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Abstract
OBJECTIVES Vicarious racism-witnessing or hearing about other individuals of one's ethnic/racial group being the target of racism-has been salient among Asian Americans during the coronavirus disease (COVID-19) pandemic. There is emerging evidence that such experiences adversely impact several health-related outcomes, including sleep. The present study examines associations between vicarious racism and subjective sleep duration and quality, and the potential moderating role of ethnic/racial identity (ERI). METHOD Multivariable regression models assessed the association between vicarious racism, private regard, and centrality on self-reported sleep disturbance and duration. The sample consisted of an online sample of 600 Asian American adults (Mage = 38.55, SDage = 17.11; 65.17% female; 60% ≥ Bachelor's degree) recruited from May to June 2020. RESULTS Vicarious racism was associated with compromised sleep quality and duration, including after adjustment for sociodemographic variables that have been linked to sleep. Private regard toward one's own ethnic/racial group and centrality of ethnicity/race to self-identity buffered the association between vicarious racism and sleep quality and duration. Adverse effects of high vicarious racism on sleep quality and duration were lessened among respondents reporting high levels of ERI private regard and centrality. CONCLUSIONS Findings from this study extend research on racism and sleep by examining vicarious racism, an understudied facet of racism, and by focusing specifically on Asian Americans and in the context of the COVID-19 pandemic. Future research and practice should consider expanding research on discrimination to include a broader range of unjust experiences. Vicarious racism contributes to health hazards experienced by Asian Americans during the COVID-19 pandemic. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Tiffany Yip
- Department of Psychology, Fordham University
| | - Kara Chung
- School of Public Health and Tropical Medicine, Tulane University
| | - David H Chae
- School of Public Health and Tropical Medicine, Tulane University
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ElTohamy A, Hyun S, Rastogi R, Wong GTF, Kim GS, Chae DH, Hahm H“C, Liu CH. Effect of vicarious discrimination on race-based stress symptoms among Asian American young adults during the COVID-19 pandemic. Psychol Trauma 2024; 16:217-224. [PMID: 37227832 PMCID: PMC10674031 DOI: 10.1037/tra0001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has led to a rise in anti-Asian hate crimes in the United States. Previous work has established that experiencing racism increases one's dysfunctional anxiety and avoidance actions-key symptoms of race-based stress symptoms. However, the psychological impact of vicarious, or secondhand, discrimination (witnessing racism targeting one's own race group) remains less understood. METHOD We tested the hypothesis that higher reported vicarious discrimination would be associated with higher levels of race-based stress symptoms reported by Asian American young adults (n = 135) during the pandemic using a cross-sectional analysis of the COVID-19 Adult Resilience Experiences Study (CARES). Starting in April 2020, CARES assessed sociodemographic characteristics and key psychometric scales in young adults through three waves of online surveys. RESULTS Our multiple regression analysis showed vicarious discrimination significantly predicted race-based stress symptoms, even after controlling for direct discrimination (p < .01). This association remained significant after controlling for age, gender, subjective childhood family social status, and preexisting psychiatric disorders (p < .01). Our results demonstrate that regardless of the effect that direct discrimination might have on race-based stress symptoms, witnessing discrimination against members of one's own racial group is significantly associated with increased race-based stress symptoms (b = 2.68, p < .01). Social media was the most common source of vicarious discrimination, with one out of three participants in our sample reporting nearly daily exposure. CONCLUSION Providers should intentionally create a space within the therapeutic setting to discuss the effects of vicarious discrimination. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Abdelrahman ElTohamy
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Psychiatry, Brigham and Women’s Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Sunah Hyun
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Ritika Rastogi
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Ga Tin Finneas Wong
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Grace S. Kim
- Wheelock College of Education & Human Development, Boston University, 2 Silber Way, Boston, MA, 02215, USA
| | - David H. Chae
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Hyeouk “Chris” Hahm
- School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA
| | - Cindy H. Liu
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Psychiatry, Brigham and Women’s Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
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Martz CD, Webb-Detiege T, Danila MI, Chae DH. Sociodemographic profiles and organ damage accural in the Black Women's Experience Living with Lupus study. Lupus 2024; 33:17-25. [PMID: 38048450 PMCID: PMC10777614 DOI: 10.1177/09612033231218923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE Black/African American women with systemic lupus erythematosus (SLE) experience greater organ damage and at younger ages than white women. The objective of this study was to advance research on SLE inequities by identifying sociodemographic risk profiles associated with organ damage accrual specifically among Black/African American women. METHODS Latent profile analysis was conducted among 438 Black/African American women with SLE living in Atlanta, GA and enrolled in the Black Women's Experiences Living with Lupus (BeWELL) Study (May 2015 to April 2017). Proportional hazard and Poisson regression models examined prospective associations between sociodemographic profiles and the timing and degree of organ damage accrual over 2 years. RESULTS Four profiles emerged: (1) "Younger/Lower SES with Uncontrolled SLE" (44.8%), (2) "Older/Lower SES with Uncontrolled SLE" (23.3%), (3) "Mid-SES with Controlled SLE" (19.6%), and (4) "Higher SES with Controlled SLE" (11.2%). Approximately 42% of participants experienced new organ damage during the follow-up period. Proportional hazard models indicated that "Older/Lower SES with Uncontrolled SLE" participants were at greatest risk of new organ damage (HR = 2.41; 95% CI = 1.39, 4.19), followed by "Younger/Lower SES with Uncontrolled SLE" participants (HR = 1.56; 95% CI = 0.92, 2.67), compared to those in the "Higher SES with Controlled SLE" profile. Poisson regression models revealed that these two groups also exhibited greater organ damage accrual (b = 0.98, SE = 0.24, 95% CI = 0.52, 1.44 and b = 0.72, SE = 0.23, 95% CI = 0.27, 1.17, respectively). CONCLUSIONS Black/African American women with fewer socioeconomic resources and uncontrolled SLE are at greatest risk for increasing disease severity over time. Social inequities likely contribute to racial inequities in SLE progression.
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Affiliation(s)
- Connor D Martz
- Population Research Center, The University of Texas at Austin, Austin, TX, USA
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Tamika Webb-Detiege
- Department of Rheumatology, Ochsner Health, New Orleans, LA, USA
- The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA, USA
| | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
- Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
| | - David H Chae
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Reeves A, Michaels EK, Thomas MD, Okoye U, Price MM, Hasson RE, Chae DH, Allen AM. All Stressors Are Not Equal: The Salience of Racial Discrimination and Appraisal for Blood Pressure in African American Women. Psychosom Med 2024; 86:20-29. [PMID: 37774102 PMCID: PMC10842959 DOI: 10.1097/psy.0000000000001255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
OBJECTIVE Psychosocial stress is a major predictor of chronic disease among African American (AA) women. Stress is a process involving exposure, appraisal of threat, coping, and psychobiologic adaptation. However, many studies focus on the frequency of stress events and/or coping; few explicitly study stress events and their appraisals; and AA women experience high levels of racial discrimination, a well-known form of social identity threat (i.e., negative experiences due to judgment based on identity). Stressors related to social identity threat may be differentially appraised and associated with divergent physiologic outcomes. This study examined the differences in the frequency and stressfulness associated with general stressors and racial discrimination in relation to blood pressure (BP) among AA women. METHODS Multivariable regression was used on cross-sectional data from 208 middle-aged AA women residing in the San Francisco Bay Area. RESULTS AA women reported less frequency of racial discrimination compared with general stressors, but were more likely to appraise racial discrimination events as stressful. Racial discrimination stressfulness was more strongly associated with systolic BP (SBP) than the number of racial discrimination events. There was a U-shaped association between racial discrimination stress and SBP, with those reporting "none" and "high/very high" distress having the highest SBP ( b = 12.2 [2.7 to 21.8] and b = 15.7 [1.5-29.8], respectively, versus moderate stress). Conversely, those reporting "very low" general stressfulness had the lowest SBP ( b = -7.9 [-15.8 to -0.1], versus moderate stress). Diastolic BP followed a similar pattern, although results were nonsignificant. CONCLUSIONS This study highlights the importance of stress appraisal measures and adds to the body of evidence documenting racial discrimination as a salient psychosocial stressor for AA women.
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Affiliation(s)
- Alexis Reeves
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA
| | - Eli K. Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Marilyn D. Thomas
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA
| | - Uche Okoye
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Melisa M. Price
- Phil R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA
| | - Rebecca E. Hasson
- Department of Kinesiology and Nutritional Sciences, University of Michigan, Ann Arbor, MI
| | - David H. Chae
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA
| | - Amani M. Allen
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA
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Daniels KP, D Thomas M, Chae DH, Allen AM. Black Mothers' Concern for Their Children as a Measure of Vicarious Racism-Related Vigilance and Allostatic Load. J Health Soc Behav 2023; 64:520-536. [PMID: 37332176 DOI: 10.1177/00221465231175942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
This study investigates the relationship between allostatic load and a novel form of altruistic racism-related fear, or concern for how racism might harm another, which we term vicarious racism-related vigilance. Using a subsample of Black mothers from the African American Women's Heart & Health Study (N = 140), which includes detailed health and survey data on a community sample of Black women in the San Francisco Bay Area, this study investigates the relationship between Black mothers' experiences with racism-related vigilance as it relates to their children and allostatic load-a multisystem metric of underlying health across multiple biological systems. Findings indicate that vicarious racism-related vigilance was positively associated with allostatic load (i.e., worse health). Findings highlight the salience of vicarious racism-related vigilance for the health of Black mothers, underscoring how intersections between race, gender, and parenthood result in susceptibility to unique forms of health-harming stress.
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Martz CD, Wang Y, Chung KW, Jiakponnah NN, I Danila M, Webb-Detiege T, Allen AM, Chae DH. Incident racial discrimination predicts elevated C-Reactive protein in the Black Women's experiences Living with Lupus (BeWELL) study. Brain Behav Immun 2023; 112:77-84. [PMID: 37286173 PMCID: PMC10919347 DOI: 10.1016/j.bbi.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/21/2023] [Accepted: 06/03/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Racial discrimination is a distinct health threat that increases disease risk among Black Americans. Psychosocial stress may compromise health through inflammatory mechanisms. This study examines incident experiences of racial discrimination and changes in the inflammatory biomarker C-reactive protein (CRP) over a two-year period among Black women with systemic lupus erythematosus (SLE)-an inflammatory autoimmune disease sensitive to psychosocial stress and characterized by stark racial inequities in outcomes. METHODS Data are from the Black Women's Experiences Living with Lupus (BeWELL) Study. Participants (n = 380) from metropolitan Atlanta, Georgia were enrolled from April 2015 to May 2017. Incident racial discrimination was assessed bi-annually via self-report using the Experiences of Discrimination measure. CRP was assessed annually over a two-year period. Latent change score analyses modeled longitudinal within-person associations between incident racial discrimination and change in log-transformed CRP from baseline to Year 2. RESULTS Incident experiences of racial discrimination were associated with elevated log-CRP across the two-year study period (b = 0.039, SE = 0.017, 95% CI: 0.006, 0.071). For each domain of incident racial discrimination experienced, CRP increased 3.98%. CONCLUSION This study contributes to growing evidence on the biological consequences of racism and is the first to document an association between incident racial discrimination and changes in inflammation among Black women with SLE. Racial inequities in SLE outcomes and other diseases driven by inflammatory pathways may be explained in part through experiences of racial discrimination.
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Affiliation(s)
- Connor D Martz
- Population Research Center, The University of Texas at Austin, 305 E. 23(rd) Street, Stop G1800, RLP 2.602, Austin, TX 78712, United States.
| | - Yijie Wang
- Department of Human Development and Family Studies, Michigan State University, 552 W. Circle Drive, Human Ecology, 13C, East Lansing, MI 48824, United States
| | - Kara W Chung
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, United States
| | - Nwanyieze N Jiakponnah
- Tulane Center for Aging, Tulane University School of Medicine, 1430 Tulane Avenue, Suite 8513, New Orleans, LA 70112, United States
| | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham, 510 20(th) Street South #834, Birmingham, AL 35294, United States
| | - Tamika Webb-Detiege
- Department of Rheumatology, Ochsner Health, 1514 Jefferson Highway, New Orleans, LA 70121, United States; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA 70121, United States
| | - Amani M Allen
- Divisions of Community Health Sciences and Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA 94720, United States
| | - David H Chae
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, United States
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Macaranas AR, ElTohamy A, Hyun S, Chae DH, Stevens C, Chen JA, Liu CH. COVID-19-related direct and vicarious racial discrimination: Associations with psychological distress among U.S. college students. J Affect Disord 2023; 325:747-754. [PMID: 36642315 PMCID: PMC9837219 DOI: 10.1016/j.jad.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has been accompanied by a myriad of racist incidents targeting minorities in the U.S. Young adults are susceptible to direct and vicarious (indirect) pandemic-related racial discrimination. We sought to examine associations between both types of discrimination experiences and psychological distress among college students across different racial groups. METHODS We analyzed self-reported data from 64,041 undergraduate students from the Spring 2021 American College Health Association-National College Health Assessment. Logistic regression examined odds of severe distress based on self-reported exposure to direct and vicarious racial discrimination. RESULTS Even after controlling for sociodemographic characteristics and prior mental health diagnoses, there was a significant association between direct discrimination and distress among Asian (AOR: 1.3, p < 0.001), Hispanic (AOR: 1.6, p < 0.001), and Multiracial (AOR: 1.4, p < 0.001) students. Vicarious discrimination was significantly associated with distress among White (AOR: 1.4, p < 0.001), Asian (AOR: 1.4, p < 0.001), Hispanic (AOR: 1.5, p < 0.001), and Multiracial (AOR: 1.3, p < 0.001) students. Further analysis considering distress as a continuous measure revealed a significant association between vicarious discrimination and distress for Black participants (β = 0.9, p < 0.001). LIMITATIONS Self-reported variables are susceptible to recall bias. Minority racial group analyses may be underpowered. CONCLUSIONS Our findings reveal an overall link between both direct and vicarious racial discrimination and distress across several racial groups. Further studies should examine effective mental health interventions and anti-racism initiatives to support students who have experienced direct or vicarious discrimination due to COVID-19.
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Affiliation(s)
| | - Abdelrahman ElTohamy
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA,Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Sunah Hyun
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - David H. Chae
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Courtney Stevens
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA,Department of Psychology, Willamette University, Salem, OR, USA
| | - Justin A. Chen
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Cindy H. Liu
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA,Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA,Corresponding author at: Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA
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Fields ND, VanKim NA, Whitcomb BW, Bertone-Johnson ER, Martínez AD, Chae DH. Racism-Related Experiences and Adiposity: Findings From the Black Women's Experiences Living With Lupus (BeWELL) Study. Womens Health Issues 2023; 33:153-159. [PMID: 36319516 PMCID: PMC10010936 DOI: 10.1016/j.whi.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Studies suggest that higher rates of excess adiposity in Black women may in part be driven by experiences of racism. Racial microaggressions, which include unintentional and subtle slights and insults, and responses to racism such as racism-related vigilance, may contribute to adiposity in this population. This study examined these understudied racism-related facets as well as interpersonal racial discrimination in relation to adiposity in a cohort of Black women with systemic lupus erythematosus. METHODS Data are from the Black Women's Experiences Living with Lupus (BeWELL) Study (2015-2017; n = 432). Linear regression was used to examine adiposity measures (body mass index [BMI], percent body fat, and waist-to-hip ratio), measured during a physical examination, in relation to self-reported measures of racial microaggressions, racism-related vigilance, and interpersonal racial discrimination. RESULTS Compared with infrequent microaggressions, very frequent experiences of microaggressions were associated with 2.9 kg/m2 higher BMI (95% confidence [CI], 0.63-5.21) and 2.6% higher body fat (95% CI, 0.32-4.80) after adjusting for covariates. Racism-related vigilance, measured continuously, was positively associated with BMI (b = 0.84; 95% CI-0.08, 1.61) and percent body fat (b = 0.89; 95% CI, 0.14-1.64). Very frequent experiences of everyday discrimination were associated with a higher BMI (b = 2.70; 95% CI, 0.58-4.83) and waist-to-hip ratio (b = 0.32; 95% CI, 0.09-0.55) compared with less frequent everyday discrimination. CONCLUSIONS Our results suggest that various dimensions of racism are associated with excess adiposity. Efforts to address obesity among Black women with systemic lupus erythematosus should consider these multiple aspects to decrease racial inequities in adiposity.
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Affiliation(s)
- Nicole D Fields
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Nicole A VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts; Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Airín D Martínez
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - David H Chae
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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Perez AD, Dufault SM, Spears EC, Chae DH, Woods-Giscombe CL, Allen AM. Superwoman Schema and John Henryism among African American women: An intersectional perspective on coping with racism. Soc Sci Med 2023; 316:115070. [PMID: 35690497 DOI: 10.1016/j.socscimed.2022.115070] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/13/2022] [Accepted: 05/22/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE John Henryism and Superwoman Schema (SWS) are dispositional characteristics adopted to overcome the challenges of chronic psychosocial stress, and have particular salience for African American women. Both show protective and harmful effects on health and share conceptual similarities and distinctions, yet there is no empirical evidence of the potential overlap resulting in uncertainty about the unique roles they may each play concerning the health of African American women. OBJECTIVE We examined: 1) whether and to what extent John Henryism and SWS represent similar or distinct constructs relevant to the unique sociohistorical and sociopolitical position of African American women, and 2) whether the two differentially predict health outcomes. METHODS Data are from a purposive and socioeconomically diverse sample of 208 African American women in the San Francisco Bay Area. First, we conducted a progressive series of tests to systematically examine the conceptual and empirical overlap between John Henryism and SWS: correlation analysis, exploratory factor analysis (EFA), principal component analysis and k-modes cluster analysis. Next, we used multivariable regression to examine associations with psychological distress and hypertension. RESULTS John Henryism and SWS were moderately correlated with one another (rs = 0.30-0.48). In both EFA and cluster analyses, John Henryism items were distinct from SWS subscale items. For SWS, feeling an obligation to present an image of strength and an obligation to help others predicted higher odds of hypertension (p < 0.05); having an intense motivation to succeed predicted lower odds (p = 0.048). John Henryism did not predict hypertension. Feeling an obligation to help others and an obligation to suppress emotions predicted lower levels of psychological distress (p < 0.05) whereas John Henryism predicted higher distress (p = 0.002). CONCLUSIONS We discuss the implications of these findings for the measurement of culturally specific phenomena and their role in contributing to the unequal burden of ill health among African American women.
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Affiliation(s)
- Amanda D Perez
- Divisions of Community Health Sciences and Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA.
| | - Suzanne M Dufault
- Divisions of Community Health Sciences and Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA
| | - Erica C Spears
- Louisiana Public Health Institute, 400 Poydras St., Suite 1250, New Orleans, LA 70130, USA
| | - David H Chae
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA
| | - Cheryl L Woods-Giscombe
- School of Nursing, The University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, 27599-7460, USA
| | - Amani M Allen
- Divisions of Community Health Sciences and Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA
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Curtis DS, Smith KR, Chae DH, Washburn T, Lee H, Kim J, Kramer MR. Highly public anti-Black violence and preterm birth odds for Black and White mothers. SSM Popul Health 2022; 18:101112. [PMID: 35535210 PMCID: PMC9077530 DOI: 10.1016/j.ssmph.2022.101112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 12/02/2022] Open
Abstract
Highly public anti-Black violence may increase preterm birth in the general population of pregnant women via stress-mediated paths, particularly Black women exposed in early gestation. To examine spillover from racial violence in the US, we included a total of 49 high publicity incidents of the following types: police lethal force toward Black persons, legal decisions not to indict/convict officers involved, and hate crime murders of Black victims. National search interest in these incidents was measured via Google Trends to proxy for public awareness of racial violence. Timing of racial violence was coded in relation to a three-month preconception period and subsequent pregnancy trimesters, with the primary hypothesis being that first trimester exposure is associated with higher preterm birth odds. The national sample included 1.6 million singleton live births to US-born Black mothers and 6.6 million births to US-born White mothers from 2014 to 2017. Using a preregistered analysis plan, findings show that Black mothers had 5% higher preterm birth odds when exposed to any high publicity racial incidents relative to none in their first trimester, and 2–3% higher preterm birth odds with each log10 increase in national interest. However, post hoc sensitivity tests that included month fixed effects attenuated these associations to null. For White mothers, associations were smaller but of a similar pattern, and were attenuated when including month fixed effects. Highly public anti-Black violence may act as a national stressor, yet whether racial violence is associated with reproductive outcomes in the population is unknown and merits further research. Publicized racial violence may influence population preterm birth rates via elevated stress. We identified 49 incidents of anti-Black violence and assessed national search interest. First trimester exposure to racial violence was associated with preterm birth for Black mothers. Monthly differences in preterm birth odds attenuated the association with racial violence.
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Abstract
BACKGROUND In recent years, there has been growing interest in "moving beyond the individual" to measure area-level racism as a social determinant of health. Much of this work has aggregated racial prejudice data collected at the individual-level to the area-level. OBJECTIVE As this is a rapidly emerging area of research, we conducted a systematic literature review to describe evidence of the relationship between area-level racial prejudice and health, whether results differed by race/ethnicity, and to characterize key conceptual and methodological considerations to guide future research. METHOD We searched four interdisciplinary databases for US-based, peer-reviewed articles measuring area level racial prejudice by aggregating individual-level indicators of racial prejudice and examining associations with mental or physical health outcome(s). Data extraction followed PRISMA guidelines and also included theory and conceptualization, pathways to health, and strengths and limitations. RESULTS Fourteen of 14,632 identified articles met inclusion criteria and were included in the review. Health outcomes spanned all-cause (n = 4) and cause-specific (n = 4) mortality, birth outcomes (n = 4), cardiovascular outcomes (n = 2), mental health (n = 1), and self-rated health (n = 1). All studies found a positive association between area-level racial prejudice and adverse health outcomes among racial/ethnic minoritized groups, with four studies also showing a similar association among Whites. Engagement with formal theory was limited and exposure conceptualization was mixed. Methodological considerations included unmeasured confounding and trade-offs between generalizability, self-censorship, and specificity of measurement. CONCLUSIONS Future research should continue to develop the conceptual and methodological rigor of this work and test hypotheses to inform evidence-based interventions to advance population health and reduce racial health inequities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Eli K. Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Christine Board
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Corinne A. Riddell
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Biostatistics, School of Public Health, University of California, Berkeley
| | - David H. Chae
- Department of Global Community Health & Behavioral Sciences, Tulane School of Public Health and Tropical Medicine
| | | | - Amani M. Allen
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley
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12
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Bridges J, Chung KW, Martz CD, Smitherman EA, Drenkard C, Wu C, Lin J, Lim SS, Chae DH. Leukocyte Telomere Length and Childhood Onset of Systemic Lupus Erythematosus in the Black Women's Experiences Living with Lupus Study. ACR Open Rheumatol 2022; 4:426-431. [PMID: 35178897 PMCID: PMC9096517 DOI: 10.1002/acr2.11411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022] Open
Abstract
Objective The study objective was to compare leukocyte telomere length (LTL) among patients with systemic lupus erythematosus (SLE) diagnosed in childhood versus adulthood. Methods Data are from the Black Women's Experiences Living with Lupus (BeWELL) study. Multivariable linear regression analyses that examined childhood diagnosis of SLE (diagnosed before 18 years of age), age, and their interaction in relationship to LTL were conducted, adjusting for a range of demographic, socioeconomic, and health‐related covariates. Results The total analytic sample size was 415. Forty participants (9.6%) were diagnosed in childhood. There was no main effect of childhood diagnosis on LTL (b = 0.007; 95% confidence interval [CI]: −0.089 to 0.103). However, the interaction between age and childhood diagnosis was significant (b = −0.008; 95% CI: −0.016 to −0.001), indicating a steeper inverse association between age and LTL among those diagnosed in childhood compared with those diagnosed in adulthood. This interaction remained statistically significant (P = 0.024) after controlling for disease duration measured dichotomously (less than 10 years vs. 10 years or more); it was marginally significant (P = 0.083) when controlling for disease duration measured continuously. Conclusion This cross‐sectional analysis suggests that Black women with childhood‐onset SLE may undergo accelerated LTL shortening compared with their adult‐onset counterparts. This relationship persisted even after controlling for differences in SLE damage and disease duration. These findings inform research on immunosenescence mechanisms of SLE.
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Affiliation(s)
- John Bridges
- Division of Pediatric Rheumatology, University of Alabama at Birmingham, Birmingham, USA.,Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, USA
| | - Kara W Chung
- Department of Social, Behavioral, and Population Sciences, Tulane University, New Orleans, USA
| | - Connor D Martz
- Department of Human Development and Family Science, Auburn University, Auburn, USA
| | - Emily A Smitherman
- Division of Pediatric Rheumatology, University of Alabama at Birmingham, Birmingham, USA
| | | | - Calvin Wu
- School of Medicine, University of California San Francisco, San Francisco, USA
| | - Jue Lin
- School of Medicine, University of California San Francisco, San Francisco, USA
| | - S Sam Lim
- Division of Rheumatology, Emory University, Atlanta, USA
| | - David H Chae
- Department of Social, Behavioral, and Population Sciences, Tulane University, New Orleans, USA
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13
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Thomas MD, Mendez RM, Zhang Y, Wang Y, Sohail S, Chae DH, Márquez-Magaña L, Sellers R, Woods-Giscombé CL, Allen AM. OUP accepted manuscript. The Gerontologist 2022; 62:762-772. [PMID: 35084030 PMCID: PMC9154235 DOI: 10.1093/geront/gnac005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives African American women experience faster telomere shortening (i.e., cellular aging) compared with other racial–gender groups. Prior research demonstrates that race and gender interact to influence culturally specific norms for responding to socially-relevant stress and other stress-coping processes, which may affect healthy aging. Research Design and Methods Data are from African American Women’s Heart & Health Study participants who consented to DNA extraction (n = 140). Superwoman Schema (SWS) was measured using 5 validated subscales: presenting strength, emotion suppression, resisting vulnerability, motivation to succeed, and obligation to help others. Racial identity was measured using 3 subscales from the Multidimensional Inventory of Black Identity: racial centrality, private regard, and public regard. Relative telomere length (rTL) was measured using DNA extracted from blood samples. Path analysis tested associations and interactions between SWS and racial identity dimensions with rTL. Results For SWS, higher resistance to being vulnerable predicted longer telomeres. For racial identity, high private regard predicted longer telomeres while high public regard predicted shorter telomeres. Interactions were found between public regard and 2 SWS dimensions: among women with high public regard, emotion suppression (β = 0.20, p < .05) and motivation to succeed (β = 0.18, p < .05) were associated with longer rTL. The interaction between high centrality and emotion suppression predicted shorter rTL (β = −0.17, p < .05). Discussion and Implications Culturally specific responses to gendered racism and racial identity, developed early in life and shaped over the life course, are important psychosocial determinants of cellular aging among African American women.
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Affiliation(s)
- Marilyn D Thomas
- Departments of Epidemiology & Biostatistics and Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Address correspondence to: Marilyn D. Thomas, PhD, MPH, Departments of Epidemiology & Biostatistics and Psychiatry & Behavioral Sciences, University of California, San Francisco, 1001 Potrero Avenue, Box 0852, San Francisco, CA 94110, USA. E-mail:
| | - Rebecca M Mendez
- Department of Biology, San Francisco State University, San Francisco, California, USA
| | - Youchuan Zhang
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Yijie Wang
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Saba Sohail
- Department of Biology, San Francisco State University, San Francisco, California, USA
| | - David H Chae
- Department of Global Community Health and Behavioral Sciences, Tulane University, School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA
| | | | - Rob Sellers
- Office of Diversity, Equity & Inclusion, University of Michigan, Ann Arbor, Michigan, USA
| | - Cheryl L Woods-Giscombé
- School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amani M Allen
- School of Public Health, Divisions of Community Health Sciences and Epidemiology, University of California, Berkeley, Berkeley, California, USA
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14
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Spears EC, Allen AM, Chung KW, Martz CD, Hunter EA, Fuller-Rowell TE, Lim SS, Drenkard C, Chae DH. Anticipatory racism stress, smoking and disease activity: the Black women's experiences living with lupus (BeWELL) study. J Behav Med 2021; 44:760-771. [PMID: 34159500 DOI: 10.1007/s10865-021-00235-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
African American women with systemic lupus erythematosus (SLE) have worse disease outcomes compared to their White counterparts. Stressors associated with race may contribute to poorer health in this population through maladaptive behavioral pathways. This study investigated relationships between stress associated with anticipating racism, smoking, and SLE disease activity. Data were from 432 African American women with SLE in the Black Women's Experiences Living with Lupus (BeWELL) Study. Controlling for sociodemographic and health-related covariates, multivariable regression analyses revealed a significant association between anticipatory racism stress (ARS) and disease activity (p = 0.00, b = 1.13, 95% CI [0.43, 1.82]). A significant interaction between ARS and smoking also indicated that smoking exacerbated the effect of ARS on disease activity (p = 0.04, b = 1.95, CI = 0.04, 3.96). Test for evidence of smoking mediating the effect of ARS on disease activity were not statistically significant (z = 1.77, p = 0.08). Findings have implications for future SLE disparities research among African American women with SLE.
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Affiliation(s)
- Erica C Spears
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Amani M Allen
- Divisions of Community Health Sciences and Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Kara W Chung
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, AL, USA
| | - Connor D Martz
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, AL, USA
| | - Evelyn A Hunter
- Department of Special Education, Rehabilitation & Counseling, College of Education, Auburn University, Auburn, AL, USA
| | - Thomas E Fuller-Rowell
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, AL, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Christina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David H Chae
- Department of Global Community Health and Behavioral Science, School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA, USA
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15
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Chae DH, Snipes SA, Chung KW, Martz CD, LaVeist TA. Vulnerability and Resilience: Use and Misuse of These Terms in the Public Health Discourse. Am J Public Health 2021; 111:1736-1740. [PMID: 34554819 PMCID: PMC8561197 DOI: 10.2105/ajph.2021.306413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/04/2022]
Affiliation(s)
- David H Chae
- David H. Chae and Kara W. Chung are with the Department of Social, Behavioral, and Population Sciences and Thomas A. LaVeist is with the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Shedra A. Snipes is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Connor D. Martz is with the Department of Human Development and Family Science, Auburn University, Auburn, AL
| | - Shedra A Snipes
- David H. Chae and Kara W. Chung are with the Department of Social, Behavioral, and Population Sciences and Thomas A. LaVeist is with the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Shedra A. Snipes is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Connor D. Martz is with the Department of Human Development and Family Science, Auburn University, Auburn, AL
| | - Kara W Chung
- David H. Chae and Kara W. Chung are with the Department of Social, Behavioral, and Population Sciences and Thomas A. LaVeist is with the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Shedra A. Snipes is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Connor D. Martz is with the Department of Human Development and Family Science, Auburn University, Auburn, AL
| | - Connor D Martz
- David H. Chae and Kara W. Chung are with the Department of Social, Behavioral, and Population Sciences and Thomas A. LaVeist is with the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Shedra A. Snipes is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Connor D. Martz is with the Department of Human Development and Family Science, Auburn University, Auburn, AL
| | - Thomas A LaVeist
- David H. Chae and Kara W. Chung are with the Department of Social, Behavioral, and Population Sciences and Thomas A. LaVeist is with the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. Shedra A. Snipes is with the Department of Biobehavioral Health, Pennsylvania State University, University Park. Connor D. Martz is with the Department of Human Development and Family Science, Auburn University, Auburn, AL
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16
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Akré ER, Anderson A, Stojanovski K, Chung KW, VanKim NA, Chae DH. Depression, Anxiety, and Alcohol Use Among LGBTQ+ People During the COVID-19 Pandemic. Am J Public Health 2021; 111:1610-1619. [PMID: 34410817 PMCID: PMC8589058 DOI: 10.2105/ajph.2021.306394] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To describe disparities in depression, anxiety, and problem drinking by sexual orientation, sexual behavior, and gender identity during the COVID-19 pandemic. Methods. Data were collected May 21 to July 15, 2020, from 3245 adults living in 5 major US metropolitan areas (Atlanta, Georgia; Chicago, Illinois; New Orleans, Louisiana; New York, New York; and Los Angeles, California). Participants were characterized as cisgender straight or LGBTQ+ (i.e., lesbian, gay, bisexual, and transgender people, and men who have sex with men, and women who have sex with women not identifying as lesbian, gay, bisexual, or transgender). Results. Cisgender straight participants had the lowest levels of depression, anxiety, and problem drinking compared with all other sexual orientation, sexual behavior, and gender identity groups, and, in general, LGBTQ+ participants were more likely to report that these health problems were "more than usual" during the COVID-19 pandemic. Conclusions. LGBTQ+ communities experienced worse mental health and problem drinking than their cisgender straight counterparts during the COVID-19 pandemic. Future research should assess the impact of the pandemic on health inequities. Policymakers should consider resources to support LGBTQ+ mental health and substance use prevention in COVID-19 recovery efforts.
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Affiliation(s)
- Ellesse-Roselee Akré
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
| | - Andrew Anderson
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
| | - Kristefer Stojanovski
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
| | - Kara W Chung
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
| | - Nicole A VanKim
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
| | - David H Chae
- At the time of the study, E. R. Akré was a postdoctoral researcher at Vanderbilt University, Nashville, TN, and she completed the work while with Geisel School of Medicine at Dartmouth, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Andrew Anderson is with Tulane University, School of Public Health and Tropical Medicine, Department of Health Policy and Management, New Orleans, LA. Kristefer Stojanovski is with University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor. Kara W. Chung and David H. Chae are with Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences. Nicole A. VanKim is with University of Massachusetts: Amherst, School of Public Health and Health Sciences, Department of Epidemiology
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17
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Martz CD, Hunter EA, Kramer MR, Wang Y, Chung K, Brown M, Drenkard C, Lim SS, Chae DH. Pathways linking census tract typologies with subjective neighborhood disorder and depressive symptoms in the Black Women's Experiences Living with Lupus (BeWELL) Study. Health Place 2021; 70:102587. [PMID: 34116496 PMCID: PMC8328917 DOI: 10.1016/j.healthplace.2021.102587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/04/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022]
Abstract
Depression is a common comorbidity among Black women with systemic lupus erythematosus (SLE), an understudied autoimmune disease characterized by major racial and gender inequities. Research is needed that examines how area-level factors influence risk of depression in this population. Latent profile analysis revealed four neighborhood typologies among metropolitan Atlanta, Georgia census tracts that participants (n=438) in the Black Women's Experiences Living with Lupus (BeWELL) Study were living in: Integrated/High-SES, Moderately Segregated/Mid-SES, Highly Segregated/Mid-SES, and Highly Segregated/Low-SES. Structural equation models indicated that highly segregated census tracts were associated with the greatest levels of depression via increased subjective assessments of neighborhood disorder. Policies that invest in segregated areas and address physical and social aspects of the environment that contribute to neighborhood disorder may promote mental health among Black women with SLE.
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Affiliation(s)
- Connor D Martz
- Department of Human Development and Family Science, Auburn University, 203 Spidle Hall, Auburn, AL, 36849, USA.
| | - Evelyn A Hunter
- Department of Special Education, Rehabilitation, and Counseling, Auburn University, 2084 Haley Center, Auburn, AL, 36849, USA
| | - Michael R Kramer
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Yijie Wang
- Department of Human Development and Family Studies, Michigan State University, 552 W. Circle Dr, East Lansing, MI, 48824, USA
| | - Kara Chung
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA
| | - Michael Brown
- School of Kinesiology, Auburn University, 301 Wire Rd., Auburn, AL, 36849, USA
| | - Cristina Drenkard
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA; Department of Medicine, Division of Rheumatology, Emory University School of Medicine, 1658 Clifton Rd. A, Atlanta, GA, 30322, USA
| | - S Sam Lim
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA; Department of Medicine, Division of Rheumatology, Emory University School of Medicine, 1658 Clifton Rd. A, Atlanta, GA, 30322, USA
| | - David H Chae
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA
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Chae DH, Yip T, Martz CD, Chung K, Richeson JA, Hajat A, Curtis DS, Rogers LO, LaVeist TA. Vicarious Racism and Vigilance During the COVID-19 Pandemic: Mental Health Implications Among Asian and Black Americans. Public Health Rep 2021; 136:508-517. [PMID: 34034574 DOI: 10.1177/00333549211018675] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Experiences of vicarious racism-hearing about racism directed toward one's racial group or racist acts committed against other racial group members-and vigilance about racial discrimination have been salient during the COVID-19 pandemic. This study examined vicarious racism and vigilance in relation to symptoms of depression and anxiety among Asian and Black Americans. METHODS We used data from a cross-sectional study of 604 Asian American and 844 Black American adults aged ≥18 in the United States recruited from 5 US cities from May 21 through July 15, 2020. Multivariable linear regression models examined levels of depression and anxiety by self-reported vicarious racism and vigilance. RESULTS Controlling for sociodemographic characteristics, among both Asian and Black Americans, greater self-reported vicarious racism was associated with more symptoms of depression (Asian: β = 1.92 [95% CI, 0.97-2.87]; Black: β = 1.72 [95% CI, 0.95-2.49]) and anxiety (Asian: β = 2.40 [95% CI, 1.48-3.32]; Black: β = 1.98 [95% CI, 1.17-2.78]). Vigilance was also positively related to symptoms of depression (Asian: β = 1.54 [95% CI, 0.58-2.50]; Black: β = 0.90 [95% CI, 0.12-1.67]) and anxiety (Asian: β = 1.98 [95% CI, 1.05-2.91]; Black: β = 1.64 [95% CI, 0.82-2.45]). CONCLUSIONS Mental health problems are a pressing concern during the COVID-19 pandemic. Results from our study suggest that heightened racist sentiment, harassment, and violence against Asian and Black Americans contribute to increased risk of depression and anxiety via vicarious racism and vigilance. Public health efforts during this period should address endemic racism as well as COVID-19.
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Affiliation(s)
- David H Chae
- 25812 School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Tiffany Yip
- 5923 Department of Psychology, Fordham University, New York, NY, USA
| | - Connor D Martz
- 135047 Department of Human Development and Family Science, Auburn University, Auburn, AL, USA
| | - Kara Chung
- 25812 School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jennifer A Richeson
- 189248 Department of Psychology, Institution for Social and Policy Studies, Yale University, New Haven, CT, USA
| | - Anjum Hajat
- 246474 Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - David S Curtis
- 114325 Department of Family and Consumer Sciences, University of Utah, Salt Lake City, UT, USA
| | - Leoandra Onnie Rogers
- 216368 Department of Psychology, Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Thomas A LaVeist
- 25812 School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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Fuller-Rowell TE, Nichols OI, Burrow AL, Ong AD, Chae DH, El-Sheikh M. Day-to-day fluctuations in experiences of discrimination: Associations with sleep and the moderating role of internalized racism among African American college students. ACTA ACUST UNITED AC 2021; 27:107-117. [DOI: 10.1037/cdp0000342] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nguyen TT, Criss S, Dwivedi P, Huang D, Keralis J, Hsu E, Phan L, Nguyen LH, Yardi I, Glymour MM, Allen AM, Chae DH, Gee GC, Nguyen QC. Exploring U.S. Shifts in Anti-Asian Sentiment with the Emergence of COVID-19. Int J Environ Res Public Health 2020; 17:ijerph17197032. [PMID: 32993005 PMCID: PMC7579565 DOI: 10.3390/ijerph17197032] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 01/01/2023]
Abstract
Background: Anecdotal reports suggest a rise in anti-Asian racial attitudes and discrimination in response to COVID-19. Racism can have significant social, economic, and health impacts, but there has been little systematic investigation of increases in anti-Asian prejudice. Methods: We utilized Twitter’s Streaming Application Programming Interface (API) to collect 3,377,295 U.S. race-related tweets from November 2019–June 2020. Sentiment analysis was performed using support vector machine (SVM), a supervised machine learning model. Accuracy for identifying negative sentiments, comparing the machine learning model to manually labeled tweets was 91%. We investigated changes in racial sentiment before and following the emergence of COVID-19. Results: The proportion of negative tweets referencing Asians increased by 68.4% (from 9.79% in November to 16.49% in March). In contrast, the proportion of negative tweets referencing other racial/ethnic minorities (Blacks and Latinx) remained relatively stable during this time period, declining less than 1% for tweets referencing Blacks and increasing by 2% for tweets referencing Latinx. Common themes that emerged during the content analysis of a random subsample of 3300 tweets included: racism and blame (20%), anti-racism (20%), and daily life impact (27%). Conclusion: Social media data can be used to provide timely information to investigate shifts in area-level racial sentiment.
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Affiliation(s)
- Thu T. Nguyen
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA 94110, USA
- Correspondence:
| | - Shaniece Criss
- Department of Health Sciences, Furman University, Greenville, SC 29613, USA;
| | - Pallavi Dwivedi
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (P.D.); (D.H.); (J.K.); (Q.C.N.)
| | - Dina Huang
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (P.D.); (D.H.); (J.K.); (Q.C.N.)
| | - Jessica Keralis
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (P.D.); (D.H.); (J.K.); (Q.C.N.)
| | - Erica Hsu
- Department of Public Health Science, University of Maryland, College Park, MD 20742, USA; (E.H.); (L.P.); (L.H.N.); (I.Y.)
| | - Lynn Phan
- Department of Public Health Science, University of Maryland, College Park, MD 20742, USA; (E.H.); (L.P.); (L.H.N.); (I.Y.)
| | - Leah H. Nguyen
- Department of Public Health Science, University of Maryland, College Park, MD 20742, USA; (E.H.); (L.P.); (L.H.N.); (I.Y.)
| | - Isha Yardi
- Department of Public Health Science, University of Maryland, College Park, MD 20742, USA; (E.H.); (L.P.); (L.H.N.); (I.Y.)
| | - M. Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA;
| | - Amani M. Allen
- Divisions of Community Health Sciences and Epidemiology, University of California, Berkeley, CA 94704, USA;
| | - David H. Chae
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA;
| | - Gilbert C. Gee
- Department of Community Health Sciences, University of California, Los Angeles, CA 90095, USA;
| | - Quynh C. Nguyen
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (P.D.); (D.H.); (J.K.); (Q.C.N.)
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Darling-Hammond S, Michaels EK, Allen AM, Chae DH, Thomas MD, Nguyen TT, Mujahid MM, Johnson RC. After "The China Virus" Went Viral: Racially Charged Coronavirus Coverage and Trends in Bias Against Asian Americans. Health Educ Behav 2020; 47:870-879. [PMID: 32911985 PMCID: PMC7488172 DOI: 10.1177/1090198120957949] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
On March 8, 2020, there was a 650% increase in Twitter retweets using the term “Chinese virus” and related terms. On March 9, there was an 800% increase in the use of these terms in conservative news media articles. Using data from non-Asian respondents of the Project Implicit “Asian Implicit Association Test” from 2007–2020 (n = 339,063), we sought to ascertain if this change in media tone increased bias against Asian Americans. Local polynomial regression and interrupted time-series analyses revealed that Implicit Americanness Bias—or the subconscious belief that European American individuals are more “American” than Asian American individuals—declined steadily from 2007 through early 2020 but reversed trend and began to increase on March 8, following the increase in stigmatizing language in conservative media outlets. The trend reversal in bias was more pronounced among conservative individuals. This research provides evidence that the use of stigmatizing language increased subconscious beliefs that Asian Americans are “perpetual foreigners.” Given research that perpetual foreigner bias can beget discriminatory behavior and that experiencing discrimination is associated with adverse mental and physical health outcomes, this research sounds an alarm about the effects of stigmatizing media on the health and welfare of Asian Americans.
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Affiliation(s)
| | | | | | - David H Chae
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Thu T Nguyen
- University of California, San Francisco, CA, USA
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Affiliation(s)
| | - Eric Breton
- École des Hautes Études en Santé Publique, Rennes, France
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23
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Chae DH, Chung K, Martz CD, Drenkard CM, Lim SS, Lin J, Epel ES. Telomere length predicts mortality in the Black Women’s Experiences Living with Lupus (BeWELL) Study. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.224.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease marked by inflammation that disproportionately impacts Black women. Telomeres are repetitive sequences of DNA capping the ends of chromosomes that shorten more rapidly in response to inflammation. Studies suggest that the telomere maintenance system may be disrupted in those with SLE, who have been shown to have shorter telomeres compared to healthy controls. Among those with SLE, Blacks have been found to experience more accelerated telomere shortening compared to those of other race groups. We examined the relationship between telomere length (TL) and mortality using data from the Black Women’s Experiences Living with Lupus (BeWELL) Study. Participants were 438 Black women with a validated diagnosis of SLE living in the Atlanta, Georgia metropolitan area, recruited between April 2015 and May 2017 predominantly from a large population-based registry. TL was assayed from dried blood spots collected at baseline and measured as the relative telomere to single copy gene (T/S) ratio. Mortality was assessed prospectively through April 2019. A total of 24 participants died during this time period. There was a negative association between TL and mortality, with shorter TL being associated with greater mortality risk (hazard ratio = 0.01, p=0.02). This relationship remained statistically significant after controlling for age and years since diagnosis, and further adjustment for a range of socio-demographic and health-related factors, including SLE damage and activity. Findings suggest that TL may forecast mortality among Black women with SLE. The association between TL and mortality among people with SLE should be further explored.
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Affiliation(s)
| | | | | | | | | | - Jue Lin
- 3University of California, San Francisco
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24
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Hunter EA, Spears EC, Martz CD, Chung K, Fuller-Rowell TE, Lim SS, Drenkard C, Chae DH. Racism-related stress and psychological distress: Black Women's Experiences Living with Lupus study. J Health Psychol 2020; 26:2374-2389. [PMID: 32228184 DOI: 10.1177/1359105320913085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Disparate health consequences in African American women with systemic lupus erythematosus include greater severity of physical and psychological distress. Racism-related stress is also related to psychological distress correlates in this population. This study examined the relationships between racism-related experiences, psychological distress, and systemic lupus erythematosus activity in 430 African American women from the Black Women's Experiences Living with Lupus study. The structural equation model suggests that psychological distress mediates the relationship between racism-related stress and systemic lupus erythematosus disease activity. The impact of racism-related stress on systemic lupus erythematosus disease activity may occur primarily through their impact on psychological health variables. Implications for clinical care and future directions are explored.
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25
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Clouston SA, Acker J, Rubin MS, Chae DH, Link BG. Fundamental social causes of inequalities in colorectal cancer mortality: A study of behavioral and medical mechanisms. Heliyon 2020; 6:e03484. [PMID: 32190753 PMCID: PMC7068626 DOI: 10.1016/j.heliyon.2020.e03484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/14/2019] [Accepted: 02/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fundamental cause theory posits that social conditions strongly influence the risk of health risks. This study identifies risk mechanisms that social conditions associated with socioeconomic status (SES) and race/ethnicity shape in the production of colorectal cancer (CRC) mortality. METHODS Two large datasets in the United States examining behavioral and medical preventive factors (N = 4.63-million people) were merged with population-level mortality data observing 761,100 CRC deaths among 3.31-billion person-years of observation to examine trends in CRC mortality from 1999-2012. Analyses examined the changing role of medical preventions and health behaviors in catalyzing SES and racial/ethnic inequalities in CRC mortality. RESULTS Lower SES as well as Black, Hispanic, Asian/Pacific Islander, and Native American race/ethnicity were associated with decreased access to age-appropriate screening and/or increased prevalence of behavioral risk factors. Analyses further revealed that SES and racial/ethnic inequalities were partially determined by differences in engagement in two preventive factors: use of colonoscopy, and participation in physical activity. DISCUSSION Social inequalities were not completely determined by behavioral risk factors. Nevertheless, a more equitable distribution of preventive medicines has the potential to reduce both the risk of, and social inequalities in, CRC mortality.
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Affiliation(s)
- Sean A.P. Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Julia Acker
- Family Community Medicine, University of California, San Francisco, CA, USA
| | - Marcie S. Rubin
- Section of Social and Behavioral Sciences, College of Dental Medicine, Columbia University, New York, NY, USA
| | - David H. Chae
- Center for Health Ecology and Equity Research, College of Human Sciences, Auburn University, Auburn, AL, USA
| | - Bruce G. Link
- Department of Sociology and School of Public Policy, University of California – Riverside, Riverside, CA, USA
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26
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Chae DH, Wang Y, Martz CD, Slopen N, Yip T, Adler NE, Fuller-Rowell TE, Lin J, Matthews KA, Brody GH, Spears EC, Puterman E, Epel ES. Racial discrimination and telomere shortening among African Americans: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Health Psychol 2020; 39:209-219. [PMID: 31928029 DOI: 10.1037/hea0000832] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Telomeres are protective sequences of DNA capping the ends of chromosomes that shorten over time. Leukocyte telomere length (LTL) is posited to reflect the replicative history of cells and general systemic aging of the organism. Chronic stress exposure leads to accelerated LTL shortening, which has been linked to increased susceptibility to and faster progression of aging-related diseases. This study examined longitudinal associations between LTL and experiences of racial discrimination, a qualitatively unique source of minority psychosocial stress, among African Americans. METHOD Data are from 391 African Americans in the Coronary Artery Risk Development in Young Adults (CARDIA) Telomere Ancillary Study. We examined the number of domains in which racial discrimination was experienced in relation to LTL collected in Years 15 and 25 (Y15: 2000/2001; Y25: 2010/2011). Multivariable linear regression examined if racial discrimination was associated with LTL. Latent change score analysis (LCS) examined changes in racial discrimination and LTL in relation to one another. RESULTS Controlling for racial discrimination at Y15, multivariable linear regression analyses indicated that racial discrimination at Y25 was significantly associated with LTL at Y25. This relationship remained robust after adjusting for LTL at Y15 (b = -.019, p = .015). Consistent with this finding, LCS revealed that increases in experiences of racial discrimination were associated with faster 10-year LTL shortening (b = -.019, p = .015). CONCLUSIONS This study adds to evidence that racial discrimination contributes to accelerated physiologic weathering and health declines among African Americans through its impact on biological systems, including via its effects on telomere attrition. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- David H Chae
- Department of Human Development and Family Studies, Auburn University
| | - Yijie Wang
- Department of Human Development and Family Studies, Michigan State University
| | - Connor D Martz
- Department of Human Development and Family Studies, Auburn University
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland
| | - Tiffany Yip
- Department of Psychology, Fordham University
| | - Nancy E Adler
- Department of Psychiatry, University of California, San Francisco
| | | | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco
| | | | - Gene H Brody
- Department of Human Development and Family Science, University of Georgia
| | - Erica C Spears
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center
| | - Eli Puterman
- School of Kinesiology, University of British Columbia
| | - Elissa S Epel
- Department of Psychiatry, University of California, San Francisco
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27
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Allen AM, Wang Y, Chae DH, Price MM, Powell W, Steed TC, Rose Black A, Dhabhar FS, Marquez‐Magaña L, Woods‐Giscombe CL. Cover Image, Volume 1457, Issue 1. Ann N Y Acad Sci 2019. [DOI: 10.1111/nyas.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Allen AM, Wang Y, Chae DH, Price MM, Powell W, Steed TC, Black AR, Dhabhar FS, Marquez-Magaña L, Woods-Giscombe CL. Racial discrimination, the superwoman schema, and allostatic load: exploring an integrative stress-coping model among African American women. Ann N Y Acad Sci 2019; 1457:104-127. [PMID: 31403707 PMCID: PMC6904516 DOI: 10.1111/nyas.14188] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/30/2019] [Accepted: 06/11/2019] [Indexed: 12/12/2022]
Abstract
Racial discrimination has been linked to allostatic load (i.e., cumulative biological stress) among African American women. However, limited attention has been given to psychosocial processes involved in the stress response-critical for understanding biological pathways to health-in studies examining racial discrimination as a social determinant of health. We examined whether the superwoman schema (SWS), a multidimensional culture-specific framework characterizing psychosocial responses to stress among African American women, modifies the association between racial discrimination and allostatic load. We used purposive sampling to recruit a community sample of African American women ages 30-50 from five San Francisco Bay Area counties (n = 208). Path analysis was used to test for interactions while accounting for the covariance among SWS subscales using both linear and quadratic models. Significant interactions were observed between racial discrimination and four of the five SWS subscales. Feeling obligated to present an image of strength and an obligation to suppress emotions were each protective whereas feeling an intense motivation to succeed and feeling an obligation to help others exacerbated the independent health risk associated with experiencing racial discrimination. Our findings affirm the need to consider individual variability in coping and potentially other psychosocial processes involved in the stress response process, and offer several insights that may help elucidate the mechanisms by which racial discrimination gets "under the skin."
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Affiliation(s)
- Amani M. Allen
- Divisions of Community Health Sciences and Epidemiology,
University of California Berkeley School of Public Health, Berkeley,
California
| | - Yijie Wang
- Department of Human Development and Family Studies,
Michigan State University, East Lansing, Michigan
| | - David H. Chae
- Department of Human Development and Family Studies, College
of Human Sciences, Auburn University, Auburn, Alabama
| | - Melisa M. Price
- Phil R. Lee Institute for Health Policy Studies, University
of California, San Francisco, California
| | - Wizdom Powell
- Department of Psychiatry and Health Disparities Institute,
UConn Health
| | - Teneka C. Steed
- Department of Educational Research Methodology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Angela Rose Black
- University of Wisconsin-Madison Department of Family
Medicine and Community Health, Madison, Wisconsin
| | - Firdaus S. Dhabhar
- Department of Psychiatry and Behavioral Sciences, Sylvester
Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami,
Florida
| | - Leticia Marquez-Magaña
- Department of Cell and Molecular Biology, San Francisco
State University, San Francisco, California
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Michaels EK, Reeves AN, Thomas MD, Price MM, Hasson RE, Chae DH, Allen AM. Everyday Racial Discrimination and Hypertension among Midlife African American Women: Disentangling the Role of Active Coping Dispositions versus Active Coping Behaviors. Int J Environ Res Public Health 2019; 16:E4759. [PMID: 31783683 PMCID: PMC6935759 DOI: 10.3390/ijerph16234759] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/24/2019] [Accepted: 11/24/2019] [Indexed: 12/23/2022]
Abstract
Racial discrimination, a psychosocial stressor, may contribute to disproportionate rates of hypertension among African American women. Coping moderates the effects of psychosocial stress on health. Coping dispositions describe stable personality characteristics, whereas contextual frameworks emphasize flexible coping behaviors in response to specific stressful encounters. Using data from the African American Women's Heart and Health Study-a non-probability cross-section of 208 midlife African American women in Northern California-we estimated the association between everyday racial discrimination (Everyday Discrimination Scale, EDS) and prevalence of hypertension (HTN), and evaluated moderation by coping disposition (John Henryism Active Coping scale, JH) versus context-specific active coping behavior (Active Coping with Racism scale, ACR). There were no main associations between EDS, JH, or ACR on HTN prevalence. There was evidence of statistical interaction between EDS and ACR (p-int = 0.05), but not JH (p-int = 0.90). Among those with high levels of ACR, reporting monthly (prevalence ratio (PR) = 2.35, 95% confidence interval (CI) = 1.13, 4.87), weekly (PR = 2.15, 95% CI = 1.01, 4.61), or daily (PR = 2.36, 95% CI = 1.14, 4.88) EDS was associated with higher HTN prevalence, versus reporting racial discrimination yearly or less. In contrast, among those with low levels of ACR, reporting more chronic racial discrimination was associated with lower hypertension prevalence, although results were less precise. Findings suggest that ongoing active coping with chronic racial discrimination may contribute to hypertension risk among African American women.
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Affiliation(s)
- Eli K. Michaels
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA; (A.N.R.); (M.D.T.)
| | - Alexis N. Reeves
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA; (A.N.R.); (M.D.T.)
| | - Marilyn D. Thomas
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA; (A.N.R.); (M.D.T.)
| | - Melisa M. Price
- Division of Community Health Sciences, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA;
| | - Rebecca E. Hasson
- Schools of Kinesiology and Public Health, University of Michigan, 2110 Observatory Lodge/1402 Washington Heights, Ann Arbor, MI 48109-2029, USA;
| | - David H. Chae
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, 210 Spidle Hall, Auburn, GA 36849, USA;
| | - Amani M. Allen
- Divisions of Community Health Sciences and Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA 94720-7360, USA;
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Chae DH, Martz CD, Fuller-Rowell TE, Spears EC, Smith TTG, Hunter EA, Drenkard C, Lim SS. Racial Discrimination, Disease Activity, and Organ Damage: The Black Women's Experiences Living With Lupus (BeWELL) Study. Am J Epidemiol 2019; 188:1434-1443. [PMID: 31062841 DOI: 10.1093/aje/kwz105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 12/21/2022] Open
Abstract
Black women are disproportionately affected by systemic lupus erythematosus (SLE), a chronic, potentially debilitating autoimmune disease, and they also experience more rapid progression and worse outcomes compared with other groups. We examined if racial discrimination is associated with disease outcomes among 427 black women with a validated diagnosis of SLE, who live in the Atlanta, Georgia, metropolitan area, and were recruited to the Black Women's Experiences Living with Lupus Study (2015-2017). Frequency of self-reported experiences of racial discrimination in domains such as employment, housing, and medical settings was assessed using the Experiences of Discrimination measure. SLE activity in the previous 3 months, including symptoms of fatigue, fever, skin rashes, and ulcers, was measured using the Systemic Lupus Activity Questionnaire; irreversible damage to an organ or system was measured using the Brief Index of Lupus Damage. Results of multivariable linear regression analyses examining the Systemic Lupus Activity Questionnaire and log-transformed Brief Index of Lupus Damage scores indicated that increasing frequency of racial discrimination was associated with greater SLE activity (b = 2.00, 95% confidence interval: 1.32, 2.68) and organ damage (b = 0.08, 95% confidence interval: 0.02, 0.13). Comprehensive efforts to address disparities in SLE severity should include policies that address issues of racial discrimination.
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Affiliation(s)
- David H Chae
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, Alabama
| | - Connor D Martz
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, Alabama
| | - Thomas E Fuller-Rowell
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, Alabama
| | - Erica C Spears
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, Alabama
| | - Tianqi Tenchi Gao Smith
- Department of Industrial and Systems Engineering, Samuel Ginn College of Engineering, Auburn University, Auburn, Alabama
| | - Evelyn A Hunter
- Department of Special Education, Rehabilitation and Counseling, College of Education, Auburn University, Auburn, Alabama
| | - Cristina Drenkard
- Department of Medicine, Division of Rheumatology, School of Medicine, Emory University, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, School of Medicine, Emory University, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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31
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Taylor RJ, Forsythe-Brown I, Mouzon DM, Keith VM, Chae DH, Chatters LM. Prevalence and correlates of everyday discrimination among black Caribbeans in the United States: the impact of nativity and country of origin. Ethn Health 2019; 24:463-483. [PMID: 28669197 PMCID: PMC6054561 DOI: 10.1080/13557858.2017.1346785] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Black Caribbeans in the United States have been the victims of major discrimination (e.g. unfairly fired, denied a promotion, denied housing). What is not known is the degree to which they also experience more routine forms of everyday discrimination such as receiving poor restaurant service, being perceived as dishonest, and being followed in stores. This paper investigates the distribution and correlates of everyday discrimination among a national sample of black Caribbeans in the U.S. DESIGN This analysis used the black Caribbean sub-sample (n = 1,621) of the National Survey of American Life. Demographic and immigration status correlates of ten items from the Everyday Discrimination Scale were investigated: being treated with less courtesy, treated with less respect, receiving poor restaurant service, being perceived as not smart, being perceived as dishonest, being perceived as not as good as others, and being feared, insulted, harassed, or followed in stores. RESULTS Roughly one out of ten black Caribbeans reported that, on a weekly basis, they were treated with less courtesy and other people acted as if they were better than them, were afraid of them, and as if they were not as smart. Everyday discrimination was more frequent for black Caribbeans who were male, never married, divorced/separated, earned higher incomes, and who were second or third generation immigrants. Black Caribbeans attributed the majority of the discrimination they experienced to their race. CONCLUSION To our knowledge, this is the first study to provide an in-depth investigation of everyday discrimination among the black Caribbean population. It provides the frequency, types and correlates of everyday discrimination reported by black Caribbeans in the United States. Understanding the frequency and types of discrimination is important because of the documented negative impacts of everyday discrimination on physical and mental health.
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Affiliation(s)
- Robert Joseph Taylor
- a School of Social Work and Institute for Social Research , University of Michigan , Ann Arbor , MI , USA
| | - Ivy Forsythe-Brown
- b Department of Behavioral Sciences , University of Michigan , Dearborn , MI , USA
| | - Dawne M Mouzon
- c Edward J. Bloustein School of Planning and Public Policy, Institute for Health, Health Care Policy, and Aging Research , Rutgers, The State University of New Jersey , New Brunswick , NJ , USA
| | - Verna M Keith
- d Department of Sociology, Race and Ethnic Studies Institute , Texas A & M University , College Station , TX , USA
| | - David H Chae
- e Department of Human Development and Family Studies , Auburn University , Auburn , AL , USA
| | - Linda M Chatters
- f School of Social Work, School of Public Health and Institute for Social Research , University of Michigan , Ann Arbor , MI , USA
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32
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Thomas MD, Michaels EK, Reeves AN, Okoye U, Price MM, Hasson RE, Chae DH, Allen AM. Differential associations between everyday versus institution-specific racial discrimination, self-reported health, and allostatic load among black women: implications for clinical assessment and epidemiologic studies. Ann Epidemiol 2019; 35:20-28.e3. [PMID: 31235363 PMCID: PMC7179332 DOI: 10.1016/j.annepidem.2019.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Black women have the highest estimated allostatic load (AL). AL and self-perceived health are strong health predictors and have been linked to racial discrimination. Research suggests that everyday and institution-specific racial discrimination may predict different AL and self-reported health (SRH) outcomes. Furthermore, discrepancies between AL and self-perceived health could widen disparities. We estimated associations between everyday versus institution-specific racial discrimination with AL and SRH. METHODS Data are from a San Francisco Bay Area community sample of 208 black women aged 30-50 years. Participation involved a questionnaire, self-interview, blood draw, and anthropometric measurements. Adjusted generalized linear regression models estimated associations of racial discrimination with AL and SRH. RESULTS After adjusting for age, socioeconomic position, and medication use, institution-specific discrimination was negatively associated with AL (i.e., better health), whereas everyday experiences showed no association. Those reporting very-high (vs. moderate) institution-specific discrimination had lower AL (β = -1.31 [95% CI: -2.41, -0.20]; AL range: 0-15). No racial discrimination-SRH association was found. CONCLUSIONS For black women, (1) institution-specific racial discrimination may be differentially embodied compared with everyday experiences and (2) institutional racism may contribute to physiologic stress-regulation regardless of self-perceived health status. Potential factors that may contribute to an inverse racial discrimination-AL association, and future research, are discussed.
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Affiliation(s)
- Marilyn D Thomas
- Division of Epidemiology, School of Public Health, University of California, Berkeley.
| | - Elizabeth K Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Alexis N Reeves
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Uche Okoye
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Melisa M Price
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Rebecca E Hasson
- Schools of Kinesiology and Public Health, University of Michigan, Ann Arbor
| | - David H Chae
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, AL
| | - Amani M Allen
- Division of Epidemiology, School of Public Health, University of California, Berkeley
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Martz CD, Allen AM, Fuller-Rowell TE, Spears EC, Lim SS, Drenkard C, Chung K, Hunter EA, Chae DH. Vicarious Racism Stress and Disease Activity: the Black Women's Experiences Living with Lupus (BeWELL) Study. J Racial Ethn Health Disparities 2019; 6:1044-1051. [PMID: 31215018 DOI: 10.1007/s40615-019-00606-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Indirect or vicarious exposure to racism (e.g., hearing about or observing acts of racism or discrimination) is a salient source of stress for African Americans. Emerging research suggests that these "secondhand" experiences of racism may contribute to racial health inequities through stress-mediated pathways. Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease that disproportionately impacts African American women and is characterized by racial disparities in severity. Health outcomes in this population may be susceptible to vicarious racism given that SLE is shown to be sensitive to psychosocial stress. METHODS Data are from 431 African American women with SLE living in Atlanta, Georgia in the Black Women's Experiences Living with Lupus (BeWELL) Study (2015-2017). Vicarious racism stress was measured with four items assessing distress from (1) hearing about racism in the news; (2) experiences of racism among friends or family; (3) witnessing racism in public; and (4) racism depicted in movies and television shows. Multivariable linear regression was used to examine associations with disease activity measured using the Systemic Lupus Activity Questionnaire. RESULTS Adjusting for sociodemographic and health-related covariates, vicarious racism stress was associated with greater disease activity (b = 2.15; 95% CI = 1.04-3.27). This association persisted even after adjustment for personal experiences of racial discrimination (b = 1.80; 95% CI = 0.67-2.92). CONCLUSIONS Vicarious racism may result in heightened disease activity and contribute to racial disparities in SLE. Our findings suggest that acts of racism committed against members of one's racial group may have distinct health consequences beyond the immediate victim or target.
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Affiliation(s)
- Connor D Martz
- Department of Human Development and Family Studies, Auburn University, College of Human Sciences, Auburn, AL, USA.
| | - Amani M Allen
- Divisions of Community Health Sciences and Epidemiology, University of California - Berkeley, School of Public Health, Berkeley, CA, USA
| | - Thomas E Fuller-Rowell
- Department of Human Development and Family Studies, Auburn University, College of Human Sciences, Auburn, AL, USA
| | - Erica C Spears
- Department of Health Behavior and Health Systems, University of North Texas Health Sciences Center, School of Public Health, Fort Worth, TX, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University, School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University, School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Kara Chung
- Department of Human Development and Family Studies, Auburn University, College of Human Sciences, Auburn, AL, USA
| | - Evelyn A Hunter
- Department of Special Education, Rehabilitation and Counseling, Auburn University, College of Education, Auburn, AL, USA
| | - David H Chae
- Department of Human Development and Family Studies, Auburn University, College of Human Sciences, Auburn, AL, USA
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Slopen N, Strizich G, Hua S, Gallo LC, Chae DH, Priest N, Gurka MJ, Bangdiwala SI, Bravin JI, Chambers EC, Daviglus ML, Llabre MM, Carnethon MR, Isasi CR. Maternal experiences of ethnic discrimination and child cardiometabolic outcomes in the Study of Latino Youth. Ann Epidemiol 2019; 34:52-57. [PMID: 31060896 DOI: 10.1016/j.annepidem.2019.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 01/31/2019] [Accepted: 03/18/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Limited research has examined maternal experiences of racial/ethnic discrimination in relation to child cardiometabolic health. In this study, we investigated whether maternal experiences of ethnic discrimination were associated with cardiometabolic risk in Hispanic/Latino youth several years later. METHODS Our sample included 1146 youth (8-16 years) from the Study of Latino Youth (2012-2014), who were children of the Hispanic Community Health Study/Study of Latinos participants (2008-2011). We used regression models to examine the prospective associations between maternal report of ethnic discrimination in relation to her child's body mass index (BMI) z-score, metabolic syndrome score (MetS), and high sensitivity C-reactive protein (hsCRP) levels 2 years later. RESULTS Maternal ethnic discrimination was associated with youth hsCRP, but not BMI or MetS (P-values >.05). Adjusting for age, nativity, and national background, maternal ethnic discrimination was associated with higher (log) hsCRP levels (β = 0.18, 95% CI = 0.04 to 0.32) in children. This association was robust to adjustment for maternal and household characteristics (β = 0.17, 95% CI = 0.04 to 0.31), as well as maternal depression and maternal BMI. CONCLUSIONS Maternal ethnic discrimination is associated with inflammation among Hispanic/Latino youth, and not BMI z-score or MetS. Studies are needed to address temporality and pathways.
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Affiliation(s)
- Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland, College Park.
| | - Garrett Strizich
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Simin Hua
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
| | - David H Chae
- Department of Human Development and Family Studies, Auburn University, Auburn, AL
| | - Naomi Priest
- ANU Centre for Social Research and Methods, College of Arts and Social Sciences, Australian National University, Canberra, Australia; Population Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Matthew J Gurka
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Julia I Bravin
- Department of Psychology, San Diego State University, San Diego, CA
| | | | - Martha L Daviglus
- Institute for Minority Health Research, College of Medicine, University of Illinois, Chicago
| | - Maria M Llabre
- Department of Psychology, University of Miami, Coral Gables, FL
| | | | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
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Allen AM, Thomas MD, Michaels EK, Reeves AN, Okoye U, Price MM, Hasson RE, Syme SL, Chae DH. Racial discrimination, educational attainment, and biological dysregulation among midlife African American women. Psychoneuroendocrinology 2019; 99:225-235. [PMID: 30286445 PMCID: PMC6289261 DOI: 10.1016/j.psyneuen.2018.09.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the association between self-reported racial discrimination and allostatic load, and whether the association differs by socioeconomic position. METHODS We recruited a purposive cross-section of midlife (ages 30-50) African American women residing in four San Francisco Bay area counties (n = 208). Racial discrimination was measured using the Experience of Discrimination scale. Allostatic load was measured as a composite of 15 biomarkers assessing cardiometabolic, neuroendocrine, and inflammatory activity. We calculated four composite measures of allostatic load and three system-specific measures of biological dysregulation. Multivariable regression was used to examine associations, while adjusting for relevant confounders. RESULTS In the high education group, reporting low (b = -1.09, P = .02, 95% CI = -1.99, -0.18) and very high (b = -1.88, P = .003, 95% CI = -3.11, -0.65) discrimination was associated with lower allostatic load (reference=moderate). Among those with lower education, reporting low (b = 2.05, P = .008, 95% CI = 0.55,3.56) discrimination was associated with higher allostatic load. Similar but less consistent associations were found for poverty status. Associations were similar for cardiometabolic functioning, but not for neuroendocrine or inflammatory activity. CONCLUSIONS Racial discrimination may be an important predictor of cumulative physiologic dysregulation. Factors associated with educational attainment may mitigate this association for African American women and other groups experiencing chronic social stress.
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Affiliation(s)
- Amani M Allen
- Divisions of Community Health Sciences and Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA.
| | - Marilyn D Thomas
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA.
| | - Eli K Michaels
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA.
| | - Alexis N Reeves
- Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA.
| | - Uche Okoye
- Division of Community Health Sciences, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA.
| | - Melisa M Price
- Division of Community Health Sciences, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA.
| | - Rebecca E Hasson
- Schools of Kinesiology and Public Health, University of Michigan, 2110 Observatory Lodge/1402 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | - S Leonard Syme
- Divisions of Community Health Sciences and Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720-7360, USA.
| | - David H Chae
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, 210 Spidle Hall, Auburn, GA, 36849, USA.
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Fuller-Rowell TE, Curtis DS, Chae DH, Ryff CD. Longitudinal health consequences of socioeconomic disadvantage: Examining perceived discrimination as a mediator. Health Psychol 2018; 37:491-500. [PMID: 29698020 DOI: 10.1037/hea0000616] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Foundational theoretical perspectives suggest that socioeconomic disadvantage (SED) increases an individual's risk of being exposed to unfair treatment or discrimination. However, little empirical attention has been given to the role of perceived discrimination in the SED-health gradient. Addressing this knowledge gap, the current study examined the mediating role of discrimination in the longitudinal association between SED and self-rated health. METHOD Participants in the Midlife in the United States (MIDUS) study were followed over 3 waves covering a 17- to 19-year period (N = 6,286; 53% female; 91% White; mean age at baseline = 47 years, SD = 13). SED was assessed from education, occupational prestige, income, and assets; self-rated health was measured at baseline and follow-up assessments. Two measures of discrimination-perceived inequality in work and everyday discrimination-were considered as mediators. RESULTS Both measures of discrimination emerged as important explanatory variables in the link between SED and health. SED at the baseline assessment was associated with changes in self-rated health over the 17- to 19-year period (B = -.15, p < .001). Measures of discrimination partially mediated this longitudinal association, explaining 22% of the total effect. Exposure to discrimination and its health consequences were also more pronounced at younger ages. CONCLUSION Additional research is needed to replicate the findings of this study using objective health measures and to examine possible interventions. Challenging the ideologies and practices that underlie social class-related discrimination, or mitigating its harmful consequences, will both be important approaches to consider. (PsycINFO Database Record
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Affiliation(s)
| | - David S Curtis
- Department of Human Development and Family Studies, Auburn University
| | - David H Chae
- Department of Human Development and Family Studies, Auburn University
| | - Carol D Ryff
- Department of Psychology, University of Wisconsin-Madison
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Kim G, Parmelee P, Bryant AN, Crowther MR, Park S, Parton JM, Chae DH. Geographic Region Matters in the Relation Between Perceived Racial Discrimination and Psychiatric Disorders Among Black Older Adults. Gerontologist 2017; 57:1142-1147. [PMID: 27927726 PMCID: PMC5881795 DOI: 10.1093/geront/gnw129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/24/2016] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study This study examined whether the relation between perceived racial discrimination and psychiatric disorders varied by large geographic region among Black older adults in the United States. Design and Methods Black adults aged 55 or older who had experienced racial/ethnic-specific discrimination were drawn from the National Survey of American Life (NSAL). Logistic regression analysis was used to examine main and interaction effects. Results Results show that there was a significant main effect of perceived racial discrimination, indicating that greater perceived discrimination was significantly associated with increased odds of having any past-year psychiatric disorder. The interaction of region by perceived racial discrimination was significant: The effect of perceived racial discrimination on any past-year psychiatric disorder was stronger among Blacks in the West than those in the South. Implications Findings suggest that whereas, in general, perceived racial discrimination is a risk factor for poor mental health among older Blacks, this association may differ by geographic region. Additional research examining reasons for this variation is needed.
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Affiliation(s)
- Giyeon Kim
- Alabama Research Institute on Aging and
- Department of Psychology, The University of Alabama, Tuscaloosa
| | - Patricia Parmelee
- Alabama Research Institute on Aging and
- Department of Psychology, The University of Alabama, Tuscaloosa
| | - Ami N Bryant
- Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
| | | | - Soohyun Park
- Department of Psychology, The University of Alabama, Tuscaloosa
| | - Jason M Parton
- Alabama Research Institute on Aging and
- Department of Information Systems, Statistics, and Management Science, The University of Alabama, Tuscaloosa
| | - David H Chae
- Department of Human Development and Family Studies, Auburn University, Alabama
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Schrock JM, Adler NE, Epel ES, Nuru-Jeter AM, Lin J, Blackburn EH, Taylor RJ, Chae DH. Socioeconomic Status, Financial Strain, and Leukocyte Telomere Length in a Sample of African American Midlife Men. J Racial Ethn Health Disparities 2017. [PMID: 28634877 DOI: 10.1007/s40615-017-0388-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND African American men in the USA experience poorer aging-related health outcomes compared to their White counterparts, partially due to socioeconomic disparities along racial lines. Greater exposure to socioeconomic strains among African American men may adversely impact health and aging at the cellular level, as indexed by shorter leukocyte telomere length (LTL). This study examined associations between socioeconomic factors and LTL among African American men in midlife, a life course stage when heterogeneity in both health and socioeconomic status are particularly pronounced. METHODS Using multinomial logistic regression, we examined associations between multiple measures of SES and tertiles of LTL in a sample of 92 African American men between 30 to 50 years of age. RESULTS Reports of greater financial strain were associated with higher odds of short versus medium LTL (odds ratio (OR)=2.21, p = 0.03). Higher income was associated with lower odds of short versus medium telomeres (OR=0.97, p = 0.04). Exploratory analyses revealed a significant interaction between educational attainment and employment status (χ 2 = 4.07, p = 0.04), with greater education associated with lower odds of short versus long telomeres only among those not employed (OR=0.10, p = 0.040). CONCLUSION Cellular aging associated with multiple dimensions of socioeconomic adversity may contribute to poor aging-related health outcomes among African American men. Subjective appraisal of financial difficulty may impact LTL independently of objective dimensions of SES. Self-appraised success in fulfilling traditionally masculine gender roles, including being an economic provider, may be a particularly salient aspect of identity for African American men and have implications for cellular aging in this population.
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Affiliation(s)
- Joshua M Schrock
- Department of Anthropology, University of Oregon, 1218 University of Oregon, Eugene, OR, 97403, USA.
| | - Nancy E Adler
- Department of Psychiatry and Center for Health and Community, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Elissa S Epel
- Department of Psychiatry and Center for Health and Community, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Amani M Nuru-Jeter
- Divisions of Community Health Sciences and Epidemiology, University of California, Berkeley, Berkeley, CA, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Elizabeth H Blackburn
- Department of Biochemistry and Biophysics, University of California, San Francisco, School of Medicine, San Francisco, CA, USA.,Department of Microbiology and Immunology, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | | | - David H Chae
- Department of Human Development & Family Studies, College of Human Sciences, Auburn University, Auburn, AL, USA
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Chae DH, Powell WA, Nuru-Jeter AM, Smith-Bynum MA, Seaton EK, Forman TA, Turpin R, Sellers R. The Role of Racial Identity and Implicit Racial Bias in Self-Reported Racial Discrimination: Implications for Depression Among African American Men. J Black Psychol 2017; 43:789-812. [PMID: 29386696 PMCID: PMC5788304 DOI: 10.1177/0095798417690055] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Racial discrimination is conceptualized as a psychosocial stressor that has negative implications for mental health. However, factors related to racial identity may influence whether negative experiences are interpreted as instances of racial discrimination and subsequently reported as such in survey instruments, particularly given the ambiguous nature of contemporary racism. Along these lines, dimensions of racial identity may moderate associations between racial discrimination and mental health outcomes. This study examined relationships between racial discrimination, racial identity, implicit racial bias, and depressive symptoms among African American men between 30 and 50 years of age (n = 95). Higher racial centrality was associated with greater reports of racial discrimination, while greater implicit anti-Black bias was associated with lower reports of racial discrimination. In models predicting elevated depressive symptoms, holding greater implicit anti-Black bias in tandem with reporting lower racial discrimination was associated with the highest risk. Results suggest that unconscious as well as conscious processes related to racial identity are important to consider in measuring racial discrimination, and should be integrated in studies of racial discrimination and mental health.
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Fuller-Rowell TE, Curtis DS, El-Sheikh M, Chae DH, Boylan JM, Ryff CD. Racial disparities in sleep: the role of neighborhood disadvantage. Sleep Med 2016; 27-28:1-8. [PMID: 27938909 PMCID: PMC5171231 DOI: 10.1016/j.sleep.2016.10.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Disparities in sleep duration and efficiency between Black/African American (AA) and White/European American (EA) adults are well-documented. The objective of this study was to examine neighborhood disadvantage as an explanation for race differences in objectively measured sleep. METHODS Data were from 133 AA and 293 EA adults who participated in the sleep assessment protocol of the Midlife in the United States (MIDUS) study (57% female; Mean Age = 56.8 years, SD = 11.4). Sleep minutes, onset latency, and waking after sleep onset (WASO) were assessed over seven nights using wrist actigraphy. Neighborhood characteristics were assessed by linking home addresses to tract-level socioeconomic data from the 2000 US Census. Multilevel models estimated associations between neighborhood disadvantage and sleep, and the degree to which neighborhood disadvantage mediated race differences in sleep controlling for family socioeconomic position and demographic variables. RESULTS AAs had shorter sleep duration, greater onset latency, and higher WASO than EAs (ps < 0.001). Neighborhood disadvantage was significantly associated with WASO (B = 3.54, p = 0.028), but not sleep minutes (B = -2.21, p = 0.60) or latency (B = 1.55, p = 0.38). Furthermore, race was indirectly associated with WASO via neighborhood disadvantage (B = 4.63, p = 0.035), which explained 24% of the race difference. When measures of depression, health behaviors, and obesity were added to the model, the association between neighborhood disadvantage and WASO was attenuated by 11% but remained significant. CONCLUSION Findings suggest that neighborhood disadvantage mediates a portion of race differences in WASO, an important indicator of sleep efficiency.
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Affiliation(s)
| | - David S Curtis
- Department of Human Development and Family Studies, Auburn University, AL, USA
| | - Mona El-Sheikh
- Department of Human Development and Family Studies, Auburn University, AL, USA
| | - David H Chae
- Department of Human Development and Family Studies, Auburn University, AL, USA
| | | | - Carol D Ryff
- Department of Psychology, University of Wisconsin - Madison, WI, USA
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Lee S, Chae DH, Jung MY, Chen L, Juon HS. Health Examination Is Not a Priority for Less Acculturated Asian Americans. J Racial Ethn Health Disparities 2016; 4:10.1007/s40615-016-0306-0. [PMID: 27800598 PMCID: PMC5411340 DOI: 10.1007/s40615-016-0306-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
This study examines the associations between acculturation and three health examination behaviors (physical, dental, and eye exams) among 846 Chinese, Korean, and Vietnamese Americans. The study was part of a randomized, community-based trial on liver cancer prevention that targeted Asian Americans in Washington DC metropolitan area. Acculturation was assessed using Suinn-Lew Asian Self-Identity Acculturation (SL-ASIA) scale, acculturation clusters, and length of stay. Health examination behaviors in the last 2 years were self-reported. Potential confounders such as age, gender, ethnicity, income, marital status, self-rated health status, health insurance, and having a regular physician were adjusted. Increased acculturation was associated with greater receipt of preventive services when acculturation was measured by SL-ASIA and acculturation clusters. Compared to those in the "Asian" cluster, those in the "American" cluster and "bicultural" clusters were more likely to have physical exams (American odds ratio (OR) = 1.83, 95 % confidence interval (CI) 0.99, 3.88; bicultural OR = 1.11; 95 % CI 0.72, 1.70), dental exams (American OR = 1.99, 95 % CI 1.09, 3.65; bicultural OR = 1.83, 95 % CI 1.21, 2.78), and eye exams (American OR = 4.48, 95 % CI 2.67, 7.66; bicultural OR = 1.92, 95 % CI 1.31, 2.81). A gradient was observed in these associations with the American cluster having stronger associations than the bicultural cluster. Interaction was found between acculturation and gender for receipt of a physical exam. Future studies are needed to further explicate how access to health care impacts the association between acculturation and health examinations among Asian Americans.
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Affiliation(s)
- Sunmin Lee
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, 2234C School of Public Health Building, 4200 Valley Drive, College Park, MD, 20742, USA.
| | - David H Chae
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, 2234C School of Public Health Building, 4200 Valley Drive, College Park, MD, 20742, USA
| | - Mary Y Jung
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, 2234C School of Public Health Building, 4200 Valley Drive, College Park, MD, 20742, USA
| | - Lu Chen
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Chae DH, Epel ES, Nuru-Jeter AM, Lincoln KD, Taylor RJ, Lin J, Blackburn EH, Thomas SB. Discrimination, mental health, and leukocyte telomere length among African American men. Psychoneuroendocrinology 2016; 63:10-6. [PMID: 26398001 PMCID: PMC5407686 DOI: 10.1016/j.psyneuen.2015.09.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
African American men in the US experience disparities across multiple health outcomes. A common mechanism underlying premature declines in health may be accelerated biological aging, as reflected by leukocyte telomere length (LTL). Racial discrimination, a qualitatively unique source of social stress reported by African American men, in tandem with poor mental health, may negatively impact LTL in this population. The current study examined cross-sectional associations between LTL, self-reported racial discrimination, and symptoms of depression and anxiety among 92 African American men 30-50 years of age. LTL was measured in kilobase pairs using quantitative polymerase chain reaction assay. Controlling for sociodemographic factors, greater anxiety symptoms were associated with shorter LTL (b=-0.029, standard error [SE]=0.014; p<0.05). There were no main effects of racial discrimination or depressive symptoms on LTL, but we found evidence for a significant interaction between the two (b=0.011, SE=0.005; p<0.05). Racial discrimination was associated with shorter LTL among those with lower levels of depressive symptoms. Findings from this study highlight the role of social stressors and individual-level psychological factors for physiologic deterioration among African American men. Consistent with research on other populations, greater anxiety may reflect elevated stress associated with shorter LTL. Racial discrimination may represent an additional source of social stress among African American men that has detrimental consequences for cellular aging among those with lower levels of depression.
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Affiliation(s)
- David H. Chae
- Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, 2234 School of Public Health, College Park, Maryland 20742, USA.,Corresponding author at Department of Epidemiology and Biostatistics, University of Maryland at College Park, School of Public Health, 2234 School of Public Health, College Park, Maryland 20742, USA. Tel.: +1 301 405 6425; fax: +1 301 405 3575;
| | - Elissa S. Epel
- Department of Psychiatry, University of California, San Francisco, School of Medicine, 3333 California Street, San Francisco, California 94143, USA
| | - Amani M. Nuru-Jeter
- Divisions of Epidemiology and Community Health and Human Development, University of California, Berkeley, School of Public Health, 50 University Hall, Berkeley, California 94720, USA
| | - Karen D. Lincoln
- University of Southern California, School of Social Work, 669 West 34th Street, Los Angeles, California 90089, USA
| | - Robert Joseph Taylor
- University of Michigan, School of Social Work, 1080 South University, Ann Arbor, Michigan 48109, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, School of Medicine, 600 16th Street, San Francisco, California 94158, USA
| | - Elizabeth H. Blackburn
- Department of Biochemistry and Biophysics, University of California, San Francisco, School of Medicine, 600 16th Street, San Francisco, California 94158, USA
| | - Stephen B. Thomas
- Department of Health Services Administration, University of Maryland at College Park, School of Public Health, 2234 School of Public Health, College Park, Maryland 20742, USA
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Chae DH, Drenkard CM, Lewis TT, Lim SS. Discrimination and Cumulative Disease Damage Among African American Women With Systemic Lupus Erythematosus. Am J Public Health 2015; 105:2099-107. [PMID: 26270300 PMCID: PMC4566545 DOI: 10.2105/ajph.2015.302727] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We examined associations between unfair treatment, attributions of unfair treatment to racial discrimination, and cumulative disease damage among African American women with systemic lupus erythematosus (SLE). METHODS We used multivariable regression models to examine SLE damage among 578 African American women in metropolitan Atlanta, Georgia, recruited to the Georgians Organized Against Lupus cohort. RESULTS When we controlled for demographic, socioeconomic, and health-related covariates, reporting any unfair treatment was associated with greater SLE damage compared with reporting no unfair treatment (b = 0.55; 95% confidence interval = 0.14, 0.97). In general, unfair treatment attributed to nonracial factors was more strongly associated with SLE damage than was unfair treatment attributed to racial discrimination, although the difference was not statistically significant. CONCLUSIONS Unfair treatment may contribute to worse disease outcomes among African American women with SLE. Unfair treatment attributed to nonracial causes may have a more pronounced negative effect on SLE damage. Future research may further examine possible differences in the effect of unfair treatment by attribution.
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Affiliation(s)
- David H Chae
- David H. Chae is with the Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park. Cristina M. Drenkard and S. Sam Lim are with the Division of Rheumatology, School of Medicine, and Tené T. Lewis is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cristina M Drenkard
- David H. Chae is with the Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park. Cristina M. Drenkard and S. Sam Lim are with the Division of Rheumatology, School of Medicine, and Tené T. Lewis is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Tené T Lewis
- David H. Chae is with the Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park. Cristina M. Drenkard and S. Sam Lim are with the Division of Rheumatology, School of Medicine, and Tené T. Lewis is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - S Sam Lim
- David H. Chae is with the Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park. Cristina M. Drenkard and S. Sam Lim are with the Division of Rheumatology, School of Medicine, and Tené T. Lewis is with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Chae DH, Clouston S, Hatzenbuehler ML, Kramer MR, Cooper HLF, Wilson SM, Stephens-Davidowitz SI, Gold RS, Link BG. Association between an Internet-Based Measure of Area Racism and Black Mortality. PLoS One 2015; 10:e0122963. [PMID: 25909964 PMCID: PMC4409363 DOI: 10.1371/journal.pone.0122963] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 02/07/2015] [Indexed: 12/02/2022] Open
Abstract
Racial disparities in health are well-documented and represent a significant public health concern in the US. Racism-related factors contribute to poorer health and higher mortality rates among Blacks compared to other racial groups. However, methods to measure racism and monitor its associations with health at the population-level have remained elusive. In this study, we investigated the utility of a previously developed Internet search-based proxy of area racism as a predictor of Black mortality rates. Area racism was the proportion of Google searches containing the "N-word" in 196 designated market areas (DMAs). Negative binomial regression models were specified taking into account individual age, sex, year of death, and Census region and adjusted to the 2000 US standard population to examine the association between area racism and Black mortality rates, which were derived from death certificates and mid-year population counts collated by the National Center for Health Statistics (2004-2009). DMAs characterized by a one standard deviation greater level of area racism were associated with an 8.2% increase in the all-cause Black mortality rate, equivalent to over 30,000 deaths annually. The magnitude of this effect was attenuated to 5.7% after adjustment for DMA-level demographic and Black socioeconomic covariates. A model controlling for the White mortality rate was used to further adjust for unmeasured confounders that influence mortality overall in a geographic area, and to examine Black-White disparities in the mortality rate. Area racism remained significantly associated with the all-cause Black mortality rate (mortality rate ratio = 1.036; 95% confidence interval = 1.015, 1.057; p = 0.001). Models further examining cause-specific Black mortality rates revealed significant associations with heart disease, cancer, and stroke. These findings are congruent with studies documenting the deleterious impact of racism on health among Blacks. Our study contributes to evidence that racism shapes patterns in mortality and generates racial disparities in health.
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Affiliation(s)
- David H. Chae
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, School of Public Health, College Park, Maryland, United States of America
| | - Sean Clouston
- Department of Preventive Medicine, Stony Brook University, Health Sciences Center, Stony Brook, New York, United States of America
| | - Mark L. Hatzenbuehler
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, New York, United States of America
| | - Michael R. Kramer
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Hannah L. F. Cooper
- Department of Behavioral Sciences and Health Education, Emory University, Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Sacoby M. Wilson
- Maryland Institute for Applied Environmental Health, University of Maryland, College Park, School of Public Health, College Park, Maryland, United States of America
| | | | - Robert S. Gold
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, School of Public Health, College Park, Maryland, United States of America
| | - Bruce G. Link
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, New York, United States of America
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Cummings JR, Case BG, Ji X, Chae DH, Druss BG. Racial/ethnic differences in perceived reasons for mental health treatment in US adolescents with major depression. J Am Acad Child Adolesc Psychiatry 2014; 53:980-90. [PMID: 25151421 PMCID: PMC4238285 DOI: 10.1016/j.jaac.2014.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 04/07/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Racial/ethnic differences in the course of treatment for a major depressive episode (MDE) among adolescents may arise, in part, from variation in the perceived rationale for treatment. We examined racial/ethnic differences in the perceived reasons for receiving mental health (MH) treatment among adolescents with an MDE. METHOD A total of 2,789 adolescent participants who experienced an MDE and received MH treatment in the past year were drawn from the 2005 to 2008 National Survey on Drug Use and Health. Adolescents reported the settings in which they received care and reasons for their most recent visit to each setting. Distributions of specific depressive symptoms were compared across racial/ethnic groups. Racial/ethnic differences in endorsing each of 11 possible reasons for receiving treatment were examined using weighted probit regressions adjusted for sociodemographic characteristics, health and mental health status, treatment setting, and survey year. RESULTS Despite similar depressive symptom profiles, Hispanic adolescents were more likely than whites to endorse "breaking rules" or getting into physical fights as reasons for MH treatment. Black adolescents were more likely than white adolescents to endorse "problems at school" but less likely to endorse "felt very afraid or tense" or "eating problems" as reasons for treatment. Asian adolescents were more likely to endorse "problems with people other than friends or family" but less likely than whites to endorse "suicidal thoughts/attempt" and "felt depressed" as reasons for treatment. CONCLUSION Racial/ethnic minority participants were more likely than white participants to endorse externalizing or interpersonal problems and less likely to endorse internalizing problems as reasons for MH treatment. Understanding racial/ethnic differences in the patient's perceived treatment rationale can offer opportunities to enhance outcomes for depression among diverse populations.
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Affiliation(s)
| | - Brady G. Case
- Health Services Research Program, Bradley Hospital, Alpert Medical School of Brown University, and Brown Public Health Program
| | - Xu Ji
- Rollins School of Public Health, Emory University
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Brody GH, Lei MK, Chae DH, Yu T, Kogan SM, Beach SRH. Perceived discrimination among African American adolescents and allostatic load: a longitudinal analysis with buffering effects. Child Dev 2014; 85:989-1002. [PMID: 24673162 PMCID: PMC4019687 DOI: 10.1111/cdev.12213] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study was designed to examine the prospective relations of perceived racial discrimination with allostatic load (AL), along with a possible buffer of the association. A sample of 331 African Americans in the rural South provided assessments of perceived discrimination from ages 16 to 18 years. When youth were 18 years, caregivers reported parental emotional support and youth assessed peer emotional support. AL and potential confounder variables were assessed when youth were 20. Latent growth mixture modeling identified two perceived discrimination classes: high and stable, and low and increasing. Adolescents in the high and stable class evinced heightened AL even with confounder variables controlled. The racial discrimination to AL link was not significant for young adults who received high emotional support.
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Chae DH, Drenkard CM, Lewis TT, Lim S. Racial discrimination and disease damage among African American women with systemic lupus erythematosus. Arthritis Res Ther 2014. [PMCID: PMC4179513 DOI: 10.1186/ar4629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Clough J, Lee S, Chae DH. Barriers to health care among Asian immigrants in the United States: a traditional review. J Health Care Poor Underserved 2013; 24:384-403. [PMID: 23377740 DOI: 10.1353/hpu.2013.0019] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Asian immigrants in the U.S. are far less likely to have health insurance or use health care services than both U.S.-born Asians and non-Hispanic Whites. Furthermore, Asian immigrants who access the U.S. health care system are less likely than non-Hispanic Whites to receive high-quality services. This paper reviews four barriers faced by Asian immigrants to participating in the U.S. health care system fully: (1) linguistic discordance between providers and patients; (2) health-related beliefs and cultural incompetency of health systems; (3) issues related to accessing health services; and (4) discrimination in the health care system. Interventions to improve the health of Asian immigrants must address barriers experienced at multiple levels, including those that occur interpersonally and institutionally, as well as broader societal factors that affect health care access and quality.
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Affiliation(s)
- Juliana Clough
- University of Massachusetts Medical School, Worcester, MA 01605, USA.
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Taylor RJ, Chae DH, Chatters LM, Lincoln KD, Brown E. DSM-IV 12-month and lifetime major depressive disorder and romantic relationships among African Americans. J Affect Disord 2012; 142:339-42. [PMID: 22840463 PMCID: PMC3483365 DOI: 10.1016/j.jad.2012.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 04/24/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND This brief report examines the association between marital and relationship status and 12-month and lifetime prevalence of major depressive disorder (MDD) among African Americans. Previous work has found that adults with major depressive disorder are less likely to be married or in a cohabiting relationship. This report extends previous research by investigating whether unmarried, non-cohabiting African Americans with depression are also less likely to be involved in a romantic relationship. METHODS Data are from the African American sub-sample (n=3570) of the National Survey of American Life (NSAL; 2001-2003). The DSM-IV World Mental Health Composite International Diagnostic Interview was used to assess 12-month and lifetime MDD. Weighted logistic regression was used. RESULTS The findings indicate that for both 12-month and lifetime major depressive disorder, African Americans who are depressed are not only less likely to be married; they are also significantly less likely to be involved in a romantic relationship. This is particularly the case for 12-month depression. LIMITATIONS Due to limitations in the number of cohabiting respondents, currently married and cohabiting respondents were combined into a single category. CONCLUSION The findings of this brief report highlight the importance of changes in marital and relationship circumstances of the U.S. population for research and practice on depression and other psychiatric disorders. Our study provides evidence for a more nuanced approach in which examining marital and romantic relationship status together promotes a better understanding of the impact of major depression on romantic unions.
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Affiliation(s)
- Robert Joseph Taylor
- School of Social Work, University of Michigan, Ann Arbor, United States; Program for Research on Black Americans, Institute for Social Research, University of Michigan, Ann Arbor, United States.
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Aranda MP, Chae DH, Lincoln KD, Taylor RJ, Woodward AT, Chatters LM. Demographic correlates of DSM-IV major depressive disorder among older African Americans, Black Caribbeans, and non-Hispanic Whites: results from the National Survey of American Life. Int J Geriatr Psychiatry 2012; 27:940-7. [PMID: 22038674 PMCID: PMC3418432 DOI: 10.1002/gps.2805] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 08/18/2011] [Accepted: 08/22/2011] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To examine the demographic correlates of lifetime and 12-month prevalence of major depressive disorder (MDD) among older African Americans, Black Caribbeans, and non-Hispanic Whites. METHODS Data are from adults aged 55 years and older (n = 1439) recruited to the National Survey of American Life (NSAL; 2001-2003). The Diagnostic and Statistical Manual Version IV World Mental Health Composite International Diagnostic Interview was used to assess the 12-month and lifetime MDD. Weighted logistic regression was used to model demographic correlates of MDD. RESULTS The population prevalence of lifetime and 12-month MDD were 11.2% and 4.1%, respectively. Bivariate analyses revealed that younger respondents and those with greater disability had a higher prevalence of both lifetime and 12-month MDD compared with those who were older and who had lower disability. Multivariable logistic regressions controlling for demographic characteristics revealed that non-Hispanic Whites had the greatest odds of lifetime MDD (OR = 2.27, 95% CI = 1.32, 3.93). Women had significantly greater odds of lifetime MDD compared with men (OR = 2.49, 95% CI = 1.14, 5.41); there were no gender differences in 12-month MDD. Other significant predictors of MDD were marital status and region of residence. CONCLUSIONS The distribution, correlates, and nature of associations with MDD vary as a function of whether we examined lifetime vs. 12-month MDD. Future work should account for within group differences among older adults with depression. Understanding MDD correlates and the nature of intergroup diversity can inform the identification of particularly vulnerable subgroups as well as appropriate treatment approaches.
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Affiliation(s)
- María P. Aranda
- Social Work; University of Southern California; Los Angeles; California; United States; 90089
| | - David H. Chae
- Behavioral Sciences and Health Education, Rollins School of Public Health; Emory University; Atlanta; Georgia; United States
| | - Karen D. Lincoln
- Social Work; University of Southern California; Los Angeles; California; United States; 90089
| | | | - Amanda Toler Woodward
- School of Social Work; Michigan State University; East Lansing; Michigan; United States; 48824
| | - Linda M. Chatters
- Social Work; University of Michigan; Ann Arbor; Michigan; United States
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