1. 1 Understanding the Negative Impact of Racial Discrimination on HIV Risk Behaviors among African American Young Adults Michelle Stock, Ph.D. The George Washington University DC D-CFAR Research Award Project Presentation June 21, 2011

2. 2 Racial Disparities in Risky Health Behaviors Although Blacks make up around 13% of the U.S. population, they account for 46% of all HIV cases and 68% of recent HIV diagnoses among 13-24 year-olds (CDC, 2010). Main transmission route is high-risk sexual contact (e.g., casual partners and unprotected sex)—which is exacerbated by alcohol and drug use (CDC, 2010; NIMH, 2010; Turchik, Garske, et al., 2010)

3. 3 Racial Discrimination among African Americans Researchers have recently begun to focus on psychosocial factors that may contribute to these health disparities (Thomas, Price, & Lybrand, in press; Williams & Jackson, 2005). Racial discrimination has been suggested as an important factor contributing to health inequities, including HIV infection (e.g., Pachter & Garcia Coll, 2009; Williams & Mohammed, 2009). African Americans report experiencing more discrimination than do other minority groups (Landrine, et al., 2006).

4. 4 Racial Discrimination and Health among African Americans Discrimination is linked to worse physical health (e.g., higher blood pressure) and mental health (e.g., psychological distress) (Pascoe & Smart Richman, 2009; Williams & Mohammed, 2009) Discrimination is also correlated with alcohol, tobacco, and drug use (e.g., Borrell et al., 2007; Landrine et al., 2006) –Among Black adolescents and their parents, discrimination is associated with substance use two and five years later (Gibbons et al., 2004; 2007; 2010) Although substance use and risky sex behaviors are correlated, research has yet to examine both behaviors in response to discrimination among a population at-risk for HIV infection

5. 5 Aims of Current Research 1: To examine the relations between racial discrimination and HIV-related sexual risk and associated substance use cognitions and behaviors among African American young adults. 2: To identify what roles hopelessness, loss of control, and perceived and physiological stress, play in the association between racial discrimination and HIV-risk cognitions and behaviors. 3: Explore neighborhood perceptions that may moderate these effects

6. 6 Preliminary Research Longitudinal research with over 800 African American young adults (Stock et al., 2011) –Perceived discrimination predicts an increase in both substance use and risky sex behaviors 3 and 5 years later –The discrimination to risky sex pathway is mediated by an increase in substance use Causal relations and malleable psychological mediators need to be established

7. 7 Simulating Discrimination in the Lab: Cyberball One of the most common forms of racial discrimination is social exclusion/ostracism (Smart-Richman & Leary, 2009; Williams & Carter-Sowell, 2009) The social exclusion computer game Cyberball is an effective way to examine the causal effects of racial discrimination (Goodwin et al., 2010; Stock et al., in press) Included vs. Excluded by 3 White “players” –Exclusion attributed to racial discrimination Exclusion and perceived discrimination associated with higher levels of substance use cognitions

8. 8 Current Study 260 African American participants aged 18-25 T1 measures (pre-manipulation) –Neighborhood perceptions –Racial discrimination Other stressful life events –Past substance use and sexual behaviors –Perceived control, stress, hopelessness –Baseline cortisol Cyberball paradigm –Inclusion vs. Exclusion

9. 9 Current Study Post-manipulation measures –Belonging and Perceived Discrimination –Substance use and risky sex vulnerability Willingness to engage in substance use and risky sex behaviors –Sex under the influence HIV-related risk perceptions –Mediators Stress: perceived and physiological (Cortisol) Perceived control Negative mood

10. 10 Moderators/Controls Neighborhood Perceptions Stressful Life Events Perceived Discrimination Sensation Seeking Past Behaviors Demographics Potential mediators Negative Mood Stress Control Willingness HIV Risk Perceptions General model Manipulation Discrimination Substance Use Risky Sex Outcomes

11. 11 Future Research Goals Goals of National HIV/AIDS Strategy and NIH/NIDA: –Inform the ability to understand and reduce new HIV infections as well as HIV-related health disparities among at-risk populations Use knowledge to help advance prevention and intervention programs designed to reduce HIV-risk disparities among African American adolescents and young adults

12. 12 Acknowledgements Sharon Lambert, Ph.D. Laurel Peterson Laura Walsh Frederick Gibbons, Ph.D. Meg Gerrard, Ph.D.