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Research generated by the professions of psychiatry and psychology reveals that African Americans are more often diagnosed with specific mental disorders (e.g., psychotic disorders) compared with European Americans. No research to date, however, has investigated whether professional counselors make differential diagnoses according to client race. This study (N = 1,648) found that counselors diagnosed African Americans with psychotic and childhood disorders at a disproportionately high rate. Implications for counseling theory and practice are discussed., Racial/ethnic differences in the mental health treatment of clients have received increasing attention during the past decade (Harley & Dillard, 2005). The Surgeon General's recent report on mental health in [...]

Research on societal determinants of health suggests the existence of an 'inverse hazard law,' which we define as: 'The accumulation of health hazards tends to vary inversely with the power and resources of the populations affected.' Yet, little empirical research has systematically investigated this topic, including in relation to workplace exposures. We accordingly designed the United for Health study (Greater Boston Area, Massachusetts, 2003-2004) to investigate the joint distribution and health implications of workplace occupational hazards (dust, fumes, chemical, noise, ergonomic strain) and social hazards (racial discrimination, sexual harassment, workplace abuse). Focusing on blood pressure as our health outcome, we found that among the 1202 low-income multi-racial/ethnic working class participants in our cohort--of whom 40% lived below the US poverty line 79% reported exposure to at least one social hazard and 82% to at least one high- exposure occupational hazard. Only sexual harassment, the least common social hazard, was associated with elevated systolic blood pressure (SBP) among the women workers. By contrast, no statistically significant associations were detectable between the other additional highly prevalent social and occupational hazards and SBP; we did, however, find suggestive evidence of an association between SBP and response to unfair treatment, implying that in a context of high exposure, differential susceptibility to the exposure matters. These results interestingly contrast to our prior findings for this same cohort, in which we found associations between self-reported experiences of racial discrimination and two other health outcomes: psychological distress and cigarette smoking. Likely explanations for these contrasting findings include: (a) the differential etiologic periods and pathways involving somatic health, mental health, and health behaviors, and (b) the high prevalence of adverse exposures, limiting the ability to detect significant associations. As clarified by the 'inverse hazard law,' to understand health inequities, research is needed that contrasts exposures and health status population-wide, not just among those most inequitably exposed. Keywords: Blood pressure Health inequities Occupational health Racial discrimination Sexual harassment Workplace abuse USA

Medicare research has shown that there are substantial disparities by race and socioeconomic status in use of services. In this article, I review past research and discuss how findings apply specifically to vulnerable men aged 65 years or older. Six lessons from this review are Identified and Illustrated here. Disparities in certain measures of health are growing; to reverse this trend, substantial efforts are needed, including dissemination of information about disparities as well as testing of hypotheses regarding underlying causes.

The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health.

Objectives. This study examined whether individual (self-perceived) and institutional (segregation and redlining) racial discrimination was associated with poor health status among members of an ethnic group. Methods. Adult respondents (n=1503) in the cross-sectional Chinese American Psychiatric Epidemiologic Study were geocoded to the 1990 census and the 1995 Home Mortgage Disclosure Act database. Hierarchical linear modeling assessed the relationship between discrimination and scores on the Medical Outcomes Study Short-Form 36 and revised Symptom Checklist 90 health status measures. Results. Individual and institutional measures of racial discrimination were associated with health status after control for acculturation, sex, age, social support, income, health insurance, employment status, education, neighborhood poverty, and housing value. Conclusions. The data support the hypothesis that discrimination at multiple levels influences the health of minority group members.

This article provides an overview of the magnitude of and trends in racial/ethnic disparities in health for women in the United States. It emphasizes the importance of attending to diversity in the health profiles and populations of minority women. Socioeconomic status is a central determinant of racial/ethnic disparities in health, but several other factors, including medical care, geographic location, migration and acculturation, racism, and exposure to stress and resources also play a role. There is a need for renewed attention to monitoring, understanding, end actively seeking to eliminate racial/ethnic disparities in health.

Targeted marketing of high-calorie foods and beverages to ethnic minority populations, relative to more healthful foods, may contribute to ethnic disparities in obesity and other diet-related chronic conditions. We conducted a systematic review of studies published in June 1992 through 2006 (n=20) that permitted comparison of food and beverage marketing to African Americans versus Whites and others. Eight studies reported on product promotions, 11 on retail food outlet locations, and 3 on food prices. Although the evidence base has limitations, studies indicated that African Americans are consistently exposed to food promotion and distribution patterns with relatively greater potential adverse health effects than are Whites. The limited evidence on price disparities was inconclusive.

Objectives. We examined the association between work discrimination and morbidity among Filipinos in the United States, independent of more-global measures of discrimination. Methods. Data were collected from the Filipino American Community Epidemiological Survey. Our analysis focused on 1652 participants who were employed at the time of data collection, and we used negative binomial regression to determine the association between work discrimination and health conditions. Results. The report of workplace discrimination specific to being Filipino was associated with an increased number of health conditions. This association persisted even after we controlled for everyday discrimination, a general assessment of discrimination; job concerns, a general assessment of unpleasant work circumstances; having immigrated for employment reasons; job category; income; education; gender; and other sociodemographic factors. Conclusions. Racial discrimination in the workplace was positively associated with poor health among Filipino Americans after we controlled for reports of everyday discrimination and general concerns about one's job. This finding shows the importance of considering the work setting as a source of discrimination and its effect on morbidity among racial minorities. (doi:10.2105/AJPH.2007.110163)

Research has shown that experiences of discrimination negatively affect health. However, little is known about whether socioeconomic position modifies the reporting of perceived discrimination. This cross-sectional study of 69 participants investigated the modifying effects of education and income on the reporting of perceived discrimination among Hispanics and Whites. Hispanics, compared to non-Hispanic Whites, of higher education (more than high school) and income ($30,000 or more per year) status are more than 4 times more likely to report perceived discrimination (odds ratio [OR] = 4.09, 95% confidence interval [CI] = 1.31-12.72; OR = 4.43, 95% CI = 1.41-13.93, respectively). However, this difference was nonsignificant among those with lower education and income levels (OR = 1.71, 95% CI = 0.27-10.92; OR = 1.71, 95% CI = 0.20-15.02, respectively). These results may affect future study sample and effect sizes. Keywords: socioeconomic position; Hispanic; Latino; discrimination

Since 1950, dramatic advances in human genetics have occurred, racial disparities in infant mortality have widened, and the United States' international ranking in infant mortality has deteriorated. The quest for a 'preterm birth gene' to explain racial differences is now under way. Scores of papers linking polymorphisms to preterm birth have appeared in the past few years. Is this strategy likely to reduce racial disparities? We reviewed broad epidemiological patterns that call this approach into question. Overall patterns of racial disparities in mortality and secular changes in rates of prematurity as well as birth-weight patterns in infants of African immigrant populations contradict the genetic theory of race and point toward social mechanisms. We postulate that a causal link to class disparities in health exists.

Residential segregation is a common aspect of the urban experiences of African-Americans in the United States (US), yet few studies have considered how segregation might influence perinatal health. Here, we develop a conceptual model of relationships between segregation and birth outcomes and test the implications of the model in a sample of 434,376 singleton births to African-American women living in 225 US Metropolitan Statistical Areas (MSAs). Data from the National Center for Health Statistics 2002 birth files were linked to data from the 2000 US Census and two distinct measures of segregation: an index of isolation (the probability that an African-American resident will encounter another African-American resident in any random neighborhood encounter) and an index of clustering (the extent to which African-Americans live in contiguous neighborhoods). Using multilevel regression models, controlling for individual- and MSA-level socioeconomic status and other covariates, we found higher isolation was associated with lower birthweight, higher rates of prematurity and higher rates of fetal growth restriction. In contrast, higher clustering was associated with more optimal outcomes. We propose that isolation reflects factors associated with segregation that are deleterious to health including poor neighborhood quality, persistent discrimination and the intra-group diffusion of harmful health behaviors. Associations with clustering may reflect factors associated with segregation that are health-promoting such as African-American political power empowerment, social support and cohesion. Declines in isolation could represent positive steps toward improving birth outcomes among African-American infants while aspects of racial contiguity appear to be mitigating or indeed beneficial. Segregation is a complex multidimensional construct with both deleterious and protective influences on birth outcomes, depending on the dimensions under consideration. Further research to understand racial/ethnic and economic health disparities could benefit from a focus on the contributory role of neighborhood attributes associated with the dimensions segregation and other social geographies. Keywords: Birthweight; Prematurity; Fetal growth; African-Americans/Blacks; Urban health; USA; Racial residential segregation

Using a sample of 20,000 adolescents (Add Health data), this study examined the influences of community poverty and race/ethnicity on adolescent obesity. Multilevel analyses revealed strong evidence for the unique influences of community poverty and race/ethnicity on adolescent obesity net of family characteristics. The prevalence of obesity is significantly higher in poor communities than in affluent communities; and it is higher among African Americans, Hispanics and Native Americans than among Whites. The interaction between race/ethnicity and community poverty indicates that race/ethnicity moderates the influence of community poverty on the prevalence of obesity. Although the prevalence of obesity is higher among minorities than among Whites, the influence of community poverty is stronger for Whites than for minorities, suggesting that unlike Whites, most minority groups may not accrue benefits of structural community advantages. The state of being overweight as the outcome variable provided essentially the same findings. The practical implications are discussed. KEYWORDS: community poverty; race; adolescent obesity.

Objectives. Our understanding of the relationships between perceived discrimination and health was limited by the cross-sectional design of most previous studies. We examined the longitudinal association of self-reported everyday discrimination with depressive symptoms and self-rated general health. Methods. Data came from 2 waves (1996 and 2001) of the Eastside Village Health Worker Partnership survey, a community-based participatory survey of African American women living on Detroit's east side (n = 343). We use longitudinal models to test the hypothesis that a change in everyday discrimination over time is associated with a change in self-reported symptoms of depression (positive) and on self-reported general health status (negative). Results. We found that a change over time in discrimination was significantly associated with a change over time in depressive symptoms (positive) (b = 0.125; P Conclusions. The results reported here are consistent with the hypothesis that everyday encounters with discrimination are causally associated with poor mental and physical health outcomes. In this sample of African American women, this association holds above and beyond the effects of income and education.

A study aims to determine the association of race with clinical and laboratory outcomes after initiation of highly active antiretroviral therapy (HAART) in HIV-1-infected women in the US. The results reveal that no significant differences by race are found in virologic, immunologic, or clinical outcomes after adjustment for continued HAART use and depression.

There is increasing evidence of an association between stress related to job strain and hypertension. However little data exist on stress from racism and race-based discrimination at work (RBDW). The objective of this study was to investigate whether blood pressure (BP) outcomes are positively associated with stressful racism towards African--Americans from non-African-Americans as well as RBDW from other African-Americans. The metro Atlanta heart disease study was a population-based study which included 356 African-American men and women, aged [greater than or equal to] 21 years, residing in metropolitan Atlanta, Georgia during 1999-2001. Perceived stress was self-reported by 197 participants for racism from non-African-Americans and 95 for RBDW from other Africa-Americans. Sitting systolic (SBP) and diastolic (DBP) BP were taken at a clinic visit and was the average of the last two of three BP measures. Hypertension was self-reported as physician-diagnosed high BP on 2 or more visits. Logistic and least-squares linear regression models were fit accordingly and separately for each type of stress, adjusting for age, gender, body mass index, and coping abilities. The likelihood of hypertension significantly increased with higher levels of perceived stress following racism from non-African-Americans, but not from RBDW from other African Americans; adjusted odd ratios (95% CI) were 1.4 (1.0, 1.9) and 1.2 (0.8, 1.5) per unit increment of stress. The adjusted magnitude of SBP and DBP increase between low and very high level of stress, conversely, was greater when RBDW originated from African-Americans than racism from non-African-Americans. Stressful racism and RBDW encounters are associated with increased SBP and DBP and increased likelihood of hypertension in African-Americans. Future studies with a larger sample size are warranted to further explore these findings for mechanistic understanding and occupational policy consideration regarding stress risk reduction. Keywords: Intra-group discrimination; Inter/between-group racism/discrimination; Perceived stress; Hypertension: Blood pressure; Worksite; USA

This study examines the direct and indirect relationships among racial identity, racial discrimination, perceived stress, and psychological distress in a sample of 555 African American young adults. A prospective study design was used to assess the influence of two dimensions of racial identity attitudes (i.e., centrality and public regard) on other study variables to investigate the relationship between racial identity attitudes and psychological distress. The results show some evidence of a direct relationship between racial centrality and psychological distress, as well as evidence of indirect relationships for both centrality and public regard through the impact of racial discrimination and perceived stress. In addition, racial centrality was both a risk factor for experiencing discrimination and a protective factor in buffering the negative impact of discrimination on psychological distress. Results are discussed within the context of identifying multiple pathways to psychological well-being for African American young adults within the context of racial discrimination.

There is a well-documented legacy of racial discrimination toward African Americans in medical research and clinical settings. Perhaps most notably, the 1932 U.S. Public Health Service Tuskegee Syphilis Study on […]

Objectives. This study examined whether individual (self-perceived) and institutional (segregation and redlining) racial discrimination was associated with poor health status among members of an ethnic group. Methods. Adult respondents (n = 1503) in the cross-sectional Chinese American Psychiatric Epidemiologic Study were geocoded to the 1990 census and the 1995 Home Mortgage Disclosure Act database. Hierarchical linear modeling assessed the relationship between discrimination and scores on the Medical Outcomes Study Short-Form 36 and revised Symptom Checklist 90 health status measures. Results. Individual and institutional measures of racial discrimination were associated with health status after control for acculturation, sex, age, social support, income, health insurance, employment status, education, neighborhood poverty, and housing value. Conclusions. The data support the hypothesis that discrimination at multiple levels influences the health of minority group members.

This paper examines the relationships among perceived racial discrimination, coping resources, and psychological distress experienced by 372 ethnic Chinese migrants in 3 Australian cities, within the social context of ongoing debates on Asian immigration. Based on the stress--coping--strain framework, it was expected that migrants' recent increases in psychological distress would be associated with greater perceived racial discrimination, and lower levels of coping resources. Possible moderating effects of coping resources were examined. Hierarchical regression analyses provided broad support for the stress--coping--strain framework, and indicated direct effects of low personal and ethnic self-esteem and having a small number of Anglo-Australian friends on increased psychological distress. The findings are discussed with regard to implications for migrants' well-being in the context of sociopolitical debates.

This article discusses the relationship between race discrimination, high blood pressure, and cardiovascular health.