Elizabeth Brondolo

Coping with racism: a selective review of the literature and a theoretical and methodological critique

Racism is a stressor that contributes to racial/ethnic disparities in mental and physical health and to variations in these outcomes within racial and ethnic minority groups. The aim of this paper is to identify and discuss key issues in the study of individual-level strategies for coping with interpersonal racism. We begin with a discussion of the ways in which racism acts as a stressor and requires the mobilization of coping resources. Next, we examine available models for describing and conceptualizing strategies for coping with racism. Third, we discuss three major forms of coping: racial identity development, social support seeking and anger suppression and expression. We examine empirical support for the role of these coping strategies in buffering the impact of racism on specific health-related outcomes, including mental health (i.e., specifically, self-reported psychological distress and depressive symptoms), self-reported physical health, resting blood pressure levels, and cardiovascular reactivity to stressors. Careful examination of the effectiveness of individual-level coping strategies can guide future interventions on both the individual and community levels.

Perceived racism and blood pressure: a review of the literature and conceptual and methodological critique.

Racial disparities in health, including elevated rates of hypertension (HT) among Blacks, are widely recognized and a matter of serious concern. Researchers have hypothesized that social stress, and in particular exposure to racism, may account for some of the between-group differences in the prevalence of HT and a portion of the within-group variations in risk for HT However, there have been surprisingly few empirical studies of the relationship between perceived racism and blood pressure (BP) or cardiovascular reactivity (CVR), a possible marker of mechanisms culminating in cardiovascular disease. This article reviews published literature investigating the relationship of perceived racismto HT-relatedvariables, including self-reported history of HT, BP level, or CVR. Strengths andweaknesses of the existing research are discussed to permit the identification of research areas that may elucidate the biopsychosocial mechanisms potentially linking racism to HT We hope to encourage investigators to invest in research on the health effects of racism because a sound and detailed knowledge base in this area is necessary to address racial disparities in health.

Race, racism and health: disparities, mechanisms, and interventions

The goals of this special section are to examine the state-of-the-science regarding race/ethnicity and racism as they contribute to health disparities and to articulate a research agenda to guide future research. In the first paper, Myers presents an integrative theoretical framework for understanding how racism, poverty, and other major stressors relate to health through inter-related psychosocial and bio-behavioral pathways. Williams and Mohammed review the evidence concerning associations between racism and health, addressing the multiple levels at which racism can operate and commenting on important methodological issues. Klonoff provides a review and update of the literature concerning ethnicity-related disparities in healthcare, and addresses factors that may contribute to these disparities. Brondolo and colleagues consider racism from a stress and coping perspective, and review the literature concerning racial identity, anger coping, and social support as potential moderators of the racism-health association. Finally, Castro and colleagues describe an ecodevelopmental model that can serve as an integrative framework to examine multi-level social–cultural influences on health and health behavior. In aggregate, the special section papers address theoretical and methodological issues central to understanding the determinants of health disparities, with the aim of providing direction for future research critical to developing effective interventions to reduce these disparities.

A Life Course Perspective on How Racism May Be Related to Health Inequities

Recent studies show that racism may influence health inequities. As individuals grow from infancy into old age, they encounter social institutions that may create new exposures to racial bias. Yet, few studies have considered this idea fully. We suggest a framework that shows how racism and health inequities may be viewed from a life course perspective. It applies the ideas of age-patterned exposures, sensitive periods, linked lives, latency period, stress proliferation, historic period, and cohorts. It suggests an overarching idea that racism can structure ones time in asset-building contexts (e.g., education) or disadvantaged contexts (e.g., prison). This variation in time and exposure can contribute to racial inequities in life expectancy and other health outcomes across the life course and over generations.

Racism and ambulatory blood pressure in a community sample.

Objective: Racism has been identified as a psychosocial stressor that may contribute to disparities in the prevalence of cardiovascular disease. The goal of the present article was to investigate the relationship of perceived racism to ambulatory blood pressure (ABP) in a sample of American-born Blacks and Latinos. Methods: Participants included English-speaking Black or Latino(a) adults between the ages of 24 and 65. They completed daily mood diaries and measures of perceived racism, socioeconomic status, and hostility. Participants were outfitted with ABP monitors; 357 provided data on waking hours only, and 245 provided data on both waking and nocturnal ABP. Results: Perceived racism was positively associated with nocturnal ABP even when controlling for personality factors and socioeconomic status. Conclusions: The results suggest that racism may influence cardiovascular disease risk through its effects on nocturnal BP recovery. ABP = ambulatory blood pressure; SBP = systolic blood pressure; DBP = diastolic blood pressure; CVD = cardiovascular disease; SES = socioeconomic status; HTN = hypertension; AHA = American Heart Association; GHI = gross household income; BMI = body mass index; PEDQ-CV = Perceived Ethnic Discrimination Questionnaire-Community Version.

Racism and Hypertension: A Review of the Empirical Evidence and Implications for Clinical Practice

BACKGROUND Despite improved hypertension (HTN) awareness and treatment, racial disparities in HTN prevalence persist. An understanding of the biopsychosocial determinants of HTN is necessary to address racial disparities in the prevalence of HTN. This review examines the evidence directly and indirectly linking multiple levels of racism to HTN. METHODS Published empirical research in EBSCO databases investigating the relationships of three levels of racism (individual/interpersonal, internalized, and institutional racism) to HTN was reviewed. RESULTS Direct evidence linking individual/interpersonal racism to HTN diagnosis is weak. However, the relationship of individual/interpersonal racism to ambulatory blood pressure (ABP) is more consistent, with all published studies reporting a positive relationship of interpersonal racism to ABP. There is no direct evidence linking internalized racism to BP. Population-based studies provide some evidence linking institutional racism, in the forms of residential racial segregation (RRS) and incarceration, to HTN incidence. Racism shows associations to stress exposure and reactivity as well as associations to established HTN-related risk factors including obesity, low levels of physical activity and alcohol use. The effects vary by level of racism. CONCLUSIONS Overall the findings suggest that racism may increase risk for HTN; these effects emerge more clearly for institutional racism than for individual level racism. All levels of racism may influence the prevalence of HTN via stress exposure and reactivity and by fostering conditions that undermine health behaviors, raising the barriers to lifestyle change.

Cognitive-behavioral interventions improve quality of life in women with AIDS.

OBJECTIVE We tested the effects of a 10-week group-based cognitive-behavioral stress management/expressive-supportive therapy intervention (CBSM+) and a time-matched individual psychoeducational condition for 330 women with AIDS reporting moderate to poor baseline quality of life (QOL). The goal of this study was to examine treatment effects on total QOL and 11 QOL domains from baseline to post-intervention follow-up. METHODS Participants were assessed at baseline, randomized to a treatment condition (individual psychoeducation condition n=180, group-based CBSM+ condition n=150), participated in the intervention for 10 weeks and assessed again within 4 weeks following the intervention. QOL was measured using the Medical Outcomes Study-HIV-30. RESULTS QOL scores increased over the course of both interventions for the total QOL score and three QOL domains: cognitive functioning, health distress and overall health perceptions. While women in the CBSM+ group condition showed a significant improvement in mental health QOL from pre- to post-intervention, women in the individual condition did not change. No changes were observed for energy/fatigue, health transition, single-item overall QOL, pain, physical well-being, role functioning or social functioning in either condition. CONCLUSION Results suggest that group-based CBSM+ and individual psychoeducational interventions are effective at improving certain aspects of QOL and that group-based CBSM+ may be particularly effective at increasing QOL related to mental health in this population of women with AIDS.

Dimensions of perceived racism and self-reported health: examination of racial/ethnic differences and potential mediators.

BackgroundMany details of the negative relationship between perceived racial/ethnic discrimination and health are poorly understood.PurposeThe purpose of this study was to examine racial/ethnic differences in the relationship between perceived discrimination and self-reported health, identify dimensions of discrimination that drive this relationship, and explore psychological mediators.MethodsAsian, Black, and Latino(a) adults (N = 734) completed measures of perceived racial/ethnic discrimination, self-reported health, depression, anxiety, and cynical hostility.ResultsThe association between perceived discrimination and poor self-reported health was significant and did not differ across racial/ethnic subgroups. Race-related social exclusion and threat/harassment uniquely contributed to poor health for all groups. Depression, anxiety, and cynical hostility fully mediated the effect of social exclusion on health, but did not fully explain the effect of threat.ConclusionsOur results suggest that noxious effects of race-related exclusion and threat transcend between-group differences in discriminatory experiences. The effects of race-related exclusion and threat on health, however, may operate through different mechanisms.

Workplace Social Support and Ambulatory Cardiovascular Activity in New York City Traffic Agents

Objective This study examined the associations of social support from coworkers and supervisors to workday ambulatory blood pressure and heart rate. Specifically, analyses examined the association of work-related social support to the following measures: 1) baseline blood pressure and heart rate at the start of the workday, 2) blood pressure and heart rate during high stress periods, 3) blood pressure and heart rate levels throughout the workday. Methods Participants included male (N = 36) and female (N = 34) New York City Traffic Enforcement Agents. Mixed-model regression analyses were used to assess the effects of self-reported measures of workplace social support on workday ambulatory blood pressure. Results Workplace support was associated with workday ambulatory blood pressure levels, with the effects depending on the source of support and the gender of the participant. For women, immediate supervisor support was negatively associated with workday systolic blood pressure level, and a similar negative trend was found for workday diastolic blood pressure level. For men, coworker support was negatively associated with workday systolic blood pressure level. We found an interaction of social support with stress level (ie, baseline vs. high stress) such that immediate supervisor support was negatively associated with systolic blood pressure during high-stress conditions, but no effects were found under resting conditions. Conclusions These findings suggest that workplace social support is associated with workday ambulatory blood pressure, especially during stressful work periods.

The Effect of Aerobic Training and Cardiac Autonomic Regulation in Young Adults

OBJECTIVES We tested the effect of aerobic exercise on autonomic regulation of the heart in healthy young adults. METHODS Healthy, sedentary young adults (n = 149; age = 30.4 +/- 7.53 years) were randomized to receive 12 weeks of either aerobic conditioning or strength training. Primary outcomes were heart rate and RR interval variability (RRV) measured before and after training and after 4 weeks of sedentary deconditioning. RRV, a noninvasive index of cardiac autonomic regulation, reflects variability in the intervals between consecutive R waves of the electrocardiogram. RESULTS Aerobic conditioning but not strength training led to a significant increase in aerobic capacity (3.11 mL/kg/min), a decrease in heart rate (-3.49 beats per minute), and an increase in high-frequency RRV (0.25 natural log msec2), each of which returned to pretraining levels after deconditioning. Significant 3-way interactions, however, revealed autonomic effects only in men. CONCLUSIONS In sedentary, healthy young adults, aerobic conditioning but not strength training enhances autonomic control of the heart, but post hoc analyses suggested that gender plays a significant role in this exercise-related cardioprotection.