The cost of doubt: assessing the association between attributional ambiguity and mental health.

OBJECTIVE: To quantify the association between attributional ambiguity-the uncertainty of whether an experience is discrimination-and mental health. METHODS: Using a nationally representative sample of U.S. adults recruited through an online survey by Ipsos (April 23 and May 3, 2021), attributional ambiguity was quantified by asking participants if they experienced anything in the past 6 months that they were unsure was discrimination. The survey also assessed the degree to which these experiences caused participants to feel bothered and to ruminate on them. Multiple linear regression models were used to analyze associations between attributional ambiguity and depressive symptoms and mental health status. RESULTS: Black and Hispanic participants reported higher rates of attributional ambiguity than White participants. Experiencing attributional ambiguity was associated with higher levels of depressive symptoms and poorer self-reported mental health status. Among those who reported attributional ambiguity, increases in bother and rumination scores were positively associated with depressive symptoms. CONCLUSION: Attributional ambiguity is an important yet overlooked social determinant of mental health. More research is needed to fully understand the impact of this stressor on population health, particularly among minoritized populations.

Discrimination and anxiety: Using multiple polygenic scores to control for genetic liability.

An established body of research indicates that discrimination is associated with increased symptoms of anxiety and negative affect. However, the association cannot be interpreted unambiguously as an exposure effect because a common set of genetic factors can simultaneously contribute to increased liability for symptoms of anxiety, negative affect, and the perception of discrimination. The present study elucidates the association between discrimination and anxiety/negative affect by implementing strict genetic controls in a large sample of adults. We used data from the biomarker project of the Study of Midlife Development in the United States (MIDUS), a national probability sample of noninstitutionalized, English-speaking respondents aged 25 to 74 y. Participants who consented to provide genetic data were biologically unrelated and of European ancestry as determined by genotype principal components analysis (n = 1,146). A single structural regression model was fit to the data with three measures of discrimination specified to load onto a latent factor and six measures of anxiety and negative affect specified to load onto a second latent factor. After accounting for potential genetic confounds-polygenic scores for anxiety, depression, and neuroticism and the first five genetic principal components-greater discrimination was associated with greater anxiety/negative affect (ß = 0.53, SE = 0.04, P < 0.001). Findings suggest that measures of perceived discrimination should be considered environmental risk factors for anxiety/negative affect rather than indices of genetic liability for anxiety, depression, or neuroticism. Clinical interventions and prevention measures should focus on ways to mitigate the impact of discrimination to improve mental health at the population level.

The weight of childhood adversity: evidence that childhood adversity moderates the impact of genetic risk on waist circumference in adulthood.

OBJECTIVE: The present study tested the interactive effects of childhood adversity and polygenic risk scores for waist circumference (PRS-WC) on waist circumference (WC). Consistent with a diathesis-stress model, we hypothesize that the relationship between PRS-WC and WC will be magnified by increasing levels of childhood adversity. METHODS: Observational study of 7976 adults (6347 European Americans and 1629 African Americans) in the Health and Retirement Study with genotyped data. PRS-WC were calculated by the HRS administrative core using the weighted sum of risk alleles based on a genome-wide association study conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium. Childhood adversity was operationalized using a sum score of three traumatic events that occurred before the age of 18 years. RESULTS: There was a statistically significant interaction between PRS-WC and childhood adversity for European Americans, whereby the magnitude of PRS-WC predicting WC increased as the number of adverse events increased. CONCLUSIONS: This study supports the idea of the interactive effects of genetic risks and childhood adversity on obesity. More epidemiological studies, particularly with understudied populations, are needed to better understand the roles that genetics and childhood adversity play on the development and progression of obesity.

Technical report: an online international weight control registry to inform precision approaches to healthy weight management.

BACKGROUND: Personalizing approaches to prevention and treatment of obesity will be a crucial aspect of precision health initiatives. However, in considering individual susceptibility to obesity, much remains to be learned about how to support healthy weight management in different population subgroups, environments and geographical locations. SUBJECTS/METHODS: The International Weight Control Registry (IWCR) has been launched to facilitate a deeper and broader understanding of the spectrum of factors contributing to success and challenges in weight loss and weight loss maintenance in individuals and across population groups. The IWCR registry aims to recruit, enroll and follow a diverse cohort of adults with varying rates of success in weight management. Data collection methods include questionnaires of demographic variables, weight history, and behavioral, cultural, economic, psychological, and environmental domains. A subset of participants will provide objective measures of physical activity, weight, and body composition along with detailed reports of dietary intake. Lastly, participants will be able to provide qualitative information in an unstructured format on additional topics they feel are relevant, and environmental data will be obtained from public sources based on participant zip code. CONCLUSIONS: The IWCR will be a resource for researchers to inform improvements in interventions for weight loss and weight loss maintenance in different countries, and to examine environmental and policy-level factors that affect weight management in different population groups. This large scale, multi-level approach aims to inform efforts to reduce the prevalence of obesity worldwide and its associated comorbidities and economic impacts. TRIAL REGISTRATION: NCT04907396 (clinicaltrials.gov) sponsor SB Roberts; Tufts University IRB #13075.

Assessing the role of socioeconomic status and discrimination exposure for racial disparities in inflammation.

Socioeconomic status (SES) and discrimination have been implicated as social determinants of health and health disparities. Yet, very little research has been done to assess their contributing role in Black-White disparities in inflammation. Using data from the Midlife in the United States (2004-2006), we conducted Oaxaca-Blinder decomposition analysis to quantify the extent to which three indicators of SES (i.e., education, household income, and employment status) and three forms of discrimination exposures (i.e., everyday, lifetime, and workplace discrimination) explained Black-White differences in inflammation. Education, particularly having a college degree or more, explained 16.88% of the differences between Blacks and Whites. There was no evidence that household income and employment status explained Black-White inflammation differences. Lifetime discrimination significantly explained 18.18% of Black-White difference in inflammation burden. There was no evidence that everyday and workplace discrimination explained Black-White difference in inflammation burden. Together, the predictors explained 44.16% of inflammation differences between Black and White participants. Education and lifetime exposure to discrimination may play a role in inflammation disparities. Further research is needed to examine other dimensions of SES (e.g., wealth) and discrimination (e.g., racial segregation) that are associated with health to better understand the contributions of these key social determinants of Black-White inflammation disparities.

Contested racial identity and the health of women and their infants.

Contested racial identity- self-identified race not matching socially-assigned race-may be an indication of experiences with racism. We aimed to understand the relationship between contested racial identity and women's health behaviors, health outcomes, and infant health outcomes. We used 2012-2015 Massachusetts Pregnancy Risk Assessment Monitoring System data on 5735 women linked with infants' birth certificates. We conducted regression analyses to examine associations between contested racial identity with pregnancy and infant health outcomes and further sub-analyses among women who had experienced a contested racial identity. A total of 901 (15.7%) women reported a contested racial identity. When compared to those who did not, women who had a contested racial identity had lower odds of initiating prenatal care in the first trimester (AOR: 0.76, 95% CI: 0.62, 0.95) and higher odds of smoking (AOR: 1.70, 95% CI: 1.32, 2.19). Among women who had experienced a contested racial identity, those who were socially-assigned as White had decreased odds of having a low birth weight baby (AOR: 0.52, 95% CI: 0.28, 0.99) when compared to those socially-assigned as non-White. Contested racial identity is common; it affects the behaviors that women engage in and the outcomes they experience postpartum. Further, we found that there is a potential benefit to a White social ascription. This work adds to growing evidence of the impact of racism on maternal and infant health in the United States.

Skin Tone, Discrimination, and Allostatic Load in Middle-Aged and Older Puerto Ricans.

OBJECTIVE: A growing body of research suggests that skin tone may be a health risk indicator for Hispanics. Black and darker-skinned Hispanics have worse mental and physical outcomes than White and lighter-skinned Hispanics. Discrimination exposure has been implicated as a risk factor that may explain the association between skin tone and health. However, there is scant research examining the interrelationship between skin tone, discrimination, and health, particularly among Puerto Ricans. We examine the interrelationships between two measures of skin tone, two measures of discrimination, and allostatic load (AL) among Puerto Rican adults. METHODS: Using cross-sectional data from wave 3 of the Boston Puerto Rican Health Study (n = 882), we examined the indirect association (IA) of skin tone on physiological dysregulated systems, also known as AL, through major discrimination and everyday discrimination. We tested these associations using two distinct measures of skin tone: interviewer-ascribed skin tone and spectrophotometer-measured skin tone. RESULTS: Interviewer-ascribed skin tone was indirectly associated with AL through major discrimination (IA = 0.03, 95% confidence interval = 0.004 to 0.06). However, there was no evidence of an IA of interviewer-ascribed skin tone on AL through everyday discrimination (IA = -0.01, 95% confidence interval = -0.03 to 0.01). In addition, there was no evidence that spectrophotometer-measured skin tone was indirectly associated with AL through major discrimination or everyday discrimination. CONCLUSIONS: The sociocultural significance of skin tone may affect how Puerto Ricans are perceived and treated by others, which can, in turn, have physiological health consequences. Future research is needed to replicate these findings and examine the interrelationship between skin tone, discrimination, and other health outcomes.

Developmental timing of initial racial discrimination exposure is associated with cardiovascular health conditions in adulthood.

OBJECTIVE: To examine the association between developmental timing of initial exposure to racial discrimination and cardiovascular health conditions. DESIGN: Using data from the 1995 Detroit Area Study, logistic and negative binomial regression models were used to assess the association between timing of initial exposure to racial/ethnic discrimination, classified as early childhood (0-7), childhood (8-12), adolescence (13-19), and adulthood (>19), on physician-diagnosed cardiovascular health conditions during adulthood. Each analysis adjusted for age, gender, race/ethnicity, income, education, marital status, health-related behaviors, and pre-existing health conditions. RESULTS: Of the 1,106 participants in the final sample, 520 identified as White and 586 identified as Black. Over half (64%) of the sample experienced at least one major cardiovascular health event at the time of the study, with 39% reporting two or more events. Results from logistic regression models showed that initial exposure to racial discrimination during early childhood was associated with a 2.96 (95%CI:1.15, 7.83) times greater odds of having any cardiovascular-related health condition later in life compared to individuals who reported no discrimination. Results from negative binomial regression models demonstrated that individuals who reported initial exposure to racial discrimination during early childhood and adolescence had a CVD incidence rate that was 1.63 (95%CI:1.11, 2.38) and 1.37 (95%CI:1.10, 1.69) times higher than individuals who reported no discrimination. CONCLUSION: Initial exposure to racial discrimination in early childhood and adolescence may increase the risk of cardiovascular conditions later in life. Clinicians and researchers should consider racial discrimination during childhood as a possible risk factor for illness and disease.

Discrimination and systemic inflammation: A critical review and synthesis.

Exposure to discrimination or unfair treatment has emerged as an important risk factor for illness and disease that disproportionately affects racial and ethnic minorities. Discriminatory experiences may operate like other stressors in that they activate physiological responses that adversely affect the maintenance of homeostasis. Research suggests that inflammation plays a critical role in the pathophysiology of stress-related diseases. Recent findings on discrimination and inflammation are discussed. We highlight limitations in the current evidence and provide recommendations for future studies that seek to examine the association between discrimination and inflammation.

Sugar-sweetened beverage consumption among Indigenous Australian children aged 0-3 years and association with sociodemographic, life circumstances and health factors.

OBJECTIVE: To explore beverage intake and associations between sugar-sweetened beverage (SSB) intake and sociodemographic, life circumstances, health and well-being factors in a national cohort of Indigenous children. DESIGN: We calculated prevalence ratios for any SSB consumption across exposures, using multilevel Poisson regression (robust variance), adjusted for age group and remoteness. A key informant focus group contextualised these exploratory findings. SETTING: Diverse settings across Australia. PARTICIPANTS: Families of Indigenous children aged 0-3 years, in the Longitudinal Study of Indigenous Children. RESULTS: Half (50·7 %, n 473/933) of children had ever consumed SSB at survey, increasing from 29·3 % of 0-12-month-olds to 65·7 % of 18-36-month-olds. SSB consumption prevalence was significantly lower in urban and regional v. remote areas, and in families experiencing socio-economic advantage (area-level advantage, caregiver employed, financial security), better life circumstances (caregiver social support, limited exposure to stressors) and caregiver well-being (non-smoking, social and emotional well-being, physical health). SSB consumption prevalence was significantly lower among those engaged with health services (adequate health-service access, regular prenatal check-ups), except SSB consumption prevalence was higher among those who received home visits from an Aboriginal Health Worker compared with no home visits. Key informants highlighted the role of water quality/safety on SSB consumption. CONCLUSIONS: A substantial proportion of Indigenous children in this sample consumed SSB from an early age. Health provider information needs to be relevant to the context of families' lives. Health system strategies must be paired with upstream strategies, such as holistic support programmes for families, reducing racism and improving water quality.

A national study of gender and racial differences in colorectal cancer screening among foreign-born older adults living in the US.

This study examined within group heterogeneity in colorectal cancer screening (CRCS) among foreign-born individuals. Data were from the 2010, 2013 and 2015 National Health Interview Survey data on older adults (N = 5529). In 2018, multivariable logistic regression analysis was conducted to determine whether gender and race/ethnicity were associated with CRCS after controlling for sociodemographic, health access, and acculturation related factors. Overall, Asians were significantly less likely to report CRCS compared with Whites (aOR 0.63, CI 0.52-0.76). Hispanic race/ethnicity was negatively associated with CRCS among men (aOR 0.68, CI 0.50-0.91), but not women compared to white men/women, respectively. Additionally, factors associated with CRCS include having fair/poor health, usual source of care, insurance, ≥ 10 years of US residency and citizenship. Screening disparities experienced by these immigrants may be addressed by improving healthcare access, especially for noncitizens and those with limited healthcare access.

Assessing racial differences in lifetime and current smoking status & menthol consumption among Latinos in a nationally representative sample.

Objective: To examine the relationship between race and smoking behaviors among Latinos/Hispanics. Design: Using data from the National Adult Tobacco Survey (NATS), we implemented Log-Poisson regression models for each dependent variable (smoking pattern and menthol cigarette use). Each analysis adjusted for age, gender, marital status, employment status, and socioeconomic status (SES). Final pooled cross-sectional sample included 505 Black-Latinos and 9078 White-Latinos. Results: While no racial differences were found in lifetime smoking status among Latinos, Black-Latinos had a 16.6% (95% CI: 0.274, 0.057) increased risk of menthol smoking compared to White-Latinos. Conclusions: The results indicate that menthol consumption is influenced by race among Hispanics/Latinos. To comprehensively address racial disparities among Latinos/Hispanics, further attention needs to be given to racial differences in smoking-related risks among Latinos/Hispanics.

Placing prostate cancer disparities within a psychosocial context: challenges and opportunities for future research.

Black men are more likely to be diagnosed with prostate cancer compared with White men. Despite advances in prevention and treatment strategies, disparities in prostate cancer among Black men persist. While research on the causes of higher incidence and mortality is ongoing, there is limited evidence in the existing literature that clearly speaks to the potential psychological or social factors that may contribute to disparities in prostate cancer incidence. Given the lack of attention to this issue, we review scientific evidence of the ways in which social factors, including socioeconomic status and racial segregation, as well as psychological factors, like depression and anxiety, are related to subsequent prostate cancer risk, which could occur through behavioral and biological processes. Our objective is to illuminate psychosocial factors and their context, using a racial disparity lens, which suggests opportunities for future research on the determinants of prostate cancer. Ultimately, we aim to contribute to a robust research agenda for the development of new prostate cancer prevention measures to reduce racial disparities.

The Association Between Perceived Discrimination and Allostatic Load in the Boston Puerto Rican Health Study.

OBJECTIVE: Perceived discrimination is a risk factor for poor health among ethnic and racial minority groups. However, few studies have examined the association between major lifetime and everyday perceived discrimination and allostatic load (AL), a preclinical indicator of disease. We examine the association between two measures of discrimination and AL among Puerto Rican adults. METHODS: Using primarily wave 3 data from the longitudinal Boston Puerto Rican Health Study, we examined the association between major lifetime and everyday perceived discrimination and AL (multisystem dysregulation of 11 physiological components) among Puerto Rican adults residing in the Boston metro area (N = 882). Five models were tested using multivariable regression. The final model adjusted for demographic factors, migration factors, socioeconomic status and work history, health behaviors/risk factors, and depressive symptom. RESULTS: Respondents had a M (SD) AL score of 5.11 (1.76; range = 0-11). They had an average score of 0.21 (0.42) for major lifetime perceived discrimination (0-3) and 0.29 (0.49) for everyday perceived discrimination (0-3). In a fully adjusted model, major lifetime perceived discrimination was associated with greater AL (b = 0.56; 95% CI = 0.19 to 0.92), whereas greater everyday perceived discrimination was marginally, but not significantly, associated with lower AL (b = -0.42; 95% CI = -0.87 to 0.04). CONCLUSIONS: Perceived discrimination remains a common stressor and may be a determinant of AL for Puerto Ricans, although the type of perceived discrimination may have differing effects. Further research is needed to better understand the ways in which major lifetime and everyday perceived discrimination operate to effect physiological systems among Puerto Ricans.

Psychosocial Stress and Overweight and Obesity: Findings From the Chicago Community Adult Health Study.

BACKGROUND: Psychosocial stress has been implicated as a risk factor for overweight and obesity. However, research on psychosocial stressors and overweight and obesity has typically focused on single stressors in isolation, which may overestimate the impact of a specific stressor and fail to describe the role of cumulative stress on overweight and obesity risk. PURPOSE: This study explores the association between overweight/obesity and cumulative exposure to a wide range of psychosocial stressors, among a multiracial/ethnic sample of adults. METHODS: Using secondary data from the Chicago Community Adult Health Study (n = 2,983), we conducted multinomial logistic regression analyses to quantify associations between eight psychosocial stressors, individually and in combination, and measured overweight and obesity, adjusted for sociodemographic factors, alcohol use and smoking. RESULTS: In separated covariate-adjusted models, childhood adversities (odds ratio [OR] = 1.16; confidence interval [CI] = [1.03, 1.30]), acute life events (OR = 1.18; CI = [1.04, 1.34]), financial strain (OR = 1.30; CI = [1.15, 1.47]), and relationship stressors (OR = 1.18; CI = [1.04, 1.35]) were associated with increased odds of obesity. In a model adjusted for all stressors simultaneously, financial strain was the only stressor independently associated with overweight (OR = 1.17; CI = [1.00, 1.36]) and obesity (OR = 1.21; CI = [1.05, 1.39]). Participants with stress exposure in the highest quintile across 2, 3, or ≥4 (compared to no) types of stressors had significantly higher odds of obesity. CONCLUSIONS: Multiple types of stressors may be risk factors for obesity, and cumulative exposure to these stressors may increase the odds of obesity. Reducing exposure to stressors at the population level may have the potential to contribute to reducing the burden of obesity.

The moderating role of race/ethnicity and nativity in the relationship between perceived discrimination and overweight and obesity: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

BACKGROUND: The overweight/obesity epidemic is a public health issue in the United States (US), that disproportionately affect certain racial/ethnic minority groups. Perceived discrimination has been implicated as a health risk factor. However, research on race/ethnicity, perceived discrimination, and obesity has been mixed. Researchers suggest that perceptions of discrimination may be dependent upon nativity status. This study evaluated the role that nativity status and race/ethnicity play in the relationship between perceived discrimination and overweight/obesity. METHODS: We used Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005) [N = 33,319]). Multinomial logistic regression assessed a three-way interaction (perceived discrimination × race/ethnicity × nativity) on overweight and obesity, adjusting for sociodemographic factors and health-related behaviors. RESULTS: The three-way interaction was significant for overweight [F (17, 49) = 3.35; p < 0.001] and obesity [F (17, 49) = 5.05; p < 0.001]. Among US-born individuals, US-born non-Hispanic Blacks had a decreased risk of being obese compared to US-born non-Hispanic Whites at mean levels of perceived discrimination [aRRR = 0.71; 95% CI (0.51-0.98); p = 0.04). Among foreign-born individuals, foreign-born South Americans had an increased risk of being overweight at mean levels of perceived discrimination compared to foreign-born non-Hispanic Whites [aRRR = 8.07; 95% CI (1.68-38.77); p = 0.01], whereas foreign-born Dominicans had a decreased risk of being obese compared to foreign-born non-Hispanic Whites [aRRR = 0.05; 95% CI (0.01-0.20); p < 0.001]. CONCLUSION: Perceived racial discrimination is a risk factor for overweight/obesity for certain groups. Race/ethnicity and nativity may play important roles in the relationship between perceived discrimination and overweight/obesity. Future research is needed to identify the behavioral and psychological pathways that link perceived discrimination and overweight/obesity.

Intra-Ethnic Racial Differences in Waterpipe Tobacco Smoking among Latinos?

BACKGROUND AND OBJECTIVES: This study examined differences in waterpipe smoking (both lifetime and current) by race and ethnicity. More specifically, we evaluated intra-ethnic racial differences among Latinos using a nationally representative sample. METHODS: Pooled data from the National Adult Tobacco Survey (NATS) [2012-2014] was used, in which Log-Poisson multivariable regression models were deployed to determine the prevalence of waterpipe smoking behavior. Models were stratified by gender and we further investigated acculturation, controlling for relevant sociodemographic characteristics. RESULTS: In fully-adjusted models assessing lifetime WTS, Black Latinos and White Latinos exhibited an increase prevalence of lifetime WTS compared to their non-Hispanic white counterparts. Once stratifying by gender, Black Latino men (PR = 1.49; 95% CI = 1.16, 1.90) exhibited increased prevalence of lifetime WTS compared to their non-Hispanic white men counterparts; although white Latino men (PR = 0.88; 95% CI = 0.80, 0.98) exhibited decreased prevalence compared to their non-Hispanic white male counterparts. Similar trends were found for current WTS among men. In fully adjusted models assessing lifetime WTS, among women, only white Latina's (PR = 1.23; 95% CI = 1.04, 1.46) exhibited increased prevalence compared to their non-Hispanic white women counterparts. When evaluating current WTS, Black Latina's (PR = 2.19; 95% CI = 1.32, 3.65) and white Latinas (PR = 1.28; 95% CI = 1.00, 1.63) exhibited increased prevalence of WTS compared to their non-Hispanic white women counterparts. Conclusions/Importance: Among the U.S. general adult population, intra-ethnic racial differences in WTS behaviors exist among Latinos; and is shaped by gender. Future efforts to eliminate racial disparities in WTS should be attentive intra-ethnic racial differences among Latinos.

Race and Skin Color in Latino Health: An Analytic Review.

We examined 22 articles to compare Black Latinos/as' with White Latinos/as' health and highlight findings and limitations in the literature. We searched 1153 abstracts, from the earliest on record to those available in 2016. We organized the articles into domains grounded on a framework that incorporates the effects of race on Latinos/as' health and well-being: health and well-being, immigration, psychosocial factors, and contextual factors. Most studies in this area are limited by self-reported measures of health status, inconsistent use of race and skin color measures, and omission of a wider range of immigration-related and contextual factors. We give recommendations for future research to explain the complexity in the Latino/a population regarding race, and we provide insight into Black Latinos/as experiences.