Interpersonal Discrimination, Gendered Race, and Cardiovascular Disease Inequities: Application of the Emerging Identity Pathology Model

An emerging framework, the Identity Pathology (IP) model, partially addresses persistent uncertainties about the primary causes of disparities in cardiovascular health (CVH) between black and white women and men through outlining how identity beliefs associated with social group membership lead to predictable differences in the health-damaging effects of discrimination exposure. Using data from the CARDIA cohort, this doctoral thesis seeks to: 1) propose a novel psychosocial characteristic, identity pathology, that drives the distribution of reported race and gender discrimination in health-relevant ways, 2) assess whether there are group differences in the effects of multiple versus single forms of discrimination on future CVH, and 3) assess variation between these groups in the relationships of reported racial and gender discrimination in a variety of daily life settings with future CVH. The IP framework suggests that beliefs about identity unique to each gendered race group influence the perception of discrimination and whether reported exposure will be associated with CVH. Simultaneous reports of racial and gender discrimination in multiple settings (compared with no discrimination) were negatively associated with future CVH only among white men. Further, the setting in which discrimination was reported appeared to be a significant indicator of whether experiencing multiple forms of discrimination negatively impacted CVH in each group. Our findings contribute to the literature through introducing a novel framework for assessing the effects of interpersonal discrimination. This work also provides preliminary evidence that compounded experiences of interpersonal racial and gender discrimination may not substantially contribute to poorer CVH among black women

Race/Sex Group Modification of the Association between Allostatic Load and Depression: Findings from the National Health and Nutrition Examination Survey, 2005-2010

Objective: We assessed whether the relationship between depression and chronic stress as measured in allostatic load (AL) differs by race and sex among US black and white adults. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) 2005-2010, we examined race/sex modification of the relationship between AL and depression in black and white women and men aged 18-64 years (n=6431). AL scores, ranging from 0-9, were calculated using 9 cardiovascular, metabolic, and immunologic biomarkers; scores ≥ 4 were considered “high-risk”. Depression was assessed using the PHQ-9; scores ≥ 10 indicate clinical depression. Logistic regression models estimated odds of elevated depressive symptoms as a function of AL for each race/sex group; age and socioeconomic status were included as covariates in each model. All analyses were weighted to represent U.S. adults. Results: The association between AL and depression was strongest among white women (OR=2.1, 95% CI: 1.5, 3.0), followed by black men (OR=1.7 95% CI: 1.0, 2.9), and not statistically significant among black women (OR=1.1 95% CI: .60, 2.0) or white men (OR=1.4 95% CI: .82, 2.5). Conclusions: Our findings that the association between AL and depression was strongest and statistically significant only among white women and black men despite black women having the highest mean AL and depression scores suggests a measure of psychological resistance to chronic stress among those coping with intersecting pressures of systemic race and gender-based discrimination. These results also suggest that social inequality may shape the manner in which chronic stress is expressed. Further research should explore other potential racialized and gendered manifestations of chronic stress in order to better understand social factors influencing health inequity

Health Disparities at the Intersection of Gender and Race: Beyond Intersectionality Theory in Epidemiologic Research

Racial disparities in health have long been one of the primary foci of health inequity research in the United States, yet the use of theoretical frameworks outside of biological determinism has generally been minimal within this literature. Only recently has epidemiology begun to incorporate Intersectionality and other social theories in the study of racial health inequities. Even still, the majority of this research base neglects to engage deeply the theoretical complexity that such frameworks demand, often leaving unanswered the important question of whether and why any observed race effects vary across other social group categories. The limited body of epidemiologic work grounded in Intersectionality Theory indicates that race can be further divided into meaningfully disparate categories with important implications for accurately assessing health and health disparities. Yet, Intersectionality Theory, as it is frequently applied, is only one lens with which to appraise disparate health outcomes at these social junctures. This chapter provides an overview of current evidence for racial differences in health, which vary across gender, building support for the necessity of wholistic identity approaches that move beyond current understandings of Intersectionality Theory

Allostatic Load Biomarker Associations with Depressive Symptoms Vary among US Black and White Women and Men

The prevalence and severity of depression differ in women and men and across racial groups. Psychosocial factors such as chronic stress have been proposed as contributors, but causes of this variation are not fully understood. Allostatic load, a measure of the physiological burden of chronic stress, is known to be associated with depression. Using data from the National Health and Nutrition Examination Survey 2005(-)2010, we examined the associations of nine allostatic load biomarkers with depression among US black and white adults aged 18(-)64 years (n = 6431). Depressive symptoms were assessed using the Patient Health Questionaire-9; logistic models estimated adjusted odds of depression based on allostatic load biomarkers. High-risk levels of c-reactive protein were significantly associated with increased odds of depression among white women (adjusted odds ratio (aOR) = 1.7, 95% CI: 1.1(-)2.5) and men (aOR = 1.8, 95% CI: 1.1(-)2.8) but not black women (aOR = 0.8, 95% CI: 0.6(-)1.1) or men (aOR = 0.9, 95% CI: 0.5(-)1.5). Among black men, hypertension (aOR = 1.7, 95% CI: 1.1(-)2.7) and adverse serum albumin levels (aOR = 1.7, 95% CI: 1.0(-)2.9) predicted depression, while high total cholesterol was associated with depression among black women (aOR = 1.6, 95% CI: 1.0(-)2.7). The associations between allostatic load biomarkers and depression varies with gendered race, suggesting that, despite consistent symptomatology, underlying disease mechanisms may differ between these groups

Intersectional effects of racial and gender discrimination on cardiovascular health vary among black and white women and men in the CARDIA study

Testing hypotheses from the emerging Identity Pathology (IP) framework, we assessed race-gender differences in the effects of reporting experiences of racial and gender discrimination simultaneously compared with racial or gender discrimination alone, or no discrimination, on future cardiovascular health (CVH). Data were from a sample of 3758 black or white adults in CARDIA, a community-based cohort recruited in Birmingham, AL; Chicago, IL; Minneapolis, MN, and Oakland, CA in 1985-6 (year 0). Racial and gender discrimination were assessed using the Experiences of Discrimination scale. CVH was evaluated using a 12-point composite outcome modified from the Life\u27s Simple 7, with higher scores indicating better health. Multivariable linear regressions were used to evaluate the associations between different perceptions of discrimination and CVH scores two decades later by race and gender simultaneously. Reporting racial and gender discrimination in \u3e /=2 settings were 48% of black women, 42% of black men, 10% of white women, and 5% of white men. Year 30 CVH scores (mean, SD) were 7.9(1.4), 8.1(1.6), 8.8(1.6), and 8.7(1.3), respectively. Compared with those of their race-gender groups reporting no discrimination, white women reporting only gender-based discrimination saw an adjusted score difference of +0.3 (95% CI: 0.0,0.6), whereas white men reporting only racial discrimination had on average a 0.4 (95% CI: 0.1,0.8) higher score, and scores among white men reporting both racial and gender discrimination were on average 0.6 (95% CI: 1.1,-0.1) lower than those of their group reporting no discrimination. Consistent with predictions of the IP model, the associations of reported racial and gender discrimination with future CVH were different for different racially-defined gender groups. More research is needed to understand why reported racial and gender discrimination might better predict deterioration in CVH for whites than blacks, and what additional factors associated with gender and race contribute variability to CVH among these groups

Theories for Race and Gender Differences in Management of Social Identity-Related Stressors: a Systematic Review

Sociodemographic group-specific strategies for stress management may contribute to racial and gender disparities in health outcomes in the USA. We aimed to systematically review theoretical and empirical investigations of factors influencing variation in response to and management of identity-related stress among black and white Americans. OvidPsychInfo and PubMed databases were searched to identify eligible studies. Criteria were participant age of \u3e /= 18 years, conducted in the US sampling black or white participants, and published in English in a peer-reviewed journal. The final sample included 167 articles. Theories suggesting social status inequities as the primary contributor to disparate strategies employed by black and white women and men to manage social identity-related stress were most frequently tested and supported. Studies disproportionally focused on how women and black persons cope as targets of prejudice and discrimination rather than on how management strategies of men or white persons are affected as perpetrators. Finally, there was theoretical support for an interactive effect of race and gender on stress management, but empirical evidence was lacking, particularly among black men, white women, and white men. The literature could be strengthened through the use of prospective cohorts and nationally representative samples, as well as study designs accounting for potential within-race and within-gender variation in the effects of social identity-related stressors on coping. With greater consistency in methodology, future empirical studies may yield additional information regarding group differences in stress management pertinent to clarifying mechanisms for the health consequences of exposure to social inequity among black and white women and men

Distinct moderating pathways for psychosocial risk and resilience in the association of neighborhood disadvantage with incident heart failure among Black persons

Objective: To assess whether psychosocial factors moderate the associations between neighborhood disadvantage and incident heart failure (HF). Methods: Among 1448 Non-Hispanic (NH) Black persons dually enrolled in two community-based cohorts in Jackson, Mississippi who were free of HF as of January 1, 2000, 336 HF events classified by reviewer panel accrued through December 31, 2017. Multilevel, multivariable Cox regression models were used to examine whether optimism and negative affect moderated the associations of two measures of neighborhood characteristics (the national Area Deprivation Index (ADI) and perceived neighborhood problems) on incident hospitalized HF. Results: Optimism moderated the association of the ADI with incident HF. Compared to participants reporting the lowest tertile of optimism, those in the highest tertile of optimism had a 29% lower rate of HF associated with increasing ADI in fully adjusted models. We found no evidence for a moderating effect of negative affect. Conclusions: This study supports optimism as a source of resilience to the detrimental effects of neighborhood disadvantage on HF risk. Population-level strategies to promote sociocultural antecedents to optimism may serve as a viable method of reducing the disproportionate burden of HF among NH Black persons

Gendered Race Modification of the Association Between Chronic Stress and Depression Among Black and White U.S. Adults

Chronic stress stemming from social inequity has long been recognized as a risk factor for poor physical and psychological health, yet challenges remain in uncovering the mechanisms through which such exposures affect health outcomes and lead to racial and gender health disparities. Examination of sociocultural influences on group identity, coping, and the expression of stress may yield relevant insight into potential pathways of inequity\u27s effect on risk for chronic disease. The objective of this study was to examine the relationship between chronic stress as measured by allostatic load (AL) and depression by gendered race group. Using National Health and Nutrition Examination Survey 2005-2010 data, we included Black and White U.S. adults aged 18-64 years (n = 6,431). AL was calculated using 9 biomarkers; scores \u3e /=4 indicated high risk. Depression was assessed using the Patient Health Questionnaire-9; scores \u3e /=10 indicated likely clinical depression. Logistic models estimated odds of depression as a function of AL for each gendered race group adjusting for age and family poverty-to-income ratio. Effect modification was assessed by analysis of variance and relative excess risk due to the interaction. We observed modification on the multiplicative scale. High AL was more strongly associated with depression among White women and Black men than among Black women or White men. In conclusion, a potential manifestation of high chronic stress burden, depression, differs across gendered race groups. These disparities may be due to group-specific coping strategies that are shaped by unequal social contexts

Association between food insecurity and emotional eating in Latinos and the mediating role of perceived stress

OBJECTIVE: To examine the association between food insecurity and emotional eating (EE) in US Latinxs and explore the mediating role of perceived stress. DESIGN: Cross-sectional analysis. Food insecurity was measured with the six-item US Department of Agriculture Household Food Security Scale; EE with the Three-Factor Eating Questionnaire R18-V2; and perceived stress with Cohen\u27s Perceived Stress Scale-10. Covariates included age, sex, education, marital status, household size and country of birth. Mediation was tested using the Baron and Kenny method and the mediated proportion was calculated. Analyses included multivariable linear regression and multinomial logistic regression. SETTING: A largely Latinx city in Massachusetts, USA. Participants were recruited from a community health centre serving a large portion of this Latinx community. PARTICIPANTS: Latinx individuals (n 580), aged 21-84 years. RESULTS: Overall, 34.4 % were food insecure and 33.8 % experienced High EE. Food insecurity was associated (adjusted OR; 95 % CI) with higher odds of High EE (1.96; 1.28, 3.02) but not Low EE (1.27; 0.82, 1.99). Food insecurity was associated (beta; 95 % CI) with higher perceived stress (5.69; 4.20, 7.19). Perceived stress was associated (adjusted OR; 95 % CI) with High EE (1.09; 1.06, 1.12) but not Low EE (1.00; CI 0.97, 1.02). When perceived stress was added in the main effects model, food insecurity was no longer associated (OR; 95 % CI) with High EE (1.31; 0.83, 2.07) and explained 69.9 % of the association between food insecurity and High EE. CONCLUSIONS: The association between food insecurity and high EE among Latinxs may be largely mediated by perceived stress. Longitudinal studies are needed