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Understanding the Negative Understanding the Negative Impact of Racial Discrimination Impact of Racial Discrimination on HIV Risk Behaviors among on HIV Risk Behaviors among African American Young AdultsAfrican American Young Adults

Michelle Stock, Ph.D.Michelle Stock, Ph.D.The George Washington UniversityThe George Washington University

DC D-CFARDC D-CFARResearch Award Project Presentation Research Award Project Presentation

June 21, 2011June 21, 2011

22

Racial Disparities in Risky Health Racial Disparities in Risky Health Behaviors Behaviors

Although Blacks make up around 13% of Although Blacks make up around 13% of the U.S. population, they account for 46% the U.S. population, they account for 46% of all HIV cases and 68% of recent HIV of all HIV cases and 68% of recent HIV diagnoses among 13-24 year-oldsdiagnoses among 13-24 year-olds (CDC, 2010).(CDC, 2010).

Main transmission route is high-risk sexual Main transmission route is high-risk sexual contact (e.g., casual partners and contact (e.g., casual partners and unprotected sex)—which is exacerbated by unprotected sex)—which is exacerbated by alcohol and drug usealcohol and drug use (CDC, 2010; NIMH, 2010; Turchik, (CDC, 2010; NIMH, 2010; Turchik,

Garske, et al., 2010)Garske, et al., 2010)

33

Racial Discrimination among Racial Discrimination among African AmericansAfrican Americans

Researchers have recently begun to focus on Researchers have recently begun to focus on psychosocial factors that may contribute to these psychosocial factors that may contribute to these health disparitieshealth disparities (Thomas, Price, & Lybrand, in press; Williams & (Thomas, Price, & Lybrand, in press; Williams & Jackson, 2005). Jackson, 2005).

Racial discrimination has been suggested as an Racial discrimination has been suggested as an important factor contributing to health inequities, important factor contributing to health inequities, including HIV infectionincluding HIV infection (e.g., Pachter & Garcia Coll, 2009; (e.g., Pachter & Garcia Coll, 2009; Williams & Mohammed, 2009).Williams & Mohammed, 2009).

African Americans report experiencing more African Americans report experiencing more discrimination than do other minority groupsdiscrimination than do other minority groups (Landrine, et al., 2006). (Landrine, et al., 2006).

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Racial Discrimination and Health Racial Discrimination and Health among African Americansamong African Americans

Discrimination is linked to worse physical health Discrimination is linked to worse physical health (e.g., higher blood pressure) and mental health (e.g., (e.g., higher blood pressure) and mental health (e.g., psychological distress) psychological distress) (Pascoe & Smart Richman, 2009; Williams & (Pascoe & Smart Richman, 2009; Williams & Mohammed, 2009) Mohammed, 2009)

Discrimination is also correlated with alcohol, Discrimination is also correlated with alcohol, tobacco, and drug usetobacco, and drug use (e.g., Borrell et al., 2007; Landrine et al., 2006)(e.g., Borrell et al., 2007; Landrine et al., 2006)– Among Black adolescents and their parents, discrimination Among Black adolescents and their parents, discrimination

is associated with substance use two and five years later is associated with substance use two and five years later (Gibbons et al., 2004; 2007; 2010)(Gibbons et al., 2004; 2007; 2010)

Although substance use and risky sex behaviors are Although substance use and risky sex behaviors are correlated, research has yet to examine both correlated, research has yet to examine both behaviors in response to discrimination among a behaviors in response to discrimination among a population at-risk for HIV infectionpopulation at-risk for HIV infection

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Aims of Current ResearchAims of Current Research

1: To examine the relations between racial 1: To examine the relations between racial discrimination and discrimination and HIV-related sexual risk and HIV-related sexual risk and associated substance use cognitions and behaviorsassociated substance use cognitions and behaviors among African American young adults.among African American young adults.

2: To identify what roles 2: To identify what roles hopelessness, loss of hopelessness, loss of control, and perceived and physiological stresscontrol, and perceived and physiological stress, play , play in the association between racial discrimination and in the association between racial discrimination and HIV-risk cognitions and behaviors.HIV-risk cognitions and behaviors.

3: Explore neighborhood perceptions that may 3: Explore neighborhood perceptions that may moderate these effectsmoderate these effects

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Preliminary ResearchPreliminary Research

Longitudinal research with over 800 African Longitudinal research with over 800 African American young adults American young adults (Stock et al., 2011)(Stock et al., 2011)

– Perceived discrimination predicts an increase in Perceived discrimination predicts an increase in both substance use and risky sex behaviors 3 and both substance use and risky sex behaviors 3 and 5 years later5 years later

– The discrimination to risky sex pathway is The discrimination to risky sex pathway is mediated by an increase in substance usemediated by an increase in substance use

Causal relations and malleable psychological Causal relations and malleable psychological mediators need to be established mediators need to be established

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Simulating Discrimination in the Simulating Discrimination in the Lab: Lab: CyberballCyberball

One of the most common forms of racial One of the most common forms of racial discrimination is social exclusion/ostracismdiscrimination is social exclusion/ostracism (Smart-(Smart-Richman & Leary, 2009; Williams & Carter-Sowell, 2009)Richman & Leary, 2009; Williams & Carter-Sowell, 2009)

The social exclusion computer game Cyberball is The social exclusion computer game Cyberball is an effective way to examine the causal effects of an effective way to examine the causal effects of racial discriminationracial discrimination (Goodwin et al., 2010; Stock et al., in press)(Goodwin et al., 2010; Stock et al., in press)

Included vs. Excluded by 3 White “players”Included vs. Excluded by 3 White “players”– Exclusion attributed to racial discriminationExclusion attributed to racial discrimination

Exclusion and perceived discrimination associated Exclusion and perceived discrimination associated with higher levels of substance use cognitionswith higher levels of substance use cognitions

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Current StudyCurrent Study260 African American participants aged 18-25260 African American participants aged 18-25T1 measures (pre-manipulation)T1 measures (pre-manipulation)– Neighborhood perceptionsNeighborhood perceptions– Racial discriminationRacial discrimination

Other stressful life eventsOther stressful life events– Past substance use and sexual behaviorsPast substance use and sexual behaviors– Perceived control, stress, hopelessnessPerceived control, stress, hopelessness– Baseline cortisol Baseline cortisol Cyberball paradigmCyberball paradigm– Inclusion vs. ExclusionInclusion vs. Exclusion

99

Current StudyCurrent StudyPost-manipulation measuresPost-manipulation measures– Belonging and Perceived DiscriminationBelonging and Perceived Discrimination– Substance use and risky sex vulnerabilitySubstance use and risky sex vulnerability

Willingness to engage in substance use and risky Willingness to engage in substance use and risky sex behaviorssex behaviors

– Sex under the influenceSex under the influenceHIV-related risk perceptionsHIV-related risk perceptions

– MediatorsMediatorsStress: perceived and physiological (Cortisol)Stress: perceived and physiological (Cortisol)Perceived controlPerceived controlNegative mood Negative mood

1010

Moderators/Controls

Neighborhood PerceptionsStressful Life EventsPerceived DiscriminationSensation SeekingPast BehaviorsDemographics

Potential mediators

Negative Mood

Stress

Control

Willingness

HIV Risk Perceptions

General modelGeneral model

Manipulation

Discrimination

Substance UseRisky SexOutcomes

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Future Research GoalsFuture Research Goals

Goals of National HIV/AIDS Strategy and Goals of National HIV/AIDS Strategy and NIH/NIDA:NIH/NIDA:– Inform the ability to understand and reduce new Inform the ability to understand and reduce new

HIV infections as well as HIV-related health HIV infections as well as HIV-related health disparities among at-risk populations disparities among at-risk populations

Use knowledge to help advance prevention Use knowledge to help advance prevention and intervention programs designed to and intervention programs designed to reduce HIV-risk disparities among African reduce HIV-risk disparities among African American adolescents and young adults American adolescents and young adults

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AcknowledgementsAcknowledgements

Sharon Lambert, Ph.D.Sharon Lambert, Ph.D.Laurel PetersonLaurel PetersonLaura WalshLaura WalshFrederick Gibbons, Ph.D.Frederick Gibbons, Ph.D.Meg Gerrard, Ph.D.Meg Gerrard, Ph.D.