Implications of Immigration, Racism, and the Current Sociopolitical Climate

Objectives: To characterize the availability, content, and psychometric properties of self-reported measures that assess race/ethnicity-related discrimination or psychosocial stress and have potential relevance to studies of health disparities in children and adolescents.Design: Using PRISMA extension guidelines for scoping reviews, we searched Ovid Medline, CINAHL, PsychInfo, and Scopus databases from 1946 to April 20, 2020, using the search terms “stress,” “child,” “adolescents,” “discrimination,” and “psychometrics.” We limited the search to articles in English, with children and adolescents, in the United States. For each measure, we extracted information about the content, reliability, and construct validity.Results: The 12 measures that met inclusion criteria assessed discrimination or stress from racial discrimination in African American children and adolescents (n=8), acculturative stress in Hispanic/Latino children (n=1), or bicultural stress in Mexican American adolescents (n=2), and one measure assessed both discrimination-related and acculturative stress in Hispanic/Latino children. The majority (n=7) articles were published between 2001 and 2010. All discrimination measures evaluated individual experiences of discrimination and one also evaluated stressfulness of discrimination and coping. The acculturative stress measures assessed general stress and immigration-related discrimination, and the bicultural stress measures evaluated many different aspects of biculturalism.Conclusions: Despite the recent increased interest in the racial discrimination and stress as a contributor to racial or ethnic health disparities affecting U.S. children and adolescents, the small number of eligible measures identified and incomplete coverage of various types of racial and ethnic discrimination within and across population groups indicates a currently inadequate capacity to conduct child health disparity studies on this issue.

There is abundant evidence about the negative impact of discrimination on well-being, but less research on factors that can reduce this negative effect, mainly focused on North American samples and with incipient development on South–South migration. The objective of this research was to analyze the effect of ethnic identity on the relationship between the experience of racial and ethnic discrimination and psychological well-being in Colombian immigrants living in Chile. A total of 962 immigrants over the age of 18 from three cities in Chile participated. Of these, 50.7% were women. The average age was 35 years (SD = 10.23). Participants were evaluated using Ryff’s Psychological Well-Being Scales, Phinney’s adapted version of the Multigroup Ethnic Identity Scale, and Krieger’s Discrimination Experience Scale. After the analysis of the measurement models, a mediation model was analyzed using structural equations. The results provide evidence that ethnic and racial discrimination have negative effects on psychological well-being, with the effect of racial discrimination being greater. Likewise, ethnic identity has positive effects on psychological well-being and partially and completely mediates the effects of ethnic and racial discrimination on psychological well-being. The full effect of discrimination on psychological well-being, mediated by ethnic identity, is exercised only by racial discrimination and not by ethnic discrimination.

Investigating racial and ethnic discrimination in medical education is crucial for addressing disparities and fostering an inclusive environment. To assess how racial and ethnic discrimination in medical school is associated with personal and professional identity formation (PPIF) by race and ethnicity. This retrospective cross-sectional study used deidentified data on 37 610 medical students who matriculated in 2014 or 2015 and took the Association of American Medical Colleges Graduation Questionnaire (GQ) between 2016 and 2020. Statistical analysis was performed from September 1 to November 20, 2023. Experiences of racial and ethnic discrimination were assessed through responses to 3 GQ questions about denial of opportunities, offensive remarks or names, and lower evaluations or grades due to race or ethnicity. Personal and professional development were measured as 2 separate outcomes using 2 GQ statements rated on a 5-point Likert scale (where 1 indicated strongly disagree and 5 indicated strongly agree): "My medical school has done a good job fostering and nurturing my development as a person" and "My medical school has done a good job fostering and nurturing my development as a physician." Variables of personal and professional development were both dichotomized. Of 37 610 medical students, 18 200 (48.4%) were female, and 19 410 (51.6%) were male; 2458 (6.5%) were African American or Black, 7801 (20.7%) were Asian, 2430 (6.5%) were Hispanic, 21 380 (56.9%) were White, 2404 (6.4%) were multiracial, and 1137 (3%) were other race or ethnicity. Most respondents attested that their medical school fostered their personal (27 272 [72.5%]) and professional (34 560 [91.9%]) development. African American or Black students reported the lowest rates of personal (1603 of 2458 [65.2%]) and professional (2182 of 2458 [88.8%]) development, and experienced lower likelihoods of personal (adjusted risk ratio [ARR], 0.89 [95% CI, 0.86-0.93]) and professional (ARR, 0.95 [95% CI, 0.94-0.97]) development than White students. Racial discrimination was inversely associated with development, with the highest PPIF rates among those never experiencing discrimination (personal, 25 089 of 33 508 [74.9%]; and professional, 31 257 of 33 508 [93.3%]). Those experiencing isolated discrimination (personal: ARR, 0.83 [95% CI, 0.80-0.87]; professional: ARR, 0.92 [95% CI, 0.91-0.95]) and recurrent discrimination (personal: ARR, 0.63 [95% CI, 0.60-0.66]; professional: ARR, 0.82 [95% CI, 0.80-0.84]) had relatively lower likelihoods of PPIF. African American or Black students experienced the highest rate of recurrent discrimination (543 of 2458 [22.1%]). No significant PPIF risk differences were found for other racial and ethnic groups underrepresented in medicine without discrimination compared with White students without discrimination, but all groups with recurrent discrimination had relatively lower PPIF risk. In this cross-sectional study of US medical students, racial and ethnic discrimination was associated with lower PPIF across all racial and ethnic groups compared with White students without such experiences. African American or Black students disproportionately faced this discrimination. Systemic changes in medical education are needed to combat discrimination and ensure equity in holistic student development.

BackgroundRacial and ethnic discrimination are known stressors and are associated with negative psychological and physical health outcomes. Previous studies have found relationships between racial/ethnic discrimination and binge-eating disorder (BED), though they have mainly focused on adult populations. The aim of this study was to determine associations between racial/ethnic discrimination and BED in a large, national cohort study of early adolescents. We further sought to explore associations between the racial/ethnic discrimination perpetrator (students, teachers, or other adults) and BED.MethodsWe analyzed cross-sectional data from the Adolescent Brain Cognitive Development Study (N = 11,075, 2018–2020). Logistic regression analyses examined associations between self-reported experiences of racial or ethnic discrimination and binge-eating behaviors and diagnosis, adjusting for potential confounders. Racial/ethnic discrimination measures were assessed based on the Perceived Discrimination Scale, which measures experiences of discrimination based on race/ethnicity and frequency of ethnic discrimination by teachers, adults outside of school, and students. Binge-eating behaviors and diagnosis were based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSAD-5).ResultsIn this racially diverse sample of adolescents (N = 11,075, age range 9–12 years), 4.7% of adolescents reported racial or ethnic discrimination and 1.1% met the criteria for BED. In the adjusted models, racial/ethnic discrimination was associated with 3 times higher odds of having BED (OR 3.31, CI 1.66–7.74). Further, experiences of ethnic discrimination by students and adults outside school were associated with significantly increased odds of BED diagnosis (OR 1.36, CI 1.10–1.68 and OR 1.42 CI 1.06–1.90, respectively)., Increased odds of binge eating behaviors were only significantly associated with ethnic discrimination perpetuated by students (OR 1.12, CI 1.02–1.23).ConclusionsChildren and adolescents who have experienced racial/ethnic discrimination, particularly when discrimination was perpetuated by other students, have higher odds of having binge-eating behaviors and diagnoses. Clinicians may consider screening for racial discrimination and providing anti-racist, trauma-informed care when evaluating and treating patients for BED.

Asian Indians were the first South Asians to immigrate to the United States in the late 1800s and are currently the largest ethnic group of South Asians living in the United States. Despite this the literature on perceived ethnic and racial discrimination experiences among this group is relatively understudied. The documented experiences of Asian Indians who either recently immigrated from India or were born and raised in America pose an important question: what are the experiences of perceived discrimination among Asian Indians living in America, particularly among younger populations who are continuing to develop their racial and ethnic identities? The current study utilized phenomenological methodology to explore the experiences of nine Asian Indian American adolescents' (ages 12–17 years). Data were collected via semi-structured interviews to assess participants' experiences of ethnic and racial discrimination and identity development. Thematic analysis was used to identify themes and subthemes among the participants' responses. Asian Indian adolescents living in the United States report experiencing discrimination at a young age. It is also evident that Asian Indian youth experience significant challenges when developing their sense of ethnic and racial identity while living within the United States. Findings document the racial and ethnic discrimination that Asian Indian adolescents living in the United States may experience from a young age. Importantly, these discrimination experiences are occurring as Asian Indian adolescents are developing their racial and ethnic identities. This study provides insight for future research, which is necessary to fully understand the experiences of Asian Indian adolescents.

Drawing from cultural ecological models of adolescent development, the present research investigates how early adolescents received ethnic–racial socialization from parents as well as how experiences of ethnic and racial discrimination are associated with their ethnic identity (i.e., centrality, private regard, and public regard). Data for this study were drawn from a multimethod study of ethnically and socioeconomically diverse early adolescents in three mid‐ to high‐achieving schools in New York City. After accounting for the influences of race/ethnicity, social class, gender, immigrant status, and self‐esteem, parental ethnic–racial socialization was associated with higher levels of ethnic centrality (i.e., the extent to which youth identify themselves in terms of their group), more positive private regard (i.e., feelings about one's own ethnic group), and public regard (i.e., perceptions of other people's perceptions of their ethnic group). Ethnic discrimination from adults at school and from peers was associated with more negative perceptions of one's ethnic group (i.e., public regard). In addition, the association of ethnic–racial parent socialization and ethnic identity beliefs was stronger for those who reported higher levels of adult discrimination. Results highlight key ways in which ethnic identity may be shaped by the social ecologies in which adolescents are embedded.

There is not much evidence on the effects of south–south migration and its consequences on physical and mental health. Our objective was to examine the mediating role of Acculturative Stress in the association between ethnic discrimination and racial discrimination with physical and mental health. This research is a non-experimental, analytical, cross-sectional study. A total of 976 adult Colombian migrants living in Chile were interviewed. We used the Everyday Discrimination Scale, the acculturative stress scale, and the Medical Outcomes Study Short Form (SF-12) for health status; we found that racial and ethnic discrimination had a negative effect on physical and mental health. In the simultaneous presence of both types of discrimination, racial discrimination was completely absorbed by ethnic discrimination, the latter becoming a total mediator of the effect of racial discrimination on mental and physical health. Our findings are consistent with the literature, which suggests that there are various types of discrimination which, individually or in their intersectionality, can have negative effects on health.

Using the IAT to Predict Ethnic and Racial Discrimination: Small Effect Sizes of Unknown Societal Significance

Greenwald, Banaji, and Nosek (2015) present a reanalysis of the meta-analysis by Oswald, Mitchell, Blanton, Jaccard, and Tetlock (2013) that examined the effect sizes of Implicit Association Tests (IATs) designed to predict racial and ethnic discrimination. We discuss points of agreement and disagreement with respect to methods used to synthesize the IAT studies, and we correct an error by Greenwald et al. that obscures a key contribution of our meta-analysis. In the end, all of the meta-analyses converge on the conclusion that, across diverse methods of coding and analyzing the data, IAT scores are not good predictors of ethnic or racial discrimination, and explain, at most, small fractions of the variance in discriminatory behavior in controlled laboratory settings. The thought experiments presented by Greenwald et al. go well beyond the lab to claim systematic IAT effects in noisy real-world settings, but these hypothetical exercises depend crucially on untested and, arguably, untenable assumptions.

ObjectivesResearch and policies in the United Kingdom have repeatedly highlighted the need to reduce ethnic disparities and improve engagement with mental health services among Black African and Caribbean people with psychosis. The aim of this study was to examine the role of social network characteristics and psychological factors in engagement with services in Black people with psychosis.MethodsA cross‐sectional study was conducted with 51 Black African and Caribbean adults with non‐affective psychosis and currently receiving care from mental health services in England. Measures were completed to examine relationships between social networks, illness perceptions, perceived racial or ethnic discrimination in services, internalized stigma, and current engagement with services from service user and staff perspectives.ResultsSocial network composition (ethnic homogeneity) moderately correlated with better service user and staff reported engagement. Greater perceived personal control over problems was associated with better staff reported engagement. Lower perceived ethnic or racial discrimination in services, and specific illness perceptions (higher perceived treatment control, greater self‐identification with psychosis symptoms, more concern and greater emotional response related to problems) were associated with better service user reported engagement. Internalized stigma was not associated with service engagement. Multivariate regression analyses suggested that a more ethnically homogenous social network was the strongest predictor of better service user and staff reported engagement.ConclusionsPsychosocial interventions that target social networks, perceived ethnic and racial discrimination in services, and illness perceptions may facilitate better engagement and improve outcomes. Further longitudinal studies are required to examine causal mechanisms.

BackgroundRacial and ethnic diversity of healthcare workers have benefits on team functioning and patient care. However, a significant barrier to retaining diverse providers is discrimination.ObjectiveTo assess the predictors, perpetrators, and narratives of racial discrimination among healthcare workers.DesignSurvey study.ParticipantsHealthcare workers employed at academic hospitals.Main MeasuresWe assessed prevalence and perpetrators of racial and ethnic discrimination using the General Ethnic Discrimination Scale. We included an open-ended question asking respondents to recount experiences of discrimination and analyzed responses using grounded theory.Key ResultsOf the 997 participants, 12.2% were females from backgrounds underrepresented in medicine (URM), 4.0% URM males, 10.1% Asian females, 4.7% Asian males, 49.1% non-Hispanic White females, and 19.8% non-Hispanic White males. Among healthcare workers of color, 85.2% reported discrimination. Over half of URM females (51.4%), URM males (52.6%), and Asian females (62.5%) reported discrimination by patients. About 20–25% of URM females, URM males, and Asian females reported discrimination by teachers, supervisors, co-workers, and institutions. In adjusted binary logistic models, URM females had 10.14 odds (95% confidence interval [95%CI]: 5.13, 20.02, p<.001), URM males 6.23 odds (95%CI: 2.59, 14.98, p<.001), Asian females 7.90 odds (95%CI: 4.07, 15.33, p<.001), and Asian males 2.96 odds (95% CI: 1.47, 5.97, p=.002) of reporting discrimination compared with non-Hispanic White males. Needing more support was associated with 2.51 odds (95%CI: 1.54, 4.08, p<.001) of reporting discrimination. Our qualitative findings identified that the murder of George Floyd intensified URM healthcare workers’ experiences of discrimination through increased fear of violence and requests for unpaid diversity work. Asian healthcare workers reported that pandemic-related anti-Asian violence shaped their experiences of discrimination through increased fear of violence and care refusal from patients.ConclusionsOur findings provide insights into experienced discrimination among healthcare workers and opportunities for hospitals to create programs that improve inclusivity.

Racial and ethnic discrimination in health care have been associated with suboptimal use of health care. However, limited research has examined how facets of health care utilization influence, and are influenced by, discrimination. This study aimed to determine if type of insurance coverage and location of usual source of care used were associated with perceptions of racial or ethnic discrimination in health care. Additionally, this study examined if perceived racial or ethnic discrimination influenced delaying or forgoing prescriptions or medical care. Data from the 2015-2016 California Health Interview Survey were used. Logistic regression models estimated odds of perceiving racial or ethnic discrimination from insurance type and location of usual source of care. Logistic regression models estimated odds of delaying or forgoing medical care or prescriptions. Responses for 39,171 adults aged 18 and over were used. Key health care utilization variables were as follows: current insurance coverage, location of usual source of care, delaying or forgoing medical care, and delaying or forgoing prescriptions. We examined if these effects differed by race. Ever experiencing racial or ethnic discrimination in the health care setting functioned as a dependent and independent variable in analyses. When insurance type and location of care were included in the same model, only the former was associated with perceived discrimination. Specifically, those with Medicaid had 66% higher odds of perceiving discrimination, relative to those with employer-sponsored coverage (AOR = 1.66; 95% CI 1.11, 2.47). Race did not moderate the impact of discrimination. Perceived discrimination was associated with higher odds of delaying or forgoing both prescriptions (AOR = 1.97; 95% CI 1.26, 3.09) and medical care (AOR = 1.84; 95% CI 1.31, 2.59). Health care providers have an opportunity to improve the experiences of their patients, particularly those with publiclysponsored coverage.

Sociological research has linked racism and discrimination among children to poorer health outcomes and social conditions later in life. Given the change in the political climate in the United States, highly publicized deaths of Black men and women by police, and the rise in hate crimes against Asian Americans from 2016 through 2020, our primary objective was to assess trends in racial or ethnic discrimination among children in the United States. We conducted a cross-sectional analysis of the National Survey of Children's Health (NSCH), a nationally representative survey, utilizing data from 2016 to 2020. We calculated yearly population estimates of whether a child had experienced discrimination based on race/ethnicity via a parent-reported item. We further divided the estimates by race/ethnicity and plotted linear trends over time. Data from the NSCH show that racial/ethnic discrimination reported by parents of children who are minorities increased from 6.7% in 2016 to approximately 9.3% in 2020. Indigenous children were reported to experience discrimination at high rates ranging from 10.8% in 2016 to 15.7% in 2020, as well as Black children ranging from 9.69% in 2018 to 15.04% in 2020. The percent of Asian, Hawaiian or Pacific Islander, and Hispanic children reported to have experience discrimination was between 4.4 and 6.8% during this time. Discrimination negatively impacts the developmental experiences of children, disproportionately affecting those identifying as Indigenous and Black. Therefore, addressing harmful stereotyping of Indigenous and Black cultures is necessary, especially in media targeted toward children. Providing culturally competent healthcare, critically in the Indigenous and Black pediatric population, may improve long-term outcomes by reducing discriminatory barriers to healthcare access.

Ethnic and racial discrimination and sleep among black college students: The moderating role of public regard.

This article compares feelings of discomfort and experiences of discrimination attributed to racial and ethnic difference among visible minorities and two white groups: “Europeans” and “white charter” individuals. In conducting the analysis, attention is given to the role of location by examining how responses vary in three types of locations in Canada: large and diverse metropolitan areas, smaller “second‐tier” cities, and towns and rural areas. Using the Ethnic Diversity Survey (EDS) as the principal data source, the results of descriptive and explanatory multivariate analyses are presented. Logistic regression analyses confirm that race frequently is interpreted as underlying experiences of discomfort and discrimination in Canada, with visible minorities much more likely to report racial and ethnic discomfort and discrimination than the two white groups. While location is not strongly related to racial and ethnic discrimination, it has a significant impact on reports of discomfort. Residents of Montreal, Toronto, and Vancouver are more likely to report racial and ethnic discomfort than those living in non‐metropolitan areas. As others have reported in Australia and Great Britain, living in diverse social environments where negotiation of difference is an everyday necessity heightens discomfort. The findings highlight geographical variations in the lived experience of multiculturalism that warrant further investigation.