摘要：Objectives. We investigated associations among racial discrimination, psychological distress, and self-rated health among US-born and immigrant Black Americans. Methods. We conducted a cross-sectional analysis of a cohort of employed working-class Black Americans (193 US-born, 275 foreign-born). Results. Both US-born and foreign-born Black participants had high levels of exposure to poverty (51% and 57%, respectively) and racial discrimination (76% and 60%) and reported high levels of severe psychological distress (14% and 16% had a Kessler 6 [K6] score of 13 or greater); 17% and 7% reported fair or poor health. After controlling for relevant covariates, their risk parameters for racial discrimination (high vs no exposure) were 4.0 (95% confidence interval [CI] = 2.3, 5.6) and 3.3 (95% CI = 2.1, 4.5), respectively, for continuous K6 score; corresponding odds ratios for severe psychological distress were 6.9 (95% CI = 1.4, 35.7) and 6.8 (95% CI = 2.5, 18.3). No associations existed between racial discrimination and self-reported health, suggesting that an underlying propensity to report adversity does not account for our psychological distress findings. Conclusions. Our results attest to the salience of racial discrimination, nativity, and socioeconomic position in understanding the experiences and psychological health of Black Americans. Despite growing evidence that racial discrimination harms health, 1 – 4 its toll on the everyday well-being of Black Americans remains poorly understood. Surprisingly few community-based studies have quantified its impact on the US Black population's relative risk of either psychological distress 3 – 7 or self-rated health. 8 – 11 Further adding to gaps in knowledge are the dynamics of immigration. Between 1980 and 2005, the percentage of the US Black population that was foreign born tripled and currently stands at 10% nationally and upwards of 30% in such major metropolitan areas as New York City; Boston, Massachusetts; Miami, Florida; and Washington, DC. 12 A small but provocative literature suggests that recent Black immigrants may be less likely than are their US-born counterparts to report racial discrimination, even when they are exposed to similar types of discriminatory treatment, and also that the levels they report rise with longer duration in the United States. 13 – 15 Only a handful of studies, however, have directly focused on the health implications of these findings, 9 , 16 – 18 with 2 of the larger investigations hinting that the adverse impact of self-reported experiences of racial discrimination may be greater among US-born than foreign-born Black Americans. 9 , 18 We thus sought to estimate and compare the prevalence of self-reported experiences of racial discrimination and its association with psychological distress and self-rated health among US-born Black Americans versus foreign-born Black Americans. Our a priori hypotheses were that levels of self-reported racial discrimination would be higher among US-born than among foreign-born Black participants (and would be positively associated in the latter group with duration of time in the United States) and that estimates of the association between racial discrimination and health outcomes would be biased in analyses that failed to take into account nativity. We conducted these cross-sectional analyses within a study population that consisted of employed working-class adults, a group representing the majority of the working-age population in both groups, 12 , 19 and that lived in a major US urban area in which almost one third of the Black residents were immigrants.
