{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:36:24Z","timestamp":1792611384687,"version":"4.5.0"},"reference-count":90,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,3,5]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Carotid intima\u2010media thickness (cIMT) and carotid plaque are reliable indicators of cardiovascular disease risk, and research highlights that racial and ethnic minority individuals generally exhibit higher cIMT and carotid plaque than White individuals. At present, the mechanisms driving these disparities among different racial and ethnic and biological sex groups are poorly understood.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Data came from the baseline examination of MESA (Multi\u2010Ethnic Study of Atherosclerosis). A total of 6814 participants aged 45 to 84\u2009years free of clinical cardiovascular disease completed assessments on health behavior and perceived discrimination. Four sex\u2010stratified moderated mediation models examined associations between discrimination, cigarette smoking, and mean cIMT and plaque. We hypothesized that cigarette use would mediate the association between discrimination and carotid artery disease features, and that these would differ by race and ethnicity. Indirect effects of discrimination on plaque were observed among Hispanic women such that discrimination was associated with cigarette use and, in turn, higher plaque (\u03b2=0.04 [95% CI, 0.01\u20130.08]). Indirect effects of discrimination on mean cIMT were found among Hispanic (\u03b2=0.003 [95% CI, 0.0001\u20130.007]) and White men (\u03b2=0.04 [95% CI, 0.01\u20130.08]) such that discrimination was associated with cigarette use and, in turn, higher cIMT. Finally, a positive indirect effect of discrimination on plaque was observed among Hispanic men (\u03b2=0.03 [95% CI, 0.004\u20130.07]). No other racial and ethnic differences were observed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">To understand and address social determinants of cardiovascular disease, researchers must incorporate an intersectional framework that will allow us to understand the complex nature of discrimination and cardiovascular disease risk for individuals of varying intersecting identities and social positions.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.032659","type":"journal-article","created":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T10:51:44Z","timestamp":1708685504000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Discrimination, Smoking, and Cardiovascular Disease Risk: A Moderated Mediation Analysis With MESA"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4505-0813","authenticated-orcid":false,"given":"Stephanie H.","family":"Cook","sequence":"first","affiliation":[{"name":"Department of Social and Behavioral Sciences New York University School of Global Public Health New York NY USA"},{"name":"Department of Biostatistics New York University School of Global Public Health New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0795-6158","authenticated-orcid":false,"given":"Erica P.","family":"Wood","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences New York University School of Global Public Health New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2770-8223","authenticated-orcid":false,"given":"James H.","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-1512","authenticated-orcid":false,"given":"Robyn L.","family":"McClelland","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Washington School of Public Health Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000534"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000936"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000228"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000366"},{"key":"e_1_3_1_6_2","unstructured":"Heart disease. Centers for Disease Control and Prevention. 2022. Accessed June 24 2023. https:\/\/www.cdc.gov\/heartdisease\/index.htm"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-018-0287-x"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-019-0643-8"},{"key":"e_1_3_1_9_2","unstructured":"Men and heart disease. Centers for Disease Control and Prevention. 2021. Accessed June 24 2023. https:\/\/www.cdc.gov\/heartdisease\/men.htm"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000071"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000580"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.10.1061"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.318"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.14306"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.111.057232"},{"key":"e_1_3_1_16_2","unstructured":"Racial and ethnic disparities in heart disease. Centers for Disease Control and Prevention. 2019. Accessed June 24 2023. https:\/\/stacks.cdc.gov\/view\/cdc\/77732"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2017.12.007"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-2505"},{"key":"e_1_3_1_19_2","unstructured":"Social determinants of health. World Health Organization. 2022. Accessed June 28. https:\/\/www.who.int\/teams\/social\u2010determinants\u2010of\u2010health"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0033718"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0000000000000684"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.22.3.300"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.019541"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.psy.0000221360.94700.16"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv035"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13939"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0016059"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2016.09.026"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0033857"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2013.12.021"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2012.300750"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.037689"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000331"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1038\/ajh.2010.200"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1111\/josi.12061"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.307547"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12170-013-0365-2"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2020-215998"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2005.08.010"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2010.05.017"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.113.300156"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1080\/15332640.2018.1511493"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1080\/13557858.2012.713092"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2016.08.011"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.118.311807"},{"key":"e_1_3_1_46_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.26.3.386"},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.11.075"},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.005179"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.114.002262"},{"key":"e_1_3_1_50_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.118.312267"},{"key":"e_1_3_1_51_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.023704"},{"key":"e_1_3_1_52_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2018.06.005"},{"key":"e_1_3_1_53_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.026644"},{"key":"e_1_3_1_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2007.11.011"},{"key":"e_1_3_1_55_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.005669"},{"key":"e_1_3_1_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2022.105825"},{"key":"e_1_3_1_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2022.03.009"},{"key":"e_1_3_1_58_2","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0000000000000765"},{"key":"e_1_3_1_59_2","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000288"},{"key":"e_1_3_1_60_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwf113"},{"key":"e_1_3_1_61_2","unstructured":"Multi\u2010Ethnic Study of Atherosclerosis (MESA). National Heart Lung and Blood Institute. Accessed Accessed June 24 2023. https:\/\/biolincc.nhlbi.nih.gov\/studies\/mesa\/"},{"key":"e_1_3_1_62_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.119.14240"},{"key":"e_1_3_1_63_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2011.08.042"},{"key":"e_1_3_1_64_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9136(199708)14:3+<S25::AID-DIA441>3.0.CO;2-1"},{"key":"e_1_3_1_65_2","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.114.100305"},{"key":"e_1_3_1_66_2","doi-asserted-by":"publisher","DOI":"10.1089\/152460999319129"},{"key":"e_1_3_1_67_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000698"},{"key":"e_1_3_1_68_2","doi-asserted-by":"publisher","DOI":"10.1177\/135910539700200305"},{"key":"e_1_3_1_69_2","first-page":"228","volume-title":"Cardiac Electrophysiology: From Cell to Bedside","author":"Antzelevitch C","year":"1995","unstructured":"Antzelevitch C, Sicouri S, Lukas A, Nesterenko VV, Liu DW, Di Diego JM. Regional differences in the electrophysiology of ventricular cells: physiological and clinical implications. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. Philadelphia, Pa: WB Saunders Co Inc; 1995:228\u2013245."},{"key":"e_1_3_1_70_2","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen J","year":"1988","unstructured":"Cohen J. Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates; 1988."},{"key":"e_1_3_1_71_2","volume-title":"Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression\u2010Based Approach","author":"Hayes AF","year":"2017","unstructured":"Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression\u2010Based Approach. Guilford Publications; 2017."},{"key":"e_1_3_1_72_2","volume-title":"IBM SPSS Statistics for Macintosh, Version 27.0","author":"IBM Corp","year":"2020","unstructured":"IBM Corp . IBM SPSS Statistics for Macintosh, Version 27.0. Armonk, NY: IBM Corp; 2020. Accessed: January 5, 2024. https:\/\/www.ibm.com\/products\/spss\u2010statistics"},{"key":"e_1_3_1_73_2","volume-title":"Stata Statistical Software: Release 17","author":"StataCorp","year":"2021","unstructured":"StataCorp . Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC; 2021. Accessed: January 5, 2024. https:\/\/www.stata.com\/"},{"key":"e_1_3_1_74_2","doi-asserted-by":"publisher","DOI":"10.1177\/1540415320921489"},{"key":"e_1_3_1_75_2","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e31815ff3bd"},{"key":"e_1_3_1_76_2","doi-asserted-by":"publisher","DOI":"10.1093\/abm\/kay069"},{"key":"e_1_3_1_77_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0217623"},{"key":"e_1_3_1_78_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00126.2019"},{"key":"e_1_3_1_79_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2011.04.004"},{"key":"e_1_3_1_80_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2019.100446"},{"key":"e_1_3_1_81_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-021-01085-6"},{"key":"e_1_3_1_82_2","doi-asserted-by":"publisher","DOI":"10.1037\/sah0000103"},{"key":"e_1_3_1_83_2","doi-asserted-by":"publisher","DOI":"10.1037\/1099-9809.14.4.326"},{"key":"e_1_3_1_84_2","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.606718"},{"key":"e_1_3_1_85_2","doi-asserted-by":"publisher","DOI":"10.1186\/ar4489"},{"key":"e_1_3_1_86_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.01.036"},{"key":"e_1_3_1_87_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2013.11.014"},{"key":"e_1_3_1_88_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcm.2021.04.002"},{"key":"e_1_3_1_89_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-023-01561-1"},{"key":"e_1_3_1_90_2","first-page":"143","article-title":"Racial and ethnic differences in cardiovascular disease risk factors a systematic review","volume":"17","author":"Kurian AK","year":"2007","unstructured":"Kurian AK, Cardarelli KM. Racial and ethnic differences in cardiovascular disease risk factors a systematic review. Ethn Dis. 2007;17:143\u2013152.","journal-title":"Ethn Dis"},{"key":"e_1_3_1_91_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10865-019-00120-6"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.123.032659","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T12:29:26Z","timestamp":1715603366000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.123.032659"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,5]]},"references-count":90,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,3,5]]}},"alternative-id":["10.1161\/JAHA.123.032659"],"URL":"https:\/\/doi.org\/10.1161\/jaha.123.032659","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,5]]},"assertion":[{"value":"2023-09-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-31","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e032659"}}