Differential Impacts of Routine vs. Non-routine ...

Differential Impacts of Routine vs. Non-routine Experiences of Racial Discrimination on Allostatic Load Among African American Women Marilyn Thomas, Elizabeth Michaels, Alexis Reeves, Uche Okoye, Melisa Price, Rebecca Hasson, David Chae, Amani Nuru-Jeter

University of California, Berkeley School of Public Health

Allostatic Load

(McEwen, 1983)

(McEwen, 2007)

Study Aim & Hypothesis • Study

Aim: To compare EDS and EOD and assess whether they show similar or differing associations with Allostatic Load (AL)

• Hypothesis:

Variations in AL levels will emerge between the EDS and EOD scales

African American Women’s Heart & Health Study •

Cross-section of 208 African American women aged 30-50 in SF Bay Area

•

Purposive sampling & targeted recruitment

Two Visits: 1) Interviewer-administered questionnaire & computer-assisted self-interview 2) Physical examination & venous blood-draw •

Discrimination Scales Scale

Experiences of Discrimination Scale (EOD)

Never

Likert Scale

Items Categories

Everyday Discrimination Scale (EDS)

Never

Less than once a year

Once

A few times a year

2-3 times

A few times a month

4-5 times

At least once a week

6+ times

Almost everyday

8 items (score range 8-40)

10 items (score range 10-60)

Very low, Low, Moderate, High, Very high

Note: EDSα= 0.95; EOD α= 0.92; Both scales have been validated among AA women

Allostatic Load Measurement Biomarker

Allostatic Load Cutpoint

Metabolic System HDL (mg/dL) LDL (mg/dL) Waist Circumference (in) Glucose (mg/dL) HbA1c (mmol/mol) Total Cholesterol (mg/dL) Triglycerides (mg/dL) Body Mass Index (kg/m2)

35 ≥ 100 or 77.70 >686.30

Inflammatory System Il-6 (pg/mL) hsCRP (mg/L)

>7.85 >3

Limitation

Strength

Limited generalizability

Sample demographics similar to demographics of AA women in same counties

Clinical guidelines not available for all biomarkers

Most subclinical cutpoints were about at the 75th percentile; minimal misclassification

Reporting bias

Self-administered questionnaire reduces social desirability bias

Contributions to the Literature • First

study, to our knowledge, to explicitly examine the health impacts of differential measurement of racial discrimination

• Facilitated by a within-group study  Exposure heterogeneity  Race is not a proxy for racism  Intersectionality • Possible

design

implications for intervening on different dimensions of racial discrimination and health

Acknowledgements Funders: • Robert Wood Johnson Foundation • The University of California Center for New Racial Studies • UC Berkeley Institute for the Study of Societal Issues, Population Center • Hellman Faculty Fund • Research Bridging Grant • We also acknowledge the generous support of the UC Berkeley Experimental Social Science Laboratory (X-lab)

Thanks for listening!

Special Recognition: • The HEART Research Group  Marilyn Thomas, MPH  Alexis Reeves, MPHc  Uche Okoye, BA  A very special thank you to our fabulous mentor: Dr. Amani Nuru-Jeter, PhD •

• •

Co-authors: Dr. David Chae, Rebecca Hasson, Melissa Price, and Uche Okoye Berkeley Center for Social Medicine UC Berkeley Institute for the Study of Societal Issues

References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 1. 11. 12. 13. 14. 15.

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