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