Racism as a Psychosocial Stressor: New Racism as a Psychosocial Stressor: New Methods, Models & FindingsMethods, Models & Findings

Elizabeth Brondolo, PhDElizabeth Brondolo, PhD St. John’s UniversitySt. John’s University

May 2009May 2009

Overview Overview

Racism in everyday lifeRacism in everyday life– Setting the stage: Interpersonal racism and Setting the stage: Interpersonal racism and

hypertensionhypertension– Frequency of exposure to racism in everyday Frequency of exposure to racism in everyday

lifelife– Effects of racism on moodEffects of racism on mood– Effects on blood pressureEffects on blood pressure

Racial disparities in Hypertension Racial disparities in Hypertension

Across studies, the prevalence rates for Across studies, the prevalence rates for for HTN range from 24.4% to 29% for for HTN range from 24.4% to 29% for WhitesWhites;; whereas the rates range from whereas the rates range from 30.6% to 40.5% for Blacks . 30.6% to 40.5% for Blacks .

Despite treatment, HTN-related morbidity Despite treatment, HTN-related morbidity and mortality remain higher in Blacks than and mortality remain higher in Blacks than in Whites. in Whites.

The questionThe question

Does racism/ethnic discrimination Does racism/ethnic discrimination contribute, directly or indirectly, to these contribute, directly or indirectly, to these disparities? disparities?

If so, how?If so, how?

DefinitionsDefinitions

Racism is defined as “the beliefs, Racism is defined as “the beliefs, attitudes, institutional arrangements, and attitudes, institutional arrangements, and acts that tend to denigrate individuals or acts that tend to denigrate individuals or groups because of phenotypic groups because of phenotypic characteristics or ethnic group affiliation characteristics or ethnic group affiliation (Clark et al., 1999).(Clark et al., 1999).

Racism as social ostracismRacism as social ostracism

We consider racism to be a form of social We consider racism to be a form of social ostracism in which individuals are ostracism in which individuals are stigmatized because of their race or stigmatized because of their race or ethnicity; and consequently, excluded, ethnicity; and consequently, excluded, rejected, treated unfairly or harassed.rejected, treated unfairly or harassed.

Multiple levelsMultiple levels

CulturalCultural

InstitutionalInstitutional

InterpersonalInterpersonal

IntrapersonalIntrapersonal

Interpersonal Racism Interpersonal Racism

Interpersonal racism has been defined as Interpersonal racism has been defined as ”directly perceived discriminatory ”directly perceived discriminatory interactions between individuals whether interactions between individuals whether in their institutional roles or as public and in their institutional roles or as public and private individuals” (Krieger, 1999).private individuals” (Krieger, 1999).

Is interpersonal racism related to Is interpersonal racism related to hypertension? hypertension?

Interpersonal racism and HTNInterpersonal racism and HTN

13 Studies of BP level or self-reported or doctor 13 Studies of BP level or self-reported or doctor diagnosed HTN: diagnosed HTN: – 8 studies report no direct association of racism to 8 studies report no direct association of racism to

HTN or BP levelHTN or BP level (Barksdale 2009; Broman, 1996; Dressler et al 1996; Din-(Barksdale 2009; Broman, 1996; Dressler et al 1996; Din-

Dzietham et al 2004; James et al, 1984; Peters, 2004; Peters 2006; Poston et al 2001).Dzietham et al 2004; James et al, 1984; Peters, 2004; Peters 2006; Poston et al 2001).

– 2 studies find a small positive effect either in full 2 studies find a small positive effect either in full sample sample ((James et al 1996James et al 1996)) or in one subgroup or in one subgroup (non-US born women: (non-US born women: Cozier et al 2006)Cozier et al 2006)

– 2 studies find a U-shape effect 2 studies find a U-shape effect (for men only, Krieger & Sidney, 1996; (for men only, Krieger & Sidney, 1996; Ryan et al, 2006). Ryan et al, 2006).

– 2 studies report negative effects in at least one group2 studies report negative effects in at least one group (Krieger 1990; older subjects: Peters 2004)(Krieger 1990; older subjects: Peters 2004) ..

Our findingsOur findings

We also do not find a relationship of perceived racism to We also do not find a relationship of perceived racism to resting/clinic visit BP or past history of HTN in any of our resting/clinic visit BP or past history of HTN in any of our studies of Black adults studies of Black adults ((unpublished dataunpublished data ))

We find a relationship of perceived racism to self-We find a relationship of perceived racism to self-reported past or current HTN status in Asian and reported past or current HTN status in Asian and Latino(a)s adults Latino(a)s adults (unpublished data). (unpublished data).

Interpersonal racism and ABPInterpersonal racism and ABP

All four studies of adults find an All four studies of adults find an association of racism to ABP:association of racism to ABP:– Daytime only Daytime only (Steffen et al, 2006)(Steffen et al, 2006)

– Night-time only Night-time only (Brondolo et al, 2008; Singleton et al, 2008)(Brondolo et al, 2008; Singleton et al, 2008)

– Daytime and night-time Daytime and night-time (Hill et al, 2007)(Hill et al, 2007)

Interaction of PEDQ-CV X Interaction of PEDQ-CV X Awake/Sleep for SBPAwake/Sleep for SBP

121122123124125126127128129130131

-1sd MeanPEDQ

+1sd

Wake

Sleep

Interaction of PEDQ-CV X Interaction of PEDQ-CV X Awake/Sleep for DBPAwake/Sleep for DBP

73

74

75

76

77

78

79

-1sd Mean PEDQ +1sd

Wake

Sleep

Interpersonal racism and BP Interpersonal racism and BP reactivityreactivity

Consistent evidence of BP reactivity to Consistent evidence of BP reactivity to racist stressors (although not necessarily racist stressors (although not necessarily greater reactivity than seen for non-racist greater reactivity than seen for non-racist stressors).stressors).

Some evidence that past exposure to Some evidence that past exposure to racism is associated with increased BP racism is associated with increased BP reactivity to lab stressors.reactivity to lab stressors.

Summary of effectsSummary of effects

Not a direct relationship to HTN*Not a direct relationship to HTN*

Instead, interpersonal racism serves as a Instead, interpersonal racism serves as a risk factor for HTN through BP response to risk factor for HTN through BP response to stress:stress:– At the time of the acute stressor; At the time of the acute stressor; – And through potentially increased reactivity to And through potentially increased reactivity to

other situations (generalization); other situations (generalization); – And/or poorer BP recovery following stress.And/or poorer BP recovery following stress.

Mechanisms?Mechanisms?

How does interpersonal racism lead to a How does interpersonal racism lead to a greater and more sustained BP response? greater and more sustained BP response?

How does an acute stressor elicit an How does an acute stressor elicit an intense and persistent psychophysiological intense and persistent psychophysiological response? response?

12 different studies – 3000+ people12 different studies – 3000+ peoplePEDQ-CV survey development (n = 301, community sample)PEDQ-CV survey development (n = 301, community sample)Brief PEDQ-CV survey development (n = 177, student sample)Brief PEDQ-CV survey development (n = 177, student sample)Perceived Racism, Mood, & Emotional Intelligence (n = 112 students) Perceived Racism, Mood, & Emotional Intelligence (n = 112 students) Perceived Racism & Daily Mood, & Interpersonal Interactions (n = 113, Perceived Racism & Daily Mood, & Interpersonal Interactions (n = 113, community sample)community sample)Perceived racism, stereotype threat and academic achievement at HBC & Perceived racism, stereotype threat and academic achievement at HBC & PWI (n = 200, students at Clark Atlanta Univ. & SJU)PWI (n = 200, students at Clark Atlanta Univ. & SJU)Perceived Racism & Physical Self-Esteem/Body Dissatisfaction (n = 200, Perceived Racism & Physical Self-Esteem/Body Dissatisfaction (n = 200, SJU students & staff)SJU students & staff)Perceived Racism & Appraisals and Coping- SJU (total n = 420, new n = 200, Perceived Racism & Appraisals and Coping- SJU (total n = 420, new n = 200, community sample)community sample)Racism, Coping, & Ambulatory Blood Pressure (n = 771, community sample)Racism, Coping, & Ambulatory Blood Pressure (n = 771, community sample)Type of racist incident & coping (n = 302, student & community)Type of racist incident & coping (n = 302, student & community)Validation of PEDQ in Asian sample (n = 563, student and community Validation of PEDQ in Asian sample (n = 563, student and community sample)sample)Perceived racism, rumination, and cardiovascular reactivity (n=70)Perceived racism, rumination, and cardiovascular reactivity (n=70)Worksite study of experiences of racism and coping( n= 245)Worksite study of experiences of racism and coping( n= 245)

Funding & CollaboratorsFunding & CollaboratorsCollaborators from Universities, Community Health Centers, Community-based Collaborators from Universities, Community Health Centers, Community-based

Organizations, and Clinical Director’s Network:Organizations, and Clinical Director’s Network:

– Richard Contrada, Ph.D., Richard Contrada, Ph.D., Rutgers UniversityRutgers University– William Gerin, Ph.D., Gbenga Ogedegbe, M.D., Thomas Pickering, M.D., William Gerin, Ph.D., Gbenga Ogedegbe, M.D., Thomas Pickering, M.D.,

Joseph Schwartz, Ph.D., Joseph Schwartz, Ph.D., Columbia University Medical CollegeColumbia University Medical College – Maya McNeilly, Ph.D. Maya McNeilly, Ph.D. Triangle AssociatesTriangle Associates– Jonathan Tobin, Ph.D., Andrea Cassells, MPH Jonathan Tobin, Ph.D., Andrea Cassells, MPH Clinical Directors NetworkClinical Directors Network– Monica Sweeney, MD, Monica Sweeney, MD, Bedford Stuyvesant Family Health CenterBedford Stuyvesant Family Health Center– Alan Roth, DO., Alan Roth, DO., Jamaica Hospital Medical CenterJamaica Hospital Medical Center– Joseph Diamond, MD, Joseph Diamond, MD, Long Island Jewish Medical CenterLong Island Jewish Medical Center– Susan Saegert, Ph.D.Susan Saegert, Ph.D., CUNY, CUNY– Jeff Fish, Ph.D. and Robin Wellington, Ph.D. Jeff Fish, Ph.D. and Robin Wellington, Ph.D. St. John’s UniversitySt. John’s University

Projects funded by seed grants from St. John’s University and NHLBI R01 HL068590 and Projects funded by seed grants from St. John’s University and NHLBI R01 HL068590 and two minority supplements two minority supplements

Collaborating and Participating Collaborating and Participating Sites Sites

AFAMAFAMBedford Stuyvesant Family Health CenterBedford Stuyvesant Family Health CenterCommunity Health Care Network – Bronx CenterCommunity Health Care Network – Bronx CenterGreenburgh Neighborhood Health CenterGreenburgh Neighborhood Health CenterFlushing Hospital Medical CenterFlushing Hospital Medical CenterJamaica HospitalJamaica HospitalJoseph P. Addabbo Family Health CenterJoseph P. Addabbo Family Health CenterLeonardo Covello Senior CenterLeonardo Covello Senior CenterMorris Heights Health Center at St. Ann’sMorris Heights Health Center at St. Ann’sSt. John’s University – Manhattan and QueensSt. John’s University – Manhattan and QueensYWCA of BrooklynYWCA of Brooklyn

The research teamThe research teamSt. John’s University Doctoral Fellows and Project St. John’s University Doctoral Fellows and Project

Staff: Staff: Risa Appel Broudy, Ph.D., Jenni Atencio, Risa Appel Broudy, Ph.D., Jenni Atencio, Karina Bienfait, Ph.D., Nisha Brady, Kia Brinson. Karina Bienfait, Ph.D., Nisha Brady, Kia Brinson. Ph.D., Vonetta Coakley, Ellen-ge Denton, Kamau Ph.D., Vonetta Coakley, Ellen-ge Denton, Kamau Imarogbe, Ph.D., Juhee Jhalani, Kim Kelly, Ph.D., Imarogbe, Ph.D., Juhee Jhalani, Kim Kelly, Ph.D., Asha Kumar, Jasmin Kwok, Shonda Lackey, Asha Kumar, Jasmin Kwok, Shonda Lackey, Daniel Libby, Erica Love, Harrald Magny, Ricardo Daniel Libby, Erica Love, Harrald Magny, Ricardo Rieppi, Ph.D., Aida Mencia-Ripley, Melissa Rieppi, Ph.D., Aida Mencia-Ripley, Melissa Pencille, Tremaine Sayles, Shola Thompson, Jade Pencille, Tremaine Sayles, Shola Thompson, Jade Ullah, Ullah,

CUNY Doctoral Fellow: CUNY Doctoral Fellow: Danielle Beatty, Ph.D.Danielle Beatty, Ph.D.

Clinical Directors Network StaffClinical Directors Network Staff: Daniel Rivera, : Daniel Rivera, Carmen Rodriguez, Yunisha Dee AlamoCarmen Rodriguez, Yunisha Dee Alamo

Methods for capturing everyday Methods for capturing everyday experiencesexperiences

Surveys – quantitative and qualitative Surveys – quantitative and qualitative informationinformation

Daily diary studies followed by interviews Daily diary studies followed by interviews about daily experiencesabout daily experiences

Ambulatory BP monitoring Ambulatory BP monitoring

Lab/field studies: combining reactivity Lab/field studies: combining reactivity challenges with daily diary completion challenges with daily diary completion

Possible mechanisms – Possible mechanisms – A vicious cycleA vicious cycle

Race-related stressor exposure occurs Race-related stressor exposure occurs frequently.frequently.

Racism elicits negative emotions, and past Racism elicits negative emotions, and past exposure makes this more intense.exposure makes this more intense.

Negative mood effects persist after acute Negative mood effects persist after acute exposure. And lifetime exposure is exposure. And lifetime exposure is associated with sustained negative mood.associated with sustained negative mood.

Overview continuedOverview continued

The psychological effects generalize to The psychological effects generalize to other stressors, including perceptions of other stressors, including perceptions of routine social interactions.routine social interactions.

And these events are associated with And these events are associated with elevated blood pressure. elevated blood pressure.

Perceived racism engenders a persistent Perceived racism engenders a persistent negative mood state which potentiates negative mood state which potentiates stress reactivity and impairs BP recovery. stress reactivity and impairs BP recovery.

The first stepThe first step

Measuring exposure to racism.Measuring exposure to racism.

PEDQ-CVPEDQ-CVAdaptation of a measure developed by Contrada and Adaptation of a measure developed by Contrada and colleagues to make it applicable for use with colleagues to make it applicable for use with community samplescommunity samplesMeasure for use across ethnic groupsMeasure for use across ethnic groupsSubscales allow investigation of different aspects of Subscales allow investigation of different aspects of interpersonal racism: social exclusion, workplace interpersonal racism: social exclusion, workplace discrimination, stigmatization, and threat and discrimination, stigmatization, and threat and harassment. harassment. Items are worded to permit investigators to Items are worded to permit investigators to distinguish exposure to events from reactions to distinguish exposure to events from reactions to events.events.

BECAUSE OF YOUR ETHNICITY OR BECAUSE OF YOUR ETHNICITY OR RACE, HOW OFTEN …..RACE, HOW OFTEN …..

Exclusion/RejectionExclusion/Rejection– have others been nice to your face, but said bad have others been nice to your face, but said bad

things behind your back?things behind your back?– has a clerk or waiter ignored you?has a clerk or waiter ignored you?

Because of your ethnicity or race….Because of your ethnicity or race….

Stigmatization/DisvaluationStigmatization/Disvaluation– Have others hinted you must be lazy?Have others hinted you must be lazy?– Have others hinted that you are dishonest?Have others hinted that you are dishonest?

BECAUSE OF YOUR ETHNICITY BECAUSE OF YOUR ETHNICITY OR RACE, HOW OFTEN….OR RACE, HOW OFTEN….

Workplace DiscriminationWorkplace Discrimination– have you been treated unfairly by your boss?have you been treated unfairly by your boss?– have others thought you couldn’t do things or have others thought you couldn’t do things or

handle a job?handle a job?

Because of your ethnicity or race…Because of your ethnicity or race…

Threat and harassmentThreat and harassment– Have others physically hurt you?Have others physically hurt you?– Have others threatened to damage your Have others threatened to damage your

property?property?

Path 1: FrequencyPath 1: Frequency

Episodes of interpersonal racism occur Episodes of interpersonal racism occur often.often.

Repeated exposure to the stressor may Repeated exposure to the stressor may result in frequent episodes of distress with result in frequent episodes of distress with limited opportunities for recovery. limited opportunities for recovery.

PrevalencePrevalence

Full scale scores on the PEDQ-CV in Full scale scores on the PEDQ-CV in community samples of Black and Latino(a) community samples of Black and Latino(a) adultsadults– Mean = range from 1.98 -- 2.17:Mean = range from 1.98 -- 2.17:– range 1 - 4.65range 1 - 4.65– 98% reported some exposure over the lifetime98% reported some exposure over the lifetime

Exposure to ethnic discrimination: Exposure to ethnic discrimination: Comparisons among subscalesComparisons among subscales

1

1.25

1.5

1.75

2

2.25

2.5

2.75

Tot EX WK ST TH

Full n = 301

Brief n = 177

During the past week…During the past week…

In our first study, 78% In our first study, 78% reported 1 or more reported 1 or more events, 59% reported 3 events, 59% reported 3 or more events. or more events. In another sample of 449 In another sample of 449 community dwelling Black community dwelling Black and Latino adults, 74% and Latino adults, 74% had 1 or more events, had 1 or more events, with 55% reporting 3 or with 55% reporting 3 or more events. more events. Average of 5 events in Average of 5 events in previous week. previous week.

In the past week, because of your In the past week, because of your race/ethnicity how often did race/ethnicity how often did someone…someone…

Ignore youIgnore you 0.900.90

Avoid talking to Avoid talking to youyou

0.830.83

Say something Say something mean or nastymean or nasty

0.830.83

Look at you in a Look at you in a mean or nasty mean or nasty wayway

0.930.93

On a single day of testing On a single day of testing

Participants completed diary every 20 minutes. Participants completed diary every 20 minutes.

If they indicated feeling angry, or were If they indicated feeling angry, or were engaged in an interaction in which they felt engaged in an interaction in which they felt harassed, excluded or treated unfairly, we harassed, excluded or treated unfairly, we interview them about this episode. interview them about this episode.

What happened, what did you do, and why do What happened, what did you do, and why do you think it happened? (Choices: age, gender, you think it happened? (Choices: age, gender, race, mood, personality, and the situation) . race, mood, personality, and the situation) . Rated on a 1-5 scale.Rated on a 1-5 scale.

Day-of-testing events attributed Day-of-testing events attributed to racial biasto racial bias

There were 509 (of 656) people who There were 509 (of 656) people who reported some episode of anger or a reported some episode of anger or a negative interpersonal interaction negative interpersonal interaction occurring during the day at the time of occurring during the day at the time of diary entry.diary entry.

No attribution to race: 393 (77.2%)No attribution to race: 393 (77.2%)

Yes attribution to race: 116 (22.8%)Yes attribution to race: 116 (22.8%)

Past exposure made day-of-testing exposure Past exposure made day-of-testing exposure more likely more likely (all ps < .001)(all ps < .001)

Tell Us What Happened….Tell Us What Happened….Explicit Racism: “Think about a time when someone treated you badly, and you knew it was because of your race or ethnicity, because the other person specifically referred to your race/ethnicity.”(e.g., Someone avoided sitting near you, and you overheard them say something negative about people of your race or ethnicity)

Implicit Racism: “Think about a time when someone treated you badly, and you knew it was because of your race or ethnicity, even though the other person did not specifically refer to your race.”

(e.g., Someone avoided sitting next to you.)

Ambiguous Racism: “Think about a time when someone treated you badly, and you thought it was because of your race or ethnicity, but you weren’t sure.”

Not Race-Related: “Think about a time when someone treated you badly, and you knew it was not because of your race or ethnicity.”

Some typical examples Some typical examples (composites of similar examples from multiple respondents) (composites of similar examples from multiple respondents)

I was looking at some expensive items. I was looking at some expensive items. The clerk tried to show me the less The clerk tried to show me the less expensive ones. expensive ones. I was shopping, and a sales associate was I was shopping, and a sales associate was following me and not anybody else. So I keep following me and not anybody else. So I keep shopping and go to the checkout. The cashier shopping and go to the checkout. The cashier asked me to show ID with my credit card, but did asked me to show ID with my credit card, but did not do this for the customer before me who used not do this for the customer before me who used a credit card, but was of a different race.a credit card, but was of a different race.

More examplesMore examples

I was sitting on a crowded bus. There was an empty I was sitting on a crowded bus. There was an empty seat next to me. This guy got on the bus, saw the open seat next to me. This guy got on the bus, saw the open seat, looked at me, and decided to stand. seat, looked at me, and decided to stand.

I got on a bus and there was an open seat next. When I I got on a bus and there was an open seat next. When I sat down, the lady next to me clutched her bag closely sat down, the lady next to me clutched her bag closely and immediately stood upand immediately stood up..

More examplesMore examples

I went to rent an apartment in a mostly White I went to rent an apartment in a mostly White neighborhood. Over the phone, the landlord agreed to rent neighborhood. Over the phone, the landlord agreed to rent me the apartment for a year. When I came to meet him, the me the apartment for a year. When I came to meet him, the landlord changed his mind. He said I could only rent it for 2 landlord changed his mind. He said I could only rent it for 2 months and could not have company over. months and could not have company over.

I applied for a job as a sales representative. The I applied for a job as a sales representative. The interviewer seemed really impressed with my resume over interviewer seemed really impressed with my resume over the phone. When I came in for the interview, the the phone. When I came in for the interview, the interviewer, who was of a different race, didn’t shake hands interviewer, who was of a different race, didn’t shake hands with me, didn’t acknowledge my previous experiences and with me, didn’t acknowledge my previous experiences and tried to deter me from wanting the position. I got hired , but tried to deter me from wanting the position. I got hired , but then I was not given the job that I was hired to do. then I was not given the job that I was hired to do.

Variations in exposureVariations in exposure

Exposure to different kinds of racism vary Exposure to different kinds of racism vary socioeconomic status. socioeconomic status.

– Low SES --Low SES -- more stigmatization, threat, and more stigmatization, threat, and past-week exposurepast-week exposure

– Higher SES --Higher SES -- more work-place more work-place discrimination. discrimination.

A part of everyday lifeA part of everyday life

Exposure to race-based maltreatment Exposure to race-based maltreatment occurs frequently and is embedded in occurs frequently and is embedded in everyday interactions. everyday interactions.

In addition to more explicit denigration or In addition to more explicit denigration or harassment, some episodes involve social harassment, some episodes involve social distancing. distancing.

In others cases, the target perceives a In others cases, the target perceives a communication of lower relative valuation.communication of lower relative valuation.

What happens as a What happens as a consequence of acute consequence of acute

exposure? exposure?

Racism and affective reactivityRacism and affective reactivity

Acute exposure to racism elicits negative Acute exposure to racism elicits negative affect, and in particular, anger. affect, and in particular, anger.

Past exposure intensifies this effect. Past exposure intensifies this effect.

Recalling race-related maltreatment is Recalling race-related maltreatment is acutely anger-evokingacutely anger-evoking

Laboratory task: baseline rest, math Laboratory task: baseline rest, math stressor, another rest, followed by random stressor, another rest, followed by random assignment to one of the following: assignment to one of the following:

– Tell about a situation in which you were Tell about a situation in which you were mistreated because of your race or ethnicitymistreated because of your race or ethnicity

– Defend a TV show or movie that is in danger Defend a TV show or movie that is in danger of being cancelled. of being cancelled.

Exposure to the racial stressorExposure to the racial stressor (n = 19) (n = 19)

Effects by PEDQ-CV GroupEffects by PEDQ-CV Group

Talking is associated with a drop in positive mood, but not for Talking is associated with a drop in positive mood, but not for everyone. (Mean changes in happiness from pre-post everyone. (Mean changes in happiness from pre-post controlling for controlling for

gender1 and baseline happiness)gender1 and baseline happiness)

Affective recovery is slow.Affective recovery is slow.

Persistence of the mood effectsPersistence of the mood effectsThe magnitude of changes in mood in the The magnitude of changes in mood in the lab (from before to after the speech task) lab (from before to after the speech task) predicted mood during the first four hours predicted mood during the first four hours of the diary monitoring, controlling for of the diary monitoring, controlling for baseline affective response (or recovery). baseline affective response (or recovery).

Lab reactivity (n = 40)

Diary ratings of mood: First 4 hours

Diary ratings of mood: Second 4 hours

Nervousness Angry: r=.40* Nervous: r = .44*Sad : r = .42*

Sadness Angry: r =.38*

And the effects of perceived And the effects of perceived racism on emotion appear to be racism on emotion appear to be

cumulative.cumulative.

Racism and negative mood Racism and negative mood

Dependent VariablesDependent Variables

N = 362 Black and Latino(a) adultsN = 362 Black and Latino(a) adults

Trait Negative MoodTrait Negative Mood– Positive and Negative Affect Scale Positive and Negative Affect Scale

(PANAS; Watson, Clark, & Tellegen, (PANAS; Watson, Clark, & Tellegen, 1988)1988)

Daily Negative MoodDaily Negative Mood– Diary measures of daily mood (angry, Diary measures of daily mood (angry,

sad, nervous, happy)sad, nervous, happy)– Completed every 20 minutes on PDAsCompleted every 20 minutes on PDAs

PEDQ-CV Groups and Trait negative mood PEDQ-CV Groups and Trait negative mood (means adjusted for age, gender, ethnicity, (means adjusted for age, gender, ethnicity,

education, income, occupation, and hostility)education, income, occupation, and hostility)

1.71.751.8

1.851.9

1.952

2.052.1

2.152.2

PEDQtot Threat Stigma

Low PEDQ

Hi PEDQ

PEDQ-CV groups: Differences in adjusted daily PEDQ-CV groups: Differences in adjusted daily mood, controlling for age, gender, ethnicity, mood, controlling for age, gender, ethnicity,

education, income occupation, & hostilityeducation, income occupation, & hostility

0

2

4

6

8

10

12

Angry Nervous Sad

Low PEDQ

Hi PEDQ

Variations by SES-EducationVariations by SES-Education

For trait negative mood, For trait negative mood, the interaction of the interaction of education level and PEDQ-education level and PEDQ-CV was highly significant CV was highly significant (B = -31, SE = 0.09, t = -(B = -31, SE = 0.09, t = -3.47, p < .001).3.47, p < .001).

Less than High School: Less than High School: 32%, p < .000132%, p < .0001

High school/some coll: 4 High school/some coll: 4 %, p < .01%, p < .01

Completed college: NSCompleted college: NS

B B SESE tt BB

< HS< HS 0.680.68 .10.10 6.75**6.75** 0.610.61

HS/SCHS/SC 0.220.22 .08.08 2.88**2.88** 0.210.21

COLL+COLL+ .06.06 .16.16 .40.40 .06.06

PEDQ-Group differences in daily PEDQ-Group differences in daily sadness by education levelsadness by education level

0

2

4

6

8

10

12

14

16

< HS HS/SC COLL+

Low PEDQ

Hi PEDQ

Do the effects generalize Do the effects generalize to routine social interactions? to routine social interactions?

Racism and Appraisals of Current Social Racism and Appraisals of Current Social InteractionsInteractions

Does past exposure to racism Does past exposure to racism influence the way we perceive routine influence the way we perceive routine on-going interactions? on-going interactions?

Sample of 113 community members, Sample of 113 community members, majority were Black or Latino(a)majority were Black or Latino(a)

Study VariablesStudy Variables

Perceived ethnic Perceived ethnic discriminationdiscrimination

Quality or intensity of Quality or intensity of interpersonal interactionsinterpersonal interactions– Perceptions of being Perceptions of being

comfortablecomfortable– Perceptions of being Perceptions of being

ignoredignored– Perceptions of being Perceptions of being

harassedharassed– Perceptions of being Perceptions of being

treated unfairlytreated unfairly

Mixed Models Regression Analyses for Mixed Models Regression Analyses for Lifetime PEDQ and Daily Interpersonal Lifetime PEDQ and Daily Interpersonal Interactions (Controlling for Cynicism, Interactions (Controlling for Cynicism, Hostile Attributions, Trait Anxiety, and Hostile Attributions, Trait Anxiety, and

Defensiveness and individual SES)Defensiveness and individual SES)

BB SESE tt

HarassedHarassed 4.424.42 1.711.71 2.58*2.58*

IgnoredIgnored 3.423.42 1.181.18 2.88**2.88**

Treated Treated UnfairlyUnfairly

3.903.90 1.801.80 2.16*2.16*

* p < .05. **p < .01.

Summary of Part 2Summary of Part 2

Racism elicits negative moods, both acutely and Racism elicits negative moods, both acutely and persistently.persistently.

The effects generalize to everyday social The effects generalize to everyday social interactions.interactions.

SES matters. The effects are much more intense SES matters. The effects are much more intense in individuals with lower levels of education. in individuals with lower levels of education.

Past exposure matters. The effects of acute Past exposure matters. The effects of acute exposure depend on past experiences. exposure depend on past experiences.

Are these daily experiences Are these daily experiences associated with blood pressure? associated with blood pressure?

Masked hypertensionMasked hypertension..

Masked hypertension (HTN): Masked hypertension (HTN): – normal clinic or office blood pressure (BP) readings (e.g., less normal clinic or office blood pressure (BP) readings (e.g., less

than 140/90 mmHg) than 140/90 mmHg) – elevated BP readings outside of the office (e.g., ABP greater elevated BP readings outside of the office (e.g., ABP greater

than or equal to 135/85 mmHg).than or equal to 135/85 mmHg).

Masked HTN is hypothesized to be a precursor to Masked HTN is hypothesized to be a precursor to chronic essential HTN, and is associated with levels of chronic essential HTN, and is associated with levels of coronary morbidity and mortality that are similar to those coronary morbidity and mortality that are similar to those seen in sustained HTN.seen in sustained HTN.

ParticipantsParticipants

Participants (n = 630)Participants (n = 630)

Mean age = 39 years Mean age = 39 years (range = 25-65 years) (range = 25-65 years)

Time 1: Clinic and Time 1: Clinic and screeningscreening

Time 2: ABPTime 2: ABP

Black Latino Mixed

W 163 147 7

M 159 153 1

Masked hypertensionMasked hypertension

A more conservative criteriaA more conservative criteria

– CLINIC: Normal BPCLINIC: Normal BP (SBP < = 120mmHg & and DBP < = 80mmHg) (SBP < = 120mmHg & and DBP < = 80mmHg)

– ABP : Elevated BPABP : Elevated BP(SBP>= 135 or DBP > = 85mmHg). (SBP>= 135 or DBP > = 85mmHg).

Predicting ABP status from diary Predicting ABP status from diary datadata

A stepwise discriminant function analysis was A stepwise discriminant function analysis was performed performed including only the initially including only the initially normotensive participants (n = 252) normotensive participants (n = 252) to test to test whether measures of daily unfair treatment –– whether measures of daily unfair treatment –– can differentiate those in 3 ABP groups (i.e., can differentiate those in 3 ABP groups (i.e., normotensive, borderline hypertensive or normotensive, borderline hypertensive or hypertensive). hypertensive).

Daily experiences of harassment significantly Daily experiences of harassment significantly differentiated the 3 groups (p=0.008), above and differentiated the 3 groups (p=0.008), above and beyond the effects of age, gender, BMI and race beyond the effects of age, gender, BMI and race

Daily experiences of harassment or unfair Daily experiences of harassment or unfair treatment by ABP group, treatment by ABP group,

among initially normotensive patients (n = 252)among initially normotensive patients (n = 252)

0

1

2

3

4

5

6

7

8

9

ABP:N ABP:HiN ABP:HT

Dailyharassment

Predicting ABP status: Initially Predicting ABP status: Initially normotensive patientsnormotensive patients

0

2

4

6

8

10

12

ABP:N ABP:HiN ABP:HT

Dailyunfairness

SummarySummary

Race-related maltreatment is a fact of everyday Race-related maltreatment is a fact of everyday life for many individuals. life for many individuals.

Acute exposure evokes negative mood. Acute exposure evokes negative mood.

The mood effects are persistent. The mood effects are persistent.

The effects appear to be cumulative (i.e., past The effects appear to be cumulative (i.e., past exposure intensifies this distress.)exposure intensifies this distress.)

Summary, con’tSummary, con’t

The greater the past exposure, the more The greater the past exposure, the more likely individuals are to have more frequent likely individuals are to have more frequent negative interpersonal interactions in negative interpersonal interactions in everyday life. everyday life.

These daily experiences appear to be These daily experiences appear to be associated with increased ABP, even associated with increased ABP, even when they are not associated with resting when they are not associated with resting clinic BP. clinic BP.

Conclusion Conclusion

Exposure to racism is associated with a cycle of Exposure to racism is associated with a cycle of increasing anger and increasingly “sticky” increasing anger and increasingly “sticky” affect.affect.

These emotional experiences potentiate stress These emotional experiences potentiate stress sensitivity. sensitivity.

The situation is not the same for everyone. The The situation is not the same for everyone. The consequences and course of acute exposure consequences and course of acute exposure differ depending on past history, making differ depending on past history, making resolution of individual events more resolution of individual events more complicated both for the target and for others. complicated both for the target and for others.