ABSTRACT
Systemic and structural racism is a public health crisis. However, little is known about the impact of
structural racism and discrimination (SRD) on the health and emotional well-being of individuals across the life
course. While prior studies have shown associations between discrimination and negative health outcomes in
adults (e.g., cardiometabolic disease, depression), these studies have been cross-sectional and primarily
examined individual-level sources of racism and discrimination. Much more research is needed to fill gaps
in our understanding about the relationship between SRD and health disparities before interventions
can be developed. To significantly advance the field regarding SRD and health equity, studies need to
include: (1) multi-level measures of SRD including individual (both intrapersonal and interpersonal),
neighborhood, institutional, and societal/policy levels; (2) rigorous mixed-methods designs (e.g., ecological
momentary assessment (EMA), biological measures, geographic information system (GIS) data, surveys); (3)
multi-site samples with urban and rural participants; (4) a life course approach; (5) whole-person outcome
measures (i.e., mental, physical, behavioral health); and (6) longitudinal study designs. Including these study
elements will allow for comprehensively examining the relationships between SRD and health and emotional
well-being to identify mechanisms to target in interventions to mitigate SRD. The main objective of the
proposed study is to examine multiple levels (i.e., individual, neighborhood, institutional,
societal/policy) of SRD and associations with mental, physical, and behavioral health outcomes across
the life course to identify intervention targets to promote health equity. The proposed study is built on a
prospective longitudinal cohort study of 627 racially/ethnically diverse families (i.e., African American, Hispanic,
Native American, Immigrant/Refugee, White) across the life course (childhood, adolescence,
adulthood/parenthood) from urban settings (i.e., Minneapolis, St. Paul). The parent R01 already has three
time-points of mixed-methods data (i.e., EMA, GIS, survey) that includes discrimination and neighborhood
segregation measures and physical and behavioral health outcomes carried out using a community-based
participatory approach. For the proposed study, a sample of 300 racially/ethnically diverse families from rural
Georgia (i.e., Athens) will be added to compare SRD experiences in urban versus rural settings. In addition,
cardiometabolic and stress biomarker data (i.e., heart rate, blood pressure, waist circumference, lipids, HbA1C,
cytokines) and multi-level measures of structural racism (i.e., individual, neighborhood, institutional,
societal/policy) will be added at two time points, 18 months apart. The proposed study will be one of the first to
prospectively measure multiple levels of SRD using mixed-methods across two sites and associations with
mental, physical, and behavioral health disparities across the life course in diverse families. Results of the
study will inform the development of an intervention targeting multi-level SRDs to promote health equity.
