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Objective: Increasing evidence suggests that chronic exposure to unfair treatment or day-to-day discrimination increases risk for poor health, but data on biological stress mechanisms are limited. This study examined chronic experiences of unfair treatment in relation to allostatic load (AL), a multisystem index of biological dysregulation., Method: Data are from a sample of 233 African-American adults (37-85 years; 64% women). Perceptions of everyday unfair treatment were measured by questionnaire. An AL index was computed as the sum of 7 separate physiological system risk indices (cardiovascular regulation, lipid, glucose, inflammation, sympathetic nervous system, parasympathetic nervous system, hypothalamic pituitary adrenal axis)., Results: Adjusting for sociodemographics, medication use, smoking status, alcohol consumption, depressive symptoms, lifetime discrimination, and global perceived stress, everyday mistreatment was associated with higher AL., Conclusions: The results add to a growing literature on the effects of chronic bias and discrimination by demonstrating how such experiences are instantiated in downstream physiological systems. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Background: We used a latent class analysis (LCA) to characterize coping styles of urban youth and examined if coping styles moderated the association between experiencing discrimination and bullying and depressive symptoms., Methods: The data come from the 2006 Boston Youth Survey, where students were asked to select 2 behaviors they do most often when they are upset, from a list of 15 options. A total of 927 (75%) students contributed to the LCA analytic sample (44% non-Hispanic Blacks, 29% Hispanics, and 58% girls). Relative and absolute fit indices determined the number of classes. An interaction term between types of discrimination and bullying experienced and coping style tested for moderation., Results: The LCA revealed that a 3-class solution had the best fit (Lo-Mendell-Rubin likelihood ratio test, 4-class vs 3-class, p-value .12). The largest coping style class was characterized by high endorsement of distractive coping strategies (59%), the second class was characterized by using supportive coping strategies (27%), and the third class was characterized by using avoidance coping strategies (12%). We found a significant interaction between discrimination and coping style for depressive symptoms., Conclusions: The relationship between experiencing discrimination and depression varied based on coping style and the type of discrimination and bullying experienced., (© 2015, American School Health Association.)

Over the past two decades, research examining the impact of self-reported experiences of discrimination on mental and physical health has increased dramatically. Studies have found consistent associations between exposure to discrimination and a wide range of Diagnostic and Statistical Manual of Mental Disorders (DSM)-diagnosed mental disorders as well as objective physical health outcomes. Associations are seen in cross-sectional as well as longitudinal studies and persist even after adjustment for confounding variables, including personality characteristics and other threats to validity. However, controversies remain, particularly around the best approach to measuring experiences of discrimination, the significance of racial/ethnic discrimination versus overall mistreatment, the need to account for "intersectionalities," and the importance of comprehensive assessments. These issues are discussed in detail, along with emerging areas of emphasis including cyber discrimination, anticipatory stress or vigilance around discrimination, and interventions with potential to reduce the negative effects of discrimination on health. We also discuss priorities for future research and implications for interventions and policy.

Objectives: Using Jackson Heart Study data, we examined whether perceived discrimination was associated with prevalent hypertension in African Americans., Methods: Everyday discrimination, lifetime discrimination, burden of discrimination, and stress from discrimination were examined among 4939 participants aged 35 to 84 years (women = 3123; men = 1816). We estimated prevalence ratios of hypertension by discrimination, and adjusted for age, gender, socioeconomic status, and risk factors., Results: The prevalence of hypertension was 64.0% in women and 59.7% in men. After adjustment for age, gender, and socioeconomic status, lifetime discrimination and burden of discrimination were associated with greater hypertension prevalence (prevalence ratios for highest vs lowest quartile were 1.08 [95% confidence interval (CI) = 1.02, 1.15] and 1.09 [95% CI = 1.02,1.16] for lifetime discrimination and burden of discrimination, respectively). Associations were slightly weakened after adjustment for body mass index and behavioral factors. No associations were observed for everyday discrimination., Conclusions: Further understanding the role of perceived discrimination in the etiology of hypertension may be beneficial in eliminating hypertension disparities.

Objectives: Our goal in this study was to better understand racial and socioeconomic status (SES) variations in experiences of racial and nonracial discrimination., Methods: We used 1999 and 2000 data from the YES Health Study, which involved a community sample of 50 Black and 50 White respondents drawn from 4 neighborhoods categorized according to racial group (majority Black or majority White) and SES (≤ 150% or > 250% of the poverty line). Qualitative and quantitative analyses examined experiences of discrimination across these neighborhoods., Results: More than 90% of Blacks and Whites described the meaning of unfair treatment in terms of injustice and felt certain about the attribution of their experiences of discrimination. These experiences triggered similar emotional reactions (most frequently anger and frustration) and levels of stress across groups, and low-SES Blacks and Whites reported higher levels of discrimination than their moderate-SES counterparts., Conclusions: Experiences of discrimination were commonplace and linked to similar emotional responses and levels of stress among both Blacks and Whites of low and moderate SES. Effects were the same whether experiences were attributed to race or to other reasons.

Background: Discrimination may be adversely associated with abdominal obesity, but few studies have examined associations with abdominal fat., Purpose: The purpose of this study was to examine whether discrimination was independently associated with visceral (VAT) and subcutaneous (SAT) fat and whether these associations differed by sex and age., Methods: Participants self-reported experiences of everyday and lifetime discrimination. The main reason for and the coping response to these experiences were also reported. VAT and SAT were quantified by computed tomography., Results: In fully adjusted models, higher reports of everyday discrimination were associated with greater SAT, but not VAT, volumes in men only: SAT increased by 3.6 (standard error = 1.8) cm(3) for each unit increase in the everyday discrimination score. In women, higher reports of lifetime non-racial discrimination were associated with greater VAT (71.6 ± 32.0, P < 0.05) and SAT (212.6 ± 83.6, P < 0.05), but these relationships were attenuated after controlling for body mass index., Conclusions: These cross-sectional findings do not fully support the independent hypothesis of discrimination and abdominal fat. Additional investigations involving longitudinal designs are warranted.

Background: There is mounting evidence that discriminatory experiences can harm health. However, previous research has mainly focused on the health effects of racial discrimination in U.S. or European countries although there is pervasive discrimination by gender, age, education and other factors in Asian countries., Methods: We analyzed the data from the 7th wave of Korean Labor and Income Panel Study to investigate the association between perceived discriminatory experience and poor self-rated health in South Korea. Perceived discriminatory experiences were measured in eight situations through a modified Experience of Discrimination questionnaire. In each of eight situations, the lifetime prevalence of perceived discriminatory experience was compared between men and women and the main causes of those experiences were identified separately by gender. After adjusting for potential confounders, we examined the association between perceived discriminatory experience and poor self-rated health in each of eight social situations and also checked the association using the number of situations of perceived discriminatory experiences., Results: For both men and women, education level and age were the main sources of work-related perceived discriminatory experiences. Gender was one of the main causes among women across eight situations and more than 90% of women reported their gender as a main cause of discriminatory experience in getting higher education and at home. Discriminatory experiences in four situations were positively associated with poor self-rated health. The odds ratio for poor self-rated health for those exposed to one, two, three or four or more social situations of perceived discrimination were respectively 1.06 (95% CI : 0.87-1.29), 1.15 (95% CI : 0.96-1.55), 1.59 (95% CI : 1.19-2.14), and 1.78 (95% CI :1.26-2.51)., Conclusion: There is consistent association between perceived discriminatory experience and poor self-rated health across eight social situations in South Korea.

Objectives: To investigate the possibility that Koreans show different patterns in reporting discriminatory experiences based on their gender and education level, we analyzed the participants who answered "Not Applicable" for the questions of discriminatory experiences that they were eligible to answer., Methods: Discriminatory experiences in eight social situations were assessed using the 7(th) wave of Korean Labor and Income Panel Study. After restricting the study population to waged workers, a logistic regression model was constructed to predict the probability that an individual has experienced discrimination based on the observed covariates for each of eight situations, using the data of participants who answered either Yes or No. With the model fit, the predicted logit score of discrimination (PLSD) was obtained for participants who answered Not Applicable (NA), as well as for those who answered Yes or No. The mean PLSD of the NA group was compared with those of the Yes group and the No group after stratification by gender and education level using an ANOVA model., Results: On the questions of discrimination in getting hired and receiving income, the PLSD of the NA group was significantly higher than that of the No group and was not different from that of Yes group for female and junior high or less educated workers, suggesting that their NA responses were more likely to mean that they have experienced discrimination. For male and college or more educated workers, the NA group had a PLSD similar to that for the No group and had a significantly higher PLSD than the Yes group, implying that their NA responses would mean they that they have not experienced discrimination., Conclusions: Our findings suggest that the responses of NA on the discrimination questionnaire may need different interpretation based on the respondents' gender and education level in South Korea.

Objective: To explore levels of perceived racial and non-racial discrimination and their associations with self-esteem and mastery in the U.S.A. and South Africa., Design: We used ordinary least square regressions to test the cross-sectional associations between discrimination and psychological resources using two national probability samples of adults: the National Survey of American Life and the South African Stress and Health Study., Results: Levels of perceived racial discrimination were higher in the U.S.A. than in South Africa. In the U.S.A., both African-Americans and Caribbean blacks have comparable or higher levels of self-esteem and mastery than whites. In contrast, South African whites have higher levels of both self-esteem and mastery than Africans, Coloureds, and Indians. Perceived discrimination, especially chronic everyday discrimination, is inversely related to self-esteem and mastery in both societies. In South Africa, stress and socioeconomic status (SES) but not discrimination are important determinants of racial differences in self-esteem and mastery., Conclusions: In two racialized societies, perceived discrimination acts independent of demographic factors, general stressors, social desirability bias, racial identity, and SES, to negatively affect the psychological resources of self-esteem and mastery.

A growing body of research suggests that perceived discrimination, in multiple societies, is a neglected but important predictor of increased risk of disease for a broad range of health status indicators. Several prior studies propose that discrimination is adversely related to increased cardiovascular disease risk. The studies by Hunte (Am J Epidemiol. 2011;173(11):1223-1231) and Lewis et al. (Am J Epidemiol. 2011;173(11):1232-1239) find that self-reported discrimination is associated with increased risk of adiposity for men and women. These studies highlight the potentially important role of discrimination as a risk factor for excess fat but also raise important research questions regarding the role of fat in cardiovascular disease and racial differences in these processes. More generally, they also provide an important reminder to epidemiologists and medical professionals that discrimination and other aspects of racism persist in contemporary society and that increased efforts are needed to document the extent to which they may have pathogenic consequences and to identify the most promising initiatives to reduce any observed negative effects. Equally important, these studies remind us that, although social stressors are difficult to measure accurately and comprehensively, understanding how multiple stressors combine over the life course to affect the risk of morbidity and mortality remains an important priority for concerted research attention.

Background: To date, research on racial discrimination and health typically has employed explicit self-report measures, despite their potentially being affected by what people are able and willing to say. We accordingly employed an Implicit Association Test (IAT) for racial discrimination, first developed and used in two recent published studies, and measured associations of the explicit and implicit discrimination measures with each other, socioeconomic and psychosocial variables, and smoking., Methodology/principal Findings: Among the 504 black and 501 white US-born participants, age 35-64, randomly recruited in 2008-2010 from 4 community health centers in Boston, MA, black participants were over 1.5 times more likely (p<0.05) to be worse off economically (e.g., for poverty and low education) and have higher social desirability scores (43.8 vs. 28.2); their explicit discrimination exposure was also 2.5 to 3.7 times higher (p<0.05) depending on the measure used, with over 60% reporting exposure in 3 or more domains and within the last year. Higher IAT scores for target vs. perpetrator of discrimination occurred for the black versus white participants: for "black person vs. white person": 0.26 vs. 0.13; and for "me vs. them": 0.24 vs. 0.19. In both groups, only low non-significant correlations existed between the implicit and explicit discrimination measures; social desirability was significantly associated with the explicit but not implicit measures. Although neither the explicit nor implicit discrimination measures were associated with odds of being a current smoker, the excess risk for black participants (controlling for age and gender) rose in models that also controlled for the racial discrimination and psychosocial variables; additional control for socioeconomic position sharply reduced and rendered the association null., Conclusions: Implicit and explicit measures of racial discrimination are not equivalent and both warrant use in research on racial discrimination and health, along with data on socioeconomic position and social desirability.

Objective: Assessing the discrimination-health disparities hypothesis requires psychometrically sound, multidimensional measures of discrimination. Among the available discrimination measures, few are multidimensional and none have adequate psychometric testing in a large, African American sample. We report the development and psychometric testing of the multidimensional Jackson Heart Study Discrimination (JHSDIS) Instrument., Methods: A multidimensional measure assessing the occurrence, frequency, attribution, and coping responses to perceived everyday and lifetime discrimination; lifetime burden of discrimination; and effect of skin color was developed and tested in the 5302-member cohort of the Jackson Heart Study. Internal consistency was calculated by using Cronbach alpha coefficient. Confirmatory factor analysis established the dimensions, and intercorrelation coefficients assessed the discriminant validity of the instrument., Setting: Tri-county area of the Jackson, MS metropolitan statistical area., Results: The JHSDIS was psychometrically sound (overall alpha = .78, .84 and .77, respectively, for the everyday and lifetime subscales). Confirmatory factor analysis yielded 11 factors, which confirmed the a priori dimensions represented., Conclusions: The JHSDIS combined three scales into a single multidimensional instrument with good psychometric properties in a large sample of African Americans. This analysis lays the foundation for using this instrument in research that will examine the association between perceived discrimination and CVD among African Americans.

Objective: The development of measures of self-reported racial/ethnic discrimination is an active area of research, but few measures have been validated across multiple racial/ethnic and language groups. Our goal is to develop and evaluate a discrimination measure that is appropriate for use in surveys of racially and ethnically diverse populations., Methods: To develop our measure, we employ a mixed-methods approach for survey research, drawing from both qualitative and quantitative traditions, including literature review, cognitive testing, psychometric analyses, behavior coding as well as two rounds of field testing using a split-sample design. We tested our new measure using two different approaches to elicit self-reported experiences of racial/ethnic discrimination., Results: Our new measure captures four dimensions of racial/ethnic discrimination: 1) frequency of encounters with discrimination across several domains (eg, medical care, school, work, street and other public places); 2) timing of exposure (eg recent, lifetime); 3) appraisal of discrimination as stressful; and 4) responses to discrimination., Conclusions: Because of the growing interest in measurement of racial/ethnic discrimination in health surveys, we think this report on the methods informing the development and testing of the discrimination module that will be used on the California Health Interview Survey would be useful to other researchers. The application of mixed methods to rigorously test the validity and reliability of our instrument proves to be a good roadmap for measuring racial/ethnic discrimination in multicultural and multilingual populations.

Chronic discrimination in both minority and non-minority populations is linked to adverse health outcomes, including increased risk of cardiovascular disease and increased mortality, but the biological processes through which discrimination affects health are unclear. The current study tested the hypothesis that discrimination in a sample of Caucasians would predict elevated serum levels of E-selectin, an indication of endothelial dysfunction which itself is associated with atherosclerosis and cardiovascular disease risk. Participants (N=804) in the biomarker sample from the Survey of Midlife in the United States (MIDUS) provided information about experiences of both major and everyday discrimination at two times separated by a 9-10 year interval. The discrimination measures were designed to assess perceived unfair treatment (e.g. being fired unfairly) independently of the perceived reasons for the unfair treatment (e.g. race, gender). Serum E-selectin was measured at the second wave of data collection. Women reported significantly more instances of major (P<0.05) and everyday P<0.001) discrimination than men. Analyses of Covariance (ANCOVA) showed that both greater lifetime exposure to major discrimination (P<0.05) and chronic exposure to everyday discrimination (P<0.05) predicted higher circulating levels of E-selectin, but only in men. These associations remained statistically significant after adjustments for potential confounding variables, including age, race, socioeconomic status, health status, and health behavior. These results highlight a potential biological mechanism by which exposure to unfair treatment may be related to health, particularly cardiovascular function. Moreover, they add to a growing literature suggesting that unfair treatment in general may predict adverse health outcomes.

Objectives: We examined whether perceived chronic discrimination was related to excess body fat accumulation in a random, multiethnic, population-based sample of US adults., Methods: We used multivariate multinomial logistic regression and logistic regression analyses to examine the relationship between interpersonal experiences of perceived chronic discrimination and body mass index and high-risk waist circumference., Results: Consistent with other studies, our analyses showed that perceived unfair treatment was associated with increased abdominal obesity. Compared with Irish, Jewish, Polish, and Italian Whites who did not experience perceived chronic discrimination, Irish, Jewish, Polish, and Italian Whites who perceived chronic discrimination were 2 to 6 times more likely to have a high-risk waist circumference. No significant relationship between perceived discrimination and the obesity measures was found among the other Whites, Blacks, or Hispanics., Conclusions: These findings are not completely unsupported. White ethnic groups including Polish, Italians, Jews, and Irish have historically been discriminated against in the United States, and other recent research suggests that they experience higher levels of perceived discrimination than do other Whites and that these experiences adversely affect their health.

An independent panel of experts, convened by the American Medical Association (AMA) Institute for Ethics, analyzed the roots of the racial divide within American medical organizations. In this, the first of a 2-part report, we describe 2 watershed moments that helped institutionalize the racial divide. The first occurred in the 1870s, when 2 medical societies from Washington, DC, sent rival delegations to the AMA's national meetings: an all-white delegation from a medical society that the US courts and Congress had formally censured for discriminating against black physicians; and an integrated delegation from a medical society led by physicians from Howard University. Through parliamentary maneuvers and variable enforcement of credentialing standards, the integrated delegation was twice excluded from the AMA's meetings, while the all-white society's delegations were admitted. AMA leaders then voted to devolve the power to select delegates to state societies, thereby accepting segregation in constituent societies and forcing African American physicians to create their own, separate organizations. A second watershed involved AMA-promoted educational reforms, including the 1910 Flexner report. Straightforwardly applied, the report's population-based criterion for determining the need for phySicians would have recommended increased training of African American physicians to serve the approximately 9 million African Americans in the segregated south. Instead, the report recommended closing all but 2 African American medical schools, helping to cement in place an African American educational system that was separate, unequal, and destined to be insufficient to the needs of African Americans nationwide.

Between 1910 and 1968, the National Medical Association (NMA) repeatedly clashed with the American Medical Association (AMA) over the latter organization's racial bars to membership and other health policy issues. The NMA, founded in 1895 as a nonexclusionary medical society to provide a voice for disenfranchised black physicians and patients, struggled in its early years, during which AMA leadership took scant notice of it. But skirmishes ensued over such actions as stigmatizing racial labels in the AMA's American Medical Directory, which, beginning in 1906, listed all U.S. physicians but designated African Americans with the notation col. The NMA also repeatedly asked the AMA to take action against overt racial bars on blacks' membership in its constituent state and county societies. During the civil rights era, African American physicians received no AMA support in seeking legal remedies to hospital segregation. And the NMA and AMA found themselves opposed on other policy issues, including Medicaid and Medicare. These differences eventually catalyzed a series of direct confrontations. The 1965 AMA meeting in New York City, for example, was protested by about 200 NMA-led picketers. The NMA's quest for racial equality in medicine was supported by some other medical organizations, such as the Medical Committee for Human Rights. In 1966, the AMA House voted to amend the AMA Constitution and Bylaws, giving its Judicial Council (now the Council on Ethical and Judicial Affairs) the authority to investigate allegations of discrimination. This paved the way for a subsequent era of increasing cooperation and understanding.

Objectives: To describe the demographic correlates of perceived discrimination and explore the association between perceived discrimination and psychiatric disorders., Design: A national household survey was conducted between 2002 and 2004 using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate diagnoses of psychiatric disorders. Additional instruments provided data on perceived discrimination and related variables., Setting: A nationally representative sample of adults in South Africa., Subjects: 4351 individuals aged 18 years and older., Outcomes: 12-month and lifetime mood, anxiety and substance use disorders., Results: In the multivariate analyses, acute and chronic racial discrimination were associated with an elevated risk of any 12-month DSM-IV disorder when adjusted for socio-demographic factors, but this association was no longer statistically significant when adjusted for other sources of social stress. In fully adjusted models, acute racial discrimination was associated with an elevated risk of lifetime substance use disorders. Acute and chronic non-racial discrimination were associated with an elevated risk of 12-month and lifetime rates of any disorder, even after adjustment for other stressors and potentially confounding psychological factors. The association of chronic non-racial discrimination and 12-month and lifetime disorder was evident across mood, anxiety, and substance use disorders in the fully adjusted models., Conclusion: The risk of psychiatric disorders is elevated among persons who report experiences of discrimination. These associations are more robust for chronic than for acute discrimination and for non-racial than for racial discrimination. Perceived discrimination constitutes an important stressor that should be taken into account in the aetiology of psychiatric disorders.

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.

Purpose: To examine associations between individual and vicarious racial discrimination via the Internet and psychological adjustment., Methods: This study was a cross-sectional survey using a school-based sample of adolescents. Two hundred sixty-four high school students aged 14-18 completed the online survey., Results: Twenty percent of whites, 29% of African Americans and 42% of multiracials/other experienced individual discrimination and approximately 71% of African Americans and whites and 67% of multiracials witnessed discrimination experienced by same-race and cross-race peers. Hierarchical linear regressions revealed that individual racial discrimination was significantly related to depression and anxiety over and above offline measures. Vicarious discrimination was not related to psychological adjustment measures., Conclusions: Adolescents frequently experienced both individual and vicarious discrimination online. Consistent with offline studies, online racial discrimination was negatively associated with psychological functioning. This study highlights the need to address racial issues in Internet safety prevention.

Background: Questions have existed as to whether residential segregation is a mediator of racial/ethnic disparities in breast cancer care and breast cancer mortality, or has a differential effect by race/ethnicity., Methods: Data from the Surveillance, Epidemiology, and End Results-Medicare database on white, black, and Hispanic women aged 66 to 85 years with breast cancer were examined for the receipt of adequate breast cancer care., Results: Blacks were less likely than whites to receive adequate breast cancer care (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.71-0.86). Individuals, both black and white, who lived in areas with greater black segregation were less likely to receive adequate breast cancer care (OR, 0.73; 95% CI, 0.64-0.82). Black segregation was a mediator of the black/white disparity in breast cancer care, explaining 8.9% of the difference. After adjustment, adequate care for Hispanics did not significantly differ from whites, but individuals, both Hispanic and white, who lived in areas with greater Hispanic segregation were less likely to receive adequate breast cancer care (OR, 0.73; 95% CI, 0.61-0.89). Although Blacks experienced greater breast cancer mortality than whites, black segregation did not substantially mediate the black-white disparity in survival, and was not significantly associated with mortality (hazards ratio, 1.03; 95% CI, 0.87-1.21). Breast cancer mortality did not differ between Hispanics and whites., Conclusions: Among seniors, segregation mediates some of the black-white disparity in breast cancer care, but not mortality. Individuals who live in more segregated areas are less likely to receive adequate breast cancer care., ((c) 2008 American Cancer Society.)

To assess the levels of perceived acute and chronic racial and non-racial discrimination in South Africa, their association with health, and the extent to which they contribute to racial differences in physical and mental health, data were used from a national probability sample of adults, the South African Stress and Health Study (SASH). All Black groups in South Africa (African, Coloured and Indian) were two to four times more likely than Whites to report acute and chronic experiences of racial discrimination. Africans and Coloureds report higher levels of ill health than Whites, but acute and chronic racial discrimination were unrelated to ill health and unimportant in accounting for racial differences in self-rated health. In contrast, all Black groups had higher levels of psychological distress than Whites, and perceived chronic discrimination was positively associated with distress. Moreover, these experiences accounted for some of the residual racial differences in distress after adjustment for socioeconomic status. Our main findings indicate that, in a historically racialized society, perceived chronic racial and especially non-racial discrimination acts independently of demographic factors, other stressors, psychological factors (social desirability, self-esteem and personal mastery), and multiple SES indicators to adversely affect mental health.

Background: Disparities in cancer survival may be related to differences in stage. Segregation may be associated with disparities in stage, particularly for cancers for which screening promotes survival., Objectives: The objective of the study was to examine whether segregation modifies racial/ethnic disparities in stage., Design: The design of the study was analysis of Surveillance, Epidemiology, and End Results Medicare data for seniors with breast, colorectal, lung, and prostate cancer (n = 410,870)., Measurements and Main Results: The outcome was early- versus late-stage diagnosis. Area of residence was categorized into 4 groups: low segregation/high income (potentially the most advantaged), high segregation/high income, low segregation/low income, and high segregation/low income (possibly the most disadvantaged). Blacks were less likely than whites to be diagnosed with early-stage breast, colorectal, or prostate cancer, regardless of area. For colorectal cancer, the black/white disparity was largest in low-segregation/low-income areas (black/white odds ratio [OR] of early stage 0.51) and smallest in the most segregated areas (ORs 0.71 and 0.74, P < .005). Differences in disparities in stage by area category were not apparent for breast, prostate, or lung cancer. Whereas there were few Hispanic-white differences in early-stage diagnosis, the Hispanic/white disparity in early-stage diagnosis of breast cancer was largest in low-segregation/low-income areas (Hispanic/white OR of early stage 0.54) and smallest in high-segregation/low-income areas (OR 0.96, P < .05 compared to low-segregation/low-income areas)., Conclusions: Disparities in stages for cancers with an established screening test were smaller in more segregated areas.

The authors investigated whether substance use and self-reported racial discrimination were associated in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Smoking status, alcohol consumption, and lifetime use of marijuana, amphetamines, and opiates were ascertained in 2000-2001, 15 years after baseline (1985-1986). Most of the 1,507 African Americans reported having experienced racial discrimination, 79.5% at year 7 and 74.6% at year 15, compared with 29.7% and 23.7% among the 1,813 Whites. Compared with African Americans experiencing no discrimination, African Americans reporting any discrimination had more education and income, while the opposite was true for Whites (all p < 0.001). African Americans experiencing racial discrimination in at least three of seven domains in both years had 1.87 (95% confidence interval (CI): 1.18, 2.96) and 2.12 (95% CI: 1.42, 3.17) higher odds of reporting current tobacco use and having any alcohol in the past year than did their counterparts experiencing no discrimination. With control for income and education, African Americans reporting discrimination in three or more domains in both years had 3.31 (95% CI: 1.90, 5.74) higher odds of using marijuana 100 or more times in their lifetime, relative to African Americans reporting no discrimination. These associations were similarly positive in Whites but not significant. Substance use may be an unhealthy coping response to perceived unfair treatment for some individuals, regardless of their race/ethnicity.

This review provides an overview of the existing empirical research of the multiple ways by which discrimination can affect health. Institutional mechanisms of discrimination such as restricting marginalized groups to live in undesirable residential areas can have deleterious health consequences by limiting socio-economic status (SES) and creating health-damaging conditions in residential environments. Discrimination can also adversely affect health through restricting access to desirable services such as medical care and creating elevated exposure to traditional stressors such as unemployment and financial strain. Central to racism is an ideology of inferiority that can adversely affect non-dominant groups because some members of marginalized populations will accept as true the dominant society's ideology of their group's inferiority. Limited empirical research indicates that internalized racism is inversely related to health. In addition, the existence of these negative stereotypes can lead dominant group members to consciously and unconsciously discriminate against the stigmatized. An overview of the growing body of research examining the ways in which psychosocial stress generated by subjective experiences of discrimination can affect health is also provided. We review the evidence from the United States and other societies that suggest that the subjective experience of discrimination can adversely affect health and health enhancing behaviours. Advancing our understanding of the relationship between discrimination and health requires improved assessment of the phenomenon of discrimination and increased attention to identifying the psychosocial and biological pathways that may link exposure to discrimination to health status.

This study investigates the association between self-reported physical and mental health and both perceived racial discrimination and skin color in African American men and women. We used data from the longitudinal coronary artery risk development in young adults study (CARDIA) in African American men and women (n=1722) in the USA. We assessed self-reported mental and physical health status and depressive symptoms at the Year 15 (2000-2001) follow-up examination using the Medical Outcomes Study Short Form (SF-12) and the Center for Epidemiologic Studies Depression scale. Skin color was measured at the Year 7 examination (1992-1993). To assess racial discrimination, we used a summary score (range 0-21) for 7 questions on experiencing racial discrimination: at school, getting a job, getting housing, at work, at home, getting medical care, on the street or in a public setting. Self-reported racial discrimination was more common in men than in women (78.1% versus 73.0%, p<0.05) and in those with higher educational attainment, independent of gender. Discrimination was statistically significantly associated with worse physical and mental health in both men and women, before and after adjustment for age, education, income, and skin color. For example, mental health (0-100 scale) decreased an average of 0.29 units per unit increase in racial discrimination score in men; this became 0.32 units after adjustment. There was no association between self-reported physical and mental health and skin color. Further studies of the health consequences of discrimination will require investigation of both the upstream determinants of discrimination and the downstream mechanisms by which perceived discrimination affects health outcomes.

Objectives: Our understanding of the relationships between perceived discrimination and health was limited by the cross-sectional design of most previous studies. We examined the longitudinal association of self-reported everyday discrimination with depressive symptoms and self-rated general health., Methods: Data came from 2 waves (1996 and 2001) of the Eastside Village Health Worker Partnership survey, a community-based participatory survey of African American women living on Detroit's east side (n=343). We use longitudinal models to test the hypothesis that a change in everyday discrimination over time is associated with a change in self-reported symptoms of depression (positive) and on self-reported general health status (negative)., Results: We found that a change over time in discrimination was significantly associated with a change over time in depressive symptoms (positive) (b=0.125; P<.001) and self-rated general health (negative) (b=-0.163; P<.05) independent of age, education, or income., Conclusions: The results reported here are consistent with the hypothesis that everyday encounters with discrimination are causally associated with poor mental and physical health outcomes. In this sample of African American women, this association holds above and beyond the effects of income and education.

The Jackson Heart Study (JHS) is a prospective, population-based cohort study designed to investigate risk factors for cardiovascular disease (CVD) in African-American men and women. An aim of the JHS is the elucidation of the role that sociocultural factors play in the excess CVD risk and mortality in African Americans. Considerable evidence is available to document the influence of social, cultural, psychological, and other lifestyle risk factors on cardiovascular outcomes. Far less is known about how these factors affect health outcomes for African Americans. The JHS provides a unique opportunity to evaluate the presence and impact of these factors in this ethnoracial group. This paper describes the rationale and overall approach for sociocultural assessment in the JHS, both generally and for each content area.

This article provides an overview of the evidence on the ways racism can affect the disproportionate rates of cardiovascular disease (CVD) in African Americans. It describes the significant health disparities in CVD for blacks and whites and suggests that racial disparities should be understood within the context of persistent inequities in societal institutions and relations. Evidence and potential pathways for exploring effects of 3 levels of racism on cardiovascular health risk factors and outcomes are reviewed. First, institutional racism can lead to limited opportunities for socioeconomic mobility, differential access to goods and resources, and poor living conditions that can adversely affect cardiovascular health. Second, perceived/personally mediated racism acts as a stressor and can induce psychophysiological reactions that negatively affect cardiovascular health. Third, in race-conscious societies, such as the United States, the negative self-evaluations of accepting negative cultural stereotypes as true (internalized racism) can have deleterious effects on cardiovascular health. Few population-based studies have examined the relationship between racism and CVD. The findings, though suggestive of a positive association, are neither consistent nor clear. The research agenda of the Jackson Heart Study in addressing the role of racism in CVD is presented.

The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health.

Background: Although it is recognized that African Americans experience racial discrimination, relatively little research has explored the health implications of this experience. Few studies have examined the relationship between racial discrimination and specific health risks., Objectives: To examine the relationship between smoking habits and perceptions of racial discrimination among African American adolescent girls and to identify and test potential psychological mechanisms through which racial discrimination may operate to increase smoking among this group., Methods: A sample of 105 African American adolescent girls (mean age 15.45 years) derived from a larger cross-sectional research project comprised the sample. Univariate analyses were conducted to provide descriptive data on the participants of the study, including information about their use of licit and illicit substances. Bivariate correlational analyses were conducted to evaluate the relationship between perceptions of discrimination and smoking habits. The ability of stress to mediate the relationship between discrimination and smoking was examined by using standard analytical procedures for testing mediation models as outlined by Baron and Kenny (1986)., Results: The sample (93%) reported experiencing discrimination and racial discrimination was highly correlated with cigarette smoking (r =.35, p >.001). Removing the effects of stress significantly reduced the relationship between racial discrimination and smoking (r =.17, p <.05), indicating that racial discrimination is related to smoking because of its stressful nature., Conclusion: Perceptions of racial discrimination are related to the smoking habits of African American adolescent girls.

African Americans in the United States have a higher than average risk of morbidity and mortality, despite declining mortality rates for many causes of death for the general population. This article examines race-based residential segregation as a fundamental cause of racial disparities, shaping differences in exposure to, and experiences of, diseases and risk factors. The spatial distribution of racial groups, specifically the residential segregation of African Americans in aging urban areas, contributes to disparities in health by influencing access to economic, social, and physical resources essential to health. Using the Detroit metropolitan area as a case study, this article looks at the influences of the distribution of African American and white residents on access to these resources and discusses the implications for urban policies to reduce racial disparities in health status.

This paper reviews the available scientific evidence that relates racism to the elevated rates of hypertension for African Americans. Societal racism can indirectly affect the risk of hypertension by limiting socioeconomic opportunities and mobility for African Americans. Racism can also affect hypertension by 1) restricting access to desirable goods and services in society, including medical care; and 2) creating a stigma of inferiority and experiences of discrimination. This paper evaluates the available evidence for perceptions of discrimination. African Americans frequently experience discrimination and these experiences are perceived as stressful. Several lines of evidence suggest that stressors are positively related to hypertension risk. Exposure to racial stressors under laboratory conditions reliably predicts cardiovascular reactivity and such responses have been associated with longer-term cardiovascular risk. Few population-based studies have examined the association between exposure to racial discrimination and hypertension, and the findings, though suggestive of a positive association between racial bias and blood pressure, are neither consistent nor clear. However, the existing literature identifies important new directions for the comprehensive measurement of discrimination and the design of rigorous empirical studies that can evaluate theoretically derived ideas about the association between discrimination and hypertension.

Racial residential segregation is a fundamental cause of racial disparities in health. The physical separation of the races by enforced residence in certain areas is an institutional mechanism of racism that was designed to protect whites from social interaction with blacks. Despite the absence of supportive legal statutes, the degree of residential segregation remains extremely high for most African Americans in the United States. The authors review evidence that suggests that segregation is a primary cause of racial differences in socioeconomic status (SES) by determining access to education and employment opportunities. SES in turn remains a fundamental cause of racial differences in health. Segregation also creates conditions inimical to health in the social and physical environment. The authors conclude that effective efforts to eliminate racial disparities in health must seriously confront segregation and its pervasive consequences.

This paper provides an overview of United States-based research on the ways in which racism can affect mental health. It describes changes in racial attitudes over time, the persistence of negative racial stereotypes and the ways in which negative beliefs were incorporated into societal policies and institutions. It then reviews the available scientific evidence that suggests that racism can adversely affect mental health status in at least three ways. First, racism in societal institutions can lead to truncated socioeconomic mobility, differential access to desirable resources, and poor living conditions that can adversely affect mental health. Second, experiences of discrimination can induce physiological and psychological reactions that can lead to adverse changes in mental health status. Third, in race-conscious societies, the acceptance of negative cultural stereotypes can lead to unfavorable self-evaluations that have deleterious effects on psychological well-being. Research directions are outlined.

Various authors have noted that interethnic group and intraethnic group racism are significant stressors for many African Americans. As such, intergroup and intragroup racism may play a role in the high rates of morbidity and mortality in this population. Yet, although scientific examinations of the effects of stress have proliferated, few researchers have explored the psychological, social, and physiological effects of perceived racism among African Americans. The purpose of this article was to outline a biopsychosocial model for perceived racism as a guide for future research. The first section of this article provides a brief overview of how racism has been conceptualized in the scientific literature. The second section reviews research exploring the existence of intergroup and intragroup racism. A contextual model for systematic studies of the biopsychosocial effects of perceived racism is then presented, along with recommendations for future research.

The survey data presented here are on the national prevalences of major life-time perceived discrimination and day-to-day perceived discrimination; the associations between perceived discrimination and mental health; and the extent to which differential exposure and differential emotional reactivity to perceived discrimination account for the well-known associations between disadvantaged social status and mental health. Although more prevalent among people with disadvantaged social status, results show that perceived discrimination is common in the total population, with 33.5 percent of respondents in the total sample reporting exposure to major lifetime discrimination and 60.9 percent reporting exposure to day-to-day discrimination. The associations of perceived discrimination with mental health are comparable in magnitude to those of other more commonly studied stressors, and these associations do not vary consistently across subsamples defined on the basis of social status. Even though perceived discrimination explains only a small part of the observed associations between disadvantaged social status and mental health, given its high prevalence, wide distribution, and strong associations with mental health, perceived discrimination needs to be treated much more seriously than in the past in future studies of stress and mental health.

In the past decade, racial/ethnic discrepancy in health status has drawn increased attention from academicians, policy makers and planners, service providers, and community advocates. While the field has witnessed a growth in research projects and intervention programs, the gap in health status among racial/ethnic groups persists, which suggests that future research should incorporate a focus on one neglected area, ie, the health implications of discrimination. Using the National Survey of Functional Health (N=1,659), a nationally representative sample of English-speaking persons 18 years of age and older living in non-institutional arrangements within the United States, we analyzed how self-perceived unfairness (discrimination due to racial identity or to low socioeconomic status [SES]) was linked to self-assessed health status. The study found that racial and class discrimination were rather pervasive in the United States. Experiences of discrimination tended to have a strong negative association with health and accounted for some racial/ethnic differences in health status. The study also revealed a complex relationship between experiences of discrimination and social class, suggesting that future research should focus on specifying the social distribution of discrimination and assessing its subsequent association with health.

Higher disease rates for blacks (or African Americans) compared to whites are pervasive and persistent over time, with the racial gap in mortality widening in recent years for multiple causes of death. Other racial/ethnic minority populations also have elevated disease risk for some health conditions. This paper considers the complex ways in which race and socioeconomic status (SES) combine to affect health. SES accounts for much of the observed racial disparities in health. Nonetheless, racial differences often persist even at "equivalent" levels of SES. Racism is an added burden for nondominant populations. Individual and institutional discrimination, along with the stigma of inferiority, can adversely affect health by restricting socioeconomic opportunities and mobility. Racism can also directly affect health in multiple ways. Residence in poor neighborhoods, racial bias in medical care, the stress of experiences of discrimination and the acceptance of the societal stigma of inferiority can have deleterious consequences for health.

This paper examined the relationships between the experiences and perceptions of racism and the physical and mental health status of African Americans. The study was based upon thirteen year (1979 to 1992), four wave, national panel data (n = 623) from the National Survey of Black Americans. Personal experiences of racism were found to have both adverse and salubrious immediate and cumulative effects on the physical and mental well-being of African Americans. In 1979-80, reports of poor treatment due to race were inversely related to subjective well-being and positively associated with the number of reported physical health problems. Reports of negative racial encounters over the 13-year period were weakly predictive of poor subjective well-being in 1992. A more general measure of racial beliefs, perceiving that whites want to keep blacks down, was found to be related to poorer physical health in 1979-80, better physical health in 1992, and predicted increased psychological distress, as well as, lower levels of subjective well-being in 1992. In conclusion, the authors suggested future research on possible factors contributing to the relationship between racism and health status among African Americans.