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      What are the effects of ethnicity, sexuality, disability and obesity on the odds of experiencing discrimination among Australian males? A nationwide cross-sectional survey

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          Abstract

          Objectives

          The global public health community has been slow to acknowledge the important role of discrimination in health inequality. Existing evidence on discrimination is largely based on studies of specific subpopulations and specific forms of discrimination, with limited evidence from general population samples. We assessed the individual and combined effects of ethnicity, sexuality, disability and obesity on the likelihood of discrimination among a general population sample of Australian males.

          Design and setting

          We used data from The Australian Longitudinal Study on Male Health (n=15 988, with response rate of 35%) to estimate the prevalence of self-perceived discrimination within the preceding 2 years and we used binary logistic regression models to assess the individual and combined effects of ethnicity, sexuality, disability and obesity on discrimination.

          Participants

          13 763 adult males were included in this analysis.

          Results

          One in five (19.7%) males reported experiencing discrimination in the preceding 2 years. Aboriginal and/or Torres Strait Islander males were nearly three times (OR=2.97, p<0.001) more likely to experience discrimination. Those born in Southern/Eastern Europe, Asia or Africa were at least twice more likely to report discrimination. Homosexual or bisexual males (35.2%; OR=2.23, p=<0.001), men with morbid obesity (29.2%; OR=1.91, p<0.001) and men with a disability (33.8%; OR=2.07, p<0.001) also had higher odds of experiencing discrimination. Those belonging to one (30.4%; OR=2.60, p<0.001) or two or more (38.2%; OR=3.50, p<0.001) risk groups were increasingly more likely to experience discrimination.

          Conclusions

          Discrimination was correlated with ethnicity, sexuality, obesity and disability. Belonging to two or more of the risk groups was associated with substantial increases in the likelihood of experiencing discrimination. Approaches to preventing discrimination need to acknowledge and address the impact of this intersectionality.

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          Most cited references42

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          The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health.

          Intersectionality is a theoretical framework that posits that multiple social categories (e.g., race, ethnicity, gender, sexual orientation, socioeconomic status) intersect at the micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro, social-structural level (e.g., racism, sexism, heterosexism). Public health's commitment to social justice makes it a natural fit with intersectionality's focus on multiple historically oppressed populations. Yet despite a plethora of research focused on these populations, public health studies that reflect intersectionality in their theoretical frameworks, designs, analyses, or interpretations are rare. Accordingly, I describe the history and central tenets of intersectionality, address some theoretical and methodological challenges, and highlight the benefits of intersectionality for public health theory, research, and policy.
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            Obesity stigma: important considerations for public health.

            Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.
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              The consequences of perceived discrimination for psychological well-being: a meta-analytic review.

              In 2 meta-analyses, we examined the relationship between perceived discrimination and psychological well-being and tested a number of moderators of that relationship. In Meta-Analysis 1 (328 independent effect sizes, N = 144,246), we examined correlational data measuring both perceived discrimination and psychological well-being (e.g., self-esteem, depression, anxiety, psychological distress, life satisfaction). Using a random-effects model, the mean weighted effect size was significantly negative, indicating harm (r = -.23). Effect sizes were larger for disadvantaged groups (r = -.24) compared to advantaged groups (r = -.10), larger for children compared to adults, larger for perceptions of personal discrimination compared to group discrimination, and weaker for racism and sexism compared to other stigmas. The negative relationship was significant across different operationalizations of well-being but was somewhat weaker for positive outcomes (e.g., self-esteem, positive affect) than for negative outcomes (e.g., depression, anxiety, negative affect). Importantly, the effect size was significantly negative even in longitudinal studies that controlled for prior levels of well-being (r = -.15). In Meta-Analysis 2 (54 independent effect sizes, N = 2,640), we examined experimental data from studies manipulating perceptions of discrimination and measuring well-being. We found that the effect of discrimination on well-being was significantly negative for studies that manipulated general perceptions of discrimination (d = -.25), but effects did not differ from 0 when attributions to discrimination for a specific negative event were compared to personal attributions (d = .06). Overall, results support the idea that the pervasiveness of perceived discrimination is fundamental to its harmful effects on psychological well-being.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2022
                21 January 2022
                : 12
                : 1
                : e053355
                Affiliations
                [1 ]The University of Melbourne School of Population and Global Health , Melbourne, Victoria, Australia
                [2 ]departmentMelbourne School of Population and Global Health , University of Melbourne , Melbourne, Victoria, Australia
                [3 ]departmentCentre for Health Equity , The University of Melbourne School of Population and Global Health , Melbourne, Victoria, Australia
                [4 ]departmentCentre for Adolescent Health , Murdoch Childrens Research Institute , Parkville, Victoria, Australia
                [5 ]Deakin University Alfred Deakin Institute for Citizenship and Globalisation , Burwood, Victoria, Australia
                Author notes
                [Correspondence to ] Dr Gregory Armstrong; g.armstrong@ 123456unimelb.edu.au
                Author information
                http://orcid.org/0000-0002-8073-9213
                http://orcid.org/0000-0001-5702-372X
                Article
                bmjopen-2021-053355
                10.1136/bmjopen-2021-053355
                8785162
                35063959
                87711fa6-84d1-4582-9f4b-d37342084f72
                © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 12 May 2021
                : 17 November 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100003921, Department of Health, Australian Government;
                Award ID: N/A
                Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: GNT1138096
                Award ID: GNT1178027
                Categories
                Public Health
                1506
                1724
                Original research
                Custom metadata
                unlocked

                Medicine
                preventive medicine,social medicine,public health
                Medicine
                preventive medicine, social medicine, public health

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