Reference no: EM133313157

Question: The final model for consideration is the psychosocial stress model, which suggests that the stresses of racism are the main source of racial health disparities. This model is biocultural because it proposes a clear, physiological mechanism between the lived experience of racism and the chronic activation of the stress response. There are a few approaches within this model worth highlighting.

"The ?rst approach can be best exempli?ed by the social epidemiologists Krieger (1999, 2003) and Williams (Williams &Collins 1995, Wyatt et al. 2003). In this approach, there is a clear distinction made between institutional racism and perceived racism, the former referring to the system of structured inequality that places black Americans lower on all indicators of economic well-being, and the latter referring to the conscious perception of discriminatory acts and practices and the distress associated with that perception. Institutional racism results in the limited access of racial and ethnic minorities to resources, both in the sense of limited access to high-paying jobs or educational opportunities and in the sense of limited access to resources that would support the attainment of better health status (e.g., living in neighborhoods with markets that stock fresh fruits and vegetables, neighborhoods in which it is safe to walk for exercise). The concept of institutional racism has mainly offered a framework for the interpretation of racial and ethnic health disparities that is an alternative to other (e.g., racial-genetic) models, providing what Krieger (1999, p. 310) calls an "indirect" approach to the study of discrimination and health.

"Perceived racism, by comparison, is measured directly by self-reports of respondents about their experiences of discriminatory acts, both in institutional settings (e.g., on the job) and in mundane social interactions (Krieger 1990, Krieger & Sidney 1996). The empirical record for measures of perceived discrimination is mixed. In a recent review, Williams and associates (2003) report eleven studies that examine the association of perceived discrimination and blood pressure. Of these studies, three ?nd a direct association, three ?nd no association, and ?ve ?nd associations that pertain only to particular subgroups (e.g., gender or occupational groups; see also Brondolo et al. 2003). A recent study reports a direct association of perceived discrimination and blood pressure, although data were collected from a convenience sample (Din-Dzietham et al. 2004). Two studies in the review by Williams et al. (2003) examined perceived discrimination and low birth weight; one found no association and one found a conditional association. Amore recent study found that controlling for self-reported discrimination reduced by half the risk for black women of reporting having had a low birth weight baby (Mustillo et al. 2004; see also Collins et al. 2004).

"The second approach to the study of psychosocial stress and health disparities employs a more general understanding of the term stress as negative affect (depression, anxiety) experienced by individuals, which in turn can be associated with deleterious health outcomes. This approach has been taken in the incorporation of psychosocial data into large national studies, such as CARDIA (Cardiovascular Disease in Young Adults) and the various waves of the NHANES (see Williams 1999 for a useful discussion of national data sets). Jonas et al. (1997) and Jonas & Lando (2000) looked at overall negative affect as a prospective predictor of incident hypertension in two different follow-up waves of the NHANES, ?nding that those who report negative affect are at a higher risk for developing hypertension and that this association is greater for African Americans. Davidson et al. (2000) found a similar pattern of results using the CARDIA data. Finally, using a subset of the CARDIA data, Knox and colleagues (2002) found that young African Americans who were more reactive to stressful stimuli in the laboratory in turn had higher ambulatory blood pressures three years later.

"The third approach to the study of psychosocial stress and health outcomes is best represented by the early work of Harburg and associates (1973), and the subsequent work of James on the John Henryism hypothesis (James et al. 1983). These researchers adapted general models of the stress process to the speci?c ethnographic realities of the African American community. For example, Harburg et al. (1973) argued that persons, black or white, living in high "socioecologic stress" areas (characterized by low SES and high rates of social instability as measured by crime) were at a higher risk for stressful experiences on a daily basis, increasing the likelihood of high blood pressure. For African Americans, and especially darker-skinned black men, there was the added insult of racist interactions (with police or other representatives of the white power establishment). These racist interactions were in turn likely to provoke hostility on the part of the black participant in the interaction, who may then suppress that hostility to avoid negative repercussions. The model thus predicted that darker-skinned black men who lived in high stress areas and suppressed hostility would have the highest blood pressures. Research results have been generally consistent with these predictions, although the strength of the anger expression and suppression effect has been found to be modest (Schum et al. 2003)....

"Finally, studies by Dressler (1990, 1991a) are relevant here. Like James's studies of John Henryism, Dressler eschewed the attempt to account for racial or ethnic differences in disease risk, focusing instead on factors within the African American community. On the basis of ethnographic observations, he adapted the concept of status incongruity, arguing that individuals' struggles to achieve a middle-class lifestyle in the face of limited economic resources would be a potent stressor. At the same time, traditional features of social organization in the black community, especially reliance on the extended family for social support, would moderate that stressor. He found that the interaction of status incongruence and social support was associated with blood pressure within a Southern black community; however, the interaction of kin support and status incongruence was signi?cant only for older (>45 years) respondents. For younger respondents, non-kin support buffered the pressor effect of status incongruence." (Dressler et al 2005:238-241)

How might model (the psychosocial stress model) be seen as an advancement over the other models?