title: Racial discrimination and racial identity attitudes in relation to self-rated health and physical pain and impairment among two-spirit American Indians/Alaska Natives.
abstract: OBJECTIVE
  We examined associations between racial discrimination and actualization, defined as the degree of positive integration between self-identity and racial group identity, and self-rated health and physical pain and impairment.
  
  
  METHODS
  We used logistic regressions to analyze data from 447 gay, lesbian, bisexual, and other sexual-minority American Indians/Alaska Natives.
  
  
  RESULTS
  Greater self-reported discrimination was associated with higher odds of physical pain and impairment (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.13, 1.78); high levels of actualization were associated with lower odds of physical pain and impairment (OR = 0.59; 95% CI = 0.35, 0.99) and self-rated fair or poor health (OR = 0.54; 95% CI = 0.32, 0.90). Actualization also moderated the influence of discrimination on self-rated health (t = -2.33; P = .020). Discrimination was positively associated with fair or poor health among participants with low levels of actualization, but this association was weak among those with high levels of actualization.
  
  
  CONCLUSIONS
  Among two-spirit American Indians/Alaska Natives, discrimination may be a risk factor for physical pain and impairment and for fair or poor self-rated health among those with low levels of actualization. Actualization may protect against physical pain and impairment and poor self-rated health and buffer the negative influence of discrimination.
authors.affiliation: School of Public Health, University of California, Berkeley, USA. dhchae@post.harvard.edu
authors.forename: David H
authors.initials: DH
authors.lastname: Chae
authors.forename: Karina L
authors.initials: KL
authors.lastname: Walters
mesh_terms: D000223:Adaptation, Psychological; D000413:Alaska / Q000453:epidemiology; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D016015:Logistic Models; D010146:Pain / Q000453:epidemiology / Q000208:ethnology*; D011287:Prejudice; D015995:Prevalence; D011594:Psychometrics; D012307:Risk Factors; D012933:Social Identification; D014861:Washington / Q000453:epidemiology