Day-to-day discrimination and health among Asian Indians: A population-based study of Gujarati men and women in Metropolitan Detroit

This study examined the relationship between experiences of day-to-day discrimination and two measures of health among Gujaratis, one of the largest ethnic groups of Asian Indians in the U.S. Data were collected via computer-assisted telephone interviews with a random sample of Gujarati men and women aged 18-64 in Metropolitan Detroit (N = 423). Using structural equation modeling, we tested two gender-moderated models of the relationship between day-to-day discrimination and health, one using the single-item general health status and the other using the 4-item emotional wellbeing measure. For both women and men, controlling for socio-demographic and other relevant characteristics, the experience of day-to-day discrimination was associated with worse emotional wellbeing. However, day-to-day discrimination was associated with the single-item self-rated general health status only for men. This study identified not only gender differences in discrimination-health associations but also the importance of using multiple questions in assessing perceived health status.     

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.     

Perceived racial discrimination as an independent predictor of sleep disturbance and daytime fatigue

Perceived discrimination is a potential cause of racial and ethnic disparities in health. Disturbed sleep may serve as a mechanism linking perceived racism with health consequences. This study investigates data from 7,148 adults from Michigan and Wisconsin who participated in the 2006 Behavioral Risk Factor Surveillance System. Hierarchical logistic regression analyses explored associations between perceived racial discrimination and self-reported sleep disturbance and daytime fatigue. Sleep disturbance and daytime fatigue were reported in 19% and 21% of the sample, respectively. Black/African American respondents (21%) report perceiving worse experiences, compared to people of other races, when seeking health care at higher rates than non-Hispanic White respondents (3%). Results from logistic regression models show that perceived racial discrimination is associated with increased risks of sleep disturbance (odds ratio [OR] = 2.62, p < .0001) and daytime fatigue (OR = 2.07, p < .0001). After adjustment for all covariates, perceived discrimination remains a significant predictor of sleep disturbance (OR = 1.60, p = .04). The interaction between perceived racism and race (Black/African American vs. non-Hispanic White) was nonsignificant. This population-based research adds to the growing body of data, suggesting that perceived racism may impact health via its influence on sleep-wake behaviors.     

The association of perceived discrimination with low back pain

A handful of recent studies have documented perceived discrimination as a correlate of poor physical and mental health status among ethnic and racial minority groups. To date, however, despite a proliferation of research on ethnic disparities in the severity and impact of a number of persistent pain conditions, there have been no reports on associations between perceived discrimination and pain-related symptoms. Using data from a national survey (the National Survey of Midlife Development in the United States; MIDUS), we explore the relationships between perceived discriminatory events and the report of back pain among African-American and white men and women. As expected, African-American participants reported substantially greater perceptions of discrimination than white participants. Moreover, in models that included a variety of physical and mental health variables, episodes of major lifetime discriminatory events were the strongest predictors of back pain report in African-Americans, and perceived day-to-day discrimination was the strongest predictor of back pain report specifically in African-American women. Among white participants, perceptions of discrimination were minimally related or unrelated to back pain. To our knowledge, these are the first data documenting an association between perceived discrimination and report of back pain; the fact that perceptions of discrimination were stronger predictors than physical health variables highlights the potential salience and adverse impact of perceived discrimination in ethnic and racial minority groups.     

Past racial discrimination exacerbates the effects of racial exclusion on negative affect,perceived control,and alcohol-risk cognitions among Black young adults

Racial discrimination is associated with alcohol use and risky sex cognitions and behaviors, which are risk factors for negative health outcomes, including human immunodeficiency virus infection. The current study investigated the causal impact of racial discrimination on alcohol and sexual-risk cognitions while exploring potential mediators that might help explain this relation: negative affect, perceived control, and meaningful existence. We also examined if past discrimination impacts the strength of (moderates) these effects. Participants were 287 Black/African American young adults aged 18–25. They were randomly assigned to be excluded or included by White peers via the game Cyberball. Racial exclusion (vs. inclusion) predicted greater: perceived racial discrimination, negative affect, alcohol use willingness, and reduced perceived control and meaningful existence. Furthermore, excluded participants who experienced more past racial discrimination reported the lowest perceived control, and greatest negative affect and alcohol-risk cognitions. The findings suggest that past racial discrimination exacerbates the harmful health effects of immediate experiences of discrimination.     

The relationship between racial identity, income, stress and C-reactive protein among parous women: implications for preterm birth disparity research

The persistent racial disparity in preterm birth (PTB)remains one of the most obvious yet poorly understood health disparities in the United States, and current evidence suggests that maternal stress, infection and inflammation may play an important role in the etiology of PTB. In this context, we assessed the complex relationships among racial identity; socioeconomic status (SES); psychosocial factors; and serum C-reactive protein (CRP), an inflammatory biomarker, among parous women in King County, WA. African-American women consistently reported a higher number of stressful life events than white American women (4.6 vs. 2.9, p < 0.001), as well as slightly higher levels of perceived stress and lower social support (24.7 vs. 22.2, p = 0.011, and 3.4 vs. 3.6, p = 0.06, respectively). In the multivariate analysis, African-American race, low-income status and their interaction were all independently associated with CRP; when further adjusted for proximal psychosocial, behavioral and infectious factors, race and income associations were significantly reduced. Stressful life events score was the single best proximal predictor of CRP levels (beta = 0.07 per event,p < 0.001), while perceived stress and social support were not significantly related to CRP. These results support the hypothesis that differences in CRP by racial identity and income may be mediated by differences in proximal risk factors, including stressful life events and health behaviors such as smoking. Objective life event stressors may be important to consider in future studies investigating a potential inflammatory etiology for preterm birth.     

Discrimination,psychosocial stress,and health among Latin American immigrants in Oregon

Chronic psychosocial stress related to discrimination has been shown to be associated with biological measures such as elevated systolic blood pressure (SBP), increased body fat, and higher fasting glucose levels. Few studies have examined these relationships in immigrant populations. The present study recruited a sample of 132 Oregon Latino immigrant adults to investigate the relationships between perceived discrimination and several health measures (blood pressure, body mass index [BMI], and fasting glucose). Results indicate that perceived discrimination stress predicted elevated SBP among men but not among women. Perceived discrimination was significantly higher among obese women than among women of normal BMI. The same pattern was not observed for men. Further, a strong trend relationship was detected: the higher women's reported discrimination stress, the higher their fasting glucose levels. Again, this pattern was not observed for men. These results suggest that chronic psychosocial stress plays an important role in disease risk among Latin American immigrants, and that male and female immigrants may have distinctive physiological responses. If confirmed, these findings may have important clinical and public health implications for chronic disease prevention among Latinos. Am. J. Hum. Biol., 2010. © 2009 Wiley‐Liss, Inc.     

Perceived Ethnic Discrimination in Relation to Daily Moods and Negative Social Interactions

Ethnic discrimination experienced in an interpersonal context has been identified as a stressor contributing to racial disparities in health. Exposure to racism may influence the way people view their ongoing experiences, making it more likely that individuals will appraise new situations as threatening and harmful, adding to their overall stress burden. A multiethnic sample of 113 adults completed a diary page every 30 min for one day. The diary inquired about moods and perceptions of social interactions. When controlling for personality characteristics, mixed models regression analyses indicated that baseline measures of ethnic discrimination (assessed with the Perceived Ethnic Discrimination Scale-Community Version) were positively associated with daily levels of anger and the intensity of participants' rating of routine social interactions as harassing, exclusionary, and unfair. These findings have implications for models of the contribution of psychosocial factors to racial disparities in health.     

Racial identity and autonomic responses to racial discrimination

Several studies identify racial identity—the significance and meaning that individuals attribute to race—as a mitigating factor in the association between racial discrimination and adjustment. In this study, we employed a visual imagery paradigm to examine whether racial identity would moderate autonomic responses to blatant and subtle racial discrimination analogues with Black and White perpetrators. We recruited 105 African American young adults from a public, southeastern university in the United States. The personal significance of race as well as personal feelings about African Americans and feelings about how others view African Americans moderated autonomic responses to the vignettes. We use polyvagal theory and a stress, appraisal, and coping framework to interpret our results with an eye toward elucidating the ways in which racial identity may inform individual differences in physiological responses to racial discrimination.     

Perceived barriers to opportunity and their relation to substance use among Latino immigrant men

Theory and empirical evidence suggest that perceived barriers to opportunity, such as discrimination, can lead to the adoption of unhealthy behaviors. The study assessed the relationship between perceived racial/ethnic, language and legal status barriers to opportunity and substance use among Latino immigrant men in North Carolina. Logistic regression was used to test for the association between perceived barriers and odds of binge drinking in the past 30 days and cigarette smoking. In both crude and adjusted models, perceived language barriers (OR = 3.05, 95% CI: 1.78–5.25) and legal status barriers (OR = 2.25, 95% CI: 1.26–4.01) were associated with increased odds of having engaged in binge drinking. Perceived barriers to opportunity were not significantly associated with cigarette smoking. Further research is needed to better understand the effect of language and legal status barriers on health among Latino immigrants.     

Racial Discrimination Is Associated with a Measure of Red Blood Cell Oxidative Stress: A Potential Pathway for Racial Health Disparities

Background

There are racial health disparities in many conditions for which oxidative stress is hypothesized to be a precursor. These include cardiovascular disease, diabetes, and premature aging. Small clinical studies suggest that psychological stress may increase oxidative stress. However, confirmation of this association in epidemiological studies has been limited by homogenous populations and unmeasured potential confounders.

Purpose

We tested the cross-sectional association between self-reported racial discrimination and red blood cell (RBC) oxidative stress in a biracial, socioeconomically heterogeneous population with well-measured confounders.

Methods

We performed a cross-sectional analysis of a consecutive series of 629 participants enrolled in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Conducted by the National Institute on Aging Intramural Research Program, HANDLS is a prospective epidemiological study of a socioeconomically diverse cohort of 3,721 Whites and African Americans aged 30?C64?years. Racial discrimination was based on self-report. RBC oxidative stress was measured by fluorescent heme degradation products. Potential confounders were age, smoking status, obesity, and C-reactive protein.

Results

Participants had a mean age of 49?years (SD?=?9.27). In multivariable linear regression models, racial discrimination was significantly associated with RBC oxidative stress (Beta?=?0.55, P?<?0.05) after adjustment for age, smoking, C-reactive protein level, and obesity. When stratified by race, discrimination was not associated with RBC oxidative stress in Whites but was associated significantly for African Americans (Beta?=?0.36, P?<?0.05).

Conclusions

These findings suggest that there may be identifiable cellular pathways by which racial discrimination amplifies cardiovascular and other age-related disease risks.     

One size fits all? Race,gender and body mass index among U.S. adults.

This study examined the extent to which factors presumed to be correlated with body mass index (BMI) vary across four race- and gender-specific groups. Data were drawn from the American Changing Lives Survey to estimate separate multivariate regression models for the total study sample that included African-American males, Caucasian males, African-American females and Caucasian females. The dependant variable of interest was BMI. Independent variables included age, human capital variables, relationship and support measures, health status and behavior measures, and stress and outlook measures. Results from the pooled model indicated that BMI was associated with a number of factors such as employment status, chronic illness, financial strain and religiosity. However, race- and gender-specific regression models revealed that predictors of BMI varied considerably for African-American men, Caucasian men, African-American women and Caucasian women. In other words, these models disentangled important correlations not observed in the pooled model. These findings suggest that addressing racial disparities in body weight-related outcomes requires health practitioners to modify obesity prevention and treatment efforts to incorporate a broader array of factors inherent to specific racial and gender populations.     

Racism and health inequity among Americans

Research reports often cite socioeconomic status as an underlying factor in the pervasive disparities in health observed for racial/ethnic minority populations. However, often little information or consideration is given to the social history and prevailing social climate that is responsible for racial/ethnic socioeconomic disparities, namely, the role of racism/racial discrimination. Much of the epidemiologic research on health disparities has focused on the relationship between demographic/clinical characteristics and health outcomes in main-effects multivariate models. This approach, however, does not examine the relationship between covariate levels and the processes that create them. It is important to understand the synergistic nature of these relationships to fully understand the impact they have on health status. PURPOSE: A review of the literature was conducted on the role that discrimination in education, housing, employment, the judicial system and the healthcare system plays in the origination, maintenance and perpetuation of racial/ethnic health disparities to serve as background information for funding Program Announcement, PA-05-006, The Effect of Racial/ Ethnic Discrimination/Bias on Healthcare Delivery (http:// grants.nih.gov/grants/ guide/pa-files/PA-05-006.html). The effect of targeted marketing of harmful products and environmental justice are also discussed as they relate to racial/ethnic disparities in health. CONCLUSION: Racial/ethnic disparities in health are the result of a combination of social factors that influence exposure to risk factors, health behavior and access to and receipt of appropriate care. Addressing these disparities will require a system that promotes equity and mandates accountability both in the social environment and within health delivery systems.     

Prevalence and correlates of everyday discrimination among U.S. Latinos

This study reports on the prevalence and correlates of perceived discrimination among a national sample of Latinos in the United States. Understanding the prevalence and correlates of discrimination can help us better address disparities in the health care system. The authors define perceived discrimination as self‐reported everyday experiences of unfair treatment. Logistic regression analyses were used to assess rates of perceived discrimination among Latinos and identify correlates of discrimination. Data came from the National Latino and Asian American Study (NLAAS). The prevalence of perceived discrimination among Latinos was 30%. Cubans and Latinos with high ethnic identity were less likely to perceive discrimination compared to other Latino subgroups or Latinos with low ethnic identity. American‐born Latinos and Latinos arriving in the United States at younger ages were more likely to perceive discrimination compared to immigrants arriving at older ages. Perceived discrimination among Latinos is less prevalent than what has been reported for other minorities. Variations in perceived discrimination are related to sociodemographic and cultural differences across ethnic subgroups. © 2008 Wiley Periodicals, Inc.     

Perceived discrimination and youths' adjustment: sleep as a moderator

Adolescents' sleep duration was examined as a moderator of the association between perceived discrimination and internalizing (anxiety, depression) and externalizing symptoms. Participants were 252 adolescents (mean: 15.79 years; 66% European American, 34% African American) who reported on their perceived discrimination (racial and general) and adjustment. Sleep duration was measured using actigraphy. Moderation effects were evident. The lowest levels of internalizing symptoms were observed for adolescents with longer sleep duration in conjunction with lower levels of perceived racial discrimination. Further, general perceived discrimination was associated more strongly with externalizing behaviours for youth with shorter versus longer sleep. Findings highlight the importance of sleep as a bioregulatory system that can ameliorate or exacerbate the effects of discrimination on youths' adjustment.     

RACE,PERCEIVED DISCRIMINATION,AND EMOTION‐FOCUSED COPING

This study examined the associations among race, perceived discrimination, and emotion‐focused coping. Participants were 3,688 respondents (160 Blacks and 3,533 non‐Hispanic Whites) to the National Survey of Midlife Development in the United States. We tested our hypotheses with analyses of covariance and multiple regression, and we confirmed mediation with bias‐corrected bootstrap confidence intervals. All analyses controlled for age and gender; educational attainment and household income were included as covariates in additional analyses. Consistent with previous research, Blacks engaged in more emotion‐focused coping than did Whites. However, as predicted, perceived discrimination explained the association between race and emotion‐focused coping. Being Black compared with White predicted more perceived discrimination; in turn, perceived discrimination predicted more emotion‐focused coping. Perceived discrimination fully mediated the association between race and emotion‐focused coping. Findings demonstrate that relying on emotion‐focused coping is a function of facing daily discrimination rather than racial status.     

Minority stress and inflammatory mediators: covering moderates associations between perceived discrimination and salivary interleukin-6 in gay men

Physical health disparities by sexual orientation are widespread yet under-investigated. Drawing upon theories of biological embedding of social adversity, we tested whether minority stress (in the form of perceived discrimination) is associated with salivary interleukin-6 (IL-6), an inflammatory mediator. Furthermore, we examined whether covering, a strategy involving downplaying a stigmatized social identity, modified this association. A community sample (N = 99) of gay men (n = 78) and lesbian women (n = 21) completed self-report measures of minority stress and identity management and provided saliva samples which were assayed for IL-6. Among gay men, results from generalized linear models supported a hypothesized interaction between perceived discrimination and covering, such that perceived discrimination was predictive of higher levels of IL-6 for those who engaged in less covering but not for those who engaged in more covering. This interaction was robust to a number of potential covariates (alcohol, medication, body mass index, race and age). Results for lesbian women suggested a different pattern: the only statistically significant association detected was between greater perceived discrimination and lower levels of IL-6. Findings from the current study point to an important role for inflammatory processes in understanding and remediating health disparities based upon sexual orientation that stem from exposure to prejudice and discrimination.     

Examining the service‐related experiences and outcomes of caregivers involved in a system of care who experienced everyday discrimination

Individuals who report everyday experiences of discrimination are at heightened risk for adverse health outcomes and tend to report underutilization of health services. Systems of care (SOCs) have the potential to engage members of minority groups and to reduce health disparities. We examined the service‐related experiences of predominantly Latinx caregivers enrolled in a SOC for their children with severe psychological health needs. We used independent samples t‐tests and regression analyses to compare relations among service access, perceived service characteristics, and caregiver stress according to whether caregivers reported frequent or infrequent discrimination. The frequent discrimination group scored significantly higher on dimensions of stress and had greater dosage than the infrequent group. There were no differences in relations between service characteristics and outcomes by group. Findings indicated important differences in the service‐related experiences and outcomes of caregivers who reported frequent and infrequent discrimination. We discuss limitations and implications.     

The Effect of Demographic Variables on Ethnic Experience

Research on ethnicity and health has increased recently, but there is still comparatively little known about the nuances of ethnicity and how they might influence health and health behaviors. Using the Scale of Ethnic Experience, this study revealed ethnic differences on perceived discrimination, ethnic identity, and mainstream comfort. Within the African American sample, socioeconomic status (SES), age, and gender influenced these factors. However, Caucasian Americans reported less perceived discrimination and ethnic identity than did African Americans regardless of age, gender, or SES. They also perceived more control over their ability to succeed in mainstream society than did African Americans. These findings suggest that ethnicity consists of multiple components, which may be influenced by demographic factors in African Americans. It is possible that each aspect of ethnicity differentially relates to health outcomes.     

Racial (vs. self) affirmation as a protective mechanism against the effects of racial exclusion on negative affect and substance use vulnerability among black young adults

Affirming one’s racial identity may help protect against the harmful effects of racial exclusion on substance use cognitions. This study examined whether racial versus self-affirmation (vs. no affirmation) buffers against the effects of racial exclusion on substance use willingness and substance use word associations in Black young adults. It also examined anger as a potential mediator of these effects. After being included, or racially excluded by White peers, participants were assigned to a writing task: self-affirmation, racial-affirmation, or describing their sleep routine (neutral). Racial exclusion predicted greater perceived discrimination and anger. Excluded participants who engaged in racial-affirmation reported reduced perceived discrimination, anger, and fewer substance use cognitions compared to the neutral writing group. This relation between racial-affirmation and lower substance use willingness was mediated by reduced perceived discrimination and anger. Findings suggest racial-affirmation is protective against racial exclusion and, more generally, that ethnic based approaches to minority substance use prevention may have particular potential.