文章基本信息

标题：Association Between Perceived Discrimination and Racial/Ethnic Disparities in Problem Behaviors Among Preadolescent Youths
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作者：Laura M. Bogart ; Marc N. Elliott ; David E. Kanouse 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2013
卷号：103
期号：6
页码：1074-1081
DOI：10.2105/AJPH.2012.301073
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the contribution of perceived racial/ethnic discrimination to disparities in problem behaviors among preadolescent Black, Latino, and White youths. Methods. We used cross-sectional data from Healthy Passages, a 3-community study of 5119 fifth graders and their parents from August 2004 through September 2006 in Birmingham, Alabama; Los Angeles County, California; and Houston, Texas. We used multivariate regressions to examine the relationships of perceived racial/ethnic discrimination and race/ethnicity to problem behaviors. We used values from these regressions to calculate the percentage of disparities in problem behaviors associated with the discrimination effect. Results. In multivariate models, perceived discrimination was associated with greater problem behaviors among Black and Latino youths. Compared with Whites, Blacks were significantly more likely to report problem behaviors, whereas Latinos were significantly less likely (a “reverse disparity”). When we set Blacks’ and Latinos’ discrimination experiences to zero, the adjusted disparity between Blacks and Whites was reduced by an estimated one third to two thirds; the reverse adjusted disparity favoring Latinos widened by about one fifth to one half. Conclusions. Eliminating discrimination could considerably reduce mental health issues, including problem behaviors, among Black and Latino youths. Racial/ethnic disparities in mental health, including problem behaviors (e.g., disruptive or aggressive behaviors), are substantial among US youths. Black adolescents report higher rates of problem behaviors than do their White counterparts. 1,2 Latino adolescents generally report lower rates of these behaviors than do Blacks but greater rates than do Whites. In a nationally representative survey of high school students, 41% of Blacks, 36% of Latinos, and 28% of Whites reported involvement in a physical fight in the preceding year. 2 However, little research has gone beyond mere documentation of disparities to examine reasons for disparities or why youths of different races/ethnicities show distinct outcomes. One factor that may contribute to disparities in mental health is discrimination. 3–7 Biopsychosocial models of discrimination 3–7 posit that discrimination can lead to stress responses that are detrimental to physical and mental health, including physiological changes and poor health behaviors. Chronic discrimination can wear away at protective psychological mechanisms and lead to a lower capacity for coping with new stressors, precipitating maladaptive coping responses. Such responses include poor self-control, including substance use and externalizing behaviors (e.g., aggression). A substantial body of work, mostly among adults, indicates that discrimination is significantly related to poor mental and physical health and health behaviors, including problem behaviors among children. 8 Discrimination experienced at young ages may have implications for mental health disparities across the life course. Nevertheless, a relatively small amount of research has examined health effects of discrimination among children and adolescents. 9–24 This work, which has primarily focused on Black youths, has shown relationships between discrimination and greater externalizing symptoms (i.e., problem behaviors), 9,10,16,19,20 internalizing symptoms (anxiety, depression), 9,11,14,15,21–24 and substance use. 12,13 Little is known regarding whether Latino youths similarly experience mental health deficits following discrimination. A major gap in the discrimination literature is examination of the extent to which discrimination explains health disparities, especially among youths. 6 Some research indicates that discrimination has a mediating or explanatory effect on the relationship between race/ethnicity and mental and physical health in adults, although no research has examined health behaviors. 25–29 These studies have demonstrated that significant associations between race/ethnicity and health outcomes decrease or become nonsignificant when discrimination is controlled, suggesting that discrimination influences inequities. For example, a study found that, after controlling for everyday perceived discrimination, Black (vs White) differences in self-reported health decreased even after adjusting for socioeconomic status. 25 Although work examining potential roles of discrimination in disparities has advanced the field, it has limitations. No research in this vein has examined the effects of discrimination on disparities among Latino youths. Furthermore, previous analyses have conflated the effects of racial discrimination against Whites and disadvantaged racial/ethnic groups (e.g., Blacks) by measuring perceptions of discrimination among all groups, including Whites. For example, in a study of New Zealand Maori and Europeans, the disparity favoring Europeans on health outcomes was nonsignificant after adjusting for age, gender, socioeconomic status, and discrimination experiences among both Maori (the disadvantaged group) and Europeans (the dominant group). 28 Such models do not provide a clear demonstration of the distinct effects of discrimination against a disadvantaged group only, separate from the effects of discrimination against Whites. Rather, these analyses test effects of discrimination against both the dominant and the disadvantaged groups as potential reasons for health inequalities. Conceptually, however, discrimination is posited to be a reason for poor health in disadvantaged groups only, 6 because the dominant group tends both to fare better on health outcomes and to perpetrate discrimination and because the nature of discrimination experienced by dominant and minority groups may differ qualitatively. An analysis that considers the effects of discrimination against the disadvantaged group in particular would be more consistent with conceptual models discussing discrimination as a reason for health disparities. We extended previous work on the discrimination–health relationship by testing the magnitude of the statistical contribution of perceived discrimination to disparities in problem behaviors among preadolescent Black and Latino children. Our analytic approach differs from previous approaches, which have documented the extent of disparities and effects of discrimination but have not examined the magnitude of disparities explained by discrimination specifically from the Black and Latino perspectives. We used data from Healthy Passages, a Centers for Disease Control and Prevention–funded study of 5119 fifth graders on risk factors, protective factors, health behaviors, and health outcomes. 30 Previous multivariate analyses of these data demonstrated that Black youths were more likely to have perpetrated both physical aggression (e.g., hit another child) and nonphysical aggression (e.g., put down other children to their faces) than were White youths; although Latino youths were more likely to have perpetrated aggression than were White youths in bivariate analyses, this disparity was reversed in multivariate analyses. 31 Perceived discrimination was associated with mental health problems for both Black and Latino youths. 32