Discrimination

ANALYSIS WORKGROUP
Our mission is to foster the improvements in the analysis of health related phenomena among older minority; encourage the development of methods and measures that better capture the health and determinants of health of diverse elders; promote collaboration between RCMAR sites on analysis issues; and disseminate new knowledge in this area.

Discrimination


Discrimination Measurement Review Articles
Prepared by: Center for Aging in Diverse Communities (CADC), UCSF
  • Bastos JL, Celeste RK, Faerstein E, Barros AJ. Racial discrimination and health: A systematic review of scales with a focus on their psychometric properties. Soc Sci Med. 2010 Jan 30.

    24 scales were included in the review. Despite the fact that discrimination stands as topic of international relevance, 23 (96%) scales were developed within the United States. Most studies (67%, N = 16) were published in the last 12 years, documenting initial attempts at scale development, with a dearth of investigations on scale refinements or cross-cultural adaptations. Psychometric properties were acceptable; sixteen of all scales presented reliability scores above 0.7, 19 out of 20 instruments confirmed at least 75% of all previously stated hypotheses regarding the constructs under consideration, and conceptual dimensional structure was supported by means of any type of factor analysis in 17 of 21 scales. However, independent researchers, apart from the original scale developers, have rarely examined such scales. The use of racial terminology and how it may influence self-reported experiences of discrimination has not yet been thoroughly examined.

  • Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009 Feb;32(1):20-47.

    This paper provides a comprehensive review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared between 2005 and 2007. This research continues to document an inverse association between discrimination and health in a wide range of contexts and for a broad array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

  • Kressin NR, Raymond KL, Manze M. Perceptions of race/ethnicity-based discrimination: a review of measures and evaluation of their usefulness for the health care setting. J Health Care Poor Underserved. 2008 Aug;19(3):697-730.

    This article reviews the literature over the past 40 years on measures of perceived race/ethnicity-based discrimination and evaluates their characteristics and usefulness in assessing discrimination from health care providers. It identifies 34 measures of racism/discrimination; 16 of which specifically assessed dynamics in health care settings. Few measures were theoretically based; most assessed only general dimensions of racism and focused specifically on the experiences of African American patients. Acceptable psychometric properties were documented for about half of the instruments.

  • Paradies Y. A systematic review of empirical research on self-reported racism and health. Int J Epidemiol. 2006 Aug;35(4):888-901.

    This paper reviews 138 quantitative population-based studies of self-reported racism and health. These studies show an association between self-reported racism and ill health for oppressed racial groups after adjustment for a range of confounders. The strongest and most consistent findings are for negative mental health outcomes and health-related behaviours, with weaker associations existing for positive mental health outcomes, self-assessed health status, and physical health outcomes. The field is limited by a dearth of cohort studies, a lack of psychometrically validated exposure instruments, poor conceptualization and definition of racism, conflation of racism with stress, and debate about the aetiologically relevant period for self-reported racism.

  • Thrasher AD, Clay OJ, Ford CL, Stewart AL. Theory-guided selection of discrimination measures for racial/ ethnic health disparities research among older adults. J Aging Health. 2012;24(6):1018-43. PMCID: PMC3693449

    This article illustrates the process of assessing the appropriateness of existing measures for theory-based research on perceived discrimination and health. Existing measures of perceived discrimination may have limitations when used in studies of older adults. The paper describes three theoretical frameworks relevant to the study of perceived discrimination and health: stress-process models, life course models, and the Public Health Critical Race praxis. Four widely-used measures of discrimination are reviewed and compared in terms of their content and how well they address key aspects of each framework. Potential areas of modification are noted that could to improve the applicability of each measure to older adults.

Last updated February 2016