Health researchers have investigated the association between racial segregation and racial health disparities with multilevel approaches. This study systematically reviews these multilevel studies and identifies broad trends and potential directions for future research on racial segregation and health disparities in the US. After searching databases including CINAHL and MEDLINE, we systematically reviewed 66 articles published between 2003 and 2019 and found four major gaps in racial/ethnic segregation and health disparities: (a) the concept of segregation was rarely operationalized at the neighborhood level, (b) except for the evenness and exposure dimension, other dimensions of segregation are overlooked, (c) little attention was paid to the segregation between whites and non‐black minorities, particularly Hispanics and Asians, and (d) mental health outcomes were largely absent. Future directions and opportunities include: First, other segregation dimensions should be explored. Second, the spatial scales for segregation measures should be clarified. Third, the theoretical frameworks for black and non‐black minorities should be tested. Fourth, mental health, substance use, and the use of mental health care should be examined. Fifth, the long‐term health effect of segregation has to be investigated, and finally, other competing explanations for why segregation matters at the neighborhood level should be answered.
Little research investigates whether sleep mediates the adverse effect of perceived discrimination on health and even less is known about whether sleep quality and sleep duration mediate the relationships in the same fashion. We applied a recently developed mediation analysis approach to a survey administered in 2008 in Philadelphia, PA, that includes 9042 adults. Health was measured with self-rated health, stress, and mental illness. Perceived discrimination was operationalized with self-reported discriminatory experience in two social contexts, namely health care system and housing market. Sleep quality and duration were measured with a five-point Likert scale and the self-reported sleep time at night, respectively. After controlling for one's demographic, socioeconomic, and health-related characteristics, the mediation analysis quantified how much sleep quality and duration can account for the effect of perceived discrimination on these health outcomes. The key findings are: (a) sleep quality and duration accounted for approximately 15 to 25% of the adverse effect of perceived discrimination. (b) Sleep quality is more important than sleep duration in mediating the relationship between perceived discrimination and health. (c) The proportion of the effect mediated by sleep differs by the social context where perceived discrimination occurred. It was confirmed that sleep mediates the relationship between perceived discrimination and health and the interventions to improve sleep, particularly sleep quality, should help to attenuate the effect of perceived discrimination on health.
Using the National Longitudinal Surveys of Youth 1979, this study examines the roles of alcohol and substance use as mediators in the mechanism between self-esteem and depression, and investigates whether the mechanism works for both men and women. Results demonstrate that alcohol and substance use during young adulthood mediates the effect of self-esteem on depression among men. Furthermore, self-esteem during young adulthood remains a determinant of high depression in middle adulthood. However, we did not find evidence to support that same mechanism among women. Our findings provide insight into how self-esteem affects depression over the transition from young to middle adulthood, and elucidate potential gendered responsivity to low self-esteem.
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