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Investing in the Health and Well-Being of Young Adults (2015)

Chapter: Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being

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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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B

Diversity and the Effects of Bias and Discrimination on Young Adults’ Health and Well-Being

This appendix focuses in greater detail on the adverse effects of continuing patterns of prejudice and discrimination1 on the health and well-being of young adults summarized in Chapter 2. We take note of variations across racial and ethnic groups, and summarize what is known about factors that protect or buffer young people against these effects.

EXPERIENCE OF BIAS AND DISCRIMINATION

As noted in Chapter 2, the experience of being exposed to biased and discriminatory behavior has been characterized as a pervasive and normative stressor in the lives of people of color (García Coll et al., 1996) and can take a toll on adolescents and young adults, negatively affecting their future well-being. Importantly, during adolescence and young adulthood, many minority youth start to make meaning of their ethnic and racial group membership as a core component of their identity and may become increasingly aware of negative societal views of and prejudices toward their group, which can heighten sensitivity to perceived bias and discrimination (Cross and Cross, 2008). Thus, normative processes of identity development can

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1Prejudice and bias are used synonymously to refer to attitudes even if unaccompanied by discriminatory behavior. Although surveys of minorities ascertain their perceptions of biased or discriminatory behavior rather than the intentions of the persons exhibiting the behavior, we have not inserted the word “perceived” in every instance. Finally, when used generally (and not being used to report on a specific study), the term discrimination is meant to encompass bias or prejudice. We generally do not use the term racism because we typically are referring to bias and discrimination based on either ethnicity or race.

Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

potentially increase vulnerabilities; at the same time, these processes can play a protective role in attenuating the negative effects of bias and discrimination, which we address in more detail later in this appendix.

As reported in Chapter 2, results of a 2013 national survey of adults by the Pew Research Center (2013b) indicate that 88 percent of non-Hispanic blacks and 57 percent of non-Hispanic whites believe that African Americans are subject to “some”/“a lot” of discrimination in the United States, while another report found that among all adults, 73 percent and 65 percent, respectively, hold that view of Muslim Americans and Hispanics (Pew Research Center, 2013a). Interestingly, the perception that racial or ethnic minorities face discrimination is more widespread among young adults (aged 18-29) of all racial/ethnic backgrounds than among older age groups of all backgrounds (Pew Research Center, 2013a).

Until recently, research on racial/ethnic bias and discrimination in the United States focused primarily on African Americans. A substantial majority of blacks report that they have personally been exposed to race-related stimuli perceived as biased or discriminatory (Clark, 2000; Seaton et al., 2008; Simons et al., 2002; Williams et al., 2003). In the National Survey of African Life, the majority of black young adults (in this instance, African American and Caribbean blacks) reported experiencing at least one discriminatory event in the previous year, with increased episodes occurring as they transitioned into young adulthood (Seaton et al., 2008). A higher incidence of discrimination was reported among females from both ethnic groups. African Americans and Caribbean Americans reported equal numbers of discriminatory incidents; however, one interesting finding was that exposure to discrimination was associated with greater vulnerability and more negative outcomes for Caribbean American young adults compared with their African American counterparts. The authors speculate that lack of preparation for negative race-related stress among the recent Caribbean immigrants may explain the variability in the groups’ responses. Importantly, these differences reveal that people from the same pan-racial group have diverse experiences with discrimination that are affected by differences in patterns of immigration and cultural norms. In addition to African Americans, evidence is growing that other immigrant groups, such as Asians and Hispanics, are reporting discrimination that is associated with physical and mental health issues, harmful health behaviors, and decreased access to quality health care (Viruell-Fuentes et al., 2012). Further, the longer immigrants reside in the United States, the more likely they are to have heightened exposure to bias and discrimination (Viruell-Fuentes et al., 2012), although bias and discrimination can be particularly salient for immigrants in the context of anti-immigration legal policies and social messages (Lopez et al., 2010).

According to the minority stress theory, minorities who are openly gay

Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

(e.g., gay African Americans, Asian Americans, or Hispanics) are at greater risk of experiencing discrimination at the structural and institutional levels (Krieger and Sidney, 1997; Kyung-Hee et al., 2013; Mays and Cochran, 2001; Schmitt et al., 2014), including in housing, employment, and health care, and are at increased risk of substance use, particularly when experiencing discrimination targeting multiple social group memberships (e.g., gender, race, sexual orientation) (McCabe et al., 2010). Of course, in the United States, all disadvantaged and marginalized groups, including people of color, individuals of low-income status, immigrants, religious minorities (e.g., Muslims), sexual minorities, individuals with disabilities, and those in low-resource settings (e.g., public housing) are at risk of experiencing some form of bias or discrimination. Results of a 2014 review of both correlational and experimental studies that manipulated perceptions of discrimination in laboratories offer support for the detrimental effects of perceived discrimination for groups stigmatized because of sexual orientation, race/ethnicity, gender, or disabilities (Schmitt et al., 2014).

EFFECTS OF DISCRIMINATION ON WELL-BEING

Impact on Educational Performance and Employment

As noted in Chapter 2, African Americans and Hispanics are overrepresented among high school dropouts. This problem, which has its roots in grade school, is widely perceived to have been magnified by harsh enforcement of “zero tolerance” school discipline policies, including suspension and expulsion, and by increased use of law enforcement officers in school settings, thereby creating the so-called schools-to-prisons pipeline (Alfaro et al., 2009; NRC, 2013; U.S. Department of Education and National Center for Education Statistics, 2014). The associations between early school leaving and young adults’ future outcomes, including joblessness, have been well established (see Chapter 4 of this report). Future research is needed to determine the extent to which young adults’ perceptions and experiences of racial discrimination at the interpersonal and structural levels limit their ability to succeed in education and employment.

Psychological and Physical Functioning

Several systematic reviews and recent studies (Lee et al., 2009; Priest et al., 2013; Williams and Williams-Morris, 2000; Williams et al., 2003) have found strong associations between racial discrimination and mental health outcomes among all racial/ethnic groups. According to the results of one review (Priest et al., 2013), 76 percent of 121 studies demonstrate a significant association between exposure to racial discrimination and men-

Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

tal health outcomes such as depression and anxiety. A recent meta-analytic review of experimental and correlational studies concludes that perceiving pervasive instances of discrimination negatively affects psychological well-being across a wide range of measures (Schmitt et al., 2014). Perceived discrimination by both peers and adults is significantly associated with decreased self-esteem and increased symptoms of depression among African American, Asian American, and Latino/a high school students (Greene et al., 2006). Exposure to race-related stress can evoke feelings of anger, hurt, frustration, bitterness, helplessness, and hopelessness and a desire to lash out (Wagner et al., 2011), which in turn can elevate depressive symptoms and anxiety. Individuals may attempt to manage their psychological state by relying on various self-soothers, such as overeating and use of alcohol and other substances, which over time can lead to chronic health problems (Karlamangla et al., 2006b; Ogden, 2012).

Negative emotions that may emanate from race-related stress also have been associated with the amplification of biological and physiological responses, including increased blood pressure, elevated fasting glucose, and increased plasma lipid levels, which forecast cardiovascular problems among African American young adults (Brody et al., 2014; Karlamangla et al., 2010); similar patterns are evinced among Asian Americans and Hispanics (Earnshaw et al., 2013; Lee et al., 2009). Living in a society where one’s everyday life experiences are filtered through prejudice and racism triggers negative reactivity and the use of coping behaviors that may increase one’s vulnerability to the onset and escalation of chronic diseases (Harrell et al., 2003; Williams and Williams-Morris, 2000). Further, exposure to racism, directly and indirectly, even during childhood, can have long-term consequences (Martin et al., 2011; Williams and Williams-Morris, 2000).

Persistent exposure to incidents of racism can negatively affect physical health by creating demands on individuals to respond to stress-inducing stimuli, requiring the activation of one’s psychological and physiological systems to operate at high levels. This constant engagement of the “flight-fight” response, commonly referred to as “allostatic load,” has been linked to increased inflammation and compromised autoimmune functioning, and is a significant predictor of the onset and escalation of major chronic diseases (Karlamangla et al., 2006a). Stress-response dysfunction increases blood pressure, which in turn increases vascular restriction and cardio output. Elevated blood pressure over time causes vascular resistance. The cycle of heightened physiological responses causes wear and tear on biological systems, including damage to the cardiovascular system. This cyclic link between race-related stress and cardiovascular risk vulnerabilities has been implicated as a major predictor of a range of developmental and health outcomes, including sleep disorders (Beatty et al., 2011), higher visceral

Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

fat, poor ambulatory blood pressure responses, and increases in vascular reactivity (Clark, 2000).

Childhood exposure to racism is associated with less healthy pregnancy outcomes among African American women of childbearing age (Hilmert et al., 2014). This finding reveals that one can be greatly affected by witnessing race-related events occurring to someone else, and that such experiences can be linked to blood pressure and depressive symptoms many years later (Caughy et al., 2004; Simons et al., 2002). Further, race-related stress has consistently been linked to preterm and low-birthweight infants among African American and Puerto Rican women (Earnshaw et al., 2013). Decline in psychological functioning and elevated blood pressure in response to race-related stress create a toxic maternal-fetal environment, causing reduced fetal growth and early delivery (Earnshaw et al., 2013; Hilmert et al., 2014). Additional research is needed to determine and explain how exposure to racism is transmuted from psychosocial experiences into physiological outcomes and to identify the etiological mechanisms by which experiences of racism and discrimination affect the health and well-being of adolescents and young adults of color.

Acculturation Stress

Acts of discrimination toward individuals because of immigrant status, legal status, skin tone, and language can contribute to acculturation stress. Immigrant status, skin tone, and phenotypic characteristics intersect through social interactions with members of the dominant culture among adolescents and young adults of color. They are faced with decisions that require negotiation of their “home culture” and internalization of the dominant culture, creating individual-level acculturation stress in determining the degree to which they should or can assimilate. Many, but not all, adolescents and young adults who abandon their home culture and fully assimilate in the dominant culture fare less well than those who maintain the home culture (Berry, 2005). Assimilation heightens family conflict that can reduce cultural support systems shown to buffer persons of color from negative outcomes often associated with stress-inducing events (Burnam et al., 1987; Cuéllar, 2000; Cuéllar et al., 1997; Heilemann et al., 2002).

Acculturation stress has been associated with increased depression in immigrants (Heilemann et al., 2002). It also has been associated with higher odds of a past suicide attempt among immigrants compared with individuals born in the United States (Gomez et al., 2011). Further, acculturative stress and perceived discrimination have been found to be strong predictors of hopelessness and depressive symptoms among Asian Americans, Latina/os, and Native Americans (Fritz et al., 2008; Kalibatseva and Leong, 2011; LaFromboise et al., 2010; Stein et al., 2012). On the other hand, the

Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

experience of bias or discrimination may foster stronger connections to one’s own culture as young adults reject pressures to adapt and assimilate to the dominant society and instead maintain norms, attitudes, behaviors, and practices of their home culture (Padilla, 2002). Deeper understanding of this potentially protective process is needed.

PROTECTIVE PROCESSES

Current patterns of discrimination are associated with structural factors (e.g., economic and/or residential segregation, institutional racism) that restrict opportunity and well-being in pervasive ways. However, it is also important to recognize that disadvantaged cultural groups have developed productive, adaptive means of coping with their deprivations and that individual resilience and family strengths play important roles in supporting the healthy development of ethnic minority young adults even in the face of societal stressors (García Coll et al., 1996). Several studies have identified factors that buffer, protect against, or reduce the impact of racism and discriminatory experiences on individuals (Luthar, 2006).

Social Support, Connections, and Belongingness

Racial and ethnic identity, perceived to reflect closeness to members of one’s own group, has been shown to serve a protective function for people of color. Across all racial/ethnic groups, high self-regard for one’s ancestral heritage has been associated with the promotion of a sense of belongingness, supportiveness, and ethnic affirmation, which in turn bolsters self-esteem, self-control, and future orientation (Berkel et al., 2010; Seaton et al., 2011; Sellers et al., 2006; Wills et al., 2007). In addition, racial/ethnic group connections counteract potential adverse effects of perceived discrimination, protecting individuals from negative mental health outcomes, including internalizing behaviors, such as depression, shyness, and social isolation, and externalizing behaviors, such as aggression, violence, anger, and substance use (Neblett et al., 2012: Stock et al., 2013). Racial and ethnic identity, therefore, buffers the deleterious effects of discrimination on mental health functioning through parental/family adaptive cultural socialization (discussed in the following section) that prepares individuals to reject the internalization of bias and discriminatory messages (Berkel et al., 2010; Hughes et al., 2009). In addition, racial identity reduces the negative effects of discrimination on individual well-being through the protection of psychosocial resources, specifically social relationships and social support (Ida and Christie-Mizell, 2012).

Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

Cultural Socialization

All individuals experience socialization processes that prepare them to be functional members of a society (Farver et al., 2007). Parents of racial and ethnic minorities also socialize their children into their own ethnic or natal culture and into the dominant culture, processes that include being aware of, understanding, and developing skills to resolve inconsistencies and conflicting views across cultures (Boykin, 1986; Farver et al., 2007). These parenting socialization processes, which encompass racial socialization (Harris-Britt et al., 2007; Hughes et al., 2006) and acculturation socialization (Dumka et al., 2009; Hill, 2011; Kim et al., 2013), may foster culturally specific forms of resilience and self-regulation, which can contribute to the development of adaptive coping mechanisms throughout childhood and lessen the likelihood of maladaptive behavior in adolescence and young adulthood (Yasui and Dishion, 2007).

Conclusion

A highly salient feature of growing up in America today is the increasingly multicultural character of the society, marked by significant increases in immigration from many different parts of the world. Today’s young adults and their successors will be in their middle years when the country becomes majority minority. As the face of the nation changes, the social experiences of young people maturing in an increasingly diverse population will differ substantially from those of their elders. At the same time, this country still struggles to overcome its legacy of racial oppression and to ensure equal opportunity for all, regardless of race, ethnicity, sexual preference, and disability. By itself, the increasing diversity of the population provides no assurance that existing patterns of bias, stereotyping, and discrimination will be erased. However, young adults are the leading edge of the demographic change and can also become the most powerful force for equal rights in the 21st century.

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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Suggested Citation:"Appendix B: Diversity and the Effects of Bias and Discrimination on Young Adults' Health and Well-Being." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Young adulthood - ages approximately 18 to 26 - is a critical period of development with long-lasting implications for a person's economic security, health and well-being. Young adults are key contributors to the nation's workforce and military services and, since many are parents, to the healthy development of the next generation. Although 'millennials' have received attention in the popular media in recent years, young adults are too rarely treated as a distinct population in policy, programs, and research. Instead, they are often grouped with adolescents or, more often, with all adults. Currently, the nation is experiencing economic restructuring, widening inequality, a rapidly rising ratio of older adults, and an increasingly diverse population. The possible transformative effects of these features make focus on young adults especially important. A systematic approach to understanding and responding to the unique circumstances and needs of today's young adults can help to pave the way to a more productive and equitable tomorrow for young adults in particular and our society at large.

Investing in The Health and Well-Being of Young Adults describes what is meant by the term young adulthood, who young adults are, what they are doing, and what they need. This study recommends actions that nonprofit programs and federal, state, and local agencies can take to help young adults make a successful transition from adolescence to adulthood. According to this report, young adults should be considered as a separate group from adolescents and older adults. Investing in The Health and Well-Being of Young Adults makes the case that increased efforts to improve high school and college graduate rates and education and workforce development systems that are more closely tied to high-demand economic sectors will help this age group achieve greater opportunity and success. The report also discusses the health status of young adults and makes recommendations to develop evidence-based practices for young adults for medical and behavioral health, including preventions.

What happens during the young adult years has profound implications for the rest of the life course, and the stability and progress of society at large depends on how any cohort of young adults fares as a whole. Investing in The Health and Well-Being of Young Adults will provide a roadmap to improving outcomes for this age group as they transition from adolescence to adulthood.

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