PresentationPDF Available

Differential Impacts of Routine vs. Non-routine Experiences of Racial Discrimination on Allostatic Load Among African American Women School of Public Health

Authors:
Marilyn D. Thomas at University of California, San Francisco
Marilyn D. Thomas
  • University of California, San Francisco
Eli Michaels at University of California, Berkeley
Eli Michaels
Alexis Reeves
Alexis Reeves
Alexis Reeves
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Uche Okoye
Uche Okoye
Uche Okoye
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Show all 8 authorsHide
Download file PDF
Read file
Download citation

Abstract and Figures

The study purpose was to compare the Everyday Discrimination Scale and Experiences of Discrimination to assess whether they show similar or differing association with allostatic load.
No caption available
… 
Figures - uploaded by Marilyn D. Thomas
Author content
All figure content in this area was uploaded by Marilyn D. Thomas
Content may be subject to copyright.
Content uploaded by Marilyn D. Thomas
Author content
All content in this area was uploaded by Marilyn D. Thomas on Oct 08, 2017
Content may be subject to copyright.
Differential Impacts of Routine vs.
Non-routine Experiences of Racial
Discrimination on Allostatic Load Among
African American Women
Marilyn Thomas, Elizabeth Michaels, Alexis Reeves, Uche Okoye, Melisa Price, Rebecca
Hasson, David Chae, Amani Nuru-Jeter
University of California, Berkeley
School of Public Health
(McEwen, 2007)
Allostatic Load
(McEwen, 1983)
Study Aim & Hypothesis
•Study Aim: To compare EDS and EOD and assess
whether they show similar or differing associations with
Allostatic Load (AL)
•Hypothesis: Variations in AL levels will emerge between
the EDS and EOD scales
African American Women’s
Heart & Health Study
•Cross-section of 208 African American women
aged 30-50 in SF Bay Area
•Purposive sampling & targeted recruitment
•Two Visits:
1) Interviewer-administered questionnaire &
computer-assisted self-interview
2) Physical examination & venous blood-draw
Scale
Experiences of Discrimination
Scale (EOD)
Everyday Discrimination
Scale
(EDS)
Likert Scale Never
Never Less than once a year
Once A few times a year
2-3 times A few times a month
4-5 times At least once a week
6+ times Almost everyday
Items 8 items (score range 8-40) 10 items (score range 10-60)
Categories Very low, Low, Moderate, High, Very high
Discrimination Scales
Note: EDSα= 0.95; EOD α= 0.92; Both scales have been validated among AA women
Allostatic Load Measurement
Biomarker Allostatic Load Cutpoint
Metabolic System
HDL (mg/dL
)
<50
LDL (mg/dL
)
≥100
Waist Circumference (in)
>35
Glucose (mg/dL
)
≥100 or <70
HbA1c (mmol/mol
)
≥5.7
Total Cholesterol (mg/dL
)
≥160
Triglycerides (mg/dL
)
≥150
Body Mass Index (kg/m2
)
≥25 or <18.5
Cardiovascular System
Systolic Blood Pressure (mm Hg)
≥120
Diastolic Blood Pressure (mm Hg)
≥80
Neuroendocrine System
Cortisol (µg/dL
)
>12.69
Epinephrine (pg
/mL)
>77.70
Norepinephrine (pg
/mL)
>686.30
Inflammatory System
Il-6 (pg
/mL)
>7.85
hsCRP
(mg/L)
>3
Limitation
Strength
Limited generalizability
Sample demographics similar to
demographics of AA
women in same counties
Clinical guidelines not available for
all biomarkers
Most subclinical cutpoints were about at the
75
th percentile; minimal misclassification
Reporting bias
Self
-
administered questionnaire reduces social
desirability bias
Contributions to the Literature
•First study, to our knowledge, to explicitly examine the health
impacts of differential measurement of racial discrimination
•Facilitated by a within-group study design
Exposure heterogeneity
Race is not a proxy for racism
Intersectionality
•Possible implications for intervening on different dimensions of
racial discrimination and health
Acknowledgements
Funders:
•Robert Wood Johnson Foundation
•The University of California Center for New
Racial Studies
•UC Berkeley Institute for the Study of Societal
Issues, Population Center
•Hellman Faculty Fund
•Research Bridging Grant
•We also acknowledge the generous support of
the UC Berkeley Experimental Social Science
Laboratory (X-lab)
Thanks for listening!
Special Recognition:
•The HEART Research Group
Marilyn Thomas, MPH
Alexis Reeves, MPHc
Uche Okoye, BA
A very special thank you to our
fabulous mentor:
Dr. Amani Nuru-Jeter, PhD
•Co-authors: Dr. David Chae,
Rebecca Hasson, Melissa Price, and
Uche Okoye
•Berkeley Center for Social Medicine
•UC Berkeley Institute for the Study
of Societal Issues
References
1. Brondolo, E., Brady ver Halen, N., Pencille, M., Beatty, D., & Contrada, R. J. (2009). Coping with racism: a selective review of the literature and a theoretical and
methodological critique. Journal of Behavioral Medicine, 32(1), 64–88.
2. Brondolo, E., Rieppi, R., Kelly, K. P., & Gerin, W. (2003). Perceived racism and blood pressure: a review of the literature and conceptual and methodological critique.
Annals of Behavioral Medicine, 25(1), 55–65.
3. Chae, D. H., Nuru-Jeter, A. M., & Adler, N. E. (2012). Implicit racial bias as a moderator of the association between racial discrimination and hypertension: a study of
Midlife African-American men. Psychosomatic medicine,74(9), 961.
4. Clark, R., & Adams, J. H. (2004). Moderating Effects of Perceived Racism on John Henryism and Blood Pressure Reactivity in Bl ack Female College Students. Annals of
Behavioral Medicine, 28(2), 126–131.
5. Geronimus, A. T., Bound, J., Waidmann, T. A., Hillemeier, M. M., & Burns, P. B. (1996). Excess mortality among blacks and whites in the United States. New England journal
of medicine,335(21), 1552-1558.
6. Geronimus AT, Hicken M, Keene D, et al. “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health.
2006;96(5):826-833.
7. Kemeny, M. E. (2003). The psychobiology of stress. Current directions in psychological science,12(4), 124-129.
8. Krieger, N. (2001). A glossary for social epidemiology. Journal of epidemiology and community health, 55(10), 693-700.
9. Krieger, N., Rowley, D. L., Herman, A. A., & Avery, B. (1993). Racism, sexism, and social class: implications for studies of health, disease, and well-being. American journal
of preventive medicine.
10. Krieger, N., Smith, K., Naishadham, D., Hartman, C., & Barbeau, E. M. (2005). Experiences of discrimination: validity and reliability of a self-report measure for
population health research on racism and health. Social science & medicine, 61(7), 1576-1596.
1. LaVeist, T. A., Sellers, R., & Neighbors, H. W. (2000). Perceived racism and self and system blame attribution: consequences for longevity. Ethnicity & disease,11(4), 711-721.
11. McEwen, B.S. (2007). Physiology and neurobiology of stress and adaptation: central role of the brain. Physiological reviews, 87(3), 873-904
12. McEwen BS. Stress, adaptation, and disease: Allostasis and allostatic load. An. N Y Acad Sci 1998;840(1):33-44
13. Nazroo, J. Y. (2003). The structuring of ethnic inequalities in health: economic position, racial discrimination, and racism. American journal of public health,93(2), 277-284.
14. Spruill, T. M. (2010). Chronic psychosocial stress and hypertension. Current hypertension reports,12(1), 10-16.
15. Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health. Journal of Health Psychology, 2(3), 335-351.
Questions?
ResearchGate has not been able to resolve any citations for this publication.
Coping With Racism: A Selective Review of the Literature and a Theoretical and Methodological Critique
Article
Full-text available
  • Feb 2009
Racism is a stressor that contributes to racial/ethnic disparities in mental and physical health and to variations in these outcomes within racial and ethnic minority groups. The aim of this paper is to identify and discuss key issues in the study of individual-level strategies for coping with interpersonal racism. We begin with a discussion of the ways in which racism acts as a stressor and requires the mobilization of coping resources. Next, we examine available models for describing and conceptualizing strategies for coping with racism. Third, we discuss three major forms of coping: racial identity development, social support seeking and anger suppression and expression. We examine empirical support for the role of these coping strategies in buffering the impact of racism on specific health-related outcomes, including mental health (i.e., specifically, self-reported psychological distress and depressive symptoms), self-reported physical health, resting blood pressure levels, and cardiovascular reactivity to stressors. Careful examination of the effectiveness of individual-level coping strategies can guide future interventions on both the individual and community levels.
View
The Psychobiology of Stress
Article
  • Aug 2003
Stressful life experience can have significant effects on a variety of physiological systems, including the autonomic nervous system, the hypothalamic-pituitary-adrenal axis, and the immune system. These relationships can be bidirectional; for example, immune cell products can act on the brain, altering mood and cognition, potentially contributing to depression. Although acute physiological alterations may be adaptive in the short term, chronic or repeated provocation can result in damage to health. The central dogma in the field of stress research assumes a stereotyped physiological response to all stressors (the generality model). However, increasing evidence suggest that specific stressful conditions and the specific way an organism appraises these conditions can elicit qualitatively distinct emotional and physiological response (the integrated specificity model). For example, appraisals of threat (vs. challenge), uncontrollability, and negative social evaluation have been shown to provoke specific psychobiological responses. Emotional responses appear to have specific neural substrates, which can result in differentiated alterations in peripheral physiological systems, so that it is incorrect to presume a uniform stress response.
View
Implicit Racial Bias as a Moderator of the Association Between Racial Discrimination and Hypertension: A Study of Midlife African American Men
Article
  • Oct 2012
  • PSYCHOSOM MED
Objectives Empirical findings on racial discrimination and hypertension risk have been inconsistent. Some studies have found no association between self-reported experiences of discrimination and cardiovascular health outcomes, whereas others have found moderated or curvilinear relationships. The current cross-sectional study examined whether the association between racial discrimination and hypertension is moderated by implicit racial bias among African American midlife men.Methods This study examined the data on 91 African American men between 30 and 50 years of age. Primary variables were self-reported experiences of racial discrimination and unconscious racial bias as measured by the Black-White Implicit Association Test. Modified Poisson regression models were specified, examining hypertension, defined as a mean resting systolic level of at least 140 mm Hg or diastolic level of at least 90 mm Hg, or self-reported history of cardiovascular medication use with a physician diagnosis of hypertension.ResultsNo main effects for discrimination or implicit racial bias were found, but the interaction of the two variables was significantly related to hypertension (χ(2)(1) = 4.89, p < .05). Among participants with an implicit antiblack bias, more frequent reports of discrimination were associated with a higher probability of hypertension, whereas among those with an implicit problack bias, it was associated with lower risk.Conclusions The combination of experiencing racial discrimination and holding an antiblack bias may have particularly detrimental consequences on hypertension among African American midlife men, whereas holding an implicit problack bias may buffer the effects of racial discrimination. Efforts to address both internalized racial bias and racial discrimination may lower cardiovascular risk in this population.
View
View
Chronic Psychosocial Stress and Hypertension
Article
  • Feb 2010
  • Curr Hypertens Rep
Genetic and behavioral factors do not fully explain the development of hypertension, and there is increasing evidence suggesting that psychosocial factors may also play an important role. Exposure to chronic stress has been hypothesized as a risk factor for hypertension, and occupational stress, stressful aspects of the social environment, and low socioeconomic status have each been studied extensively. The study of discrimination is a more recent and rapidly growing area of investigation and may also help to explain the well-known racial disparities in hypertension. Research regarding mechanisms underlying stress effects on hypertension has largely focused on cardiovascular reactivity, but delayed recovery to the pre-stress level is increasingly being evaluated as another possible pathway. Recent findings in each of these areas are reviewed, and directions for future research are discussed.
View
Racial Differences in Physical and Mental Health
Article
This article examines the extent to which racial differences in socio-economic status (SES), social class and acute and chronic indicators of perceived discrimination, as well as general measures of stress can account for black-white differences in self-reported measures of physical and mental health. The observed racial differences in health were markedly reduced when adjusted for education and especially income. However, both perceived discrimination and more traditional measures of stress are related to health and play an incremental role in accounting for differences between the races in health status. These findings underscore the need for research efforts to identify the complex ways in which economic and non-economic forms of discrimination relate to each other and combine with socio-economic position and other risk factors and resources to affect health. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/67159/2/10.1177_135910539700200305.pdf
View
Excess Mortality Among Blacks and Whites in the United States
Article
  • Dec 1996
Although the general relations between race, socioeconomic status, and mortality in the United States are well known, specific patterns of excess mortality are not well understood. Using standard demographic techniques, we analyzed death certificates and census data and made sex-specific population-level estimates of the 1990 death rates for people 15 to 64 years of age. We studied mortality among blacks in selected areas of New York City, Detroit, Los Angeles, and Alabama (in one area of persistent poverty and one higher-income area each) and among whites in areas of New York City, metropolitan Detroit, Kentucky, and Alabama (one area of poverty and one higher-income area each). Sixteen areas were studied in all. When they were compared with the nationwide age-standardized annual death rate for whites, the death rates for both sexes in each of the poverty areas were excessive, especially among blacks (standardized mortality ratios for men and women in Harlem, 4.11 and 3.38; in Watts, 2.92 and 2.60; in central Detroit, 2.79 and 2.58; and in the Black Belt area of Alabama, 1.81 and 1.89). Boys in Harlem who reached the age of 15 had a 37 percent chance of surviving to the age of 65; for girls, the likelihood was 65 percent. Of the higher-income black areas studied, Queens--Bronx had the income level most similar to that of whites and the lowest standardized mortality ratio (men, 1.18; women, 1.08). Of the areas where poor whites were studied, Detroit had the highest standardized mortality ratios (men, 2.01; women, 1.90). On the Lower East Side of Manhattan, in Appalachia, and in Northeast Alabama, the ratios for whites were below the national average for blacks (men, 1.90; women, 1.95). Although differences in mortality rates before the age of 65 between advantaged and disadvantaged groups in the United States are sometimes vast, there are important differences among impoverished communities in patterns of excess mortality.
View
McEwen BS. Stress, adaptation, and disease. Allostasis and allostatic load. Ann NY Acad Sci 840: 33-44
Article
  • Jun 1998
Adaptation in the face of potentially stressful challenges involves activation of neural, neuroendocrine and neuroendocrine-immune mechanisms. This has been called "allostasis" or "stability through change" by Sterling and Eyer (Fisher S., Reason J. (eds): Handbook of Life Stress, Cognition and Health. J. Wiley Ltd. 1988, p. 631), and allostasis is an essential component of maintaining homeostasis. When these adaptive systems are turned on and turned off again efficiently and not too frequently, the body is able to cope effectively with challenges that it might not otherwise survive. However, there are a number of circumstances in which allostatic systems may either be overstimulated or not perform normally, and this condition has been termed "allostatic load" or the price of adaptation (McEwen and Stellar, Arch. Int. Med. 1993; 153: 2093.). Allostatic load can lead to disease over long periods. Types of allostatic load include (1) frequent activation of allostatic systems; (2) failure to shut off allostatic activity after stress; (3) inadequate response of allostatic systems leading to elevated activity of other, normally counter-regulated allostatic systems after stress. Examples will be given for each type of allostatic load from research pertaining to autonomic, CNS, neuroendocrine, and immune system activity. The relationship of allostatic load to genetic and developmental predispositions to disease is also considered.
View
View
Perceived Racism and Self and System Blame Attribution
Article
  • Feb 2001
In this article, we examine the National Survey of Black Americans to assess the relationship between perceived racism, self and system blaming attribution and survival. Perceived exposure to racism and other covariates were measured at baseline (1979) with a mortality follow up 13 years later (1992). We test the hypothesis that an external attributional orientation (which we refer to as system blaming) as opposed to an internal attributional orientation (which we refer to as self blaming) will be protective of health (as measured at 13-year survival) when individuals are exposed to racism. Using Cox proportional hazards regression modeling, we found support for our hypothesis. African Americans with a system-blaming orientation who reported experiencing racism were more likely to survive the 13-year follow-up period, compared to self blamers who did not perceive themselves to have been exposed to racism (OR = .37, CI95: .21, .64). Controlling for other known correlates of survival (age, health status at baseline, sex, marital status, smoking, and income) did not eliminate the significant effect of self-blame orientation among those exposed to racism (OR = .43, CI 95: .23, .82). The findings suggest that the attribution of negative events to external factors, such as systemic societal racism, rather than to individual characteristics, may be adaptive and protective of health status.
View