The pathways from perceived discrimination to self-rated health: An investigation of the roles of distrust, social capital, and health behaviors

Abstract

Although there has been extensive research on the adverse impacts of perceived discrimination on health, it remains unclear how perceived discrimination gets under the skin. This paper develops a comprehensive structural equation model (SEM) by incorporating both the direct effects of perceived discrimination on self-rated health (SRH), a powerful predictor for many health outcomes, and the indirect effects of perceived discrimination on SRH through health care system distrust, neighborhood social capital, and health behaviors and health conditions. Applying SEM to 9,880 adults (aged between 18 and 100) in the 2008 Southeastern Pennsylvania Household Health Survey, we not only confirmed the positive and direct association between discrimination and poor or fair SRH, but also verified two underlying mechanisms: 1) perceived discrimination is associated with lower neighborhood social capital, which further contributes to poor or fair SRH; and 2) perceived discrimination is related to risky behaviors (e.g., reduced physical activity and sleep quality, and intensified smoking) that lead to worse health conditions, and then result in poor or fair SRH. Moreover, we found that perceived discrimination is negatively associated with health care system distrust, but did not find a significant relationship between distrust and poor or fair SRH.

Treating Tobacco Dependence at the Intersection of Diversity, Poverty, and Mental Illness: A Randomized Feasibility and Replication Trial

“…Unrelated to abstinence were measures of income, employment status, housing stability, nicotine dependence, mental health, and racial discrimination. Prior studies have supported the link between discrimination experiences, nicotine dependence and heavier smoking, [56][57][58] and Kendzor and colleagues 59 found a greater number of racial discrimination experiences predicted lower tobacco abstinence among treatment seeking Latinos; however, Fagerström Test of Cigarette Dependence and cigarettes per day were not associated with discrimination in our sample.…”

Social determinants and health behaviors: conceptual frames and empirical advances

“…Example investigations include discrimination and social resistance [78, 79], emotions and stress [80, 81], and cognitive processes such as decision-making and framing [82]. Attempts to incorporate feedback processes conceptually and methodologically are growing [83, 84], as are efforts to address the challenges of causality [85].…”

The Relation Between Discrimination, Sense of Coherence and Health Varies According to Ethnicity: A Study Among Three Distinct Populations in Israel

“…Ethnicity-discrimination and ethnicity-SOC interaction terms were included to assess moderation. All models controlled for demographic variables mentioned above and all regression procedures were performed using the PROCESS macro in SPSS (11).…”

“…The strongest and most consistent findings show a negative association between perceived discrimination and mental health and self-rated health in oppressed racial groups [1][2][3][4][5]. Discrimination is suggested to be a stressor among individuals that experience discrimination [6] and this may increase use of addictive substances [7][8][9], may influence risk behaviors, prevent lifestyle changes and increase prevalence of hypertension [10][11][12]. Furthermore, in a study measuring the length of telomeres (repetitive DNA sequences that protect the end of the chromosome and shorten with every replication, the shorter they are the shorter life expectancy is), it was demonstrated that those reporting higher rates of discrimination had shorter telomeres suggesting discrimination may affect health by accelerating biological aging [13].…”