Coding the everyday discrimination scale: implications for exposure assessment and associations with hypertension and depression among a cross section of mid-life African American women
Open accessAbstract
Background Studies suggest that racial discrimination impacts health via biological dysregulation due to continual adaptation to chronic psychosocial stress. Therefore, quantifying chronicity is critical for operationalising the relevant aetiological exposure and hence maximising internal validity. Using one of the most common discrimination scales in the epidemiological literature, we develop a novel approach for more accurately assessing chronicity and compare it with conventional approaches to determine whether coding influences differential exposure classification and associations with hypertension and depression among African American women. Methods Data are from a socioeconomically diverse cross section of 208 mid-life African American women in Northern California (data collection: 2012–2013). Racial discrimination was assessed using the Everyday Discrimination Scale (α=0.95), and was coded using two conventional approaches: (1) situation-based coding : number of different situations ever experienced; (2) frequency-based coding : sum of Likert scale responses ranging from 'never' to 'almost everyday'; and (3) a new chronicity-based coding approach: sum of responses, weighted to capture annual chronicity (eg, ‘a few times a month’=3×12=36×/year). Outcomes are hypertension and depressive symptomatology (10-item Center for Epidemiologic Studies-Depression Scale). Findings Exposure classification differed by coding approach, by up to 41%. There was a positive association between racial discrimination and hypertension prevalence for chronicity coding only (prevalence ratio=1.61, 95% CI 1.03 to 2.49). For depressive symptoms, a dose–response relationship of similar magnitude was observed for all three coding approaches. Conclusion Scale coding is an important methodological consideration for valid exposure assessment in epidemiological research. Coding can impact exposure classification and associations with important indicators of African American women’s mental and physical health.
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One recent study found no association among a community sample of African American women, whereas another found a protective association among a sample of Black women in the South.
“One recent study found no association among a community sample of African American women (Michaels et al., 2019), whereas another found a protective association among a sample of Black women in the South (Dressler et al., 1998).”
From Superwoman Schema and John Henryism among African American women: An intersectional perspective on coping with racism (2023) · cites this paper as Michaels et al., 2019
The Study and recruitment section identifies a community sample of African American women. The Results section reports no association between everyday discrimination and hypertension with situation- or frequency-based coding, but a positive association with chronicity-based coding. Thus, describing the study as finding no association omits a key qualification. No page numbers are available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFew studies examined the John Henryism-hypertension association with separate estimates for women or in samples of only women.
“Few studies examined the John Henryism-hypertension association with separate estimates for women or in samples of only women (Dressler et al., 1998;LeBrón et al., 2015;Michaels et al., 2019).”
From Superwoman Schema and John Henryism among African American women: An intersectional perspective on coping with racism (2023) · cites this paper as Michaels et al., 2019
The Methods (Study and recruitment; Analysis) describe a women-only study of everyday discrimination and hypertension, not a study of the John Henryism–hypertension association. A search for “John Henryism” found it only in a References entry for a paper about discrimination and depression. Our copy does not assess how many studies estimated the John Henryism–hypertension association in women. (LLM, conf=0.76)
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- Authors
- Michaels, E., Thomas, M., Reeves, A., Price, M., Hasson, R., Chae, D., & Allen, A.
- Affiliations
- University of California, Berkeley (US)
- University of Michigan (US)
- Auburn University (US)
- Corresponding author
- Michaels, Eli
- Venue
- Journal of Epidemiology and Community Health
- Publisher
- BMJ
- Published
- 2019-03-20
- Volume
- 73
- Issue
- 6
- Pages
- 577-584
- ISSN
- 0141-7681 (ISSN-L)
- 0143-005X
- 1470-2738
- PMC
- PMC7200149
- OpenAlex
- W2922982587
- Cited by
- 93
- References
- 58
- Citations by year
- 2026: 17 · 2025: 26 · 2024: 19 · 2023: 14 · 2022: 8 · 2021: 5 · 2020: 3 · 2019: 1
- FWCI
- 8.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Epidemiology & Community Health (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Susan G. Komen (GTDR14301469)
- University of California Berkeley (Center for New Racial Studies, Experimental Social Science Library, Hellman Fund, Institute for the Study of Societal Issues, Population Center, Research Bridging Grant)
- Robert Wood Johnson Foundation (Health & Society Scholars Program)
- National Institute of General Medical Sciences (UL1GM118985)
- National Institute on Minority Health and Health Disparities (P60MD006902)
- Topics
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Sociology and Political Science › Gender, Health, and Social Inequality
- Keywords
- Everyday Discrimination Scale, racial discrimination, exposure assessment, hypertension, depressive symptoms, African American women, middle-aged women, psychosocial stress, dose-response relationship
- MeSH terms
- Adult, Black or African American, California, Cross-Sectional Studies, Depression, Female, Humans, Hypertension, Middle Aged, Surveys and Questionnaires, Stress, Psychological, Prevalence, Racism
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