Dimensions of perceived racism and self-reported health: examination of racial/ethnic differences and potential mediators.

BACKGROUND: Many details of the negative relationship between perceived racial/ethnic discrimination and health are poorly understood. PURPOSE: The purpose of this study was to examine racial/ethnic differences in the relationship between perceived discrimination and self-reported health, identify dimensions of discrimination that drive this relationship, and explore psychological mediators. METHODS: Asian, Black, and Latino(a) adults (N=734) completed measures of perceived racial/ethnic discrimination, self-reported health, depression, anxiety, and cynical hostility. RESULTS: The association between perceived discrimination and poor self-reported health was significant and did not differ across racial/ethnic subgroups. Race-related social exclusion and threat/harassment uniquely contributed to poor health for all groups. Depression, anxiety, and cynical hostility fully mediated the effect of social exclusion on health, but did not fully explain the effect of threat. CONCLUSIONS: Our results suggest that noxious effects of race-related exclusion and threat transcend between-group differences in discriminatory experiences. The effects of race-related exclusion and threat on health, however, may operate through different mechanisms.

A Pilot Randomized Controlled Trial to Promote Immunosuppressant Adherence in Adult Kidney Transplant Recipients.

BACKGROUND: Nonadherence to immunosuppressant medication is a prevalent practice among kidney transplant recipients and has been associated with increased risk for graft failure and economic burden. The aim of this pilot study was to test whether a culturally sensitive cognitive-behavioral adherence promotion program could significantly improve medication adherence to tacrolimus prescription as measured by telephone pill counts among kidney transplant recipients. METHODS: Thirty-three adult transplant recipients were less than 98% adherent to tacrolimus prescription based on 3 telephone pill counts and were randomized either to the 2-session cognitive-behavioral adherence promotion program or to standard care. The curriculum was developed from an iterative process with transplant recipients into a 2-session group program that provided psychoeducation, addressed barriers to adherence, fostered motivation to improve adherence behavior, and discussed cultural messages on adherence behavior. RESULTS: The intervention group displayed significantly higher levels of adherence when compared to the control group (t = 2.2, p = 0.04) and. similarly, when the amount of change was compared between the groups, the intervention group showed more change than the control condition (F (22,1) = 12.005, p = 0.003). Tacrolimus trough concentration levels were used as a secondary measure of adherence and, while there were no significant between-group differences for mean trough concentration levels, the variability in the trough levels did significantly decrease over time indicating more consistent pill-taking behavior in the intervention group. CONCLUSIONS: There is preliminary support for the pilot program as a successful intervention in helping patients with their immunosuppressant medication.

Sleep health in a black community sample.

BACKGROUND: Poor sleep health is a major health disparity and public health concern. The primary goal of this study was to accurately obtain the rates of self-reported sleep disorders, sleep dysfunction, and daytime sleepiness in a true community sample of black adults. METHODS: We used a community-based participatory research design to identify a health priority to design a study that could (a) provide an accurate assessment of the problem, (b) help to better understand the barriers to treatment, and (c) provide the community with access to care. Subsequently, 470 black adults, approached at salons, barber shops, and churches throughout Brooklyn participated. They underwent anthropometric measurement and completed a self-reported sleep assessment. RESULTS: Sleep disorders (insomnia, obstructive sleep apnea) were found in 34% of the sample, and 75% of the population that had a sleep disorder was unaware of it. Fourteen percent of the sample self-identified as having obstructive sleep apnea, 38.0% reported having Insomnia, and 38% reported having excessive daytime somnolence. People with a sleep disorder described less satisfaction with their sleep quality and poorer health than did those without a sleep disorder. CONCLUSION: The variability in the reported rates of sleep disorders in black samples suggests that the true rates of these conditions are not well-known. However, the large number of black individuals who have sleep disturbances warrants increased scientific and public health attention. In addition, with increased community involvement in research, there can be increased buy-in and greater accuracy in the assessments and reduced barriers to treatment.

Racism and hypertension: a review of the empirical evidence and implications for clinical practice.

BACKGROUND: Despite improved hypertension (HTN) awareness and treatment, racial disparities in HTN prevalence persist. An understanding of the biopsychosocial determinants of HTN is necessary to address racial disparities in the prevalence of HTN. This review examines the evidence directly and indirectly linking multiple levels of racism to HTN. METHODS: Published empirical research in EBSCO databases investigating the relationships of three levels of racism (individual/interpersonal, internalized, and institutional racism) to HTN was reviewed. RESULTS: Direct evidence linking individual/interpersonal racism to HTN diagnosis is weak. However, the relationship of individual/interpersonal racism to ambulatory blood pressure (ABP) is more consistent, with all published studies reporting a positive relationship of interpersonal racism to ABP. There is no direct evidence linking internalized racism to BP. Population-based studies provide some evidence linking institutional racism, in the forms of residential racial segregation (RRS) and incarceration, to HTN incidence. Racism shows associations to stress exposure and reactivity as well as associations to established HTN-related risk factors including obesity, low levels of physical activity and alcohol use. The effects vary by level of racism. CONCLUSIONS: Overall the findings suggest that racism may increase risk for HTN; these effects emerge more clearly for institutional racism than for individual level racism. All levels of racism may influence the prevalence of HTN via stress exposure and reactivity and by fostering conditions that undermine health behaviors, raising the barriers to lifestyle change.

Coping with racism: a selective review of the literature and a theoretical and methodological critique.

Racism is a stressor that contributes to racial/ethnic disparities in mental and physical health and to variations in these outcomes within racial and ethnic minority groups. The aim of this paper is to identify and discuss key issues in the study of individual-level strategies for coping with interpersonal racism. We begin with a discussion of the ways in which racism acts as a stressor and requires the mobilization of coping resources. Next, we examine available models for describing and conceptualizing strategies for coping with racism. Third, we discuss three major forms of coping: racial identity development, social support seeking and anger suppression and expression. We examine empirical support for the role of these coping strategies in buffering the impact of racism on specific health-related outcomes, including mental health (i.e., specifically, self-reported psychological distress and depressive symptoms), self-reported physical health, resting blood pressure levels, and cardiovascular reactivity to stressors. Careful examination of the effectiveness of individual-level coping strategies can guide future interventions on both the individual and community levels.