Real Time Racial Microaggression and Physiological Stress Responses Among Young and Middle Aged Black Adults

Introduction: Perceived racial discrimination has been associated with dysregulation of sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axis, two major physiological stress response systems linked to cardiovascular disease outcomes. Most studies, to date, used cross-sectional data that captured retrospective measures of lifetime racial discrimination associated with current physiological stress responses. Relative to overt racial discrimination, a subtle form of racial discrimination, known as microaggression is more prevalent, yet most commonly measured retrospectively, and understudied. The purpose of this pilot study was to examine the relationship between microaggression measured in real-time and physiological stress responses. Methods: Twelve healthy Black adults (mean age=43.4 years) completed baseline surveys, and self-collected saliva 4x a day for 4 days to measure cortisol and alpha amylase (AA) as a proxy of HPA and SAM systems, respectively. Real-time microaggression was measured using ecological momentary assessments (EMA) sent to participants 5x a day for 7 days. Multilevel models were conducted to examine the relationship between microaggressions and the SAM and HPA axis activities. Results: In the bivariate analyses, the area under the curve with respect to ground (AUCg: total cortisol output throughout the day) was significantly associated with the same day microaggression (r=.40, p=.02). Microaggression was associated with cortisol awakening response (CAR) on the same day (r=.34, p=.04). In multilevel models, microaggression was associated with wake-up cortisol level on the same day (β=.22, p=.05). Microaggression was also associated with wake-up AA levels both the same day (β=.58, p<.01) and the next day (β=.40, p=.05). Conclusions: Microaggression was associated with same day and next day physiological stress responses. We determined that concurrent use of salivary biomarkers and EMA was feasible methods to examine the temporal relationship between microaggression and physiological stress responses. Future work will include the development of an intervention that buffers the physiologic stress response related to microaggression to improve cardiovascular health.