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Developmental histories of perceived racial discrimination and diurnal cortisol profiles in adulthood: A 20-year prospective study
... When stressful experiences like discrimination occur, the body can also alter its cortisol release and diurnal rhythm to mobilize energies in coping with such stress (Chida & Steptoe, 2009). While these acute cortisol responses to discrimination may be an adaptive process in the short term, chronic stress including cumulative experiences of discrimination, especially when spanning across developmental stages (e.g., from adolescence to adulthood; Adam et al., 2015), can result in excessive cortisol concentrations and dysregulated diurnal rhythm, contributing to the wear and tear on the body and affecting long-term health (Busse et al., 2017). ...
... We excluded samples from days when adolescents reported taking any Western or traditional Chinese medicine (k = 71). We also excluded second cortisol samples (k = 33) collected outside the 20-40 min window after waking (Adam et al., 2015). This resulted in 658 cortisol samples (k = 236 for wakeup time, 190 for 30 min upon wakeup, 232 for bedtime). ...
Adolescents’ experiences of discrimination and their health consequences are understudied in non-Western cultures. Using data from 90 rural Chinese adolescents (Mage = 13.70; 49% female), this study examined cumulative and daily experiences of peer discrimination (based on socioeconomic status, gender, parental migration status, appearance, grades) and their associations with diurnal cortisol output. Data highlighted a high prevalence of peer discrimination, with 85% of the sample reporting any type of cumulative discrimination in the current semester and 56% of the sample reporting any type of daily discrimination over three consecutive days. At the within-person level, daily peer discrimination (regardless of type) was associated with exaggerated cortisol functioning (i.e., more pronounced rise and fall as indicated by steeper slopes and lower bedtime levels) on the same day; daily discrimination based on parental migration status was also associated with higher cortisol awakening responses on the next day. At the between-person level, cumulative discrimination based on socioeconomic status and gender (but not other factors) was associated with exaggerated cortisol functioning (higher waking levels, steeper slopes). The study also offered a methodological example for collecting daily and cortisol data in rual boarding schools in China.
... Although based on a small sample, we observed the highest HCC levels among Black participants and an increased risk of SARS-CoV-2 infection. This finding is consistent with previous studies comparing HCC levels between Whites and Blacks, with evidence of an association between higher HCC levels and perceived discrimination for Blacks that may be mediated by psychological symptoms such as anxiety [67][68][69][70]. Moreover, several studies report a dysregulated and/or dampened cortisol response because of perceived discrimination among Blacks [39,69,71]. ...
... This finding is consistent with previous studies comparing HCC levels between Whites and Blacks, with evidence of an association between higher HCC levels and perceived discrimination for Blacks that may be mediated by psychological symptoms such as anxiety [67][68][69][70]. Moreover, several studies report a dysregulated and/or dampened cortisol response because of perceived discrimination among Blacks [39,69,71]. Our results are suggestive and provide motivation to explore how discrimination affects HPA axis dysregulation and increases the risk of respiratory infections. ...
Chronic psychosocial stress is known to adversely impact immune function. During the SARS-CoV-2 pandemic, occupational stress among workers in healthcare was at an unprecedented level due to risks of infection and work demands. We performed a nested case–control study to investigate the associations between chronic stress and the risks of contracting SARS-CoV-2. We collected 3 cm of hair from employees at an academic medical center who tested positive for SARS-CoV-2 (N = 49) and controls who tested negative (N = 49), matched for age, race, and sex. The diagnosis of SARS-CoV-2 was based on polymerase chain reaction or antibody tests. As a proxy for chronic stress, we segmented hair into 1 cm sections each representing one month and measured cortisol levels using a cortisol enzyme-linked immunosorbent assay. For cases, we used cortisol concentrations measured in hair segments from the month prior to a positive SARS-CoV-2 test, and for controls, we used time-matched hair segments. We fitted conditional logistic regression models adjusted for sex, age, race, body mass index, and healthcare worker status, and stratified models by older vs. younger age (cutoff = 41 years). African Americans had higher hair cortisol levels relative to participants of other races and ethnicities. In adjusted models, higher hair cortisol concentrations were associated with an increased odds of infection with SARS-CoV-2 (OR = 1.84; CI: 1.10–3.07) among older, but not younger, participants. The results suggest that psychosocial stress may be a risk factor for SARS-CoV-2 infection; stress management may be an important part of a comprehensive approach to protect against SARS-CoV-2 infection.
... In a 20-year study examining the relationship between adolescent discrimination and adult CAR, individuals who experienced greater perceived racial discrimination during adolescence were more likely to have an attenuated CAR in adulthood (17). As it pertains to younger populations, Doane and Zeider (18) reported that greater exposure to discrimination was associated with a blunted CAR in adolescents, suggesting that the relationship of discrimination and CAR may occur earlier in the life course. ...
... Previous research has consistently documented associations between racial discrimination and dysregulated cortisol patterns (17,18,33). Doane and Zeider (18) reported on this inverse association between perceived discrimination and CAR in a multiethnic group of emerging adults, whereas others observed lower waking and bedtime cortisol and a blunted overall cortisol response (i.e., greater overall AUC) in adolescents with greater discrimination frequency, or number of experiences (33). ...
Objectives:
The role of context, for which a discriminatory event occurs, on cortisol dysregulation is unclear in adolescents at higher risk for chronic disease. 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.
Methods:
One-hundred adolescents [13-19 years; 49% non-Hispanic Black; 65% female; Body Mass Index Percentile (BMI%): 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 three 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.
Results:
Primary findings show that cumulative racial discrimination and peer discrimination were associated with a greater diurnal slope (cumulative: β = 0.010 ± 0.004; p = 0.03; peer: β = 0.023 ± 0.010; p = 0.026).
Conclusions:
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, policymakers should work to eliminate discrimination exposure.
... 4 In addition to pre-registered moderator analyses, we also explored the possibility of examining the effects of race/ethnicity and season in which the data were collected as moderators of the relationship. This is based on studies that have observed racial/ethnic (Adam et al., 2015;DeSantis et al., 2007) and seasonal (Miller et al., 2016) differences in diurnal cortisol patterns. ...
... For example, most of the samples reported either did not report race at all, or samples were comprised of mostly white participants. Many studies have found differences in diurnal cortisol patterns between racial/ethnic groups (Adam et al., 2015;DeSantis et al., 2007). Future research should always account for the race/ethnicity of samples and report the demographics clearly. ...
Physical activity participation is associated with effective stress coping, indicated by decreases in both physiological stress reactivity and perceived stress. Quantifying the effect of physical activity on the diurnal regulation of one key physiological stress indicator, the stress hormone, cortisol, across studies may demonstrate the extent to which physical activity participation is associated with diurnal HPA axis regulation. We meta-analyzed studies examining relations between physical activity participation and indices of HPA axis regulation: the diurnal cortisol slope and the cortisol awakening response. We also examined moderators of the relation. The analysis revealed a small, non-zero negative averaged correlation between physical activity and the diurnal cortisol slope (r = -0.043, 95% CI [-0.080, -0.004]). Examination of sample sociodemographic differences, study design characteristics, cortisol measurement methods, and physical activity variables as moderators revealed few effects on the relation between physical activity and diurnal cortisol slope. We did not observe lower levels of variability in the mean cortisol awakening response at higher levels of physical activity participation, and moderator analyses showed little evidence of reductions in heterogeneity for this effect. We found some evidence of systematic publication bias. Findings suggest higher physical activity is associated with a steeper diurnal cortisol slope. However, the cortisol awakening response did not differ by physical activity level. Future studies testing the physical activity and cortisol regulation association should use standardized physical activity measures, follow guidelines for better quality cortisol sampling collection and analysis, and test relations in large-scale empirical studies to confirm the direction and causality of the effect.
... While S1 comprises only a singular value, several measures are available for capturing endocrine responses, such as the CAR. These include the area under the curve with respect to increase (AUC I ; Pruessner et al., 2003), the mean Increase (MnInc), the min-max difference (Miller et al., 2018) or a specific component added to a multilevel growth curve model (Adam et al., 2015). By contrast, measures that combine information on S1 and the CAR, particularly the area under the curve with respect to ground (AUC G ; Pruessner et al., 2003), are useful for capturing 'total post-awakening cortisol concentrations'. ...
... Concerning more stable, trait-like influences, recent meta-analytic evidence confirmed an association between ethnicity and both S1 as well as the CAR (Boileau et al., 2019), thus marking ethnicity as a relevant covariate to consider, although it is important to note that increasing evidence suggests that ethnic differences in cortisol are driven by sociocultural experiences such as differential exposure to discrimination (Adam et al., 2015;Boileau et al., 2019). Another trait-like factor, which was not mentioned in the guidelines report, relates to individual differences in the timing of circadian activity preference, i.e., morningness vs. eveningness chronotype. ...
The cortisol awakening response (CAR) is frequently assessed in psychobiological (stress) research. Obtaining reliable CAR data, however, requires careful attention to methodological detail. To promote best practice, expert consensus guidelines on the assessment of the CAR were published (Stalder et al., 2016, PNEC). However, it is unclear whether these highly cited guidelines have resulted in actual methodological improvements. To explore this, the PNEC editorial board invited the present authors to conduct a critical evaluation and update of current CAR methodology, which is reported here. (i) A quantitative evaluation of methodological quality of CAR research published in PNEC before and after the guidelines (2013-2015 vs. 2018-2020) was conducted. Disappointingly, results reveal little improvement in the implementation of central recommendations (especially objective time verification) in recent research. (ii) To enable an update of guidelines, evidence on recent developments in CAR assessment is reviewed, which mostly confirms the accuracy of the majority of the original guidelines. Moreover, recent technological advances, particularly regarding methods for the verification of awakening and sampling times, have emerged and may help to reduce costs in future research. (iii) To aid researchers and increase accessibility, an updated and streamlined version of the CAR consensus guidelines is presented. (iv) Finally, the response of the PNEC editorial board to the present results is described: potential authors of future CAR research to be published in PNEC will be required to submit a methodological checklist (based on the current guidelines) alongside their article. This will increase transparency and enable reviewers to readily assess the quality of the respective CAR data. Combined, it is hoped that these steps will assist researchers and reviewers in assuring higher quality CAR assessments in future research, thus yielding more reliable and reproducible results and helping to further advance this field of study.
... Thus, while exploring and solidifying their identities, adolescents are encountering a new stressor, PED, which impacts their mental and physical health (Grollman, 2012). Further, adolescents' experiences of PED have an even more profound impact on their physical health as adults than PED that occurs during adulthood (Adam et al., 2015). Thus, examining the impact of adolescents' experiences of PED is particularly important. ...
... Further, reports of PED have also been linked to depressive symptoms for adolescents (e.g., English et al., 2014;Hou et al., 2015;Weeks & Sullivan, 2019). It has been found that reports of PED during adolescence are more predictive of negative health symptoms in adulthood than PED that is reported during adulthood (Adam et al., 2015). Thus, chronic experiences of PED may contribute to sustained elevations in BP as a response to the experiences of PED, which may contribute to risk for poorer health not only in adolescence but in adulthood as well. ...
Perceived everyday discrimination (PED) is related to depressive symptoms and elevated systolic (SBP) and diastolic blood pressure (DBP) in adolescents. This is an especially important relation to investigate, as both depressive symptoms and high blood pressure (BP) are acknowledged risk factors for cardiovascular disease (CVD). However, the mechanisms underlying the relation among these variables is unknown. Based on the Response Style Theory, which supports that engaging in rumination after a stressful event contributes to depressive symptoms, and existing research that shows an association between rumination and increased BP following stressful events, one variable that might underlie this association is a type of rumination called brooding. In the current study, we proposed that brooding but not reflection rumination would mediate the relation of PED with depressive symptoms, SBP, and DBP. Our sample of 65 adolescents (35.4% female) aged 13 to 15 (M = 14.06, SD = 0.55) who identified as Black (50.8%), White (43.1%), and Mixed Race (6.1%) had their BP measured and completed self-reports of PED, rumination, and depressive symptoms. Mediation analyses were conducted for hypothesis testing. Brooding, reflection, and PED were significantly related to depressive symptoms. Further, brooding was a significant mediator between PED and SBP and between PED and DBP, and reflection was a significant mediator between PED and DBP. We found that the relation between these variables may not operate exactly as would be predicted based on extant research, thus highlighting the need for further investigation to minimize CVD risk experienced by members of underrepresented groups.
... Discrimination may also impact health through reduced access to healthcare [8], increased likelihood of working or living near harmful environmental exposures [9], and/or reduced access to education [10]. In addition, discrimination is widely recognized as a chronic psychosocial stressor [11,12] and has been associated with stressrelated dysregulation in bodily systems including flattening of diurnal cortisol slopes [13,14], increased systemic inflammation [15][16][17], and elevated blood pressure [18,19], as well as with composite measures of allostatic load [20]. ...
Perceived discrimination, recognized as a chronic psychosocial stressor, has adverse consequences on health. DNA methylation (DNAm) may be a potential mechanism by which stressors get embedded into the human body at the molecular level and subsequently affect health outcomes. However, relatively little is known about the effects of perceived discrimination on DNAm. To identify the DNAm sites across the epigenome that are associated with discrimination, we conducted epigenome-wide association analyses (EWAS) of three discrimination measures (everyday discrimination, race-related major discrimination, and non-race-related major discrimination) in 1,151 participants, including 565 non-Hispanic White, 221 African American, and 365 Hispanic individuals, from the Multi-Ethnic Study of Atherosclerosis (MESA). We conducted both race/ethnicity-stratified analyses as well as trans-ancestry meta-analyses. At false discovery rate of 10%, 7 CpGs and 4 differentially methylated regions (DMRs) containing 11 CpGs were associated with perceived discrimination exposures in at least one racial/ethnic group or in meta-analysis. Identified CpGs and/or nearby genes have been implicated in cellular development pathways, transcription factor binding, cancer and multiple autoimmune and/or inflammatory diseases. Of the identified CpGs (7 individual CpGs and 11 within DMRs), two CpGs and one CpG within a DMR were associated with expression of cis genes NDUFS5, AK1RIN1, NCF4 and ADSSL1. Our study demonstrated the potential influence of discrimination on DNAm and subsequent gene expression.
... Qualitative research on racially/ethnically diverse youth also observed differences such that Asians experienced more peer discrimination compared to Black and Latiné counterparts, whereas Black and Latiné youth experienced more discrimination from adults (Rosenbloom & Way, 2004). Indeed, just one instance of experiencing discrimination can act as a major, long-term stressor (Adam et al., 2015;Luo et al., 2012). ...
Although research has established the immediate, detrimental impact of discrimination on sleep, how changes in experiences of discrimination may be related to changes in sleep duration over multiple years is less clear. This three-year longitudinal study investigated: (1) intercept-only and linear trajectories of sleep and everyday discrimination across three years of high school; (2) ethnic/racial differences in these trajectories; and (3) the associations between changes in sleep and changes in everyday discrimination. The sample consisted of ethnically/racially minoritized adolescents from five northeast U.S. public high schools (n = 329; 70% female, 30% male, 0% non-binary; 42% Asian, 21% Black, 37% Latiné; Mage = 14.72, SD = 0.54). Latent growth curve models found that both sleep duration and everyday discrimination declined linearly throughout the first three years of high school and varied by race/ethnicity. Asian adolescents reported longer sleep duration in the 9th grade relative to Black and Latiné adolescents but underwent a significant decline such that these differences were no longer significant in the 10th and 11th grades. In addition, Black and Latiné, but not Asian, adolescents reported a significant decline in discrimination from the 9th–11th grades. Although average sleep duration declined for the entire sample, slower declines in discrimination were associated with faster decreases in sleep duration. This was particularly salient among Black adolescents. The current study contributes to research on ethnic/racial disparities in sleep by highlighting that everyday discrimination can have both an immediate and cumulative detrimental impact on sleep duration.
... Exposure to chronic stress may increase the risk of high BMI through multiple pathways, including behavioral responses to stress (e.g., increased food consumption and sedentariness); biochemical mechanisms (e.g., leptin, ghrelin, and neuropeptide Y production) modulating hunger and appetite; and metabolic dysregulation of the hypothalamic-pituitary-adrenal axis, mediating the neurohormonal stress response through cortisol production [65]. Cortisol dysregulation has been shown to affect Black and Hispanic adolescents disproportionately in comparison to their White counterparts, with evidence linking perceived racial discrimination and perception of safety among Black and Hispanic adolescents and adults to heightened cortisol levels [66,67]. ...
To examine the association between adherence to sleep, dietary, screen time, and physical activity (PA) (8-5-2-1-0) guidelines and risk of high body mass index (BMI ≥ 85 percentile) among U.S. adolescents and to assess for racial inequities and age-varying effects in these associations.
Data from the 2019 Youth Risk Behavior Surveillance System survey were used to conduct multivariable logistic regression models and moderation analysis by race/ethnicity and age using time-varying varying effect models (TVEM) and estimate associations of interest.
Of the 13,518 adolescents aged ≥ 14 years, only 0.5% met all guidelines. Adolescents adhering to sleep guidelines had a 21% reduction in their odds of having a high BMI (OR 0.79, 95% CI 0.67–0.93). Those adhering to PA guidelines had a 34% reduction in their odds of having a high BMI (OR 0.66, 95% CI 0.56–0.79), and those adhering to screen time guidelines had a 17% reduction in their odds of having a high BMI (OR 0.83, 95% CI 0.72–0.95). TVEM showed associations between adherence to sleep and screen time guidelines with high BMI fluctuate and are at specific ages. TVEM revealed substantial racial/ethnic differences in the age-varying association between adherence to 8-5-2-1-0 guidelines and high BMI throughout adolescence.
Associations between adherence to sleep and screen time guidelines and high BMI fluctuate with age, highlighting the need for nuanced interventions targeting 24-h movement guidelines (sleep, PA, and screen time) across adolescence, particularly given racial/ethnic disparities.
... The heterogeneities observed in this study highlight the pervasive impact of racism on the health and well-being of Black youth [63][64][65] . The disruption of the SES-impulsivity-substance use pathway among Black youth is a clear indication of how racism can undermine the protective effects of socioeconomic resources. ...
Background
Socioeconomic status (SES) is traditionally viewed as a protective factor against impulsivity and subsequent tobacco use in youth. The prevailing model suggests that higher SES is associated with lower impulsivity, which in turn reduces the likelihood of future tobacco use. However, this pathway may not hold uniformly across racial groups due to differences in impulsivity and the phenomenon of Minorities' Diminished Returns (MDRs), where the protective effects of SES, such as educational attainment, tend to be weaker or even reversed for Black youth compared to their White counterparts.
Objectives
This study aims to examine the racial heterogeneity in the pathway from childhood SES to impulsivity and subsequent tobacco use initiation during adolescence, focusing on differences between Black and White youth.
Methods
Data were drawn from the Adolescent Brain Cognitive Development (ABCD) Study, which includes a diverse sample of youth aged 9 to 16 years. The analysis examined the relationship between baseline family SES (age 9), impulsivity (age 9), and subsequent tobacco use (ages 9 to 16). Impulsivity was measured using the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, and Positive Urgency Impulsive Behavior Scale (UPPS-P). Structural equation modeling (SEM) was employed, with analyses stratified by race to explore potential differences in these associations.
Results
Overall, 6,161 non-Latino White and 1,775 non-Latino Black adolescents entered our analysis. In the full sample, higher family SES was linked to lower childhood impulsivity and, consequently, less tobacco uses in adolescence. However, racial differences emerged upon stratification. Among White youth, higher SES was associated with lower impulsivity, leading to reduced tobacco use, consistent with the expected model. In contrast, among Black youth, higher SES was not associated with lower impulsivity, thereby disrupting the protective effect of SES on tobacco use through this pathway. These findings suggest that racial heterogeneity exists in the SES-impulsivity-tobacco use pathway, aligning with the MDRs framework, which highlights how structural factors may weaken the protective effects of high SES among Black youth.
Conclusions
These findings underscore the importance of considering racial heterogeneity in the relationships between SES, impulsivity, and tobacco use. The observed disparities suggest a need for targeted interventions that address the unique challenges faced by Black youth, who may not experience the same protective benefits of high SES as their White peers. These results carry significant implications for public health strategies aimed at reducing tobacco use in racially diverse populations.
... Mechanisms linking minority stressors with poor sleep outcomes among minoritized adults are likely multifactorial. For instance, minority stressors are theorized to indirectly influence sleep by increasing vigilance or rumination (Bernard et al., 2022;Chae et al., 2021;Himmelstein et al., 2015), psychological distress (in the form of depression, anxiety, or anger) (MacIntyre et al., 2023;Nwanaji-Enwerem et al., 2022;Paradies et al., 2015), and physiological disruptions (e.g., hypothalamic pituitary adrenal dysregulation or overactivation of the sympathetic nervous system; Adam et al., 2015;Allen et al., 2019;Bell et al., 2019). ...
Objetivo: Determinar las asociaciones cotidianas entre los estresores de las minorías (es decir, la discriminación anticipada y experimentada) y los resultados de la salud del sueño (es decir, el tiempo total de sueño, los trastornos del sueño y los trastornos relacionados con el sueño) entre las personas de color de minorías sexuales y de género (SGM, por sus siglas en inglés). Métodos: Una muestra en línea de personas de color SGM que viven en los Estados Unidos participó en un estudio diario de 30 días. La discriminación diaria anticipada y experimentada, así como los resultados subjetivos del sueño, se evaluaron mediante diarios electrónicos utilizando medidas validadas. Se utilizó actigrafía en muñeca para evaluar objetivamente el tiempo total de sueño. Se utilizaron modelos lineales multinivel (MLM, por sus siglas en inglés) para estimar las asociaciones independientes de los estresores interseccionales diarios de las minorías con los resultados posteriores del sueño, ajustados por factores demográficos y discriminación a lo largo de la vida. Resultados: La muestra incluyó a 43 personas SGM de color con una edad media de 27.0 años (±7.7), de los cuales el 84% eran Latinx, el 47% eran multirraciales y el 37% eran bisexuales. Los resultados de los MLM indicaron que un mayor informe de discriminación experimentada diariamente se asoció positivamente con alteraciones del sueño la misma noche, B (SE) = 0.45 (0.10), p < .001. La discriminación diaria anticipada se asoció positivamente con el deterioro relacionado con el sueño al día siguiente, B (SE) = 0.77 (0.17), p < .001. Sin embargo, la discriminación diaria anticipada y experimentada no se asoció con el tiempo total de sueño la misma noche. Conclusiones: Los hallazgos resaltan la importancia de considerar los efectos diferenciales de los estresores minoritarios interseccionales diarios en la salud del sueño de las personas de color SGM. Se necesitan más investigaciones para identificar los factores que impulsan el vínculo entre los factores estresantes minoritarios diarios y los resultados del sueño para informar las intervenciones de salud del sueño adaptadas a esta población.
... However, chronic exposure to racial discrimination is also associated with daily cortisol patterns, with results documenting a flatter diurnal cortisol slope (less of a decline from waking to bedtime levels) (Skinner et al., 2011;Zeiders et al., 2014;Zilioli et al., 2023). Notably, this pattern has also emerged in longitudinal work (Adam et al., 2015), mirroring other stress-related changes in daily cortisol rhythm. Blunted diurnal rhythm is generally associated with biological dysregulation and has been previously associated with neuropsychiatric disorders such as PTSD (Garcia et al., 2020), highlighting yet another possible pathway by which racism may increase biological risk for poorer mental health (Skinner et al., 2011). ...
... As those with the highest enacted stigma showed significantly higher cortisol concentration before bedtime when compared to those with low enacted stigma, this finding along with our other results, allows us to speculate that high levels of stigma exposure recalibrate HPA-axis diurnal variation in two distinct ways: 1) blunted cortisol awakening response and 2) flattened diurnal declines leading to elevated cortisol concentrations before bedtime. Overall, our results align with previous literature which has reported an overall association between race-based discrimination and flattening of diurnal HPA-axis functioning among presumably heterosexual cisgender men and cisgender women (Adam et al., 2015) as well as sexual minority men presumed to be cisgender (Cook et al., 2017). Flattened, less dynamic diurnal responses may result from chronic exposure to stress that has been associated with negative health outcomes (Miller et al., 2007). ...
... In summary, the cumulative stress indicators of ACEs, perceived discrimination, bullying victimization, and perceived current stress may contribute to HPA axis dysregulation and influence cortisol levels (Adam et al., 2015;Carney et al., 2010;Zeiders et al., 2014), which has physical and mental health implications. Despite the growing evidence regarding exposure to stressful experiences at an early age and the association with cortisol dysregulation and negative health outcomes, such a relationship has not been examined among Arab American immigrants. ...
The prevalence of mental health problems among young adults is widely recognized. However, limited research has examined the mental health of Arab American young adults specifically. To address this gap in the literature, this study aimed to investigate the effects of multiple stressors including adverse childhood experiences (ACEs), discrimination, and bullying victimization on the mental health of first‐ and second‐generation Arab American young adults. The participants ( N = 162) were recruited from a Midwest university using online and in‐person methods. They were screened and completed a demographic questionnaire and self‐report measures of ACEs, discrimination, bullying victimization, and mental health. Hierarchical multiple regression analysis was conducted to examine the effect of psychosocial stressors on mental health and the moderating effect of generation (first vs. second) on that relationship. Female gender, increased perceived discrimination, and more ACEs were associated with lower mental health scores ( β = −0.316, p < 0.001, β = −0.308, p < 0.001, and β = −0.230, p = 0.002, respectively). There was a significant negative relationship between victimization and mental health for first‐generation Arab Americans ( β = −0.356, p = 0.010). However, that association all but disappeared for second‐generation participants ( β = 0.006, p = 0.953). The results highlight the impact of multiple adversities on Arab American young adults' mental health and indicate important nuances related to their generation in the association between bullying victimization and mental health. Implications for practice and future research are discussed.
... Adolescents are particularly vulnerable to the deleterious effects of discrimination due to their sensitivity to social evaluation (Sumter et al., 2010) and the fact that their identities and coping strategies are still developing (Spencer, 2007). The adverse effects of discrimination for children and adolescents are stronger compared to those for adults (Schmitt et al., 2014), and such negative impacts may carry over into adulthood (Adam et al., 2015). Therefore, it is imperative to gain a deeper understanding of adolescents' discriminatory experiences and identify avenues for interventions to combat the negative consequences associated with discrimination. ...
Using 10-day daily diary data collected in 2019 from 10th grade students in southern U.S. (N=161, 57% Latina/x/o, 21% Biracial, 10% Asian, 9% White, 4% Black; 55% female, Mage=15.51), this study examined various forms of peer-based discrimination in adolescents’ everyday lives. Results showed that personally experienced discrimination, peer racial teasing, and vicarious discrimination were frequent and impactful events. Results also provided strong evidence for the protective role of psychological resilience and some evidence for the protective-reactive roles of peer support and school climate in moderating the link between peer-based discrimination and daily well-being. The findings highlight the necessity to eliminate peer-based discrimination and shed light on interventions to reduce the harmful effects of peer-based discrimination on adolescents’ daily well-being.
... Indeed, there is strong evidence suggesting that exposure to the effects of systemic racism, including interpersonal racial discrimination and financial strain, during early adolescence has both adverse effects on current functioning and lasting impacts on health and functioning into adulthood (e.g., Adam et al., 2015;Cave et al., 2020;Ford et al., 2013). For example, previous research has found experiences of racial discrimination in youth to be associated with poor mental health outcomes such as depression, generalized anxiety, and psychological distress, as well as poor behavioral health outcomes such as cigarette and alcohol use (for review, see Benner et al., 2018). ...
This study examines whether shift-and-persist coping, a coping strategy defined by accepting challenges and remaining hopeful for the future, is associated with psychosocial and physical health and/or moderates the effects of contextual stress (i.e., racial discrimination, financial strain) on health among African American adolescents living in the rural Southeastern United States. Participants (N = 299, 56% boys, Mage = 12.91) completed measures of shift-and-persist coping, contextual stress, and psychosocial and physical health. Shift-and-persist coping was generally associated with better health but did not buffer the effects of contextual stress. Results suggest that shift-and-persist coping may serve as a source of resilience among African American adolescents living in a context where many experience heightened contextual stress.
... 33,34 In a 20-year longitudinal study of Black and White Americans followed from ages 12 to 32, discrimination during adolescence predicted more dysregulated cortisol activity outcomes than did discrimination during adulthood, and such effects of discrimination were more pervasive for Black Americans than their White American peers. 35 Unfortunately, when scholars have examined ethnic/racial disparities in DNAm profiles, their empirical studies have primarily focused on aging samples and cross-sectional approaches. ...
Ethnic/racial disparities in DNA methylation age profiles have been commonly captured in relatively small, community samples of individuals from a single age group. Whether such findings extend to large, national samples of individuals is unclear, especially in studies covering multiple developmental periods, including childhood, adolescence, and adulthood. These DNA methylation profiles linked to age can be used to derive epigenetic clocks as indices of pre-mature aging and inform possible cellular mechanisms linking ethnic/race-related adversities and ethnic/racial disparities in mortality and morbidity. Thus, the present descriptive study leveraged data from 3,349 individuals who participated in one of two national and ethnically/racially diverse studies, the Future of Families and Child Wellbeing (FFCW) study and the Midlife in the United States (MIDUS) Study. The FFCW study included repeated measures of children’s DNA methylation age profiles at age 9 (i.e., childhood) and age 15 (i.e., adolescence), and the MIDUS study included participants’ DNA methylation profiles at a single wave during adulthood. Results showed that ethnic/racial minorities exhibited more accelerated within-person changes in the GrimAge, PhenoAge, and Dunedin epigenetic clocks across childhood and adolescence and more accelerated between-person differences in the Dunedin epigenetic clock during adulthood. Collectively, both studies show robust ethnic/racial disparities in DNA methylation age profiles and underscore the need to address institutional racism and ethnocentrism in the United States.
... Because diurnal cortisol patterns have been found to vary with sex (e.g., Larsson et al., 2009;Netherton et al., 2004), percent of the sample identified as female was coded as a continuous moderator variable. Additionally, race/ethnicity has been associated with differences in diurnal cortisol patterns when examining potential adversity or stressors (e.g., DeSantis, Adam et al., 2015;Zeiders et al., 2014). Thus, the percent of the sample identified as a racial/ethnic minority was coded as a continuous moderator variable. ...
Childhood adversity has been associated with hypothalamic-pituitary-adrenal axis dysregulation, which is associated with mental and physical health consequences. However, associations between childhood adversity and cortisol regulation in the current literature vary in magnitude and direction. This multilevel meta-analysis examines the association between childhood adversity and diurnal cortisol measures, as well as potential moderators of these effects (adversity timing and type, study or sample characteristics). A search was conducted in online databases PsycINFO and PubMed for papers written in English. After screening for exclusion criteria (papers examining animals, pregnant women, people receiving hormonal treatment, people with endocrine disorders, cortisol before age 2 months, or cortisol after an intervention), 303 papers were identified for inclusion. In total, 441 effect sizes were extracted from 156 manuscripts representing 104 studies. A significant overall effect was found between childhood adversity and bedtime cortisol, r = 0.047, 95% CI [0.005, 0.089], t = 2.231, p = 0.028. All other overall and moderation effects were not significant. The lack of overall effects may reflect the importance of the timing and nature of childhood adversity to adversity's impact on cortisol regulation. Thus, we offer concrete recommendations for testing theoretical models linking early adversity and stress physiology.
... Studies that have investigated the biological impact of racial discrimination on health implicated stress, depression, inflammation, immune response, and accelerated cellular aging as mediators in this relationship. A 2015 prospective cohort study on perceived racial discrimination on diurnal cortisol levels showed that the effects of perceived racial discrimination on cortisol levels were more pervasive for Black individuals, especially during adolescence when developmental periods are more sensitive [150]. Stress and depressive symptoms have also been shown to mediate the relationships between discrimination and smoking and discrimination and obesity, with smoking and obesity being on their own major risk factors for cancer [151,152]. ...
Low socioeconomic status (SES) is associated with early onset of chronic diseases and reduced life expectancy. The involvement of neighborhood-level factors in defining cancer risk and outcomes for marginalized communities has been an active area of research for decades. Yet, the biological processes that underlie the impact of SES on chronic health conditions, such as cancer, remain poorly understood. To date, limited studies have shown that chronic life stress is more prevalent in low SES communities and can affect important molecular processes implicated in tumor biology such as DNA methylation, inflammation, and immune response. Further efforts to elucidate how neighborhood-level factors function physiologically to worsen cancer outcomes for disadvantaged communities are underway. This review provides an overview of the current literature on how socioenvironmental factors within neighborhoods contribute to more aggressive tumor biology, specifically in Black U.S. women and men, including the impact of environmental pollutants, neighborhood deprivation, social isolation, structural racism, and discrimination. We also summarize commonly used methods to measure deprivation, discrimination, and structural racism at the neighborhood-level in cancer health disparities research. Finally, we offer recommendations to adopt a multi-faceted intersectional approach to reduce cancer health disparities and develop effective interventions to promote health equity.
... ACEs and Related Life Events were measured using the PEARLS tool, an adversity screening tool developed with input from multiple staff and patient stakeholders [10]. The PEARLS tool includes the ten original ACE categories [2] and assessment of seven additional Related Life Events [10] thought to increase the risk of a toxic stress response [11] including separation from caregiver, caregiver death and caregiver physical illness as well as social determinants of health including food insecurity [12][13][14][15], housing instability [16][17][18], discrimination [19][20][21][22][23][24][25][26], and community violence (including police violence and bullying) [27]. Participants were randomized to: (1) no screening (control group), (2) screening with item-level response format of PEARLS tool (responses to each adversity were recorded as yes/no) or (3) screening with aggregate-level response format of PEARLS tool (responses were recorded as a total count, i.e., "How many of the following has your child experiences?'). ...
Background
While there is growing support for screening for Adverse Childhood Experiences (ACEs), rigorous evidence on the efficacy and preference of screening methods is needed.
Objective
To examine caregiver: (1) rates of disclosure of their child’s exposure to ACEs using item-level response (each item can be endorsed) versus aggregate-level response (only total score reported) screening format, (2) associations between family demographic factors and disclosure by screening format, and (3) emotional reaction and experience of screening formats in a diverse, low-income pediatric population.
Methods
Caregiver participants (n = 367) were randomized to complete the Pediatric ACEs and Related Life Events Screener (PEARLS) tool, in an aggregate-level response vs item-level response format from 2016–2019. Select caregivers (n = 182) participated in debriefing interviews. T-test and chi-square analyses in 2019 compared PEARLS disclosure rates and reactions between the screening modalities. Regression models explored interactions with child characteristics. Thematic analysis of interview notes captured caregiver screening experience.
Results
PEARLS disclosure rates were significantly higher in the aggregate-level response compared to the item-level response screening arm (p <0.05). This difference was accentuated for children identified as black and/or male (p <0.05). Caregiver reactions to PEARLS screening were rarely negative in either screening format. Qualitative data demonstrated strong caregiver preference for the item-level response format; additional themes include provider relationship, fear with disclosure, and screening outcome expectations.
Conclusion
While caregivers reported a preference for the item-level response format, the aggregate-level response screening format elicited higher disclosures rates particularly for children who are black or ma.
Trial registration
Clinical trial registry: NCT04182906.
... In summary, the cumulative stress indicators of ACEs, perceived discrimination, bullying victimization, and perceived current stress may contribute to HPA axis dysregulation and influence cortisol levels (Adam et al., 2015;Carney et al., 2010;Zeiders et al., 2014), which has physical and mental health implications. Despite the growing evidence regarding exposure to stressful experiences at an early age and the association with cortisol dysregulation and negative health outcomes, such a relationship has not been examined among Arab American immigrants. ...
Background:
The effect of multiple stressors on immigrant young adults' endocrine functioning and health outcomes has not been comprehensively investigated.
Aims:
This study tested a theoretical model of cumulative and current stressor effects on the hypothalamic-pituitary-adrenocortical (HPA) axis functioning and health-related quality of life (HRQL) among Arab American young adults.
Methods:
Using a cross-sectional design, we recruited 160 participants, ages 18 to 24 years, from an urban university in the Midwest. Cumulative stress was assessed by self-report measures of childhood adversity, bullying victimization, and perceived ethnic discrimination. Current perceived stress was measured using the Perceived Stress Scale (PSS) while cortisol levels were measured in participants' hair. Structural equation modeling tested the effects of cumulative and current stress on cortisol and HRQL.
Results:
Cumulative stress was negatively associated with HRQL (standardized path coefficient = -.51, p < .05). Interestingly, however, cumulative stress was inversely associated with hair cortisol level (standardized path coefficient = -.51, p < .05). Current stress was positively associated with cortisol level (standardized path coefficient = .43, p < .05) and negatively associated with the mental HRQL (standardized path coefficient < -.37, p < .05).
Conclusion:
Cumulative stress exhibited a different effect on HPA functioning from current perceived stress. Mental health was significantly impaired by both cumulative and current perceived stress. Implications for mental health nursing practice and research among Arab Americans are discussed.
... Indeed, greater perceptions of discrimination are associated with poorer psychological well-being, including greater anxiety, anger, loneliness, and depressive symptoms (e.g., Nadimpalli et al., 2015;Stein et al., 2019;Sutin et al., 2015), some of which have been shown to mediate the link between perceived discrimination and cognition (e.g., Zahodne et al., 2017aZahodne et al., , 2017b. Perceptions of discrimination are also associated with stress-related physiological pathways such as elevated cortisol and systemic inflammation (e.g., Adam et al., 2015;Friedman et al., 2009). These biological markers of stress are associated with reduced cognitive function (Lupien et al., 2009) and have been shown to mediate the perceived discrimination-cognition link. ...
Objectives
Hispanic/Latinx adults are at increased risk for cognitive impairment, and it is critically important to identify modifiable risk factors for cognitive impairment in this population. We addressed two key questions: (1) How does perceived discrimination change across middle adulthood? And (2) How are discrimination and the trajectory of discrimination associated with cognitive function?
Methods
We used data from 1110 Mexican-origin adults between 26 and 62 years old (63% female; 85% born in Mexico). Participants completed a perceived ethnic discrimination scale five times across 12 years and completed cognitive assessments in the last wave, which were composited into a measure of overall cognitive function. We used latent growth curve models to estimate the longitudinal trajectory of perceived ethnic discrimination and growth mixture models to identify sub-groups of change trajectories. We evaluated whether patterns of perceived discrimination trajectories, baseline, intermediary, and concurrent discrimination predicted cognitive function at the last wave.
Results
Perceived ethnic discrimination decreased over time on average. Significant individual differences in within-person change revealed two change trajectory classes: Stable Low and High Declining. The Stable Low class had better cognitive performance compared to the High Declining class, but this effect was not robust to educational attainment. Perceived discrimination at the last wave was associated with worse cognitive function, and this effect remained after accounting for covariates.
Conclusions
This study is among the first to evaluate changes in perceived ethnic discrimination in a sample of Mexican-origin adults and their associations with cognitive function. The results highlight the need for more research to better understand the role of discrimination and other social stressors on cognitive health outcomes.
... Further, the study utilized a college-based sample that may not serve as an adequate representation of Latinx young adults. Moreover, research has demonstrated perceived discrimination may lead to cumulative negative effects on the brain's stress response system across development (Adam et al., 2015), suggesting replication of this model from a developmental perspective could be critical in understanding the complex interactions that increase risk for the development of suicide related thoughts and behaviors in racial/ethnic minority groups. Future research should endeavor replication with a broader Latinx sample to better identify significant relations between perceived discrimination, depressive symptoms, familismo, and suicide-related thoughts and behaviors through a developmental lens. ...
In recent years, there has been a significant increase in rates of suicide-related thoughts and behaviors among Latinx young adults. Given Latinx young adults are one of the fastest growing subgroups in the United States, this raises significant public health concern. Perceived discrimination has consistently been identified as a risk factor and has been positively associated with depressive symptoms, further exacerbating risk for the development of suicide-related thoughts and behaviors. Critical to understanding Latinx mental health is familismo, a core cultural value that entails connectedness, dedication, commitment, and loyalty to family. Moreover, it involves seeking family for advice and support. The current study sought to examine depressive symptoms as mediator for the relation between perceived discrimination and suicide-related thoughts and behaviors while investigating familismo as a moderator in attenuating these relations within a college aged Latinx sample (N = 1037, 75.3 % female, Mage = 21, SD = 4.49). Across models, depressive symptoms explained the relation between perceived discrimination and suicide-related thoughts and behaviors (p ≤0.001–0.024) with familismo significantly acting as moderator (p = .009). In exploring the protective effects of an important Latinx cultural value on a growing public health disparity, the current study provides novel insight that may be used to tailor and adapt current intervention and prevention efforts for Latinx young adults at risk for suicide-related thoughts and behaviors.
... Yet, our pattern of findings aligns with studies that have used non-survey measures of discrimination and adolescents' adjustment outcomes. [37][38][39] Also, the intensive longitudinal nature of the present study provided us with a 58-day snapshot of youths' experiences, which is a relatively short time period. Scholars should consider a more longterm longitudinal study to understand whether and how our findings hold over the course of adolescence. ...
Objective
To determine whether rates of online racial discrimination changed over the course of 2020 and their longitudinal effects on Black youth’s mental health.
Method
This longitudinal study collected 18,454 daily assessments from a nationally representative sample of 602 Black and White adolescents in the United States (58% Black, 42% White; Mage = 15.09, SDage = 1.56) across 58 days during the heightened racial tensions between March and November 2020.
Results
Black youth experienced increases in online racial discrimination, and these increases were not fully explained by time spent online nor general cybervictimization experiences. Online racial discrimination predicted poorer same- and next-day mental health among Black youth but not among White youth. Black youth’s mental health did not predict their online racial discrimination experiences.
Conclusion
Online racial discrimination has implications for shaping mental health disparities that disadvantage Black youth relative to their White peers. Programs can be implemented to decrease online hate crimes, and health providers (e.g., pediatricians, psychiatrists) should develop procedures that mitigate the negative mental health effects following online racial discrimination experiences.
... Cortisol is the hormonal end-product of the hypothalamic-pituitaryadrenal axis which is activated to cope with stressful stimuli (McEwen, 1998). After encountering physical stressors, such as pain (Zimmer et al., 2003) or psychosocial stressors, such as experiences of racial discrimination (Adam et al., 2015;Palmer-Bacon et al., 2020), the stress response system triggers limbic neurocircuitry activation. Alongside emotion-related structures, the hypothalamus is prompted to initiate a hormonal cascade (Tsigos and Chrousos, 1994) that culminates in the production and secretion of glucocorticoids from the adrenal glands (Munck et al., 1984), including cortisol. ...
The biomarker cortisol assesses the impact of biopsychosocial stressors that activate the stress response system. Hair has emerged as a valid and non-invasive means of gauging cumulative cortisol deposited over month-long periods of time. Established protocols for the extraction of hair cortisol are being validated and refined in humans, yet methodological information about hair characteristics on cortisol remains limited. In addition to external hair exposures (e.g. dye, time spent outside), we examined hair categorization or type (e.g. kinky, straight) by extending a hair typing methodology for scientific use that is currently popular among hair care professionals. We then examined the interaction between hair type and race on cortisol levels with a hair questionnaire. Three studies were pooled to investigate how sample weight, hair type, race, heat exposures, and hair treatments impacted cumulative hair cortisol concentrations. Study 1 consisted of Adult Kenyan Medical Workers (N=44); Study 2 Mexican and Mexican Americans (N=106); and Study 3 American Youth (N=107). We found significantly higher cortisol in 5 mg of hair when compared to larger sample weights, and higher cortisol in those who spent more time outdoors. Cortisol concentrations differed between racial groups and varied by hair type; moreover, there were directional differences in cumulative cortisol from straighter to curlier hair types which depended on racial group. In addition to demonstrating the impact of relatively novel control factors like hair sample weight, outdoor exposure, and hair type, the present study illustrates the importance of disentangling hair type and race to understand variability in cumulative hair cortisol. These influences should be included in future studies that measure hair cortisol.
... These findings correspond well to the small number of previous studies in this field, which found positive associations between ethnic discrimination and hair cortisol levels in a sample of African Americans (Lehrer et al., 2020), in ethnically diverse samples in the US (Yip et al., 2021), and in Canadian First Nation communities (Henley et al., 2013). Moreover, our finding of higher long-term cortisol levels with a reduced cortisol reactivity to acute ethnic discrimination in the high group may also tie in with two studies linking ethnic discrimination to a higher overall diurnal cortisol secretion (Adam et al., 2015;Skinner et al., 2011). While the literature on ethnic discrimination and diurnal cortisol is still relatively mixed (Busse et al., 2017), overactivation of the HPA axis might occur in persons affected by chronic ethnic discrimination (Miller et al., 2007), and might be mirrored by higher cumulative cortisol levels measured in the hair. ...
Objective
Ethnic discrimination negatively affects the health of ethnic minorities. The dysregulation of psychobiological stress systems, such as the autonomic nervous system (ANS) or the hypothalamic-pituitary-adrenal (HPA) axis, might be an intermediary in this association and chronicity of ethnic discrimination may matter. We studied stress responses to a standardized discriminatory event in Turkish immigrants living in Austria.
Background
Seventy-two male Turkish immigrants were recruited; n = 35 had experienced high levels of ethnic discrimination (high), n = 37 infrequent ethnic discrimination (low). During a two-hour laboratory appointment, they underwent a previously validated 10-minute ethnic discrimination paradigm, i.e., a simulated physician’s consultation with verbal and non-verbal discriminatory cues. Perceived stress, perceived discrimination, salivary cortisol, and alpha-amylase were assessed seven times, and ANS measures (heart rate, heart rate variability, and electrodermal activity) were measured continuously. In addition, hair cortisol concentrations were determined.
Results
The ethnic discrimination paradigm elicited stress responses across all outcomes in both groups. Compared to the low group, the high group reported higher levels of perceived stress and discrimination, exhibited a less steep increase in cortisol in response to the paradigm, and showed higher hair cortisol concentrations. No group differences were found regarding ANS measures.
Conclusions
The combination of high subjective stress, flattened cortisol responses, and relatively high hair cortisol concentrations may indicate a dysregulation of the HPA axis in chronic ethnic discrimination. A better understanding of the psychobiological effects of chronic ethnic discrimination is crucial given that alterations in stress response systems may, over time, lead to illness and ultimately to substantial health inequities in ethnic minorities.
Black babies and their mothers are dying at disproportionately high rates. Also, Black women are experiencing higher rates of racial discrimination than other racial-ethnic groups are facing in the United States. An intervention promoting the health of Black women and their unborn babies requires addressing the disproportionate level of racial stress that Black women experience. In this article, the creation of such a program is discussed. To consider individual, community, and systemic factors, three theoretical models were utilized: (a) Race-based traumatic stress injury, (b) stress-health model, and (c) racial identity model. This intervention was co-developed with community stakeholders by using community-based participatory research principles. This process resulted in the development of the Afya Black Women Wellness program, a multidimensional and strength-based intervention grounded in the experiences of Black women. Afya focuses on promoting holistic health through psychoeducation, skills building, and social support. The program is constructed to be implemented twice-a-week for 12 weeks. This will allow pregnant Black women to receive the maximum benefit from the program, improving the quality of life for themselves and their unborn children. Ameliorating health disparities in Black maternal health requires addressing the disproportionate amount of racial stress that Black women experience. Afya is a model intervention that provides practical strategies for addressing racial health inequities in Black maternal health. It does so by promoting the health of Black women at the individual and community levels.
Parental ethnic‐racial socialization is a source of adolescents' resilience against ethnic‐racial discrimination. Recent meta‐analyses have documented the promotive aspects of ethnic‐racial socialization (i.e., how ethnic‐racial socialization is directly related with adolescents' adjustment regardless of their discrimination experiences). However, extant empirical studies have produced conflicting results about the protection or moderating role of ethnic‐racial socialization, with studies suggesting that ethnic‐racial socialization buffers, exacerbates, or does not moderate the impacts of ethnic‐racial discrimination. We offer a reconceptualization of existing studies' findings and draw from existing theories to propose Hidden Resilience as a new conceptual framework that highlights how resilience and the positive benefits linked to ethnic‐racial socialization may not be noticeable when studies use psychosocial measures but is rather hidden “underneath the skin.” Conversations about racism may momentarily feel uncomfortable, upsetting, or stressful for youth, but such conversations can help youth learn how to cope with ethnic‐racial discrimination in the long term. Following a review of studies supporting our conceptual framework, we provide suggestions for future research to expand the field's understanding of resilience linked to ethnic‐racial socialization.
Black men experience poor health outcomes across a spectrum of chronic medical conditions and co-morbidities that ultimately lead to lower quality of life and premature death. Lack of access to medical care is one of many factors that contributes to these poor outcomes. This study examines the impact of the Patient Protection and Affordable Care Act of 2010 (ACA) on Black men’s access to care compared to White men ages 18-64; and proposes strategies to help address any inequities. The ACA undergirds this study because it includes several provisions that are specifically meant to help address racial and ethnic health disparities and improve health outcomes.
This study took a longitudinal approach by examining access to care among non-Hispanic Black men and non-Hispanic White men ages 18-64 from 2011-2019. Using a publicly available secondary data source, the Medical Expenditure Panel Survey (MEPS), a descriptive and multi-variate analysis was conducted to examine the relationship between race, sociodemographic characteristics, and two indicators of health care access (insurance status and usual source of care). To statistically test hypotheses regarding the impact of the ACA on racial differences in these two indicators, an interaction term for race and two time periods (2011-2014 vs. 2015-2019) was included in regression models.
The analysis found that the ACA decreased the proportions of non-Hispanic Black men and non-Hispanic White men who were uninsured after 2014 by nearly 50%; however, racial disparities persisted. Other key findings are as follows: 1) race was a significant predictor of being uninsured, with non-Hispanic Black men having 30% greater odds than non-Hispanic White men of being uninsured and 2) non-Hispanic Black men had 25% lower odds than non-Hispanic White men of having a usual source of care. Other factors significantly associated with a greater likelihood of being uninsured were being part-time and intermittently employed and living in a Southern state. Factors significantly associated with a greater likelihood of not having a usual source of care were education (i.e., completing high school, college degree) full-time, part-time, or intermittent employment, and region (living in the South or the West).
While the ACA achieved one of its goals of increasing health insurance coverage for men of both racial groups examined in this study, the racial gap between non-Hispanic Black men and non-Hispanic White men did not close for the two outcomes of interest – being uninsured or having a usual source of care post-ACA. These findings have implications for policy and practice to improve health care access. Specific policy recommendations proposed include: 1) develop pathways to coverage for states that have yet to adopt Medicaid expansion and 2) use a multilevel approach to expand the proportion of men with a usual source of care that includes: a) disseminating educational messages to improve men's awareness of the value of having a regular source of care and b) facilitating health care delivery and payment reforms that incentivize health care institutions to increase the number of Black men who are meaningfully engaged with a regular source of care.
Keywords: Black men, Affordable Care Act, access to care, equity, policy, advocacy
A robust literature is developing around how the stress of discrimination is implicated in individual‐ and group‐level sleep disturbances, and how these disturbances contribute to the development of population‐level sleep disparities over time. Although discrimination can be based on many individual and intersecting biases, like gender, sexuality, socioeconomic status, and education, in this article, we focus on discrimination rooted in ethnicity and race because of the well‐founded documentation of disparities in sleep by race. Focusing primarily on adolescence and young adulthood, we integrate research linking ethnic and racial discrimination to sleep across a variety of methods and developmental time spans, ending with reflections on interventions. In so doing, we seek to advance research and encourage conversations that cross‐fertilize collaborations between those with interests in discrimination, sleep, and population‐level health equity.
Amidst this era of rapid technological advancement, the impact of White dominance in STEM causes inequity throughout the design, implementation, and function of modern technologies. Evidence of this includes AI systems that perpetuate racial and gender biases, medical devices that are incompatible with non-White medical needs, and hiring algorithms that prioritize the White male experience. Though not a panacea, greater representation of traditionally marginalized groups in the STEM workforce will help reduce and safeguard against digital racism, sexism, and ableism. Advocates of greater representation in STEM fields suggest that makerspace pedagogy and design that is rooted in equity and inclusivity can attract students from traditionally marginalized groups and make STEM more accessible and welcoming to all. To this end, this paper proposes a modification of the TPACK theoretical framework (Koehler and Mishra in Contemp Issues Tech Teach Educ 9(1):60–70, 2009) that centers knowledge of technological and inclusive practices in Makerspaces, giving rise to the Maker Technology, Pedagogy, Inclusion, and Content Knowledge (MakerTPICK) theoretical framework. Additionally, this paper presents the Makerspace Planning, Implementation, Establishment, and Reassessment (PIER) conceptual framework. This framework outlines the process for makerspace leaders to create and sustain an inclusive makerspace through the MakerTPICK framework, be they teachers in a school setting or makerspace coordinators outside of the field of K-12 education. The paper describes future implications for these frameworks in terms of practical applications for makerspaces and applied to research settings.
There is a dearth of knowledge in the coping literature on how minoritized youth cope with racism‐related stressors and the predictors of effective coping responses. This two‐wave study examined the direct and indirect effects of ethnic‐racial socialization on depressive and anxiety symptoms via proactive coping with discrimination in a community sample of 135 Latinx adolescents ( M age = 16, SD = 1.27; 59% female). Results indicate that cultural socialization was related to higher use of proactive coping with discrimination 6 months later, which in turn, was related to fewer depressive and anxiety symptoms. There were no direct or indirect effects between preparation for bias and mental health outcomes.
Background:
Allostatic load (AL) is associated with a heightened predisposition to disease due to prolonged activation of biological stress-response systems. Alcohol use disorder (AUD) is known to activate these systems. The primary aim of the current study was to examine the relationship between AL and AUD.
Methods:
Participants were males (100%) with DSM-IV Alcohol Dependence (n = 48) and healthy participants with no history of substance use disorder (n = 17). Participants with AUD were 4-6 weeks abstinent. The AL index used cortisol, interluken-6 (IL-6), fibrinogen, tumor necrosis factor-alpha (TNFa), C-reactive protein (CRP), glucose, insulin, leptin, pulse, systolic blood pressure readings, diastolic blood pressure readings, and body mass index (BMI). Physiological dysregulation for each biological measure was determined based on values within the 25th or 75th percentiles; AL was calculated as the total number of physiologically dysregulated biological measures.
Results:
No differences in mean AL scores between the cases and controls (t(63) = .48, p = .63) were observed. Among cases, AL was not associated with lifetime drinks per drinking day (F(2, 42) = .42, p = .66), lifetime total drinks (F(2, 42) = .48, p = .62), total drinks 6-months prior to participating in the study (F(2, 43) = .58, p = .56), or drinks per drinking day at 3-month follow-up (F(2, 35) = 1.93, p = .16). AL was negatively associated with drinks per drinking day 6-months prior to study participation (F(2, 42) = 3.71, p = .033).
Conclusions:
The hypotheses were not supported. Given that alcohol is likely to lead to physiological dysregulation, the apparent absence of a relationship between biomarkers of cumulative stress as indicated by AL and drinking status was both unanticipated and remarkable. Based on the results, AL in the context of drinking status or drinking among males with AUD may not be applicable.
Although research has overwhelmingly demonstrated the negative consequences of perceived racial–ethnic discrimination on children’s and youth’s well-being and academic outcomes, context- and perpetrator-specific discrimination experiences are rarely disaggregated. Racial–ethnic discrimination in the school environment is common, and the perpetrators are often teachers who may treat racial–ethnic minority students unfairly. This work used a three-level multilevel approach to meta-analytically synthesize existing evidence with the aim to (a) document the links between perceived teacher-based racial–ethnic discrimination (TBRED) and students’ psychological, behavioral, and physical well-being, substance use, grade point average and school motivation, and (b) to examine whether these associations differ by sample and study characteristics. Based on 68 studies and 259 effect size estimates, we found that perceived TBRED is linked to lower well-being (r = −.15, 95% confidence interval [CI] [−.18, −.12]), higher substance use (r = .13, 95% CI [.06, .20]), and lower academic performance (r = −.16, 95% CI [−.20, −.13]) with substantial heterogeneity across effect sizes. Similarly, TBRED had small-to-medium negative associations within each domain of well-being and academics. The results were partially moderated by school racial–ethnic composition, suggestive of a protective function of a higher concentration of racial–ethnic minority students. In addition, more reliable scales and a greater number of items measuring TBRED were associated with stronger negative correlations with well-being. These findings highlight the importance of increasing awareness around issues of racism and discrimination in initial teacher training and professional development. We encourage further exploration of effect size heterogeneity and call for research on TBRED outside the United States.
Experiences of discrimination can be major life events or daily chronic hassles that occur in various social contexts (e.g., housing, education, employment) and have been found to predict adverse health outcomes, including dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. Previous work on daily cortisol dynamics has generally revealed an association between discrimination and flatter cortisol slopes, particularly among racial minorities. However, most of the existing studies have focused on youth and young adults, with little work among older adults. The current study aimed to investigate the relationship between three measures of discrimination (lifetime discrimination, habitual everyday discrimination, and daily everyday discrimination) and diurnal cortisol secretion in a sample of 203 older African Americans. Study results indicated that individuals reporting higher levels of lifetime discrimination experienced morning hypocortisolism and flatter diurnal cortisol slopes. Exploratory analyses also showed that prior daily everyday discrimination was significantly associated with blunted cortisol awakening response (CAR) the next day. Our findings underline the role of discrimination in modulating daily cortisol dynamics among older African American adults and advance knowledge on how social stressors influence healthy aging.
Objective:
Black-White disparities in physiological stress during adolescence are increasingly evident but remain incompletely understood. We examine the role of real-time perceptions of safety in the context of everyday routines to gain insight into the sources of observed adolescent racial differences in chronic stress as measured by hair cortisol concentration (HCC).
Method:
We combined social survey, ecological momentary assessment (EMA), and hair cortisol data on 690 Black and White youth ages 11-17 from wave 1 of the Adolescent Health and Development in Context (AHDC) study to investigate racial differences in physiological stress. Individual-level, reliability-adjusted measures of perceived unsafety outside the home were drawn from a week-long smartphone-based EMA and tested for association with hair cortisol concentration.
Results:
We observed a statistically significant interaction (p < .05) between race and perceptions of unsafety. For Black youth, perceived unsafety was associated with higher HCC (p < .05). We observed no evidence of an association between perceptions of safety and expected HCC for White youth. For youth who perceive their out-of-home activity locations to be consistently safe, the racial difference in expected HCC was not statistically significant. At the high end of perceived unsafety, however, Black-White differences in HCC were pronounced (0.75 standard deviations at the 95th percentile on perceived unsafety; p < .001).
Discussion:
These findings call attention to the role of everyday perceptions of safety across non-home routine activity contexts in explaining race differences in chronic stress as assessed by hair cortisol concentrations. Future research may benefit from data on in situ experiences to capture disparities in psychological and physiological stress.
Background
Research suggests adolescent depression is increasing and certain adolescents may be uniquely vulnerable. However, limited conceptualizations of identity and time, as well as the reliance on unitary conceptualizations of depression, inhibits a nuanced perspective on these trends. In response, we examined how adolescent depressive symptoms, depressed mood, and anhedonia, vary across intersecting identities over time.
Methods
Secondary data analysis on the National Survey on Drug Use and Health between 2009 and 2017 was conducted. In total 145,499 nationally representative adolescents (ages 12–17) completed a diagnostic assessment for depression. Lifetime and past year reports of depressive symptoms, depressed mood, and anhedonia were treated as separate variables. A novel, mixed-level model in which participants were nested within identity (defined by one's age, gender, race/ethnicity, poverty level) and time was used to test our aims.
Results
Overall, the relation between depression outcomes and identity did not vary over time (p > .01). Further, identity's impact on depression was approximately ten-fold that of temporal effects. Multiracial, late adolescent, female adolescents were at particular risk. Findings concerning depressed mood and anhedonia were similar across analyses.
Limitations
All facets of identity (e.g., sexual identity) were not included in the model and a unidimensional measure of poverty may have underestimated its depressogenic influence.
Conclusion
Adolescent depression outcomes are mostly consistent across criterial symptom subtypes and time, but vary as a function of identity. Prevention protocols that highlight mechanisms of risk tethered to social identity, and include salient experiences of females, late adolescents, and multiracial youth in particular, need to be prioritized in mental health initiatives.
Although research has overwhelmingly demonstrated the negative consequences of perceived racial-ethnic discrimination on children’s and youth’s well-being and academic outcomes, context- and perpetrator-specific discrimination experiences are rarely disaggregated. Racial-ethnic discrimination in the school environment is common, and the perpetrators are often teachers who may treat racial-ethnic minority students unfairly. This work used a three-level multilevel approach to meta-analytically synthesize existing evidence with the aim of 1) documenting the links between perceived teacher-based racial-ethnic discrimination (TBRED) and students’ psychological, behavioral, physical well-being, substance use, grade point average and school motivation, and 2) examining whether these associations differ by sample and study characteristics. Based on 68 studies and 259 effect size estimates, we found that perceived TBRED is linked to lower well-being (r = -0.15, 95% [-0.18, -0.12]), higher substance use (r = 0.13, 95% [0.06, 0.20]), and lower academic performance (r = -0.16, 95% [-0.20, -0.13]) with substantial heterogeneity across effect sizes. Similarly, TBRED had small-to-medium negative associations within each domain of well-being and academics. The results were partially moderated by school racial-ethnic composition, suggestive of a protective function of a higher concentration of racial-ethnic minority students. In addition, more reliable scales and a greater number of items measuring TBRED were associated with stronger negative correlations with well-being. These findings highlight the importance of increasing awareness around issues of racism and discrimination in initial teacher training and professional development. We encourage further exploration of effect size heterogeneity and call for research on TBRED outside the United States.
Background
Immigrants from Turkey experience health disadvantages relative to non-immigrant populations in Germany that are manifest from the earliest stages of the lifespan onwards and are perpetuated across generations. Chronic stress and perturbations of stress-responsive physiological systems, including the hypothalamus-pituitary-adrenal (HPA)-axis, are believed to in part mediate this relationship. Cortisol plays an important role in the association between maternal stress during pregnancy and many pregnancy-, birth- and offspring-related outcomes. We therefore examined whether maternal migrant background is associated with diurnal cortisol variation during pregnancy.
Methods
109 pregnant women (incl. n = 32 Turkish origin women) that participated in a multi-site prospective cohort study in Germany collected saliva samples across the day on two consecutive days around 24 and 32 weeks gestation. Hierarchical linear models were applied to quantify associations between migrant background and diurnal cortisol variation across pregnancy.
Results
Women of Turkish origin exhibited a significantly lower cortisol awakening response (CAR) and a flatter diurnal cortisol slope (DCS) compared to non-migrant women after adjusting for household income. These relationships between migrant status and diurnal cortisol variation were mainly driven by 2nd generation migrants.
Discussion
A potential HPA axis dysregulation of Turkish-origin pregnant women may contribute to the intergenerational transmission of health disadvantages in this group.
Objective
U.S. Latino/a adolescents experience high levels of ethnic discrimination, particularly in new immigrant destinations. Due to the salience of peers during adolescence, this study examined how peer discrimination related directly and indirectly, through deviant peer affiliation, to changes in Latino/a adolescents’ internalizing and externalizing symptoms. Culture-specific moderators hypothesized to buffer discrimination impacts on adolescent symptomology included Spanish language enculturation and adolescents’ social ties to relatives in the family’s country-of-origin.
Method
The sample of 547 Latino/a adolescent participants from the Caminos al Bienestar study (55.4% female; age M = 12.8, range = 11–16) was selected at random from middle schools in a large, suburban school district in Atlanta, Georgia. Three time points of survey data spaced roughly 6 months apart were collected during 2018 and 2019.
Results
Results from longitudinal structural equation models revealed that peer discrimination was associated indirectly with increased externalizing symptoms, through increases in affiliation with deviant peers (β = 0.05; SE = 0.02; B = 0.02; 95% CI = 0.01, 0.09). We did not observe direct or indirect effects of peer discrimination on changes in internalizing symptoms, and we found no significant protective effects of either Spanish language enculturation or social ties with the country-of-origin.
Conclusions
Ethnic discrimination by peers may lead to deviant peer affiliation and, in turn, increased externalizing behaviors. Future research identifying protective factors that buffer discrimination impacts on deviant peer affiliation is needed to inform the development of interventions that can prevent Latino/a adolescents’ externalizing symptoms.
Psychiatry and allied disciplines have recognized the potency of structural and social determinants of mental health, yet there has been scant attention given to the roles of neurobiology in the links between structural and social determinants and mental health. In this article, we make the case for why greater attention must be given to structural and social determinants of biological psychiatry by researchers, practitioners and policy-makers. After defining these terms and theoretical frameworks for considering their relevance in biological psychiatry, we review empirical research with marginalized and minoritized racial, ethnic, gender, sexual and economic communities that reveals the ways in which structural and social determinants affect neurobiological functioning with implications for mental health. We give particular emphasis to developmental science and developmentally-informed research, as structural and social determinants influence neurobiological adaptation and maturation across the lifespan. We conclude with recommendations for advancing research, practice and policy connecting biological psychiatry with structural and social determinants of health. Foremost among these is diversifying the ranks of biological psychiatry, from the classrooms through the laboratories, hospitals and community health centers. Transforming and advancing the understanding of the structural and social determinants of neurobiology and mental health is most likely to come through transforming the discipline itself.
Background: Poorly coordinated diurnal cortisol and circadian rest-activity rhythms predict earlier mor tality in metastatic breast and colorectal cancer, respectively. We examined the prognostic value of the diurnal cortisol rhythm in lung cancer. Methods: Lung cancer patients (n = 62, 34 female) were within 5 years of diagnosis and had primarily non small-cell lung cancer, with disease stage ranging from early to advanced. Saliva collected over two days allowed calculation of the diurnal cortisol slope and the cortisol awakening response (CAR). Lymphocyte numbers and subsets were measured by flow cytometry. Survival data were obtained for 57 patients. Cox Proportional Hazards analyses were used to test the prognostic value of the diurnal cortisol rhythm on survival calculated both from study entry and from initial diagnosis.
Although ethnic and racial identity (ERI) are central to the normative development of youth of color, there have been few efforts to bring scholars together to discuss the theoretical complexities of these constructs and provide a synthesis of existing work. The Ethnic and Racial Identity in the 21st Century Study Group was assembled for this purpose. This article provides an overview of the interface of ERI with developmental and contextual issues across development, with an emphasis on adolescence and young adulthood. It proposes a metaconstruct to capture experiences that reflect both individuals’ ethnic background and their racialized experiences in a specific sociohistorical context. Finally, it presents milestones in the development of ERI across developmental periods.
Speculation that adverse early life events can have a deleterious effect on the course of human development dates back at least 2 centuries. However, it was not until the second half of the 1900s that a causal link between early adversity and poor developmental outcomes was made, and it was not until the last 20 years that the biological mechanisms that may underpin this association have been identified. Advances in both neuroscience and genetics have increasingly shed light on how early experience “gets under the skin.” Whether we adopt the term developmental programming or biological embedding, the construct remains the same: early experience weaves its way into the neural and biological infrastructure of the child in such a way as to impact developmental trajectories and outcomes.
Alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning have been associated with major depression disorder (MDD) and some anxiety disorders. Few researchers have tested the possibility that high levels of recent life stress or elevations in negative emotion may partially account for the HPA axis alterations observed in these disorders. In a sample of 300 adolescents from the Youth Emotion Project, we examined associations between MDD and anxiety disorders, dimensional measures of internalizing symptomatology, life stress, mood on the days of cortisol testing, and HPA axis functioning. Adolescents with a past MDD episode and those with a recent MDD episode comorbid with an anxiety disorder had flatter diurnal cortisol slopes than adolescents without a history of internalizing disorders. Higher reports of general distress, a dimension of internalizing symptomatology, were also associated with flatter slopes. Negative emotion, specifically sadness and loneliness, was associated with flatter slopes and partially accounted for the associations between comorbid MDD and anxiety disorders and cortisol. The associations between past MDD and cortisol slopes were not accounted for by negative emotion, dimensional variation in internalizing symptomatology, or levels of life stress, indicating that flatter cortisol slopes may also be a "scar" marker of past experiences of MDD.
How is adolescent functioning related to experiences of connection, regulation, and supportfor autonomy at home, in school, and with peers? Using datafrom the Maryland Adolescent Growth in Context (MAGIC) study (an ongoing longitudinal study of 1,387 African Amenrican and European American adolescents and theirfamilies), it was found that: (a)family demographic characteristics helped predict only academicperformance; (b) although positive experiences on one indicator predicted positive experiences on the other two, each of the three types of experience explained a unique amount of variance in adolescentfunctioning (e.g., regulation related most strongly to externalizing behaviors; in contrast, supportfor autonomy related to all aspects offunctioning); (c) although adolescents with positive interactions in one context were likely to have positive interactions in the other contexts, characteristics of each context explained unique amounts of variance infifuctioning (e.g., experiences with siblings emerged as uniquely important predictors of mental health).
This chapter provides a viable conceptual framework for the study of Black child socialization processes. First, there is considerable complexity attendant to Black family life in America. A multiplicity of socialization agendas must be negotiated simultaneously. The demands that result from having to cope within the America social context are multifaceted and inherently contradictory. Consequently, a conceptual framework is needed to provide illumination and integration of the myriad of issues that must be taken simultaneously into consideration. —PP It seems appropriate to posit that though a Black cultural orientation may be present, Blacks still must posses distinctly pragmatic and expedient ways of responding to racially and economically problematic life circumstances. Thus, adaptive reactions, coping styles, and adjustment techniques have surely become part and parcel of the social negotiational reality for Afro-Americans as well. Indeed, the particular ways Black families cope with the exigencies of racism and oppression have crucial and distinct implications for the socializing process. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The processes involved in well-being maintenance among African Americans who differed in their attributions to prejudice were examined. A rejection–identification model was proposed where stable attributions to prejudice represent rejection by the dominant group. This results in a direct and negative effect on well-being. The model also predicts a positive effect on well-being that is mediated by minority group identification. In other words, the generally negative consequences of perceiving oneself as a victim of racial prejudice can be somewhat alleviated by identification with the minority group. Structural equation analyses provided support for the model and ruled out alternative theoretical possibilities. Perceiving prejudice as pervasive produces effects on well-being that are fundamentally different from those that may arise from an unstable attribution to prejudice for a single negative outcome.
While adult hypothalamic-pituitary-adrenocortical (HPA) axis functioning is thought to be altered by traumatic experiences, little data exist on the effects of cumulative stress on HPA functioning among pregnant women or among specific racial/ethnic groups. The goal of this study was to explore the effects of multiple social stressors on HPA axis functioning in a sample of urban Black (n = 68) and Hispanic (n = 132) pregnant women enrolled in the Asthma Coalition on Community, Environment, and Social Stress (ACCESS). Women were administered the Revised Conflict Tactics Scale (R-CTS) survey, the Experiences of Discrimination (EOD) survey, the Crisis in Family Systems-Revised (CRISYS-R) negative life events survey, and the My Exposure to Violence (ETV) survey, which ascertains community violence exposure. A cumulative stress measure was derived from these instruments. Salivary cortisol samples were collected five times per day over three days in order to characterize diurnal salivary cortisol patterns. Repeated measures mixed models, stratified by race/ethnicity, were performed adjusting for education level, age, smoking status, body mass index and weeks pregnant at time of cortisol sampling. The majority of Hispanic participants (57%) had low cumulative stress, while Black participants had intermediate (35%) or high (41%) cumulative stress. Among Black but not Hispanic women, cumulative stress was associated with lower morning cortisol levels, including a flatter waking to bedtime rhythm. These analyses suggest that the combined effects of cumulative stressful experiences are associated with disrupted HPA functioning among pregnant women. The etiology of racial/ethnic differences in stress-induced HPA alterations warrants further research.
Little is known about normative variation in stress response over the adolescent transition. This study examined neuroendocrine and cardiovascular responses to performance and peer rejection stressors over the adolescent transition in a normative sample. Participants were 82 healthy children (ages 7–12 years, n = 39, 22 females) and adolescents (ages 13–17, n = 43, 20 females) recruited through community postings. Following a habituation session, participants completed a performance (public speaking, mental arithmetic, mirror tracing) or peer rejection (exclusion challenges) stress session. Salivary cortisol, salivary alpha amylase (sAA), systolic and diastolic blood pressure (SBP, DBP), and heart rate were measured throughout. Adolescents showed significantly greater cortisol, sAA, SBP, and DBP stress response relative to children. Developmental differences were most pronounced in the performance stress session for cortisol and DBP and in the peer rejection session for sAA and SBP. Heightened physiological stress responses in typical adolescents may facilitate adaptation to new challenges of adolescence and adulthood. In high-risk adolescents, this normative shift may tip the balance toward stress response dysregulation associated with depression and other psychopathology. Specificity of physiological response by stressor type highlights the importance of a multisystem approach to the psychobiology of stress and may also have implications for understanding trajectories to psychopathology.
Perceived racial discrimination (PRD) has been implicated in undermining the mental and physical health of racial/ethnic minorities. Researchers have begun to explore the indirect role of health behaviors as one factor in helping to explain this relationship. The goal of the present study was to examine the relationship between PRD and a wide range of health behaviors using a prospective, longitudinal design and to explore the role of gender in moderating these relationships. Using data from the Maryland Adolescent Development in Context Study, we examined the relationship between adolescent PRD (accumulated across ages 14-21) and health behaviors (i.e., diet, substance use, exercise) at age 30 in a sample of middle-class black men and women. Using structural equation modeling, results revealed that more cumulative PRD during adolescence was associated with less healthy eating, more substance use (among men), and more exercise (among women) in young adulthood. Implications of these findings for understanding the role of health behaviors in explaining the link between PRD and health outcomes are considered.
Background
The cortisol awakening response (CAR) has been shown to predict major depressive episodes (MDEs) over a 1-year period. It is unknown whether this effect: ( a ) is stable over longer periods of time; ( b ) is independent of prospective stressful life events; and ( c ) differentially predicts first onsets or recurrences of MDEs.
Method
A total of 270 older adolescents (mean age 17.06 years at cortisol measurement) from the larger prospective Northwestern-UCLA Youth Emotion Project completed baseline diagnostic and life stress interviews, questionnaires, and a 3-day cortisol sampling protocol measuring the CAR and diurnal rhythm, as well as up to four annual follow-up interviews of diagnoses and life stress.
Results
Non-proportional person-month survival analyses revealed that higher levels of the baseline CAR significantly predict MDEs for 2.5 years following cortisol measurement. However, the strength of prediction of depressive episodes significantly decays over time, with the CAR no longer significantly predicting MDEs after 2.5 years. Elevations in the CAR did not significantly increase vulnerability to prospective major stressful life events. They did, however, predict MDE recurrences more strongly than first onsets.
Conclusions
These results suggest that a high CAR represents a time-limited risk factor for onsets of MDEs, which increases risk for depression independently of future major stressful life events. Possible explanations for the stronger effect of the CAR for predicting MDE recurrences than first onsets are discussed.
This article reviewed six instruments developed to assess the psychological processes associated with the experience of racism among African Americans. Although the instruments reviewed in this article are relatively new and have not undergone any extensive psychometric scrutiny, all of them contribute to providing the psychological technology necessary to assess the cognitive, emotional, and behavioral consequences of racial discrimination amongAfricanAmericans. The Racism Reaction Scale (RRS), Perceived Racism Scale (PRS), Index of Race-Related Stress (IRRS), Racism and Life Experience Scale-Brief Version (RaLES-B), Schedule of Racist Events (SRE), and the Perceptions of Racism Scale (PoRS) were all reviewed with regard to their initial development, psychometric properties, and practical use. Recommendations for modifications, revisions, and additional reliability and validity evidence are presentedfor each measure.
Racial/ethnic minorities experience persistent health disparities due in part to their exposure to chronic SES and psychosocial risk. The hypothalamic-pituitary-adrenal axis and its hormonal end product, cortisol, are believed to mediate the associations between chronic stress and poor health. In this study, racial/ethnic differences in diurnal salivary cortisol rhythms in 179 preadolescent youths and the contributing roles of SES risk, psychosocial risk, perceived discrimination, harsh parenting, and parental monitoring were examined. The analyses revealed racial/ethnic differences in diurnal cortisol rhythms, with African Americans having significantly flatter morning-to-evening cortisol slopes than Caucasians and with Latinos having significantly lower evening cortisol levels than Caucasians. Greater psychosocial risk and less parental monitoring were associated with flatter cortisol slopes. Racial/ethnic differences on the cortisol measures persisted when controlling for SES, psychosocial risk, and parenting quality. The need to assess chronic risk across the lifespan and disentangle possible genetic from environmental contributors is discussed.
The relative contribution of genetic and environmental influences to the US black-white disparity in cardiovascular disease (CVD) is hotly debated within the public health, anthropology, and medical communities. In this article, we review evidence for developmental and epigenetic pathways linking early life environments with CVD, and critically evaluate their possible role in the origins of these racial health disparities. African Americans not only suffer from a disproportionate burden of CVD relative to whites, but also have higher rates of the perinatal health disparities now known to be the antecedents of these conditions. There is extensive evidence for a social origin to prematurity and low birth weight in African Americans, reflecting pathways such as the effects of discrimination on maternal stress physiology. In light of the inverse relationship between birth weight and adult CVD, there is now a strong rationale to consider developmental and epigenetic mechanisms as links between early life environmental factors like maternal stress during pregnancy and adult race-based health disparities in diseases like hypertension, diabetes, stroke, and coronary heart disease. The model outlined here builds upon social constructivist perspectives to highlight an important set of mechanisms by which social influences can become embodied, having durable and even transgenerational influences on the most pressing US health disparities. We conclude that environmentally responsive phenotypic plasticity, in combination with the better-studied acute and chronic effects of social-environmental exposures, provides a more parsimonious explanation than genetics for the persistence of CVD disparities between members of socially imposed racial categories.
Current research indicates that racial discrimination is pervasive in the lives of African Americans. Although there are a variety of ways in which discrimination may contribute to health, one potentially important pathway is through its impact on substance use. Addressing the paucity of longitudinal research on this topic, the present study examined the influence of teacher discrimination on changes in substance use over time among African American adolescents and considered three dimensions of racial identity as moderators of this association (centrality, private regard, and public regard). Latent variable SEM analyses indicated that, on average, levels of discrimination were associated with increases in substance use across the high school years. However, public regard was found to moderate this association such that discrimination was less strongly associated with increases in substance use for individual who reported lower levels of public regard. The implications of these findings are discussed.
The current study considered the influence of perceived discrimination on the diurnal cortisol rhythm of 50 African American older adults and a matched comparison groups of 100 Whites (M(age)=56.6; 58% female). The role of socioeconomic status (SES) as a moderator of the effects of discrimination on the diurnal decline was also considered for each group. In support of the idea that perceptions of unfair treatment take on a unique meaning for stigmatized minority groups, results suggest that perceived discrimination is associated with a flatter (less healthy) diurnal slope among Whites but a steeper (more healthy) diurnal slope among African Americans. Perceived discrimination was also found to be more strongly associated with a steepening of the diurnal slope among lower SES African Americans than higher SES African Americans.
The association between racism and the physical health of native U.S. populations has yet to be examined despite their high risk for stress-related disorders and a history of discrimination toward them. We examined the correlation between perceived racism and the two physiological stress indices of cortisol level and blood pressure in 146 adult Native Hawaiians. Attributed and felt racism were assessed with a 10-item shortened version of the Oppression Questionnaire. Height, weight, blood pressure, and salivary cortisol samples (AM and PM) were collected and analyzed along with information on Hawaiian ancestry, BMI, age, sex, marital status, education level, general psychological stress, and ethnic identity. The results indicated that Native Hawaiians reporting more attributed racism had significantly (P < .05) lower average cortisol levels than those reporting less attributed racism, after adjusting for socio-demographic, biological, and psychosocial confounders. Native Hawaiians reporting more felt racism had a significantly higher systolic blood pressure than those reporting less, but this association was not significant after adjusting for the aforementioned confounders. Racism appears to be a chronic stressor that can "get under the skin" of Native Hawaiians by affecting their physical health and risk for stress-related diseases, possibly, through mechanisms of cortisol dysregulation.
PART I THE LOGIC OF HIERARCHICAL LINEAR MODELING Series Editor 's Introduction to Hierarchical Linear Models Series Editor 's Introduction to the Second Edition 1.Introduction 2.The Logic of Hierarchical Linear Models 3. Principles of Estimation and Hypothesis Testing for Hierarchical Linear Models 4. An Illustration PART II BASIC APPLICATIONS 5. Applications in Organizational Research 6. Applications in the Study of Individual Change 7. Applications in Meta-Analysis and Other Cases where Level-1 Variances are Known 8. Three-Level Models 9. Assessing the Adequacy of Hierarchical Models PART III ADVANCED APPLICATIONS 10. Hierarchical Generalized Linear Models 11. Hierarchical Models for Latent Variables 12. Models for Cross-Classified Random Effects 13. Bayesian Inference for Hierarchical Models PART IV ESTIMATION THEORY AND COMPUTATIONS 14. Estimation Theory Summary and Conclusions References Index About the Authors
The aim of the present study was to evaluate the pattern of basal cortisol release in PTSD and major depression using a chronobiological analysis. Plasma for cortisol determination was obtained from 15 combat veterans with PTSD, 14 subjects with major depression, and 15 normal men every 30 min during a 24-hour period of bed rest. Raw cortisol data were modeled using standard and multioscillator cosinor models to determine the best fitting functions for circadian, hemicircadian, and ultradian components of cortisol release. PTSD subjects had substantially lower cortisol levels, and displayed a pattern of cortisol release that was better modeled by circadian rhythm. PTSD subjects also showed a greater circadian signal-to-noise ratio than the other groups. In contrast, depressed patients displayed a less rhythmic, more chaotic pattern of cortisol release. The pattern of cortisol secretion and regulation observed in the PTSD group under baseline conditions may reflect an exaggerated sensitization, whereas the chronobiological alterations in depression may reflect dysregulation, of the hypothalamic-pituitary-adrenal (HPA) axis.
The processes involved in well-being maintenance among African Americans who differed in their attributions to prejudice were examined. A rejection-identification model was proposed where stable attributions to prejudice represent rejection by the dominant group. This results in a direct and negative effect on well-being. The model also predicts a positive effect on well-being that is mediated by minority group identification. In other words, the generally negative consequences of perceiving oneself as a victim of racial prejudice can be somewhat alleviated by identification with the minority group. Structural equation analyses provided support for the model and ruled out alternative theoretical possibilities. Perceiving prejudice as pervasive produces effects on well-being that are fundamentally different from those that may arise from an unstable attribution to prejudice for a single negative outcome.
1. The Waste of White Racism 2. Racism in Practice: Case Studies 3. Ghosts of Segregation: Discrimination in Restaurants 4. Racism and Murder: The Cases of Boston, Portland, and Jasper 5. The Racial Profile of Police Brutality 6. Racism in the Halls of Power: The Texaco "Wille" Horton, and Sister Souljah Cases 7. Sincere Fictions of the White Self 8. Taking Action Against Racism: Problems and Prospects
Prior research indicates that blacks and Hispanics/Latinos have flatter diurnal cortisol declines across the day, a profile associated with poorer health. The stability of racial and ethnic differences in cortisol levels over time is not well understood, and additional research is needed to establish racial and ethnic differences in psychosocial stress levels as related to changes in cortisol levels.
With data from a community-based study of 152 adults (mean age = 58 years; 53% women; 34% black, 26% Hispanic/Latino), we examined the magnitude of racial and ethnic differences over a 5-year period. Salivary cortisol samples were obtained 3 times per day for 3 days in Years 1, 3, 4, and 5. Life events and chronic stress were assessed by questionnaires in which participants reported on whether they had experienced specific types of events or stress within the past year. Depressive symptoms scales (Center for Epidemiologic Studies of Depression Scale) were also administered annually. Daily cortisol slopes were calculated by subtracting wakeup cortisol from bedtime levels and dividing by hours awake.
Increases in psychosocial stress were associated with flatter cortisol slopes among blacks (β = 0.010) and Hispanics/Latinos (β = 0.014), although including cardiovascular disease risk factors attenuates associations in blacks (β = 0.007; p = .125). Higher income predicts a steepening of cortisol rhythms across the study (β = -0.003; p = .019).
Racial and ethnic differences in diurnal cortisol rhythms are stable over time. However, the magnitude of changes in cortisol levels associated with chronic stress levels may vary by racial and ethnic subgroups.
Race, ethnicity, and social class differences in the prevalence and effects of cardiovascular risk factors have been observed in many studies. Understanding the drivers of these differences is critical to efforts aimed at reducing racial disparities in health. Two articles in this volume of Psychosomatic Medicine contribute to our understanding of the underlying mechanisms driving racial disparities in health. The first article confirms the deleterious effects of psychosocial stressors on neuroendocrine function and suggests that the effects of stress on cortisol patterning are worse for Black and Latino individuals than for White individuals. The second meta-analysis article indicates that, in comparison to Whites, Black individuals display higher levels of high frequency heart rate variability, a measure of parasympathetic activity that may be an indicator of potential resilience to stress. To interpret these effects, it can be useful to move beyond assessments of phenotype and to consider the psychosocial context in which people live and assessments of risk are made. The psychosocial context includes variables and processes that influence the type, timing, and frequency of stress exposure, and the levels of background stress. Ultimately, these variables may create race and class differences in the underlying mechanisms that contribute to the development of different risk factors for adverse health outcomes such as cardiovascular disease, diabetes, and cancer. This editorial describes the relevance of incorporating the variables associated with psychosocial context when building new models in the next generation of research on health disparities.
Discrimination is theorized to set in motion a neuroendocrine response, which includes cortisol secretion from the hypothalamic-pituitary-adrenal axis. Repeated exposure to perceived discrimination is thought to contribute to alterations in diurnal cortisol rhythms and to have implications for health. Discrimination may have particularly strong effects on racial/ethnic minority individuals, based on histories of past exposure and/or greater perceived implications of discriminatory events. Utilizing an ethnically and racially diverse sample of young adults (N=140; Mage=22.8 years) and a multiple-day naturalistic cortisol protocol, the present study examined associations between self-reported discrimination and diurnal cortisol rhythms, and whether this relation was moderated by racial/ethnic minority status. Results revealed that self-reported discrimination predicted flatter diurnal cortisol slopes for racial/ethnic minority individuals only. These findings align with theory suggesting that discrimination experiences are important among racial/ethnic minorities.
Experiences of racial and ethnic discrimination pose significant threats to the development and well‐being of racial and ethnic minority children. Fortunately, not all youth who experience discrimination are susceptible to its harmful effects. Growing evidence points to several racial and ethnic factors that promote positive youth development and protect against the potentially damaging effects of racial and ethnic adversity. This article summarizes emerging research trends and conclusions regarding the “promotive” and “protective” effects of racial and ethnic identity, ethnic‐racial socialization, and cultural orientation, as well as some of the mechanisms that may account for their salutary properties. The article concludes with a brief discussion of important considerations and directions for the future study of racial and ethnic resilience processes in ethnic minority youth.
Cross-sectional associations have been found between anxiety disorders (ADs) and hypothalamic-pituitary-adrenal (HPA) axis functioning, as measured by levels of salivary cortisol, but prospective data are lacking, as are studies examining specific ADs. We have previously shown that one aspect of the diurnal rhythm of cortisol, the cortisol awakening response (CAR), prospectively predicts both new onsets and recurrences of major depressive disorder (MDD). Here we sought to examine whether it also predicts ADs. Participants (N = 232) were drawn from the larger Northwestern-UCLA Youth Emotion Project, a two-site, longitudinal study of older adolescents, which aims to identify common and specific risk factors for mood and anxiety disorders. After baseline interviews for mental health diagnoses, a subset of adolescents completed a three-day cortisol sampling protocol measuring the CAR and other diurnal rhythm indices. Participants with past or current anxiety disorders at the time of cortisol measurement were excluded and Cox regression (survival analysis) was used to predict first onsets of ADs over the subsequent six years. AD onsets (N = 25), the largest subset of which were social anxiety disorder (SAD) onsets (N = 11), were observed over six annual follow up diagnostic interviews. Even when statistically adjusting for past and prospective MDD onsets and other covariates, a higher CAR significantly predicted increased first onsets of ADs (HR = 2.20, p < .05). A higher CAR was also a strong and significant predictor of the subset of SAD onsets (HR = 5.37, p < .005). Implications for the etiology of ADs, with a focus on SAD, are discussed.
This chapter begins by examining five general approaches to the study of identity development during adolescence that dominate the field today. Erik Erikson (1963, 1968) first used the term "ego identity," and has provided central, identity-related concepts which researchers continue to explore today in empirical and narrative investigations. Among researchers, J. E. Marcia's (1966, 1967) identity-status paradigm has provided a popular model for expanding and empirically investigating Erikson's notions regarding identity. This chapter has focused primarily on this paradigm, overviewing key personality factors associated with the identity statuses, as well as developmental patterns of movement over time. The chapter has also focused, in conclusion, on general issues related to identity development in context, as well as on questions regarding the relationship of gender and ethnicity to adolescent identity development. Individual sections have presented some possibilities for future research directions that might fruitfully be explored, and responses to recent major criticisms of the identity-status approach have been presented.
Children raised in poverty are prone to physical health problems late in life. To understand these findings and address the scientific challenge they represent, we must formulate integrative conceptual frameworks at the crossroads of behavioral and biomedical science, with a strong developmental emphasis. In this article, we outline such a framework and discuss research bearing on its validity. We address how childhood poverty gets under the skin, at the level of tissues and organs, in a manner that affects later disease risks. We also tackle questions about resilience; Even with lengthy exposure to childhood poverty, why do only a subset of people acquire diseases? Why are some individuals protected while others remain vulnerable? Maternal nurturance might be a source of resilience, buffering children from the long-term health consequences of poverty. We conclude with research priorities.