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Developing measures of racism relevant to
childbearing women
Amani Nuru-Jeter, PhDAimee Afable-Munsuz, PhD
Susan Egerter, PhD Marilyn Skaff, PhD
Paula Braveman, MD, and the
Measures of Racism and Social Position Working Group
December 9, 2005
Outline
Background Research objectives Conceptual framework Research methods Results Next steps Remaining questions
US Preterm Birth Rate
Source: National Center for Health Statistics, final natality data. Prepared by the March of Dimes Perinatal Data Center, 2000
Racial disparities in reproductive health outcomes
Disparity not fully explained Known risk factors explain ~50% of the risk differential Disparity is greater at higher SES
Role of social context “Eco-social” perspective (Krieger) Contextual factors pregnancy outcomes (e.g., area
poverty/SES, unemployment, income incongruity, racial density)
[Perceived] racism: potential race-related stressor
Perceived racism and pregnancy outcomes
~9 studies examining relationship between perceived racism and pregnancy outcomes 3X higher odds of VLBW (Collins et al 2000; Collins et al 2004) Increased risk of preterm birth (Rosenberg et al 2000; Dole et al 2003)
Feeling a need to protect children from racism and racism in the workplace distress (Jackson et al 2001) Hypothesized: perceived racism prior to and during pregnancy adverse
pregnancy outcomes
Other studies Psychosocial stress LBW among blacks (Orr et al 1996) Hypothesized: racism and psychosocial factors (e.g., coping style) adverse
pregnancy outcomes (David and Collins 1991)
Research objectives
To better understand the range of life-course experiences of perceived racism among African-American women of childbearing age.
To systematically develop a reliable and validated measure of perceived racism as a tool for pregnancy outcome studies.
Conceptual framework
Levels of Racism (Jones 2000) Internalized: acceptance of negative stereotypes/images Personally-mediated: acute and chronic/ episodic interpersonal experiences Institutional: differential access to goods, services, and opportunities
Stress and coping Exposure and emotional/behavioral response (McNeilly et al 1996; Krieger
1990; Harrell 2000) Exposure, appraisal, response framework (Selye 1956) Stress-response process (e.g., CRH and HPA axis)
Life-course (cumulative) approach
Methods
Measures of Racism and Social Position Working Group: UCSF Center on Social Disparities in Health CDC partners Berkeley and Sacramento Divisions of Public Health; and the San
Francisco Department of Public Health Organized community groups (BIH, WIC, Youth Alive, etc.)
5 phases1. Literature review2. Focus groups for initial constructs/domains and questions3. Analysis to develop measures for testing4. Psychometric testing (reliability and validity)5. Recommend measures
Phase 1: Literature review
How well do existing measures capture Levels of racism Stress & coping response Lifecourse exposure Validity and reliability
21 measures 2 captured 3 levels of racism 4 capture stress and coping response 2 capture lifecourse experience/exposure 13 have been psychometrically tested
No overlaps!
Measure Level of Racism
Exposure/stress and coping
Life-course Psychometric testing
Krieger 1990 PM Both
Major life events (Williams et al 97)
PM Exposure
Everyday Discrimination (Williams et al 97)
PM Exposure
Perceptions of Racism Scale (Green 1995)
PM, INST Exposure Yes
Perceived Racism Scale (McNeilly et al 1996)
PM Both Yes
Schedule of Racist Events (Landrine and Klonoff 1996)
PM, INST Exposure & stress (“how stressful was this for you?”)
Yes
Racism Reaction Scale (Thompson et al 1990)
PM Exposure Yes
Index of Race-related Stress (Utsey and Ponterotto 1996)
PM, INST, INT
Exposure Yes
Reactions to Race (CDC MRWG, 2003)
PM, INST Exposure Yes
NAD Scale (Taylor & Grundy 1996)
INT n/a Yes
Telephone PRS (Vines et al 2001)
PM Both Yes Yes
Measure Level of Racism
Exposure/stress and coping
Life-course Psychometric testing
Racism and Life Experience Scale (Harrell 1996)
PM Exposure Yes
Cultural Mistrust Inventory (Terrell and Terrell)
PM Exposure Yes
The Acculturative Stress Scale (Williams-Flournoy & Anderson)
PM Exposure Yes
Scale of Racial Socialization (Stevenson) PM Exposure Yes
Racial Discrimination Index (Terrell & Miller 1980)
PM, INST Exposure Yes
Multifactor Racial Attitudes Inventory (Brighman et al 1976)
PM Exposure ?
Climate for Racism Scale (Barbarin & Gilbert 1981)
PM, INST Exposure ?
Personal Discrimination and Racial Climate Scales (Watts and Carter 1991)
PM Exposure ?
Racialistic Incidents Inventory (Allan-Claiborne and Taylor 1981)
PM, INST, INT
Exposure ?
Racism Stress (Dominguez et al, in press)
PM Both Yes
Phase 2: Participants
8 focus groups of 5 to 10 African American participants each (N=43) 2 teen groups (Oak, Sac) 6 adult groups (2 Berk, 2 Sac, 1 SF, 1 Oak)
Low and moderate/high-SES black women with children < 15 years old
Low and moderate/high-SES black teens (13-18 yrs)
Northern California region: Berkeley, Sacramento, Oakland, San Francisco
SES markers: participation in programs for low-income (e.g., WIC, BIH), professional groups/networks, private school
Focus group guide
Semi-structured focus group guide Levels of racism Stress and coping Life-course
Probes Setting (e.g., work, school, public, home, neighborhood) Frequency, chronicity, intensity Personal vs. vicarious (individual and/or group; PGDD)
Analysis
6 coders independently analyzed 8 transcripts for thematic content
Coding: manually and software Unit of analysis: words and phrases Coding layers: edge coding, thematic coding, pattern
coding Codebook development: consensus building Frequencies of agreement Re-analyze data using software and codebook
pull out language describing themes Use language for item development
Phase 3: Preliminary Results
Anticipatory racism Racial identity
Direct/vicarious Concern for children
Coping response (emotional, cognitive, behavioral) Physical response
Lifestage of experienceChronicity
PervasivenessContextualized experience
Anticipatory Racism
Necessity to be prepared for possibility of being treated differently because of race. (e.g., how often do you think about your race?)
I expect it [racism] to happen everyday. (low SES, Sacramento)
It’s a constant thing that we [Blacks] have to deal with… (low SES, Berkeley)
It’s everyday life, it’s going to be there. If you try to ignore it, it’s going to be there.
(low SES, Sacramento)
Racial identity/GroupConnectedness
How connected one feels to other AAs.
Because it was a black mother because they already look down on us and we don’t need to give them more reason to do so.
(mod SES, Berkeley)
We already have this reputation, don’t give them a reason to treat me different when I get up to them, or to look down on us. (mod SES, Berkeley)
Direct personal experiences
Direct/personal experiences with perceived racism (covered by existing measures but not across lifecourse)
I was walking down the street and a white woman grabbed her purse….that’s something you always feel…because no matter what you have, you’re black first….they will kiss your behind as long as you have money but they still see a nigger…
(low SES, Berkeley)
Vicarious experiences
Indirect experience with perceived racism (individual or group).
My brother, he stays in trouble. But in our neighborhood, he was about 14 and we’re not even a year apart, but they arrested him at AM/PM and they had the description when they arrested him of a black man in a black coat with braids. Do you know how many people that is in our neighborhood?
(mod SES, Sacramento)
Concern for children
I remember looking at my baby, he had to be about 2, I remember looking at him and saying oh my God, what have I done? And that’s a sad, sad, sad feeling when you bring...because your child is supposed to be the happiest thing that you have on this earth and I’m looking at him going what have I done? My child is going to have to go through this life being black.
(mod SES Sacramento)
I think about it everyday. More than myself, I think about the fact that my daughter is black.
(mod SES, Sacramento)
Concern for children
Racism has affected me differently at different stages. As a child having best friends that did not look like me affected [me]. I wanted to have blonde hair and blue eyes like my friend. In high school going from the white school to the black school and feeling fear…because having all that social stigma, stereotyped stuff inside saying that there’s something wrong with us… but trust me, the pressure of racism is a trip…I instill this to my children…I’ve heard my son say to me, why don’t I have blue eyes? And I look at him because I have brown eyes and your daddy has brown eyes, that’s why you brown eyes. And be proud that you have beautiful brown eyes and nappy hair. So constantly having to fight against that and educating.
(high SES, Sacramento)
Emotional coping response
When you’re working your hardest to get to a place in life where you want to be, and you see white people or people other than blacks getting ahead so quickly, it starts to wear on you where you get depressed and you start thinking bad thoughts, and wondering if you’re really a valued part of society. (mod SES Sac)
Realistically, it’s going to affect you…it does bother you, you just put it in a different place. (low SES Berkeley)
Cognitive coping response
So everyday I have to deal with that [racism] so it’s stressful. I take that in internally. It’s subtle…it’s like hidden, but you feel it still. So I feel like I feel it everyday. And it’s more so because I’ve got kids I think.
(low SES teens, Oakland)
I think that when it happens to you so much that you not necessarily learn to accept it, but you learn to not trip off of it no more.
(low SES teens, Oakland)
You’ve just got to work harder I guess. (low SES teens, Oakland)
Behavioral coping response
I will take forever to find something to wear because I feel I’m not going to be treated right when I go shopping. It makes me feel bad and sad
(impression management)
Physical (bodily) response
My heart starts beating fast (low SES, SF)
My stomach. My, like my baby. I know my baby is stressed out. My stomach is in a knot when I come over here. (low SES, SF)
I get a stomach ache, I’ve broken out (low SES, SF)
Overarching themes
Impact (invasive) Multiplicity of emotions Response Chronic/pervasive nature Cumulative Subtle and implicit The “I” in “we” Discrimination shifts across domains of
interaction across the lifecourse (contextualized experience)
Where we go from here?
Literature review manuscript
Finalize codebook
Re-analyze data using software coding
Draft measures of racism
Validation
Recommend measures
Acknowledgements
Measures of Racism and Social Position Working Group: Wizdom Powell, PhD (UCSF/UCB) Tyan Parker Dominguez, PhD (USC) JanXin Leu, PhD (UCSF/UCB) Cassius Lockett, PhD (Sacramento DPH) Barbara Curry (Sacramento DPH) Vicky Alexander, MD (Berkeley DPH) Tiffany Simpson (Berkeley DPH) Lynda Dailey, NP (Berkeley DPH) Twila Brown,(San Francisco DPH) Camara Jones, MD, PhD, (CDC)
Funding Support: California Endowment CDC RWJ Health Disparities Working Group (UCSF)