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Explaining the Black-white depression paradox: Interrogating the Environmental Affordances Model

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  • Pamplin, John R.
  • Kezios, Katrina L.
  • Hayes-Larson, Eleanor
  • Keyes, Katherine M.
  • Susser, Ezra S.
  • Factor-Litvak, Pam
  • Link, Bruce G.
  • Bates, Lisa M.

Abstract

The Environmental Affordances (EA) model posits that Black Americans' engagement with unhealthy behaviors (i.e. smoking, alcohol use, eating calorie-dense foods) to cope with stressor exposure may simultaneously account for their observed greater risk of chronic physical illness, and their observed equal or lesser prevalence of depression, relative to white Americans – the so-called “Black-white depression paradox.” However, the specific mechanisms through which such effects might arise have been theorized and analyzed inconsistently across studies, raising concerns regarding the appropriateness of existing empirical tests of the model as well as the validity of the conclusions. We specify the two mechanisms most consistent with the EA model – ‘Mediation-only’ and ‘Mediation and Modification’ - and derive a priori predictions based on each. We systematically test these pathways using a subset of 559 participants of the Child Health and Development Study who were included in an adult follow-up study between 2010 and 2012 and self-identified as Black or white. Results failed to support either of the two mechanisms derived from the EA model, challenging the validity and utility of the model for explaining racial differences in depression; efforts to develop alternative hypotheses to explain the paradox are needed.

Suggested Citation

  • Pamplin, John R. & Kezios, Katrina L. & Hayes-Larson, Eleanor & Keyes, Katherine M. & Susser, Ezra S. & Factor-Litvak, Pam & Link, Bruce G. & Bates, Lisa M., 2021. "Explaining the Black-white depression paradox: Interrogating the Environmental Affordances Model," Social Science & Medicine, Elsevier, vol. 277(C).
    • Handle: RePEc:eee:socmed:v:277:y:2021:i:c:s027795362100201x
    DOI: 10.1016/j.socscimed.2021.113869
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    References listed on IDEAS

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    1. Keyes, Katherine M. & Vo, Thomas & Wall, Melanie M. & Caetano, Raul & Suglia, Shakira F. & Martins, Silvia S. & Galea, Sandro & Hasin, Deborah, 2015. "Racial/ethnic differences in use of alcohol, tobacco, and marijuana: Is there a cross-over from adolescence to adulthood?," Social Science & Medicine, Elsevier, vol. 124(C), pages 132-141.
    2. Jackson, J.S. & Knight, K.M. & Rafferty, J.A., 2010. "Race and unhealthy behaviors: Chronic stress, the HPA Axis, and physical and mental health disparities over the life course," American Journal of Public Health, American Public Health Association, vol. 100(5), pages 933-939.
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    6. Link, Bruce G. & Susser, Ezra S. & Factor-Litvak, Pam & March, Dana & Kezios, Katrina L. & Lovasi, Gina S. & Rundle, Andrew G. & Suglia, Shakira F. & Fader, Kim M. & Andrews, Howard F. & Johnson, Eile, 2017. "Disparities in self-rated health across generations and through the life course," Social Science & Medicine, Elsevier, vol. 174(C), pages 17-25.
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    1. Smith, Nicholas C., 2024. "Residential segregation and Black-White differences in physical and mental health: Evidence of a health paradox?," Social Science & Medicine, Elsevier, vol. 340(C).

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