572456 research-article2015
HPQ0010.1177/1359105315572456Journal of Health PsychologyEarnshaw et al.
Article
Everyday discrimination and physical health: Exploring mental health processes
Journal of Health Psychology 1–11 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1359105315572456 hpq.sagepub.com
Valerie A Earnshaw1,2,3, Lisa Rosenthal1,4, Amy Carroll-Scott1,5, Alycia Santilli1, Kathryn GilstadHayden1 and Jeannette R Ickovics1
Abstract Goals of this study were to examine the mental health processes whereby everyday discrimination is associated with physical health outcomes. Data are drawn from a community health survey conducted with 1299 US adults in a low-resource urban area. Frequency of everyday discrimination was associated with overall self-rated health, use of the emergency department, and one or more chronic diseases via stress and depressive symptoms operating in serial mediation. Associations were consistent across members of different racial/ethnic groups and were observed even after controlling for indicators of stressors associated with structural discrimination, including perceived neighborhood unsafety, food insecurity, and financial stress.
Keywords depressive symptoms, everyday discrimination, health, stress, structural discrimination
Introduction Discrimination adversely affects health (Pascoe and Smart Richman, 2009; Williams and Mohammed, 2008). Results from cross-sectional, longitudinal, and experimental studies demonstrate that discrimination is associated with a wide range of poor physical and mental health outcomes (Williams and Mohammed, 2008). Discrimination is associated with worse overall self-rated health (Harris et al., 2006; Schulz et al., 2006) and higher risk of chronic disease incidence (e.g. respiratory, cardiovascular, and pain conditions; Gee et al., 2007). It is also associated with specific diseases (e.g. cardiovascular and respiratory conditions; Gee et al., 2007) and behaviors (e.g. substance use,
violence; Borrell et al., 2007; Romero et al., 2007; Simmons et al., 2006) that increase risk of urgent health problems requiring emergency department visits (Centers for Disease Control
1Yale
School of Public Health, USA Medical School, USA 3Boston Children’s Hospital, USA 4Pace University, USA 5Drexel School of Public Health, USA 2Harvard
Corresponding author: Valerie A Earnshaw, Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 21 Autumn Street Room 212.1, Boston, MA 02115, USA. Email: [email protected]
Downloaded from hpq.sagepub.com at CMU Libraries - library.cmich.edu on September 28, 2015
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Journal of Health Psychology
and Prevention, 2010). Moreover, discrimination is associated with depressive symptoms (Banks et al., 2006; Brody et al., 2006; Steffen and Bowden, 2006) and stress (Pascoe and Smart Richman, 2009). Everyday discrimination— involving chronic yet subtle mistreatment due to a socially devalued characteristic (e.g. race, weight, low income)—is pervasive and theorized to play a powerful role in creating and maintaining the substantial health disparities observed in the United States (Essed, 1991; Williams et al., 2003; Williams and Mohammed, 2008). Despite the wealth of evidence demonstrating harmful associations between discrimination and health, significant gaps in understanding of these associations have been highlighted. Williams and Mohammed (2008) emphasize the importance of understanding the processes whereby discrimination relates to physical health, which may provide insight into how to intervene. We examined the mental health processes through which everyday discrimination is associated with indicators of general, emergency, and chronic health among a sample of mostly Black residents of a low-income urban area in the United States.
The mediating roles of stress and depressive symptoms Stress and depressive symptoms appear to play important roles in the process whereby everyday discrimination is associated with physical health. Experimental studies demonstrate that experiences of discrimination elicit both physiological (e.g. cardiovascular reactivity) and psychological (e.g. perceived stress) stress responses (Pascoe and Smart Richman, 2009). Stress responses, in turn, impact a range of chronic and acute physical health conditions (Pearlin et al., 2005; Williams et al., 1997, 2003; Williams and Mohammed, 2008). Everyday discrimination is also associated with depression and depressive symptoms (Pascoe and Smart Richman, 2009; Williams et al., 2003). Carter’s model of Race-Based Traumatic Stress Injury suggests that accumulated experiences of stress resulting from discrimination may lead to
greater depressive symptoms over time (Carter, 2007). Longitudinal evidence demonstrates that people who experience stress subsequently experience greater depressive symptoms (Kessler, 1997). Depressive symptoms, in turn, are associated with poor physical health in part via changes in physiological (e.g. cellular immunity; Herbert and Cohen, 1993) and behavioral (e.g. physical activity; Ruo et al., 2003; Whooley et al., 2008) activity.
This study We hypothesize that greater frequency of everyday discrimination is associated with greater stress, which in turn is associated with greater depressive symptoms, and which in turn are associated with worse physical health. That is, we expect a serial mediation model linking everyday discrimination with poorer physical health outcomes, including indicators of general, emergency, and chronic health. Williams and Mohammed (2008) note that experiences of everyday discrimination at the individual level are merely one way in which discrimination generates stress and poor health. At the structural level, residential segregation, a legacy of institutionalized discrimination in residential contexts, exposes individuals to ongoing violence and results in chronic safety concerns (Williams and Collins, 2001; Williams and Mohammed, 2008). Economic hardship, a lasting effect of institutionalized discrimination in employment contexts, further leads to financial stress and food insecurity. We control for perceived neighborhood unsafety, food insecurity, and financial stress in all analyses to better understand the unique contribution of everyday discrimination to poor health outcomes amidst these stressors associated with structural discrimination.
Methods Participants and procedure Health and behavior surveys were conducted with adults aged 18–65 years living in six low-income neighborhoods in New Haven, Connecticut, in the
Downloaded from hpq.sagepub.com at CMU Libraries - library.cmich.edu on September 28, 2015
3
Earnshaw et al. fall of 2012. Households were randomized from a complete list of addresses provided by the City of New Haven. Randomly selected addresses were approached three times until (1) an eligible resident answered and consented to be surveyed, (2) an eligible resident answered and refused, or (3) no one answered. If the survey was not conducted, another address was selected and approached. Surveys were administered by locally hired and trained residents, lasted 20–30 minutes, and were collected via handheld computers. Participants received a US$10 grocery gift card and entry into a US$500 raffle. Participants included 1299 adults (73% response rate) who were older and more likely to be women and Black than neighborhood residents as a whole. During the time of data collection, structural interventions designed to improve community health were being implemented in several neighborhoods. All procedures received ethics approval.
Measures Participants answered questions about sociodemographic and other characteristics related to health and behavior. Socio-demographic characteristics. Participants were asked to identify their gender with response options including male, female, and transgender. Only four participants identified as transgender, and they were marked as “missing” for this variable. Participants were asked to identify their race/ethnicity with response options including White, Black, Hispanic/ Latino, Asian, American Indian/ Alaska Native, Native Hawaiian/ Pacific Islander, Multiracial, and Other. All participants who identified as Hispanic/Latino were coded as Latino(a) or Hispanic American; all non-Latino participants who identified as Black were coded as Black or African American; and all other participants were coded as White or Other. Participants were asked to list their age. Participants were asked whether they were born in the United States with response options including yes and no. Participants were asked their highest level of completed education with response
options including no formal schooling, grade school completed, some secondary school, high school/General Educational Development (GED) completed, some college or associate’s degree completed, bachelor’s completed, and some or completed post-graduate degree. These responses were categorized into Less than High School Degree, High School/GED Completed, and Some College or More. Participants reported their height and weight, which were used to calculate categories of body mass index (BMI). Participants were asked whether they had health insurance with response options including Yes, I have health insurance, Medicare, or Medicaid; No, I do not have it now, but I used to have health insurance; or I have never had health insurance. For this study, participants were categorized as either currently or not currently having health insurance. Health outcomes. Overall health was measured with the validated item “How would you rate your overall health?”, rated on a 5-point scale from poor to excellent (Pleis et al., 2010). Participants were asked the number of times in the past year they visited a hospital emergency department. Answers were dichotomized to reflect zero emergency department visits (57.3%) or one or more visits (42.7%) (Long et al., 2012). Participants were also asked to indicate whether they had ever been told by a doctor or health professional that they had the following chronic conditions: high cholesterol, diabetes, heart disease, stroke, asthma, chronic bronchitis or emphysema, or cancer (Pleis et al., 2010). Answers were dichotomized to reflect zero chronic conditions (57.4%) versus one or more conditions (42.6%) (National Health Interview Survey (NHIS) Description, 2012). Everyday discrimination. Everyday discrimination was measured using the 5-item Everyday Discrimination Scale (Stucky et al., 2011). Participants were asked how frequently they were treated with less respect than others, treated as not smart, treated as dishonest, treated as if others were better than them, and insulted or called names on 5-point scale from never to very often.
Downloaded from hpq.sagepub.com at CMU Libraries - library.cmich.edu on September 28, 2015
4
Journal of Health Psychology
Items were averaged and demonstrated strong reliability (Cronbach’s α = 0.79). Stress and depressive symptoms. Stress was measured using Cohen’s 4-item Perceived Stress Scale (Cohen et al., 1983; Cohen and Williamson, 1988). Participants were asked how often, on a 5-point scale from never to very often, they were unable to control important things in their life, felt confident about their ability to handle personal problems (reverse-scored), felt that things were going their way (reverse-scored), and felt difficulties piling up so high that they could not overcome them. Items were averaged (Cronbach’s α = 0.60). Depressive symptoms were measured using two items from the Patient Health Questionnaire (Li et al., 2007), adapted to ask about the past 30 days. Participants were asked how often they felt bothered by feeling down, depressed, or hopeless and by little interest or pleasure in doing things on a 4-point scale from not at all to nearly every day. Items were averaged (Cronbach’s α = 0.80). Other stressors. Perceived unsafety was measured with the item “I feel unsafe to go on walks in my neighborhood during the day,” rated on a 5-point scale from strongly disagree to strongly agree (Bauman et al., 2009). Food insecurity was measured with two items, which asked whether members of participants’ households worried whether their food would run out before they got money to buy food and whether the food they bought did not last and they did not have money to get more in the past 12 months (Hager et al., 2010). Participants indicated responses on a 3-point scale from often true to never true. Items were reverse-coded such that higher scores reflected greater food insecurity and then averaged (α = 0.89). To measure financial stress, participants were asked how well they were managing financially these days (Weich and Lewis, 1998). Response options were on a 5-point scale including living comfortably, doing alright, just getting by, finding it difficult, and very difficult. Survey order. Items and scales used in this study were embedded within a larger survey including
a total of 176 items. Items appeared in the following order within the survey: perceived unsafety, everyday discrimination, overall health, chronic health conditions, health insurance, emergency department visits, weight and height for BMI, depressive symptoms, stress, food insecurity, gender, age, race/ethnicity, nativity, education, and financial stress.
Analyses First, participant socio-demographic characteristics and other stressors were characterized using descriptive statistics. Differences in frequency of everyday discrimination scores by socio-demographic characteristics and other stressors were explored using analyses of variance with Bonferroni post hoc tests and correlations. Second, we tested whether stress and depressive symptoms operating in serial mediated associations between everyday discrimination and health outcomes while adjusting for other stressors (perceived unsafety, food insecurity, and financial stress) and socio-demographic characteristics (gender, race/ethnicity, age, place of birth, education, BMI, health insurance) using path analysis. Analyses also controlled for whether participants lived in neighborhoods implementing the structural intervention to improve community health (referred to as study condition). We used bootstrapping to estimate the indirect effects of everyday discrimination on health outcomes via stress and depressive symptoms. A post hoc power analysis indicated that we were adequately powered to conduct this analysis (power = 1.00; Gnabs, 2008; MacCallum et al., 1996).
Results The majority of participants identified as female, Black or African American, and US born (Table 1). The average age of participants was 40 years. Close to half of participants reported achieving at least some college. Over one-half of participants were overweight or obese based on self-reported weight and height.
Downloaded from hpq.sagepub.com at CMU Libraries - library.cmich.edu on September 28, 2015
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Earnshaw et al. Table 1. Participant socio-demographic characteristics and other stressors (N = 1299). % (n) or M (SD) Socio-demographic characteristics Gender Female Male Race/ethnicity Black or African American Latino(a) or Hispanic American White or Other Age Nativity US born Other Education Less than high school High school/GED completed Some college or more BMI categories Underweight Healthy weight Overweight Obese Health Insurance Insured Not insured Other stressors Perceived unsafety Food insecurity Financial stress Total
64.0 (832) 35.3 (458) 62.0 (805) 17.5 (227) 19.7 (256) 40.60 (13.37) 90.8 (1179) 8.9 (115) 14.3 (186) 36.5 (474) 47.7 (620) 3.9 (51) 23.3 (303) 22.9 (297) 37.4 (486) 87.1 (1132) 11.9 (155) 2.00 (1.06) 1.53 (0.65) 2.57 (1.08)
Everyday discrimination F(1, 1286) = 3.41, p = 0.07 1.62 (0.72) 1.70 (0.78) F(2, 1282) = 3.25, p = 0.04 1.61 (0.72) 1.70 (0.74) 1.73 (0.82) r = −0.07, p = 0.02 F(1, 1290) = 0.23, p = 0.64 1.65 (0.74) 1.62 (0.78) F(2, 1276) = 7.37, p = 0.001 1.82 (0.91)a,b 1.64 (0.70)a 1.59 (0.68)b F(3, 1134) = 0.45, p = 0.72 1.65 (0.78) 1.68 (0.73) 1.61 (0.75) 1.63 (0.73) F(1, 1286) = 0.55, p = 0.02 1.63 (0.72)a 1.78 (0.89)a r = 0.12, p
HPQ0010.1177/1359105315572456Journal of Health PsychologyEarnshaw et al.
Article
Everyday discrimination and physical health: Exploring mental health processes
Journal of Health Psychology 1–11 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1359105315572456 hpq.sagepub.com
Valerie A Earnshaw1,2,3, Lisa Rosenthal1,4, Amy Carroll-Scott1,5, Alycia Santilli1, Kathryn GilstadHayden1 and Jeannette R Ickovics1
Abstract Goals of this study were to examine the mental health processes whereby everyday discrimination is associated with physical health outcomes. Data are drawn from a community health survey conducted with 1299 US adults in a low-resource urban area. Frequency of everyday discrimination was associated with overall self-rated health, use of the emergency department, and one or more chronic diseases via stress and depressive symptoms operating in serial mediation. Associations were consistent across members of different racial/ethnic groups and were observed even after controlling for indicators of stressors associated with structural discrimination, including perceived neighborhood unsafety, food insecurity, and financial stress.
Keywords depressive symptoms, everyday discrimination, health, stress, structural discrimination
Introduction Discrimination adversely affects health (Pascoe and Smart Richman, 2009; Williams and Mohammed, 2008). Results from cross-sectional, longitudinal, and experimental studies demonstrate that discrimination is associated with a wide range of poor physical and mental health outcomes (Williams and Mohammed, 2008). Discrimination is associated with worse overall self-rated health (Harris et al., 2006; Schulz et al., 2006) and higher risk of chronic disease incidence (e.g. respiratory, cardiovascular, and pain conditions; Gee et al., 2007). It is also associated with specific diseases (e.g. cardiovascular and respiratory conditions; Gee et al., 2007) and behaviors (e.g. substance use,
violence; Borrell et al., 2007; Romero et al., 2007; Simmons et al., 2006) that increase risk of urgent health problems requiring emergency department visits (Centers for Disease Control
1Yale
School of Public Health, USA Medical School, USA 3Boston Children’s Hospital, USA 4Pace University, USA 5Drexel School of Public Health, USA 2Harvard
Corresponding author: Valerie A Earnshaw, Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 21 Autumn Street Room 212.1, Boston, MA 02115, USA. Email: [email protected]
Downloaded from hpq.sagepub.com at CMU Libraries - library.cmich.edu on September 28, 2015
2
Journal of Health Psychology
and Prevention, 2010). Moreover, discrimination is associated with depressive symptoms (Banks et al., 2006; Brody et al., 2006; Steffen and Bowden, 2006) and stress (Pascoe and Smart Richman, 2009). Everyday discrimination— involving chronic yet subtle mistreatment due to a socially devalued characteristic (e.g. race, weight, low income)—is pervasive and theorized to play a powerful role in creating and maintaining the substantial health disparities observed in the United States (Essed, 1991; Williams et al., 2003; Williams and Mohammed, 2008). Despite the wealth of evidence demonstrating harmful associations between discrimination and health, significant gaps in understanding of these associations have been highlighted. Williams and Mohammed (2008) emphasize the importance of understanding the processes whereby discrimination relates to physical health, which may provide insight into how to intervene. We examined the mental health processes through which everyday discrimination is associated with indicators of general, emergency, and chronic health among a sample of mostly Black residents of a low-income urban area in the United States.
The mediating roles of stress and depressive symptoms Stress and depressive symptoms appear to play important roles in the process whereby everyday discrimination is associated with physical health. Experimental studies demonstrate that experiences of discrimination elicit both physiological (e.g. cardiovascular reactivity) and psychological (e.g. perceived stress) stress responses (Pascoe and Smart Richman, 2009). Stress responses, in turn, impact a range of chronic and acute physical health conditions (Pearlin et al., 2005; Williams et al., 1997, 2003; Williams and Mohammed, 2008). Everyday discrimination is also associated with depression and depressive symptoms (Pascoe and Smart Richman, 2009; Williams et al., 2003). Carter’s model of Race-Based Traumatic Stress Injury suggests that accumulated experiences of stress resulting from discrimination may lead to
greater depressive symptoms over time (Carter, 2007). Longitudinal evidence demonstrates that people who experience stress subsequently experience greater depressive symptoms (Kessler, 1997). Depressive symptoms, in turn, are associated with poor physical health in part via changes in physiological (e.g. cellular immunity; Herbert and Cohen, 1993) and behavioral (e.g. physical activity; Ruo et al., 2003; Whooley et al., 2008) activity.
This study We hypothesize that greater frequency of everyday discrimination is associated with greater stress, which in turn is associated with greater depressive symptoms, and which in turn are associated with worse physical health. That is, we expect a serial mediation model linking everyday discrimination with poorer physical health outcomes, including indicators of general, emergency, and chronic health. Williams and Mohammed (2008) note that experiences of everyday discrimination at the individual level are merely one way in which discrimination generates stress and poor health. At the structural level, residential segregation, a legacy of institutionalized discrimination in residential contexts, exposes individuals to ongoing violence and results in chronic safety concerns (Williams and Collins, 2001; Williams and Mohammed, 2008). Economic hardship, a lasting effect of institutionalized discrimination in employment contexts, further leads to financial stress and food insecurity. We control for perceived neighborhood unsafety, food insecurity, and financial stress in all analyses to better understand the unique contribution of everyday discrimination to poor health outcomes amidst these stressors associated with structural discrimination.
Methods Participants and procedure Health and behavior surveys were conducted with adults aged 18–65 years living in six low-income neighborhoods in New Haven, Connecticut, in the
Downloaded from hpq.sagepub.com at CMU Libraries - library.cmich.edu on September 28, 2015
3
Earnshaw et al. fall of 2012. Households were randomized from a complete list of addresses provided by the City of New Haven. Randomly selected addresses were approached three times until (1) an eligible resident answered and consented to be surveyed, (2) an eligible resident answered and refused, or (3) no one answered. If the survey was not conducted, another address was selected and approached. Surveys were administered by locally hired and trained residents, lasted 20–30 minutes, and were collected via handheld computers. Participants received a US$10 grocery gift card and entry into a US$500 raffle. Participants included 1299 adults (73% response rate) who were older and more likely to be women and Black than neighborhood residents as a whole. During the time of data collection, structural interventions designed to improve community health were being implemented in several neighborhoods. All procedures received ethics approval.
Measures Participants answered questions about sociodemographic and other characteristics related to health and behavior. Socio-demographic characteristics. Participants were asked to identify their gender with response options including male, female, and transgender. Only four participants identified as transgender, and they were marked as “missing” for this variable. Participants were asked to identify their race/ethnicity with response options including White, Black, Hispanic/ Latino, Asian, American Indian/ Alaska Native, Native Hawaiian/ Pacific Islander, Multiracial, and Other. All participants who identified as Hispanic/Latino were coded as Latino(a) or Hispanic American; all non-Latino participants who identified as Black were coded as Black or African American; and all other participants were coded as White or Other. Participants were asked to list their age. Participants were asked whether they were born in the United States with response options including yes and no. Participants were asked their highest level of completed education with response
options including no formal schooling, grade school completed, some secondary school, high school/General Educational Development (GED) completed, some college or associate’s degree completed, bachelor’s completed, and some or completed post-graduate degree. These responses were categorized into Less than High School Degree, High School/GED Completed, and Some College or More. Participants reported their height and weight, which were used to calculate categories of body mass index (BMI). Participants were asked whether they had health insurance with response options including Yes, I have health insurance, Medicare, or Medicaid; No, I do not have it now, but I used to have health insurance; or I have never had health insurance. For this study, participants were categorized as either currently or not currently having health insurance. Health outcomes. Overall health was measured with the validated item “How would you rate your overall health?”, rated on a 5-point scale from poor to excellent (Pleis et al., 2010). Participants were asked the number of times in the past year they visited a hospital emergency department. Answers were dichotomized to reflect zero emergency department visits (57.3%) or one or more visits (42.7%) (Long et al., 2012). Participants were also asked to indicate whether they had ever been told by a doctor or health professional that they had the following chronic conditions: high cholesterol, diabetes, heart disease, stroke, asthma, chronic bronchitis or emphysema, or cancer (Pleis et al., 2010). Answers were dichotomized to reflect zero chronic conditions (57.4%) versus one or more conditions (42.6%) (National Health Interview Survey (NHIS) Description, 2012). Everyday discrimination. Everyday discrimination was measured using the 5-item Everyday Discrimination Scale (Stucky et al., 2011). Participants were asked how frequently they were treated with less respect than others, treated as not smart, treated as dishonest, treated as if others were better than them, and insulted or called names on 5-point scale from never to very often.
Downloaded from hpq.sagepub.com at CMU Libraries - library.cmich.edu on September 28, 2015
4
Journal of Health Psychology
Items were averaged and demonstrated strong reliability (Cronbach’s α = 0.79). Stress and depressive symptoms. Stress was measured using Cohen’s 4-item Perceived Stress Scale (Cohen et al., 1983; Cohen and Williamson, 1988). Participants were asked how often, on a 5-point scale from never to very often, they were unable to control important things in their life, felt confident about their ability to handle personal problems (reverse-scored), felt that things were going their way (reverse-scored), and felt difficulties piling up so high that they could not overcome them. Items were averaged (Cronbach’s α = 0.60). Depressive symptoms were measured using two items from the Patient Health Questionnaire (Li et al., 2007), adapted to ask about the past 30 days. Participants were asked how often they felt bothered by feeling down, depressed, or hopeless and by little interest or pleasure in doing things on a 4-point scale from not at all to nearly every day. Items were averaged (Cronbach’s α = 0.80). Other stressors. Perceived unsafety was measured with the item “I feel unsafe to go on walks in my neighborhood during the day,” rated on a 5-point scale from strongly disagree to strongly agree (Bauman et al., 2009). Food insecurity was measured with two items, which asked whether members of participants’ households worried whether their food would run out before they got money to buy food and whether the food they bought did not last and they did not have money to get more in the past 12 months (Hager et al., 2010). Participants indicated responses on a 3-point scale from often true to never true. Items were reverse-coded such that higher scores reflected greater food insecurity and then averaged (α = 0.89). To measure financial stress, participants were asked how well they were managing financially these days (Weich and Lewis, 1998). Response options were on a 5-point scale including living comfortably, doing alright, just getting by, finding it difficult, and very difficult. Survey order. Items and scales used in this study were embedded within a larger survey including
a total of 176 items. Items appeared in the following order within the survey: perceived unsafety, everyday discrimination, overall health, chronic health conditions, health insurance, emergency department visits, weight and height for BMI, depressive symptoms, stress, food insecurity, gender, age, race/ethnicity, nativity, education, and financial stress.
Analyses First, participant socio-demographic characteristics and other stressors were characterized using descriptive statistics. Differences in frequency of everyday discrimination scores by socio-demographic characteristics and other stressors were explored using analyses of variance with Bonferroni post hoc tests and correlations. Second, we tested whether stress and depressive symptoms operating in serial mediated associations between everyday discrimination and health outcomes while adjusting for other stressors (perceived unsafety, food insecurity, and financial stress) and socio-demographic characteristics (gender, race/ethnicity, age, place of birth, education, BMI, health insurance) using path analysis. Analyses also controlled for whether participants lived in neighborhoods implementing the structural intervention to improve community health (referred to as study condition). We used bootstrapping to estimate the indirect effects of everyday discrimination on health outcomes via stress and depressive symptoms. A post hoc power analysis indicated that we were adequately powered to conduct this analysis (power = 1.00; Gnabs, 2008; MacCallum et al., 1996).
Results The majority of participants identified as female, Black or African American, and US born (Table 1). The average age of participants was 40 years. Close to half of participants reported achieving at least some college. Over one-half of participants were overweight or obese based on self-reported weight and height.
Downloaded from hpq.sagepub.com at CMU Libraries - library.cmich.edu on September 28, 2015
5
Earnshaw et al. Table 1. Participant socio-demographic characteristics and other stressors (N = 1299). % (n) or M (SD) Socio-demographic characteristics Gender Female Male Race/ethnicity Black or African American Latino(a) or Hispanic American White or Other Age Nativity US born Other Education Less than high school High school/GED completed Some college or more BMI categories Underweight Healthy weight Overweight Obese Health Insurance Insured Not insured Other stressors Perceived unsafety Food insecurity Financial stress Total
64.0 (832) 35.3 (458) 62.0 (805) 17.5 (227) 19.7 (256) 40.60 (13.37) 90.8 (1179) 8.9 (115) 14.3 (186) 36.5 (474) 47.7 (620) 3.9 (51) 23.3 (303) 22.9 (297) 37.4 (486) 87.1 (1132) 11.9 (155) 2.00 (1.06) 1.53 (0.65) 2.57 (1.08)
Everyday discrimination F(1, 1286) = 3.41, p = 0.07 1.62 (0.72) 1.70 (0.78) F(2, 1282) = 3.25, p = 0.04 1.61 (0.72) 1.70 (0.74) 1.73 (0.82) r = −0.07, p = 0.02 F(1, 1290) = 0.23, p = 0.64 1.65 (0.74) 1.62 (0.78) F(2, 1276) = 7.37, p = 0.001 1.82 (0.91)a,b 1.64 (0.70)a 1.59 (0.68)b F(3, 1134) = 0.45, p = 0.72 1.65 (0.78) 1.68 (0.73) 1.61 (0.75) 1.63 (0.73) F(1, 1286) = 0.55, p = 0.02 1.63 (0.72)a 1.78 (0.89)a r = 0.12, p
