Gee et al., 2012 – Life Course Perspective
Individual, social, contextual, and historical factors change in prevalence & importance, and impact an individual across age, time, and development
- Main thesis: research on racism should adopt more of a life course perspective to better understand racial inequalities in health
Age pattern exposures
- Discrimination may change in frequency over time
- Exposure changes as a function of age because of movement in and out of different social contexts
Why use birth cohorts to measure age-patterned discrimination exposure?
To not confound the passage of time with actual age-based differences
- Look at how age-based discrimination changes across every age represented in the data set
Gee et al., 2007 study of age discrimination in women across birth cohorts
- Age discrimination against women starts fairly high and decreases in 20s to mid 30s
- Climbs to peak around 55, then declines
- Higher gender and racial disc at each age associated w/ more age discrimination
Accelerated longitudinal design
- Powerful for looking at change over broad series of time
- Each cohort followed for 25 years had different trajectories
- We can study 45 years time span because we created groups of ages at first
Discrimination among Black youth followed across 18 years (Assari et al., 2018)
- Increasing trajectory of exposure to racial discrimination over time (age 10-12→28-30)
Steeper increase in racial discrimination exposure X time for:
Men
Those who lived in Iowa (very White state)
Those whose families earned more
When there is only 1 cohort, we cannot distinguish…
- Change over time from of historical sociopolitical changes
- Because everyone is being measured in the same time of history, that time in history may be more or less representative of what might happen if you look at the same phenomena at other times in history
Solution: look at birth cohorts or people of different ages since change might differ depending on how old you are at the start
Sensitive Periods
Certain events have a more profound effect on health when they are experienced during specific developmental stages. Outside of this period, the effect is much weaker.
Implications of sensitive periods
- Exposure to discrimination at certain developmental periods can have a greater impact on health than at other developmental periods
- Studies should consider “age x exposure to discrimination” effects on health
Fetal development sensitive period
- Certain weeks are important for development of certain organs of the fetus
- If a fetus experiences a significant stressor like lead poisoning or alcohol during a sensitive organ formation period, it can impact organ development
Childhood sensitive period for discrimination
- Sensitive period in childhood where discrimination is extra harmful for mental health relative to adulthood
- Within childhood, younger kids are even more sensitive to the impacts of discrimination than older kids.
Discrimination Example: Sensitive Periods (Christophe & Stein, 2021)
Multiple birth cohorts
1. Trajectory of depression 20s-60s: depression goes down a little across each decade of life
- But: if you report higher discrimination at each decade, you show depression at higher level than expected
3. Midlife sensitive period: discrimination reported in the 40s led to greater discrimination in the 50s
Adam et al., 2015 - study of discrimination and diurnal cortisol
1 cohort: followed up with 7 times over 20 years (age at W7 ~32)
Diurnal cortisol:
- Level at wake
-Cortisol awakening response (CAR)
- Slope throughout day: cortisol decreases
- Area under the curve (AUC): the total amount of cortisol that was flowing through your system that day
Adam et al,. 2015 - Findings
Racial discrimination as a teen predicted:
- a blunted or lower cortisol awakening response in black participants
- a lower area under the curve: lower level of total daily cortisol
In adults, adolescent racial discrimination predicts:
- lower waking cortisol level among Black adults
- lower AUC (total daily cortisol) in Black adults
Emerging adult Discrimination associated with:
- larger CAR among Black adults
Linked lives
Events that affect 1 person also affect others in their network: research on racism that focuses solely on the target of racism is missing important indirect effects of racism on others in the target’s social network
Latency Period
- Period between exposure and disease appearance
- Exposure to discrimination may have a longer latency period for physical health than for mental health
- E.g. lower gray matter = long-term effect of stress accumulation
Pavalko et al., 2003: Workplace discrimination against women
- Workplace discrimination against women @ baseline was not associated with psychological distress 7 years later but was associated with functional limitations (daily living activities)
- At 7 year follow up, current discrimination associated with distress but not associated w functional limitations
Life expectancies in US in 2021
White 76.4 years
Indigenous 65.2 years (-11.2 years)
Black 70.8 years (-5.6 years)
Not all attributable to differences in things like SES (education, income, poverty, etc.
Differences in Mortality over time: Lawrence et al., 2023
Study of Black, Latinx, and White participants ages 45-84 in United States across 5 waves (16-18 years)
- For each 1-point increase in lifetime discrimination, Black adults had an 8% increase in all-cause mortality risk and 18% increase in cardiovascular mortality
- Not significant for White adults who experienced discrimination
Life expectancy gaps in Canada
- Large gap for indigenous people compared to White people (Statistics Canada, 2019) partially due to personal and systematic discrimination
-Lower risk of all-cause mortality among Black populations in Canada (Statistics Canada, 2023) – held up after controlling for many demographics and social determinants of health
Immigrant paradox
North American phenomenon where the health of newcomers tends to be better than the health of natives in the country with the same racial background
Why: maybe higher SES due to immigration fast track programs for jobs requiring high education
Stress Proliferation
- Exposure to a single stressor may lead to additional secondary stressors
- Researchers must pay careful attention to whether a given factor is a confounder or mediator of the discrimination-health pathway
Mediator example
- Work place discrimination increases depression through the mediator of socio-economic status
- Workplace discrimination by itself also causes higher depression level
Confound example
- Socio-economic status and workplace discrimination are associated with each other, but they do not cause each other.
- They are related factors that both contribute to higher level of depression
