All Stressors Are Not Equal: The Salience of Racial Discrimination and Appraisal for Blood Pressure in African American Women.

OBJECTIVE: Psychosocial stress is a major predictor of chronic disease among African American (AA) women. Stress is a process involving exposure, appraisal of threat, coping, and psychobiologic adaptation. However, many studies focus on the frequency of stress events and/or coping; few explicitly study stress events and their appraisals; and AA women experience high levels of racial discrimination, a well-known form of social identity threat (i.e., negative experiences due to judgment based on identity). Stressors related to social identity threat may be differentially appraised and associated with divergent physiologic outcomes. This study examined the differences in the frequency and stressfulness associated with general stressors and racial discrimination in relation to blood pressure (BP) among AA women. METHODS: Multivariable regression was used on cross-sectional data from 208 middle-aged AA women residing in the San Francisco Bay Area. RESULTS: AA women reported less frequency of racial discrimination compared with general stressors, but were more likely to appraise racial discrimination events as stressful. Racial discrimination stressfulness was more strongly associated with systolic BP (SBP) than the number of racial discrimination events. There was a U-shaped association between racial discrimination stress and SBP, with those reporting "none" and "high/very high" distress having the highest SBP ( b = 12.2 [2.7 to 21.8] and b = 15.7 [1.5-29.8], respectively, versus moderate stress). Conversely, those reporting "very low" general stressfulness had the lowest SBP ( b = -7.9 [-15.8 to -0.1], versus moderate stress). Diastolic BP followed a similar pattern, although results were nonsignificant. CONCLUSIONS: This study highlights the importance of stress appraisal measures and adds to the body of evidence documenting racial discrimination as a salient psychosocial stressor for AA women.

Everyday Racial Discrimination and Hypertension among Midlife African American Women: Disentangling the Role of Active Coping Dispositions versus Active Coping Behaviors.

Racial discrimination, a psychosocial stressor, may contribute to disproportionate rates of hypertension among African American women. Coping moderates the effects of psychosocial stress on health. Coping dispositions describe stable personality characteristics, whereas contextual frameworks emphasize flexible coping behaviors in response to specific stressful encounters. Using data from the African American Women's Heart and Health Study-a non-probability cross-section of 208 midlife African American women in Northern California-we estimated the association between everyday racial discrimination (Everyday Discrimination Scale, EDS) and prevalence of hypertension (HTN), and evaluated moderation by coping disposition (John Henryism Active Coping scale, JH) versus context-specific active coping behavior (Active Coping with Racism scale, ACR). There were no main associations between EDS, JH, or ACR on HTN prevalence. There was evidence of statistical interaction between EDS and ACR (p-int = 0.05), but not JH (p-int = 0.90). Among those with high levels of ACR, reporting monthly (prevalence ratio (PR) = 2.35, 95% confidence interval (CI) = 1.13, 4.87), weekly (PR = 2.15, 95% CI = 1.01, 4.61), or daily (PR = 2.36, 95% CI = 1.14, 4.88) EDS was associated with higher HTN prevalence, versus reporting racial discrimination yearly or less. In contrast, among those with low levels of ACR, reporting more chronic racial discrimination was associated with lower hypertension prevalence, although results were less precise. Findings suggest that ongoing active coping with chronic racial discrimination may contribute to hypertension risk among African American women.

Racial discrimination, the superwoman schema, and allostatic load: exploring an integrative stress-coping model among African American women.

Racial discrimination has been linked to allostatic load (i.e., cumulative biological stress) among African American women. However, limited attention has been given to psychosocial processes involved in the stress response-critical for understanding biological pathways to health-in studies examining racial discrimination as a social determinant of health. We examined whether the superwoman schema (SWS), a multidimensional culture-specific framework characterizing psychosocial responses to stress among African American women, modifies the association between racial discrimination and allostatic load. We used purposive sampling to recruit a community sample of African American women ages 30-50 from five San Francisco Bay Area counties (n = 208). Path analysis was used to test for interactions while accounting for the covariance among SWS subscales using both linear and quadratic models. Significant interactions were observed between racial discrimination and four of the five SWS subscales. Feeling obligated to present an image of strength and an obligation to suppress emotions were each protective whereas feeling an intense motivation to succeed and feeling an obligation to help others exacerbated the independent health risk associated with experiencing racial discrimination. Our findings affirm the need to consider individual variability in coping and potentially other psychosocial processes involved in the stress response process, and offer several insights that may help elucidate the mechanisms by which racial discrimination gets "under the skin."

Racial discrimination, educational attainment, and biological dysregulation among midlife African American women.

OBJECTIVE: To examine the association between self-reported racial discrimination and allostatic load, and whether the association differs by socioeconomic position. METHODS: We recruited a purposive cross-section of midlife (ages 30-50) African American women residing in four San Francisco Bay area counties (n = 208). Racial discrimination was measured using the Experience of Discrimination scale. Allostatic load was measured as a composite of 15 biomarkers assessing cardiometabolic, neuroendocrine, and inflammatory activity. We calculated four composite measures of allostatic load and three system-specific measures of biological dysregulation. Multivariable regression was used to examine associations, while adjusting for relevant confounders. RESULTS: In the high education group, reporting low (b = -1.09, P = .02, 95% CI = -1.99, -0.18) and very high (b = -1.88, P = .003, 95% CI = -3.11, -0.65) discrimination was associated with lower allostatic load (reference=moderate). Among those with lower education, reporting low (b = 2.05, P = .008, 95% CI = 0.55,3.56) discrimination was associated with higher allostatic load. Similar but less consistent associations were found for poverty status. Associations were similar for cardiometabolic functioning, but not for neuroendocrine or inflammatory activity. CONCLUSIONS: Racial discrimination may be an important predictor of cumulative physiologic dysregulation. Factors associated with educational attainment may mitigate this association for African American women and other groups experiencing chronic social stress.

Differential associations between everyday versus institution-specific racial discrimination, self-reported health, and allostatic load among black women: implications for clinical assessment and epidemiologic studies.

PURPOSE: Black women have the highest estimated allostatic load (AL). AL and self-perceived health are strong health predictors and have been linked to racial discrimination. Research suggests that everyday and institution-specific racial discrimination may predict different AL and self-reported health (SRH) outcomes. Furthermore, discrepancies between AL and self-perceived health could widen disparities. We estimated associations between everyday versus institution-specific racial discrimination with AL and SRH. METHODS: Data are from a San Francisco Bay Area community sample of 208 black women aged 30-50 years. Participation involved a questionnaire, self-interview, blood draw, and anthropometric measurements. Adjusted generalized linear regression models estimated associations of racial discrimination with AL and SRH. RESULTS: After adjusting for age, socioeconomic position, and medication use, institution-specific discrimination was negatively associated with AL (i.e., better health), whereas everyday experiences showed no association. Those reporting very-high (vs. moderate) institution-specific discrimination had lower AL (ß = -1.31 [95% CI: -2.41, -0.20]; AL range: 0-15). No racial discrimination-SRH association was found. CONCLUSIONS: For black women, (1) institution-specific racial discrimination may be differentially embodied compared with everyday experiences and (2) institutional racism may contribute to physiologic stress-regulation regardless of self-perceived health status. Potential factors that may contribute to an inverse racial discrimination-AL association, and future research, are discussed.