title: Effects of perceived racial discrimination on health status and health behavior: a differential mediation hypothesis.
abstract: OBJECTIVE
  Prospective data tested a "differential mediation" hypothesis: The relations (found in previous research) between perceived racial discrimination and physical health status versus health-impairing behavior (problematic substance use) are mediated by two different types of affective reactions, internalizing and externalizing.
  
  
  METHODS
  The sample included 680 African American women from the Family and Community Health Study (M age = 37 years at Time 1; 45 years at Time 4). Four waves of data were analyzed. Perceived discrimination was assessed, along with anxiety and depression (internalizing) and hostility/anger (externalizing) as mediators, and physical health status and problematic substance use (drinking) as outcomes.
  
  
  RESULTS
  Structural equation modeling indicated that discrimination predicted increases in both externalizing and internalizing reactions. These affective responses, in turn, predicted subsequent problematic substance use and physical health status, respectively, also controlling for earlier reports. In each case, the indirect effects from discrimination through the affective mediator to the specific health outcome were significant and consistent with the differential mediation hypothesis.
  
  
  CONCLUSIONS
  Perceived racial discrimination is associated with increases in internalizing and externalizing reactions among Black women, but these reactions are related to different health outcomes. Changes in internalizing are associated with self-reported changes in physical health status, whereas changes in externalizing are associated with changes in substance use problems. Discussion focuses on the processes whereby discrimination affects health behavior and physical health status.
authors.affiliation: Department of Psychology, Dartmouth College.
authors.forename: Frederick X
authors.initials: FX
authors.lastname: Gibbons
authors.affiliation: Department of Psychology, Dartmouth College.
authors.forename: John H
authors.initials: JH
authors.lastname: Kingsbury
authors.affiliation: Department of Psychology, Dartmouth College.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Weng
authors.affiliation: Norris Cotton Cancer Center, Dartmouth Medical School.
authors.forename: Meg
authors.initials: M
authors.lastname: Gerrard
authors.affiliation: Department of Psychology, Iowa State University.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Cutrona
authors.affiliation: Department of Epidemiology, University of Hawaii Cancer Center.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wills
authors.affiliation: Department of Psychology, The George Washington University.
authors.forename: Michelle
authors.initials: M
authors.lastname: Stock
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000428:Alcohol Drinking / Q000208:ethnology; D000786:Anger; D001007:Anxiety / Q000208:ethnology; D003863:Depression / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006304:Health Status; D006791:Hostility; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D063505:Racism / Q000208:ethnology* / Q000523:psychology; D012938:Social Perception; D019966:Substance-Related Disorders / Q000208:ethnology