Assessing mediators between discrimination, health behaviours and physical health outcomes: a representative cross-sectional study.
OBJECTIVE
Discrimination is a social determinant of health; however, the pathways linking discrimination to ill-health are under-researched. This study investigated the mediators through which discrimination affects health behaviours and physical health outcomes, as well as assessed whether sex moderated these mechanisms.


METHODS
Data from a representative survey (n = 1023) of undergraduate students enrolled in a Brazilian university in 2012 were used. Structural equation models were applied to assess the following mediation mechanisms--(1) discrimination influences self-rated health and body mass index via anxiety/depression; (2) discrimination affects behaviours (alcohol consumption, problem drinking, smoking, fruit/vegetable consumption, and physical activity) through discomfort associated with discriminatory experiences. The potential of sex to act as an effect-modifying variable was also explored in each of the postulated pathways.


RESULTS
The effect of discrimination on self-rated poor health was totally (100.0%) mediated by anxiety/depression, while body mass index was not correlated with discrimination. Self-reported discrimination was associated with some behaviours via discomfort. Particularly, discomfort partially mediated the positive association between discrimination, leisure time physical activity (43.3%), and fruit/vegetable consumption (52.2%). Sex modified the association between discrimination, discomfort and physical activity in that such mechanism (more discrimination → more discomfort → more physical activity) was statistically significant in the entire sample and among females, but not among males.


CONCLUSIONS
This is one of the first studies to demonstrate that discrimination is associated with physical health outcomes and behaviours via distinct pathways. Future investigations should further explicate the mediational pathways between discrimination and key health outcomes.
Post-graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Santa Catarina, 88040-970, Brazil. joao.luiz.epi@gmail.com.
João Luiz
JL
Bastos
Post-graduate Program in Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil. roger.keller@ufrgs.br.
Roger Keller
RK
Celeste
Post-graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Santa Catarina, 88040-970, Brazil. diego.augusto@ufsc.br.|Post-graduate Program in Physical Education, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, SC, 88040-970, Brazil. diego.augusto@ufsc.br.
Diego Augusto Santos
DA
Silva
Australian Centre for Applied Social Research Methods, Australian National University, Acton ACT, Canberra, NSW, 0200, Australia. naomi.priest@anu.edu.au.
Naomi
N
Priest
Faculty of Arts and Education, Alfred Deakin Research Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC, 3125, Australia. yin.paradies@deakin.edu.au.
Yin Carl
YC
Paradies
D000293:Adolescent; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D063508:Social Discrimination / Q000523:psychology*; D055815:Young Adult
Brazil; Health behaviour; Physical health; Social discrimination