Top

BMC Public Health

Published in:

Open Access 01-12-2021 | Research article

Understanding measures of racial discrimination and microaggressions among American Indian and Alaska Native college students in the Southwest United States

Authors: Brenna L. Greenfield, Jessica H. L. Elm, Kevin A. Hallgren

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

Racial discrimination, including microaggressions, contributes to health inequities, yet research on discrimination and microaggressions has focused on single measures without adequate psychometric evaluation. To address this gap, we examined the psychometric performance of three discrimination/microaggression measures among American Indian and Alaska Native (AI/AN) college students in a large Southwestern city.

Methods

Students (N = 347; 65% female; ages 18–65) completed the revised-Everyday Discrimination Scale, Microaggressions Distress Scale, and Experiences of Discrimination measure. The psychometric performance of these measures was evaluated using item response theory and confirmatory factor analyses. Associations of these measures with age, gender, household income, substance use, and self-rated physical health were examined.

Results

Discrimination and microaggression items varied from infrequently to almost universally endorsed and each measure was unidimensional and moderately correlated with the other two measures. Most items contributed information about the overall severity of discrimination and collectively provided information across a continuum from everyday microaggressions to physical assault. Greater exposure to discrimination on each measure had small but significant associations with more substance use, lower income, and poorer self-rated physical health. The Experiences of Discrimination measure included more severe forms of discrimination, while the revised-Everyday Discrimination Scale and the Microaggressions Distress Scale represented a wider range of severity.

Conclusions

In clinical practice, these measures can index varying levels of discrimination for AI/ANs, particularly for those in higher educational settings. This study also informs the measurement of racial discrimination and microaggressions more broadly.

Available only for authorised users

Moreover, only 6.7% of items were answered as “not sure but think so”, compared to 30.2% of items answered “yes” and 63.2% of items answered “no”. Although a graded response IRT could be conducted to accommodate all three response options, the resulting parameters would indicate the probabilities of moving from “no” to “not sure but think so” and from “not sure but think so” to “yes”, which we determined was less substantively meaningful than the probabilities of moving from “no” to “yes” and/or “not sure but think so” that would be obtained by combining the latter two responses into a single response.

Although experiences of discrimination and microaggressions are not traits of individuals, our utilization of the latent trait model conceptualizes the constructs we measure as latent variables (e.g., overall experiences with discrimination or microaggressions) that are imperfectly measured by a finite set of indicators (i.e., items included in each measure).

For this analysis, the ordinal r-Everyday Discrimination Scale responses were converted to binary responses (so all responses would be in a binary scale) by classifying “never” as 0 and all responses greater than “never” as 1.

Note that even though these specific microaggressions provided less information for differentiating the severity of overall microaggression experiences a person had, our analyses should not be interpreted as indicating that the consequences of these specific microaggressions are less impactful than other microaggressions.

Bastos JL, Celeste RK, Faerstein E, Barros AJ. Racial discrimination and health: a systematic review of scales with a focus on their psychometric properties. Soc Sci Med. 2010;70(7):1091–9. https://doi.org/10.1016/j.socscimed.2009.12.020.CrossRefPubMed

Bleich SN, Findling MG, Casey LS, Blendon RJ, Benson JM, SteelFisher GK, et al. Discrimination in the United States: experiences of black Americans. Health Serv Res. 2019;54(S2):1399–408. https://doi.org/10.1111/1475-6773.13220.CrossRefPubMedPubMedCentral

Brockie TN, Elm JHW, ML. Examining protective and buffering associations between sociocultural factors and adverse childhood experiences among American Indian adults with type 2 diabetes: a quantitative, community-based participatory research approach. BMJ Open. 2018;8(9):e022265. https://doi.org/10.1136/bmjopen-2018-022265.CrossRefPubMedPubMedCentral

Centers for Disease Control and Prevention. 2011 Behavioral risk factor surveillance system. Retrieved from https://www.cdc.gov/brfss/questionnaires/pdf-ques/2011brfss.pdf

Chae DH, Walters KL. Racial discrimination and racial identity attitudes in relation to self-rated health and physical pain and impairment among two-spirit American Indians/Alaska natives. Am J Public Health. 2009;99(S1):S144–51. https://doi.org/10.2105/AJPH.2007.126003.CrossRefPubMedPubMedCentral

Couwenbergh C, Van Der Gaag RJ, Koeter M, De Ruiter C, Van den Brink W. Screening for substance abuse among adolescents validity of the CAGE-AID in youth mental health care. Subst Use Misuse. 2009;44(6):823–34. https://doi.org/10.1080/10826080802484264.CrossRefPubMed

Cruz D, Rodriguez Y, Mastropaolo C. Perceived microaggressions in health care: a measurement study. PLoS One. 2019;14(2):e0211620. https://doi.org/10.1371/journal.pone.0211620.CrossRefPubMedPubMedCentral

Drasgow F, Lissak RI. Modified parallel analysis: a procedure for examining the latent dimensionality of dichotomously scored item responses. J Appl Psychol. 1983;68(3):363–73. https://doi.org/10.1037/0021-9010.68.3.363.CrossRef

Dovidio JF, Kawakami K, Gaertner SL. Implicit and explicit prejudice and interracial interaction. J Pers Soc Psychol. 2002;82(1):62–8. https://doi.org/10.1037/0022-3514.82.1.62.CrossRefPubMed

10.

Eason AE, Brady LM, Fryberg SA. Reclaiming representations & interrupting the cycle of bias against native Americans. Daedalus. 2018;147(2):70–81. https://doi.org/10.1162/DAED_a_00491.CrossRef

11.

Elm D, Antone H. The Oneida creation story. Lincoln: University of Nebraska Press; 2000.

12.

Elm JH, Walls ML, Aronson BD. Sources of stress among Midwest American Indian adults with type 2 diabetes. Am Indian Alsk Native Ment Health Res. 2019;26(1):33–62. https://doi.org/10.5820/aian.2601.2019.33.CrossRefPubMedPubMedCentral

13.

Findling MG, Casey LS, Fryberg SA, Hafner S, Blendon RJ, Benson JM, et al. Discrimination in the United States: experiences of native Americans. Health Serv Res. 2019 Dec;54(S2):1431–41. https://doi.org/10.1111/1475-6773.13224.CrossRefPubMedPubMedCentral

14.

Gibbons FX, Yeh HC, Gerrard M, Cleveland MJ, Cutrona C, Simons RL, et al. Early experience with racial discrimination and conduct disorder as predictors of subsequent drug use: a critical period hypothesis. Drug Alcohol Depend. 2007;88:S27–37. https://doi.org/10.1016/j.drugalcdep.2006.12.015.CrossRefPubMedPubMedCentral

15.

Gibbons FX, Etcheverry PE, Stock ML, Gerrard M, Weng CY, Kiviniemi M, et al. Exploring the link between racial discrimination and substance use: what mediates? What buffers? J Pers Soc Psychol. 2010;99(5):785–801. https://doi.org/10.1037/a0019880.CrossRefPubMedPubMedCentral

16.

Gonzales KL, Lambert WE, Fu R, Jacob M, Harding AK. Perceived racial discrimination in health care, completion of standard diabetes services, and diabetes control among a sample of American Indian women. Diab Educ. 2014;40(6):747–55. https://doi.org/10.1177/0145721714551422.CrossRef

17.

Gonzales KL, Noonan C, Goins RT, Henderson WG, Beals J, Manson SM, et al. Assessing the everyday discrimination scale among American Indians and Alaska natives. Psychol Assess. 2016;28(1):51–8. https://doi.org/10.1037/a0039337.CrossRefPubMed

18.

Goosby BJ, Malone S, Richardson EA, Cheadle JE, Williams DT. Perceived discrimination and markers of cardiovascular risk among low-income African American youth. Am J Hum Biol. 2015;27(4):546–52. https://doi.org/10.1002/ajhb.22683.CrossRefPubMedPubMedCentral

19.

Greenfield BL, Venner KL, Tonigan JS, Honeyestewa M, Hubbell H, Bluehorse D. Low rates of alcohol and tobacco use, strong cultural ties for Native American college students in the Southwest. Addict Behav. 2018;82:122-8.

20.

Harrell SP. A multidimensional conceptualization of racism-related stress: implications for the well-being of people of color. Am J Orthop. 2000;70(1):42–57. https://doi.org/10.1037/h0087722.CrossRef

21.

Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat. 1979;1:65–70.

22.

Hollingsworth DW, Cole AB, O’Keefe VM, Tucker RP, Story CR, Wingate LRR. Experiencing racial microaggressions influences suicide ideation through perceived burdensomeness in African Americans. J Couns Psychol. 2017;64(1):104–11. https://doi.org/10.1037/cou0000177.

23.

Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6(1):1-55.

24.

Hwang WC, Goto S. The impact of perceived racial discrimination on the mental health of Asian American and Latino college students. Cult Divers Ethn Minor Psychol. 2008;14(4):326–35. https://doi.org/10.1037/1099-9809.14.4.326.CrossRef

25.

Iacobucci D. Everything you always wanted to know about SEM (structural equations modeling) but were afraid to ask. J Consum Psychol. 2009;19(4):673–80. https://doi.org/10.1016/j.jcps.2009.09.002.CrossRef

26.

Jacobs TL, Shaver PR, Epel ES, Zanesco AP, Aichele SR, Bridwell DA, et al. Self-reported mindfulness and cortisol during a Shamatha meditation retreat. Health Psychol. 2013;32(10):1104–9. https://doi.org/10.1037/a0031362.CrossRefPubMed

27.

Johnston-Goodstar K, VeLure RR. “Our kids Aren’t dropping out; They’re being pushed out”: native American students and racial microaggressions in schools. J Ethn Cult Divers Soc Work. 2017 Jan 2;26(1–2):30–47. https://doi.org/10.1080/15313204.2016.1263818.CrossRef

28.

Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90(8):1212.CrossRef

29.

Jones ML, Galliher RV. Daily racial microaggressions and ethnic identification among native American young adults. Cult Divers Ethn Minor Psychol. 2015;21(1):1–9. https://doi.org/10.1037/a0037537.CrossRef

30.

Kim G, Sellbom M, Ford KL. Race/ethnicity and measurement equivalence of the everyday discrimination scale. Psychol Assess. 2014;26(3):892–900. https://doi.org/10.1037/a0036431.CrossRefPubMedPubMedCentral

31.

Kline RB. Principles and practice of structural equation modeling: Guilford publications; 2015.

32.

Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM. Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med. 2005;61(7):1576–96. https://doi.org/10.1016/j.socscimed.2005.03.006.CrossRefPubMed

33.

Landrine H, Klonoff EA. The schedule of racist events: a measure of racial discrimination and a study of its negative physical and mental health consequences. J Black Psychol. 1996;22(2):144–68. https://doi.org/10.1177/00957984960222002.CrossRef

34.

Lee H, Turney K. Investigating the relationship between perceived discrimination, social status, and mental health. Soc Ment Health. 2012;2(1):1–20. https://doi.org/10.1177/2156869311433067.

35.

Lewis ME, Myhra LL. Integrated care with indigenous populations: considering the role of health care systems in health disparities. J Health Care Poor Underserved. 2018;29(3):1083–107. https://doi.org/10.1353/hpu.2018.0081.CrossRefPubMed

36.

Lewis TT, Cogburn CD, Williams DR. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol. 2015;11:407-40. https://doi.org/10.1146/annurev-clinpsy-032814-112728.

37.

Nadal KL, Wong Y, Griffin KE, Davidoff K, Sriken J. The adverse impact of racial microaggressions on college students’ self-esteem. J Coll Stud Dev. 2014;55(5):461–74. https://doi.org/10.1353/csd.2014.0051.CrossRef

38.

O’Keefe VM, Wingate LR, Cole A, Hollingsworth DW, Tucker RP. Seemingly harmless racial communications are not so harmless: Racial microaggressions lead to suicidal ideation by way of depression symptoms. Suicide and Life-Threatening Behavior. 2015;45(5):567–76. https://doi.org/10.1111/sltb.12150.

39.

Ong AD, Fuller-Rowell T, Burrow AL. Racial discrimination and the stress process. J Pers Soc Psychol. 2009;96(6):1259–71. https://doi.org/10.1037/a0015335.CrossRefPubMed

40.

Pascoe EA, Smart RL. Perceived discrimination and health: a meta-analytic review. Psychol Bull. 2009;135(4):531–54. https://doi.org/10.1037/a0016059.CrossRefPubMedPubMedCentral

41.

Pierce CM, Carew JV, Pierce-Gonzalez D, Wills D. An experiment in racism: TV commercials. Educ Urban Soc. 1977;10(1):61–87. https://doi.org/10.1177/001312457701000105.CrossRef

42.

Perry JL, Nicholls AR, Clough PJ, Crust L. Assessing model fit: caveats and recommendations for confirmatory factor analysis and exploratory structural equation modeling. Meas Phys Educ Exerc Sci. 2015;19(1):12–21. https://doi.org/10.1080/1091367X.2014.952370.CrossRef

43.

Priest N, Williams DR. Racial discrimination and racial disparities in health. In: Major B, Dovidio J, Link B, editors. The Oxford handbook of stigma, discrimination, and health. London: Oxford; 2018. p. 163–82.

44.

R Core Team. R: the R project for statistical computing, version 3.5.3 [computer application]. Vienna: R Foundation for Statistical Computing; 2019. [cited 5 May 2020]. Available from: https://www.r-project.org/

45.

Revelle W. Psych: procedures for psychological, psychometric, and personality research, version 1.8.12 [computer application]. Evanston: Northwestern University; 2018. [cited 5 May 2020]. Available from: https://CRAN.R-project.org/package=psych

46.

Rizopoulos D. ltm: an R package for latent variable modeling and item response theory analyses. J Stat Softw. 2006;17(5):1–25.CrossRef

47.

Rosseel Y. Lavaan: an R package for structural equation modeling and more. Version 0.5–12 (BETA). J Stat Softw. 2012;48(2):1–36.CrossRef

48.

Schmitt MT, Postmes T, Branscombe NR, Garcia A. The consequences of perceived discrimination for psychological well-being: A metaanalytic review. Psychol Bull. 2014;140(4):921–48. https://doi.org/10.1037/a0035754.

49.

Siddiqi A, Shahidi FV, Ramraj C, Williams DR. Associations between race, discrimination and risk for chronic disease in a population-based sample from Canada. Soc Sci Med. 2017;194:135–41. https://doi.org/10.1016/j.socscimed.2017.10.009.CrossRefPubMed

50.

Shariff-Marco S, Breen N, Landrine H, Reeve BB, Krieger N, Gee GC, et al. Measuring everyday racial/ethnic discrimination in health surveys: how best to ask the questions, in one or two stages, across multiple racial/ethnic groups? Du Bois Rev. 2011;8(1):159–77. https://doi.org/10.1017/S1742058X11000129.CrossRefPubMedPubMedCentral

51.

Sittner KJ, Greenfield BL, Walls ML. Microaggressions, diabetes distress, and self-care behaviors in a sample of American Indian adults with type 2 diabetes. J Behav Med. 2018;41(1):122–9. https://doi.org/10.1007/s10865-017-9898-z.CrossRefPubMed

52.

Stevens C, Liu CH, Chen JA. Racial/ethnic disparities in US college students’ experience: discrimination as an impediment to academic performance. J Am Coll Heal. 2018;66(7):665–73. https://doi.org/10.1080/07448481.2018.1452745.CrossRef

53.

Stucky BD, Gottfredson NC, Panter AT, Daye CE, Allen WR, Wightman LF. An item factor analysis and item response theory-based revision of the everyday discrimination scale. Cult Divers Ethn Minor Psychol. 2011;17(2):175–85. https://doi.org/10.1037/a0023356.CrossRef

54.

Sue DW, Capodilupo CM, Torino GC, Bucceri JM, Holder A, Nadal KL, et al. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007;62(4):271–86. https://doi.org/10.1037/0003-066X.62.4.271.CrossRefPubMed

55.

Thayer ZM, Blair IV, Buchwald DS, Manson SM. Racial discrimination associated with higher diastolic blood pressure in a sample of American Indian adults. Am J Phys Anthropol. 2017;163(1):122–8. https://doi.org/10.1002/ajpa.23190.CrossRefPubMedPubMedCentral

56.

Thornton R. American Indian holocaust and survival: a population history since 1492: University of Oklahoma Press; 1987.

57.

Walters KL. Historical trauma, microaggressions, and colonial trauma response: indigenous concepts in search of a measure. In: 2nd international Indigenous health knowledge development conference; 2005.

58.

Walters KL, Simoni JM. Reconceptualizing native women's health: an "indigenist" stress-coping model. Am J Public Health. 2002;92(4):520-4.https://doi.org/10.2105/ajph.92.4.520.

59.

Whitbeck LB, Chen X, Hoyt DR, Adams GW. Discrimination, historical loss and enculturation: culturally specific risk and resiliency factors for alcohol abuse among American Indians. J Stud Alcohol. 2004;65(4):409–18. https://doi.org/10.15288/jsa.2004.65.409.CrossRefPubMed

60.

Whitbeck LB, Hoyt DR, McMorris BJ, Chen X, Stubben JD. Perceived discrimination and early substance abuse among American Indian children. J Health Soc Behav. 2001;1:405–24.CrossRef

61.

Wille SM, Kemp KA, Greenfield BL, Walls ML. Barriers to healthcare for American Indians experiencing homelessness. J Soc Distress Homeless. 2017;26(1):1–8. https://doi.org/10.1080/10530789.2016.1265211.CrossRefPubMedPubMedCentral

62.

Williams DR, John DA, Oyserman D, Sonnega J, Mohammed SA, Jackson JS. Research on discrimination and health: an exploratory study of unresolved conceptual and measurement issues. Am J Public Health. 2012;102(5):975–8. https://doi.org/10.2105/AJPH.2012.300702.CrossRefPubMedPubMedCentral

63.

Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32(1):20–47. https://doi.org/10.1007/s10865-008-9185-0.CrossRefPubMed

64.

Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2008;93(2):200–8.CrossRef

65.

Wolfe P. Settler colonialism and the elimination of the native. J Genocide Res. 2006;8(4):387–409. https://doi.org/10.1080/14623520601056240.CrossRef

66.

Zinbarg RE, Revelle W, Yovel I, Li W. Cronbach’s α, Revelle’s β, and McDonald’s ω H: their relations with each other and two alternative conceptualizations of reliability. Psychometrika. 2005;70(1):123–33. https://doi.org/10.1007/s11336-003-0974-7.CrossRef

Title: Understanding measures of racial discrimination and microaggressions among American Indian and Alaska Native college students in the Southwest United States
Authors: Brenna L. Greenfield
Jessica H. L. Elm
Kevin A. Hallgren
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-11036-9

2024 ASCO Annual Meeting

Springer Medicine

Understanding measures of racial discrimination and microaggressions among American Indian and Alaska Native college students in the Southwest United States

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

“It started 30 years ago, and it still haunts me”: an exploratory investigation of Territorians’ gambling behaviours, harm, and help-seeking for gambling issues in an Australian jurisdiction

Use of the socio-ecological model to explore factors that influence the implementation of a diabetes structured education programme (EXTEND project) inLilongwe, Malawi and Maputo, Mozambique: a qualitative study

Causes of anxiety among teachers giving face-to-face lessons after the reopening of schools during the COVID-19 pandemic: a cross-sectional study

Relative children’s lipid accumulation with hypertension in Chinese children and adolescents

Decolonising violence against women research: a study design for co-developing violence prevention interventions with communities in low and middle income countries (LMICs)

Socio-economic and demographic factors associated with never having tested for HIV among sexually active men across the four administrative regions of Uganda