Racial discrimination, educational attainment, and biological dysregulation among midlife African American women

Abstract

Objective: To examine the association between self-reported racial discrimination and allostatic load, and whether the association differs by socioeconomic position. Methods: We recruited a purposive cross-section of midlife (ages 30–50) African American women residing in four San Francisco Bay area counties (n=208). Racial discrimination Was measured using the Experience of Discrimination scale. Allostatic load was measured as a comPosite of 15 biomarkers assessing cardiometabolic, neuroendocrine, and inflammatory activity. We calculated four composite measures of allostatic load and three system-specific measures of biological dysregulation. Multivariable regression was used to examine associations, while adjusting for relevant confounders. Results: In the high education group, reporting low (b=−1.09, P=.02, 95% CI=−1.99,−0.18) and very high (b=−1.88, P=.003, 95% CI=−3.11,−0.65) discrimination was associated with lower allostatic load (reference=moderate). Among those with lower education, reporting low (b=2.05, P=.008, 95% CI=0.55,3.56) discrimination was associated with higher allostatic load. Similar but less consistent associations were found for poverty status. Associations were similar for cardiometabolic functioning, but not for neuroendocrine or inflammatory activity. Conclusions: Racial discrimination may be an important predictor of cumulative physiologic dysregulation. Factors associated with educational attainment may mitigate this association for African American women and other groups experiencing chronic social stress.

Racial discrimination, the superwoman schema, and allostatic load: exploring an integrative stress‐coping model among African American women

“…First, we restricted our sample to AA women. We did this for several reasons: (1) to avoid conflating the racial discrimination experiences reported by AA women and white women, thus avoiding what scholars have noted as the incommensurability of measures across groups, which compromises internal validity; (2) to acknowledge the heterogeneity that exists among AA women both with respect to the experience of racial discrimination and the SWS, thereby avoiding the conventional practice of using averages to describe the experience of a heterogeneous group (i.e., common when examining differences between groups) and better isolating variability in the exposure of interest (i.e., providing a more appropriate counterfactual quantity); and (3) to avoid treating AAs as a monolith and instead use intersectionality as an analytic strategy to explore the unique experiences of AA women . Second, the cross‐sectional nature of this study and purposive sampling strategy preclude our ability to infer causality and generalize our study findings.…”

“…Data are from the African American Women's Heart & Health Study, an observational cross‐sectional study designed to examine associations between socioenvironmental stressors and mental and physical health among a community sample of midlife AA women residing in the San Francisco Bay area ( n = 208). The study design has been described in detail elsewhere . Briefly, purposive sampling was used to recruit a socioeconomically and geographically diverse sample of AA women from specific Bay area counties: Alameda, Contra Costa, San Francisco, and Solano.…”

“…Moreover, AA women report racial discrimination as a particularly salient and chronic psychosocial stressor over their lifecourse, and as distinct from other forms of unfair treatment . Previous research shows associations between racial discrimination and allostatic load among AA women . Accordingly, researchers have called for measuring racial discrimination as a particular form of SET, and considering intersectionality in both measuring and assessing the health effects of racism .…”

“…The strong black woman role/SWS develops over time starting early in life . Although psychological schemas are activated by situational cues, studies also suggest that (1) schemas can become stabilized over time and are activated not only as a result of situational cues but become enduring aspects of the “self” (i.e., dispositions) that are invariant across situations; (2) racial discrimination is a chronic stressor among AA women; (3) when salient and frequent, discrimination can make relevant schemas more accessible, resulting potentially in chronic accessibility or activation; and (4) schemas influence threat appraisals, which influence the biological stress response . Given our sample of midlife AA women, many of whom report having experienced frequent racial discrimination over their lifecourse, we hypothesize that one or more dimensions of the SWS can become relatively stable dispositions that moderate how racial discrimination affects allostatic load.…”

Coding the Everyday Discrimination Scale: implications for exposure assessment and associations with hypertension and depression among a cross section of mid-life African American women

“…Study procedures are described in detail elsewhere 29. Briefly, we used purposive sampling to maximise heterogeneity of sociodemographic factors and risk of experiencing racial discrimination.…”