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1.  həli?dxw/Healthy Hearts Across Generations: Development and Evaluation Design of a Tribally Based Cardiovascular Disease Prevention Intervention for American Indian Families 
The journal of primary prevention  2012;33(4):197-207.
American Indian and Alaska Native (AIAN) populations are disproportionately at risk for cardiovascular disease (CVD), diabetes, and obesity, compared with the general US population. This article describes the həli?dxw/Healthy Hearts Across Generations project, an AIAN-run, tribally based randomized controlled trial (January 2010–June 2012) designed to evaluate a culturally appropriate CVD risk prevention program for AI parents residing in the Pacific Northwest of the United States. At-risk AIAN adults (n = 135) were randomly assigned to either a CVD prevention intervention arm or a comparison arm focusing on increasing family cohesiveness, communication, and connectedness. Both year-long conditions included 1 month of motivational interviewing counseling followed by personal coach contacts and family life-skills classes. Blood chemistry, blood pressure, body mass index, food intake, and physical activity were measured at baseline and at 4- and 12-month follow-up times.
doi:10.1007/s10935-012-0274-z
PMCID: PMC3505854  PMID: 22965622
American Indians; Alaska Natives; Cardiovascular; Heart disease; Intervention; Motivational interviewing
2.  Research on Discrimination and Health: An Exploratory Study of Unresolved Conceptual and Measurement Issues 
American Journal of Public Health  2012;102(5):975-978.
Objectives
Our goal in this study was to better understand racial and socioeconomic status (SES) variations in experiences of racial and nonracial discrimination.
Methods
We used 1999 and 2000 data from the YES Health Study, which involved a community sample of 50 Black and 50 White respondents drawn from 4 neighborhoods categorized according to racial group (majority Black or majority White) and SES (≤ 150% or > 250% of the poverty line). Qualitative and quantitative analyses examined experiences of discrimination across these neighborhoods.
Results
More than 90% of Blacks and Whites described the meaning of unfair treatment in terms of injustice and felt certain about the attribution of their experiences of discrimination. These experiences triggered similar emotional reactions (most frequently anger and frustration) and levels of stress across groups, and low-SES Blacks and Whites reported higher levels of discrimination than their moderate-SES counterparts.
Conclusions
Experiences of discrimination were commonplace and linked to similar emotional responses and levels of stress among both Blacks and Whites of low and moderate SES. Effects were the same whether experiences were attributed to race or to other reasons.
doi:10.2105/AJPH.2012.300702
PMCID: PMC3329155  PMID: 22420798
3.  Perceived Discrimination and Psychological Well-Being in the U.S. and South Africa 
Ethnicity & health  2012;17(0):111-133.
This study uses two national probability samples of adults, the National Survey of American Life (NSAL) and the South African Stress and Health Study (SASH) to systematically assess how the levels of perceived racial and non-racial discrimination and their effects on self-esteem and mastery in the U.S. compares to those in South Africa. Levels of perceived racial discrimination are higher in the U.S. than South Africa. In the U.S. both African Americans and Caribbean blacks have comparable or higher levels of self-esteem and mastery than whites. In contrast, South African Whites have higher levels of both self-esteem and mastery than blacks, Coloureds and Indians. Perceived discrimination, especially chronic everyday discrimination, is inversely related to self-esteem and mastery in both societies. In South Africa, stress and socioeconomic status (SES) but not discrimination are important determinants of racial differences in self-esteem and mastery. Our main findings indicate that in two racialized societies, perceived discrimination acts independent of demographic factors, other stressors, social desirability, racial identity and SES to negatively affect psychological functioning.
doi:10.1080/13557858.2012.654770
PMCID: PMC3468317  PMID: 22339224
4.  Race, Socioeconomic Status and Health: Complexities, Ongoing Challenges and Research Opportunities 
This paper provides an overview of racial variations in health and shows that differences in socioeconomic status (SES) across racial groups are a major contributor to racial disparities in health. However, race reflects multiple dimensions of social inequality and individual and household indicators of SES capture relevant but limited aspects of this phenomenon. Research is needed that will comprehensively characterize the critical pathogenic features of social environments and identify how they combine with each other to affect health over the life course. Migration history and status are also important predictors of health and research is needed that will enhance understanding of the complex ways in which race, SES, and immigrant status combine to affect health. Fully capturing the role of race in health also requires rigorous examination of the conditions under which medical care and genetic factors can contribute to racial and SES differences in health. The paper identifies research priorities in all of these areas.
doi:10.1111/j.1749-6632.2009.05339.x
PMCID: PMC3442603  PMID: 20201869
5.  Moving Upstream: How Interventions that Address the Social Determinants of Health can Improve Health and Reduce Disparities 
There is considerable scientific and policy interest in reducing socioeconomic and racial/ethnic disparities in healthcare and health status. Currently, much of the policy focus around reducing health disparities has been geared towards improving access, coverage, quality and the intensity of healthcare. However, health is more a function of lifestyles linked to living and working conditions than of healthcare. Accordingly, effective efforts to improve health and reduce gaps in health need to pay greater attention to addressing the social determinants of health within and outside of the healthcare system. This paper highlights research evidence documenting that tackling the social determinants of health can lead to reductions in health disparities. It focuses both on interventions within the healthcare system that address some of the social determinants of health, as well as, interventions in upstream factors such as housing, neighborhood conditions and increased socioeconomic status that can lead to improvements in health. The studies reviewed highlight the importance of systematic evaluation of social and economic policies that might have health consequences and the need for policy makers, healthcare providers, and leaders across multiple sectors of society to apply currently available knowledge to improve the underlying conditions that impact the health of populations.
doi:10.1097/01.PHH.0000338382.36695.42
PMCID: PMC3431152  PMID: 18843244
racial disparities; socioeconomic disparities; interventions; healthcare
6.  Discrimination and racial disparities in health: evidence and needed research 
This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.
doi:10.1007/s10865-008-9185-0
PMCID: PMC2821669  PMID: 19030981
Racism; Discrimination; Stress; Health disparities; Race; Ethnicity
7.  Perceived Discrimination, Race and Health in South Africa 
Social science & medicine (1982)  2008;67(3):441-452.
To assess the levels of perceived acute and chronic racial and non-racial discrimination in South Africa, their association with health, and the extent to which they contribute to racial differences in physical and mental health, data were used from a national probability sample of adults, the South African Stress and Health Study (SASH). All Black groups in South Africa (African, Coloured and Indian) were two to four times more likely than Whites to report acute and chronic experiences of racial discrimination. Africans and Coloureds report higher levels of ill health than Whites, but acute and chronic racial discrimination were unrelated to ill health and unimportant in accounting for racial differences in self rated health. In contrast, all Black groups had higher levels of psychological distress than Whites, and perceived chronic discrimination, was positively associated with distress. Moreover, these experiences accounted for some of the residual racial differences in distress after adjustment for socioeconomic status. Our main findings indicate that, in a historically racialized society, perceived chronic racial and especially non-racial discrimination acts independently of demographic factors, other stressors, psychological factors (social desirability, self-esteem and personal mastery), and multiple SES indicators to adversely affect mental health.
doi:10.1016/j.socscimed.2008.03.021
PMCID: PMC2643465  PMID: 18486292
South Africa; Perceived Discrimination; Race; mental health; distress; South African Stress and Health Study (SASH)

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