Analysis of data from the Metro Atlanta Heart Disease Study illustrates the promise of this approach. This study found that although perceived discrimination was unrelated to hypertension, both discrimination at work (Din-Dzietharn et al. 2004) and discrimination more generally (Davis et al. 2005) were associated with increased risk of hypertension, but only among persons reporting high levels of stress because of discrimination. In this study, if respondents reported experiences of discrimination they were asked to rank their general level of stress when they had those experiences from 1 = none to 5 = high. Several states participating in the annual Behavioral Risk Factor Surveys in the U.S. have included the Reactions to Race module, developed by Camara Jones, which includes questions that assess emotional and physical symptoms as a result of exposure to discriminatory experiences. This is a fertile opportunity to explore the contribution of ratings of severity to the association between discrimination and health. One limitation of obtaining appraisals of stressfulness is that for studies of mental health, respondents’ reports of stressfulness can lead to confounding between the measure of stress and the self-reported outcome (Dohrenwend 2006).
