https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2012.30070

Pearson AR

Pebbles Fagan

Vickie L. Shavers

William M. P. Klein

PubMed

Shavers, Vickie L

Klein, William

Fagan, Pebbles

Digital Repository at the University of Maryland

EDITORIALResearch onRace/Ethnicityand Health CareDiscrimination:Where We Areand Where WeNeed to GoRacial/ethnic disparities in accessto care, receipt of treatment, healthstatus, and health outcomes arewell documented. A number offactors are posited to underliethese disparities including socio-economic status, lack of health careknowledge, cultural beliefs andpreferences, and racial/ethnicity-based discrimination—the focus ofthis theme issue of the AmericanJournal of Public Health (AJPH ).Both overt and more subtle andindirect1 expressions of personalprejudice and racial/ethnic dis-crimination remain prevalent inthe general US community. Be-cause the current social and legalenvironment is no longer openlysupportive of discriminationagainst racial/ethnic minorities,contemporary discriminatory be-havior is often attributed to otherfactors that can be more easilyjustified.2 This makes it difficult toaccurately assess the overall prev-alence of racial/ethnic discrimina-tion and to track trends over timewhich may contribute to the beliefamong some that discriminationis no longer a problem in theUnited States. Nevertheless, ina 2008 nationwide Gallup Pollconducted June 5---6, 2008, 56%of those surveyed agreed that rac-ism against African Americans waswidespread.3 Data from the Na-tional Latino and Asian AmericanStudy show that 30% of Latinosperceived that they had been dis-criminated against.4a Unfortu-nately, biases, stereotypes andprejudices prevalent in the generalcommunity are unlikely to be heldat bay at the doors of our medicalor other institutions. In 2008 theUnited Nations Committee on theElimination of Racial Discrimination(CERD) urged then PresidentGeorgeW. Bush’s administration to“take effective actions to end racistpractices against minorities in theUnited States in areas of criminaljustice, housing, healthcare andeducation.”4bThe specific objective of thistheme issue of the AJPH is tohighlight the need for and stateof empirical research on racial/ethnic discrimination and its asso-ciation with the health and healthcare received by racial/ethnicminority populations. Discrimina-tion is experienced by manyminority and population sub-groups. However, the majority ofprevious research on discrimina-tion and health has focused onAfrican Americans which is likelya result of the predominant rolethat race has played in AfricanAmerican social history. From themore than 100 abstracts we re-ceived in response to our opencall for papers, it is clear thata vast amount of current researchfocuses on African Americans.HOW DISCRIMINATIONCONTRIBUTES TO HEALTHDISPARITIESIn the first article, Smedley5proposes a comprehensivemodel of the lived experienceof race, one that will facilitatea better understanding of theinteraction of race with gender,socioeconomic status, geogra-phy and that also considers thenegative consequences of rac-ism for Whites. Krieger6 pro-poses an integrated approachfor assessing how discriminationultimately produces health dis-parities. The approach is guidedThis photograph by Lori Waselchuk from the “Grace Before Dying” exhibition humanizes a namelesspopulation, and bears witness to a community of men who provide love and support in an institution thatwas constructed to provide neither. Printed with permission.930 | Editorial American Journal of Public Health | May 2012, Vol 102, No. 5by ecosocial theory, which con-ceptualizes discrimination at mul-tiple levels with multiple pathwaysthat span the life course andgenerations. Dovidio and Fiske7use a social psychological frame-work to explain how unexaminedracial/ethnic biases contribute tohealth disparities and discuss im-plications for understandinghealth care bias and developingappropriate interventions.STATE OF RESEARCHShavers et al.8 focus on theprevalence and state of empiricalresearch regarding racial/ethnicdiscrimination by health care pro-viders or occurring within healthcare settings. Currently used mea-sures, research approaches, dataresources, and results of researchon race/ethnicity-based health carediscrimination are reviewed. Thisarticle sets the stage for the othertheme articles, which cover issuesof measurement, implicit bias, andperception of discrimination.MEASUREMENTThe accurate measurementand tracking of exposure to dis-crimination although essentialto establishing discrimination asa health risk remains a challengefor researchers interested in thistopic area. Gee et al.9 expandon the discussion of the life courseperspective with a detailed ex-amination of how sensitivityto discrimination and the contextin which discrimination occurschanges over time. The authorsalso provide an interesting dis-cussion of the relevance ofdiscrimination experienced byothers, latency, and stress prolif-eration. Williams et al.10 examinequestion framing, racial categori-zation, type of discrimination, andvariation in the assessment ofdiscriminatory experiences byrace and socioeconomic status.IMPLICIT BIASOur unconscious biases reflectour attitudes, beliefs, stereotypesand prejudicial associations wehave for particular groups. Thesebiases or implicit attitudes havethe potential to influence the waywe perceive and behave towardothers. Four studies in the themesection focus on implicit attitudesand biases. Cooper et al.11 de-scribe the results of a cross-sec-tional study of the associationbetween clinician implicit atti-tudes about race and cliniciancommunication and patient rat-ings of care. Sabin and Green-wald12 use clinical vignettes andImplicit Association Tests to ex-amine the relationship betweenpediatricians’ implicit and ex-plicit racial attitudes and racialvariation in treatment recom-mendations. In an intriguingstudy of stereotypes, Moskowitzet al.13 use subliminal exposuresof the faces of Black and Whitemen to explore stereotype acti-vation among White physicians.The study by Mazzocco andBrunner14 provides insight intofactors that underlie opposition forrace-focused health care policiesby examining its association withcognitive- and belief-based mecha-nisms regarding the salience ofracial health disparities.PERCEIVEDDISCRIMINATIONThe extent to which discrimina-tion influences important outcomesdepends not only on the attitudesand actions of the perceiver (typi-cally a health care provider) butalso how individuals perceive andrespond to discrimination. Threestudies in the theme section ofAJPH focus on perceived discrim-ination processes and outcomes.In a prospective study amongadolescents Brody et al.,15 exam-ine the association of perceivedracial discrimination and subse-quent increase in substance use.Harris et al.16 examine the associ-ation between experiences withhealth care and general discrimi-nation and the perception of neg-ative health care experiences andreceipt of cancer screening amongMaori women. Sawyer et al.17show that anticipating a raciallyincongruent interaction witha person perceived to be preju-diced is sufficient to trigger hemo-dynamic and vascular effects andhas psychological consequences.These studies demonstrate thatperceiving discrimination in healthcare settings can have palpablephysiological, attitudinal, and be-havioral downstream effects withsubstantial consequences.It was our goal to highlight theimportance and need for researchthat examines racial/ethnic dis-crimination as a putative risk forracial/ethnic health disparities.Noticeably absent from this themedsection are articles that focus oninstitutional racism. Perhaps themost insidious form of racism is thestructural or systemic factors thatinfluence differential availability,access, appropriateness and utiliza-tion of and access to health care.This form of racism is less easilyrecognized than personal discrimi-nation because the perception ofwhat is racist in the United Statesis largely shaped by our system oflegal remedy for discriminatorybehavior, which focuses on thepresence of conscious intent.Whether regulations, policies, rulesand customary procedures withinhealth systems, organizations, orgovernments have a discriminatoryintent is an important question.Equally important, however, iswhether these regulations, policies,rules, and procedures have a dis-criminatory impact.Together, the articles in thistheme issue provide a good over-view and informed discussion ofthe limitations of current measuresand approaches for examining ra-cial/ethnic health care discrimina-tion. The articles also identifystrategies for improving measure-ment and suggest areas for futureresearch. As these articles clearlyindicate, there is much that wedon’t know about the overall prev-alence and impact of racial/ethnicdiscrimination on health, particu-larly within US health care settings.On February 2---4, 2011, theNational Cancer Institute (NCI) ofthe National Institutes of Health(NIH) sponsored a three-day con-ference in collaboration with theAgency for Health Care Researchand Quality (AHRQ), National In-stitute on Drug Abuse (NIDA),Office of Behavioral and SocialScience Research (OBSSR) andNational Heart Lung and BloodInstitute (NHLBI) to examine theresearch and research methodsused for investigating the role ofracial/ethnic discrimination inhealth. The specific purposes ofthe conference were to (1) pro-mote the science and research onracial/ethnic discrimination andits contribution to racial/ethnicdisparities in health, (2) identifygaps in the research literature andareas for future research or NCI/NIH funding initiatives, and (3)increase awareness of the NCI’sinterest in funding research in thistopic area through the ProgramAnnouncement, The Effect ofRacial and Ethnic Discrimination/Bias on Health Care Delivery (PA-11---162, PA-11---163, PA-11-165).Several of the articles are frompresenters from this conference,many of whom are leaders in thisfield of research. It is our beliefMay 2012, Vol 102, No. 5 | American Journal of Public Health Editorial | 931THE SCIENCE OF RESEARCH ON RACIAL/ETHNIC DISCRIMINATION AND HEALTHthat the articles in this themesection of AJPH both illustratethe state of the field and willalso help position researchers,policymakers, and professionalsat all levels of health care toaddress the effects of discrimina-tion in the evolving health careenvironment. jVickie L. Shavers, PhDWilliam M. P. Klein, PhDPebbles Fagan, PhD, MPHAbout the AuthorsVickie L. Shavers is with the Health Servicesand Economics Branch, Applied ResearchProgram, Division of Cancer Control andPopulation Sciences, National Cancer In-stitute, Bethesda, MD. William M. P. Kleinis with the Behavioral Research Program,Division of Cancer Control and PopulationSciences, National Cancer Institute. PebblesFagan is with the Cancer Prevention andControl Program, University of HawaiiCancer Center, Honolulu.Correspondence should be sent to VickieL Shavers, PhD, NCI, Division of CancerControl and Population Science, 6130Executive Blvd EPN Room 4005, Bethesda,MD 20892 (e-mail: shaversv@mail.nih.gov). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.This editorial was accepted January 20,2012.doi:10.2105/AJPH.2012.300708ContributorsAll authors participated in the con-ceptualization, writing, or editing ofthe article.AcknowledgmentsThe authors thank Martin L. Brown, PhD,and Rachel Ballard Barbash, MD, MPH,for their review of the manuscript forNational Cancer Institute publicationclearance.Human Participant ProtectionBecause no human subjects were in-volved, institutional review board ap-proval was not required.References1. Hehman E, Gaertner SL, Dovidio JF.Evaluations of presidential performance:Race, prejudice and perceptions of Amer-icanism. J Exp Soc Psychol. 2011;47:430---435.2. Pearson AR, Dovidio JF, Gaertner SL.The nature of contemporary prejudice: In-sights from aversive racism. Soc PersonalPsychol Compass. 2009;3:324--338.3. Jones JM. Majority of Americans sayracism against blacks is widespread.GALLUP Poll. August 4, 2008. Availableat: http://www.gallup.com/poll/109258/majority-americans-say-racism-against-blacks-widespread.aspx. Accessed August11, 2011.4a. Perez DJ, Fortuna L, Alegria M.Prevalence and correlates of everyday dis-crimination among U.S. Latinos. J Commu-nity Psychol. 2008;36:421---433.4b. Rizvi H. UN panel finds two-tiersociety. North American Inter Press Ser-vice. March 11, 2008. Available at:http://ipsnorthamerica.net/news.php?idnews=1353. Accessed January 25, 2012.5. Smedley BD. The lived experience ofrace and its health consequences. Am JPublic Health. 2012;102(5):933---935.6. Krieger N. Methods for the scientificstudy of discrimination and health: anecosocial approach. Am J Public Health.2012;102(5):936---944.7. Dovidio JF, Fiske ST. Under theradar: how unexamined biases in deci-sion-making processes in clinical interac-tions can contribute to health care dis-parities. Am J Public Health. 2012;102(5):945---952.8. Shavers VL, Fagan P, Jones D, KleinW, Moten C, Rorie E. The state of re-search on racial/ethnic discrimination inthe receipt of health care. Am J PublicHealth. 2012;102(5):953---966.9. Gee GC, Walsemann KM, Brondolo E.A life course perspective on how racismmay be related to health inequities. Am JPublic Health. 2012;102(5):967---974.10. Williams DR, John DA, Oyserman D,Sonnega J, Mohammed SA, Jackson JS.Research on discrimination and health:an exploratory study of unresolved con-ceptual and measurement issues. Am JPublic Health. 2012;102(5):975---978.11. Cooper LA, Roter DL, Carson KA,et al. The associations of clinicians’ im-plicit attitudes about race with medicalvisit communication and patient ratings ofinterpersonal care. Am J Public Health.2012;102(5):979---987.12. Sabin JA, Greenwald AG. The in-fluence of implicit bias on treatment re-commendations for 4 common pediatricconditions: pain, urinary tract infection,attention deficit hyperactivity disorder,and asthma. Am J Public Health. 2012;102(5):988---955.13. Moskowitz GB, Stone J, Childs A.Implicit stereotyping and medical deci-sions: unconscious stereotype activationin practitioners’ thoughts about AfricanAmericans. Am J Public Health. 2012;102(5):996---1001.14. Mazzocco PJ, Brunner RP. Anexperimental investigation of possiblememory biases affecting support forracial health care policy. Am J PublicHealth. 2012;102(5):1002---1005.15. Brody GH, Kogan SM, Chen Y.Perceived discrimination and longitudi-nal increases in adolescent substanceuse: gender differences and mediationalpathways. Am J Public Health. 2012;102(5):1006---1011.16. Harris R, Cormack D, Tobias M, et al.Self-reported experience of racial dis-crimination and health care use in NewZealand: results from the 2006/07 NewZealand Health Survey. Am J PublicHealth. 2012;102(5):1012---1019.17. Sawyer PJ, Major B, Casad BJ,Townsend SSM, Mendes WB. Discrimi-nation and the stress response: psycho-logical and physiological consequencesof anticipating prejudice in interethnicinteractions. Am J Public Health. 2012;102(5):1020---1026.932 | Editorial American Journal of Public Health | May 2012, Vol 102, No. 5THE SCIENCE OF RESEARCH ON RACIAL/ETHNIC DISCRIMINATION AND HEALTH

English

Research on Race/Ethnicity and Health Care Discrimination: Where We Are and Where We Need to Go

Minority Health Archive

EDITORIAL
Research on
Race/Ethnicity
and Health Care
Discrimination:
Where We Are
and Where We
Need to Go
Racial/ethnic disparities in access
to care, receipt of treatment, health
status, and health outcomes are
well documented. A number of
factors are posited to underlie
these disparities including socio-
economic status, lack of health care
knowledge, cultural beliefs and
preferences, and racial/ethnicity-
based discrimination—the focus of
this theme issue of the American
Journal of Public Health (AJPH ).
Both overt and more subtle and
indirect1 expressions of personal
prejudice and racial/ethnic dis-
crimination remain prevalent in
the general US community. Be-
cause the current social and legal
environment is no longer openly
supportive of discrimination
against racial/ethnic minorities,
contemporary discriminatory be-
havior is often attributed to other
factors that can be more easily
justiﬁed.2 This makes it difﬁcult to
accurately assess the overall prev-
alence of racial/ethnic discrimina-
tion and to track trends over time
which may contribute to the belief
among some that discrimination
is no longer a problem in the
United States. Nevertheless, in
a 2008 nationwide Gallup Poll
conducted June 5---6, 2008, 56%
of those surveyed agreed that rac-
ism against African Americans was
widespread.3 Data from the Na-
tional Latino and Asian American
Study show that 30% of Latinos
perceived that they had been dis-
criminated against.4a Unfortu-
nately, biases, stereotypes and
prejudices prevalent in the general
community are unlikely to be held
at bay at the doors of our medical
or other institutions. In 2008 the
United Nations Committee on the
Elimination of Racial Discrimination
(CERD) urged then President
GeorgeW. Bush’s administration to
“take effective actions to end racist
practices against minorities in the
United States in areas of criminal
justice, housing, healthcare and
education.”4b
The speciﬁc objective of this
theme issue of the AJPH is to
highlight the need for and state
of empirical research on racial/
ethnic discrimination and its asso-
ciation with the health and health
care received by racial/ethnic
minority populations. Discrimina-
tion is experienced by many
minority and population sub-
groups. However, the majority of
previous research on discrimina-
tion and health has focused on
African Americans which is likely
a result of the predominant role
that race has played in African
American social history. From the
more than 100 abstracts we re-
ceived in response to our open
call for papers, it is clear that
a vast amount of current research
focuses on African Americans.
HOW DISCRIMINATION
CONTRIBUTES TO HEALTH
DISPARITIES
In the ﬁrst article, Smedley5
proposes a comprehensive
model of the lived experience
of race, one that will facilitate
a better understanding of the
interaction of race with gender,
socioeconomic status, geogra-
phy and that also considers the
negative consequences of rac-
ism for Whites. Krieger6 pro-
poses an integrated approach
for assessing how discrimination
ultimately produces health dis-
parities. The approach is guided
This photograph by Lori Waselchuk from the “Grace Before Dying” exhibition humanizes a nameless
population, and bears witness to a community of men who provide love and support in an institution that
was constructed to provide neither. Printed with permission.
930 | Editorial American Journal of Public Health | May 2012, Vol 102, No. 5
by ecosocial theory, which con-
ceptualizes discrimination at mul-
tiple levels with multiple pathways
that span the life course and
generations. Dovidio and Fiske7
use a social psychological frame-
work to explain how unexamined
racial/ethnic biases contribute to
health disparities and discuss im-
plications for understanding
health care bias and developing
appropriate interventions.
STATE OF RESEARCH
Shavers et al.8 focus on the
prevalence and state of empirical
research regarding racial/ethnic
discrimination by health care pro-
viders or occurring within health
care settings. Currently used mea-
sures, research approaches, data
resources, and results of research
on race/ethnicity-based health care
discrimination are reviewed. This
article sets the stage for the other
theme articles, which cover issues
of measurement, implicit bias, and
perception of discrimination.
MEASUREMENT
The accurate measurement
and tracking of exposure to dis-
crimination although essential
to establishing discrimination as
a health risk remains a challenge
for researchers interested in this
topic area. Gee et al.9 expand
on the discussion of the life course
perspective with a detailed ex-
amination of how sensitivity
to discrimination and the context
in which discrimination occurs
changes over time. The authors
also provide an interesting dis-
cussion of the relevance of
discrimination experienced by
others, latency, and stress prolif-
eration. Williams et al.10 examine
question framing, racial categori-
zation, type of discrimination, and
variation in the assessment of
discriminatory experiences by
race and socioeconomic status.
IMPLICIT BIAS
Our unconscious biases reﬂect
our attitudes, beliefs, stereotypes
and prejudicial associations we
have for particular groups. These
biases or implicit attitudes have
the potential to inﬂuence the way
we perceive and behave toward
others. Four studies in the theme
section focus on implicit attitudes
and biases. Cooper et al.11 de-
scribe the results of a cross-sec-
tional study of the association
between clinician implicit atti-
tudes about race and clinician
communication and patient rat-
ings of care. Sabin and Green-
wald12 use clinical vignettes and
Implicit Association Tests to ex-
amine the relationship between
pediatricians’ implicit and ex-
plicit racial attitudes and racial
variation in treatment recom-
mendations. In an intriguing
study of stereotypes, Moskowitz
et al.13 use subliminal exposures
of the faces of Black and White
men to explore stereotype acti-
vation among White physicians.
The study by Mazzocco and
Brunner14 provides insight into
factors that underlie opposition for
race-focused health care policies
by examining its association with
cognitive- and belief-based mecha-
nisms regarding the salience of
racial health disparities.
PERCEIVED
DISCRIMINATION
The extent to which discrimina-
tion inﬂuences important outcomes
depends not only on the attitudes
and actions of the perceiver (typi-
cally a health care provider) but
also how individuals perceive and
respond to discrimination. Three
studies in the theme section of
AJPH focus on perceived discrim-
ination processes and outcomes.
In a prospective study among
adolescents Brody et al.,15 exam-
ine the association of perceived
racial discrimination and subse-
quent increase in substance use.
Harris et al.16 examine the associ-
ation between experiences with
health care and general discrimi-
nation and the perception of neg-
ative health care experiences and
receipt of cancer screening among
Maori women. Sawyer et al.17
show that anticipating a racially
incongruent interaction with
a person perceived to be preju-
diced is sufﬁcient to trigger hemo-
dynamic and vascular effects and
has psychological consequences.
These studies demonstrate that
perceiving discrimination in health
care settings can have palpable
physiological, attitudinal, and be-
havioral downstream effects with
substantial consequences.
It was our goal to highlight the
importance and need for research
that examines racial/ethnic dis-
crimination as a putative risk for
racial/ethnic health disparities.
Noticeably absent from this themed
section are articles that focus on
institutional racism. Perhaps the
most insidious form of racism is the
structural or systemic factors that
inﬂuence differential availability,
access, appropriateness and utiliza-
tion of and access to health care.
This form of racism is less easily
recognized than personal discrimi-
nation because the perception of
what is racist in the United States
is largely shaped by our system of
legal remedy for discriminatory
behavior, which focuses on the
presence of conscious intent.
Whether regulations, policies, rules
and customary procedures within
health systems, organizations, or
governments have a discriminatory
intent is an important question.
Equally important, however, is
whether these regulations, policies,
rules, and procedures have a dis-
criminatory impact.
Together, the articles in this
theme issue provide a good over-
view and informed discussion of
the limitations of current measures
and approaches for examining ra-
cial/ethnic health care discrimina-
tion. The articles also identify
strategies for improving measure-
ment and suggest areas for future
research. As these articles clearly
indicate, there is much that we
don’t know about the overall prev-
alence and impact of racial/ethnic
discrimination on health, particu-
larly within US health care settings.
On February 2---4, 2011, the
National Cancer Institute (NCI) of
the National Institutes of Health
(NIH) sponsored a three-day con-
ference in collaboration with the
Agency for Health Care Research
and Quality (AHRQ), National In-
stitute on Drug Abuse (NIDA),
Ofﬁce of Behavioral and Social
Science Research (OBSSR) and
National Heart Lung and Blood
Institute (NHLBI) to examine the
research and research methods
used for investigating the role of
racial/ethnic discrimination in
health. The speciﬁc purposes of
the conference were to (1) pro-
mote the science and research on
racial/ethnic discrimination and
its contribution to racial/ethnic
disparities in health, (2) identify
gaps in the research literature and
areas for future research or NCI/
NIH funding initiatives, and (3)
increase awareness of the NCI’s
interest in funding research in this
topic area through the Program
Announcement, The Effect of
Racial and Ethnic Discrimination/
Bias on Health Care Delivery (PA-
11---162, PA-11---163, PA-11-165).
Several of the articles are from
presenters from this conference,
many of whom are leaders in this
ﬁeld of research. It is our belief
May 2012, Vol 102, No. 5 | American Journal of Public Health Editorial | 931
THE SCIENCE OF RESEARCH ON RACIAL/ETHNIC DISCRIMINATION AND HEALTH
that the articles in this theme
section of AJPH both illustrate
the state of the ﬁeld and will
also help position researchers,
policymakers, and professionals
at all levels of health care to
address the effects of discrimina-
tion in the evolving health care
environment. j
Vickie L. Shavers, PhD
William M. P. Klein, PhD
Pebbles Fagan, PhD, MPH
About the Authors
Vickie L. Shavers is with the Health Services
and Economics Branch, Applied Research
Program, Division of Cancer Control and
Population Sciences, National Cancer In-
stitute, Bethesda, MD. William M. P. Klein
is with the Behavioral Research Program,
Division of Cancer Control and Population
Sciences, National Cancer Institute. Pebbles
Fagan is with the Cancer Prevention and
Control Program, University of Hawaii
Cancer Center, Honolulu.
Correspondence should be sent to Vickie
L Shavers, PhD, NCI, Division of Cancer
Control and Population Science, 6130
Executive Blvd EPN Room 4005, Bethesda,
MD 20892 (e-mail: shaversv@mail.nih.
gov). Reprints can be ordered at http://www.
ajph.org by clicking the “Reprints” link.
This editorial was accepted January 20,
2012.
doi:10.2105/AJPH.2012.300708
Contributors
All authors participated in the con-
ceptualization, writing, or editing of
the article.
Acknowledgments
The authors thank Martin L. Brown, PhD,
and Rachel Ballard Barbash, MD, MPH,
for their review of the manuscript for
National Cancer Institute publication
clearance.
Human Participant Protection
Because no human subjects were in-
volved, institutional review board ap-
proval was not required.
References
1. Hehman E, Gaertner SL, Dovidio JF.
Evaluations of presidential performance:
Race, prejudice and perceptions of Amer-
icanism. J Exp Soc Psychol. 2011;47:430---
435.
2. Pearson AR, Dovidio JF, Gaertner SL.
The nature of contemporary prejudice: In-
sights from aversive racism. Soc Personal
Psychol Compass. 2009;3:324--338.
3. Jones JM. Majority of Americans say
racism against blacks is widespread.
GALLUP Poll. August 4, 2008. Available
at: http://www.gallup.com/poll/109258/
majority-americans-say-racism-against-
blacks-widespread.aspx. Accessed August
11, 2011.
4a. Perez DJ, Fortuna L, Alegria M.
Prevalence and correlates of everyday dis-
crimination among U.S. Latinos. J Commu-
nity Psychol. 2008;36:421---433.
4b. Rizvi H. UN panel ﬁnds two-tier
society. North American Inter Press Ser-
vice. March 11, 2008. Available at:
http://ipsnorthamerica.net/news.php?
idnews=1353. Accessed January 25, 2012.
5. Smedley BD. The lived experience of
race and its health consequences. Am J
Public Health. 2012;102(5):933---935.
6. Krieger N. Methods for the scientiﬁc
study of discrimination and health: an
ecosocial approach. Am J Public Health.
2012;102(5):936---944.
7. Dovidio JF, Fiske ST. Under the
radar: how unexamined biases in deci-
sion-making processes in clinical interac-
tions can contribute to health care dis-
parities. Am J Public Health. 2012;102
(5):945---952.
8. Shavers VL, Fagan P, Jones D, Klein
W, Moten C, Rorie E. The state of re-
search on racial/ethnic discrimination in
the receipt of health care. Am J Public
Health. 2012;102(5):953---966.
9. 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(5):967---974.
10. Williams DR, John DA, Oyserman D,
Sonnega J, Mohammed SA, Jackson JS.
Research on discrimination and health:
an exploratory study of unresolved con-
ceptual and measurement issues. Am J
Public Health. 2012;102(5):975---978.
11. Cooper LA, Roter DL, Carson KA,
et al. The associations of clinicians’ im-
plicit attitudes about race with medical
visit communication and patient ratings of
interpersonal care. Am J Public Health.
2012;102(5):979---987.
12. Sabin JA, Greenwald AG. The in-
ﬂuence of implicit bias on treatment re-
commendations for 4 common pediatric
conditions: pain, urinary tract infection,
attention deﬁcit hyperactivity disorder,
and asthma. Am J Public Health. 2012;
102(5):988---955.
13. Moskowitz GB, Stone J, Childs A.
Implicit stereotyping and medical deci-
sions: unconscious stereotype activation
in practitioners’ thoughts about African
Americans. Am J Public Health. 2012;
102(5):996---1001.
14. Mazzocco PJ, Brunner RP. An
experimental investigation of possible
memory biases affecting support for
racial health care policy. Am J Public
Health. 2012;102(5):1002---1005.
15. Brody GH, Kogan SM, Chen Y.
Perceived discrimination and longitudi-
nal increases in adolescent substance
use: gender differences and mediational
pathways. Am J Public Health. 2012;
102(5):1006---1011.
16. Harris R, Cormack D, Tobias M, et al.
Self-reported experience of racial dis-
crimination and health care use in New
Zealand: results from the 2006/07 New
Zealand Health Survey. Am J Public
Health. 2012;102(5):1012---1019.
17. Sawyer PJ, Major B, Casad BJ,
Townsend SSM, Mendes WB. Discrimi-
nation and the stress response: psycho-
logical and physiological consequences
of anticipating prejudice in interethnic
interactions. Am J Public Health. 2012;
102(5):1020---1026.
932 | Editorial American Journal of Public Health | May 2012, Vol 102, No. 5
THE SCIENCE OF RESEARCH ON RACIAL/ETHNIC DISCRIMINATION AND HEALTH


http://health-equity.pitt.edu/3979/1/Research_on_Race_Ethnicity_and_Health_Care_Discrimination.pdf

Research on Race/Ethnicity and Health Care Discrimination: Where We Are and Where We Need to Go

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