Racial differences in birth outcomes: The role of general, pregnancy, and racism stress.

Objective: This study examined the role of psychosocial stress in racial differences in birth outcomes. Design: Maternal health, sociodemographic factors, and 3 forms of stress (general stress, pregnancy stress, and perceived racism) were assessed prospectively in a sample of 51 African American and 73 non-Hispanic White pregnant women. Main Outcome Measures: The outcomes of interest were birth weight and gestational age at delivery. Only predictive models of birth weight were tested as the groups did not differ significantly in gestational age. Results: Perceived racism and indicators of general stress were correlated with birth weight and tested in regression analyses. In the sample as a whole, lifetime and childhood indicators of perceived racism predicted birth weight and attenuated racial differences, independent of medical and sociodemographic control variables. Models within each race group showed that perceived racism was a significant predictor of birth weight in African Americans, but not in non-Hispanic Whites. Conclusions: These findings provide further evidence that racism may play an important role in birth outcome disparities, and they are among the first to indicate the significance of psychosocial factors that occur early in the life course for these specific health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subjective, behavioral, and physiological reactivity to ethnically matched and ethnically mismatched film clips.

This study examined whether individuals from 4 major ethnic groups within the United States (African American, Chinese American, European American, and Mexican American) showed greater subjective, behavioral, and physiological responses to emotional film clips (amusement, sadness, and disgust) with actors from their own ethnic group (ethnically matched) compared with actors from the other 3 ethnic groups (ethnically mismatched). Evidence showed greater responsivity to ethnically matched films for African Americans and European Americans, with the largest effect for African Americans. These findings were consistent across both sex and level of cultural identification. Findings of ethnic difference notwithstanding, there were many areas in which ethnic differences were not found (e.g., little or no evidence was found of greater response to ethnically matched films in Chinese-American or Mexican- American participants). These findings indicate that the emotional response system clearly reacts to stimuli of diverse ethnic content; however, the system is also amenable to subtle "tuning" that allows for incrementally enhanced responding to members of one's own ethnic or cultural group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Severity of homelessness and adverse birth outcomes.

Predictors and the prevalence of adverse birth outcomes among 237 homeless women interviewed at 78 shelters and meal programs in Los Angeles in 1997 were assessed. It was hypothesized that they would report worse outcomes than national norms, that African Americans would report the worst outcomes because of their greater risk in the general population, and that homelessness severity would independently predict poorer outcomes beyond its association with other adverse conditions. Other predictors included reproductive history, behavioral and health-related variables, psychological trauma and distress, ethnicity, and income. African Americans and Hispanics reported worse outcomes than are found nationally, and African Americans reported the worst outcomes. In a predictive structural equation model, severity of homelessness significantly predicted low birth weight and preterm births beyond its relationship with prenatal care and other risk factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial and ethnic differences in determinants of intrauterine growth retardation and other compromised birth outcomes

OBJECTIVES: This study examined the extent of variation by race/ethnicity in the prevalence of adverse birth outcomes, whether differentials persisted after other risk factors were controlled for, and whether the direction and magnitude of relationships differed by type of outcome. METHODS: A revised system of measurement was used to estimate multinomial logistic models in a large, nationally representative US data set. RESULTS: Considerable racial/ethnic variation was found across birth outcome categories; differences persisted in the adjusted parameter estimates; and the effects of other risk factors on birth outcomes were similar as to direction, but varied somewhat in magnitude. The odds of compromised birth outcomes were much higher among African Americans than among Mexican Americans and non-Hispanic Whites. CONCLUSIONS: In addition to persistent racial inequality, we found strong adverse effects of both inadequate and "adequate-plus" prenatal care and smoking. Risk of intrauterine growth retardation was higher in the absence of medical insurance, and risk of all adverse birth outcomes was lower among mothers participating in the Special Supplemental Food Program for Women, Infants, and Children.     

Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women.

This study examined the association between a composite index of stress that included measures of life events, ongoing stress, discrimination, and economic hardship and subclinical carotid disease among 109 African American and 225 Caucasian premenopausal women. African Americans reported more chronic stress and had higher carotid intima-media thickness (IMT) as compared with Caucasians. Among African Americans only, the composite stress index and unfair treatment were associated with higher IMT. These effects were partially mediated by biological risk factors. African Americans who reported experiencing racial discrimination had marginally more carotid plaque than did those who did not report experiencing racial discrimination. The results suggest that African Americans may be particularly vulnerable to the burden of chronic stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Registered image subtraction for CT-, MR- and coronary angiography

The study described regional fat distribution and anthropometric variables in an ethnically diverse sample of women (N = 143) who were between 20 and 30 (premenopausal) or 40 and 50 (perimenopausal) yr of age and of normal weight for height. Measurements included 11 skinfolds (abdomen, biceps, calf, forearm, midaxillary, pectoral, subscapular, suprailiac, suprapatellar, thigh, and triceps), waist and hip circumferences, height and mass. Regional fat distribution for African American, Mexican American, and Caucasian women was described as gluteal femoral. African American women had the smallest waist-to-hip ratio, with larger absolute measures for both the waist and gluteal C than the Caucasians or Mexican Americans. Native American women had an abdominal fat distribution pattern which was explained by more fat on the abdomen rather than less fat on the gluteal-femoral area. Native Americans had a different fat distribution from the other ethnic groups. Caucasians are not a good comparison group for African Americans or Native Americans because there are large differences as indicated by effect sizes in regional fat distribution. Variation within the ethnic groups was larger than differences between the groups for most variables. The distribution within ethnic groups was biased by extreme scores; thus 50-70% of the subjects were similar regardless of ethnic group.     

American = White?

Six studies investigated the extent to which American ethnic groups (African, Asian, and White) are associated with the category "American." Although strong explicit commitments to egalitarian principles were expressed in Study 1, Studies 2-6 consistently revealed that both African and Asian Americans as groups are less associated with the national category "American" than are White Americans. Under some circumstances, a dissociation between mean levels of explicit beliefs and implicit responses emerged such that an ethnic minority was explicitly regarded to be more American than were White Americans, but implicit measures showed the reverse pattern (Studies 3 and 4). In addition, Asian American participants themselves showed the American = White effect, although African Americans did not (Study 5). The American = White association was positively correlated with the strength of national identity in White Americans. Together, these studies provide evidence that to be American is implicitly synonymous with being White. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of ethnic identity during adolescence.

The development of ethnic identity is a critical facet of adolescence, particularly for adolescents of color. In order to examine the developmental trajectory of ethnic identity, African American, Latino American, and European American early and middle adolescents (N=420) were assessed over 3 years. Two components of ethnic identity were assessed--group-esteem was found to rise for both early and middle adolescents; exploration rose for middle adolescents. African Americans and Latino Americans were lower in group-esteem but have greater increases than European Americans, particularly across a school transition. The course of ethnic identity development during early and middle adolescence, the role of school context, and the variability in developmental trajectories among racial and ethnic groups are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability and construct validity of the psychopathy checklist-revised for Latino, European American, and African American male inmates.

The utility of the psychopathy construct in predicting laboratory deficits, criminal behavior, response to intervention, and recidivism has been well documented in European American populations. However, less is known about the manifestation and correlates of psychopathy in Latino and African American populations. The present study examined the reliability and construct validity of the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 2003) in 83 Latino inmates compared with matched samples of African Americans and European Americans. Results provide preliminary evidence that the PCL-R provides a reliable and valid measure of psychopathy in Latinos, with generally similar patterns emerging across external correlates; however, some ethnic group differences were noted for relationships between psychopathy indicators and some external correlates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural differences in optimism, pessimism, and coping: Predictors of subsequent adjustment in Asian American and Caucasian American college students.

Cultural differences were examined between 111 Asian American and 111 Caucasian American students matched on age and sex in a prospective design study. Using separate optimism and pessimism scores, Asian Americans were found to be more pessimistic than Caucasian Americans. Asian Americans were also found to use more problem avoidance and social withdrawal coping strategies than Caucasian Americans. When health outcomes were assessed 6 weeks later, Asian Americans were found to report more depressive and psychological symptoms, but not more physical symptoms, than Caucasian Americans. Results of separate regression analyses for each ethnic group indicated that along with different coping strategies, lack of optimism predicted all 3 health outcomes for Asian Americans, whereas pessimism predicted 2 of the 3 health outcomes for Caucasian Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Future directions in studies of trauma among ethnoracial and sexual minority samples: Commentary.

Objective: Studies examining psychological trauma or posttraumatic stress disorder (PTSD) in ethnoracial or sexual minority groups are relatively few. The Journal of Consulting and Clinical Psychology recently published 4 articles (Balsam, Lehavot, Beadnall, & Circo, 2010; Harrington, Crowther, & Shipherd, 2010; Lester, Resick, Young-Xu, & Artz, 2010; Marshall, Schell, & Miles, 2009) that examine trauma exposure and posttraumatic outcomes in ethnoracial and sexual minority samples. This commentary focuses on the overlap between traumatic stress and diversity studies in order to consider future areas in need of development. Method: Within the framework of a generalized overview of current trends in the study of traumatic stress, an assessment of the strengths and limitations of these 4 articles is provided. Populations and syndromes covered by the articles include ethnoracial differences in child maltreatment and adverse mental health outcomes among sexual minority participants, PTSD symptom elevations among Hispanic Americans, binge eating and the strong Black woman schema, and retention of African American female participants in cognitive behavioral psychotherapy trials for PTSD. Results: Recommendations to enhance culturally competent traumatic stress studies include increasing the examination of within-group cultural variability and key social, contextual, and cultural variables and constructs; examining the temporal sequencing of traumatic events and key transitions in sexual and ethnic minority identity development; and conducting prevention and treatment studies for those sexual minority children most at risk for maltreatment. Conclusions: By following these recommendations, the next generation of studies of traumatic stress studies will be enhanced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of familism in stress and coping processes among African American and White dementia caregivers: Effects on mental and physical health.

Objective: To explore how familism, burden, and coping styles mediate the relationships between ethnicity and the mental and physical health of caregivers. Design: A probability sample of 65 White and 95 African Americans respondents caring for an older family member with dementia was used to test hypotheses from a sociocultural stress and coping model using path analysis. Main outcome measures: Measures of caregivers' health included subjective health, self-reported diseases, blood pressure, and heart rate. Mental health measures included self-reported depression and psychological symptoms. Results: Contrary to the hypothesis, familism had an adverse effect on outcomes and was related to low education levels rather than to African American ethnicity. A buffering effect of active coping between being African American and diastolic blood pressure was found even after controlling for levels of education. Conclusions: Findings supported a core stress and coping model in which more behavior problems of care recipients were associated with poorer mental health of caregivers via greater burden and more use of avoidant coping. Results also demonstrate that this core model can be extended to physical health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intimate partner violence and its effects on the health of African American HIV-positive women.

The medical outcomes of women infected with HIV are typically worse than those of HIV-positive men. HIV-positive women report high rates of intimate partner violence, and there is evidence that traumatic events have a negative impact on health status. In addition, African American women make up 1 of the fastest growing groups of HIV-positive individuals. Therefore, this study sought to examine the impact of intimate partner violence on HIV medication adherence, HIV-related physical health outcomes, and health-related quality of life in 40 HIV-positive African American women. The results were that women who had experienced intimate partner violence had worse HIV-related health as indicated by reduced CD4 counts and increased HIV viral load. In addition, posttraumatic stress disorder symptoms were related to both intimate partner violence and health-related quality of life. Lastly, HIV medication adherence mediated the relationships between intimate partner violence and the HIV-related health outcomes. Implications for further work and clinical interventions to address intimate partner violence, medication adherence, and health-related quality of life in this population are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnic and gender differences in risk factors for smoking onset.

The purpose of this investigation was to explore gender and ethnic differences in the prevalence of risk factors for smoking onset. As part of a larger study, 6,967 seventh graders completed a questionnaire measuring variables shown in previous research to predict cigarette smoking. The results indicated that at this age level, risk factors for smoking initiation are less prevalent among African Americans than European American youth and among girls relative to boys. These findings are consistent with the lower incidence of smoking among African Americans and girls at this young age. Future research should examine changes in risk factors over time to determine whether such changes accompany the rising smoking rate typically observed among girls and African Americans later in adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hepatic lipase activity is lower in African American men than in white American men: effects of 5' flanking polymorphism in the hepatic lipase gene (LIPC)

Plasma high density lipoprotein cholesterol (HDL-C) concentrations are higher in African American men than in white men, but the mechanism(s) responsible for this ethnic difference has not been elucidated. This study examined the relationship between hepatic lipase activity, plasma HDL-C concentrations, and a hepatic lipase polymorphism (-514T) in African American and white American men. Consistent with previous reports, plasma HDL-C concentrations were significantly higher in African American men than in white American men. Mean post-heparin plasma hepatic lipase activity was significantly lower in African American than in white American men (27 +/- 12 vs. 44 +/- 17 mmol x h(-1) x l(-1), P < 0.001). The -514T hepatic lipase allele was associated with low hepatic lipase activity in both populations, and was 3-fold more common among African Americans than white Americans. Taken together, these data suggest that genetic differences in hepatic lipase activity contribute to the differences in plasma HDL-C concentrations between African American men and white American men.     

What college students really think about ethnic student organizations.

In this study, the authors examined European, Hispanic, and African American college students' attitudes toward ethnic student organizations (ESOs). Based on data from Study 1 (N = 750), it was found that students across ethnic groups expressed uncertainty about whether ESOs were beneficial/necessary, fair/acceptable, and about their interest in joining an ESO. As a group, Hispanic and African American students did not believe that ESOs contributed to racial or ethnic separatism on campus, whereas European Americans expressed uncertainty about that possibility. In Study 2, a separate sample of students (N = 631) was randomly assigned to read the mission statement of a White, Hispanic, or African American ESO. Consistent with asymmetry theory, students in general judged the White American ESO as significantly less beneficial/necessary, less fair/acceptable, and as contributing more to racial/ethnic separatism than the Hispanic and African American ESOs. European, Hispanic, and African American students viewed their own ESO most favorably, although European American students were more consistent in their appraisals of ESOs irrespective of the ethnic focus of the ESO. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety psychopathology in African American adults: Literature review and development of an empirically informed sociocultural model.

In this review, the extant literature concerning anxiety psychopathology in African American adults is summarized to develop a testable, explanatory framework with implications for future research. The model was designed to account for purported lower rates of anxiety disorders in African Americans compared to European Americans, along with other ethnoracial differences reported in the literature. Three specific beliefs or attitudes related to the sociocultural experience of African Americans are identified: awareness of racism, stigma of mental illness, and salience of physical illnesses. In our model, we propose that these psychological processes influence interpretations and behaviors relevant to the expression of nonpathological anxiety as well as features of diagnosable anxiety conditions. Moreover, differences in these processes may explain the differential assessed rates of anxiety disorders in African Americans. The model is discussed in the context of existing models of anxiety etiology. Specific follow-up research is also suggested, along with implications for clinical assessment, diagnosis, and treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does one size fit all African American smokers? The moderating role of acculturation in culturally specific interventions.

There is a consensus that interventions for ethnic minority populations should be culturally specific (CS). A previous study found that although African American smokers indicated a preference for CS self-help materials over standard materials, several outcomes were superior for the standard information (Webb, 2008). The current study reports on a priori analyses that tested level of acculturation as a moderating variable for the efficacy of CS interventions in a sample of low-income African Americans. Participants (N = 182) completed the African American Acculturation Scale--Revised before receiving a CS smoking cessation guide or a standard guide. As hypothesized, level of acculturation predicted evaluations of the intervention content, readiness to quit smoking, and 24-hr point prevalence abstinence at the 3-month follow-up. Lower levels of acculturation (i.e., more engagement in traditional African American culture) predicted a preference for CS materials and greater readiness to quit smoking after receiving the CS guide. Yet, among participants who were less acculturated, 24-hr abstinence was greater after receiving the standard guide. Overall, these findings emphasize that individual differences in levels of acculturation to the dominant culture affect receptivity to CS written interventions. Intragroup differences should be considered prior to the provision of CS interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial discrimination and the stress process.

The unique and combined effects of chronic and daily racial discrimination on psychological distress were examined in a sample of 174 African American doctoral students and graduates. Using a daily process design, 5 models of the stress process were tested. Multilevel random coefficient modeling analyses revealed that chronic exposure to racial discrimination predicted greater daily discrimination and psychological distress. Further, results show that differences in daily discrimination and negative events accounted for meaningful variation in daily distress responses. Finally, findings indicate that daily discrimination and negative events mediated the relationship between chronic discrimination and psychological distress. The study provides support for the need to measure chronic strains as distinctive from daily stressors in the lives of African Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life stress, maternal optimism, and adolescent competence in single mother, African American families.

Although research demonstrates many negative family outcomes associated with single-parent households, little is known about processes that lead to positive outcomes for these families. Using 3 waves of longitudinal data, we examined how maternal dispositional optimism and life stressors are associated with parenting and child outcomes in 394 single mother African American families. Confirming prior research, we found that mothers' childhood adversities, current economic pressure, and internalizing problems were associated with lower levels of maternal warmth and child management and with lower child school competence. Extending previous studies, we found that maternal optimism was a positive resource, predicting lower levels of maternal internalizing symptoms and higher levels of effective child management and moderating the impact of economic stress on maternal internalizing problems. These findings highlight the need for further investigation of processes and resources that promote positive outcomes for African American mother-headed families and single mother families in general. (PsycINFO Database Record (c) 2010 APA, all rights reserved)