A Prospective Investigation of Discrimination, Medical Mistrust, and Health Behavior Responses to the COVID-19 Pandemic

• In Event: COVID-19 Based Discrimination and Economic Stress on Psychosocial and Health Risks in Children

Abstract

The effects of systemic racism on health are well-documented (Pascoe & Richman, 2009), and have been brought into relief by the disproportionate impact of the current pandemic on communities of color (Hooper et al., 2020). In addition to systemic barriers to healthcare (e.g., insurance; Sohn, 2016) and direct impacts on physical health (Paradies et al., 2015), legacies of ethnic-racial discrimination and medical exploitation have fomented medical mistrust among ethnic-racial minorities (Jaiswal & Halikitis, 2019), which is associated with reduced healthcare engagement, satisfaction, and adherence (Whetten et al., 2006). Despite these robust relations in adult studies, developmental scientists have rarely considered the etiology and impact of medical mistrust in adolescence. Moreover, research on medical mistrust has rarely considered relations with health risk behaviors (HRBs) and health protective behaviors (HPBs) outside the medical setting, let alone in the context of the current COVID-19 pandemic.


Adopting the Behavioral Model for Vulnerable Populations (BMVP) Framework (Gelberg et al., 1999), this investigation evaluated prospective relations between ethnic-racial minority youth's experienced discrimination at age 12, to their mistrust of the medical profession (as assessed at age 15 during the initial weeks of the pandemic), and their engagement in COVID-specific HRBs and HPBs. Participants were 189 ethnic-racial minority youth (47.6% female; 51.9% Latinx, 20.6% Black, 27.5% multi-ethnic/racial) who completed a laboratory assessment at age 12 (N = 184; Mage_w1 = 12.24; SD = 0.36) and an online assessment three years later during the first weeks of the US pandemic (N = 144; Mage_w2 = 15.21, SD = .57). At wave 1, youth reported the frequency of 8 ethnic-racial discrimination (ERD) experiences using the Perceptions of Racism of Children and Youth Questionnaire (Pachter et al., 2010). At wave 2, youth completed the Trust in the Medical Profession Scale (Dugan et al., 2005), and indicated how frequently they engaged in COVID-HRBs (e.g., riding public transport, visiting a friend) without the parent’s knowledge and COVID-HPBs (e.g., avoiding crowds, handwashing).


At the bivariate level, ERD was correlated with medical mistrust (r = .257) and HRBs (r = .310), but not with HPBs (r = -.107). Medical mistrust was related to higher HRBs (r = .229) and lower HPBs (r = -.296), and HRBs and HPBs were not significantly related (r = -.113). Hayes’ (2013) PROCESS routine revealed significant indirect effects from children’s ERD to higher HRBs and lower HPBs during COVID-19 as explained by elevated levels of medical mistrust.


At this time, behavior is the only available tool for managing the pandemic (NCIRD, 2020), and adolescents have been difficult to engage in behavioral prevention efforts. These findings suggest that pre-COVID experiences of ERD and heightened levels of medical mistrust have significant influences on both risk and protective behaviors among minority adolescents. Thus, in addition to reducing adolescents’ experiences of ERD and improving culturally responsive healthcare, helping adolescents cope with experiences of ERD and acknowledging their concerns and doubts about the medical guidance they are receiving may be powerful tools to support their own and others’ protection against COVID-19.

Authors

• Tuppett M. Yates, University of California - Riverside
  Presenting Author

• Duyen T. Trang, University of California - Riverside
  Non-Presenting Author

• Stacey N Doan, Claremont Mckenna College
  Non-Presenting Author