Lifetime Discrimination Research Articles

Recent versus lifetime experiences of discrimination and the mental and physical health of older lesbian women and gay men

AbstractThis study examines the potential health-related impact of recent versus lifetime experiences of sexual orientation discrimination among older Australian lesbian women and gay men. In a nationwide survey, a sample of 243 lesbian women and 513 gay men aged 60 years and over reported on their experiences of sexual orientation discrimination and their mental and physical health, including psychological distress, positive mental health and self-rated health. Among both lesbian women and gay men, recent discrimination uniquely predicted lower positive mental health after adjusting for experiences of discrimination across the lifetime and socio-demographic variables. In addition, recent discrimination uniquely predicted higher psychological distress among gay men. Experiences of discrimination over the lifetime further predicted higher psychological distress and poorer self-rated health among gay men after adjusting for recent experiences of discrimination and socio-demographic variables. However, there were no associations between lifetime discrimination and any of the outcome variables among lesbian women. Overall, recent and lifetime experiences of sexual orientation discrimination were related to mental and physical health in different ways, especially among the men. These findings have potential implications for policy/practice, and suggest that distinguishing between recent and lifetime experiences of discrimination may be useful when assessing potential health-related impacts of sexual orientation discrimination among older lesbian women and gay men, while also taking account of differences between these two groups.

Major Discrimination Experiences, Education, and Genes.

Objectives: Rather than acting as a buffer, educational attainment has a known positive linkage with major experiences of lifetime discrimination. Recently established genetic roots of education, then, may also influence such reports. The current study examined these patterns. Methods: Data were from the 2010 wave of the Health and Retirement Study. Polygenic scores indexed one's genetic propensity for more education. Mediation analysis was through counterfactual methods. Results: Among Whites as well as Blacks, genetic antecedents of education also elevated discrimination reports. Part of this influence was channeled through education. At least among Whites, direct effects were also found. Discussion: Major discrimination experiences seem partly rooted in genes. Mechanisms are tentatively suggested. Direct genetic influences, in particular, indicate potential confounding of previously estimated linkages between discrimination and health or life course factors. Given the range of these prior results, and their implications for healthy aging, investigation of these possibilities is needed.

Characterizing Discrimination Experiences by Race among Homeless Adults.

Objectives: Among domiciled samples, racial discrimination is a known stressor linked with poorer quality of life. However, homeless adults may be particularly vulnerable to discrimination due to multiple factors beyond race. In this study, we characterized perceived discrimination and its reported impact on quality of life in a sample of adults who were homeless. Methods: Homeless adults recruited from Oklahoma City self-reported their socio-demographics, past discrimination experiences, and their impact on quality of life via the MacArthur Major Experiences of Discrimination Questionnaire. Descriptive statistics and frequencies were used to characterize perceived discrimination experiences and impact. Racial differences were examined using ANO- VAs/Kruskal-Wallis tests and chi-square tests. Results: Discrimination experiences attributed to homelessness were common and consistent between the races. Black adults perceived significantly more lifetime discrimination experiences than white adults, and attributed the majority to race. Relative to Whites and American Indians, black adults were more likely to endorse links between discrimination and having a harder life. Conclusions: Results suggest that black homeless adults may represent the most vulnerable racial subgroup for hardships in life as a conse- quence of perceived discrimination among homeless adults.

Disparities in insulin resistance between black and white adults in the United States: The role of lifespan stress exposure

BackgroundDisparities in insulin resistance between Black and White adults in the United States are well documented, yet relatively little is known about the psychosocial or biological antecedents of these inequities. The current study examined childhood adversity and contemporaneous psychosocial stressors in adulthood as possible mediators of the racial disparity in insulin resistance. Inflammatory and hypothalamic-pituitary adrenal (HPA) axis mechanisms implicated in associations between lifespan stress exposure and insulin resistance were also considered. MethodsData were derived from the biomarker component of the Midlife in the United States Study (N = 1170, 20% Black, 56% female, Mean age = 54.7 years, SD = 11.6). A homeostatic model assessment of insulin resistance (HOMA-IR) was calculated from fasting glucose and insulin concentrations. Twelve risk factors relating to household dysfunction, socioeconomic disadvantage, and maltreatment were sum scored to index childhood adversity. Measures of adult stress included socioeconomic adversity, major stressful events, everyday discrimination, and lifetime discrimination. ResultsLevels of insulin resistance were higher among Black than White adults. Childhood adversity was positively associated with HOMA-IR, and attenuated 18% of the race difference. Measures of adult stress mediated 33% of the association between childhood adversity and HOMA-IR, and accounted for an additional 47% of the race difference. Higher inflammation and lower nocturnal cortisol both played an important role in mediating the association between stress exposure and HOMA-IR. ConclusionsFindings are consistent with prior research showing that childhood adversity and adult stress are salient predictors of glucose metabolism, and extend this work by showing that lifespan stress exposures attenuate a significant portion of the Black-White disparity in HOMA-IR. Results also suggest stress effects on insulin resistance through inflammatory and HPA-axis pathways.

Expression of socially sensitive genes: The multi-ethnic study of atherosclerosis.

BackgroundGene expression may be an important biological mediator in associations between social factors and health. However, previous studies were limited by small sample sizes and use of differing cell types with heterogeneous expression patterns. We use a large population-based cohort with gene expression measured solely in monocytes to investigate associations between seven social factors and expression of genes previously found to be sensitive to social factors.MethodsWe employ three methodological approaches: 1) omnibus test for the entire gene set (Global ANCOVA), 2) assessment of each association individually (linear regression), and 3) machine learning method that performs variable selection with correlated predictors (elastic net).ResultsIn global analyses, significant associations with the a priori defined socially sensitive gene set were detected for major or lifetime discrimination and chronic burden (p = 0.019 and p = 0.047, respectively). Marginally significant associations were detected for loneliness and adult socioeconomic status (p = 0.066, p = 0.093, respectively). No associations were significant in linear regression analyses after accounting for multiple testing. However, a small percentage of gene expressions (up to 11%) were associated with at least one social factor using elastic net.ConclusionThe Global ANCOVA and elastic net findings suggest that a small percentage of genes may be “socially sensitive,” (i.e. demonstrate differential expression by social factor), yet single gene approaches such as linear regression may be ill powered to capture this relationship. Future research should further investigate the biological mechanisms through which social factors act to influence gene expression and how systemic changes in gene expression affect overall health.

Multifactorial discrimination, discrimination salience, and prevalent experiences of internalized homophobia in middle-aged and older MSM

Objectives: We sought to test whether discrimination salience and multifactorial discrimination were associated with prevalent experiences of internalized homophobia among middle-aged and older men who have sex with men (MSM).Methods: We analyzed data from 498 middle-aged and older MSM from the Multicenter AIDS Cohort Study (MACS) who reported any lifetime discrimination experience. We estimated the prevalence ratio of current internalized homophobia using multivariable Poisson regressions, accounting for discrimination salience, multifactorial discrimination, and covariates. We then assessed whether multifactorial discrimination moderated the association between discrimination salience and internalized homophobia.Results: Over half (56.4%) of our sample reported any current experience of internalized homophobia. More than two-thirds reported multifactorial discrimination (68.2%) and more than one-third (36.7%) reported moderate-to-high discrimination salience. Increases in discrimination salience (PR = 1.11; 95% CI: 1.03-1.20) were associated with any current internalized homophobia among middle-aged and older MSM. Multifactorial discrimination was not statistically associated with internalized homophobia and did not moderate the association between discrimination salience and internalized homophobia.Conclusions: Our study underscores internalized homophobia as a persisting concern among MSM in midlife and older adulthood. Our findings suggest that salience, as a characteristic of discrimination experiences, may have a greater impact on internalized homophobia compared with exposure. Future research efforts should assess facets of discrimination salience, such as severity, frequency, and chronicity, to better understand how discrimination shapes psychosocial well-being across the life course. Mental health advocates at policy, organizational, and community levels should aim to reduce intersectional stigma and address individual experiences of internalized homophobia.

Abstract P027: Perceived Discrimination and Trajectory of High-Sensitivity C-Reactive Protein: The Jackson Heart Study

Introduction: Perceiving discriminatory treatment against oneself may induce a stress response, and over time contribute to cardiovascular pathophysiology. The study evaluated the association of self-reported discrimination and changes in high-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation predictive of incident cardiovascular disease. Hypothesis: We assessed the following hypotheses: 1) higher levels of perceived discrimination are associated with higher serum hs-CRP at baseline, 2) over 13 years of follow-up, greater mean increases in hs-CRP are observed among those with higher levels of baseline discrimination than those with lower levels of discrimination, and 3) body composition mediates the longitudinal trajectory. Methods: The sample included 5145 African American participants, aged 21-92, in the Jackson Heart Study. Multiple imputation addressed missingness in baseline sociodemographic (e.g, age, sex, education), behavioral (e.g., AHA smoking and physical activity categorizations) and clinical covariates (e.g, estimated glomerular filtration rate, diastolic blood pressure, hemoglobin A1c) as well as in hs-CRP taken at all three study examinations. Everyday, lifetime, and burden from perceived discrimination -attributed to reasons including race, gender, age, or weight- comprised primary predictors in three sets of multivariable linear regression models of baseline (2000-2004) discrimination and ln(hs-CRP). Linear mixed models (LMMs) were fitted to assess mean changes in ln(hs-CRP) between three study examinations (2000-2013).Mediation was quantified by percent changes in estimates adjusted for the adiposity measures BMI, waist circumference, or waist-to-height ratio. Results: In the cross-sectional analyses, those in the highest tertile of lifetime discrimination had adjusted ln(hs-CRP) levels 0.08 ln(mg/dL) lower than those in the lowest tertile (95% CI= -0.16, -0.01). However, the ln(hs-CRP) increases among those reporting more frequent everyday discrimination were 0.07 ln(mg/dL) higher per examination than those reporting no everyday discrimination (95% CI=0.01, 0.12) A similar trend emerged for lifetime discrimination and changes in ln(hs-CRP) (adjusted mean increase per visit: 0.04 ln(mg/dL), CI=0.01, 0.08). BMI, waist circumference, or waist-to-height ratio did not mediate the longitudinal associations between any discrimination measure and hs-CRP. In sensitivity analyses, the magnitude of these estimates did not change before or after multiple imputation. Conclusion: Everyday and lifetime discrimination were associated with significant hs-CRP increases over 13 years of follow-up. These conclusions build upon the existing research that indicates the physiological response to discrimination may lead to systemic inflammation and in turn cardiovascular disease.

Abstract P359: Pervasive Discrimination and Allostatic Load in African-American and White Adults

Introduction: Self-reported experiences of discrimination have been associated with a range of important clinical disease outcomes; however, most studies have focused on discrimination assessed using a single scale which may fail to capture the pervasive nature of experiences of discrimination in the lives of certain groups. We sought to examine associations between reports of “pervasive” discrimination—conceptualized by combining multiple scales assessing discriminatory experiences-- and an indicator of homeostatic dysfunction, allostatic load (AL), among African-Americans and Whites. We also examined whether associations were stronger among African-Americans than Whites. AL was chosen as it is a measure of cumulative “wear and tear” on the body caused by stressors (i.e., discrimination) and has been associated with cardiovascular-related outcomes. Hypothesis: We hypothesized that pervasive discrimination would be associated with higher allostatic load, and that associations would be stronger among African-Americans compared to Whites. Methods: We conducted linear regression models using data from 215 African-American and 985 White adults (57% female; mean age=54.7 years) in the Midlife in the United States II (MIDUS II) Biomarker Project. A pervasive discrimination score was created by combining three discrimination scales (Everyday Discrimination, Lifetime Discrimination, and Workplace Discrimination), resulting in a score measuring 0-3 domains of discrimination, and an AL score was created based on a set of 24 biomarkers representing 7 biological systems (including inflammation, lipid metabolism, and cardiovascular, among others). Results: African-Americans had higher pervasive discrimination and AL scores than Whites (p<0.001). In models fully-adjusted for demographics and other relevant covariates, raceхpervasive discrimination interaction was observed (p<0.05). A pervasive discrimination score of 2 vs. 0 was associated with a greater increase in AL among African-Americans (b=0.32; p<0.001) compared to Whites (b=0.18; p<0.001). Conclusions: African-Americans report more pervasive discrimination than Whites. This pervasive discrimination in turn, has a greater impact on multisystemic physiological dysregulation in African-Americans compared to Whites. Findings suggest that measuring discrimination by combining multiple forms of discriminatory experiences may be particularly important for studying the health effects of discrimination among African-Americans.

Abstract P122: Intersectional Effects of Racial and Gender Discrimination on Cardiovascular Health Vary Among Black and White Women and Men in the Cardia Study

Background: Some evidence suggests an association of perceived racial but not gender discrimination with disparities in cardiovascular health (CVH) among U.S. black women and men. We assessed whether there are race-gender differences in the effects of reporting experiences of racial and gender discrimination simultaneously compared with racial or gender discrimination alone, or no discrimination, on future CVH. Methods: Data were from a sample of 3,758 black or white adults in CARDIA, a population-based cohort recruited in Birmingham, AL; Chicago, IL; Minneapolis, MN, and Oakland, CA in 1985-6 (year 0). Racial and gender discrimination were assessed using the Lifetime Discrimination Scale at year 7. CVH at year 30 was evaluated using a 12-point composite outcome modified from the AHA’s Simple 7, with higher scores indicating better health. Multivariable linear regressions evaluated the associations between level of perceived discrimination at year 7 and CVH scores at year 30 stratified by race-gender. Results: Reporting racial and gender discrimination in ≥2 settings were 48% (496/1039) of black women, 42% (311/743) of black men, 10% (109/1045) of white women, and 5% (45/931) of white men. Year 30 CVH scores (mean, SD) were 7.9 (1.4), 8.1 (1.6), 8.8 (1.6), and 8.7 (1.3), respectively. Table: Compared with those of their race-gender groups reporting no discrimination, white women reporting gender only saw an adjusted score difference of +0.3 ( p =0.04); white men reporting racial only, +0.4 ( p =0.02), and both racial and gender, -0.6 ( p =0.03). Conclusions: Racial and gender discrimination interact in their association with CVH differently for different race-gender groups. While modest, a 1-point decrease in CVH score among white men has been shown to correspond to an ~30% increase in the rate of CVD development. More research is needed to understand why perceived discrimination might better predict CVH for whites than blacks, and which other factors associated with race-gender contribute variability to CVH among these groups.

Low use of routine medical care among African Americans with high CKD risk: the Jackson Heart Study

BackgroundUse of routine medical care (RMC) is advocated to address ethnic/racial disparities in chronic kidney disease (CKD) risks, but use is less frequent among African Americans. Factors associated with low RMC use among African Americans at risk of renal outcomes have not been well studied.MethodsWe examined sociodemographic, comorbidity, healthcare access, and psychosocial (discrimination, anger, stress, trust) factors associated with low RMC use in a cross-sectional study. Low RMC use was defined as lack of a physical exam within one year among participants with CKD (estimated glomerular filtration rate < 60 mL/min/1.73m2 or urine albumin-to-creatinine ratio > 30 mg/g) or CKD risk factors (diabetes or hypertension). We used multivariable logistic regression to estimate the odds of low RMC use at baseline (2000–2004) for several risk factors.ResultsAmong 3191 participants with CKD, diabetes, or hypertension, 2024 (63.4%) were ≥ 55 years of age, and 700 (21.9%) reported low RMC use. After multivariable adjustment, age < 55 years (OR 1.61 95% CI 1.31–1.98), male sex (OR 1.71; 1.41–2.07), <high school diploma (OR 1.31; 1.07–1.62), absence of hypertension (OR 1.74; 1.27–2.39) or diabetes (OR 1.34; 1.09–1.65), and tobacco use (OR 1.43; 1.18–1.72) were associated with low RMC use. Low trust in providers (OR 2.16; 1.42–3.27), high stress (OR 1.41; 1.09–1.82), high daily discrimination (OR 1.30; 1.01–1.67) and low burden of lifetime discrimination (OR 1.52; 1.18–1.94), were also associated with low RMC use.ConclusionsHigh-risk African Americans who were younger, male, less-educated, and with low trust in providers were more likely to report low RMC use. Efforts to improve RMC use by targeting these populations could mitigate African Americans’ disparities in CKD risks.

Lifetime discrimination, global sleep quality, and inflammation burden in a multiethnic sample of middle-aged adults.

Despite considerable evidence that greater exposure to discrimination over the life course increases risk for systemic inflammation, little is known about the mechanisms responsible for this association. Here we examine the role of global sleep quality as a potential pathway by which self-reported experiences of discrimination contribute to inflammatory dysfunction in a multiethnic sample of middle-aged adults. Participants were 300 adults (36-85 years; 65% women) from Milwaukee, Wisconsin, a subset of the Midlife in the United States Study 2 (2004-2006). Racial/ethnic representation included African American (77.7%), Hispanic (12.7%), Asian/Pacific Islander (5.6%), and Native American (4.0%). Global sleep quality and perceptions of lifetime and daily discrimination were measured by questionnaire. A composite score of inflammation burden was computed as the sum of five markers including C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, E-selectin, and intracellular adhesion molecule-1 (ICAM-1). Greater lifetime exposure to discrimination was associated with higher inflammation burden. This relationship remained significant after adjustments for potential confounding factors, including demographics, medication use, health behaviors, psychological distress, and daily discrimination. Mediation analyses suggested that poor global sleep quality was a key mechanism underlying the link between lifetime discrimination and inflammation burden. These results add to a growing literature on the effects of bias and unfair treatment experienced by people of color and other marginalized groups by demonstrating how such experiences may be particularly consequential for sleep and physiological functioning in midlife. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Lifetime discrimination burden, racial discrimination, and subclinical cerebrovascular disease among African Americans.

Explore interactive relations of lifetime discrimination burden and racial discrimination-chronic stressors among African Americans (AAs)-and age with MRI-assessed white matter lesion volume (WMLV), a prognostic indicator of poor clinical brain health outcomes. AAs (N = 71; 60.6% female, mean age = 50) participating in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) SCAN study underwent quantitative magnetic resonance imaging coded for WMLV. Participants self-reported lifetime discrimination burden and racial discrimination approximately 5 years earlier. Multivariable regression models assessed interactions of linear and quadratic effects of discrimination and age with WMLV adjusted for sex and socioeconomic status. Findings revealed significant interactive relations of age and (a) quadratic, lifetime discrimination burden, B = .05, p = .014, ηpartial2 = .092, and (b) quadratic, racial discrimination, B = .03, p = .001, ηpartial2 = .155, with WMLV. Among older AA, increases in lifetime discrimination burden and racial discrimination were associated with increases in WMLV (ps < .03); in younger AA, decreasing levels of racial discrimination were related to increases in WMLV (p = .006). Among older AA, as lifetime discrimination burden and racial discrimination increased, so did WMLV. However, in younger AA, decreases in racial discrimination were associated with increased WMLV. Elucidation of complex mechanistic underpinnings, including potentially differential impacts of the acknowledgment versus suppression or underreporting of discriminatory experiences, among AA of different age cohorts, is critical to understanding the present pattern of findings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Interpersonal-level discrimination indices, sociodemographic factors, and telomere length in African-Americans and Whites

ObjectiveStudies have linked self-reported discrimination to telomere attrition, a biological marker of accelerated cellular aging. However, it is unknown whether intersections between social categories—race, socioeconomic status (SES), sex, and age—influence the association of varying forms of discrimination with telomere length. We examined these associations in a socioeconomically and racially/ethnically diverse urban sample. MethodsCross-sectional data were from 341 middle-aged (30–64 years) African American and White, community participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span Study (HANDLS). Multiple regression models examined up to 3-way interactions between a discrimination measure (i.e., everyday, racial, gender, lifetime burden, and frequency of discrimination across sources) and two social categories. ResultsAfter adjusting for depressive symptoms, waist circumference, and lifetime substance use, two themes emerged: 1) among women with higher SES, a) greater lifetime discrimination burden (b = -0.23, p = .011), gender discrimination (b = -0.29, p = .040), and racial discrimination (b = -0.24, p = 0.023) and 2) among younger adults, irrespective of race and sex, greater frequency of discrimination across sources (b = 0.002, p = .008) was associated with shorter telomeres. ConclusionsIrrespective of race, women with higher SES and younger adults reporting greater discrimination may be at particular risk for accelerated aging. Telomere attrition promotes and accelerates chronic health conditions for which there are health disparities. Future research explicating intersections among specific discrimination indices and social categories is warranted.

Self-reported Instances of Major Discrimination, Race/Ethnicity, and Inflammation Among Older Adults: Evidence From the Health and Retirement Study.

This study examines the relationship between self-reported instances of major discrimination and inflammation among older adults, and explores whether this relationship varies in accordance with race/ethnicity. We hypothesized that self-reported instances of major discrimination would be associated with higher levels of high-risk inflammation and that this relationship would be stronger for racial/ethnic minorities than whites. Data from the 2006/2008 Health and Retirement Study, an ongoing biennial nationally representative sample of older adults in the United States, were used to collect measures of self-reported instances of major discrimination and high-risk C-reactive protein (CRP), which was assayed from blood samples. Modified Poisson regression with robust standard errors was applied to estimate the prevalence ratios of self-reported instances of major discrimination, as it relates to high-risk CRP (CRP ≥ 22 kg/m2), and test whether this relationship varies by race/ethnicity. Respondents who experienced any instances of major discrimination had a higher likelihood of high-risk CRP (prevalence ratio [PR]: 1.14, 95% confidence interval [CI] = 1.07-1.22) than those who did not report experiencing any instances of major discrimination. This association was independent of differences in newly diagnosed health conditions and socioeconomic status. The relationship between any self-reported instance of major discrimination and high-risk CRP was weaker for blacks than whites (PR: 0.81, 95% CI = 0.69-0.95). Our study confirms that self-reported instances of major lifetime discrimination is a psychosocial factor that is adversely associated with high-risk CRP among older adults; this association is especially pronounced among older whites. Future studies among this population are required to examine whether the relationship between self-reported instances of major discrimination and high-risk CRP changes over time.

Supplemental Material for Lifetime Discrimination Burden, Racial Discrimination, and Subclinical Cerebrovascular Disease Among African Americans

Supplemental Material for Lifetime Discrimination Burden, Racial Discrimination, and Subclinical Cerebrovascular Disease Among African Americans

Beliefs about people with albinism in Uganda: A qualitative study using the Common-Sense Model.

Albinism includes a group of inherited conditions that result in reduced melanin production. It has been documented across the world, with a high frequency in sub-Saharan Africa. There is very little published research about the lives of people with albinism, but available evidence shows that myths abound regarding their condition. They are feared, viewed with suspicion and believed to have supernatural powers. In this study we explored the links between beliefs, myths, traditions and positive/negative attitudes that surround people with albinism in Uganda. The study was located philosophically within Ubuntu—an Afrocentric worldview—and theoretically within the Common-Sense Model of self-regulation of health and illness that originates from the work of Leventhal in 2003. This qualitative study took place in eight districts of Busoga sub-region, Uganda between 2015 and 2017. Data collection comprised eight group discussions and 17 individual interviews with a range of informants, capturing the viewpoints of 73 participants. Findings lend support to previous research, highlighting the life-time discrimination and disadvantage experienced by many people with albinism. It shows that there is still much to be done to address the pervasive and potentially harmful beliefs and misconceptions about people with albinism.

Effects of Discrimination on HIV-Related Symptoms in Heterosexual Men of Color

HIV-related symptoms have a deleterious effect on quality of life. One determinant of HIV symptom burden among individuals of color may be discrimination. The aim of this study was to explore whether multiple lifetime discrimination events are associated with a greater number of HIV-related symptoms among heterosexual HIV-positive men of color and to examine the influence of anxiety and social support on this relationship. Data for this study were drawn from a cross-sectional survey of 307 heterosexual HIV-positive men recruited from health and social service agencies in New York City (NYC). This study indicated that the number of discrimination events experienced in one’s lifetime was positively associated with the number of HIV-related symptoms experienced in the past month. Moreover, the direct effect of discrimination on HIV symptoms remained significant after anxiety was included as a mediator in the model, and there was a significant indirect effect of discrimination on HIV symptoms through anxiety. Evidence supported a potential moderated mediation effect involving social support: As social support increased, the indirect effect of discrimination on HIV symptoms through anxiety decreased. The results of this study suggest an association between discrimination and HIV-related symptom burden. Furthermore, the relationship between number of major discrimination experiences and HIV symptom burden was partially mediated by anxiety. Future research should consider how lifetime discrimination might be associated with negative health outcomes among HIV-positive individuals of color.

Abstract P115: Race, Sex, and Geographical Variation in Perceived Racial Discrimination: The Coronary Artery Risk Development in YoungAdults (CARDIA) Study

Introduction: Variation in exposure to discrimination has been proposed as a contributor to disparities in cardiovascular disease (CVD) among black and white women and men in the U.S. Yet, evidence is conflicting, perhaps due to insufficiently studied race-sex and geographical differences in the pathogenicity of discrimination. We hypothesized that the prevalence of perceived racial discrimination in a variety of settings differs by race, sex, and geographic location. Methods: We used data from CARDIA, a population-based cohort of black and white adults recruited in Birmingham, AL; Chicago, IL; Minneapolis, MN, and Oakland, CA in 1985-6 (year 0). Racial discrimination perceived in several scenarios was assessed using the Lifetime Discrimination Scale at years 7, 15, and 20 (2005-6). We assessed the prevalence at each of these exams and in each scenario, stratified by race-sex group. Results: Prevalence of reported discrimination did not differ markedly over time; we report on year 7 only (n=4,025, figure), with qualitatively similar findings at the other years. Reported discrimination in ≥2 scenarios ranged from 52% in Birmingham to 70% in Minneapolis among black women; among black men, from 65% in Birmingham and 75% in Minneapolis and Oakland. This prevalence was &lt;20% among white women and men in every city. Within all groups, discrimination on the street or in a public setting was most prevalent (p&lt;0.001) and least prevalent in receiving medical care (p&lt;0.001). The proportion of black men reporting discrimination by the police or courts was substantially greater than the other three race-sex groups in each of the four cities (all p&lt;0.001). Conclusions: We found variation in the prevalence of reported racial discrimination across race, sex, and geography. Differences in the experience of discrimination may lead to differences in the health-damaging effects of exposure and partially explain inconsistencies in the evidence of discrimination as a cause of disparities in cardiovascular disease between black and white women and men.

Modeling racial disparities in physical health via close relationship functioning: A life course approach

ObjectiveThe aim of the present study was to test a life course model in which racial disparities in physical health between Caucasian and African Americans are driven by disparities in close relationship functioning. This model also examined relative evidence for intergenerational transmission of relationship functioning and ongoing exposure to prejudice and discrimination as two pathways that might shape adult relationship functioning. MethodA sample of 523 Caucasian and African American men and women were prospectively tracked from a birth cohort initiated in the 1960s. Reports of parental relationship functioning were obtained from participants and their mothers in adolescence. In midlife, participants completed measures of perceived discrimination (lifetime and everyday discrimination), close relationship functioning (relationship strain and support) and physical health (self-rated health, resting heart rate and systolic blood pressure). ResultsAs hypothesized, close relationship functioning was a strong predictor of physical health in adulthood. Furthermore, we observed that perceived discrimination over the life course was linked to impaired relationship functioning. Evidence for intergenerational transmission of relationship functioning was more equivocal. ConclusionRacial disparities in physical health may be maintained via social factors throughout the life course. Although such factors have sometimes been considered outside the purview of the medical field, it is vital that researchers and clinicians begin to more fully address the implications of social forces in order to remediate racial health disparities.

Perceived discrimination and mental health among older African Americans: the role of psychological well-being

ABSTRACTObjectives: Examine the effect of perceived discrimination (both racial and non-racial) on the mental health of older African Americans and explore the buffering role of psychological well-being (purpose in life and self-acceptance).Methods: Using an older African American subsample from the National Health Measurement Study (n = 397), multiple regression model by gender was used to estimate the effects of two types of discrimination (every day and lifetime) on SF-36 mental component and mediating role of two concepts of psychological well-being.Results: With no gender difference on the everyday discrimination, older men experienced more lifetime discrimination than older women. The older men's model found that the depressive symptomology was significantly explained by only everyday discrimination and mediated by self-acceptance. The older women's model was significant, with everyday discrimination and both self-acceptance and purpose in life emerging as mediating variables.Discussion: The prevalence of institutional lifetime discrimination for older African American men is consistent with previous research. Inconsistency with past research indicated that only everyday discrimination is statistically associated with depressive symptoms. Considering the buffering role of psychological well-being served for mental health problems, practitioners need to emphasize these factors when providing services to older African Americans. Equally important, they must address racial discrimination in mental health care settings.