Interpersonal Racism Research Articles

Improving adult behavioural weight management services for diverse UK Black Caribbean and Black African ethnic groups: a qualitative study of insights from potential service users and service providers.

A significantly higher proportion of UK Black ethnic adults live with overweight or obesity, compared to their White British counterparts. The role of obesity in excess infection rates and mortality from COVID-19 has increased the need to understand if weight management interventions are appropriate and effective for Black ethnic groups. There is a paucity of existing research on weight management services in Black populations, and whether anticipated or experienced institutional and interpersonal racism in the healthcare and more widely affects engagement in these services. Understanding the lived experience of target populations and views of service providers delivering programmes is essential for timely service improvement. A qualitative study using semi-structured interviews was conducted in June-October 2021 among 18 Black African and Black Caribbean men and women interested in losing weight and 10 weight management service providers. The results highlighted a positive view of life in the United Kingdom (UK), whether born in the UK or born abroad, but one which was marred by racism. Weight gain was attributed by participants to unhealthy behaviours and the environment, with improving appearance and preventing ill health key motivators for weight loss. Participants relied on self-help to address their overweight, with the role of primary care in weight management contested as a source of support. Anticipated or previously experienced racism in the health care system and more widely, accounted for some of the lack of engagement with services. Participants and service providers agreed on the lack of relevance of existing services to Black populations, including limited culturally tailored resources. Community based, ethnically matched, and flexibly delivered weight management services were suggested as ideal, and could form the basis of a set of recommendations for research and practice. Cultural tailoring of existing services and new programmes, and cultural competency training are needed. These actions are required within systemic changes, such as interventions to address discrimination. Our qualitative insights form the basis for advancing further work and research to improve existing services to address the weight-related inequality faced by UK Black ethnic groups.

Social Determinants of Learning: Implications for Research, Policy, and Practice

The COVID-19 pandemic revealed what educators, policymakers, and researchers have long known—namely, that learning opportunities and outcomes are intimately intertwined with other aspects of children’s and families’ lives. The list of social forces outside the education sector that can affect learning is endless and includes economic experiences that are inequitably distributed, such as housing security (Gallagher et al., 2020), income (Hoynes & Rothstein, 2019), and wealth (Pfeffer, 2018), as well as social experiences, such as interpersonal and structural racism, (dis)ability, and xenophobia (Anderson-Nathe, 2020; DeMatthews, 2020). Now, it is time to lock in this learning among policymakers, practitioners, and researchers. We posit that the concept of “social determinants of learning” can serve as a powerful reframing tool for promoting educational equity, similar to the conceptual shift and policy impact we have seen in public health as “social determinants of health” has become an accepted and eventually essential concept.

The experience of hate incidents across racial and ethnic groups during the COVID-19 pandemic.

Racism is a root cause of ill health for communities of color, and hate incidents are one manifestation of racism. Marginalized racial and ethnic groups, including but not limited to Asian Americans, have been the target of highly publicized violence, hate, and discrimination which has been amplified during the COVID-19 pandemic. This paper investigates (1) the prevalence of hate incidents across racial and ethnic groups, and (2) the relationship between race and ethnicity and hate incidents during the first year of the COVID-19 pandemic. We also seek to (3) situate study findings within theories of racism. This study utilizes national data from the Understanding America Study (UAS) COVID-19 Longitudinal Survey from June 10, 2020 to March 30, 2021 (n = 8,436). Hate incidents in six categories were examined: being treated with less courtesy, receiving poorer service, others acting as if they were not smart, others acting as if they were afraid of them, being threatened or harassed, and experiencing any of the previous categories of hate incidents. Main analyses were conducted via population averaged logistic panel regression. The majority of members of all six marginalized racial and ethnic groups reported at least one hate incident during the first year of the COVID-19 pandemic. In addition, all marginalized racial or ethnic groups had statistically significant higher odds of experiencing at least two categories of hate incidents compared to white individuals. Asian, AI/AN, Black, and Multiracial groups had significantly higher odds of experiencing each category of hate incident. All marginalized racial and ethnic groups had significantly higher odds of receiving poorer service and others acting as if they were afraid of them. All marginalized racial and ethnic groups experienced significant levels of hate incidents within the first year of the COVID-19 pandemic. The public health community must continue to research, monitor, treat, and prevent hate incidents as a public health issue while recognizing the social and historical contexts of structural and interpersonal racism in the US.

Geospatial analysis of patients' social determinants of health for health systems science and disparity research.

Geospatial analysis of patients' social determinants of health for health systems science and disparity research.

Relationship of daily, institutional and structural racism with cognition in ethnically/racially diverse middle‐age Americans

AbstractBackgroundRacism is a social determinant of health that operates at multiple levels ‐ interpersonal, institutional, structural ‐ producing stress and limiting access to resources that have dire biopsychosocial effects for historically marginalized communities. Research on older adults suggests interpersonal and structural racism, separately, are associated with worse cognition and may be an underlying reason for racial/ethnic disparities in cognitive aging. An evidence gap remains on how multilevel racism influences cognition throughout the life‐course.MethodWe assessed 942 middle‐aged community‐dwelling adults (mean age = 55, SD = 11; 64% women; 19% non‐Latinx White; 23% non‐Latinx Black; 55% Latinx). Daily interpersonal racism was ascertained by the Everyday Discrimination (ED) scale, institutional racism by the Major Discrimination (MD) Scale, and structural racism in early life was measured by residential segregation of the census block group in which parents of our respondents lived. Our outcomes were derived from a neuropsychological evaluation with the Digit Span assessing attention and working memory, and delayed recall from the Selective Reminding Test capturing episodic memory. Two fluency measures (animal and letter) were also studied. The relationship between multilevel racism indicators and cognition was estimated using age‐adjusted linear regression models. Additional models were stratified by racialized/ethnic group and added education as a covariate.ResultExposure to multilevel racism varied across racialized/ethnic group. Non‐Latinx Black respondents scored highest on interpersonal racism, second highest on institutional racism, and were more likely to grow up in segregated residential areas with higher proportion of other Black residents. Exposure to interpersonal (Figure A) and institutional racism (Figure B) was associated with lower memory scores and these associations were driven by non‐Latinx Black respondents. Structural racism was associated with lower episodic memory in the full sample.ConclusionOur findings indicate that multilevel racism related to cognition and due to higher exposure among marginalized groups may be a substantial driver of racial/ethnic disparities in cognitive health. In future, additive and multiplicative effects of our exposures will be examined.

Explanations Underlying the Lack of Utility of Diagnostic Depression Scales in Black Americans

Major depression disorder is one of the most common mental disorders in the United States. However, Black Americans are often underdiagnosed, misdiagnosed, or not treated for depression. Limited research has been conducted on the utility of diagnostic tools in identifying depression in the Black community and could explain lack of research and public health attention to mental illness in this population. Other explanations discussed include greater ability to cope with stressful situations and the myth of the ‘resiliency expectation,’ social activism and positive health outcomes, and lack of trust in institutions due to structural and interpersonal racism. Further research that provides contextualized results is warranted to better understand and recognize symptoms of depression, and development of more effective treatment modalities. [ Psychiatr Ann. 2022;52(12):504–508.]

An urgent call to address interpersonal and structural racism and social inequities in Australia

On Oct 13, 2022, Cassius Turvey, a young Aboriginal teenager, was brutally attacked in Perth, Western Australia, and died 10 days later, amidst concerns that more could have been done to save him.1 His death spread waves of shock and condemnation globally, with the Prime Minister, Anthony Albanese, calling it “racially motivated”.2 The teenager's death adds to innumerable instances of racial brutality against Indigenous peoples and Black people across the world, generating Black Lives Matter marches and calls for global justice.

Identifying Pathways of Physiological Deterioration to Understand Racial Disparities in Cognitive Status: A 4‐way Mediation‐Interaction Decomposition Analysis

AbstractBackgroundExposure to interpersonal and structural racism may increase the risk of adverse cognitive aging in racialized groups. Physiological deterioration may lie on the causal pathway leading racism to cognitive aging, but this potential mediating role has never been investigated. We quantified the extent to which the racial disparity (a proxy measure of exposure to racism) in cognitive status was mediated through physiological biomarkers of inflammation, glucose homeostasis, cholesterol ratios, and renal functioning.MethodsData were from the US Health and Retirement Study in 2006 and 2008. We performed cross‐sectional (n = 9,107) and 2‐year follow‐up analyses (n = 6,147) to explore the mediating roles of four physiological biomarkers in racial/ethnic disparities in prevalent and incident dementia. We used self‐reported race/ethnicity as a proxy for exposure to structural and interpersonal forms of racism. Mediators were serum biomarkers of systemic inflammation (hsCRP), glucose homeostasis (HbA1C), cholesterol processing and atherosclerosis risk (TC/HDL‐C ratio), and renal functioning (cystatin C). We performed a 4‐way decomposition analysis that accommodated exposure‐mediator interactions to identify natural direct and indirect effects.ResultsIn this sample, the prevalence of dementia was 2.2% among non‐Hispanic White, 8.5% among non‐Hispanic Black, and 6.0% among Hispanic participants. Among non‐Hispanic Black relative to non‐Hispanic White participants, the mediating effect of HbA1C on prevalent dementia was 6% (95% CI: ‐4%, 16%) and the interaction effect with race was 11% (95% CI: ‐11%, 34%) (Table 1). Similarly, we estimated a mediating effect of cystatin C on prevalent dementia of 0% (95% CI: ‐2%,2%) and an interaction effect with race of 10% (95% CI: ‐5%, 25%). For incident dementia, among non‐Hispanic Black relative to non‐Hispanic White participants, the mediating effect of hsCRP on incident dementia was 18% (95% CI: ‐6%, 41%), and the interaction effect with race was 45% (95% CI: ‐20%, 110%) (Table 2). Results were similar for Hispanic relative to non‐Hispanic White participants.ConclusionsThe relationships between race/ethnicity and prevalent and incident dementia were not mediated by or interacted with serum biomarkers of physiological deterioration. Racial disparities in cognitive status in mid‐to‐later life may be attributable to structural factors to racism and the mediating effects of other biomarkers.

Prioritizing Sickle Cell Disease.

Sickle cell disease (SCD), a group of inherited disorders, is a bellwether example of a chronic, disabling, life-threatening condition that is disproportionately underserved by the medical community. SCD is arguably associated with the most significant health inequities of both the 20th and 21st centuries. Although these inequities, which are linked to historical interpersonal and institutional racism, have been long recognized, there has been scant progress in closing the healthcare gaps.1 SCD affects at least 100,000 individuals in the United States, the vast majority being Black or African American individuals.1 Abnormal hemoglobin produced in SCD causes red blood cells (RBCs) to sickle, clogging blood flow and leading to vaso-occlusive crises and potential impacts on every organ system. Persons with SCD experience numerous complications, including recurrent episodes of severe pain, pneumonia and acute chest syndrome, stroke, and organ damage. Estimated life expectancy of those with SCD in the US is >20 years shorter than the average expected and the deficit in quality-adjusted life expectancy is particularly stark (>30 years shorter).2 esting is a safe and feasible alternative to mandatory quarantine and can be used to maximize safe in-person learning time during the pandemic.

Contributions of Structural Racism to the Food Environment: A Photovoice Study of Black Residents With Hypertension in Baltimore, MD.

Disproportionate exposure to poor food environments and food insecurity among Black Americans may partially explain critical chronic disease disparities by race and ethnicity. A complex set of structural factors and interactions between Black residents and their food environments, including store types, quantity, proximity, and quality of goods and consumer interactions within stores, may affect nutritional behaviors and contribute to higher cardiovascular and kidney disease risk. We used the Photovoice methodology to explore the food environment in Baltimore, MD, through the perspectives of Black residents with hypertension between August and November 2019. Twenty-four participants were enrolled in the study (mean age: 65.1 years; 67% female). After a brief photography training, participants captured photos of their food environment, which they discussed in small focus groups over the course of 5 weeks. Discussions were audiotaped and analyzed for emergent themes using a line-by-line inductive approach. Themes were, then, organized into a collective narrative. Findings describe physical and social features of the food environment as well as participants' perceptions of its origins and holistic and generational health effects. The study illustrates the interrelationships among the broader socio-political environment, the quality and quantity of stores in the food landscape, and the ways in which they engage with the food environment as residents and consumers who have been marginalized due to their race and/or social class. The following meta-themes emerged from the data: (1) social injustice; (2) structural racism and classism; (3) interpersonal racism; (4) generational effects; (5) mistrust; (6) social programs; and (7) community asset-based approaches, including advocacy and civic engagement. Understanding residents' perceptions of the foundations and effects of the food environment on their health may help stakeholders to cocreate multilevel interventions alongside residents to improve access to healthy food and health outcomes among disparities affected populations.

Health inequalities, ethnic minorities and COVID19: interactive theatre workshop drawing on a qualitative interview study

BackgroundThe COVID19 pandemic revealed and deepened existing inequalities. These were exacerbated by institutional and interpersonal racism and poorly conceived public health messaging. As a result, people from minority ethnic backgrounds in the UK were disproportionately affected. We conducted a creative interdisciplinary session to support interactive reflection and discussion on these inequalities between the actors and the audience, who was comprised of public health scientists and NHS practitioners, to come up with practical ways to address ethnicity-based health inequalities going forward. MethodsWe prepared a 45 min interactive scenario drawing on forum theatre approaches, which are based on the Theatre of the Oppressed: a set of dramatical techniques created by Augusto Boal. To understand what to include the interactive scenario we carried out a workshop built on a narrative interview study with 70 adults who had Covid between March, 2020, and November, 2021. We adopted a maximum variation sampling strategy focusing on people from minority ethnic backgrounds (45 of total sample). Interviews were done remotely and recorded via video or audio. Study participants were invited to tell their story in their own words, alongside semi-structured prompting. After thematic analysis, the research team worked with theatre practitioners from the Performing Medicine company to create scenarios from verbatim interview content. The format allows audience members to watch scenarios and interact directly with actors, giving advice on how to improve the situation. The study was approved by Berkshire Ethics Committee. Informed verbal and written consent were obtained from all participants. FindingsFive themes from analysis explored in the workshop emerged: (1) existing racialised disadvantages that impacted COVID-19 exposure: employment, housing, and caring responsibilities; (2) unequal access to care, welfare, and support; (3) fears about the health-care system regarding quality of care and vaccine safety; (4) perceptions that the media and public health messaging blamed minority ethnic groups for spreading infection; and (5) increases in acts of direct racism. These informed the development of a 45-minute interactive scenario, which will be performed at the 10th UK Public Health Science conference. InterpretationThere is an urgent need to re-evaluate public health messaging and care for people from minority ethnic backgrounds. This theatre workshop will support reflection to refine workshop content for further dissemination. FundingUK Economic and Social Research Council.

The Future of Nursing 2020–2030: Charting a path to achieve health equity

The Future of Nursing 2020–2030: Charting a path to achieve health equity

Impact of structural racism on inclusion and diversity in precision oncology: A scoping and critical review of the literature.

Inclusion and diversity in precision oncology are essential in reducing cancer disparities among racial and ethnic groups. However, present studies have favored the recruitment and participation of Whites, with limited applicability of their results to minority groups. Many reasons for their underrepresentation are downstream manifestations of structural racism. Therefore, this scoping review provides a precise mapping of recruitment and participation barriers for minorities in precision oncology that are associated with structural racism, including a critical appraisal of how disciplinary norms, paradigms, and tools used therein could inadvertently contribute to unforeseen inclusion and diversity challenges. Empirical and theoretical publications from Web of Science and PubMed were searched and analyzed to identify recruitment and participation barriers for minorities in precision oncology. In addition, using the public health critical race praxis (PHCRP) as guiding analytical framework, empirical studies were analyzed to identify unforeseen barriers resulting from simplification processes, assumptions, norms, paradigms, and tools used during the research process. One-hundred thirty-five barriers to recruitment and participation were identified or reported in included publications. They were subsequently categorized as being a manifestation of one of the following forms of racism, namely internalized, interpersonal, institutional, and structural racism. The PCHRP analysis revealed four additional factors to be considered in precision oncology studies in ensuring appropriate representation of their study populations. Future interventions aimed at reducing health disparities should focus predominantly on barriers associated with structural and institutional racism, which should then have ripple effects on other forms of racism. Importantly, the four factors identified through the PHCRP framework could further explain the lower participation rates of minorities in precision oncology and related activities. Therefore, they should be given due consideration by all stakeholders involved in the precision oncology ecosystem, from researchers and healthcare professionals to policy-makers, research ethics committees, and funders.

The Impact of Global Health Disparities on Atopic Dermatitis in Displaced Populations: Narrowing the Health Equity Gap for Patients with Skin of Color.

Atopic dermatitis (AD) is a relatively common inflammatory skin disease marked by eczematous lesions and pruritus often leading to significant morbidity and quality of life impairment for those affected. Recent studies have shown that patients with skin of color (SOC) carry a larger disease burden than patients of European descent. In the USA, these disparities are partly due to structural, environmental, and interpersonal racism. From a global perspective, there is a paucity of research on the burden of atopic dermatitis and other inflammatory skin diseases experienced by the record numbers of refugees, migrants, and asylum seekers around the world. Although it is still unclear whether the true prevalence of AD in displaced communities is higher compared with the general population, those who are displaced suffer from unique risk factors that render them especially vulnerable. In this review, we outline a number of factors contributing to AD susceptibility and/or aggravation in displaced communities. These include poor living conditions, climate change events, psychological stress, and lack of access to medical care and health-related behaviors.

Does personality functioning relate to attitude toward minorities?

The relationship between negative attitudes and psychopathology is not yet clear. The current shift to a dimensional approach to mental disorders, as reflected in both the DSM-5 and ICD-11 models of personality disorders, seems to enrich the traditional approach to study attitudes. This study investigates whether and how impairments in personality functioning are linked to attitudes toward minorities. A comparison of levels of impairment in global and Self and interpersonal personality functioning, negative attitudes, social distance, and racism was conducted in the sample of 127 adults from the general population group (n = 69) and a group of people with diagnosed personality disorders (n = 58). Differences between both groups were found. The personality disorders group showed higher impairment in personality functioning, scored higher on negative attitude measures, and was more prone to the blatant expression of attitudes than the general population. The association between attitudes and personality functioning did not fully reflect these trends. However, given the nature of differences, it is suspected that the proclivity to the blatant expression of negative attitudes could go beyond negative attitudes toward minorities themselves and reflect disorder-related characteristics, that is, more problematic and conflicted relationships with others in general.

Patient, Caregiver, and Oncologist Experiences With and Perceptions of Racial Bias and Discrimination in Cancer Care Delivery.

Cancer prevention and treatment systems are significantly impacted by interpersonal, organizational, and structural and systemic racism. A wide body of research has found that racial disparities in access to guideline-adherent cancer care are pervasive throughout the United States and contributing factors include social determinants of health, insurance status, and bias and discrimination in care delivery. Although the existence of racial disparities in cancer care and outcomes is well established, there has been limited research exploring the patient and caregiver experience with bias and discrimination in cancer care. Two national surveys were conducted, one of patients and caregivers and one of oncologists. The surveys examined patient and caregiver experiences with and oncologist perceptions of racial disparities in cancer care. The surveys found that when patients and caregivers were asked about negative care experiences, differences across race were observed. Patients and caregivers identifying as African American/Black (AA/B) or Hispanic/Latino (H/L) were more likely to report at least one negative care experience than patients and caregivers identifying as White (W). Patients who were AA/B or H/L were also more likely than W patients to report that the healthcare system treats people unfairly based on their racial or ethnic background and that racial bias occurs often or very often when a patient and doctor are of different racial/ethnic background. A slight majority of oncologists reported that the healthcare system treats people unfairly based on their racial or ethnic background. The survey results highlight a need for improved racial representation in the oncology professional workforce, improved implicit bias training, and improved clinical trial recruitment efforts.

Guest Editors’ Introduction: Opening Conversations that Matter in Public Music Studies

Guest Editors’ Introduction: Opening Conversations that Matter in Public Music Studies

We cannot empathize with what we do not recognize: Perceptions of structural versus interpersonal racism in South Africa.

Recent research suggests holding a structural, rather than interpersonal, understanding of racism is associated with greater impetus to address racial disparities. We believe greater acknowledgment of structural racism also functions to mitigate against empathic failures in response to structural injustices. Given South Africa’s situatedness as a country characterized by historical racialized oppression and continuing unjust legacies, it is appropriate to examine these ideas there. Across three studies, we tested the hypotheses that members of advantaged groups’ perspective taking and empathic concern may be compromised in response to people challenging the unequal status quo, and that a priori perceptions about the impact of structural (vs interpersonal) racism may mitigate or exacerbate such empathic failures. In Study 1, a national sample of White South Africans (n = 195) endorsed perceptions of interpersonal racism more readily than perceptions of structural racism, and expressed high levels of competitive victimhood for perceived anti-White structural racism. Studies 2 (n = 138) and 3 (n = 85) showed that White participants at a historically White university responded with impaired perspective taking and intergroup empathy bias in response to people challenging structural disparities. Finally, reduced recognition of continuing structural racism predicted greater intergroup empathy bias, which, in turn, was associated with reduced willingness to engage in intergroup discussions about past harm (Study 3). We propose that greater acknowledgment of structural racism is necessary not only to surmount intergroup empathic failures, but also to transcend the socioeconomically unequal legacies of apartheid and beyond.

Anti-Indigenous bias of medical school applicants: a cross-sectional study

BackgroundStructural and interpersonal anti-Indigenous racism is prevalent in Canadian healthcare. The Truth and Reconciliation Commission calls on medical schools to address anti-Indigenous bias in students. We measured the prevalence of interpersonal anti-Indigenous bias among medical school applicants to understand how the medical school selection process selects for or against students with high levels of bias.MethodsAll applicants to a single university in the 2020–2021 admissions cycle were invited to participate. Explicit anti-Indigenous bias was measured using two sliding scale thermometers. The first asked how participants felt about Indigenous people (from 0, indicating ‘cold/unfavourable’ to 100, indicating ‘warm/favourable’) and the second asked whether participants preferred white (scored 100) or Indigenous people (scored 0). Participants then completed an implicit association test examining preferences for European or Indigenous faces (negative time latencies suggest preference for European faces). Explicit and implicit anti-Indigenous biases were compared by applicant demographics (including gender and racial identity), application status (offered an interview, offered admission, accepted a position), and compared to undergraduate medical and mathematics students.ResultsThere were 595 applicant respondents (32.4% response rate, 64.2% cisgender women, 55.3% white). Applicants felt warmly toward Indigenous people (median 96 (IQR 80–100)), had no explicit preference for white or Indigenous people (median 50 (IQR 37–55), and had mild implicit preference for European faces (− 0.22 ms (IQR -0.54, 0.08 ms)). There were demographic differences associated with measures of explicit and implicit bias. Applicants who were offered admission had warmer feelings toward Indigenous people and greater preference for Indigenous people compared to those were not successful.ConclusionsMedical school applicants did not have strong interpersonal explicit and implicit anti-Indigenous biases. Outlier participants with strong biases were not offered interviews or admission to medical school.

Racism and health: the need for urgent action

Racism and health: the need for urgent action