Advancing novel methods to measure and analyze multiple types of discrimination for population health research

为人口健康研究推进测量和分析多种类型歧视的新方法

• 批准号: 10551734
• 负责人: NANCY KRIEGER
• 金额: $ 64.84万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-19 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10551734
• 关键词: Address; Adult; Age; Chronic Disease; Complement; Computers; Conscious; Consensus; Data; Data Reporting; Discrimination; Empirical Research; Ensure; Ethnic Origin; Exposure to; Gender Identity; Health; Heterosexuals; Implicit Association Test; Individual; Knowledge; Lesbian Gay Bisexual; Link; Measures; Mediation; Mediator; Methods; Modeling; Neighborhood Health Center; Non obese; Obesity; Outcome; Participant; Patient Self-Report; Patients; Persons; Population Study; Psychologist; Quality of life; Race; Random Allocation; Reaction Time; Research; Research Methodology; Risk; Sampling; Sex Discrimination; Sex Orientation; Sleep Apnea Syndromes; Sleep Deprivation; Sleep Disorders; Social Desirability; Specific qualifier value; Structural Models; Substance abuse problem; Techniques; Testing; Time; Unconscious State; Weight; Woman; analytical method; cis-female; cis-male; comparison group; design; experience; gender minority; health equity promotion; health inequalities; implicit bias; improved; innovation; intersectionality; member; men; novel; people of color; population health; psychological distress; psychological outcomes; queer; racial discrimination; recruit; response; sexual minority; social; social group; transgender

Project Summary Our study seeks to advance methods to measure and analyze multiple types of discrimination for population health research. We will compare novel implicit vs. conventional explicit (self-report) measures of exposure, investigate different approaches to modeling exposure to multiple types of discrimination, and test novel hypotheses using causal mediation analyses. We are motivated by profound concerns that current widely- used approaches are underestimating the impact of discrimination on population health. Our population-based study directly tackles these issues, and focuses on two health outcomes linked to current and lifetime discrimination that harm quality of life and increase risk of both chronic disease and substance abuse: psychological distress and sleep disorders. We will employ a refined version of the first- ever implicit association test (IAT) for discrimination we recently developed, along with our prior validated self-report measure that is among the most widely-used measures in health research on discrimination. To ensure 350 participants per comparison group, we will recruit 1092 adult patient members and staff randomly selected from two diverse community health centers to address the following specific aims: Aim 1. Assess exposure to discrimination using implicit and explicit (self-report) measures, using the validated brief IAT format, to enable time-efficient assessment of lifetime exposure in the US to discrimination based on: race/ethnicity, gender identity, age, sexual orientation, and weight, and assess different ways to combine individuals’ exposure to multiple types of discrimination. Aim 2. Test hypotheses about the health impact of exposure to discrimination, for single and combined measures across the social comparison groups (i.e., people of color vs. white; gender minority [GM/TGNC (transgender/non-conforming)] vs. cis-gender women vs. cis-gender men vs.; older vs. younger; sexual minority [LGBQ (lesbian/gay/bisexual/queer)/SM] vs. heterosexual; obese vs. non-obese) Aim 2.1. Test the hypotheses that the implicit and explicit discrimination measures will be independently associated with psychological distress and sleep disorders (insufficient sleep; sleep disordered breathing). Aim 2.2. Using causal mediation techniques, quantify the effects for discrimination as mediator of health inequities and determine which type and combination of discrimination measures yields the largest effects. Impact: If our hypotheses are supported, results would demonstrate that predominant measures and methods underestimate the health impacts of discrimination, and that better methods would entail use of implicit and explicit measures of multiple types of discrimination and counterfactual causal mediation techniques. We expect our study, designed for high internal validity, will significantly advance methods for feasibly measuring and rigorously analyzing, in large population-based studies, exposure to multiple types of discrimination, knowledge crucial for evidence to promote health equity, a priority for US health agencies.

项目摘要 我们的研究旨在提高测量和分析种群多种类型歧视的方法 健康研究。我们将比较新颖的隐式与常规显式（自我报告）暴露的度量， 研究不同的方法来建模暴露于多种类型的歧视，并测试新颖的方法 使用因果中介分析的假设。我们受到目前广泛关注的深刻关注的动机 - 使用的方法低估了歧视对人口健康的影响。 我们基于人群的研究直接解决了这些问题，并着重于与与之相关的两个健康结果 当前和终身歧视，损害生活质量并增加慢性疾病的风险和 滥用药物：心理困扰和睡眠障碍。我们将采用第一个精致版本 我们最近开发的歧视歧视的隐性协会测试（IAT）以及我们先前的经过验证的 自我报告测量是歧视健康研究中最广泛使用的措施之一。 为了确保每个比较组350名参与者，我们将招募1092名成年患者和员工 从两个潜水员社区卫生中心随机选择以解决以下具体目标： 目标1。使用隐式和明确（自我报告）措施评估对歧视的暴露 经过验证的简短IAT格式，以对美国的终身暴露时间进行计时效率评估 基于：种族/民族，性​​别认同，年龄，性取向以及体重和评估的歧视 将个人接触多种类型的歧视的不同方法。 目标2。关于单身和 社会比较群体的合并措施（即，有色人种与白人；性别少数 [GM/TGNC（变性/不合格）]与顺式性别女性与顺式性别男性vs。年龄较大的vs。 年轻性少数群体[LGBQ（女同性恋/双性恋/Queer）/SM]与异性恋；肥胖与非肥胖） 目标2.1。测试隐式和明确歧视措施将是独立的假设 与心理困扰和睡眠障碍有关（睡眠不足；睡眠不足呼吸）。 目标2.2。使用因果调解技术，量化歧视的效果作为健康的介体 不平等并确定歧视措施的哪种类型和组合产生的影响最大。 影响：如果支持我们的假设，结果将证明主要措施和 方法低估了歧视的健康影响，更好的方法将需要使用 多种类型的歧视和反事实导致调解的隐性和明确度量 技术。我们预计我们的研究专为高度内部有效性而设计，将大大提高方法 在基于人群的大型研究中，可行地测量和严格分析多种类型 歧视，知识对于促进健康公平的证据至关重要，这是美国卫生机构的优先事项。

项目成果

The target/perpetrator brief-implicit association test (B-IAT): an implicit instrument for efficiently measuring discrimination based on race/ethnicity, sex, gender identity, sexual orientation, weight, and age.

• DOI: 10.1186/s12889-021-10171-7
• 发表时间: 2021-01-19
• 期刊: BMC public health
• 影响因子: 4.5
• 作者: Marini M;Waterman PD;Breedlove E;Chen JT;Testa C;Reisner SL;Pardee DJ;Mayer KH;Krieger N
• 通讯作者: Krieger N

Using Implicit Measures of Discrimination: White, Black, and Hispanic Participants Respond Differently to Group-Specific Racial/Ethnic Categories vs. the General Category "People of Color" in the USA.

• DOI: 10.1007/s40615-022-01353-z
• 发表时间: 2023-08
• 期刊: JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES
• 影响因子: 3.9
• 作者: Marini, Maddalena;Waterman, Pamela D;Breedlove, Emry R;Chen, Jarvis T;Testa, Christian;Pardee, Dana J;LeBlanc, Merrily;Reisner, Sari L;Oendari, Apriani;Krieger, Nancy
• 通讯作者: Krieger, Nancy

Contextualizing Response Rates During the COVID-19 Pandemic: Experiences From a Boston-Based Community Health Centers Study.

• DOI: 10.1097/phh.0000000000001785
• 发表时间: 2023-11-01
• 期刊: Journal of public health management and practice : JPHMP