One step further in mistreatment research: Assessing the scalability of the Explicit Discrimination Scale among Brazilian working-age adult respondents.

Though the Explicit Discrimination Scale (EDS) has been subjected to extensive psychometric evaluation in Brazil, the instrument has yet to be comprehensively assessed among working-age adult respondents in the country. This study aimed to fill this knowledge gap. Data from around 1200 diverse members of a cohort investigation were used to examine: (1) the positioning of respondents along the continuum of the EDS latent trait; (2) how well the corresponding items represent the EDS construct map; and (3) the extent to which the EDS items follow their expected levels of intensity. We assessed these properties with Loevinger's H, Guttman errors, and Item Response Theory parameters. Findings suggest that two abridged versions of the instrument-but especially the eight-item EDS-may adequately arrange respondents along the latent trait continuum. Analyses also revealed that scale items are reasonably spread over the construct map, with some discrepancy between the expected levels of intensity and their empirical positioning in the corresponding plot. The shortened versions of EDS have good psychometric properties among Brazilian working-age adult respondents. In addition to examining the invariance of the EDS across multiple groups, future psychometric evaluations should assess the external validity of the scale.

[Assessing experiences with discrimination in multiple social groups: invariance analysis of the Explicit Discrimination Scale in university students]. / Aferindo experiências com discriminação em múltiplos grupos sociais: análise de invariância da Escala de Discriminação Explícita em estudantes universitários.

This study evaluated the ability of the Explicit Discrimination Scale (EDS) to produce comparable estimates among respondents according to gender, color/race, and socioeconomic status. Analysis was based on data from two studies with students from Brazilian public universities. An abridged version of the EDS with eight items was evaluated by the alignment method. Findings indicated violation of invariance between color/race and gender groups. Reports of discriminatory experiences had better comparability between socioeconomic status strata. This study showed that EDS should be used with caution, especially to compare discrimination estimates between respondents of different colors/races and genders. The observed violation of invariance reinforces the need for additional research examining whether such a scenario persists in larger and more diverse samples from Brazil.

O objetivo foi avaliar a capacidade da Escala de Discriminação Explícita (EDE) de produzir estimativas comparáveis entre grupos de gênero, cor/raça e posição socioeconômica. A análise se baseou em dados de dois estudos, realizados com estudantes de universidades públicas brasileiras. Uma versão abreviada da EDE com oito itens foi avaliada, utilizando o método alignment (alinhamento). Nossos achados indicaram violação de invariância entre grupos de cor/raça e gênero. Os relatos de experiências discriminatórias tiveram melhor comparabilidade entre estratos de posição socioeconômica. Este estudo demonstrou que a EDE deve ser utilizada com cautela, especialmente para fazer comparações de estimativas de discriminação entre respondentes de cor/raça e gênero distintos. A violação de invariância observada reforça a necessidade de pesquisas adicionais, examinando se tal cenário se mantém em amostras mais amplas e diversas do país.

El objetivo fue evaluar la capacidad de la Escala de Discriminación Explícita (EDE) para producir estimaciones comparables entre grupos de género, color/raza y posición socioeconómica. El análisis se basó en los datos de dos estudios, realizados con estudiantes de universidades públicas brasileñas. Se evaluó una versión abreviada de la EDE con 8 ítems, utilizando el método alignment (alineación). Nuestros hallazgos indicaron una violación de la invariancia entre los grupos de color/raza y género. Los informes de experiencias discriminatorias fueron más comparables entre los estratos de posición socioeconómica. Este estudio demostró que la EDE debe usarse con precaución, especialmente para hacer comparaciones de estimaciones de discriminación entre encuestados distintos de color/raza y género. La violación de la invariancia observada refuerza la necesidad de investigaciones adicionales, examinando si tal escenario se mantiene muestras más amplias y diversas del país.

Discriminatory experiences among gay, bisexual, and other men who have sex with men, and transgender and non-binary individuals: a cross sectional analysis.

Background: Several systems of oppression combine in complex ways to impact the lives of minority populations. Following an intersectionality framework, we assessed the frequency and perceived reasons for discrimination among gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender and non-binary individuals (TGNB), stratified by race. Methods: Online survey among MSM and TGNB ≥18 years living in Brazil, between November/2021 and January/2022. We used the 18-item Explicit Discrimination Scale to assess day-to-day experiences of differential treatment, and perceived discrimination. For each item, participants indicated their perceived reasons for differential treatment using 14 pre-defined options. Negative binomial regression models assessed if race was a significant predictor of discrimination. Subsequent models, stratified by race, examined associations of perceived reasons and number of reasons with perceived discrimination. Findings: Of 8464 MSM and TGNB, 4961 (58.6%) were White, 2173 (25.7%) Pardo (Brazil's official term for admixed populations), and 1024 (12.1%) Black. Black participants' scores for perceived discrimination (mean, standard deviation) were higher (10.2, 8.8) [Pardo (6.5, 6.8), White (5.2, 5.7)], and race was both the main reason for and the strongest predictor of perceived discrimination. The number of reasons participants used to interpret their discriminatory experiences was also a predictor of discrimination score among White, Pardo, and Black participants. Interpretation: LGBTQIA+phobia was highly prevalent among all participants. Additionally, our results indicated that Black MSM and TGNB participants were more frequently discriminated against than other racial groups, with racial discrimination uniquely contributing these experiences. Funding: Fundação Oswaldo Cruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro.

Aferindo experiências com discriminação em múltiplos grupos sociais: análise de invariância da Escala de Discriminação Explícita em estudantes universitários / Assessing experiences with discrimination in multiple social groups: invariance analysis of the Explicit Discrimination Scale in university students / Evaluación comparativa de experiencias de discriminación en múltiples grupos sociales: análisis de invariancia de la Escala de Discriminación Explícita en estudiantes universitarios

Resumo: O objetivo foi avaliar a capacidade da Escala de Discriminação Explícita (EDE) de produzir estimativas comparáveis entre grupos de gênero, cor/raça e posição socioeconômica. A análise se baseou em dados de dois estudos, realizados com estudantes de universidades públicas brasileiras. Uma versão abreviada da EDE com oito itens foi avaliada, utilizando o método alignment (alinhamento). Nossos achados indicaram violação de invariância entre grupos de cor/raça e gênero. Os relatos de experiências discriminatórias tiveram melhor comparabilidade entre estratos de posição socioeconômica. Este estudo demonstrou que a EDE deve ser utilizada com cautela, especialmente para fazer comparações de estimativas de discriminação entre respondentes de cor/raça e gênero distintos. A violação de invariância observada reforça a necessidade de pesquisas adicionais, examinando se tal cenário se mantém em amostras mais amplas e diversas do país.

Abstract: This study evaluated the ability of the Explicit Discrimination Scale (EDS) to produce comparable estimates among respondents according to gender, color/race, and socioeconomic status. Analysis was based on data from two studies with students from Brazilian public universities. An abridged version of the EDS with eight items was evaluated by the alignment method. Findings indicated violation of invariance between color/race and gender groups. Reports of discriminatory experiences had better comparability between socioeconomic status strata. This study showed that EDS should be used with caution, especially to compare discrimination estimates between respondents of different colors/races and genders. The observed violation of invariance reinforces the need for additional research examining whether such a scenario persists in larger and more diverse samples from Brazil.

Resumen: El objetivo fue evaluar la capacidad de la Escala de Discriminación Explícita (EDE) para producir estimaciones comparables entre grupos de género, color/raza y posición socioeconómica. El análisis se basó en los datos de dos estudios, realizados con estudiantes de universidades públicas brasileñas. Se evaluó una versión abreviada de la EDE con 8 ítems, utilizando el método alignment (alineación). Nuestros hallazgos indicaron una violación de la invariancia entre los grupos de color/raza y género. Los informes de experiencias discriminatorias fueron más comparables entre los estratos de posición socioeconómica. Este estudio demostró que la EDE debe usarse con precaución, especialmente para hacer comparaciones de estimaciones de discriminación entre encuestados distintos de color/raza y género. La violación de la invariancia observada refuerza la necesidad de investigaciones adicionales, examinando si tal escenario se mantiene muestras más amplias y diversas del país.

Research on racial/ethnic inequities in oral health over the past 80 years: The role of racism.

AIM: This study aims to (1) describe trends in explanations provided for racial/ethnic inequities in dental caries and periodontitis, and (2) explore the patterns of relatedness among explanations for these inequities. MATERIALS AND METHODS: Highly cited publications based on studies indexed in the Scopus database were retrieved and assessed for eligibility. Explanations for racial/ethnic inequities were classified into eight different, but interrelated domains. We assessed trends and examined the relations among explanations using multiple correspondence analysis. RESULTS: A total of 200 articles among the most cited publications were selected. The proportion of studies invoking racism as an explanation for racial inequities in oral health increased from 0% to 14.3%, from 1937 to 2020. The proportions of individual socio-economic factors increased from 52.0% to 82.9%, and dental care from 28.0% to 62.9%. The remaining explanations were stable: psychological/behavioural processes (62.5%), biological factors (49.5%), contextual/area-level effects (24.0%) and immigrant paradox (4.0%). Multiple correspondence analysis revealed a smaller axial distance between racism and the following categories: studies from Brazil, recent publications and Blacks/Hispanics/mixed-race groups. Publications about immigrants were axially closer to the high-income countries category. CONCLUSIONS: Our findings call on dental researchers to consider racism as a cause for existing racial/ethnic inequities in oral health.

The more you need, the less you get: Intersectionality and the inverse care law in the Brazilian depression care cascade.

Substantial research has shown that the population distribution of major depressive disorder (MDD) is strongly influenced by race, gender, and socioeconomic position. However, a deeper understanding of inequities in access to care for MDD according to these social markers is yet to be reached. We use data from the 2019 Brazilian National Health Survey, which includes 87,187 respondents aged 18 years and over, to test two hypotheses derived from the inverse care law: women, Black, and low-education respondents have higher frequencies of MDD, but lower access to each step of the depression care cascade, including diagnosis by a health professional, regular healthcare visits, and access to specialised treatment (H1); low-education Black women show the highest MDD frequency and the lowest access to care across the entire cascade (H2). Partially supporting H1 and H2, our results reveal a bottleneck in the first step of the depression care cascade. While no racial inequities were observed in the MDD prevalence, Black individuals were less likely than whites to be diagnosed by a health professional (OR 0.74). Women (OR 2.64) and low-education (OR 1.18) were more likely to have probable MDD in relation to men and high-education respondents, respectively, but only women (OR 1.58) were more likely to be diagnosed. Low-education Black women were equally more likely to have probable MDD (OR 3.11) than high-education white men. Conversely, high-education white women emerged as the most likely to be diagnosed with MDD (OR 1.63). Our findings suggest the inverse care law applies to the depression care cascade in Brazil through indication that its healthcare system perpetuates a multilayered system of oppression that overlooks multiply marginalised individuals. We also show that adequate screening by health care professionals should mitigate the complex patterns of inequity revealed by our study.

How do state-level racism, sexism, and income inequality shape edentulism-related racial inequities in contemporary United States? A structural intersectionality approach to population oral health.

OBJECTIVE: Research on racial oral health inequities has relied on individual-level data with the premise being that the unequal distribution of dental diseases is an intractable problem. We address these insufficiencies by examining the relationships between structural racism, structural sexism, state-level income inequality, and edentulism-related racial inequities according to a structural intersectionality approach. METHODS: Data were from two sources, the 2010 survey of the U.S. Behavioral Risk Factor Surveillance System, and Patricia Homan et al.'s (2021) study on the health impacts from interlocking systems of oppression. While the first contains information on edentulism from a large probabilistic sample of older (65+) respondents, the second provides estimates of racism, sexism, and income inequality across the US states. Taking into account a range of individual characteristics and contextual factors in multilevel models, we determine the extent to which structural forms of marginalization underlie racial inequities in edentulism. RESULTS: Our analysis reveals that structural racism, structural sexism, and state-level income inequality are associated with the overall frequency of edentulism and the magnitude of edentulism-related racial inequities, both individually and intersectionally. Coupled with living in states with both high racism and sexism (but not income inequality), the odds of edentulism were 60% higher among non-Hispanic Blacks, relative to Whites residing where these structural oppressions were at their lowest. CONCLUSIONS: These findings provide evidence that racial oral health inequities cannot be disentangled from social forces that differentially allocate power and resources among population groups. Mitigating race-based inequities in oral health entails dismantling the multifaceted systems of oppression in the contemporary U.S. society.

Where are race-based oral health inequities bound? Protocol for a systematic review on interventions to tackle racial injustice in dental outcomes.

BACKGROUND: Only three literature reviews have assessed the impact of interventions on the reduction of racial inequities in general health to date; none has drawn from attempts at promoting racial oral health equity. This protocol aims to increase transparency and reduce the potential for bias of an ongoing systematic review conceived to answer the following questions: Are there any interventions to mitigate racial oral health inequities or improve the oral health of racially marginalized groups? If so, how successful have they been at promoting racial oral health equity? How do conclusions of previous reviews change by taking the findings of oral health interventions into account? METHODS: Reviewed studies must deploy interventions to reduce racial gaps or promote the oral health of groups oppressed along ancestral and/or cultural lines. We will analyze randomized clinical trials, natural experiments, pre-post studies, and observational investigations that emulate controlled experiments by assessing interactions between race and potentially health-enhancing interventions. Either clinically assessed or self-reported oral health outcomes will be considered by searching for original studies in MEDLINE, LILACS, PsycInfo, SciELO, Web of Science, Scopus, and Embase from their earliest records to March 2022. Upon examining abstracts of conference proceedings, trial registries, reports of related stakeholder organizations, as well as contacting researchers for unpublished data, we will identify studies in the grey literature. If possible, we will carry out a meta-analysis with subgroup and sensitivity analysis, including formal meta-regression, to address potential heterogeneity and inconsistency among selected studies. DISCUSSION: Conducting a systematic review of interventions to mitigate racial oral health inequities is crucial for determining which initiatives work best and under which conditions they succeed. Such knowledge will help consolidate an evidence base that may be used to inform policy and practice against persistent and pervasive racial inequities in general and oral health. SYSTEMATIC REVIEW REGISTRATION: This protocol has been registered at the International Prospective Register of Systematic Reviews, under the identification number CRD42021261450 .

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.

Advancing racial equity in oral health (research): more of the same is not enough.

By critically appraising the literature on the oral health effects of race-based oppression, this focus article makes four recommendations that may both facilitate more nuanced research on the topic and mitigate racial/ethnic inequities in (oral) health. The first is recognizing that science itself may perpetuate racial/ethnic injustice, such that adopting a 'neutral' position must be replaced with actively fostering anti-racist narratives. The second is to not imply that racial oppression is bad because it harms oral health. Rather, studies should help build a fairer world, wherein oral health inequities would not abound. The third recommendation is encouraging initiatives that understand systems of oppression as conjointly operating to shape oral health. The fourth and final recommendation is taking race-based oppression as a multi-level system that operates on three inter-related conceptual levels - intra-personal, inter-personal, and structural. The extent to which scholars, practitioners, and policymakers are willing to follow these recommendations may determine how successful attempts to eradicate (oral) health inequities might be. Learning from, and avoiding mistakes made in, previous publications is one ethical pathway towards this end.

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).

Mediators between education and dental pain: a cross-sectional study to assess the role of dental services utilization.

This study tested whether the pattern of dental services utilization and the reason for the last dental visit mediate the association between educational attainment and dental pain. This is a cross-sectional analysis (n = 1099) based on data from a prospective cohort study in adults, southern Brazil. The mediating effects were assessed by including interaction terms in logistic regression models and by the KHB method, which estimated the direct, mediated, and total effects of education on dental pain. The prevalence of dental pain was 17.5%. Individuals with less than 12 yr of study who visited the dentist to solve dental problems had a 20% higher odds of reporting dental pain than those with 12 or more years of study, who sought the dentist for preventive reasons. Dental services should also focus on preventive measures, especially if less-educated individuals visit the dentist only to treat problems; this may help reduce the frequency of negative oral health outcomes, including dental pain.

Tooth loss is associated with severe cognitive impairment among older people: findings from a population-based study in Brazil.

BACKGROUND: A consistent and low-to-moderate association between markers of oral infection and loss of cognitive function has been demonstrated in the literature. However, such evidence comes from population studies carried out mainly in the USA. OBJECTIVES: To assess the association between tooth loss and loss of cognitive function in older people from Southern Brazil, with particular interest on how age may modify such association. In addition, we also test the association between loss of cognition (exposure) and tooth loss (outcome). METHODS: Data from a baseline population-based cohort study were cross-sectionally analyzed, including tooth loss, cognitive impairment, sex, income, educational attainment, color/race, smoking status and a range of self-reported chronic diseases. Participants (n = 1705) were 60 years of age and over, from a midsized Southern Brazilian city. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using multivariable logistic and partial ordinal logistic analyses. RESULTS: Edentate status was associated (OR 3.3; 95%CI 1.2-9.3) with severe cognitive impairment in the fully adjusted model. Moreover, there was an interaction between number of teeth and age on severe cognitive impairment. A weak association between severe cognitive impairment (exposure) and tooth loss (outcome) was identified after the adjustment for potential covariates. CONCLUSIONS: This study lends support to hypothesized association between tooth loss and severe cognitive impairment. Older adults seem to be particularly vulnerable to such effects. However, the bidirectional association between tooth loss and severe cognitive impairment cannot be ruled out.

Socio-demographic and behavioural inequalities in the impact of dental pain among adults: a population-based study.

OBJECTIVES: To assess socio-demographic and behavioural inequalities in the impact of dental pain on daily activities, as well as to estimate the prevalence and intensity of dental pain. METHODS: A population-based cross-sectional study was carried out in Florianopolis, Southern Brazil, with 1720 adults aged 20-59 years in 2009-2010. Interviews were performed at adults' households, which included socio-demographics and behavioural characteristics, such as smoking status and alcohol abuse, along with mental health, self-reported health, number of retained teeth, dental pain occurrence (including its intensity and its impact on daily life). The association between the impact of dental pain and the covariates was tested using multinomial logistic regression. RESULTS: The global prevalence of dental pain was 14.8% (95% CI, 12.9-16.7). Adjusted analysis showed that women, those who self-classified as dark-skinned Blacks, those with low family income, current smokers and those with common mental disorders reported a higher impact of dental pain than their counterparts. Among subjects reporting dental pain, 12.7% indicated the maximum intensity, whereas 6.0% had some daily activity disrupted by it, such as difficulties in chewing certain foods (38.0%), sleep disturbance (21.0%), difficulty to work (21.0%) and difficulty in performing household tasks (8.0%). Prevalence ratios of impact of dental pain between the poorest income group and richest income group (2.4), between the highest and lowest schooling group (2.6), and between dark-skinned Blacks and Whites (2.1) were of higher magnitude than the dental pain prevalence ratios among the same groups (1.7, 1.3 and 1.4, respectively). CONCLUSIONS: The impact of dental pain showed a social gradient. Inequalities between socio-economic groups found in this study should be taken into account, as the impact of dental pain leads to reduced daily activities and poor quality of life.