JMIR Publications

ABSTRACT

Background:

Two psychosocial constructs that have shown a consistent associations with negative health outcomes are discrimination and perceived unfairness.

Objective:

The current analyses report the effects of discrimination and unfairness on medical, psychologic, and behavioral outcomes from a recent cross-sectional survey conducted in a multi-ethnic sample of adults in Michigan.

Methods:

A cross section survey was collected using multiple approaches, 1) Community Settings, 2) Telephone listed sample, and 3) Online panel. Unfairness was assessed with a single-item previously used in the Whitehall Study, and everyday discrimination was assessed with the Williams 9-item scale. Outcomes included mental health symptoms, past month cigarette use, past month alcohol use, past month marijuana use, lifetime pain medication use, and self-reported medical history.

Results:

A total of 2,238 usable surveys were collected. In bivariate analyses, higher unfairness values were significantly associated with lower educational attainment, lower age, lower household income, and being unmarried. Highest unfairness values were observed for Black and multiracial respondents followed by Middle Eastern or North African (MENA) participants. Unfairness was significantly related to worse mental health functioning, net adjustment for sociodemographic variables and everyday discrimination. Unfairness was also related to self-reported history of depression and high blood pressure although after including everyday discrimination in the model, only the association with depression remained significant. Unfairness was significantly related to 30-day marijuana use, 30-day cigarette use, and lifetime opiate use.

Conclusions:

Our findings of a generally harmful effect of perceived unfairness on health are consistent with prior studies. Perceived unfairness may be one of the psychologic pathways through which discrimination negatively impacts health. Future studies examining the relationships we observed using longitudinal data and including more objective measures of behavior and health status are needed to confirm and extend our findings.