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Racial Discrimination, Cultural Resilience, and Stress
Abstract
Objective:
Racial discrimination is a social determinant of health for First Nations people. Cultural resilience has been regarded as a potentially positive resource for social outcomes. Using a compensatory model of resilience, this study sought to determine if cultural resilience (compensatory factor) neutralized or offset the detrimental effect of racial discrimination (social risk factor) on stress (outcome).
Methods:
Data were collected from October 2012 to February 2013 (N = 340) from adult members of the Kettle and Stony Point First Nation community in Ontario, Canada. The outcome was perceived stress; risk factor, racial discrimination; and compensatory factor, cultural resilience. Control variables included individual (education, sociability) and family (marital status, socioeconomic status) resilience resources and demographics (age and gender). The model was tested using sequential regression.
Results:
The risk factor, racial discrimination, increased stress across steps of the sequential model, while cultural resilience had an opposite modest effect on stress levels. In the final model with all variables, age and gender were significant, with the former having a negative effect on stress and women reporting higher levels of stress than males. Education, marital status, and socioeconomic status (household income) were not significant in the model. The model had R(2) = 0.21 and adjusted R(2) = 0.18 and semipartial correlation (squared) of 0.04 and 0.01 for racial discrimination and cultural resilience, respectively.
Conclusions:
In this study, cultural resilience compensated for the detrimental effect of racial discrimination on stress in a modest manner. These findings may support the development of programs and services fostering First Nations culture, pending further study.
... Factors explaining why discrimination may more detrimentally affect certain racial/ethnic groups than others are speculative. One factor is cultural resilience [44,45]. Resilience against discrimination is generally protective against the effects of stress [44], and having a strong racial/ethnic identity can attenuate the mental detriments of discrimination [45]. ...
... One factor is cultural resilience [44,45]. Resilience against discrimination is generally protective against the effects of stress [44], and having a strong racial/ethnic identity can attenuate the mental detriments of discrimination [45]. While resilience may help decrease the risk of health problems caused by discrimination [44], dismantling racism to eliminate discrimination is a better public health solution. ...
... Resilience against discrimination is generally protective against the effects of stress [44], and having a strong racial/ethnic identity can attenuate the mental detriments of discrimination [45]. While resilience may help decrease the risk of health problems caused by discrimination [44], dismantling racism to eliminate discrimination is a better public health solution. Another factor is racial centrality, which has been shown to mediate associations between prior experiences of discrimination and cigarette use among Black adults [46]. ...
Introduction
Racial/ethnic discrimination (hereafter, discrimination) is associated with tobacco use. However, little is known about the relationship between discrimination and dual/polytobacco use and tobacco use disorder (TUD), including how these relationships vary by race/ethnicity.Methods
Data on adults 18 and older come from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 35,881). Past-year discrimination was measured using the Experiences of Discrimination scale. Past 30-day exclusive, dual, and polytobacco use was measured as the mutually exclusive use of any combination of four types of tobacco products: cigarettes, electronic nicotine delivery systems, other combustibles (i.e., cigars and pipe), and smokeless tobacco. Past-year TUD was defined according to DSM-5 criteria. Associations between discrimination and exclusive, dual, and polytobacco use and discrimination and TUD were estimated using multinomial logistic regression and logistic regression, respectively. Models were stratified by race/ethnicity (i.e., Hispanic, non-Hispanic (NH) White, NH Black, another race/ethnicity) to assess effect modification.ResultsAdults who used tobacco and who had TUD was 24.2% and 19.2%, respectively. More discrimination was associated with higher odds of exclusive, dual, and polytobacco use as well as TUD. Models stratified by race/ethnicity suggest that discrimination was associated with dual/polytobacco use among NH Black adults (OR: 1.05, 95% CI: 1.002–1.11) and NH White adults (OR: 1.18, 95% CI: 1.13–1.22). While more discrimination was associated with TUD among all racial/ethnic groups, the relationship was the strongest for NH White adults.Conclusions
Discrimination was associated with more severe tobacco use outcomes among multiple racial/ethnic groups, but associations were the strongest for NH White adults.
... The importance of understanding cultural relevance is evident in a study of cultural resilience among youth; connections to culture was found to lower the detrimental impact of racial discrimination on stress (Spence et al., 2016). Cultural resilience is defined as resilience centered on culture, with a focus on shared beliefs, values, and other core elements (e.g., social institutions, language, conventions), which provide meaning and significance to an individual (Spence et al., 2016). ...
... The importance of understanding cultural relevance is evident in a study of cultural resilience among youth; connections to culture was found to lower the detrimental impact of racial discrimination on stress (Spence et al., 2016). Cultural resilience is defined as resilience centered on culture, with a focus on shared beliefs, values, and other core elements (e.g., social institutions, language, conventions), which provide meaning and significance to an individual (Spence et al., 2016). Colonization has contributed to the loss of Indigenous culture over generations, making Indigenous youth more vulnerable to stress in the face of racial discrimination and ongoing disparities. ...
Background:
Despite facing challenges to mental wellness from ongoing multifold trauma, Indigenous youth continue to galvanize their resilience. One pathway undertaken is embracing technology. The JoyPop™ youth resilience mobile application (app) was invited by Six Nations of the Grand River (SN) leadership to consider its use with their reserve youth.
Objective:
This study explored the feasibility of JoyPop™ research from the SN community adult perspective for appropriateness and relevance to SN youth, as a precursor to a user-experience study with community youth.
Methods:
Semi-structured, online interviews with 19 adult community members (26 % male) about JoyPop™ were conducted with nominated stakeholders from SN. Based on a standard presentation of the app, comments were solicited about app features, design, and relevance to Haudenosaunee culture. Interviews were transcribed, coded in a double-blind fashion, and analyzed for themes.
Results:
Most offered positive feedback, with some level of support for each feature of JoyPop™. Themes were identified (Need for Indigenous Design, Incorporation of Indigenous Culture, Appreciation of Ease, Flexibility and Personalization), stemming from comments of appraisal and suggestions for adaptations (e.g., incorporating more cultural elements, localized resources, simplification of app).
Conclusions:
The JoyPop™ app was viewed as positive and relevant, based on feedback from adults within SN. Adaptations were identified by adults to better fit SN youth needs, and research with SN youth is pending before implementation of adaptations. Research with other communities is encouraged to expand the reach of technology interventions, to holistically support Indigenous youth mental health in a culturally relevant way.
... We explore the duality of health-care workers as people within a system who can both discriminate and be discriminated against. A fully referenced version of the figure and accompanying prose can be found in the appendix (pp [30][31][32][33][34][35][36][37][38]. NICE=The National Institute for Health and Care Excellence. ...
... Protective buffers of stress and allostatic load include religiosity, social support, and strong cultural identity, even if it is an identity that is discriminated against. [36][37][38][39] The effect of racism, xenophobia, and discrimination on health systems Discrimination, past and present, substantially affects the experience and usage of health-care systems. 40,41 WHO's quality of care framework emphasises that services must be available, accessible, acceptable, and of the highest quality. ...
Despite being globally pervasive, racism, xenophobia, and discrimination are not universally recognised determinants of health. We challenge widespread beliefs related to the inevitability of increased mortality and morbidity associated with particular ethnicities and minoritised groups. In refuting that racial categories have a genetic basis and acknowledging that socioeconomic factors offer incomplete explanations in understanding these health disparities, we examine the pathways by which discrimination based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour affect health. Discrimination based on these categories, although having many unique historical and cultural contexts, operates in the same way, with overlapping pathways and health effects. We synthesise how such discrimination affects health systems, spatial determination, and communities, and how these processes manifest at the individual level, across the life course, and intergenerationally. We explore how individuals respond to and internalise these complex mechanisms psychologically, behaviourally, and physiologically. The evidence shows that racism, xenophobia, and discrimination affect a range of health outcomes across all ages around the world, and remain embedded within the universal challenges we face, from COVID-19 to the climate emergency.
... Although research is limited, there is some evidence that positive racial socialization messages contribute to building resilience in the face of discrimination among African Americans (Brown and Tylka, 2011), even contributing to resilience against the criminogenic effects of racism (Burt et al., 2017). Similarly, among Indigenous peoples of Canada, cultural resilience, that is deriving meaning and purpose from one's cultural identity has been shown to buffer against the negative effects of racial discrimination (Spence et al., 2016). Psychological resilience can also include turning to social supports during times of distress but is a broader construct that may encompass other buffering variables between racism and anxiety such as those already explored in the extant literature. ...
... Previous studies have shown that church-based social support (Graham and Roemer, 2012) and social connectedness to one's ethnic community can guard (Liao et al., 2016) against anxiety symptoms among African Americans who have experienced racial discrimination. The measure of resilience employed in the present study may have been too general to capture the effect of the more specific effect of cultural resilience, which has been shown to protect against the impact of racial discrimination on stress among Indigenous peoples (Spence et al., 2016). Future studies should examine whether factors such as social connectedness, racial identity and religiosity are similarly protective in a Canadian context and explore the nature of the relationship of these variables to the construct of resilience. ...
Objective
Anxiety disorders are highly prevalent worldwide but vary significantly by country and ethnoracial background. Minimal published data exist on the prevalence of clinically significant anxiety among Black people in Canada and none using validated measures. Therefore, this study sought to establish the frequency of clinically significant anxiety symptoms among a sample of Black people living in Canada as well as examine the association with two forms of racism (racial discrimination and racial microaggressions).
Methods
Data collected from the Black Community Mental Health project in Canada was analyzed. Participants provided (N = 845) sociodemographic information and completed measures assessing anxiety symptomology (GAD-7), everyday racial discrimination, racial microaggressions, and resilience. Prevalence of anxiety symptomatology was determined across sociodemographic variables as well as categories of everyday racial discrimination and racial microaggressions. Two regression models were conducted to examine the relationship between anxiety symptoms and the two forms of racism controlling for sociodemographic factors.
Results
Overall, nearly a third of participants endorsed clinically significant levels of anxiety symptoms, with higher rates observed among men, unemployed people, those with higher education, people who are separated, and those with no reported family history of mental health problems. Logistic regression models demonstrated that, except for those reporting the greatest frequency of racial discrimination, there is a general linear trend such that those experiencing higher levels of racial discrimination or racial microaggressions are increasingly more likely to present with anxiety symptoms when compared to those reporting low levels of discrimination/microaggressions. Psychological resilience afforded nominal protection but only against exposure to racial microaggressions.
Conclusions
Rates of clinically significant anxiety are higher among Black people in Canada than reported previously. Both racial discrimination and racial microaggressions predicted higher rates of anxiety symptoms. The results are discussed in relation to previous findings from the US that report similar findings.
... Indigenous Peoples in Canada experience a disproportionate burden of both mental and physical health issues (Nelson & Wilson, 2017;Rotenberg, 2016). These health inequities must be understood in light of colonialist and neo-colonialist practices (such as residential schools, the Sixties Scoop, and the overrepresentation of Indigenous children in care), widespread poverty, homelessness, and racism (Currie et al., 2012;Patrick, 2014;Press, 2019;Spence et al., 2016). In healing from past and ongoing effects of colonization, culture is a key source of strength for many Indigenous communities (Assembly of First Nations & Health Canada, 2015;Gone, 2013). ...
... Several studies have shown that a sense of belonging and connection to community are important aspects of urban Indigenous health and wellbeing (Cardinal, 2006;Environics Institute, 2010;Smylie et al., 2011). Furthermore, Indigenous connection to culture and community can buffer against the negative impacts of discrimination (e.g., Bombay et al., 2010;Spence et al., 2016). Culture is frequently the foundation of interventions designed by and for Indigenous Peoples (e.g., Fiedeldey-Van Dijk et al., 2017). ...
The DUDES Club is a novel men's health and wellness organization founded in 2010 in Vancouver, BC. Since 2017, the DUDES Club has rapidly expanded in Northern BC and, with the help of a partnership with the First Nations Health Authority, has grown to include 40 sites in British Columbia and 2 sites nationally. In this study, we analyze data from interviews (n = 5) and 15 focus groups (n = 101) conducted as part of a program evaluation with DUDES Club members, Elders, providers, and health care professionals. We focus on men's experiences with the DUDES Club to identify four main themes in the data: brotherhood and community, accessible health care information, disrupting colonial constructions of masculinity, and systemic and structural challenges. We conclude with policy recommendations. Keywords Indigenous men, community-based health promotion programming, men's health, qualitative program evaluation, social support.
... Indigenous Peoples in Canada experience a disproportionate burden of both mental and physical health issues (Rotenberg, 2016;Nelson & Wilson, 2017). These health inequities must be understood in light of colonialist and neo-colonialist practices (such as residential school, the sixties scoop, and the overrepresentation of Indigenous children in care), widespread poverty, homelessness, and racism (Press, 2019;Patrick, 2014;Currie et al., 2012;Spence et al., 2016). In healing from the past and ongoing effects of colonization, culture is a key source of strength for many Indigenous communities (Gone, 2013;Assembly of First Nations & Health Canada, 2015); an emerging body of evidence for "culture as treatment" points to the significance of interconnectedness in healing and underscores the need to incorporate Indigenous cultural practices into health programming (Barker et al., 2017). ...
... Furthermore, Indigenous connection to culture and community can buffer against the negative impacts of discrimination (e.g., Bombay et al., 2010;Spence et al., 2016). Culture is frequently the foundation of interventions designed by and for Indigenous Peoples (e.g., Fiedeldey-Van Dijk et al., 2017). ...
Indigenous and men’s health represent challenging policy issues around the world. The DUDES Club, a novel men’s health organization founded in 2010 in Vancouver, B.C., attempts to address these issues. With the help of the First Nations Health Authority, the DUDES Club has expanded to 40 sites in British Columbia and two nationally. The purpose of this study was to evaluate men’s experiences with DUDES Club. To that end, we analyzed five interviews and 15 focus groups (n ≈ 101). We focused on men’s experiences with the DUDES Club to identify four themes: brotherhood and community; accessible health care information; disrupting colonial constructions of masculinity; and systemic and structural challenges. We conclude with policy recommendations.
... The historical consequences of colonization of Indigenous Peoples across the globe have left a legacy of economic and health disparity, typically disadvantaging Indigenous populations (4)(5)(6)(7)(8). Many Indigenous Peoples have had lands misappropriated, and their freedom to practice their traditional cultures and lifestyles curtailed, resulting in a complex network of disadvantage (4-6, 9, 10). ...
... Many Indigenous Peoples have had lands misappropriated, and their freedom to practice their traditional cultures and lifestyles curtailed, resulting in a complex network of disadvantage (4-6, 9, 10). While income disparity and disadvantage are not limited to Indigenous populations, in most countries in the world racism has been particularly virulent toward Indigenous Peoples (4), and in many cases continues (5)(6)(7)11). While institutionally and scientifically sanctioned racist views are now widely discredited, the legacy of these views and policies persists in many ways (6). ...
Background and Aims: Despite known Indigenous health and socioeconomic disadvantage in countries with a Very High Human Development Index, data on the incidence of stroke in these populations are sparse. With oversight from an Indigenous Advisory Board, we will undertake a systematic review of the incidence of stroke in Indigenous populations of developed countries or regions, with comparisons between Indigenous and non-Indigenous populations of the same region, though not between different Indigenous populations.
Methods: Using PubMed, OVID-EMBASE, and Global Health databases, we will examine population-based incidence studies of stroke in Indigenous adult populations of developed countries published 1990-current, without language restriction. Non-peer-reviewed sources, studies including <10 Indigenous People, or with insufficient data to determine incidence, will be excluded. Two reviewers will independently validate the search strategies, screen titles and abstracts, and record reasons for rejection. Relevant articles will undergo full-text screening, with standard data extracted for all studies included. Quality assessment will include Sudlow and Warlow's criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and the CONSIDER checklist for Indigenous research.
Results: Primary outcomes include crude, age-specific and/or age-standardized incidence of stroke. Secondary outcomes include overall stroke rates, incidence rate ratio and case-fatality. Results will be synthesized in figures and tables, describing data sources, populations, methodology, and findings. Within-population meta-analysis will be performed if, and where, methodologically sound and comparable studies allow this.
Conclusion: We will undertake the first systematic review assessing disparities in stroke incidence in Indigenous populations of developed countries. Data outputs will be disseminated to relevant Indigenous stakeholders to inform public health and policy research.
... The purpose of this study was to provide first person accounts of the relationship between experiences of pain and discrimination and stigma, thereby informing equity-oriented responses to chronic pain tailored to people experiencing both pain and social marginalization. To study the relationship between chronic pain and diverse experiences of social marginalization as well as implications for interventions, we conducted a community-based qualitative study using focus groups with people living with chronic pain and identifying with one of three groups known to experience high levels of inequity, discrimination, and stigma in Canada, specifically Indigenous 1 [34,35], LGBTQ2S 2 [36] and refugees or newcomers [34]. ...
... The purpose of this study was to provide first person accounts of the relationship between experiences of pain and discrimination and stigma, thereby informing equity-oriented responses to chronic pain tailored to people experiencing both pain and social marginalization. To study the relationship between chronic pain and diverse experiences of social marginalization as well as implications for interventions, we conducted a community-based qualitative study using focus groups with people living with chronic pain and identifying with one of three groups known to experience high levels of inequity, discrimination, and stigma in Canada, specifically Indigenous 1 [34,35], LGBTQ2S 2 [36] and refugees or newcomers [34]. ...
Objective
For people who experience social inequities and structural violence, pain and related care are inexorably linked to experiences of injustice and stigma. The purpose of this study was to examine in greater depth the experiences of pain and discrimination and stigma across diverse marginalized communities in order to recommend equity-oriented healthcare approaches.
Methods
This community-based qualitative study reports on four focus groups that included 36 people living with pain. All participants identified with one of three groups known to experience high levels of inequities and structural violence including an Indigenous group, a LGBTQ2S group, and two newcomer and refugee groups.
Results
Pain was entangled with and shaped by: social locations and identities, experiences of violence, trauma and related mental health issues, experiences of discrimination, stigma and dismissal, experiences of inadequate and ineffective health care, and the impacts of these intersecting experiences.
Conclusions
Equity-oriented responses to chronic pain would recognize pain not only as a biomedical issue but as a social justice issue. The EQUIP Framework is an approach to integrating trauma- and violence-informed care; culturally-safe care; and harm reduction in health care that may hold promise for being tailored to people experiencing pain and social marginalization.
... The purpose of this study was to provide rst person accounts of the relationship between experiences of pain and discrimination and stigma, thereby informing equity-oriented responses to chronic pain tailored to people experiencing both pain and social marginalization. To study the relationship between chronic pain and diverse experiences of social marginalization as well as implications for interventions, we conducted a community-based qualitative study using focus groups with people living with chronic pain and identifying with one of three groups known to experience high levels of inequity, discrimination, and stigma in Canada, speci cally Indigenous [1] (34,35), LGBTQ2S [2] (36) and refugees or newcomers (34) We employ a health equity framework to investigate the links among the complexities of inequities, social marginalization, and structural violence to inform equity-oriented responses to chronic pain. Namely, the EQUIP Health Care program of research (37)(38)(39)(40) informs the theoretical framework for this inquiry as well as the analytical processes. ...
... The purpose of this study was to provide rst person accounts of the relationship between experiences of pain and discrimination and stigma, thereby informing equity-oriented responses to chronic pain tailored to people experiencing both pain and social marginalization. To study the relationship between chronic pain and diverse experiences of social marginalization as well as implications for interventions, we conducted a community-based qualitative study using focus groups with people living with chronic pain and identifying with one of three groups known to experience high levels of inequity, discrimination, and stigma in Canada, speci cally Indigenous [1] (34,35), LGBTQ2S [2] (36) and refugees or newcomers (34) We employ a health equity framework to investigate the links among the complexities of inequities, social marginalization, and structural violence to inform equity-oriented responses to chronic pain. Namely, the EQUIP Health Care program of research (37)(38)(39)(40) informs the theoretical framework for this inquiry as well as the analytical processes. ...
Objective: For people who experience social inequities and structural violence, pain and related care are inexorably linked to experiences of injustice and stigma. The purpose of this study was to examine in greater depth the experiences of pain and discrimination and stigma across diverse marginalized communities in order to recommend equity-oriented healthcare approaches.
Methods: This community-based qualitative study reports on four focus groups that included 36 people living with pain. All participants identified with one of three groups known to experience high levels of inequities and structural violence including an Indigenous group, a LGBTQ2S group, and two newcomer and refugee groups.
Results: Pain was entangled with and shaped by: social locations and identities, experiences of violence, trauma and related mental health issues, experiences of discrimination, stigma and dismissal, experiences of inadequate and ineffective health care, and the impacts of these intersecting experiences.
Conclusions: Equity-oriented responses to chronic pain would recognize pain not only as a biomedical issue but as a social justice issue. The EQUIP Framework is an approach to integrating trauma- and violence-informed care; culturally-safe care; and harm reduction in health care that may hold promise for being tailored to people experiencing pain and social marginalization.
... To explore the relationship between experiences of pain and discrimination and stigma, we conducted a community-based qualitative study using focus groups with people living with chronic pain and identifying with one of three groups known to experience high levels of inequity, discrimination and stigma in Canada Indigenous 1 (22,23), LGBTQ2S (24) and refugees or newcomers (22). 1 In Canada, Indigenous people include diverse First Nations, Inuit and Metis peoples. Royal Commission on Aboriginal Peoples. ...
... To explore the relationship between experiences of pain and discrimination and stigma, we conducted a community-based qualitative study using focus groups with people living with chronic pain and identifying with one of three groups known to experience high levels of inequity, discrimination and stigma in Canada Indigenous 1 (22,23), LGBTQ2S (24) and refugees or newcomers (22). 1 In Canada, Indigenous people include diverse First Nations, Inuit and Metis peoples. Royal Commission on Aboriginal Peoples. ...
Objective: For people who experience inequities and structural violence, pain and related care are inexorably linked to experiences of injustice and stigma.
Methods: A community-based qualitative study included four focus groups with 36 people living with pain from groups known to experience high levels of inequities and structural violence including an Indigenous group, a LGBTQ2S group, and two newcomer and refugee groups.
Results: Pain was entangled with and shaped by: social locations and identities, experiences of violence, trauma and related mental health issues, experiences of discrimination, stigma and dismissal, experiences of inadequate and ineffective health care, and the impacts of these intersecting experiences.
Conclusions: Equity-oriented responses to chronic pain would establish pain not only as a biomedical issue but as a social justice issue. The EQUIP Framework is an approach to integrating trauma- and violence-informed care; culturally-safe care; and harm reduction in health care that may hold promise for being tailored to people experiencing pain and social marginalization.
... Prior studies have found that White adults with lower levels of education and income may have an increased risk of exposure to stressors, such as discrimination from disparate expectations and realities, and lack strategies/resources to effectively cope with their circumstances (Vilsaint et al., 2019;Bower et al., 2013). Comparatively, other studies have suggested that ethnically minoritized adults, who experience discrimination more frequently and have been impacted across generations, might be more prepared to deal with exposure to stressors (i.e., culturally resilient, Spence et al., 2016). ...
The current study aimed to further explore the construct validity of a broad-band, screening measure—Strengths and Difficulties Questionnaire Hyperactivity-Inattention Subscale (SDQHI)—by first analyzing its factor structure and subsequently assessing for measurement invariance and latent mean differences. The study sample consisted of 6,673 children, aged 4-17, from the 2019 National Health Interview Survey Sample Child Files, inclusive of White, Black, Hispanic/Latinx, and Asian children. A series of confirmatory factor analyses were used to establish the factor structure of the SDQ-HI and determine configural invariance across ethnic groups. Furthermore, the alignment optimization approach was employed to examine subsequent measurement invariance of the SDQ-HI and compare latent means between the groups. Results from this study indicated that 1) the SDQ-HI best fit a two-factor structure, 2) the SDQ-HI was deemed invariant across White, Black, Hispanic/Latinx, and Asian groups, except for scalar invariance, and 3) no significant differences were found in latent means between White and ethnically minoritized groups. The findings from this study help to support the use of the SDQHI as a screening tool across ethnic groups and provide important implications for considering the cultural impact toward behavior perceptions and endorsements. Limitations and future research directions are discussed.
... The existing literature on the moderating and mediating role of resilience in the relationship between racial discrimination and health outcomes presents inconsistent findings. Some studies demonstrate these effects, such as one noting that cultural resilience mediated the adverse impact of racial discrimination on stress [67]. In a Canadian study, resilience partially mediated the correlation between perceived racial discrimination and psychosomatic symptoms [68]. ...
Introduction
Unmet oral health needs remain a significant issue among immigrant adolescents, often exacerbated by experiences of racial discrimination. This study aimed to examine the associations between perceived discrimination and oral health behaviours in adolescents with immigrant backgrounds and explore the potential moderating role of resilience on this association.
Methods
Ethical approval for this cross-sectional study was obtained from the University of Alberta Research Ethics Board. Participants were 12 to 18-year-old adolescents from immigrant backgrounds. Participants were recruited through nine community organizations using a snowball sampling technique. After obtaining active parental consent and assent from the adolescent, the participants completed a questionnaire covering demographics, oral health behaviours, and perceived racial discrimination and resilience. Perceived racial discrimination and resilience were measured using validated scales. Descriptive statistics summarized variables. Logistic regression assessed associations, controlling for confounding factors. Resilience’s moderating impact was analyzed via the interaction model of regression analysis.
Results
In this cross-sectional study of 316 participants, average age of 15.3 (SD = 1.9) years, and a median age of 15 years (Inter Quartile Range-12-18), 76% reported discrimination experiences. Adjusted analysis showed that an increase of one unit in the total discrimination distress score was associated with 51% less likelihood of categorizing self-rated oral health as good (OR = 0.49, 95% CI: 0.29–0.81). The odds of brushing teeth more than twice a day, as opposed to once a day, decreased by 58% with one unit increase in the total discrimination distress score (OR = 0.42, 95% CI: 0.25–0.71). The odds of visiting the dentist for an urgent procedure instead of a regular check-up were 2.3 times higher with a unit increase in the total discrimination distress score (OR = 2.3: 95% CI:1.3–4.0) Resilience did not moderate the observed association.
Conclusion
Perceived racial discrimination was associated with the pattern for dental attendance, tooth brushing frequency, and self-rated oral health. Resilience did not moderate the observed association.
... 68,69 This positive association has been reported to modulate the effects of RRCS on systolic blood pressure 70 and stress levels. 71 Overall, our preliminary findings were not significant, but a higher number of participants is needed to make any firm conclusions regarding if stress related to racial discrimination has an impact on the hippocampal memory system. ...
The incidence of Alzheimer’s Disease (AD) in the African American (AA) and
Hispanic or Latino American populations in the United States (US) is twice as high
compared to non-Hispanic White Americans. The study of race-related factors to explain the disparity in the incidence of AD and other health outcomes has been of growing interest. African Americans in the US experience higher discrimination due to race on a daily basis than any other minority group, and race-based discrimination (racism) is a known chronic stressor. It has been shown that in humans and rodents, chronic stress negatively affects hippocampal-dependent memory and reduces hippocampal volume. Pattern separation (PS), the ability to create distinguishable memory traces for similar information and thus avoiding interference to discriminate between similarly patterned visual percepts, is known to rely on the dentate gyrus (DG) hippocampal subfield integrity. Although the detrimental effects of chronic stress have been documented before, the effects of racism-related chronic stress (RRCS) on hippocampal-dependent memory system remain understudied. This pilot/preliminary study tested the hypothesis that higher frequency of experiences of discrimination in AA older adults would correlate with deficits in a behavioral PS task and with DG/CA3 volume. Seven African American older residents from the greater Boston area participated in both the cognitive testing to examine behavioral PS and structural MRI to examine DG/CA3 vii volume. Contrary to our hypothesis, a Spearman correlation analysis did not demonstrate a significant association between discrimination scores and behavioral PS performance or DG/CA3 volume. However, a significant correlation was found between performance on the behavioral PS task and right DG/CA3 volume. These results are consistent with previous studies on PS. Continued future research on the impact of RRCS on the hippocampal memory system among AA older adults as an important modulating factor in health for this population is needed.
... Holtorf (2018) explored cultural resilience, demonstrating its capacity to inspire individuals to endure uncertainty and withstand adversity during periods of change. Cultural resilience is seen as an asset that enhances societal well-being (Spence et al., 2016). Studies by Rapoport (2000), Austin and Khan (2012), and Talò et al. (2014) suggest that cultural values play a significant role in individuals' choices of where to live and their emotional connections to their places of residence, fostering adaptability and endurance in the face of challenges. ...
... On the one hand, the adjusted R squared reflected at least a medium-level effectiveness of our model. Prior studies showed the adjusted R squared varied from 0.05 to 0.86 [68][69][70][71]. On the other hand, the adjusted R squared in our model reflected the complexity of the mental health, which may contribute to other factors that affect mental health. ...
Background:
Mental health issues affect rich and poor, young and old, and are widespread in Asia as well as in Europe. However, few studies have investigated the influence of perceived stress and income on mental health among general population in China and in Germany.
Methods:
We conducted an online survey from December 2021 to February 2022 to investigate how perceived stress and income affect mental health among the general population in China (N = 1123) and in Germany (N = 1018). Accordingly, we used the 10-item Perceived Stress Scale (PSS-10) and the 12-item General Health Questionnaire (GHQ-12). We ran a multiple linear regression model to investigate the relationship between perceived stress, income, and mental health.
Results:
Overall, we found that 53.4% participants reported mental health issues (GHQ-12 score ≥12). The proportion of our sample who reported mental health issues was higher in Germany (60.3%) than in China (44.8%). The regression model revealed that a higher perceived stress score was associated with more mental health issues in both countries (b = 0.60, p < 0.01). Individuals with a low income reported poorer mental health in Germany than those in China. Interestingly, the situation was reversed when incomes were high: individuals with a high income reported worse mental health in China than in Germany (b = -0.40, p < 0.01).
Conclusion:
Perceived stress has a negative impact on mental health, while income has differential effects. Mental health promotion programmes may involve teaching stress management, while considering differences in mental health outcomes in developed and developing countries.
... Black participants as a group had the highest resilience scores of any race. These findings suggest that the effect of discrimination on mental health in this group is likely being buffered by top-down processes related to resilience and cognitive flexibility (98)(99)(100)(101). ...
Background
Discrimination is associated with negative health outcomes as mediated in part by chronic stress, but a full understanding of the biological pathways are lacking. Here, we investigate the effects of discrimination involved in dysregulating the brain-gut microbiome (BGM) system.
Methods
154 participants underwent brain MRI to measure functional connectivity, fecal samples were obtained for 16s rRNA profiling and fecal metabolites, and serum for inflammatory markers, along with questionnaires. The everyday Discrimination Scale was administered to measure chronic and routine experiences of unfair treatment. A sparse partial least squares-discriminant analysis was conducted to predict BGM alterations as a function of discrimination, controlling for sex, age, body mass index, and diet. Associations between discrimination-related BGM alterations and psychological variables were assessed using a tripartite analysis.
Results
Discrimination was associated with anxiety, depression, and visceral sensitivity. Discrimination was associated with alterations of brain networks related to emotion, cognition and self-perception, and structural and functional changes in the gut microbiome. BGM discrimination-related associations vary by race/ethnicity. Among Black and Hispanic individuals, discrimination leads to brain network changes consistent with psychological coping and increased systemic inflammation. For White individuals, discrimination is related to anxiety but not inflammation, while for Asian individuals, the patterns suggest possible somatization and behavioral (e.g., dietary) responses to discrimination.
Conclusions
Discrimination is attributed to changes in the BGM system more skewed towards inflammation, threat response, emotional arousal, and psychological symptoms. By integrating diverse lines of research, our results demonstrate evidence that may explain how discrimination contributes to health inequalities.
... Empirical evidence confirms the protective role of resilience on the detrimental consequences of racial discrimination among Black individuals [33][34][35]. According to Utsey and colleagues (2008), psychological resources (optimism and resilience) are positively correlated with decreases in psychological distress, whereas social resources (family, adaptability, and cohesion) have a significant stress-suppressing effect on race-related stress [36]. ...
Objective
Although no study has explored psychosomatic symptoms in Black communities in Canada, several studies in the United States showed that psychological distress expression involves physical pain in African Americans. Using a cross-sectional design, the present study documents the frequency of psychosomatic symptoms and its association to racial discrimination, and resilience among Black individuals aged 15 to 40 in Canada.
Method
A total of 860 participants (Mage = 25.0 years, SD = 6.3), predominantly born in Canada (79.1%) and women (75.6%), completed the Symptom Checklist-90-Revised (somatization subscale), the Everyday Discrimination Scale, and the Resilience Scale-14.
Results
Findings revealed that 81.7% of participants experienced psychosomatic symptoms, with higher prevalence among women (84.2%) compared to men (70.7%;), ꭓ² = 21.5, p < .001; participants aged 25 to 40 years old (93.7%) compared to those aged 15–24 years old (75.2%) (ꭓ² = 45.0, p < .001). Participants with higher experience of racial discrimination had more psychosomatic symptoms (89.4%) compared to others (72.9%), ꭓ² = 39.2, p < .001). The moderated mediation model showed that everyday racial discrimination was positively associated with psychosomatic symptoms (B = 0.1, SE = 0.01, p < .001). The model showed that the association between racial discrimination and psychosomatic symptoms was partially mediated by resilience (B = -0.01, SE = 0.0, p < .01), and negatively moderated by gender (B = -0.04, SE = 0.01, p < .01). In other words, being a woman is associated with a higher level of psychosomatic symptoms among those victims of racial discrimination.
Conclusion
By highlighting the association between racial discrimination and psychosomatic symptoms and the role of resilience and gender in this relation, this article reveals important factors to integrate to improve healthcare services, prevention, and interventions among Black individuals with psychosomatic symptoms.
... In addition to social connections, participation in Anishinaabe cultural practices was also cited by some participants as being a major source of strength that contributed to wellbeing. This affirms prior research which has demonstrated the buffering impacts of First Nations culture and/or cultural identities on substance use and mental health outcomes [40,41]. As noted above, reconnecting with First Nations culture and/or cultural identity may serve to alleviate the social and cultural disruption that underpins contemporary substance use challenges [18][19][20]. ...
Research on substance use challenges in First Nations communities is often deficit-focused and can reinforce paternalistic stereotypes that lead to further discrimination. In this article, we report on findings of a strengths-based Photovoice project done in collaboration with a First Nations’ community in southern Ontario, Canada to better understand experiences with substance use challenges in the community. We analyzed interview data collected with seventeen individuals who have lived experience or are supporting a loved one with lived experience with a substance use challenge. Participants described sources of strength that characterized their path to wellness, including strong family and social connections, cultural practices, identity, spirituality, day-to-day activities, and helpful supports and services. Furthermore, participants made several suggestions for improving services, including the need for integrated and flexible systems of care and trustful client-provider relationships. At its core, nurturing wellness involved a transformative process involving social and/or cultural connections. The stories shared by participants demonstrate the unique and varied strengths drawn from by individuals dealing with a substance use challenge.
... from Hungary [33], all above studies were conducted among college students using the GHQ-12. These differences might be attributed to racial, cultural, and socio-demographic disparities [34]. With the increase of SSQ, the risk of mental health problems among college students showed a significant decreasing trend, suggesting that improving the SSQ could be an effective and practical method to prevent mental health problems of college students. ...
Background
Mental health problems are important public health issues among college students and are associated with various social factors. However, these influencing factors were scarcely summarized in Chinese college students comprehensively. This study aims to assess the associations between socio-demographic characteristics, lifestyles, social support quality (SSQ) and mental health among Chinese college students .
Methods
A cross-sectional study was conducted in Wuhan, China, from October 2017 to February 2018. College students from 18 colleges or universities were randomly recruited using multi-stage cluster sampling method. The Multidimensional Scale of Perceived Social Support scale and 12-items General Health Questionnaire were used to estimate students’ SSQ and mental health statuses, respectively. Logistic regression analysis was used to evaluate the associations between socio-demographic characteristics, lifestyles, SSQ and mental health problems.
Results
A total of 10,676 college students were included. Among them, 21.4% were identified as having possible mental health problems. Students being a female, aged 18–22 years old, whose mother held college degrees and above, and drinking alcohol were more likely to have mental health problems ( P < 0.05). Contrarily, having general or higher household economic levels, work-rest regularly, and sleeping ≥ 7 h were preventive factors ( P < 0.05). Especially, a decreasing trend in the risk of having mental health problems with the improvement of SSQ was identified.
Conclusion
Besides socio-demographic and lifestyle factors, social support is a critical factor for mental health among college students. Improving SSQ, especially which from the family, could be an effective method to prevent mental health problems among college students.
... Resilience resources are theorized to buffer acts of discrimination. For example, Spence et al. (2016) tested the compensatory model of resilience showing support for a relationship between resilience and stress reduction. Aronowitz (2005) identified manageability as one source that assists in the ability to cope with stress. ...
An unanticipated outcome of coronavirus disease (COVID-19) has been increased Sinophobia directed toward Asian Americans. The present study used a mixed-methods design and investigated how 345 East Asian Americans responded to COVID-19-related microaggressions and how their responses affected stress and well-being. The qualitative data included 196 narratives describing anti-Asian microaggressions experienced by participants during COVID-19. Four themes emerged from narratives including nonverbal rejection responses, verbal rejection, physical assault, and exposure to aggression on the social media. Additionally, quantitative data collected participants’ responses to scales measuring microaggressions, personal resilience, social support, coping strategies (engagement and disengagement coping), stress, and psychological well-being. Path analysis showed that participants who reported more microaggressions experienced significantly more stress. Participants with more social support had better psychological well-being. Those with stronger personal resilience were more likely to use engagement coping. Even though engagement coping was associated with more stress, confronting aggressors was also associated with better psychological well-being compared to ignoring the threat (disengagement coping). Implications of these findings are discussed.
... Given that research has established a link between sexual minority discrimination, stress as a result of racial prejudice, and mental and physical health [97], it is imperative to acknowledge the unique complexity for those who identify as POC and a sexual minority. Typically, for BIPOC individuals, their culture and community are protective factors to their physical and mental well-being, especially in terms of racial discrimination [99,100]; however, due to the vast stigmatization of sexual minorities and transgender identities amongst racialized communities, this facet of resilience is not a certain option [97]. Additionally, a study of BIPOC members of the LGBTQ community via 11 semi-structured interviews with LGBTQ-POC individuals found that participants felt disconnected from their racial community as a result of their sexual identity [97]. ...
Purpose of Review
While research has identified racial trauma in other contexts, it is often overlooked amongst Canadian society. Racial trauma occurs as a result of an event of racism or cumulative events over time whereby an individual experiences stress and consequent mental health sequelae. Given that the BIPOC (Black, Indigenous, and/or Person of Colour) population in Canada is increasing, it is imperative to identify racial discrimination and the subsequent stress and trauma associated with being racialized in Canada, which subjects BIPOC Canadians to various forms of racism, including microaggressions.
Recent Findings
This paper reviews the published literature on racism and racial discrimination that identifies or infers racial trauma as the source of the mental health implications for various groups (e.g., Indigenous people, Black Canadians, Asian Canadians, immigrants, and refugees). In addition, intersectionality of racialized persons is prominent to their psychological well-being as their psychosocial and socioeconomic position are complex. Therefore, this paper both provides insight into the Canadian experience as a person of colour and signifies the need for further research on racial trauma in a Canadian context.
Summary
Despite Canada’s emphasis on multiculturalism, racialized individuals are at risk for racial trauma due to prejudice and discrimination. The politicization of multiculturalism has permitted Canada to deny claims of racism, yet the historical basis of established institutions results in irrefutable systemic and systematic barriers for Canadian people of colour.
... Nonetheless, the literature makes special emphasis on the role that resilience plays when people experience discrimination. In some cases, specific types of resistance such as cultural resilience help repair the detrimental impact of racism in the form experienced by BIPOC (Spence et al., 2016). Thus, demonstrating that resilience can operate as a protective factor against discriminatory acts. ...
... A measure was created for the present analyses based on whether participants agreed that the following four strengths were a characteristic of their community: "use of First Nations language", "the natural environment", "traditional ceremonial activities and awareness of First Nations culture", and "Elders". Affirmative responses were summed to create a count variable that ranged from 0 to 4 as done previously by Spence and colleagues [29]. Use of traditional healing practices was assessed using a pair of measures capturing use of traditional healers and use of traditional medicines. ...
We examined the explanatory roles of social determinants of health (SDOH) for First Nations people using a four-domain model of health and wellness based on the Medicine Wheel (i.e., physical, mental, emotional, and spiritual health), including colonial-linked stressors (i.e., historical trauma, childhood adversities, racial discrimination) and cultural resilience factors (i.e., cultural strengths, traditional healing practices, social support). Data were collected in partnership with a First Nation in Ontario, Canada in 2013 through a community survey (n = 194). For each outcome (physical, mental, emotional, and spiritual health), a modified Poisson regression model estimated prevalence ratios for the SDOH, adjusting for age, sex, education, and marital status. Negative associations were found for historical trauma with physical, mental, emotional, and spiritual health; for childhood adversities with mental health; and for racial discrimination with physical, mental, and emotional health. Positive associations were found for cultural strengths with physical, mental, and emotional health and for social support with physical, mental, emotional, and spiritual health. We observed negative associations between use of traditional healing practices and mental and emotional health. Our findings suggest that these SDOH may play important roles in relation to wellness through associations with the domains of health modelled by the Medicine Wheel.
... from Hungary [33], all above studies were conducted among college students using the GHQ-12. These differences might be attributed to racial, cultural, and socio-demographic disparities [34,35]. With the increase of SSQ, the risk of mental health problem among college students showed a signi cant decreasing trend, suggesting that improving the SSQ could be an effective and practical method to prevent mental health problems of college students. ...
Background: Mental health problem is an important public health issue among college students and is associated with various soical factors. However, these influencing factors were scarcely summarized in Chinese college students comprehensively. This study aims to assess the associations between socio-demographic characteristics, lifestyles, social support quality (SSQ) and mental health among Chinese college students.
Methods: A cross-sectional study was conducted in Wuhan, China, from October 2017 to February 2018. College students from 18 colleges or universities were randomly recruited using multi-stage cluster sampling method. The Multidimensional Scale of Perceived Social Support scale and 12-items General Health Questionnaire were used to estimate students’ SSQ and mental health status, respectively. Logistic regression analysis was used to evaluate the associations between socio-demographic characteristics, lifestyles, SSQ and mental health problems.
Results: A total of 10676 (96.24%) college students were included in the study. Among them, 21.4% were identified as having mental health problems. Students being a female, aged 18-22 years old, whose mother held college degrees and above, and drinking alcohol were more likely to have mental problems (P <0.05). Contrarily, having general or higher family economic levels, working and resting regularly, and sleeping ≥ 7 hours could be preventive factors (P <0.05). Especially, there was a decreasing trend in the risk of mental health problems with the improvement of SSQ.
Conclusion: Besides socio-economic and lifestyle factors, social support is a critical factor for mental health among college students. Improving SSQ, especially which from the family, could be an effective method to prevent mental problems among college students.
... Lifetime and daily discrimination encompass discrimination around education, employment, financial services, and experiencing hostility in social encounters such as being harassed by the police, being treated with less respect than others, and having people act as if they are afraid of you (Chou & Choi, 2011;Kessler et al., 1999;McNeilly et al., 1996). Experiencing discrimination has been shown to result in increased perceived and biological stress levels (O'Brien et al., 2016;Sawyer et al., 2012;Spence et al., 2016), and increased stress is known to be associated with mortality. Studies have shown an association between perceived discrimination and increased rates of mortality by up to 18% (Barnes et al., 2008;Farmer et al., 2019). ...
Objective:
To understand the relationship between mortality and three types of perceived discrimination (lifetime, daily, chronic job) using a nationally representative sample of U.S. adults.
Methods:
Data from 4562 adults in the Midlife in the United States (MIDUS) between 2004 and 2006 (MIDUS II and MIDUS African American sample) were analyzed. Unadjusted associations between primary independent discrimination variables (lifetime, chronic job, daily) and mortality were analyzed using univariate Cox's proportional hazards regression models. Covariates were added to the models by group: predisposing (sex, age, race/ethnicity, education, marital status); enabling (household income, employment status, insurance status); and need factors (body mass index, diabetes, hypertension, stroke, cancer) to estimate hazard ratios.
Results:
After adjusting for all covariates, hazard ratios for lifetime discrimination (HR: 1.09, p = 0.034) and daily discrimination (HR: 1.03, p = 0.030) were statistically significant. There was no relationship between mortality and chronic job discrimination (HR:1.03, p = 0.15).
Conclusions:
Adults experiencing lifetime and daily discrimination had significantly increased risk of mortality after adjusting for predisposing, enabling, and need factors. The findings highlight the importance of screening patients during clinical encounters for experiences of discrimination and providing appropriate resources to mitigate the negative impact of discriminatory events on mortality. Future research should work to fully understand the mechanism by which discrimination increases risk of mortality. These future findings should be used to develop targets for interventions designed to decrease mortality among adults who have experienced discrimination.
... In other words, both a risk exposure factor and a compensatory factor could contribute additively towards the outcome, but with independent influences in opposite ways. 30 This suggests that resilience may play a mediating role in the association between discrimination experiences and OHRQoL. Further research into the relationship between resilience and OHRQoL in later life is much needed. ...
Objectives
It is well-established that racial discrimination influences quality of life, but there is scarce evidence about how racial discrimination affects oral health-related quality of life (OHRQoL). Furthermore, the pathways linking racial discrimination and OHRQoL remain unknown. Guided by the integrative framework of immigration, ageing, and oral health, psychosocial stressors and resources exert influences on OHRQoL. In addition, according to the compensatory model of resilience, resilient resources could counteract risk exposures to stressors given specific outcomes. Hence, this study examined the relationship between experiences of discrimination and OHRQoL and investigated resilience as a mediator in such a relationship among older Chinese immigrants.
Methods
Data came from the Population Study of Chinese Elderly in Chicago collected between 2017 and 2019. The working sample included 3054 foreign-born older Chinese Americans aged 60 years or older. OHRQoL was measured by seven items from the Geriatric Oral Health Assessment Index. Experiences of discrimination (yes or no) were measured by the 9-item Experiences of Discrimination instrument. Resilience was measured by the 10-item Connor Davidson Resilience Scale. Mediation analysis was conducted to examine the direct and indirect pathways towards OHRQoL.
Results
Experiences of discrimination were directly associated with poorer OHRQoL (b = −0.98, P < .05). Resilience partially mediated the relationship between discrimination experiences and OHRQoL. Specifically, discrimination experiences were associated with weaker resilience (b = −1.58, P < .05), and weaker resilience was associated with poorer OHRQoL (b = 0.06, P < .05).
Conclusions
Findings illustrate the importance of studying racial discrimination and resilience in OHRQoL. Interventions need to consider individuals’ discrimination experiences and stress coping abilities to promote OHRQoL.
... However, it will be important to better understand the role that knowledge and attitudes play in influencing health behaviour when considered through the lens of TTB-for example, it is worth considering if increased knowledge or improved selfefficacy about health behaviours supports individual resilience. In addition, as we have noted, the TTB resilience factors are limited to individual characteristics, whereas community and cultural factors such as social support (Ozbay et al., 2007) and cultural resilience (Spence et al., 2016) have been identified as important protective factors. Finally, while TTB is concerned with the role of trauma exposure in eliciting a physiological trauma response, TTB does not reflect on the biological mechanisms that may underly the trauma response such as the epigenetic component of the human stress response (Stankiewicz et al., 2013). ...
Exposure to trauma increases the risk of engaging in detrimental health behaviors such as tobacco and substance use. In response, the United States Substance Abuse and Mental Health Services Administration developed Trauma-Informed Care (TIC), an organizational framework for improving the provision of behavioral health care to account for the role exposure to trauma plays in patients' lives. We adapt TIC to introduce a novel theory of behavior change, the Trauma-Informed Theory of Individual Health Behavior (TTB). TTB posits that individual capacity to undertake intentional health-promoting behavior change is dependent on three factors: 1) the forms and severity of trauma they have been and are exposed to; 2) how this trauma physiologically manifests (i.e., the trauma response); and 3) resilience to undertake behavior change despite this trauma response. We define each of these factors and their relationships to one another. We anticipate that the introduction of TTB will provide a foundation for developing theory-driven research, interventions, and policies that improve behavioral health outcomes in trauma-affected populations.
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... Researchers have identified various individual-level factors that moderate the association between discrimination and health, including coping resources (Brondolo et al., 2009;Polanco-Roman et al., 2019), family and peer influences (Jelsma & Varner, 2020;Roberts et al., 2012), racial identity (Banks & Kohn-Wood, 2007;Brody et al., 2015;Chae et al., 2016;Lucas et al., 2017;Sellers & Shelton, 2003), racial socialization (Brown & Tylka, 2011;Neblett et al., 2008), resilience (Spence et al., 2016), vigilance (Hicken et al., 2013;Himmelstein et al., 2015;LaVeist et al., 2014), and psychological traits such as anger (Pittman, 2011). In this study, | 3 of 16 JELSMA Et AL. ...
Personality and psychological traits are known to influence how individuals react to and cope with stress, and thus have downstream health and aging consequences. However, research considering psychological health traits as individual-level difference factors moderating the links been racism-related stress and health for racial and ethnic minorities in the United States is rare. Using intensive daily diaries and a wearable sensor that continuously recorded sympathetic nervous system arousal in a college sample of racial and ethnic minority college students (80% African American, first-generation Black, or African; 20% Latinx), we linked arousal to racism-related experiences dynamically throughout the day as participants naturally went about their lives. Findings suggest that multiple traits are associated with increased arousal in real-time when interpersonal discrimination is perceived, but that only anger and anxiety also predicted increased arousal during moments of rumination and reflection on race-related inequities. Vicarious discrimination exposure moments were also linked to suppressed arousal in general, but particularly for more anxious individuals. We use a stress appraisal and coping framework to elucidate the ways in which individual psychological differences may inform physiological responses to race-related stress. The biopsychosocial pathways by which cognitive appraisal and interpersonal race-related stress contribute to racial health disparities are also discussed.
... from Hungary [22], all above studies were conducted among college students using the GHQ-12. These differences might be attributed to racial, cultural diversities, and socioeconomic disparities [23,24]. With the increase of SSQ, the risk of being mental disorder among college students showed a signi cant decreasing trend. ...
Background
Social support could improve college students’ mental health status. However, mental health varies across different geographic areas, and most of previous studies only included small sample sizes, thus the nationwide survey are warranted. This study sought to estimate the association between social support quality (SSQ) and mental health among Chinese college students using data yielding from a nationwide survey.MethodsA cross-sectional study with a web-based questionnaire survey was conducted in Wuhan, China, from October 2017 to February 2018. A total of 11093 college students were recruited from 18 colleges or universities through multi-stage random cluster sampling method. The Multidimensional Scale of Perceived Social Support scale and 12-items General Health Questionnaire were used to estimate students’ SSQ and mental health status, respectively. Logistic regression analysis was used to identify the association between SSQ and the mental health disorder in college students.ResultsA total of 10,676 (96.24%) college students were included in this study. Of them, 21.4% were identified as having a mental disorder. Students being a female, aged 18-22 years old, whose mother held a college degree and above, and drinking alcohol had more risks of being mental health problems ( P <0.05). However, having general or higher family economic levels, working and resting regularly, and sleeping ≥ 7 hours could be preventive factors for mental health problem ( P <0.05). Especially, with the improvement of SSQ, there was a decreasing trend in the risk of being mental disorder.Conclusion
Mental health disorder is an important public health challenge among college students in China. Improving SSQ could be the practical and valuable method to prevent college students’ mental problem.
Management scholarship has long explored how life outside of work impacts work, and it has accumulated rich theoretical insights on how being a mother or father impacts one’s job and the organization. Importantly, however, this literature has adopted a limited scope of who and what caregiving embodies, overlooking the millions of workers globally who find themselves caring for a parent, a person with a disability, or someone who faces unique marginalization. We use new research on nontraditional caregiving (NTC) roles to enrich the topic of caregiving more broadly. As such, we provide an integrative review of 353 multidisciplinary workplace articles to detail the workplace outcomes explored in the literature and identify four caregiving dimensions that cannot be fully understood by a traditional caregiving framework alone. Further, we build a multilevel framework that identifies novel processes across roles, thereby bridging the nontraditional and traditional caregiving literatures and introducing ways to redirect future research. Overall, this review aims to show that caregiving should be viewed more broadly than it is currently, and this review aims to build a foundation for better understanding the complexities of caregiving in all its forms.
Purpose: Our objective was to estimate inequities in heavy drinking between heterosexual, gay or lesbian, and bisexual or pansexual individuals, by sex/gender, and to determine whether this association is heterogeneous across racially minoritized status and income groups in Canadians aged 15 and older. Methods: We pooled three Canadian Community Health Survey cycles (2015-2020) and used separate modified Poisson regressions to explore the sex/gender-specific association between sexual identity and heavy drinking prevalence by racially minoritized status, and income, adjusted for survey cycle, age, marital status, and region. Results: With racially minoritized status, and income categories collapsed, heavy drinking was 1.3 times higher (95% confidence interval [CI] = 1.0-1.7) among bisexual or pansexual women compared with heterosexual women, with no differences among men. Among racially minoritized women, heavy drinking was 2.9 (95% CI = 1.3-6.4) times higher among bisexual or pansexual women and 1.9 (95% CI = 0.7-5.2) times higher among gay or lesbian women compared with heterosexual women. Among racially minoritized men, heavy drinking was 1.9 (95% CI = 0.9-4.0) times higher among gay men compared with heterosexual men. No differences were observed across sexual identity in White men or women. Bisexual or pansexual women reported increased heavy drinking relative to heterosexual women across income quintiles. Conclusion: Heavy drinking is distributed heterogeneously across sexual identity, sex/gender, racially minoritized status, and income. These results encourage equity-focused interventions to reduce heavy drinking among intersecting sociodemographic groups experiencing a greater burden of heavy drinking.
This qualitative study is an exploration of how women in higher education information technology (IT) positions navigate constructing their leadership identities. This includes the messy, personal, internal identity work that occurs prior to claiming their leadership identities on the public stage, followed by an examination of what the experience of attempting to claim and negotiate a leadership identity is like in the social context of their organizations. This educational and sociological study employs an Interpretative Phenomenological Analysis approach with a series of three interviews per participant that allowed the researcher to deeply explore the personal identity experiences of participants. Findings reveal that women in IT experience challenges that can hinder their ability to successfully claim and establish a leadership identity. Women in IT and IT organizations will benefit from the knowledge generated in this study.
Until now, the cultural values embodied in the traditions of the Javanese people have not been conclusively explained. The purpose of this research is to describe and explain the cultural value of the ritual of bathing rituals in Sendang Modo and its potential as a source of cultural resilience, especially in people’s livelihoods. This study uses an ethnographic approach. The research was conducted for two years in Kandangsapi Village, Jenar District, Sragen Regency, Central Java Province, Indonesia. Retrieval of data using observation and interviews. The data obtained were analyzed using an interactive model. From the research conducted, it was found that the ritual of bathing in Sendang Modo has been carried out since the XVIII century. The community performs the ritual at this spring because spring water is considered efficacious and as the beginning of giving life to the people of Kandangsapi Village. These findings also show that the mandi-temanten tradition has the potential to offer an alternative or adaptive strategy, namely not only as a complement to the tradition but also to generate new opportunities as livelihood security which can ultimately increase economic, social, and even political income. So that the cultural traditions carried out have strengthened the survival of the surrounding community.
This study reviews the challenges faced by indigenous undergraduates in learning programming and identifies interventions to address them. A systematic review of 37 studies published between 2000 and 2022 found that Indigenous undergraduates face barriers to learning programming related to their indigeneity, motivation, mathematics anxiety, cognitive load, pedagogy, prior knowledge, critical thinking, and programming language anxiety. Interventions such as ethnoprogramming, culturally responsive pedagogy, ethnomathematics, and gamification have been proposed to overcome these challenges. Our review and analysis suggest that culturally responsive pedagogy and gamification show promise in improving indigenous undergraduates' programming learning outcomes. This study highlights the importance of designing effective interventions to support Indigenous undergraduates' learning and career opportunities in the global programming market. Future research could explore specialised interventions tailored to indigenous learners' unique needs and perspectives.
We investigate discrimination experiences of (1) immigrants and racialized individuals, (2) Indigenous peoples, and (3) comparison White non-immigrants in nine regions of Southwestern Ontario containing small- and mid-sized communities. For each region, representative samples of the three groups were recruited to complete online surveys. In most regions, over 80 percent of Indigenous peoples reported experiencing discrimination in the past 3 years, and in more than half of the regions, over 60 percent of immigrants and racialized individuals did so. Indigenous peoples, immigrants and racialized individuals were most likely to experience discrimination in employment settings and in a variety of public settings, and were most likely to attribute this discrimination to racial and ethnocultural factors, and for Indigenous peoples also their Indigenous identity. Immigrants and racialized individuals who had experienced discrimination generally reported a lower sense of belonging and welcome in their communities. This association was weaker for Indigenous peoples. The findings provide new insight into discrimination experienced by Indigenous peoples, immigrants and racialized individuals in small and mid-sized Canadian communities, and are critical to creating and implementing effective anti-racism and anti-discrimination strategies.
Introduction:
Racial/ethnic discrimination (hereafter, discrimination) is associated with use of individual tobacco and cannabis products. However, we know little about how discrimination affects dual/polytobacco and cannabis use and associated use disorders.
Methods:
We used cross-sectional data on adults (18+) from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 35,744). We defined past-year discrimination as a summary scale (range: 0-24) based on six scenarios. We created a mutually exclusive six-category use variable: noncurrent, individual tobacco and noncannabis, individual tobacco and cannabis, individual cannabis and nontobacco, dual/polytobacco and noncannabis, and dual/polytobacco and cannabis based on past 30-day tobacco use of four products (i.e., cigarettes, electronic nicotine delivery systems, other combustibles (cigars, pipe), smokeless tobacco) and cannabis use. We also examined past-year tobacco use disorder (TUD) and cannabis use disorder (CUD) as a four-level variable: no disorders, TUD only, CUD only, and TUD and CUD. We estimated associations between discrimination and each outcome using adjusted multinomial logistic regression and assessed effect modification by stratifying adjusted models by race/ethnicity (i.e., Hispanic, non-Hispanic (NH) White, NH Black, and another race/ethnicity).
Results:
Experiencing more discrimination was associated with each outcome but was most strongly associated with dual/polytobacco and cannabis use (OR: 1.13, 95 % CI: 1.07-1.19) and joint TUD and CUD (OR: 1.16, 95 % CI: 1.12-1.20). Models stratified by race/ethnicity showed that discrimination was associated with dual/polytobacco and cannabis only among NH White adults, and with joint TUD and CUD only among NH Black and NH White adults.
Conclusions:
Discrimination was associated with tobacco and cannabis use outcomes among multiple adult racial/ethnic populations, but associations were more profound for NH White and NH Black adults than adults from other racial/ethnic populations.
The timeless social activity of passing down oral stories preserves family memory, identity, values, and culture. Existing tools for family memories often take a techno-determinist approach by focusing on the mechanics of connecting families and the resulting documentation, rather than the social process of sharing stories and morals, and largely without considering the specific needs of immigrant families. For immigrant families, cultural exchange, particularly crucial across grandparent and grandchild generations, is threatened by the language and cultural barriers emerging from displacement and migration. As a result, immigrant grandparents and their young grandchildren struggle with fostering social kinship, leading to social disconnect and loss of cultural heritage. In our research, we collaborate with multi-generational and culturally-at-risk immigrant families through Participatory Design activities towards the design of reminiscence tools that support their needs focusing on language and cultural connection. We report on the designs created by families and propose design guidelines supporting cultural resilience, focusing on flexible, visual storytelling.
The healthcare staff who supported Wuhan's rescue work were the first batch of cross-regional supporters during the outbreak of the COVID-19 pandemic. To determine the cultural factors that affected their mental health and resilience, as well as the processes that organizations and individuals underwent to transform cultural resources into benefits. This study collected narrative materials in the form of national and individual statements and used Social Ecology of Resilience theory to analyse them. It identified and analysed the cultural factors of resilience in macrosystems, mesosystems, and microsystems according to four themes, namely: cognition, emotion, will, and behaviour. Altogether, it was found that the national voice adopted an optimistic narrative tone reminiscent of that used during the context of war and that the personal or public voice approved of it. The study revealed that the party and government's use of moral narration derived from its heritage culture and its belief in its continuity in new China's culture served as a mechanism of cultural resilience and mobilisation. The above is the experience of the operation of living culture (LC) and cultural heritage (CH) mentioned in Culture Based Development (CBD). In light of this, it was concluded that the predominant form of cultural input during China's national public health crisis has been storytelling with narrative resilience.
Internalized racism (IR) is sometimes conceptualized as a form of racism, a psychological response to experiencing racism, and/or an external sociocultural process. However, while a growing body of work shows that IR is associated with adverse health among racial minorities, this work is limited in explaining this association. I present an integrated framework using the Stigma‐induced Identity Threat Model and the Minority Stress Theory Model to help better understand the mechanisms through which IR gets both “under the skin” and “into the mind” to impact health. With this integrated framework, I suggest IR is both a source of race‐ and racism‐related stress and a consequence of experiencing racism that increases risk of adverse health directly, and indirectly via psychological, biophysiological, and behavioral stress responses. Primarily, I argue IR is a racism‐induced identity threat response that triggers stress‐related psychological (e.g., hopelessness) and biophysiological (e.g., autonomic nervous system activation) responses, and increases engagement in maladaptive coping behaviors (e.g., drug use). These stress responses then operate as mechanisms through which IR is associated with adverse health. I discuss limitations of this initial framework and IR scholarship, along with directions for future research.
Introduction
Aboriginal and Torres Strait Islander (Aboriginal) people compared with non-Aboriginal people in Australia have higher rates of chronic conditions. These conditions increase the risk of poorer health outcomes if infected with COVID-19, highlighting the importance of COVID-19 vaccination. This study examined what Aboriginal people think about COVID-19 vaccines, reasons why they were vaccinated or not vaccinated and factors involved in receiving COVID-19 vaccination.
Methods
We used a participatory peer researcher method to interview 35 Aboriginal people aged 15–80 years living in Western Sydney, Australia. Local Aboriginal people who had ties with the community conducted the interviews. The questions and analyses were framed using the WHO’s Behavioural and Social Drivers of COVID-19 model. Interviews occurred between February 2021 and March 2021. Peer researchers were paid for their time in training and to conduct the interviews and each participant received $50.
Results
Reasons why participants would seek vaccination included: to protect themselves from infection and severe illness, to protect others in their community, to travel again and to return to ‘normal life’. Reasons why some participants were hesitant about being vaccinated included: fear of vaccine side effects; negative stories on social media; and distrust in Australian governments and medical institutions. Aboriginal people preferred to access COVID-19 vaccination through their local Aboriginal Health Service or a general practitioner they already knew.
Conclusion
Achieving high vaccination rates in Aboriginal communities is possible if vaccination programmes are delivered through trusted general practitioners or Aboriginal Health Services.
Racism is a chronic stressor fueled by stigma that can result in significant distress and dysfunction as well as negatively affect emotions, behavior, quality of life, and brain health. The effects of stigma and discrimination emerge early in life, with long-term consequences. The present review sought to use neuroscience research to describe how stigma, racism, and discrimination can impact the brain and mental health. Societal stigmas may be ‘encoded’ by associative fear learning and pattern completion networks, and experiences of racial discrimination may similarly affect threat-responsive regions and circuits. Race-related differences in brain function and structure supporting threat circuitry are largely attenuated when negative life experiences and discrimination are taken into account. Downstream, chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal medullary (SAM) axis in the context of discrimination and stigma can contribute to physical health disparities in minoritized and marginalized groups. Finally, we discuss models that provide a framework for interventions and societal-level strategies across ecological systems to build resilience and foster posttraumatic growth.
We used a novel measure of cultural efficacy to examine empirical pathways between enculturation, efficacy, and two wellbeing outcomes. Cultural factors are not consistently linked to better wellbeing in the academic literature despite widespread understanding of these processes in Indigenous communities. Healing pathways is a community‐based participatory study with eight reservations/reserves in the upper Midwest and Canada. This study uses data collected in 2017–2018 (n = 453, 58.1% women, mean age = 26.3 years) and structural equation modeling to test the relationships between enculturation, cultural efficacy, and mental health. The direct effect of enculturation on anxiety was positive. The indirect effect of enculturation via cultural efficacy was negatively associated with anxiety and positively associated with positive mental health. Cultural efficacy is an important linking variable through which the protective effects of culture manifest. The complex nature of culture must be met with innovative measures and deep understanding of Indigenous peoples to fully capture the protective role of culture. Empirical evidence often fails to reflect the innate wisdom within Indigenous communities. Cultural efficacy considers the colonial impact on one's personal agency to engage culturally. Cultural efficacy is important to consider when promoting Indigenous mental wellbeing. Empirical evidence often fails to reflect the innate wisdom within Indigenous communities. Cultural efficacy considers the colonial impact on one's personal agency to engage culturally. Cultural efficacy is important to consider when promoting Indigenous mental wellbeing.
Metaphors are often used to describe cancer experiences (e.g., battle, journey). Few studies explore how social threats (e.g., discrimination) shape metaphor preferences. We examined the relationship between discrimination and preferences for cancer battle metaphors (i.e., concrete, action-based) versus journey metaphors (i.e., open-ended, reflective) and mediating effects of needs for personal significance and cognitive closure. We also stratified the analysis when discrimination was/was not attributed to race and by racial/ethnic group.
Four-hundred twenty-seven U.S. participants completed an online survey. Items included everyday discrimination, need for personal significance, need for cognitive closure, and preference for cancer scenarios using battle or journey metaphors. Multigroup structural equation modeling examined: serial mediation (i.e., discrimination predicting metaphor preference via needs for personal significance and cognitive closure) stratified by discrimination attribution; and single mediation (i.e., discrimination predicting need for cognitive closure via need for personal significance) stratified by racial/ethnic group.
Discrimination was associated with battle metaphors preferences through serial mediation when discrimination was not attributed to race (β = 0.02, 95% CI [0.01,0.05]). Discrimination was directly associated with journey metaphor preferences (β = −0.20, 95% CI [-0.37,-0.06]) and the serial mediation was nonsignificant when discrimination was attributed to race. The single mediation model varied across racial/ethnic groups and was strongest for Non-Hispanic White participants (β = 0.17, 95% CI [0.07,0.30]).
Discrimination may shape cancer metaphor preferences through needs for personal significance and cognitive closure, yet these relationships differ based on whether discrimination is attributed to race and racial/ethnic group. Given that the U.S. health system often focuses on battle metaphors when framing cancer treatment and screenings, individuals who prefer journey metaphors (i.e., those who experienced more frequent racial discrimination in the present study) may experience a systematic disadvantage in cancer communication. A more careful consideration of cultural, racial, and ethnic differences in metaphor use may be a crucial step towards reducing cancer disparities.
The present study examined the demographic correlates of gene expression in a sample of adults (n = 543) from the Study of Midlife in the United States (MIDUS). Inflammatory and antiviral gene sets were operationalized using a priori composite scores and empirically derived co-regulatory gene sets. For both composite scores and co-regulatory gene sets, White/European Americans showed lower while Black/African Americans showed higher expression of genes involved in interferon responses and antibody synthesis. The effects of chronological age on gene expression varied by sex, such that pro-inflammatory gene expression increased with age more rapidly for females than males. The difference between the average expression of inflammatory and antiviral genes also increased with age for females but not males. Results shed light on differential gene expression as a potential physiological correlate for race/ethnicity, age, and sex-related health disparities in adulthood.
Purpose of review:
Both social and genetic factors are associated with health outcomes in systemic lupus erythematosus (SLE), thus playing a role in its health disparities. Despite the growing list of social and genetic factors associated with SLE outcomes, studies integrating sociocultural and individual determinants of health to understand health disparities in SLE are lacking. We review the contributions of different social and genetic factors to the disparities in SLE, and propose a socioecological model to integrate and examine the complex interactions between individual and social factors in SLE outcomes.
Recent findings:
Multiple studies collecting comprehensive social data and biospecimens from diverse populations are underway, which will contribute to the elucidation of the interplay and underlying mechanisms by which positive and negative social determinants of health influence epigenomic variation, and how the resulting biological changes may contribute to the lupus health disparities.
Summary:
There is growing awareness of the need to integrate genomic and health disparities research to understand how social exposures affect disease outcomes. Understanding the contributions of these factors to the SLE health disparity will inform the development of interventions to eliminate risk exposures and close the health disparity gap.
Academic stress is becoming an alarming mental health problem in Pakistan. The study aims to explore the causes of academic stress in the undergraduate students in Khyber Pakhtunkhwa, Pakistan. Qualitative exploratory research design is adopted for this study. Data is elicited through structured-interview guide from 80 students from different study programs at the University of Malakand. Findings of the study show that nearly all (96.25%) students experienced an academic stress. Further, main causes of academic stress mentioned by students include: the lack of time management (90%); the semester system and frequent exams (86%); high study load and lengthy syllabi (80%); financial constraints (78%); favouritism and discrimination (72%); ineffective teacher-student relationship (68%); conventional and multilingual teaching style (60%); family and parental expectations (56%); and difficulty in adjustment to the university environment (44%). This study concludes that academic stress can be curbed by revamping on the identified factors, establishment of effective counselling services, and other efficient coping strategies.
Abstract
Objective: In the United States, American Indian and Alaska Native (AI/AN) people suffer health inequities associated with alcohol and other drug use and also experience historical trauma symptoms resulting from colonization. Research suggests that historical trauma may be associated with substance use among AI/ANs. Method: As part of a Community Based Participatory Research project with tribal partners from a rural AI reservation, our team collected cross-sectional survey data from 198 tribal members who self-identified as having substance use problems. We examined associations between historical trauma thoughts, historical trauma symptoms, and substance use outcomes. We also examined historical trauma symptoms, current trauma symptoms, awareness of systemic discrimination, and ethnic identity as moderators of the associations between historical trauma thoughts and substance use variables. Results: Historical trauma thoughts, controlling for symptoms, were associated with greater abstinent days, fewer heavy alcohol use days, fewer drinks per drinking day, and fewer drug use days; historical trauma symptoms, controlling for thoughts, were associated only with fewer abstinent days. Moderation analyses showed that historical trauma thoughts were associated with better substance use outcomes when historical trauma symptoms were low, current trauma symptoms were low, awareness of systemic discrimination was high, and ethnic identity was high. Conclusion: When distressing trauma symptoms are low, historical trauma thoughts may act as a protective factor or as a marker for other factors associated with better substance use outcomes.
Age differences in emotional experience over the adult life span were explored, focusing on the frequency, intensity, complexity, and consistency of emotional experience in everyday life. One hundred eighty-four people, age 18 to 94 years, participated in an experience-sampling procedure in which emotions were recorded across a 1-week period. Age was unrelated to frequency of positive emotional experience. A curvilinear relationship best characterized negative emotional experience. Negative emotions declined in frequency until approximately age 60, at which point the decline ceased. Individual factor analyses computed for each participant revealed that age was associated with more differentiated emotional experience. In addition, periods of highly positive emotional experience were more likely to endure among older people and periods of highly negative emotional experience were less stable. Findings are interpreted within the theoretical framework of socioemotional selectivity theory.
Despite well-documented associations between everyday racial discrimination and depression, mechanisms underlying this association among African-American men are poorly understood. Guided by the Transactional Model of Stress and Coping, we frame masculine self-reliance and John Henryism as appraisal mechanisms that influence the relationship between racial discrimination, a source of significant psychosocial stress, and depressive symptoms among African-American men. We also investigate whether the proposed relationships vary by reported discrimination-specific coping responses. Participants were 478 African-American men recruited primarily from barbershops in the West and South regions of the United States. Multiple linear regression and Sobel-Goodman mediation analyses were used to examine direct and mediated associations between our study variables. Racial discrimination and masculine self-reliance were positively associated with depressive symptoms, though the latter only among active responders. John Henryism was negatively associated with depressive symptoms, mediated the masculine self-reliance–depressive symptom relationship, and among active responders moderated the racial discrimination-depressive symptoms relationship. Though structural interventions are essential, clinical interventions designed to mitigate the mental health consequences of racial discrimination among African-American men should leverage masculine self-reliance and active coping mechanisms.
The purpose of this article is to present a culturally situated, asset‐based developmental framework for understanding successful adaptation to stress. Making use of theory and research on differential exposure and reactivity to racial discrimination, it introduces a framework that can be used to investigate positive development in the context of other stressors. Toward this goal, the article highlights research related to the roles of racial socialization messages, racial identity, stress appraisals, and unique coping in influencing responses to racial discrimination. By integrating these themes, the article presents an asset‐based framework for understanding how these components influence one another and can function together to promote positive youth development in the context of racial discrimination. Ultimately, it also illustrates how the framework can be applied to other stressors that are experienced by African American youth and offers examples of how cultural assets work to promote positive youth development.
Disparities in African American health remain pervasive and persist transgenerationally. There is a growing consensus that both structural and interpersonal racial discrimination are key mechanisms affecting African American health. The Biopsychosocial Model of Racism as a Stressor posits that the persistent stress of experiencing discrimination take a physical toll on the health of African Americans and is ultimately manifested in the onset of illness. However, the degree to which the health consequences of racism and discrimination can be passed down from one generation to the next is an important avenue of exploration. In this review, we discuss and link literature across disciplines demonstrating the harmful impact of racism on African American physical health and the health of their offspring.
This review exploits the concepts of race and racism and defines particularities for the health profile of individuals or groups subject to discrimination or racial prejudice. In addition, we intend to seek evidences of the relationship between racism and health from the studies on stress. It presents social inequality as a powerful factor in the causality of health inequalities, which generates disparities in the stress prevalence. Racism is a creator and sustainer element of stressors in the context of social relations, and it explains how racial discrimination provokes fundamental limitations in the individuals' life, which impacts broadly on the amount of stress experienced. We tried to systematize knowledge about the relationship between race and health, investigating the deleterious impact of racism on the principle of social distribution of stress.
Purpose
The purpose of this study was to review articles related to the psychometric properties of the Perceived Stress Scale (PSS).
Methods
Systematic literature searches of computerized databases were performed to identify articles on psychometric evaluation of the PSS.
Results
The search finally identified 19 articles. Internal consistency reliability, factorial validity, and hypothesis validity of the PSS were well reported. However, the test-retest reliability and criterion validity were relatively rarely evaluated. In general, the psychometric properties of the 10-item PSS were found to be superior to those of the 14-item PSS, while those of the 4-item scale fared the worst. The psychometric properties of the PSS have been evaluated empirically mostly using populations of college students or workers.
Conclusion
Overall, the PSS is an easy-to-use questionnaire with established acceptable psychometric properties. However, future studies should evaluate these psychometric properties in greater depth, and validate the scale using diverse populations.
The current paper reviews research that has explored the intergenerational effects of the Indian Residential School (IRS) system in Canada, in which Aboriginal children were forced to live at schools where various forms of neglect and abuse were common. Intergenerational IRS trauma continues to undermine the well-being of today's Aboriginal population, and having a familial history of IRS attendance has also been linked with more frequent contemporary stressor experiences and relatively greater effects of stressors on well-being. It is also suggested that familial IRS attendance across several generations within a family appears to have cumulative effects. Together, these findings provide empirical support for the concept of historical trauma, which takes the perspective that the consequences of numerous and sustained attacks against a group may accumulate over generations and interact with proximal stressors to undermine collective well-being. As much as historical trauma might be linked to pathology, it is not possible to go back in time to assess how previous traumas endured by Aboriginal peoples might be related to subsequent responses to IRS trauma. Nonetheless, the currently available research demonstrating the intergenerational effects of IRSs provides support for the enduring negative consequences of these experiences and the role of historical trauma in contributing to present day disparities in well-being.
This introduction to the Special Issue Indigenous Youth Resilience in the Arctic reviews relevant resilience theory and research, with particular attention to Arctic Indigenous youth. Current perspectives on resilience, as well as the role of social determinants, and community resilience processes in understanding resilience in Indigenous circumpolar settings are reviewed. The distinctive role for qualitative inquiry in understanding these frameworks is emphasized, as is the uniquely informative lens youth narratives can offer in understanding Indigenous, cultural, and community resilience processes during times of social transition. We then describe key shared cross-site methodological elements of the Circumpolar Indigenous Pathways to Adulthood study, including sampling, research design, procedures, and analytic strategies. The site-specific papers further elaborate on methods, focusing on those elements unique to each site, and describe in considerable detail locally salient stressors and culturally patterned resilience strategies operating in each community. The concluding paper considers these across sites, exploring continuities and discontinuities, and the influence of cross-national social policies.
As part of a government policy of assimilation beginning in the mid-1800s, a large proportion of Aboriginal children in Canada were forcibly removed from their homes to attend Indian Residential Schools (IRSs), a practice which continued into the 1990s. This traumatic experience had lasting negative effects not only on those who attended but also on their offspring, who were previously found to report higher levels of perceived discrimination and depressive symptoms compared with Aboriginal adults whose families were not directly affected by IRSs. In attempt to elucidate the processes involved in these previous findings, the current study (N = 399) revealed that greater levels of past perceptions of discrimination among IRS offspring, together with their greater likelihood of considering their Aboriginal heritage to be a central component of their self-concept (i.e., high identity centrality), were associated with an increased likelihood of appraising subsequent negative intergroup scenarios to be a result of discrimination and as threatening to their well-being. In turn, these altered appraisals of threat in response to the scenarios were associated with higher levels of depressive symptoms relative to non-IRS adults. The apparent reinforcing relationships between past discrimination, identity centrality, and appraisals of discrimination and threat in intergroup interactions highlight the need for interventions targeting this cycle that appears to contribute to heightened psychological distress among offspring of those who were directly victimized by collective race-based traumas.
There is now considerable evidence that racism is a pernicious and enduring social problem with a wide range of detrimental outcomes for individuals, communities and societies. Although indigenous people worldwide are subjected to high levels of racism, there is a paucity of population-based, quantitative data about the factors associated with their reporting of racial discrimination, about the settings in which such discrimination takes place, and about the frequency with which it is experienced. Such information is essential in efforts to reduce both exposure to racism among indigenous people and the harms associated with such exposure.
Weighted data on self-reported racial discrimination from over 7,000 Indigenous Australian adults participating in the 2008--09 National Aboriginal and Torres Strait Islander Survey, a nationally representative survey conducted by the Australian Bureau of Statistics, were analysed by socioeconomic, demographic and cultural factors.
More than one in four respondents (27%) reported experiencing racial discrimination in the past year. Racial discrimination was most commonly reported in public (41% of those reporting any racial discrimination), legal (40%) and work (30%) settings. Among those reporting any racial discrimination, about 40% experienced this discrimination most or all of the time (as opposed to a little or some of the time) in at least one setting. Reporting of racial discrimination peaked in the 35--44 year age group and then declined. Higher reporting of racial discrimination was associated with removal from family, low trust, unemployment, having a university degree, and indicators of cultural identity and participation. Lower reporting of racial discrimination was associated with home ownership, remote residence and having relatively few Indigenous friends.
These data indicate that racial discrimination is commonly experienced across a wide variety of settings, with public, legal and work settings identified as particularly salient. The observed relationships, while not necessarily causal, help to build a detailed picture of self-reported racial discrimination experienced by Indigenous people in contemporary Australia, providing important evidence to inform anti-racism policy.
Socioeconomic status (SES) is consistently associated with health outcomes, yet little is known about the psychosocial and behavioral mechanisms that might explain this association. Researchers usually control for SES rather than examine it. When it is studied, only effects of lower, poverty-level SES are generally examined. However, there is evidence of a graded association with health at all levels of SES, an observation that requires new thought about domains through which SES may exert its health effects. Variables are highlighted that show a graded relationship with both SES and health to provide examples of possible pathways between SES and health end points. Examples are also given of new analytic approaches that can better illuminate the complexities of the SES-health gradient.
The authors of this excellent text define social epidemiology as the epidemiologic study of the social distribution and social determinants of states of health, implying that the aim is to identify socio-environmental exposures which may be related to a broad range of physical and mental health outcomes. In the first systematic account of this field, they focus on methodological approaches but draw widely from related disciplines such as sociology, psychology, physiology, and medicine in the effort to develop and evaluate testable hypotheses about the pathways between social conditions and health. The persistent patterns of social inequalities in health make this a timely publication.
Praise for the First Edition of Statistical Analysis with Missing Data “An important contribution to the applied statistics literature.... I give the book high marks for unifying and making accessible much of the past and current work in this important area.”—William E. Strawderman, Rutgers University “This book...provide[s] interesting real-life examples, stimulating end-of-chapter exercises, and up-to-date references. It should be on every applied statistician’s bookshelf.”—The Statistician “The book should be studied in the statistical methods department in every statistical agency.”—Journal of Official Statistics Statistical analysis of data sets with missing values is a pervasive problem for which standard methods are of limited value. The first edition of Statistical Analysis with Missing Data has been a standard reference on missing-data methods. Now, reflecting extensive developments in Bayesian methods for simulating posterior distributions, this Second Edition by two acknowledged experts on the subject offers a thoroughly up-to-date, reorganized survey of current methodology for handling missing-data problems. Blending theory and application, authors Roderick Little and Donald Rubin review historical approaches to the subject and describe rigorous yet simple methods for multivariate analysis with missing values. They then provide a coherent theory for analysis of problems based on likelihoods derived from statistical models for the data and the missing-data mechanism and apply the theory to a wide range of important missing-data problems. The new edition now enlarges its coverage to include: Expanded coverage of Bayesian methodology, both theoretical and computational, and of multiple imputation Analysis of data with missing values where inferences are based on likelihoods derived from formal statistical models for the data-generating and missing-data mechanisms Applications of the approach in a variety of contexts including regression, factor analysis, contingency table analysis, time series, and sample survey inference Extensive references, examples, and exercises Amstat News asked three review editors to rate their top five favorite books in the September 2003 issue. Statistical Analysis With Missing Data was among those chosen.
More than two decades after Michael Rutter (1987) published his summary of protective processes associated with resilience, researchers continue to report definitional ambiguity in how to define and operationalize positive development under adversity. The problem has been partially the result of a dominant view of resilience as something individuals have, rather than as a process that families, schools,communities and governments facilitate. Because resilience is related to the presence of social risk factors, there is a need for an ecological interpretation of the construct that acknowledges the importance of people's interactions with their environments. The Social Ecology of Resilience provides evidence for this ecological understanding of resilience in ways that help to resolve both definition and measurement problems. © Springer Science+Business Media, LLC 2012. All rights reserved.
Although there are biological pathways that conceivably might link stress with preterm birth, studies attempting to demonstrate such a relationship have given conflicting results. For the most part, social support has notbeen found to reduce preterm births. The present study is a prospective examination of how such factors as life events, social support, depression, and anxiety related to pregnancy may be associated with birth before 37 weeks' gestation. The study cohort included 1962 women who gave birth in central North Carolina in the years 1996-2000. Participants, aged 16 years and older, were entered into the study at 24-29 weeks' gestation. Many subjects were African-American women, and about half were nulliparous. More than half were not married when entering the study. Low-income households were liberally represented in the study group. The incidence of preterm birth was 12%. Life events, social support, and depression were not associated with preterm birth in this study, but women having medium and high scores for self-rated pregnancy-related anxiety were at increased risk; risk ratios were 1.5 and 2.1, respectively. High scores on a scale of perceived racial discrimination also correlated with an increased risk of preterm birth (risk ratio, 1.4). Similar findings were obtained when alcohol or tobacco use was taken into account. Women with greater self-rated anxiety were more at risk of spontaneous than of medically indicated preterm birth. A risk ratio of 1.8 was associated with life events perceived as having had a negative impact. Among women with negative life events, pregnancy-related anxiety was associated with preterm birth triggered by either labor or ruptured membranes. The association between high levels of pregnancy-related anxiety and preterm birth was less marked when limited to women lacking comorbid medical conditions, but it persisted. These findings suggest that some psychosocial measures are in fact associated with preterm birth.
Today, as in the past, racial oppression is not just a surface-level feature of society, but rather it pervades, permeates, and interconnects all major social groups, networks, and institutions across society.
The study of resilience in development has overturned many negative assumptions and deficit-focused models about children growing up under the threat of disadvantage and adversity. The most surprising conclusion emerging from studies of these children is the ordinariness of resilience. An examination of converging findings from variable-focused and person-focused investigations of these phenomena suggests that resilience is common and that it usually arises from the normative functions of human adaptational systems, with the greatest threats to human development being those that compromise these protective systems. The conclusion that resilience is made of ordinary rather than extraordinary processes offers a more positive outlook on human development and adaptation, as well as direction for policy and practice aimed at enhancing the development of children at risk for problems and psychopathology. The study of resilience in development has overturned many negative assumptions and deficit-focused models about children growing up under the threat of disadvantage and adversity.
Developmental risk refers to conditions, characteristics, experiences, or situations with potentially deleterious effects that lead to outcomes later in life that do not meet societal expectations. While risk is typically framed as the statistical probability of a problematic outcome in relation to the general population, the converse notion of well-being is considered in relation to the level of functioning at a given developmental stage. The contributors to this volume provide insight into developmental well-being by examining the ways that culture and context affect outcomes associated with various types of risk, such as those related to oppression, academic performance, family background, life history, physical health, and psychiatric conditions. Even though certain outcomes may seem inevitable in cases involving harmful environments, diseases, and disorders, they are virtually all influenced by complex interactions among individuals, their families, communities, and societies.
Various authors have noted that interethnic group and intraethnic group racism are significant stressors for many African Americans. As such, intergroup and intragroup racism may play a role in the high rates of morbidity and mortality in this population. Yet, although scientific examinations of the effects of stress have proliferated, few researchers have explored the psychological, social, and physiological effects of perceived racism among African Americans. The purpose of this article was to outline a biopsychosocial model for perceived racism as a guide for future research. The first section of this article provides a brief overview of how racism has been conceptualized in the scientific literature. The second section reviews research exploring the existence of intergroup and intragroup racism. A contextual model for systematic studies of the biopsychosocial effects of perceived racism is then presented, along with recommendations for future research.
Objectives:
Debates surrounding the importance of social context versus individual level processes have a long history in public health. Aboriginal peoples in Canada are very diverse, and the reserve communities in which they reside are complex mixes of various cultural and socioeconomic circumstances. The social forces of these communities are believed to affect health, in addition to individual level determinants, but no large scale work has ever probed their relative effects. One aspect of social context, relative deprivation, as indicated by income inequality, has greatly influenced the social determinants of health landscape. An investigation of relative deprivation in Canada's Aboriginal population has never been conducted. This paper proposes a new model of Aboriginal health, using a multidisciplinary theoretical approach that is multilevel.
Methods:
This study explored the self-rated health of respondents using two levels of determinants, contextual and individual. Data were from the 2001 Aboriginal Peoples Survey. There were 18,890 Registered First Nations (subgroup of Aboriginal peoples) on reserve nested within 134 communities. The model was assessed using a hierarchical generalized linear model.
Results:
There was no significant variation at the contextual level. Subsequently, a sequential logistic regression analysis was run. With the sole exception culture, demographics, lifestyle factors, formal health services, and social support were significant in explaining self-rated health.
Conclusions:
The non-significant effect of social context, and by extension relative deprivation, as indicated by income inequality, is noteworthy, and the primary role of individual level processes, including the material conditions, social support, and lifestyle behaviors, on health outcomes is illustrated. It is proposed that social structure is best conceptualized as a dynamic determinant of health inequality and more multilevel theoretical models of Aboriginal health should be developed and tested.
In 1999, only 20 studies in the public health literature employed instruments to measure self-reported experiences of discrimination. Fifteen years later, the number of empirical investigations on discrimination and health easily exceeds 500, with these studies increasingly global in scope and focused on major types of discrimination variously involving race/ethnicity, indigenous status, immigrant status, gender, sexuality, disability, and age, separately and in combination. And yet, as I also document, even as the number of investigations has dramatically expanded, the scope remains narrow: studies remain focused primarily on interpersonal discrimination, and scant research investigates the health impacts of structural discrimination, a gap consonant with the limited epidemiologic research on political systems and population health. Accordingly, to help advance the state of the field, this updated review article: (a) briefly reviews definitions of discrimination, illustrated with examples from the United States; (b) discusses theoretical insights useful for conceptualizing how discrimination can become embodied and produce health inequities, including via distortion of scientific knowledge; (c) concisely summarizes extant evidence--both robust and inconsistent--linking discrimination and health; and (d) addresses several key methodological controversies and challenges, including the need for careful attention to domains, pathways, level, and spatiotemporal scale, in historical context.
Numerous studies, inquiries, and statistics accumulated over the years have demonstrated the poor health status of Aboriginal peoples relative to the Canadian population in general. Aboriginal Health in Canada is about the complex web of physiological, psychological, spiritual, historical, sociological, cultural, economic, and environmental factors that contribute to health and disease patterns among the Aboriginal peoples of Canada. The authors explore the evidence for changes in patterns of health and disease prior to and since European contact, up to the present. They discuss medical systems and the place of medicine within various Aboriginal cultures and trace the relationship between politics and the organization of health services for Aboriginal people. They also examine popular explanations for Aboriginal health patterns today, and emphasize the need to understand both the historical-cultural context of health issues, as well as the circumstances that give rise to variation in health problems and healing strategies in Aboriginal communities across the country. An overview of Aboriginal peoples in Canada provides a very general background for the non-specialist. Finally, contemporary Aboriginal healing traditions, the issue of self-determination and health care, and current trends in Aboriginal health issues are examined.
Basics Introduction The problem of missing data Concepts of MCAR, MAR and MNAR Simple solutions that do not (always) work Multiple imputation in a nutshell Goal of the book What the book does not cover Structure of the book Exercises Multiple imputation Historic overview Incomplete data concepts Why and when multiple imputation works Statistical intervals and tests Evaluation criteria When to use multiple imputation How many imputations? Exercises Univariate missing data How to generate multiple imputations Imputation under the normal linear normal Imputation under non-normal distributions Predictive mean matching Categorical data Other data types Classification and regression trees Multilevel data Non-ignorable methods Exercises Multivariate missing data Missing data pattern Issues in multivariate imputation Monotone data imputation Joint Modeling Fully Conditional Specification FCS and JM Conclusion Exercises Imputation in practice Overview of modeling choices Ignorable or non-ignorable? Model form and predictors Derived variables Algorithmic options Diagnostics Conclusion Exercises Analysis of imputed data What to do with the imputed data? Parameter pooling Statistical tests for multiple imputation Stepwise model selection Conclusion Exercises Case studies Measurement issues Too many columns Sensitivity analysis Correct prevalence estimates from self-reported data Enhancing comparability Exercises Selection issues Correcting for selective drop-out Correcting for non-response Exercises Longitudinal data Long and wide format SE Fireworks Disaster Study Time raster imputation Conclusion Exercises Extensions Conclusion Some dangers, some do's and some don'ts Reporting Other applications Future developments Exercises Appendices: Software R S-Plus Stata SAS SPSS Other software References Author Index Subject Index
This paper describes the traditions and philosophy behind successful substance abuse treatment strategies used by Aboriginal people in Canada. Disconnection from cultural values and traditions have led to a painful and meaningless existence for many Aborigi-nal people who have turned to drugs and alcohol in an unsuccessful attempt to deal with their anxiety and pain. The discovery of meaning and the resultant healing for Aborigi-nal clients is being enabled through substance abuse treatment strategies that facilitate reconnection to cultural values and traditions.
Psychological stress was assessed in 3 national surveys administered in 1983, 2006, and 2009. In all 3 surveys, stress was higher among women than men; and increased with decreasing age, education, and income. Unemployed persons reported high levels of stress, while the retired reported low levels. All associations were independent of one another and of race/ethnicity. Although minorities generally reported more stress than Whites, these differences lost significance when adjusted for the other demographics. Stress increased little in response to the 2008–2009 economic downturn, except among middle-aged, college-educated White men with full-time employment. These data suggest greater stress-related health risks among women, younger adults, those of lower socioeconomic status, and men potentially subject to substantial losses of income and wealth.
Racial discrimination is a chronic stressor in the lives of African Americans. Chronic stress can lead to individual mental and physical health problems, which subsequently can have deleterious effects on family life. The current study explored the effects of perceived discrimination on youth outcomes and examined the potential mediating role of maternal depression. Using data from 189 African American mothers with children aged 7–14 years, maternal perceived discrimination accounted for variance in reported child externalizing behaviors over and beyond that attributable to other stressful life events and socio-demographic variables. Also, maternal depressive symptoms mediated the effect of maternal perceived discrimination on child externalizing behaviors. These results are consistent with the view that mothers’ experience of greater discrimination leads to higher maternal depression which, in turn, leads to greater externalizing behavior among their children. The findings support the need for further exploration of macrosystemic effects that can influence African American youth externalizing behaviors. The results are discussed in terms of the need to include consideration of discrimination in preventive interventions aimed at increasing support systems available to African American mothers.
Although racial/ethnic disparities in health have been well-characterized in biomedical, public health, and social science research, the determinants of these disparities are still not well-understood. Chronic psychosocial stress related specifically to the American experience of institutional and interpersonal racial discrimination may be an important determinant of these disparities, as a growing literature in separate scientific disciplines documents the adverse health effects of stress and the greater levels of stress experienced by non-White compared to White Americans. However, the empirical literature on the importance of stress for health and health disparities specifically due to racial discrimination, using population-representative data, is still small and mixed. In this paper, we explore the association between a novel measure of racially-salient chronic stress - "racism-related vigilance" - and sleep difficulty. We found that, compared to the White adults in our sample, Black (but not Hispanic) adults reported greater levels of vigilance. This vigilance was positively associated with sleep difficulty to similar degrees for all racial/ethnic groups in our sample (White, Black, Hispanic). Black adults reported greater levels of sleep difficulty compared to White adults. This disparity was slightly attenuated after adjustment for education and income. However, this disparity was completely attenuated after adjustment for racism-related vigilance. We found similar patterns of results for Hispanic compared to White adults, however, the disparities in sleep difficulty were smaller and not statistically significant. Because of the importance of sleep quality to health, our results suggest that the anticipation of and perseveration about racial discrimination is an important determinant of racial disparities in health.
Racism is a complex phenomenon with a number of different impacts on individuals and their communities. These individual, group and community effects may increase the risk of mental distress and mental illness. Perceived interpersonal racial discrimination has been associated in epidemiological studies with higher rates of common mental disorders and more recently with higher rates of psychosis. Initial cross-sectional work has been supplemented by a longitudinal study which demonstrates that victims of discrimination are at an increased risk of developing a psychosis.
Objectives To compare the off-reserve Aboriginal population with the rest of the Canadian population in terms of health status, health behaviours, and health care utilization. Data source
The study of race and ethnic conflict historically has been hampered by in- adequate and simplistic theories. I contend that the central problem of the various approaches to the study of racial phenomena is their lack of a struc- tural theory of racism. I review traditional approaches and alternative ap- proaches to the study of racism, and discuss their limitations. Following the leads suggested by some of the alternative frameworks, I advance a struc- tural theory of racism based on the notion of racialized social systems. "The habit of considering racism as a men- tal quirk, as a psychological flaw, must be abandoned." -Frantz Fanon (1967:77) he area of race and ethnic studies lacks a _ sound theoretical apparatus. To compli- cate matters, many analysts of racial matters have abandoned the serious theorization and reconceptualization of their central topic: rac- ism. Too many social analysts researching racism assume that the phenomenon is self- evident, and therefore either do not provide a definition or provide an elementary definition (Schuman, Steeh, and Bobo 1985; Sniderman and Piazza 1993). Nevertheless, whether im- plicitly or explicitly, most analysts regard rac- ism as a purely ideological phenomenon.
This study examined the relationship between marriage and psychological well-being using a sample from the National Survey of Families and Households panel data. Eight different marital status groups were identified and used to test two competing perspectives explaining the relationship between marriage and individual psychological well-being (protection vs. selection). Findings confirmed the strong effects of marital status on psychological well-being, supporting the protection perspective. The effect of the quality of marital (cohabiting) relationship on psychological well-being was significant, but the strong effect of marital status remained unchanged after controlling for relationship quality. Findings also indicated that the transition to cohabiting did not have the same beneficial effects as marriage for psychological well-being, suggesting that the protective effects of marriage are greater than those of cohabiting relationships. The selection effects of psychological well-being were found to be weak and inconsistent. The findings generally did not vary by gender.
Indigenous "First Nations" communities have consistently associated their disproportionate rates of psychiatric distress with historical experiences of European colonization. This emphasis on the socio-psychological legacy of colonization within tribal communities has occasioned increasingly widespread consideration of what has been termed historical trauma within First Nations contexts. In contrast to personal experiences of a traumatic nature, the concept of historical trauma calls attention to the complex, collective, cumulative, and intergenerational psychosocial impacts that resulted from the depredations of past colonial subjugation. One oft-cited exemplar of this subjugation-particularly in Canada-is the Indian residential school. Such schools were overtly designed to "kill the Indian and save the man." This was institutionally achieved by sequestering First Nations children from family and community while forbidding participation in Native cultural practices in order to assimilate them into the lower strata of mainstream society. The case of a residential school "survivor" from an indigenous community treatment program on a Manitoba First Nations reserve is presented to illustrate the significance of participation in traditional cultural practices for therapeutic recovery from historical trauma. An indigenous rationale for the postulated efficacy of "culture as treatment" is explored with attention to plausible therapeutic mechanisms that might account for such recovery. To the degree that a return to indigenous tradition might benefit distressed First Nations clients, redressing the socio-psychological ravages of colonization in this manner seems a promising approach worthy of further research investigation.