Racial Context and Health Behaviors Among Black Immigrants.

Testing the Racial Context Hypothesis (Read and Emerson 2005), we examine the relationship between racial context of origin and three health behaviors (smoking, drinking, and physical activity) among Black immigrants in the USA. We conduct multinomial logistic regression analyses using data from the 2000-2018 National Health Interview Survey (N = 248,401) to determine if racial context of origin is a mechanism of health differential between Black immigrants and US-born Black Americans. Supporting the Racial Context Hypothesis, we find that Black immigrants from racially mixed (Mexico, Central America, the Caribbean, South America) and majority-Black contexts (Africa) are significantly less likely to be current or former smokers and drinkers than US-born Black Americans. Black immigrants from majority-white (Europe) contexts, on the other hand, look more similar to US-born Black Americans - again supporting the premise that racial context of origin is consequential for health. After controlling for a host of covariates, Black immigrants do not significantly differ from US-born Black Americans in exercise status. Together, these findings suggest that the impacts of racism and white supremacy have lasting effects on people of color, where Black immigrants from majority-white contexts exhibit worse health behaviors than their counterparts from majority-Black and racially mixed regions.

How Skin Tone Influences Relationships Between Discrimination, Psychological Distress, and Self-Rated Mental Health Among Older African Americans.

OBJECTIVES: As within-group differences have emerged as a key area of inquiry for health disparities among African Americans, skin tone has been identified as an important factor. This study aims to examine: (a) the moderating role of skin tone in the relationship between discrimination, self-rated mental health, and serious psychological distress (SPD) and (b) whether this moderating effect differs across genders in a nationally representative sample of older African Americans. METHODS: Analyses were conducted on a subsample of African Americans aged 55+ (N = 837) from the National Survey of American Life. The mental health outcomes were SPD and self-rated mental health. Discrimination was assessed with the Everyday Discrimination Scale. Skin tone was self-reported. Multiple linear regressions tested the study aims. RESULTS: Discrimination was associated with worse self-rated mental health and SPD in the total sample and among women. Skin tone moderated the association between discrimination and SPD in the total sample and among men and women. The associations between discrimination and mental health outcomes were stronger among darker-skinned respondents than lighter respondents. Gender-stratified analyses indicated skin tone moderated the association between discrimination and self-rated mental health for men but not women. DISCUSSION: This study contributes to the emerging body of literature on skin tone, discrimination, and mental health. Uncovering mechanisms behind the "why" is an important next step in understanding how skin tone influences the relationship between discrimination and mental health. The negative psychological effects associated with darker complexion provide several areas to be examined.

Racial stratification in self-rated health among Black Mexicans and White Mexicans.

How do Mexicans of distinct racial backgrounds fit into the recognized patterns of racial health disparities? We conduct regression analyses using data from the 2000-2017 National Health Interview Survey to determine if Mexicans who self-identify as White or Black have a relative advantage or disadvantage in self-rated health in relation to Non-Hispanic (NH) Whites and Blacks in the U.S. Our results indicate that both Black Mexicans and White Mexicans have a significant disadvantage in relation to NH-Whites while White Mexicans have a slight advantage in relation to both NH-Blacks and Black Mexicans. Overall, our results suggest that studying health outcomes among Hispanics without considering race may mask inequalities not observed in the aggregate.

Caste Differences in Hypertension Among Women in India: Diminishing Health Returns to Socioeconomic Status for Lower Caste Groups.

INTRODUCTION: The caste system is a relatively rigid system of social hierarchy in India. The caste membership defines one's access to resources and life opportunities. A growing body of research suggests that lower caste groups have an excess burden of morbidity and mortality in India. However, it is not clear as to what extent caste differences in health are conditioned by socioeconomic status (SES) indicators. PURPOSE: This study examined the caste differences in hypertension and tested whether caste differences in hypertension are conditioned by education and household wealth in a representative sample of women in India. METHODS: This study used data from the National Family Health Survey (NFHS) 2015-2016, India. The analysis is based on a nationally representative sample of 648,064 adult women aged 15-49 years. We used logistic regression to examine whether the association between caste and hypertension varied by education and wealth index using interactions and controlling for potential confounders. RESULTS: The regression models suggest that scheduled tribes and non-caste members have the highest odds of hypertension compared with privileged upper caste members. Interaction models indicate complex intersections of caste, education, and wealth index. The predicted probabilities derived from these interaction models suggest that while SES indicators are inversely associated with the odds of hypertension, the inverse patterning was significantly weaker in other backward classes and more protective in non-caste members compared with upper caste. Additionally, caste difference in predictive risk of hypertension tends to diverge at the lower levels of SES and become narrower at the higher levels of SES. CONCLUSIONS: These findings provide evidence of differential returns to SES and have implications for understanding the causes of SES patterning in health among disadvantaged caste groups in India.

The color of death: race, observed skin tone, and all-cause mortality in the United States.

Objective: This paper examines how mortality covaries with observed skin tone among blacks and in relation to whites. Additionally, the study analyzes the extent to which social factors such as socioeconomic status affect this relationship. Design: This study uses data from the 1982 General Social Survey (N = 1,689) data linked to the National Death Index until 2008. We use this data to examine the links between race, observed skin tone among blacks, and all-cause mortality. Piecewise exponential hazard modeling was used to estimate disparities in skin tone mortality among blacks, and relative to whites. The multivariate models control for age, education, gender, region, metropolitan statistical area, marital status, labor force status, and household income. Results: Observed skin tone is a significant determinant of mortality among blacks and in relation to whites. Light skinned blacks had the lowest mortality hazards among blacks, while respondents with medium and dark brown skin experienced significantly higher mortality. The observed skin tone mortality disparities covaried with education; there are significant mortality disparities across observed skin tone groups among black respondents with high school or more education, and nonsignificant disparities among those with less education. Conclusion: It is crucial to identify the social processes driving racial disparities in health and mortality. The findings reveal that the nuanced social experiences of blacks with different observed skin tones markedly change the experience of racial inequality. Research on the nuanced social processes and biological mechanisms that connect differences in observed skin tone to mortality outcomes promises to better illuminate the experience of racial inequality and policy mechanisms we can use to undermine it.

Skin Tone Matters: Racial Microaggressions and Delayed Prenatal Care.

INTRODUCTION: Literature posits that discrimination can be a barrier to racial and ethnic minorities' healthcare use. This study examines the relationship between perceived discrimination in the form of racial microaggressions and delayed prenatal care in African American women. It also investigates whether this relationship is modified by women's shade of skin color owing to societal attitudes and beliefs tied to colorism (also known as skin-tone bias). METHODS: Data were collected from a cohort of 1,410 black, African American women in metropolitan Detroit, Michigan, enrolled in 2009-2011 (analyzed between August 2017 and July 2018). Perceived racial microaggressions were assessed using the 20-item Daily Life Experiences of Racism and Bother scale. Logistic regression modeled the relationship between the Daily Life Experiences of Racism and Bother scale and delayed prenatal care, defined as third trimester or no prenatal care entry. RESULTS: Nearly a quarter (24.8%) of women had delayed prenatal care. Logistic regression models showed that a Daily Life Experiences of Racism and Bother score above the median was associated with delayed prenatal care (AOR=1.31, 95% CI=1.00, 1.71). This association was moderated by self-reported maternal skin tone (interaction p=0.03). A higher Daily Life Experiences of Racism and Bother score was associated with delayed prenatal care among African-American women at either end of the color continuum (light brown: AOR=1.64, 95% CI=1.02, 2.65; dark brown: AOR=2.30, 95% CI=1.20, 4.41) but not in the middle (medium brown women). CONCLUSIONS: Skin tone-based mistreatment in tandem with racial discrimination in the form of racial microaggressions may influence African American women's use of prenatal care. These findings have implications related to the engagement of women of color, particularly African American women, in healthcare systems and maternal and child health programs.

Prevalence and correlates of everyday discrimination among black Caribbeans in the United States: the impact of nativity and country of origin.

OBJECTIVES: Black Caribbeans in the United States have been the victims of major discrimination (e.g. unfairly fired, denied a promotion, denied housing). What is not known is the degree to which they also experience more routine forms of everyday discrimination such as receiving poor restaurant service, being perceived as dishonest, and being followed in stores. This paper investigates the distribution and correlates of everyday discrimination among a national sample of black Caribbeans in the U.S. DESIGN: This analysis used the black Caribbean sub-sample (n = 1,621) of the National Survey of American Life. Demographic and immigration status correlates of ten items from the Everyday Discrimination Scale were investigated: being treated with less courtesy, treated with less respect, receiving poor restaurant service, being perceived as not smart, being perceived as dishonest, being perceived as not as good as others, and being feared, insulted, harassed, or followed in stores. RESULTS: Roughly one out of ten black Caribbeans reported that, on a weekly basis, they were treated with less courtesy and other people acted as if they were better than them, were afraid of them, and as if they were not as smart. Everyday discrimination was more frequent for black Caribbeans who were male, never married, divorced/separated, earned higher incomes, and who were second or third generation immigrants. Black Caribbeans attributed the majority of the discrimination they experienced to their race. CONCLUSION: To our knowledge, this is the first study to provide an in-depth investigation of everyday discrimination among the black Caribbean population. It provides the frequency, types and correlates of everyday discrimination reported by black Caribbeans in the United States. Understanding the frequency and types of discrimination is important because of the documented negative impacts of everyday discrimination on physical and mental health.

Discrimination Fully Mediates the Effects of Incarceration History on Depressive Symptoms and Psychological Distress Among African American Men.

AIM: Using a nationally representative sample of African American men, this study investigated the associations between lifetime history of incarceration, discrimination, and mental health (e.g., depressive symptoms and psychological distress). We hypothesized that discrimination would fully mediate the association between incarceration history and mental health outcomes among African American men. METHODS: Using a cross-sectional design, our analysis included 1271 African American men who participated in the National Survey of American Life (NSAL), 2001-2003. Incarceration history was the main independent variable. Depressive symptoms and psychological distress were the dependent variables. Everyday discrimination was the mediator. Age, education, and income were covariates. Structural equation models (SEMs) were used for data analysis. RESULTS: Among African American men, incarceration history was positively associated with perceived discrimination, depressive symptoms, and psychological distress. Everyday discrimination fully mediated the associations between incarceration history and both depressive symptoms and psychological distress. CONCLUSION: Discrimination may play an important role in the mental health problems of African American men with a history of incarceration. These findings have public policy implications as well as clinical implications for mental health promotion of African American men. Policies that reduce preventable incarceration or at least reduce subsequent discrimination for those who have been incarcerated may enhance mental health of previously incarcerated African American men.

The role of colorism in explaining African American females' suspension risk.

African American female students' elevated suspension risk has received national attention. Despite a number of studies documenting racial/ethnic disparities in African American females' school suspension risk, few investigations have attempted to explain why these disparities occur. The purpose of this study was to examine the role of colorism in explaining suspension risk using a nationally representative sample of adolescent females. Controlling for individual- and school-level characteristics associated with school discipline such as student-teacher relationships, prior discipline history, school size and type, the results indicate that colorism was a significant predictor of school suspension risk. African American female adolescents with darker complexions were almost twice as likely to receive an out-of-school suspension as their White female peers. This finding was not found for African American female students with lighter skin complexions. Implications for adopting a colorist framework for understanding school discipline outcomes and future research for advancing the field in this area are discussed. (PsycINFO Database Record

Maintaining functional independence in elderly adults: the roles of health status and financial resources in predicting home modifications and use of mobility equipment.

PURPOSE: We investigated whether health status (i.e., need characteristics) and financial resources (i.e., enabling characteristics) were important predictors of two types of functional adaptations among elderly adults: home modifications such as putting nonslip tape on rugs or installing more telephones and use of equipment for mobility or activities of daily living (ADLs) such as canes or walkers. DESIGN AND METHODS: Participants were identified from the National Survey of Self-Care and Aging (n = 3,485), a nationally representative sample of noninstitutionalized U.S. adults aged 65 and older. Need and enabling characteristics were used to predict home modifications and equipment use in multinomial logistic analysis, controlling for predisposing characteristics. RESULTS: Although several health-status (need) variables had significant, direct effects on functional adaptations, the effects of ADL limitations were diminished at higher levels of impairment. Among the financial (enabling) variables, subjective income measures and supplemental insurance had significant, direct effects on functional adaptations. IMPLICATIONS: Promotion of functional adaptations among elderly people may benefit from both a proactive approach that targets elders with few limitations and a consideration of financial factors in addition to health status.