Exposing Racial Discrimination: Implicit & Explicit Measures–The My Body, My Story Study of 1005 US-Born Black & White Community Health Center Members

Background To date, research on racial discrimination and health typically has employed explicit self-report measures, despite their potentially being affected by what people are able and willing to say. We accordingly employed an Implicit Association Test (IAT) for racial discrimination, first developed and used in two recent published studies, and measured associations of the explicit and implicit discrimination measures with each other, socioeconomic and psychosocial variables, and smoking. Methodology/Principal Findings Among the 504 black and 501 white US-born participants, age 35–64, randomly recruited in 2008–2010 from 4 community health centers in Boston, MA, black participants were over 1.5 times more likely (p<0.05) to be worse off economically (e.g., for poverty and low education) and have higher social desirability scores (43.8 vs. 28.2); their explicit discrimination exposure was also 2.5 to 3.7 times higher (p<0.05) depending on the measure used, with over 60% reporting exposure in 3 or more domains and within the last year. Higher IAT scores for target vs. perpetrator of discrimination occurred for the black versus white participants: for “black person vs. white person”: 0.26 vs. 0.13; and for “me vs. them”: 0.24 vs. 0.19. In both groups, only low non-significant correlations existed between the implicit and explicit discrimination measures; social desirability was significantly associated with the explicit but not implicit measures. Although neither the explicit nor implicit discrimination measures were associated with odds of being a current smoker, the excess risk for black participants (controlling for age and gender) rose in models that also controlled for the racial discrimination and psychosocial variables; additional control for socioeconomic position sharply reduced and rendered the association null. Conclusions Implicit and explicit measures of racial discrimination are not equivalent and both warrant use in research on racial discrimination and health, along with data on socioeconomic position and social desirability

Study participant characteristics: sociodemographic and socioeconomic profile: 504 black US-born and 501 white US-born community health center members, <i>My Body My Story</i> (Boston, MA, 2008–2010).

<p>Note: <b>values in bold</b> indicate that, for the specified variables, the difference in distribution by race/ethnicity is statistically significant (p<0.05), using relevant non-parametric tests.</p><p>*financial assets: bonds, treasury notes, IRA's, certificates of deposit, shares of stocks or mutual funds; does not include value of home.</p>§<p>Jim Crow states/district : District of Columbia plus Alabama, Arizona, Arkansas, Delaware, Florida, Georgia, Kansas, Kentucky, Louisiana, Maryland, Mississippi, Missouri, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wyoming <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0027636#pone.0027636-US3" target="_blank">[51]</a>.</p

Domains of self-reported experiences of racial discrimination: distribution and comparisons by race/ethnicity and gender: 504 black US-born and 501 white US-born participants, <i>My Body My Story</i> (Boston, MA, 2008–2010) (observed data).

<p>Note: <b>values in bold</b> indicate that the 95% CI for the odds ratio excludes 1.0, hence observed difference is <b>significantly different (p<0.05)</b>; data presented: observed data (not including missing values).</p

Study enrollment: <i>My Body My Story</i> (Boston, MA, 2008–2010).

<p>Study enrollment: <i>My Body My Story</i> (Boston, MA, 2008–2010).</p

Association of smoking (current smoker vs all others) with explicit measure of racial discrimination (EDS (race)), implicit measures of racial discrimination, and covariates: odds ratio (OR) and 95% confidence interval (CI) for analyses within and comparing the 504 black US-born and 501 white US-born participants, <i>My Body My Story</i> (Boston, MA, 2008–2010)(imputed data).

<p>Note: values in bold have 95% CI that do not cross 1.00;</p><p>*IAT analyses control for IAT order effects.</p

Association of smoking (current smoker vs all others) with explicit measure of racial discrimination (EOD), implicit measures of racial discrimination, and covariates: odds ratio (OR) and 95% confidence interval (CI) for analyses within and comparing the 504 black US-born and 501 white US-born participants, <i>My Body My Story</i> (Boston, MA, 2008–2010)(imputed data).

<p> <b>Note: values in bold have 95% CI that do not cross 1.00;</b></p><p>*IAT analyses control for IAT order effects.</p

Association of smoking (current smoker vs all others) with explicit measure of racial discrimination (EDS (any)), implicit measures of racial discrimination, and covariates: odds ratio (OR) and 95% confidence interval (CI) for analyses within and comparing the 504 black US-born and 501 white US-born participants, <i>My Body My Story</i> (Boston, MA, 2008–2010)(imputed data).

<p> <b>Note: values in bold have 95% CI that do not cross 1.00;</b></p><p>*IAT analyses control for IAT order effects.</p

Distribution, by education and gender, of the implicit and explicit measures of racial discrimination: 504 black US-born and 501 white US-born participants, <i>My Body My Story</i> (Boston, MA, 2008–2010) (observed data).

<p>Note: <b>values in bold</b> indicate that, within the specified racial/ethnic-gender group, the distribution is <b>significantly different (p<0.05)</b> across socioeconomic strata, as based on 2-sided t-test for continuous variables and chi-square test for categorical variables; data presented: observed data (not including missing values).</p>‡<p>“race” includes, as specified reasons, “race” and “ancestry or national origin”; all non-racial exposures scored as 0.</p><p>For statistical significance of IAT effect (within racial/ethnic-gender-socioeconomic group): * = 0.01</p

Correlations between the explicit and implicit racial discrimination measures and additional psychosocial covariates: Spearman's <i>r</i> (p-value), 504 black, US-born and 501 white US-born community health center members, <i>My Body My Story</i> (Boston, MA, 2008–2010) (observed data).

<p><b>Note: values in bold</b> indicate the Spearman correlation coefficient is statistically significant (p<0.05); based on observed data [N], excluding missing values.</p

Distribution, by education and gender, of psychosocial variables, and Jim Crow birthplace status: 504 black US-born and 501 white US-born participants, <i>My Body My Story</i> (Boston, MA, 2008–2010) (observed data).

<p>Note: <b>values in bold</b> indicate that, within the specified racial/ethnic-gender group, the distribution is <b>significantly different (p<0.05)</b> across socioeconomic strata, as based on 2-sided t-test for continuous variables and chi-square test for categorical variables; data presented: observed data (not including missing values).</p>§<p>Jim Crow states/district : District of Columbia plus Alabama, Arizona, Arkansas, Delaware, Florida, Georgia, Kansas, Kentucky, Louisiana, Maryland, Mississippi, Missouri, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wyoming <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0027636#pone.0027636-US3" target="_blank">[51]</a>.</p