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Links between discrimination and sleep difficulties: romantic relationships as risk and resilience factors

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Links between discrimination and sleep difficulties: romantic relationships as risk and resilience factors

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Links Between Discrimination and Sleep Difficulties:
Romantic Relationships as Risk and Resilience Factors

by

Yehsong Kim

A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(PSYCHOLOGY)

August 2023

Copyright 2023 Yehsong Kim
ii
Acknowledgements
The work in this dissertation has been supported by the NSF GRFP Grant No. DGE-
1842487 (Kim, PI), the NSF Grant No. BCS-1627272 (Margolin, PI), the NIH-NICHD
R21HD072170-A1 (Margolin, PI), and the USC Center for the Changing Family.
I would like to begin by thanking my dissertation committee members, Drs. Stanley
Huey, Richard John, Gayla Margolin, and Shrikanth Narayanan for their time and attention in
reviewing this project in addition to their guidance throughout my training. I also wanted to
extend my gratitude to past and current Family Studies Project lab members for their
collaboration on these projects as well as being sources of support and inspiration throughout
graduate school: Dr. Reout Arbel, Sarah Barrett, Alexis Beale, Dr. Theodora Chaspari, Dr.
Geoffrey Corner, Dr. Marie-Ève Daspe, Merai Estafanous, Alaina Gold, Dr. Sohyun Han, Dr.
Kelly Kazmierski, Dr. Laura Perrone, Corey Pettit, Hannah Rasmussen, Yana Ryjova, Dr.
Hannah Schacter, Dr. Lauren Shapiro, Stassja Sichko, Dr. Adela Timmons, and Dr. Joanna Yau.
I am also deeply grateful to all of the individuals who dedicated their time and energy to
participate in these studies. These projects would not have been possible without the collective
efforts of this community.
I am particularly indebted to Dr. Adela Timmons, who took me under her wing when I
was first volunteering at the Family Studies Project, and helped guide me towards successfully
entering graduate school and this lab that has been home to me for eight years. To Sohyun,
Geoff, and Hannah, thank you for your friendship and being my graduate school sunbaes,
teaching me the ins and outs of surviving graduate school. Thank you to my advisor, Dr. Gayla
Margolin, who saw something in me and invested countless hours in me, without which I would
not be the researcher, clinician, and psychologist I am today. Though you may have initially tried
iii
to dissuade me from becoming a clinical psychologist (and become a lawyer or policy maker
instead), you always upheld my various interests and helped me forge a unique path in my
graduate schooling to include a public policy certificate and pursue research questions close to
my heart.
Finally, this work would not have been possible without the constant love and support of
my family and friends. Thank you to all of you who cheered me on when my concentration or
will would flag and who bought me meals because I “chose a life of poverty” during graduate
school. Thank you to my mother and father, Junghee Oh and Dr. Heewon Kim, who have always
inspired me to live a life in pursuit of love, care, and equity, my reason for pursuing this degree.
Finally, thank you to my partner, Jerry Yuan, who has provided me with endless care and
support along with reminders to rest and be in nature, which have sustained me throughout this
work.

iv
Table of Contents

Acknowledgements………………………………………………………………………………….………………………………… ii

List of Tables………………………………………………………………………………….………………………………………….. vi

List of Figures………………………………………………………………………………….………………………………………… vii

Abstract………………………………………………………………………………….…………………………………………………... viii

Chapter 1: General Introduction………………………………………………………………………………….…………….. 1
References………………………………………………………………………………….…………………………………... 4

Chapter 2: Paper 1. Perceived Discrimination and Sleep Difficulties: Moderating Effects of
Romantic Partners’ Perspective Taking and Psychological Aggression……….………............. 6
Abstract………………………………………………………………………………….…………………………………….… 7
Introduction………………………………………………………………………………….………………………………... 8
Method………………………………………………………………………………….………………………………………... 13
Results………………………………………………………………………………….……………………………………….... 18
Discussion………………………………………………………………………………….…………………………………... 19
References………………………………………………………………………………….…………………………………... 26
Tables & Figures……………………………………………………….……………….…………………………………... 34

Chapter 3: Paper 2. Anti-Black Violence, Discrimination, and Sleep Difficulties Amongst
Racially Diverse Americans: The Aftermath of the Murder of George Floyd……………… 37
Abstract…………………………………………………………………………………………………………………………. 38
Introduction……………………………………………………………………………………………………………………. 39
Method………………………………………………………………………………………………………………………….... 45
Results……………………………………………………………………………………………………………………………. 49
Discussion……………………………………………………………………………………………………………………… 50
References…………………………………………………………………………………………………………………….... 59
Tables & Figures …………………………………………………………………………………………………………… 66

Chapter 4: Paper 3. Discrimination During the COVID-19 Pandemic Against Asian Americans:
Links to Sleep and Romantic Relationships as Relevant Context……………………..................... 72
Abstract………………………………………………………………………………….………………………………………. 73
Introduction………………………………………………………………………………….……………………………….... 74
Method………………………………………………………………………………….………………………………….…….. 81
Results………………………………………………………………………………….…………………………………….…... 85
Discussion………………………………………………………………………………….……………………………….….. 86
References………………………………………………………………………………….……………………………….….. 93
Tables & Figures……………………………………………………….……………….……………………………….….. 100
Supplemental Materials……………….…………………………………..…….……………….………….………...… 103

Chapter 5: General Discussion………………………………………………………………………………….………………. 105
Contributions to the Literature………………………………………………….…………………………………… 106
v
Limitations and Future Directions……………………………………………….………………………………… 109
Conclusion……………………………………………….…………………………….………………………………………. 111
References………………………………………………………………………………….…………………………………... 113

Comprehensive References………………………………….…………………………….………………………………………. 115

Appendices……………..………………………………………………………………………………….…………………….………… 136
Appendix A: Paper 1 Measures ………………………………………………………….……………….………… 136
Appendix B: Paper 2 Measures ………………………………………….……………….………………….………139
Appendix C: Paper 3 Measures ………………………………………………………………………….…………..141

vi
List of Tables

Paper 1
Table 1. Bivariate correlations and descriptive statistics for main study variables
by gender……………………………………………….…………………………….………………………..……………….. 39
Table 2. Multi-level models examining the association between perceived
discrimination and sleep difficulties and the moderating influences of partner
perspective taking and partner psychological aggression………..…..…..…..…..….………………… 40

Paper 2
Table 1. Sociodemographic characteristics by race…………………………….………………………….75
Table 2. Descriptives and ANOVA results of main variables of interest by race ………… 76
Table 3. Direct and interactive effects between negative impacts of anti-Black
violence (NIAV), direct discrimination (DD), and race on sleep difficulties …………….… 77

Paper 3
Table 1. Correlations and descriptives of study variables …………….…………………………….… 112
Table 2. Direct and interactive effects between proximal discrimination, partner
support, and partner conflict on T2 sleep difficulties.………… ………………..………………………. 113
Supplemental Table 1. Supplemental Analyses ……………………….…………………………………… 116
vii
List of Figures

Paper 1
Figure 1. Moderating effects of partner perspective taking and partner
psychological aggression on the association between discrimination and sleep
difficulties……………………………………………….…………………………….………………………..……………… 41

Paper 2
Figure 1. Direct effects of negative impact of anti-Black violence (NIAV) and
direct discrimination on sleep difficulties.…………………….………………… ……………………..…….. 78
Figure 2. Moderating effect of race on the association between direct
discrimination and sleep difficulties ……………………………….………………………..…………………… 79
Figure 3. Moderating effect of direct discrimination on the association between
negative impact of anti-Black violence (NIAV) and sleep difficulties.… ……………………... 80

Paper 3
Figure 1. Partner conflict moderates the association between proximal
discrimination and T2 sleep difficulties …………………….…………………………….……………………. 114

viii
Abstract
This dissertation examines links between perceived discrimination and sleep difficulties,
as sleep is a critical biological process for health and wellbeing. In addition, studies examine the
relevance of romantic relationships and sociopolitical contexts to better understand effects of
discrimination on sleep. The first paper in this dissertation examines romantic partner
perspective taking and psychological aggression as general relationship qualities that
respectively buffer and exacerbate the association between discrimination and sleep in racially
diverse young adults. The second paper investigates links between negative impacts of anti-
Black violence (NIAV), perceived discrimination, and sleep difficulties among Black, Asian,
Latinx, and White participants approximately 6-8 months after the murder of George Floyd. The
third paper hones in on romantic relationship interactions related to discrimination and anti-
Asian racism as potential moderators of the link between discrimination experienced during the
COVID-19 pandemic and sleep difficulties among Asian American adults. These studies provide
greater understanding of how the contextual factors of close relationships and a milieu of anti-
Black and anti-Asian racism can provide a more nuanced understanding of the association
between discrimination and sleep.

1
Chapter 1
General Introduction
Discrimination is the behavioral manifestation of a negative attitude, judgment, or unfair
treatment toward members of a group (Pascoe & Smart Richman, 2009). Psychology has
primarily focused on perceived discrimination, which denotes that we do not verify the objective
nature of an event, but rather measure an individual’s perception of having experienced
discrimination. Perceiving an event as discrimination is enough to engage our cognition,
emotions, and physiology in ways similar to other kinds of stressors (Goosby et al., 2018;
Sawyer et al., 2012). In Pascoe and Smart Richman’s (2009) model, discrimination affects both
mental and physical health through activating physiological stress responses (e.g., cardiovascular
reactivity), psychological stress responses (e.g., anger, stress, self-esteem), and influencing
health behaviors. Through this cascade of responses, discrimination negatively impacts a wide
range of mental and physical health outcomes (Paradies et al., 2015; Schmitt et al., 2014;
Williams et al., 2003).
Sleep is a biological process critical for health and wellbeing, affecting epigenetic and
cellular processes, which in turn affect biological systems such as inflammation, nervous system,
and hormonal responses, leading to health and disease functioning (Buysse, 2014; Hale et al.,
2020). This dissertation examines links between perceived discrimination and sleep difficulties.
A growing literature shows emerging evidence that discrimination is related to poorer sleep
outcomes (Slopen et al., 2016). The three papers of this dissertation seek to add to this literature
by examining perceived discrimination and sleep among racially diverse Americans across three
different datasets.

2
Of note, data for two of the three papers were collected within the sociopolitical context
of the murder of George Floyd and increases in anti-Asian sentiment during the COVID-19
pandemic. In line with ecological systems theory by Bronfenbrenner (1994) regarding the
influences of multilayered contexts on individuals, we sought to understand how these historic,
ongoing sociopolitical contexts were related to individual and relational functioning. One of the
papers examines negative impacts of anti-Black violence (NIAV)—a specific form of vicarious
racism or secondhand exposure to racism directed at another individual—and how NIAV
intersects with direct, personal encounters with discrimination. Another paper addresses
discrimination experienced by Asian Americans during the COVID-19 pandemic, a period of
heightened anti-Asian sentiment.
In addition, this dissertation is among the first to examine romantic relationships as a
putatively important context in which discrimination relates to sleep difficulties. To date, a
substantial literature shows that romantic relationships, the most emotionally and physically
close relationships for many individuals, have meaningful effects on health (Braithwaite & Holt-
Lunstad, 2017; Loving & Slatcher, 2013)–with effect sizes similar to diet and exercise (Robles et
al., 2014). Sleep may be one mechanism underlying the association between romantic
relationships and health (Pietromonaco & Collins, 2017). Strong relationships promote good
quality sleep by providing a sense of safety, promoting physiological responses that sustain good
sleep, and increasing healthy sleep-related behaviors; however, difficult relationships appear to
have the opposite effect (Troxel et al., 2007).
Despite the literature showing adverse effects of discrimination on sleep, the critical role
of sleep in mental and physical health outcomes, and effects of romantic relationships on sleep
and health, little has been examined at the nexus of discrimination, sleep, and romantic

3
relationships. Thus, this dissertation aims to bring together these various nascent literatures to
investigate how qualities of romantic relationships may act as risk or resilience factors in the link
between discrimination and sleep. The first paper explores the connection between perceived
discrimination due to membership in protected groups and self-reported sleep difficulties 1.5
years later among racially diverse young adults in romantic relationships. Additionally, we
examined partners’ perspective taking and partners’ psychological aggression as moderators of
the association between discrimination and sleep difficulties. The second paper investigates links
between negative impacts of anti-Black violence (NIAV), perceived discrimination, and sleep
difficulties among Black, Asian, Latinx, and White adults approximately 6-8 months after the
murder of George Floyd (Kim et al., revise and resubmit). NIAV measured self-reported
emotional and cognitive effects of the violent deaths of Black Americans, including Ahmaud
Arbery, Breonna Taylor, and George Floyd. In addition, experiencing discrimination personally
was examined as a moderator of the association between NIAV and sleep difficulties. Racial
differences were also examined. The third paper examines discrimination experienced during the
COVID-19 pandemic and its association with sleep difficulties among Asian Americans, an
understudied population. We honed in on romantic relationship interactions explicitly related to
discrimination and anti-Asian racism as moderators of this association. Specifically, we
examined perceptions of partner support regarding proximal discrimination (i.e., feeling
understood and supported related to discriminatory events) as well as conflict with romantic
partners about anti-Asian racism. As a whole, this dissertation aims to better understand effects
of discrimination on sleep within various sociopolitical contexts and populations and how
romantic relationship interactions may provide respite or incur additional distress to those
experiencing discrimination.

4
References
Braithwaite, S., & Holt-Lunstad, J. (2017). Romantic relationships and mental health. Current
Opinion in Psychology, 13, 120-125. https://doi.org/10.1016/j.copsyc.2016.04.001

Bronfenbrenner, U. (1994). Ecological models of human development. In M. Gauvain & M.
Cole (Eds.) International encyclopedia of education (Vol 3, 2
nd
Ed.).

Buysse, D. J. (2014). Sleep health: Can we define it? Does it matter?. Sleep, 37, 9-17.
https://doi.org/10.5665/sleep.3298

Goosby, B. J., Cheadle, J. E., & Mitchell, C. (2018). Stress-related biosocial mechanisms of
discrimination and African American health inequities. Annual Review of Sociology, 44,
319-340. https://doi.org/10.1146/annurev-soc-060116-053403

Hale, L., Troxel, W., & Buysse, D. J. (2020). Sleep health: An opportunity for public health to
address health equity. Annual Review of Public Health, 41, 81-99.
https://doi.org/10.1146/annurev-publhealth-040119-094412

Kim, Y., Beale, A. M., Rasmussen, H. F., Kazmierski, K. F. M., & Margolin, G. Anti-Black
violence, discrimination, and sleep difficulties amongst racially diverse Americans: The
aftermath of the murder of George Floyd. Manuscript received a revise and resubmit.

Loving, T. J., & Slatcher, R. B. (2013). Romantic relationships and health. In J. A. Simpson & L.
Campbell (Eds.), The Oxford handbook of close relationships (pp. 617–637). Oxford
University Press. https://doi.org/10.1093/oxfordhb/9780195398694.013.0028

Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M., &
Gee, G. (2015). Racism as a determinant of health: A systematic review and meta-
analysis. PloS one, 10, e0138511. https://doi.org/10.1371/journal.pone.0138511

Pascoe, E. A., & Smart Richman, L. (2009). Perceived discrimination and health: A meta-
analytic review. Psychological Bulletin, 135, 531–554. https://doi.org/10.1037/a0016059

Pietromonaco, P. R., & Collins, N. L. (2017). Interpersonal mechanisms linking close
relationships to health. American Psychologist, 72, 531-542.
https://doi.org/10.1037/amp0000129

Robles, T. F., Slatcher, R. B., Trombello, J. M., & McGinn, M. M. (2014). Marital quality and
health: A meta-analytic review. Psychological Bulletin, 140, 140-
187. https://doi.org/10.1037/a0031859

Sawyer, P. J., Major, B., Casad, B. J., Townsend, S. S., & Mendes, W. B. (2012). Discrimination
and the stress response: Psychological and physiological consequences of anticipating
prejudice in interethnic interactions. American Journal of Public Health, 102, 1020-1026.
https://doi.org/10.2105/AJPH.2011.300620

5
Schmitt, M. T., Branscombe, N. R., Postmes, T., & Garcia, A. (2014). The consequences of
perceived discrimination for psychological well-being: A meta-analytic
review. Psychological Bulletin, 140, 921. https://doi.org/10.1037/a0035754

Slopen, N., Lewis, T. T., & Williams, D. R. (2016). Discrimination and sleep: A systematic
review. Sleep Medicine, 18, 88-95. https://doi.org/10.1016/j.sleep.2015.01.012

Troxel, W. M., Robles, T. F., Hall, M., & Buysse, D. J. (2007). Marital quality and the marital
bed: Examining the covariation between relationship quality and sleep. Sleep Medicine
Reviews, 11, 389-404. https://doi.org/10.1016/j.smrv.2007.05.002

Williams, D. R., Neighbors, H. W., & Jackson, J. S. (2003). Racial/ethnic discrimination and
health: Findings from community studies. American Journal of Public Health, 93, 200-
208. https://doi.org/10.2105/AJPH.93.2.200

6
Chapter 2
Paper 1

Perceived Discrimination and Sleep Difficulties: Moderating Effects of Romantic
Partners’ Perspective Taking and Psychological Aggression

Yehsong Kim,
1
Geoff Corner,
1
Kelly F. M. Kazmierski,
2

Hannah F. Rasmussen,
1
Hannah L. Schacter,
3
and Gayla Margolin
1

1. University of Southern California
2. University of California, Irvine
3. Wayne State University
Note: Authors 2-5 are listed alphabetically due to equal intellectual contribution to this document
and share second authorship.

7
Abstract
Discrimination disrupts biological regulatory processes, such as sleep. However, social
relationships have been shown to influence the strength of the impact of adverse events on later
health. In light of wide-ranging findings on social relationships buffering impacts of adverse
events, the current study investigated whether the link between discrimination and later sleep
difficulties is moderated by qualities of one’s romantic partner. In a racially diverse sample of 86
couples, perceived discrimination was associated with sleep difficulties approximately 1.5 years
later. Additionally, having a romantic partner who engaged in greater perspective taking
mitigated the association between discrimination and sleep difficulties, whereas having a
romantic partner who engaged in greater psychological aggression exacerbated this association.
These findings suggest the importance of considering various romantic relationship qualities
among partnered individuals in understanding the toll of discrimination on everyday restorative
processes, such as sleep.

8
The toll of discrimination is multifaceted. Commonly understood as the differential or
unfair treatment of people due to specific characteristics (Williams et al., 1994), discrimination
has been linked to harmful effects on life satisfaction (Schmitt et al., 2014), psychological and
physical health (Paradies et al., 2015; Pascoe & Smart Richman, 2009), education, and
employment (Levy et al., 2016). One putative mechanism by which discrimination impacts these
outcomes may be poor quality sleep. Among adults, discrimination is associated with sleep
difficulties, including self-reported sleep difficulties, insomnia, fatigue, sleep duration,
wakefulness after sleep onset, and a smaller proportion of REM sleep (Lewis et al., 2013; Slopen
et al., 2016). In turn, poor sleep is associated with worse learning abilities (Kelley et al., 2015)
and work productivity (Rosekind et al., 2010), as well as health problems ranging from
psychiatric illnesses (Tesler et al., 2013) to coronary heart disease, stroke, and even a shortened
lifespan (Luyster et al., 2012). Despite these severe consequences, sleep is still relatively
understudied in relation to discrimination, and to our knowledge, no studies have investigated
links between discrimination and sleep in the context of romantic relationships.
The present study offers a novel look into the association between discrimination and
sleep by examining this link in romantic relationships, a dyadic context in which individuals
navigate and process difficult life events, such as discrimination experiences. Specifically, we
examine the effects of protective and risky relationship qualities on the association between
discrimination and sleep, as support from romantic partners can improve adjustment in the face
of difficult experiences (Dagan et al., 2014), whereas negative social interactions with romantic
partners can exacerbate adverse effects of other life stressors (Jaremka et al., 2013).
Additionally, the present study examines these effects during young adulthood, a unique

9
developmental stage when romantic relationships emerge as a primary mode of social connection
(Fraley & Davis, 1997) and sleep disorders often begin to develop (Ram et al., 2010).
Discrimination and Sleep
Sleep is a biological imperative critical not only for survival but overall physical health,
with poor sleep having negative consequences for endocrine, metabolic, and immune functioning
(Luyster et al., 2012). Those from vulnerable groups, such as racial minorities, immigrants, and
those with low income, tend to experience poorer sleep (Hale & Rivero-Fuentes, 2011; Hall et
al., 2009). These findings hold across the lifespan, from childhood to older adulthood (Yip et al.,
2020; Friedman et al., 2007). Due to the critical role sleep plays in healthy functioning, it is
important to examine what may be contributing to poorer sleep and sleep disparities.
Discrimination, experienced more frequently by more vulnerable groups (Lee et al.,
2009; Stepanikova & Oates, 2017), is one key risk factor for poor sleep. A number of
mechanisms may link discrimination to sleep. Discrimination can disrupt a sense of safety and
contribute to increased feelings of threat and vigilance, psychological distress, or changes in
stress physiology (Brondolo et al., 2011; Harrell et al., 2005), which can then impact sleep (Han
et al., 2012; Hicken et al., 2013). A review of 16 studies found associations between
discrimination and poorer sleep in adolescents and adults of all races (Slopen et al., 2016).
Though the studies were primarily cross-sectional, a few longitudinal investigations established
links between everyday discrimination and more sleep complaints and worse sleep continuity in
racially diverse middle-aged women (Lewis et al., 2013); and poorer self-reported sleep in
Latinx low-income college students (Gordon et al., 2020). Therefore, we seek to add to existing
literature by examining prospective links between poorer sleep and discrimination due to
membership in protected classes (e.g., race/ethnicity, national origin, disability).

10
Romantic Relationships as a Buffer Against Deleterious Effects of Discrimination
Social support has been shown to reduce the negative impact of various types of
discrimination on well-being, mood, and outlook (Jasinskaja-Lahti et al., 2006; Seawell et al.,
2014). Romantic partners are therefore in a unique position to mitigate the impact of
discrimination because of their salience as a source of support and their immediate and proximal
availability (Kiecolt-Glaser & Newton, 2001). For example, spousal support was shown to
weaken the impact of everyday discrimination on depressive symptoms, even when accounting
for other sources of support (Donnelly et al., 2019). Discrimination was also associated with
depression and anxiety among single bisexual individuals but not among bisexual individuals
who were in romantic relationships (Feinstein et al., 2016). Other studies highlight specific
characteristics of the relationship or the romantic partner that may protect against harm from
discrimination. In a study of Asian American adults, being able to share worries with one’s
spouse was found to reduce the negative effects of unfair treatment on mental health (Rollock &
Lui, 2016). Among engaged or married African American adults, racism-specific support, or
being able to speak to one’s partner after a racist incident, buffered effects of racial
discrimination on women’s mental health (McNeil Smith et al., 2020). As these studies suggest,
sharing one’s worry or distress with a partner may be a protective mechanism.
Perspective taking, the cognitive component of empathy that involves seeing the world
through the eyes of another (Pulos et al., 2004), may be particularly helpful in responding
sensitively when supporting a partner who has faced discrimination. In a qualitative study of
participants who faced discrimination, most participants actively confided in someone after a
racist incident, particularly in those who could understand the experience (Lowe et al., 2012). On
the other hand, participants reported experiencing secondary injury when the confidant dismissed

11
the significance or impact of the event or invalidated their thoughts and feelings, and further
reported feeling more insecure and afraid to tell others about the incident. Thus, partner
perspective taking is potentially important with respect to discrimination to provide validation
and a sense of safety that may otherwise be taken away by experiences of discrimination.
Psychological Aggression as Additional Risk
Whereas some qualities in a romantic partner or relationship may buffer adverse effects
of discrimination, other characteristics could intensify injurious effects. One example of this is
psychological aggression, which devalues and dismisses a partner through wide-ranging
behaviors used to hurt, coerce, control, intimidate, psychologically harm, or express anger
(Follingstad, 2007). Psychological aggression occurs at a high frequency (prevalence rates
estimated as 40-41% for women and 32-43% for men; Carney & Barner, 2012) and is associated
with depression, anxiety, post-traumatic stress disorder, and suicidal thoughts (Campbell, 2002;
Pico-Alfonso et al., 2006), as well as sleep disturbances (Matos & Goncalves, 2019). Beyond the
direct effects of aggression from a partner, psychological aggression can make the relationship
an unsafe place to discuss and deal with a history of discrimination experiences. As with
discrimination, psychological aggression from a partner can heighten hypervigilance and stress
physiology, which can precipitate or maintain sleep disturbances (Pigeon et al., 2011; Woods et
al., 2010). Being on guard can become second nature for some individuals, particularly when
interpersonal aggression permeates multiple domains of someone’s life. With the addition of
partner aggression, the vigilance associated with experiencing discrimination may also extend to
the home and situations otherwise considered to be a safe haven. This study therefore
investigates the interactive effects of discrimination and partner psychological aggression on

12
sleep as a way to better understand the implications when these two significant interpersonal
stressors co-occur.
Gender Differences
Few studies have yet examined gender differences in the link between discrimination and
sleep, though existing studies have mixed findings. Among adolescents, one study found that
sleep was less affected by everyday discrimination among adolescent girls than among
adolescent boys (Yip et al., 2020); however, another study of adolescents found no effects of
gender on racial discrimination-sleep associations (Huynh & Gillen-O’Neel, 2016). A study of
Black and White adults found that links between racial discrimination and sleep disturbance
were stronger in men than women (Grandner et al., 2012). Investigating gender differences in
young adults may have unique results, as the onset of puberty in adolescence impacts girls’, but
not boys’, sleep (Knutson, 2005) and young adult men have worse objective sleep quality than
women, but women report more sleep difficulties (e.g., insomnia, inadequate sleep) than men
(Krishnan & Collop, 2006; Mallampalli & Carter, 2014). Additionally, perspective taking and
relationship aggression and their effects may vary by gender (Caldwell et al., 2012; Christov-
Moore et al., 2014; Desmarais et al., 2012). Thus, with gender potentially playing a role in the
three variables of interest here—discrimination, sleep, and relationships—further exploration of
the links between these variables is warranted.
Present Study
The present study investigates associations between discrimination and sleep through the
dyadic lens of romantic relationships by examining how a romantic partner’s behavior may alter
the relationship between discrimination and sleep. First, we seek to replicate previous literature
that links discrimination—presently focusing on perceived discrimination related to protected

13
class group membership—and later sleep difficulties (Hypothesis 1). Second, with no studies to
our knowledge examining relationship mechanisms moderating effects of discrimination on
sleep, this study extends the literature by investigating whether positive and negative relationship
qualities moderate the association between discrimination and later sleep difficulties.
Specifically, we hypothesize that partners’ perspective taking abilities will buffer the effect of
discrimination on future sleep difficulties (Hypothesis 2a) and partners’ psychological aggression
will exacerbate effects of discrimination on future sleep difficulties (Hypothesis 2b). Finally,
because the literature to date does not clearly shape hypotheses on gender differences pertaining
to the relationship context in the link between discrimination and sleep and others have called for
additional studies to evaluate gender differences in the discrimination-sleep link (Slopen et al.,
2016), this study includes gender as an exploratory variable. Specifically, we test whether the
association between discrimination and future sleep difficulties varies by gender and whether the
moderation effects of the relationship context on the association between discrimination and
sleep differ by gender.
Method
Overview
Participants for the current study came from a larger study on romantic relationship
functioning (see Margolin et al., under review). The larger study (N = 123 couples) involved a
prelab survey and lab visit, where partners completed questionnaires assessing past
discrimination experiences, perceptions of the partner’s perspective taking, and partner’s
psychological aggression within the current relationship. Approximately 1.5 years later (M =
17.5 months, SD = 6.5 months), participants were invited to take part in follow-up procedures,
including questionnaires on sleep quality and relationship status (i.e., still together or broken up).

14
Couples originally were recruited for the larger study from social media, postings in the
community, and invitations to participants who completed a prior study on adolescents and their
families. Eligibility for the study required that at least one partner was between 18-25 years of
age; one partner had lived in a two-parent family at least until the age of 10; and the couple had
been dating for at least two months.
Participants
Of the larger sample, 86 couples, two of which were same-sex, met the following
eligibility criteria to be included in the present study: 1) the romantic relationship remaining
intact as a primary relationship (27 couples had split up), and 2) at least one partner provided
follow-up data (10 couples had no follow-up data). In 8 of the couples, one partner did not
provide follow-up sleep data; however, their reports of psychological aggression were included
for calculating partner psychological aggression. Average relationship length for the 86 couples
at the beginning of the study was 29.5 months (range: 2-109 months, SD = 24.1), with 53.7% of
couples reporting that they were cohabitating. Participants’ mean age was 22.8 (range 18-41, SD
= 2.5) with 50.0% of participants in school at least part-time and 74.4% working at least part-
time. Participants were racially diverse (12.8% Asian, 14.0% Black, 25.6% Latinx, 15.9%
Multiracial, 31.7% White) and came from economically diverse backgrounds (6.7% reported that
their parents’ annual family income was less than $25,000, 15.9% between $25-50,000, 23.8%
between $50-100,000, and 31.7% over $100,000).
Measures
Perceived discrimination. Past experiences of discrimination were measured using 5
items of a longer survey assessing the extent to which participants have been “teased, picked on,
excluded from something [they] wished to do, felt disliked, or discriminated against” in their

15
lifetime due to specific characteristics (Rasmussen et al., 2018). The five items used here
represent discrimination related to membership in protected groups, specifically: being part of an
ethnic or racial group (endorsed as a source of discrimination by 35.4% of the sample); being
born outside of the U.S. (4.3% endorsed); being part of a religious group (14.1% endorsed); not
being masculine or feminine enough (17.7% endorsed); or having a disability or problem since
birth (3.7% endorsed). Across the items, 50.0% of women and 59.0% of men endorsed some
discrimination (i.e., responded to at least one item above a score of 0). Responses were provided
on a 4-point scale ranging from 0 (not at all) to 3 (a lot). Responses were averaged across the 5
items, with scores from the current sample ranging from 0.00 to 2.20.
Partner perspective taking. Participants reported on their partner’s perspective taking
abilities (i.e., adopting the psychological point of view of others) on a 7-item scale based on the
perspective-taking scale of the Interpersonal Reactivity Index (Davis, 1980). We modified the
scale to assess perceptions of the partner’s perspective-taking (e.g., before criticizing somebody,
my partner tries to imagine how he/she would feel if he/she were in their place). Responses are
on a 4-point Likert scale ranging from 1 (does not describe my partner well) to 4 (does describe
my partner well). Two items were reverse coded, and all items were averaged, with scores in the
current sample ranging from 1.00 to 4.00. Reliability across items for the present study was high
(α = .84).
Partner psychological aggression. Partner psychological aggression was assessed
through both partners’ responses to 27-items from the How Dating Partners Treat Each Other
questionnaire (Bennett et al., 2011). Each participant went through the same list of items two
times, first to report how often over the course of the current relationship their partner committed
each psychologically aggressive act (e.g., insulted you with put-downs) and then a second time

16
to report their own psychologically aggressive behavior toward their partner using the same
items (e.g., you insulted partner with put-downs). Response choices were on a 5-point scale
ranging from 0 (never happened) to 4 (more than 10 times). The scores for aggression used here
were based on partner reports of aggression perpetrated and self-reports of aggression received.
Participant and partner reports were compared item-by-item. Due to the potential for romantic
relationship aggression to be underreported by both victims and perpetrators (Chan, 2011), we
used the higher report of aggression against a participant for each item, and items were averaged
for a partner psychological aggression score for each partner. Scores ranged from 0.00 to 1.86,
with 61.6% of women and 66.7% of men reporting some partner psychological aggression.
Reliability for this scale in the present study was excellent (α = .93).
Sleep difficulties. A 14-item self-report survey based on a subset of items from the
Pittsburgh Sleep Quality Index (Buysse et al., 1989) was used to measure sleep-related
difficulties in the past month. Participants responded on a 5-point scale ranging from 1 (never) to
5 (almost every night) reporting how often sleep problems (e.g., having trouble getting to sleep
within 30 minutes; wake up in the middle of the night) occurred. A mean score was calculated
from all items, with scores from the current sample ranging from 1.00 to 3.43. Reliability across
items for the present study was high (α = .81).
Data Analysis
Descriptive statistics and bivariate correlations were computed for variables of interest,
and independent sample t-tests were conducted to compare women and men. Hypotheses were
tested using multilevel models with random intercepts to account for shared variance among
romantic partners. Participants (Level 1) were nested within couples (Level 2). Discrimination,

17
partner perspective taking, and partner psychological aggression were centered to their respective
means to avoid multicollinearity and for ease of interpretation.
Model 1 tested Hypothesis 1, a multilevel model with perceived discrimination predicting
later sleep difficulties. For Hypothesis 2, we ran two additional models to test the moderating
effects of relationship factors: Model 2a tested Hypothesis 2a, adding partner perspective taking
and the interaction between discrimination and partner perspective taking as predictors, and
Model 2b tested Hypothesis 2b, adding partner psychological aggression and the interaction
between discrimination and partner psychological aggression to Model 1. For our exploratory
aim, we ran a separate multilevel model that added the interaction between discrimination and
gender to Model 1. Next, we added 3-way interaction terms between discrimination, either
partner perspective taking or partner psychological aggression, and gender and the corresponding
2-way interaction terms to Models 2a and 2b.
All models controlled for Level 1 variables of race, gender, and time between the first set
of surveys and the follow up survey, and Level 2 variables of length of the relationship and co-
habitation. In light of the literature on racial differences in sleep quality in both adolescents and
adults (Lewis et al., 2013; Tomfohr et al., 2012; Yip et al., 2020), we adjusted for race to account
for other sources of racial differences in sleep beyond discrimination, e.g., comorbid health
conditions (McWilliams et al., 2009) or living in lower income neighborhoods (Sheehan et al.,
2018). Race was dummy coded to have five categories: Asian, Black, Latinx, Multiracial, and
White, and White, as the largest racial group in the sample, was used as the reference group. In
addition to exploring the effects of gender as an exploratory aim, gender was included as a
covariate (1 = women; 0 = men) in all analyses. Given some variability between the first and
second time points of data collection, we adjusted for the time between these two assessments,

18
measured in days. The length of the romantic relationship, measured in months, was included as
a covariate, as various relationship qualities such as partner perspective taking or aggression may
be reported differently or have different impacts depending on how long an individual has been
in a relationship. Additionally, cohabitation can impact relationship quality and sleep quality
(Diamond et al., 2008), and thus was also included as a covariate (1 = cohabitating; 0 = not
cohabitating). Significant interaction effects were decomposed through simple slopes analyses.
Mean-centered discrimination and relationship variables were plotted at 1 SD above the mean,
the mean, and 1 SD below the mean or the minimum value if the minimum value was higher than
1 SD below the mean.
Results
Descriptive Statistics
Bivariate correlations, descriptive statistics by gender, and results from independent
samples t-tests between men and women appear in Table 1. Bivariate correlations show that
women who report more partner perspective taking report lower partner psychological
aggression. Men who report higher perceived discrimination report more sleep difficulties.
Results from independent samples t-tests show that women report more sleep difficulties than
men. No other differences were found between men and women in the variables of interest.
Multilevel Models
Table 2 presents the multilevel model results testing the main study hypotheses. In Model
1, consistent with Hypothesis 1, discrimination was associated with more sleep difficulties. In
Model 2a, consistent with Hypothesis 2a, partner perspective taking moderated the association
between perceived discrimination and sleep difficulties. The plot in Figure 1a shows a positive
association between discrimination and sleep difficulties among those in relationships with low

19
partner perspective taking (i.e., 1 SD below the mean, b = 0.47, p < .001) but not average (i.e., at
the mean, b = 0.23, p = 0.06) or high partner perspective taking (i.e., 1 SD above the mean, b = -
0.01, p = .96). In Model 2b, consistent with Hypothesis 2b, partner psychological aggression
moderated the association between perceived discrimination and sleep. The plot in Figure 1b
shows a positive association between discrimination and sleep difficulties among those
experiencing high partner psychological aggression (i.e., 1 SD above the mean, b = 0.62, p
< .001) but not among those experiencing average (i.e., at the mean, b = 0.20, p = 0.10) or no
partner psychological aggression (i.e., the minimum value, b = -0.10, p = .58). In all models, a
main effect emerged for gender with women reporting more sleep difficulties. However, no
significant findings emerged in models testing the two-way interaction between discrimination
and gender (b = -0.29, p = .22); the three-way interaction between discrimination, partner
perspective taking, and gender (b = 0.04, p = .91); nor the three-way interaction between
discrimination, partner psychological aggression, and gender (b = 1.76, p = .11) predicting future
sleep difficulties. Due to the null results of exploratory analyses, these models were not
presented in a table.
Discussion
The present study tested whether specific protective and risky qualities in a romantic
partner influence links between discrimination and subsequent sleep difficulties. In line with
previous research and consistent with our first hypothesis, higher perceived discrimination was
associated with more sleep difficulties. Consistent with a buffering hypothesis, the link between
discrimination and sleep was not significant when partners were described as showing high
perspective taking but was significant for those who described partners as low on perspective
taking. Moreover, consistent with our hypothesis that psychological aggression would exacerbate

20
effects of discrimination, positive associations between discrimination and sleep difficulties
emerged when partners showed high levels of psychological aggression but not in the absence of
partner psychological aggression. Together, these findings suggest that the health-related
ramifications of discrimination, as measured through self-reported sleep difficulties, may vary
based on characteristics of an ongoing relationship. In this study of young adults, these findings
did not differ by gender, although women reported more sleep difficulties.
As others have noted (Griggs et al., 2017; Serchen et al., 2020; Williams et al., 2019), the
insidious impact of discrimination on health demands societal attention, and this study
underscores prior findings that discrimination is linked to fundamental biological processes such
as sleep (Slopen et al., 2016). Moreover, the prospective nature of the study provides elucidation
on longer-term effects of discrimination on sleep difficulties. That discrimination is associated
with sleep over a year after the assessment of reported discrimination experiences highlights the
potential long-term impacts of discrimination. Additionally, showing this link between
discrimination and sleep difficulties as early as young adulthood leaves substantial time for the
possibility of intervening on negative effects of discrimination on long-term health problems
associated with poor sleep. Some studies investigate discrimination due to one facet of identity
(e.g., sexuality or race; Bauermeister et al., 2014; Lee et al., 2016) while others investigate
multiple sources of discrimination (Ghabrial, 2017; Gonzales et al., 2019). In our sample, we
assessed discrimination related to identification with five protected groups. Over half of the
participants endorsed some level of discrimination and 17.6% of the sample reported more than
one type of discrimination, showing high rates of perceived discrimination due to even a few key
identity characteristics in young adulthood.

21
Findings from this study show the salience of romantic relationships as an important
context for understanding discrimination as a health risk. This study contributes to a growing
literature suggesting that positive relationship contexts can mitigate associations between early
adverse life events and later health consequences, whereas risky relationships can exacerbate
such effects. Relationships offer opportunities for mitigating and perhaps even repairing the
biological impact of life’s harsh blows (Liebman et al., 2020; Rosand et al., 2012). Other studies
have shown buffering effects of romantic relationship qualities on the link between
discriminatory experiences and mental (Rollock & Lui, 2016) and physical health (Williams et
al., 2019). The present study extends those findings to the everyday restorative process of sleep.
In the present study, the interactive effect between discrimination and partner perspective
taking indicates that perspective taking has meaningful implications for those who have a history
of discrimination. This interactive effect between discrimination and perspective taking,
however, still leaves open several interpretations. For example, does partner perspective taking
buffer the impact of discrimination on sleep because the individual knows there is a sympathetic,
caring person who can provide respite from other pains in life? Or is the buffering due to
communication between partners about the discrimination—that is, their partner listens to, helps
process, and helps cope with discrimination experiences? A study of African American couples
showed evidence that racism-specific support—assessed by a single item, “If you experienced an
act of racism, how likely is it that talking to your mate would help you feel better?”—was
associated with better mental and physical health overall and also buffered effects of
discrimination on mental health in wives (McNeil Smith et al., 2020). Yet, even this study did
not examine support from a partner directly in relation to an experience of discrimination. While
our study examined perspective taking as a general characteristic of the partner, follow-up

22
studies should investigate whether and how this characteristic translates into specific interactions
and conversations between the partners surrounding discrimination.
The interaction between discrimination and partner psychological aggression illustrates
how the co-occurrence of risks can increase sleep difficulties. The present study’s findings
suggest that the presence of risk in multiple interpersonal contexts allows the harm from these
experiences to accrue rapidly enough that sleep consequences are detectable in young adulthood.
Both discrimination and psychological aggression are potentially traumatic events, and although
trauma is not assessed here, it may be an explanatory factor for the interaction’s significant
association with more sleep difficulties (Woods et al., 2010). Additionally, our findings may also
suggest that the absence of aggression may be indicative of a relationship that ameliorates effects
of interpersonal threats in other areas of life. For example, less relationship aggression is found
in partners who are securely attached (Miga et al., 2010). Having a non-aggressive partner may
indicate a partner who provides security and refuge, and thus could be a “safe base” from
external social injury. Examining additional relationship qualities such as attachment style and
the associations between risky and protective relationship qualities is warranted.
The present study did find higher levels of self-reported sleep difficulties in women
compared to men, which is consistent with prior research (Krishnan & Collop, 2006). However,
no evidence for gender differences in the association between discrimination and sleep
difficulties emerged, nor gender differences in how relationship qualities impacted this
association. Issues of power may have been a limitation for 3-way interactions testing effects of
gender, discrimination, and couple qualities on sleep. Additional studies are needed to determine
whether the discrimination-sleep link and impacts of the relationship context on this link are
similar across men and women during young adulthood. For example, studies with a larger

23
sample may seek to test gender differences across various time periods, as women’s sleep
changes across the menstrual cycle (Baker & Lee, 2018), and by using both objective and
subjective measurements of sleep, as men and women differ across various sleep difficulties
(Krishnan & Collop, 2006).
Limitations and Future Research
This study should be considered with a number of limitations in mind. First, though we
aimed to assess discrimination due to a variety of characteristics, there are still more
comprehensive ways to assess discrimination: for example, focusing more on experiences of
systemic discrimination in addition to personal attacks and slights. Moreover, because we used
one-time self-report measures, we lack information about temporal connections among the
constructs and whether the discrimination is ongoing or a past event. More precise measurement
of discrimination is necessary to understand whether effects on sleep are immediate, long-term,
or both. Relatedly, it would be helpful to know if the moderating influences of couple
relationships apply to ongoing or past discrimination. Additionally, it has been shown that young
people’s interpretations of negative interpersonal experiences vary depending upon the
experiences of those in their immediate social networks (Schacter & Juvonen, 2019). More in-
depth exploration of adverse consequences of discrimination, such as sleep difficulties, needs to
go hand-in-hand with more nuanced assessments of discrimination experiences, their persistence
over time, and the overall context in which they occur. As per recent studies using repeated,
daily measures of discrimination (Livingston et al., 2017; Wang & Yip, 2020), future studies
using techniques like ecological momentary assessment can assess day-to-day fluctuations in
discrimination, couple interactions, and sleep quality to test temporal as well as directional links
between these variables.

24
Second, predictive and bidirectional effects across variables of interests not examined in
the present study have been shown in other studies. For example, discrimination experiences
predict increased aggression perpetration (Lavner et al., 2018) and bidirectional aggression
(Forster et al., 2017). Other research shows that sleep difficulties can precipitate hostilities in
couples (Wilson et al., 2017). With high likelihood of discrimination’s influences on relationship
processes and bi-directional influences between couple qualities and sleep (Hasler & Troxel,
2010), other models deserve attention. Third, partner perspective taking was assessed as a
general quality of one’s partner. Questions surrounding this construct could also address partner
perspective taking with respect to specific discrimination experiences. Fourth, the assessment of
sleep difficulties here is quite broad, and sleep could be measured more precisely through daily
data and objective measures of sleep such as actigraphy. Relatedly, the study of other biological
experiences of stress and biobehavioral regulation could further elucidate the questions
addressed here. Fifth, participants in this study are young adult couples, which may
underestimate these results relative to older individuals who have a longer history of
discrimination experiences. In addition, these are almost exclusively heterosexual couples from a
large metropolitan U.S. city, and thus, these results may not generalize to couples in non-
heterosexual relationships, longer relationships, or those living in different types of geographic
regions.
Despite these limitations, this study offers evidence that injurious impacts of
discrimination can extend over months and years and can affect sleep, an important biological
regulatory process. Finding a link between discrimination and sleep difficulties even in young
adulthood suggests the possibility of substantial cumulative effects across the life span. Though
research on discrimination typically examines impacts on individuals, increasing attention is

25
being directed to the intersection of discrimination and social support systems, such as romantic
partners (McNeil Smith et al., 2020; Rollock & Lui, 2016). Examining effects of romantic
relationships on the link between discrimination and future sleep difficulties in young adults—
who are more prone to relationship aggression than other adults (Breiding et al., 2014; Rivara et
al., 2009) and are not as likely to be married or in more permanent forms of relationships—
allows us to understand these relationship factors during a more malleable life stage. Given that
relationships are amenable targets of intervention, an important future focus is identifying ways
to enhance the protective qualities of relationships and minimize the aggravating effects of
relationships on the toll of discrimination. Interventions to reduce negative impacts of
discrimination should be multipronged and focus on the individual, their context, and societal
structures. Based on the findings here, strengthening reparative processes in romantic
relationships is one potential means of curtailing adverse effects of discrimination.

26
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34
Table 1

Bivariate Correlations and Descriptive Statistics for Main Study Variables by Gender (N = 86
women, 78 men)
Variables Bivariate correlations Descriptives
Women Men
1 2 3 4 M (SD) M (SD)
1. Perceived Discrimination -- -.06 .14 .17 0.3 (0.4) 0.2 (0.3)
2. Partner Perspective Taking -.09 -- -.26* -.10 2.9 (0.7) 2.8 (0.7)
3. Partner Psychological
Aggression
.04 -.02 -- .08 0.2 (0.2) 0.2 (0.3)
4. Sleep Difficulties at Follow Up .36** -.22 .01 -- 2.1 (0.5)
a
1.7 (0.4)
a
Note. Correlations for women are above the diagonal and for men are below the diagonal.
a
Independent t-tests showed women reported significantly more sleep difficulties than men (F =
7.19, p < .01). Independent t-tests for differences between men and women for all other
variables of interest were non-significant.
*p<.05; **p<.01, ***p<.001.

35

36

37
Chapter 3
Paper 2
Manuscript invited for revision.

Anti-Black Violence, Discrimination, and Sleep Difficulties Amongst Racially Diverse
Americans: The Aftermath of the Murder of George Floyd

Yehsong Kim
ac
, Alexis M. Beale
ad
, Hannah F. Rasmussen
ae
, Kelly F. M. Kazmierski
bf
, Gayla
Margolin
ag

a
University of Southern California
3620 South McClintock Ave, SGM 501
Los Angeles, CA 90089, USA

b
University of California, Irvine
4201 Social & Behavioral Sciences Gateway
University of California Irvine
Irvine, CA 92697, USA

38
Abstract
To contribute to burgeoning research on discrimination and vicarious racism, the present
study applied the concept of vicarious racism to examine vicariously witnessed anti-Black
violence in 2020—i.e., the murder of George Floyd and other Black Americans. We examined
negative impacts of anti-Black violence (NIAV) and personal experiences with discrimination in
association with sleep difficulties, a critical intermediary health process. Participants in this
cross-sectional study were racially diverse Americans (N = 487) recruited between December 11,
2020 and February 11, 2021. Black participants endorsed greater NIAV than Asian, Latinx, and
White participants. Moreover, Black, Asian, and Latinx participants reported greater direct
discrimination than White participants. NIAV and direct discrimination were each associated
with more sleep difficulties. Although associations between NIAV and sleep difficulties did not
vary by race, race moderated the association between direct discrimination and sleep difficulties.
In addition, direct discrimination moderated the association between NIAV and sleep difficulties
in an unanticipated direction: the link between NIAV and sleep difficulties was weaker for those
experiencing more direct discrimination. Findings suggest that anti-Black violence and police
brutality not only impact targeted victims but have wide-spread vicarious impacts on racially
diverse Americans, and highlight that vicarious anti-Black racism and discrimination are
important issues of public health.

Key words: anti-Black violence, vicarious racism, discrimination, race, sleep

39
Black Americans are disproportionately more likely to be killed by police than White
Americans (Edwards et al., 2019; Schwartz & Jahn, 2020), and similar racial disparities exist for
non-lethal force (Hollis & Jennings, 2018). In addition to the evident impacts of anti-Black
violence on victims of these assaults, effects of such incidents also have ripple effects. Even
without directly experiencing or witnessing these events, proximity in space and time to police
killings of unarmed Black Americans is associated with negative mental health impacts on Black
individuals in the general population (Bor et al., 2018; Curtis et al., 2021). In 2020—during
which Breonna Taylor, George Floyd, and many other Black Americans were murdered—most
Americans were exposed through various media to vivid details of anti-Black violence (Sanders,
2020). Exposure to anti-Black violence is widespread and repeated, yet rarely studied. Therefore,
this paper investigates the negative impact of anti-Black violence (NIAV)—a form of vicarious
racism. We examine both NIAV and direct, personal experiences of discrimination, separately
and in combination, as predictors of sleep quality in a diverse sample of Americans.
The current study builds upon both an emerging literature linking vicarious racism to
health (Chae et al., 2021; Martz et al., 2019) and a considerable literature tying direct
experiences of discrimination to health (Schmitt et al., 2014; Slopen et al., 2016). We focus on
sleep difficulties, as poor sleep has been identified as one pathway by which discrimination
affects health (Hisler & Brenner, 2019), suggesting that sleep could be an intervention target for
mitigating effects of discrimination on health. Whereas much of the existing literature on
vicarious racism and health has assessed racial group differences only between Black and White
individuals, we also include Asian and Latinx participants to assess whether highly publicized
incidents of anti-Black violence differentially impact Black participants compared to those of

40
other races, and we examine race as a possible moderator of links between vicarious anti-Black
racism or direct discrimination and sleep difficulties.
Impact of Anti-Black Violence, a Form of Vicarious Racism
Vicarious racism is the secondhand exposure to racism directed at another individual
(Heard-Garris et al., 2018). The anti-Black violence witnessed via media in 2020 is a form of
vicarious racism and aspects of these experiences may be unique compared to other studied
forms of vicarious racism, which often focused on witnessing peers or family members
experience racism. In recent years, much of the anti-Black violence seen and highlighted in
media has been perpetrated by police. Police enacting extrajudicial violence may be particularly
disturbing because such actions are antithetical to the stated purpose of police, i.e., to “protect
and serve”; most of the victims were unarmed and non-threatening; and police officers have
rarely been prosecuted for use of excessive force, suggesting that the justice system will not
prosecute police regardless of circumstance (Simmons, 2015). Lending support to the emotional
impact of vicariously experienced police violence, a group of Black Americans in a qualitative
study expressed how stories and graphic images of police brutality led to increased emotional
strain, chronic fear, and helplessness (Hawkins, 2021). In addition, media in the present day is
more pervasive than it has been in the past. Witnessing police brutality via media allows for
seeing incidents that occur across the country, often on repeating news cycles, and witnessing
heart-wrenching testimonies of family and friends. Moreover, it is a relatively recent
phenomenon that these events are now captured via video, which shows graphic details and
allows for repeated sharing via social media, increasing the omnipresence of these incidents.
Several theories explain how vicarious racism might negatively impact individuals, and
why identification with victims may be an important factor. First, in line with social identity

41
theory (Haslam et al., 2020), seeing discrimination against those in one’s own social group may
threaten a sense of self and community, leading to lower self-esteem (Liang & Fassinger, 2008)
and poorer mental health (Crocker et al., 1994). Second, historical trauma theory (Sotero, 2006)
suggests that seeing acts of anti-Black violence may elicit historical memories of slavery,
lynching, and other forms of brutality and result in collective anger, grief, and hopelessness
(Hawkins, 2021). Third, vicarious racism may lead to fear of something similar happening to
oneself or a loved one, possibly eliciting a mental and physiological stress response (Alang et al.,
2017). Together, these theories offer explanations as to why Black individuals may be most
adversely impacted by anti-Black violence.
However, the assumption that effects of vicarious racism are limited to those of the same
racial group remains largely untested. To date, studies of vicarious racism generally examined
witnessing racism towards those of one’s own ethnic or racial group, maintaining the assumption
that sharing the racial identity of the victims is a relevant factor but not testing it directly. Two
studies that did test racial differences show that proximity to anti-Black violence has negative
impacts on the mental health of Black Americans but not White Americans (Bor et al., 2018;
Curtis et al., 2021). However, in another study, symptoms of depression and anxiety were higher
after the murder of George Floyd in both Black and Asian Americans, but not in Latinx or White
Americans (Fowers & Wan, 2020). Though reasons for increased mental health symptoms in
Asian but not Latinx or White Americans are unclear, this finding suggests that anti-Black
violence can also impact the mental health of non-Black individuals. Therefore, in the present
study, we first seek to test whether negative emotional and cognitive impacts of vicariously
witnessing anti-Black violence in 2020 vary across racial groups.

42
Direct Discrimination
In contrast to vicarious racism, psychology research to date has primarily focused on an
individual’s direct experiences with discrimination, particularly, interpersonal encounters (e.g.,
microaggressions, threats, inferior care). Direct discrimination has been linked to negative
mental health outcomes, including depression and alcohol-related disorders (Goto et al., 2013),
as well as physical health outcomes, such as hypertension and adverse birth outcomes (Alhusen
et al., 2016; Dolezsar et al., 2014). Much of the discrimination literature has focused on racial
discrimination, which is experienced primarily by non-White individuals (Lee et al., 2019). Non-
White individuals, who already have marginalized racial-ethnic identities, also report
experiencing more discrimination due to characteristics other than race. However, regardless of
the characteristic targeted for discrimination (e.g., disability status, health status, sexuality),
similar negative mental and physical health outcomes are noted (Logie et al., 2013; Rogers et al.,
2015; Sutter & Perrin, 2016).
Sleep Difficulties, Vicarious Racism, and Discrimination
Sleep is a critical, yet understudied intermediary health process that is susceptible to
stressful life events (Âkerstedt, 2006). Sleep has implications for health problems, such as risk
for the development and progression of cardiovascular diseases, metabolic diseases, and cancer
(Luyster et al., 2012). Discrimination has been identified as one of many psychosocial stressors
that can lead to sleep difficulties, including insomnia, fatigue, and shortened sleep duration
(Lewis et al., 2013; Slopen et al., 2016). A comprehensive review by Slopen et al. (2016) shows
links between direct discrimination and sleep across genders, races, and nationalities, with
discrimination including experiences of racism, ageism, and sexism. In addition, sleep has been
identified as a pathway by which discrimination negatively impacts health (Hisler & Brenner,

43
2019). The magnitude of associations between everyday discrimination and sleep duration,
quality, complaints, and latency did not vary by racial/ethnic group, when measured among
Native, Asian, Black, and White Americans (Hill et al., 2021; Lewis et al., 2013).
With respect to vicarious racism, studies on links to sleep thus far have primarily been
limited to vicarious racism experienced by those within one’s immediate family or social
network. Specifically, mothers of youth who have experienced stops by police were twice as
likely as other mothers to report depression and anxiety-related sleep difficulties (Jackson &
Turney, 2021). Among Australian adolescents, those who had witnessed peers being
discriminated against due to race or culture experienced shorter sleep duration, longer sleep
latency, and increased sleep disruption (Priest et al., 2020). One study examining anti-Asian
vicarious racism experiences among Asian Americans during the COVID-19 pandemic
examined vicarious racism using a measure that included both racism vicariously witnessed
within one’s personal social network and more distally, e.g., from social media (Yip et al., 2022).
These experiences of anti-Asian vicarious racism were associated with poorer sleep quality and
duration, suggesting that vicariously witnessing racism beyond one’s own network similarly
relates to poorer sleep. The present study furthers the investigation of links between vicarious
racism beyond one’s own social network and sleep by examining the impacts of anti-Black
violence and police killings of Black Americans that occurred in 2020. Furthermore, as the first
study to our knowledge to examine the link between impacts of vicarious anti-Black violence
and sleep, we investigate whether this link differs between Black and non-Black people.
Combined Impacts of Vicarious Racism and Direct Discrimination
One important question is whether and how individuals’ personal histories of
discrimination affect their response to seeing and hearing about similar events occurring in the

44
world. The few studies examining both vicarious racism and direct discrimination provide mixed
findings. In a study of ethnically diverse, immigrant Australian adolescents, no relationship was
found between vicarious racism at school and depressive symptoms beyond effects of individual
experiences of racial discrimination at school (Priest et al., 2017). However, in a study of Black
and Latinx U.S. college students, learning about the mistreatment of people of color on social
media and direct discrimination both related to increased stress physiology, though effects
differed depending on students’ racial-ethnic background and level of acculturation (Cheadle et
al., 2020). Similarly, among Black American women, direct racial discrimination and vicarious
racial discrimination were each associated with increased odds of preterm labor (Daniels et al.,
2020). These studies primarily sought to examine vicarious racism and direct discrimination as
two separate types of experiences that each related to a health outcome. Another study of Black
and White South African adults (Fourie et al., 2019) conceptualized direct discrimination as an
individual contextual factor that informs peoples’ reactions to vicarious racism. In that study, a
history of interpersonal discrimination was associated with heightened brain activity, indicative
of heightened salience, when watching video clips of victims and perpetrators of apartheid
crimes. The present study similarly seeks to investigate discrimination as a contextual factor
possibly relevant to the link between reactions to the anti-Black violence that occurred in 2020
and sleep difficulties.
Present Study
The current study extends the concept of vicarious racism to the highly publicized
incidents of anti-Black violence in 2020 and investigates the separate and combined impacts of
vicarious racism and direct discrimination on sleep difficulties. We conceptualize the vicarious
racism examined here as the negative impact of anti-Black violence (NIAV), that is, the

45
experience of distressing emotions (e.g., pain, fear) and cognitive difficulties (i.e., difficulty
concentrating) connected to vicariously witnessing widely publicized incidents of lethal violence
against Black Americans. As few studies have examined Asian and Latinx individuals when
examining the impact of anti-Black violence, we recruited Asian, Latinx, and White along with
Black participants.
We test the following five hypotheses. First, given the specific salience of NIAV for
Black Americans, we anticipate higher NIAV in Black Americans compared to other racial
groups. Second, we hypothesize that non-White racial groups will report higher direct
discrimination than White Americans. Third, we hypothesize NIAV and direct discrimination
will each be associated with more sleep difficulties, even when controlling for the other. Fourth,
given that NIAV specifically addresses violence against Black Americans, we expect the
association between NIAV and sleep difficulties to be stronger for Black participants than
participants of other races. However, in line with previous literature (Hill et al., 2021; Lewis et
al., 2013), we do not anticipate the association between direct discrimination and sleep to differ
by race. Fifth, we anticipate that discrimination will moderate the effect of NIAV on sleep
difficulties such that those with more direct discrimination experiences will have a stronger
positive association between NIAV and sleep difficulties.
Method
Sample and Procedure
Participants in the present study were drawn from a sample of 504 racially diverse
Americans recruited for an online survey via Prolific as part of a pre-registered study on
romantic couple’s functioning during the COVID-19 pandemic. Approval from the [University
blinded] Institutional Review Board was obtained. To be included in the larger study,

46
participants had to be 18 years or older, living with a romantic partner, and residing in the U.S.
Roughly equivalent numbers of Asian (N = 110), Black (N = 108), Latinx (N = 113), and White
(N = 156) participants were recruited. Participants ranged in age from 19-72 (Mage = 34.6, SDage
= 9.8); men comprised 47.8% with 1 transgender woman and 2 gender non-binary/non-
conforming participants. Participants were encouraged to invite their romantic partner to also
complete the online study; 106 paired couples were part of the total sample. Surveys were
completed between December 11, 2020 and February 11, 2021.
To be included in the present study, participants needed to have missed no more than one
of four attention checks and identify as monoracial. Two participants were excluded due to
missing attention checks and 15 participants were excluded due to identifying as multiracial,
leaving 487 participants. Sociodemographic characteristics appear in Table 1.
Measures
Negative Impact of Anti-Black Violence (NIAV). NIAV was assessed with four Likert items
developed for this study prefaced with the following statement: “People have been affected
differently by the violent deaths of Ahmaud Arbery, Breonna Taylor, George Floyd, and others.
To what extent do the following statements describe your reactions to these deaths and the
movement against racial injustice?” The four items were: the violent deaths of Black people have
caused me pain and/or frustration; I am concerned for my personal safety due to the color of my
skin or my race; I am concerned for the safety of a loved one due to the color of their skin or
their race; I am struggling to concentrate on everyday activities due to these deaths (α
= .82). Response options were “Not at all” (0), “A little” (1), “A moderate amount” (2), and “A
lot” (3). A mean NIAV score was calculated across the four items, with scores ranging from 0.0
to 3.0 (Cronbach’s α = .82).

47
Direct Discrimination. Direct discrimination was assessed using items adapted from the
Everyday Discrimination Scale (Williams et al., 1997). Participants were asked, “How often
have you experienced the following discriminatory experiences?” For purposes here, we
included four serious forms of discrimination: verbal harassment/name-calling/threats; being
coughed at/spat upon; physical assault; and racial profiling. As the larger study focused on the
COVID-19 pandemic, participants completed four items twice, first with respect to lifetime
occurrence prior to the pandemic and second, since the pandemic began (Cronbach’s α across all
eight items = .83). Response options for both time periods were “Never” (0), “Infrequently” (1),
“Frequently” (2), and “All the time” (3). If participants endorsed any of the items, they were
asked to identify the primary characteristic (i.e., race/ethnicity, religion, gender, sexual
orientation, disability) that was targeted in these incidents. A mean score was calculated for the
four items for each time frame. Given the high correlation between the two discrimination scores
(r = .73, p < .001) and to account for both lifetime and recent experiences, the two mean scores
were summed to calculate an overall discrimination score. Scores ranged from 0.0 to 5.1.
Sleep Difficulties. Sleep difficulties were assessed using six items modified from the Pittsburgh
Sleep Quality Index, e.g., trouble falling asleep (took more than 30 minutes); bad dreams
(Buysse et al., 1991). Response options to the question “how often have you experienced the
following over the past month?” were “Not during the past month” (0), “Less than once a week”
(1), “Once or twice a week” (2), and “Three or more times per week” (3). A mean score was
calculated from all items, with scores from the current sample ranging from 0.0 to 3.0
(Cronbach’s α = .86).

48
Statistical Analysis
First, to test racial group differences in NIAV (Hypothesis 1) and discrimination
(Hypothesis 2), between-subjects ANOVA and post-hoc Tukey HSD tests were conducted
between all groups. Similar descriptive analyses were conducted for sleep. To test the remaining
Hypotheses 3-5, we conducted four multilevel models with random intercepts to account for
shared variance among partnered couples. Missing data were accounted for through multiple
imputation to minimize bias (Sidi & Harel, 2018), using the MICE and MICEADDS packages in
R (Robitzsch & Grund, 2021; van Buuren & Groothuis-Oudshoorn, 2011). Participants (Level 1)
were nested within couples (Level 2). NIAV and direct discrimination were grand mean centered
to avoid multicollinearity and for ease of interpretation. Covariates in all multilevel models were
gender, coded as man (1) vs. not a man (0) due to a few gender non-binary participants; age;
couple income; and race, dummy coded as Asian, Black, Latinx, and White, with Black as the
reference group.
The first multilevel model tested NIAV and direct discrimination as separate predictors of
sleep difficulties, controlling for the other predictor (Hypothesis 3). The second multilevel model
examined the moderating effect of race on the association between NIAV and sleep difficulties,
controlling for discrimination. In a parallel fashion, the third model examined the moderating
effect of race on the association between direct discrimination and sleep difficulties, controlling
for NIAV (Hypothesis 4). The fourth model examined the moderating effect of direct
discrimination on the association between NIAV and sleep difficulties (Hypothesis 5). Simple
slopes analyses were conducted for significant interactions. Interactions were tested at +1 SD, the
mean, and -1 SD for NIAV, and at +1 SD, the mean, and none (as -1 SD was below none) for
direct discrimination.

49
Results
Table 2 provides descriptive data on the main variables of interest and item endorsement
of NIAV and direct discrimination for the total sample and by race. Pearson correlation
coefficients showed that NIAV and direct discrimination were correlated across the whole
sample (r = .44, p < .001) and within each racial group (Asian: r = .40, p < .001; Black: r = .42,
p < .001; Latinx: r = .36, p < .001; White: r = .25, p = .002).
Table 2 also presents racial group comparisons for NIAV and direct discrimination.
Consistent with Hypothesis 1, results of ANOVA and post-hoc Tukey HSD tests showed
significant differences between racial groups on NIAV [F(4, 483) = 53.27, p < .001] such that
Black participants reported higher NIAV than Asian (estimate = 0.68, p < .001), Latinx
(estimate = 0.94, p < .001), and White (estimate = 1.11, p < .001) participants. In addition,
Asian participants also reported higher NIAV than Latinx (estimate = 0.30, p = .01) and White
(estimate = 0.40, p < .001) participants. Consistent with Hypothesis 2, racial groups also
differed on direct discrimination [F(4, 483) = 20.00, p < .001] such that White participants
reported less direct discrimination than Black (estimate = 0.67, p < .001), Asian (estimate =
0.56, p < .001), and Latinx (estimate = 0.27, p = .03) participants. Further differentiation also
emerged between racial groups with Black participants (estimate = 0.40, p = .001) and Asian
participants (estimate = 0.29, p = .02) reporting higher direct discrimination than Latinx
participants. Although we did not hypothesize about racial differences in sleep, there was a
significant difference in sleep difficulties [F(4, 483) = 6.91, p < .001], such that Black
participants reported fewer sleep difficulties than Asian (estimate = -0.41, p = .002), Latinx
(estimate = -0.47, p < .001), and White (estimate = -0.36, p = .003) participants.

50
Table 3 presents results for all multilevel models. Consistent with Hypothesis 3, NIAV
and direct discrimination were each associated with more sleep difficulties, as seen in Model 1
and Figure 1. That is, NIAV and direct discrimination each contributed unique variance to sleep
difficulties above and beyond the other. Contrary to Hypothesis 4 that NIAV would have
stronger associations with sleep difficulties for Black participants, no differences emerged in
comparisons between Black participants and participants of other races (shown in Model 2). Also
contrary to Hypothesis 4 where we did not expect group differences for the association between
direct discrimination and sleep difficulties, Latinx participants significantly differed from Black
participants, (shown in Model 3). Simple slope analyses presented in Figure 2 show the
association between direct discrimination and sleep difficulties was significant for all racial
groups (Asian: b = 0.23, p = .006, Latinx: b = 0.34, p = .002, White: b = 0.28, p = .007) except
for Black (Black: b = 0.07, p = .42).
In Model 4, which tested whether direct discrimination moderates the association
between NIAV and sleep (Hypothesis 5), a significant interaction emerged but the pattern of
moderation was not as hypothesized. Simple slope analyses presented in Figure 3 show a
significant positive association between NIAV and sleep difficulties in those who experienced no
direct discrimination (b = 0.18, p = .003) but not in those who experienced mean (b = 0.10, p
= .06) or high levels of direct discrimination (i.e., b = 0.01, p = .90).
Discussion
The present study addresses vicarious racism with respect to the highly publicized anti-
Black violence of 2020 of which George Floyd’s murder was a cornerstone of national attention.
NIAV was reported at higher levels by Black participants compared to participants of other races
but was reported to some degree across all races. In addition, Black, Asian, and Latinx

51
participants reported experiencing greater direct discrimination than White participants. While
accounting for the other, NIAV and direct discrimination were each associated with more sleep
difficulties. The link between NIAV and sleep difficulties did not differ by race whereas the link
between direct discrimination and sleep difficulties did differ by race. Direct discrimination was
unrelated to sleep difficulties for Black participants but was significantly linked for participants
of other races. In addition, a significant interaction between NIAV and direct discrimination
emerged, although in an unexpected direction; a significant positive association between NIAV
and sleep difficulties was found only for those with lower levels of direct discrimination.
Our finding that Black participants reported higher NIAV than non-Black participants
suggests that vicarious racism is experienced more acutely by persons of the same racial identity
as the targeted victims. Of the top quartile of scores on NIAV, 54.1% are Black participants
though Black participants are only 22.2% of the sample, thereby supporting prior theoretical
explanations (Alang et al., 2017; Haslam et al., 2020; Sotero, 2006) about the toll incurred by
those who share an identity with the victim of a racist attack. Thus, vicarious anti-Black racism
is putatively impacting Black individuals disproportionately through heighten emotional pain,
concern for the safety of self or loved ones, and difficulty concentrating in reaction to vicarious
exposure to anti-Black violence and, as reported in other investigations (Eichstaedt et al., 2021),
greater anger, sadness, depression, and anxiety following George Floyd’s death compared to
White Americans.
It is important to note, however, that NIAV was reported by persons of each racial
identity represented here. Based on our results, over 85% of Asian, Latinx, and White
participants also endorsed some negative impacts of anti-Black violence. Another survey
(Fowers & Wan, 2020) similarly reported an increase in mental health symptoms in Asian

52
Americans as well as Black Americans subsequent to anti-Black incidents. Yet, few studies have
examined negative impacts of vicarious racism directed at one racial group on those from other
racial groups, nor have they included multiple non-White racial groups, suggesting that the scope
of impacts of vicarious racism is still underrepresented. For persons who are not Black,
experiencing NIAV may signify greater awareness of anti-Black racism, and more empathy
toward the victims of such racism. Moreover, it is possible that the discomfort of NIAV can
translate into positive consequences if it promotes responsiveness and engagement with action
against anti-Black racism. In fact, the murders of George Floyd and other Black Americans
during 2020 were said to catalyze considerable consensus among Americans that racism is a
current and persistent problem (Dann, 2020). Future research is needed to understand the
ramifications of NIAV on people’s beliefs and actions as well as to identify what personal
characteristics beyond racial identity make individuals more apt to have compassion for victims
of anti-Black violence.
In line with an investigation by Lee and colleagues (2019), we found that Asian, Black,
and Latinx, compared to White, participants reported more direct discrimination (based not only
on race but also on religion, disability status, sexuality or gender). Between 66% and 85% of
Asian, Black, and Latinx respondents, depending on their race, reported experiencing serious
forms of discrimination within their lifetime (i.e., verbal harassment, being coughed at or spat
upon, physical assault, racial profiling). Moreover, 42% to 59% of Asian, Black, and Latinx
respondents, compared to only 25% of White respondents, reported the occurrence of such
incidents since the onset of the COVID-19 pandemic. These reports of discrimination show the
breadth of discrimination as a problem, particularly for non-White people in the US.

53
Our investigation of sleep as an outcome produced both expected and unexpected
findings. As hypothesized, both NIAV and discrimination were significantly associated with
self-reported sleep difficulties. Results for discrimination support prior findings linking
discrimination and sleep (Slopen et al., 2016) and the present focus on NIAV and sleep offers a
new perspective on the reach of vicarious anti-Black racism. Our data show that NIAV accounts
for significant variance above and beyond being victimized directly by personal discriminatory
attacks. Moreover, with previous studies reporting that impacts of police shootings of unarmed
Black Americans on mental health are strongest 1-2 months from the event (Bor et al., 2018), it
is noteworthy that there are significant sleep effects associated with NIAV even with the 6-
month lag between the peak of the racial violence coverage and our sleep assessments. Contrary
to expectation, however, the association between NIAV and sleep difficulties did not differ by
race. That is, though Black Americans reported higher NIAV, thereby registering greater
cognitive and emotional impacts associated with anti-Black violence, the links between those
impacts and sleep difficulties manifested similarly regardless of race. This finding suggests that
differences exist in who is experiencing cognitive and emotional impacts of vicarious anti-Black
violence, but when cognitive and emotional impacts do occur, they show similar effects on sleep
for individuals regardless of race.
Several findings regarding sleep and discrimination were unanticipated. First, the
association between discrimination and sleep differed by race, with significant differences
emerging between Latinx and Black participants. The general pattern, however, showed that,
only among Black participants, was direct discrimination unrelated to sleep difficulties. This may
be due to the adaptive cultural practices Black individuals, families, and communities have
developed to combat racism and its deleterious effects (Peters & Massey, 1983). Racial

54
socialization, familial and community support, and spirituality are among a number of protective
practices that Black communities have cultivated in response to persistent discrimination and
marginalization (Murray et al., 2018). Thus, it may be that Black individuals access these
protective cultural practices in the face of discrimination. Research additionally shows that
among Black Americans, exposure to social stressors, including lifetime experiences of
discrimination, may provide resiliency against effects of present stressors (Tobin, 2021). Second,
Black participants in the present study generally reported fewer sleep difficulties than those of
other racial groups, which is inconsistent with much of prior literature (Johnson et al., 2019).
However, as noted elsewhere (Jackson et al., 2020; Mezick et al., 2008), self-reported sleep
measures do not always capture the disparities in sleep found in more objective sleep measures.
Regarding the data here, one possibility is that Black Americans were reporting fewer sleep
difficulties relative to the prior months closer to the death of George Floyd and the height of
racial unrest.
The third unanticipated finding concerns the significant interaction between NIAV and
discrimination on sleep difficulties. In decomposing this interaction, we found that the link
between NIAV and sleep difficulties was stronger in those who had experienced lower, rather
than higher, direct discrimination. That is, we did not find prior discrimination provided an
additive or sensitization effect to NIAV. Rather, across the whole sample, those who had
experienced high levels of discrimination were experiencing high levels of sleep difficulties,
regardless of NIAV level. Similar to other significant stressors, direct discrimination experiences
may have a “blunting” effect, such that having high levels of discriminatory experiences leads to
emotional and cognitive numbing (Vaccaro & Mena, 2011) and possibly, a less intense response
to additional bias-related experiences (Busse et al., 2017). Though a blunted stress response is

55
more commonly studied through stress hormones, physiological underpinnings of sleep may
similarly be disrupted. Alternatively, those who have experienced discrimination may be more
likely to have developed resources and skills contributing to resilience in response to additional
bias-related events (i.e., vicarious racism), such as seeking social support (Fuller & Riggs, 2018).
Implications
The results of this study augment and extend what is known about vicarious racism.
Vicarious racism has been understudied. Yet, exposure to vicarious racism is likely becoming
more prevalent through increased technology use (e.g., social media, body cameras, bystander
recordings). Thus, understanding vicarious racism and its effects on health is becoming
increasingly imperative. The findings of the present study, particularly its focus on the vicarious
or secondary effects of anti-Black incidents, i.e., that anti-Black violence has diffuse negative
impacts beyond the direct victims of violence, highlights that rooting out anti-Black racism is a
matter not only of justice but of public health. The present study found that Americans and Black
Americans especially experienced high levels of cognitive and emotional impacts of vicarious
anti-Black violence and that these impacts are related to sleep difficulties. Medical and mental
health practitioners should directly address the ways in which ongoing sociopolitical events and
related vicarious racism might be affecting their patients, particularly for but not limited to those
who share identities with the victims of violence. The data here also serve as a reminder about
the impacts of discrimination more generally on individuals’ mental health and wellbeing. Our
findings shed light on sleep as only one indication of how vicarious racism and discrimination
potentially get under the skin. However, other research has demonstrated the impact of sleep on
wide-ranging health outcomes and daily functioning (Luyster et al., 2012) and has shown sleep
to be one pathway by which discrimination affects mental and physical health (Hisler & Brenner,

56
2019). Sleep treatments thus may be an intervention target to mitigate negative effects of racism
and discrimination on health.
In the larger context, however, policies directed to reduce incidents of police brutality
and hate crimes are critical to prevent unjust and undue injuries and deaths as well as to prevent
downstream effects such as vicarious racism. Though the treatment of health conditions related
to or exacerbated by incidents of bias and violence is necessary, policies that prevent incidents of
racism and bias can provide upstream solutions to promoting the health and wellbeing of all
Americans.
Limitations
The present study has a number of limitations, largely reflecting circumstances
surrounding data collection. First, we designed our assessment of NIAV to capture the stress of
anti-Black violence but did not attend to possible benefits of media coverage of anti-Black
violence, such as relief that ongoing anti-Black racism was finally being widely acknowledged.
It is possible that the co-occurrence of stress and relief account for some of our unanticipated
findings. Second, our NIAV measure did not quantify the extent of exposure to vicarious anti-
Black racism nor the nature of exposure (e.g., written text vs. video). Instead, we focused on a
more subjective measure i.e., the response to vicarious anti-Black racism, as six-months had
elapsed since the peak of anti-Black violence media coverage, which we believed might be too
long of a delay for participants to accurately report their degree of relevant exposure. Future
studies should capture more objective exposure data and pre-existing levels of mental health
symptoms to better elucidate links between vicarious exposure, mental health symptoms, and
sleep difficulties, which may possibly show that NIAV is better understood as a mechanism by
which exposure leads to sleep problems. Third, another limitation related to the timing of data

57
collection is that the six-month time lag may underestimate the plausible link between NIAV and
sleep. At the time of data collection, coverage surrounding George Floyd’s murder had lessened
but still continued due, in part, to the impeding Chauvin trial; moreover, other incidents of anti-
Black racism were publicized, but to a lesser extent. Fourth, this study used a cross-sectional
design and preclude statements about causality. As with most assessments of unanticipated,
large-scale events, no pre-event or baseline measurements were available. Nonetheless, an
alternative for future research is to collect assessments that are concurrent with vicarious
witnessing anti-Black racism. Repeated sampling (e.g., daily assessments) would make it
possible to study the dynamic interplay between vicarious anti-Black racism exposure, NIAV,
and sleep. Fifth, the present study only examined self-reported sleep measures but future studies
should supplement self-report measures with objective measures of sleep, e.g., actigraphy
(Jackowska et al., 2011), which is increasingly possible via wearable technology. Sixth, the anti-
Black racist attacks examined here occurred in the midst of the coronavirus pandemic and at a
time in the course of the pandemic when it was becoming increasingly clear that Black and
Latinx people were at higher risk for infection and death. Thus, disrupted sleep may be due, in
part, to pandemic concerns, particularly for non-White Americans (Hisler & Twenge, 2021).
Investigating this sample’s COVID-19 reactions is beyond our scope here and is examined
elsewhere (e.g., Gold et al., 2022). Lastly, because the data reported here were part of a larger
project on couples during the coronavirus pandemic, all participants were in a romantic
relationship, thereby precluding generalizability to persons not in relationships. In addition,
multiracial participants were excluded from the current study due to the diversity within that
group.

58
Conclusion
The present study shows the salience of vicarious anti-Black racism and direct
discrimination to everyday Americans, suggesting a greater need to attend to vicarious racism
and discrimination in research and health practices, particularly as vicariously witnessing racism
via media is becoming increasingly common. As a preliminary step, this paper introduces
NIAV—one dimension of reactions to vicarious exposure to anti-Black racist attacks involving
emotional pain, concerns about safety, difficulties concentrating. NIAV, though clearly
heightened for Black Americans, was experienced also by persons across diverse racial
identities. Findings linking NIAV, direct discrimination, and sleep difficulties highlight the
importance of future research to more fully understand the health implications of vicarious
racism.

59
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Figure 1
Direct effects of negative impact of anti-Black violence (NIAV) and direct discrimination on
sleep difficulties.

Note. NIAV and direct discrimination were grand mean centered. The scale for NIAV is from -1
SD to +1 SD and the scale for direct discrimination is from the no discrimination, as -1 SD is
below none, to +1 SD. The dotted vertical grey line represents the sample mean of NIAV and
direct discrimination, respectively.
*p<.05; **p<.01, ***p<.001.

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Figure 2
Moderating effect of race on the association between direct discrimination and sleep difficulties.

Note. Direct discrimination was grand mean centered. The scale for direct discrimination is from
no discrimination, as -1 SD is below none, to +1 SD. The dotted vertical grey line represents the
sample mean.
*p<.05; **p<.01, ***p<.001.

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Figure 3
Moderating effect of direct discrimination on the association between negative impact of anti-
Black violence (NIAV) and sleep difficulties.

Note. Direct discrimination and NIAV were grand mean centered. The scale for NIAV is from -1
SD to +1 SD. Direct discrimination is plotted at +1 SD, the mean, and no discrimination, as -1
SD is below no discrimination. The dotted vertical grey line represents the sample mean.
*p<.05; **p<.01, ***p<.001.

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Chapter 4
Paper 3

Discrimination During the COVID-19 Pandemic Against Asian Americans: Links to Sleep and
Romantic Relationships as Relevant Context

Yehsong Kim, Hannah F. Rasmussen, & Gayla Margolin

University of Southern California

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Abstract
Objectives: The COVID-19 pandemic has been a period of increased discrimination and hate
crimes against Asian Americans. This study examines effects of discrimination on sleep
difficulties among Asian Americans during this time period. In addition, the study investigates
both supportive and conflictual romantic partner interactions related to topics of discrimination,
race, and activism as possible moderators of this association. Method: At two time points during
the COVID-19 pandemic, 92 partnered Asian American adults (Mage = 35.0, 63.0% women)
completed online surveys that assessed discrimination, sleep, discrimination-specific partner
support, and partner conflict about anti-Asian racism. Results: Discrimination during the
COVID-19 pandemic was associated with greater sleep difficulties. In addition, partner conflict
about anti-Asian racism strengthened the association between discrimination and sleep
difficulties. Discrimination-specific partner support did not buffer this association. Conclusions:
The present study extends emerging research on discrimination and sleep by investigating
romantic relationship interactions as relevant context for sleep difficulties. Findings point to the
significance of evaluating discrimination and close personal relationships as potential
contributors to sleep difficulties, and likely, other aspects of health among Asian Americans.
Public Significance Statement: Asian Americans have been understudied and increased anti-
Asian discrimination during the COVID-19 highlights the need to better understand and provide
quality care to this population. Discrimination experienced during COVID-19 was associated
with sleep difficulties in Asian Americans with greater difficulties reported by those who also
experienced conflict with their romantic partner about race and activism.

Keywords: Asian American health, discrimination, sleep, romantic relationships

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During the COVID-19 pandemic, anti-Asian hate crimes and incidents of anti-Asian
discrimination rose in the U.S. as many in the U.S. blamed China or Chinese people for the
COVID-19 pandemic, stoked by racist comments and references to the novel coronavirus as the
“Chinese Virus” and “Kung Flu” (Jackson et al., 2020). Between March 2020 and December
2021, 10,905 hate incidents against AAPI persons were reported to Stop Asian American and
Pacific Islander (AAPI) Hate, a coalition that arose in response to the escalation in anti-Asian
incidents and sentiments during the COVID-19 pandemic (Yellow Horse et al., 2022). One
qualitative study showed that news media during the first half of 2020 were replete with stories
of Asian Americans being followed, spit on, cursed at, and physically assaulted by attackers’
perceptions of their victims as foreign, Chinese, “virus carriers” (Yang et al., 2021). Some stories
of violence against Asian Americans rose to the national stage, from physical assaults of older
adults (Westervelt, 2021) to the Georgia spa shootings leading to the deaths of six Asian
American women (The Associated Press, 2021). Beyond these nationally publicized incidents of
violence, Asian Americans across the U.S. reported increased incidents of discrimination. In one
national, multi-lingual, community-based survey of almost 5,000 Asian Americans, 61% of
participants reported experiences of discrimination since the start of the COVID-19 pandemic
(Ta Park et al., 2022). In light of this heightened level of anti-Asian discrimination, the present
study investigates the association between discrimination and sleep difficulties in Asian
Americans during a period of the COVID-19 pandemic.
Sleep, Racial Disparities, and Discrimination
Sleep is a critical biological process that plays a role in maintenance of health. Poor sleep
has implications for a wide range of health outcomes, from depression to coronary heart disease
and even mortality (Buysse, 2014). Yet, sleep quantity among U.S. adults has been trending

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downward in recent years, with a third of U.S. adults sleeping less than the recommended
amount (i.e., six hours or less; Ford et al., 2015). Meta-analyses showed that during the COVID-
19 pandemic, sleep difficulties were notably high across world, with 20-45% of the global
population reporting insomnia symptoms (Becker, 2022) and 32% reporting sleep problems, with
even higher rates among health care workers and patients with COVID-19 (Jahrami et al., 2021).
A nationally representative sample of U.S. adults reported higher prevalence of both shorter and
longer than recommended sleep duration and increased days with difficulty falling asleep,
staying asleep, and not feeling rested in 2020 compared to 2018 (Hisler & Twenge, 2021). Racial
disparities in sleep are well documented, with particular focus on disparities between White and
Black Americans (Ahn et al., 2021; Johnson et al., 2019). Sleep disparities in Asian Americans
have been historically understudied, in part due to the “model minority” myth, which perpetuates
the belief that Asian Americans do not experience racism and have achieved parity with White
Americans (Cheng & Johnson, 2021). However, subjective and objective assessments show
lower sleep durations and poorer sleep quality in Asian Americans compared to White
Americans (for a review, see Nandagiri et al., 2022).
Discrimination experienced by racial minorities is one factor that contributes to racial
disparities in sleep (Fuller-Rowell et al., 2017; Mead et al., 2022). Perceived discrimination and
unfair treatment have been linked to a number of sleep difficulties, including poorer sleep
efficiency, poorer sleep quality, longer wakefulness after sleep onset, and shorter sleep (Owens
et al., 2017; Slopen et al., 2016). With the increase in discrimination against Asian Americans
during the COVID-19 pandemic, putative impacts on sleep deserve attention. Indeed, one study
conducted during the COVID-19 pandemic showed that Asian Americans’ experiences with
racial discrimination were associated with greater sleep difficulties (Lee & Waters, 2021).

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Among Chinese immigrants, personal experiences of racist incidents as well as attacks directed
at others in participants’ social network were associated with poorer sleep quality, longer sleep
latency, shorter sleep duration, and greater daytime dysfunction (Li et al., 2022).
Social Support as a Buffer
Social support can buffer negative effects of discrimination. Perceived discrimination is,
in part, perceiving social rejection and as such, can increase expectations for exclusion, rejection,
or other kinds of social pain (Brondolo et al., 2017). Thus, close relationships can provide a
corrective experience to discrimination, providing support and belonging. Among Asian
Americans, social support may be particularly salient, as Asian Americans have a stronger group
orientation compared to White Americans, who have a stronger individual orientation (Kim,
2012). Having a group orientation means that views of oneself are strongly influenced by others’
views of oneself, which, on the one hand, may make Asian Americans more susceptible to
negative consequences of discrimination; however, a group orientation may also mean that Asian
Americans are more likely to receive benefits from social support as a counterbalance to
discrimination. Research on buffering effects of social support on the link between
discrimination and health among Asian Americans has been mixed, with some studies finding
buffering effects of social support from family and friends on outcomes of depression or
psychological distress (Chae et al., 2012; Tummala-Narra et al., 2012; Wei et al., 2013) whereas
others have found null effects for the same outcomes (Chung & Epstein, 2014; Yoshihama et al.,
2022). Mixed findings may be related to the lack of specificity and the wide range in how social
support has been conceptualized and measured. Most studies assessed overall social support, i.e.,
assessing how much the respondent could rely on or open up to someone about general worries,

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rather than assessing social support specific to discrimination. In addition, studies often asked
about social support from a broad range of relatives or combined family and friends.
Because discrimination can be a sensitive topic and people may vary in how they
approach experiences of discrimination, those who provide general social support such as being
reliable or caring, may not always be able to provide the kind of support needed to alleviate
distressing thoughts and emotions related to discrimination experiences. Therefore, being
supported through discrimination experiences specifically may be needed to buffer negative
effects of discrimination on health. One study conducted with Asian American participants
showed that receiving emotional support from family or relatives for a serious problem buffered
effects of everyday discrimination on psychological well-being while general social support (i.e.,
talking on the phone and getting together) was not a buffer (Mossakowski & Zhang, 2014). This
study suggests that receiving emotion support specific to difficulties rather than general support
may be uniquely protective. Indeed, another study of Asian Americans found that effects of
COVID-19 discrimination on depressive symptoms was buffered by participants talking about
their COVID-19 related discrimination experiences with their partners (Woo & Jun, 2021).
Romantic Relationships and Discrimination
Romantic partners, as physically and emotionally proximal connections for partnered
adults, may be well-suited to provide helpful social support and undercut the negative impact of
discrimination. Romantic partners have strong effects on individuals’ health. Broadly speaking
married people tend to have better mental and physical health and lower morbidity and mortality
than unmarried people (Kiecolt-Glaser & Wilson, 2017). In analogue research, even viewing
pictures of a romantic partner, compared to pictures of acquaintances, elicited lower pain ratings
in a thermal pain task (Younger et al., 2010), suggesting that romantic partners have a special

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role in health-related processes. When examining romantic partners as potential buffers against
discrimination, however, some studies found evidence of a buffer (Motz & Currie, 2019), others
had null results (Killoren et al., 2020), and some found evidence of a buffer for certain
populations but not others (Feinstein et al., 2016). These studies varied by population (e.g.,
bisexual adults, gay or lesbian adults, Indigenous postsecondary students in Canada, Latino/a
young adults), relationship measure (e.g., being partnered or not, living with partner, perception
of partner’s relationship efforts), and outcomes (depression, anxiety, post-traumatic stress
disorder), suggesting more work in needed to hone in on how romantic relationships may
provide relief from discrimination’s deleterious effects. There is some evidence, however, that
discrimination-specific social support from a romantic partner can be protective. In a study of
heterosexual African American couples, partners’ provision of racism-specific support buffered
negative mental health impacts of both own and partner’s racial discrimination on women
(McNeil et al., 2020). Though this study was conducted with African American couples, these
findings may be applicable to other groups, such as Asian Americans.
On the other hand, romantic partnerships can also be fraught with difficult and harmful
interactions as well as positive, supportive interactions. Negative interactions between romantic
partners, such as aggression, denigration, severe criticism, or threats of separation or divorce, can
increase harm to an individual’s health (Braithwaite & Holt-Lundstad, 2017). For those already
experiencing stress from discrimination, difficult interactions with romantic partners can
exacerbate negative effects on health (Waltermaurer et al., 2006). Moreover, romantic partners
could worsen negative effects of discrimination if they respond to sharing of discrimination
experiences with a lack of support or invalidation, potentially intensifying a sense of loneliness,
alienation, or self-blame (Carter, 2007; Zubernis & Snyder, 2007).

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Findings among Asian Americans mirror those from other populations such that the
combination of receiving support from romantic partners and receiving discrimination-specific
support provides a buffer to discrimination on health among Asian Americans while findings of
more broadly measured social support are mixed. For example, one study of Asian Americans
found that talking about COVID-19 related discrimination experience(s) with a romantic partner
buffered COVID-19 discrimination on depressive symptoms; however, similar conversations
with friends, mental health professionals, and online communities did not have a buffering effect
(Woo & Jun, 2021). In addition to null findings of support from more distal relationships, among
Asian Americans, studies of general social support (compared to discrimination-specific support)
from romantic partners as a buffer against discrimination on psychological distress also had null
results (Kwon, 2020; Rollock & Lui, 2016).
As for negative interactions among Asian Americans couples, evidence suggests that
strain in romantic relationships exacerbate negative effects of discrimination on health. Among
Asian immigrants, interpersonal strain within a romantic relationship (e.g., partner being
demanding or criticizing or feeling let down by a partner) exacerbated the negative association
between racial discrimination and psychological distress (Chung & Epstein, 2014). Among
partnered Asian Americans, the association between discrimination and psychological distress
was mediated by partner strain and family conflict (Kwon, 2020), suggesting that discrimination
disrupted these close relationships and subsequently increased the impact of discrimination on
psychological distress. Qualitatively, Asian American victims of racism during the COVID-19
pandemic described feeling further harmed by responses from their support network, including
partners, of not being able to relate, encouraging their silence, minimizing or denying anti-Asian
racism, and victim-blaming (Wang & Santos, 2022).

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Of note, most studies investigating romantic relationships as relevant context for Asian
Americans who have experienced discrimination have only examined mental health outcomes.
To our knowledge, there is only one study of Asian Americans that examined sleep as an
outcome of discrimination with social support as a moderator (Lee & Waters, 2021). This study
found direct effects of discrimination on sleep difficulties but did not find buffering effects of
social support on this link. Despite the lack of significant findings, further research is needed, as
this study examined broadly defined social support rather than discrimination-specific support
and also focused on a wide network of social support.
The Present Study
The present study addresses current gaps in the literature on the effects of discrimination
on the health of Asian American adults in the following ways. First, we focus on romantic
partners as one critically important close relationship. Second, we assess romantic partner
interactions specific to discrimination experiences and the salient sociopolitical context of anti-
Asian hate rather than more general relationship qualities. Specifically, we examine perceptions
of partner support regarding proximal discrimination (i.e., feeling understood and supported
related to discriminatory events) as well as conflict with romantic partners about topics of race
and activism since the uptick in racist incidents against Asian Americans during COVID-19.
Third, we examine sleep difficulties as the outcome. Using a sample of partnered Asian
Americans living across the U.S., we gathered data from two timepoints, allowing us to control
for more distal discrimination experiences and prior sleep difficulties. In addition, due to the
significant changes in society, and likely stress, caused by the COVID-19 pandemic, we also
accounted for other COVID-19-related stress in this study. The following hypotheses (not part of
the study registration) were tested. We anticipate that Asian Americans’ recent discrimination

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experiences will be associated with greater sleep difficulties (Hypothesis 1). We also hypothesize
that partner support regarding proximal discrimination will buffer the link between
discrimination and sleep difficulties (Hypothesis 2) whereas partner conflict about anti-Asian
racism will exacerbate the link (Hypothesis 3).
Method
Participants and Procedure
Participants were initially recruited between December 11, 2020 and February 11, 2021 using the
Prolific platform as part of a larger, pre-registered study on couple functioning during the
COVID-19 pandemic (Margolin et al., 2020). To be included in the larger study, participants had
to be 18 years or older, living with a romantic partner, and residing in the U.S. Following the
March 16, 2021 Atlanta spa attacks that resulted in eight dead, six of whom were Asian
American women, we developed the Time 2 (T2) survey to address the questions of this study.
Time 1 (T1) recruitment included 110 participants who self-identified as Asian Americans, who
were then invited to complete the T2 survey between April 14, 2021 to May 13, 2021, over one
year since the start of the COVID-19 pandemic. Of the initial 110 Asian American participants,
92 (83.6%) participated in the T2 survey. Participants ranged in age from 20-72 (M = 35.0, SD =
10.6). Among participants, 63.0% identified as women, 60.9% were born in the U.S. or U.S.
territories, and ethnically, 59.8% were East Asian, 18.5% were Southeast Asian, 15.2% were
South Asian, and 6.5% were East and Southeast Asian. Participants resided across 25 different
states. Participants were encouraged to invite their romantic partner to complete the online
survey; thus, 4 paired couples were part of the total sample. Of the 92 participants, 58 (63%) had
an Asian American partner and 3 participants were in same-sex relationships. The [University
blinded] Institutional Review Board approved both T1 and T2 procedures.

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Measures
T2 Proximal Discrimination. Proximal discrimination was assessed using items adapted from
the Everyday Discrimination Scale (Williams et al., 1997). Participants were asked, “How often
have you experienced the following discriminatory experiences since January 2021?” This
timeframe was specified to reference the new year and include anti-Asian hate that received wide
media coverage in the early months of 2021. Ten items were specified, including discriminatory
experiences that appeared more frequently during COVID-19 pandemic, such as verbal
harassment/name-calling/threats; online harassment; and coughed at/spat upon. Response
options for both time periods were “Never” (0), “Infrequently” (1), “Frequently” (2), and “All
the time” (3). A mean score across all items was calculated, with scores from the current sample
ranging from 0.0 to 2.0 (Cronbach’s α = .87). If participants endorsed any of the items, they were
asked to identify the primary characteristic(s) that was targeted in these incidents. Of all
participants, 79.3% of participants endorsed some level of proximal discrimination (M = 0.5, SD
= 0.4). Additionally, 78.3% endorsed race as at least one of the primary reasons for these
experiences. Other endorsements included 21.7% due to gender, 6.5% due to religion, 5.4% due
to sexual orientation, and 2.2% wrote in: (due to) political view.
T2 Discrimination-specific Partner Support. Those who endorsed any level of proximal
discrimination were asked two items related to feeling supported by their partner: “my partner
fully understands my experience related to these discriminatory events” and “my partner has
been able to support me in the ways that I need related to these discriminatory events”
(Cronbach’s α = .89). Response options were “strongly disagree” (-2), “somewhat disagree” (-1),
“neither agree nor disagree” (0), “somewhat agree” (1), and “strongly agree” (2) for both items.

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A mean score across the two items was calculated, with scores from the current sample ranging
from -2.0 to 2.0 (Cronbach’s α = .89).
T2 Partner Conflict about Anti-Asian Racism. All participants responded to two questions
regarding conflict with their romantic partner related to racist incidents occurring against Asian
Americans: “I have had conflict with my partner about topics of race since the uptick in racist
incidents against Asian Americans” and “my partner and I have had disagreements about how to
engage in activism against racial injustice against Asian Americans”. Response options were
“not at all” (0), “a little” (1), “a moderate amount” (2), and “a lot” (3). A mean score across the
two items was calculated, with scores from the current sample ranging from 0.0 to 3.0
(Cronbach’s α = .92).
T2 Sleep Difficulties. Participants were asked about sleep difficulties in the past month using six
items adapted from the Pittsburgh Sleep Quality Index, e.g., trouble falling asleep (took more
than 30 minutes); bad dreams (Buysse et al., 1991). Response options were “Not during the past
month” (0), “Less than once a week” (1), “Once or twice a week” (2), and “Three or more times
per week” (3). A mean score was calculated across all items, with scores from the current sample
ranging from 0.0 to 3.0 (Cronbach’s α = .81).
Covariates. Gender was coded as man (1), woman (0). To calculate the COVID-19 stress
covariate, participants endorsed whether or not (1 vs. 0) they were feeling stressed due to 15
COVID-19 related stressors (e.g., household severe illness, disruption to future plans) at T1. A
sum was taken across all 15 items (see [MASKED FOR REVIEW] for more information).
General relationship quality was calculated by summing five items from the Quality of Marriage
Index (Norton, 1983) at T2. Depression symptoms were assessed using the PHQ-9 (Kroenke et
al., 2001) at T2. T1 sleep difficulties were assessed in the same manner as T2 sleep difficulties.

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To assess distal discrimination at T1, we used the same items as the T2 discrimination measure
but considered two separate time frames in the participants’ life: during their lifetime prior to the
COVID-19 pandemic and since the COVID-19 pandemic. Mean scores for each time frame were
calculated then summed for one measure of distal discrimination.
Statistical Analysis
The only missing data across all variables was partner conflict data from one participant. We
dealt with the missing score through multiple imputation to minimize bias (Sidi & Harel, 2018),
using the MICE and MICEADDS packages in R (Robitzsch & Grund, 2021; van Buuren &
Groothuis-Oudshoorn, 2011). Four multilevel models with random intercepts were used to test
hypotheses. Participants (Level 1) were nested within couples (Level 2) to account for the four
partnered couples in the sample. Proximal discrimination, partner support, and partner conflict
were grand mean centered to avoid multicollinearity and for ease of interpretation. Model 0
included only covariates (i.e., gender, T1 COVID-19 stress, T2 general relationship quality, T2
depression symptoms, T1 sleep difficulties, and T1 distal discrimination). Model 1 tested effects
of proximal discrimination on T2 sleep difficulties. Model 2 tested the moderating effect of
partner support on the association between proximal discrimination on T2 sleep difficulties. As
only those who endorsed discrimination were asked about partner support, Models 2 only
included 73 participants, while all other models included all participants. Model 3 tested the
moderating effect of partner conflict on the association between proximal discrimination on T2
sleep difficulties. Significant interaction effects were decomposed through simple slopes
analyses.

85
Results
Descriptives
Table 1 provides descriptive data on the variables used in the models. Correlations
showed that proximal discrimination is positively correlated with partner conflict (r = .35, p
< .001), COVID-19 stress (r = .26, p = .01), depression symptoms (r = .28, p = .01), and distal
discrimination (r = .65, p < .001). Partner support is positively correlated with general
relationship quality (r = .67, p < .001) and negatively correlated with partner conflict (r = -.39, p
< .001) and depression symptoms (r = -.39, p < .001). Partner conflict is positively correlated
with COVID-19 stress (r = .21, p = .05) and distal discrimination (r = .36, p < .001). T2 sleep
difficulties are positively correlated with COVID-19 stress (r = .33, p = .001), depression
symptoms (r = .54, p < .001), and T1 sleep difficulties (r = .59, p < .001), and negatively
correlated with general relationship quality (r = -.21, p = .05). Other correlations emerged among
covariates.
Substantive Analyses
Table 2 presents results for all multilevel models. Consistent with Hypothesis 1 (Model
1), proximal discrimination was associated with more sleep difficulties (b = 0.44, p = .01).
Contrary to Hypothesis 2 (Model 2), no moderating effects of partner support on the association
between proximal discrimination and sleep difficulties was found (b = 0.18, p = .47). In support
of Hypothesis 3 (Model 3), partner conflict moderated the association between proximal
discrimination and sleep difficulties, such that greater partner conflict strengthened this
association (b = 0.28, p = .05). Simple slope analyses presented in Figure 1 show that the
association between proximal discrimination and sleep difficulties was significant at mean levels
(b = 0.42, p = .02) and 1 SD above the mean (b = 0.65, p = .001) in partner conflict.

86
Supplemental Analyses
Because of the prime role of partners in our research questions, we conducted
supplemental analyses that included partner race, a dichotomous variable of having an Asian
American partner or a partner who is not Asian American. When we included partner race as a
moderator of association between discrimination and sleep, there was not a significant effect (b =
-0.02, p = .94, see Model 3, Table 1 of supplemental materials). Adding partner race as a
dichotomous covariate in the analyses testing support and conflict as moderators did not change
the findings (see Models 1 and 2, Table 1 of supplemental materials). Relatedly, in descriptive
analyses, Asian American partners (M = 0.83, SD = 1.12) did not differ from non-Asian
American partners (M = 1.29, SD = 0.83) on partner support (t36.00 = -1.77, p = .16). Asian
American partners (M = 0.55, SD = 0.82) also did not differ from non-Asian American partners
(M = 0.40, SD = 0.83) on partner conflict (t68.44 = -0.87, p = .45). Additionally, to further
understand the association between discrimination and sleep, we turned to two survey questions
that assessed worry about loved ones due to racist attacks on Asian Americans. The mean of
those items did not moderate the association between personal discrimination and sleep
difficulties (b = -0.08, p = .68, see Model 4, Table 1 of supplemental materials). Finally, we
further explored gender differences by testing gender as a moderator of the association between
proximal discrimination and sleep. Although gender did not emerge as a significant moderator (b
= 0.06, p = .81, see Model 5, Table 1 of supplemental materials), that analysis may have been
limited by our overall sample size and the relatively high proportion of women.
Discussion
The present study builds upon emerging research highlighting the impacts of
discrimination on sleep amongst Asian Americans, a relatively understudied population. We

87
examined this link during the COVID-19 pandemic, a period of heightened anti-Asian sentiment
and violence. We further tested romantic relationships as interpersonal contexts potentially
promoting resilience or risk when faced with discrimination. Proximal discrimination (i.e.,
during the COVID-19 pandemic when there was heightened media attention to anti-Asian
attacks) was associated with more sleep difficulties among our Asian American sample, even
after controlling for prior discrimination, depression symptoms, and COVID-19-related stressors.
The link between proximal discrimination and sleep difficulties was not buffered by
discrimination-specific partner support as hypothesized. However, partner conflict about the
topic of anti-Asian racism exacerbated the connection between proximal discrimination and
sleep difficulties.
Our finding that discrimination is related to greater sleep difficulties in Asian Americans
during the COVID-19 pandemic adds to studies linking anti-Asian discrimination to mental
health difficulties (reviews: Gee et al., 2009; Nadimpalli & Huchinson, 2012) and to the smaller
number of studies linking discrimination to disrupted sleep in Asian Americans (Lee & Waters,
2021; Li et al., 2022; Yip et al., 2022). Proximal discrimination predicted sleep difficulties above
and beyond prior lifetime discrimination and other forms of stress related to the COVID-19
pandemic. Of note, a startlingly high 79.3% of our sample endorsed experiencing some level of
discrimination within the 5-month period between January 2021 and April or May 2021. This
high level of endorsement aligns with larger studies documenting the increase in discrimination
towards Asian Americans during the COVID-19 pandemic (Ta Park et al., 2022). The high level
of endorsement may also reflect our assessment of varied and specific forms of discriminatory
behavior including those that specifically arose during the COVID-19 pandemic (e.g., being
coughed at/spat upon) as well as discriminatory behaviors that could occur even as people were

88
curtailing their activities outside the home (e.g., online harassment). The association between
discrimination and sleep difficulties in this Asian American sample is important to recognize
given the broader literature linking sleep problems to wide-ranging problems in daily functioning
(e.g., difficulties with cognition, memory, stress reactivity, pain, mood) as well as long-term
health effects (e.g., hypertension, metabolic syndrome, type 2 diabetes, all-cause mortality;
Medic et al., 2017). In fact, sleep is considered one of the three lifestyle pillars of health
alongside diet and exercise because of its impact in biological processes critical to health broadly
(Ghanemi et al., 2022). These implications of poor sleep go beyond the scope of the present
study but are plausible subsequent outcomes.
A detail worth noting in our data is the number of Asian Americans who attribute
discrimination to race, as contrasted with other personal characteristics, including gender, sexual
orientation, religion, and so on. At T2, 78.3% of our participants’ who reported experiencing
proximal discrimination listed race or ethnicity as one of the main reasons for discrimination
experiences during the time frame of January 2021 to April/May 2021. This contrasts with our
lifetime discrimination assessments (i.e., all discrimination experienced prior January 2021) in
which these same participants attributed only 43.7% of their discrimination experiences to race
or ethnicity. This uptick in attributing discrimination experiences to race/ethnicity in conjunction
with higher reports of discrimination suggests the reality of anti-Asian hate during COVID-19. It
is important to note, however, that while the COVID-19 pandemic acted as a trigger for increases
in anti-Asian sentiment, anti-Asian sentiment is not a new phenomenon in the U.S. Both state-
sanctioned racism against Asian Americans (e.g., the People v. Hall in 1854, the 1882 Chinese
Exclusion Act, Japanese Internment from 1942 to 1945; Cheng & Johnson, 2021) and hate
crimes against Asian Americans, who have been seen as perpetual foreigners and scapegoats

89
(e.g., lynching of at least 17 Chinese immigrants in 1871, setting Vietnamese shrimpers’ boats on
fire, murder of Vincent Chen; Brockell, 2021) have a long history in the U.S. Thus, findings
from the present study and others during COVID-19 have relevance not only to this time period
but the past, and likely, the future.
Our study also sought to examine romantic relationships as a potential resilience- or risk-
promoting context for those experiencing discrimination. Results did not support the buffering
hypothesis of discrimination-specific partner support. Methodologically, discrimination-specific
partner support may share variance with the more general measure of relationship quality (r
= .67), although that global relationship construct also did not show main effects with sleep.
From a cultural lens, socialization within Asian cultures often emphasizes attunement to the
emotional states of others and an interdependent self-construal, which may make discrimination
experiences particularly painful and resistant to buffers (Chan & Mendoza-Denton, 2008; Lau et
al., 2009). In addition, as we examined discrimination experiences occurring during a period of
heightened levels of anti-Asian hate, the salience of Asian Americans being targeted may have
heightened a sense of vulnerability after experiencing discrimination compared to other time
periods. These factors may have reduced the likelihood of social support buffering distress
related to discrimination, as there is some suggestion that social support may be helpful at low
levels of stress exposure but not at high levels (Brondolo et al., 2009).
In our results, partner conflict about anti-Asian racism exacerbated links between
proximal discrimination and sleep difficulties. Other studies show temporal links between couple
conflict and poorer sleep the following night (Hasler & Troxel, 2010; Hicks & Diamond, 2011),
thus showing the consequences of various couple conflicts for sleep. The present study, however,
highlights the importance of conflict or disagreement specifically related to topics of race and

90
activism with a partner as an additional source of harm to sleep for those who have experienced
discrimination. Partners bring different lenses, shaped by different life experiences, to
understanding and reacting to the current climate of anti-Asian sentiment. However, conflict or
disagreement between partners on topics of race and activism, likely prompted by the
sociopolitical milieu and media coverage of increased anti-Asian hate, may reflect invalidation
of one partner’s direct experience of discrimination or ruptures in shared values. In a qualitative
study, Wang & Santos (2022) report a number of ways that Asian Americans have felt
invalidated by loved ones as they shared discrimination experiences, for example, having loved
ones downplay their discrimination experiences by telling them to “brush it off” or that “racism
against Asians isn’t real”. Other potentially invalidating messages to outrage about
discrimination include being told to “keep your head down” or simply being silent, all of which
can lead to disappointment, anger, and feelings of isolation between partners.
Limitations
Limitations to the present study should be considered. First, all of our measures were
self-report, online survey data, which is subject to various forms of bias. Self-reported sleep
measures are correlated with objective sleep measures but appear to be influenced by variables
such as regularity of sleep schedule, depressive symptoms, age, and personality (O’Donnell et
al., 2009; Tsuchiyama et al., 2003). Thus, future studies may benefit from using objective
measures, such as actigraphy, in addition to subjective measures. Second, our sample only
included English-speaking Asian Americans, precluding generalizability to non-English-
speaking Asian Americans. In addition, because no other racial groups were sampled, it is
unclear whether findings are generalizable to those of other racial groups or whether they are
specific to Asian Americans. Support and conflict in romantic relationships related to topics of

91
discrimination, race, and activism may be relevant to sleep among those of other racial
backgrounds and thus, should be examined in future studies. Third, our sample size precluded
more detailed analyses such as conducting analyses disaggregated by ethnicity. As Asian
Americans are a heterogeneous group, disaggregating data is necessary to better understand
unique difficulties experienced by some ethnic groups and make visible effects that may
otherwise be hidden by the heterogeneous sample (Young & Cho, 2021). In addition, to limit the
scope of our study, we did not examine other individual factors such as nativity status,
acculturation, or age, which may provide relevant additional context in future studies. Fourth, we
collected data one to two months after the Atlanta spa shootings that killed six Asian American
women, a timeframe that may or may not have affected Asian Americans’ views of their own
discrimination experiences. In future studies, repeated sampling over time could better track the
interplay between personal experiences with discrimination and larger sociopolitical contexts.
Daily monitoring of discriminatory acts experienced personally as well as vicariously witnessed
racism (Kim et al., under review) would better delineate the associations of interest between
discrimination, the greater sociopolitical context of racism, and daily sleep. Fifth, with only a
handful of exceptions, the study assessed relationship phenomena (support, conflict) with reports
from only one partner, thus precluding examination of cross-partner influences. As romantic
relationships are reciprocal and partners have different perspectives, data collection from both
partners would better characterize the nuances of dyadic processes.
Summary
Attention is clearly needed on the emotional and physical toll associated with the rise in
hate crimes and discrimination against Asian Americans. Toward this end, the present study
provides additional insights on the link between discrimination and sleep and, by extension,

92
health, in Asian Americans. A non-random yet geographically varied sample of Asian Americans
from across the United States reported high rates of discrimination during the COVID-19
pandemic, with such discrimination being associated with sleep difficulties. Although just
scratching the surface in terms of what Asian Americans are currently undergoing, the results
provide meaningful evidence that Asian Americans are experiencing and being impacted by
discriminatory incidents. In this sample, conflict with a partner about race and activism
heightened associations between discrimination and sleep difficulties. From health care
perspectives, these findings point to the importance of assessing discrimination as a contributor
to sleep disturbance as well as evaluating whether close personal relationships are a source of
added tension or support surrounding discrimination experiences and concerns.

93
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101

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Figure 1.
Partner conflict moderates the association between proximal discrimination and T2 sleep
difficulties.

Note. Proximal discrimination and partner conflict were grand mean centered. Partner conflict is
plotted at +1 SD, the mean, and no levels of partner conflict.

b = 0.65**
b = 0.28
b = 0.42*
none
mean
+1SD
Partner Conflict

-1SD Mean +1SD
Proximal Discrimination
Sleep Difficulties

103
Supplemental Materials

Supplemental Analyses

Five additional analyses were conducted using multilevel models with random
intercepts. Analyses were run in the same manner as substantive analyses. See statistical
analysis section for more information about models. In Table 1, Models 1 and 2 show multilevel
models testing substantive moderation analyses with the additional covariate of partner race, a
dichotomous variable of having an Asian American partner (1) or a non-Asian American partner
(0). Model 1 tests partner support as a moderator and Model 2 tests partner conflict as a
moderator. Models 3, 4, and 5 test three additional moderators of the association between
proximal discrimination and sleep difficulties. Model 3 tests partner race, Model 4 tests,
relational worry, and Model 5 tests gender as potential moderators. Relational worry is the mean
of two items: “the hate crimes against Asian Americans make me worry about attacks against
relatives and people I care about” and “the hate crimes against Asian Americans make me check
up on loved ones more often than usual”. Response options to these items were “not at all” (0),
“a little” (1), “a moderate amount” (2), and “a lot” (3). Gender was coded as man (1), woman
(0).

104

105
Chapter 5
General Discussion
This dissertation investigated links between discrimination and sleep difficulties with the
romantic relationship as an important context for those who have experienced discrimination.
Using three different datasets and study samples, we examined discrimination within relevant
ongoing, historical times, including the racial reckoning occurring after the murder of George
Floyd and increased anti-Asian sentiment during the COVID-19 pandemic. In Paper 1, we found
that perceived discrimination was associated with sleep difficulties 1.5 years later and that
romantic partner qualities moderated this association. Specifically, having a partner who exhibits
greater perspective taking, or perceiving and understanding one’s perspectives, emotions, and
motives (Cahill et al., 2020), mitigated the association between discrimination and sleep
difficulties. On the other hand, having a partner who is psychologically aggressive heightened
this association. In Paper 2, we found that negative impacts of anti-Black violence (NIAV) and
direct experiences with discrimination were each associated with sleep difficulties. Black
participants endorsed greater NIAV than those of other races and Black, Asian, and Latinx
participants reported greater discrimination than White participants. There were some
unexpected moderation findings, where the association between discrimination and sleep
difficulties differed by race such that, only among Black participants, direct discrimination was
unrelated to sleep difficulties. Moreover, discrimination moderated the association between
NIAV and sleep difficulties such that this link was weaker among those who reported more
discrimination. In Paper 3, we found that among our sample of Asian Americans, discrimination
during the COVID-19 pandemic was associated with greater sleep difficulties. In addition,
conflict with romantic partners about anti-Asian racism strengthened this association.

106
Discrimination-specific support from a romantic partner, however, did not significantly moderate
this association.
Contributions to the Literature
The studies in this dissertation confirm the growing evidence that discrimination has
negative effects on sleep health within a variety of contexts and across racially diverse
Americans. Paper 1 detected links between discrimination and sleep difficulties 1.5 years later
among a relatively healthy sample of young adults, suggesting that impacts of discrimination
may be long-term. Paper 2 showed effects of discrimination on sleep difficulties above and
beyond negative effects of vicariously witnessed anti-Black violence, highlighting
discrimination’s impact even within difficult and relevant sociopolitical contexts. Additionally,
the converse was also true: effects of NIAV were associated with sleep difficulties above and
beyond personal experiences with discrimination. Experiences of anti-Black vicarious racism
appears to be distinct from direct discrimination and have their own effects on sleep. Paper 3
found effects of discrimination experienced during COVID-19 on sleep difficulties above and
beyond past, lifetime experiences of discrimination, showing that experiencing discrimination in
an ongoing manner acts as a continuous harm to sleep health. Together, these studies examine
discrimination across time, contexts, and populations, with consistent evidence for its deleterious
effects on sleep. These findings are unsurprising considering two premises. First, we
conceptualize discrimination as a stressor, as it shares the three elements named by Dickerson
and Kemeny (2004) to define a psychological stressor: unpredictability, uncontrollability, and
social-evaluative threat. Second, sleep is sensitive to stress, with stress increasing physiological
pathways (e.g., activation of the hypothalamic-pituitary-adrenal axis) and changes in behaviors
(e.g., poor eating, poor impulse control) that lead to sleep disruption (Hirotsu et al., 2015; Van

107
Reeth et al., 2000). Thus, we may understand discrimination to increase sleep difficulties through
the various pathways by which stress impacts sleep. Given the strong evidence of the effect of
poor sleep on daily functioning (Kelley et al., 2015; Rosekind et al., 2010) and overall health
(Buysse, 2014; Hale et al., 2020), findings in this dissertation underscore the high cost of
discrimination.
Additionally, these studies point to the relevance of relational and sociopolitical contexts
when considering possibilities for disrupting the adverse effects of discrimination on sleep.
Though both discrimination and sleep are often framed as individual constructs, ecological
systems theory by Bronfenbrenner (1994) posits that individual constructs are inextricably linked
to relational and ecological contexts. Regarding relational contexts, having a partner high in
perspective taking likely speaks to the partner’s ability to be attuned, perceptive, understanding,
and compassionate. It may be that this trait-like quality in a partner provides respite from
discrimination experiences through numerous ways, such as feeling safe within the relationship,
feeling validated and understood through a variety of daily stressors and experiences, and
experiencing a compassionate and validating response to sharing about one’s discrimination
experiences. On the other hand, partner psychological aggression may also be conceptualized as
a psychological stressor, as it shares the three elements of psychological stressors, and like
discrimination, is linked to poorer mental health and sleep (Campbell, 2002; Matos & Goncalves,
2019; Pico-Alfonso et al., 2006). For individuals who experienced discrimination in the outside
world, coming home to psychological aggression from a romantic partner may emphasis a lack
of safety and validation, acting as an additional blow to healthy sleep. These findings suggest
that couple-level interventions may be able reduce harm from discrimination on sleep health.
Additionally, these buffering and exacerbating effects of broad-based relationship qualities were

108
found among young adults, meaning interventions could occur as early as young adulthood,
increasing the likelihood of mitigate long-term health outcomes affected by disrupted sleep.
Though conflict about anti-Asian racism with a partner may not be as damaging as
psychological aggression from a partner, it may be a potent difficulty for individuals who are
Asian American and experiencing discrimination during a period of increased anti-Asian
sentiment. Indeed, an alarming 79.3% of participants in our third study reported discrimination
during a period of the COVID-19 pandemic, with 78.3% of those who endorsed discrimination
attributing it to their race or ethnicity, suggesting the salience of anti-Asian discrimination and
hate to this population during this time. This finding occurred while accounting for general
relationship satisfaction, suggesting that not only are general romantic relationship qualities
important for sleep but that romantic relationship interactions informed by the greater
sociopolitical context are also relevant.
Paper 2 also speaks to the importance and relevance of sociopolitical contexts for
individuals’ sleep and wellbeing. Despite the high numbers of Black Americans killed each year
by police, the availability of the moment-by-moment depiction of George Floyd’s murder and
the repetition of this recording across various media platforms triggered a public recognition of
anti-Black racism (Sanders, 2020). To understand the impacts of discrimination more fully, we
built on the idea of vicarious forms of discrimination and constructed a measure to study second-
hand anti-Black racism. Indeed, it was notable that most of our sample, regardless of race, did
endorse some level of cognitive and emotional disturbance due to the highly publicized anti-
Black violence in 2020. Stated differently, the impact of vicarious racism was not limited to
those of the same race but anti-Black violence affected Americans of all races. Moreover, this
form of vicarious discrimination, though understudied relative to direct experiences with

109
discrimination, was also related to poorer sleep, an increasingly relevant finding as social media
and advances in mobile technologies allow greater access to visceral, vicarious content. In
addition, the significant moderation effect of direct experiences with discrimination on the
association between NIAV and sleep suggests that how individuals are affected by national
events (i.e., the murder of unarmed, Black Americans by police) is informed by their own
experiences of discrimination. Thus, our findings fit within Bronfenbrenner’s ecological systems
theory that the context individuals are embedded within affect individuals in meaningful ways.
Though the studies in this dissertation focused on some unique moments in our history that have
elevated anti-Black and anti-Asian racism to the national stage, anti-Black and anti-Asian racism
have been present for centuries. Thus, our findings are not limited to the current context but have
implications for the future until systemic and cultural changes occur.
Limitations and Future Directions
Despite the contributions made by these three studies, there are also several limitations to
note. One limitation is that these studies rely on self-report data, which are subject to biases such
as recall bias or social desirability bias, which may have been present particularly as participants
reflected on how anti-Black violence affected them. Across all studies, sleep was measured
through self-report of sleep difficulties. While some dimensions of sleep may be better measured
through objective measures, sleep satisfaction and quality are by nature, subjective. Subjective
sleep quality appears to be orthogonal to objective measures (Krystal et al., 2002) and is reliably
related to mental health and physical health outcomes (Clement-Carbonell et al., 2021; Lo et al.,
2018). However, future studies may benefit from gathering objective measures of sleep through
actigraphy or polysomnography along with subjective measures. In addition to gathering
objective sleep measures, gathering passive data on couple interactions through mobile sensing

110
technologies (e.g., audio, physiological, GPS data) can provide a valuable window into romantic
relationships in addition to subjective reports of romantic partnerships (Timmons et al., 2017).
Moreover, most measures across the three studies were only collected at one time point,
limiting conclusions about causation and directionality of effects. The timing of data collection is
also important in better understanding sleep disturbance. We examined participants’ reactions to
anti-Black violence approximately six months after the murder of George Floyd and participants’
experiences of discrimination one to two months after the Atlanta spa shooting resulting in the
murder of six Asian American women. While anti-Black and anti-Asian racism and violence
have been ongoing, these two incidents received high levels of national attention and proximity
to these timepoints may have had relevance to the level of sleep disturbance experienced by
participants. Having repeated sampling of variables can provide a more accurate understanding
of effects of vicarious racism and direct discrimination on short-term and long-term sleep
outcomes as well as assess direction of effects.
Furthermore, samples for these studies were convenience samples. In addition, all
participants were in romantic relationships, living in the U.S., and were fluent in English, thus
limiting generalizability. Those in romantic relationships tend to have better health, which likely
includes better sleep quality (Robards et al., 2012). In addition, the power of culture in shaping
perceptions and experiences is strong (Mendoza-Denton & Worrell, 2019) with likely
implications for discrimination, relationships, and sleep. Immigration into the U.S. has continued
to trend upward after the passing of 1965 Immigration and Nationality Act, leading to more
diversity in the U.S. population and in languages spoken (Budiman, 2020). Thus, we have
precluded parts of the population in a number of ways, which should be considered when
interpreting findings. Future studies may benefit from collecting data in other languages.

111
Finally, these studies were conducted within the traditions of clinical psychology
research, which have a primary focus on the individual. Family systems researchers have
expanded clinical psychology’s purview into relational research such as the study of romantic
partnerships and families, which this dissertation has contributed to. However, human health and
wellbeing is inextricably tied to various layers of contexts that individuals are embedded in.
When examining effects of discrimination, we, like most clinical psychology research, have
primarily focused on direct, interpersonal forms of discrimination. However, psychology
research focusing more heavily on institutional forms of discrimination (e.g., discrimination in
policing, policy, healthcare, housing) is sparse and is needed to contribute to greater, systemic
interventions needed to reduce and eliminate discrimination (Williams et al., 2019). Though
studies of institutions may appear to be beyond the purview of clinical psychology, institutional
racism have effects on individual health and wellbeing and permeate the realm of clinical
psychology (Elias & Paradies, 2021). Thus, rather than relegating research on institutional forms
of discrimination to other fields, future research in clinical psychology would benefit from
engaging systems-focused questions to pursue pathways to greater equity beyond individual care.
Conclusion
This dissertation contributes to the growing literature linking discrimination to sleep
quality and identifies aspects of romantic relationships that may serve as risk or resilience factors
in the face of discrimination. In addition, two of the three papers explore the relevance of the
sociopolitical context of anti-Black violence after the murder of George Floyd and anti-Asian
sentiment during the COVID-19 pandemic to experiences of discrimination and sleep. Findings
highlight the deleterious effects of discrimination on a critical biological process relevant to daily

112
functioning and long-term health and the importance of understanding relational and
sociopolitical contexts as potential contributors to better or worse sleep outcomes.

113
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Appendix A: Paper 1 Measures
A1. Perceived Discrimination

Scale: 0 = not at all, 1 = a little, 2 = some, 3 = a lot.

To what extent have you ever been teased, picked on, excluded from something you wished to
do, felt disliked, or discriminated against because of:

1. being part of an ethnic or racial group
2. being born outside of the U.S.
3. being part of a religious group
4. not being masculine or feminine enough
5. having a disability or problem since birth

A2. Interpersonal Reactivity Index, Perspective Taking Subscale Modified for Partner

Scale: 1 = does not describe my partner well to 4 = does describe my partner well.

Please indicate how well each statement describes your partner.

1. My partner sometimes finds it difficult to see things from the "other guy's" point of view.
(-)
2. My partner tries to look at everybody's side of a disagreement before he/she makes a
decision.
3. My partner sometimes tries to understand my friends better by imagining how things look
from their perspective.
4. If my partner is sure he/she is right about something, he/she doesn’t waste much time
listening to other people's arguments. (-)
5. My partner believes that there are two sides to every question and tries to look at them
both.
6. When my partner is upset at someone, he/she usually tries to "put himself/herself in his
shoes" for a while.
7. Before criticizing somebody, my partner tries to imagine how he/she would feel if he/she
were in their place.

A3. How Dating Partners Treat Each Other, Psychological Aggression Items

Scale:
0 = never happened
1 = happened 1-2 times
2 = happened 3-5 time
3 = happened 6-10 times
4 = happened more than 10 times

Has your dating partner (the person with you today) ever done the following to you?

137
After filling this out one time, you also will be asked the same questions in terms of whether you
did it to a dating partner.

1. Told others things you said in confidence
2. Pressured you to take drugs/drunk alcohol
3. Pressured you to break parent or school rule
4. Pressured you to break the law
5. Made you feel as if your thoughts and feelings are not important
6. Turned friends against you
7. Pressured you to stop seeing friends or people you like
8. Did something to make you jealous
9. Told you that you were to blame for your arguments
10. Said things just to make you angry
11. Said things to hurt your feelings
12. Spoke in a hostile or mean tone of voice to you
13. Insulted you with “put-downs”
14. Said things to your friends to turn them against you
15. Ridiculed or made fun of you in front of others
16. Kept track of who you are with and what you are doing
17. Blamed you for a problem
18. Accused you of flirting with someone else
19. Deliberately tried to frighten you
20. Threatened to hurt you
21. Threatened to end the relationship
22. Threatened to hit or throw something at you
23. Spread rumors about you
24. Drove recklessly with you in the car
25. Argued with you while they were driving
26. Threatened to do something bad to you if you stopped seeing him/her
27. Threatened to do something bad to him/herself if you stopped seeing him/her

A4. Pittsburgh Sleep Quality Index, Sleep Disturbance Subscale Modified

Scale:
1 = never
2 = occasionally but less than once a week
3 = once or twice a week
4 = three or more times a week
5 = almost every night

In the past month, how often did you:

1.Fall asleep while working or at the computer
2. Have trouble getting to sleep within 30 minutes
3. Wake up in the middle of the night
4. Wake up early in the morning before you wanted to be awake

138
5. Have bad dreams
6. Have trouble falling back asleep if you woke up in the middle of the night or early in the
morning
7. Have trouble sleeping because you couldn’t turn your mind off
8. Have trouble sleeping because you were worried, upset or cared about things in your life
9. Worry about not being able to sleep
10. Look forward to getting into bed
11. Fall asleep when socializing with other people
12. Fall asleep or almost fall asleep while driving
13. Fall asleep when in a car, bus, or train
14. Not find enough time to sleep due to homework, other commitments, a job, etc.

139
Appendix B: Paper 2 Measures
B1. Negative Impact of Anti-Black Violence

Scale:
0 = Not at all
1 = A little
2 = A moderate amount
3 = A lot

People have been affected differently by the violent deaths of Ahmaud Arbery, Breonna Taylor,
George Floyd, and others. To what extent do the following statements describe your reactions to
these deaths and the movement against racial injustice?

1. The violent deaths of Black people have caused me pain and/or frustration
2. I am concerned for my personal safety due to the color of my skin or my race
3. I am concerned for the safety of a loved one due to the color of their skin or their race
4. I am struggling to concentrate on everyday activities due to these deaths

B2. Everyday Discrimination Scale, Modified

Scale:
0 = Never
1 = Infrequently
2 = Frequently
3 = All the time

How often have you experienced the following discriminatory experiences?

1. verbal harassment/name-calling/threats
2. being coughed at/spat upon
3. physical assault
4. racial profiling

B3. Pittsburgh Sleep Quality Index, Sleep Disturbance Subscale Modified

Scale:
0 = Not during the past month
1 = Less than once a week
2 = Once or twice a week
3 = Three or more times a week

How often have you experienced the following over the past month?

1. Trouble falling asleep (ex: took more than 30 min)
2. Trouble staying asleep (waking up in the middle of the night)

140
3. Waking up in the middle of the night and can’t fall back asleep
4. Bad dreams
5. Waking up too early or too late
6. Trouble getting going in the morning

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Appendix C: Paper 3 Measures
C1. Everyday Discrimination Scale, Modified

Scale:
0 = Never
1 = Infrequently
2 = Frequently
3 = All the time

How often have you experienced the following discriminatory experiences since January 2021?

1. People act as if they’re better than you or treat you with less respect
2. People act as if they wre afraid of you
3. Gaslighting / someone making you question your own experience or reality
4. Verbal harassment / name-calling / threats
5. Online harassment
6. Coughed at / spat upon
7. Physical assault
8. Racial profiling
9. Workplace discrimination
10. Vandalism / graffiti

What do you think is the main reason for these experiences?
Race/ethnicity, religion, gender, sexual orientation, disability, other (please describe)

C2. Discrimination-specific Partner Support

Scale:
-2 = strongly disagree
-1 = somewhat disagree
0 = neither agree nor disagree
1 = somewhat agree
2 = strongly agree

Please indicate to what degree you agree with the following statements.

1. My partner fully understands my experience related to these discriminatory events
2. My partner has been able to support me in the ways that I need related to these
discriminatory events

142
C3. Partner Conflict about Anti-Asian Racism

Scale:
0 = Not at all
1 = A little
2 = A moderate amount
3 = A lot

1. I have had conflict with my partner about topics of race since the uptick in racist
incidents against Asian Americans
2. My partner and I have had disagreements about how to engage in activism against racial
injustice against Asian Americans

C4. Pittsburgh Sleep Quality Index, Sleep Disturbance Subscale Modified

Scale:
0 = Not during the past month
1 = Less than once a week
2 = Once or twice a week
3 = Three or more times a week

How often have you experienced the following over the past month?

1. Trouble falling asleep (ex: took more than 30 min)
2. Trouble staying asleep (waking up in the middle of the night)
3. Waking up in the middle of the night and can’t fall back asleep
4. Bad dreams
5. Waking up too early or too late
6. Trouble getting going in the morning

Abstract (if available)

Abstract This dissertation examines links between perceived discrimination and sleep difficulties, as sleep is a critical biological process for health and wellbeing. In addition, studies examine the relevance of romantic relationships and sociopolitical contexts to better understand effects of discrimination on sleep. The first paper in this dissertation examines romantic partner perspective taking and psychological aggression as general relationship qualities that respectively buffer and exacerbate the association between discrimination and sleep in racially diverse young adults. The second paper investigates links between negative impacts of anti-Black violence (NIAV), perceived discrimination, and sleep difficulties among Black, Asian, Latinx, and White participants approximately 6-8 months after the murder of George Floyd. The third paper hones in on romantic relationship interactions related to discrimination and anti-Asian racism as potential moderators of the link between discrimination experienced during the COVID-19 pandemic and sleep difficulties among Asian American adults. These studies provide greater understanding of how the contextual factors of close relationships and a milieu of anti-Black and anti-Asian racism can provide a more nuanced understanding of the association between discrimination and sleep.

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Asset Metadata

Creator Kim, Yehsong (author)

Core Title Links between discrimination and sleep difficulties: romantic relationships as risk and resilience factors

School College of Letters, Arts and Sciences

Degree Doctor of Philosophy

Degree Program Psychology

Degree Conferral Date 2023-08

Publication Date 11/26/2024

Defense Date 05/01/2023

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Discrimination,OAI-PMH Harvest,romantic relationships,Sleep

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Advisor Margolin, Gayla (committee chair), Huey, Stanley Jr. (committee member), John, Richard (committee member), Narayanan, Shrikanth (committee member)

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