RACISM AS A CHRONIC STRESSOR: DEPRESSIVE COPING RESPONSE

种族歧视和偏见的压力经历已被证明对非洲裔美国人的身心健康状况产生不利影响。再加上日常的压力事件，许多非洲裔美国人每天都面临着对自己的“黑人”意识提高的额外压力。因此，对种族主义的经历和反应可能会增加非洲裔美国人患病的风险。种族主义，像其他压力源一样，可能会通过激活下丘脑垂体肾上腺轴引起生物反应，从而导致压力激素皮质醇的增加。皮质醇水平的增加被认为会导致脂肪组织被定向到腹内区域。腹内脂肪堆积或内脏肥胖被广泛认为是心血管和关节炎等不良健康结果的危险因素。为了研究种族主义作为一种慢性应激源与内脏性肥胖之间的关系，研究人员对子宫肌瘤研究（UFS）中35-49岁的非裔美国女性进行了横断面研究。UFS的妇女是从一个大型城市保健组织中随机挑选的。完成了门诊访问、电话访谈和邮寄人口统计、生活方式和健康问卷调查的非裔美国妇女将被纳入研究。将会有一封信寄给这些妇女，解释这项研究并提供知情同意的信息。在这封信之后，这些女性将被召集并邀请参加一个20分钟的电话采访，询问她们对种族主义的看法以及她们对种族主义的情感和行为反应。为了验证问卷中关于压力的数据，将对血液和尿液样本进行压力激素皮质醇的检测。内脏肥胖将使用腰臀比进行连续和分类测量。在控制身体活动、体重指数、吸烟、饮酒和社会经济地位等潜在危险因素的同时，提出了多元线性和逻辑回归模型来检验所提出的关系。重要的是，我们要探索种族主义的压力经历和对种族主义的反应，以便采用有效的种族特定压力管理策略。此外，确定种族主义可能影响内脏肥胖的程度将是理解并最终降低与此结果相关的高发病率和死亡率的第一步。

The stressful experiences of racial discrimination and prejudice have been shown to adversely affect the physical and mental health status of African Americans. Coupled with daily stressful events, many African Americans encounter the additional stress of living daily in a state of heightened awareness of their "blackness". As a consequence, experiences of and responses to racism may increase the disease risk for African Americans. Racism, like other stressors, may elicit a biological response through the activation of the hypothalamic pituitary adrenal axis that leads to an increase in the stress hormone, cortisol. This increase in cortisol levels is believed to cause adipose tissue to be directed to the intra-abdominal region. Intra-abdominal fat accumulation or visceral obesity is widely accepted as a risk factor for adverse health outcomes such as cardiovascular and arthritis. To examine the relationship between racism as a chronic stressor and visceral obesity, a cross-sectional study of African American women aged 35-49, who are participants in the Uterine Fibroid Study (UFS), is proposed. Women in the UFS have been randomly selected from a large urban health maintenance organization. African American women who have completed a clinic visit, telephone interview, and mail questionnaire on demographics, lifestyle, and health will be included in the study. A letter will be mailed to the women explaining the study and providing information on informed consent. Following the letter, the women will be called and invited to participate in a 20-minute telephone interview about their perceptions of racism and their emotional and behavioral responses to racism. To validate the questionnaire data on stress, blood and urine specimens will be assayed for the stress hormone, cortisol. Visceral obesity will be measured both continuously and categorically using the waist-to-hip ratio. Multiple linear and logistic regression modeling are proposed to examine the proposed relationship while controlling for potential risk factors such as physical activity, body mass index, smoking, alcohol, and socioeconomic status. It is important that we explore the stressful experiences of and responses to racism so that effective-race specific stress-management strategies can be employed. Also, determining the extent to which racism may influence visceral obesity will be the first step toward understanding and ultimately reducing the high morbidity and mortality associated with this outcome.