ment and a variety of health outcomes, including psychological distress, blood pressure, and mental health functioning (Harrell et al., 2003). But prospective studies of the long-term effects of chronic discrimination have not been conducted.

CORRELATIONAL STUDIES

A recent review (Williams et al., 2003) identifies 53 separate community-based epidemiological studies of the association of experiences and perceptions of discrimination with health outcomes. Most of the U.S. studies have involved blacks, but there are some studies of other minorities, and studies have been conducted with immigrant groups in such other countries as Canada, England, and the Netherlands. The majority of the studies find that the self-reported experience of discrimination has an unfavorable effect, producing psychological distress, reduced psychological well-being, lowered self-esteem, impaired mental health, and even definable psychiatric disorders.

These correlational studies have also commonly examined self-reported overall health. More than 70 percent of the studies report poorer health among those who report discrimination. The studies have shown somewhat more variable relationships of discrimination to more specific health indicators. Blood pressure, an important health status measure, has sometimes been positively associated with discrimination, but sometimes has had no association or even a negative association. Cigarette smoking and alcohol use have also been linked to discrimination. Some studies attempt to show that perceptions of discrimination, net of socioeconomic factors, account for racially related health differences.

Systematic investigation of the role of discrimination in health over the life course is rare (Williams and Neighbors, 2001). One longitudinal panel study did find that reports of discrimination that were related to poorer health in the first year were still linked, 13 years later, to poorer mental health, though by that time they were related, somewhat surprisingly, to better self-reported physical health (Jackson et al., 1996). Another study that used reports of the experience of chronic discrimination found that these were related to subclinical carotid artery disease for black but not white premenopausal women (Troxel et al., 2003).

EXPERIMENTAL AND PHYSIOLOGICAL STUDIES

Harrell et al. (2003) recently reviewed 13 experimental studies of discrimination and health. Some studies focused on using analogs to racially charged stimuli in the laboratory and examining physiological reactions. For the most part, these studies show that such stimuli increase physiological



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