We found evidence that racial inequalities in health exist across a range of biological systems among adults and are not explained by racial differences in poverty. The weathering effects of living in a race-conscious society may be greatest among those Blacks most likely to engage in high-effort coping.

Although racial/ethnic disparities in health have been well-characterized in biomedical, public health, and social science research, the determinants of these disparities are still not well-understood. Chronic psychosocial stress related specifically to the American experience of institutional and interpersonal racial discrimination may be an important determinant of these disparities, as a growing literature in separate scientific disciplines documents the adverse health effects of stress and the greater levels of stress experienced by non-White compared to White Americans. However, the empirical literature on the importance of stress for health and health disparities specifically due to racial discrimination, using population-representative data, is still small and mixed. In this paper, we explore the association between a novel measure of racially-salient chronic stress – “racism-related vigilance” – and sleep difficulty. We found that, compared to the White adults in our sample, Black (but not Hispanic) adults reported greater levels of vigilance. This vigilance was positively associated with sleep difficulty to similar degrees for all racial/ethnic groups in our sample (White, Black, Hispanic). Black adults reported greater levels of sleep difficulty compared to White adults. This disparity was slightly attenuated after adjustment for education and income. However, this disparity was completely attenuated after adjustment for racism-related vigilance. We found similar patterns of results for Hispanic compared to White adults, however, the disparities in sleep difficulty were smaller and not statistically significant. Because of the importance of sleep quality to health, our results suggest that the anticipation of and perseveration about racial discrimination is an important determinant of racial disparities in health.

We hypothesize that black women experience accelerated biological aging in response to repeated or prolonged adaptation to subjective and objective stressors. Drawing on stress physiology and ethnographic, social science, and public health literature, we lay out the rationale for this hypothesis. We also perform a first population-based test of its plausibility, focusing on telomere length, a biomeasure of aging that may be shortened by stressors. Analyzing data from the Study of Women's Health Across the Nation (SWAN), we estimate that at ages 49-55, black women are 7.5 years biologically "older" than white women. Indicators of perceived stress and poverty account for 27% of this difference. Data limitations preclude assessing objective stressors and also result in imprecise estimates, limiting our ability to draw firm inferences. Further investigation of black-white differences in telomere length using large-population-based samples of broad age range and with detailed measures of environmental stressors is merited.Correspondence to: Arline T. Geronimus, arline@umich.edu. NIH Public Access Author ManuscriptHum Nat. Author manuscript; available in PMC 2011 March 10. Despite overall gains in active life expectancy and efforts to reduce health disparities in the United States, black-white and socioeconomic inequalities in life expectancy and the prevalence of chronic disease persist (Flegal et al. 2002;Geronimus et al. 1996;Levine et al. 2001;Mokdad et al. 2001;Wong et al. 2002). These health disadvantages are severe among African Americans. More troubling still, some evidence suggests that black health disadvantages worsened after the early 1990s, especially among women. In some high-poverty localities, excess mortality rates increased among black women residents between 1990 and 2000, largely due to deaths attributed to chronic disease (Geronimus et al. 2008). Yet another example, estimates using data from the National Health and Nutrition Examination Surveys III (1988 and IV (1999IV ( -2002 show that hypertension prevalence rates grew in nonelderly black adults nationwide between the two survey waves, both absolutely and relative to whites (Geronimus et al. 2007). The entrenchment and, in some cases, worsening of black health disadvantages occurred across a wide range of health outcomes and during a period when the reduction or elimination of health disparities was identified as a high-priority national health objective. The clear failure to meet this objective suggests that future success may require new conceptual models and deepening understandings of the sources and mechanisms leading to health disparities. 1 The age dimension of black-white health disadvantages may provide key insights. For example, in the case cited above, black women in young through middle adulthood experienced the steepest increase with age in the probability of being hypertensive, even net of excess obesity rates among US black relative to white women. More broadly, the most pronounced differences in health between US bla...

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Objectives We investigated the association between anticipatory stress, also known as racism-related vigilance, and hypertension prevalence in Black, Hispanic, and White adults. Methods We used data from the Chicago Community Adult Health Study, a population-representative sample of adults (n=3105) surveyed in 2001 to 2003, to regress hypertension prevalence on the interaction between race/ethnicity and vigilance in logit models. Results Blacks reported the highest vigilance levels. For Blacks, each unit increase in vigilance (range=0–12) was associated with a 4% increase in the odds of hypertension (odds ratio [OR]=1.04; 95% confidence interval [CI]=1.00, 1.09). Hispanics showed a similar but nonsignificant association (OR=1.05; 95% CI=0.99, 1.12), and Whites showed no association (OR=0.95; 95% CI=0.87, 1.03). Conclusions Vigilance may represent an important and unique source of chronic stress that contributes to the well-documented higher prevalence of hypertension among Blacks than Whites; it is a possible contributor to hypertension among Hispanics but not Whites.

In the United States, racial/ethnic inequalities in obesity are well-documented, particularly among women. Using the Chicago Community Adult Health Study, a probability-based sample in 2001–2003 (N=3,105), we examined the roles of discrimination and vigilance in racial inequalities in two weight-related measures, body mass index (BMI) and waist circumference (WC), viewed through a cultural racism lens. Cultural racism creates a social environment in which Black Americans bear the stigma burden of their racial group while White Americans are allowed to view themselves as individuals. We propose that in this context, interpersonal discrimination holds a different meaning for Blacks and Whites, while vigilance captures the coping style for Blacks who carry the stigma burden of the racial group. By placing discrimination and vigilance within the context of cultural racism, we operationalize existing survey measures and utilize statistical models to clarify the ambiguous associations between discrimination and weight-related inequalities in the extant literature. Multivariate models were estimated for BMI and WC separately and were stratified by gender. Black women had higher mean BMI and WC than any other group, as well as highest levels of vigilance. White women did not show an association between vigilance and WC but did show a strong positive association between discrimination and WC. Conversely, Black women displayed an association between vigilance and WC, but not between discrimination and WC. These results demonstrate that vigilance and discrimination may hold different meanings for obesity by ethnoracial group that are concealed when all women are examined together and viewed without considering a cultural racism lens.

In just the last forty years, imprisonment has been transformed from an event experienced by only the most marginalized to a common stage in the life course of American men—especially Black men with low levels of educational attainment. Although much research considers the causes of the prison boom and how the massive uptick in imprisonment has shaped crime rates and the life course of the men who experience imprisonment, in recent years, researchers have gained a keen interest in the spillover effects of mass imprisonment on families, children, and neighborhoods. Unfortunately, although this new wave of research documents the generally harmful effects of having a family member or loved one incarcerated, it remains unclear how much the prison boom shapes social inequality through these spillover effects because we lack precise estimates of the racial inequality in connectedness—through friends, family, and neighbors—to prisoners. Using the 2006 General Social Survey, we fill this pressing research gap by providing national estimates of connectedness to prisoners—defined in this article as knowing someone who is currently imprisoned, having a family member who is currently imprisoned, having someone you trust who is currently imprisoned, or having someone you know from your neighborhood who is currently imprisoned—for Black and White men and women. Most provocatively, we show that 44% of Black women (and 32% of Black men) but only 12% of White women (and 6% of White men) have a family member imprisoned. This means that about one in four women in the United States currently has a family member in prison. Given these high rates of connectedness to prisoners and the vast racial inequality in them, it is likely that mass imprisonment has fundamentally reshaped inequality not only for the adult men for whom imprisonment has become common, but also for their friends and families.

Why do racial inequalities endure despite numerous attempts to expand civil rights in certain sectors? A major reason for this endurance is due to lack of attention to structural racism. Although structural and institutional racism are often conflated, they are not the same. Herein, we provide an analogy of a “bucky ball” (Buckminster­fullerene) to distinguish the two concepts. Structural racism is a system of intercon­nected institutions that operate with a set of racialized rules that maintain White supremacy. These connections and rules al­low racism to reinvent itself into new forms and persist, despite civil rights interventions directed at specific institutions. To illustrate these ideas, we provide examples from the fields of environmental justice, criminal justice, and medicine. Racial inequities in power and health will persist until we redi­rect our gaze away from specific institutions (and specific individuals), and instead focus on the resilient connections among institu­tions and their racialized rules.Ethn Dis. 2021;31(Suppl 1):293-300; doi:10.18865/ed.31.S1.293