Abstract
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.
Notes
We draw from sociological traditions, particularly of Pearlin, Aneshensel, and others, when discussing the stress process. We conceptualize the stress process within the sociological framework with the following components: (1) social stressors, which are the “socio-environmental demands that tax or exceed the individual’s ordinary capacity to adapt and/or the absence of the means to attain sought-after ends” (Pearlin 2013); (2) stress, which refers to the “internal dysfunctions that result from these circumstances [social stressors]”; and (3) distress, which refers to the various health outcomes that result from stress. Psychosocial stress is the term used to describe psychological dysfunction with social origins. Biosocial stress is the term used to describe biological dysfunction with social origins. Stress is sometimes also called “stress response” or “strain” in the literature.
Chronic stress refers to the chronic dysfunction resulting from stressors. Chronic stress may not necessarily be linked to a specific event (i.e., acute stressors), but to conditions that arise from more enduring circumstances (i.e., chronic stressors). An acute stressor may result in chronic stress is through rumination and perseveration about that stressor. In this case, the acute stressor is transformed into a chronic stressor through the rumination and perseveration (Brosschot et al. 2006; Brosschot 2010).
Racism and discrimination are conceptually distinct. Racism has been defined as “a system of dominance, power, and privilege based on racial group designations … where members of the dominant group create or accept their societal privilege by maintaining structures, ideologies, values, and behaviors that have the intent or effect of leaving non-dominant-group members relatively excluded from power, esteem, status, and/or equal access to societal resources” (Harrell et al. 2011, p. 43). Racial discrimination is one by-product of racism and refers specifically to behaviors that result in the unfair treatment of one group over another based on racial designation.
Although the study of sleep architecture in lab settings on small samples is relatively established, the study of sleep within large population representative samples is novel. Therefore, there is a lack of consensus on state-of-the-art survey measures of sleep quality and no clear recommendations have been made (See Knutson 2013 for example).
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An African American proverb/saying derived from Blues Lyrics (but used widely in the African American community) to denote profound distrust, antagonism, or awareness in situations where someone might be deceived (Prahlad 1996).
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Hicken, M.T., Lee, H., Ailshire, J. et al. “Every Shut Eye, Ain’t Sleep”: The Role of Racism-Related Vigilance in Racial/Ethnic Disparities in Sleep Difficulty. Race Soc Probl 5, 100–112 (2013). https://doi.org/10.1007/s12552-013-9095-9
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DOI: https://doi.org/10.1007/s12552-013-9095-9