weighted to represent a population of 258 237 552 US adults (mean age, 48.1 years [95% CI, 47.8-48.4 years]; 51.1% female; 17.5% Hispanic or Latino, 2.5% multiracial or other, 6.2% non-Hispanic Asian, 11.6% non-Hispanic or non-Latino Black, and 62.2% non-Hispanic or non-Latino White), each unit increase in exposure to discrimination was associated with increased odds of positive screening results for depression (odds ratio [OR], 1.15 [95% CI, 1.12-1.17]), anxiety (OR, 1.14 [95% CI, 1.12-1.16]), and both depression and anxiety (OR, 1.19 [95% CI, 1.16-1.21]). Compared with no exposure to discrimination, low and high exposure to discrimination were associated with increased odds of positive screening results for depression (low exposure: OR, 2.20 [95% CI, 1.77-2.72]; high exposure: OR, 5.39 [95% CI, 3.61-8.04]), anxiety (low exposure: OR, 1.97 [95% CI, 1.66-2.33]; high exposure: OR, 4.98 [95% CI, 3.59-6.91]), and both depression and anxiety (low exposure: OR, 2.60 [95% CI, 2.13-3.18]; high exposure: OR, 8.84 [95% CI, 6.44-12.14]). Associations between discrimination and positive screening results for depression alone (F4,607 = 3.35; P = .01) and between discrimination and positive screening results for both depression and anxiety (F4,607 = 2.80; P = .03) varied by race and ethnicity. Associations of interest did not differ by sex.

Conclusions and Relevance

Findings of this cross-sectional study suggest an association between discrimination and mental health across US adults, emphasizing the need for further evaluation and increased awareness of how these associations may vary across different demographic groups.

What Is Social Connection in the Context of Human Need: An Interdisciplinary Literature Review

The U.S. Surgeon General made an impactful declaration in the 2023 advisory on America's loneliness and social isolation epidemic that social connection, or human relationships, is a human need equivalent to water, food, and shelter. After witnessing the impact of social isolation measures during the COVID-19 pandemic, there is a global urgency to better understand social connection in public health responses. However, meaningfully effective interventions for social isolation or loneliness have yet to be identified, and the consensus that social connection is an equivalent human need is unclear. To understand what social connection, oxygen, water, food, and shelter have in common regarding population health, we conducted an interdisciplinary literature review between September 2021 and October 2024, seeking to find commonalities between research literature advocating social connection as a human need critical to survival and key concepts across population health disciplines that explain how oxygen, water, food, and shelter function as human needs. We integrated the concepts of evolution, resource, environment, ecosystem, exposure science, embodiment, homeostasis, allostatic load theory, and interdisciplinary from 44 core publications to develop a unified conceptual model and definition for social connection as a human need. We believe a holistic understanding of social connection within the shared context of oxygen, water, food, and shelter can better support health researchers across a variety of disciplines to find common ground in developing evidence-based interventions within public health.

Intersections of Structural State-Level Racism and Neighborhood Deprivation on Nutrition and Obesity for Black Adolescents

PURPOSE

Black adolescents in the United States face disproportionate poor nutrition and obesity risk due to racism. Intersections of larger structural contexts that pose differential access to Black adolescents' health resources, such as state-level racism and neighborhood-level disadvantage, may govern these risks. The purpose of this correlational study was to examine the associations between state-level racism, neighborhood disadvantage, and their intersection with nutrition and obesity for Black adolescents in a longitudinal study.

METHODS

Publicly available administrative data measuring state-level racism was linked to 2 waves (collected 2016-2018) of individual-level demographic, health, and neighborhood data from 1,530 Black adolescents (Mage at baseline = 9.46; 47.70% female) from the Adolescent Brain and Cognitive Development Study. Neighborhood deprivation scores were calculated from American Community Survey data. Caregivers reported adolescents' nutrition and demographics. Adolescent waist circumference and height and weight (converted to body mass index) were measured.

RESULTS

Residing in a state higher in racism was associated with greater body mass index for adolescents 1 year later (B = 0.29, p = .001), and residing in a neighborhood higher in area deprivation was associated with worse nutrition 1 year later (B = -0.02, p = .001).

DISCUSSION

Both state-level racism and neighborhood disadvantage exert separate negative influences on health outcomes. Targeting separate state- and neighborhood-level social policies for obesity and nutrition risk may be crucial to bolster the health of Black adolescents.

Variations in documentation of alcohol use disorder (AUD) diagnoses across race, ethnicity, and sex in a health system that assesses AUD symptoms as part of routine primary care

INTRODUCTION

Prior studies have highlighted potential inequities in provider-documented alcohol use disorder (AUD) across race, ethnicity, and sex. Whether subgroup differences in AUD reflect true variation or diagnostic disparities is unknown. This study aims to describe variations in the prevalence of provider-documented AUD across race, ethnicity, and sex: 1) after adjustment for alcohol consumption, and 2) after additional adjustment for patient-reported AUD symptoms.

METHODS

In Kaiser Permanente Washington, patients with high-risk drinking (AUDIT-C score 7-12; 2.4 % of screened patients) complete a validated Alcohol Symptom Checklist of DSM-5 AUD symptoms with results documented in electronic health records. This study included Asian, Black, Latine, and White patients in primary care settings (03/2015-02/2022) who indicated high-risk drinking and thus completed an Alcohol Symptom Checklist. The prevalence of AUD was estimated for women and men across race or ethnic groups using marginally standardized generalized linear models. Models were first unadjusted, then adjusted for consumption (AUDIT-C scores 7-12), and then consumption plus AUD symptom counts (0-11).

RESULTS

Among 14,442 patients with high-risk drinking (6.0 % Asian, 5.8 % Black, 7.8 % Latine, 80.4 % White; 32.1 % women), provider-documented AUD increased with alcohol consumption and the number of AUD symptoms. The prevalence of AUD across 8 subgroups defined by race, ethnicity, and sex varied in analyses adjusted for alcohol consumption alone (range 11.6 % [95 % CI: 9.3-14.4] to 20.2 % [18.9-21.5]). However, after adjustment for both alcohol consumption and AUD symptoms, the prevalence of AUD ranged from 11.2 % [95 % CI: 7.9-15.6] to 15.0 % [95 % CI: 13.9-16.3] in women, and from 11.0 % [95 % CI: 8.7-13.8] to 15.1 % [95 % CI: 14.3-16.0] in men. AUD did not appear to vary across race or ethnicity.

CONCLUSIONS

In this study of primary care patients with high-risk drinking in a regional healthcare system that routinely assesses AUD symptoms, variations in provider-documented AUD diagnosis across race, ethnicity, and sex were observed after adjusting for alcohol consumption but were diminished after adjusting for AUD symptoms. This may suggest that among patients with similar alcohol consumption and AUD symptoms, intersectional variations in AUD diagnosis may be less apparent. Assessing AUD severity with Alcohol Symptom Checklists may help support equitable clinical AUD diagnosing.

Are Experiences of Discrimination Associated With Views of Physical Activity and Climate Policy Support in Canada?

BACKGROUND

Social climate refers to the general feelings, norms, and opinions in a society and may be affected by experiences of discrimination. This study examined whether experiences of discrimination are associated with the social climate of physical (in)activity and support for policies addressing dual benefits of physical activity (PA) and climate change.

METHODS

Data from the 2023 Social Climate Survey were used (n = 1950; ≥18 y). Adherence to PA guidelines, perceived importance of PA, social norms, and support for 8 policy actions addressing dual benefits were each regressed on experiences of discrimination.

RESULTS

Experiencing discrimination was not associated with the importance of PA, causal attribution of physical inactivity (individual vs external), adherence to PA guidelines, or policy support addressing PA and climate change. However, experiencing discrimination was associated with social norms that are favorable to PA: seeing children playing actively outdoors (odds ratio [OR]: 1.04; 95% CI, 1.02-1.06), perceiving that half of people their age meeting PA guidelines (OR: 1.04; 95% CI, 1.02-1.06), agreeing with societal disapproval of physical inactivity (OR: 1.03; 95% CI, 1.01-1.06), and having important people (eg, family/friends) meeting PA guidelines (OR: 1.10; 95% CI, 1.08-1.12).

CONCLUSIONS

Unlike structural discrimination, interpersonal experiences of discrimination may not shape the perceived importance of and engagement in PA. However, experiencing discrimination may be associated with an individual's perceptions of their social environment, including how they observe and interpret the behaviors of others within their community. Generally strong support for policies addressing dual benefits, regardless of experiences with discrimination, aligns well with the planetary health agenda.

Discrimination in the medical setting among LGBTQ+ adults and associations with cancer screening

PURPOSE

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals experience disparities in cancer screening. We examined whether experience of LGBTQ+ -related discrimination in medical settings was associated with cancer screening disparities.

METHODS

Participants were recruited via social media for a cross-sectional survey study. Those who self-reported as LGBTQ+ , being 40+ years of age, and residing in the US were eligible. Participants reported their clinical and demographic characteristics, cancer screening history, and experiences of discrimination in a medical setting. We examined the odds (OR) of ever undergoing cancer screening by experienced discrimination, stratified by sex assigned at birth.

RESULTS

Participants (n = 310) were on average 54.4 ± 9.0 years old and primarily White (92.9%). Most identified as lesbian (38.1%) or gay (40.0%) while 17.1% were transgender or gender diverse. Nearly half (45.5%) reported experiencing LGBTQ+ -related discrimination in the medical setting. Participants assigned female at birth with discriminatory experiences had significantly lower odds of ever undergoing colonoscopy/sigmoidoscopy compared to those without discriminatory experiences (OR: 0.37; 95% Confidence Interval (CI) 0.15-0.90). No significant differences in colonoscopy/sigmoidoscopy uptake were observed in those assigned male at birth by discriminatory experiences (OR: 2.02; 95% CI 0.59-6.91). Pap tests, mammogram, and stool colorectal cancer screening did not differ by discriminatory experience.

CONCLUSION

Discrimination in medical settings was commonly reported by LGBTQ+ individuals in this study. When treating LGBTQ+ patients, clinicians should ask about prior experiences and continue to promote cancer screening. Future studies should examine discrimination as a key driver of LGBTQ+ disparities in cancer screening.

"The panic stays in your mind…concentrating more on the worries than the relationship": Intimate partnerships during COVID-19 for immigrant women in New York City

Objective

This study examines perceptions of changes in intimate relationships among partnered, immigrant women in New York City during the first year of the COVID-19 pandemic. We pay close attention to how structural oppression, particularly related to undocumented immigration status, shaped women's experiences with their intimate partners during a period of social upheaval.

Background

COVID-19 has exacerbated many existing structural inequities and subsequent stressors that have been shown to have an adverse effect on intimate relationships, including increased economic instability and mental health distress. Immigrant women may be particularly vulnerable to relationship strain because of intersecting social and structural inequities.

Methods

We draw on in-depth, semi-structured interviews among a heterogenous sample of 22 women with varied legal status from Latin America, South and East Asia, and the Middle East.

Results

Findings reveal three primary pathways through which structural inequities shaped women's experiences with intimate partnership strain, including financial and material scarcity; uneven caregiving burdens; and constrained access to support in situations of violence and abuse.

Conclusion

Our analysis demonstrates ways that structural inequity, particularly driven by exclusionary immigration laws, influence intimate partner relationships through the legal status of immigrant women. Understanding how structural oppression shapes immigrant partnerships is essential for the field of family demography and for family-serving professionals in referring clients to resources and services, as well as helping women explore sources of resilience and coping within their families and communities.

Racialized migrant women's discrimination in maternal care: a scoping review

BACKGROUND

Despite equality and quality being the core of good healthcare, racial and ethnic inequalities continue to persist. Racialized groups, including racialized migrant women, experience various forms of discrimination-particularly during maternal care encounters, where intersectional forms of discrimination may occur. Experiences of discrimination in maternal care have been associated with poor health-seeking behavior and adverse maternal health outcomes. However, research on racialized migrant women's discrimination in maternal care is limited. This scoping review aims to give an overview of the state of current research on the discriminatory experiences of racialized migrant women when utilizing maternal healthcare and its gaps to ensure equity in global maternal healthcare.

METHODOLOGY

This scoping review mapped out all available English-language scientific empirical literature published between 2012 and 2023. All authors agreed on the inclusion criteria. Collecting, charting, and reviewing the included material were done using the 2018 Preferred Reporting Items for reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The search strategy included electronic databases, such as Pubmed, CINAHL, MEDLINE, Web of Science, and PsycInfo.

RESULTS

A total of 57 articles were included and analyzed. The majority were qualitative and conducted in European and North American countries. None of the included article's aims originally intended to focus on discrimination. However, their findings exposed the many ways racialized migrant women experienced discrimination when using maternal healthcare services-from accessibility problems, non-utilization of interpreters, and untimely and delayed care to disrespect, abuse, and differential care. Racialized migrant women's discrimination resulted in a lack of agency and being excluded from decision-making.

CONCLUSIONS

While the included articles allude to some issues related to discrimination in maternal healthcare experienced by racialized migrant women, this review delineated knowledge gaps warranting discussion. Few articles focus on and conceptualize discrimination from a racialized lens in maternal healthcare. A limited geographical scope in research and knowledge generation on discrimination and racialization exist in this field as does a lack of sufficient articles on discrimination and racism from healthcare personnel. Lastly, many of the existing studies lack an intersectional lens in exploring discrimination in maternal care against racialized migrant women.

Structural, Institutional, and Interpersonal Racism: Calling for Equity in Autism Research and Practice

Disparities in autism research and practices based on race and ethnicity are evident across many outcomes and life course stages. However, most of the research has focused on outlining differences and not the underlying systemic inequities driving these disparities. In this conceptual paper, we aim to shift the focus by outlining mechanisms of structural racism within the institutions of science, healthcare, and residential segregation and educational systems in the United States (U.S.). We argue that these and other forms of institutional racism constitute structural racism that are influencing the racial and ethnic disparities we see in autism services and care. For each of these institutions, we identify institutional racism related to autism and offer an example of how it shapes interpersonal racism and adverse outcomes, including misdiagnosis, delayed diagnosis, unequal access to educational services, and differential treatment in clinical encounters. We then provide anti-racism approaches in autism research and practice for each of these institutions that addresses institutional and interpersonal racism shaping autism inequities among racial and ethnic minorities. We conclude with a call to action to clinicians, researchers, and others to prioritize and disrupt the impacts of structural, institutional, and interpersonal racism through targeted anti-racism approaches.

Mental Health and the Intersection of Perceived Discrimination and Social Inequalities Among Students in Germany - a Quantitative Intersectional Study

Objectives

Discrimination poses a threat to the mental health of university students, especially those affected by social inequality, yet understanding its intersectional impact remains limited. This study examines the intersection of social inequalities with perceived discrimination to explore differences in mental health among students in Germany.

Methods

Data from the cross-sectional project "Survey on study conditions and mental health of university students" (n = 14,592) were analysed using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA). Depressive symptoms, cognitive stress symptoms, and exhaustion were examined across 48 intersectional strata based on gender, first academic generation, family care tasks, and perceived discrimination.

Results

The MAIHDA analysis revealed substantial between strata variance, with most of it explained by additive rather than intersectional interaction effects. Perceived discrimination, diverse or female gender, first academic generation, and family care tasks (for exhaustion only) were associated with worse mental health outcomes.

Conclusion

The profound associations between perceived discrimination and the mental health among university students call for urgent attention and intervention within university settings. Adopting an intersectional lens is key to identifying and addressing inequalities.

Exposure to structural racism-related state laws is associated with worse cardiovascular health among US adults, BRFSS 2011 and 2013

The objective of this study was to determine whether exposure to structural racism-related state laws is associated with cardiovascular health among a racially and ethnically diverse sample of US adults. Data were from the Database of Structural Racism-Related State Laws and the Behavioral Risk Factor Surveillance System (BRFSS). The sample included 958 019 BRFSS 2011 and 2013 respondents aged 18 years or older from all 50 US states. The exposure was a summary index of 22 state laws related to the criminal legal system, economics and labor, education, health care, housing, immigration, and political participation. The outcome was the American Heart Association's Life's Simple 7 (LS7), a summary index of 7 cardiovascular health indicators. Linear regression models included fixed effects for year and state to control for time trends and unmeasured, time-invariant, state-level contextual factors. In the full sample, a 1 SD increase in the structural racism state legal index was associated with a 0.06-unit decrease in the LS7 (b = -0.06; 95% CI, -0.09 to 0.02; P = .001), controlling for individual- and state-level covariates. Contrary to expectations, stratified models revealed no statistically significant differences by race and ethnicity in the association between the structural racism state legal index and the LS7.

Racism in German healthcare: uncovering the construction and silencing of the "other"

While the impact of racism on healthcare interactions has been researched extensively in many parts of the world, substantive studies on healthcare-related racism in Europe, and particularly in Germany, remain scarce. This paper builds on a study that applies Community-Based Participatory Research (CBPR) and aims to explore healthcare users' experiences of racism within German healthcare. Community members were trained as peer researchers and given support as they conducted a total of six focus group discussions that involved a total of 14 study participants: these participants were organized into two subsamples of seven participants each (subsample one: Black, African, Afro-diasporic healthcare users; subsample two: healthcare users perceived or self-describing as Muslim), and each subsample had three focus group discussions. A democratic approach to qualitative data analysis was applied in the form of the DEPICT model. The data analysis developed iteratively, with inductive and deductive steps complementing one another. The study results illustrate how the collaboratively developed concepts of being treated as "other" and being made inaudible can advance our understanding of the forms, dynamics, and effects of racism in healthcare encounters. Because this paper focuses on the process of racialization, it helps illumine the mechanisms of subtle racism, which, as study results suggest, can damage healthcare users, cause a loss of trust in the system, and lead to invisibilization of racism in healthcare. By doing so, it draws attention to areas for change and transformation, to larger power structures that must be challenged in order to ensure responsive and equal healthcare for all healthcare users. The application of CBPR and, particularly, the engagement of racialized healthcare users in the research process offered pathways for analyzing the subtle, otherwise hard-to-detect mechanisms of racism, and for learning from the wisdom of situated knowledges.

Sociodemographic disparities in everyday discrimination among a national sample of adults in the United States, 2023

Objective

Discrimination is a social determinant contributing to health inequities in the United States (US). This study investigated the prevalence of, and sociodemographic disparities in, perceived everyday discrimination among a national sample of US adults.

Methods

We used data from the 2023 National Health Interview Survey (n = 27,538) and estimated the prevalence of three perceived everyday discrimination outcomes (1) any discrimination, (2) unique components of the discrimination experience, and (3) the Everyday Discrimination Scale (EDS) (range: 0-20) overall and by age, sex assigned at birth, race and ethnicity, sexual orientation, educational attainment, income-to-poverty ratio, and urban-rural status.

Results

Over half of US adults experienced any discrimination (55.8 %), and the most common form of perceived discrimination was being treated with less respect (45.2 %). Adults who were younger (aged 18-44), female, non-Hispanic Black, sexual minority, some college-educated, low income, or urban-living generally reported higher discrimination. For example, among the sample, non-Hispanic Black (vs. non-Hispanic White) (OR: 1.61, 95 % CI: 1.44-1.81) and sexual minority (vs. heterosexual) (OR: 2.48, 95 % CI: 2.12-2.90) adults had the highest odds of any discrimination and EDS scores (β: 1.38 (95 % CI: 1.17-1.59) and β: 1.65 (95 % CI: 1.35-1.94), respectively). The odds of perceived discrimination varied in magnitude by specific experience; for example, sexual minority adults had the highest odds of being threatened or harassed (OR: 2.93, 95 % CI: 2.52-3.42).

Conclusions

Perceived everyday discrimination is prevalent and differentially affects adults, especially members of marginalized and underserved populations. Understanding discrimination patterns will benefit public health and medical efforts aimed at mitigating exposure and deleterious health consequences.

Intersectional Anticipated Discrimination Among Women Experiencing Homelessness in Argentina

Women experiencing homelessness constitute a group with idiosyncratic characteristics and needs that have largely remained invisible. Their discriminatory situation has been studied very little which may limit the design of specific intervention strategies. Buenos Aires (Argentina) is one of the main megalopolises in Latin America, where information on women experiencing homelessness is scarcely available. The main objective of this paper is to analyze different aspects related to intersectional anticipated discrimination perceived by women experiencing homelessness in Buenos Aires (n = 72). A structured interview was used to collect the information. The findings show that the vast majority of women experiencing homelessness in Buenos Aires reported experiencing unfair treatment and anticipated discrimination. In addition, more than two-thirds of the women interviewed indicated that they felt they could be insulted or detained without cause, among other unfair treatment. Among the main reasons attributed by the interviewees to these situations of discrimination were the fact of being homeless, being women (cis or trans), and being poor. The results obtained may be useful to guide the design and implementation of policies, services, and programs for women experiencing homelessness with a gender perspective.

Racial and nonracial discrimination and tobacco use among high school students in California

BACKGROUND

The public health literature has established a relationship between discrimination, health outcomes, and health and well-being in adolescence. The objective of this study is to add vaping to the existing studies on discrimination and tobacco use among youth. To achieve this objective, the analysis examined the relationship between discrimination, type of discrimination, and current tobacco use, including current vape use, among adolescents in California.

METHODS

This study uses data from the 2023 California Youth Tobacco Survey, which was administered to a representative sample of middle and high school students (8th, 10th, and 12th graders) attending public and private schools in California. The analysis focused on high school students in public schools. Outcome variables were current use of any tobacco product and current vape use. Predictor variables were any, racial, and nonracial discrimination. Covariates included race/ethnicity, gender identity and sexual orientation, and age. Separate logistic regression models examined the relationship between any discrimination or racial and nonracial discrimination and current tobacco use or current vape use, adjusting for covariates. Analyses were adjusted by sampling weights and stratification variables to account for complex sampling techniques.

RESULTS

Any, racial, and nonracial discrimination were associated with significantly higher odds of current tobacco use. Any discrimination was also associated with significantly higher odds of current vape use. Nonracial, but not racial, discrimination was significantly associated with significantly higher odds of current vape use.

CONCLUSION

The results of this analysis are consistent with other analyses demonstrating a significant positive relationship between experiences of discrimination and tobacco use. These results contribute to existing knowledge by revealing that this relationship also exists for vaping among youth. Discrimination remains a public health crisis, including for youth in California. Increased use of supportive, rather than punitive, tobacco control approaches and cessation resources should be considered for schools in California.

Defining health equity: A modern US perspective

Health equity is a concept that has gained increasing attention and relevance in the context of the COVID-19 pandemic, which has exposed and exacerbated the health disparities and inequities among different population groups in the United States. This article aims to provide a comprehensive and critical overview of the historical, theoretical, and empirical foundations of health equity, as well as the challenges and opportunities for advancing it in the modern US society. By adopting an interdisciplinary and intersectional approach, and by drawing on literature from public health, sociology, economics, and human rights, we argue that health equity is not only a matter of fairness and justice, but also a strategic and pragmatic goal for improving the health and well-being of the entire nation. Here, we propose a modern definition of health equity for the US context, and conclude with some recommendations for policy, practice, and research to promote health equity in the US.

Impact of increasing workforce racial diversity on black-white disparities in cardiovascular disease mortality

BACKGROUND

Structural racism's influence on workforce policies and practices presents possible upstream targets for assessing and reducing racial health disparities. This study is the first to examine workforce racial diversity in association with racial disparities in cardiovascular disease (CVD) outcomes.

METHODS

This retrospective cohort study of 39 693 hourly autoworkers from three Michigan automobile plants, includes 75 years of follow-up (1941-2015). Workforce racial diversity (per cent black autoworkers) was a plant and year level variable. Annual exposure was cumulated over each individual's working life and divided by time since hire. This time-varying measure was categorised into low, moderate and high. We estimated age-standardised rates of CVD and Cox proportional HRs by race.

RESULTS

CVD mortality per 100 000 person-years decreased among autoworkers over the study period; however, black workers' rates remained higher than white workers. Among black workers, we observed a strong protective association between greater workforce racial diversity and CVD mortality. For example, at the Detroit plant, the HR for moderate exposure to racial diversity was 0.94 (0.83, 1.08) and dropped to 0.78 (0.67, 0.90) at the highest level. Among white workers, results were mixed by plant, with protective effects in plants where less than 20% of workers were black and null results where black workers became the majority.

CONCLUSION

Our findings provide evidence that workplace racial diversity may reduce CVD mortality risk among black workers. Workplace practices encouraging diverse hiring and retention have potential to improve all workers' health; particularly the socially racialised groups in that workforce.

New York State Climate Impacts Assessment Chapter 07: Human Health and Safety

New Yorkers face a multitude of health and safety risks that are exacerbated by a changing climate. These risks include direct impacts from extreme weather events and other climate hazards, as well as indirect impacts occurring through a chain of interactions. Physical safety, physical health, and mental health are all part of the equation-as are the many nonclimate factors that interact with climate change to influence health outcomes. This chapter provides an updated assessment of all these topics at the intersection of climate change, public health and safety, and equity in the state of New York. Key findings are presented below.

Intersectionality in Health Communication: How Health Communication Influences the Association Between Intersectional Discrimination and Health Information Seeking

With an intersectional orientation, we examine associations between discrimination, health communication, and information-seeking intention about HIV prevention in the context of pre-exposure prophylaxis (PrEP) among cisgender women through an online survey (N = 341). We elaborate on the idea that intersectional discrimination is a social determinant of health by considering the context with differing power relations-day-to-day life and the healthcare field-based on Bourdieu's field theory, and explore moderating roles of health communication in this relationship according to the structural influence model of communication (SIM). The relationships between intersectional discrimination and intention show different patterns by the context in which intersectional experiences are considered, and the relationships are moderated differently by the mode of health communication. We discuss how to conduct intersectionality-informed health communication research without sacrificing intersectionality's foundational foci.

Experienced Racism and Discrimination and Psychological Distress amid Different Phases of the COVID-19 Pandemic: Evidence from Wisconsin

The SARS-COV-2 pandemic created an unprecedented crisis and raised concerns about racial discrimination and psychological distress. We assessed trends in COVID-19-related racism and discrimination irrespective of infection status and changes in emotional health and mental well-being outcomes due to experienced racism and discrimination. Using three waves of the Wisconsin COVID-19 Community Impact Survey (2020-2021), we compared demographics of respondents categorized by two mutually exclusive groups: reporting vs. not reporting COVID-19-related racism and discrimination. Using longitudinal logistic-multivariable regressions, we modeled changes in racism and discrimination-induced stress and 4-item patient health questionnaire screening for anxiety and depression (PHQ-4) associated with experiencing racism and discrimination. Prevalence of reported experiencing COVID-19-related racism and discrimination increased among adult Wisconsinites between 2020 and 2021: 6.28% in Wave 1, 11.13% in Wave 2 (Pearson's chi-square Wave 1 vs 2=16.96, p<.001) vs. 10.87% in Wave 3 (chi-square, Wave 1 vs 3=14.99, p<.001). Experiencing COVID-19-related racism and discrimination was associated with a higher likelihood stress (OR=3.15, 95% CI 2.32-4.29) and a higher PHQ-4 score (coeff=0.63, 95% CI 0.32-0.94). Relative to White respondents, racial/ethnic minorities had a higher likelihood of feeling stress: Black OR=7.13, 95% CI 4.68-10.85; Hispanics OR=3.81, 95% CI 2.11-6.89; and other races OR=2.61, 95% CI 1.51-4.53. Estimated associations varied across racial/ethnic groups, age groups, and survey waves. Our study showed that experienced COVID-19-related racism and discrimination increased during the first 2 years of the pandemic and was associated with greater psychological distress among Wisconsinites of all racial/ethnic groups. Public health policies promoting inclusiveness should be implemented to reduce (COVID-19-related) racism and discrimination and its long-term effects on mental health and well-being.

A school-wide approach to cultural responsivity and student engagement: A randomized trial of Double Check in middle schools

The present study reports findings from a school-level randomized controlled trial (RCT) of the Double Check cultural responsivity and student engagement model. Consistent with the focus of this special issue on the conceptual and methodological advances for understanding contextual, identity, and cultural effects in intervention research, we report outcomes of the multi-component, school-wide Double Check model, testing the combined impacts of school-wide data-based decision-making along with staff professional development on school-level discipline, culturally responsive practices, classroom contextual factors, and classroom coaching using the Double Check version of the Classroom Check-up. The results from the 41 middle-school RCT indicated significant impacts on proximal outcomes of culturally responsive teacher self-efficacy, observations of instructional support, and indicators of student engagement, but no effect on other intended outcomes (e.g., observations of culturally responsive practices, suspensions). Findings suggest an effect of the Double Check on select teachers' classroom management strategies and student behaviors moderated by key classroom contextual factors. The contextual findings suggest implications for future tailoring of Double Check coaching supports in classrooms with low levels of tier 1 PBIS supports and high levels of disruptive student behavior.

Discrimination and Dignity Experiences in Prior Oral Care Visits Predict Racialized Oral Health Inequities Among Nationally Representative US Adults

Racism, an oppressive and fallacious sociopolitical hierarchy, is a fundamental cause of oral health inequities worldwide. Everyday discrimination is associated with worse self-rated oral health, toothache and adult tooth loss, and lower oral care utilization. Few studies examine discrimination or microaggressions within oral care settings or their effects on oral health outcomes. We adapted the seven-item Everyday Discrimination Scale to the oral care setting (EDSOC); developed a four-item Dignity in Oral Care Scale (DOCS); fielded them to a probability-based nationally representative sample of US households as part of the 2022 State of Oral Health Equity in America survey (SOHEA, n = 5682); and examined associations between EDSOC and DOCS scores and three outcomes: self-rated oral health, duration since last oral care visit, and planning for future preventive/routine oral care. Nearly, all EDSCOC and DOCS measures were significantly associated with oral health outcomes. Discrimination experience in dental settings had an additive effect on reporting fair/poor oral health and a suppressive effect on planning a future dental visit. Indignity experience doubled-to-quadrupled the likelihood of reporting fair/poor oral health, not having visited a dentist in 2 years, and not planning a future oral care visit. Racio-ethnically minoritized patients may experience the unjust double bind of resolving urgent dental or completing preventive services needs amidst being treated in a discriminatory manner or without dignity. Oral health stakeholders should invest more effort to understand relationships between racism and oral health outcomes and introduce evidence-based interventions to ultimately abolish this societal harm.

The socioecology of sexual minority stigma: Advancing theory on stigma-based mechanisms underlying sexual orientation-based disparities in health

Research in public health and psychology has identified sexual minority stigma-related risk factors that contribute to sexual orientation-based health disparities across settings and societies worldwide. Existing scholarship, however, has predominantly focused on these factors as independent, stand-alone risk factors, neglecting their interconnected nature across different levels. This article theoretically explores how sexual minority stigma may function as a multilevel socioecological system, by building on prevailing theories and emphasizing the interplay between structural, interpersonal, and intrapersonal stigma-related factors. Drawing on the minority stress and socioecological theories, three central tenets are proposed, namely 1) chronosystem with immediate, accumulating, or lasting effects across spatiotemporal contexts, 2) nested multilevel system with cross-level effects, and 3) mechanistic pathways linking stigma exposure to health. By providing a nuanced and comprehensive understanding of how sexual minority stigma may operate as a multilevel socioecological system, this article reflects on the novel implications of this interpretation for future research and aims to guide future conceptualizations and studies, acknowledging the complexity of sexual minority stigma exposure across historical contexts, societies, and the individual life course in shaping physical and mental health of sexual minorities. Limitations of current research and recommendations for future research are being discussed.

Racism and health and wellbeing among children and youth-An updated systematic review and meta-analysis

BACKGROUND

Evidence of racism's health harms among children and youth is rapidly increasing, though attention to impacts on physical health and biomarker outcomes is more emergent. We performed a systematic review of recent publications to examine the association between racism and health among children and youth, with a meta-analysis of the specific relationships between racism and physical health and biomarkers.

METHODS

We conducted a systematic literature search using four databases: Medline, PsycINFO, PubMed, and ERIC. Four inclusion criteria were used to identify eligible studies: (1) exposure was experiences of racism, (2) outcome was health and wellbeing, (3) quantitative methods were used to estimate the association between racism and health outcomes, and (4) the effect size of associations between racism and health and wellbeing was reported for participants aged 0-24 years. Correlation coefficients were used to report the pooled effect size for each outcome indicator.

RESULTS

There were 463 eligible studies included in the screening process, with 42 studies focusing on physical health or biomarker outcomes. Random-effects meta-analysis found minimal to moderate positive associations between racism and C-reactive protein, Interleukin 6, body mass index (BMI), obesity, systolic blood pressure, salivary cortisol, asthma, and somatic symptoms. There were marginal positive associations between racism and Tumour Necrosis Factor-α, cortisol collected via saliva, urine and hair, BMI-z score, and diastolic blood pressure, with imprecise estimates and wide confidence intervals.

CONCLUSIONS

Racism is associated with negative physical health and biomarker outcomes that relate to multiple physiological systems and biological processes in childhood and adolescence. This has implications for health and wellbeing during childhood and adolescence and future chronic disease risk. Collective and structural changes to eliminate racism and create a healthy and equitable future for all children and youth are urgently required.

Unmasking population undercounts, health inequities, and health service access barriers across Indigenous populations in urban Ontario

OBJECTIVES

Our Health Counts (OHC) methods are designed to address gaps in urban-based Indigenous health information. In partnership with local Indigenous health service providers, we have successfully implemented OHC in six Ontario cities. The aim of this study is to summarize findings regarding Indigenous population undercount, health inequities, and health service access barriers across study sites.

METHODS

We estimated Indigenous population size using OHC census participation survey responses and a multiplier approach. Health inequities between Indigenous populations and overall populations in each city were examined using respondent-driven sampling (RDS), adjusted OHC survey results, and existing public data. Measures included health status outcomes; determinants of health; barriers to health service access, including discrimination by health service providers; and unmet health needs.

RESULTS

Indigenous social networks were strong and extensive, and the urban populations demonstrate resilience and cultural continuity across multiple measures. Self-reported rates of census participation for Indigenous populations were markedly lower than those for the general population in each city, and OHC Indigenous population size estimates were consistently 2‒4 times higher than reported in the census. Indigenous to general population health inequities cut across measures of chronic disease, determinants of health, and unmet health needs. Indigenous populations experienced multiple barriers to health services access, including racial discrimination by health service providers.

CONCLUSION

The Canadian census appears to markedly underestimate Indigenous population size in urban areas. Indigenous health inequities and service access barriers are striking and cross-cutting. Timely adaptation of health policies, services, and funding allocations in response to these findings is recommended.

Racial discrimination and cognitive function: An instrumental variable analysis

Racial inequities in cognitive function persist with mixed evidence regarding the impacts of racial discrimination on cognitive outcomes. We examined the association between experiences of racial discrimination within institutional settings, such as getting a job or housing, and multiple measures of cognitive function among middle-aged adults using analytic methods to strengthen the existing evidence base and provide potential points for intervention. We used cross-sectional data from 2895 participants in Wave 8 (Mage = 50.20, range: 43-55) and 2618 participants in Wave 9 (Mage = 55.20, range: 48-60) of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Self-reported racial discrimination was operationalized using the Experiences of Discrimination Scale. Cognitive measures included were the Stroop Interference Test, Rey Auditory Verbal Learning Test, Digit Symbol Substitution Test, and the Montreal Cognitive Assessment. Analyses were conducted using ordinary least squares regression (OLS) and instrumental variable (IV) analysis using reflectance meter-measured skin color as the instrument. We find that increased experiences of racial discrimination are associated with poorer performance on cognitive assessments across OLS and IV analyses. For example, reporting one additional experience of racial discrimination was associated with approximately 0.50 SD lower auditory verbal learning scores using IV and 0.08 SD lower scores using OLS (Wave 8 IV 95% CI: -0.54, -0.41; OLS 95% CI: -0.10, -0.06). Such results in a relatively young sample yield insight into the potential implications of navigating a racialized society over one's life course in contributing to inequities in cognitive decline in older age.

Discrimination among American Indian and Alaska Native people: implications for public health communication

Introduction

American Indian and Alaska Native People (AI/AN) have experienced discrimination stemming from sustained attempts to erase AI/AN People and their culture or livelihood. Research identifying the types of discrimination experienced by AI/AN People is needed to help individuals recognize discrimination in daily life. We examine experiences of discrimination among an urban AI/AN population using a mixed methods approach.

Methods

Self-identified AI/AN participants (N = 303, n = 294 with complete data; 63% women, mean age = 43 years) were recruited from the Denver-metro area in Colorado. Stress and coping models of discrimination guided our analysis. Exposure to discrimination was quantitatively assessed via the Brief Perceived Ethnic Questionnaire - Community Version (BPEDQ-CV), a self-report measure including four subscales assessing workplace discrimination, social exclusion, physical threat and harassment, and stigmatization. Participants responded to a laboratory recall task in which they described an episode of discrimination and their affective and coping responses. Content analysis was conducted on transcribed responses to illustrate discrimination exposure as reported in the BPEDQ-CV and in prior theoretical work on coping with discrimination.

Results

Repeated measures analyses revealed participants reported experiencing social exclusion more than other forms of discrimination, followed by reports of workplace discrimination, stigmatization, and physical threat. Consistent with these quantitative findings, participants were more likely to recall experiences of social threat (94%), including episodes of workplace discrimination, social exclusion, and stigmatization than physical threat and harassment. Almost half the participants (47%) reported confronting or directly addressing the discrimination, and 38% reported avoiding a direct approach. For 44% of participants, their predominant emotional response included internalizing emotions such as fear/sadness/embarrassment, and another 44% reported experiencing externalizing emotions, including anger.

Conclusion

Our descriptive findings present the experiences of urban AI/AN People who have experienced many forms of unjust and prejudicial treatment. These data can provide useful information to help the general public and AI/AN individuals more readily recognize and prevent discriminatory behavior, and consequently mitigate deleterious effects of discrimination on health.

Structural Racism Conceptualization and Operationalization for Research for the U.S. HIV Epidemic: Findings from a Scoping Review and Implications for Advancing Research for Structural Interventions

In the U.S., inequities by race/ethnicity in health outcomes, such as in the HIV epidemic, are long standing but have come to the forefront during the COVID-19 pandemic. There is growing recognition of the role of structural racism in racialized health inequities, yet the conceptualization and operationalization of structural racism in HIV research lags. We conducted a scoping review of existing published literature, between 1999-April 2024, conceptualizing and measuring structural racism's impact among people living with or at risk for HIV in the U.S. Our initial search yielded 236 unique articles, which after title and abstract screening yielded ten articles meeting full text review criteria. We then extracted key parameters, such as conceptualization, method of measurement of structural racism, study aims, design, and findings. Three of the articles were qualitative studies that conceptualized structural racism using (1) the social network model, (2) individual and structural intersectionality and (3) critical race theory. Operationalization of structural racism within the seven quantitative studies fell into three categories: (1) structural level, (2) a scale of experiences of racism, including structural racism, and (3) using explanatory demographic factors as downstream measures of the effects of structural racism. The variance in the conceptualization and operationalization of structural racism highlights the different interpretations of structural racism in its applications to the field of HIV research. Given the vast racial/ethnic inequities in HIV, we propose three overarching suggestions for next steps in improving the conduct of research on structural racism in HIV: (1) we must prioritize measuring racism past the individual and interpersonal levels to consider systemic factors at a societal level that manifest as structural racism to improve HIV outcomes in the U.S., (2) consider intergenerational effects of structural racism through the use of longitudinal data, and (3) broaden the agenda of structural racism to incorporate other systems of oppression. Additionally, broadening the scope of funding and inclusion of more researchers and individuals with lived experiences to support structural racism research to drive the scientific agenda and design of structural-level interventions will not only bolster achieving the U.S. Ending the HIV Epidemic goals but will do so by addressing inequities.

Associations between perceived discrimination experiences, treatment adherence self-efficacy, and depressive symptoms among people living with HIV in the Southern United States

This study examined associations between perceived discrimination, treatment adherence self-efficacy, and depressive symptoms among people living with HIV (PLHIV) in the Southern United States. Cross-sectional survey data were collected from 402 PLHIV who self-reported on interpersonal discrimination experiences based on HIV status, sexuality, gender, income, and living condition. Participants also reported on adherence self-efficacy and depressive symptoms. We employed K-means clustering to identify groups based on discrimination experiences, and logistic regressions to examine group differences on adherence self-efficacy and depressive symptoms. Results suggested three groups: a cluster with high perceived discrimination across all identities/conditions (n = 41; 11%; Cluster 1); a cluster with high perceived discrimination based on HIV status, income, and living condition (n = 49; 13%; Cluster 2); and a cluster with low perceived discrimination across all identities/conditions (n = 288; 76%; Cluster 3). Compared to Cluster 3, Cluster 1 and 2 had 2.22 times (p = .037) and 3.98 times (p<.001) greater odds of reporting depressive symptoms. Compared to Cluster 3, Cluster 2 had 3.40 times (p = .003) greater odds of reporting lower adherence self-efficacy. Findings demonstrate the need for individual-level support for PLHIV with discrimination histories, and broader efforts to end the stigma, discrimination, and marginalization of PLHIV based on HIV status and other characteristics.

Consumption of food markers of a healthy diet according to racial groups of women in Brazil

This article aims to analyze the consumption of healthy food consumption markers, according to racial groups of Brazilian women interviewed in the 2019 National Health Survey (NHS). This work was a cross-sectional study with data from 45,148 white and black women, aged ≥ 20 years. The variables used were the consumption of fruits, vegetables and legumes, beans, and fish. The association between color/race and the dietary intake indicators was tested using crude Poisson regression and adjusted to estimate prevalence ratios and 95% confidence intervals (95%CI). The prevalence of the consumption of fruits and vegetables was statistically higher among white women, while fish and beans was higher among black women. After adjusting for socioeconomic and demographic variables, it was found that black women remained only less likely to consume fruit (PR = 0.91; 95% CI: 0.88-0.95) and only more likely to consume beans (PR = 1.07; 95% CI: 1.04-1.10) than whites. There were racial inequalities for the consumption of healthy foods among Brazilian women, indicating that color/race defined a dietary pattern for black women that put them in vulnerable conditions in terms of fruit consumption.

"Does Religious Service Attendance Modify the Relationship between Everyday Discrimination and Risk of Obesity? Results from the Study on Stress, Spirituality and Health"

This study examined the association of everyday discrimination with risk of obesity and the potential modifying effect of religious service attendance. Participants included Black, South Asian, and white women in three cohort studies that belong to the Study on Stress, Spirituality and Health. Logistic regression models estimated odds of obesity classification (BMI ≥ 30) relative to experiences of everyday discrimination. In initial pooled analyses, high levels of discrimination were related to increased odds of obesity. Race-specific analyses revealed marginal associations for white and South Asian women. Among Black women, high levels of discrimination and religious service attendance were both associated with higher odds of obesity. However, among women who attended religious services frequently, higher levels of everyday discrimination were associated with slightly lower odds of obesity. These findings underline the complex association between obesity and religion/spirituality, suggesting that higher levels of discrimination may uniquely activate religious resources or coping strategies. Findings highlight the need for additional studies to examine the impact of everyday discrimination on risk of obesity across racial/ethnic communities and how religious practices or coping strategies might affect these dynamics.

Experiences of Discrimination Among Women and Gender Diverse Veterans Using Veterans Health Administration Health Care

Introduction

Women Veterans are diverse in terms of racial, ethnic, and gender identities and sexual orientation and may experience a variety of forms of discrimination and stigma in health care settings. Our objective was to understand discrimination experienced by women Veterans in the context of Veterans Health Administration (VA) care.

Methods

We analyzed data from a series of semistructured telephone interviews with Veterans identified as females in the VA medical record who received VA health care in the past 12 months, purposively sampled by race/ethnicity and age (N = 28). The interview guide elicited experiences with VA health care, including discrimination. Interviews were audio-recorded, transcribed, and analyzed using inductive and deductive content analysis.

Results

We identified themes regarding structural discrimination, interpersonal discrimination, and strategies employed in response to discrimination. Veterans described structural discrimination, including challenges with spaces not designed to accommodate disabilities or safety needs and care not sensitive to their gender, trauma histories, or sexual orientation. Interpersonal discrimination included harassment from other Veterans and biased treatment from VA providers and staff based on gender, appearance, and sexual orientation. Gender-based discrimination compounded across additional axes of marginalization including body size and stigma regarding mental illness. Experiences of discrimination undermined Veterans' sense of belonging and trust in VA and created barriers to accessing care. Veterans engaged in various strategies to protect themselves from discrimination and get needed care.

Discussion

Quality improvement efforts that address the experience of women Veterans using VA health care must consider multiple forms and sources of discrimination and the intersection of gender-based discrimination with other forms of marginalization.

Psychometric evaluation of the Intersectional Discrimination Index for use in Brazil

This cross-sectional study evaluated the configural and metric structures of the Intersectional Discrimination Index (InDI), an instrument that measures anticipated (InDI-A), dat-to-day (InDI-D), and major (InDI-M) discrimination. Data from a broader study, focused on the impacts of discrimination on the mental health of women living in Brazil, were used. Approximately 1,000 women, selected according to a convenience sampling scheme, answered the InDI and questions about sociodemographic characteristics in an electronic form that was administered in 2021. Exploratory factor analyses and exploratory structural equation modeling were applied to the first half of the sample; for the second, confirmatory factor analysis was conducted. Taken together, the findings suggest that each of the three measures is one-dimensional. However, unlike the study that originally proposed the InDI for use in Canada and the United States, we observed the presence of residual correlations in the three subscales evaluated, all of which were suggestive of content redundancy between specific pairs of items. The three measures showed moderate to strong factor loadings and acceptable fit to the data. InDI exhibited reasonable internal validity, potentially becoming a valuable instrument for investigating the health effects of intersectional discrimination in Brazil. Future studies should evaluate the consistency of these findings, examine the scalar structure of the instrument, and analyze its invariance among different marginalized groups.

Intersectionality and the Association Between State-Level Structural Racism, Binge Alcohol Consumption, and Smoking Status Among Black Americans

BACKGROUND

Structural racism is associated with alcohol and tobacco use among Black Americans. There is a need to understand how this relationship differs within varying groups of Black Americans. This study assessed the moderating roles of age, gender, and income in the association between structural racism and binge alcohol consumption and tobacco smoking status among Black Americans.

METHODS

A state-level index of structural racism was merged with data from a national probability sample of 1946 Black Americans. Hierarchical linear and logistic regression models tested associations between structural racism (measured by residential segregation, and economic, incarceration, and educational inequities) and binge alcohol use and smoking status among Black Americans by stratified by age, gender, and income. Moderating effects of age, gender, and income were tested using slope estimate comparisons.

RESULTS

Results indicated statistically significant positive associations between incarceration disparities and binge drinking and smoking status among Black Americans below age 65. An inverse association was detected between education disparities and smoking status among Black Americans below age 65 and among higher-income Black Americans. Age, gender, and income were not significant moderators of these associations.

CONCLUSIONS

Age, gender, and income do not moderate the association between state-level structural racism and binge alcohol or tobacco use behaviors among the current sample of Black Americans.

IMPACT

Addressing structural racism may have implications for reducing participation in binge drinking and tobacco use behaviors among Black Americans, regardless of their age, gender, or income. This has implications for healthy equity and cancer prevention and control.

School Segregation During Adolescence is Associated with Higher 30-Year Cardiovascular Risk of Black but not White Young Adults

Although cardiovascular disease (CVD) mortality rates are declining for American adults, a disparity remains between non-Hispanic Black and non-Hispanic White adults. Previous research has shown that residential segregation, a form of structural racism, experienced in childhood is associated with later-life racial and ethnic health disparities, including disparities in CVD and its risk factors. However, little is known about the health consequences of exposure to segregated schools, especially among those living in neighborhoods with high concentrations of minoritized people. This study used data from the In-School, Wave I, and Wave IV surveys of the National Longitudinal Study of Adolescent to Adult Health to examine a novel school measure of school racial segregation (Index of the Concentration of Extremes, ICE) as a predictor of Framingham 30-year CVD risk scores. We used General Estimating Equation models to evaluate the association between ICE, measured at Wave I, and two different 30-year CVD risk scores, measured at Wave IV, and examined whether the relationship varied by race. We observed that higher levels of school segregation were associated with a higher 30-year CVD risk among non-Hispanic Black participants while higher segregation was associated with a lower 30-year CVD risk for non-Hispanic White participants. This research suggests that exposure to segregation in the school setting may contribute to observed disparities in CVD among US adults.

A qualitative study exploring the perinatal experiences of social stress among first- and second-generation immigrant parents in Quebec, Canada

BACKGROUND

Perinatal psychological distress adversely impacts the well-being and social adjustment of parents and their children. Expectant parents who have migrated may be at higher risk for perinatal psychological distress due to various migration-specific stressors and healthcare service barriers. Limited studies have examined the perceived determinants of perinatal distress in immigrant parents, particularly men. This study explored first and second-generation immigrant parents' lived experiences of social stressors and facilitators of perinatal psychological well-being.

METHODS

Participants were recruited by convenience and purposive sampling as part of a larger study. Semi-structured interviews were conducted virtually with first and second-generation immigrant women and men in Quebec, Canada. An inductive thematic analysis was performed.

RESULTS

Sixteen women (age = 34.8 ± 3.7 years) and ten men (age = 35.1 ± 4.9 years) from various ethnic backgrounds participated in the study at 7.4 ± 0.73 and 7.5 ± 0.72 months postpartum, respectively. Three themes were identified: (1) cultural pressures (cultural differences in parenting, gender-related cultural pressures, health and baby-related practices), (2) health and social service access (social benefits and resources, and systemic barriers in health care), and (3) discrimination (physical appearance or parental-related discrimination, gender-related discrimination, ethnic-related discrimination). First-generation immigrant parents reported greater acculturative stress (i.e. mental health stigma, health care access) and ethnic discrimination concerns related to their distress. Among men, barriers include feeling as though the paternal role was devalued by society and not receiving consideration by health care.

CONCLUSIONS

Our results highlight different social factors of perinatal well-being perceived by men and women from various ethnic and immigration backgrounds during the perinatal period. Perceived factors include macro-level factors, such as a country's social climate, health and social policies and services, and social aspects of acculturative stress. Our findings suggest the need for continued efforts to challenge and eliminate discriminatory practices. Interventions and resources directed at first-generation immigrant parents should be bolstered. Understanding what parents perceive to facilitate or hinder their psychological well-being can help inform the development of tailored evidence-based programs and policies to better meet the mental health needs of Canadians and reduce gender disparities in the treatment of perinatal distress.

When a baby is born, so is a parent: Understanding the effects of preterm birth on Black parents through the lens of the NIMHD framework

BACKGROUND

The rate of preterm birth (PTB) is high in the United States and Black infants remain disproportionately affected, with the disparity between Black and White infant deaths greater today than it was under antebellum slavery.

PURPOSE

The National Institute on Minority Health and Disparities Research Framework reflects a unique set of determinants relevant to the understanding and promotion of minority health.

METHODS

We have applied this framework to better understand the effects of PTB on Black parents and the distribution of the social determinants of health, including structural determinants and root causes of inequities.

DISCUSSION

This adaptation shows the intersection in maternal and infant health that shapes individuals' experiences, drives disparities and impacts perinatal outcomes in critical periods over the lifecourse.

CONCLUSION

In our efforts to achieve health equity, it is imperative that we study the underlying mechanisms and recognize that policies, institutional structures, and social factors are drivers of racism.

The Association Between Perceived Discrimination, Age and Proportion of Lifetime in the United States Among Somali Immigrants: A Cross-Sectional Analysis

Discrimination is detrimental to health. Little is known about perceived discrimination among Somali immigrants. We examined whether age or proportion of lifetime in the United States was associated with perceived discrimination among Somali immigrants. Guided by Intersectionality, we described a secondary analysis of Everyday Discrimination Scale (EDS) survey data from the Healthy Immigrant Community study. Younger participants ( ≤40 years) experienced more discrimination than older participants ( >40 years). Higher education, being male, and earning $20,000-$39,999 was associated with more perceived discrimination. These findings suggest that Somali immigrants who are younger, more formally educated, male, and/or earn $20,000-$39,000 report more discrimination than their counterparts. Possible explanations include exposure to discrimination outside the Somali community or more awareness about racism. Alternatively, the EDS may not capture the discrimination experienced by Somali women or older adults. Further research is needed to address the discrimination experienced by Somali immigrants. Clinical Trial Registration: NCT05136339, November 29,2021.

A Multigenerational Model of Environmental Risk for Black, Indigenous, and People of Color (BIPOC) Children and Families

BACKGROUND

In recent years, public discourse has increasingly brought institutional and structural racism to the foreground of discussion on the well-being of BIPOC (Black, Indigenous, and People of Color) communities. Environmental toxicity in combination with the social triggers of institutional and structural racism are among the factors that shape the short- and long-term health of BIPOC Americans across multiple lifespans.

OBJECTIVES

We outline a 2 + Generation Model for examining the mechanisms through which institutional and structural racism promotes the intergenerational transmission of environmental health risk and family and interpersonal relationships across the life course and across multiple generations. We present the model's theoretical underpinnings and rationale, discuss model limitations and needed sources of data, and implications for research, policy, and intervention.

DISCUSSION

Parents and children are not only biologically linked in terms of transmission of environmental toxicities, but they are also linked socially and intergenerationally. The 2 + Generation Model foregrounds family and interpersonal relationships occurring within developmental contexts that are influenced by environmental toxicity as well as institutional and structural racism. In sum, the 2 + Generation Model highlights the need for an equity-first interdisciplinary approach to environmental health and redirects the burden of risk reduction away from the individual and onto the institutions and structures that perpetuate the racial disparities in exposure. Doing so requires institutional investment in expanded, multigenerational, and multimethod datasets. https://doi.org/10.1289/EHP13110.

Spatial and spatio-temporal statistical implications for measuring structural racism: A review of three widely used residential segregation measures

Social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning and quality of life outcomes and risks - these social determinants of health often aid in explaining the racial and ethnic health inequities present in the United States (US). The root cause of these social determinants of health has been tied to structural racism, and residential segregation is one such domain of structural racism that allows for the operationalization of the geography of structural racism. This review focuses on three residential segregation measures that are often utilized to capture segregation as a function of race/ethnicity, income, and simultaneously race/ethnicity and income. Empirical findings related to the spatial and spatio-temporal heterogeneity of these residential segregation measures are presented. We also discuss some of the implications of utilizing these three residential segregation measures.

Adverse Infant Health Outcomes Increased After the 2016 U.S. Presidential Election Among Non-White U.S.-born and Foreign-born Mothers

Macro-level events such as elections can improve or harm population health across existing axes of stratification through policy changes and signals of inclusion or threat. This study investigates whether rates of, and disparities in, adverse birth outcomes between racialized and nativity groups changed after Donald Trump's November 2016 election, a period characterized by increases in xenophobic and racist messages, policies, and actions in the United States. Using data from 15,568,710 U.S. births between November 2012 and November 2018, we find that adverse birth outcomes increased after Trump's election among U.S.- and foreign-born mothers racialized as Black, Hispanic, and Asian and Pacific Islander (API), compared with the period encompassing the two Obama presidencies. Results for Whites suggest no change or a slight decrease in adverse outcomes following Trump's election, yet this finding was not robust to checks for seasonality. Black-White, Hispanic-White, and API-White disparities in adverse birth outcomes widened among both U.S.- and foreign-born mothers after Trump's election. Our findings suggest that Trump's election was a racist and xenophobic macro-level political event that undermined the health of infants born to non-White mothers in the United States.

Associations between Individual- and Structural-Level Racism and Gestational Age at Birth in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be

The purpose of this study was to investigate the associations between multilevel racism and gestational age at birth among nulliparous women. We conducted a secondary analysis of data of the nuMoM2b Study (2010-2013) to examine the associations between individual- and structural-level experiences of racism and discrimination and gestational age at birth among nulliparous women (n = 9148) at eight sites across the U.S. Measures included the individual Experiences of Discrimination (EOD) scale and the Index of Concentration at the Extremes (ICE) to measure structural racism. After adjustment, we observed a significant individual and structural racism interaction on gestational length (p = 0.012). In subgroup analyses, we found that among those with high EOD scores, women who were from households concentrated in the more privileged group had significantly longer gestations (β = 1.27, 95% CI: 0.48, 2.06). Women who reported higher EOD scores and more economic privilege had longer gestations, demonstrating the moderating effect of ICE as a measure of structural racism. In conclusion, ICE may represent a modifiable factor in the prevention of adverse birth outcomes in nulliparas.

Racial Arrest Disparities in the USA by Rural-Urban Location and Region

BACKGROUND

Urban racial arrest disparities are well known. Emerging evidence suggests that rural policing shares similar patterns as urban policing in the USA, but without receiving the same public scrutiny, raising the risk of biased rural policing going unnoticed.

METHODS

We estimated adult and adolescent arrest rates and rate ratios (RR) by race, rural-urban status, and US region based on 2016 Uniform Crime Reporting Program arrest and US Census population counts using general estimating equation Poisson regression models with a 4-way interaction between race, region, age group, and urbanicity.

RESULTS

With few exceptions, arrest rates were highest in small towns and rural areas, especially among Black and American Indian populations. Arrest rates differed between US regions with highest rates and racial disparities in the Midwest. For example, arrest rates among Black adults in the rural Midwest were 148.6 arrests [per 1000 population], 95% CI 131.4-168.0, versus 94.4 arrests, 95% CI 77.2-115.4 in the urban Midwest; and versus corresponding rural Midwest arrests among white adults, 32.7 arrests, 95% CI 30.8-34.8, Black versus white rural RR 4.54, 95% CI 4.09-5.04. Racial arrest disparities in the South were lower but still high, e.g., rural South, Black versus White adults, RR 1.86, 95% CI 1.71-2.03.

CONCLUSIONS

Rural areas and small towns are potential hotspots of racial arrest disparities across the USA, especially in the Midwest. Approaches to overcoming structural racism in policing must include strategies targeted at rural/small town communities. Our findings underscore the importance of dismantling racist policing in all US communities.