Sept 18 Flashcards

1
Q

Gee et al Life Course Perspective racism and health inequalities

A

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

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2
Q

main thesis of Gee’s life course perspective

A

research on racism should adopt more of a LIFE COURSE PERSPECTIVE to better understand racial inequalities in health

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3
Q

7 important factors in a life course perspective

A
  1. age-patterned exposures
  2. sensitive period
  3. linked lives
  4. latency period
  5. stress proliferation
  6. period effect
  7. cohort effect
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4
Q

age patterned exposures

A

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

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5
Q

example of age-patterned exposure: discrimination towards women in the workforce

A

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

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6
Q

discrimination towards women in the workforce: confound of development & passage of time

A

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

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7
Q

discrimination towards women in the workforce: findings

A
  1. age discrimination starts off high in early 20s
  2. then decreases from 20s to mid 30s
  3. climbs to peak around 55
  4. then declines
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8
Q

discrimination among black youth followed across 18 years - setup

A

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

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9
Q

discrimination among black youth followed across 18 years - 2 questions

A
  1. what is trajectory of racial discrimination against black us youth across time?
  2. how is it influenced by gender, SES and geography?
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10
Q

discrimination among black youth followed across 18 years - findings

A
  1. INCREASING TRAJECTORY of exposure to racial discrimination over time (ages 10-12 > 28-30)
  2. STEEPER increase in racial disc exposure over time for:
    - men
    - those who lived in Iowa (very white state)
    - those whose families earned more money
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11
Q

discrimination among black youth followed across 18 years - steeper increase in racial disc exposure over time for…

A
  1. men
  2. people living in Iowa
  3. those whose families earned more money
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12
Q

summary of age-patterned exposure

A
  1. age-patterned exposure matters
  2. cross-sectional studies are taking snapshots of disc and looking at effects - limited
  3. need to look at PROGRESSION and CHANGE in disc exposure longitudinally
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13
Q

sensitive period

A

certain events have a MORE PROFOUND EFFECT on health when they’re experienced during SPECIFIC DEVELOPMENTAL STAGES

outside this period, effect is much weaker

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14
Q

sensitive period implication

A

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

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15
Q

one reason why studies should consider AGE x exposure to discrimination effects on health

A

because of SENSITIVE PERIODS

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16
Q

discrimination example: sensitive periods depression and discrimination - study questions

A
  1. what’s the trajectory of depression across the life course?
  2. how does discrimination in each decade of life impact deviations (changes) from that trajectory?
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16
Q

an obvious sensitive period

A

fetal development

embyronic period is HIGHLY SENSITIVE

weeks 3-8

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17
Q

discrimination example: sensitive periods depression and discrimination - study setup

A

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

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18
Q

discrimination example: sensitive periods depression and discrimination - study results

A

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

19
Q

discrimination example: sensitive periods depression and discrimination - sensitive period

A

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

20
Q

sensitive period study setup: how does discrimination experienced in adolescence and early adulthood relate to diurnal cortisol rhythms in adulthood?

A

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)

21
Q

sensitive period study FINDINGS SEGMENTED INTO: how does discrimination experienced in adolescence and early adulthood relate to diurnal cortisol rhythms in adulthood?

A

segmented into:

  1. overall discrimination (averaged across all waves)
  2. adolescent discrimination
  3. young adult discrimination
22
Q

diurnal cortisol

A

natural cortisol rhythm throughout the day

stress can disrupt this rhythm

what we care about:

  1. level at WAKE
  2. CAR (cortisol awakening response)
  3. slope throughout the day
  4. (AUC) area under the curve
23
Q

cortisol levels we care about

A
  1. level at wake
  2. slope throughout the day
    - is it decreasing throughout the day?
  3. CAR (cortisol awakening response)
  4. AUC (area under the curve)
24
Q

sensitive period study ADOLESCENT FINDINGS: how does discrimination experienced in adolescence and early adulthood relate to diurnal cortisol rhythms in adulthood?

A

adolescent racial discrimination predicts…

  1. LOWER WAKING CORTISOL level among Black participants
  • especially low in those who have high perceived discrimination
  1. LOWER AUC (area under the curve - total daily cortisol)
  2. FLATTER SLOPE
    - their cortisol doesn’t go down at quick rate
    - although they have less overall, it stays high for longer
    - non-adaptive response
25
Q

sensitive period study YOUNG ADULT FINDINGS: how does discrimination experienced in adolescence and early adulthood relate to diurnal cortisol rhythms in adulthood?

A

emerging adult discrimination associated with LARGER CAR among Black adults

NOTE: adolescent discrimination isn’t related to CAR

26
Q

is adolescent discrimination related to CAR?

A

no

but emerging adult discrimination is

27
Q

takeaway from study: how does discrimination experienced in adolescence and early adulthood relate to diurnal cortisol rhythms in adulthood?

A

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
28
Q

linked lives

A

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

29
Q

linked lives is related to concept of…

A

vicarious discrimination

30
Q

vicarious discrimination

A

HEARING or OBSERVING about someone else from an ingroup (ie. parent, sibling) facing discrimination

31
Q

latency period

A

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

32
Q

exposure to discrimination may have a longer latency period for…

A

physical health

than for mental health

33
Q

longer latency period of discrimination on physical health example

A

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

34
Q

latency period: physical health effects

A

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

35
Q

life expectancies in US in 2021

A

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)

36
Q

Indigenous and Black US 2021 life expectancies are how much shorter than White ones?

A

Indigenous: 11.2 years shorter

Black: 5.6 years shorter

37
Q

differences in mortality over time study setup

A

study of:

1633 Black
1403 Latinx
2473 White

ages 45-84 in US

followed across 5 waves (16-18 years)

38
Q

differences in mortality over time study findings

A

for each 1 point increase in lifetime discrimination…

  1. Black adults had an 8% increase in ALL-CAUSE MORTALITY RISK
  2. 18% increase in CARDIOVASCULAR MORTALITY

not significant for White adults

39
Q

life expectancy gaps in Canada

A
  1. large gap for Indigenous people compared to White people
  2. 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

40
Q

immigrant paradox

A

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

41
Q

stress proliferation

A

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

42
Q

example of fact that researchers must pay careful attention to whether a given factor is a CONFOUNDER or MEDIATOR of discrimination-health pathway

A

relationship between:
- socio-economic status
- workplace discrimination
- depression

two options:
1. socio-economic status and workplace discrimination are correlated and both contribute to depression

  1. 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?

43
Q

period effect

A

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
44
Q

cohort effect

A

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
45
Q

overall summary

A

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