The Effect of Everyday Discrimination and Mastery on Chronic Health Conditions Among Residents of Chicago

Background and Purpose: One's exposure to stress and the availability of coping resources comes from the social context in which the individual lives.  Susceptibility to stress results from the circumstances of people's lives and is distributed differently across race, socioeconomic status and gender.  Physical health disparities also arise from differences in exposure to stress.  There is evidence that supports a link between stress exposure and chronic health problems (e.g., cardiovascular disease and respiratory disease).  Consequently, discrimination experiences (stressor) have negative effects on physical health outcomes. Combinations of stress exposure and low levels of protective factors, such as a sense of mastery, result in worse physical health outcomes. Mastery is the extent to which individuals believe that they have personal power and control over their life and environment.  Feelings of control and mastery have been determined to be an important aspect of physical health.

This study builds off existing literature by asking does everyday discrimination predict chronic conditions among Chicago resident? And does mastery mediate the relationship between discrimination and chronic conditions?

 

Methods: We used data from the 2001-2003 Chicago Community Adult Health Study, a face-to-face survey of 3105 adults (ages 18-92). The sample was diverse: 31.7% White, 25.8% Hispanic/Latino, and 40.0% Black.

Measures. Chronic conditions was the sum of 13 items that asked respondents to report if they had the chronic condition (e.g., heart attack, chronic bronchitis, osteoporosis) within the past 12 months. Everyday discrimination, the independent variable, was the sum of a 5-item discrimination index, which asked respondents how often they experience discriminatory events such as “people act as if they think you are not smart”. Response options ranged from 1 (at least once a week) to 5 (never). The final variable was z-score standardized (M=0, SD=1). Mastery, the mediating variable, was measured with a short version of the Pearlin Mastery Index. Mastery was the average of 4 Likert-type items that ranged from 1 to 4 (indicating higher levels of mastery). Controls included gender, age, race, education, marital status, income, and generation of immigration.      

Analysis. We conducted mixed-effects Poisson regression models in Stata 14 to test mediation and moderation. Survey weights were employed.

Results: More frequent experiences of discrimination predicted more chronic conditions (Coef: 0.13, p<0.01). Higher mastery scores predicted fewer chronic conditions (Coef: -0.17, p<0.01). When mastery was included in the model, the effect of discrimination decreased slightly but was still significantly associated with more chronic conditions (Coef: 0.11, P<.01). In the first step to test mediation, discrimination significantly predicted mastery (p<0.00), and coupled with the remaining steps mastery partially mediated discrimination and chronic conditions.

Conclusions and Implications: The everyday discrimination experienced by residents in Chicago is associated with more chronic conditions, while higher mastery predicts less chronic conditions. These results have implications for Social Workers.  As a way to mitigate the effects of discrimination experiences on one's physical health, Social Work practitioners can assist in increasing clients' sense of mastery which in turn can impact one's control, confidence, and self-esteem in dealing with these negative experiences.