The TPRS provides an innovative approach for examining the epidemiology of racism as a chronic stressor. Within a multidimensional framework, the TPRS captures perceptions of and responses to racism within a 15-minute telephone interview. The TPRS adds to the field of epidemiology by providing not only a tool to examine perceived racism, but also by including questions to assess both the individual’s experiences of racism and the perceptions of experiences of racism faced by Blacks as a group. The rationale for including these two types of subscales is that an individual’s personal perceptions may be greatly influenced by his/her social environment, as well as by knowledge of how racism affects the group (Black race).
The TPRS broadens the conceptualization of racism by considering factors that could influence one’s personal experience of racism and responses to racist event(s). This instrument considers the influence of past experiences of racism by asking the participants about their childhood (before age 20) and experiences during their twenties. The TPRS is also the first instrument to acknowledge the stress of raising a child in a color-conscious society with the inclusion of questions about a mother’s concern for her Black son(s), daughter(s), or grandchildren. For example, a person who was the victim of racial discrimination while growing-up, or someone who has a child experiencing racism, may experience more stress than someone without these experiences.
Further, the TPRS extends the PRS to establish subscales for the emotional and behavioral responses to racism in terms of active and passive coping responses. Five emotional and behavioral response subscales were determined: passive emotions, active emotions, passive behaviors, internal active behavior, and external active behavior. Clustering of coping styles, as such, may be more advantageous in linking exposure to racism and coping with certain health outcomes.
The passive behaviors subscale (does not speak up, accept or keep to yourself, ignore or forget) represents a more passive style of coping where one chooses not to take action. This type of inhibitory response has been suggested as a risk factor for hypertension and other poor health outcomes.9,22
For example, among Black women who experienced unfair treatment, those who kept quiet and accepted it were four times as likely to have high blood pressure as those who talked about it or took action.23
Similarly, the external active behavior subscale, a form of “John Henryism,” is the active attempt to overcome adversity or prove oneself to others. This coping response has also been found to be maladaptive in terms of health.24,25
Praying, an internal active behavior, has been seen as a positive behavioral coping response for Black people because of the group’s strong affiliation with the church.4
Historically, the church has been viewed as a supportive social-network for Blacks, and may modify the negative consequences of racism.26
Items on the passive emotions subscale (eg, hopeless and powerless) are depressive symptoms that suggest increased mental distress and may be linked to negative health outcomes such as obesity.27,28
The items on the active emotions subscale (eg, angry, frustrated, anxious, sad) may be viewed as adaptive emotions because they are expressed, allowing the body to recover from stressful experiences.22
These emotions allow the body to respond immediately to the stressor when the expression of anger, frustration, or the externalization of feelings onto someone else are within moderation. In the TPRS, questions pertaining to emotional and behavioral responses to racism were asked in a hypothetical way of women who reported no personal experiences of racism. Thus, it provides data to address researchers’ speculations that women with high blood pressure who do not report experiences of racism may be internalizing the racial discrimination.9,23
With respect to psychometric properties, the alpha values for the TPRS ranged from 0.76 to 0.92 for all subscales, except for the passive coping behavior subscale (α = 0.68). The Cronbach alpha values for the Concern for the Children and Past Experiences of Racism scales were high (α = 0.90) to moderately high (α = 0.82), respectively. The test-retest reliabilities using the intraclass correlation coefficient were overall fair to adequate. Overall, the results from the tests of internal consistency and test-retest reliability found the TPRS to be psychometrically sound.
The TPRS was constructed specifically for use with employed Black women to study the effects of perceived racism on women’s health. The study sample was generally of middle income, though there was a wide range; a small proportion fell below poverty level, and nearly 20% had an annual household income of over $100,000. Further testing would be required to determine the psychometric properties of this instrument in a low socioeconomic sample. The youngest women in our sample were in their thirties. We expect that the questionnaire will be applicable to younger women as well, but further testing would be useful. To gain further insight into the role of perceived racism on health status, we plan to describe the prevalence of and responses to racism as captured by the TPRS using the sample of 476 Black women interviewed. We also plan to use the TPRS to examine the association between perceived racism and chronic diseases such as uterine fibroids and obesity. We encourage others to make use of this scale.