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      Racism as a Determinant of Health: A Systematic Review and Meta-Analysis

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          Abstract

          Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health ( r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health ( r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.

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          Most cited references 208

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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            Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.

             R L Tweedie,  S Duval (2000)
            We study recently developed nonparametric methods for estimating the number of missing studies that might exist in a meta-analysis and the effect that these studies might have had on its outcome. These are simple rank-based data augmentation techniques, which formalize the use of funnel plots. We show that they provide effective and relatively powerful tests for evaluating the existence of such publication bias. After adjusting for missing studies, we find that the point estimate of the overall effect size is approximately correct and coverage of the effect size confidence intervals is substantially improved, in many cases recovering the nominal confidence levels entirely. We illustrate the trim and fill method on existing meta-analyses of studies in clinical trials and psychometrics.
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              Does rejection hurt? An FMRI study of social exclusion.

              A neuroimaging study examined the neural correlates of social exclusion and tested the hypothesis that the brain bases of social pain are similar to those of physical pain. Participants were scanned while playing a virtual ball-tossing game in which they were ultimately excluded. Paralleling results from physical pain studies, the anterior cingulate cortex (ACC) was more active during exclusion than during inclusion and correlated positively with self-reported distress. Right ventral prefrontal cortex (RVPFC) was active during exclusion and correlated negatively with self-reported distress. ACC changes mediated the RVPFC-distress correlation, suggesting that RVPFC regulates the distress of social exclusion by disrupting ACC activity.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                23 September 2015
                2015
                : 10
                : 9
                Affiliations
                [1 ]Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
                [2 ]School of Social Sciences and Psychology, University of Western Sydney, Sydney, New South Wales, Australia
                [3 ]Australian Centre for Applied Social Research Methods, Australian National University, Canberra, Australian Capital Territory, Australia
                [4 ]Division of Counseling Psychology, University at Albany, State University of New York, New York, New York, United States of America
                [5 ]Oppenheimer Center for Neurobiology of Stress, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
                [6 ]Centre for Health Policy Programs and Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
                [7 ]Department of Community Health Sciences, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California, United States of America
                Cardiff University, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: YP JB NP AP AG MK GG. Performed the experiments: YP JB AE NP AP AG MK GG. Analyzed the data: YP JB ND. Wrote the paper: YP JB ND AE NP AP AG MK GG.

                Article
                PONE-D-15-17168
                10.1371/journal.pone.0138511
                4580597
                26398658

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                Page count
                Figures: 5, Tables: 4, Pages: 48
                Product
                Funding
                The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This research was partially funded by grant LP100200057 (YP, MK) funded by the Australian Research Council ( http://www.arc.gov.au/), Victorian Health Promotion Foundation ( https://www.vichealth.vic.gov.au/ YP, MK, NP) and the Australian Human Rights Commission ( https://www.humanrights.gov.au/ YP). YP is supported by an Australian Research Council Future Fellowship grant ( http://www.arc.gov.au/ FF130101148).
                Categories
                Research Article
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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