13 th Annual Summer Public Health Research Videoconference on Minority Health Racial Discrimination in the Coronary Racial Discrimination in the Artery Risk Development in Young Adults (CARDIA) Study CARDIA) Study Luisa N. Borrell, DDS, PhD Luisa N. Borrell, DDS, PhD Columbia University Columbia University Department of Epidemiology June 25 th , 2007
Outline Outline Introduction Introduction Physical and Mental Health in African Physical and Mental Health in African Americans Americans Racial Discrimination Racial Discrimination Skin color Skin color Substance use in African Americans and Substance use in African Americans and whites whites Implications for future research Implications for future research Columbia University MSPH Columbia University MSPH
Introduction Introduction Disparities in heath status between blacks (or Disparities in heath status between blacks (or African Americans) and whites are large, African Americans) and whites are large, pervasive and persistent over time pervasive and persistent over time Socioeconomic position Socioeconomic position Existing research reveals that Existing research reveals that A substantial proportion of African Americans A substantial proportion of African Americans experience discrimination experience discrimination Discrimination is adversely related to multiple Discrimination is adversely related to multiple indicators of health status including poorer indicators of health status including poorer self- -rated physical and mental health, blood rated physical and mental health, blood self pressure and other cardiovascular outcomes as pressure and other cardiovascular outcomes as well as other health outcomes and related well as other health outcomes and related behaviors behaviors Columbia University MSPH Columbia University MSPH
Self- -reported health, reported health, Self perceived racial discrimination perceived racial discrimination and skin color in African and skin color in African Americans Americans Borrell LN, Kiefe CI, Williams DR, Diez-Roux AV, Gordon-Larsen P. Social Science & Medicine 2006;63(6):1415-27 Columbia University MSPH Columbia University MSPH
Background Background Racial discrimination has emerged as an Racial discrimination has emerged as an important risk factor for the health of important risk factor for the health of African Americans African Americans Evidence suggests that skin tone may be a Evidence suggests that skin tone may be a marker for discrimination, with darker marker for discrimination, with darker skinned blacks reporting higher levels of skinned blacks reporting higher levels of discrimination than their lighter skinned discrimination than their lighter skinned peers peers Columbia University MSPH Columbia University MSPH
Aim of the Study Aim of the Study To investigate the association of To investigate the association of perception of racial discrimination and perception of racial discrimination and skin color with self- -reported physical reported physical skin color with self and mental health status in African and mental health status in African Americans Americans Columbia University MSPH Columbia University MSPH
Source of the Data Source of the Data The CARDIA study The CARDIA study A prospective study of cardiovascular risk A prospective study of cardiovascular risk factors factors 5,115 African American and white adults 18- -30 30 5,115 African American and white adults 18 years of age recruited from 4 US urban areas in years of age recruited from 4 US urban areas in 1985- 1985 -86, balanced on age, sex, race and 86, balanced on age, sex, race and education education Re- -examined every 2 examined every 2- -5 years, retention for 5 years, retention for Re Year 15 (2000- -01): 74% 01): 74% Year 15 (2000 A sample of 1,722 African Americans A sample of 1,722 African Americans Columbia University MSPH Columbia University MSPH
Outcomes Outcomes Physical and Mental Health Physical and Mental Health Data collected during Year 15 Data collected during Year 15 SF- -12: 12 questions representing two summary 12: 12 questions representing two summary SF scores, the Physical Component Score (PCS) and scores, the Physical Component Score (PCS) and the Mental Component Score (MCS) the Mental Component Score (MCS) Scores on scale from 0 (worst) to 100 (best) Scores on scale from 0 (worst) to 100 (best) Mean score for a healthy population is 50 Mean score for a healthy population is 50 Columbia University MSPH Columbia University MSPH
Exposures Exposures Racial Discrimination Racial Discrimination Data collected during Year 15 Data collected during Year 15 Self- -reported experience of discrimination in 7 reported experience of discrimination in 7 Self domains: at school, getting a job, getting housing, at domains: at school, getting a job, getting housing, at work, at home, getting medical care, on the street work, at home, getting medical care, on the street or in a public setting or in a public setting Answers for 7 domains added for a summary score Answers for 7 domains added for a summary score Range from 0 (no discrimination) to 21 (highest Range from 0 (no discrimination) to 21 (highest frequency/intensity of discrimination) frequency/intensity of discrimination) Columbia University MSPH Columbia University MSPH
Exposures… Exposures… Skin Color Skin Color Data collected during Year 7 follow up follow up Data collected during Year 7 examination examination By amber, blue, and green filters of a By amber, blue, and green filters of a Photovolt 577 reflectance meter 577 reflectance meter Photovolt Values pertain to percentage reflected Values pertain to percentage reflected light light Range from 0 (darkest) to 100 (lightest) Range from 0 (darkest) to 100 (lightest) Columbia University MSPH Columbia University MSPH
Covariates Covariates Age Age Marital status Marital status Education (years and degrees) Education (years and degrees) Family income Family income Columbia University MSPH Columbia University MSPH
Characteristics of the Study Population Characteristics of the Study Population Women Men Women Men Characteristics (n=1016) (n=706) Characteristics (n=1016) (n=706) Education (%) Education (%) Incomplete high school 6.6 9.7 Incomplete high school 6.6 9.7 Complete high school or GED Complete high school or GED 21.7 21.7 28.5 28.5 1- 1 -3 years of college 3 years of college 42.5 42.5 37.8 37.8 4 years of college 4 years of college 19.1 19.1 17.0 17.0 Some graduate or professional school 10.1 7.0** Some graduate or professional school 10.1 7.0** Income (%) Income (%) <$12,000 <$12,000 11.4 10.3 11.4 10.3 $12,000- -$15,999 $15,999 5.5 5.1 $12,000 5.5 5.1 $16,000- -$24,999 $24,999 10.8 7.0 $16,000 10.8 7.0 $25,000- $25,000 -$34,999 $34,999 12.9 12.9 13.0 13.0 $35,000- $35,000 -$49,999 $49,999 18.6 18.6 18.4 18.4 $50,000- $50,000 -$74,999 $74,999 20.9 20.9 19.7 19.7 $75,000- -$99,999 $99,999 11.6 13.8 $75,000 11.6 13.8 >$100,000 $100,000 8.2 12.7** > 8.2 12.7** Columbia University MSPH **<0.01 Columbia University MSPH
Mean scores for physical and mental health at Mean scores for physical and mental health at Year 15 Year 15 60 51.5 ** 50.1 51.3 * 48.6 Women 50 Men 40 M e a n 30 20 10 *<0.05 **<0.01 0 Physical Health Mental Health Columbia University MSPH Columbia University MSPH
Mean skin color reflectance by tertile tertile at at Mean skin color reflectance by Year 7 Year 7 50 Women 43.5 Men 45 40.3 40 34.4 32.2 35 30 Percent 25.2 24.3 ** 25 20 15 10 5 0 Low est (Darkest) Middle Highest (Lightest) Tertiles **<0.01 Columbia University MSPH Columbia University MSPH
Racial discrimination at Year 15 and race/ethnicity: Racial discrimination at Year 15 and race/ethnicity: Prevalence (any versus none) and mean score Prevalence (any versus none) and mean score 90 78.1 * 80 73 Women 70 Men 60 50 40 30 20 4.25 4.58 10 0 Prevalence Mean Score *<0.05 Columbia University MSPH Columbia University MSPH
Average change in physical and mental Average change in physical and mental health score per unit increase in the racial health score per unit increase in the racial discrimination summary score discrimination summary score Women Men Women Men β β β β Outcomes Outcomes (95% CI) (95% CI) (95% CI) (95% CI) PCS -0.16 0.16 -0.14 0.14 - - (- -.28, .28, - -.04) .04) (- -.27, .27, - -.00) .00) ( ( MCS -0.52 0.52 -0.29 0.29 - - (- -.67, .67, - -.37) .37) (- -.45, .45, - -.14) .14) ( ( Columbia University MSPH Columbia University MSPH
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