Self-reported Discrimination Research Articles

Interpersonal, Community, and Societal Stressors Mediate Black-White Memory Disparities.

Structural racism creates contextual stressors that disproportionately affect Black, relative to White, older adults in the U.S. and may contribute to worse cognitive health. We examined the extent to which interpersonal, community, and societal stressors uniquely explain Black-White disparities in initial memory and memory change. The sample included 14,199 non-Latino Black and White older adults (Mage=68.32, 19.8% Black) from the U.S. Health and Retirement Study who completed psychosocial questionnaires at baseline and a word list memory task every two years over an eight-year period. Interpersonal, community, and societal stressors were operationalized as self-reported everyday discrimination, neighborhood physical disorder, and subjective societal status, respectively. Latent growth curves modeled longitudinal memory performance. Stressors were modeled simultaneously and allowed to correlate. Covariates included age, sex, education, wealth, parental education, and Southern residence. Compared to White participants, Black participants experienced more discrimination (β=-.004, SE=.001, p<.001), more neighborhood physical disorder (β=-.009, SE=.002, p<.001), and lower perceived societal status (β =-.002, SE=.001, p=.001), each of which uniquely mediated the racial disparity in initial memory. Sensitivity analyses utilizing proxy-imputed memory scores revealed an additional racial disparity in memory change, wherein Black participants evidenced faster decline than White participants. This disparity in memory change was only uniquely mediated by more everyday discrimination among Black participants. Elements of structural racism may contribute to cognitive disparities via disproportionate stress experiences at multiple contextual levels among Black older adults. Future research should consider multilevel protective factors that buffer against negative impacts of racism on health.

Profiles of community support and challenges associated with insomnia symptoms: Findings from the pilot Bhutanese Community of Central Ohio Health Study

Study objectivesWe investigated profiles of community support and challenges in relation to insomnia symptoms among the Bhutanese living in the United States. MethodsUsing data from the pilot Bhutanese Community of Central Ohio Health Study (N = 495; 51.5% men, 69.8% aged 18-44years), we used latent class analysis to identify distinct profiles of neighborhood social cohesion, social support, and community challenges (e.g., limited access to healthcare services and transportation, crime and safety issues, substance use, intimate partner violence) and their associations with insomnia symptoms. Insomnia symptoms were self-reported as difficulty falling and staying asleep and dichotomized as “not at all” vs. “some to always.” Identified classes/profiles were further differentiated by self-reported sociodemographic, socioeconomic, health, acculturative, and discrimination factors. ResultsLatent class analysis revealed four distinct classes/profiles. The High Cohesion (class 1) profile (30.1% of sample) had the lowest likelihood of insomnia symptoms at 6.5%, followed by class 2 or High Support (23.6%) with a 15.3% likelihood. Class 3 or High Challenges profile (11.5%) had a moderate likelihood of insomnia symptoms at 49%. Class 4 or the Low Cohesion/Support profile (34.7%) had a 100% likelihood of reporting insomnia symptoms. Class 4 when compared to class 1 was more likely to report cardiometabolic conditions, experiences of everyday discrimination, limited English linguistic proficiency, and not using telehealth. ConclusionCommunity social cohesion and support may play an important role in mitigating insomnia symptoms among Bhutanese refugees. Further investigations are warranted.

Accumulation of perceived discrimination over time and likelihood of probable mental health problems in UK adults: A longitudinal cohort study

BackgroundLimited research has examined whether accumulation of discrimination over time is associated with worse mental health and whether such experiences are related to socioeconomic status (SES). MethodsA sample of UK adults with self-reported discrimination experiences (n = 3863) was taken from 3 waves of the UK Household Longitudinal Study (2015–2020). Multinomial logistic regression assessed associations between SES (income, education, occupation) and cumulative discrimination (number of timepoints discrimination was reported). Logistic regression models assessed prospective associations between cumulative discrimination and probable mental health problems (GHQ-12; 4+ threshold). ResultsThose with lower income were more likely to report discrimination at one timepoint (vs. none). No SES measures were associated with experiencing discrimination at multiple timepoints. Participants who reported one timepoint of discrimination (vs no experiences) were significantly more likely to report probable mental health problems (OR = 1.47, p < .001, 95 % CI 1.20–1.80). However, compared to those experiencing one timepoint, participants reporting multiple timepoints of discrimination were significantly more likely to report probable mental health problems (OR = 1.46, p = .002, 95 % CI 1.15–1.86), indicating a cumulative association between discrimination and mental health. There was limited evidence that SES moderated this cumulative association. LimitationsMental health measures were based on self-report questionnaires and not a clinical diagnosis. ConclusionsAmongst a sample of UK adults, perceiving discrimination at multiple timepoints increased the likelihood of experiencing probable mental health problems. There was limited evidence that this cumulative association differed by SES. National measures designed to reduce discrimination may benefit mental health.

Determinants of Mental Health Inequalities Among People With Selected Citizenships in Germany.

Mental health is essential for overall health and is influenced by different social determinants. The aim of this paper was to examine which determinants are associated with mental health inequalities among people with selected citizenships in Germany. Data were derived from the multilingual interview survey "German Health Update: Fokus (GEDA Fokus)" among adults with Croatian, Italian, Polish, Syrian, or Turkish citizenship (11/2021-05/2022). Poisson regressions were used to calculate prevalence ratios for symptoms of depression (PHQ-9) and anxiety disorder (GAD-7). Sociodemographic (sex, income, age, household size) and psychosocial (social support and self-reported discrimination) determinants were associated with symptoms of depression and/or anxiety disorder. The prevalence of mental disorders varied most by self-reported discrimination. Our findings suggest mental health inequalities among people with selected citizenships living in Germany. To reduce these, social inequities and everyday discrimination need to be addressed in structural prevention measures as well as in interventions on the communal level. Protective factors (e.g., social support) are also important to reduce mental health inequalities on the individual and community level.

Pathways between childhood mistreatment/victimization, posttraumatic stress, and lifetime substance use disorders among Latinx nationwide.

Childhood mistreatment (CM)/victimization, posttraumatic stress disorder (PTSD), and lifetime substance-use disorders (LT-SUD) are major behavioral health concerns. Their associations were established in mainstream populations but remain under-investigated in Latinx Americans. This study aimed to model the mediating effect of PTSD in the link between CM and LT-SUD among Latinx Americans. Using a nationally representative sample (N = 2,554) from the National Latinx and Asian American Study, three path models were performed for the whole-group, U.S.-born, and foreign-born Latinx (aged 18 or over), controlling for known predictors for Latinx' mental health. Latinx reported high rates of childhood physical (32%) and sexual (11.8%) abuse. Latinx subgroups significantly varied in educational attainment, LT-SUD, income, English proficiency, and self-reported discrimination. A fully constrained multiple group path analysis demonstrated direct effects of childhood physical mistreatment (CPM) and childhood sexual mistreatment to lifetime PTSD; PTSD significantly mediated the relationship between CPM with LT-SUD. No significant differences in path coefficients were observed among the Mexican, Cuban, and Puerto Rican subgroups. Findings suggest that CPM may contribute to using substance to avoid physical and emotional pain, which lends support for the self-medication hypothesis. Latinx who were traumatized by both physical and sexual abuse are more likely to use substances as a negative coping strategy. The study underscores the need for assessing the role of substance use as a coping mechanism for Latinx individuals who have experienced childhood traumatic victimization. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trajectories of ethnic discrimination and school adjustment of ethnically minoritized adolescents: The role of school diversity climate.

This study investigated trajectories of ethnic discrimination experiences in school, diversity climates as contextual antecedents, and school adjustment as outcome. Latent-Growth-Mixture-Models of repeated self-reported discrimination over 3 years (2012-2015) by 1445 ethnically-minoritized adolescents of Turkish and Moroccan background in 70 Belgian schools (52.6% boys, Mage = 15.07) revealed four trajectories: low (72.5%), moderate (16.6%), initially-high (6.5%), or increasingly high discrimination (4.4%). Adolescents who attended schools with more minoritized peers, or schools that valued cultural diversity and equality, were more often in low-discrimination trajectories, which predicted better academic outcomes. Overall, school diversity climates can protect minoritized adolescents from experiencing persistent or initially high discrimination over time. Moreover, high discrimination at any point in schooling-initially or later-is harmful to adolescents' school adjustment.

Racial Discrimination, Neural Connectivity, and Epigenetic Aging Among Black Women

Racial discrimination increases the risk of adverse brain health outcomes, potentially via neuroplastic changes in emotion processing networks. The involvement of deep brain regions (brainstem and midbrain) in these responses is unknown. Potential associations of racial discrimination with alterations in deep brain functional connectivity and accelerated epigenetic aging, a process that substantially increases vulnerability to health problems, are also unknown. To examine associations of racial discrimination with brainstem and midbrain resting-state functional connectivity (RSFC) and DNA methylation age acceleration (DMAA) among Black women in the US. This cohort study was conducted between January 1, 2012, and February 28, 2015, and included a community-based sample of Black women (aged ≥18 years) recruited as part of the Grady Trauma Project. Self-reported racial discrimination was examined in association with seed-to-voxel brain connectivity, including the locus coeruleus (LC), periaqueductal gray (PAG), and superior colliculus (SC); an index of DMAA (Horvath clock) was also evaluated. Posttraumatic stress disorder (PTSD), trauma exposure, and age were used as covariates in statistical models to isolate racial discrimination-related variance. Data analysis was conducted between January 10 and October 30, 2023. Varying levels of racial discrimination exposure, other trauma exposure, and posttraumatic stress disorder (PTSD). Racial discrimination frequency was assessed with the Experiences of Discrimination Scale, other trauma exposure was evaluated with the Traumatic Events Inventory, and current PTSD was evaluated with the PTSD Symptom Scale. Seed-to-voxel functional connectivity analyses were conducted with LC, PAG, and SC seeds. To assess DMAA, the Methylation EPIC BeadChip assay (Illumina) was conducted with whole-blood samples from a subset of 49 participants. This study included 90 Black women, with a mean (SD) age of 38.5 (11.3) years. Greater racial discrimination was associated with greater left LC RSFC to the bilateral precuneus (a region within the default mode network implicated in rumination and reliving of past events; cluster size k = 228; t85 = 4.78; P < .001, false discovery rate-corrected). Significant indirect effects were observed for the left LC-precuneus RSFC on the association between racial discrimination and DMAA (β [SE] = 0.45 [0.16]; 95% CI, 0.12-0.77). In this study, more frequent racial discrimination was associated with proportionately greater RSFC of the LC to the precuneus, and these connectivity alterations were associated with DMAA. These findings suggest that racial discrimination contributes to accelerated biological aging via altered connectivity between the LC and default mode network, increasing vulnerability for brain health problems.

Hepatitis B discrimination: global responses requiring global data

Over 250 million individuals live with chronic hepatitis B (CHB) infection worldwide. A significant proportion of these people often face discrimination defined as the unjust, unfair, or prejudicial treatment of a person on the grounds of their hepatitis B status. Hepatitis B related discrimination has not been widely documented in the literature. This study aims to describe the lived experience of discrimination, document its impact, and shed light on its consequences. A hepatitis B discrimination registry was launched to record self-reported discrimination associated with hepatitis B. The registry included brief demographic questions (age, gender, country of origin), discrimination-specific questions (where, when, and how discrimination occurred), and open-ended questions to detail specific experiences. The registry was distributed to hepatitis B patient/people-focused listservs, social media networks, and community-based organizations around the globe. Descriptive data were analyzed including comparative analysis by country and type of discrimination occurring along with qualitative data (open-ended responses) which were analyzed using thematic analysis techniques A total of 569 individuals responded to the survey between May 2021 and December 2023. Individuals identified as residing in the Philippines (34%; N = 194), Nigeria (11%; N = 60), Pakistan (8%; N = 45), India (6%, N = 34), Uganda (5%; N = 31), the United States of America (4%, N = 26), Ghana (3%; N = 15), Ethiopia (2%; N = 14), and other countries in smaller number with a total of 65 countries reported discrimination at least by one individual. Of these, 461 individuals shared details about their experiences of discrimination with most relating to restrictions on access to work visas, followed by in-country hepatitis B-related employment restrictions, educational-based discrimination, discrimination within the community and health facilities, and the emotional impact of hepatitis B discrimination. This is the largest primary collection of hepatitis B-associated discrimination events and highlights how hepatitis B discrimination clearly has a significant impact on individuals’ lives and limits economic opportunities regardless of physical symptoms. Such impacts likely act as barriers to diagnosis and engagement in care, so need to be addressed to achieve the global hepatitis B elimination goals. The data highlight a need for global, national responses and more systematic responses to discrimination experienced by people with hepatitis B.

Gender and Drug Use Discrimination Among People Who Inject Drugs: An Intersectional Approach Using the COSINUS Cohort.

Injection drug use is strongly associated with stigmatization by loved ones, healthcare providers, and society in general. This stigmatization can have negative consequences on the health of people who inject drugs (PWID) and limit their access to care. Women who inject drugs face greater stigma than men because of gendered social norms and the intersectional effect between gender and drug use identities. For this analysis, we aimed to study discrimination - which is closely linked to stigmatization - experienced by PWID, considering the intersectionality between drug use discrimination and gender discrimination in the French context. We used data from the COSINUS cohort study, conducted between June 2016 and May 2019 in four French cities. We selected 427 of the 665 PWID who regularly injected drugs enrolled in COSINUS, at three months of follow-up, and performed multivariable logistic regression to identify factors associated with self-reported drug use discrimination. Women comprised 20.6% of the study sample. Sixty-nine percent of the participants declared drug use discrimination and 15% gender discrimination. In the multivariable regression analysis, PWID who had hurried injection out of fear of being seen were almost twice as likely to have experienced drug use discrimination (OR [95% CI]: 1.77 [1.15, 2.74], p = 0.010). Likewise, women experiencing gender discrimination were almost three times as likely to have experienced drug use discrimination (OR [95% CI]: 2.84 [1.07,7.56], p=0.037). Women who inject drugs experienced gender and drug use intersectional discrimination. This could be a reason for the low attendance rates of women in healthcare settings. In addition, discrimination negatively impacted injection drug use practices (eg, hurried injection), particularly for people with unstable housing who injected in public spaces. We recommend introducing adapted services in healthcare facilities for women who inject drugs, and creating a favorable social and physical environment for all PWID in order to improve their health and access to care.

INTERPERSONAL, COMMUNITY, AND SOCIETAL STRESSORS MEDIATE BLACK–WHITE MEMORY DISPARITIES

Abstract Psychosocial factors may contribute to racial disparities in cognitive aging beyond socioeconomic status. Contextual stressors at multiple ecological levels, which may be related to structural racism, disproportionately affect Black older adults in the U.S. and may explain increased dementia risk. This study examined the extent to which interpersonal, community, and societal level stressors independently explained Black-White disparities in memory at baseline and over time. The sample included 16,890 older Black and White adults (Mage=67.98, 22% Black) from the US Health and Retirement Study who completed psychosocial questionnaires and a word list memory task. Interpersonal, community, and societal stressors were operationalized as self-reported everyday discrimination, neighborhood physical disorder, and subjective societal status, respectively. Latent growth curves modeled memory performance over six years. Stressors were modeled simultaneously and allowed to correlate. Covariates included age, sex, education, wealth, and questionnaire year. Compared to White older adults, Black older adults experienced higher discrimination (b = -.004, SE=.001, p&amp;lt;.001), greater neighborhood physical disorder (b = -.012, SE=.002, p&amp;lt;.001), and lower perceived societal status (b = -.003, SE=.001, p=.001), each of which independently mediated the association between Black race and worse initial memory. Together, these stressors explained 11% of the racial disparity in initial memory. There was no racial disparity in memory decline. Individual experiences of stressors across multiple contextual levels contribute to racial disparities in memory, providing evidence that structural racism negatively influences dementia risk among Black older adults. Future research should consider protective factors that buffer against negative impacts of structural racism on health.

Racial discrimination and mental health in the context of anti-Asian xenophobia: An intersecting approach of race, ethnicity, nativity, and socioeconomic status

The COVID-19 pandemic, polarized politics, and heightened stigma and discrimination are salient drivers for negative mental health outcomes, particularly among marginalized racial and ethnic minoritized groups. Intersectionality of race, ethnicity, foreign-born status, and educational attainment may distinctively shape an individual's experience of discrimination and mental health during such unprecedented time. The present study examines the differential associations of racial discrimination and mental health based on an individual's race, ethnicity, foreign-born status, and educational attainment during the COVID-19 pandemic. Analyses were based on a nationally representative sample of U.S. adults collected between October and November 2021 (n = 6276). We utilized multivariable linear regressions to identify the multiplicative effects of race, ethnic, foreign-born status and self-reported racial discrimination on mental health, stratified by educational attainment. Among individuals with lower educational attainment, associations between racial discrimination and poor mental health were stronger among Asians (US-born: β = −2.07, p = 0.03; foreign-born: β = −3.18, p = 0.02) and US-born multiracial individuals (β = −1.96, p = 0.02) than their White counterparts. Among individuals with higher educational attainment, foreign-born Hispanics (β = − 3.66, p < 0.001) and US-born Asians (β = −2.07, p = 0.01) reported worst mental health when exposed to racial discrimination out of all other racial, ethnic and foreign-born groups. Our results suggest that association of racial discrimination and mental health varies across racial, ethnic, foreign-born, and education subgroups. Using an intersectional approach to address the widening inequities in racial discrimination and mental health during the COVID-19 pandemic contextualizes unique experience of discrimination and provides crucial insight on the patterns of mental health among marginalized groups.

Knowledge and perceived competence with sexual and gender minority healthcare topics among medical students and medical school faculty

BackgroundDespite changes in social attitudes in the United States over the last decade, sexual and gender minority (SGM) individuals continue to face significant health disparities, driven partly by disproportionately higher rates of self-reported discrimination and harassment when seeking healthcare. Historically, physicians have received little to no required training on how to provide sensitive, competent care to SGM patients, and continue to demonstrate poor competency with SGM topics despite calls for increased education and published guidelines to promote competency. The present study aimed to investigate competency with SGM topics among both faculty and medical students at one institution.MethodsThe authors distributed an anonymous online survey (2020–2021) to medical students and student-facing faculty at one allopathic medical school in the United States. The objective of the study was to evaluate knowledge, clinical skills, and self-reported competence with SGM topics.ResultsOf survey respondents, 223 medical students and 111 faculty were included in final analysis. On average, medical students were significantly more likely to answer General Knowledge questions correctly (97.2%) compared to faculty (89.9%). There were no significant differences in responses to Clinical Knowledge questions between medical students and faculty. however medical students were significantly more likely to report competence with eliciting a thorough sexual history, and faculty were significantly more likely to report receiving adequate clinical training and supervision to work with lesbian, gay, and bisexual patients.ConclusionsMedical students demonstrated significantly higher general knowledge about SGM topics compared to faculty. Medical students and faculty demonstrated similarly low average clinical knowledge, with percent correct 65.6% for students and 62.7% for faculty. Despite significant differences in general knowledge and low clinical knowledge, medical students and faculty self-reported similar levels of competence with these topics. This indicates insufficient curricular preparation to achieve the AAMC competencies necessary to care for SGM patients.

Financial Risk Aversion Among Older Black and White Adults.

Risk aversion has a substantial impact on decision making and is associated with key demographic characteristics. However, few studies have investigated whether risk aversion varies by race. We investigated racial differences in financial risk aversion in 684 older Black and White adults without dementia in the Minority Aging Research Study and Rush Memory and Aging Project matched for age, education, sex, and cognition using Mahalanobis distance. We also investigated whether select contextual factors (self-reported discrimination, socioeconomic status, and literacy) mediated or affective factors (trust, loneliness, and neuroticism) moderated any observed racial differences. In regression models adjusted for age, education, sex, and cognitive function, older Black adults were more risk averse than older White adults (Beta = 0.1264, standard error = 0.0227, p value ≤ .00001). None of the contextual or affective factors mediated or moderated this association. Older Black adults are more financially risk averse than older White adults. Because risk aversion may be associated with important financial and health outcomes in older age, more research is needed to investigate the reasons for this difference.

Prospective Survey of Discrimination in Pregnant Persons and Correlation with Unplanned Healthcare Utilization.

To determine the association between lifetime exposure to discrimination and unplanned healthcare utilization in pregnant persons. This was a prospective cohort study of pregnant persons receiving care from 2021 to 2022. Primary data was collected from participants on sociodemographic factors and on Perceived Ethnic Discrimination Questionnaire (PED-Q), a validated 17-item scale measuring perceived lifetime interpersonal racial and ethnic discrimination in four domains: work/school, social exclusion, stigmatization, and threat. The primary outcome was unplanned healthcare utilization, defined as unplanned labor and delivery admissions, triage, Emergency Department, or urgent care visits. Bivariate and multivariate analyses were done to examine the association between lifetime exposure to discrimination and unplanned healthcare utilization. A total of 289 completed the PED-Q and were included in the analysis. Of these, 123 (42.6%) had unplanned healthcare utilization. Mean (SD) of lifetime racial and ethnic discrimination was significantly higher in people with unplanned healthcare utilization compared to those with planned healthcare utilization [1.67 (0.63) vs 1.48 (0.45), p = 0.003]. Univariate analysis showed that lifetime racial and ethnic discrimination was significantly associated with unplanned healthcare utilization (OR1.96, 95% CI 0.23-3.11). Significant associations were found between unplanned healthcare utilization and maternal age (p = 0.04), insurance type (p = 0.01), married status (p < 0.001), education (p = 0.013), household income (p = 0.001), and chronic hypertension (p = 0.004). After controlling for potential confounding factors, self-reported lifetime racial and ethnic discrimination remained significantly associated with higher odds of unplanned healthcare utilization (aOR 1.78, CI 95% 1.01-3.11). We found that a higher level of self-reported lifetime racial and ethnic discrimination was associated with increased unplanned healthcare utilization during pregnancy.

Self-reported Racial Discrimination and Healthy Behaviors in Black Adults Residing in Rural Persistent Poverty Areas.

Racism is a social determinant of health inequities and associated with poorer health and health behaviors. As a domain of racism, self-reported racial discrimination affects health through unhealthy behaviors (e.g., smoking) but the understudied impact of self-reported racial discrimination's relationship with healthy behaviors (e.g., cancer screening) precludes a comprehensive understanding of racism's impact on health inequities. Understanding how self-reported racial discrimination impacts healthy behaviors is even more important for those living in rural persistent poverty areas (poverty rates of 20% or more of a population since 1980), who have a higher disease burden due to poverty's interaction with racism. The distinct sociocultural context of rural persistent poverty areas may result in differential responses to self-reported racial discrimination compared to those in non-persistent poverty areas. A community-engaged process was used to administer a survey to a convenience sample of 251 Black adults residing in 11 rural persistent poverty counties in the state of Arkansas. Self-reported racial discrimination, fruit and vegetable intake, colorectal cancer screening, cervical cancer screening, and screening mammography were assessed. Stress and religion/spirituality were also assessed as potential mediators or moderators in the relationship between self-reported racial discrimination and healthy behaviors. In adjusted models, those reporting more self-reported racial discrimination had a higher probability of having had a test to check for cervical cancer (situation discrimination: OR = 1.23, 95% CI: 1.04-1.5; frequency discrimination: OR = 1.06, 95% CI: 1.02-1.12). Stress and religion/spirituality were not significant mediators/moderators. Greater self-reported racial discrimination was associated with a higher odds of cervical cancer screening. Black adults residing in rural persistent poverty areas may have greater self-reported racial discrimination-specific coping and racial identity attitudes.

The Relationship Between Intersectional Oppression and Affirmation and Latino Sexual Minority Men's Mental Health.

Purpose: Latino sexual minority men (LSMM) may experience oppression based on their ethnicity, sexual orientation, and migratory status, yet scientific literature is only beginning to explore the intersection of these experiences. This study examined mental health (MH) in relation to LSMM's experiences of intersectional oppression and affirmation. Methods: We conducted a secondary analysis of baseline data from a cohort study examining LSMM's (n = 290) health care engagement in Miami, FL, from February to September 2020. Latent class analysis (LCA) identified classes based on self-reported multiple identity discrimination (e.g., race, ethnicity, and skin color), sexual orientation stigma/affirmation, and migration-related stress. Logistic and linear regressions examined associations between class membership and anxious, depressive, post-traumatic stress, somatic symptoms, and overall MH burden. Results: The LCA revealed a three-class solution: (1) affirmed LSMM (73.8%), (2) LSMM with intersectional oppression (21.7%), and (3) LSMM with immigration stress (4.5%). The three classes varied in terms of multiple identity discrimination, sexual orientation stigma/affirmation, and migration-related stress. Compared with Class 1, Class 2 had greater conditional probabilities of reporting clinically significant depressive (p = 0.033) and post-traumatic stress symptoms (p = 0.031), and at least one MH concern (p = 0.018). Greater depressive symptoms (p = 0.007), post-traumatic stress symptoms (p = 0.049), somatic symptoms (p = 0.024), and clinically significant MH concerns (p = 0.018) were found among Class 2 than among Class 1. Conclusion: Findings identified three groups of LSMM based on their experiences of intersectional oppression and affirmation. Discrimination at the intersection of multiple identities, sexual orientation stigma/affirmation, and migration-related stress were associated with LSMM's MH outcomes, particularly among immigrants.

Racial Discrimination and Hypothalamic-Pituitary-Adrenal Axis Dysregulation in Adolescents With Overweight and Obesity: Does Context Matter?

In adolescents at higher risk for chronic disease, the role that context of a discriminatory event may play on cortisol dysregulation is unclear. The purpose of this study was to perform a cross-sectional analysis examining the association between racial discrimination context (peer, educational, institutional, and cumulative) and diurnal cortisol patterning in adolescents with overweight and obesity. One hundred adolescents (13-19 years; 49% non-Hispanic Black; 65% female; body mass index percentile = 93.9% [4.14%]) were included in this analysis. Racial discrimination context was measured using the self-reported Adolescent Discrimination Distress Index. Salivary cortisol, collected across 3 days at five time points during the day, was used to calculate Δ 0-30 minutes, diurnal slope, and average total diurnal cortisol area under the curve. Sixteen separate multivariable linear regression models were performed to analyze the relationship between racial discrimination and diurnal cortisol patterns. Primary findings show that cumulative racial discrimination and peer discrimination were associated with a greater diurnal slope (cumulative: β = 0.010 ± 0.004, p = .03; peer: β = 0.023 ± 0.010, p = .026). Findings from this study identified cross-sectional associations between racial discrimination experienced among peers and diurnal cortisol patterns in adolescents with overweight/obesity. If our findings were to be confirmed in longitudinal analyses, evidence-based programs should be considered to buffer the effects of discrimination on adolescent health, and more importantly, policy makers should work to eliminate discrimination exposure.

Prevalence and correlates of experiencing drug-related discrimination among people who use drugs presenting at emergency department at high risk of opioid overdose

ObjectivesOur objective is to determine if specific sociodemographic characteristics were associated with perceived drug-related discrimination among people who use drugs (PWUD) presenting for care in the emergency department (ED). MethodsWe conducted a secondary analysis of data from the Navigator trial, a randomized control trial of two behavioral interventions in the ED for people at risk of an opioid overdose. Participants included adult patients presenting to two Rhode Island EDs. Eligible participants included those high risk for an opioid overdose, resided or received most of their healthcare in Rhode Island, and were able to provide consent. The primary outcome of this analysis was self-reported feelings of drug-related discrimination by the medical community. The independent variables of interest included race/ethnicity, gender identity, and sexual orientation. Log-binomial multivariable regression models were constructed with all three independent variables of interest and a selection of sociodemographic covariates. ResultsOf 620 eligible participants, 251 (40.5%) reported ever experiencing drug-related discrimination in their lifetime. In the adjusted model, participants who identified as women and participants who identified as LGBQIA+ were more likely to report experiencing drug-related discrimination from the medical community in EDs. Racial/ethnic minority groups were less likely than White (non-Hispanic) participants to report drug-related discrimination. DiscussionIn this study population, White participants reported more drug-related discrimination than their minority counterparts, although female and LGBQIA+ patients reported more discrimination. Future studies should further assess the significance of these intersecting identities on self-reported discrimination. This knowledge could improve ED-based interventions, policies, and services for PWUD.

Migrants’ intention to vote in two countries, one country, or neither

ABSTRACT While most electoral behavior affects politics in just one political community, migrant voters may affect turnout rates in two: the countries of origin and residence. Considering this context, we evaluate individual-level intentions to vote in national elections, as an emigrant for origin-country elections and as an immigrant in the residence country. Examining South-South migrants, our dataset comprises 1,477 respondents from an online survey during Chile’s 2017 presidential election; 94.7% are from Latin American countries, meaning most also hold external voting rights. Chile automatically registers immigrants in the electorate for multilevel elections after a five-year residence; we find many respondents are ill-informed about this, but those who know they can vote show higher probabilities of being an immigrant voter (they vote only in the residence country) or a dual transnational voter (they vote in both countries). Being interested in politics also increases the decision to vote in not just one but two countries. Longer intention to stay increases immigrant and dual transnational voting, while decreases emigrant voting. We also find that high self-reported discrimination is conducive to participating only in origin-country elections.

Violence, Discrimination, Psychological Distress, and HIV Vulnerability Among Men Who Have Sex With Men in Memphis, Tennessee.

Gay, bisexual, and other men who have sex with men (MSM) are disproportionally impacted by HIV. Discrimination, violence, and psychological distress (PD) may influence engagement with HIV prevention services and amplify HIV vulnerability among this priority population. These dynamics are understudied in the Southern United States. Understanding how these relationships interact is critical to designing effective HIV programs. We examined associations between MSM-related discrimination, MSM-related violence, and severe PD with HIV status among 2017 National HIV Behavioral Surveillance study participants in Memphis, Tennessee. Eligible participants were aged ≥18 years, born and identified as male, and reported having sex with another man in their lifetime. Participants completed a Centers for Disease Control and Prevention-designed anonymous survey and self-reported discrimination and violence across their lifetime, and PD symptoms within the past month, scored on the Kessler-6 Scale. Optional HIV rapid tests were performed on-site. Logistic regressions examined the associations between the exposure variables and HIV antibody-positive results. Among 356 respondents, 66.9% were aged <35 years and 79.5% identified as non-Hispanic Black; 13.2% reported experiencing violence, 47.8% reported discrimination, and 10.7% experienced PD. Of the 297 participants who tested, 33.33% were living with HIV. Discrimination, violence, and PD were significantly associated with each other (p < .0001). HIV antibody-positive test results were associated with violence (p < .01). Memphis-based MSM face a complex array of social experiences, which may increase vulnerability to HIV. On-site testing at community-based organizations and clinical settings among MSM may be an opportunity to screen for violence and incorporate strategies when designing HIV programs.