Racial discrimination and allostatic load among First Nations Australians: a nationally representative cross-sectional study.

BACKGROUND: Increased allostatic load is linked with racial discrimination exposure, providing a mechanism for the biological embedding of racism as a psychosocial stressor. We undertook an examination of how racial discrimination interacts with socioecological, environmental, and health conditions to affect multisystem dysregulation in a First Nations population. METHODS: We conducted latent class analysis (LCA) using indicators of life stress, socioeconomic background, and physical and mental health from a nationally representative sample of Australian Aboriginal adults (N = 2056). We used LCA with distal outcomes to estimate the effect of the latent class variable on our derived allostatic load index and conducted a stratified analysis to test whether allostatic load varied based on exposure to racial discrimination across latent classes. RESULTS: Our psychosocial, environmental, and health measures informed a four-class structure; 'Low risk', 'Challenged but healthy', 'Mental health risk' and 'Multiple challenges'. Mean allostatic load was highest in 'Multiple challenges' compared to all other classes, both in those exposed (4.5; 95% CI: 3.9, 5.0) and not exposed (3.9; 95% CI: 3.7, 4.2) to racial discrimination. Allostatic load was significantly higher for those with exposure to racial discrimination in the 'Multiple challenges' class (t = 1.74, p = .04) and significantly lower in the 'Mental health risk' class (t = - 1.67, p = .05). CONCLUSIONS: Racial discrimination may not always modify physiological vulnerability to disease. Social and economic contexts must be considered when addressing the impact of racism, with a focus on individuals and sub-populations experiencing co-occurring life challenges.

Racial discrimination and child and adolescent health in longitudinal studies: A systematic review.

RATIONALE: The association between racial discrimination and adverse health outcomes has been documented across an increasing body of evidence in recent years, although a close examination of longitudinal studies has not yet taken place. This review applied a life course lens in examining the evidence for a longitudinal association between racial discrimination exposure during childhood and adolescence, and later mental and physical health outcomes. METHOD: Medline, PsycINFO, Global Health, ERIC, CINAHL Plus, Academic Search Premier and SocINDEX were searched from earliest records to October 2017 for eligible articles. Results were described through a narrative synthesis of the evidence. RESULTS: Findings from 46 studies reported in 88 empirical articles published between 2003 and 2017 were identified. Studies were primarily based on cohorts from the United States, comprised of young people aged 11-18 years, and were published since 2010. Data were most frequently collected over two to three timepoints at intervals exceeding 12 months. Statistically significant associations with racial discrimination were most commonly reported for behaviour problems including delinquency and risk-taking behaviour, with significant adverse effects found in 74% of these associations. Statistically significant adverse effects were also reported in 63% of associations with health-harming behaviours including substance use, and 61% found associations with mental health outcomes. Consistently significant associations were reported between accumulated racism and later health outcomes, and the health effects of racism were reported to vary with developmental periods, although few studies featured these analyses. CONCLUSIONS: Evidence from this review highlights that the duration and timing of exposure to racial discrimination matters. This review emphasises the need to gain evidence for the mechanisms linking early racism exposure to adverse health outcomes in later life. Future longitudinal research can address this need by capitalising on prospective cohort studies and ensuring that proposed analysis informs variable selection and timing of data collection.

Levelling Education Outcomes for Students With Medical and Mental Health Needs.

Students' educational and behavioural outcomes can be adversely impacted by the unique challenges posed by chronic health conditions. As some children and adolescents may live with these challenges throughout their education, hospital-based educators play a crucial role in reducing the impacts of health conditions on educational outcomes. This study assessed the extent to which the support provided by the School of Special Educational Needs: Medical and Mental Health (SSEN:MMH, Western Australia) attenuated the negative association between higher absences and lower student outcomes. Administrative education records relating to absences, student behaviour, achievement outcomes, and level of support provided by the SSEN:MMH were used to assess the study questions. Regression models revealed no significant association between higher levels of teaching support and student outcomes after controlling for baseline characteristics. However, the negative association between higher absences and lower academic achievement was lower among students receiving higher levels of liaison. Additional analysis highlighted challenges in evaluating student outcomes, including the finding that most students receiving support missed at least two weeks of school over a year but received less than the equivalent of two days of teaching support, suggesting that the available measures were not sensitive to the level of teaching support provided. Together, the findings of this study suggest that liaison services informing schools about the educational needs of students are an important tool for supporting students academically and that the process of supporting students with chronic health conditions is not a simple task given the varying complexity of student needs and behaviours.

Racial discrimination and the health and wellbeing of Aboriginal and Torres Strait Islander children: Does the timing of first exposure matter?

Racial discrimination has been observed to negatively impact on the health of Aboriginal and Torres Strait Islander children, although evidence surrounding periods of greater vulnerability to the stressor of racism have not yet been explored in this population. We compared first exposure to interpersonal racism at either ages 4-5 years or 7 years with no exposure to examine the influence of sensitive periods of racism exposure on mental health and physiological outcomes during middle childhood (7-12 years). The study cohort comprised 1,759 Aboriginal and Torres Strait Islander children aged 4-12 years from waves 2-8 (2009-2015) of the Footprints in Time: 1The Longitudinal Study of Indigenous Children (LSIC) dataset. Multilevel logistic regression was used in all analysis. We observed a larger effect (OR: 2.8; 95% CI: 1.4-5.4) for negative mental health with first exposure at 4-5 years compared to 7 years (OR: 2.1; 95% CI: 1.2-3.6), referenced to children with no exposure. Effect sizes were similar in both exposure groups for the significantly increased risk of sleep difficulties, while a stronger adverse effect on behavioural issues was found at 7 years (OR: 2.2; 95% CI: 1.3-4.0) relative to 4-5 years (OR: 1.7; 95% CI: 0.8-3.7). No significant associations were found with general health, obesity or being underweight. This study generates new evidence surrounding sensitive periods of exposure to racism in Aboriginal and Torres Strait Islander children. A pattern of consistently greater adverse effects on mental and physiological health was not observed with first exposure at 4-5 compared to 7 years, although initial evidence indicates that first exposure to racism at these ages increases the likelihood of negative mental health relative to children without racism exposure. Longitudinal data extending from earlier to later developmental periods will allow further investigations into the presence of sensitive periods of exposure to racism in these children.

Caregiver-perceived racial discrimination is associated with diverse mental health outcomes in Aboriginal and Torres Strait Islander children aged 7-12 years.

BACKGROUND: Racial discrimination is acknowledged as a central social determinant of Australian Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) health, although quantitative empirical literature on the impacts of racism on Aboriginal children remains sparse. We use a novel, longitudinal dataset to explore the relationship between caregiver-perceived racism exposure and a range of mental health and related behavioural and physiological outcomes in childhood. METHOD: The study cohort comprised 1759 Aboriginal children aged 4-12 years from waves 2-8 (2009-2015) of the Footprints in Time: The Longitudinal Study of Indigenous Children (LSIC) dataset. We examined exposure to caregiver-perceived racism between 4 and 11 years as a predictor for mental health and related outcomes at ages 7-12 and substance use at 10-12 years. Unadjusted models and models adjusted for remoteness, community-level and family-level socio-economic status, child age and gender were used in analysis. Multilevel logistic regression was used in all analysis. RESULTS: In fully adjusted models, perceived exposure to racism at ages 4-11 was associated with twice the risk of negative mental health (95% CI: 1.3-3.0), sleep difficulties (95% CI: 1.4-3.0), and behaviour issues at school (95% CI: 1.2-2.9), 1.7 times the risk of obesity (95% CI: 1.1-2.5), and nearly 7 times the risk of trying cigarettes (95% CI: 1.1-43.9). Increased risks were also found for being underweight and trying alcohol though estimates did not reach statistical significance. There was no evidence that racism was associated with poorer general health. CONCLUSION: Exposure to racial discrimination in Aboriginal children increased the risk for a spectrum of interrelated psychological, behavioural and physiological factors linked to negative mental health. Our results further affirm the importance of interventions aimed at reducing the prevalence of racial discrimination for the benefits of population health and health inequalities. The services and institutions which aim to support the mental health and wellbeing of Aboriginal children should also support interventions to reduce racism and implement accountable policies which prioritise this goal.