Scaling up research on discrimination and health: The abridged Explicit Discrimination Scale.

Using data from two studies conducted among diverse undergraduate students, we assessed the scalar structure of the Explicit Discrimination Scale (EDS), and developed an abridged version of the instrument. Our findings suggest that the EDS has acceptable scalability properties, including an adequate dispersion of items along the latent trait continuum. Results also support the idea that increasing raw scale scores reflect higher intensities of perceived discrimination. This shortened version of the EDS may be used in large-scale studies on the health impacts of discrimination.

Perceived discrimination south of the equator: Reassessing the Brazilian Explicit Discrimination Scale.

OBJECTIVE: To reassess the Explicit Discrimination Scale (EDS; Bastos, Faerstein, Celeste, & Barros, 2012), an instrument developed in Brazil to examine intersecting forms of discrimination, with particular attention to the number of underlying dimensions, residual correlations, share of explained item variance, and stability of the configural and metric structure in broader populations. METHOD: Data from two cross-sectional studies and one cohort investigation were used. Although the cross-sectional studies were conducted among racially diverse undergraduate students (n = 1,022, 45% women, mean age = 23 years; n = 424, 59% women, mean age = 22 years), the cohort study included a probabilistic sample of community residents with 18% racial/ethnic minority respondents (n = 1,187, 57% women, mean age = 42 years). A series of exploratory models, exploratory structural equation models, and confirmatory factor analyses models was estimated. RESULTS: The EDS items might be best represented by a 3-factor model, which includes a second-order factor. Although only 1 pair of correlated residuals emerged, at least 4 different items with a sizable share of error variance were observed. The revised scale structure had an excellent fit to the data and was consistent among both undergraduate students and community residents. CONCLUSIONS: As well as demonstrating that discrimination may be structured by proximal, medial, and distal experiences with mistreatment, we suggest that the EDS has the potential to enhance research on the intersectional health impacts of discrimination. Future studies are required to assess scalability and provide scholars with a shortened version of the instrument. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Health care barriers, racism, and intersectionality in Australia.

While racism has been shown to negatively affect health care quality, little is known about the extent to which racial discrimination works with and through gender, class, and sexuality to predict barriers to health care (e.g., perceived difficulty accessing health services). Additionally, most existing studies focus on racial disparities in the U.S. context, with few examining marginalized groups in other countries. To address these knowledge gaps, we analyze data from the 2014 Australian General Social Survey, a nationally representative survey of individuals aged 15 and older living in 12,932 private dwellings. Following an intersectional perspective, we estimate a series of multivariable logit regression models to assess three hypotheses: racial discrimination will be positively associated with perceived barriers to health care (H1); the effect of perceived racial discrimination will be particularly severe for women, sexual minorities, and low socio-economic status individuals (H2); and, in addition to racial discrimination, other forms of perceived discrimination will negatively impact perceived barriers to health care (H3). Findings show that perceptions of racial discrimination are significantly associated with perceived barriers to health care, though this relationship is not significantly stronger for low status groups. In addition, our analyses reveal that perceived racism and other forms of discrimination combine to predict perceived barriers to health care. Taken together, these results speak to the benefits of an intersectional approach for examining racial inequalities in perceived access to health care.

Are racist attitudes related to experiences of racial discrimination? Within sample testing utilising nationally representative survey data.

Although the relationship between an individual's racist attitudes and discriminatory behaviours has been widely studied, the association between racist attitudes among perpetrators and experiences of racism among targets has been under-examined. Based on data from the 2001-8 Australian Challenging Racism Project survey, this paper details a novel method to investigate the link between racist attitudes and experiences of discrimination utilising two separate models linked by nomination of cultural or ethnic groups who do not fit into Australian society (i.e., out-groups). Those identified as out-groups were more likely to report experiences of discrimination than those who were not nominated as out-groups. Overall, out-group nomination by those with racist attitudes strongly predict experiences of discrimination among these same target out-groups, OR=2.2, F(6, 12,348)=78.61, p<.001. Racist attitudes are related to racist behaviours among perpetrators that are, in turn, related to experiences of racial discrimination among targets. This study demonstrates that attitudes not only affect majority group behaviour but also drive the resulting experiences of discrimination for minority group members.

Patterns and correlates of self-reported racial discrimination among Australian Aboriginal and Torres Strait Islander adults, 2008-09: analysis of national survey data.

BACKGROUND: There is now considerable evidence that racism is a pernicious and enduring social problem with a wide range of detrimental outcomes for individuals, communities and societies. Although indigenous people worldwide are subjected to high levels of racism, there is a paucity of population-based, quantitative data about the factors associated with their reporting of racial discrimination, about the settings in which such discrimination takes place, and about the frequency with which it is experienced. Such information is essential in efforts to reduce both exposure to racism among indigenous people and the harms associated with such exposure. METHODS: Weighted data on self-reported racial discrimination from over 7,000 Indigenous Australian adults participating in the 2008-09 National Aboriginal and Torres Strait Islander Survey, a nationally representative survey conducted by the Australian Bureau of Statistics, were analysed by socioeconomic, demographic and cultural factors. RESULTS: More than one in four respondents (27%) reported experiencing racial discrimination in the past year. Racial discrimination was most commonly reported in public (41% of those reporting any racial discrimination), legal (40%) and work (30%) settings. Among those reporting any racial discrimination, about 40% experienced this discrimination most or all of the time (as opposed to a little or some of the time) in at least one setting. Reporting of racial discrimination peaked in the 35-44 year age group and then declined. Higher reporting of racial discrimination was associated with removal from family, low trust, unemployment, having a university degree, and indicators of cultural identity and participation. Lower reporting of racial discrimination was associated with home ownership, remote residence and having relatively few Indigenous friends. CONCLUSIONS: These data indicate that racial discrimination is commonly experienced across a wide variety of settings, with public, legal and work settings identified as particularly salient. The observed relationships, while not necessarily causal, help to build a detailed picture of self-reported racial discrimination experienced by Indigenous people in contemporary Australia, providing important evidence to inform anti-racism policy.

Socio-demographic factors and psychological distress in Indigenous and non-Indigenous Australian adults aged 18-64 years: analysis of national survey data.

BACKGROUND: Indigenous Australians are known to be at greater risk of morbidity and mortality from mental health related conditions, but most available data relate to the use of mental health services, and little is known about other aspects of social and emotional wellbeing. Using the first available nationally representative data, we examined the prevalence and patterning of psychological distress among Indigenous Australian adults and compared these with corresponding data from the non-Indigenous population. METHODS: The analysis used weighted data on psychological distress, as measured by a modified Kessler Psychological Distress score (K5), and a range of socio-demographic measures for 5,417 Indigenous and 15,432 non-Indigenous adults aged 18-64 years from two nationally representative surveys. Very high psychological distress (VHPD) was defined as a K5 score ≥ 15 (possible range = 5-25). RESULTS: Indigenous adults were about three times more likely than non-Indigenous adults to be classified with VHPD: 14.5% (95% confidence interval (CI) 12.9-16.0%) versus 5.5% (95% CI 5.0-5.9%). After adjusting for age, most socio-demographic variables were significantly associated with VHPD in both populations, although the relative odds were generally larger among non-Indigenous people. Indigenous people in remote areas had a lower prevalence of VHPD than their non-remote counterparts, and only marital status, main language, and food insecurity were significantly associated with VHPD in remote areas. CONCLUSIONS: Higher absolute levels of VHPD combined with smaller socio-demographic gradients in the Indigenous population suggest the importance of risk factors such as interpersonal racism, marginalization and dispossession, chronic stress and exposure to violence that are experienced by Indigenous Australians with common and/or cross-cutting effects across the socioeconomic spectrum. The lower prevalence of VHPD and lack of association with many socio-demographic variables in remote areas suggests either that the instrument may be less valid for Indigenous people living in remote areas or that living in an Indigenous majority environment (such as exists in most remote communities) may mitigate the risk of psychological distress to some degree.

The DRUID study: racism and self-assessed health status in an indigenous population.

BACKGROUND: There is now considerable evidence from around the world that racism is associated with both mental and physical ill-health. However, little is known about the mediating factors between racism and ill-health. This paper investigates relationships between racism and self-assessed mental and physical health among Indigenous Australians as well as potential mediators of these relationships. METHODS: A total of 164 adults in the Darwin Region Urban Indigenous Diabetes (DRUID) study completed a validated instrument assessing interpersonal racism and a separate item on discrimination-related stress. Self-assessed health status was measured using the SF-12. Stress, optimism, lack of control, social connections, cultural identity and reactions/responses to interpersonal racism were considered as mediators and moderators of the relationship between racism/discrimination and self-assessed health status. RESULTS: After adjusting for socio-demographic factors, interpersonal racism was significantly associated with the SF-12 mental (but not the physical) health component. Stress, lack of control and feeling powerless as a reaction to racism emerged as significant mediators of the relationship between racism and general mental health. Similar findings emerged for discrimination-related stress. CONCLUSIONS: Racism/discrimination is significantly associated with poor general mental health among this indigenous population. The mediating factors between racism and mental health identified in this study suggest new approaches to ameliorating the detrimental effects of racism on health. In particular, the importance of reducing racism-related stress, enhancing general levels of mastery, and minimising negative social connections in order to ameliorate the negative consequences of racism.

The DRUID study: exploring mediating pathways between racism and depressive symptoms among indigenous Australians.

PURPOSE: Racism is an important determinant of mental and physical health for minority populations. However, to date little is known about the relationship between racism and ill-health outside of the U.S. or the causal pathways between racism and poor health. This paper focuses on the relationship between racism and depression in a non-U.S. indigenous population, including examination of novel mediators and moderators. METHODS: One hundred and eighty-five adults in the Darwin Region Urban Indigenous Diabetes study responded to a validated instrument assessing multiple facets of racism. Depressive symptoms were assessed using the Centre for Epidemiologic Studies Depression Scale. Stress, optimism, lack of control, social connections, cultural identity and reactions/responses to interpersonal racism were considered as possible mediators and moderators in linear regression models. RESULTS: Interpersonal racism was significantly associated with depression after adjusting for socio-demographic factors (ß = 0.08, p < 0.001). Lack of control, stress, negative social connections and feeling ashamed, amused or powerless as reactions to racism were each identified as significant mediators of the relationship between racism and depressive symptoms. All examined mediators together accounted for 66% of the association between interpersonal racism and depressive symptoms. CONCLUSIONS: This study demonstrates that racism is associated with depressive symptoms in an indigenous population. The mediating factors between racism and depressive symptoms identified in this study suggest new approaches to ameliorating the detrimental effects of racism on health.

Oral health and social and emotional well-being in a birth cohort of Aboriginal Australian young adults.

BACKGROUND: Social and emotional well-being is an important component of overall health. In the Indigenous Australian context, risk indicators of poor social and emotional well-being include social determinants such as poor education, employment, income and housing as well as substance use, racial discrimination and cultural knowledge. This study sought to investigate associations between oral health-related factors and social and emotional well-being in a birth cohort of young Aboriginal adults residing in the northern region of Australia's Northern Territory. METHODS: Data were collected on five validated domains of social and emotional well-being: anxiety, resilience, depression, suicide and overall mental health. Independent variables included socio-demographics, dental health behaviour, dental disease experience, oral health-related quality of life, substance use, racial discrimination and cultural knowledge. RESULTS: After adjusting for other covariates, poor oral health-related items were associated with each of the social and emotional well-being domains. Specifically, anxiety was associated with being female, having one or more decayed teeth and racial discrimination. Resilience was associated with being male, having a job, owning a toothbrush, having one or more filled teeth and knowing a lot about Indigenous culture; while being female, having experienced dental pain in the past year, use of alcohol, use of marijuana and racial discrimination were associated with depression. Suicide was associated with being female, having experience of untreated dental decay and racial discrimination; while being female, having experience of dental disease in one or more teeth, being dissatisfied about dental appearance and racial discrimination were associated with poor mental health. CONCLUSION: The results suggest there may be value in including oral health-related initiatives when exploring the role of physical conditions on Indigenous social and emotional well-being.

Racism as a determinant of social and emotional wellbeing for Aboriginal Australian youth.

OBJECTIVE: To explore the associations between self-reported racism and health and wellbeing outcomes for young Aboriginal Australian people. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study of 345 Aboriginal Australians aged 16-20 years who, as participants in the prospective Aboriginal Birth Cohort Study, were recruited at birth between 1987 and 1990 and followed up between 2006 and 2008. MAIN OUTCOME MEASURES: Self-reported social and emotional wellbeing using a questionnaire validated as culturally appropriate for the study's participants; recorded body mass index and waist-to-hip ratio. RESULTS: Self-reported racism was reported by 32% of study participants. Racism was significantly associated with anxiety (odds ratio [OR], 2.18 [95% CI, 1.37-3.46]); depression (OR, 2.16 [95% CI, 1.33-3.53]); suicide risk (OR, 2.32 [95% CI, 1.25-4.00]); and poor overall mental health (OR, 3.35 [95% CI, 2.04-5.51]). No significant associations were found between self-reported racism and resilience or any anthropometric measures. CONCLUSIONS: Self-reported racism was associated with poor social and emotional wellbeing outcomes, including anxiety, depression, suicide risk and poor overall mental health.

Development and validation of the Measure of Indigenous Racism Experiences (MIRE).

BACKGROUND: In recent decades there has been increasing evidence of a relationship between self-reported racism and health. Although a plethora of instruments to measure racism have been developed, very few have been described conceptually or psychometrically Furthermore, this research field has been limited by a dearth of instruments that examine reactions/responses to racism and by a restricted focus on African American populations. METHODS: In response to these limitations, the 31-item Measure of Indigenous Racism Experiences (MIRE) was developed to assess self-reported racism for Indigenous Australians. This paper describes the development of the MIRE together with an opportunistic examination of its content, construct and convergent validity in a population health study involving 312 Indigenous Australians. RESULTS: Focus group research supported the content validity of the MIRE, and inter-item/scale correlations suggested good construct validity. A good fit with a priori conceptual dimensions was demonstrated in factor analysis, and convergence with a separate item on discrimination was satisfactory. CONCLUSION: The MIRE has considerable utility as an instrument that can assess multiple facets of racism together with responses/reactions to racism among indigenous populations and, potentially, among other ethnic/racial groups.

Racialized genetics and the study of complex diseases: the thrifty genotype revisited.

Current debate on the use of population genetic data for complex disease research is driven by the laudable goals of disease prevention and harm reduction for all, especially dispossessed, formerly enslaved, or colonized populations. This article examines one of the oldest gene-based theories of complex disease causation: the thrifty genotype hypothesis (THG). This hypothesis is emblematic of the way in which genetic research into complex disease attracts a high investment of scientific resources while contributing little to our capacity to understand these diseases and perpetuating problematic conceptions of human variation. Although there are compelling reasons to regard the high prevalence of type 2 diabetes mellitus as a by-product of our biological incapacity to cope with modern affluent and sedentary lifestyles, there is at present no consistent evidence to suggest that minority populations are especially genetically susceptible. Nor is it clear why such genetic differences would be expected, given the original pan-species orientation of the TGH. The limitations inherent in current applications of the TGH demonstrate that genetic research into complex disease demands careful attention to key environmental, social, and genetic risk factors operating within and between groups, not the simplistic attribution of between-group differences to racialized genetics. A robust interdisciplinary approach to genetic epidemiological research is proposed.