Methodological Challenges in Causal Research on Racial and Ethnic Patterns of Cognitive Trajectories: Measurement, Selection, and Bias

Research focused on understanding how and why cognitive trajectories differ across racial and ethnic groups can be compromised by several possible methodological challenges. These difficulties are especially relevant in research on racial and ethnic disparities and neuropsychological outcomes because of the particular influence of selection and measurement in these contexts. In this article, we review the counterfactual framework for thinking about causal effects versus statistical associations. We emphasize that causal inferences are key to predicting the likely consequences of possible interventions, for example in clinical settings. We summarize a number of common biases that can obscure causal relationships, including confounding, measurement ceilings/floors, baseline adjustment bias, practice or retest effects, differential measurement error, conditioning on common effects in direct and indirect effects decompositions, and differential survival. For each, we describe how to recognize when such biases may be relevant and some possible analytic or design approaches to remediating these biases.     

Race-Norming of Neuropsychological Tests

Recent studies in the United States indicate that some neurologically intact minority groupings perform well below White Americans on neuropsychological tests. This has sparked the production of race-norms, especially for African Americans, that seek to reduce false positive rates (i.e., neurologically intact individuals misdiagnosed with cognitive impairment) in neuropsychological assessments. There are problems with this enterprise including: possible justification for inferior/superior treatment of different racial groupings; unknown effects on false negative rates (i.e., cognitive deficit misdiagnosed as normal); the overlooking of factors possibly responsible for group racial differences (e.g., acculturation); non-scientific and non-operational definitions of race/ethnic groupings; and an impossibly large number of potential race/ethnic groupings for which to generate race-norms. An alternative approach is to use a single set of combined race/ethnic norms and estimate preexisting neuropsychological skill levels by using individual comparison standards. This alternative has been poorly researched, a situation that needs correcting.     

The Effect of Cognitive Complexity and Nature of the Outcome on Causal Attribution

Because even subtle forms of racial discrimination can damage well-being, identifying individual differences that shape this stress process is important. Dispositional forgiveness has been shown to influence how people perceive and react to interpersonal transgressions, yet its role in the context of racial discrimination has not received much research attention. In the current study, participants completed an initial measure of dispositional forgiveness and then considered a scenario that could be deemed racially discriminatory. Next, participants' perceptions of the scenario, negative affect, and cognitive performance were assessed. Dispositional forgiveness predicted all three outcomes such that more forgiving individuals were less likely to view the event as racially discriminatory and showed lower negative affect and greater cognitive performance after reading the scenario. Moreover, race moderated these relationships such that forgiveness played a more beneficial role for ethnic minorities than for whites.     

Differences between African American and European American first-year college students in the relationship between self-efficacy, outcome expectations, and academic achievement

First-year African American and European American college students were surveyed to examine ethnic differences in how their social cognitive beliefs (self-efficacy and outcome expectations) influenced their academic achievement. It was hypothesized that outcome expectations may better explain academic achievement for African Americans due to the fact that they may perceive that external factors such as discrimination may influence their academic outcomes. Because European Americans are less likely to anticipate discrimination, they are more likely to believe that their outcomes would be the result of their own behavior. Higher levels of self-efficacy were related to better academic achievement for both ethnic groups. However, African Americans with negative outcome expectations (e.g. my education will not lead to a well paying job) had better achievement than those with more positive outcome expectations. This pattern was not found for European Americans. Potential explanations for the relationship between outcome expectations and academic achievement for African Americans such as racial socialization for preparation for bias are discussed and implications for interventions are addressed.     

Community‐Based Participatory Research With Black Churches

Black Americans are more likely than other racial/ethnic groups to rely on spiritual and religious resources for mental health support. As such, counselors must seek unique ways to reach and understand Black communities. This article provides an overview of Black Americans' help‐seeking behaviors, the significance and culture of the Black Church, and a framework for counselors and counseling researchers to form effective partnerships to conduct community‐based participatory research initiatives that will produce empirical outcomes and promote culturally responsive mental health and wellness programming in Black communities.     

Online racial discrimination and the protective function of ethnic identity and self-esteem for African American adolescents

A growing body of literature has shown that being victimized online is associated with poor mental health. Little is known about the factors that protect youth from the negative outcomes that may result from these victimization experiences, particularly those related to race. Using a risk and resilience framework, this study examined the protective function of ethnic identity and self-esteem among African Americans who experience online racial discrimination. For the sample of 125 adolescents, hierarchical regression results revealed that higher levels of ethnic identity and self-esteem significantly moderated the negative impact of online racial discrimination on anxiety levels. These findings show that ethnic identity and self-esteem can buffer the negative mental health outcomes associated with online racial discrimination, at least with respect to adolescents' anxiety. Findings from the current study have significant implications for adolescent adjustment given the increased time youth spend doing online activities.     

Neuropsychological outcomes of pediatric demyelinating diseases: a review

Immune-mediated central nervous system (CNS) demyelinating diseases impact various areas of the brain, optic nerves, and/or spinal cord and can result in a wide range of neurologic symptoms including adverse cognitive outcomes. Neuropsychological outcomes in adult multiple sclerosis (MS) are well documented, while literature on such outcomes in pediatric cohorts is more limited. Furthermore, literature on neuropsychological outcomes in pediatric acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), and transverse myelitis (TM) is even more limited. This paper is the first to review what is known about neuropsychological outcomes associated with immune-mediated CNS demyelinating diseases, with a focus on pediatric MS, ADEM, NMO, and TM. Additionally, this review illuminates the need to clarify differences in neuropsychological sequelae between conditions, characterize longitudinal cognitive outcomes, and investigate neuropsychological outcomes in relation to clinical variables (e.g., age of onset, disease duration, number of relapses) and psychosocial variables (e.g., fatigue, emotional problems, behavioral functioning) to better understand neuropsychological outcomes associated with these conditions.     

Statistical Effects of Religious Participation and Marriage on Substance Use and Abuse in Racial and Ethnic Minorities

Substance use and abuse, which includes alcohol use, alcohol dependence, drug use, and drug dependence, inflicts a substantial toll on Americans. Although studies have demonstrated the protective effect of social support, such as religious participation and via marriage, understanding their influence on racial and ethnic minorities is limited. Thus, the aim of this study is to assess the impact of social support on substance use and abuse in racial and ethnic minorities. The Collaborative Psychiatric Epidemiology Surveys, sponsored by the National Institute of Mental Health, a repository of race, ethnicity, and mental health data, was leveraged to develop four models using multivariate analysis, specifically logistic regression to estimate the probability of meeting the criteria for substance use and abuse. Racial and ethnic minorities were found to have lower rates of substance use and abuse compared to Whites, and foreign-born individuals were consistently less likely to use or abuse substances compared to American-born minorities. Mental health conditions were highly associated with substance use and abuse, and social support by way of religious participation and marriage was protective against substance use and abuse. In racial and ethnic minorities, nativity and social support were protective against substance use and abuse; however, these protective factors did not completely eliminate risk. Thus, although race and ethnicity are important to understanding health outcomes and health behaviors, such as substance use and abuse, it is the intersection of multiple factors, representing internal and external forces, which may be more informative and offer a more comprehensive picture of the landscape influencing drug and alcohol use and dependence. Targeted interventions should consider leveraging religious spaces and bilingual materials when attempting to reach racial and ethnic minorities.     

State of Multicultural Neuropsychological Assessment in Children: Current Research Issues

Scientific attention to cultural considerations in child neuropsychological assessment has not developed parallel to the focus these issues have received in adult and elderly neuropsychological assessment. There are limited data on the presence, magnitude, etiology, and implications of culture-related differences in cognitive test performance among children. This preliminary report reviews the available empirical literature on the current state of multicultural neuropsychological assessment in children. The review identified articles by searching PubMed and PsycINFO databases, and the tables of contents of Developmental Neuropsychology and Child Neuropsychology from 2003-2008. Of the 1,834 abstracts reviewed, ten papers met inclusion criteria for the review. Five studies were completed in America; four of these compared performance between ethnic groups while the fifth examined neighborhood level poverty indicators exclusively within African-American children. Of the five international studies, all established local normative data and/or were exploratory investigations of neuropsychological functions in specific cultural groups, including Taiwanese infants, South African youth, and bilingual British children. Taken together, the results yield important clinical and research data that begin to inform many of the complex and fascinating mechanisms by which ethnic identity and culture impact cognitive development and the neuropsychological assessment of children. A critique of the existing literature and directions for future research are provided.     

A meta-analytic test of intergroup contact theory

The present article presents a meta-analytic test of intergroup contact theory. With 713 independent samples from 515 studies, the meta-analysis finds that intergroup contact typically reduces intergroup prejudice. Multiple tests indicate that this finding appears not to result from either participant selection or publication biases, and the more rigorous studies yield larger mean effects. These contact effects typically generalize to the entire outgroup, and they emerge across a broad range of outgroup targets and contact settings. Similar patterns also emerge for samples with racial or ethnic targets and samples with other targets. This result suggests that contact theory, devised originally for racial and ethnic encounters, can be extended to other groups. A global indicator of Allport's optimal contact conditions demonstrates that contact under these conditions typically leads to even greater reduction in prejudice. Closer examination demonstrates that these conditions are best conceptualized as an interrelated bundle rather than as independent factors. Further, the meta-analytic findings indicate that these conditions are not essential for prejudice reduction. Hence, future work should focus on negative factors that prevent intergroup contact from diminishing prejudice as well as the development of a more comprehensive theory of intergroup contact.     

Racial/ethnic disparities in therapist effectiveness: a conceptualization and initial study of cultural competence

As a result of mental health disparities between White and racial/ethnic minority clients, researchers have argued that some therapists may be generally competent to provide effective services but lack cultural competence. This distinction assumes that client racial/ethnic background is a source of variability in therapist effectiveness. However, there have been no direct tests of the therapist as a source of health disparities. We provided an initial test of the distinction between general and cultural competence by examining client racial/ethnic background as a source of variability in therapist effectiveness. We analyzed cannabis use outcomes from a psychotherapy trial (N = 582) for adolescent cannabis abuse and dependence using Bayesian multilevel models for count outcomes. We first tested whether therapists differed in their effectiveness and then tested whether disparities in treatment outcomes varied across therapist caseloads. Results suggested that therapists differed in their effectiveness in general and that effectiveness varied according to client racial/ethnic background. Therapist effectiveness may depend partially on client racial/ethnic minority background, providing evidence that it is valid to distinguish between general and cultural competence.     

Racial/ethnic differences in Body Mass Index: the roles of beliefs about thinness and dietary restriction

The greater BMI of African American relative to Caucasian women is implicated in racial/ethnic disparities in health outcomes. The principal aim of the current study was to evaluate a theoretical account of racial/ethnic differences in BMI. Thin-ideal internalization, the perceived romantic appeal of thinness, dietary restriction, weight, and height were assessed via self-report measures on a sample of female undergraduates of African American (n = 140) and Caucasian (n = 676) race/ethnicity. Using structural equation modeling, support was obtained for the primary hypothesis that racial/ethnic differences in BMI are explained by Caucasian women's greater thin-ideal internalization and perceived romantic appeal of thinness, thereby resulting in greater levels of dietary restriction. Current findings illustrate the potential for racial/ethnic differences in sociocultural standards of appearance to influence racial/ethnic disparities in physical health, of which BMI is a marker, via effects on weight control behavior.     

Academic adjustment across middle school: the role of public regard and parenting

In the current longitudinal study, we examined associations between Black and Latino youths' perceptions of the public's opinion of their racial/ethnic group (i.e., public regard) and changes in academic adjustment outcomes across middle school. We also tested combinations of racial/ethnic socialization and parent involvement in academic activities as moderators of this association. We used a 2nd-order latent trajectory model to test changes in academic adjustment outcomes in a sample of 345 Black and Latino urban youth across 6th, 7th, and 8th grades (51% female). Results revealed a significant average linear decline in academic adjustment from 6th to 8th grade, as well as significant variation around this decline. We found that parenting moderated the association between public regard and the latent trajectory of academic adjustment. Specifically, for youth who reported high racial/ethnic socialization and low parent academic involvement, lower public regard predicted lower academic adjustment in 6th grade. For youth who reported both low racial/ethnic socialization and low parent academic involvement, lower public regard predicted a steeper decline in academic adjustment over time. Finally, among youth who reported high racial/ethnic socialization and high parent academic involvement, public regard was not associated with either the intercept or the slope of academic adjustment. Thus, the combination of high racial/ethnic socialization and parent academic involvement may protect youths' academic motivation and performance from the negative effects of believing the public has low opinions of one's racial/ethnic group. Implications for protecting Black and Latino youths' academic outcomes from decline during middle school are discussed.     

Racial/ethnic matching of clients and therapists in mental health services: a meta-analytic review of preferences, perceptions, and outcomes

Across several decades the effects of matching clients with therapists of the same race/ethnicity have been explored using a variety of approaches. We conducted a meta-analysis of 3 variables frequently used in research on racial/ethnic matching: individuals' preferences for a therapist of their own race/ethnicity, clients' perceptions of therapists across racial/ethnic match, and therapeutic outcomes across racial/ethnic match. Across 52 studies of preferences, the average effect size (Cohen's d) was 0.63, indicating a moderately strong preference for a therapist of one's own race/ethnicity. Across 81 studies of individuals' perceptions of therapists, the average effect size was 0.32, indicating a tendency to perceive therapists of one's own race/ethnicity somewhat more positively than other therapists. Across 53 studies of client outcomes in mental health treatment, the average effect size was 0.09, indicating almost no benefit to treatment outcomes from racial/ethnic matching of clients with therapists. These 3 averaged effect sizes were characterized by substantial heterogeneity: The effects of racial/ethnic matching are highly variable. Studies involving African American participants demonstrated the highest effect sizes across all 3 types of evaluations: preferences, perceptions, and outcomes.     

Consideration of Genetic Counseling as a Career: Implications for Diversifying the Genetic Counseling Field

Under-representation of racial/ethnic minority counselors has been an ongoing issue in the genetic counseling field. A better understanding of genetic counseling awareness and career consideration may help to increase the number of applicants to genetic counseling training programs from racial/ethnic minorities. This study sampled high school and college students (n = 233) to examine their awareness and perceptions of genetic counseling. Ethnicity, gender, parental level of education, and interest in biology were significant predictors of a subjects genetic counseling awareness; previous awareness of genetic counseling, interest in psychology, and level of education were significant predictors of whether a subject would consider genetic counseling as a career. The findings suggest that knowledge of genetic counseling is lower among racial/ethnic minorities, but that racial/ethnic minorities are just as likely to consider genetic counseling as a career. Awareness of genetic counseling prior to university education may increase racial/ethnic minority representation among potential applicants to genetic counseling training programs.     

Bias at school: Perceptions of racial/ethnic discrimination among Latino and European American children

Latino and White/European American children (N = 99; 5–11 years of age) participated in a study designed to examine their perceptions of racial/ethnic discrimination in educational settings. Children heard scenarios involving two children of different races/ethnicities, one who received a more positive outcome from a teacher than the other. Children were then asked about the reasons for the differential outcomes. The role of (a) situational information (i.e., the race/ethnicity of the children and teacher in the story, and information about the teacher's past choices); (b) social-cognitive abilities (i.e., theory of mind); and (c) child characteristics (i.e., child's race/ethnicity and racial/ethnic attitudes) in facilitating children's attributions to discrimination was assessed. Results indicated that children most frequently attributed differential outcomes to the quality of work or the ability of students. Children were most likely to make an attribution to discrimination when the teacher rewarded a same-race/ethnicity child and had a history of similar behavior. Children's attention to situational information was moderated, however, by their social-cognitive abilities. Children's own race/ethnicity and ethnic attitudes also affected their perceptions of discrimination.     

Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta-analysis

Psychotherapy is a culturally encapsulated healing practice that is created from and dedicated to specific cultural contexts (Frank & Frank, 1993; Wampold, 2007; Wrenn, 1962). Consequently, conventional psychotherapy is a practice most suitable for dominant cultural groups within North America and Western Europe but may be culturally incongruent with the values and worldviews of ethnic and racial minority groups (e.g., D. W. Sue, Arredondo, & McDavis, 1992). Culturally adapted psychotherapy has been reported in a previous meta-analysis as more effective for ethnic and racial minorities than a set of heterogeneous control conditions (Griner & Smith, 2006), but the relative efficacy of culturally adapted psychotherapy versus unadapted, bona fide psychotherapy remains unestablished. Furthermore, one particular form of adaptation involving the explanation of illness-known in an anthropological context as the illness myth of universal healing practices (Frank & Frank, 1993)-may be responsible for the differences in outcomes between adapted and unadapted treatments for ethnic and racial minority clients. The present multilevel-model, direct-comparison meta-analysis of published and unpublished studies confirms that culturally adapted psychotherapy is more effective than unadapted, bona fide psychotherapy by d = 0.32 for primary measures of psychological functioning. Adaptation of the illness myth was the sole moderator of superior outcomes via culturally adapted psychotherapy (d = 0.21). Implications of myth adaptation in culturally adapted psychotherapy for future research, training, and practice are discussed.     

Prayer and Spiritual Practices for Health Reasons among American Adults: The Role of Race and Ethnicity

Many studies find racial differences in prayer and religious practices, but few reports examine factors that help explain the effects of Hispanic ethnicity or African American race. A national survey conducted in 2002 collected data on 10 non-religious spiritual practices as well as on prayer for health reasons in 22,929 adults aged 18 years and over. We found marked racial and ethnic differences in the use of prayer and other spiritual practices for health reasons. Greater proportions of African Americans and Hispanic Americans than European Americans reported prayer for health reasons. Sociodemographic variables and health status could not explain these differences. Further, among those who reported prayer, African Americans were more likely than European Americans to report being prayed for by others. However, African American women and Hispanic women and men were significantly less likely than European Americans to use other spiritual practices such as meditation and Tai Chi. Surprisingly African American men were just as likely to report these practices as European American men. Sociodemographic variables and health status could not explain these differences.     

Sex, race/ethnicity, and romantic attractions: multiple minority status adolescents and mental health

This study examined the association between multiple minority statuses and reports of suicidal thoughts, depression, and self-esteem among adolescents. Data from the National Longitudinal Study of Adolescent Health were used to examine mental health outcomes across racial/ethnic groups for same-sex-attracted youths and female youths. Hispanic/Latino, African American, and White female adolescents reported more suicidal thoughts, higher depression, and lower self-esteem compared with male adolescents in their racial/ethnic group. Same-sex-attracted youths did not consistently demonstrate compromised mental health across racial/ethnic groups. Follow-up analyses show that White same-sex-attracted female adolescents reported the most compromised mental health compared with other White adolescents. However, similar trends were not found for racial/ethnic minority female youths with same-sex attractions.     

The Influence of Intersecting Identities on Self‐Harm,Suicidal Behaviors,and Depression among Lesbian,Gay, and Bisexual Individuals

Individuals with lesbian, gay, and bisexual (LGB) identities have higher prevalence of self‐directed violence, but very little is known about racial/ethnic differences between LGB populations. This study aimed to examine racial/ethnic differences in self‐harm, suicidal ideation, suicide attempt, and depression among LGB and heterosexual emerging adults. Data are compiled from the Fall 2008 and Spring 2009 National College Health Assessment and limited to respondents within emerging adulthood (ages 18–24) who indicated their sexual orientation and racial/ethnic identities (n = 89,199). Within each racial/ethnic group, LGB individuals were significantly more likely to report self‐harm, suicidal ideation, suicide attempt, and depression than non‐LGB individuals.