1. Shane Lloyd, MPH 2011, 1,2 Annie Gjelsvik, PhD, 1,2 Deborah N. Pearlman, PhD, 1,2 Carrie Bridges, MPH, 2 1 Brown University Alpert Medical School, 2 Rhode Island Department of Health

2.  Racial discrimination has been linked to a variety of negative health outcomes.  Individuals exposed to discrimination report low levels of life satisfaction and high levels of psychological distress.  In 2009, among non-institutionalized adults 10.6% overall and 13.6% of Black, non- Hispanic adults reports FMD.

3.  The purpose of this study is to assess the association between frequent thoughts of race, experience of discrimination in the health care and workplace settings and frequent mental distress (FMD) among Black adults.

4. Reactions to Race Created by Camara P. Jones, MD, PhD in 2002 Designed to assess how differential perceptions of race relate to health. 2004: Arkansas, Colorado, Delaware, District of Columbia, Mississippi, Rhode Island, South Carolina, Wisconsin 2005: Delaware, Ohio, Wisconsin 2006: Michigan, Wisconsin 2007: Rhode Island 2008: Nebraska, Virginia 2009: Indiana, Nebraska 2010: Rhode Island

5. INCLUSION CRITERIA Valid information for the following variables:  Age  Race  Gender  Educational level  Income  Exposure variables:  Thoughts of race (n=9,334)  Discrimination in health care setting (n=5,216)  Discrimination in the work setting (n=8,484)  Outcome variable:  Frequent mental distress

6. Mental distress was measured by respondents’ answers to the question below. (range: 0-30, median: 3.3)

7. Thoughts of race were assessed by the respondents’ answers to the question below.

8. Measures of discrimination in the health care and workplace settings were created using respondents’ answers to the following questions:

9. Table 1. Characteristics of respondents by frequency of thoughts of race “Never/Rarely” Thoughts of Race Weighted % (Unweighted n) 58.1% (5,627) “Often” Thoughts of race Weighted % (Unweighted n) 41.9% (3,707) P-value Sex P < 0.0001 Male39.2% (1,469)52.9% (1,426) Female60.8% (4,158)47.1% (2,281) Income P < 0.0001 < $15K16.9% (1,207)15.0% (641) $15K < $25K23.7% (1,385)18.9% (779) $25K < $35K15.1% (815)12.3% (511) $35K < $50K11.6 (694)16.6% (565) $50K +19.1 (770)25.5% (868) DK/NS/Refused13.7% (756)11.7% (343) Age P < 0.0001 18 to 3436.3% (1,331)42.0% (1,020) 35 to 5437.6% (2,124)41.6% (1,742) 55 +26.1% (2,172)16.4% (945) Education P < 0.0001 < High school17.0% (1,060)11.2% (439) High school graduate66.5% (3,607)61.6% (2,190) College graduate16.5% (946)27.2% (1,074) Mental Health P < 0.0001 0 poor mental health days67.8% (3,750)58.1% (2,122) 1-30 poor mental health days32.2% (1,877)41.9% (1,585) Frequent mental distress <14 poor mental health days88.8% (4,945) 84.8% (3,125)P=0.003 14-30 poor mental health days11.4% (682) 15.2% (582)

10.  Assessed the distribution of sociodemographic characteristics across categories of the three exposures.  Used multivariable logistic regression to assess the association between each exposure and frequent mental distress controlling for age, sex, education and income.  Stratified each model by gender and age to assess if the association differed by these demographic characteristics.  Conducted specificity analysis where the weight assigned to each respondent was divided by the number of times the module was administered by that state.  STATA statistical software was used to analyze the pooled BRFSS survey data to account for complex sampling design 20.

11. Thoughts of race Rarely/neverOften OR (95% CI) Crude OR1.001.39 (1.12, 1.73) Adjusted OR * 1.001.61 (1.30, 2.01) Stratified Analyses AOR Men ±1.001.99 (1.33, 2.98) AOR Women ±1.001.41 (1.10, 1.80) AOR 18-34 ±±1.001.63 (1.10, 2.42) AOR 35-54 ±±1.001.64 (1.21, 2.22) AOR 55+ ±±1.001.59 (1.02, 2.46) Odds of Frequent Mental Distress Among Black Adults * Adjusted for sex, age, income and education ± Adjusted for age, income and education ±±Adjusted for sex, income and education

12. Perception of health care experience Worse than other races OR (95% CI) Same as other races Better than other races OR (95% CI) Crude OR2.39 (1.78, 3.22)1.001.44 (0.95, 2.18) Adjusted OR * 2.23 (1.64, 3.03)1.001.30 (0.86, 1.97) Stratified Analyses AOR Men ±2.09 (1.22, 3.57)1.002.11 (1.08, 4.14) AOR Women ±2.23 (1.52, 3.28)1.000.91 (0.59, 1.39) AOR 18-34 ±±2.46 (1.39, 4.34)1.001.82 (0.84, 3.96) AOR 35-54 ±±1.65 (1.07, 2.57)1.001.18 (0.69, 2.02) AOR 55+ ±±3.81 (2.06, 7.05)1.001.06 (0.50, 2.23) * Adjusted for sex, age, income and education ± Adjusted for age, income and education ±±Adjusted for sex, income and education

13. Perception of workplace experience Worse than other races OR (95% CI) Same as other races Better than other races OR (95% CI) Crude OR1.89 (1.32, 2.70)1.001.26 (0.60, 2.65) Adjusted OR * 2.09 (1.43, 3.04)1.001.32 (0.65, 2.69) Stratified Analyses AOR Men ±1.88 (0.99, 3.57)1.001.55 (0.52, 4.64) AOR Women ±2.25 (1.46, 3.45)1.001.08 (0.40, 2.92) AOR 18-34 ±±2.59 (1.32, 5.08)1.001.73 (0.53, 5.60) AOR 35-54 ±±1.84 (1.16, 2.91)1.001.13 (0.48, 2.64) AOR 55+ ±±1.59 (0.65, 3.88)1.001.44 (0.19, 11.18) * Adjusted for sex, age, income and education ± Adjusted for age, income and education ±±Adjusted for sex, income and education

14.  Frequent thoughts of race, health care discrimination and workplace discrimination were significantly associated with frequent mental distress among Black adults.  This result is consistent with previous research that has demonstrated that Blacks who experience racial oppression had:  decreased levels of life satisfaction and happiness  increased levels of psychological distress, particularly depression, anxiety, and interpersonal sensitivity 3,21,22.  Of note is the consistent association between experience of discrimination and FMD and that this association persisted when stratified by age and gender.  In all cases experiences with workplace and health care discrimination were associated with higher odds of FMD.

15.  5/13 states included had higher percentages of racial and ethnic minorities when compared to the demographic distribution of the United States population 23.  In so much as FMD 19 and experiences of discrimination 24 are not equally distributed geographically these results may not be nationally representative.  The current study cannot determine causality or temporality between the exposure variables and FMD because the BRFSS is a cross sectional survey.  Issues related to mental health carry a significant stigma for the African American community 3,26  Additionally, the findings may also underestimate discrimination due to underreporting 28.

16. Any questions? Shane Lloyd, MPH ‘11 Brown University Warren Alpert Medical School Program in Public Health Providence, Rhode Island 02912 Shane_Lloyd@Brown.EDU