title: Perceived discrimination, coping, and quality of life for African-American and Caucasian persons with cancer.
abstract: In racial disparities research, perceived discrimination is a proposed risk factor for unfavorable health outcomes. In a proposed "threshold-constraint" theory, discrimination intensity may exceed a threshold and require coping strategies, but social constraint limits coping options for African Americans, who may react to perceived racial discrimination with disengagement, because active strategies are not viable under this social constraint. Caucasian Americans may experience less discrimination and lower social constraint, and may use more active coping strategies. There were 213 African Americans and 121 Caucasian Americans with cancer who participated by completing measures of mistreatment, coping, and quality of life. African Americans reported more mistreatment than Caucasian Americans (p < 001) and attributed mistreatment more to race or ethnicity (p < .001). In the mistreatment-quality of life relationship, disengagement was a significant mediator for Caucasians (B = -.39; CI .13-.83) and African Americans (B = -.20; CI .07-.43). Agentic coping was a significant mediator only for Caucasians (B = -.48; CI .18-.81). Discrimination may exceed threshold more often for African Americans than for Caucasians and social constraint may exert greater limits for African Americans. Results suggest that perceived discrimination affects quality of life for African Americans with cancer because their coping options to counter mistreatment, which is racially based, are limited. This process may also affect treatment, recovery, and survivorship.
authors.affiliation: Department of Psychology.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Merluzzi
authors.affiliation: Memorial Sloan Kettering Cancer Center.
authors.forename: Errol J
authors.initials: EJ
authors.lastname: Philip
authors.affiliation: Department of Psychology.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: University of Massachusetts Medical School.
authors.forename: Courtney
authors.initials: C
authors.lastname: Sullivan
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010465:Perception / Q000502:physiology*; D011788:Quality of Life; D063505:Racism / Q000523:psychology*; D014481:United States; D044465:White People / Q000523:psychology*
references.citation: Soc Sci Med. 2000 Mar;50(6):813-28
references.pmid: 10695979
references.citation: Am J Public Health. 1996 Oct;86(10):1370-8
references.pmid: 8876504
references.citation: Int J Behav Med. 1997;4(1):92-100
references.pmid: 16250744
references.citation: Med Care. 1981 Aug;19(8):787-805
references.pmid: 7278416
references.citation: Nat Rev Cancer. 2002 Nov;2(11):873-9
references.pmid: 12415257
references.citation: J Behav Med. 2009 Feb;32(1):64-88
references.pmid: 19127420
references.citation: J Pers Assess. 1985 Feb;49(1):71-5
references.pmid: 16367493
references.citation: Psychooncology. 1997 Mar;6(1):13-23
references.pmid: 9126712
references.citation: J Gen Intern Med. 2006 Jan;21 Suppl 1:S21-7
references.pmid: 16405705
references.citation: Psychooncology. 2001 May-Jun;10(3):206-17
references.pmid: 11351373
references.citation: J Pers Soc Psychol. 2005 Jun;88(6):984-98
references.pmid: 15982117
references.citation: Psychosom Med. 2006 May-Jun;68(3):362-8
references.pmid: 16738065
references.citation: Cultur Divers Ethnic Minor Psychol. 2009 Jan;15(1):86-95
references.pmid: 19209983
references.citation: Int J Equity Health. 2008 Jan 31;7:5
references.pmid: 18237395
references.citation: J Pers Soc Psychol. 1996 Feb;70(2):271-82
references.pmid: 8636882
references.citation: J Clin Oncol. 2003 Mar 1;21(5):855-63
references.pmid: 12610185
references.citation: Cancer Epidemiol Biomarkers Prev. 2008 Nov;17(11):2913-23
references.pmid: 18990731
references.citation: Soc Sci Med. 1990;30(12):1273-81
references.pmid: 2367873
references.citation: Am Psychol. 2007 May-Jun;62(4):271-86
references.pmid: 17516773
references.citation: Soc Sci Med. 1995 Nov;41(10):1403-9
references.pmid: 8560308
references.citation: J Health Psychol. 1997 Jul;2(3):335-51
references.pmid: 22013026
references.citation: Am Psychol. 1999 Oct;54(10):805-16
references.pmid: 10540593
references.citation: Cultur Divers Ethnic Minor Psychol. 2008 Jul;14(3):173-82
references.pmid: 18624581
references.citation: Am J Public Health. 2010 Aug;100(8):1485-92
references.pmid: 19965567
references.citation: Cultur Divers Ethnic Minor Psychol. 2008 Oct;14(4):307-14
references.pmid: 18954166
references.citation: Am J Hypertens. 2011 May;24(5):518-29
references.pmid: 21331054
references.citation: Psychooncology. 2002 Nov-Dec;11(6):495-504
references.pmid: 12476431
references.citation: Ther Adv Med Oncol. 2011 Mar;3(2):57-71
references.pmid: 21789156
references.citation: J Clin Oncol. 1993 Mar;11(3):570-9
references.pmid: 8445433
references.citation: J Pain Symptom Manage. 2004 Nov;28(5):433-44
references.pmid: 15504620
references.citation: Cultur Divers Ethnic Minor Psychol. 2002 Aug;8(3):224-33
references.pmid: 12143100
references.citation: Cancer. 1999 Jan 15;85(2):418-26
references.pmid: 10023710
references.citation: Am J Prev Med. 1993 Nov-Dec;9(6 Suppl):82-122
references.pmid: 8123288
references.citation: Health Psychol. 2004 May;23(3):259-66
references.pmid: 15099166
references.citation: Health Psychol. 2001 Sep;20(5):315-25
references.pmid: 11570645