Multi-level predictors of structural racism and discrimination and associations with health and well-being across the life course in diverse families

摘要 系统性和结构性种族主义是一场公共卫生危机。然而，人们对 结构性种族主义和歧视（SRD）对个人一生的健康和情感福祉的影响 当然了虽然先前的研究表明歧视与负面健康结果之间存在关联， 成年人（例如，心脏代谢疾病，抑郁症），这些研究是横断面的，主要是 审查了种族主义和歧视的个人根源。需要更多的研究来填补空白 在我们对干预前SRD与健康差异之间关系的理解中， 可以被开发。为了显著推进SRD和健康公平领域的研究，研究需要 包括：（1）多层次SRD测量， 社区、机构和社会/政策层面;（2）严格的混合方法设计（例如，生态 瞬时评估（EMA）、生物措施、地理信息系统（GIS）数据、调查）;（3） 城乡参与者的多地点样本;（4）生命历程方法;（5）全人结果 措施（即，心理、身体、行为健康）;（6）纵向研究设计。包括这些研究 这些因素将允许全面研究SRD与健康和情绪之间的关系， 健康，以确定在干预措施中针对的机制，以减轻SRD。的主要目标 所提出的研究是检查多个水平（即，个人，社区，机构， 社会/政策）以及与心理、身体和行为健康结果的关联 生命历程，确定干预目标，促进健康公平。拟议的研究是建立在一个 对627个种族/民族多样化家庭的前瞻性纵向队列研究（即，非裔美国人，西班牙裔， 美洲土著人、移民/难民、白色）在整个生命过程中（童年、青春期、 成年/父母身份）从城市环境（即，明尼阿波利斯，圣保罗）。父R 01已经有三个 混合方法数据的时间点（即，环境管理局、地理信息系统、调查），包括歧视和邻里关系 隔离措施和身体和行为健康的结果进行了使用社区为基础的 参与式方法。对于拟议的研究，来自农村的300个种族/民族多样化家庭的样本 格鲁吉亚（即，雅典），以比较城市和农村环境中的SRD经验。此外，本发明还提供了一种方法， 心脏代谢和应激生物标记数据（即，心率、血压、腰围、血脂、HbA 1C 细胞因子）和结构性种族主义的多水平测量（即，个人，社区，机构， 社会/政策）将在两个时间点添加，间隔18个月。这项拟议中的研究将是第一批 使用两个研究中心的混合方法前瞻性测量多个水平的SRD， 在不同家庭的生命历程中，心理、身体和行为健康的差异。结果 这项研究将为制定针对多层次性关系发展的干预措施提供信息，以促进卫生公平。

ABSTRACT Systemic and structural racism is a public health crisis. However, little is known about the impact of structural racism and discrimination (SRD) on the health and emotional well-being of individuals across the life course. While prior studies have shown associations between discrimination and negative health outcomes in adults (e.g., cardiometabolic disease, depression), these studies have been cross-sectional and primarily examined individual-level sources of racism and discrimination. Much more research is needed to fill gaps in our understanding about the relationship between SRD and health disparities before interventions can be developed. To significantly advance the field regarding SRD and health equity, studies need to include: (1) multi-level measures of SRD including individual (both intrapersonal and interpersonal), neighborhood, institutional, and societal/policy levels; (2) rigorous mixed-methods designs (e.g., ecological momentary assessment (EMA), biological measures, geographic information system (GIS) data, surveys); (3) multi-site samples with urban and rural participants; (4) a life course approach; (5) whole-person outcome measures (i.e., mental, physical, behavioral health); and (6) longitudinal study designs. Including these study elements will allow for comprehensively examining the relationships between SRD and health and emotional well-being to identify mechanisms to target in interventions to mitigate SRD. The main objective of the proposed study is to examine multiple levels (i.e., individual, neighborhood, institutional, societal/policy) of SRD and associations with mental, physical, and behavioral health outcomes across the life course to identify intervention targets to promote health equity. The proposed study is built on a prospective longitudinal cohort study of 627 racially/ethnically diverse families (i.e., African American, Hispanic, Native American, Immigrant/Refugee, White) across the life course (childhood, adolescence, adulthood/parenthood) from urban settings (i.e., Minneapolis, St. Paul). The parent R01 already has three time-points of mixed-methods data (i.e., EMA, GIS, survey) that includes discrimination and neighborhood segregation measures and physical and behavioral health outcomes carried out using a community-based participatory approach. For the proposed study, a sample of 300 racially/ethnically diverse families from rural Georgia (i.e., Athens) will be added to compare SRD experiences in urban versus rural settings. In addition, cardiometabolic and stress biomarker data (i.e., heart rate, blood pressure, waist circumference, lipids, HbA1C, cytokines) and multi-level measures of structural racism (i.e., individual, neighborhood, institutional, societal/policy) will be added at two time points, 18 months apart. The proposed study will be one of the first to prospectively measure multiple levels of SRD using mixed-methods across two sites and associations with mental, physical, and behavioral health disparities across the life course in diverse families. Results of the study will inform the development of an intervention targeting multi-level SRDs to promote health equity.