Elsevier

Social Science & Medicine

Volume 61, Issue 7, October 2005, Pages 1576-1596
Social Science & Medicine

Experiences of discrimination: Validity and reliability of a self-report measure for population health research on racism and health

https://doi.org/10.1016/j.socscimed.2005.03.006Get rights and content

Abstract

Population health research on racial discrimination is hampered by a paucity of psychometrically validated instruments that can be feasibly used in large-scale studies. We therefore sought to investigate the validity and reliability of a short self-report instrument, the “Experiences of Discrimination” (EOD) measure, based on a prior instrument used in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

Study participants were drawn from a cohort of working class adults, age 25–64, based in the Greater Boston area, Massachusetts (USA). The main study analytic sample included 159 black, 249 Latino, and 208 white participants; the validation study included 98 African American and 110 Latino participants who completed a re-test survey two to four weeks after the initial survey. The main and validation survey instruments included the EOD and several single-item discrimination questions; the validation survey also included the Williams Major and Everyday discrimination measures.

Key findings indicated the EOD can be validly and reliably employed. Scale reliability was high, as demonstrated by confirmatory factor analysis, Cronbach's alpha (0.74 or greater), and test–re-test reliability coefficients (0.70). Structural equation modeling demonstrated the EOD had the highest correlation (r=0.79) with an underlying discrimination construct compared to other self-report discrimination measures employed. It was significantly associated with psychological distress and tended to be associated with cigarette smoking among blacks and Latinos, and it was not associated with social desirability in either group. By contrast, single-item measures were notably less reliable and had low correlations with the multi-item measures. These results underscore the need for using validated, multi-item measures of experiences of racial discrimination and suggest the EOD may be one such measure that can be validly employed with working class African Americans and Latino Americans.

Introduction

Although the idea that racial injustice harms health has appeared in the public health and medical literature since the 18th century (Krieger, 2000; Banton, 1998; Byrd & Clayton, 2000; Willie, Kramer, & Brown, 1973), research on specific measures that could be used in empirical health research is more recent. During the 1960s and 1970s, a variety of measures were introduced into the psychological literature, concerned with understanding the impact of racism on mental health (Barbarin, Good, Pharr, & Siskind, 1981) and evaluating the US Army's “racial climate” (Hiett et al., 1978). Social science research likewise began to explore assessing how racial discrimination restricts opportunities for employment, housing, and education (Blank, Dabady, & Citro, 2004). It was not until the 1990s, however, that a small but growing number of public health studies, both quantitative and qualitative, began to investigate explicitly associations of self-reported experiences of racial discrimination with somatic and also mental health (reviewed in Krieger, Rowley, Herman, Avery, & Phillips, 1993; Krieger, 2000; Williams, Neighbors, & Jackson, 2003), with additional work focused on racial discrimination in the provision of health care (Smedley, Stith, & Nelson, 2003).

For population health research to contribute meaningfully to understand links between racial discrimination and health, studies need valid and reliable measures that can feasibly be used in large-scale population-based studies. Yet, because work in this area is in its infancy, the field is hampered by an important problem: a paucity of instruments whose psychometric properties have been rigorously assessed (Krieger, 2000; Williams et al., 2003; Blank et al., 2004). Moreover, to the extent psychometric validation studies have been done, they have been conducted principally among US black participants, mostly recruited from university students, faculty, and staff (Utsey, 1998; Landrine & Klonoff, 1996; McNeilly et al., 1996; Vines et al., 2001). Whether these measures can be used among working class and low income African Americans, or among other racial/ethnic groups, remains unknown and is a salient question, given their concentration among persons with less education and low-wage jobs (Smith, 2001).

The objectives of our study were thus to investigate, within a US study population comprised of African American, Latino, and white working class participants, the validity and reliability of a short self-report instrument to measure exposure to racial discrimination. The selected instrument, which we call the “Experiences of Discrimination” (EOD) measure, is based on a prior instrument developed by Krieger (1990), used in the Coronary Artery Risk Development in Young Adults (CARDIA) study (Krieger & Sidney, 1996) and in other epidemiologic investigations (e.g., Yen, Ragland, Greiner, & Fisher, 1999; Stancil, Hertz-Picciotto, Schramm, & Watt-Morse, 2000; Stuber, Galea, Ahern, Blaney, & Fuller, 2003; Dole et al., 2004). To aid investigation of the EODs validity, we also employed the Major and Everyday discrimination measure developed by Williams (Williams, Yu, Jackson, & Anderson, 1997), plus several single-item questions.

Section snippets

Study population

Study participants were drawn from a cohort of working adults, age 25–64, recruited for United for Health, a study of the health impacts of physical and social hazards at work among union members employed in a variety of manufacturing and retail sites located in or near Boston, Massachusetts (USA). The validation study was designed to recruit the first 100 African American and first 100 Latino workers who agreed to participate in the main and validation survey, thereby ensuring adequate sample

Sociodemographic characteristics

Table 1 presents data on the sociodemographic characteristics of the main (n=616) and validation (n=208) study populations. Within the main study, the 159 black, 249 Latino, and 208 white participants were, on average, in their late 30 s to early 40 s, evenly split among women and men, and mainly working class non-supervisory employees; 60–80% had completed at most a high school education or its equivalent. Despite being predominantly union members, 53% earned less than a living wage

Discussion

Our study is among the first to evaluate the psychometric properties of a self-report measure of racial discrimination specifically among working class African American, Latino, and white adults for public health research. The results provide evidence that the 9-item EOD scale, whether scored by frequency of occurrence or by situation counts, is a valid and reliable self-report measure of racial discrimination. The confirmatory factor analysis indicated that the EOD items comprised a

Acknowledgements

This validation study was supported by the American Legacy Foundation (PI=Krieger) and the parent study in which it was nested, “United for Health,” was funded by the National Institute of Occupational Safety and Health (grant # 1R01 OHO7366-01; PI=Barbeau). Both institutions solely provided funding and had no involvement in: the design or conduct of the study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript.

The

References (49)

  • N. Krieger

    Racial and gender discrimination: risk factors for high blood pressure?

    Social Science & Medicine

    (1990)
  • N. Krieger et al.

    Racism, sexism, and social class: Implications for studies of health, disease, and well-being

    American Journal of Preventive Medicine

    (1993)
  • Association of Community Organizations for Reform Now (ACORN), 2004. Living Wage Resource Center. Available at:...
  • M. Banton

    Racial theories

    (1998)
  • Barbarin, O. A., Good, P. R., Pharr, M., & Siskind, J. A. (Eds.). (1981). Institutional racism and community...
  • Blank, R.M., Dabady, M., Citro, C.F., (Eds.), (2004). Measuring racial discrimination. Panel on Methods for Assessing...
  • E. Bonilla-Silva

    Racism without racists: color-blind racism and the persistence of racial inequality in the United States

    (2003)
  • A. Boomsma et al.

    The robustness of LISREL modeling revisited

  • W.M. Byrd et al.
    (2000)
  • F.J. Crosby

    Affirmative action is dead: long live affirmative action

    (2004)
  • G. Davey Smith et al.

    Data dredging, bias, or confounding

    British Medical Journal

    (2002)
  • N. Dole et al.

    Psychosocial factors and preterm birth among African American and white women in Central North Carolina

    American Journal of Public Health

    (2004)
  • B.K. Finch et al.

    Perceived discrimination and depression among Mexican-origin adults in California

    Journal of Health and Social Behavior

    (2000)
  • J.A. Fleishman et al.

    Demographic variation in SF-12 scores: True differences or differential item functioning?

    Medical Care

    (2003)
  • B.J. Guthrie et al.

    African American girls’ smoking habits and day-to-day experiences with racial discrimination

    Nursing Research

    (2002)
  • M. Guyll et al.

    Discrimination and unfair treatment: relationship to cardiovascular reactivity among African American and European American women

    Health Psychology

    (2001)
  • J.P. Harrell et al.

    Physiological responses to racism and discrimination: an assessment of the evidence

    American Journal of Public Health

    (2003)
  • R.D. Hays

    A five-item measure of socially desirable response set

    Educational Psychology Measurement

    (1989)
  • R.L. Hiett et al.

    The racial attitudes and perceptions survey (RAPS)

    (1978)
  • K. Joreskog et al.

    LISREL 8: structural equation modeling with the SIMPLIS Command Language

    (1993)
  • R.C. Kessler et al.

    Short screening scales to monitor population prevalences and trends in nonspecific psychological distress

    Psychological Medicine

    (2002)
  • R.C. Kessler et al.

    The prevalence, distribution and mental health correlates of perceived discrimination in the United States

    Journal of Health and Social Behavior

    (1999)
  • N. Krieger

    Discrimination and health

  • N. Krieger

    Theories for social epidemiology in the 21st century: An ecosocial perspective

    International Journal of Epidemiology

    (2001)
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