Skip to main content
SpringerLink
Log in

Association between perceived racism and physiological stress indices in Native Hawaiians

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

The association between racism and the physical health of native U.S. populations has yet to be examined despite their high risk for stress-related disorders and a history of discrimination toward them. We examined the correlation between perceived racism and the two physiological stress indices of cortisol level and blood pressure in 146 adult Native Hawaiians. Attributed and felt racism were assessed with a 10-item shortened version of the Oppression Questionnaire. Height, weight, blood pressure, and salivary cortisol samples (AM and PM) were collected and analyzed along with information on Hawaiian ancestry, BMI, age, sex, marital status, education level, general psychological stress, and ethnic identity. The results indicated that Native Hawaiians reporting more attributed racism had significantly (P < .05) lower average cortisol levels than those reporting less attributed racism, after adjusting for socio-demographic, biological, and psychosocial confounders. Native Hawaiians reporting more felt racism had a significantly higher systolic blood pressure than those reporting less, but this association was not significant after adjusting for the aforementioned confounders. Racism appears to be a chronic stressor that can “get under the skin” of Native Hawaiians by affecting their physical health and risk for stress-related diseases, possibly, through mechanisms of cortisol dysregulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Balabis, J., Pobutsky, A., Kromer Baker, K., Tottori, C., & Salvail, F. (2007). The burden of cardiovascular disease in Hawaii 2007. Honolulu, HI: Hawaii State Department of Health.

    Google Scholar 

  • Belcourt-Dittloff, A., & Stewart, J. (2000). Historical racism: Implications for native Americans. American Psychologist, 55, 1166–1167. doi:10.1037/0003-066X.55.10.1166.

    Article  PubMed  CAS  Google Scholar 

  • Bjorntorp, P., Holm, G., & Rosmond, R. (1999). Hypothalamic arousal, insulin resistance and type 2 diabetes mellitus. Diabetes Medicine, 16, 373–383. doi:10.1046/j.1464-5491.1999.00067.x.

    Article  CAS  Google Scholar 

  • Brondolo, E., Beatty, D., Cubbin, C., Pencile, M., Saegert, S., Wellington, R. L., et al. (2009). Sociodemographic variations in self-reported racism in a community sample of Blacks and Latino. Journal of Applied Social Psychology, 29, 407–429. doi:10.1111/j.1559-1816.2008.00444.x.

    Article  Google Scholar 

  • Brondolo, E., Rieppi, R., Erickson, S. A., Bagiella, E., Shapiro, P. A., McKinley, P., et al. (2003). Hostility, interpersonal interactions, and ambulatory blood pressure. Psychosomatic Medicine, 65, 1003–1011. doi:10.1097/01.PSY.0000097329.53585.A1.

    Article  PubMed  Google Scholar 

  • Carter, R. T. (2007). Racism and psychological and emotional injury: Recognizing and assessing race-based traumatic stress. Counseling Psychology, 35, 13–105. doi:10.1177/0011000006292033.

    Article  Google Scholar 

  • Chambers, E. C., Tull, E. S., Fraser, H. S., Mutunhu, N. R., Sobers, N., & Niles, E. (2004). The relationship of internalized racism to body fat distribution and insulin resistance among African adolescent youth. Journal of the National Medical Association, 96, 1594–1598.

    PubMed  Google Scholar 

  • Chrousos, G. P., & Gold, P. W. (1992). The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. Journal of the American Medical Association, 267, 1244–1252.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396. doi:10.2307/2136404.

    Article  PubMed  CAS  Google Scholar 

  • Cohen, S., Schwartz, J. E., Epel, E., Kirschbaum, C., Sidney, S., & Seeman, T. (2006). Socioeconomic status, race, and diurnal cortisol decline in the coronary artery risk development in young adults (CARDIA) study. Psychosomatic Medicine, 68, 41–50. doi:10.1097/01.psy.0000195967.51768.ea.

    Article  PubMed  Google Scholar 

  • Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapam & S. Oskamp (Eds.), The social psychology of health: Claremont symposium on applied social psychology (pp. 31–67). Newbury Park: Sage Publishers.

    Google Scholar 

  • Cole, S. R. (1999). Assessment of differential item functioning in the perceived stress scale-10. Journal of Epidemiology and Community Health, 53, 319–320. doi:10.1136/jech.53.5.319.

    Article  PubMed  CAS  Google Scholar 

  • Cronbach, L. (1970). Essentials of psychological testing. New York: Harper & Row.

    Google Scholar 

  • DeSantis, A. S., Adam, E. K., Doane, L. D., Mineka, S., Zinbarg, R. E., & Craske, M. G. (2007). Racial/ethnic differences in cortisol diurnal rhythms in a community sample of adolescents. Journal of Adolescent Health, 41, 3–13. doi:10.1016/j.jadohealth.2007.03.006.

    Article  PubMed  Google Scholar 

  • Feagin, J. R. (2006). Systemic racism: A theory of oppression. New York: Routledge.

    Google Scholar 

  • Fekedulegn, D. B., Andrew, M. E., Burchfiel, C. M., Violanti, J. M., Hartley, T. A., Charles, L. E., et al. (2007). Area under the curve and other summary indicators of repeated waking cortisol measurements. Psychosomatic Medicine, 69, 651–659. doi:10.1097/psy.0b013e31814c405c.

    Article  PubMed  CAS  Google Scholar 

  • Fries, E., Hesse, J., Hellhammer, J., & Hellhammer, D. H. (2005). A new view on hypocortisolism. Psychoneuroendocrinology, 30, 1010–1016. doi:10.1016/j.psyneuen.2005.04.006.

    Article  PubMed  CAS  Google Scholar 

  • Gasperin, D., Netuveli, G., Dias-da-Costa, J. S., & Pattussi, M. P. (2009). Effect of psychological stress on blood pressure increase: A meta-analysis of cohort studies. Cadernos De Saúde Pública, 25, 715–726. doi:10.1590/S0102-311X2009000400002.

    Article  PubMed  Google Scholar 

  • Gold, P. W., & Chrousos, G. P. (2002). Organization of the stress system and its dysregulation in melancholic and atypical depression: High vs. low CRH/NE states. Molecular Psychiatry, 7, 254–275.

    Article  PubMed  CAS  Google Scholar 

  • Grandinetti, A., Chen, R., Kaholokula, J. K., Yano, K., Rodriguez, B., Chang, H. K., et al. (2002). Relationship between blood pressure and degree of Hawaiian ancestry. Ethnicity and Disease, 12, 221–228.

    PubMed  Google Scholar 

  • Grandinetti, A., Kaholokula, J. K., Theriault, A. G., Mor, J. M., Chang, H. K., & Waslien, C. (2007). Prevalence of diabetes and glucose intolerance in an ethnically diverse rural community of Hawaii. Ethnicity and Disease, 17, 250–255.

    PubMed  Google Scholar 

  • Greico, E. M. (2001). The native Hawaiian and other Pacific Islander population: 2000 (no. C2KBR/01–14). Washington, D.C.: U.S. Census Bureau.

    Google Scholar 

  • Haas, M. (1992). Institutional racism: The case of Hawaii. Santa Barbara: Praeger Publishers.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Heim, C., Ehlert, U., Hanker, J. P., & Hellhammer, D. H. (1998). Abuse-related posttraumatic stress disorder and alterations of the hypothalamic–pituitary–adrenal axis in women with chronic pelvic pain. Psychosomatic Medicine, 60, 309–318.

    PubMed  CAS  Google Scholar 

  • Kaholokula, J. K. (2007). Colonialism, acculturation and depression among Kānaka Maoli of Hawai’i. In P. Culbertson, M. N. Agee, & C. Makasiale (Eds.), Penina Uliuli: Confronting challenges in mental health for Pacific peoples. Honolulu, HI: University of Hawai’i Press.

    Google Scholar 

  • Kaholokula, J. K., Braun, K. L., Kana’iaupuni, S., Grandinetti, A., & Chang, H. K. (2006). Ethnic-by-gender differences in cigarette smoking among Asian and Pacific Islanders. Nicotine & Tobacco Research, 8, 275–286.

    Article  Google Scholar 

  • Kaholokula, J. K., Iwane, M. K., & Nacapoy, A. H. (2010). Effects of perceived racism and acculturation on hypertension in Native Hawaiians. Hawaii Medical Journal, 69, 11–15.

    PubMed  Google Scholar 

  • Kaholokula, J. K., Nacapoy, A. H., Grandinetti, A., & Chang, H. K. (2008). Association between acculturation modes and type 2 diabetes among Native Hawaiians. Diabetes Care, 31, 698–700. doi:10.2337/dc07.1560.

    Article  PubMed  Google Scholar 

  • Lewis, T. T., Everson-Rose, S. A., Powell, L. H., Matthews, K. A., Brown, C., Karavolos, K., et al. (2006). Chronic exposure to everyday discrimination and coronary artery calcification in African-American women: the SWAN heart study. Psychosomatic Medicine, 68, 362–368. doi:10.1097/01.psy.0000221360.94700.16.

    Article  PubMed  Google Scholar 

  • Lo, M. S., Ng, M. L., Azmy, B. S., & Khalid, B. A. (1992). Clinical applications of salivary cortisol measurements. Singapore Medical Journal, 33, 170–173.

    PubMed  CAS  Google Scholar 

  • Manuel, R. C. (2004). Perceived race discrimination moderates dietary beliefs' effects on dietary intake. Ethnicity and Disease, 14, 405–416.

    PubMed  Google Scholar 

  • Matthews, K., Schwartz, J., Cohen, S., & Seeman, T. (2006a). Diurnal cortisol decline is related to coronary calcification: CARDIA study. Psychosomatic Medicine, 68, 657–661. doi:10.1097/01.PSY.0000244071.42939.0e.

    Article  PubMed  CAS  Google Scholar 

  • Matthews, K. A., Zhu, S., Tucker, D. C., & Whooley, M. A. (2006b). Blood pressure reactivity to psychological stress and coronary calcification in the coronary artery risk development in young adults study. Hypertension, 47, 391–395. doi:10.1161/01.HYP.0000200713.44895.38.

    Article  PubMed  CAS  Google Scholar 

  • Mau, M. K., Grandinetti, A., Arakaki, R. F., Chang, H. K., Kinney, E. K., & Curb, J. D. (1997). The insulin resistance syndrome in native Hawaiians. Native Hawaiian Health Research (NHHR) Project. Diabetes Care, 20, 1376–1380.

    Article  PubMed  CAS  Google Scholar 

  • Mau, M. K., Sinclair, K., Saito, E. P., Baumhofer, K. N., & Kaholokula, J. K. (2009). Cardiometabolic health disparities in native Hawaiians and other Pacific Islanders. Epidemiologic Reviews, 31, 113–129. doi:10.1093/epirev/mxp004.

    Article  PubMed  Google Scholar 

  • Miller, G. E., Chen, E., & Zhou, E. S. (2007). If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychological Bulletin, 133, 25–45. doi:10.1037/0033-2909.133.1.25.

    Article  PubMed  Google Scholar 

  • Miller, G. E., Cohen, S., & Ritchey, A. K. (2002). Chronic psychological stress and the regulation of pro-inflammatory cytokines: A glucocorticoid-resistance model. Health Psychology, 21, 531–541. doi:10.1037/0278-6133.21.6.531.

    Article  PubMed  Google Scholar 

  • Office of Hawaiian Affairs. (2006). Native Hawaiian databook 2006. Honolulu: Office of Hawaiian Affairs.

    Google Scholar 

  • Okamura, J. (2008). Ethnicity and inequality in Hawai’i. Philadelphia: Temple University Press.

    Google Scholar 

  • Paradies, Y. (2006). A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology, 35, 888–901. doi:10.1093/ije/dy1056.

    Article  PubMed  Google Scholar 

  • Pickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J. W., Hill, M. N., et al. (2005). Recommendations for blood pressure measurement in humans: An AHA scientific statement from the council on high blood pressure research professional and public education subcommittee. Journal of Clinical Hypertension, 7, 102–109. doi:10.1111/j.1524-6175.2005.04377.x.

    Article  PubMed  Google Scholar 

  • Pruessner, J. C., Hellhammer, D. H., & Kirschbaum, C. (1999). Burnout, perceived stress, and cortisol responses to awakening. Psychosomatic Medicine, 61, 197–204.

    PubMed  CAS  Google Scholar 

  • Reynolds, R. M., & Walker, B. R. (2007). Can cortisol predict the future in obesity? Clinical Endocrinology, 67, 1–2. doi:10.1111/j.1365.2265.2007.02838.x.

    Article  PubMed  Google Scholar 

  • Roberti, J. W., Harrington, L. N., & Storch, E. A. (2006). Further psychometric support for the 10-item version of the Perceived Stress Scale. Journal of College Counseling, 9, 135–147.

    Article  Google Scholar 

  • Rohleder, N., Joksimovic, L., Wolf, J. M., & Kirschbaum, C. (2004). Hypocortisolism and increased glucocorticoid sensitivity of pro-inflammatory cytokine production in Bosnian war refugees with posttraumatic stress disorder. Biological Psychiatry, 55, 745–751. doi:10.1016/j.biopsych.2003.11.018.

    Article  PubMed  CAS  Google Scholar 

  • Rosmond, R., & Bjorntrop, P. (2000). The hypothalamic-pituitary-adernal axis activity as a predictor of cardiovascular disease, type 2 diabetes, and stroke. Journal of Internal Medicine, 247, 188–197. doi:10.1046/j.1365-2796.2000.00603.x.

    Article  PubMed  CAS  Google Scholar 

  • Salomon, K., & Jagusztyn, N. E. (2008). Resting cardiovascular levels and reactivity to interpersonal incivility among Black, Latina/o, and White individuals: the moderating role of ethnic discrimination. Health Psychology, 27, 473–481. doi:10.1037/0278-6133.27.4.473.

    Article  PubMed  Google Scholar 

  • Seedat, S., Stein, M. B., Kennedy, C. M., & Hauger, R. L. (2003). Plasma cortisol and neuropeptide Y in female victims of intimate partner violence. Psychoneuroendocrinology, 28, 796–808. doi:10.1016/S0306-4530(02)00086-0.

    Article  PubMed  CAS  Google Scholar 

  • Smyth, J., Ockenfels, M. C., Porter, L., Kirschbaum, C., Hellhammer, D. H., & Stone, A. A. (1998). Stressors and mood measured on a momentary basis are associated with salivary cortisol secretion. Psychoneuroendocrinology, 23, 353–370. doi:10.1016/S0306-4530(98)00008-0.

    Article  PubMed  CAS  Google Scholar 

  • Stevenson, H. C., & Arrington, E. G. (2009). Racial/ethnic socialization mediates perceived racism and the racial identity of African American adolescents. Cultural Diversity & Ethnic Minority Psychology, 15, 125–136. doi:10.1037/a0015500.

    Article  Google Scholar 

  • Susman, E. J. (2007). Toward a psychobiologic understanding of youth health disparities. Journal of Adolescent Health, 41, 1–2. doi:10.1016/j.jadohealth.2007.04.002.

    Article  PubMed  Google Scholar 

  • Sweet, E., McDade, T. W., Kiefe, C. I., & Liu, K. (2007). Relationships between skin color, income, and blood pressure among African Americans in the CARDIA study. American Journal of Public Health, 97, 2253–2259. doi:10.2105/AJPH.2006.088799.

    Article  PubMed  Google Scholar 

  • Thompson, H. S., Kamarck, T. W., & Manuck, S. B. (2002). The association between racial identity and hypertension in African-American adults: Elevated resting and ambulatory blood pressure as outcomes. Ethnicity and Disease, 12, 20–28.

    PubMed  Google Scholar 

  • 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 

  • Tull, S. E., Wickramasuriya, T., Taylor, J., Smith-Burns, V., Brown, M., Champagnie, G., et al. (1999). Relationship of internalized racism to abdominal obesity and blood pressure in Afro-Caribbean women. Journal of the National Medical Association, 91, 447–452.

    PubMed  CAS  Google Scholar 

  • Victoroff, J. (2005). Introduction to the oppression questionnaire (OQ). Retrieved from http://www.humiliationstudies.org/documents/VictoroffOppressionQuestionnaire.pdf.

  • Vines, A. I., Baird, D. D., McNeilly, M., Hertz-Picciotto, I., Light, K. C., & Stevens, J. (2006). Social correlates of the chronic stress of perceived racism among Black women. Ethnicity and Disease, 16, 101–107.

    PubMed  Google Scholar 

  • Williams, D. R., & Neighbors, H. (2001). Racism, discrimination and hypertension: Evidence and needed research. Ethnicity and Disease, 11, 800–816.

    PubMed  CAS  Google Scholar 

  • Yehuda, R., Bierer, L. M., Schmeidler, J., Aferiat, D. H., Breslau, I., & Dolan, S. (2000). Low cortisol and risk for PTSD in adult offspring of holocaust survivors. American Journal of Psychiatry, 157, 1252–1259.

    Article  PubMed  CAS  Google Scholar 

  • Zhao, W. H., Xu, H. Q., Zhang, X., Wang, J. I., Yin, C. C., Li, M., et al. (2000). The association of BMI and WHR on blood pressure levels and prevalence of hypertension in middle-aged and elderly people in rural China. Biomedical and Environmental Sciences, 13, 189–197.

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Lisa Ricketts and Eunice Kawamoto for their contribution to this study as community recruiters and assessors. This study was supported by a grant (2P20MD000173) from the National Center on Minority Health and Health Disparities (NCMHD) of the National Institutes of Health (NIH). The JMP statistical software used in this study was made possible by a grant from the National Center for Research Resources (NCRR) of NIH (Grant P20RR016467). The content in this paper is solely the responsibility of the authors and does not necessarily represent the official views of the NCMHD, the NCRR, or the NIH.

Author information

Authors and Affiliations

  1. Department of Native Hawaiian Health, University of Hawaii at Manoa, 651 Ilalo Street, MEB 307L, Honolulu, HI, 96813, USA

    Joseph Keawe‘aimoku Kaholokula & Marjorie K. Mau

  2. Public Health Sciences, University of Hawaii at Manoa, 1960 East–West Road, Biomedical Sciences Bldg. D104-L, Honolulu, HI, 96822, USA

    Andrew Grandinetti & Stefan Keller

  3. Department of Psychology, University of Hawaii at Manoa, 2430 Campus Road, Gartley Hall 110, Honolulu, HI, 96822, USA

    Andrea H. Nacapoy

  4. Te Mata o te Tau, Massey University, Level 2, Adelaide Road, Wellington, New Zealand

    Te Kani Kingi

Authors
  1. Joseph Keawe‘aimoku Kaholokula
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Grandinetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea H. Nacapoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Te Kani Kingi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marjorie K. Mau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph Keawe‘aimoku Kaholokula.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kaholokula, J.K., Grandinetti, A., Keller, S. et al. Association between perceived racism and physiological stress indices in Native Hawaiians. J Behav Med 35, 27–37 (2012). https://doi.org/10.1007/s10865-011-9330-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-011-9330-z

Keywords

Search

Navigation