Bastos João Luiz, Celeste Roger Keller, Silva Diego Augusto Santos, Priest Naomi, Paradies Yin Carl
Post-graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Santa Catarina, 88040-970, Brazil.
Post-graduate Program in Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil.
Soc Psychiatry Psychiatr Epidemiol. 2015 Nov;50(11):1731-42. doi: 10.1007/s00127-015-1108-0. Epub 2015 Aug 12.
Discrimination is a social determinant of health; however, the pathways linking discrimination to ill-health are under-researched. This study investigated the mediators through which discrimination affects health behaviours and physical health outcomes, as well as assessed whether sex moderated these mechanisms.
Data from a representative survey (n = 1023) of undergraduate students enrolled in a Brazilian university in 2012 were used. Structural equation models were applied to assess the following mediation mechanisms--(1) discrimination influences self-rated health and body mass index via anxiety/depression; (2) discrimination affects behaviours (alcohol consumption, problem drinking, smoking, fruit/vegetable consumption, and physical activity) through discomfort associated with discriminatory experiences. The potential of sex to act as an effect-modifying variable was also explored in each of the postulated pathways.
The effect of discrimination on self-rated poor health was totally (100.0%) mediated by anxiety/depression, while body mass index was not correlated with discrimination. Self-reported discrimination was associated with some behaviours via discomfort. Particularly, discomfort partially mediated the positive association between discrimination, leisure time physical activity (43.3%), and fruit/vegetable consumption (52.2%). Sex modified the association between discrimination, discomfort and physical activity in that such mechanism (more discrimination → more discomfort → more physical activity) was statistically significant in the entire sample and among females, but not among males.
This is one of the first studies to demonstrate that discrimination is associated with physical health outcomes and behaviours via distinct pathways. Future investigations should further explicate the mediational pathways between discrimination and key health outcomes.
歧视是健康的社会决定因素；然而，将歧视与健康不良联系起来的途径尚未得到充分研究。本研究调查了歧视影响健康行为和身体健康结果的中介因素，并评估了性别是否调节了这些机制。
使用了2012年对巴西一所大学本科生进行的代表性调查（n = 1023）的数据。应用结构方程模型来评估以下中介机制——（1）歧视通过焦虑/抑郁影响自评健康和体重指数；（2）歧视通过与歧视经历相关的不适感影响行为（饮酒、问题饮酒、吸烟、水果/蔬菜消费和体育活动）。在每个假定途径中还探讨了性别作为效应修饰变量的可能性。
歧视对自评健康不良的影响完全（100.0%）由焦虑/抑郁介导，而体重指数与歧视无关。自我报告的歧视通过不适感与某些行为相关。特别是，不适感部分介导了歧视与休闲时间体育活动（43.3%）和水果/蔬菜消费（52.2%）之间的正相关。性别改变了歧视、不适感和体育活动之间的关联，因为这种机制（更多歧视→更多不适感→更多体育活动）在整个样本和女性中具有统计学意义，但在男性中没有。
这是首批证明歧视通过不同途径与身体健康结果和行为相关的研究之一。未来的研究应进一步阐明歧视与关键健康结果之间的中介途径。
