Racism as a social determinant of health: Link to school-related psychosocial stressors in a population-based sample of African adolescents in Canada

Background: Racism is a social determinant of health that links to the health and wellbeing of racial/ethnic marginalized populations. However, perceived racism among African Canadian adolescents has not been adequately addressed, especially the link between racism and psychosocial stressors in school settings.Aim: The aim of the current study was to assess racism and the link to school-related psychosocial stressors in a population based sample of African Canadian adolescents. Design: Secondary analysis of the population based 2018 British Columbia Adolescent Health Survey dataset.Methods: Logistic regression and generalized linear models tested the link between racism and psychosocial stressors among African Canadian adolescents (n = 942), adjusting for sociodemographic factors.Results/Findings: More than 38% of the adolescents reported racism in the year preceding the survey. Regardless of gender and birthplace, and controlling for covariates, those who experienced racism were significantly more likely to report peer victimization, which includes teasing, social exclusion, cyberbullying and sexual harassment, and they felt less safe and connected to their schools compared to those who did not experience racism. With gender and birthplace differences, those who reported racism had higher odds of having been physically assaulted, stayed away from school, reported negative emotional responses and used avoidant behaviours to evade racism.Conclusion: African Canadian adolescents are a visible racialized ethnic group in British Columbia, who are at heightened risk of racism and the associated psychosocial stressors.Impact: These findings demonstrate the influences of racism on psychosocial stress ors and related emotional responses among African Canadian adolescents. Nurses and other healthcare providers should be cognizant of racism and the psychological impacts when providing care to "at-risk" populations. Promoting positive and inclusive school climates and addressing racism at all levels of the society will foster bettersocial integration, as well as improve the health and academic achievement of African Canadian adolescents.Patient or Public Contribution: We presented the research and preliminary results of the data analysis to the African community (parents and adolescents who self identify as African). The African community who attended the gathering corroborated the link between racism and health and reiterated that addressing these psychosocial stressors can promote adolescent health and well-being. The attendees accepted all the variables that we included in the analysis. However, they emphasized the need for more African representation among school staff and teachers to foster trust, feelings of safety and connectedness, and to promote African students' academic achievement and well-being. They stressed the need to train and build the capacities of the school staff and teachers so that they can assist students regardless of race. They emphasized the need to promote cultural awareness and cultural sensitivity among all healthcare providers. We included the recommendations in the appropriate sections of the manuscript.