Sept 18 Flashcards
Gee et al Life Course Perspective racism and health inequalities
life course perspective:
- individual, social, contextual and historical factors impact the individual across time
- they change in prevalence, importance, and impact across age, time, and development
focus on CHANGE
main thesis of Gee’s life course perspective
research on racism should adopt more of a LIFE COURSE PERSPECTIVE to better understand racial inequalities in health
7 important factors in a life course perspective
- age-patterned exposures
- sensitive period
- linked lives
- latency period
- stress proliferation
- period effect
- cohort effect
age patterned exposures
exposure to diff things may change as a function of age
discrimination may change in frequency over time
ie. as individuals age they exit some social institutions and enter new ones
ie. presence of disc within certain settings = likely to vary over the life course
example of age-patterned exposure: discrimination towards women in the workforce
how does age-based disc change across lifetime among women in the workforce?
- nationally representative US sample
- 7225 working women
- followed 1972-1989
- ‘mature women’: 30-40 yrs old at baseline
- ‘young women’: 14-24 at baseline
measured at 4 year intervals
split into BIRTH COHORTS
discrimination towards women in the workforce: confound of development & passage of time
ie. studying diff in math ability - study 5 year olds and 45 year olds - assess their abilities 5 years later
passage of 5 years will be very diff for a 5 versus 45 year old
the change a 5 year old goes through in their math ability during this period is much larger than the change a 40 year old would go through
if we average the trend of the 14-24 year olds with that of the 30-40 year olds, the effects would counteract and we’d get a flat line/no effect
separating allows ut to see how changes in discrimination happen across development AND time
discrimination towards women in the workforce: findings
- age discrimination starts off high in early 20s
- then decreases from 20s to mid 30s
- climbs to peak around 55
- then declines
discrimination among black youth followed across 18 years - setup
889 black youth
1/2 from Georgian (southern US state with large black population)
1/2 from Iowa (rural midwest, 88% white)
10-12 at baseline
6 follow-ups over 18 years
discrimination among black youth followed across 18 years - 2 questions
- what is trajectory of racial discrimination against black us youth across time?
- how is it influenced by gender, SES and geography?
discrimination among black youth followed across 18 years - findings
- INCREASING TRAJECTORY of exposure to racial discrimination over time (ages 10-12 > 28-30)
- STEEPER increase in racial disc exposure over time for:
- men
- those who lived in Iowa (very white state)
- those whose families earned more money
discrimination among black youth followed across 18 years - steeper increase in racial disc exposure over time for…
- men
- people living in Iowa
- those whose families earned more money
summary of age-patterned exposure
- age-patterned exposure matters
- cross-sectional studies are taking snapshots of disc and looking at effects - limited
- need to look at PROGRESSION and CHANGE in disc exposure longitudinally
sensitive period
certain events have a MORE PROFOUND EFFECT on health when they’re experienced during SPECIFIC DEVELOPMENTAL STAGES
outside this period, effect is much weaker
sensitive period implication
EXPOSURE to discrimination at certain developmental periods may have a GREATER EFFECT on health than at other developmental periods
studies should consider “age X exposure to discrimination” effects on health
one reason why studies should consider AGE x exposure to discrimination effects on health
because of SENSITIVE PERIODS
discrimination example: sensitive periods depression and discrimination - study questions
- what’s the trajectory of depression across the life course?
- how does discrimination in each decade of life impact deviations (changes) from that trajectory?
an obvious sensitive period
fetal development
embyronic period is HIGHLY SENSITIVE
weeks 3-8
discrimination example: sensitive periods depression and discrimination - study setup
Midlife in the United States Dataset
3 waves data, each spaced 10 years apart
3685 adults
age range: 20-49 at WAVE 1
5.7% Black, 2.2% Latinx
mostly GENDER-BASED discrimination reported
discrimination example: sensitive periods depression and discrimination - study results
between 20s-60s - PREDICTED a downward trajectory of depression
NORMAL TRAJECTORY: depression goes down a little bit each decade of life
DISCRIMINATION IMPACT:
participants who face discrimination display MORE depressive symptoms than expected DURING EACH DECADE of life
discrimination example: sensitive periods depression and discrimination - sensitive period
discrimination during the 40’s led to GREATER depression in the 50’s
this was the only decade we found this effect in
there’s smtg extra harmful about facing discrimination in your 40’s, such that it impacts you a full decade later
40’s are a generally turbulent time - kids, divorce, parents dying, hormonal changes
sensitive period study setup: how does discrimination experienced in adolescence and early adulthood relate to diurnal cortisol rhythms in adulthood?
diurnal cortisol rhythms affected by discrimination?
112 (50 black, 50 white) adolescents
followed up with them 7 times over 20 years
(age at wave 7 was about 32)
sensitive period study FINDINGS SEGMENTED INTO: how does discrimination experienced in adolescence and early adulthood relate to diurnal cortisol rhythms in adulthood?
segmented into:
- overall discrimination (averaged across all waves)
- adolescent discrimination
- young adult discrimination
diurnal cortisol
natural cortisol rhythm throughout the day
stress can disrupt this rhythm
what we care about:
- level at WAKE
- CAR (cortisol awakening response)
- slope throughout the day
- (AUC) area under the curve
cortisol levels we care about
- level at wake
- slope throughout the day
- is it decreasing throughout the day? - CAR (cortisol awakening response)
- AUC (area under the curve)
sensitive period study ADOLESCENT FINDINGS: how does discrimination experienced in adolescence and early adulthood relate to diurnal cortisol rhythms in adulthood?
adolescent racial discrimination predicts…
- LOWER WAKING CORTISOL level among Black participants
- especially low in those who have high perceived discrimination
- LOWER AUC (area under the curve - total daily cortisol)
- FLATTER SLOPE
- their cortisol doesn’t go down at quick rate
- although they have less overall, it stays high for longer
- non-adaptive response
sensitive period study YOUNG ADULT FINDINGS: how does discrimination experienced in adolescence and early adulthood relate to diurnal cortisol rhythms in adulthood?
emerging adult discrimination associated with LARGER CAR among Black adults
NOTE: adolescent discrimination isn’t related to CAR
is adolescent discrimination related to CAR?
no
but emerging adult discrimination is
takeaway from study: how does discrimination experienced in adolescence and early adulthood relate to diurnal cortisol rhythms in adulthood?
for Black adults, racial discrimination experienced in ADOLESCENCE matters more for cortisol
- lower initial levels
- flatter slope
- less AUC
than racial disc experienced in young adulthood
- greater CAR
linked lives
events that affect one person also affect other persons in their network
individuals are INTERDEPENDENT
research on racism focusing solely on the target is missing IMPORTANT INDIRECT EFFECTS of racism on others in the target’s social networks
linked lives is related to concept of…
vicarious discrimination
vicarious discrimination
HEARING or OBSERVING about someone else from an ingroup (ie. parent, sibling) facing discrimination
latency period
period between exposure and disease appearance
exposure to discrimination may have a LONGER latency period for PHYSICAL health than for mental health
short-term reactions (ie. pulse rate, somatic symptoms) may or may not have long-term health outcomes
exposure to discrimination may have a longer latency period for…
physical health
than for mental health
longer latency period of discrimination on physical health example
workplace discrimination against women at baseline wasn’t associated with PSYCH DISTRESS 7 years later, but WAS associated with FUNCTIONAL LIMITATIONS
at 7 YEAR FOLLOW UP, current discrimination associated with DISTRESS but NOT with FUNCTIONAL LIMITATIONS
latency period: physical health effects
physiological and biological dysfunction leads to…
accumulation of damage over time
may take time for disc to result in specific health consequences
wear and tear over time
life expectancies in US in 2021
WHITE: 76.4 years
INDIGENOUS: 65.2 years (-11.2 years)
BLACK: 70.8 years (-5.6) years
not all attributable to diffs in things like SES (income, education, poverty etc)
Indigenous and Black US 2021 life expectancies are how much shorter than White ones?
Indigenous: 11.2 years shorter
Black: 5.6 years shorter
differences in mortality over time study setup
study of:
1633 Black
1403 Latinx
2473 White
ages 45-84 in US
followed across 5 waves (16-18 years)
differences in mortality over time study findings
for each 1 point increase in lifetime discrimination…
- Black adults had an 8% increase in ALL-CAUSE MORTALITY RISK
- 18% increase in CARDIOVASCULAR MORTALITY
not significant for White adults
life expectancy gaps in Canada
- large gap for Indigenous people compared to White people
- actually LOWER RISK of all-cause mortality among Black populations in Canada - held up after controlling for many demographics and social determinants of health
why the diff relative to US? immigrant paradox and other reasons
immigrant paradox
lots of black people in Canada are recent immigrants
health/wellbeing of newcomers tends to be better than native born people of the same ethnic group
arrive in better health, although over time and across generations their health becomes more similar to people of the same ethnic group
stress proliferation
exposure to a single stressor may lead to ADDITIONAL SECONDARY stress
researchers must pay careful attention to whether a given factor is a CONFOUNDER or MEDIATOR of the discrimination-health pathway
example of fact that researchers must pay careful attention to whether a given factor is a CONFOUNDER or MEDIATOR of discrimination-health pathway
relationship between:
- socio-economic status
- workplace discrimination
- depression
two options:
1. socio-economic status and workplace discrimination are correlated and both contribute to depression
- workplace discrimination leads to depression, but is also mediated by SES
are they both at play simultaneously, or is one leading to another which is leading to downstream health outcomes?
period effect
HISTORICAL EVENTS and SOCIAL CHANGE affect individuals’ life course trajectories or pathways
but the EFFECT IS RELATIVELY UNIFORM ACROSS COHORT
ie. all pregnant Arab American women had worse birth outcomes in 6 months after 9/11
- regardless of age
cohort effect
HISTORICAL EVENTS and SOCIAL CHANGE DIFFERENTIALLY affect individuals’ life course trajectories or pathways
across SUCCESSIVE BIRTH COHORTS
ie. only younger Black people showed better health and mortality outcomes after Civil Rights Act in US
- older populations had already suffered from legal unequal treatment for too long to reap benefits of policy changes
overall summary
thinking about discrimination via LIFE COURSE PERSPECTIVE lets us go far BEYOND SNAPSHOT understandings
we should be thinking about:
- age patterned exposures
- sensitive periods
- linked lives
- latency period
- stress proliferation
- period effect and cohort effects
