The Relationship Between Perceived Racism/Discrimination and Health Among Black American Women: a Review of the Literature from 2003 to 2013

J. Racial and Ethnic Health Disparities (2015) 2:11–20 DOI 10.1007/s40615-014-0043-1 The Relationship Between Perceived Racism/Discrimination and Health Among Black American Women: a Review of the Literature from 2003 to 2013 Lora L. Black & Rhonda Johnson & Lisa VanHoose Received: 30 April 2014 / Revised: 11 July 2014 / Accepted: 5 August 2014 / Published online: 11 September 2014 # W. Montague Cobb-NMA Health Institute 2014 Abstract Objectives The purpose of this paper was to systematically review the literature investigating the relationship between perceived racism/discrimination and health among black American women. Methods Searches for empirical studies published from January 2003 to December 2013 were conducted using PubMed and PsycInfo. Articles were assessed for possible inclusion using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 framework. In addition, the Agency for Healthcare Research and Quality (AHRQ) system for rating the strength of scientific evidence was used to assess the quality of studies included in the review. Results Nineteen studies met criteria for review. There was mixed evidence for general relationships between perceived racism/discrimination and health. Consistent evidence was found for the relationship between adverse birth outcomes, illness incidence, and cancer or tumor risk and perceived racism/discrimination. Inconsistent findings were found for the relationship between perceived racism/discrimination and heart disease risk factors. There was no evidence to support the relationship between perceived racism/ discrimination and high blood pressure. L. L. Black : R. Johnson : L. VanHoose University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA L. L. Black University of Kansas, 1415 Jayhawk Blvd, Lawrence, KS 66045, USA L. L. Black (*) Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, USA e-mail: Conclusions There is mixed evidence to support the association between perceived racism/discrimination and overall objective health outcomes among black American women. The strongest relationship was seen between perceived racism/ discrimination and adverse birth outcomes. Better understanding of the relationship between health and racism/ discrimination can aid in identifying race-based risk factors developing primary prevention strategies. Future studies should aim to investigate the role of perceived racism/ discrimination as a specific chronic stressor within discrete pathogenesis models. Keywords Women . Racism . Discrimination . Health Over the years, studies have investigated the health disparities that exist in the USA, particularly between black Americans and their white counterparts [1–4]. Research has shown that blacks are at a higher risk for premature death compared to whites in America, due in part to the higher rates of diseases such as diabetes, heart disease, hypertension, and obesity [1, 5]. It is believed that a number of factors work in tandem to create these disparities, such as cultural lifestyle patterns, inherited health risks, social inequalities, and stereotype threat [1, 6]. In addition, there have been a number of theories suggesting that the deleterious effects of racism may contribute both directly and indirectly to these health disparities. Studies have shown the relationship between encounters of racist events, physiological activity, and health outcomes [7]. However, no systematic reviews have focused solely on its impact on black women in America. This is surprising given the evolving area of research showing the relationship between racism and low birth weight [8], heart disease [9], and breast cancer incidence [10] in women. 12 The purpose of this review is to critically review the existing research that focuses on the relationship between perceived racism and health outcomes among black American women over the last decade using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2009 framework [11]. In addition, the Agency for Healthcare Research and Quality (AHRQ) system for rating the strength of scientific evidence [12] was used to assess the quality of studies included in the review. Methods Defining and Measuring Racism and Discrimination While there is no universal definition of racism, the one that will be used for this review defines racism as “beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic characteristics or ethnic group affiliation” [5]. This definition of racism includes both intergroup (racism from members of another ethnic group) and intragroup (racism from members of the same ethnic group) racism. A related concept, racial discrimination, occurs when one unfavorably distinguishes someone from others based upon race [13]. Racism is considered to be a cognitive concept involving thoughts and beliefs, while discrimination is the action that stems from those thoughts and beliefs [14]. Given the interrelatedness of these two concepts, both racism and discrimination will be examined in this review. Further, as the perception of racism and discrimination is paramount to the theoretical foundation of racism as a stressor [5], only studies that measure racism and discrimination directly at an individual level through self-report as a primary measure will be included in this review. There are also variables that serve as mediators, including racism as a perceived stressor, coping responses, and psychological and physiological stress responses [5]. Based on the original Lazarus and Folkman model of stress [15], the effects of a potential stressor depend on the person’s perception of the event as stressful and their subsequent coping responses. In the case of racism, one must first perceive the external stimuli as involving racism to be considered a stressor. Further, the coping responses employed by the person can also mediate the relationship between events and health outcomes, with maladaptive coping leading to increased stress responses and adaptive coping possibly diminishing stress responses. The repeated combination of perceived racism and maladaptive coping may result in poor health outcomes by increasing and prolonging sympathetic nervous system responses. Finally, psychological responses (e.g., anger) and physiological responses (e.g., impact on the immune system) also serve as mediators in the relationship between external stimuli and health outcomes [5]. The purpose of this review is to broadly J. Racial and Ethnic Health Disparities (2015) 2:11–20 assess the relationship between perceived racism/ discrimination and health outcomes among black women; thus, mediators and moderators will not be addressed when reviewing studies. Study Selection Articles were assessed for possible inclusion using the Preferred Reporting Items for Systematic Reviews and Meta- (...truncated)