The Role of Social Support in Machismo and Acceptance of Violence Among Adolescents in Europe: Lights4Violence Baseline Results

PurposeTo analyze the potential association between social support, experiences of violence, and sociodemographic characteristics of adolescents and the likelihood of acceptance of violence and machismo in different European countries.MethodsCross-sectional design. We recruited 1,555 participants ages 13–16 from secondary schools in Alicante (Spain), Rome (Italy), Iasi (Romania), Matosinhos (Portugal), Poznan (Poland), and Cardiff (UK). We used linear regression models to identify how social support from teachers and parents, experiences of violence—dating violence, bullying, cyberbullying, abuse in childhood—and sociodemographic characteristics were associated with violent thinking, specifically: machismo and acceptance of violence. The analysis was stratified by sex.ResultsAcceptance of violence was higher for those who had lower perceived social support from parents (β_girls = ?154, p < .001; β_boys = ?.114, p = .019) for both sexes. Perpetration of bullying and/or cyberbullying was associated with higher scores for machismo and acceptance of violence for both sexes (β_girls = .067, p = .035; β_boys = .225, p < .001; (β_girls = .118, p < .001; β_boys = .210, p < .001). Being the victim of dating violence, having suffered physical and/or sexual abuse in childhood, and lower perceived social support from teachers were associated with higher scores for both machismo and acceptance of violence. These associations differed between girls and boys.ConclusionsMachismo and acceptance of violence are widely present amongst adolescents in different European countries. Our results suggest the importance of providing educational/psycho-educational interventions with boys and girls to prevent these attitudes and, in turn, prevent interpersonal violence, including bullying and dating violence.     

First-Generation College Students,Emotional Support,and Systemic Inflammation Following the College Transition

PurposeTo examine whether emotional support moderates the association between college generation status and concurrent and prospective levels of systemic inflammation during the college transition among a sample of older U.S. adolescents.MethodsAt an undergraduate tertiary institution, 41 first-generation college students (first-gens) and 46 continuing-generation college students (continuing-gens) in their first semester of college reported on basic demographic information and perceived emotional support. They also had their blood drawn midway through both the first and second semester to measure C-reactive protein and interleukin-6. An inflammatory composite for each semester was created by averaging the standardized scores for log-transformed C-reactive protein and interleukin-6.ResultsCompared to continuing-gens, first-gens had greater systemic inflammation in the first semester regardless of their level of emotional support (B = 0.515, p = .003). However, emotional support moderated the association between college generation status and prospective systemic inflammation in the second semester (B = ?0.525, p = .007) such that first-gens had greater systemic inflammation compared to continuing-gens, but only if they reported lower levels of emotional support (B = 0.826, p = .002). This moderation effect held after further adjusting for systemic inflammation in the first semester (B = ?0.374, p = .022). Also discussed are results of secondary analyses examining sources of support.DiscussionCompared to continuing-gens, first-gens had greater systemic inflammation in the first semester irrespective of emotional support, suggesting all first-gens may stand to benefit from college resources provided early in the college transition. Furthermore, first-gens who reported lower levels of emotional support may benefit from additional college resources provided beyond the first semester.     

Perceived social and physical environmental correlates of physical activity in older adolescents and the moderating effect of self-efficacy

ObjectiveTo determine if perceptions of the social and physical environment are associated with active transport and leisure-time sports among Belgian youth and to investigate if this relationship is moderated by self-efficacy.MethodsIn February–May 2008, 1445 adolescents (17.4 ± 0.6 yrs) were recruited in 20 randomly selected Belgian schools. Physical activity, psychosocial, and environmental factors were assessed using validated questionnaires. Moderated multilevel regression analysis was used to examine the association between physical activity and possible correlates.ResultsSocial environmental variables (modeling and social support) were positively associated with active transportation and leisure-time sports (p < 0.05). Higher land use mix diversity, higher street connectivity, more attractive environments, better access to recreational facilities, and higher emotional satisfaction with the neighborhood were associated with more active transportation (p < 0.05). Higher perceived safety from traffic, better access to recreational facilities, more physical activity equipment at home, and fewer electronic devices in the bedroom were associated with more leisure-time sports (p < 0.05). Lower perceived safety and poorer access to (recreational) facilities were only associated with lower active transport among youth with lower self-efficacy (p < 0.05).ConclusionCreating more supportive environments could have the potential to affect the physical activity levels of Belgian adolescents with both high and low self-efficacy.     

Psychological Distress in Women Living with Polycystic Ovary Syndrome: The Role of Illness Perceptions

IntroductionPolycystic ovary syndrome (PCOS) is an endocrine and metabolic condition linked to increased risk of anxiety and depression (psychological distress). This study examined the relationship between illness perceptions and psychological distress in women living with PCOS.MethodsWe used a cross-sectional survey to assess psychological distress (Hospital Anxiety and Depression Scale) and illness perceptions (Illness Perception Questionnaire-Revised) in women living with PCOS in the UK (N = 487). Hierarchical multiple linear regression tested the associations between illness perceptions and psychological distress, adjusting for age, years since PCOS diagnosis, education, body mass index, current depression, and current anxiety disorder.ResultsIn the fully adjusted regression model, illness perceptions explained 18.6% of the variance in psychological distress, F(7,458) = 21.0, p < .001. Reporting more symptoms (B = 0.226), higher perceived consequences (B = 0.204), lower personal control (B = –0.184), and lower illness coherence (B = –0.127) were significantly associated with higher psychological distress (all p < .001).ConclusionsIllness perceptions may play an important role in psychological distress, even after adjusting for relevant demographics and clinical characteristics. Our findings highlight key areas where researchers and clinicians could develop targeted self-management interventions for women with PCOS, focused on altering maladaptive illness perceptions to reduce psychological burden.     

The Impact of Positive Youth Development Attributes on Posttraumatic Stress Disorder Symptoms Among Chinese Adolescents Under COVID-19

PurposeThis study examined the prevalence of posttraumatic stress disorder (PTSD) symptoms among adolescents in mainland China under COVID-19. The direct effects of the perceived threat of COVID-19 and positive youth development (PYD) qualities, as well as the moderating effect of PYD qualities on PTSD symptoms, were studied.MethodsFive schools in Chengdu, Sichuan, China, participated in this study. Two waves of data were collected before school lockdown (Wave 1, between December 2019 and January 2020) and after school resumption (Wave 2, between June 2020 and July 2020), respectively. A total of 4,981 adolescents aged above 11 years (Mean age = 13.15, SD = 1.32 at Wave 1, 51.5% girls) completed questionnaires at both waves. Students responded to measures of PYD qualities at both waves and perceived threat and PTSD symptoms at Wave 2.ResultsA total of 517 adolescents (10.4%) could be regarded as having PTSD. Results indicated significant unique main effects of perceived threat (β = .13, p < .001) and Wave 1 PYD qualities (β = ?.16, p < .001) on PTSD symptoms. Besides, results showed a significant moderating effect of PYD qualities in mitigating the negative impact of perceived threat on PTSD symptoms.ConclusionsThis study revealed the protective effect of PYD attributes in reducing the negative influence of traumatic situations such as COVID-19 on adolescent mental health. Results underscore the importance of promoting PYD qualities in adolescents in mainland China via effective PYD programs.     

Associations between intimate partner violence,violence-related policies,and HIV diagnosis rate among women in the United States

PurposeTo assess the association between state-level intimate partner violence (IPV) prevalence and HIV diagnosis rates among women in the United States and investigate the modifying effect of state IPV health care policies.MethodsData on HIV diagnosis rates were collected from HIV surveillance data from 2010 to 2015, and IPV prevalence data were collected from the National Intimate Partner and Sexual Violence Survey from 2010 to 2012. States were coded for IPV health care policies on training, screening, reporting, and insurance discrimination.ResultsStates with higher IPV prevalence was associated with higher HIV diagnoses among women (B = 0.02; 95% confidence interval [CI] = 0.003, 0.04; P = .02). State policies were a significant effect modifier (B = −0.05; 95% CI = −0.07, −0.02; P < .001). Simple slopes revealed that the association between IPV and HIV diagnosis rates was stronger in states with low IPV protective health care policies (B = 0.09; CI = 0.06, 0.13; P < .001) and moderate IPV protective policies (B = 0.05; 95% CI = 0.02, 0.07, P < .001), but not in states with high IPV protective policies (B = −0.009; 95% CI = −0.04, 0.02; P = .59).ConclusionsHIV prevention programs should target IPV and link to community resources. IPV-related policies in the health care system may protect the sexual health of women experiencing IPV.     

Correlates of Physical Activity Engagement among Pregnant Women with Overweight and Obesity

BackgroundExcess weight during pregnancy increases risk for adverse obstetrical outcomes. Physical activity (PA) may buffer these effects, although it is unclear what factors are associated with PA in women who begin pregnancy with overweight/obesity. The present study sought to characterize the demographic and psychological correlates of PA among women with prepregnancy overweight/obesity.MethodsPregnant women (N = 249; mean age, 28.48 ± 5.48 years; mean body mass index, 34.13 ± 7.07 kg/m²) at 12–20 weeks of gestation (mean, 15.68 ± 2.44 weeks of gestation) completed ratings of perceived stress and depressive symptoms and were interviewed using the pregnancy version of the Eating Disorders Examination. The Paffenbarger Physical Activity Survey was administered via interview to estimate energy expenditure. Continuous outcomes were evaluated via linear regression, while logistic regression was conducted to assess likelihood of meeting PA guidelines.ResultsMean weekly duration of moderate to vigorous PA was 109.50 ± 248.17 minutes, with 21% of women meeting federal PA guidelines of 150 minutes or more. Higher perceived stress (β = –0.217; p = .02) and eating psychopathology (β = –0.213; p < .01) were associated with lower total energy expenditure. Black women reported lower expenditure specifically from walking compared with White women (β = –0.180; p = .03). Depressive symptoms were not associated with PA. No estimate of PA predicted body mass index.ConclusionsPregnant women with overweight/obesity engage in modest amounts of PA early in pregnancy, although few meet PA guidelines. Greater perceived stress and eating psychopathology were associated with lower PA engagement. These factors should be monitored by obstetrics providers to identify women who may particularly benefit from counseling about PA during pregnancy.     

Resilience among Cisgender and Transgender Women in Street-Based Sex Work in Baltimore,Maryland

IntroductionResilience represents adaptability and empowerment and can buffer against the consequences of traumatic events. Cisgender and transgender women in street-based sex work are at high risk for trauma, yet data on their resilience are sparse. A clearer understanding of resilience and its correlates is useful for informing sex worker-centered interventions.MethodsUsing the Connor-Davidson 10-item Resilience Scale (range, 0–40), we describe resilience among 165 cisgender and 42 transgender street-based women sex workers in Baltimore, Maryland. Longitudinal cohort data were used to examine correlates of resilience in each population. Analyses are conducted using multiple linear regression.ResultsThe mean resilience score was 24.2 (95% confidence interval, 23.6–24.8) among cisgender women sex workers and 32.2 among transgender women sex workers (95% confidence interval, 30.8–32.7). Among cisgender participants, positive correlates of resilience were being Black, Hispanic, or other race (ß = 2.7; p = .004), having housing (ß = 1.9; p = .034), social cohesion score (ß = 0.18; p = .047), and daily drug injection (ß = 3.7; p < .001); negative correlates of resilience were sexual violence (ß = –4.8; p = .006) and exposure to egregious police acts (ß = –0.6; p = .015). Among transgender participants, higher education level (ß = 8.8; p < .001), food security (ß = 3.5; p = .005), and housing stability (ß = 2.0; p < .001) were associated with increased resilience, and daily noninjection drug use (excluding marijuana; ß = –3.3; p < .001) and physical violence (ß = –2.9; p < .001) were associated with reduced resilience.ConclusionsThis study is the first to characterize factors that may influence resilience among cisgender and transgender women sex workers. Results highlight tangible intervention targets for promoting mental health and safety among a uniquely vulnerable population of women.     

Soft Drink Consumption and Mental Health in Adolescents: A Longitudinal Examination

PurposePrevious studies showed associations between soft drink consumption and mental health problems in adolescents, but the direction of these effects is unknown. This study examines the hypotheses that soft drink consumption predicts aggression and depressive symptoms over time and that these mental health problems predict soft drink consumption.MethodsInterviews were conducted with 5,147 children and their caregivers from three sites at child ages 11, 13, and 16. At each time point, youth reported on their frequency of consuming soft drinks, aggressive behavior, and depressive symptoms. An autoregressive cross-lagged path model tested reciprocal relationships between soft drink consumption, aggressive behavior, and depressive symptoms over time.ResultsMore frequent consumption of soft drinks was associated with more aggressive behavior at each time point and depressive symptoms at ages 11 and 13 (r = .04 to .18, p ≤ .002). After adjusting for covariates and stability of each behavior over time, soft drink consumption at ages 11 and 13 predicted more aggressive behavior at the next time point (β = .08 and .06, p < .001). Aggressive behavior at age 13 also predicted more soft drink consumption at age 16 (β = .06, p = .002). Soft drink consumption at age 13 predicted fewer depressive symptoms (β = ?.04, p = .007), but depressive symptoms did not predict soft drink consumption.ConclusionsMore frequent consumption of soft drinks may contribute to aggressive behavior in adolescents over time; there is some support for reciprocal relationships. There is no evidence for soft drink consumption contributing to adolescents' depression. Future research should examine longitudinal effects over shorter intervals.     

Human papillomavirus vaccine-related risk perceptions and subsequent sexual behaviors and sexually transmitted infections among vaccinated adolescent women

ObjectiveTo examine the association between risk perceptions after human papillomavirus (HPV) vaccination and sexual behaviors and sexually transmitted infection (STI) diagnosis over 30 months following vaccination.MethodsParticipants included 112 sexually experienced girls aged 13–21 years who were enrolled at the time of first HPV vaccination and completed ⩾2 of 4 follow-up visits at 2, 6, 18, 30 months and including 30 months. At each visit, participants completed surveys assessing risk perceptions (perceived need for safer sexual behaviors, perceived risk of STIs other than HPV) and sexual behaviors. STI testing was done at 6, 18, and 30 months. Outcomes were condom use at last intercourse with main male partner, number of sexual partners since last study visit, and STI diagnosis. Associations between risk perceptions and sexual behaviors/STIs were examined using generalized linear mixed models.ResultsMean age was 17.9 years; 88% were Black; 49% had a history of STI at baseline. Scale scores for perceived need for safer sexual behaviors did not change significantly over time. Scale scores for perceived risk of STIs other than HPV significantly changed (p = 0.027), indicating that girls perceived themselves to be more at risk of STIs other than HPV over 30 months following vaccination. Multivariable models demonstrated that greater perceived need for safer sexual behaviors following vaccination was associated with condom use (p = 0.002) but not with number of partners or STI diagnosis. Perceived risk of STIs other than HPV was not associated with the three outcomes.ConclusionsThe finding that perceived risk for STIs other than HPV was not associated with subsequent sexual behaviors or STI diagnosis is reassuring. The association between perceived need for safer sexual behaviors and subsequent condom use suggests that the HPV vaccination visit is an important opportunity to reiterate the importance of safer sexual behaviors to sexually experienced girls.     

Time Off Work After Childbirth and Breastfeeding Supportive Workplaces: Associations with Near-Exclusive Breastfeeding Trajectory Membership

ObjectiveWe aimed to determine whether the association between time off work and a near-exclusive breastfeeding trajectory is moderated by perceived employer support for breastfeeding.MethodsWe conducted a secondary analysis of working mothers (n = 1,468) from the Infant Feeding Practices Study II, a longitudinal observational (2005–2007) study of U.S. infant feeding behaviors. Previous studies have found four latent infant feeding subgroups in the Infant Feeding Practices Study II sample, each following a distinct breastfeeding intensity trajectory. Multivariate least-squares regression was conducted to estimate whether time off work after delivery predicted increased membership in the subgroup characterized by near-exclusive breastfeeding, and whether this association was moderated by perceived employer support for workplace breastfeeding.ResultsBoth time off work and perception of more breastfeeding support were independently, positively related to probability of membership in the near-exclusive breastfeeding trajectory (β = 0.16, p = .019, and β = 0.14, p = .004, respectively). The interaction of these two factors suggests an attenuation effect. The addition of paid leave to the model did not change the estimates.ConclusionThe positive relationship between time off and trajectory membership was significant only for mothers who perceived their workplaces to be unsupportive of breastfeeding.     

Postpartum Perceived Stress Explains the Association between Perceived Social Support and Depressive Symptoms

BackgroundLimited research has focused on longitudinal interrelations between perceived social support, perceived stress, and depressive symptoms beyond the first postpartum months. This study tested an alternative primary hypothesis within the stress process model examining whether perceived stress mediated the association between perceived social support and depressive symptoms from 1 to 24 months postpartum. Secondary purposes examined whether these factors 1) changed from 1 to 24 months postpartum and 2) predicted depressive symptoms.MethodsWomen (N = 1,316) in a longitudinal cohort study completed validated measures of perceived social support, perceived stress, and depressive symptoms at 1, 6, 12, 18, and 24 months postpartum via telephone interviews. Analyses examined changes in psychosocial factors (repeated measures analysis of variance) and the extent to which perceived social support and perceived stress predicted depressive symptoms and supported mediation (linear regression).ResultsPerceived social support decreased, perceived stress increased, and depressive symptoms remained constant from 1 to 18 months, then increased at 24 months. Low perceived social support predicted 6-month depressive symptoms, whereas perceived stress predicted depressive symptoms at all time points. Perceived stress mediated the association between perceived social support and depressive symptoms across 24 months such that low perceived social support predicted perceived stress, which in turn predicted depressive symptoms.ConclusionsIntervention scientists may want to focus on strengthening perceived social support as a means to manage perceived stress in an effort to prevent a long-term trajectory of depression.     

Improving Adolescent Perceptions of Barriers and Facilitators to Sexual and Reproductive Health Services Through Sexual Health Education

PurposeThis study examines whether comprehensive sexual health education that provides information on clinical services can change adolescents’ perceptions of barriers, facilitators, and intention to use services and whether changes in perceptions differ by participant characteristics.MethodsAdolescent participants in a statewide sexual health education program in California were surveyed at baseline and at exit about their perceptions of barriers, facilitators, and intention to use clinical services. Linked baseline and exit surveys (n = 7,460) assessed change in perceptions after program completion. Logistic regression analyses that accounted for the clustered data structure assessed associations between participant characteristics and improvement in perceptions.ResultsAfter the program, there were significant reductions in two perceived barriers (worry about cost and judgment by staff), but there were also small but significant increases in perceptions of two barriers (worry about confidentiality of services and test results). There were significant increases in all three perceived facilitators and intention to use sexual and reproductive health services, which rose from 90.6% at baseline to 96.2% at exit. Younger youth were more likely than older youth to show improvement in all perceived facilitators and intentions. Girls and Black youth were more likely than boys and Hispanic youth to show improvement in two facilitators (knowing what to expect and access). No sociodemographic characteristics were consistently associated with reductions in perceived barriers.DiscussionComprehensive sexual health education that addresses adolescents’ questions and concerns regarding clinical services can help to reduce perceived barriers, increase facilitators, and increase intention to use services if needed.     

Weight and health-related quality of life: The moderating role of weight discrimination and internalized weight bias

ObjectivesObesity is an increasingly prevalent public health concern, with associated medical comorbidities and impairment in health-related quality of life (HRQoL). Obese women are frequently victims of weight-related discrimination. The HRQoL impairments among obese people could be related to this discrimination and to internalized weight bias.DesignWe examined the potential moderating role of discrimination (from others) and self-directed (internalized) weight-based discrimination in the association between body mass index (BMI) and HRQoL.MethodsEighty-one women (mean age = 41.1 years; mean BMI = 43.40 kg/m², 97% Caucasian) completed valid and reliable measures of weight bias internalization (weight bias internalization scale), perceived discrimination by others (everyday discrimination scale) and both physical and mental HRQoL (SF-36 Health Survey). Multiple regression analysis was used to test whether internalized weight bias or discrimination moderated the association between BMI and the summary scores for physical and mental HRQoL, controlling for age.ResultsSignificant associations were found between BMI and discrimination (r = .36, p = .002), between internalized weight bias and both mental (r = .61, p < .001) and physical HRQoL (r = .45, p < .001), and between discrimination and physical HRQoL (r = .29, p = .014). A statistically significant interaction was found between BMI and internalized weight bias (b = − .21, SE = .10, p < 0.05) in accounting for the variance in physical HRQoL.ConclusionsThe association between higher BMI and poorer physical HRQoL was found only in individuals reporting high levels of internalized weight bias. Self-discrimination among overweight individuals may be a critical factor in their physical health impairment.     

Community Perceptions of Safety in Relation to Perceived Youth Violence-Delinquency in a Primarily Native Hawaiian and Asian American Community in Hawai‘i

Perception of safety is an important component to the well-being of community members in their own neighborhood. The present study was the first of its kind to model community perception of safety utilizing a primarily Native Hawaiian and Asian American community sample (N = 101) and with perceived youth violence and delinquency as prominent potential influences. The study found that the majority of participants felt that several types of youth violence and delinquency were problems in the community. The overall social-ecological model evidenced a strong fit and indicated that community perception of safety was adversely impacted by perceived youth violence and delinquency and increased through positive relations with neighbors. The implications included the need for a more comprehensive approach to positive youth development and community capacity-building, including incorporation of cultural components, and to determine whether the model is applicable to other minority communities.     

Influence of rapid COVID-19 vaccine development on vaccine hesitancy

IntroductionIn the race to deploy vaccines to prevent COVID-19, there is a need to understand factors influencing vaccine hesitancy. Secondary risk theory is a useful framework to explain this, accounting for concerns about vaccine efficacy and safety.MethodsDuring the first week of July, 2020, participants (N = 216) evaluated one of three different hypothetical vaccine scenarios describing an FDA-approved vaccine becoming available “next week,” “in one year,” or “in two years.” Dependent variables were perceived vaccine efficacy, self-efficacy, perceived vaccine risk, and vaccination willingness. Covariates included vaccine conspiracy beliefs, science pessimism, media dependency, and perceived COVID-19 risk. Data analysis employed multiple analysis of covariance (MANCOVA).ResultsPerceived vaccine efficacy was lowest for the next-week vaccine (η²_p = .045). Self-efficacy was higher for the two-year vaccine than the next-week vaccine (η²_p = .029). Perceived vaccine risk was higher for the next-week vaccine than for the one-year vaccine (η²_p = .032). Vaccination willingness did not differ among experimental treatments. In addition, vaccine conspiracy beliefs were negatively related to perceived vaccine efficacy (η²_p = .142), self-efficacy (η²_p = .031), and vaccination willingness (η²_p = .143) and positively related to perceived vaccine risk (η²_p = .216).ConclusionsThe rapid development of the COVID-19 vaccine may have heightened public concerns over efficacy, availability, and safety. However, the current findings showed a general willingness to take even the most rapidly developed vaccine. Nonetheless, there remains a need to communicate publicly and transparently about vaccine efficacy and safety and work to reduce vaccine conspiracy beliefs.     

Factors That Contribute or Impede the Physical Health Recovery of Women Exposed to Intimate Partner Violence: A Longitudinal Study

BackgroundSeveral cross-sectional studies have demonstrated the negative impact that intimate partner violence (IPV) has on the physical health of women. However, longitudinal studies are needed to establish the time course of this effect. This study assessed the physical health course of female IPV victims and established the factors that enhance or impede their recovery.MethodsWomen (n = 91) who participated in a previous cross-sectional study (T-1) and were either victims of physical/psychological IPV (n = 33) or psychological IPV (n = 23) were evaluated 3 years later (T-2). A control group of women (n = 35) was included for comparison. Structured interviews provided information regarding IPV characteristics, physical health, and lifestyle.FindingsPhysical symptoms decreased over time for both groups of abused women. Factors that contributed to this improvement were perception of social support and the cessation of physical IPV. Factors that impaired recovery included cohabitation with the aggressor, victimization experiences at T-2, negative perceptions of life events, and continuing psychological IPV.ConclusionsThis study shows that physical health improvement is possible in female victims of IPV, but that continuing psychological IPV hinders recovery. Additional longitudinal studies are needed to investigate the factors that best predict health recovery in female IPV victims to design effective intervention programs.     

Cross-Sectional and Longitudinal Effects of Racism on Mental Health Among Residents of Black Neighborhoods in New York City

Objectives. We investigated the impact of reported racism on the mental health of African Americans at cross-sectional time points and longitudinally, over the course of 1 year.Methods. The Black Linking Inequality, Feelings, and the Environment (LIFE) Study recruited Black residents (n = 144) from a probability sample of 2 predominantly Black New York City neighborhoods during December 2011 to June 2013. Respondents completed self-report surveys, including multiple measures of racism. We conducted assessments at baseline, 2-month follow-up, and 1-year follow-up. Weighted multivariate linear regression models assessed changes in racism and health over time.Results. Cross-sectional results varied by time point and by outcome, with only some measures associated with distress, and effects were stronger for poor mental health days than for depression. Individuals who denied thinking about their race fared worst. Longitudinally, increasing frequencies of racism predicted worse mental health across all 3 outcomes.Conclusions. These results support theories of racism as a health-defeating stressor and are among the few that show temporal associations with health.Racism doggedly structures American social life and institutions. In February 2014—Black History Month—The New York Times reported and editorialized on several racial inequalities and racist events, including overly harsh and racially patterned disciplinary policies in schools; the impact of mass incarceration on disenfranchisement; racial gaps in access to conventional mortgages; the defacement of and hanging of a noose on a campus statue of James Meredith, the University of Mississippi’s first Black student; and the death of Jordan Davis, a Black youth shot by a White man enraged by his playing loud hip-hop (“thug music”).1–5Most often, experiences with racism are not newsworthy, but quotidian; they are the product of a society for which racism is part and parcel of doing business.6 As a result, individuals who face racism must not only cope with the opportunity costs of racial exclusion but also manage emotional consequences and the awareness that it is likely to be an ongoing stressor.7 Whether as discrete instances of discriminatory exclusion from societal resources or as behaviors and social narratives that subjugate people of African ancestry, racism causes pain that many Black people would rather not acknowledge and to which many Whites remain inured.8 This pain is borne out in empirical research showing that racism negatively affects mental health.A 2006 review of the literature on racism and health analyzed 62 studies and found negative associations with mental health outcomes to be the most consistent finding.9 Similarly, a meta-analysis published 3 years later identified 110 studies on discrimination and mental health, with outcomes including symptoms of depression, anxiety, posttraumatic stress disorder, psychological distress, and several measures of general well-being.10 Discrimination was negatively (average zero-order correlation = −0.20) and equally associated across outcomes, with recent and chronic events having stronger effects than cumulative lifetime events. Although findings on mental health are often consistent, it is notable that they emanate from numerous and conceptually distinct measurements of exposure. The 2006 review found 152 different instruments employed.9 These measures assess interpersonal acts, daily hassles, more severe racist events, and nonspecific discrimination (unfair treatment), though the most common theoretical frame is often a stress-coping model.11Research conducted subsequent to these reviews continues to show the psychological sequelae of racism. One study investigated whether the experience of racism relates most strongly to psychiatric disorders with symptom profiles analogous to responses to racism. Results supported this premise: discriminatory experiences predicted generalized anxiety disorder, with its symptoms of chronic anxiety, worry, and muscle tension.12 Other work has linked racism with symptoms of depression among Black men, and risk increased for men who experienced difficulty in and fears about expressing their feelings.13 Finally, in a sample of US-born Black participants, reports of high levels of discrimination were associated with increased psychological distress, particularly for those who accepted unfair treatment as a fact of life.14Taken together, accumulated evidence is consistent on the negative mental health effects of racism, but because the majority of work is cross-sectional (76% in 1 review9), the ability to identify causes is reduced and researchers have called for longitudinal studies that better model directionality. One such study investigated everyday discrimination and symptoms of depression among a sample of Black women in Detroit. There, discrimination reported at baseline and change in discrimination over time predicted increases in depression over time.12We conducted cross-sectional and longitudinal assessments of the mental health impact of experiences with racism. We used self-report of nonspecific psychological distress, symptoms of depression, and the number of days in poor mental health over the past month to examine whether racism reported at baseline was associated with concurrently reported mental health indicators and with indicators 1 year later and whether changes in experiences with racism over time were associated with changes in mental health indicators.     

Racial and Ethnic Abortion Disparities Following Georgia's 22-Week Gestational Age Limit

IntroductionGeorgia's 2012 House Bill 954 (HB954) prohibiting abortions after 22 weeks from last menstrual period (LMP) has been associated with a significant decrease in abortions after 22 weeks. However, the policy's effects by race or ethnicity remain unexplored. We investigated whether changes in abortion numbers and ratios (per 1,000 live births) in Georgia after HB954 varied by race or ethnicity.MethodsUsing Georgia Department of Public Health induced terminations of pregnancy data from 2007 to 2017, we examined changes in number of abortions and abortion ratios (per 1,000 live births) by race and ethnicity following HB954 implementation.ResultsAfter full implementation of HB954 in 2015, the number of abortions and abortion ratios at or after 22 weeks (from last menstrual period) decreased among White (b_Number = –261.83, p < .001; b_Ratio = –3.31, p < .001), Black (b_Number = –416.17, p < .001; b_Ratio = –8.84, p < .001), non-Hispanic (b_Number = –667.00, p = .001; b_Ratio = –5.82, p < .001), and Hispanic (b_Number = –56.25, p = .002; b_Ratio = –2.44, p = .002) people. However, the ratio of abortions before 22 weeks increased for Black people (b_{LessThan22Weeks} = 44.06, p = .028) and remained stable for White (b_{LessThan22Weeks} = –6.78, p = .433), Hispanic (b_{LessThan22Weeks} = 21.27, p = .212), and non-Hispanic people (b_{LessThan22Weeks} = 26.93, p = .172).ConclusionThe full implementation of HB954 had differential effects by race/ethnicity and gestational age. Although abortion at 22 weeks or more decreased for all groups, abortion at less than 22 weeks increased among Black people. Additional research should elucidate the possible causes, consequences, and reactions to differential effects of abortion restrictions by race and ethnicity.