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  • A Partnership Between Researchers and the Navajo Nation to Study a Junk Food Tax

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    Co-Authored By
    Regina Eddie, Ph.D., Northern Arizona University School of Nursing
    Hendrik “Dirk” de Heer, Ph.D., Department of Health Sciences, Northern Arizona University
    Del Yazzie, M.P.H., Navajo Epidemiology Center

    Eight years ago, the Navajo Nation enacted the first junk food tax within the United States and the first in any sovereign tribal nation in the world. The Healthy Diné Nation Act (HDNA) of 2014 created a 2% tax on foods and beverages that had little to no nutritional value. A companion piece of legislation removed the usual sales tax (then 5%, now 6%) for healthy foods, including water, nuts, fruits, and vegetables. The revenue from the unhealthy food tax is designated for local wellness projects in the 110 local communities that make up the Navajo Nation.

    Because they are sovereign nations, tribal nations are uniquely able to implement policies aimed at improving public health that may be difficult to implement in other places. Through partnerships with researchers at academic institutions, tribal nations can also measure the effects of these policies and share that information widely.

    Over the last five years, we have worked together to study the effects of this change in food policy on the Navajo Nation. The process was complex, but the rewards were great: The Navajo Nation acquired evidence to inform its decision about whether to extend the policy and the scientists learned about the effects of junk food taxes. Together, we increased the capacity for research in the Navajo Nation.

    Other tribes and researchers can learn from our example by partnering to advance both the research needs of Indigenous people and the research community’s understanding of the effects of public health policies.

    The legislature gave the Navajo Department of Health until 2020 to determine whether the policy was achieving the desired goals: promoting healthier diets and lifestyles in the Navajo Nation and supporting local community wellness projects. If the law was helping, it would be extended. If not, it would expire at the end of that year. That gave the department about five years to determine whether the tax was working. That’s where our research team came in, collaboratively building a partnership between the Navajo Epidemiology Center, Northern Arizona University, and Brigham and Women’s Hospital affiliate Community Outreach and Patient Empowerment (COPE).

    In this example of community-directed research, community interests and academic research interests were closely aligned. The Navajo Nation needed to know whether this tax was working or not, and the researchers needed to study the effects of junk food taxes.

    We based our evaluation on data already being collected by the tribal government, along with federal government data and new data that we collected as part of this partnership.

    We learned that the tax revenue decreased by about 3% every year, despite the lack of changes in overall sales tax revenue in the Navajo Nation, suggesting that people weren’t buying as much junk food as before. We also learned that more than 99% of the revenue was successfully allocated to local communities, an impressive feat. With the tax revenue, the local communities focused primarily on supporting the built recreational environment (such as walking trails and playgrounds), exercise equipment, nutrition and fitness classes, and social events. We further learned that stores in the Navajo Nation implemented the tax with nearly 90% accuracy, about the same as in major cities implementing soda taxes. Modest improvements in the food environment were found, with pricing and healthy food availability more aligned with those in nearby areas outside of the Navajo Nation. Informed by these findings, in 2020, the Navajo Nation Tribal Council reauthorized the tax with no expiration date.

    When collaborating with tribal nations, researchers must understand the historical context of relations between tribes and outsiders. For the Navajo Nation, this includes forced relocations, hundreds of environmentally damaging uranium mines, and children being sent to boarding schools against their families’ wishes. And, until the late 1980s, the Navajo people did not have control over what kind of research was done about their lives.

    Now the Navajo Nation Human Research Review Board makes decisions about what kind of research can be done in the Navajo Nation. One of us is a member of that board, and the partnership with that board has been crucial to the success of this project. The board also reviews all scientific publications about research conducted in the Navajo Nation. Through this collaboration, we have been able to publish eight scientific articles. All are open access and available on the Navajo Epidemiology Center’s website alongside our educational materials.

    Research protections and government processes exist to protect the Navajo people from exploitation. Although it is possible to hire consultants who specialize in navigating tribal government for outsiders, we recommend that researchers instead take the time to understand a tribal nation’s protections and processes, including the historical background that explains why the protections and processes are needed. Working through these processes has given our research team perspective and helped build the partnership between researchers and the Navajo Nation. This close relationship has made it possible to work through the variety of issues that come up while conducting research.

    In addition, this partnership has enabled us to build capacity for research in the Navajo Nation. This includes figuring out infrastructure issues, such as creating templates for frequently used documents and renewing a federal registration number that allowed the Navajo Department of Health to receive federal funds.

    The partnership has also involved supporting students. This project has supported eight Navajo students in master’s programs at Northern Arizona University. Six have graduated, and the other two are on track to do so at the end of this academic year; one of our graduate students is now in a doctoral program at the University of Arizona. Junior faculty have also been able to work on the project. We are advancing careers and supporting scholars’ advancement to higher levels of leadership. Eventually, these trainees will be able to lead research projects in their own tribal communities.

    Our partnership over the past five years has advanced the needs of both the Navajo Nation and the research community. We recommend that other tribal nations and researchers follow our lead and pursue common goals together. Our communities share interests and goals, and with thoughtful cooperation, we can work together toward a better future.

  • The Dementia Epidemic Among Older Black Americans

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    Co-authored by

    Mark D. Hayward, Ph.D.
    University of Texas at Austin

    Mateo P. Farina, Ph.D.
    University of Southern California

    November is Alzheimer’s Awareness month. While it is a time to recognize the importance of supporting persons living with dementia, it is also a time to acknowledge the glaring disparities in dementia in our country. One such disparity is the epidemic levels of dementia among older Black Americans compared to White Americans.

    The prevalence of dementia among Black Americans aged 65 years and older is about 2.5 times that for White Americans of the same age. In 2012, for example, a nationally representative study reported that 19.3% of older Black people had dementia compared to 7.4% of older White people1. These differences are starker at older ages. For Black persons aged 75 years and older, the prevalence of dementia is 31%, compared to 9% for White persons of that age2. Research reporting race differences in dementia onset—that is, new cases of dementia—document a similar race gap: Black people have about a 2.7 times greater risk of onset compared to White people3. These numbers translate into an extraordinary and disproportionate burden for Black individuals, their families, and their communities. This burden is often compounded by older Black Americans having fewer personal, social, economic, clinical, and community resources compared to White Americans. Moreover, the COVID-19 pandemic has increased these inequities, making care more difficult to obtain and placing a greater burden on familial caregivers.

    The race disparity in dementia prevalence and incidence is largely reflective of the differences in exposures that Black Americans and White Americans experience throughout their lives, and not innate biological differences (e.g., genetic differences). For example, recent studies have documented a decline in both Black people and White people living with dementia from 2000-20142. The reason for the declining trend was unclear. Several hypotheses have been suggested: education improvements across birth cohorts, better control of hypertension, positive health behaviors, and improved childhood conditions. The evidence for this period points to a straightforward explanation. The downward trend in dementia prevalence for both Black people and White people since 2000 has been driven by increased educational attainment—shown by research to be one of the major risk factors contributing to the Black-White disparity—and is, largely, unrelated to changes in other major risk factors. This shows that improvements in education, and not medical interventions, had far-reaching benefits for dementia trends, although it is clear that the persistence of the race gap over time likely reflects Black individuals’ continued challenges in obtaining greater levels of education. This finding also provides additional evidence that improvements in social risk factors in early life can dramatically move the needle and reduce the burden of dementia decades later in the older population.

    There is little doubt that cognitive health disparities defined by both race and education are enormous, and that highly educated White people and less educated Black people anchor the tail ends of the disparity. For example, highly educated 65-year-old White people can expect to live free of dementia for more than 17 years—an expectancy even greater than the total life expectancy for less educated Black people4. Less educated 65-year-old Black people, on the other hand, can only expect 10.59 years of life without dementia. The 7-year difference in life expectancy without dementia shows how stark these cognitive health inequalities can be. This difference is even more striking when considering the educational composition of the race groups; more than 50% of older Black individuals do not have a high school diploma, while about 38% of older White individuals have more than a high school education.

    How, then, can we explain the higher rates of dementia among older Black people compared to White people? Addressing this problem is not straightforward. The lives of many older Black people differed in fundamental ways from the lives of older White people. About 80% of older Black Americans were born in the pre-1964 Jim Crow South, although many now live elsewhere as older adults. Growing up in the Jim Crow South not only meant dramatically different childhoods for Black Americans compared to White Americans due to curtailed economic, political, and social rights, but also because of living with the threat of violence. These childhood exposures may have had developmental consequences through stressors and limited opportunities, which reverberate decades later and place older Black Americans at greater risk of dementia. Research clearly documents that early life in a Southern context is associated with poor cognitive health. This association remains after controlling for educational attainment and adult risk factors. Understanding how and why a Southern context in childhood may be associated with poor cognitive health is essential to understand today’s disparities in cognitive health. What the future holds is unclear, yet it is clear that the racial divide in dementia will almost certainly reflect future disparities in resources, risks and opportunities.


    1. Chen, C. and J.M. Zissimopoulos, Racial and ethnic differences in trends in dementia prevalence and risk factors in the United States. Alzheimer’s & dementia (New York, N. Y.), 2018. 4: p. 510-520.
    2. Hayward, M.D., et al., The Importance of Improving Educational Attainment for Dementia Prevalence Trends From 2000 to 2014, Among Older Non-Hispanic Black and White Americans. The Journals of Gerontology: Series B, 2021.
    3. Zhang, Z., M.D. Hayward, and Y.-L. Yu, Life Course Pathways to Racial Disparities in Cognitive Impairment among Older Americans. Journal of Health and Social Behavior, 2016. 57(2): p. 184-199.
    4. Farina, M.P., et al., Racial and Educational Disparities in Dementia and Dementia-Free Life Expectancy. The Journals of Gerontology: Series B, 2020. 75: p. e105-e112. PMC7530490.

  • Helping Youth from Racial and Ethnic Minority Groups Access Effective ADHD Treatment

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    By Lauren Haack, Ph.D.
    Associate Professor
    Department of Psychiatry and Behavioral Sciences
    University of California, San Francisco

    Attention-Deficit, Hyperactivity/Impulsivity Disorder (ADHD) is one of the most common mental health disorders impacting approximately 5% of children across cultures.1 Brain differences related to ADHD influence those affected in several ways.1,2 To begin, new or challenging tasks seem overwhelming, making it hard to map out a plan for completion and self-motivate initiation.3 In addition, individuals with ADHD have a tendency to over-perceive negative feedback and under-perceive positive feedback,2,4 which relates to difficulty regulating emotions.2 Unfortunately, as children with ADHD reach school age, they encounter more difficulties and more opportunities for critical rather than positive feedback from parents, teachers, and peers.2,5 As a result, ineffective patterns of interaction between children with ADHD and others in their lives can become entrenched, contributing to stress, confusion, and even hopelessness.4,5

    Fortunately, behavioral ADHD treatments help parents/caregivers and teachers use strategies that have been found to be effective but can be difficult to put into place consistently without support.5,6 Three key goals for behavioral ADHD treatments can be thought of as the “3 C’s”

    1. Clarity – well-defined and reasonable expectations that children can achieve
    2. Coordination – communication between families and teachers to provide children a clear roadmap for success
    3. Celebration – frequent and specific praise, as well as rewards, when children meet expectations.

    Consistent use of “3 C” strategies by parents/caregivers and teachers can help mend broken bonds, improve child functioning, and convey optimism and hope for all.5,6

    Unfortunately, there are barriers across all stages of ADHD help-seeking that prevent youth in need from receiving treatments that work.7 Many barriers are especially pronounced for families from racial and ethnic minority groups.7,8

    ADHD Help-Seeking Stages

    Recognizing there is a problem that needs support
    The first step in ADHD help-seeking involves recognizing there is a problem that needs support. Barriers in this stage include limited knowledge about ADHD, as well as differing beliefs about the causes of—and developmental expectations for—child behavior.7–10 For example, if one believes that impulsivity is just part of the typical childhood experience (“Boys will be boys; no big deal”) and they have never heard a biopsychosocial explanation for ADHD, they may be less likely to recognize a need for treatment even if the child’s behavior becomes impairing.

    Deciding to seek help and selecting a service
    If one does identify problematic child behaviors warranting support, they may progress to the next steps of deciding to seek help and selecting a service. A primary barrier here can be finding treatment in one’s native language.7,8 Additionally, given that families from racial and ethnic minority groups are disproportionately uninsured and financially strained in the United States, their decisions to seek help may be obstructed by out-of-pocket costs.7,8 There also may be hesitancy to seek treatment due to societal stigma and distrust, perceived lack of family support, fears about revealing undocumented status, and prior experiences with discrimination and racism by care providers.7–9

    Utilizing the service selected
    The final step in ADHD help-seeking is utilizing the service selected. Even if one can locate affordable treatment in their native language, they may have difficulty securing transportation, time off work, and/or child care, thus impeding consistent attendance.7,8 They also may lack genuine connection with providers or find that services focus on strategies which don’t feel relevant in their communities, which can lead to dissatisfaction, dropout, or poorer treatment outcomes.7–9

    • A potential solution addressing many of the barriers to ADHD help-seeking outlined above is offering services for free in familiar and accessible settings, such as schools.5,11 Research supports the following recommendations when using this approach:
      Redeploy school resources from ADHD practices with limited evidence (such as individual counseling) to treatments that work (such as behavioral parent/caregiver groups and classroom management)5,6,11
    • Offer linguistically and culturally appropriate services whenever possible; for example, the Collaborative Life Skills (CLS) school-based program11 shows feasibility, acceptability, and effectiveness in Spanish with Latinx families in the U.S. and Mexico12,13
    • Describe services using words that carry less stigma, such as “a program to improve youth attention and behavior” rather than “treatment for ADHD and related disorders”13
    • Harness technology to improve service reach and feasibility; for example, offer groups via videoconference for those who can’t attend in-person14

    For more information on clinical research programs focused on culturally-attuned school-based ADHD services in English and Spanish, see and


    1. Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based Conclusions about the Disorder. Neuroscience & Biobehavioral Reviews.
    2. Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion Dysregulation in Attention Deficit Hyperactivity Disorder. American Journal of Psychiatry, 171(3), 276–293.
    3. Sibley, M. H., Graziano, P. A., Ortiz, M., Rodriguez, L., & Coxe, S. (2019). Academic impairment among high school students with ADHD: The role of motivation and goal-directed executive functions. Journal of School Psychology, 77, 67–76.
    4. Babinski, D. E., Kujawa, A., Kessel, E. M., Arfer, K. B., & Klein, D. N. (2019). Sensitivity to Peer Feedback in Young Adolescents with Symptoms of ADHD: Examination of Neurophysiological and Self-Report Measures. Journal of Abnormal Child Psychology, 47(4), 605–617.
    5. Pfiffner, L. J., & Haack, L. M. (2014). Behavior Management for School-Aged Children with ADHD. Child and Adolescent Psychiatric Clinics of North America, 23(4), 731–746.
    6. Friedman, L. M., & Pfiffner, L. J. (2020). Chapter 7—Behavioral interventions. In M. M. Martel (Ed.), The Clinical Guide to Assessment and Treatment of Childhood Learning and Attention Problems (pp. 149–169). Academic Press.
    7. Eiraldi, R. B., Mazzuca, L. B., Clarke, A. T., & Power, T. J. (2006). Service utilization among ethnic minority children with ADHD: A model of help-seeking behavior. Administration and Policy in Mental Health and Mental Health Services Research, 33, 607–622.
    8. Gerdes, A. C., Lawton, K. E., Haack, L. M., & Schneider, B. W. (2014). Latino Parental Help Seeking for Childhood ADHD. Administration and Policy in Mental Health and Mental Health Services Research, 41(4), 503–513.
    9. Araujo, E. A., Pfiffner, L., & Haack, L. M. (2017). Emotional, Social and Cultural Experiences of Latino Children with ADHD Symptoms and their Families. Journal of Child and Family Studies, 26(12), 3512–3524.
    10. Lawton, K. E., Gerdes, A. C., Haack, L. M., & Schneider, B. (2014). Acculturation, cultural values, and Latino parental beliefs about the etiology of ADHD. Administration and Policy in Mental Health, 41(2), 189–204.
    11. Pfiffner, L. J., Rooney, M., Haack, L., Villodas, M., Delucchi, K., & McBurnett, K. (2016). A Randomized Controlled Trial of a School-Implemented School–Home Intervention for Attention-Deficit/Hyperactivity Disorder Symptoms and Impairment. Journal of the American Academy of Child & Adolescent Psychiatry, 55(9), 762–770.
    12. Haack, L. M., Araujo, E. J., Delucchi, K., Beaulieu, A., & Pfiffner, L. (2019). The Collaborative Life Skills Program in Spanish (CLS-S): Pilot Investigation of Intervention Process, Outcomes, and Qualitative Feedback. Evidence-Based Practice in Child and Adolescent Mental Health, 4(1), 18–41.
    13. Haack, L. M., Araujo, E. A., Meza, J., Friedman, L. M., Spiess, M., Beltrán, D. K. A., Delucchi, K., Herladez, A. M., & Pfiffner, L. (2020). Can School Mental Health Providers Deliver Psychosocial Treatment Improving Youth Attention and Behavior in Mexico? A Pilot Randomized Controlled Trial of CLS-FUERTE: Journal of Attention Disorders.
    14. Haack, L. M., Lai, J., Guerrero, M. F. A., Valdez, M. E. U., Beltrán, D. K. A., Rivera, E. C. Z., Saldaña, D. M. L., García, K. D., Candil, E. M., Beltran, J. U. M., & Araujo, E. A. (2022, November). Adapting a Comprehensive ADHD Intervention and School Clinician Training Program for Fully Remote Delivery in Mexico: The CLS-R-FUERTE Program. In M. Dvorksy’s and L.M. Haack’s (Chairs) Optimizing Interventions for ADHD Using Technology: Designs to Improve Treatment Engagement and Implementation. Association for Behavioral and Cognitive Therapies Annual Convention, New York, NY,

  • Environmental Risk Factors for Prostate Cancer in Overburdened, Understudied Populations

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    By Lauren Hurwitz, Ph.D., MHS
    2022 Coleman Research Innovation Awardees
    National Institute on Minority Health and Health Disparities
    Postdoctoral Fellow
    National Cancer Institute

    Prostate cancer is the second most frequently diagnosed cancer among men globally, and the leading cause of cancer death among men in 48 countries, most of which are in Africa, the Caribbean, and South America1. In the United States, prostate cancer is also the cancer with the largest disparities by race, with incidence rates 60-70% higher and mortality rates 100-120% higher in Black men as compared to non-Hispanic White men2. The underlying drivers of prostate cancer racial disparities are not well understood but likely involve a complex interplay of genetic, social, structural, and environmental factors2.

    As a Postdoctoral Fellow at the National Cancer Institute (NCI), I am part of group studying environmental and occupational risk factors for prostate cancer, including how they may be inequitably distributed and contributing to these disparities. Using studies of highly exposed occupational groups in the U.S., we have been investigating pesticide exposure and its potential impact on prostate cancer risk among farmers. Evidence from the Agricultural Health Study, a large prospective cohort study, suggests that specific pesticides (certain organophosphate and organochlorine insecticides) are associated with risk of more aggressive forms of prostate cancer3, 4. Similar associations have been observed in case-control studies as well5. While informative, the prior studies have one major limitation—most studies of pesticides and prostate cancer risk have been conducted in non-Hispanic White populations.

    These prior studies indicate that exposure to specific pesticides may increase prostate cancer risk among White men. However, we do not know if these same pesticides also increase risk of prostate cancer among Black men from the U.S., or men from the Caribbean and sub-Saharan Africa, where both exposure to pesticides and prostate cancer incidence and mortality rates are particularly high. Men from different racial and ethnic groups may be exposed to different types or levels of pesticides due to different historical patterns of pesticide use within and across countries, and due to interacting social and structural factors. This was highlighted in the news recently6 in studies from the French islands of Martinique and Guadeloupe—islands with primarily African-descent populations, and some of the highest prostate cancer incidence rates in the world. These studies found a link between prostate cancer risk and chlordecone and the dichlorodiphenyltrichloroethane (DDT) metabolite DDE, organochlorine insecticides that were widely used on these islands7,8, underscoring the need to investigate pesticides and cancer risk across geographically and racially diverse populations.

    Sub-Saharan Africa is another region of the world with heavy use of pesticides and a high burden of prostate cancer, yet no epidemiologic studies to date have investigated pesticides and prostate cancer risk among African men9. Exposure to organochlorine insecticides, and specifically DDT and its metabolites, may be particularly high in sub-Saharan Africa; though most countries have now banned the use of DDT for agricultural purposes, many countries in this region still use DDT to combat mosquitos that spread malaria. Like other organochlorine insecticides, DDT is extremely persistent and known to have detrimental effects on the environment, but the human health effects of exposure are not fully understood.

    To address this gap, our group initiated a study to measure blood levels of organochlorine insecticides among men with and without prostate cancer from the Greater Accra Region of Ghana. This work is still ongoing, but our pilot results indicate that exposure to DDT in this population is ubiquitous; all samples in the pilot had detectable levels of p,p’- DDE, the primary DDT metabolite, and levels were much higher than those of men from the U.S. Overall, we hope this work will further our understanding of the relationship between pesticide exposures and prostate cancer risk, while shedding light on environmental risk factors that may disproportionately affect overburdened yet understudied populations.


    1. Sung, H., et al., Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin., 2021. 71(3): p. 209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4.
    2. Nyame, Y.A., et al., Deconstructing, Addressing, and Eliminating Racial and Ethnic Inequities in Prostate Cancer Care. Eur Urol, 2022. 30(22): p. 01677-3.
    3. Koutros, S., et al., Risk of total and aggressive prostate cancer and pesticide use in the Agricultural Health Study. Am J Epidemiol., 2013. 177(1): p. 59-74. doi: 10.1093/aje/kws225. Epub 2012 Nov 21.
    4. Pardo, L.A., et al., Pesticide exposure and risk of aggressive prostate cancer among private pesticide applicators. Environ Health., 2020. 19(1): p. 30. doi: 10.1186/s12940-020-00583-0.
    5. Koutros, S., et al., Prediagnostic Serum Organochlorine Concentrations and Metastatic Prostate Cancer: A Nested Case-Control Study in the Norwegian Janus Serum Bank Cohort. Environ Health Perspect., 2015. 123(9): p. 867-72. doi: 10.1289/ehp.1408245. Epub 2015 Mar 3.
    6. Whewell, T., The Caribbean islands poisoned by a carcinogenic pesticide, in BBC News. 2020.
    7. Emeville, E., et al., Associations of plasma concentrations of dichlorodiphenyldichloroethylene and polychlorinated biphenyls with prostate cancer: a case-control study in Guadeloupe (French West Indies). Environ Health Perspect., 2015. 123(4): p. 317-23. doi: 10.1289/ehp.1408407. Epub 2014 Nov 21.
    8. Multigner, L., et al., Chlordecone exposure and risk of prostate cancer. J Clin Oncol., 2010. 28(21): p. 3457-62. doi: 10.1200/JCO.2009.27.2153. Epub 2010 Jun 21.
    9. United Nations Environment Programme Chemicals, Regionally Based Assessment of Persistent Toxic Chemicals: Sub-Saharan Africa Regional Report. 2002: Switzerland.
  • The COVID-19 Pandemic Has Amplified the Effects of Racism on Mental Health

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    By Celia B. Fisher, Ph.D.
    Marie Ward Doty University Chair in Ethics
    Professor of Psychology
    Director, Center for Ethics Education
    Director, HIV/Drug Abuse Prevention Research Ethics Institute
    Fordham University

    Dr. Celia Fisher shares how COVID-19 is affecting the mental health of people from racial and ethnic minorities communities

    People from racial and ethnic minorities in the United States have borne a disproportionately higher burden of COVID-19 infection and mortality. During the pandemic, depression and anxiety among American Indian/Alaska Native (AI/AN), Asian, Black, and Hispanic people have also increased. These disparities are rooted in long-standing racial and ethnic inequities in medical and behavioral health treatment utilization and access to culturally relevant health services.

    Racial discrimination has long been documented as a psychosocial stressor among racial and ethnic minority individuals and national surveys indicate racism increased during the current pandemic. During the pandemic racially and ethnically marginalized persons in the U.S. were also more likely to be employed in the health care work force or as frontline workers in industries such as food services, pharmacies, personal care and public transportation. Employment in these positions not only increased risk of COVID-19 infection, but increased public perception that racial and ethnic groups were more likely to be infected with the coronavirus. Simultaneously, the U.S, saw an upsurge in racially based hate crimes, particularly directed against Asian Americans. The surge in racial bias and violence underscores the urgency of studying the effects of pandemic-related forms of victimization and discrimination on the mental health of racial and ethnic youth and adults in the U. S.

    In online national surveys involving AI/AN, Asian, Black and Hispanic adolescents and adults, my colleagues and I examined the mental health effects of coronavirus victimization distress (i.e., distress in response to being verbally or physically harassed “because someone thought I had the coronavirus”) and coronavirus-related increases in racial bias (belief that the country has become more dangerous for people in one’s racial and ethnic group because of fear of the coronavirus). Across racial and ethnic groups of adults, we found that beyond the effects of pre-existing COVID-19 health risks, any employment or employment disruption during this period (whether as an essential or “non-essential” worker) or financial, health care, and housing insecurity, coronavirus victimization distress and perceived national increases in racial biases contributed to symptoms of depression and anxiety. Perhaps not surprisingly, given the sociopolitically fomented pandemic related anti-Asian bias, Asian participants reported the highest levels of pandemic related national biases against their racial and ethnic group. Sleep quality and duration have also been associated with corresponding mental health disparities among racial and ethnic minority populations in the U.S. Compared to AI/AN, Asian, Latinx and non-Hispanic White young adults during the pandemic, Black individuals reported less hours of sleep duration and quality, explained in part by their reported higher engagement as essential workers and higher levels of reported coronavirus victimization distress.

    Racial and ethnic minority youth have also been affected by increases in racial discrimination during COVID. Pandemic shelter-at-home policies and the reignited racial justice movement increased the use of social media among youth of color, potentially exposing them to social media racial discrimination. Whereas offline civic engagement has been associated with positive development among minority youth, online racial justice activities can expose youth to anonymous actors who subject them to different forms of social media racial discrimination. During the pandemic, we found that among 15- to 18-year-old AI/AN, Asian, Black and Latinx youth, hours of use and racial justice civic engagement were associated with increased exposure to social media racial discrimination directed at them both personally and vicariously to members of their racial groups. These experiences were in turn related to increases in depressive symptoms, anxiety, and substance use.

    The COVID-19 pandemic has created new pathways to mental health disparities among adolescents and adults of color by reversing formerly protective factors such as employment and social justice civic engagement, and by exacerbating existing mental health and societal inequities linked to race. These patterns highlight the necessity of moving away from aggregated findings that may mask differences among racial groups and call for creating mental health services tailored to the specific needs of different racial and ethnic minority groups during ongoing and future health crises. The pandemic has also highlighted the importance of identifying strategies to mitigate the negative effects of social media racial discrimination on youth mental health and calls for additional public discourse on whether social media algorithms are amplifying exposure to racial bias in ways that jeopardize psychological well-being of racial and ethnic minority adolescents.


    Artiga, S., Hill, L., & Halar, S. (2021). COVID-19 cases and deaths by race/ethnicity: Current data and changes over time.

    Ballard, P. J., Hoyt, L. T. & & Pachucki, M. C. (2019). Impacts of adolescent and young adult civic engagement on health and socioeconomic status in adulthood. Child Development, 90, 1138-1154. doi: 10.1111/cdev.12998

    Fisher, C. B., Tao, X., Liu, T., Giorgi, S., & Curtis, B. L. (2021). COVID-Related Victimization, Racial Bias and Employment and Housing Disruption Increase Mental Health Risk Among US Asian, Black and Latinx Adults. Frontiers in Public Health, 1625. doi: 10.3389/fpubh.2021.772236.

    Fisher, C. B., Tao., & Yip, T. (2020, preprint). The effects of coronavirus victimization distress and coronavirus racial bias on mental health among AIAN, Asian, Black and Latinx young adults.

    Fisher, C. B., & Yip, T. (2020). The coronavirus racial bias scale (CRBS).

    Fisher, C. B. & Yip, T. (2020). The coronavirus victimization distress scale (CVDS).

    McKnight-Eily, L. R., Okoro, C. A., Strine, T. W., Verlenden, J., Hollis, N. D., Njai, R., Mitchell, E. W., Board, A., Puddy, R., & Thomas, C. (2021). Racial and Ethnic Disparities in the Prevalence of Stress and Worry, Mental Health Conditions, and Increased Substance Use Among Adults During the COVID-19 Pandemic—United States, April and May 2020. Morbidity and Mortality Weekly Report, 70(5), 162. https:// doi: 10.15585/mmwr.mm7005a3

    Paine, L., de la Rocha, P., Eyssallenne, A. P, Andrews, C. A., Loo, L. Jones, C. P., Collins, A. M., & orse, M. (2021). Declaring racism a public health crises in the United States: Cure, poison, or both. Frontiers in Public Health,

    Tao, X., & Fisher, C. B. (2021). Exposure to social media racial discrimination and mental health among adolescents of color. Journal of Youth and Adolescence.

    Yip, T., Feng, Y., Fowle, J. & Fisher, C. B. (2021). Sleep disparities during the COVID-19 pandemic An Investigation of AIAN, Asian, Black, Latinx and White young adults. Sleep Health: Journal of the National Sleep Foundation, 7, 459-467.

    Yip T., Cheon, Y.M. (2020). Sleep, psychopathology and cultural diversity. Curr Opin Psychol, 34:123-127. doi: 10.1016/j.copsyc.2020.02.006. Epub 2020 Feb 22. PMID: 32203913; PMCID: PMC7308190.