Effects of Perceived Racial Discrimination on Health Status and Health Behavior: A Differential Mediation Hypothesis
Effects of Perceived Racial Discrimination on Health Status and Health Behavior: A Differential Mediation Hypothesis
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DOI：
10.1037/a0033857
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发表时间：
2014-01-01
影响因子：
4.2
通讯作者：
Stock, Michelle
中科院分区：
文献类型：
--
作者：
Gibbons, Frederick X.;Kingsbury, John H.;Stock, Michelle
目的：前瞻性数据测试了“差异中介”假设：感知的种族歧视和身体健康状况与损害健康的行为（有问题的物质使用）之间的关系（在先前的研究中发现）是由两种不同类型的情感反应（内化和外化）介导的。方法：样本包括来自家庭和社区健康研究的 680 名非裔美国女性（时间 1 时年龄为 37 岁；时间 4 时年龄为 45 岁）。分析了四波数据。评估感知到的歧视，以及作为中介的焦虑和抑郁（内化）和敌意/愤怒（外化），以及作为结果的身体健康状况和有问题的物质使用（饮酒）。结果：结构方程模型表明，歧视预示着外化反应和内化反应都会增加。这些情感反应反过来分别预测了随后的有问题的物质使用和身体健康状况，也控制了早期的报告。在每种情况下，通过情感中介的歧视对特定健康结果的间接影响都是显着的，并且与差异中介假设一致。结论：感知到的种族歧视与黑人女性内化和外化反应的增加有关，但这些反应与不同的健康结果有关。内化的变化与自我报告的身体健康状况的变化相关，而外化的变化与物质使用问题的变化相关。讨论重点是歧视影响健康行为和身体健康状况的过程。
Objective: Prospective data tested a "differential mediation" hypothesis: The relations (found in previous research) between perceived racial discrimination and physical health status versus health-impairing behavior (problematic substance use) are mediated by two different types of affective reactions, internalizing and externalizing. Method: The sample included 680 African American women from the Family and Community Health Study (M age = 37 years at Time 1; 45 years at Time 4). Four waves of data were analyzed. Perceived discrimination was assessed, along with anxiety and depression (internalizing) and hostility/anger (externalizing) as mediators, and physical health status and problematic substance use (drinking) as outcomes. Results: Structural equation modeling indicated that discrimination predicted increases in both externalizing and internalizing reactions. These affective responses, in turn, predicted subsequent problematic substance use and physical health status, respectively, also controlling for earlier reports. In each case, the indirect effects from discrimination through the affective mediator to the specific health outcome were significant and consistent with the differential mediation hypothesis. Conclusions: Perceived racial discrimination is associated with increases in internalizing and externalizing reactions among Black women, but these reactions are related to different health outcomes. Changes in internalizing are associated with self-reported changes in physical health status, whereas changes in externalizing are associated with changes in substance use problems. Discussion focuses on the processes whereby discrimination affects health behavior and physical health status.