Published Papers

The Race Against Time: Lived time, time loss and Black health opportunity

Published October 27, 2016
NOTE: This paper is not yet published, but is accepted at the Du Bois Review In this paper I argue that time is a social determinant of health, and one that perpetuates racial health inequalities. Specifically, Black people in the United States experience time losses across numerous domains throughout the life course, putting them at risk of disproportionate morbidity and mortality. Fundamental cause theory holds that social conditions structure health through pathways to resources including money, knowledge, power, prestige, freedom, and social networks. Racialized time indirectly harms health by disrupting or denying access to these flexible resources and by undoing utility among those that are obtained. Racialized time harms health directly when it produces stress and exacerbates conditions of racial subordination. I examine racialized time in three categories: Black people spending too much time to meet basic needs; Black people having less time spent on them than is required; and lost years of (good quality of) life. Linkages between time and health disadvantage exist in material resources, interactions with the state, intimate lives, public space, and cognitive processes.

Fast food and liquor store density, co-tenancy, and turnover: Vice store operations in Chicago, 1995-2008

Published December 14, 2015
Kwate, N.O.A., & Loh, J.M. (2016). Fast food and liquor store density, co-tenancy, and turnover: Vice store operations in Chicago, 1995-2008. Applied Geography, 67, 1-13.

Fast food restaurants and liquor storesdvice storesdhave been shown to be more prevalent in pre- dominantly Black and low income U.S. neighborhoods, and are associated with a number of health risks and social ills. The purpose of this study was to investigate in the City of Chicago vice store density and spatial distribution as a function of racial, socioeconomic, and other population characteristics; to examine spatial clustering among these outlets; and to study how store turnover follows population change over a 13-year period. We used spatial point process analysis to fit linear and non-linear models for the intensity function of stores. Spatial clustering was estimated using the K function. We found heterogeneous associations between stores and population characteristics, with the most consistent finding being a positive association between percent Black and liquor store exposure. A high degree of spatial clustering was evident, and liquor stores were more likely to stay in business over time than fast food restaurants. However, when liquor stores closed, they were more likely to be replaced by non-vice businesses. Results suggest that vice stores are associated with lower positions in racial and socioeco- nomic hierarchies, and this patterning is often durable over time.

Does learning about race prevent substance abuse? Racial discrimination, racial socialization and substance use among African Americans

Published May 18, 2016
Thompson, A.B., Goodman, M.S., & Kwate, N.O.A. (2016). Does learning about race prevent substance abuse? Racial discrimination, racial socialization and substance use among African Americans. Addictive Behaviors, 61, 1-7.

In a sample of African American residing in New York City, experiences of racial discrimination increased the risk of alcohol use. Specifically, the risk of weekend and problematic alcohol use increased with the greater number of setting in which racial discrimination was experienced. We did not find support for our hypothesis that the relationship between substance use and racial discrimination depended on levels of racial socialization. In other words, learning about race in childhood and adolescence did not prevent substance use or abuse associated with racial discrimination in adulthood. We also did not find a relationship be- tween racial discrimination, racial socialization and being a lifetime cigarette smoker or using alcohol on the weekday.

Racism at the intersections: Gender and socioeconomic differences in the experience of racism among African Americans

Published October 17, 2015
Kwate, N.O.A., & Goodman, M.S. (2015). Racism at the intersections: Gender and socioeconomic differences in the experience of racism among African Americans. American Journal of Orthopsychiatry, 85(5), 397-408.

Several studies investigating the health effects of racism have reported gender and socioeconomic differences in exposures to racism, with women typically reporting lower frequencies, and individuals with greater resources reporting higher frequencies. This study used diverse measures of socioeconomic position and multiple measures and methods to assess experienced racism. Socioeconomic position included education and financial and employment status. Quantitative racism measures assessed individual experiences with day-to-day and with major lifetime incidents and perceptions of the extent to which African Americans as a group experience racism. A brief qualitative question asked respondents to describe a racist incident that stood out in recent memory. Participants comprised a probability sample of N = 144 African American adults aged 19 to 87 residing in New York City. Results suggested that women reported fewer lifetime incidents but did not differ from men on everyday racism. These differences appear to be partly because of scale content. Socioeconomic position as measured by years of education was positively associated with reported racism in the total sample but differently patterned across gender; subjective social status showed a negative association. Qualitative responses describing memorable incidents fell into 5 key categories: resources/opportunity structures, criminal profiling, racial aggression/assault, interpersonal incivilities, and stereotyping. In these narratives, men were more likely to offer accounts involving criminal profiling, and women encountered incivilities more often. The findings highlight the need for closer attention to the intersection of gender and socioeconomic factors in investigations of the health effects of racism.

Perceiving the Black female body: Race and gender in police constructions of body weight

Published July 15, 2015
Kwate, N.O.A., & Threadcraft, S. (2015, online first). Perceiving the Black female body: Race and gender in police constructions of body weight. Race and Social Problems.

Representations of black women in US popular culture and public discourse frequently depict them stereotypically as fat and in need of policing for moral failures. As well, research has shown that black women are perceived and constructed as non-prototypical for their gender. Taken together, observers within a white-dominant social frame could be said to have difficulty correctly seeing black women's bodies and gender presentations. In this study, we examined how black women are seen in the context of New York City Police Department (NYPD) stops and searches (known as stop and frisk). We examined how officers categorized black women's body weight; investigated whether stops took place in public or private space; and assessed the extent to which body weight brought additional sanctions (i.e., being frisked). We used publicly available datasets from the NYPD's stop and frisk program, in which stops numbering in the hundreds of thousands were recorded in yearly databases from 2003 to 2012. For each stop, officers record a number of attributes about the potential suspect and context, including race, gender, physique, date, and precinct. We conducted logistic regressions to model the odds of being categorized as heavy by race and gender, controlling for age, calculated BMI, location in a black precinct, and season of the year. Results showed that across 10 years of data, black women were more likely than white women to be labeled heavy. Black women were also much more likely than all other subgroups to be stopped inside rather than outside. Body size showed little association with stop locations or frisks. We interpret these findings as a reflection of black women's positioning with regard to racial and gender representations and the disciplinary projects of the state.

Cross-Sectional and Longitudinal Effects of Racism on Mental Health Among Residents of Black Neighborhoods in New York City

Published December 18, 2014
Kwate, N.O.A., & Goodman, M.S. (2015). Cross-sectional and longitudinal effects of racism on the mental health of urban African Americans. American Journal of Public Health, 107, 711-718.

We investigated the impact of reported racism on the mental health of African Americans at cross-sectional time points and longitudinally, over the course of 1 year. The Black Life Study recruited Black residents (n = 144) from a probability sample of 2 predominantly Black New York City neighborhoods during December 2011 to June 2013. Respondents completed self-report surveys, including multiple measures of racism. We conducted assessments at baseline, 2-month follow-up, and 1-year follow-up. Weighted multivariate linear regression models assessed changes in racism and health over time. Cross-sectional results varied by time point and by outcome, with only some measures associated with distress, and effects were stronger for poor mental health days than for depression. Individuals who denied thinking about their race fared worst. Longitudinally, increasing frequencies of racism predicted worse mental health across all 3 outcomes. These results support theories of racism as a health-defeating stressor and are among the few that show temporal associations with health.

An empirical analysis of White privilege, social position and health

Published July 10, 2014
Kwate, N.O.A., & Goodman, M.S. (2014). An empirical analysis of White privilege, social position and health. Social Science & Medicine, 116, 150-160. doi: 10.1016/j.socscimed.2014.05.041

Accumulated evidence has demonstrated that social position matters for health. Those with greater socioeconomic resources and greater perceived standing in the social hierarchy have better health than those with fewer resources and lower perceived standing. Race is another salient axis by which health is stratified in the U.S., but few studies have examined the benefit of White privilege. In this paper, we investigated how perceptions of inequality and subjective and objective social status affected the health and well-being of N = 630 White residents in three Boston neighborhoods lying on a social gradient differentiated by race, ethnicity, income and prestige. Outcomes were self-rated health, dental health, and happiness. Results suggested that: neighborhood residence was not associated with health after controlling for individual level factors (e.g., positive ratings of the neighborhood, education level); objective measures of socioeconomic status were associated with better self-reported and dental health, but subjective assessments of social position were more strongly associated; and White residents living in the two wealthiest neighborhoods, and who perceived Black families as welcome in their neighborhoods enjoyed better health than those who believed them to be less welcome. However, those who lived in the least wealthy and most diverse neighborhood fared worse when reporting Black families to be welcome. These results suggest that White privilege and relative social position interact to shape health outcomes.

"Racism Still Exists": A public health intervention using racism "countermarketing" outdoor advertising in a Black neighborhood

Published May 24, 2014
Kwate, N.O.A. (2014). "Racism Still Exists": A public health intervention using racism "countermarketing" outdoor advertising in a Black neighborhood. Journal of Urban Health, 91(5), 851-872. doi: 10.1007/s11524-014-9873-8.

The negative health effects of racism have been well documented, but how to intervene to redress these effects has been little studied. This study reports on RISE (Racism Still Exists), a high-risk, high-reward public health intervention that used outdoor advertising to disseminate a "countermarketing" campaign in New York City (NYC). Over 6 months, the campaign advertised stark facts about the persistence of racism in the USA. A probability sample of N=144 participants from two predominantly Black NYC neighborhoods completed measures of health status, health behaviors, and social attitudes. Three months postintervention, statistically significant declines in psychological distress were seen among study participants who were exposed to the campaign compared to those who were not. There were no changes in other hypothesized outcomes. The campaign also generated significant public discourse, particularly in social media. The results suggest that racism countermarketing campaigns may have promise as a community-based intervention to address health inequalities.

Spatial and Racial Patterning of Real Estate Broker Listings in New York City

Published October 11, 2012
Kwate, N.O.A., Goodman, M.S., Jackson, J., & Harris, J. (2012). Spatial and racial patterning of real estate broker listings in New York City. The Review of Black Political Economy. 10.1007/s12114-012-9148-0

It has been well documented that Black homeseekers face discrimination in the housing market in the form of racial steering and other institutional policies and practices that are critical in limiting housing access. Less is known about the mechanisms that operate on the other side of real estate transactions to perpetuate racially segregated neighborhoods. We investigated whether White and Black brokers face segregation in the housing market. That is, to what extent do White and Black brokers differentially market property listings in neighborhoods of varying racial composition? Using real estate listings extracted from the websites of two of the largest New York City real estate brokerages, we examined whether Black and White brokers market properties primarily in Black and White neighborhoods, respectively; and whether, controlling for gender and experience level, Black brokers had a lower average price per square foot than White brokers. Results showed that Black brokers overwhelmingly marketed properties in Black neighborhoods, with fewer listings in White areas. Black brokers also marketed properties with an average price per square foot that was $197 lower than White brokers. Black brokers who worked in offices in Black neighborhoods had the lowest asking price of all brokers. Taken together, Black and White real estate brokers control a bifurcated market in NYC, perpetuating residential segregation and Black–White income and wealth disparities.

Retail redlining in New York City: Racialized access to day-to-day retail resources

Published July 15, 2012
Kwate, N.O.A., Loh, J.M., White, K., & Saldana, N.T. (2012). Retail redlining in New York City:
Racialized access to day-to-day retail resources. Journal of Urban Health, doi: 10.1007/s11524-012-9725-3

Racial residential segregation is associated with health inequalities in the USA, and one of the primary mechanisms is through influencing features of the neighborhood physical environment. To better understand how Black residential segregation might contribute to health risk, we examined retail redlining; the inequitable distribution of retail resources across racially distinct areas. A combination of visual and analytic methods was used to investigate whether predominantly Black census block groups in New York City had poor access to retail stores important for health. After controlling for retail demand, median household income, population density, and subway ridership, percent Black was associated with longer travel distances to various retail industries. Our findings suggest that Black neighborhoods in New York City face retail redlining. Future research is needed to determine how retail redlining may perpetuate health disparities and socioeconomic disadvantage.

On sticks and stones and broken bones: Stereotypes and African American health

Published April 25, 2011
Kwate, N.O.A., & Meyer, I.H. (2011). On sticks and stones and broken bones: Stereotypes and African American health. DuBois Review, 8 (1), 191-198.

Deeply embedded in everyday discourse, social interactions, and institutional practices, racism negatively affects the health and well-being of Black people in the United States. Theory and empirical research on the impact of racism on health have focused on stressful events and individual perceptions of racism, although racism is not expressed only as racist acts. Racism subordinates people and diminishes their importance; stereotyping is one of the most insidious forms of such subordination. The stereotypes that underlie social discourse about race influence how others perceive Black people and, to some extent, how Black people perceive themselves. Thus stereotypes help maintain and promote racism. Despite the importance of stereotypes in understanding racism and its effects on Black people, little attention has been paid to the impact of stereotypes on health. This paper explores the adverse effects of stereotypes on African American health, focusing on the psychological and structural pathways through which stereotyping operates. Psychological pathways are salient for these reasons: stereotyping constitutes a form of racism that may be experienced vicariously; stereotypes induce vigilance and rumination as people caricatured by them anticipate their use and spend time trying to disconfirm them; stereotypes may be internalized. Structural pathways occur because stereotypes that portray Black people as deviant, undeserving, and ultimately less human negatively affect opportunity structures and physical environments.

The myth of meritocracy and African American health

Published August 19, 2010
Kwate, N.O.A., & Meyer, I.H. (2010). The myth of meritocracy and African American health. American Journal of Public Health, 100(10), 1831-1834.

Recent theoretical and empirical studies of the social determinants of health inequities have shown that economic deprivation, multiple levels of racism, and neighborhood context limit African American health chances and that African Americans' poor health status is predicated on unequal opportunity to achieve the American Dream. President Obama's election has been touted as a demonstration of American meritocracy—the belief that all may obtain the American Dream—and has instilled hope in African Americans. However, we argue that in the context of racism and other barriers to success, meritocratic ideology may act as a negative health determinant for African Americans.

Separate and unequal: The influence of neighborhood and school characteristics on spatial proximity between fast food and schools

Published May 8, 2010
Kwate, N.O.A., & Loh, J.M. (2010). Separate and unequal: The influence of neighborhood and school characteristics on spatial proximity between fast food and schools. Preventive Medicine, 51(2), 153-156.

Social science and health literature have identified residential segregation as a critical factor in exposure to health-related resources, including food environments. Differential spatial patterning of food environments surrounding schools has significant import for youth. We examined whether fast food restaurants clustered around schools in New York City, and whether any observed clustering varied as a function of school type, school racial demographics, and area racial and socioeconomic demographics. We geocoded fast food locations (N=817) and schools (N=2096; public and private, elementary and secondary) in the five boroughs of New York City. A point process model (inhomogeneous cross-K function) examined spatial clustering. A minimum of 25% of schools had a fast food restaurant within 400m. High schools had higher fast food clustering than elementary schools, and public schools had higher clustering than private schools, with 1.25 to 2 times as many restaurants than expected by chance. Schools with large proportions of Black students or in block groups with large proportions of Black residents had higher clustering than White counterparts. The results suggest that the geography of opportunity as it relates to school food environments is unequal in New York City.

Inequality in obesigenic environments: Fast food density in New York City

Published July 16, 2008
Kwate, N.O.A., Yau, C.Y., Loh, J.M., & Williams, D. (2009). Inequality in obesigenic environments: Fast food density in New York City. Health & Place, 15, 364-373.

The high prevalence of obesity in African American populations may be due to the food environment in residential communities, and the density of fast food restaurants is an important aspect of the restaurant landscape in US cities. This study investigated racial and socioeconomic correlates of fast food density in New York City. We found that predominantly Black areas had higher densities of fast food than predominantly White areas; high-income Black areas had similar exposure as low-income Black areas; and national chains were most dense in commercial areas. The results highlight the importance of policy level interventions to address disparities in food environments as a key goal in obesity prevention efforts.

Individual and group racism and problem drinking among African American women

Published December 11, 2009
Kwate, N.O.A., Meyer, I.H., Eniola, F., & Dennis, N. (2010). Individual and group racism and problem drinking among African American women. Journal of Black Psychology (36)4, 446-457.

This study investigated whether perceived individual and group racism were associated with problematic drinking patterns among urban African American women. In this cross-sectional survey, 139 African American women aged 21 to 49 years who consumed alcohol at least once per month were recruited from and interviewed at varied community sites in Central Harlem, New York City. Drinking patterns were assessed with the CAGE, a commonly used four-item screening measure. Frequent heavy drinking was measured with a single item used in the Centers for Disease Control Behavioral Risk Factor Surveillance System. The results showed that, controlling for household income and education level, individual racism was associated with drinking patterns suggestive of alcohol dependence but not frequent heavy drinking. Group racism was not associated with either outcome. The results replicate and extend findings in previous studies and contribute to building literature on the effects of racism on health-damaging behaviors.

Association between residential exposure to outdoor alcohol advertising and problem drinking among African American women in New York City

Published November 15, 2010
Kwate, N.O.A., & Meyer, I.H. (2009). Association between residential exposure to outdoor alcohol advertising and problem drinking among African American women in New York City. American Journal of Public Health, 99(2), 228-230

Despite a clear body of research documenting disproportionate outdoor marketing of alcohol ads in African American neighborhoods, no research has investigated the impact of this marketing on alcohol consumption. We evaluated the association between residential exposure to outdoor alcohol advertising and current problem drinking among 139 African American women aged 21-49, in Central Harlem, New York City. Exposure to outdoor alcohol ads was measured with street-level enumeration, and problem drinking was assessed with self-report surveys. We found that ad exposure was positively related to problem drinking (13% greater odds) even after controlling for a family history of alcohol problems and socioeconomic status (education level and adequacy of income to meet household needs). The results suggest that the density of alcohol ads in predominantly African American neighborhoods may add to problem drinking behavior of its residents.

Fried Chicken and Fresh Apples: Racial Segregation as a Fundamental Cause of Fast Food Density in Black Neighborhoods

Published April 24, 2007
Kwate, N.O.A. (2008). Fried Chicken and Fresh Apples: Racial Segregation as a Fundamental Cause of Fast Food Density in Black Neighborhoods. Health & Place, 14(1), 32-44.

As rates of overweight and obesity have surged in the US, researchers have turned attention to the environmental context of diet and disparities in access to healthful foods. Despite evidence that Black neighborhoods are disproportionately exposed to fast food, few explanations have been advanced to illuminate explanatory mechanisms. This paper contends that race-based residential segregation is a fundamental cause of fast food density in Black neighborhoods. Segregation's effects on population and economic characteristics, physical infrastructure, and social processes work in tandem to increase the likelihood that Black neighborhoods in urban environments will bear a disproportionate burden of fast food restaurants.

Prevalence, Proximity And Predictors Of Alcohol Ads In Central Harlem

Published July 28, 2007
Kwate, N.O.A., Jernigan, M., & Lee, T.H. (2007) Prevalence, proximity, and predictors of alcohol ads in Central Harlem. Alcohol & Alcoholism, 42(6), 635-640.

This study examined the prevalence of alcohol ads, the spatial relationship between alcohol ads and schools, churches and playgrounds, and area-level determinants of alcohol ad density in Central Harlem, New York City. Alcohol advertising was quantified using street observation. Data on city demographics and infrastructure were obtained from the census and municipal databases. Alcohol ads were densely distributed; almost half of ads fell within a 152 m buffer of schools, churches and playgrounds; and ad density was positively associated with retail liquor outlet density. Predominantly Black neighbourhoods continue to face high exposure to outdoor alcohol advertising, including around sites at which youth congregate.

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Take one down, pass it around, 98 alcohol ads on the wall: outdoor advertising in New York City's Black neighbourhoods

Published June 25, 2007
Kwate, N.O.A. (2007). Take one down, pass it around, 98 alcohol ads on the wall: Outdoor advertising in New York City's Black neighborhoods. International Journal of Epidemiology, 36, 988-990.

A favourite song for US children taking long school trip bus rides is '99 Bottles of Beer on the Wall'. The lyrics, which are repetitive and simple, make for easy entertainment: '99 bottles of beer on the wall, 99 bottles of beer, take one down and pass it around, 98 bottles of beer on the wall. 98 bottles of beer on the wall,...' One could sing a similar song about outdoor alcohol advertisements in Black neighbourhoods, with the exception that when these ads are taken down, new ones appear in their place.

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Ghettoizing Outdoor Advertising: Disadvantage and Ad Panel Density in Black Neighborhoods

Published June 1, 2006
Kwate, N.O.A., & Lee, T.H. (2007). Ghettoizing outdoor advertising: Neighborhood disadvantage and ad panel density in African American communities. Journal of Urban Health, 84, 21-31.

This study investigated correlates of outdoor advertising panel density in predominantly African American neighborhoods in New York City. Research shows that black neighborhoods have more outdoor advertising space than white neighbor- hoods, and these spaces disproportionately market alcohol and tobacco advertise- ments. Thus, understanding the factors associated with outdoor advertising panel density has important implications for public health. We linked 2000 census data with property data at the census block group level to investigate two neighborhood-level determinants of ad density: income level and physical decay. Results showed that block groups were exposed to an average of four ad spaces per 1,000 residents and that vacant lot square footage was a significant positive predictor of ad density. An inverse relationship between median household income and ad density did not reach significance, suggesting that relative affluence did not protect black neighborhoods from being targeted for outdoor advertisements.

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The Heresy of African-Centered Psychology

Published December 1, 2005
Kwate, N.O.A. (2005). The heresy of African-centered psychology. Journal of Medical Humanities, 26(4), 215-235.

This paper contends that African-centered models of psychopathology represent a heretical challenge to orthodox North American Mental Health. Heresy is the defiant rejection of ideology from a smaller community within the orthodoxy. African-centered models of psychopathology use much of the same language and ideas about the diagnostic process as Western psychiatry and clinical psychology but explicitly reject the ideological foundations of illness definition. The nature of the heretical critique is discussed, and implications for the future of this school of thought are offered.

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Cross-Validation of the Africentrism Scale

Published August 1, 2003
Kwate, N.O.A. (2003). Cross-validation of the Africentrism Scale. The Journal of Black Psychology, 29(3), 308-324.

This study cross-validated the Africentrism Scale and investigated the relation- ship between Africentrism and demographic variables in a diverse sample of in- dividuals of African descent. Participants were 206 individuals who identified as African, African American, or Caribbean/West Indian. Demographic variables included age, gender, ethnic background, educational level, place of rearing, and level of identification with African ancestry. The results suggested that age and education were related to Africentrism with younger and less educated individu- als endorsing less Africentrism. No other demographic variables emerged as sig- nificant predictors. Caribbeans had a slightly lower score than others after con- trolling for age. Overall, the Africentrism Scale demonstrated solid internal consistency (coefficient alpha) and convergent validity (inverse association to a measure of cultural misorientation). In addition, the obtained factor structure was similar to that obtained in the original sample.

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