Research Methods in Psychology

Contributions of Black Psychology Scholars to Models of Racism and Health: Applying Intersectionality to Center Black Women

Jioni A. Lewis Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park

Although theoretical and empirical research on the impact of racism on the mental and physical health of African Americans is well established in the literature, there is still a dearth of research that focuses on the role of the intersection of racism and sexism, or gendered racism, on the health of Black women. The purpose of this article is threefold: (a) to review the foundational contributions of Black psychologists to the study of racism and health, (b) to highlight the intellectual contributions of Black feminist scholars to the study of intersectionality in psychology, and (c) to apply an intersectionality framework to research on racism and health by introducing a conceptual Biopsychosocial Model of Gendered Racism to better understand the impact of gendered racism on Black women’s health and well-being. This article ends with recommendations for future research, clinical practice, and social justice advocacy centered on Black women’s health.

Public Significance Statement This article reviews foundational models of racism and health developed by Black psychology scholars, highlights the contributions of Black feminist scholars to the study of intersectionality in psychology, and applies an intersectional framework to uncover the role of racism and sexism on Black women’s health. This article ends with recommenda- tions for future research, clinical practice, and social justice advocacy focused on Black women’s health and well-being.

Keywords: racism, health, Black women, intersectionality, Black feminism

Persistent racial health inequalities exist in the United States with Black individuals at the greatest risk of cardio- vascular disease, stroke, certain types of cancer, and mor- tality compared to their White counterparts (National Center for Health Statistics, 2019). Black individuals report higher rates of hypertension (Williams & Neighbors, 2001), car- diovascular disease (Lewis et al., 2006), mortality rates (Barnes et al., 2008), breast cancer (Taylor et al., 2007), and maternal mortality and morbidity (Creanga et al., 2014). For example, Black women are three times more likely to experience life-threatening pregnancy complications

(i.e., preeclampsia) and nearly four times more likely to experience preventable pregnancy-related deaths (Creanga et al., 2014). In addition, the COVID-19 pandemic has had a disproportionate negative impact on Black individuals in terms of mortality and infection rates (COVID Racial Data Tracker, 2021). In the summer of 2020, the high-profile killings of Ahmaud Arbery, Breonna Taylor, and George Floyd, among others, shined a light on the longstanding issues of systemic racism, police brutality, and violence in the United States. The confluence of these two crises has highlighted the role of structural racism in exacerbating racial health inequities in Black communities. However, much of the discourse on the negative impact of COVID-19 has focused on the role of racial inequities, with little attention to the intersection of gender. For example, Black women have experienced higher unemployment rates since the start of the COVID-19 pandemic compared to White men and women (National Women’s Law Center, 2021). Moreover, Black women are more likely to work in frontline service jobs that lack the inability to work from home or have paid sick leave, which can put them at increased risk of

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

Jioni A. Lewis https://orcid.org/0000-0003-1719-4895 Jioni A. Lewis played lead role in conceptualization, writing–original draft

and writing–review and editing. Correspondence concerning this article should be addressed to Jioni A.

Lewis, Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, Benjamin Building, College Park, MD 20742, United States. Email: [email protected]

American Psychologist

© 2023 American Psychological Association 2023, Vol. 78, No. 4, 576–588 ISSN: 0003-066X https://doi.org/10.1037/amp0001141

576

contracting COVID-19 (Pirtle & Wright, 2021). Black women may be at greater risk of the combined effects of preexisting gendered racial health disparities in the context of COVID-19 (Carvalho et al., 2022; Obinna, 2021). How- ever, Black women’s unique gendered racial health inequi- ties have often been marginalized and invisible (Lewis, 2021; Pirtle & Wright, 2021). Therefore, an intersectional analysis is needed to better illuminate the impact of racism and sexism on Black women’s health. Building on the rich intellectual contributions of Black

psychologists to research on racism and health, the purpose of this article is to highlight the foundational models of racism and health and apply an intersectionality framework to elucidate the role of racism and sexism (i.e., gendered racism) on Black women’s health. First, I will briefly review the foundational contributions of Black psychology scholars to the study of racism and health (e.g., Clark et al., 1999; Harrell, 2000). Next, I will highlight the contributions of Black feminist scholars to intersectionality in psychology (e.g., Cole, 2009; Crenshaw, 1989). Then, I will apply an intersectionality framework to the study of racism and health to highlight the impact of gendered racism on Black women’s health. I will end with recommendations for future research, clinical practice, and social justice advocacy focused on Black women’s health and well-being. Given the epistemic exclusion of knowledge produced by Black scholars in the field of psychology (Settles et al., 2021), particularly Black women, I chose to center the foundational work of Black psychology scholars in my review of the literature. Also, my focus on Black women is inclusive of cisgender, transgender, and gender expansive individuals. I also acknowledge the diversity of Black women based on intersections of age, disability, ethnicity, gender identity, immigration status, religion, sexual orientation, and socioeconomic status.

Black Psychologists’ Contributions to Foundational Models of Racism and Health

Black scholars have significantly contributed to research on racism and health in the field of psychology. Although Black psychologists have conceptualized racism in many ways, racism has generally been defined as attitudes, beliefs, and behaviors as well as institutional and cultural policies and practices that justify the oppression and domination of people based on phenotypic characteristics that have been defined as inferior in society (Clark et al., 1999; Jones, 1972/ 1997; Neblett, 2019; Neville et al., 2012). Jones (1972/ 1997) wrote his foundational book, Prejudice and Racism, which introduced a tripartite model that identified three different manifestations of racism. Individual racism in- cludes racial biases, prejudices, and attitudes of racial superiority, which can be communicated on an individual or interpersonal level. Institutional racism includes policies and practices within an institution that perpetuate racial inequality, such as the legal system, education, and the health care system. Cultural racism includes aesthetics, values, and social mores that reinforce ethnocentrism, such as negative messages and stereotypes about Black culture communicated through the media. Jones argued that cultural racism encompasses both individuals and in- stitutions, which are often expressed as societal values that reinforce the racial superiority of White people and the racial inferiority of Black people. Jones was one of the first Black psychologists to conceptualize the way that multiple levels of racism manifest and interact together to impact the lives of Black people in U.S. society. Building on Jones (1972/1997) multidimensional model of

racism, several Black psychology scholars developed con- ceptual models and empirical research investigating the impact of racism on the health and well-being of African Americans (Clark et al., 1999; Harrell, 2000; Neville et al., 2012; Neville & Pieterse, 2009). For example, Dr. Helen A. Neville et al. (2012) developed a psychosocial model of racism that highlights the interlocking nature of the structure and ideology of racism and White supremacy, which are expressed at the cultural, institutional, interpersonal, and individual levels. Thus, Black psychologists have played a pivotal role in providing a psychological understanding of racism that situates individual-level racism within a larger systems-level framework. Drawing on Lazarus and Folkman’s (1984) transactional

model of stress and coping, racism has been conceptualized as a form of chronic stress that can be harmful to the mental and physical health of African Americans (Clark et al., 1999; Harrell, 2000;Myers et al., 2003; Utsey & Ponterotto, 1996). Two of the most widely cited theoretical models that conceptualize racism as a chronic stressor developed by Black psychologists are: (a) Clark et al.’s (1999) Biopsy- chosocial Model of Perceived Racism and (b) Dr. Shelly P.

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

Jioni A. Lewis

GENDERED RACISM AND HEALTH 577

Harrell’s (2000) Multidimensional Conceptualization of Racism-Related Stress.

Clark et al.’s (1999) Biopsychosocial Model of Perceived Racism

Clark et al.’s (1999) Biopsychosocial Model of Racism was one of the first models focused on conceptualizing the biop- sychosocial effects of perceived racism. This model theorized that “the perception of an environmental stimulus as racist results in exaggerated psychological and physiological stress responses” (p. 806). For example, when an individual experi- ences a racist environmental stimulus, such as racial discrimi- nation, a cognitive appraisal process occurs and the individual must determine whether the stressor is racist. After the envi- ronmental stimulus is perceived as racist, the stress and coping process is activated, and an individual’s response can depend on a variety of factors. Clark et al. argued that the appraisal of an event as racist is an important component of the stress and coping process that might negatively impact health. The biopsychosocial model of racism also hypothesized

several moderating and mediating variables that are proposed to influence the racism–health link. Specifically, Clark et al. (1999) highlight moderating variables, which they categorize as constitutional factors (e.g., skin tone, occupational status, family risk factors for chronic illness), sociodemographic factors (e.g., socioeconomic status, educational level, ethnic- ity, age, gender), and psychological and behavioral factors (e.g., neuroticism, self-esteem, anger suppression). Clark et al. (1999) also hypothesized mediating variables that help to explain the association between racism and health, such as coping responses. Specifically, adaptive coping (e.g., active and engagement strategies) and maladaptive coping (e.g., passive and disengagement/avoidance strategies) are expected to influence the frequency and stress appraisal of racist experiences, with adaptive coping mitigating nega- tive effects and maladaptive coping exacerbating negative effects of racism on health. Other mediating variables include psychological stress responses (e.g., sadness, anger, para- noia, and hopelessness) and physiological stress responses, such as the activation of the hypothalamic–pituitary–adrenal (HPA) axis, which includes the secretion of cortisol, a stress hormone, and subsequent cardiovascular activity. Clark et al. argued that these physiological stress responses can lead to a host of negative health outcomes over time.

Shelly P. Harrell’s (2000) Multidimensional Conceptualization of Racism-Related Stress

Another widely cited racism and health model developed by a Black psychologist is Shelly P. Harrell’s (2000) Multidi- mensional Conceptualization of Racism-Related Stress, which also draws on a stress and coping framework to theorize the impact of racismwith a focus onmental health and well-being.

Harrell defines racism-related stress as “the racism-related transactions between individuals or groups and their environ- ment that emerge from the dynamics of racism, and that are perceived to tax or exceed existing individual and collective resources or threaten well-being” (p. 44). In this model, there are six forms of racism-related stress: racism-related life events (acute, time-limited racist incidents, such as being called a racial slur), vicarious racism experiences (witnessing a racist incident or hearing about a racist incident happening to a friend or family member), daily racism microstressors (everyday racism, racial microaggressions), chronic-contextual stress (inequitable resources, such as unstable housing, underem- ployment), collective experiences (understanding the larger impact of racism on one’s racial/ethnic group), and transge- nerational transmissions (intergenerational racial trauma and racism experienced by one’s racial/ethnic group). Harrell’s (2000) model includes five domains and several

variables that are hypothesized to influence the racism-related stress and health process. First, Harrell describes antecedent variables, such as person factors (e.g., race/ethnicity, age, gender) and socioenvironmental factors (e.g., regional/geo- graphic location, socioeconomic status). Second, aspects of familial roles and socialization are expected to influence the racism–health link, such as family characteristics (e.g., family structure and roles) and racial socialization (e.g., from family, community). Third, the model delineates several sources of stress including racism-related stress (e.g., overt racism, racial microaggressions, racial trauma), other status-related stress (e.g., sexism, heterosexism), and generic stressors (e.g., life events, daily hassles). Fourth, internal and external mediators are expected to influence racism-related stress and health including internal characteristics (e.g., self-esteem), sociocul- tural variables (e.g., cultural values, racial/ethnic identity, racism-related coping), affective and behavioral responses to stress (e.g., sadness, anger, active/passive coping styles, collective coping), and external resources (e.g., social sup- port). Fifth, Harrell highlights several health outcomes that are expected to result from experiences with racism-related stress including physical (e.g., hypertension, cardiovascular reactiv- ity), psychological (e.g., anxiety, depression, posttraumatic stress disorder), social (e.g., social connectedness), functional (e.g., academic achievement, job performance), and spiritual (e.g., lack of faith and meaning in life). Taken together, both Clark et al. (1999) and Harrell’s

(2000) models conceptualize the biological and psycholog- ical processes that mediate or moderate the link between racism and health. Both models also highlight the complex and multidimensional factors that contribute to the associa- tion between racism and health, including sociocultural factors such as racial/ethnic identity, racial socialization, coping strategies, as well as systemic factors that might mediate or moderate the link between racism and health. A unique feature of Harrell’s model is the articulation of various types of racism-related stress including racial

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

578 LEWIS

microaggressions (i.e., automatic, stunning, racial slights, and insults), a term originally coined by Black psychiatrist Dr. Chester Pierce et al. (1977). Although the Clark et al. (1999) model highlights the role of demographic variables, such as gender, it does not explicitly mention how sexism might intersect with racism to differentially affect Black women. In contrast, Harrell’s multidimensional model ar- gues that it is possible for other forms of discrimination, such as sexism or heterosexism, to impact one’s mental health. However, both models have not directly theorized the specific role of the intersection of racism and sexism in the stress and coping process.

Empirical Support for Foundational Models of Racism and Health

A large body of research has provided empirical support for these foundational biopsychosocial models of racism to the psychological and behavioral health literature. For example, sociologist Dr. David R. Williams and Psychologist Dr. James S. Jackson established the Program for Research on Black Americans at the Institute for Social Research where they conducted groundbreaking research on the biopsychosocial impact of racial discrimination on diverse samples of Black Americans. The current body of empirical research suggests that experiencing a greater frequency and stress appraisal of racism is associated with poorer mental health outcomes (e.g., psychological distress, stress, depressive symptoms, somatiza- tion), poorer physical health outcomes (e.g., increased blood pressure, infant low birth weight), lower quality of life in- dicators (e.g., lower self-esteem, lower overall mental health), and greater engagement in unhealthy behaviors (e.g., cigarette smoking, alcohol use, and substance use; Landrine & Klonoff, 1996; Paradies et al., 2015; Pascoe & Smart Richman, 2009; Pieterse et al., 2012; Utsey & Ponterotto, 1996; Williams & Mohammed, 2009, 2013;Williams&Williams-Morris, 2000). For example, Williams et al. (2003) conducted a systematic review of 53 studies with community-based African Ameri- can samples and found that greater racial discrimination was associated with poorer mental health outcomes (e.g., lower self-esteem, depression, anxiety, psychological distress), poorer physical health outcomes (e.g., increased blood pres- sure, lower self-rated health), and greater engagement in unhealthy behaviors (e.g., smoking, alcohol use). In addi- tion, in a large-scale meta-analysis across 333 articles pub- lished between 1983 and 2013, Paradies et al. (2015) found a significant association between racism and poorer mental health, poorer general health, and poorer physical health. There is also a growing body of empirical evidence that has

found racism can impact physiological responses to stress, such as cortisol, blood pressure, HPA axis reactivity, immune system functioning, and cardiovascular functioning (Allen et al., 2019; Brody et al., 2014; Busse et al., 2017; Chae et al., 2020; Iruka et al., 2022; T. T. Lewis et al., 2015; Volpe et al.,

2019). For example, in a systematic review, Dr. Tené T. T. Lewis et al. (2015) found a significant association between racial discrimination and ambulatory blood pressure, which is a measure of stress reactivity and linked to cardiovascular disease risk. Health researchers have hypothesized that experiencing racial discrimination negatively impacts biologi- cal responses to chronic stress, which may lead to “weather- ing” or wear and tear on one’s body (Geronimus et al., 2006). There has also been research on how racial discrimination can contribute to one’s allostatic load (McEwen, 1998; Seeman et al., 1997), which refers to one’s cumulative biological risk from repeated and chronic stress. For example, Brody et al. (2014) tested the association between racial discrimination and allostatic load in a sample of 331 African American adoles- cents and found a significant positive association. Taken together, these empirical studies and meta-analytic reviews have found that the stress of racism has a negative impact on various aspects of physical health. However, studies consis- tently show that the effects of racism may be stronger for mental health than for physical health (Paradies et al., 2015; Pascoe & Smart Richman, 2009). In summary, there is a robust body of empirical literature

that has consistently found that experiencing a greater fre- quency and stress appraisal of racism is significantly associ- ated with poorer mental and physical health outcomes. However, much of this research in the field of psychology has not theorized about the intersections between racism and sexism. Thus, although this large body of research on racism and health has greatly contributed to our understanding of the psychological and physical health effects of racism on the lives of Black Americans, there is a dearth of research specifically focused on the experiences of Black women and the role of racism and sexism on health. Therefore, inter- sectionality theory (e.g., Cole, 2009; Crenshaw, 1989) might provide a more nuanced framework to elucidate the experi- ence of interlocking systems of oppression.

Black Feminism’s Contribution to Intersectionality Theory

Intersectionality is rooted in the history of Black feminist activism. Throughout the 19th and 20th centuries, Black feminist foremothers, such as Sojourner Truth, Harriet Tubman, Maria Stewart, Anna Julia Cooper, and Ida B. Wells-Barnett, fought against oppression at the intersection of race, gender, and class (Collins, 1990/2000; Giddings, 1984, Hancock, 2016; Harris-Perry, 2011). During the 1970s, Black women scholar-activists highlighted the unique marginaliza- tion of Black women in the fight for liberation; specifically, Blackwomen experienced racism in the first- and second-wave feminist movements as well as sexism within the Civil Rights and Black liberation movements (Collins, 1990/2000; hooks, 1981). The Combahee River Collective, a group of radical Black queer feminist scholar-activists, poignantly articulated

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

GENDERED RACISM AND HEALTH 579

Black women’s oppression at the intersection of racism, classism, and sexism. They stated,

We believe that sexual politics under patriarchy is as pervasive in Black women’s lives as are the politics of class and race. We also find it difficult to separate race from class from sex oppression because in our lives they are most often experienced simultaneously. (Combahee River Collective, 1977/1995, p. 234)

Therefore, Black feminist activism has always been at the foundation of intersectionality. During the 1980s and 1990s, there was a boom in Black

feminist scholarship including the work of Drs. Patricia Hill Collins, bell hooks, Audre Lorde, Beverly Guy-Sheftall, Alice Walker, and Kimberlé Crenshaw, among others (Collins, 1990/2000, 2019; Hancock, 2016). Sociologist Dr. Patricia Hill Collins (1990/2000) wrote her foundational book, Black Feminist Thought, which highlighted the impor- tance of Black women’s lived experiences (i.e., standpoint) at the intersection of race, gender, and class oppression. She introduced the concept of the matrix of domination, which is the way that interlocking systems of oppression intersect to maintain structural inequality. In addition, Collins critiqued the suppression of Black women’s knowledge production in traditional intellectual discourse and sought to center Black feminist ways of knowing. Critical race legal scholar Kim- berlé Crenshaw (1989) introduced the term intersectionality in her critique of antidiscrimination law that often focused on discrimination along a single axis (race or gender). Crenshaw asserted that Black women typically “experience discrimina- tion as Black women—not the sum of race or sex discrimi- nation, but as Black women” (p. 149). Consequently, Crenshaw and Collins similarly articulated the role of inter- locking systems of oppression, power, and inequality in the lives of Black women.

Black Feminist Psychologists’ Contributions to Intersectionality in Psychology

During the proliferation of Black feminist scholarship in the 1980s and 1990s in other academic disciplines, Black women in psychology also theorized about the impact of racism, sexism, classism, and interlocking systems of oppression on the lives of Black women (Greene, 1994; Landrine, 1995; Reid, 1988; Reid & Comas-Diaz, 1990; Thomas, 2004; Thomas & Miles, 1995). For example, Black feminist psy- chologist, Dr. Veronica G. Thomas (2004) wrote a founda- tional article in the Journal of Black Psychology on the Psychology of Black Women as a distinct specialty in the field, which she defined as the “systematic study of the motivations, cognitions, attitudes, and behaviors of Black women taking into consideration the contextual and interac- tive effects of history, culture, race, class, gender, and forms of oppression” (p. 290). Dr. Beverly Greene (1994) coined the term triple jeopardy to highlight the interactive effects of

oppression based on race, gender, and sexual orientation. In addition, Dr. Thema Bryant has been foundational to the conceptualization of womanist psychology, which centers on the healing, spirituality, self-determination, and liberation of Blackwomen in the face of intersecting forms of oppression (Bryant-Davis & Comas-Díaz, 2016). Thus, there is a herstory of Black feminist psychologists who have paved the way in centering Black women’s unique experiences, which has contributed to theories on the impact of interlocking systems of oppression in the lives of Black women. In the past 15 years, there has been an explosion of

intersectionality research in psychology. In addition to sev- eral special issues devoted to intersectionality research in psychology journals (e.g., Else-Quest & Hyde, 2016; Moradi & Grzanka, 2017; Overstreet et al., 2020; Shields, 2008), Dr. Elizabeth R. Cole’s (2009) foundational publication in the American Psychologist on intersectionality in psychology was a catalyst for psychological research on this topic. One significant intellectual contribution of Cole’s (2009) article is that she delineated three conceptualizations of intersection- ality framed around three questions psychologists could ask themselves at different stages of the research process to incorporate intersectionality into their research. The first question, “Who is included within this category?” challenges psychologists to consider the diversity within a group based on intersectional identities, such as race, ethnicity, gender, age, sexual orientation, social class, and ability/disability. The second question, “What role does inequality play?” challenges psychologists to consider the role of hierarchies, structural inequity, and power. Cole’s third question, “Where are there similarities?” challenges psychologists to consider commonalities within diverse groups, which is beneficial for coalition building and activism. There has also been much debate in the field of psychology

about the best way to conduct an intersectional analysis. Historically, researchers have utilized various approaches to study discrimination, including single axis (e.g., measuring one form of discrimination, such as race or gender), com- parative/categorical (e.g., comparing Black women with White women or Black women with Black men, using race and gender categories as a proxy for measuring discrimina- tion), additive (e.g., measuring racism and sexism separately and then adding them together), interactional/multiplicative (e.g., measuring racism and sexism separately and then multiplying them together using a statistical interaction term), and intersectional (measuring the unique intersection of the simultaneous experience of racism and sexism; Cole, 2009; Lewis et al., 2017; Lewis & Grzanka, 2016). Some intersectionality scholars have argued that additive and interactional approaches represent weak intersectionality because they treat each form of discrimination as separate, quantifiable, and focused on individual-level identities; whereas strong intersectionality is focused on analyzing the relationship between interlocking systems of oppression,

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

580 LEWIS

inequality, and power (Bowleg, 2008; Dill & Kohlman, 2012; Lewis & Grzanka, 2016). Although these approaches to intersectionality research in

psychology are important to consider, some scholars argue that these methodological debates miss the point (e.g., Buchanan & Wiklund, 2021; Cho et al., 2013). As originally articulated by Crenshaw (1989), an important function of intersectionality was to serve as a lens to illuminate the intersectional vulner- abilities of individuals who experience multiple forms of marginalization, such as Black women, who exist at the nexus of interlocking systems of oppression (Bowleg & Bauer, 2016; Lewis & Neville, 2015; Lewis et al., 2017). Recently, Black feminist scholars in psychology (Buchanan & Wiklund, 2021; Cole, 2020; Lewis, 2021; Settles et al., 2020) have also observed that intersectionality research in psychology has become depoliticized and strayed from its Black feminist roots, which has meant that Black women’s unique experiences have been marginalized and made invisible in the extant literature. Specifically, although there has been an increase in intersec- tionality research in psychology, there is still a dearth of research centered on the lived experiences of Black women (Cole, 2020; Settles et al., 2020). Thus, it is necessary to employ an intersectionality framework in research on Black women’s health to capture the influence of the simultaneous experience of racism and sexism.

Applying Intersectionality to Research on Racism and Health

Gendered Racism and Intersectional Oppression

Although some scholars use the term gendered racism to refer to gendered forms of racism experienced by both men of color and women of color alike, the term gendered racism was originally coined by sociologist Dr. Philomena Essed (1991) to refer to the simultaneous experience of both racism and sexism. According to Essed, racism and sexism “intertwine and combine under certain conditions into one hybrid phe- nomenon” (p. 31). Essed argued that Blackwomen experience gendered and classed forms of racism that are based on ideologies and stereotypes of Black womanhood. Essed’s work on gendered racism was initially a part of her larger research on everyday racism, which she referred to as the reinforcement of racism through commonplace and familiar practices that occur in everyday life. Black women’s unique experiences of gendered racism are rooted in historical and contemporary gendered racial stereotypes, such as the Jezebel (i.e., sexually promiscuous and hypersexual), mammy (i.e., asexual and self-sacrificing caretaker), sapphire (i.e., angry, domineering, and aggressive), strong Black woman (i.e., strong and can handle inordinate amounts of stress), and welfare queen (i.e., lower class and dependent on public assistance; Bailey, 2021; Collins, 1990/2000; Essed, 1991; Harris-Perry, 2011). These socially constructed stereotypes and tropes operate as controlling images that serve to justify

and rationalize oppression, marginalization, and subjugation of Black women in U.S. society. Building on previous conceptualizations of racism and

sexism, I defined systemic gendered racism as the intersec- tion between white supremacy and patriarchy, which in- cludes two interlocking components: (a) a structural mechanism of domination, and (b) a corresponding ideo- logical belief that justifies the oppression of Black women based on their marginalized race and gender (Lewis, 2021). In addition, drawing on Jones’s (1972/1997) tripartite model of racism, the manifestations of gendered racism include individual gendered racism (i.e., gendered racial biases, prejudice, or behaviors that denigrate Black women who are viewed as inferior in society), interpersonal gen- dered racism (i.e., gendered racial microaggressions including slights, insults, and behaviors that communicate negative messages and stereotypes about Black women), institutional gendered racism (i.e., institutional policies and practices that perpetuate inequality by restricting op- portunities for Black women), and cultural gendered rac- ism (i.e., aesthetics, values, symbols, and social mores that reinforce the notion that Black women are inferior to men and White women). For example, Eurocentric standards of beauty that privilege European facial features and body types as more attractive than Afrocentric aesthetics or the experience of hair discrimination for Black women in the workplace. The intersection of White supremacy and patri- archy are bound together by misogynoir, a term coined by Dr. Moya Bailey (2021) that refers to the simultaneous experience of racialized and sexualized violence unique to Black women’s positionality in society, which includes stereotypical representations, hypervisibility and tokenism, or the invisibility and erasure of Black women.

Gendered Racial Microaggressions

Drawing on Essed’s (1991) concept of gendered racism and psychologist Dr. Derald Wing Sue et al.’s (2007) schol- arship on racial microaggressions, my colleagues and I were the first to coin the term gendered racial microaggressions, which refers to “subtle and everyday verbal, behavioral, and environmental expressions of oppression based on the inter- section of one’s race and gender” (Lewis et al., 2013, p. 51). Gendered racial microaggressions refer to gendered racism at the interpersonal level, which can be reinforced through everyday practices in overt and covert ways. In the first qualitative study focused on gendered racial microaggres- sions, my colleagues and I (Lewis et al., 2010, 2016) con- ducted focus group interviews with Black women college students and created a taxonomy of gendered racial micro- aggressions. The findings included three core themes, each with two subthemes as follows: projected stereotypes (e.g., expectation of the Jezebel—being exoticized, sexualized, or objectified; expectation of the angry Black woman—being

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

GENDERED RACISM AND HEALTH 581

perceived as the stereotype of the angry Black woman), silenced and marginalized (e.g., struggle for respect—having one’s power and authority questioned or undermined; invisibility—being marginalized, invisible, or silenced in academic and professional settings), and assumptions of style and beauty (e.g., assumptions of communication styles— assumptions about Black women’s communications styles; assumptions of aesthetics—messages about Black women’s beauty and aesthetics, including body type, hairstyles, and facial features; Lewis et al., 2016). In addition, my colleague and I (Lewis & Neville, 2015) developed the Gendered Racial Microaggression Scale, which is a 26-item multi- dimensional measure that seeks to assess the frequency and stress appraisal of four dimensions of gendered racial microaggressions: assumptions of beauty and sexual objec- tification (e.g., making sexually inappropriate comments), silenced and marginalized (e.g., comments being silenced, ignored, or marginalized in workplace and professional settings), the strong Black woman stereotype (e.g., being assumed to exhibit qualities of a “strong Black woman”), and the angry Black woman stereotype (e.g., being assumed to be an “angry Black woman”; Lewis &Neville, 2015). This scale responds to calls from psychological and behavioral health scholars for more nuanced measures of discrimination (e.g., T. T. Lewis et al., 2015; T. T. Lewis & Van Dyke, 2018; Williams, 2016). In addition, this scale captures the subtle

and unique experiences of gendered racism experienced by Black women that often are not measured using existing measures of racism and discrimination.

A Biopsychosocial Model of Gendered Racism and Black Women’s Health

To integrate the foundational models of racism and health by Black psychologists (e.g., Clark et al., 1999; Harrell, 2000) with intersectionality theory (e.g., Cole, 2009; Crenshaw, 1989), the Biopsychosocial Model of Gendered Racism applies an intersectionality framework to integrate and extend Clark et al.’s (1999) biopsychosocial model of racism and Harrell’s (2000) multidimensional model of racism-related stress to conceptualize the way that gendered racism operates as a stressor in the lives of Black women (see Figure 1). Although previous conceptual racism and health models hypothesized that racism might be influenced by gender as a demographic variable or that sexism might be a separate status-related stressor, the impact of interlocking systems of racism and sexism was undertheorized. Thus, this model conceptualizes gendered racism experienced at the individual, interpersonal, institutional, or cultural level as a source of chronic stress. Experiencing gendered racism in one’s environment can produce a heightened stress response. In addition, perceptions of racist and sexist stimuli can lead to

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

Figure 1 A Biopsychosocial Model of Gendered Racism

Note. The figure illustrates a conceptual model of the biopsychosocial effects of systemic gendered racism. Moderators, mediators, and health outcomes listed represent examples of hypothesized variables. HPA = hypothalamic–pituitary–adrenal; SES = socioeconomic status.

582 LEWIS

psychological and physiological stress responses that can influ- ence mental and physical health over time. In the biopsycho- social model of gendered racism, coping responses are hypothesized to mediate the association between experiences of gendered racism and stress responses. Thus, coping responses can help to explain the link between gendered racism and health. In addition, there are several hypothesized moderating variables including sociodemographic variables such as race, gender, sexual orientation, socioeconomic status, age, and skin tone. Each of these variables could strengthen or weaken the link between gendered racism and health outcomes. In addition, sociocultural variables, such as gendered racial identity, gen- dered racial socialization, gender roles, womanist conscious- ness, and gendered racial schemas, such as the superwoman schema (Woods-Giscombé & Black, 2010; Woods-Giscombé et al., 2019) can each operate as potential moderating variables in the link between gendered racism and stress responses.

Empirical Research on Gendered Racism and Health

A growing body of empirical research has found that gendered racism is associated with negative psychological and physical health of Black women (Lewis & Neville, 2015; Rosenthal & Lobel, 2020; Szymanski & Lewis, 2016; Thomas et al., 2008). For example, several studies have found that gendered racism is associated with greater psy- chological distress (Szymanski & Lewis, 2016; Thomas et al., 2008). In addition, research has found that greater experiences of gendered racism have also been associated with negative general health and well-being (Perry et al., 2013) as well as poor sexual and reproductive health (Rosenthal & Lobel, 2020). Empirical research has also found a link between gendered racial microaggressions and negative health outcomes, including greater psychologi- cal distress and depressive symptoms (Lewis & Neville, 2015; Williams & Lewis, 2019), greater traumatic stress symptoms (Dale & Safren, 2019; Moody & Lewis, 2019; Moody et al., 2022; Sissoko et al., 2022), greater anxiety symptoms (Wright & Lewis, 2020), and negative self- reported mental and physical health (Lewis et al., 2017). In the first empirical study to test the biopsychosocial model of gendered racism, Lewis et al. (2017) conducted a cross- sectional study of 231 African American women and found that experiencing a greater frequency of gendered racial microaggressions was significantly associated with poorer self-reported mental and physical health. Although there is a dearth of research focused on the

impact of chronic stress at the intersection of racism and sexism, there is a small, but growing body of research that has begun to focus on African American women and explore the link between racial discrimination and physiological re- sponses to stress, including cortisol, blood pressure, HPA axis reactivity, and allostatic load (Allen et al., 2019; Busse et al., 2017; Chae et al., 2020; Lee et al., 2018; T. T. Lewis &

Van Dyke, 2018). In a sample of 208 African American women, Allen et al. (2019) examined the association between racial discrimination and allostatic load and found a signifi- cant link; this association was stronger for women with lower education compared to women with higher education. In a study of gender differences and HPA axis dysregulation as measured by salivary cortisol, Lee et al. (2018) found that African American women were more prone to a flatter diurnal cortisol slope, which was an indicator of HPA axis dysre- gulation compared to African American men. Together, these studies provide initial evidence for the importance of study- ing Black women’s experiences of discrimination and phys- iological stress. However, most of this research is only focused on racial discrimination and could benefit from incorporating an intersectionality approach to investigate the role of both racism and sexism as chronic stressors that influence the physiological health of Black women. Some empirical studies have also explored the role of

mediating and moderating variables in the link between gendered racism and stress responses. For example, previous research indicates that Black women may respond to the stress of intersecting forms of oppression in culturally spe- cific ways. For example, Thomas et al. (2008) conducted a study to explore the mediating role of culturally specific coping strategies in the association between gendered racism and psychological distress among African American women and they found that using cognitive/emotional debriefing (i.e., coping with stress by avoiding thinking about the situation) partially mediated the association between gen- dered racism and psychological distress, such that greater experiences with gendered racism were positively related to the use of cognitive emotional debriefing, which in turn contributed to higher distress. Lewis et al. (2017) also found that disengagement coping partially meditated the link between gendered racial microaggressions and health, such that there was a significant positive association between a greater frequency of gendered racial microaggressions and greater disengagement coping, which in turn was signifi- cantly associated with poorer self-reported mental and phys- ical health. Some studies have also explored the moderating role of gendered racial identity in the gendered racism–

mental health link and found that lower levels of gendered racial identity exacerbate the link between gendered racism and psychological distress (Lewis et al., 2017; Szymanski & Lewis, 2016; Williams & Lewis, 2019).

Future Directions

Recommendations for Research

There are several recommendations for future research on gendered racism and health. First, it is important for psychol- ogy researchers to utilize Black feminist and intersectionality approaches to study Black women because these approaches allow Black women to be at the center of the analysis and for

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

GENDERED RACISM AND HEALTH 583

the phenomenological experiences of Black women to be illuminated. Psychology researchers should also return to Cole’s (2009) three core questions to ask at different stages of the research process to incorporate intersectionality into their research. For example, the first question, “Who is included within this category?” pushes psychologists to con- sider within-group diversity. For example, to explore inter- sections of race, gender, and age, Gadson and Lewis (2022) explored Black adolescent girls’ experiences of gendered racial microaggressions and found similarities as well as unique differences that uncovered the ways that Black girls were being overdisciplined and criminalized in the school system (Epstein et al., 2017; Morris, 2016). Future research also needs to focus on Black women at the margins who experience disproportionate negative effects because of gen- dered racism, such as Black transgender women, Black immigrant women, and Black poor women. Returning to Cole’s second question, “What role does inequality play?” allows psychologists to consider examining structural in- equalities and power. For example, although much of the existing research on gendered racism is focused on individual- level discrimination, it is important for psychologists to study structural gendered racism since Black women are embed- ded in social–structural contexts that can buffer or exacerbate the impact of gendered racism in their everyday lives. Cole’s third question, “Where are there similarities?” can encourage researchers to explore commonalities within diverse groups, such as by exploring the similar experiences of gendered racism in reproductive healthcare between Black and Latina women (Rosenthal & Lobel, 2020) or the gendered racial microaggressions of exoticization experienced by Black women and Asian women (Keum et al., 2018). It is also important to investigate gendered racism at

multiple levels of analysis to explore the impact of gendered racism in various settings. For example, researchers could measure neighborhood-level data and institutional-level data to overlay onto measures of interpersonal gendered racism to gain a broader picture of the influence of systemic gendered racism on the health and well-being of Black women. It is also imperative that psychologists utilize various research methodologies, including qualitative, quantitative, mixed methods, and participatory action research, to develop innovative lines of research that seek to expand our under- standing of these complex phenomena. For example, Watson-Singleton et al. (2021) highlighted the benefits of intersectional mixed methods research, which is a methodo- logical approach that uses intersectionality theory to guide the use of both quantitative and qualitative methods within a single study. Psychologists should also engage in transdisci- plinary work and develop partnerships with researchers in public health and related fields who are conducting cutting- edge physiological and biomarker research. For example, more research is needed on the impact of chronic exposure to both racism and sexism on the body’s stress response, such as

the concept of weathering among Black women (Geronimus et al., 2006). In addition, although there is an emerging body of research on allostatic load among Black women (e.g., Allen et al., 2019), more research is needed on the impact of systemic racism and sexism on allostatic load and other biomarkers of chronic stress. Thus, future research could benefit from applying intersectionality to investigate inter- locking systems of oppression and testing the biopsychoso- cial model of gendered racism. Psychologists also need to conduct intervention-based

research using strengths-based, culturally relevant, and radical healing interventions to work towards ameliorating gendered racial health inequities that negatively impact the health and well-being of Black women. For example, there is a large body of research on the benefits of utilizing coping strategies, such as seeking social support (Lewis et al., 2013; Shorter- Gooden, 2004), for Black women coping with racism and sexism. However, more research is needed on how to scale up individual-level coping strategies to engage in collective coping and radical healing for Black women (French et al., 2020; Lewis, 2021). Psychologists have an opportunity to engage in liberatory research that can help Black women cultivate radical healing and joy while existing in the space between fighting interlocking systems of oppression and envisioning justice and liberation for the future.

Recommendations for Clinical Practice

Psychologists need to increase their own critical conscious- ness about systemic gendered racism that impacts the daily lives of their Black women clients and be more informed, empathic, and supportive in helping them navigate experiences of gendered racism. Psychologists should incorporate ques- tions about experiences of chronic stress due to racism and sexism in their assessment and intake process when working with Black women clients. Psychologists should utilize spe- cific treatment interventions to assist their Black women clients in developing critical consciousness about interlocking sys- tems of oppression. It is also important for psychologists to utilize strengths-based group-level interventions for use with Black women clients. For example, Black women therapy groups, “sister circles” and consciousness-raising groups could be helpful in providingBlackwomen clients with opportunities to receive support and validation about their gendered racism experiences (Bryant-Davis et al., 2021; Neal-Barnett et al., 2011). Psychologists could also connect Black women clients with mind-body healing interventions, such as mindfulness meditation, to reduce the stress of gendered racism in their lives (Harrell, 2018; Watson-Singleton et al., 2019; Woods- Giscombé & Black, 2010). For example, Dr. Shelly P. Harrell (2018) developed a mindfulness-based meditation called soul- fulness, which is a contemplative practice that moves beyond individual healing and toward interconnectedness, holistic healing, collective empowerment, and liberation.

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

584 LEWIS

Recommendations for Social Justice Advocacy

Given the prevalence of racism and sexism in society, it is important for psychologists to consider the ways that gendered racism operates at multiple levels in society and consider implications for our work at individual, institutional, and cultural levels. It is also important for psychologists to engage in systems-level interventions, social action, and public policy work to dismantle gendered racism in society. For example, despite the increased maternal mortality and morbidity among Black women (Creanga et al., 2014), there is a dearth of research and limited federal funding to study the intersection of racial and gender health disparities. Psychologists could use their research and clinical expertise to advocate for increased federal funding to be devoted to ameliorating gendered racial health disparities that have a disproportionate negative impact on Black women. In addition, psychologists should advocate for laws and policies in the areas of employment, housing, education, reproductive healthcare, the child welfare system and other institutions that will provide greater protections to support the wellness of Black women in society. It is important for researchers and policymakers to apply an intersectional lens to the social–structural issues that negatively influence the health and well-being of Black women in the United States to develop more culturally responsive and preventative interventions.

Conclusion

In this article, I reviewed the foundational contributions of Black psychologists to the study of racism and health with a specific focus on Clark et al.’s (1999) Biopsychosocial Model of Racism and Harrell’s (2000) Multidimensional Model of Racism-Related Stress. Then, I highlighted the intellectual contributions of Black feminist scholars to the study of intersectionality in psychology by honoring the Black feminist psychologists who have contributed to theory and research in this area. I applied an intersectionality framework to research on racism and health by introducing a conceptual Biopsycho- social Model of Gendered Racism to better understand the impact of gendered racism on Black women’s health and well- being. At the heart of intersectionality is a commitment to social justice and to disrupting the hegemonic forms of knowledge production that contribute to the epistemic exclu- sion of Black scholars in the field. I hope that this call to apply intersectionality theory to research on gendered racism and Black women’s health ushers in innovative directions for future research, clinical practice, and advocacy that seeks to dismantle interlocking systems of oppression and ameliorate gendered racial health disparities.

References

Allen, A. M., Thomas, M. D., Michaels, E. K., Reeves, A. N., Okoye, U., Price, M. M., Hasson, R. E., Syme, S. L., & Chae, D. H. (2019). Racial discrimination, educational attainment, and biological dysregulation

among midlife African American women. Psychoneuroendocrinology, 99, 225–235. https://doi.org/10.1016/j.psyneuen.2018.09.001

Bailey, M. (2021).Misogynoir transformed: Black women’s digital resistance. New York University Press. https://doi.org/10.18574/nyu/9781479803392 .001.0001

Barnes, L. L., de Leon, C. F. M., Lewis, T. T., Bienias, J. L., Wilson, R. S., & Evans, D. A. (2008). Perceived discrimination and mortality in a population-based study of older adults. American Journal of Public Health, 98(7), 1241–1247. https://doi.org/10.2105/AJPH.2007 .114397

Bowleg, L. (2008).When Black+ lesbian+woman≠Black lesbian woman: The methodological challenges of qualitative and quantitative intersec- tionality research. Sex Roles, 59(5), 312–325. https://doi.org/10.1007/ s11199-008-9400-z

Bowleg, L., & Bauer, G. (2016). Invited reflection: Quantifying intersec- tionality. Psychology of Women Quarterly, 40(3), 337–341. https:// doi.org/10.1177/0361684316654282

Brody, G. H., Lei, M.K., Chae, D. H., Yu, T., Kogan, S.M., &Beach, S. R. H. (2014). Perceived discrimination among African American adolescents and allostatic load: A longitudinal analysis with buffering effects. Child Devel- opment, 85(3), 989–1002. https://doi.org/10.1111/cdev.12213

Bryant-Davis, T., & Comas-Díaz, L. (Eds.). (2016).Womanist and mujerista psychologies: Voices of fire, acts of courage. American Psychological Association. https://doi.org/10.1037/14937-000

Bryant-Davis, T., Fasalojo, B., Arounian, A., Jackson, K. L., & Leithman, E. (2021). Resist and rise: A trauma-informed womanist model for group therapy, women & therapy. Journal of Black Psychology. Advance online publication. https://doi.org/10.1080/02703149.2021.1943114

Buchanan, N. T., & Wiklund, L. O. (2021). Intersectionality research in psychological science: Resisting the tendency to disconnect, dilute, and depoliticize. Research on Child and Adolescent Psychopathology, 49(1), 25–31. https://doi.org/10.1007/s10802-020-00748-y

Busse, D., Yim, I. S., Campos, B., & Marshburn, C. K. (2017). Discrimina- tion and the HPA axis: Current evidence and future directions. Journal of Behavioral Medicine, 40(4), 539–552. https://doi.org/10.1007/s10865- 017-9830-6

Carvalho, K., Kheyfets, A., Lawrence, B., Moky, A., Harris, L., Abouhala, S., & Amutah-Onukagha, N. (2022). Examining the role of psychosocial influences on Black maternal health during the COVID-19 pandemic. Maternal Child Health Journal, 26, 764–769. https://doi.org/10.1007/ s10995-021-03181-9

Chae, D. H.,Wang, Y.,Martz, C. D., Slopen, N., Yip, T., Adler, N. E., Fuller- Rowell, T. E., Lin, J., Matthews, K. A., Brody, G. H., Spears, E. C., Puterman, E., & Epel, E. S. (2020). Racial discrimination and telomere shortening among African Americans: The Coronary Artery Risk Devel- opment in Young Adults (CARDIA) Study. Health Psychology, 39(3), 209–219. https://doi.org/10.1037/hea0000832

Cho, S., Crenshaw, K. W., & McCall, L. (2013). Toward a field of intersectionality studies: Theory, applications, and praxis. Signs: Journal of Women in Culture and Society, 38(4), 785–810. https://doi.org/10.1086/ 669608

Clark, R., Anderson, N. B., Clark, V. R., & Williams, D. R. (1999). Racism as a stressor for African Americans: A biopsychosocial model. American Psychologist, 54(10), 805–816. https://doi.org/10.1037/0003-066X.54 .10.805

Cole, E. R. (2009). Intersectionality and research in psychology. American Psychologist, 64(3), 170–180. https://doi.org/10.1037/a0014564

Cole, E. R. (2020). Demarginalizing women of color in intersectionality scholarship in psychology: A Black feminist critique. Journal of Social Issues, 76(4), 1036–1044. https://doi.org/10.1111/josi.12413

Collins, P. H. (2000). Black feminist thought: Knowledge, power and the politics of empowerment. Routledge. (Original work published 1990).

Collins, P. H. (2019). Intersectionality as critical social theory. Duke University Press.

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

GENDERED RACISM AND HEALTH 585

COVID Racial Data Tracker. (2021). The COVID Racial Data Tracker. Retrieved March 20, 2021, from https://covidtracking.com/race

Creanga, A. A., Bateman, B. T., Kuklina, E. V., & Callaghan, W. M. (2014). Racial and ethnic disparities in severe maternal morbidity: A multistate analysis, 2008–2010. American Journal of Obstetrics and Gynecology, 210(5), 435.e1–435.e8. https://doi.org/10.1016/j.ajog.2013.11.039

Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrines, feminist theory, and antiracist politics. University of Chicago Legal Forum, 8, 139–167. http://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8

Dale, S. K., & Safren, S. A. (2019). Gendered racial microaggressions predict posttraumatic stress disorder symptoms and cognitions among Black women living with HIV. Psychological Trauma: Theory, Research, Practice, and Policy, 11(7), 685–694. https://doi.org/10.1037/tra0000467

Dill, B. T., & Kohlman, M. H. (2012). Intersectionality: A transformative paradigm in feminist theory and social justice. In S. N. Hesse-Biber (Ed.), Handbook of feminist research: Theory and praxis (Vol. 2, pp. 154–174). SAGE Publications, Inc. https://doi.org/10.4135/9781483384740

Else-Quest, N. M., & Hyde, J. S. (2016). Intersectionality in quantitative psychological research: I. Theoretical and epistemological issues. Psy- chology of Women Quarterly, 40(2), 155–170. https://doi.org/10.1177/ 0361684316629797

Epstein, R., Blake, J. J., & Gonzalez, T. (2017). Girlhood interrupted: The erasure of Black girls’ childhood. Georgetown Law Center.

Essed, P. (1991).Understanding everyday racism: An interdisciplinary theory (Vol. 2). Sage Publications. https://doi.org/10.4135/9781483345239

French, B. H., Lewis, J. A., Mosley, D., Adames, H. Y., Chavez-Dueñas, N. Y., Chen, G. A., & Neville, H. A. (2020). Toward a psychological framework of radical healing in communities of color. The Counseling Psychologist, 48(1), 14–46. https://doi.org/10.1177/0011000019843506

Gadson, C. A., & Lewis, J. A. (2022). Devalued, overdisciplined, and stereotyped: An exploration of gendered racial microaggressions among Black adolescent girls. Journal of Counseling Psychology, 69(1), 14–26. https://doi.org/10.1037/cou0000571

Geronimus, A. T., Hicken, M., Keene, D., & Bound, J. (2006). “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. American Journal of Public Health, 96(5), 826–833. https:// doi.org/10.2105/AJPH.2004.060749

Giddings, P. (1984).When and where I enter: The impact of Black women on race and sex in America. William Morrow.

Greene, B. (1994). African American women. In L. Comas-Díaz & B. Greene (Eds.),Women of color: Integrating ethnic and gender identities in psychotherapy (pp. 10–29). Guilford Press.

Combahee River Collective. (1995). Combahee River Collective statement. In B. Guy-Sheftall (Ed.),Words of fire: An anthology of African American feminist thought (pp. 232–240). The New Press. (Original work pub- lished 1977).

Hancock, A. M. (2016). Intersectionality: An intellectual history. Oxford University Press. https://doi.org/10.1093/acprof:oso/9780199370368.001.0001

Harrell, S. P. (2000). A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color. American Journal of Orthopsychiatry, 70(1), 42–57. https://doi.org/10.1037/h0087722

Harrell, S. P. (2018). Soulfulness as an orientation to contemplative practice: Culture, liberation, and mindful awareness. The Journal of Contemplative Inquiry, 5(1), 9–39.

Harris-Perry, M. V. (2011). Sister citizen: Shame, stereotypes, and Black women in America: For colored girls who’ve considered politics when being strong isn’t enough. Yale University Press.

hooks, b. (1981). Ain’t I a woman: Black women and feminism. Routledge. Iruka, I. U., Gardner-Neblett, N., Telfer, N. A., Ibekwe-Okafor, N., Curenton, S. M., Sims, J., Sansbury, A. B., & Neblett, E. W. (2022). Effects of racism on child development: Advancing antiracist developmental science. Annual Review of Developmental Psychology, 4(1), 109–132. https://doi.org/10 .1146/annurev-devpsych-121020-031339

Jones, J. M. (1997). Prejudice and racism (2nd ed.). McGraw-Hill. (Original work published 1972).

Keum, B. T., Brady, J. L., Sharma, R., Lu, Y., Kim, Y. H., & Thai, C. J. (2018). Gendered Racial Microaggressions Scale for Asian American Women: Development and initial validation. Journal of Counseling Psychology, 65(5), 571–585. https://doi.org/10.1037/cou0000305

Landrine, H. (1995). Bringing cultural diversity to feminist psychology: Theory, research, and practice. American Psychological Association. https://doi.org/10.1037/10501-000

Landrine, H., & Klonoff, E. A. (1996). The schedule of racist events: A measure of racial discrimination and a study of its negative physical and mental health consequences. Journal of Black Psychology, 22(2), 144–168. https://doi.org/10.1177/00957984960222002

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer. Lee, D. B., Peckins, M. K., Heinze, J. E., Miller, A. L., Assari, S., & Zimmerman, M. A. (2018). Psychological pathways from racial discrimi- nation to cortisol in African American males and females. Journal of Behavioral Medicine, 41, 208–220. https://doi.org/10.1007/s10865-017- 9887-2

Lewis, J. A. (2021). SayHerName: The impact of gendered racism and misogynoir on the lives of Black women. In K. O. Cokley (Ed.), Making Black Lives Matter: Confronting anti-Black racism (pp. 71–86). Cognella Academic Publishing.

Lewis, J. A., & Grzanka, P. R. (2016). Applying intersectionality theory to research on perceived racism. In A. N. Alvarez, C. T. H. Liang, & H. A. Neville (Eds.), The cost of racism for people of color: Contextualizing experiences of discrimination (pp. 31–54). American Psychological Association. https://doi.org/10.1037/14852-003

Lewis, J. A., Mendenhall, R., Harwood, S., & Browne-Huntt, M. (2010). Ain’t I a woman? The experience of racial and gender microaggressions at a predominantly White institution [Poster presentation]. 27th Annual Conference on Multicultural Psychology and Education, Columbia Tea- chers College, New York, United States.

Lewis, J. A., Mendenhall, R., Harwood, S. A., & Browne Huntt, M. (2013). Coping with gendered racial microaggressions among Blackwomen college students. Journal of African American Studies, 17(1), 51–73. https://doi.org/ 10.1007/s12111-012-9219-0

Lewis, J. A.,Mendenhall, R., Harwood, S. A., &Huntt,M. B. (2016). “Ain’t I a woman?”: Perceived gendered racialmicroaggressions experienced byBlack women. The Counseling Psychologist, 44(5), 758–780. https://doi.org/10 .1177/0011000016641193

Lewis, J. A., & Neville, H. A. (2015). Construction and initial validation of the Gendered Racial Microaggressions Scale for Black women. Journal of Counseling Psychology, 62(2), 289–302. https://doi.org/10.1037/cou0000062

Lewis, J. A., Williams, M. G., Peppers, E. J., & Gadson, C. A. (2017). Applying intersectionality to explore the relations between gendered racism and health among Black women. Journal of Counseling Psychol- ogy, 64(5), 475–486. https://doi.org/10.1037/cou0000231

Lewis, T. T., Cogburn, C. D., & Williams, D. R. (2015). Self-reported experiences of discrimination and health: Scientific advances, ongoing controversies, and emerging issues. Annual Review of Clinical Psychology, 11, 407–440. https://doi.org/10.1146/annurev-clinpsy-032814-112728

Lewis, T. T., Everson-Rose, S. A., Powell, L. H., Matthews, K. A., Brown, C., Karavolos, K., Sutton-Tyrrell, K., Jacobs, E., &Wesley, D. (2006). Chronic exposure to everyday discrimination and coronary artery calcification in African-American women: The SWAN Heart Study. Psychosomatic Medi- cine, 68(3), 362–368. https://doi.org/10.1097/01.psy.0000221360.94700.16

Lewis, T. T., & Van Dyke, M. E. (2018). Discrimination and the health of African Americans: The potential importance of intersectionalities. Current Directions in Psychological Science, 27(3), 176–182. https:// doi.org/10.1177/0963721418770442

McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33–44. https://doi.org/10.1111/j.1749-6632.1998.tb09546.x

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

586 LEWIS

Moody, A. T., & Lewis, J. A. (2019). Gendered racial microaggressions and traumatic stress symptoms among Black women. Psychology of Women Quarterly, 43(2), 201–214. https://doi.org/10.1177/0361684319828288

Moody, A. T., Lewis, J. A., & Owens, G. (2022). Gendered racism, coping, and traumatic stress among Black women: The moderating roles of Strong Black Woman schema and womanist attitudes. Psychology of Women Quarterly. Advance online publication. https://doi.org/10.1177/03616843 221143752

Moradi, B., & Grzanka, P. R. (2017). Using intersectionality responsibly: Toward critical epistemology, structural analysis, and social justice activ- ism. Journal of Counseling Psychology, 64(5), 500–513. https://doi.org/ 10.1037/cou0000203

Morris, M. W. (2016). Pushout: The criminalization of Black girls in school. The New Press.

Myers, H. F., Lewis, T., & Parker-Dominguez, T. (2003). Stress, coping & minority health. In G. Bernal, J. Trimble, K. Burlew, & F. Leong (Eds.), Handbook of racial and ethnic minority psychology (pp. 377–400). Sage Publications. https://doi.org/10.4135/9781412976008.n19

National Center for Health Statistics. (2019). Health, United States, 2019. https://www.cdc.gov/nchs/data/hus/hus19-508.pdf

NationalWomen’s Law Center. (2021). All of the jobs lost in December were women’s jobs. https://nwlc.org/resources/all-of-the-jobs-lost-in-decembe r-were-womens-jobs/

Neal-Barnett, A., Stadulis, R.,Murray,M., Payne,M. R., Thomas, A.,& Salley, B. B. (2011). Sister circles as a culturally relevant intervention for anxious African American women. Clinical Psychology: Science and Practice, 18(3), 266–273. https://doi.org/10.1111/j.1468-2850.2011.01258.x

Neblett, E. W., Jr. (2019). Racism and health: Challenges and future directions in behavioral and psychological research. Cultural Diversity and Ethnic Minority Psychology, 25(1), 12–20. https://doi.org/10.1037/ cdp0000253

Neville, H. A., & Pieterse, A. L. (2009). Racism, White supremacy, and resistance: Contextualizing Black American experiences. In H. A. Neville, B. M. Tynes, & S. O. Utsey (Eds.), Handbook of African American psychology (pp. 159–172). Sage Publications.

Neville, H. A., Spanierman, L. B., & Lewis, J. A. (2012). The expanded psychosocial model of racism: A new model for understanding and dis- rupting racism and white privilege. In N. A. Fouad, J. A. Carter, & L. M. Subich (Eds.), APA handbook of counseling psychology: Vol. 2. Practice, interventions, and applications (pp. 333–360). American Psychological Association. https://doi.org/10.1037/13755-014

Obinna, D. N. (2021). Essential and undervalued: Health disparities of African American women in the COVID-19 era. Ethnicity & Health, 26(1), 68–79. https://doi.org/10.1080/13557858.2020.1843604

Overstreet, N. M., Rosenthal, L, & Case, K. A. (2020). Intersectionality as a radical framework for transforming our disciplines, social issues, and the world. Journal of Social Issues, 76(4), 779–795. https://doi.org/10.1111/ josi.12414

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(9), Article 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(4), 531–554. https://doi.org/10.1037/a0016059

Perry, B. L., Harp, K. L., & Oser, C. B. (2013). Racial and gender discrimination in the stress process: Implications for African American women’s health and well-being. Sociological Perspectives, 56(1), 25–48. https://doi.org/10.1525/sop.2012.56.1.25

Pierce, C. M., Carew, J. V., Pierce-Gonzalez, D., & Wills, D. (1977). An experiment in racism: TV commercials. Education and Urban Society, 10(1), 61–87. https://doi.org/10.1177/001312457701000105

Pieterse, A. L., Todd, N. R., Neville, H. A., & Carter, R. T. (2012). Perceived racism and mental health among Black American adults: A meta-analytic

review. Journal of Counseling Psychology, 59(1), 1–9. https://doi.org/10 .1037/a0026208

Pirtle, W. N. L., & Wright, T. (2021). Structural gendered racism revealed in pandemic times: Intersectional approaches to understanding race and gender health inequities in COVID-19.Gender& Society, 35(2), 168–179. https://doi.org/10.1177/08912432211001302

Reid, P. T. (1988). Racism and sexism. In P. A. Katz & D. A. Taylor (Eds.), Eliminating racism. Perspectives in social psychology (pp. 203–221). Springer. https://doi.org/10.1007/978-1-4899-0818-6_10

Reid, P. T., & Comas-Diaz, L. (1990). Gender and ethnicity: Perspectives on dual status. Sex Roles, 22(7), 397–408. https://doi.org/10.1007/BF00288160

Rosenthal, L., & Lobel, M. (2020). Gendered racism and the sexual and reproductive health of Black and Latina women. Ethnicity & Health, 25(3), 367–392. https://doi.org/10.1080/13557858.2018.1439896

Seeman, T. E., Singer, B. H., Rowe, J. W., Horwitz, R. I., & McEwen, B. S. (1997). Price of adaptation—Allostatic load and its health consequences. MacArthur studies of successful aging. Archives of Internal Medicine, 157(19), 2259–2268. https://doi.org/10.1001/archinte.1997.00440400111013

Settles, I. H., Jones, M. K., Buchanan, N. T., & Dotson, K. (2021). Epistemic exclusion: Scholar(ly) devaluation that marginalizes faculty of color. Jour- nal of Diversity in Higher Education, 14(4), 493–507. https://doi.org/10 .1037/dhe0000174

Settles, I. H., Warner, L. R., Buchanan, N. T., & Jones, M. K. (2020). Understanding psychology’s resistance to intersectionality theory using a framework of epistemic exclusion and invisibility. Journal of Social Issues, 76(4), 796–813. https://doi.org/10.1111/josi.12403

Shields, S. A. (2008). Gender: An intersectionality perspective. Sex Roles, 59(5), 301–311. https://doi.org/10.1007/s11199-008-9501-8

Shorter-Gooden, K. (2004). Multiple resistance strategies: How African American women cope with racism and sexism. Journal of Black Psy- chology, 30(3), 406–425. https://doi.org/10.1177/0095798404266050

Sissoko, G., Lewis, J. A., & Nadal, K. N. (2022). It’s more than skin deep: Gendered racial microaggressions, skin tone satisfaction, and trauma symptoms among Black women. Journal of Black Psychology. Advance online publication. https://doi.org/10.1177/00957984221137957

Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271–286. https://doi.org/10.1037/0003-066X.62.4.271

Szymanski, D. M., & Lewis, J. A. (2016). Gendered racism, coping, identity centrality, and African American college women’s psychological distress. Psychology of WomenQuarterly, 40(2), 229–243. https://doi.org/10.1177/ 0361684315616113

Taylor, T. R., Williams, C. D., Makambi, K. H., Mouton, C., Harrell, J. P., Cozier, Y., Palmer, J. R., Rosenberg, L., & Adams-Campbell, L. L. (2007). Racial discrimination and breast cancer incidence in US Black women: The Black Women’s Health Study. American Journal of Epide- miology, 166(1), 46–54. https://doi.org/10.1093/aje/kwm056

Thomas, A. J., Witherspoon, K. M., & Speight, S. L. (2008). Gendered racism, psychological distress, and coping styles of African American women. Cultural Diversity and Ethnic Minority Psychology, 14(4), 307– 314. https://doi.org/10.1037/1099-9809.14.4.307

Thomas, V. G. (2004). The psychology of Black women: Studying women’s lives in context. Journal of Black Psychology, 30(3), 286–306. https:// doi.org/10.1177/0095798404266044

Thomas, V. G., & Miles, S. E. (1995). Psychology of Black women: Past, present, and future. In H. Landrine (Ed.), Bringing cultural diversity to feminist psychology: Theory, research, and practice (pp. 303–330). American Psychological Association. https://doi.org/10.1037/10501-013

Utsey, S. O., & Ponterotto, J. G. (1996). Development and validation of the Index of Race-Related Stress (IRRS). Journal of Counseling Psychology, 43(4), 490–501. https://doi.org/10.1037/0022-0167.43.4.490

Volpe, V. V., Dawson, D. N., Rahal, D., Wiley, K. C., & Vesslee, S. (2019). Bringing psychological science to bear on racial health disparities: The

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

GENDERED RACISM AND HEALTH 587

promise of centering Black health through a critical race framework. Translational Issues in Psychological Science, 5(4), 302–314. https:// doi.org/10.1037/tps0000205

Watson-Singleton, N. N., Black, A. R., & Spivey, B. N. (2019). Recom- mendations for a culturally-responsive mindfulness-based intervention for African Americans. Complementary Therapies in Clinical Practice, 34, 132–138. https://doi.org/10.1016/j.ctcp.2018.11.013

Watson-Singleton, N. N., Lewis, J. A., & Dworkin, E. R. (2021). Toward a socially just diversity science: Using intersectional mixed methods research to center multiply marginalized Black, Indigenous, and People of Color (BIPOC). Cultural Diversity and Ethnic Minority Psychology. Advance online publication. https://doi.org/10.1037/cdp0000477

Williams, D. R. (2016). Improving the measurement of self-reported racial discrimination: Challenges and opportunities. In A. N. Alvarez, C. T. H. Liang, & H. A. Neville (Eds.), The cost of racism for people of color: Contextualizing experiences of discrimination (pp. 55–83). American Psychological Association. https://doi.org/10.1037/14852-004

Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behav- ioral Medicine, 32(1), 20–47. https://doi.org/10.1007/s10865-008- 9185-0

Williams, D. R., & Mohammed, S. A. (2013). Racism and health: Pathways and scientific evidence. American Behavioral Scientist, 57(8), 1152–1173. https://doi.org/10.1177/0002764213487340

Williams, D. R., & Neighbors, H. (2001). Racism, discrimination and hyper- tension: Evidence and needed research. Ethnicity & Disease, 11(4), 800–816.

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(2), 200–208. https://doi.org/10.2105/AJPH .93.2.200

Williams, D. R., & Williams-Morris, R. (2000). Racism and mental health: The African American experience. Ethnicity & Health, 5(3–4), 243–268. https://doi.org/10.1080/713667453

Williams, M. G., & Lewis, J. A. (2019). Gendered racial microaggressions and depressive symptoms among Black women: A moderated mediation model. Psychology of Women Quarterly, 43(3), 368–380. https://doi.org/ 10.1177/0361684319832511

Woods-Giscombé, C. L., Allen, A. M., Black, A. R., Steed, T. C., Li, Y., & Lackey, C. (2019). The Giscombé Superwoman Schema Questionnaire: Psychometric properties and associations with mental health and health behaviors in African American women. Issues in Mental Health Nursing, 40(8), 672–681. https://doi.org/10.1080/01612840.2019.1584654

Woods-Giscombé, C. L., & Black, A. R. (2010). Mind-body interventions to reduce risk for health disparities related to stress and strength among African American women: The potential of mindfulness-based stress reduction, loving-kindness, and the NTU therapeutic framework. Com- plementary Health Practice Review, 15(3), 115–131. https://doi.org/10 .1177/1533210110386776

Wright, L. N., & Lewis, J. A. (2020). Is physical activity a buffer? Gendered racial microaggressions and anxiety among African American women. Journal of Black Psychology, 46(2–3), 122–143. https://doi.org/10.1177/ 0095798420929112

Received February 8, 2022 Revision received November 30, 2022

Accepted December 16, 2022 ▪

T hi s do cu m en t is co py ri gh te d by

th e A m er ic an

P sy ch ol og ic al

A ss oc ia tio

n or

on e of

its al lie d pu bl is he rs .

T hi s ar tic le

is in te nd ed

so le ly

fo r th e pe rs on al

us e of

th e in di vi du al

us er

an d is no t to

be di ss em

in at ed

br oa dl y.

588 LEWIS