There is increasing evidence that racism is a cause of poor health outcomes in the United States, including adverse birth outcomes among Blacks. However, research on the health consequences of racism has faced measurement challenges due to the more subtle nature of contemporary racism, which is not necessarily amenable to assessment through traditionally used survey methods. In this study, we circumvent some of these limitations by examining a previously developed Internet query-based proxy of area racism (Stephens-Davidowitz, 2014) in relation to preterm birth and low birthweight among Blacks. Area racism was measured in 196 designated market areas as the proportion of total Google searches conducted between 2004 and 2007 containing the "n-word." This measure was linked to county-level birth data among Blacks between 2005 and 2008, which were compiled by the National Center for Health Statistics; preterm birth and low birthweight were defined as <37 weeks gestation and <2500 g, respectively. After adjustment for maternal age, Census region, and county-level measures of urbanicity, percent of the Black population, education, and poverty, we found that each standard deviation increase in area racism was associated with relative increases of 5% in the prevalence of preterm birth and 5% in the prevalence of low birthweight among Blacks. Our study provides evidence for the utility of an Internet query-based measure as a proxy for racism at the area-level in epidemiologic studies, and is also suggestive of the role of racism in contributing to poor birth outcomes among Blacks.

Racial discrimination is conceptualized as a psychosocial stressor that has negative implications for mental health. However, factors related to racial identity may influence whether negative experiences are interpreted as instances of racial discrimination and subsequently reported as such in survey instruments, particularly given the ambiguous nature of contemporary racism. Along these lines, dimensions of racial identity may moderate associations between racial discrimination and mental health outcomes. This study examined relationships between racial discrimination, racial identity, implicit racial bias, and depressive symptoms among African American men between 30 and 50 years of age (n = 95). Higher racial centrality was associated with greater reports of racial discrimination, while greater implicit anti-Black bias was associated with lower reports of racial discrimination. In models predicting elevated depressive symptoms, holding greater implicit anti-Black bias in tandem with reporting lower racial discrimination was associated with the highest risk. Results suggest that unconscious as well as conscious processes related to racial identity are important to consider in measuring racial discrimination, and should be integrated in studies of racial discrimination and mental health.

Identification of barriers to adequate health care for sexual minority populations remains elusive as they are complex and variable across sexual orientation subgroups (e.g., gay, lesbian, bisexual). To address these complexities, we use a U.S. nationally representative sample of health care consumers to assess sexual identity differences in health care access and satisfaction. We conducted a secondary data analysis of 12 waves (2012-2018) of the biannual Consumer Survey of Health Care Access (n=30,548) to assess sexual identity differences in 6 health care access and 3 health care satisfaction indicators. Despite parity in health insurance coverage, sexual minorities – with some variation across sexual minority subgroups and sex – reported more chronic health conditions alongside restricted health care access and unmet health care needs. Gay/lesbian females had the lowest prevalence of health care utilization and higher prevalence rates of delaying needed health care and medical tests relative to heterosexual females. Gay/lesbian females and bisexual males were less likely than their heterosexual counterparts to be able to pay for needed health care services. Sexual minorities also reported less satisfactory experiences with medical providers. Examining barriers to health care among sexual minorities is critical to eliminating health disparities that disproportionately burden this population.

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Purpose: Psychosocial stress has been associated with susceptibility to many infectious pathogens. We evaluated the association between perceived stress and incident sexually transmitted infections (STIs, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis genital infections) in a prospective study of women. Stress may increase vulnerability to STIs by suppressing immune function and altering the protective vaginal microbiota.Methods: Utilizing the 1999 Longitudinal Study of Vaginal Flora (n=2,439), a primarily African-American cohort of women, we fitted Cox proportional hazards models to examine the association between perceived stress and incident STIs. We tested bacterial vaginosis (measured by Nugent Score) and sexual behaviors (condom use, number of partners, partner concurrence) as mediators using Vanderweele's difference method with bootstrapping.Results: Baseline perceived stress was associated with incident STIs both in the unadjusted model (HR=1.019; 95% CI 1.009-1.029) and after adjusting for confounders (aHR=1.015; 95% CI 1.005-1.026). Nugent score and sexual behaviors significantly mediated 21 % and 65% of this adjusted association respectively, and 78% when included together in the adjusted model. Conclusions:This study advances understanding of the relationship between perceived stress and STIs and identifies high-risk sexual behaviors and development of BV-both known risk factors for STIs-as potential mechanisms underlying this association.