arousal. What is unclear is how this response differs from arousal due to other stressors, such as those that would provoke anger.

A second set of studies tested the significance of past sensitization to racist stressors, with individuals who previously experienced discrimination assigned to various experimental conditions. Harrell et al. (2003) report, for instance, that individuals who embrace basic American values tend to be more reactive to racist material than other people.

Finally, a series of studies investigated whether physiological response is moderated by cultural affinities or personality factors, such as “John Henryism,” a dispositional orientation that leads individuals to work hard in the face of impossible barriers (James et al., 1984). These studies have shown mixed results. Harrell et al. (2003) argue that they show the need for more and better studies of basic physiological processes, particularly on cholinergic pathways that link anxiety and stress to cardiovascular reactions. To explain these linkages, the authors propose new models of allostasis and allodynamism that define physiological set points and the mechanisms that govern them. The argument is that both external stressors, such as the experience of discrimination, and internal processes alter these physiological set points, which has health implications. Harrell et al. (2003) suggest that studies in this area might use pharmacological blocks and brain imaging.

NEEDED RESEARCH

These correlational and experimental studies suggest that the subjective experience of bias and unequal treatment could affect particular health outcomes. However, the evidence is uneven and inconclusive, as almost every individual study has substantial inadequacies. Across the variety of studies, the definition and measurement of the factors of prejudice, racism, discrimination, and resulting unequal treatment are still relatively crude. Another problem is uncertain delineation of physiological pathways that serve as conduits for the effects of such factors on health. In addition, the conduits undoubtedly are affected by a host of contextual factors, such as socioeconomic status, individual host resistance factors, and coping styles and responses, as well as varying by age and possibly period and cohort.

Research into the effects of prejudice and discrimination on health differences requires some systematization. Such constructs as prejudice, discrimination, and racism have shifting definitions across studies and are often poorly operationalized. The confusion from continual redefinition makes it difficult for studies to build on one another. Measurement is also a problem, particularly the determination of discrimination from self-reports, which is the usual practice in nonexperimental studies. Response biases are possible in such data and may not be independent of response biases in self-



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