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Assessing mediators between discrimination, health behaviours and physical health outcomes: a representative cross-sectional study

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

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.

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Acknowledgments

We thank the university staff for collaboration during the fieldwork.

Author information

Authors and Affiliations

  1. Post-graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Santa Catarina, 88040-970, Brazil

    João Luiz Bastos & Diego Augusto Santos Silva

  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 Celeste

  3. Post-graduate Program in Physical Education, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, SC, 88040-970, Brazil

    Diego Augusto Santos Silva

  4. Australian Centre for Applied Social Research Methods, Australian National University, Acton ACT, Canberra, NSW, 0200, Australia

    Naomi Priest

  5. Faculty of Arts and Education, Alfred Deakin Research Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC, 3125, Australia

    Yin Carl Paradies

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  1. João Luiz Bastos
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  2. Roger Keller Celeste
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  3. Diego Augusto Santos Silva
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Correspondence to João Luiz Bastos.

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Items to assess discrimination (free translation from Portuguese).(DOCX 21 kb)

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Bastos, J.L., Celeste, R.K., Silva, D.A.S. et al. Assessing mediators between discrimination, health behaviours and physical health outcomes: a representative cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 50, 1731–1742 (2015). https://doi.org/10.1007/s00127-015-1108-0

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