Transcript Racial discrimination and substance use among African American

Understanding the Negative
Impact of Racial Discrimination
on HIV Risk Behaviors among
African American Young Adults
Michelle Stock, Ph.D.
The George Washington University
DC D-CFAR
Research Award Project Presentation
June 21, 2011
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Racial Disparities in Risky Health
Behaviors
Although Blacks make up around 13% of
the U.S. population, they account for 46%
of all HIV cases and 68% of recent HIV
diagnoses among 13-24 year-olds (CDC, 2010).
Main transmission route is high-risk sexual
contact (e.g., casual partners and
unprotected sex)—which is exacerbated by
alcohol and drug use (CDC, 2010; NIMH, 2010; Turchik,
Garske, et al., 2010)
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Racial Discrimination among
African Americans
Researchers have recently begun to focus on
psychosocial factors that may contribute to these
health disparities (Thomas, Price, & Lybrand, in press; Williams &
Jackson, 2005).
Racial discrimination has been suggested as an
important factor contributing to health inequities,
including HIV infection (e.g., Pachter & Garcia Coll, 2009;
Williams & Mohammed, 2009).
African Americans report experiencing more
discrimination than do other minority groups
(Landrine, et al., 2006).
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Racial Discrimination and Health
among African Americans
Discrimination is linked to worse physical health
(e.g., higher blood pressure) and mental health (e.g.,
psychological distress) (Pascoe & Smart Richman, 2009; Williams &
Mohammed, 2009)
Discrimination is also correlated with alcohol,
tobacco, and drug use (e.g., Borrell et al., 2007; Landrine et al., 2006)
– Among Black adolescents and their parents, discrimination
is associated with substance use two and five years later
(Gibbons et al., 2004; 2007; 2010)
Although substance use and risky sex behaviors are
correlated, research has yet to examine both
behaviors in response to discrimination among a
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population at-risk for HIV infection
Aims of Current Research
1: To examine the relations between racial
discrimination and HIV-related sexual risk and
associated substance use cognitions and behaviors
among African American young adults.
2: To identify what roles hopelessness, loss of
control, and perceived and physiological stress, play
in the association between racial discrimination and
HIV-risk cognitions and behaviors.
3: Explore neighborhood perceptions that may
moderate these effects
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Preliminary Research
Longitudinal research with over 800 African
American young adults (Stock et al., 2011)
– Perceived discrimination predicts an increase in
both substance use and risky sex behaviors 3 and
5 years later
– The discrimination to risky sex pathway is
mediated by an increase in substance use
Causal relations and malleable psychological
mediators need to be established
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Simulating Discrimination in the
Lab: Cyberball
One of the most common forms of racial
discrimination is social exclusion/ostracism
(Smart-Richman & Leary, 2009; Williams & Carter-Sowell, 2009)
The social exclusion computer game
Cyberball is an effective way to examine the
causal effects of racial discrimination (Goodwin et
al., 2010; Stock et al., in press)
Included vs. Excluded by 3 White “players”
– Exclusion attributed to racial discrimination
Exclusion and perceived discrimination
associated with higher levels of substance
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Current Study
260 African American participants aged 18-25
T1 measures (pre-manipulation)
– Neighborhood perceptions
– Racial discrimination
Other stressful life events
– Past substance use and sexual behaviors
– Perceived control, stress, hopelessness
– Baseline cortisol
Cyberball paradigm
– Inclusion vs. Exclusion
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Current Study
Post-manipulation measures
– Belonging and Perceived Discrimination
– Substance use and risky sex vulnerability
Willingness to engage in substance use and risky
sex behaviors
– Sex under the influence
HIV-related risk perceptions
– Mediators
Stress: perceived and physiological (Cortisol)
Perceived control
Negative mood
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Moderators/Controls
Neighborhood Perceptions
Stressful Life Events
Perceived Discrimination
Sensation Seeking
Past Behaviors
Demographics
Manipulation
Discrimination
General model
Potential
mediators
Negative Mood
Stress
Control
Substance Use
Risky Sex
Outcomes
Willingness
HIV Risk
Perceptions
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Future Research Goals
Goals of National HIV/AIDS Strategy and
NIH/NIDA:
– Inform the ability to understand and reduce new
HIV infections as well as HIV-related health
disparities among at-risk populations
Use knowledge to help advance prevention
and intervention programs designed to
reduce HIV-risk disparities among African
American adolescents and young adults
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Acknowledgements
Sharon Lambert, Ph.D.
Laurel Peterson
Laura Walsh
Frederick Gibbons, Ph.D.
Meg Gerrard, Ph.D.
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