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The Association of Chronic Stress Secondary to Occupational Racism and Shift Work with Diabesity


Purpose: The potential role of work place bias (WPB) and shiftwork in relationship to diabesity has not been studied in African American (AA) female nurses. Shiftwork (SW) has been shown to be associated with weight gain but this has not been studied in AA women in relationship to diabesity or WPB. The primary aim of this pilot study was to examine the relationship between WPB and diabesity in AA women. A sub-aim was to evaluate the potential mediating effects of chronic stress and moderating effects of SW.

Conceptual Framework: This study is based on three theoretical frameworks: the theory of allostatic load; intersectionality; and ecosocial epidemiology.

Methods: This was a cross sectional correlational study (n= 96) that examined the associations between WPB, SW, chronic stress and diabesity in AA registered nurses. Data acquisition was by self-report questionnaires, blood and saliva biomarkers of chronic stress and anthropometric measures.

Results: Institutional WPB was associated with diabetes in the population of AA nurses, X2 (2) = 7.21, p = .03, and BMI, r = 0.25, p =.02. Institutional WPB was associated with Waist to Hip Ratio (WHR), r= 0.21, p = .02, as was interpersonal work place bias, r= 0.21, p = .02.

WHR was also associated with HbA1C, F (1,89) = 7.38, p = .01.

More than half of the study population were shift workers. Although SW was not associated with diabetes or obesity in this population, it was associated with WHR, X2 (1) = 5.59, p = .02. Job strain was associated with institutional WPB r= -1.32, p = .032 and ERI was associated withboth institutional and interpersonal WPB r = .142, p = .001 and r = .149, p= .002 respectively. Allostatic load was not related to WPB but was associated with length of employment, r = 0.25, p = .02.

Conclusions: We found a significant relationship between interpersonal WPB and WHR, a proxy for visceral adiposity, suggesting WPB may have role in the onset of diabetes. This was not a function of socioeconomic status in this population of AA nurses, 70 % earned an annual salary of $75,000-$150,000 per year. Additional findings for this population of AA nurses suggest that body mass index is associated with institutional WPB but not associated with interpersonal WPB. When shiftwork was found to moderate the relationship suggesting there is a combined effect of SW and WPB on BMI. In this population, we did not find a clear indication of allostatic load based on the biomarkers used; however, we did find a significant relationship between job strain, effort reward imbalance and institutional WPB. This relationship suggests this population is experiencing stress from WPB and warrants further study.

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