Discrimination, Smoking, and Cardiovascular Disease Risk: A Moderated Mediation Analysis With MESA

BACKGROUND

Carotid intima-media thickness (cIMT) and carotid plaque are reliable indicators of cardiovascular disease risk, and research highlights that racial and ethnic minority individuals generally exhibit higher cIMT and carotid plaque than White individuals. At present, the mechanisms driving these disparities among different racial and ethnic and biological sex groups are poorly understood.

METHODS AND RESULTS

Data came from the baseline examination of MESA (Multi-Ethnic Study of Atherosclerosis). A total of 6814 participants aged 45 to 84 years free of clinical cardiovascular disease completed assessments on health behavior and perceived discrimination. Four sex-stratified moderated mediation models examined associations between discrimination, cigarette smoking, and mean cIMT and plaque. We hypothesized that cigarette use would mediate the association between discrimination and carotid artery disease features, and that these would differ by race and ethnicity. Indirect effects of discrimination on plaque were observed among Hispanic women such that discrimination was associated with cigarette use and, in turn, higher plaque (β=0.04 [95% CI, 0.01-0.08]). Indirect effects of discrimination on mean cIMT were found among Hispanic (β=0.003 [95% CI, 0.0001-0.007]) and White men (β=0.04 [95% CI, 0.01-0.08]) such that discrimination was associated with cigarette use and, in turn, higher cIMT. Finally, a positive indirect effect of discrimination on plaque was observed among Hispanic men (β=0.03 [95% CI, 0.004-0.07]). No other racial and ethnic differences were observed.

CONCLUSIONS

To understand and address social determinants of cardiovascular disease, researchers must incorporate an intersectional framework that will allow us to understand the complex nature of discrimination and cardiovascular disease risk for individuals of varying intersecting identities and social positions.

SARS-CoV-2 Infection and Testing Experiences in a Nationwide Sample of Transgender and Gender-Diverse Adults, June-December 2021

OBJECTIVES

COVID-19 surveillance data are rarely collected or disaggregated by gender identity in the United States. We quantified COVID-19 testing experiences and SARS-CoV-2 infection history among transgender and gender-diverse (TGD) people to inform testing strategies and public health responses.

METHODS

From June 14 through December 16, 2021, TGD adults enrolled in a US nationwide online survey with optional SARS-CoV-2 antibody testing. We used multinomial regression analyses to identify correlates of suspected and confirmed SARS-CoV-2 infection (vs no known infection). We identified correlates of inability to access COVID-19 testing when needed using generalized linear models for binomial variables.

RESULTS

Participants (N = 2092) reported trans masculine (30.5%), trans feminine (27.3%), and nonbinary (42.2%) gender identities. Ten percent of respondents had a confirmed history of SARS-CoV-2 infection, and 29.8% had a history of suspected SARS-CoV-2 infection. Nonbinary gender (adjusted prevalence ratio [aPR] = 1.68; 95% CI, 1.12-2.53), experiencing homelessness (aPR = 1.65; 95% CI, 1.05-2.60), and food insecurity (aPR = 1.45; 95% CI, 1.03-2.04) were associated with confirmed SARS-CoV-2 infection. Food insecurity (aPR = 1.38; 95% CI, 1.10-1.72), chronic physical health condition (aPR = 1.44; 95% CI, 1.15-1.80), chronic mental health condition (aPR = 3.65; 95% CI, 2.40-5.56), and increased anticipated discrimination scores (aPR = 1.03; 95% CI, 1.01-1.05) were associated with suspected SARS-CoV-2 infection. Thirty-four percent (n = 694 of 2024) of participants reported an inability to access COVID-19 testing when needed, which was associated with Latinx or Hispanic ethnicity, inconsistent telephone access, homelessness, disability, and transportation limitations. The majority (79.4%) reported a complete COVID-19 vaccine course at the time of participation.

CONCLUSIONS

Inclusion of TGD people in public health surveillance and tailored public health strategies to address TGD communities' social and structural vulnerabilities may reduce barriers to COVID-19 testing.

Intersectional discrimination, gender-based violence, and social participation of women with disabilities in Burkina Faso

This study used in-depth interviews with a diverse sample of women with disabilities in Burkina Faso to explore how discrimination based on gender and disability intersects and influences exposure to violence, as well as the impact of such discrimination on social participation, a theme barely studied in West Africa. The study thematically analysed the narratives of 35 women with disabilities - including mental, physical, auditory and visual - (age range  = 15-53), rural and urban that were collected through four focus groups and eight case stories of rape survivors. As presented in the statements of the women surveyed, the combination of stereotypes and prejudices linked to disability and unequal gender relations make these women predominantly vulnerable to gender-based violence, especially sexual violence. This increased vulnerability to sexual assault emphasises the processes of social exclusion these women experience, at all levels of society, which for most of them results in limited social participation. The findings of this study showed the need for policies related to women's empowerment and inclusion of people with disabilities to adopt an intersectional approach, to better consider the specific issues of women with disabilities.

Discrimination as A Barrier to Romani Women's Health and Empowerment: A Qualitative Study

This qualitative descriptive case study investigates perceptions of health and empowerment among Romani women and social workers in Marseille, France. I used constructivist grounded theory to develop theory emerging from interviews and participant observation data. Results suggest intersectional discrimination at individual and structural levels led to inequalities in accessing resources essential to their survival in France, including healthcare, housing, and employment. This study provides insight into the ways discrimination impacts health inequalities experienced by Romani migrant women. Ultimately, this research highlights essential knowledge and strategies for social workers and public health professionals to empower Romani women by connecting them with essential resources and by envisioning anti-racist interventions to alleviate their experience of individual and structural discrimination.

On the Central Case Methodology in Discrimination Law

The central case methodology captures the features that something must have in order for it to be that thing. As applied to the field of discrimination law, the methodology helps identify both the central cases of discrimination as well as the key features of discrimination law which address such discrimination. Theorists typically conceive central cases of discrimination law from norms prohibiting discrimination on particular grounds, such as race or sex. This gives the impression that discrimination based on more than one ground is not a central case of discrimination or not prohibited by discrimination law. This article challenges that impression. It argues that, although discrimination based on a combination of grounds ('intersectional discrimination') is considered no more than a peripheral case in discrimination law, it should actually be considered 'more than' a central case itself. This is because it is epistemically able to capture discrimination in a wider sense. With this, the article seeks to orientate the theoretical discourse in discrimination law to the correct application of the central case methodology which necessitates the consideration of intersectional discrimination.