Daily Discrimination Research Articles

Intersectional vulnerability in the relationship between discrimination and inflammatory gene expression

Addressing social disparities in health and well-being requires understanding how the effects of discrimination become biologically embedded, and how embedding processes might vary across different demographic contexts. Emerging research suggests that a threat-related gene expression response may contribute to social disparities in health. We tested a contextual vulnerability model of discrimination embedding using an empirical intersectionality (interaction discovery) analysis of pro-inflammatory gene expression in a national sample of non-institutionalized, English-speaking adults with RNA biomarker data (n = 543). At the time of data collection, the average age of participants was 55 years (SD = 13.26) and approximately half identified as female (50.46%). Most participants identified as White (∼73%) and had some college experience (∼60%). Results showed significant variation in the strength of association between daily discrimination and inflammatory gene expression by race and sex (b = −0.022; 95% CI:-0.038,-0.005, p = .009) with the estimated marginal association larger for racially-minoritized males (b = 0.007; 95% CI:-0.003,0.017, p = .163), compared to White males (b = −0.006; 95% CI:-0.013,0.001, p = .076). This study indicates that the link between daily discrimination and inflammatory gene expression may vary by sociodemographic characteristics. To improve initiatives and policies aimed at ameliorating disparities within populations, greater attention is needed to understand how interlocking systems of inequalities contribute to physiological health.

PERCEIVED DISCRIMINATION, DEPRESSIVE SYMPTOMS, AND COGNITIVE CONTROL AMONG MEXICAN-ORIGIN WOMEN

Abstract Mexican-origin adults comprise over 60% of the Latino population in the U.S., and are at greater risk for cognitive impairment compared to non-Latino Whites. Older Mexican-origin women are also disproportionally affected by cognitive impairment compared to their non-Latino White counterparts. Identifying early-life precursors for reduced cognitive function can inform prevention efforts. Perceived discrimination is a ubiquitous stressor with emergent evidence linking it to cognitive function and no studies testing mechanisms of this association among Mexican-origin women. Using data from a three-wave longitudinal study of Mexican-origin women spanning 8 years (n = 595, mean baseline age = 38.89 (5.74)) living in central Texas, we tested the longitudinal associations between baseline daily and ethnic discrimination on a task of cognitive control at Wave 3 and the mediating effects of Wave 2 depressive symptoms. We also tested the moderating effects of age, education, and financial difficulties on these links. Structural equation model results indicated that baseline daily discrimination was associated with slower reaction times at Wave 3 and that depressive symptoms at Wave 2 mediated this association; models controlled for age, education, and baseline depressive symptoms. Ethnic discrimination was positively associated with Wave 2 depressive symptoms, but not with cognitive control. Greater daily discrimination was associated with faster reaction times among those with lower financial difficulties. Findings show that greater daily discrimination is subsequently associated with lower cognitive control through increased depressive symptoms and highlight the need for future research to consider the socioeconomic context under which these links operate among Mexican-origin women.

CUMULATIVE DAILY DISCRIMINATION AS A RISK FACTOR FOR REDUCED PURPOSE

Abstract Past research shows that discriminatory experiences may reduce sense of purpose among older adults, though these associations are inconsistent across groups. Work is needed both to understand the nuanced role discrimination plays on individuals’ sense of purpose, whether it leads to feeling derailed from life goals, and if effects differ for younger versus older adults. The current study asked 354 American adults (age 19-74) to complete daily surveys over the course of two weeks, to examine whether experiencing discrimination during that two-week period led to a decline in purposefulness. Overall, findings suggest marked stability in sense of purpose during this short timeframe. However, greater daily discrimination predicted decreases in sense of purpose, and increases in derailment over the two weeks. While these associations were similar across age, older adults did report less discrimination at baseline. Findings will be discussed with a focus on successful aging among marginalized groups.

Double Impact: A Dyadic Discrimination Model for Poor, Minority, and Pregnant Couples.

Frequent daily discrimination compounds the negative health impacts of those with multiple marginalized identities, including pregnant mothers and their children. We used a dyadic, moderated, mediated model of 296 young, expectant, poor, urban, primarily minority couples. In this study, we explored if a multiple pathway discrimination model explained the relationship between multiple marginalized identities and health (depression and stress). We also examined if a mediated (discrimination moderated by gender) model, within a minority-stress and intersectional framework explained the relationship with depression and stress for couples. We observed that frequent daily discrimination was associated with negative health outcomes (depression and stress). Women reported significantly more depression than men. Frequent daily discrimination mediated the relationship between multiple marginalized identities and depression and stress and having a partner with multiple marginations increased one's personal depression and stress. Our observations suggest that discrimination's impact on health is experienced during pregnancy and the more marginalized identities one carries, the more impact it may have. Further, having a partner with multiple marginalized identities also impacts the depression and stress reported by women. Inventions to address depression and stress outcomes may be strengthened by considering multiple marginalized identities and include couples.

Intersectional Discrimination and PrEP uSe Among Young Black Sexual Minority Individuals: The Importance of Black LGBTQ Communities and Social Support.

Intersectional stigma and discrimination have increasingly been recognized as impediments to the health and well-being of young Black sexual minority men (YBSMM) and transgender women (TW). However, little research has examined the relationship between intersectional discrimination and HIV pre-exposure prophylaxis (PrEP) outcomes. This study with 283 YBSMM and TW examines the relationship between intersectional discrimination and current PrEP use and likelihood of future PrEP use. Path models were used to test associations between intersectional discrimination, resilience and social support, and PrEP use and intentions. Individuals with higher levels of anticipated discrimination were less likely to be current PrEP users (OR = 0.59, p = .013), and higher levels of daily discrimination were associated with increased likelihood of using PrEP in the future (B = 0.48 (0.16), p = .002). Greater discrimination was associated with higher levels of resilience, social support, and connection to the Black LGBTQ community. Social support mediated the effect of day-to-day discrimination on likelihood of future PrEP use. Additionally, there was a significant and negative indirect effect of PrEP social concerns on current PrEP use via Black LGBTQ community connectedness. The results of this study highlight the complexity of the relationships between discrimination, resilience, and health outcomes.

Gender in mental health: Comparing the rate and social factors of depression, anxiety, and stress among young heterosexual and sexual minority women in the Philippines

Young sexual minority Filipinos have been found to have a higher level of mental health problems compared to peers. It was also reported that Filipino sexual minority women had twice the odds of ill mental health such as depression compared to sexual minority men. Thus, this study compared the rates and social factors of depression, anxiety, and stress among young adult Filipino heterosexual and sexual minority women. Particularly, this quantitative study utilized a cross-sectional survey design. The Depression, Anxiety, and Stress Scale 21 (DASS-21), Daily Discrimination Subscale of the Perceived Discrimination Scale, and sociodemographic questionnaire were completed by 622 heterosexual and 177 sexual minority women. Afterward, descriptive statistics, chi-square, and logistic regression were done. Depression, anxiety, and stress rates were higher among sexual minority women compared to their peers. The possible risk factor for these mental health issues among heterosexual women was discrimination, while a possible protective factor was living with peers (p <.05). Among sexual minority women, it was found that discrimination is a risk factor, albeit with higher effects compared to their heterosexual counterparts. These may be explained by the reported high level of negative attitudes and discrimination that sexual minorities in the Philippines face daily in their social environment. Thus, anti-discrimination policies, gender-responsive healthcare for sexual minorities, and gender mainstreaming must be instituted and strengthened.

Gender in mental health: Comparison of the rate and social factors of depression, anxiety, and stress among young adult Filipino heterosexual cisgender men and women and LGBT+ individuals.

Previous studies showed that Filipino young women have higher rates of certain mental disorders than men, while LGBT+ individuals have higher mental disorders rates than heterosexual cisgender individuals. These differences may be due to their unique social experiences. Despite these, studies that directly compare the rates and social factors of mental health conditions among men, women, and LGBT+ individuals including depression, anxiety, and stress, remain sparse. This study aimed to compare the rates and social factors of depression, anxiety, and stress among young adult Filipino heterosexual cisgender men and women and LGBT+ individuals. This study utilized a sociodemographic questionnaire, the Daily Discrimination Scale, and the Depression, Anxiety and Stress Scale-21 (DASS-21) to determine the difference between the rates and social factors of depression, anxiety, and stress among the respondents. A total of 959 young Filipino adults completed the questionnaire. Afterward, logistic regression, chi-square, and descriptive statistics were done. LGBT+ respondents experienced the highest rates of significant depression (92.0%), anxiety (93.8%), and stress (81.3%). Discrimination had the largest effect size among men and LGBT+ individuals. While age may be a risk factor for anxiety among heterosexual cisgender males, it was protective for stress among LGBT+ individuals. Working, studying, and living with peers had protective effects against anxiety and stress among heterosexual cisgender men and women. Rates and factors of depression, anxiety, and stress varied according to gender. This variation may be accounted for by unique social experiences and contexts including violence, discrimination, cultural expectations, and social roles. Thus, gender-sensitive mental healthcare may need to extend beyond binary views limited to men and women.

Daily discrimination, church support, personal mastery, and psychological distress in black people in the United States

ABSTRACT Objective This study used the stress process model to test the mediating effects of personal mastery and moderating effects of church-based social support on the relationship between daily discrimination and psychological distress across three age groups of African American and Afro-Caribbean adults. Methods Using a national sample of 5008 African Americans and Afro-Caribbean adults from the National Survey of American Life Study, this study employs structural equation modeling to investigate the relationships between daily discrimination, personal mastery, church-based social support, and psychological distress. Results Daily discrimination was an independent predictor of psychological distress across all groups. Group- and age-specific comparisons revealed significant differences in the experience of daily discrimination and psychological distress. Mastery was a partial mediator of the relationship between discrimination and psychological distress among Afro-Caribbeans while church support was a significant moderator only among the young and older African Americans. Implications Together, our study findings provide useful first steps towards developing interventions to reduce the adverse psychological impacts of daily discrimination on African Americans and Afro-Caribbeans. Intervention efforts such as individual psychotherapy aimed to improve Afro-Caribbean individuals’ sense of mastery would be a partial solution to alleviating the adverse effects of discrimination on their psychological health.

Effects of Daily Discrimination on Pain, Mood, and Sleep in People Living with HIV

Emerging literature suggests that experiences of discrimination negatively influence health and well-being. It is unfortunately common for people living with HIV (PLWH) to be stigmatized and discriminated against because of their HIV status and other marginalized identities (e.g., ethnicity/race, sexual identity and orientation). To date, little research has specifically examined discrimination in PWLH and its associations with pain and other pain-relevant factors such as mood and sleep. The purpose of this ongoing study was to preliminarily analyze associations among daily experiences of discrimination, pain severity and interference, depressive symptoms, and sleep in PLWH. Participants included 24 PLWH recruited from a local HIV treatment center. Participants completed The Everyday Discrimination Scale (TEDS) followed by the Brief Pain Inventory – Short Form (BPI-SF), the Insomnia Severity Index (ISI), and the Center for Epidemiologic Studies – Depression Scale (CES-D). Initial findings tentatively suggest that more frequent daily experiences of discrimination may be significantly associated with greater pain interference on the BPI-SF (p = .030) and greater severity of insomnia symptoms on the ISI (p = .059). However, it appears that daily experiences of discrimination may not be meaningfully associated with pain severity on the BPI-SF (p = .401) or depressive symptoms on the CES-D (p = .235). Our findings highlight the potentially deleterious effects of daily discrimination experiences on pain and sleep in in PLWH. As this ongoing study recruits a larger sample of PLWH, data will need to be reanalyzed to better determine the durability of these preliminary findings. However, there is potential that findings from this study may assist in elucidating causal pathways linking discrimination to pain and pain relevant health behaviors like sleep in PLWH. Grant support from The Impact of Insomnia on Pain, Physical Function, and Inflammation in HIV (3R01HL147603-03S1).

Daily Discrimination and Affect in Latinx Adolescent-Parent Dyads Residing in Northeast United States.

In this 14‐day study, we tested whether Latinx adolescents’ (M age = 12.76 years, 52% female; 52% U.S. born; N = 21) and parents’ (95% female; 24% U.S. born) daily discrimination experiences were associated with their own and other’s daily affective states. Results indicated that on days when adolescents reported discrimination, they reported higher negative affect and marginally lower positive affect and, interestingly, parents reported higher positive affect. On average (i.e., across the 2‐week period), adolescents’ discrimination was associated with higher adolescent negative affect and lower parent positive affect. Together, findings suggest that Latinx adolescents’ discrimination experiences are linked to their own affective states and their parents’. Results underscore how discrimination is linked to the affective states present in family contexts.

Relationships between racial discrimination, social isolation, and mental health among international Asian graduate students during the COVID-19 pandemic

Objectives: Racial aggression against Asians and the implementation of state-wide stay-at-home orders during the COVID-19 pandemic may have negatively impacted mental health in Asian international graduate students in the United States, yet these relationships are unknown. Therefore, this study was conducted to investigate these relationships. Participants: Data were collected from 177 participants from four universities. Methods: On-line survey was used to assess perceived racial discrimination related to the COVID-19, daily racial discrimination during the pandemic, home boundness and loneliness, and depression and anxiety. Results: Daily racial discrimination was associated with an increased risk for depression. Home boundness was related to fewer depression symptoms (B = –0.728) and fewer anxiety symptoms (B = –0.558). Higher symptoms of loneliness (B = 0.377) were related to more depression symptoms. More loneliness (B = 0.257) was related to more anxiety symptoms. Conclusions: The findings can help university stakeholders to create a guideline for the development and implementation of resource programs for Asian international graduates.

Role of discrimination and resilience on birth weight: A systematic examination in a sample of Black, Latina, and White women.

Introduction:Health inequities begin before birth with Black women being more likely to have low birth weight babies than White and Latina women. Although both Latina and Black women experience discrimination, only Black women appear to be affected.Methods:In this study using medical records and face-to-face interviews, we systematically examined the role of discrimination (daily, environmental, vicarious) on continuous birth weight (controlling for gestational age and baby’s gender) in a sample of 329 Black, Latina, and White pregnant women, as well as whether familism, prayer, and/or discrimination attribution buffered this association.Results:Linear regression analyses revealed that only prayer acted as a resilience factor, with Latina women appearing to benefit from prayer in the link between vicarious and daily discrimination on birth weight conditional on gestational age, whereas Black women showed no moderation and White women showed an exacerbation in the link.Discussion:The results of this study suggest that sociocultural norms may play a role in explaining the Latina epidemiological paradox, but more research is needed to understand the significance.

Daily Experiences of Discrimination and Ethnic/Racial Minority Adolescents' Sleep: The Moderating Role of Social Support.

Using data from a 14-day diary study of 95 ethnic/racial minority adolescents, this study examined the within-person effect of daily discrimination tied to multiple social identities on adolescents' daily sleep quality and duration and whether daily support from important others (i.e., friends, parents, and teachers) would moderate these links. We found that daily discrimination was a low-frequency, but high-impact event associated with shorter sleep duration. Results pointed to the nuanced roles of daily support. Support from friends was negatively related to sleep duration, whereas support from parents appeared to be promotive to sleep quality. Support from teachers protected adolescents from the negative effects of discrimination on sleep duration. Implications for future interventions targeting sleep disturbances associated with discrimination are discussed.

Discrimination impairs cognitive function in ageing men and women

Abstract Background We sought to assess changes in episodic memory and executive functioning among men and women in the Midlife in the United States (MIDUS) cohort study; and to delineate variations in episodic memory and executive functioning by gender; and to determine the impact of discrimination on longitudinal changes in episodic memory and executive functioning. Methods We used data from the MIDUS study - a national probability sample of non-institutionalized, English speaking respondents aged 25-74 living in the 48 contiguous states of the United States. The initial wave in our study (1995) included 4963 non-institutionalized adults aged 32 to 84 (M = 55, SD = 12.4). Dependent variables are episodic memory and executive functioning, assessed with the Brief Test for Cognition. The independent variables were discrimination (lifetime and daily discrimination) variables. Furthermore, we investigated baseline cognition score, race/ethnicity (White, Hispanic, other), education (some college or more vs high school of less), whether or not living with partner, income (per 100% above Federal Poverty Level), unemployed (vs employed), retired (vs employed), physical health (self-reported), vigorous physical activity, depression (continuous scale), anxiety (continuous scale). To assess cognition changes we estimated adjusted linear regression models. Results Cross-sectional, work discrimination was associated with cognition in men and women. Longitudinally, adjusting for baseline cognition score, race/ethnicity, education, living situation, income, (un)employed, (not)retired, physical health, vigorous physical activity, depression, and anxiety, we found an association of family strain with cognition changes in high-income men, and an association of daily discrimination with cognition changes in men (Beta 0.01, P-value: 0.001). Conclusions Reducing discrimination might be an important measure to support cognitive function in ageing populations.

Research on Understanding the Vulnerabilities of Children with Disabilities Living in Alternative Care

Children with disabilities (CWDs) are one of the most marginalised and excluded groups in the society. Facing daily discrimination in the form of negative attitudes, lack of adequate policies and legislation, they are effectively barred from realising their rights to healthcare, education and even survival. It has been estimated that exposure towards all forms of violence against CWDs is four-time greater than that of children without disabilities. Bangladesh has an estimated 7–10 million CWDs (out of a total of 72 million children, World Health Organisation Report). Most of the time, these children are treated as a burden to their families or the community and thus become subject to violence. There are very few specialised institutions with residential facility to take care of them. So, they are institutionalised in general residential institutions at a significantly higher rate than other children. But both the special and general residential institutions have lack of skilled human resources and knowledge of the special situation and needs of CWDs. Peer groups of the CWDs are also less sensitised, which result in further stigma and discrimination of CWDs. A 2010 study was done by the Ministry of Women and children Affairs. The findings from interviews with adolescents’ aged 13–16 in 12 locations of Dhaka City revealed their extreme vulnerability. In 2010, a study by Bangladesh Protibondhi Foundation that conducted a survey supported by the Save the Children Sweden–Denmark found that 51.4% of CWDs are either at risk of sexual abuse (12.5%) or have been sexually abused (38.9%).The government of Bangladesh has taken a number of legislative and policy steps that indicate commitment to advancing the rights of persons with disabilities. In terms of international instruments, Department of Social Services under Ministry of Social Welfare operates various types of institutions for the children and also CWDs. The study will adopt qualitative and quantitative methods to collect information from both primary and secondary sources and also assess the situation of government non-government organisations/religious institutions where CWDs have residential facilities in order to understand which factors contribute to increased vulnerability of these children.

The Impact of Daily Discrimination on Sleep/Wake Problem Trajectories Among Diverse Adolescents.

This study examines how everyday discrimination is associated with 6-day trajectories of sleep/wake problems, operationalized as sleep disturbance and daytime dysfunction, among 350 diverse adolescents (Mage =14.27, SD=0.61, 69% female; 22% African American, 41% Asian American, 37% Latinx; 24% multiethnic/racial; across participating schools, 72% of students eligible for free/reduced price lunch) in the Northeastern United States. Adolescents encountering discrimination experienced changes in sleep/wake problem trajectories (i.e., significant increases in same-day sleep/wake problems), whereas adolescents reporting no discrimination experienced no changes in trajectories (Cohen's ds=.51-.55). Multiethnic/racial (compared to monoethnic/racial) adolescents experiencing everyday discrimination reported greater same-day sleep/wake problems, yet steeper decreases in sleep/wake problems suggesting stronger impact coupled with faster return to baseline levels.

Daily, but not lifetime discrimination is associated with greater pain interference in those with chronic pain

Experiences of being discriminated against based on some aspect of one's identity are associated with enhanced pain – both clinically and in the laboratory. However, much of the extant research has assessed the impact of racial discrimination, and has focused on pain severity or the development of chronic pain. Discrimination based on other aspects of identity and its association with pain interference has received less attention, and no direct relationship between the two has been found. Using data from the Midlife in the United States (N=1252, 57.8% female) national survey, we assessed whether both daily and/or lifetime experiences with discrimination based on any aspect of one's identity – including race, ethnicity, gender, age, religion, physical appearance, and sexual orientation – could predict pain interference among participants with a range of chronic pain conditions. Results indicated that daily (βdaily=.076, p=.006) but not lifetime (βlifetime=.024, p=.39) experiences with discrimination positively predicted pain interference, controlling for self-rated physical and mental health, number of other chronic conditions, BMI, depression, anxiety, and demographics. This association was driven by a stronger relationship among women (βdaily=.097, p=.008; βlifetime=.044, p=.21) than men (βdaily=.062, p=.15; βlifetime=-.01, p=.76). These findings are the first to describe a direct association between daily discrimination based on any aspect of one's identity and pain interference, particularly among women. Results also indicate that daily experiences of discrimination based on any aspect of one's identity – and perhaps especially those that are more likely to affect or have a greater impact on women – compound pain's interference on daily life.

Social stress and risk of declining cognition: a longitudinal study of men and women in the United States

Limited research is available on the relationship between social stress and risk of declining cognition. We sought to examine whether social stress has adverse effects on risk of declining episodic memory and executive functioning in aging individuals. We used data from the MIDUS study, a national probability sample of non-institutionalized, English speaking respondents aged 25–74 living in the 48 contiguous states of the United States. The initial wave (1995) included 4963 non-institutionalized adults aged 32–84 (M = 55, SD = 12.4). We used an analytic sample from MIDUS-II (1996/1997) and MIDUS-III (2013) (n = 1821). The dependent variables are episodic memory and executive functioning, which were assessed with the Brief Test for Cognition (BTACT). The independent variables were social stress variables (subjective social status, family and marital stress, work stress and discrimination). To evaluate episodic memory and executive functioning changes over a time period of 10 years, we estimated adjusted linear regression models. Women report significantly lower subjective social status and more discrimination stress than men across all age groups. Controlling for education and income, age, and baseline episodic memory and executive functioning, lower subjective social status had additional adverse effects on declines in episodic memory in men and women. Marital risk had adverse effects on episodic memory in men but not in women. Daily discrimination had adverse effects on executive functioning on all individuals. Public health strategies should focus on reducing social stress in a socio-ecological perspective. Especially, subjective social status and discrimination stress might be a target for prevention efforts.

The trickle‐down effect of procedural fairness on perceptions of daily discrimination: How societal actors can build social trust among minority members

AbstractThe present research investigated the trickle‐down effect of procedural fairness enacted by societal institutions on minority members’ social trust. Building on the racial identity development hypothesis, we argued that procedural fairness represents a racial socialization experience, which influences how minorities perceive discrimination in daily life. Perceived group discrimination, in turn, impacts social trust. The results of five studies with African American samples corroborated the hypothesized mediation model. Study 1 showed that minority members distinctly perceive fairness enacted by institutions and discrimination by fellow citizens. Subsequent studies demonstrated that manipulating procedural fairness influenced perceived discrimination in an “attribution‐to‐discrimination” paradigm (Study 2), and that inducing discrimination lowered trust in an allocation game (Study 3). Finally, Studies 4 and 5 obtained cross‐sectional evidence for the full model. Our results thus contribute to literature by showing that perceived discrimination mediates the relationship between procedural fairness and social trust. Societally relevant practical implications are discussed.

The Mediating role of perceived discrimination and stress in the associations between neighborhood social environment and TV Viewing among Jackson Heart Study participants.

ObjectivesThe aim of this study was to test the mediating role of perceived discrimination and stress on associations between perceived neighborhood social environment (PNSE) and TV viewing.MethodsBaseline data were used for 4716 participants (mean age = 55.1 y; 63.4% female) in the Jackson Heart Study (JHS), a large prospective cohort study of African Americans in Jackson, Mississippi. One binary TV viewing outcome was created: ≥4 h/day versus <4 h/day. PNSE variables included neighborhood violence, problems (higher value = more violence/problems), and social cohesion (higher value = more cohesion). Mediators included perceived lifetime discrimination, daily discrimination, and chronic stress (higher value = greater discrimination/stress). Multivariable regression was used with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation adjusting for demographics, health-related and psychosocial factors, and population density.ResultsNeighborhood violence, problems, and social cohesion were indirectly associated with TV viewing through lifetime discrimination (OR = 1.03, 95%BC CI = 1.00, 1.07; OR = 1.03, 95%BC CI = 0.99, 1.06 [marginal]; OR = 0.98, 95%BC CI = 0.94, 0.99, respectively) and chronic stress (OR = 0.95, 95%BC CI = 0.90, 0.99; OR = 0.96, 95%BC CI = 0.92, 0.99; OR = 1.05, 95%BC CI = 1.01, 1.10, respectively). Daily discrimination was neither directly nor indirectly associated with TV viewing.ConclusionsEach PNSE variable was indirectly associated with TV viewing via lifetime discrimination and perceived stress, but not with daily discrimination among JHS participants. Unexpected directionality of mediating effects of lifetime discrimination and chronic stress should be replicated in future studies. Further research is also needed to pinpoint effective community efforts and physical environmental policies (e.g., installing bright street lights, community policing) to reduce adverse neighborhood conditions and psychosocial factors, and decrease TV viewing and subsequent cardiovascular disease risk.