P r e j u d i c e a s S t r e s s : C o n c e p t u a l a n d M e a s u r e m e n t P r o b l e m s

Iri the fiHlfJ of sociai sci-

onces, Lheio has boon a ce
nowed inleiesl irt studying prej
udice ana discrimination BS
s^ressors and assessing iheir
impact on vanous heaith out
comes, Tnib raises a ncncl for
theoreticaiK' based anri psv
choHietncaily so^fnu nseasures
0^ projudicc.
As I'esoaiChC'S <"ipp,foach
thiS ta&k. theic ate several
conc:eptiial issues tnai need
to be addiessed, l"he author
describes 3 sunfi issues le
lateci to ( l j irKiividuai versiis
structural measures o1 U^e im-
pact ol prejudice, (2i objective
vo[Si(s subjective assess-
'r^ents oi stress, and (3) r'lea-
sijies ol major even'.s versus
everyday discrirninaSion.
How resoarrhfirs approacii
tiie prob^en^ of measurement
depends on the sp(;ci1 ic study
aiws. but they must consider
tii(ise conceptu^ii ^ssues and
understand tno advantages
and limirations of various ap-
proaches to the sUKJv ot prei
udico as stress, (.AP ! ,/ Public
Hoaith. 2003:93:262-- 265|
I lian H, Meyer, P hD
M OS T OF THE S OC IAL
[psychological work in the area of
|)reiudice lias been concerned
With tlic pcr,spective of the pf.'r-
pdmt or (c.jj., the authontarian
personality described by .Adorrio
et al,),^ Allpori's di^sr.riplion,
nearly 50 years ago. of the effect
of piejiidicc on nlemb('r,'^ oi riii-
norit\' grou|).s was one iiDlahie
exception. Recently, sociology
(ind social psychology have ,s('en
a renewed interest in the study
of prejudice fmni "Oie larget's
perspeelive,""' 'i'he slress model is
often featured ni tliesc new
works,' In 1999. Clark el al,''
published an ai-ticle titled "Rac-
ism as a Stressor for African
Anieneans: A Biopsychosocial
Model"; tiiis article, which is al-
ready having an influence on tiie
study of prejudice, explicitly
|)iHced racLsm within tlie stre,ss
conceptiud framework. Clearly,
concepfualizing prejiKiicr and
discrimination as SIR^SS l'il.s well
wilh the sociologies notion f)f
stress, which describes tbis con-
cept as embedded in sociai struc-
tures,'' 'I'lurs, in Ihe case of social
grnuj>s, ihe stress model has
been applied to stress related to
disadvantaged class, ,s(',\. se\uai
orientation, and other positions
in society.' '''
Hegardl<^ss ol the rencwiid ci-
lorts to study prejudice direclly
as stress, prejudice enlers any
stressful life event measure indi-
rectly. Race and etlinicity arc ex-
amples ( ) { stralifying ,sociai sia-
tuses that can be linked to
potentially stressful experi-
ences.*''~ i'or instance, as a result
of the excess unpact of discrimi-
nation, an African American in-
dividual is more liki'lv to have
experienc('d jo!) loss than a
White individual. Because job
loss is a routinely studied slrcs-
sor, life event nica.surcs may cap-
ture tiiis diiterential cxjMxsure,
I l<.)we\"Cr, tliere seems to be a
consensus that it is insufficient lo
understand prejudice only as a
medialor that leads to excesses m
certain life events and thai re-
searchers should rissess prejudice
and discrimination as unique
events '
U M ' , renewed interest ui preju-
dice as stress raises Ihe need for
theoretically based and psycho-
riietricaliy sound measures of
pre|udice. As we approarii ihis
task, there tire several conceptual
issues tiiat nec'd to be addressed.
I descnbe 3 of liK^se issues with-
out attempting to resolve tbeni,
rec(.>gni2ing that their resolution
dejH'nds, in part, on the puqiose
of particnlar investigations, 1 pres-
enl tJi(^se conccpiua! issues as
polar problems relaled to (1) indi-
\'idtiaJ versus stmcturdl measures
ol the impact of prejudice, (2) ob-
jcctj\'e v(?rsus subiective assess-
mcril-s of slress due to prejudice,
and ( 3) major events versus daily
hassles as measures oi prt^judice.
STRUCTURAL MEASURES
The lii-si challenge is lo sorl
oul tlic extent to wiiich prejudice
and discrimination properly lit
the stiess model. Although con-
cerned witb sociai sourctfs of
sU'css, stress research lias foi'used
on asscs-siiig stress al the individ
ual level of analysis, llowever,
slress as an iiidivi(iual-!('\e! vari-
able IS limited m tenns of captur-
ing tlic impact of ]}reJLidice ;uid
discrimination, l-or t'.\aniple,
.\dams descuibed mstitiitional { as
opposed to indixidual) racism as
in\ olving stressors tlrat thwart
prosperity, esteem and honor,
and power and innnence,"
Such institutional barriersor,
as Link and Phelan labeled them,
slructural discrimination bairi-
ersare often impossible to de-
led at Ihe individuLil level, ^*' Tins
is especially true in the case of il-
legal forms of discrimination,
.such as employinent practictts
discriminating against African
Amencans, in which the perfje-
trator is sure to have made efforts
to tlisgiiise tlie discnininatory na-
tuix^ of tlic act, Tims, an .-Xfnean
Amerieaii respondent may hon-
estly report to a researcher tliat
he or she was not denied a pro-
motion because of discrimination,
not realizing tbat the institution
for wiiich he or she worked in
fact engaged in a purposeful but
hidden policy of excluding Blacks
h'om promotions,
Stnidural barriers can also be-
come invisible in individual-level
research even when they are nof
coni:ealed. If prejudice and dis-
crimination are legal and widely
practiced, they arc likely to affect
many or ali members of a minor-
ity gixaip; thus, there would be
little Oi' no \'ariability to study,
t'or (,'xampl(\ gay men and les-
bians are uniformly and legally
excluded from marriage, but rc-
st^;ii"ch that focuses oniy on tht\s(^
individuals woEiid fail to reflect
this ])ractice as an instance of dis-
crinmiation. Such a lac'k oi' vari-
ance is esp(;e:ially pi'oblematic m
that many studies of prejndice
and discritnination assess individ-
ual measures of stress and do s<.)
?62 Commentaries. , P eer Reviewed Meyei
Am(;rican .luutriFi! ot P ublic hei^llh I'-ehrUfiry 2003, Vol 93, (Mo, 2
ill siimplcs that include only
mcmlxTs of the minority group
of interest {e.g.. studies of hypcr-
If^asion (iinorig African Ameri-
cans), tlius detecting within-f^roup
vai'iability m exposure to j)re;u-
dice and discnmmation but f'tul-
ing to delect the potentially
,slr(>nger ininiileslation of struc-
tural pre|udice,'''
Vhv impart of institutional
slressors may best be docu-
mented via assessments; oi differ-
ences in population paranicters
(including econoniics aiid health)
at Ihe gixmp rather than the indi-
\Ldual level,'' I iowever. other
measurement approaches can he
developed to capture stnirtural
variability and integrate such
variability with individual-level
observations tested by the siress
model. For e,\amp]e, Darily, an
economisi, deveiopid measures
Ibr comparing personal financial
standing based on sell'-reporls
with giTjui^i-lm't'l I'iiiaiu'.ial
achievement based on popula-
tion obser,'ations This allowed
him t(i estimate prejudice-relati'd
disfrepancies between expected
and acliial Hchievements among
Black and White respondents
{\\, A, Darit\ J!',. unpublished
data, 2002),
Even if we were interested only
in iruiividuaMevel measiinjs of
prejudiee as sti'ess and lefl tlie
.stniclural level of nicLsm tt < epi-
demiologisLs, economLsis. and
other scienlists, we would still
lace serious concc;ptnal and mea-
suremenl challenges, 'Ib mider-
,stand tlus problem, it is ini|)ortarit
to note a (Hstmcljon in the eon-
e(;piaaJi:/ati()ii nC stress thai is sig-
nili(ant in (fisrus-sions of siress
due to }>rejudic{', I refer to 2 gen-
eral approaches that underlie
stress diseourse. one viewing
sh-ess as an cibjective phenome-
non and the other \iev\ing it as a
subjecti\E' phenomenon. The ob-
jective view defines stressful life
events as real and observable
phenomena that are experienced
as stressors because of the adapta-
ticjna! demancis they impose on
most irifJniduaLs under similar cir-
cumstances, ^' Tbe suhjective \iew
defines sh'ess as an expenence
tiiat is contingent on the relation-
ship between the indmduai and
liis or her environment, Tliis rela-
tionship depends on properties of
tlie external event but also, signili-
canily, on appraisal processes ap-
plied by tlie individual,'*'*'
T h(^ distinction just described
has important conceptual and
metliod ologica! implications in
the context of stress due to prej-
udice. Most, if not all, measures
of disenniination events that
have been developed to date
rely on subjective perceptions, A
typical item asks the respondent
whether or not he or she has
been discriminated against (e,g,.
in relation to employment);
sometimes respondents are
asked to recall sueh events over
their lifetime, and sometimes
they are asked to limit them-
selves to more recent penods. In
certain instances, respondents
are also asked to identify the
n^ason (or this discrimination
(e,g., "Was tliis because of your
I'aee/ethnicity. gender, religion,
soeial status, sexual orientation,
or something else'^"),'^ However,
individual reports of discrtmina-
tion depend on perception,
vvhi(h j,iroduces discrepancies m
lindii!g,s. For example, as de-
scribed earlier, discrimination
can b(^ hidden and thus unde-
tecti'd by its victims.
More reievant to the dis<'us-
sion ?ieie, however, LS that even
when individuals ha\e oppoituni-
ties to obser\'e discnminadcjii
c;venLs, m;iny factors affect the
perception and reporting of tliese
events, Tbis is important because
of the potential for confoimding
of the measurement of the strt^s-
sor (as the independent variable)
and the measurement of out-
comes (especially mental health
outcomes). Many individual psy-
chological and demographic
characteristics may affect percep-
tions and reporting of prejudice
as a form of stress.
For example, Contrada and
colleagues'*' suggesteci that al-
though minority' gix:iup members
are motivated by self-protection
to detect dLsaTmination, they are
also motivated to ignore (evi-
dence of disciimination through
a wish to avoid false alarms that
can dismpt social relations and
undeiTnine life satisfaction. Simi-
larly, some evidence suggests
that, in ambiguous situations,
p[;ople tend to maximize perc(;j}-
tions of personal controi and
minimize recognition of discrimi-
nation. Such obsei'V'ations indi-
cate that healthier individuals
ma}- use sti'ategies that lead them
to underestimate prejudice autl
dLseiimination events. This may
lead to bias that would attenuate
the detecteti impact of perceived
discrimination on health,
TTiere are many other potential
biases in perceptions and repoits
of prejudice and discnminahon
events that ha\-e been the focus
of exciting new cognitive stud-
ies, ''' Some interesting findings
are as follows: (1 ] people who ac-
tively cope witli prejudice ai^e
more likely to notice, recall, and
report prejudice events; (2) mi-
nonty giy)up membei^s ha\'e
strong motivations to ignore prej-
udice-related events m somt; in-
stances but to be hyper\igi]anl of
them in other inslanees; and
(3) inclinations to report prejudice
events may van' d<^pending on
<'oncordance belween respon-
dents and lntemewers in lenns
of minority status. Knowledge is
incomplete regarding the coire-
lates of vanation in these biases,
but tliey are certain lo affect asso-
ciations between stress and health
outcomes. These motivationiil
factors can lead to inaccurati! re-
ports of events of disciimmation
and prejudice and present senous
challenges lo resetirchers who aj"e
interested in an objective account
cM' what actually occurrcxl,
it LS important to note, how-
t;ver, that an interest in the ob-
jeetive phenomenon Ls not uni-
formly accepted by researchers
in tbe area of prejudice. Many re-
searchers focusing on racism as
stress see .strong viiliie in record-
ing the minority person's subjec-
tive pei"spective, that is. his or
her perception of prejudice and
discrimination. They view this as
an important political choice, not-
ing the presence of bias in previ-
ous studies of mmonty popula-
tions, 1 hey suggest tliat researeh
focus on individual perceptions
of prejudice and discrimination
so as to empower Ihe respon-
dent's perspective. Indeed, in
part because of these reasons.
CUii"k and colleagues' calleii fbr
studies of racism to employ
l,azani.s and Folkman's model of
stress and focus on perceived
racism,"'
However, tlie sub|ective stress
model should not be adopti^d
without carellii deliberation.
From a methodological perspec-
tive, relying only on subjeelive
perceptions of stress is problem-
atic because senous confounding
can occur belween an individ-
ual's health and his or her per-
ception of stressors " This is par-
ticularly the case in research on
Ihe association between life
February 2003, Vol 93, No,
American Journal of Public Health Meyer Peer Reviewed Conimenianes 263
evcuLs and in(;iilal dLsorders.
Sudi studies, which attemp! ti)
estimate prejudice iis it rclak's io
ciisease outcomes, require a
niethodoiog}' ihat coneeptualizes
stress as an obiective phenome-
non independent of an individ-
ual's own vicw.s and Icciitigs.
f'Vom an ethical pcrspcrtivc. rely-
ing only on subjective pcrccp-
Liuns may have llu; beneiit oi
onipowcnng the minority respon-
dent's voice, but it also may
imply that pi"e|udi(.-e an<:i racism
air incrriy jmiblems related to
p(;rccpli(jn. Ihns indireclly ami
uniritenUonally undermining the
Tiotioii iliat radsm and other
foiTHS of prejudice are social
ratiier thaii uidividiiai stre.ssor'.s.
Still, an objeriive approach
scc.ms difficuli to n;('Oiirile with
the ai)pn)ach thai view.s |)er-
ccivcd racism as more important,
and il may be at odds with the
ideo!o,!5," expip,ssed in the litera-
ture on ))erceived racism. For ex-
ample, if,stress reseairh sen'cs
an exprcs.si\e purpose in regard
tl) minonty concenis, the practice
ot rating cviuils objcrlivi'iy and
itidcpt'ndently of indivitlual per-
ceptions raise.s ethicai concerns.
because it may involve devalua-
tion 1)1' Ihc jjcrspetlives of minor-
ity research respondeni,s.
I ix'COJith^ cc)nfront(;<.] such an
cfbica! dilemma in studying [irej-
udiee a,s stress ai Ihi; intf;rsection
of race/ethnicity, gender, and
sexual orientalion. la this project.
I used .subjective (perceived) dis-
crimination scales, but 1 also
u.scd an objectjve probed narra-
tive method to study slre.ssfu!
events related lo prejudiec. This
inetJiod. d(!\'elo;M'd hy Ooliren-
wend and colieagiics, involves
detailed probing of each event
reported hy a respondent. After
th(; narrative has heen recorded
hy the inten'ic'wer, il is rated hy
independeni raters, acrording to
.specil'ied critc^ria, on stress di-
mensions sueh as event valence,
centraliiy, and magnitude.^'
.\ case demoiistrating the sub-
jective versus ohjective dilemma
invoh'ed a young Latmo re,spon-
dent who was an illegal immi-
grani. Ill a Hie event list, he re-
l)oried moving to a new
apartment and not being able to
obtain a telephone as a sti^essful
event Because he made his li\ing
by cleaning homes, he depended
on a U'iephoiie to receive ri^fcr-
rals and calls from customers. Not
being ahle to obtain a telephone
eould liave had a .significant im-
pact on his income, making the
event more detrimental than it
mighl initially appear. In respond-
ing 1(1 a subjective perceived dis-
cnminadon qut^sdonnaire, the re-
spondent reported hi.s experience
as a discrimination event reiated
t(i his ctiinic/racial identity and
immigrani status.
If our reseairh team had
stopped tliere. that is all we
would have known. But in prob-
ing the event fiiitiier. we discov-
ered ihat the rcsjiondent was de-
nied a telephone because he was
unahie io produce the docu-
nK'nts and eash deposit routinely
required by the telephone c(jm-
pany for people with no estab-
lished credit record in tlie United
Staies In dLscussing his iiairative
alter completion of the niting
procedure, the research team
rated this event as not caused by
discriminaiion, because we deter-
mined tbat the respondent was
ti^catcLl m a manner identical to
that of any otiier person similarly
lacking documents and money,
ami tJius he was noi singled out
b(K;aiise of liis racc/eihniaty
W(^ wen; eonfident that a re-
Mew conducted by a court or
human rights commission would
yield a similar result. Yet, we fell
uneasv; ii can certainly be ar-
giicd that the respondent, despite
being treated in an equitable
manner, confronied a serious dis-
crimmator}' sodal banier related
to his mimigration status, low in-
come, and, perhaps, ethninty. In
rejecting the respondent's per-
spective and recording the event
a.s not invoh'ing pn^judiee, were
we (.x>mplicit with an oppressive
social structure whose effe('ts we
purf)ort to study? On the other
hand, is our research better
served by recording the respon-
tlent's subjective account? This
could lead to bia.sing of UK^ a,s,so-
ciation betwi^en stress and health
outcomes. p:.)ssilily diminishing
or masking a tnie effect.'"
MAJOR LIFE EVENTS
VERSUS DAILY HASSLES
Ilie third challenge to mea-
surement of prejudice as stress is
related to the signilicance. or
magnitude, of minor discrimina-
tion e\'ents. hi traditional life
events studies, researchers distin-
guish hetween niajoi- cvcnls and
daily hassles. Daily hassle.s are
ubiquitous; most people perceive
hassles as an unavoniaiile part oi"
life and are expected to recover
relatively quickly from sueh ex-
perience,s. Assodations between
daily hassles and mental health
outcomes are likely to be overes-
timated, because mood slates
jsrfjbably affect perceptions and
reporis (.if daily hassles as well as
outcome measures. This raises
questions about the utiliiy of has-
sles scales as independent vari-
ables m the study of stJ^ess and
immtal health, and many re-
s(!arehi;rs (!o nol use them.""
Yet. minor discrimination
ev(!ni,s are pei"vasive and have
an impart on many inspects of
daily life. Williams anci col-
leagues referred to "everyday
discrimination" in describing 0(^-
ciiiTcnces such as :Afnc.an .\mer-
ican men being followed in
stores for suspicion of shoplift-
ing or not being able to hail a
cab.^" If we considered such oc-
cuiTences as minor liassles, we
would err: as a result of their
meaning m a .soi'ial context, they
an; m{)r(; signilicanl than tradi-
tionally defiiK;d daily ha,ssies
thai are no( related io prejudice.
A seemingly minor everyday
discrimination occurrence, such
as not being able t(i hail a cab,
can evoke among minority indi-
viduals [Kiinful tiHMiiories relaied
io personal and conimunal his-
iories of prejudice.
In Rare Mailers. Cornel West
destTibe*.! failing to get a cab m
\ ew York because t;L\i dnvers
would not stop for him: he stfited
thai "lulgly raiial nicniones of the
past Hashed ihrough |his| mind"
as he recalled encouutei*s with
racism in his owii life and the
lives of othere. lie acknowledged
tliat his experience pak'd against
more sei^ious acts of racism but
iievertheless recalled that "ihe
menK>ri(!s cut like a merciless
knife ai my soul as 1 wiutc(i on
ihai godforsaken conier"^''''""'^"
11 is possihie thai such minor
(iiscriminaten^j" events have
greater effects on health oui-
coines llian their seeming magni-
tu<U; would suggest: for example,
their elfecis on cardiovasi;ular
health, via aclivation of ths^ .sym-
pathetic nervous system, iiave
been examined-'" if we are con-
cerned only with major events,
we niay miss an lmptHtant aspect
nf the experience of pn,'jiidice
and <iisciimination, and thus we
may underestimate the burden of
stres,s resulting from prejudice.
CONCLUSIONS
1 have identified 3 issuers that
raise c]iie.slioiis regarding mea-
264 Cor-fimEintaries Peer Reviewed Mever
American Journal of Public Healih , Febmarv 2003. Vol 93. No. 2
smenient ot prejudice and dis-
cnminahon iLS stress, but I offer
lio resolution, Indix'd, an ailcmpt
lo Iind il Resolution may bo un-
wise, lK:rau,sc thi^ solulioas to lhc
mctliodological pi-oblcnw raised
1H;I'C depend on the spccilu" re-
search questions pm-suf^d and on
investigat<jrs' conceptual thinking
about prejudice as .stress, I'or ex-
amplc, a researcher who aliempL s
to rlironiclc^ minority people's ex-
]>vnv,iu;r, in society may be inter-
ested in (.imjnicling tlieir world as
tJicy experience it, and thei^efore
he (!r sh<^ may prefer a subjective
measui"en!ent ol'ijn^judice stress,
A researcl ii,'r who aims to und(; r-
stiuid the impact of prejudice as a
cause of d[seL se and quantify its
roie in dillerenlial health out-
comes may iind il more ini[)ortant
to measure prejudice as an objec-
tive stressor. reducing bias related
lo appraisal and recall a.s \\(^1] as
tlireats rf^sulling from the eon-
loL indmg of individual characleris-
ties and disease outcomes.
Regardless of lh<.'ir aims, re-
,seari'hc;]'s niusi understand vari-
ous approaH ies to measuring
[irejudiee as stress, and tliey mast
i'on>;ider ihe a(lvantagc;s and limi-
tations of their prefenx:d ajj-
proiich, integration of various ap-
proaches, eoilahoration among
researchers from various dL sci-
pliiK^s who bring ditlerent per-
s[>eetives to understanding preju-
dice as a nsk factor Ibr disease,
and use of (X)Dtextual and mulli-
ple levels of analysis may be the
most promising routes m Ilie
study of prejudice and
A b o u t t h e A u t h o r
lla>t II. Meiier i^ wilh lhc Deptuimeni of
Sonomrdiriii Scii'ru.e^ Vliiilirian School of
I'uhlir fleiitlh Columbia VnircrsiUi. Neu:
)fi/k Cily
Requi'sts lor repnni^ should he M'nt lo
Ilan IL .Metier. Phi). Department of So-
rior/ifdical Science:^ Mailman Sdiiiol of
Pubhc Health. Columbia Vniversiti/. 722
W ifiH'Ji SI, .Xew York, \T 100.32
(e-mail, irii 1 ^tficotumbia.edu).
This article was accepted Lk'tober 8.
2002.
A c k n o w l e d g m e n t s
Wori; {in this aiticle wa^ coniplrtcii as
part o! a onijecl fimdi'd Nadoniil insti-
tute of Mental Hi;alth gi'ant Mliri9627,
Research suppon was also provirici:! by
(he ,\nieii(:an PsychDlogical As,soriation
und the Xatioiial L ibraiy oi'Mediriiie
{graiUGU L M 007660-(ll),
An I'arliiT version ol tlus arlicle was
prcsenlcr, al ilie liiglith Internalional
Confcren\-i* on S onai S iress Research,
rottsmoiilh, M(, April 20(12,
H u m a n P a r t i c i p a n t P r o t e c t i o n
I luiiian p.'iriicipaiit piDtection guidelines
wcri' i'<iilii\veiLi in accorciance witli (Ji-
iumhia Picsliylerian Mediciil Cenler ii>
,stitiilional review board protoail l J7l i 9,
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