Adolescents of color with a disability or special health care need (SHCN) were almost twice as likely to experience racial discrimination compared to peers of color without SHCNs, according to Saint Louis University (SLU) research published in the Journal of Adolescent Health.
The study’s authors hope this research will serve as a wake-up call for health care providers to develop better screening tools and start conversations between parents and children of color who have SPHNs on recognizing and navigating racial discrimination.
Racism is now widely considered a childhood source of toxic stress and a social determinant of health. For adolescents ages 11–17 in the U.S., experiencing racial discrimination is associated with poor physical, mental, and educational outcomes.
Jesse J. Helton, Ph.D., associate professor of social work, studies child abuse and neglect at SLU says this risk is exacerbated for those with SHCNs.
Over the last 20 years, researchers have begun to study Adverse Childhood Experiences (ACEs), potentially traumatic events that happen in childhood, such as experiencing or witnessing violence or living with a family member with substance use or mental health problems. Helton describes many of these events as child abuse and neglect and says ACEs have become the predominant means of measuring adversities that children experience and their impact on their health, well-being and development.
In the last five to 10 years, he adds, researchers have expanded the measurement of ACEs to include additional types of adversity, such as bullying, food insecurity, and forms of racism.
“Until recently, we haven’t had the tools in larger, nationally representative datasets to measure ACEs and racism,” explained Helton, the paper’s first author. “Now that these data are available, we can see the connections between adverse events, like racism, and special health care needs.”
In the current study, researchers examined rates of discrimination in distinct SHCN categories within different racial and ethnic groups. They found that the additional risk of racial discrimination was not uniform across racial or ethnic groups for every SHCN type.
Asian adolescents with an SHCN were over 3.5 times more likely to experience discrimination than Asian peers without. Black youth with asthma or a genetic disorder and Hispanic youth with autism or intellectual disabilities also experienced higher rates of racial discrimination. Adolescents with depression experienced higher rates of discrimination than peers without depression, regardless of race and ethnicity group.
“Our study was only able to focus on racial discrimination, but we know other forms of racism are at work here too,” Helton said. “For instance, the systemic racism that has historically forced Black and brown populations into poverty and unhealthy living conditions, that too can lead to higher rates of chronic conditions and special health care needs.”
“Those disparities are then compounded when children face additional discrimination.”
The study relied on data based on parent reports and data collected from a secondary national survey. While the paper confirmed the connections between racial discrimination and discrimination based on SPHNs, it also poses more questions requiring additional study.
Helton notes that though the study isn’t able to determine cause and effect, some of the patterns researchers observed may be bi-directional, where discrimination and a particular SPHN can both increase the potential of experiencing issues.
For instance, a higher percentage of Asian adolescents with depression experience discrimination than Asian adolescents without depression,” Helton said. “Now, we can certainly see that being depressed could make a child more vulnerable to being mistreated, but we could also see that being mistreated could make a child depressed.”
Other study limitations also demonstrate the need for additional study. For example, this study cannot say whether the discrimination was tied to negative notions toward people with disabilities among ethnic groups or whether these incidents occurred in schools, health care settings, or on a neighborhood playground.
Other authors include Kira Banks, Ph.D., professor of psychology and co-founder of the Institute for Healing Justice and Equity, Saint Louis University; Keon L. Gilbert, Dr.PH, associate professor of behavioral science and health education and co-founder of the Institute for Healing Justice and Equity, Saint Louis University; Mark Pousson, Ph.D., associate professor of higher education administration, Saint Louis University; and Autumn Asher BlackDeer, Ph.D., Washington University in St. Louis.
Jesse J. Helton et al, Racial Discrimination of Adolescents With Special Healthcare Needs, Journal of Adolescent Health (2023). DOI: 10.1016/j.jadohealth.2023.02.038
Journal of Adolescent Health
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