Interaction Between Race and Gender on Implicit Racial Bias Against Blacks

Background and aims: Exposure and vulnerability to racial discrimination is not solely a function of race but the intersection of race and gender, with Black men experiencing more discrimination than Black women. This phenomenon is explained by the subordinate male target hypothesis, suggesting that majority men specifically target men of color. If that is the case, implicit bias would be most common among the majority men. The current cross-sectional study investigated race by gender differences in implicit bias against Blacks. Methods: Data came from Harvard University’s Project Implicit, an online survey, conducted during 2006-2016. Data included 444422 implicit association tests (IATs) which were taken by Blacks (n=56384) and Whites (n=388038). Using IAT, the dependent variable was implicit bias against Blacks. Independent variables were race, gender, and age. Using SPSS, linear regressions were utilized to test the additive and multiplicative effects of race and gender on implicit bias against Blacks. Results: Race (b = 0.39; 95% CI = 0.38-0.39) and gender (b = 0.05; 95% CI = 0.05-0.05) were associated with IAT score suggesting higher implicit bias against Blacks among Whites and men. A significant interaction was found between race and gender (b = 0.05; 95% CI = 0.04-0.07), suggesting the highest level of implicit bias against Blacks among White men. Conclusion: It is not solely race and gender but their intersection that shapes social distribution of implicit bias against Blacks. This finding extends the previous literature showing that not solely race or gender but their intersection influences exposure to discrimination. Keywords: Ethnic groups, Racism, Racial discrimination, Race, Whites, Blacks, African Americans, Gender, Bias, Implicit bia

Erratum to Multiple Published Papers

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Intercourse Avoidance among Women with Coronary Artery Disease

Introduction Avoidance of sexual intercourse has not been frequently studied among patients with chronic medical conditions and patients with coronary artery disease ( CAD ) are not exception. Aim We aimed to (i) compare intercourse avoidance during the past 2 weeks among women with CAD and healthy controls; and (ii) to determine factors associated with intercourse avoidance during the past 2 weeks among women with CAD . Methods This study was conducted in an outpatient cardiology clinic in T ehran, I ran. The study included 152 married women with CAD and 50 controls. Socio‐demographic and clinical data including the severity of angina ( WHO R ose Q uestionnaire), risk factors (cigarette smoking, hyperlipidemia, diabetes, and obesity), fatigue, physical function (visual analogue scale [ VAS ]) and somatic comorbidities [ I fudu index], symptoms of anxiety and depression ( H ospital A nxiety and D epression S cale [ HADS ]), and dyadic adjustment ( R evised‐ D yadic A djustment S cale [ R ‐ DAS ]) were considered as independent variables. Logistic regression was used to determine predictors of sexual avoidance during the past 2 weeks. Main Outcome Measures The main outcome was intercourse avoidance over a 2‐week period, measured by the R elation and S exuality S cale ( RSS ). Result Avoidance of intercourse during the past 2 weeks was higher among women with CAD than controls (73.0% vs. 56%, P  = 0.024). According to the logistic regression, intercourse avoidance was positively associated with age (Odds ratio [ OR ] = 1.127, 95% confidence interval [ CI ] = 1.073, 1.185), somatic comorbidities ( OR  = 1.137, 95% CI  = 1.061, 1.218) and depressive symptoms ( OR  = 1.150, 95% CI  = 1.022, 1.293). Conclusion Our study suggests that among women with CAD , age, depressive symptoms and somatic comorbidities are associated with avoidance of intercourse. As having intercourse is safe among patients with stable CAD , all health professionals should discuss sexual behaviors with their female CAD patients, especially those that are older, with higher depressive symptoms or multiple comorbidities so as to allay fears about sexual functioning. Assari S . Intercourse avoidance among women with coronary artery disease. J Sex Med 2014;11:1709–1716.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108106/1/jsm12459.pd

Blacks’ Diminished Health Returns of Educational Attainment: Health and Retirement Study

Background: Education level reduces the risk of health problems such as poor self-rated health (SRH), high body mass index (BMI), and depressive symptoms (DS). Marginalization – related Diminished Returns (MDRs), however, refer to smaller health benefits of socioeconomic status (SES) indicators particularly educational attainment for the members of racial minority groups such as non-Hispanic Blacks compared to the majority group (non-Hispanic Whites). It is not known, however, if MDRs also hold for middle-age and older adults over a long period of time.  Aims: The current study used a nationally representative data set to explore racial variation in the predictive utility of baseline education level on protecting people against poor SRH, BMI, and DS.  Methods: Data for this analysis were borrowed from the Health and Retirement Study (HRS 1992-ongoing), a nationally representative longitudinal study that followed 10,023 middle-aged and older adults (50+ years old) for up to 26 years. From this number, 1877 (18.7%) were non-Hispanic Black Americans, and 8,146 (81.3%) were non-Hispanic White Americans. Education level was the independent variable. We used cluster analysis to categorize individuals to low and high-risk groups (outcome) based on SRH, BMI, and DS over 26 years. Age and gender were the covariates. Race was the moderator.  Results: Overall, high education level reduced the odds of poor SRH, BMI, and DS over the 26 years of follow up. Interactions were observed between race and education on all three health outcomes indicating smaller protective effects of baseline educational attainment on poor health over time, regardless of the outcome.  Conclusions: In line with the MDRs, highly educated non-Hispanic Black Americans remain at high risk for poor health across domains, a risk which is unexpected given their education. The risk of all health outcomes, however, is lowest for non-Hispanic White Americans with highest education. Policies that exclusively focus on equalizing racial gaps in SES (e.g., education) may fail to eliminate the racial and ethnic health inequalities because of the racial inequalities in the marginal health return of education. Public policies must equalize education quality and address structural and environmental barriers that are disproportionately more common in the lives of non-Hispanic Black Americans, even at high education levels. Future research should test how contextual factors, segregation, labor market practices, childhood poverty, and education quality reduces the health return of education for highly educated non-Hispanic Black Americans

Bidirectional associations between chronic medical conditions, disability, and depressive symptoms over 25 years: Black- White differences

Background and aims: Blacks have a higher rate of chronic medical conditions (CMC), disability, and depressive symptoms compared to Whites. The present study compared Blacks and Whites for bidirectional associations between CMC, disability, and depressive symptoms over a 25-year period. Methods: Data came from all five waves (1986, 1989, 1994, 2001, and 2011) of the Americans’ Changing Lives Study (ACL). This study followed 3,497 Whites and Blacks for up to 25 years. Number of CMC, disability, and depressive symptoms Center for Epidemiological Studies-Depression (CES-D) were measured at all waves. Multi-group crossed lag modeling was used to test four models, where race defined the groups. Results: Based on Models 1 and Model 2, cross-sectional associations between CMC and depressive symptoms at 1989, 2001, and 2011 were significant among Whites but not Blacks. Based on Model 3, lagged effect of CMC in 2001 on depressive symptoms in 2011 was only significant for Whites. Based on Model 4, cross-sectional associations between disability and depressive symptoms in 1989 were found among Whites but not Blacks. Conclusion: Compared to Whites, Blacks show fewer cross-sectional and longitudinal associations between CMC, disability, and depressive symptoms over time. These findings are robust, regardless of whether we conceptualize disability or depressive symptoms as the outcome

Parental Education and Spanking of American Children: Blacks’ Diminished Returns

Background: Based on the Minorities’ Diminished Returns (MDRs) framework, high socioeconomic status (SES) indicators such as parental education shows weaker protective effects against adverse experiences for Blacks than Whites. For example, Black children with highly educated parents report high levels of depression, anxiety, suicide, smoking, obesity, and chronic disease. Limited knowledge exists on MDRs of parental education on the child’s exposure to spanking by the mother. Aims: Built on the MDRs framework, we tested the hypothesis of whether the effect of parental education on the child’s exposure to spanking by the mother differs in Black and White families. We hypothesized that: 1) there is an inverse association between mothers’ educational attainment and child spanking, and 2) the effect of mothers’ educational attainment on mothers’ spanking of the child is weaker for Black than White families. Methods: We used data from the Fragile Families and Child Well-being Study (FFCWS), a 9-year follow up study of a random sample of births in cities larger than 200,000 population. In this analysis, 2722 Black or White families were followed. The main predictor was parental educational attainment at birth. The outcomes were exposure to spanking at ages 3, 5, and 9.Logisticregression was used for data analysis. Results: Higher parental educational attainment at birth was inversely associated with the child’s exposure to spanking by the mother among Whites, not Blacks. We also found a significant interaction between parental educational attainment at birth and race, suggesting that the associations between parental education and child exposure to spanking by the mother at ages3, 5, and 9were weaker for Black than White families. Conclusions: Diminished returns of parental educational attainment in terms of reducing children’s exposure to trauma and stress may be a mechanism that contributes to racial health disparities, particularly poor health of children in highly educated Black families. That is a smaller protective effect of parental education on reducing undesired exposures for Black than White children may be one of the mechanisms that may explain why children develop worse than expected physical, mental, and behavioral health in high SES Black families. Not all health disparities are due to racial differences in SES, but some of them are also secondary to the diminishing returns of socioeconomic status indicators such as parental education for racial minorities. Research should study contextual, structural, family, and behavioral factors that reduce Black families’ ability to mobilize their human capital and secure health outcomes for themselves and their children

Cognitive test score and 25-Year mortality risk; Does race matter?

Objectives: Despite our knowledge on the effect of cognitive test score on subsequent risk of mortality, few studies have compared Blacks and Whites for this association. The current study was conducted on Black-White differences in the magnitude of the association between baseline cognitive test score and all-cause mortality in a nationally representative sample of adults in the United States over 25 years. Methods: We used data of the Americans’ Changing Lives Study (ACL), 1986 – 2011, a national prospective cohort in U.S. The study followed 3,361 adults (2,205 White and 1,156 Blacks), age 25 and older, for up to 25 years. The independent variable was cognitive test score measured at baseline (1986) using the 4-item version of the Short Portable Mental Status Questionnaire, treated in two different ways (as a dichotomous and as a continuous variable). The dependent variable was time to death (due to all causes) during the follow up period. Covariates included baseline age, gender, education, income, number of chronic diseases, self-rated health, and depressive symptoms. Race (Black versus White) was the focal effect modifier. We used a series of Cox proportional hazards models in the total sample, and by race, in the absence and presence of health variables. Results: Overall, cognitive test score predicted mortality risk. A significant interaction was found between race and baseline cognitive test score suggesting that baseline cognitive test score has a weaker protective effect against all-cause mortality for Blacks in comparison to Whites. In race-stratified models, cognitive test score at baseline predicted risk of all-cause mortality for Whites but not Blacks, in the absence and presence of baseline socio-economic and health variables. The results were similar regardless of how we treated baseline cognitive test score. Conclusions: In the United States, baseline cognitive test score has a weaker protective effect against all-cause mortality over a long period of time for Blacks than Whites. The finding is in line with the Minorities Diminished Returns theory and is probably due to structural and interpersonal racism

College Graduation and Wealth Accumulation: Blacks’ Diminished Returns

Background: Based on the Minorities’ Diminished Returns (MDRs) framework, indicators of high Socioeconomic Status (SES), such as high maternal educational attainment, show weaker protective effects on various developmental, behavioral, and health outcomes for Black than White families. As a result of these MDRs, families and individuals with high educational attainment still report high levels of depression, smoking, obesity, and chronic disease. Limited knowledge exists on MDRs of maternal education on indicators of wealth such as home ownership and home value. Aims: Built on the MDRs framework, we tested the hypothesis of whether the effects of maternal educational attainment at birth on home ownership and home value, as proxies of wealth, vary between Black and White families. We hypothesized that: 1) high maternal education would be associated with more wealth 15 years later, and 2) compared to Whites, Blacks would be less likely to accumulate wealth (own a house) across all educational levels, given a weaker boosting effect of maternal educational attainment on wealth for Black than White families. Methods: The Fragile Families and Child Well-being Study, is a 15-year follow up study of a random sample of births in cities larger than 200,000 population in the US. A total number of 2004 White or Black youth were included and were followed from birth to the age of 15. The predictor of interest was maternal educational attainment at birth, treated as a categorical variable (college graduation). The outcomes were home ownership and home value (worth-owed) 15 years later, as proxies of wealth. Logistic and linear regression were used for data analysis. Results: High maternal education at birth was associated with home ownership and higher value of owned home at age 15. We also found that maternal educational attainment at birth and race interact with each other, suggesting that the effects of high maternal educational attainment at birth on home ownership/value at age 15 were weaker for Black than White families. Conclusions: Diminished returns of maternal educational attainment at birth on wealth accumulation in Black families may be a mechanism that contributes to racial health disparities in high socioeconomic status and also poor outcomes of high SES Black families. That is, a smaller effect of maternal educational attainment on changing the real lives of Black than White youth may be one of the mechanisms by which health remains worse than expected in high SES Black families. Not all of the health, behavioral, and developmental disparities are due to the racial gap in SES but also diminishing returns of socioeconomic status indicators such as maternal educational attainment for racial minorities. Research should study how social stratification, discriminatory mortgage and banking, residential segregation, family formation, employment, and occupational prestige reduce Black families’ ability to mobilize their human capital and secure tangible economic and non-economic outcomes

Cross-country variation in additive effects of socio-economics, health behaviors, and comorbidities on subjective health of patients with diabetes

Abstract Purpose This study explored cross-country differences in the additive effects of socio-economic characteristics, health behaviors and medical comorbidities on subjective health of patients with diabetes. Methods The study analyzed data from the Research on Early Life and Aging Trends and Effects (RELATE). The participants were 9,179 adults with diabetes who were sampled from 15 countries (i.e. China, Costa Rica, Puerto Rico, United States, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, India, Ghana, South Africa, and Russia). We fitted three logistic regressions to each country. Model I only included socio-economic characteristics (i.e. age, gender, education and income). In Model II, we also included health behaviors (i.e. smoking, drinking, and exercise). Model III included medical comorbidities (i.e. hypertension, respiratory disease, heart disease, stroke, and arthritis), in addition to the previous blocks. Results Our models suggested cross-country differences in the additive effects of socio-economic characteristics, health behaviors and comorbidities on perceived health of patients with diabetes. Comorbid heart disease was the only condition that was consistently associated with poor subjective health regardless of country. Conclusion Countries show different profiles of social and behavioral determinants of subjective health among patients with diabetes. Our study suggests that universal programs that assume that determinants of well-being are similar across different countries may be over-simplistic. Thus instead of universal programs that use one protocol for health promotion of patients in all countries, locally designed interventions should be implemented in each country.http://deepblue.lib.umich.edu/bitstream/2027.42/134624/1/40200_2013_Article_166.pd

Psychosocial determinants of communication satisfaction in racially concordant and discordant patient-physician interactions

Introduction: Although both socioeconomic and race- related factors both influence quality of medical encounters, it is not known how these effects differ between racially concordant and discordant medical visits. Current study investigated psychosocial determinants of physician visit satisfaction of Black adults based on racial concordance of the medical encounter. Materials and Methods: Data came from the Detroit Area Study (DAS), a community survey of adults in Michigan, United States. The current analysis included 336 Black individuals who had visited a White (n = 191) or a Black (n=145) physician in the last year. Outcome was satisfaction with the quality of communication with the doctor. Demographics (age and gender), socioeconomic staus (education and income), psychosocial factors (control beliefs and social support), race related factors (having a close White friend, negative attitudes about Blacks, discrimination), and health status (chronic disease count, self-rated health, and distress) of the patient as well as race of the doctor were measured. We used multi-group structural equation modeling (SEM) for data analysis, where the two groups were racially concordant (those who met a Black physician) and racially discordant (those who met a White physician) visits.   Results: Satisfaction with physician visit was lower in racially discordant than racially concordant encounters. In racially concordant visits, high education was associated with higher satisfaction, however, racial discrimination was associated with lower satisfaction. In racially discordant visits (i.e. with a White doctor), having a White friend as well as high sense of control were associated with a higher satisfaction, while negative attitudes about Blacks was associated with lower level of satisfaction. Conclusions: Racially concordant and discordant visits have different satisfaction levels. Racially concordant and discordant visits also have different predictors of communication satisfaction among Black patients. Socioeconomic status as well as racial attitudes and experiences impact quality of communication of the Black patients with their doctors, however, these effects depend on the race of the doctor