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种公共卫生危机。然而，人们对艾滋病的影响知之甚少 结构性种族主义和歧视(SRD)对一生中个人的健康和情感福祉的影响 当然了。虽然先前的研究表明，歧视和消极的健康结果之间存在关联 成人(例如，心脏代谢性疾病、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来源。需要更多的研究来填补空白 在干预前我们对SRD与健康差距的关系的理解 可以被开发出来。为了显著推进有关SRD和健康公平的领域，研究需要 包括：(1)SRD的多层次测量，包括个人(个人内部和人际)， 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)、生物测量、地理信息系统(GIS)数据、调查)； 城市和农村参与者的多地点样本；(4)生命历程方法；(5)全人结果 测量(即心理、身体、行为健康)；以及(6)纵向研究设计。包括这些研究 这些要素将允许全面检查SRD与健康和情感之间的关系 福祉，以确定在干预措施中有针对性的机制，以减轻SRD。该计划的主要目标是 建议的研究是检查多个层面(即个人、邻里、机构、 社会/政策)以及与心理、身体和行为健康结果之间的关系 在生命过程中确定干预目标，促进健康公平。这项拟议的研究建立在一个 对627个不同种族/民族的家庭(即非洲裔美国人、西班牙裔美国人、 美洲原住民、移民/难民、白人)贯穿整个生命过程(童年、青春期、 成人期/育儿期)来自城市环境(即明尼阿波利斯、圣保罗)。父R01已经有三个 混合方法数据(即EMA、GIS、调查)的时间点，包括区分度和邻域 以社区为基础的隔离措施以及身体和行为健康结果 参与式方法。在拟议的研究中，来自农村的300个种族/民族多样化家庭的样本 将增加格鲁吉亚(即雅典)，以比较城市和农村的可持续发展经验。此外, 心脏代谢和应激生物标记物数据(即心率、血压、腰围、血脂、糖化血红蛋白、 细胞因子)和结构性种族主义的多层次措施(即，个人、邻居、机构、 社会/政策)将在相隔18个月的两个时间点添加。这项拟议的研究将是首批 使用跨两个站点的混合方法前瞻性地测量SRD的多个级别，并与 不同家庭的心理、身体和行为健康在整个生命过程中的差异。评选结果 这项研究将为针对多层次SRD的干预措施的制定提供信息，以促进健康公平。

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.