Much current research on discrimination and health gives scant attention to the mechanisms and processes by which this association might exist. The stress literature indicates that stress affects health through three principal pathways (Cohen et al. 1995). First, exposure to stress can give rise to negative emotional states. These responses can generate psychological distress that adversely affects health. Second, behavioral coping responses to manage stress can lead to the initiation of unhealthy behaviors such as tobacco use and alcohol abuse, the disengagement from health activities such as sleep and exercise and the neglect of adherence to medical regimens. Third, both the psychological and behavioral responses to acute and chronic stressors can lead to structural and functional changes in multiple physiological systems, including the neuroendocrine, autonomic, and immune systems. These changes in physiology and behavior can lead to changes in health. Importantly, stressors, including discrimination can play a role in the onset, progression, and severity of illness. Studies of discrimination and health need to devote greater thought to the conditions under which particular aspects of discrimination are more or less likely to affect specific points of the disease continuum.
