Original articleMaternal experiences of ethnic discrimination and child cardiometabolic outcomes in the Study of Latino Youth
Introduction
Cardiometabolic disorders begin in childhood [1] and are among the leading causes of death among adults in the United States [2]. The American Heart Association has acknowledged the large public health burden of cardiometabolic disorders in Hispanic/Latinos in the United States [3], a large and rapidly growing minority group [3]. There are persistent racial/ethnic and socioeconomic disparities in the incidence, treatment, and outcomes of cardiometabolic disorders that are shaped by social determinants [4]. Racial/ethnic discrimination, defined as differential or unfair treatment based on actual or perceived membership in a racial/ethnic group, is now recognized as a social determinant of health for both children and adults [5], [6]. Research with Hispanic/Latino adolescents shows that discrimination is associated with mental health and behavioral problems [5], [7]. In the present study, we extend this work to examine the association between maternal experiences of ethnic discrimination and youth cardiometabolic risk factors in a diverse Hispanic/Latino population. This study builds on the integrative model for minority youth [8], which emphasizes the role of discriminatory experiences in the health of minority youth, and the concept of “linked lives” [9]. This model directs researchers to consider the connectedness among individuals within families and across generations (i.e., discriminatory experiences in parents’ lives would be expected to have implications for the health of their children and vice versa).
A substantial body of research has documented that stressful environments are associated with poorer child outcomes [10], including a variety of physiological factors related to the development of cardiometabolic disorders [11], [12]. Maternal experiences of racial/ethnic discrimination may be an important, yet underexplored, form of childhood adversity [13] which could influence development via a number of pathways, including elevated stress in the household that could erode capacity for supportive and sensitive parenting [5]. Furthermore, by definition, maternal experiences of discrimination are likely to be associated with difficulties that follow from unfair experiences, including restricted access to high-quality health care, housing, or employment. Previous studies that have examined a parent's experiences of discrimination [14], [15], [16], [17], [18], [19], including the related construct of acculturative stress [20], [21], have documented strong associations with child socioemotional and behavioral outcomes and overall family functioning.
Only a few previous studies have examined parental experiences of racial/ethnic discrimination in relation to nonmental health outcomes (e.g., [22], [23]), and most of these studies have relied on parent-reported body mass index (BMI) or history of illness, have largely examined young children [16], [18], [22], [23], and have rarely focused on Hispanic/Latinos (see [16], [17] for exceptions). To our knowledge, there are no previous studies of parental experiences of racial/ethnic discrimination in relation to cardiovascular risk outcomes among youth in the United States or elsewhere.
Using data from the Study of Latino (SOL) Youth, we examined the association between maternal experiences of ethnic discrimination and Hispanic/Latino youth cardiometabolic risk outcomes approximately 2 years later, including BMI, metabolic syndrome (MetS) score, and inflammation (indicated by high sensitivity C-reactive protein level [hsCRP]). Given the sex and age differences documented in SOL for a range of CVD risk outcomes [24], and the potential for sex or age differences in response to maternal experiences of ethnic discrimination, we also examined whether associations differed by sex or age. The results from this investigation may be used to (1) generate hypotheses for future prospective studies on factors that influence the emergence of racial/ethnic health disparities in cardiometabolic outcomes, (2) illustrate the importance of gathering data on discriminatory experiences of parents to better understand and devise strategies to improve cardiometabolic health among racial/ethnic minority youth over the life course, and (3) support structural-level strategies to reduce discrimination against Hispanics/Latinos in the United States.
Section snippets
Study design and data collection
The SOL Youth is a population-based study of youth aged 8–16 years recruited between 2012 and 2014 from four communities in the United States (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA). Details of recruitment and study design have been previously published [24], [25]. Briefly, SOL Youth enrolled a subset of the offspring of participants in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a comprehensive multicenter community-based cohort study of Hispanics/Latinos in the
Results
Our sample of youth included an equal proportion of females and males, with 20% born outside of the United States. Nearly half of the sample (48%) identified as having Mexican background, and over half of the sample lived in a household earning less than $20,000 a year (52%). Over a third of the youth's mothers reported depression symptom scores above a threshold indicative of risk for a clinical depression disorder (35%), and most of the youth's mothers were married or living with a partner
Summary
Drawing on data from a large sample of Hispanic/Latino youth of diverse national backgrounds, we documented elevated levels of hsCRP among children whose mothers had experienced higher levels of ethnic discrimination. However, we did not observe a relationship between maternal ethnic discrimination and youth BMI or metabolic syndrome severity score. The association between maternal ethnic discrimination and hsCRP levels in youth was robust to adjustment for maternal depression and maternal BMI.
Acknowledgment
The SOL Youth Study was supported by Grant Number R01HL102130 from the National Heart, Lung, and Blood Institute, United States. The children in SOL Youth are drawn from the study of adults: The Hispanic Community Health Study/Study of Latinos, which was supported by contracts from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina, United States (N01-HC65233), University of Miami, United States (N01-HC65234), Albert Einstein College of Medicine, United
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