Multi-level Predictors of Structural Racism and Discrimination and Associations With Health and Well-being Across the Life Course in Diverse Families

Minoritized populations face mutually reinforcing levels of structural disadvantage that contribute to poor health. Despite recognition that social and economic stratification, environmental conditions, and policy are critical determinants of health disparities, there has been limited effort in expanding interventions beyond the individual level to disrupt systemic causes of health. This is in part due to the challenges of describing how racism and discrimination have become systematized over time and across place.68 Studies that do examine SRD and health and well-being, focus on one level of SRD at a time, rather than examining multiple levels simultaneously. Also, the measurement of SRD at all levels has not been very detailed and more research is needed on the nuances of these experiences (e.g., frequency, timeframe, intensity). Finally, there is a need for more prospective longitudinal studies, as most research to date has been cross-sectional. In addition to comprehensively examining the four SRD levels, the current study will examine these multi- level predictors of SRD simultaneously, longitudinally, and across two sites to identify targets for multi-level interventions that will be more likely to be effective and sustainable.

Study Overview

• Status: Recruiting
• Conditions: Racially/Ethnically Diverse Families From Urban Settings
• Intervention / Treatment: Other: No intervention

• Study Type: Observational
• Enrollment (Estimated): 631

Contacts and Locations

• Study Contact: Name: Jerica Berge, MD; Phone Number: 612-626-3693; Email: jberge@umn.edu

Study Locations

• United States
  • Georgia
    • Athens, Georgia, United States, 30602
      • Recruiting
      • University of Georgia
      • Contact: Allan Tate; Email: allan.tate@uga.edu
  • Minnesota
    • Minneapolis, Minnesota, United States, 55455
      • Recruiting
      • University of Minnesota
      • Contact: Jerica Berge, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 8 years to 14 years (Child)
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

UMN:

The study will be enrolling vulnerable populations, just as it did during the original study. To accommodate for this, children will be assented into the study and all participant materials will be translated into Spanish, Hmong, and Somali. Bilingual staff will be employed and able to assist participants whose reading skills are limited. The study will provide free parking to participants and compensate all participants (both parents and children) for their time spent on study processes.

The study will enroll participants who happen to be pregnant and will not seek out pregnant adolescents. UGA: The University of Georgia site will follow the same process to accommodate vulnerable populations.

Description

Inclusion Criteria:

• willingness to provide informed consent (parent/guardian), parental consent (parent/guardian) and assent (minor participants) and the ability for participants to comply with study requirements
• They are the child's primary caregiver, i.e., they are the adult who spends the largest proportion of time caring for the child (e.g., cleaning, feeding, etc.) or they spent an exactly equal proportion to another caregiver (e.g., parents each with 50% of childcare responsibilities).
• They reside in Athens-Clarke County or surrounding counties (i.e., Barrow, Jackson, Madison, Oglethorpe, and Oconee) served by the Piedmont Healthcare Coalition region
• Have access to a smartphone or other internet-connected device (e.g., iPad; home computer; laptop)
• Are able to read either English or Spanish

UMN site:

• participation in the original Family Matters Ecological Momentary Assessment sub-study
• did not withdraw from the Family Matters study
• ability to participate in an in-person visit (e.g., within driving distance to make an in-person visit)
• The original Family Matters study enrolled vulnerable populations including children, pregnant women, disadvantaged persons, and non-English speakers.

UGA site:

• Child has a racial/ethnic identity reported by the parent as Black, Hispanic, or White Reside in Athens-Clarke County or surrounding counties (i.e., Barrow, Jackson, Madison, Oglethorpe, and Oconee) served by the Piedmont Healthcare Coalition region
• Have access to a smartphone or other internet-connected device (e.g., iPad; home computer; laptop)
• Are able to read either English or Spanish
• Aged 8 to 14 years old

Exclusion Criteria:

• Medically necessary dietary restrictions (e.g., feeding tubes)
• BMI < 5%ile
• A diagnosis of a serious and persistent mental illness
• The child's parent/caregiver believes that the child is not developmentally able to participate in study components (e.g., severe autism)
• The family already has one parent or one child enrolled in the study
• There are no more availabilities in the family's census tract (limited to 10 households per tract). UGA also is interested in recruiting families from a range of census tracts in the Athens, GA area. If UGA finds that many families are coming from a few census tracts, they may restrict enrollment of new participants who are from those already-represented census tracts.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
changes in cardiometabolic risk score	comprised of 5 cardiometabolic indicators of lower health - overweight status, triglyceride to HDL ratio, c-reactive protein , stage 1 or 2 hypertension, and elevated HbA1c >= 5.7across two time points 18 months apart collected in children and adults	baseline to 18 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Mental health (parent and child)	Change in depression scores using Kessler 6	baseline to 18 months
Dietary intake	Change in modified HEI score	baseline to 18 months
Physical Activity	Change in Sedentary Activity and Moderate/Vigorous Physical Activity using Godin Shephard	baseline to 18 months

Collaborators and Investigators

• Sponsor: University of Minnesota
• Investigators: Principal Investigator: Jerica Berge, MD, University of Minnesota

Study record dates

Study Major Dates

• Study Start (Actual): November 10, 2022
• Primary Completion (Estimated): March 1, 2028
• Study Completion (Estimated): March 1, 2028

Study Registration Dates

• First Submitted: February 15, 2023
• First Submitted That Met QC Criteria: February 15, 2023
• First Posted (Actual): February 27, 2023

Study Record Updates

• Last Update Posted (Actual): March 26, 2024
• Last Update Submitted That Met QC Criteria: March 25, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: SRD

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No