reported health status (Williams et al., 2003). Biases could even affect longitudinal studies, when prior experiences are reinterpreted in the light of subsequent events, though some closed-cohort longitudinal studies suggest this is not a critical issue (Jackson et al., 1996).

Methodological problems go beyond measurement, however, and require better study design (Krieger, 1999; Williams et al., 2003). Longitudinal studies are clearly superior to correlational studies (and avoid the methodological and ethical issues involved in discriminatory treatment of experimental subjects), but they also have limitations, which they generally share with other studies of the effects of stress. Selection processes, memory distortions, and period events with broad effects on cohorts can all complicate the design and interpretation of results. Dealing with all such issues in an efficient design would be the goal, but it is not easy to achieve.

Research Need 10: Determine the lifetime effects of prejudice and discrimination on health using longitudinal data and a framework that centers on stress and its effects.

Stressful events and experiences have been reliably linked to heath outcomes, as we discuss in the next chapter. However, what roots stress may have in prejudice and discrimination (Myers and Hwang, 2004; Pearlin, 1989) require better delineation. There is a need to distinguish among traumatic events and between macro- and microstressors (Williams et al., 2003), and the relationships may be complicated. Discriminatory experiences may combine with other life stressors that affect health. But stress resulting from discrimination may be less easy to deal with through normal coping responses than stress from other sources, and different groups may have generally different ways of dealing with stress. For instance, active and passive coping responses work as well for blacks in response to normal life stressors (low income, negative life events, deaths of relatives and friends, etc.) as for other groups, but blacks are reported to have relatively few effective coping responses to poor treatment due to racial prejudice (Jackson et al., 2003).

The effects of discrimination on the experience of stress and health outcomes may involve lags and host resistance factors and may change over the life course, influenced by personality and other life experiences, such as resource acquisition, exposure, and support processes. Effects related to aging have to be seen in the context of period and cohort variation. Experiences of discrimination may be tied to particular periods or significant historical events (such as the 1960s civil rights movement). And birth cohorts each have their own history, possibly reacting to events differently because of the stage in the life course at which the events are experienced. A framework that combines aging, period, and cohort factors is therefore needed to understand how early experiences may lead to a cascade of



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