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Race, racism and health: disparities, mechanisms, and interventions

Abstract

The goals of this special section are to examine the state-of-the-science regarding race/ethnicity and racism as they contribute to health disparities and to articulate a research agenda to guide future research. In the first paper, Myers presents an integrative theoretical framework for understanding how racism, poverty, and other major stressors relate to health through inter-related psychosocial and bio-behavioral pathways. Williams and Mohammed review the evidence concerning associations between racism and health, addressing the multiple levels at which racism can operate and commenting on important methodological issues. Klonoff provides a review and update of the literature concerning ethnicity-related disparities in healthcare, and addresses factors that may contribute to these disparities. Brondolo and colleagues consider racism from a stress and coping perspective, and review the literature concerning racial identity, anger coping, and social support as potential moderators of the racism-health association. Finally, Castro and colleagues describe an ecodevelopmental model that can serve as an integrative framework to examine multi-level social–cultural influences on health and health behavior. In aggregate, the special section papers address theoretical and methodological issues central to understanding the determinants of health disparities, with the aim of providing direction for future research critical to developing effective interventions to reduce these disparities.

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Notes

  1. 1.

    There is a little consensus on the best terms to use to distinguish groups based on cultural characteristics or phenotypic attributes. Both scientific and political considerations influence the debate. In this paper, we use the terms race and ethnicity interchangeably, recognizing that even within a given race, there may be substantial variations in ethnicity. Similarly, we will use the terms Black and African-American and Hispanic and Latino interchangeably to acknowledge the differences of opinion about the meaning and appropriateness of these different labels.

References

  1. Adler, N. E., & Rehkopf, D. H. (2008). U.S. disparities in health: Descriptions, causes, and mechanisms. Annual Review of Public Health, 29, 235–252. doi:10.1146/annurev.publhealth.29.020907.090852.

    PubMed  Article  Google Scholar 

  2. Adler, N. E., & Snibbe, A. C. (2003). The role of psychosocial processes in explaining the gradient between socioeconomic status and health. Current Directions in Psychological Science, 12, 119–123. doi:10.1111/1467-8721.01245.

    Article  Google Scholar 

  3. American Heart Association. (2008). Heart Disease and Stroke Statistics—2008 Update. Dallas, Texas: American Heart Association.

  4. Baumeister, R. F., DeWall, C. N., Ciarocco, N. J., & Twenge, J. M. (2005). Social exclusion impairs self-regulation. Journal of Personality and Social Psychology, 88, 589–604. doi:10.1037/0022-3514.88.4.589.

    PubMed  Article  Google Scholar 

  5. Benkert, R., & Peters, R. M. (2005). African-American women’s coping with health care prejudice. Western Journal of Nursing Research, 27, 863–889. doi:10.1177/0193945905278588.

    PubMed  Article  Google Scholar 

  6. Borrell, L. N., Jacobs, D. R., Jr, Williams, D. R., Pletcher, M. J., Houston, T. K., & Kiefe, C. I. (2007). Self-reported racial discrimination and substance use in the Coronary Artery Risk Development in Adults Study. American Journal of Epidemiology, 166, 1068–1079. doi:10.1093/aje/kwm180.

    PubMed  Article  Google Scholar 

  7. Brondolo, E., Brady, N., Libby, D. J., & Pencille, M. (2008). Racism as a psychosocial stressor. In R. Contrada, & A. Baum (Eds.), Handbook of Stress Science. New York: Springer, in press.

  8. Brondolo, E., Brady, 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. doi:10.1007/s10865-008-9193-0.

  9. Brondolo, E., Libby, D. J., Denton, E. G., Thompson, S., Beatty, D. L., Schwartz, J., et al. (2008). Racism and ambulatory blood pressure in a community sample. Psychosomatic Medicine, 70, 49–56. doi:10.1097/PSY.0b013e31815ff3bd.

    PubMed  Article  Google Scholar 

  10. Casagrande, S. S., Gary, T. L., LaVeist, T. A., Gaskin, D. J., & Cooper, L. A. (2007). Perceived discrimination and adherence to medical care in a racially integrated community. Journal of General Internal Medicine, 22, 389–395. doi:10.1007/s11606-006-0057-4.

    PubMed  Article  Google Scholar 

  11. Castro, F. G., Shaibi, G. Q., & Boehm-Smith, E. (2009). Ecodevelopmental contexts for promoting exercise for preventing diabetes among racial/ethnic minority populations. Journal of Behavioral Medicine, 32.

  12. Choi, Y., Harachi, T. W., Gillmore, M. R., & Catalano, R. F. (2006). Are multiracial adolescents at greater risk? Comparisons of rates, patterns, and correlates of substance use and violence between monoracial and multiracial adolescents. The American Journal of Orthopsychiatry, 76, 86–97. doi:10.1037/0002-9432.76.1.86.

    PubMed  Article  Google Scholar 

  13. Clark, R. (2000). Perceptions of interethnic group racism predict increased vascular reactivity to a laboratory challenge in college women. Annals of Behavioral Medicine, 22, 214–222. doi:10.1007/BF02895116.

    PubMed  Article  Google Scholar 

  14. Clark, R., Anderson, N. B., Clark, V. R., & Williams, D. R. (1999). Racism as a stressor for African-Americans. A biopsychosocial model. The American Psychologist, 54, 805–816. doi:10.1037/0003-066X.54.10.805.

    PubMed  Article  Google Scholar 

  15. Contrada, R. J., Ashmore, R. D., Gary, M. L., Coups, E., Egeth, J. D., Sewell, A., et al. (2000). Ethnicity-related sources of stress and their effects on well-being. Current Directions in Psychological Science, 9, 136–139. doi:10.1111/1467-8721.00078.

    Article  Google Scholar 

  16. Contrada, R. J., Ashmore, R. D., Gary, M. L., Coups, E., Egeth, J. D., Sewell, A., et al. (2001). Measures of ethnicity-related stress: Psychometric properties, ethnic group differences, and associations with well-being. Journal of Applied Social Psychology, 31, 1775–1820. doi:10.1111/j.1559-1816.2001.tb00205.x.

    Article  Google Scholar 

  17. Fang, C. Y., & Myers, H. F. (2001). The effects of racial stressors and hostility on cardiovascular reactivity in African-American and Caucasian men. Health Psychology, 20, 64–70. doi:10.1037/0278-6133.20.1.64.

    PubMed  Article  Google Scholar 

  18. Gallo, L. C., & Matthews, K. A. (2003). Understanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychological Bulletin, 129, 10–51. doi:10.1037/0033-2909.129.1.10.

    PubMed  Article  Google Scholar 

  19. Guyll, M., Matthews, K. A., & Bromberger, J. T. (2001). Discrimination and unfair treatment: Relationship to cardiovascular reactivity among African-American and European-American women. Health Psychology, 20, 315–325. doi:10.1037/0278-6133.20.5.315.

    PubMed  Article  Google Scholar 

  20. Harrell, S. P. (2000). A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color. The American Journal of Orthopsychiatry, 70, 42–57. doi:10.1037/h0087722.

    PubMed  Article  Google Scholar 

  21. Harrell, J. P., Hall, S., & Taliaferro, J. (2003). Physiological responses to racism and discrimination: an assessment of the evidence. American Journal of Public Health, 93, 243–248.

    PubMed  Article  Google Scholar 

  22. Hausmann, L. R., Jeong, K., Bost, J. E., & Ibrahim, S. A. (2008). Perceived discrimination in health care and use of preventive health services. Journal of General Internal Medicine, 23, 1679–1684.

    PubMed  Article  Google Scholar 

  23. Inzlicht, M., McKay, L., & Aronson, J. (2006). Stigma as ego depletion: How being the target of prejudice affects self-control. Psychological Science, 17, 262–269. doi:10.1111/j.1467-9280.2006.01695.x.

    PubMed  Article  Google Scholar 

  24. Jasso, G., Massey, D. S., Rosenzweig, M. R., & Smith, J. P. (2004). Immigrant Health-Selectivity and Acculturation. In N. B. Anderson, R. A. Bulatao, & B. Cohen (Eds.), Critical Perspectives on Racial and Ethnic Differences in Health in Late Life (pp. 227–266). National Academies Press: Washington DC.

    Google Scholar 

  25. Karlsen, S., & Nazroo, J. Y. (2002). Relation between racial discrimination, social class, and health among ethnic minority groups. American Journal of Public Health, 92, 624–631.

    PubMed  Article  Google Scholar 

  26. Kassai, S. C., & Motta, R. W. (2006). An investigation of potential Holocaust-related secondary traumatization in the third generation. International Journal of Emergency Mental Health, 8, 35–47.

    PubMed  Google Scholar 

  27. Klonoff, E. A. (2009). Disparities in the provision of medical care: An outcome in search of an explanation. Journal of Behavioral Medicine, 32.

  28. Krieger, N. (1999). Embodying inequality: A review of concepts, measures, and methods for studying health consequences of discrimination. International Journal of Health Services, 29, 295–352. doi:10.2190/M11W-VWXE-KQM9-G97Q.

    PubMed  Article  Google Scholar 

  29. Landrine, H., & Klonoff, E. A. (2000). Racial discrimination and cigarette smoking among Blacks: Findings from two studies. Ethnicity & Disease, 10, 195–202.

    Google Scholar 

  30. Landrine, H., Klonoff, E. A., Corral, I., Fernandez, S., & Roesch, S. (2006). Conceptualizing and measuring ethnic discrimination in health research. Journal of Behavioral Medicine, 29, 79–94. doi:10.1007/s10865-005-9029-0.

    PubMed  Article  Google Scholar 

  31. Matthews, K. A., Katholi, C. R., McCreath, H., Whooley, M. A., Williams, D. R., Zhu, S., et al. (2004). Blood pressure reactivity to psychological stress predicts hypertension in the CARDIA study. Circulation, 110, 74–78. doi:10.1161/01.CIR.0000133415.37578.E4.

    PubMed  Article  Google Scholar 

  32. Mays, V. M., Cochran, S. D., & Barnes, N. W. (2007). Race, race-based discrimination, and health outcomes among African-Americans. Annual Review of Psychology, 58, 201–225. doi:10.1146/annurev.psych.57.102904.190212.

    PubMed  Article  Google Scholar 

  33. McNeilly, M. D., Robinson, E. L., Anderson, N. B., Pieper, C. F., Shah, A., Toth, P. S., et al. (1995). Effects of racist provocation and social support on cardiovascular reactivity in African-American women. International Journal of Behavioral Medicine, 2, 321–338. doi:10.1207/s15327558ijbm0204_3.

    PubMed  Article  Google Scholar 

  34. Myers, H. F. (2009). Ethnicity- and socio-economic status-related stresses in context: An integrative review and conceptual model. Journal of Behavioral Medicine, 32. doi:10.1007/s10865-008-9181-4.

  35. National Center for Health Statistics. (2008). Health, United States, 2007, with chartbook on trends in the health of Americans (Rep. No. 76–641496). Hyattsville, MD: Centers for Disease Control, National Center for Health Statistics.

  36. Oyserman, D., Fryberg, S. A., & Yoder, N. (2007). Identity-based motivation and health. Journal of Personality and Social Psychology, 93, 1011–1027. doi:10.1037/0022-3514.93.6.1011.

    PubMed  Article  Google Scholar 

  37. Passel, J. S., & Cohn, D. (2008). US Population Projections: 2005–2050. Washington DC: Pew Research Center.

  38. Peters, R. M. (2004). Racism and hypertension among African-Americans. Western Journal of Nursing Research, 26, 612–631. doi:10.1177/0193945904265816.

    PubMed  Article  Google Scholar 

  39. Pew Hispanic Center. (2008). Statistical Portrait of Hispanics in the United States, 2006. Washington, DC: Pew Hispanic Center.

  40. Richman, L. S., Bennett, G. G., Pek, J., Siegler, I., & Williams, R. B., Jr. (2007). Discrimination, dispositions, and cardiovascular responses to stress. Health Psychology, 26, 675–683. doi:10.1037/0278-6133.26.6.675.

    PubMed  Article  Google Scholar 

  41. Shavers, V. L., & Shavers, B. S. (2006). Racism and health inequity among Americans. Journal of the National Medical Association, 98, 386–396.

    PubMed  Google Scholar 

  42. Singh, G. K., & Siahpush, M. (2002). Ethnic-immigrant differentials in health behaviors, morbidity, and cause-specific mortality in the United States: An analysis of two national data bases. Human Biology, 74, 83–109. doi:10.1353/hub.2002.0011.

    Article  Google Scholar 

  43. Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC, US: National Academies Press.

    Google Scholar 

  44. Steele, C. M. (1997). A threat in the air: How stereotypes shape intellectual identity and performance. The American Psychologist, 52, 613–629. doi:10.1037/0003-066X.52.6.613.

    PubMed  Article  Google Scholar 

  45. Taylor, D. M., Ruggerio, K. M., & Louis, W. R. (1996). Personal/group discrimination discrepancy: Towards a two-factor explanation. Canadian Journal of Behavioural Science (Revue canadienne des Sciences du comportement), 28, 193–202.

    Article  Google Scholar 

  46. Thrasher, A. D., Earp, J. A., Golin, C. E., & Zimmer, C. R. (2008). Discrimination, distrust, and racial/ethnic disparities in antiretroviral therapy adherence among a national sample of HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes (JAIDS), 49, 84–93. doi:10.1097/QAI.0b013e3181845589.

    Article  Google Scholar 

  47. Treiber, F. A., Kamarck, T., Schneiderman, N., Sheffield, D., Kapuku, G., & Taylor, T. (2003). Cardiovascular reactivity and development of preclinical and clinical disease states. Psychosomatic Medicine, 65, 46–62.

    PubMed  Google Scholar 

  48. Trivedi, A. N., & Ayanian, J. Z. (2006). Perceived discrimination and use of preventive health services. Journal of General Internal Medicine, 21, 553–558. doi:10.1111/j.1525-1497.2006.00413.x.

    PubMed  Article  Google Scholar 

  49. Tull, E. S., Sheu, Y. T., Butler, C., & Cornelious, K. (2005). Relationships between perceived stress, coping behavior and cortisol secretion in women with high and low levels of internalized racism. Journal of the National Medical Association, 97, 206–212.

    PubMed  Google Scholar 

  50. U.S. Census Bureau. (2008). http://www.census.gov/main/www/cen2000.htm. Accessed 24 November 2008.

  51. U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and Improving Health, 2nd edn. Washington, DC: U.S. Government Printing Office.

  52. Williams, D. R. (1996). Race/ethnicity and socioeconomic status: Measurement and methodological issues. International Journal of Health Services, 26, 483–505. doi:10.2190/U9QT-7B7Y-HQ15-JT14.

    PubMed  Article  Google Scholar 

  53. Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32.

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Correspondence to Elizabeth Brondolo.

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Brondolo, E., Gallo, L.C. & Myers, H.F. Race, racism and health: disparities, mechanisms, and interventions. J Behav Med 32, 1 (2009). https://doi.org/10.1007/s10865-008-9190-3

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Keywords

  • Ethnicity
  • Health disparities
  • Race
  • Racism
  • Health