Skip to main content

Vicarious Racism Stress and Disease Activity: the Black Women’s Experiences Living with Lupus (BeWELL) Study

Abstract

Background

Indirect or vicarious exposure to racism (e.g., hearing about or observing acts of racism or discrimination) is a salient source of stress for African Americans. Emerging research suggests that these “secondhand” experiences of racism may contribute to racial health inequities through stress-mediated pathways. Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease that disproportionately impacts African American women and is characterized by racial disparities in severity. Health outcomes in this population may be susceptible to vicarious racism given that SLE is shown to be sensitive to psychosocial stress.

Methods

Data are from 431 African American women with SLE living in Atlanta, Georgia in the Black Women’s Experiences Living with Lupus (BeWELL) Study (2015–2017). Vicarious racism stress was measured with four items assessing distress from (1) hearing about racism in the news; (2) experiences of racism among friends or family; (3) witnessing racism in public; and (4) racism depicted in movies and television shows. Multivariable linear regression was used to examine associations with disease activity measured using the Systemic Lupus Activity Questionnaire.

Results

Adjusting for sociodemographic and health-related covariates, vicarious racism stress was associated with greater disease activity (b = 2.15; 95% CI = 1.04–3.27). This association persisted even after adjustment for personal experiences of racial discrimination (b = 1.80; 95% CI = 0.67–2.92).

Conclusions

Vicarious racism may result in heightened disease activity and contribute to racial disparities in SLE. Our findings suggest that acts of racism committed against members of one’s racial group may have distinct health consequences beyond the immediate victim or target.

This is a preview of subscription content, access via your institution.

References

  1. Lim SS, Drenkard C. Epidemiology of systemic lupus erythematosus: capturing the butterfly. Curr Rheumatol Rep. 2008;10:265–72.

    Article  PubMed  Google Scholar 

  2. La Paglia GMC, Leone MC, Lepri G, Vagelli R, Valentini E, Alunno A, et al. One year in review 2017: systemic lupus erythematosus. Clin Exp Rheumatol. 2017;35:551–61.

    PubMed  Google Scholar 

  3. Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part I. Arthritis Rheum. 2008;58:15–25.

    Article  PubMed  Google Scholar 

  4. Williams EM, Bruner L, Adkins A, Vrana C, Logan A, Kamen D, et al. I too, am America: a review of research on systemic lupus erythematosus in African-Americans. Lupus Sci Med. 2016;3:e000144.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Pons-Estel GJ, Ugarte-Gil MF, Alarcón GS. Epidemiology of systemic lupus erythematosus. Expert Rev Clin Immunol. 2017;13:799–814.

    Article  CAS  PubMed  Google Scholar 

  6. Lim SS, Drenkard C. Epidemiology of lupus: an update. Curr Opin Rheumatol. 2015;27:427–32.

    Article  PubMed  Google Scholar 

  7. Lim SS, Bayakly AR, Helmick CG, Gordon C, Easley KA, Drenkard C. The incidence and prevalence of systemic lupus erythematosus, 2002-2004: the Georgia lupus registry. Arthritis Rheumatol. 2014;66:357–68.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Demas KL, Costenbader KH. Disparities in lupus care and outcomes. Curr Opin Rheumatol. 2009;21:102–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Williams DR, Lawrence JA, Davis BA. Racism and health: evidence and needed research. Annu Rev Public Health. 2019;40:105–25.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Williams DR, Mohammed SA. Racism and health I: pathways and scientific evidence. Am Behav Sci. 2013;57:1152–73.

    Article  Google Scholar 

  11. Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90:1212–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Geronimus AT, Hicken M, Keene D, Bound J. “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health. 2006;96:826–33.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32:20–47.

    Article  PubMed  Google Scholar 

  14. Lewis T, Cogburn C, Williams D. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol. 2015;11:407–40.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Brody GH, Miller GE, Yu T, Beach SRH, Chen E. Supportive family environments ameliorate the link between racial discrimination and epigenetic aging: a replication across two longitudinal cohorts. Psychol Sci. 2016;27:530–41.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Beatty DL, Matthews KA, Bromberger JT, Brown C. Everyday discrimination prospectively predicts inflammation across 7-years in racially diverse midlife women: study of women’s health across the nation. J Soc Issues. 2014;70:298–314.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Williams DR. Stress and the mental health of populations of color: advancing our understanding of race-related stressors. J Health Soc Behav. 2018;59:466–85.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Berger M, Sarnyai Z. “More than skin deep”: stress neurobiology and mental health consequences of racial discrimination. Stress. 2015;18:1–10.

    Article  PubMed  Google Scholar 

  19. Chae DH, Drenkard CM, Lewis TT, Lim SS. Discrimination and cumulative disease damage among African American women with systemic lupus erythematosus. Am J Public Health. 2015;105:2099–107.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chae DH, Martz CD, Fuller-Rowell TE, Spears EC, Smith TTG, Hunter EA, et al. Racial discrimination, disease activity, and organ damage: the black women’s experiences living with lupus (BeWELL) study. Am J Epidemiol In press. doi https://doi.org/10.1093/aje/kwz105.

  21. Krieger N. Discrimination and health inequities. Int J Health Serv. 2014;44:643–710.

    Article  PubMed  Google Scholar 

  22. Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10:e0138511.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Harrell SP. A multidimensional conceptualization of racism-related stress: implications for the well-being of people of color. Am J Orthop. 2000;70:42–57.

    Article  CAS  Google Scholar 

  24. Gee GC, Walsemann KM, Brondolo E. A life course perspective on how racism may be related to health inequities. Am J Public Health. 2012;102:967–74.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Heard-Garris NJ, Cale M, Camaj L, Hamati MC, Dominguez TP. Transmitting trauma: a systematic review of vicarious racism and child health. Soc Sci Med. 2018;199:230–40.

    Article  CAS  PubMed  Google Scholar 

  26. Elder G, Johnson MK, Crosnoe R. The emergence and development of life course theory. In: Mortimer JT, Shanahan MJ, editors. Handbook of the life course. Boston: Springer; 2003. p. 3–19.

    Chapter  Google Scholar 

  27. Woods-Giscombé CL, Lobel M, Zimmer C, Cené CW, Corbie-Smith G. Whose stress is making me sick? Network-stress and emotional distress in African-American women. Issues Ment Health Nurs. 2015;36:710–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bor J, Venkataramani AS, Williams DR, Tsai AC. Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. Lancet. 2018;392:302–10.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Novak NL, Geronimus AT, Martinez-Cardoso AM. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol. 2017;46:839–49.

    PubMed  PubMed Central  Google Scholar 

  30. Krieger N, Huynh M, Li W, Waterman PD, Wye GV. Severe sociopolitical stressors and preterm births in New York City: 1 September 2015 to 31 august 2017. J Epidemiol Community Health. 2018;72:1147–52.

    Article  PubMed  Google Scholar 

  31. Richman LS, Jonassaint C. The effects of race-related stress on cortisol reactivity in the laboratory: implications of the Duke lacrosse scandal. Ann Behav Med. 2008;35:105–10.

    Article  PubMed  Google Scholar 

  32. Nuru-Jeter A, Dominguez TP, Hammond WP, Leu J, Skaff M, Egerter S, et al. “It’s the skin you’re in”: African-American women talk about their experiences of racism. An exploratory study to develop measures of racism for birth outcome studies. Matern Child Health J. 2009;13:29–39.

    Article  PubMed  Google Scholar 

  33. Woods-Giscombé CL. Superwoman Schema: African American women’s views on stress, strength, and health. Qual Health Res. 2010;20:668–83.

    Article  PubMed  PubMed Central  Google Scholar 

  34. McEwen BS. Stress, adaptation, and disease: Allostasis and allostatic load. Ann N Y Acad Sci. 1998;840:33–44.

    Article  CAS  PubMed  Google Scholar 

  35. Brody GH, Yu T, Miller GE, Chen E. Discrimination, racial identity, and cytokine levels among African-American adolescents. J Adolesc Health. 2015;56:496–501.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Su D-L, Lu Z-M, Shen M-N, Li X, Sun L-Y. Roles of pro- and anti-inflammatory cytokines in the pathogenesis of SLE. J Biomed Biotechnol. 2012;2012:347141.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Eudy AM, Vines AI, Dooley MA, Cooper GS, Parks CG. Elevated C-reactive protein and self-reported disease activity in systemic lupus erythematosus. Lupus. 2014;23:1460–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Williams DR, Medlock MM. Health effects of dramatic societal events — ramifications of the recent presidential election. N Engl J Med. 2017;376:2295–9.

    Article  PubMed  Google Scholar 

  39. Drenkard C, Bao G, Dennis G, Kan HJ, Jhingran PM, Molta CT, et al. Burden of systemic lupus erythematosus on employment and work productivity: data from a large cohort in the southeastern United States. Arthritis Care Res. 2014;66:878–87.

    Article  Google Scholar 

  40. Aberer E. Epidemiologic, socioeconomic and psychosocial aspects in lupus erythematosus. Lupus. 2010;19:1118–24.

    Article  CAS  PubMed  Google Scholar 

  41. Pawlak CR, Witte T, Heiken H, Hundt M, Schubert J, Wiese B, et al. Flares in patients with systemic lupus erythematosus are associated with daily psychological stress. Psychother Psychosom. 2003;72:159–65.

    Article  PubMed  Google Scholar 

  42. Karlson EW, Daltroy LH, Rivest C, Ramsey-Goldman R, Wright EA, Partridge AJ, et al. Validation of a systemic lupus activity questionnaire (SLAQ) for population studies. Lupus. 2003;12:280–6.

    Article  CAS  PubMed  Google Scholar 

  43. Atkins R. Instruments measuring perceived racism/racial discrimination: review and critique of factor analytic techniques. Int J Health Serv. 2014;44:711–34.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Williams DR, Gonzalez HM, Williams S, Mohammed SA, Moomal H, Stein DJ. Perceived discrimination, race and health in South Africa. Soc Sci Med. 2008;67:441–52.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Yazdany J, Trupin L, Gansky SA, Dall’era M, Yelin EH, Criswell LA, et al. The brief index of lupus damage (BILD): a patient-reported measure of damage in SLE. Arthritis Care Res. 2011;63:1170–7.

    Article  Google Scholar 

  46. Hicken MT, Kravitz-Wirtz N, Durkee M, Jackson JS. Racial inequalities in health: framing future research. Soc Sci Med. 2018;Feb;199:11–8.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Hagiwara N, Alderson CJ, Mezuk B. Differential effects of personal-level vs group-level racial discrimination on health among black Americans. Ethn Dis. 2016;26:453–60.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Slaughter-Acey JC, Talley LM, Stevenson HC, Misra DP. Personal versus group experiences of racism and risk of delivering a small-for-gestational age infant in African American women: a life course perspective. J Urban Health. 2019;96:181–92.

    Article  PubMed  Google Scholar 

  49. Huynh VW, Huynh Q-L, Stein M-P. Not just sticks and stones: indirect ethnic discrimination leads to greater physiological reactivity. Cultur Divers Ethnic Minor Psychol. 2017;23:425–34.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Robert Wood Johnson Foundation, National Public Radio, Harvard T.H. Chan School of Public Health. Discrimination in America: Experiences and views of African Americans. 2017. https://www.rwjf.org/content/dam/farm/reports/reports/2017/rwjf441128. Accessed 21 Nov 2017.

  51. United States Department of Justice, Federal Bureau of Investigation. Hate Crime Statistics, 2017. 2018. https://ucr.fbi.gov/hate-crime/2017/topic-pages/incidents-and-offenses. Accessed 14 Jan 2019.

  52. Eligon J. Hate crimes increase for the third consecutive year, F.BI Reports N Y Times 2018. https://www.nytimes.com/2018/11/13/us/hate-crimes-fbi-2017.html. Accessed 14 Jan 2019.

  53. Mancini AD, Littleton HL, Grills AE. Can people benefit from acute stress? Social support, psychological improvement, and resilience after the Virginia Tech campus shootings. Clin Psychol Sci. 2015;4:401–17.

    Article  Google Scholar 

  54. Reifels L, Pietrantoni L, Prati G, Kim Y, Kilpatrick DG, Dyb G, et al. Lessons learned about psychosocial responses to disaster and mass trauma: an international perspective. Eur J Psychotraumatol. 2013;4:22897.

    Article  Google Scholar 

Download references

Funding

This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number R01AR065493. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Connor D. Martz.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional Review Board approval was obtained for the study.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Martz, C.D., Allen, A.M., Fuller-Rowell, T.E. et al. Vicarious Racism Stress and Disease Activity: the Black Women’s Experiences Living with Lupus (BeWELL) Study. J. Racial and Ethnic Health Disparities 6, 1044–1051 (2019). https://doi.org/10.1007/s40615-019-00606-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-019-00606-8

Keywords

  • Vicarious racism
  • Systemic lupus erythematosus
  • African American women
  • Racial discrimination