Integrating Racism as a Sentinel Indicator in Public Health Surveillance and Monitoring Systems.

Objectives. To evaluate public health surveillance and monitoring systems' (PHSMS) efforts to collect, monitor, track, and analyze racism. Methods. We employed an environmental scan approach. We defined key questions and data to be collected, conducted a literature review, and synthesized the results by using a qualitative description approach. Results. We identified 125 PHSMS; only 3-the Behavioral Risk Factor Surveillance System, Pregnancy Risk Assessment and Monitoring System, and California Health Interview Survey-collected and reported data on individual-level racism. Structural racism was not collected in PHSMS; however, we observed evidence for linkages to census and administrative data sets or social media sources to assess structural racism. Conclusions. There is a paucity of PHSMS that measure individual-level racism, and few systems are linked to structural racism measures. Public Health Implications. Adopting a standard practice of racism surveillance can advance equity-centered public health praxis, inform policy, and foster greater accountability among public health practitioners, researchers, and decision-makers. Failure to explicitly address racism and the insufficient capacity to support a robust health equity data infrastructure severely impedes efforts to address and dismantle systemic racism. (Am J Public Health. 2023;113(S1):S80-S84. https://doi.org/10.2105/AJPH.2022.307160).

Race and other sociodemographic categories are differentially linked to multiple dimensions of interpersonal-level discrimination: Implications for intersectional, health research.

OBJECTIVES: To examine whether intersections of race with other key sociodemographic categories contribute to variations in multiple dimensions of race- and non-race-related, interpersonal-level discrimination and burden in urban-dwelling African Americans and Whites. METHODS: Data from 2,958 participants aged 30-64 in the population-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to estimate up to four-way interactions of race, age, gender, and poverty status with reports of racial and everyday discrimination, discrimination across multiple social statuses, and related lifetime discrimination burden in multiple regression models. RESULTS: We observed that: 1) African Americans experienced all forms of discrimination more frequently than Whites, but this finding was qualified by interactions of race with age, gender, and/or poverty status; 2) older African Americans, particularly African American men, and African American men living in poverty reported the greatest lifetime discrimination burden; 3) older African Americans reported greater racial discrimination and greater frequency of multiple social status-based discrimination than younger African Americans; 4) African American men reported greater racial and everyday discrimination and a greater frequency of social status discrimination than African American women; and, 5) White women reported greater frequency of discrimination than White men. All p's < .05. CONCLUSIONS: Within African Americans, older, male individuals with lower SES experienced greater racial, lifetime, and multiple social status-based discrimination, but this pattern was not observed in Whites. Among Whites, women reported greater frequency of discrimination across multiple social statuses and other factors (i.e., gender, income, appearance, and health status) than men. Efforts to reduce discrimination-related health disparities should concurrently assess dimensions of interpersonal-level discrimination across multiple sociodemographic categories, while simultaneously considering the broader socioecological context shaping these factors.

Interactive Effects of Chronic Health Conditions and Financial Hardship on Episodic Memory among Older Blacks: Findings from the Health and Retirement Study.

Previous research links chronic health conditions and financial hardship to cognitive outcomes among older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship (as measured by difficulty paying monthly bills) modifies the impact of self-reported chronic health conditions (e.g., diabetes, stroke) on episodic memory among 871 older Blacks (50+ years) in the Health and Retirement Study (2006). Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender and education (F 2, 49 = 5.03, p= 0.010). This cross-sectional study suggests that both financial and physical wellbeing may have joint effects on cognitive health in older Blacks.

Interactive Relations Across Dimensions of Interpersonal-Level Discrimination and Depressive Symptoms to Carotid Intimal-Medial Thickening in African Americans.

OBJECTIVE: This study aimed to examine within-race interactions of multiple dimensions of self-reported discrimination with depressive symptoms in relation to carotid intimal-medial thickness (IMT), a subclinical marker of atherosclerosis prospectively implicated in stroke incidence, in middle-aged to older African American and white adults. METHODS: Participants were a socioeconomically diverse group of 1941 African Americans (56.5%) and whites from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (30-64 years old, 47% men, 45.2% with household income <125% federal poverty threshold) who underwent carotid IMT measurement. Discrimination was assessed across four dimensions (everyday, frequency across various social statuses, racial, and lifetime burden). The Center for Epidemiologic Studies Depression scale was used to assess depressive symptoms. RESULTS: In cross-sectional hierarchical regression analyses, two interactions were observed in African Americans: more frequent discrimination across various social statuses (b < 0.001, p = .006) and a higher lifetime discrimination burden (b < 0.001, p = .02) were each related to thicker carotid IMT in those with greater depressive symptoms. No significant findings were observed within whites. CONCLUSIONS: Among African Americans, those reporting high levels of discrimination and depressive symptoms have increased carotid atherosclerosis and may be at greater risk for clinical end points compared with those reporting one or neither of these risk factors. Findings suggest that assessment of interactive relationships among social and psychological factors may elucidate novel pathways for cardiovascular disease, including stroke, among African Americans.

Telomere length and cognitive function: Differential patterns across sociodemographic groups.

OBJECTIVE: The present study investigates whether associations between telomere length (TL) and cognitive performance across multiple domains are moderated by poverty status and race. METHOD: Participants were 325 African American and White urban-dwelling adults (M age = 47.9 years; 49.5% African American; 50.2% female; 48.9% living in poverty) from the Healthy Aging in Neighborhoods of Diversity across the Life Span study. TL was assayed from peripheral blood mononuclear cells using quantitative polymerase chain reactions. Multivariable regression analyses examined interactions of TL, poverty status, and race with performance on the following cognitive tests: Trail-Making Test Parts A and B, Digit Span Forward and Backward, semantic verbal fluency, Brief Test of Attention, Benton Visual Retention Test (BVRT), and California Verbal Learning Test-II total learning, short-delay free recall, and long-delay free recall scores. Analyses adjusted for age, sex, and high school-or-greater educational attainment. RESULTS: Significant three-way interactions of TL × Poverty Status × Race revealed that, among White participants living in poverty, shorter TL was associated with worse performance on Digit Span Forward and Backward (ps<.05). Additionally, significant two-way interactions of TL × Poverty Status revealed that, among all participants living in poverty, shorter TL was associated with worse performance on the Trail-Making Test Part B and the BVRT (ps<.05). CONCLUSIONS: TL may be differentially associated with aspects of attention, executive functioning, and memory among individuals living in poverty, who may be uniquely vulnerable to adverse effects of shorter telomeres. Replication of these findings is needed to determine their generalizability. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Sociodemographic disparities in corticolimbic structures.

This study sought to examine the interactive relations of socioeconomic status and race to corticolimbic regions that may play a key role in translating stress to the poor health outcomes overrepresented among those of lower socioeconomic status and African American race. Participants were 200 community-dwelling, self-identified African American and White adults from the Healthy Aging in Neighborhoods of Diversity across the Life Span SCAN study. Brain volumes were derived using T1-weighted MP-RAGE images. Socioeconomic status by race interactions were observed for right medial prefrontal cortex (B = .26, p = .014), left medial prefrontal cortex (B = .26, p = .017), left orbital prefrontal cortex (B = .22, p = .037), and left anterior cingulate cortex (B = .27, p = .018), wherein higher socioeconomic status Whites had greater volumes than all other groups. Additionally, higher versus lower socioeconomic status persons had greater right and left hippocampal (B = -.15, p = .030; B = -.19, p = .004, respectively) and amygdalar (B = -.17, p = .015; B = -.21; p = .002, respectively) volumes. Whites had greater right and left hippocampal (B = -.17, p = .012; B = -.20, p = .003, respectively), right orbital prefrontal cortex (B = -.34, p < 0.001), and right anterior cingulate cortex (B = -.18, p = 0.011) volumes than African Americans. Among many factors, the higher levels of lifetime chronic stress associated with lower socioeconomic status and African American race may adversely affect corticolimbic circuitry. These relations may help explain race- and socioeconomic status-related disparities in adverse health outcomes.

Everyday Discrimination Prospectively Predicts Blood Pressure Across 10 Years in Racially/Ethnically Diverse Midlife Women: Study of Women's Health Across the Nation.

BACKGROUND: Interpersonal discrimination is linked to greater risk for cardiovascular disease (CVD) and this association varies by race/ethnicity. PURPOSE: To examine whether exposure to everyday discrimination prospectively predicts elevated blood pressure (BP), whether this association differs by race/ethnicity, and is mediated by adiposity indices. METHODS: Using data for 2,180 self-identified White, Black, Chinese, Japanese, and Hispanic participants from the Study of Women's Health Across the Nation, we examined associations among exposure to (higher vs. lower) everyday discrimination at baseline and BP and hypertension (HTN; systolic blood pressure [SBP] ≥ 140 mmHg; diastolic blood pressure [DBP] ≥ 90 mmHg; or self-reported HTN medication use) risk over a 10 year period. Additionally, we used the bootstrap method to assess repeated, time-varying markers of central and overall adiposity (waist circumference and body mass index [BMI] (kg/m2), respectively) as potential mediators. RESULTS: Exposure to everyday discrimination predicted increases in SBP and DBP over time, even after adjusting for known demographic, behavioral, or medical risk factors. However, greater waist circumference or BMI (examined separately) mediated these observations. Notably, there were no racial/ethnic differences in the observed association and HTN risk was not predicted. CONCLUSIONS: The current findings suggest that everyday discrimination may contribute to elevated BP over time in U.S. women, in part, through increased adiposity. These findings demonstrate the complexity of the linkage of discrimination to CVD risk and raise the need to closely examine biobehavioral pathways that may serve as potential mediators.

Lifetime discrimination burden, racial discrimination, and subclinical cerebrovascular disease among African Americans.

OBJECTIVE: Explore interactive relations of lifetime discrimination burden and racial discrimination-chronic stressors among African Americans (AAs)-and age with MRI-assessed white matter lesion volume (WMLV), a prognostic indicator of poor clinical brain health outcomes. METHOD: AAs (N = 71; 60.6% female, mean age = 50) participating in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) SCAN study underwent quantitative magnetic resonance imaging coded for WMLV. Participants self-reported lifetime discrimination burden and racial discrimination approximately 5 years earlier. Multivariable regression models assessed interactions of linear and quadratic effects of discrimination and age with WMLV adjusted for sex and socioeconomic status. RESULTS: Findings revealed significant interactive relations of age and (a) quadratic, lifetime discrimination burden, B = .05, p = .014, ηpartial2 = .092, and (b) quadratic, racial discrimination, B = .03, p = .001, ηpartial2 = .155, with WMLV. Among older AA, increases in lifetime discrimination burden and racial discrimination were associated with increases in WMLV (ps < .03); in younger AA, decreasing levels of racial discrimination were related to increases in WMLV (p = .006). CONCLUSIONS: Among older AA, as lifetime discrimination burden and racial discrimination increased, so did WMLV. However, in younger AA, decreases in racial discrimination were associated with increased WMLV. Elucidation of complex mechanistic underpinnings, including potentially differential impacts of the acknowledgment versus suppression or underreporting of discriminatory experiences, among AA of different age cohorts, is critical to understanding the present pattern of findings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Interpersonal-level discrimination indices, sociodemographic factors, and telomere length in African-Americans and Whites.

OBJECTIVE: Studies have linked self-reported discrimination to telomere attrition, a biological marker of accelerated cellular aging. However, it is unknown whether intersections between social categories-race, socioeconomic status (SES), sex, and age-influence the association of varying forms of discrimination with telomere length. We examined these associations in a socioeconomically and racially/ethnically diverse urban sample. METHODS: Cross-sectional data were from 341 middle-aged (30-64 years) African American and White, community participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span Study (HANDLS). Multiple regression models examined up to 3-way interactions between a discrimination measure (i.e., everyday, racial, gender, lifetime burden, and frequency of discrimination across sources) and two social categories. RESULTS: After adjusting for depressive symptoms, waist circumference, and lifetime substance use, two themes emerged: 1) among women with higher SES, a) greater lifetime discrimination burden (b = -0.23, p = .011), gender discrimination (b = -0.29, p = .040), and racial discrimination (b = -0.24, p = 0.023) and 2) among younger adults, irrespective of race and sex, greater frequency of discrimination across sources (b = 0.002, p = .008) was associated with shorter telomeres. CONCLUSIONS: Irrespective of race, women with higher SES and younger adults reporting greater discrimination may be at particular risk for accelerated aging. Telomere attrition promotes and accelerates chronic health conditions for which there are health disparities. Future research explicating intersections among specific discrimination indices and social categories is warranted.

Multiple forms of discrimination, social status, and telomere length: Interactions within race.

Previous research has demonstrated inverse associations between experiences of interpersonal discrimination and telomere length, a marker of cellular aging. Here, we investigate within-race interactions between multiple indices of interpersonal discrimination and sociodemographic characteristics in relation to telomere length in African American and White adults. Participants were from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (Baltimore, Maryland). Ages ranged from 30 to 64 years old and all self-identified as either African American (n = 176) or White (n = 165). Using linear regression, three patterns were observed within African Americans: (1) women reporting greater lifetime burden of discrimination (p = .02), racial (p = .03), or gender (p = .01) discrimination; (2) those with higher socioeconomic status reporting greater lifetime burden (p = .03) or racial discrimination (p = .02); and (3) younger adults reporting greater exposure to multiple sources of discrimination (p = .03) had shorter telomere length. Among Whites, younger and older men reporting greater racial discrimination had shorter and longer telomeres, respectively (p = .02). Findings demonstrate within-race patterns of interpersonal discrimination and cellular aging, which may contribute to racial health disparities.

Everyday Discrimination and Metabolic Syndrome Incidence in a Racially/Ethnically Diverse Sample: Study of Women's Health Across the Nation.

OBJECTIVE: Everyday discrimination may contribute to incident metabolic syndrome (MetS) in the United States and related racial/ethnic differences in MetS. The study investigated whether everyday discrimination predicted MetS in a diverse sample. METHODS: A longitudinal, cohort study of 2132 women (mean [standard deviation] = 45.8 [2.7] years) who self-reported as black (n = 523), white (n = 1065), Chinese (n = 194), Japanese (n = 227), or Hispanic (n = 123) at baseline drawn from seven cities across the United States was conducted. MetS was defined in accordance with the National Cholesterol Education Program Adult Treatment Panel III criteria. The Everyday Discrimination scale was used to assess exposure to and level of everyday discrimination. RESULTS: Everyday discrimination exposure at baseline predicted a 33% greater incidence of MetS during the 13.89-year (standard deviation = 3.83, hazard ratio (HR) = 1.33, 95% confidence interval [CI] = 1.11-1.64, p = .001) follow-up in the full sample and was most pronounced in black, Hispanic, and Japanese women. Each 1-point increase in the continuous everyday discrimination score (HR = 1.03, 95% CI =1.01-1.05, p = .001) predicted a 3% greater incidence of MetS and, specifically, blood pressure (HR = 1.01, 95% CI = 1.00-1.03, p = .04), waist circumference (HR = 1.05, 95% CI =1.03-1.06, p < .001), and triglyceride level (HR = 1.02, 95% CI =1.00-1.04, p = .01). These associations were independent of risk factors including physical activity, socioeconomic status, smoking, and alcohol consumption. CONCLUSIONS: Everyday discrimination contributes to poorer metabolic health in midlife women in the United States. These findings have clinical implications for the development of MetS and, ultimately, cardiovascular disease and diabetes, and intervention strategies to reduce these outcomes.

Thresholds for Ambulatory Blood Pressure Among African Americans in the Jackson Heart Study.

BACKGROUND: Ambulatory blood pressure (BP) monitoring is the reference standard for out-of-clinic BP measurement. Thresholds for identifying ambulatory hypertension (daytime systolic BP [SBP]/diastolic BP [DBP] ≥135/85 mm Hg, 24-hour SBP/DBP ≥130/80 mm Hg, and nighttime SBP/DBP ≥120/70 mm Hg) have been derived from European, Asian, and South American populations. We determined BP thresholds for ambulatory hypertension in a US population-based sample of African American adults. METHODS: We analyzed data from the Jackson Heart Study, a population-based cohort study comprised exclusively of African American adults (n=5306). Analyses were restricted to 1016 participants who completed ambulatory BP monitoring at baseline in 2000 to 2004. Mean SBP and DBP levels were calculated for daytime (10:00 am-8:00 pm), 24-hour (all available readings), and nighttime (midnight-6:00 am) periods, separately. Daytime, 24-hour, and nighttime BP thresholds for ambulatory hypertension were identified using regression- and outcome-derived approaches. The composite of a cardiovascular disease or an all-cause mortality event was used in the outcome-derived approach. For this latter approach, BP thresholds were identified only for SBP because clinic DBP was not associated with the outcome. Analyses were stratified by antihypertensive medication use. RESULTS: Among participants not taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 134/85 mm Hg, 130/81 mm Hg, and 123/73 mm Hg, respectively. The outcome-derived thresholds for daytime, 24-hour, and nighttime SBP corresponding to a clinic SBP ≥140 mm Hg were 138 mm Hg, 134 mm Hg, and 129 mm Hg, respectively. Among participants taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 135/85 mm Hg, 133/82 mm Hg, and 128/76 mm Hg, respectively. The corresponding outcome-derived thresholds for daytime, 24-hour, and nighttime SBP were 140 mm Hg, 137 mm Hg, and 133 mm Hg, respectively, among those taking antihypertensive medication. CONCLUSIONS: On the basis of the outcome-derived approach for SBP and regression-derived approach for DBP, the following definitions for daytime, 24-hour, and nighttime hypertension corresponding to clinic SBP/DBP ≥140/90 mm Hg are proposed for African American adults: daytime SBP/DBP ≥140/85 mm Hg, 24-hour SBP/DBP ≥135/80 mm Hg, and nighttime SBP/DBP ≥130/75 mm Hg, respectively.

A Cross-sectional Study on Evidence-Based Nursing Practice in the Contemporary Hospital Setting: Implications for Nurses in Professional Development.

Evidence indicates that nurses inconsistently engage in evidence-based practice (EBP). This cross-sectional study of 402 nurses at a medical-surgical hospital identifies strategies for augmenting EBP. Nurses' EBP beliefs scores were higher than their EBP implementation scores. Those with baccalaureate/postgraduate degrees had higher EBP beliefs and implementation scores than those with associate degrees or diplomas. Bedside or direct care nurses were less likely to have baccalaureate/higher degrees and had lower EBP beliefs and implementation scores than did those nurses not serving in direct care roles.

Cross-sectional relations of race and poverty status to cardiovascular risk factors in the Healthy Aging in Neighborhoods of Diversity across the Lifespan (HANDLS) study.

BACKGROUND: Examine interactive relations of race and poverty status with cardiovascular disease (CVD) risk factors in a socioeconomically diverse sample of urban-dwelling African American (AA) and White adults. METHODS: Participants were 2,270 AAs and Whites (57% AA; 57% female; ages 30-64 years) who completed the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. CVD risk factors assessed included body mass index (BMI), waist circumference (WC), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDL-C, LDL-C), triglycerides (TG), glycated hemoglobin (HbA1c), high-sensitivity C-reactive protein (CRP), and systolic, diastolic, and pulse pressure (SBP, DBP, PP). Interactive and independent relations of race, poverty status, and sex were examined for each outcome via ordinary least squares regression adjusted for age, education, literacy, substance use, depressive symptoms, perceived health care barriers, medical co-morbidities, and medications. RESULTS: Significant interactions of race and poverty status (p's < .05) indicated that AAs living in poverty had lower BMI and WC and higher HDL-C than non-poverty AAs, whereas Whites living in poverty had higher BMI and WC and lower HDL-C than non-poverty Whites. Main effects of race revealed that AAs had higher levels of HbA1c, SBP, and PP, and Whites had higher levels of TC, LDL-C and TG (p's < .05). CONCLUSION: Poverty status moderated race differences for BMI, WC, and HDL-C, conveying increased risk among Whites living in poverty, but reduced risk in their AA counterparts. Race differences for six additional risk factors withstood extensive statistical adjustments including SES indicators.

Lifetime racial/ethnic discrimination and ambulatory blood pressure: The moderating effect of age.

OBJECTIVE: To determine whether the relationships of lifetime discrimination to ambulatory blood pressure (ABP) varied as a function of age in a sample of Black and Latino(a) adults ages 19 - 65. METHOD: Participants were 607 Black (n = 318) and Latino(a) (n = 289) adults (49% female) who completed the Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV), which assesses lifetime exposure to racism/ethnic discrimination. They were outfitted with an ABP monitor to assess systolic and diastolic blood pressure (SBP, DBP) across a 24-hr period. Mixed-level modeling was conducted to examine potential interactive effects of lifetime discrimination and age to 24-hr, daytime, and nighttime ABP after adjustment for demographic, socioeconomic, personality and life stress characteristics, and substance consumption covariates (e.g., smoking, alcohol). RESULTS: There were significant interactions of Age × Lifetime Discrimination on 24-hr and daytime DBP (ps ≤ .04), and in particular significant interactions for the Social Exclusion component of Lifetime Discrimination. Post hoc probing of the interactions revealed the effects of Lifetime Discrimination on DBP were seen for older, but not younger participants. Lifetime discrimination was significantly positively associated with nocturnal SBP, and these effects were not moderated by age. All associations of Lifetime Discrimination to ABP remained significant controlling for recent exposure to discrimination as well as all other covariates. CONCLUSIONS: Exposure to racial/ethnic discrimination across the life course is associated with elevated ABP in middle to older aged Black and Latino(a) adults. Further research is needed to understand the mechanisms linking discrimination to ABP over the life course. (PsycINFO Database Record