Everyday discrimination, emotion, and daily interactions during adolescence.

The present study examined whether everyday discrimination relates to the frequency of adolescents' positive and negative daily social interactions and whether these associations are driven by anger and positive emotion. Adolescents (N = 334) participated in a three-wave longitudinal study, in which they completed surveys regarding everyday discrimination, anger, and positive emotion, as well as 15 daily reports of conflict and getting along with friends and family. Higher everyday discrimination was related to more daily conflicts and fewer experiences of getting along with other people. Longitudinal models also provided preliminary evidence that everyday discrimination was associated with daily conflicts 4 years later indirectly through anger. Overall, results suggest everyday discrimination relates to adolescents' daily experiences, potentially through differences in emotion.

Low subjective social status is associated with daily selection of fewer healthy foods and more high-fat/high sugar foods.

Socioeconomic status has been related to poorer eating behaviors, potentially due to feeling of lower status relative to peers. Despite experimental evidence that temporarily feeling of lower status can contribute to greater caloric intake, it remains unclear how feeling of lower social status relate to eating behavior in daily life. This study aimed to test whether lower subjective social status (SSS)-the feeling of having relatively lower social status-in American society and relative to college peers were related to daily food selection. A sample of 131 young adults (Mage = 20.3, SD = 0.8; 60% female; 46% Latinos; 34% European American; 15% Asian American; 5% of other ethnicities) reported their SSS in society and in college and completed 15 daily reports regarding the number of daily servings they had of fruits, vegetables, fried foods, fast foods, desserts, and sugary drinks. Multilevel models with days nested within individuals were used to test whether low SSS in society or college related to daily food intake. Next, we examined whether associations were driven by young adults' perceived stress and daily stressors. Analyses controlled for age, gender, ethnicity, family and personal income, and parents' education to test the unique associations between subjective status and food intake. Whereas SSS in society was not related to food intake, young adults with lower SSS in their college consumed fewer daily servings of healthy foods and more daily servings of high-fat/high-sugar foods. Although lower college SSS was related to greater perceived stress, perceived stress and daily stressors were consistently unrelated to daily food intake. Findings suggested that lower SSS in local environments (e.g., college) may impact young adults' daily food choices through processes beyond heightened stress.

Short-Term Health Outcomes of a Structured Pulmonary Rehabilitation Program Implemented Within Rural Canadian Sites Compared With an Established Urban Site: A Pre-Post Intervention Observational Study.

OBJECTIVES: To evaluate congruence in program delivery and short-term health outcomes of a structured pulmonary rehabilitation (S-PR) program implemented at 11 Canadian rural pulmonary rehabilitation (PR) sites compared with an urban reference site. DESIGN: Multi-center, pre- and post-intervention, comparative, observational study. SETTING: Eleven rural Canadian PR sites and 1 urban reference PR site. PARTICIPANTS: Adults with chronic respiratory diseases (CRDs) referred to PR. INTERVENTION: Clinicians at the reference site worked with local clinicians to implement the S-PR program in rural sites. A PR survey evaluated site congruence with the S-PR components, with congruence defined as delivering program components ≥80% in alignment with the S-PR program. Participants were enrolled in 16 sessions of group education and supervised exercise, offered twice or thrice a week. Health outcomes were tracked using a quality assurance database. OUTCOME MEASURES: Main outcomes were congruence in program delivery and changes in the 6-minute walk (6MW) distance and COPD Assessment Test (CAT). RESULTS: A total of 555 participants (rural n=204 and reference n=351) were included in the analyses. There was congruence in exercise and group education; however, individual education varied. Following the S-PR program, 6MW distance increased, with greater changes observed at rural sites (51±67 m at rural sites vs 30±46 m at the reference site). CAT score was reduced by -2.6±5.4 points with no difference between reference and rural sites. Changes in 6MW distance and CAT scores were similar for participants at sites that were congruent vs noncongruent with the individual education component, and similar for patients with COPD, asthma, bronchiectasis, and interstitial lung disease. CONCLUSION: The S-PR program components can be implemented with good congruence in Canadian rural settings, resulting in similar short-term health outcomes as in an established urban site and across CRDs.

Discrimination and health: A dyadic approach.

This study examined how discrimination changes over time, how discrimination is related to health and substance use, and whether discrimination spills over to affect the health of family members. Parent-adolescent dyads (N = 341) completed measures of discrimination, physical health, mental health, and substance use over 5 years. Actor-Partner Interdependence Models indicated that individuals' experiences of discrimination can spill over to some aspects of the family context, depending on who is experiencing discrimination (i.e. parent, adolescent) and the outcome (i.e. mental health, substance use). Results suggest that parent-reported discrimination may affect adolescent depression, and adolescent-reported discrimination can spill over to parents' substance use.

"Not to exclude you, but ": Characterization of pharmacy student microaggressions and recommendations for academic pharmacy.

INTRODUCTION: Microaggressions are commonplace indignities that communicate slights to marginalized persons. Microaggressions have been shown to negatively impact student well-being and academic performance. We describe the experiences of students in relation to the occurrence of microaggressions within the learning environment of a college of pharmacy (COP). METHODS: Students in a COP were interviewed regarding their experiences of microaggressions. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using a conventional content analysis method. RESULTS: Thirteen pharmacy students participated in the study. Six (46%) identified as women. Six (46%) identified as Black, Asian, or multi-racial. Experiences were first-hand, witnessed, or stories they heard. Three themes arose from the data: (1) feeling othered; (2) power, pain, pollution, and pervasiveness of microaggressions; and (3) responsibility of academic community to mitigate microaggressions. Microaggressions were described based on race, religion, gender, sexuality, age, English proficiency, and others. Students expressed confusion with responding to microaggressions, microaggressions disguised as jokes, divisiveness related to the 2016 presidential election, unawareness of biases, dismissal of their concerns, hopelessness for change, and centering dominant groups in the curriculum. Recommendations from participants to address microaggressions included longitudinal cultural competency in the curriculum, cultural competency training for faculty, guidance on conflict management, and open discussions related to diversity and inclusion. CONCLUSIONS: Students are unsure how to identify, address, and mitigate microaggressions. Actions are needed to reduce these incidents, facilitate healing of individuals who have experienced past microaggressions, and promote a diverse and inclusive learning environment.

Subjective social status and health during high school and young adulthood.

Although many facets of social status (i.e., socioeconomic status, gender, race) are fairly stable, limited work has assessed how youths' identification with their status changes over time. Subjective social status (SSS) refers to one's perception of standing or rank relative to others, and for youth status is generally in the context of society or school. The current study assessed how adolescents' SSS in American society and in their school changes and predicts health and well-being during and after high school. A total of 336 adolescents (Mage = 16.40 at Wave 1) reported their SSS at up to three time points, each 2 years apart, such that youth provided data between the 10th grade and 3 years following the transition from high school. Piecewise multilevel modeling was used, including discontinuities to assess the importance of the transition from high school. Society SSS decreased across the period, especially among youth with lower family income, youth whose parents reported lower SSS, and youth who did not attend college. School SSS was stable during high school, declined after 12th grade, and remained stable thereafter. Moderation analyses revealed that school SSS declines more consistently among female adolescents than male adolescents and Latinos relative to other ethnic groups. Lower society and school SSS were associated with more depressive symptoms and greater likelihood of obesity, highlighting the relevance of SSS for health during this important developmental transition. Results suggest declines in SSS are especially common among disadvantaged groups as they age, and that lower SSS may indicate risk for poorer health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Influence of Disease Severity and Exercise Limitation on Exercise Training Intensity and Load and Health Benefits From Pulmonary Rehabilitation in Patients With COPD: AN EXPLORATORY STUDY.

PURPOSE: Some patients with chronic obstructive pulmonary disease (COPD) fail to achieve health benefits with pulmonary rehabilitation (PR). Exercise intensity and load represent stimulus for adaptation but it is unclear whether inappropriate exercise intensity and/or load are affected by severity of COPD, which may affect health benefits. The purpose was to determine whether COPD severity and/or the severity of pulmonary limitation to exercise (PLE) impacted exercising intensity or load and whether resultant intensity/load affected health outcomes derived from PR. METHODS: Patients with COPD (n = 58, age = 67 ± 7 y, forced expiratory volume in the first second of expiration [FEV1] % predicted = 52 ± 21%) were recruited upon referral to PR. Primary health outcomes evaluated were 6-min walk distance and St George's Respiratory Questionnaire. Patients were stratified for disease severity using Global Initiative for Obstructive Lung Disease (GOLD) staging and PLE severity by change in inspiratory capacity during exercise. Exercise intensity and load were calculated from daily exercise records. RESULTS: Participants achieved comparable training duration and load regardless of GOLD severity. Patients with more severe PLE achieved greater training duration (more severe: 546 ± 143 min., less severe: 451 ± 109 min., P = .036), and relative training load (more severe: 2200.8 ± 595.3 kcal, less severe: 1648.3 ± 597.8 kcal, P = .007). Greater overall training load was associated with greater improvements in 6-min walk distance (r = 0.24, P = .035). No significant relationships were observed between PLE, GOLD severity, training parameters, and St George's Respiratory Questionnaire response. CONCLUSIONS: Improvements in exercise tolerance can be explained by achieving greater training loads, demonstrating the importance of appropriate training load to maximize health outcomes in PR.

Discrimination and Sleep Difficulties during Adolescence: The Mediating Roles of Loneliness and Perceived Stress.

Irregular and insufficient sleep place youth at risk for adverse psychological and physical health outcomes. Recent research indicates that discrimination constitutes a type of stressor that interferes with adolescent sleep; however, the mechanisms through which discrimination affects sleep are not well understood. This study examined whether ethnic and non-ethnic (i.e., gender, age, and height/weight) discrimination were associated with adolescents' sleep duration, variability, and quality, and whether loneliness and perceived stress mediated these associations. An ethnically-diverse sample (42% Latino, 29% European American, 23% Asian) of adolescents (N = 316; M age = 16.40 years, 57% girls) reported on their experiences of discrimination, perceived stress, and loneliness. Sleep duration and variability were assessed by actigraphy and sleep quality through self-reports. Ethnic discrimination was related to shorter sleep duration and both ethnic and non-ethnic discrimination were associated with worse sleep quality. Loneliness and perceived stress partially mediated the relation between discrimination and sleep quality. Discriminatory experiences can heighten feelings of loneliness and stress, which, in turn, may contribute to diminished sleep quality during adolescence.

Sexual minority youth of color: A content analysis and critical review of the literature.

This study analyzed the content of 125 unique reports published since 1990 that have examined the health and well-being-as well as the interpersonal and contextual experiences-of sexual minority youth of color (SMYoC). One-half of reports sampled only young men, 73% were noncomparative samples of sexual minority youth, and 68% of samples included multiple racial-ethnic groups (i.e., 32% of samples were mono-racial/ethnic). Most reports focused on health-related outcomes (i.e., sexual and mental health, substance use), while substantially fewer attended to normative developmental processes (i.e., identity development) or contextual and interpersonal relationships (i.e., family, school, community, or violence). Few reports intentionally examined how intersecting oppressions and privileges related to sexual orientation and race-ethnicity contributed to outcomes of interest. Findings suggest that research with SMYoC has been framed by a lingering deficit perspective, rather than emphasizing normative developmental processes or cultural strengths. The findings highlight areas for future research focused on minority stress, coping, and resilience of SMYoC.

Not just sticks and stones: Indirect ethnic discrimination leads to greater physiological reactivity.

OBJECTIVES: We examined the effect of indirect ethnic discrimination on physiological reactivity (i.e., cortisol, blood pressure, heart rate) in Latino emerging adults. METHOD: Participants (N = 32) were randomly assigned to be exposed to indirect ethnic discrimination (experimental condition) or not (control condition) while undergoing a cognitive stress task. RESULTS: Greater total cortisol output was observed in participants in the experimental condition, relative to those in the control condition. No significant differences in heart rate or blood pressure were noted. CONCLUSIONS: Results suggest that witnessing ethnic discrimination affects cortisol recovery responses, but not cardiovascular reactivity. Words that are not intentionally hurtful or directed at a specific person may still "hurt"-affecting biological processes associated with hypothalamic-pituitary-adrenocortical (HPA) axis and potentially leading to long-term health consequences. (PsycINFO Database Record

Everyday discrimination and diurnal cortisol during adolescence.

PURPOSE: To examine the associations of the frequency and type of everyday discrimination with diurnal cortisol and whether those associations depend upon adolescents' ethnicity and gender. METHODS: Adolescents (N=292, Mage=16. 39years, SD=0.74; 58% female) reported the frequency of perceived everyday discrimination and whether they attributed that discrimination to race, gender, age, or height and weight. Five saliva samples were collected per day across 3days and assayed for cortisol. RESULTS: Higher frequency of everyday discrimination was associated with greater total daily cortisol output (area under the curve; AUC), lower wake and bedtime levels of cortisol, and less of a decline in cortisol across the day. These associations generally did not depend upon ethnicity or gender and attributions for the discrimination were not as consequential as the actual frequency of any type of unfair treatment. CONCLUSION: Everyday discrimination, regardless of its type, may contribute to heightened HPA activity among adolescents of different ethnic backgrounds and genders.

Understanding Differences in College Persistence: A Longitudinal Examination of Financial Circumstances, Family Obligations, and Discrimination in an Ethnically Diverse Sample.

Ethnic and generation differences in motivation and achievement have been well-established. However, less work has examined the role of social factors on educational outcomes among individuals from diverse backgrounds. With a longitudinal sample of 408 Latino, Asian, and European-American students, we examine family, discrimination, and financial factors in 12th grade and two years later as predictors of persistence four years after high school, and as mediators of ethnic and generation differences in persistence. Results indicate that family obligations, discrimination, and financial burdens are associated with reduced rates of persistence, while high school GPA, SES, and financial aid are associated with higher rates of persistence. Ethnic differences in persistence are related to high school GPA and SES, as well as financial circumstances. Reducing ethnic disparities in college persistence should thus involve attention not only to academic factors, but also to family circumstances that may cause college attendance to be a hardship.

Sonographic assessment of the effect of vesicoureteral reflux and urinary tract infections on growth of the pediatric solitary kidney.

INTRODUCTION: Perusal of recent guidelines relating to proper evaluation of infants and children with urinary tract infection (UTI) suggests that the occurrence of vesicoureteral reflux (VUR) may not have the clinical import previously ascribed to this anatomic abnormality. Patients with a solitary kidney uniquely allow investigation of the effects of both vesicoureteral reflux (VUR) and urinary tract infection (UTI) on renal growth unencumbered with the inevitable questions of laterality that confound analysis in patients with two kidneys. Several previous studies with conflicting results have addressed whether vesicoureteral reflux (VUR) impacts ultimate renal size in children with a solitary kidney. Few published studies have considered the occurrence of both urinary tract infection (UTI) and VUR on the degree of compensatory hypertrophy. This is the largest series to date investigating the effect of both UTI and VUR on the degree of compensatory hypertrophy with time. OBJECTIVE: Our objective was to analyze sonographically determined renal growth in patients with a solitary kidney, stratifying for both the occurrence and severity of UTIs and the occurrence and severity of VUR. STUDY DESIGN: We retrospectively reviewed the clinical history (including bladder and bowel dysfunction (BBD)) and radiology reports of 145 patients identified as having either a congenital or acquired solitary kidney in our pediatric urology practice from the prior 10 years. UTIs were tabulated by severity, where possible, and the grade of VUR was recorded based on the initial cystogram. Sonographically determined renal length was tabulated for all ultrasounds obtained throughout the study. Based on a mixed-effects model, we investigated the influence of UTI and VUR on renal growth. RESULTS: Of the 145 patients analyzed, 105 had no VUR and 39 had VUR (16 = Gr I&II, 11 = GIII, 12 = GIV&V). Comparison showed that there was no difference in the occurrence of UTI between those without VUR (27/105 with UTI) and those with VUR (15/39 with UTI; p = 0.14). There was no difference in the occurrence of BBD in patients with VUR (15/39) and those without VUR (36/106, p = 0.62). While neither VUR nor UTI alone affected renal growth in the solitary kidney, the three-way interaction term among age, VUR, and UTI was significant (p = 0.016). The growth of the kidneys in the various patient groups is depicted in the table. From the analysis, a refluxing solitary kidney with UTI showed a significantly lower growth rate than the other groups (p < 0.001). DISCUSSION: This study is limited by the inherent selection bias of retrospective studies. Additionally, the variability of sonographic renal measurement is well recognized. Lastly, our sample size did not allow us to incorporate the severity of the UTIs and the grades of VUR in our final regression model. Nevertheless, the overall patterns suggest that when both VUR and UTI are present, the solitary kidney demonstrates less renal growth with time. Study of larger cohorts of patients with solitary kidneys will be necessary to confirm our observations and discern what, if any, are the consequences of high-grade VUR and upper tract UTI in these patients. CONCLUSION: In the largest series to date we were able to discern no independent effect of either VUR or UTI on sonographically determined renal growth in patients with a solitary kidney. However, UTI and VUR together result in kidneys that are smaller than other solitary kidneys not so affected. Follow-up studies of larger cohorts seem warranted to confirm these findings and discern the clinical import of these smaller kidneys.

To study or to sleep? The academic costs of extra studying at the expense of sleep.

This longitudinal study examined how nightly variations in adolescents' study and sleep time are associated with academic problems on the following day. Participants (N = 535, 9th grade M(age) = 14.88) completed daily diaries every day for 14 days in 9th, 10th, and 12th grades. Results suggest that regardless of how much a student generally studies each day, if that student sacrifices sleep time to study more than usual, he or she will have more trouble understanding material taught in class and be more likely to struggle on an assignment or test the following day. Because students are increasingly likely to sacrifice sleep time for studying in the latter years of high school, this negative dynamic becomes increasingly prevalent over time.

Ethnic microaggressions and the depressive and somatic symptoms of Latino and Asian American adolescents.

Ethnic microaggressions are a form of everyday, interpersonal discrimination that are ambiguous and difficult to recognize as discrimination. This study examined the frequency and impact of microaggressions among Latino (n = 247) and Asian American (n = 113) adolescents (M (age) = 17.18, SD = .75; 57 % girls). Latino adolescents reported more frequent microaggressions that dismiss their realities of discrimination and microaggressions characterized by treatment as a second class citizen than Asian Americans, but similar levels of microaggressions that highlight differences or foreignness. There were no ethnic differences in the extent to which adolescents were bothered by microaggressions. Moreover, even supposedly innocuous forms of discrimination are associated with elevated levels of anxiety, anger, and stress, which may increase feelings of depression and sickness. Microaggressions should be recognized as subtle discrimination that send messages about group status and devaluation, and similar to overt discrimination, can evoke powerful emotional reactions and may affect mental health.

Perceived ethnic stigma across the transition to college.

Ethnicity-based negative treatment during the transition to college may affect the long-term adjustment of ethnic-minority youth. We examined within-person changes in youths' perceptions of overt discrimination and their sense of their ethnic group being devalued by the larger society among 563 Latino, European, Asian, and other ethnic minority emerging adults across the transition to college (M (age) = 17.79, SD = .37, 54.7% female). Analyses tested for group and context differences and associations between perceived discrimination and societal devaluation of their group and adjustment. Results indicate that although perceived discrimination decreases over time, perceived devaluation by society increases. Social context did not affect changes in perceived discrimination and societal devaluation. Whereas perceived discrimination was associated with depressive and somatic symptoms for everyone, perceived societal devaluation was only consequential for ethnic minorities. Future research should identify possible moderators to help students cope with experiences of discrimination and feelings of not being valued by society.

A longitudinal study of religious identity and participation during adolescence.

To examine the development of religious identity during the teenage years, adolescents (N = 477) from Latin American, Asian, and European backgrounds completed questionnaires in the 10th, 11th, and 12th grades (10th grade age: M = 15.81, SD = 0.36). Results indicated that religious identity remained stable across high school whereas religious participation declined. Even after controlling for ethnic differences in religious affiliation, socioeconomic background, and generational status, adolescents from Latin American and Asian backgrounds reported higher levels of religious identity and adolescents from Latin American backgrounds reported higher rates of religious participation. Within individual adolescents, changes in religious identity were associated with changes in ethnic and family identities, suggesting important linkages in the development of these social identities during adolescence.