João Luiz Bastos1, Roger Keller Celeste2, Diego Augusto Santos Silva3,4, Naomi Priest5, Yin Carl Paradies6. 1. Post-graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Santa Catarina, 88040-970, Brazil. joao.luiz.epi@gmail.com. 2. Post-graduate Program in Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil. roger.keller@ufrgs.br. 3. Post-graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Santa Catarina, 88040-970, Brazil. diego.augusto@ufsc.br. 4. Post-graduate Program in Physical Education, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, SC, 88040-970, Brazil. diego.augusto@ufsc.br. 5. Australian Centre for Applied Social Research Methods, Australian National University, Acton ACT, Canberra, NSW, 0200, Australia. naomi.priest@anu.edu.au. 6. Faculty of Arts and Education, Alfred Deakin Research Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC, 3125, Australia. yin.paradies@deakin.edu.au.
Abstract
PURPOSE: Discrimination is a social determinant of health; however, the pathways linking discrimination to ill-health are under-researched. This study investigated the mediators through which discrimination affects health behaviours and physical health outcomes, as well as assessed whether sex moderated these mechanisms. METHODS: Data from a representative survey (n = 1023) of undergraduate students enrolled in a Brazilian university in 2012 were used. Structural equation models were applied to assess the following mediation mechanisms--(1) discrimination influences self-rated health and body mass index via anxiety/depression; (2) discrimination affects behaviours (alcohol consumption, problem drinking, smoking, fruit/vegetable consumption, and physical activity) through discomfort associated with discriminatory experiences. The potential of sex to act as an effect-modifying variable was also explored in each of the postulated pathways. RESULTS: The effect of discrimination on self-rated poor health was totally (100.0%) mediated by anxiety/depression, while body mass index was not correlated with discrimination. Self-reported discrimination was associated with some behaviours via discomfort. Particularly, discomfort partially mediated the positive association between discrimination, leisure time physical activity (43.3%), and fruit/vegetable consumption (52.2%). Sex modified the association between discrimination, discomfort and physical activity in that such mechanism (more discrimination → more discomfort → more physical activity) was statistically significant in the entire sample and among females, but not among males. CONCLUSIONS: This is one of the first studies to demonstrate that discrimination is associated with physical health outcomes and behaviours via distinct pathways. Future investigations should further explicate the mediational pathways between discrimination and key health outcomes.
PURPOSE: Discrimination is a social determinant of health; however, the pathways linking discrimination to ill-health are under-researched. This study investigated the mediators through which discrimination affects health behaviours and physical health outcomes, as well as assessed whether sex moderated these mechanisms. METHODS: Data from a representative survey (n = 1023) of undergraduate students enrolled in a Brazilian university in 2012 were used. Structural equation models were applied to assess the following mediation mechanisms--(1) discrimination influences self-rated health and body mass index via anxiety/depression; (2) discrimination affects behaviours (alcohol consumption, problem drinking, smoking, fruit/vegetable consumption, and physical activity) through discomfort associated with discriminatory experiences. The potential of sex to act as an effect-modifying variable was also explored in each of the postulated pathways. RESULTS: The effect of discrimination on self-rated poor health was totally (100.0%) mediated by anxiety/depression, while body mass index was not correlated with discrimination. Self-reported discrimination was associated with some behaviours via discomfort. Particularly, discomfort partially mediated the positive association between discrimination, leisure time physical activity (43.3%), and fruit/vegetable consumption (52.2%). Sex modified the association between discrimination, discomfort and physical activity in that such mechanism (more discrimination → more discomfort → more physical activity) was statistically significant in the entire sample and among females, but not among males. CONCLUSIONS: This is one of the first studies to demonstrate that discrimination is associated with physical health outcomes and behaviours via distinct pathways. Future investigations should further explicate the mediational pathways between discrimination and key health outcomes.
Entities:
Keywords:
Brazil; Health behaviour; Physical health; Social discrimination
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